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Sample records for chronic hemodialysis patients

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

    NARCIS (Netherlands)

    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

  2. Uremic pleuritis in chronic hemodialysis patients.

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    Rashid-Farokhi, Farin; Pourdowlat, Guitti; Nikoonia, Mohammad-Reza; Behzadnia, Neda; Kahkouee, Shahram; Nassiri, Amir-Ahmad; Masjedi, Mohammad-Reza

    2013-01-01

    Chronic hemodialysis (HD) patients are predisposed to several complications associated with pleural effusion. In addition, uremia can directly cause pleuritis. However, there are inadequate data about pathogenesis and natural course of uremic pleuritis. In this study, 76 chronic HD patients with pleural effusion admitted to the Respiratory Center of Masih Daneshvari Hospital, in Tehran, Iran between June 2005 and May 2011 were evaluated to figure out the etiology of their pleural disease. Among these patients, patients with uremic pleuritis were identified and studied. The rate of uremic pleuritis was 23.7%. Other frequent etiologies of pleural effusion were parapneumonic effusion (23.7%), cardiac failure (19.7%), tuberculosis (6.6%), volume overload, malignancy, and unknown. In patients with uremic pleuritis, dyspnea was the most common symptom, followed by cough, weight loss, anorexia, chest pain, and fever. Compared to patients with parapneumonic effusion, patients with uremic effusion had a significantly higher rate of dyspnea and lower rate of cough and fever. Pleural fluid analysis showed that these patients had a significantly lower pleural to serum lactic dehydrogenase ratio, total pleural leukocytes, and polymorphonuclear count compared to patients with parapneumonic effusion. Improvement was achieved in 94.1% of patients with uremic pleuritis by continuation of HD, chest tube insertion or pleural decortication; an outcome better than the previous reports. Despite the association with an exudative effusion, inflammatory pleural reactions in patients with uremic pleuritis may not be as severe as infection-induced effusions. Owing to the advancement in HD technology and other interventions, outcome of uremic pleuritis may be improved.

  3. Longitudinal study of leptin levels in chronic hemodialysis patients

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    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.

  4. HEARING ASSESSMENT IN CHRONIC RENAL FAILURE PATIENTS UNDERGOING HEMODIALYSIS

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    Arjun Singh

    2014-01-01

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

  5. Lower Gastrointestinal Bleeding in Chronic Hemodialysis Patients

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    Fahad Saeed

    2011-01-01

    Full Text Available Gastrointestinal (GI bleeding is more common in patients with chronic kidney disease and is associated with higher mortality than in the general population. Blood losses in this patient population can be quite severe at times and it is important to differentiate anemia of chronic diseases from anemia due to GI bleeding. We review the literature on common causes of lower gastrointestinal bleeding (LGI in chronic kidney disease (CKD and end-stage renal disease (ESRD patients. We suggest an approach to diagnosis and management of this problem.

  6. Characterization of Chronic Kidney Disease Patients Undergoing Hemodialysis

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    Niovis Sosa Barberena

    2016-08-01

    Full Text Available Background: Cienfuegos has a high prevalence of chronic kidney disease, which is a health problem of great social and economic impact. Objective: to characterize patients with chronic kidney disease receiving hemodialysis. Methods: a cross-sectional study was conducted in 80 patients treated at the Specialized Outpatient Center of Cienfuegos in 2013. General variables such as age, sex, and place of origin were analyzed, in addition to the causes of the disease, length of time on hemodialysis, type of vascular access, and prevalence of hepatitis C. Absolute frequencies, percentages, and rates were calculated. Results: the 45 to 54 age group was the most affected by the condition. Males accounted for 63.7%. Cienfuegos municipality showed the highest prevalence with 27.6 per 100 000 inhabitants. The most common cause of chronic kidney disease was nephroangiosclerosis (33.3%. Seventy three percent of patients started hemodialysis as an emergency therapy. The time on hemodialysis was less than one year and one to two years in more than half of patients. An arteriovenous fistula was used in 81.3% of cases. Hepatitis C showed a high prevalence. Conclusion: renal disease is more common in men of working age in Cienfuegos municipality. The major causes of this disease are associated with hypertension and diabetes mellitus.

  7. Unusual presentation of tuberculosis in chronic hemodialysis patients.

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    Amedia, C; Oettinger, C W

    1977-08-01

    Four patients developed miliary tuberculosis while undergoing chronic hemodialysis. Two patients had diabetes mellitus. Three of the four patients were hemodialyzed 18--24 months prior to the onset of symptoms. Signs and symptoms included prolonged fever, pleural effusion, pericarditis with pericardial effusion, abdominal pain, weight loss, and ascites. All patients were PPD negative and without historical or radiographic evidence of latent tuberculosis. Disseminated tuberculosis was proven at autopsy in three patients. M. tuberculosis was eventually recovered from pleural fluid and urine in the fourth patient. The immune deficiencies of chronic renal failure and diabetes mellitus are suspected predisposing factors to the development of miliary tuberculosis in these patients.

  8. Diagnosis and Treatment of Infective Endocarditis in Chronic Hemodialysis Patients

    Institute of Scientific and Technical Information of China (English)

    Jian-ling Tao; Xue-mei Li; Xue-wang Li; Jie Ma; Guang-li Ge; Li-meng Chen; Hang Li; Bao-tong Zhou; Yang Sun; Wen-ling Ye; Qi Miao

    2010-01-01

    Objective To analyze the clinical features of hemodialysis patients complicated by infective endo-carditis.Methods The clinical features of six such patients admitted to Peking Union Medical College Hos-pital during the year 1990 to 2009 were analyzed. All of them were diagnosed based on Chinese Children Diagnostic Criteria for Infective Endocarditis.Results The average age of the six patients was 52.3±19.3 years old. Four were males. Vascular ac-cesses at the onset of infective endocarditis were as follows: permanent catheters in three, temporary cathe-ters in two, and arteriovenous fistula in one. Three were found with mitral valve involvement, two with aor-tic valve involvement, and one with both. Five vegetations were found by transthoraeic echocardiography, and one by transesophageal echocardiography. Four had positive blood culture results. The catheters were all removed. Four of the patients were improved by antibiotics treatment, in which two were still on hemodialy-sis in the following 14-24 months and the other two were lost to follow-up. One patient received surgery, but died of heart failure after further hemodialysis for three months. One was well on maintenance hemodi-alysis for three months after surgery.Conclusions Infective endocarditis should be suspected when hemodialysis patients suffer from long-term fever, for which prompt blood culture and transthoracic echocardiography confirmation could be performed. Transesophageal echocardiography could be considered even when transthoracic echocardiogra-phy produces negative findings. With catheters removed, full course of appropriate sensitive antibiotics and surgery if indicated could improve the outcome of chronic hemodialysis patients complicated by infective endocarditis.

  9. The effect of hemodialysis solution buffer on the control of blood pressure and efficacy of hemodialysis in chronic hemodialysis patients

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    Garevani H

    2007-11-01

    Full Text Available Background: The effect of kind of dialysis solution on the control of blood pressure and adequacy and efficacy of hemodialysis is a most debated and controversial issue.Methods: Twenty six chronic hemodialized patients in Ghaem hemodialysis center, Mashhad, Iran, in winter of the year 2004, enrolled this study for one month. The patients were dialyzed with bicarbonate buffer and were dialyzed in the next month with acetate. The kind of membranes and the dialysis machines were the same in both months. Systolic and diastolic pressures were measured before and after hemodialysis in at least three hemodialysis sessions, and he means recorded. The mean of the body weight were also recorded. In the same sessions of hemodialysis by measuring the urea, before and after hemodialysis, urea reduction ratio (URR, was also calculated. Statistical analysis was done with paired student t test for paired measurement, and independent t test for evaluating the effect of the kind of dialysate buffer on the measured parameters.Results: There were no significant statistical differences between acetate and bicarbonate dialysis solution buffers in the control of diastolic blood pressure. But use of acetate buffer resulted in more significant systolic blood pressure reduction compared with bicarbonate buffer (p=0.045. When adequacy of hemodialysis were compared between two kinds of buffers there were no significant statistical differences between them. When the effect of dialysate sodium concentration in the range utilized in two buffers, was evaluated on the systolic and diastolic pressure reduction, no significant differences, between two types of buffers attributable to the difference between dialysates sodium concentrations were found.Conclusion: Hemodialysis with both, acetate and bicarbonate buffers results in significant reductions in systolic and diastolic blood pressure, weight and urea ratio. Use of acetate buffer is more significantly associated with

  10. Skin autofluorescence predicts cardiovascular mortality in patients on chronic hemodialysis.

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    Kimura, Hiroshi; Tanaka, Kenichi; Kanno, Makoto; Watanabe, Kimio; Hayashi, Yoshimitsu; Asahi, Koichi; Suzuki, Hodaka; Sato, Keiji; Sakaue, Michiaki; Terawaki, Hiroyuki; Nakayama, Masaaki; Miyata, Toshio; Watanabe, Tsuyoshi

    2014-10-01

    Tissue accumulation of advanced glycation end products (AGE) is thought to contribute to the progression of cardiovascular disease (CVD). Skin autofluorescence, a non-invasive measure of AGE accumulation using autofluorescence of the skin under ultraviolet light, has been reported to be an independent predictor of mortality associated with CVD in Caucasian patients on chronic hemodialysis. The aim of this study was to assess the predictive value of skin autofluorescence on all-cause and cardiovascular mortality in non-Caucasian (Japanese) patients on chronic hemodialysis. Baseline skin autofluorescence was measured with an autofluorescence reader in 128 non-Caucasian (Japanese) patients on chronic hemodialysis. All-cause and cardiovascular mortality was monitored prospectively during a period of 6 years. During the follow-up period, 42 of the 128 patients died; 19 of those patients died of CVD. Skin autofluorescence did not have a significant effect on all-cause mortality. However, age, carotid artery intima-media thickness (IMT), serum albumin, high-sensitivity C-reactive protein (hsCRP), skin autofluorescence and pre-existing CVD were significantly correlated with cardiovascular mortality. Multivariate Cox regression analysis showed skin autofluorescence (adjusted hazard ratio [HR] 3.97; 95% confidence interval [CI]1.67-9.43), serum albumin (adjusted HR 0.05; 95% CI 0.01-0.32), and hsCRP (adjusted HR 1.55; 95% CI 1.18-2.05) to be independent predictors of cardiovascular mortality. The present study suggests that skin autofluorescence is an independent predictor of cardiovascular mortality in non-Caucasian (Japanese) patients on chronic hemodialysis.

  11. Bone Marrow Pathology Predicts Mortality in Chronic Hemodialysis Patients

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    Cheng-Hao Weng

    2015-01-01

    Full Text Available Introduction. A bone marrow biopsy is a useful procedure for the diagnosis and staging of various hematologic and systemic diseases. The objective of this study was to investigate whether the findings of bone marrow studies can predict mortality in chronic hemodialysis patients. Methods. Seventy-eight end-stage renal disease patients on maintenance hemodialysis underwent bone marrow biopsies between 2000 and 2011, with the most common indication being unexplained anemia followed by unexplained leukocytosis and leukopenia. Results. The survivors had a higher incidence of abnormal megakaryocyte distribution P=0.001, band and segmented cells P=0.021, and lymphoid cells P=0.029 than the nonsurvivors. The overall mortality rate was 38.5% (30/78, and the most common cause of mortality was sepsis (83.3% followed by respiratory failure (10%. In multivariate Cox regression analysis, both decreased (OR 3.714, 95% CI 1.671–8.253, P=0.001 and absent (OR 9.751, 95% CI 2.030–45.115, P=0.004 megakaryocyte distribution (normal megakaryocyte distribution as the reference group, as well as myeloid/erythroid ratio (OR 1.054, CI 1.012–1.098, P=0.011, were predictive of mortality. Conclusion. The results of a bone marrow biopsy can be used to assess the pathology, and, in addition, myeloid/erythroid ratio and abnormal megakaryocyte distribution can predict mortality in chronic hemodialysis patients.

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

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    Udayakumar P

    2006-01-01

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

  13. Tuberculous Peritonitis in Hemodialysis Patients with Chronic Liver Disease

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    Al Shohaib Saad

    2000-01-01

    Full Text Available Tuberculous peritonitis (TBP remains a major medical problem in many developing countries, wherein the incidence of tuberculosis (TB is still high. Since the clinical presentation may be insidious and variable, diagnosis of TBP may be delayed or missed, resulting in undue patient morbidity and mortality. Tests frequently associated with TB such as chest radiograph and Mantoux test are not usually sensitive enough for the diagnosis of TBP. The diagnosis becomes all the more difficult in the presence of chronic liver disease and/or renal failure, since the ascitic fluid may not be of the exudative type and lymphocytosis may not be the predominant cell picture. We present here three cases of TBP in diabetic Saudi patients on maintenance hemodialysis who also had associated chronic liver disease. All three patients responded satisfactorily to standard anti-tuberculous therapy. We stress that high index of suspicion is required to establish early diagnosis of TBP particularly in patients with chronic renal and/or liver disease. Laparoscopy with tissue biopsy for histology and, microbiological examination including culture are the most sensitive and specific diagnostic procedures.

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

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    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...

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

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    Reza Hekmat

    2009-03-01

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

  16. Liver enzymes serum levels in patients with chronic kidney disease on hemodialysis: a comprehensive review

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    Luís Henrique Bezerra Cavalcanti Sette

    2014-04-01

    Full Text Available We reviewed the literature regarding the serum levels of the enzymes aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyl transferase in patients with chronic kidney disease on hemodialysis with and without viral hepatitis. Original articles published up to January 2013 on adult patients with chronic kidney disease on hemodialysis were selected. These articles contained the words “transaminases” “aspartate aminotransferase” “alanine aminotransferase” “gamma glutamyl transferase,” “liver enzymes”, AND “dialysis” OR “hemodialysis”. A total of 823 articles were retrieved. After applying the inclusion and exclusion criteria, 49 articles were selected. The patients with chronic kidney disease on hemodialysis had reduced serum levels of aminotransferases due to hemodilution, lower pyridoxine levels, or elevated homocysteine levels. The chronic kidney disease patients on hemodialysis infected with the hepatitis C virus also had lower aminotransferase levels compared with the infected patients without chronic kidney disease. This reduction is in part due to decreased viremia caused by the dialysis method, the production of a hepatocyte growth factor and endogenous interferon-α, and lymphocyte activation, which decreases viral action on hepatocytes. Few studies were retrieved on gamma-glutamyl transferase serum levels; those found reported that there were no differences between the patients with or without chronic kidney disease. The serum aminotransferase levels were lower in the patients with chronic kidney disease on hemodialysis (with or without viral hepatitis than in the patients with normal renal function; this reduction has a multifactorial origin.

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

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    F.V. Perícole

    2005-09-01

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

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

    DEFF Research Database (Denmark)

    Plesner, Louis L; Warming, Peder E; Nielsen, Ture L;

    2016-01-01

    The objectives of this study were to assess the prevalence of chronic obstructive pulmonary disease (COPD) in hemodialysis patients with spirometry and to examine the effects of fluid removal by hemodialysis on lung volumes. Patients ≥18 years at two Danish hemodialysis centers were included....... Forced expiratory volume in one second (FEV1 ), forced vital capacity (FVC), and FEV1 /FVC ratio were measured with spirometry before and after hemodialysis. The diagnosis of COPD was based on both the GOLD criteria and the lower limit of normal criteria. There were 372 patients in treatment at the two...... in 24 patients (9%). Mean FVC and FEV1 decreased mildly after dialysis (FVC: 2.84 to 2.79 L, P Hemodialysis did not affect the FEV1 /FVC ratio or number of subjects with airflow limitation indicative of COPD (113 vs. 120, P = 0.324; n = 242). COPD is a frequent...

  19. Lipid profile and lipoprotein(a in chronic renal failure patients with and without hemodialysis

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    Hariom Sharma

    2012-10-01

    Full Text Available Objectives: Chronic renal failure (CRF is complicated by characteristic dyslipidemias. CRF patients on hemodialysis have abnormalities in lipid profile and have a high incidence of cardiovascular diseases. Lipoprotein(a [Lp(a] is now considered as a novel cardiovascular risk factor and its level is increased in CRF patients with and without hemodialysis. We sought to evaluate the pattern of lipid profile including Lp(a level in CRF patients with and without hemodialysis. Methodology: Study were divided into 3 groups, Group-I: healthy controls (30, Group-II: CRF patients who never undergone hemodialysis (30 and Group-III: CRF patients on hemodialysis for more than 6 months (30. We obtained serum samples from patients in the morning after an overnight fast and were analysed for total cholesterol (TC, triglycerides (TGs, HDL, LDL, Lp(a using standard colorimetric assays on fully automated analyzer. VLDL concentration was calculated using Friedewald’s Formula. Results: Among the various parameters tested triglyceride and VLDL levels were significantly higher in group-II and III as compared to controls (p0.05 observed in total cholesterol and LDL levels in between healthy controls and CRF patients with & without hemodialysis. Lp(a levels were significantly higher in group-II and III as compared to controls (p0.05. There was no significant difference (p>0.05 observed between Lp(a levels and lipid profile in male and female patients in control group and in CRF patients with and without hemodialysis. Conclusions: This study demonstrated that CRF patients with and without hemodialysis are at greater risk of development of dyslipidemias, characterized by hypertriglyceridemia, elevated VLDL and Lp(a levels and decreased HDL levels. Total cholesterol and LDL cholesterol levels remain normal or decreased in these patients. Both male and female patients of CRF with and without hemodialysis have dyslipidemias without any discrimination of sex and it is not

  20. Effects of music on complications during hemodialysis for chronic renal failure patients.

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    Koca Kutlu, Adalet; Eren, Ayşe Gül

    2014-10-01

    The study was planned as a case-control study to examine the effects of music on some of the complications experienced by chronic renal failure (CRF) patients during hemodialysis. A total of 60 patients (30 intervention and 30 control) diagnosed with end-stage renal failure undergoing hemodialysis treatment participated in this study. The study was conducted in Manisa Merkez Efendi State Hospital Hemodialysis Unit and Manisa Özel Anemon Hemodialysis between April 2012 and July 2012. The intervention group listened 30 minutes in each session (12 total sessions) Turkish art music at the beginning of the third hour of their hemodialysis sessions. Patient Information Form and visual analog scale to assess pain, nausea, vomiting, and cramps during hemodialysis session were used. For the analysis of data, the number, percentage, chi-square test, and significance test of independent group differences between two averages were conducted. According to the findings of the study, the average of the intervention and control group ages, respectively, was 50.86 ± 11.3 and 55.13 ± 9.68. The primary duration of hemodialysis treatment for both intervention and control groups was "1 year and above" (70.0%). The intervention group's pain and nausea scores were lower than the control group for all 12 sessions. The difference between the intervention and the control group's pain scores was significant (P hemodialysis treatment.

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

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    Murat Kalender

    2012-06-01

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

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

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    Perihan Öztürk

    2012-06-01

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

  3. Prolonged hypophosphatemia following parathyroidectomy in chronic hemodialysis patients

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    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.

  4. Idiopathic erythrocytosis in a patient on chronic hemodialysis

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    Dong Hyun Lee

    2015-03-01

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

  5. Role of residual renal function in phosphate control and anemia management in chronic hemodialysis patients

    NARCIS (Netherlands)

    Penne, E.L.; Weerd, N.C. van der; Grooteman, M.P.C.; Mazairac, A.H.; Dorpel, M.A. van den; Nube, M.J.; Bots, M.L.; Levesque, R.; Wee, P.M. ter; Blankestijn, P.J.; Hamersvelt, H.W. van

    2011-01-01

    BACKGROUND AND OBJECTIVES: There is increasing awareness that residual renal function (RRF) has beneficial effects in hemodialysis (HD) patients. The aim of this study was to investigate the role of RRF, expressed as GFR, in phosphate and anemia management in chronic HD patients. DESIGN, SETTING, PA

  6. Immediate hemodynamic response to furosemide in patients undergoing chronic hemodialysis.

    Science.gov (United States)

    Schmieder, R E; Messerli, F H; deCarvalho, J G; Husserl, F E

    1987-01-01

    To evaluate the effect of furosemide on cardiovascular hemodynamics in patients with end-stage renal failure, we studied ten patients undergoing hemodialysis three times a week. Arterial pressure, heart rate, and cardiac output (indocyanine green dye) were measured in triplicate; total peripheral resistance and central blood volume were calculated by standard formulas. Hemodynamics were determined at baseline and 5, 10, 15, and 30 minutes after intravenous (IV) bolus injection of furosemide 60 mg. Furosemide produced a decrease in central blood volume of -13% +/- 2.2% from pretreatment values (P less than .01) that was most pronounced five minutes after injection, together with a fall in cardiac output (from 6.76 +/- 0.59 to 6.17 +/- 0.52 L/min, P less than .10). Stroke volume decreased with a maximum fall occurring after 15 minutes (from 84 +/- 7 to 79 +/- 7 mL/min, P less than .05), and total peripheral resistance increased (from 15.8 +/- 2.1 to 17.8 +/- 2.3 units, P less than .05) after furosemide. Arterial pressure and heart rate did not change. The decrease in central blood volume reflects a shift of the total blood volume from the cardiopulmonary circulation to the periphery, suggesting dilation of the peripheral venous bed. Thus, even in patients undergoing hemodialysis, furosemide acutely decreases left ventricular preload by venous dilation and should therefore prove to be beneficial in acute volume overload.

  7. Occult hepatitis B virus infection among chronic hemodialysis patients in Alexandria, Egypt.

    Science.gov (United States)

    Helaly, Ghada F; El Ghazzawi, Ebtisam F; Shawky, Sherine M; Farag, Farag M

    2015-01-01

    The prevalence of end-stage renal disease has increased dramatically in developing countries. Hepatitis B virus (HBV) infection is a global health problem that represents a significant co-morbidity event that has led to outbreaks of hepatitis B. There are inadequate data concerning occult HBV infection among Egyptian chronic hemodialysis patients. This study aimed to detect occult HBV infection among chronic hemodialysis patients in Alexandria, Egypt. A cross-sectional study was performed on 100 patients with end-stage renal disease that received maintenance hemodialysis and had tested negative for HBV surface antigen. Blood samples were collected before the initiation of hemodialysis. Sera were tested for hepatitis C virus (HCV) and hepatitis B core (HBc) antibodies using ELISA, and HBV DNA was detected by SYBR Green real-time PCR using specific primers for the s and c genes and by nested PCR using pol gene-specific primers. The serum activity of alanine and aspartate aminotransferase (ALT and AST) were also measured. Anti-HCV and anti-HBc antibodies were detected in 34% and 48% of patients, respectively, and 70.6% of anti-HCV positive patients were also positive for anti-HBc antibodies. This association was statistically significant (p=0.001). HBV DNA was detected in 32% of the hemodialysis patients. A significant association was determined between the presence of HBV DNA and anti-HCV positivity (p=0.021). Aminotransferases were elevated in 21% of the studied patients, more often in patients with positive anti-HCV profiles than in patients negative for anti-HCV (poccult infections, especially among anti-HBc-positive hemodialysis patients, to improve our understanding of their clinical, laboratory, and epidemiological characteristics.

  8. Poor compliance with guidelines on anemia treatment in a cohort of chronic hemodialysis patients

    NARCIS (Netherlands)

    Weerd, N.C. van der; Grooteman, M.P.; Blankestijn, P.J.; Mazairac, A.H.; Dorpel, M.A. van den; Hoedt, C.H. den; Nube, M.J.; Penne, E.L.; Tweel, I. van de; Wee, P.M. ter; Bots, M.L.; Koopman, M.G.; Konings, C.J.; Haanstra, W.P.; Kooistra, M.; Jaarsveld, B.C. van; Noordzij, T.C.; Feith, G.W.; Peltenburg, H.G.; Hart, G.; Buren, M. van; Offerman, J.J.; Bosch, J.; Heer, F. de; Ven, P.J. van der; Ho, T.K.; Bax, W.A.; Groeneveld, J.O.; Gasthuis, O.L.; Lavrijssen, A.T.; Meer, S.V.; Reichert, L.J.M.; Huusen, J.; Rensma, P.L.; Schrama, Y.; Hamersvelt, H.W. van; Boer, W.H.; Kuijk, W.H.; Vervloet, M.; Wauters, I.M.

    2012-01-01

    BACKGROUND/AIMS: Guidelines for the management of anemia and iron deficiency in chronic hemodialysis (HD) patients have been developed to standardize therapy and improve clinical outcome. The present study evaluated compliance with anemia guidelines and investigated whether differences between cente

  9. Quantification of cleaved beta2-microglobulin in serum from patients undergoing chronic hemodialysis

    DEFF Research Database (Denmark)

    Corlin, Dorthe B; Sen, Jette W; Ladefoged, Søren;

    2005-01-01

    BACKGROUND: Patients on chronic hemodialysis are prone to develop amyloid deposits of misfolded beta(2)-microglobulin (beta(2)M) in osteoarticular tissues. beta(2)M with various deletions/truncations and chemical modifications has been found together with structurally intact beta(2)M in extracts...

  10. Comparison of FDG-PET/CT images between chronic renal failure patients on hemodialysis and controls.

    Science.gov (United States)

    Toriihara, Akira; Kitazume, Yoshio; Nishida, Hidenori; Kubota, Kazunori; Nakadate, Masashi; Tateishi, Ukihide

    2015-01-01

    The whole-body 2-deoxy-2-[(18)F]fluoro-D-glucose (FDG) distribution in chronic renal failure (CRF) patients on hemodialysis would be different from that in subjects with normal renal function, because they lack urinary FDG excretion and remain in a constant volume overload. We evaluated the difference in the physiological uptake pattern of FDG between chronic renal failure patients on hemodialysis and control subjects. The subjects for this retrospective study consisted of 24 chronic renal failure patients on hemodialysis (HD group) and 24 age- and sex-matched control subjects (NC group). Standardized uptake values normalized by the body weight (SUVbw), ideal body weight (SUVibw), lean body mass (SUVlbm), and body surface area (SUVbsa) in the cerebellum, lungs, liver, gluteal muscles and subcutaneous fat, spleen, thoracolumbar spine, thoracic and abdominal aorta, and right atrium were calculated in positron emission tomography/computed tomography (PET/CT) images. SUVbw in the gluteal muscles, subcutaneous fat, spleen and right atrium was significantly higher in the HD group as compared to that in the NC group (p chronic renal failure patients on hemodialysis show significantly higher physiological FDG uptake in the soft tissues, spleen and blood pool.

  11. Influence of hemodialysis on the plasma concentration of adenosine deaminase in patients with chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Eduardo O. Chielle

    2015-06-01

    Full Text Available ABSTRACT Introduction: Over the past years there has been a significant increase in hospitalizations and treatments due to kidney complications that eventually resulted in the increased number of patients on dialysis. The adenosine deaminase (ADA enzyme mediates the formation of some defense cells of the organism and is therefore a marker of inflammation. Objective: The objective of this study was to evaluate biomarkers of renal function and serum ADA of hemodialysis patients. Materials and methods: Blood samples were collected from 80 patients – 40 women and 40 men – between 19 and 60 years old, before and after the completion of hemodialysis. Results: There was a significant difference in levels of creatinine, urea and ADA in pre- and post-hemodialysis periods (p < 0.0001. There was a significant increase in post-dialysis ADA regardless of sex; however there was a significantly greater increase in men. Conclusion: The results showed a reduction in urea and creatinine parameters, evidencing the main purpose of hemodialysis. This study suggests that the determination of ADA activity could be used to monitor inflammation in hemodialysis patients, however wider and more specific studies are needed to show the effectiveness of serum ADA activity as an inflammatory marker in patients with chronic kidney disease.

  12. Evidence for severe atherosclerotic changes in chronic hemodialysis patients: comparative autopsy study against cardiovascular disease patients without chronic kidney disease.

    Science.gov (United States)

    Suzuki, Chigure; Nakamura, Satoko; Ishibashi-Ueda, Hatsue; Yoshihara, Fumiki; Kawano, Yuhei

    2011-02-01

    Atherosclerosis is a major cause of mortality and morbidity among hemodialysis patients, but whether it is more severe in hemodialysis patients than in cardiovascular disease patients without chronic kidney disease is unclear. We examined 46 autopsy patients who had undergone hemodialysis, and age and sex-matched 46 patients with cardiovascular disease and an eGFR of >60 mL/min/1.73 m(2). There was no difference in the prevalence of diabetes or hypertension between the groups. We divided the aorta into four segments: A, ascending artery to arch; B, descending artery to diaphragm; C, suprarenal; and D, infrarenal. We used the classification of the American Heart Association to evaluate atherosclerosis progression. Distribution was scored by the extent to which each segment was damaged: 0, none; 1, less than 1/3; 2, more than 1/3 to less than 2/3; 3, more than 2/3. Histological examination revealed that the progression score (P 60 mL/min/1.73 m(2). Aortic atherosclerosis was aggravated by traditional and chronic kidney disease-related risk factors.

  13. Infective endocarditis in chronic hemodialysis patients: Experience from Morocco

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    Dina Montasser

    2011-01-01

    Full Text Available Since the 1960s, regular hemodialysis (HD was recognized as a risk factor for the development of infective endocarditis (IE, particularly at vascular access sites. The present report describes our experience at the Etat Major General Agadir, Morocco, of taking care of IE in patients on regular dialysis. A retrospective analysis was made of five cases of IE in patients receiving re-gular HD having arteriovenous fistula as vascular access. They were sent from four private centers and admitted in our formation between January 2004 and March 2009. Infective endocarditis was detected after 34.5 months following initiation of dialysis. The causative organisms included Sta-phylococcus and Enterococcus in two cases each and negative blood culture in one case. A recent history of infection (<3 months of the vascular access was found in three cases. Peripheric embolic phenomena were noted in two cases. A pre-existing heart disease was common and contributed to heart failure. Mortality was frequent due to valvular perforations and congestive heart failure, making the medical treatment alone unsatisfactory. Two patients survived and three of our patients received a prosthetic valve replacement, with a median survival after surgery of 10.3 months/person. The clinical diagnosis of infective endocarditis in regularly dialyzed patients remains difficult, with the presence of vascular calcification as a common risk factor. The vascular catheter infections are the cardinal gateway of pathogenic organisms, which are mainly Staphlococcus. The prognosis is bad and the mortality is significant, whereas medical and surgical treatments are often established in these patients who have many factors of comorbidity.

  14. Oral carnitine supplementation for dyslipidemia in chronic hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Afsoon Emami Naini

    2012-01-01

    Full Text Available Carnitine deficiency is a commonly observed problem in maintenance hemodialysis (MHD patients, which results in altered metabolism of fatty acids and subsequently development of dyslipidemia. To evaluate the effect of oral L-carnitine (LC supplementation on lipid profile of adult MHD patients, we studied 30 of them (19 males, 11 females who received LC supplementation of 250 mg tablets three times a day for eight weeks. They were compared with 30 matched patients as a control group. Serum lipid profiles were compared before and after the intervention between the two groups. There was a significant decrease of the values of the lipid profile in the intervention group before and after carnitine supplementation including the mean values of total cholesterol (190 ± 36.8 vs. 177 ± 31.2 mg/dL, triglyceride (210 ± 64.7 vs. 190 ± 54.1 mg/dL and LDL-cholesterol (117 ± 30.1 vs. 106 ± 26.3 mg/dL, while the values did not change siginificantly from base line in the control group. However, the difference for HDL-cholesterol in intervention group was not statistically significant. None of the patients dropped out of the study due to drug side effects. Oral LC supplementation (750 mg/day is able to improve lipid profile in patients on MHD. Further long-term studies with adequate sample size are needed to define the population of patients who would benefit more from carnitine therapy and the optimal dose and the most efficient route for administration of the drug.

  15. Oral carnitine supplementation for dyslipidemia in chronic hemodialysis patients.

    Science.gov (United States)

    Naini, Afsoon Emami; Sadeghi, Masoumeh; Mortazavi, Mojgan; Moghadasi, Mojdeh; Harandi, Asghar Amini

    2012-05-01

    Carnitine deficiency is a commonly observed problem in maintenance hemodialysis (MHD) patients, which results in altered metabolism of fatty acids and subsequently development of dyslipidemia. To evaluate the effect of oral L-carnitine (LC) supplementation on lipid profile of adult MHD patients, we studied 30 of them (19 males, 11 females) who received LC supplementation of 250 mg tablets three times a day for eight weeks. They were compared with 30 matched patients as a control group. Serum lipid profiles were compared before and after the intervention between the two groups. There was a significant decrease of the values of the lipid profile in the intervention group before and after carnitine supplementation including the mean values of total cholesterol (190 ± 36.8 vs. 177 ± 31.2 mg/dL), triglyceride (210 ± 64.7 vs. 190 ± 54.1 mg/dL) and LDL-cholesterol (117 ± 30.1 vs. 106 ± 26.3 mg/dL), while the values did not change siginificantly from base line in the control group. However, the difference for HDL-cholesterol in intervention group was not statistically significant. None of the patients dropped out of the study due to drug side effects. Oral LC supplementation (750 mg/day) is able to improve lipid profile in patients on MHD. Further long-term studies with adequate sample size are needed to define the population of patients who would benefit more from carnitine therapy and the optimal dose and the most efficient route for administration of the drug.

  16. Porphyria cutanea tarda in a chronic hemodialysis patient

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    Labidi Jannet

    2010-01-01

    Full Text Available End-stage renal failure and long-term hemodialysis (HD treatment promote the development of genetically conditioned porphyria cutanea tarda (PCT. Iron overload is often asso-ciated with this disease and is thought to play a role in its pathogenesis. We report a case of HD-related PCT, which improved with deferoxamine treatment. A 33-year-old woman, with end-stage renal failure on HD since 1998, presented with a history of blisters on the face and dorsum of the hands, of several months duration. Laboratory analysis showed: hemoglobin 10.4 g/dL; a moderate hepatic cytolysis; ferritin 1300 μg/L (Nl: 8-120 μg/L and negative serology for HIV, HBV and HCV. Porphyrin analyses showed a PCT pattern. Skin biopsy findings and direct immunofluo-rescence were consistent with PCT. The patient received deferoxamine (40 mg/kg intravenously every week for 6 weeks which led to dramatic improvement of the symptoms. Several treatments are proposed in the management of dialysis-related PCT. This case confirms that deferoxamine can induce rapid and prolonged remission.

  17. [Brain changes in patients on chronic hemodialysis recorded by computed axial tomography].

    Science.gov (United States)

    Todorov, V; Penkova, S; Boneva, R; Kiuchukov, G

    1988-01-01

    The brain changes in patients with chronic renal failure treated by chronic hemodialysis were studied with the help of computed tomography. The results showed the development of internal hydrocephalus in the patients in whose treatment "hard" water was used. In some of these patients the hydrocephalus was accompanied by clinical manifestations of the "disequilibrium" syndrome and the "hard water" syndrome. The patients dialyzed with "soft" water showed no brain changes and clinical signs. Hydrocephalus is probably the main pathogenetic factor for the development of the "hard water" syndrome which later develops in dialysis encephalopathy.

  18. Longitudinal study of neuropsychological functioning in patients on chronic hemodialysis: a preliminary report.

    Science.gov (United States)

    McKee, D C; Burnett, G B; Raft, D D; Batten, P G; Bain, K P

    1982-01-01

    This study is part of a five-year project to investigate the long term effect of chronic hemodialysis on patients with end-stage renal failure. Previous research has associated hemodialysis with progressive dialysis encephalopathy (PDE), which is characterized by speech disturbances, cognitive impairment, myoclonus and behavioral changes. Little is known about the cause or the course of this syndrome except that it begins 14-36 months after treatment onset and usually culminates in death. The purpose of this study was to investigate neuropsychological (cognitive and behavioral) functioning in dialysis patients over a period of years. To date, 34 patients have been studied for 22 months utilizing a cross-sectional method comparing patients at different stages of treatment combined with a longitudinal method of repeated evaluations over time. Current findings show improved cognitive functioning during at least the first year of treatment and no evidence of cognitive deterioration in patients on dialysis for more than one year (M = 4.3). These findings offer strong evidence that PDE is not necessarily a general phenomenon among patients on chronic hemodialysis.

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

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    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. 2004 Japanese Society for Dialysis Therapy guidelines for renal anemia in chronic hemodialysis patients.

    Science.gov (United States)

    Gejyo, Fumitake; Saito, Akira; Akizawa, Tadao; Akiba, Takashi; Sakai, Tatsuya; Suzuki, Masashi; Nishi, Shinichi; Tsubakihara, Yoshiharu; Hirakata, Hideki; Bessho, Masami

    2004-12-01

    The guideline committee of Japanese Society for Dialysis Therapy (JSDT), chaired by Professor F. Gejyo of Niigata University, now publishes an original Japanese guideline entitled 'Guidelines for Renal Anemia in Chronic Hemodialysis Patients'. It includes the re-evaluation of the usage of recombinant human erythropoietin (rHuEPO) with the medical and economical arguments regarding the prognosis and the quality of life of Japanese hemodialysis patients. This guideline consists of 7 sections. The first section comprises the general definition and the differential diagnosis of anemia. The hemoglobin (Hb) level of the Japanese population seemed to be low when compared with that of the European and American populations. The second section describes the target Hb level in hemodialysis patients. Multivariate analysis of the data that were collected from dialysis institutions throughout the country showed that an Hb level of 10-11 g/dL (Ht level 30-33%) at the first dialysis session in a week is the ideal range for chronic hemodialysis patients in terms of the 3-5 year survival rate. The supine position at blood sampling and the sampling timing at the first dialysis session in a week might affect the lower setting of target Hb hematocrit (Ht), compared to that of European and American guidelines. However, we particularly recommended that an Hb level of 11-12 g/dL (Ht level from 33 to 36%) at the first dialysis session in a week is desirable in relatively young patients. In the third section, the markers of iron deficiency are discussed. The Transferin saturation test (TSAT) and serum ferritin were emphasized as the standard markers. The routes of administration of rHuEPO and its dosages are written in the fourth section. The subcutaneous route was associated with the occurrence of secondary red cell aplasia due to anti-rHuEPO antibodies; however, secondary red cell aplasia was seldom observed in the venous injection. From this fact we recommend venous injection for chronic

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

    Science.gov (United States)

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

    2016-01-01

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

  2. Sevelamer carbonate in the treatment of hyperphosphatemia in patients with chronic kidney disease on hemodialysis

    Directory of Open Access Journals (Sweden)

    Vincenzo Savica

    2008-09-01

    Full Text Available Vincenzo Savica1,2, Domenico Santoro1, Paolo Monardo2, Agostino Mallamace1, Guido Bellinghieri11Experimental and Clinic Department of Internal Medicine and Pharmacology, University of Messina, Italy; 2Nephrology and Dialysis Unit, Papardo Hospital, Messina, ItalyAbstract: Sevelamer carbonate is an anion exchange pharmaceutical, developed to improve on the performance of the non-absorbable, non-calcium, and metal-free phosphate binder sevelamer hydrochloride. Sevelamer carbonate is expected not to worsen metabolic acidosis, as previously reported during long-term treatment with sevelamer hydrochloride in hemodialysis (HD patients. Carbonate is the alternate counterion to chloride on the sevelamer polymeric backbone, but the active poly(allylamine responsible for phosphate (PO4 binding remains unaltered. Therefore, sevelamer carbonate is expected to reduce elevated serum phosphorus level, similarly to sevelamer hydrochloride. Sevelamers are prescribed in uremic HD patients to control hyperphosphatemia, but the carbonate has also been proposed for the treatment of chronic kidney disease (CKD non-dialysis patients. Although hyperphosphatemia is regarded as a main contributor to increased mortality in the HD population because of cardiovascular calcification, metabolic acidosis has also been advocated as a major player in the increased mortality in this population, by engendering malnutrition, negative nitrogen balance, and inflammation. This paper reviews the evidence showing that sevelamer carbonate is as good as sevelamer hydrochloride in terms of hyperphosphatemia control in CKD, but with a better outcome in serum bicarbonate balance.Keywords: chronic kidney disease, sevelamer carbonate, hyperphosphatemia, hemodialysis

  3. The serum vaspin levels are reduced in Japanese chronic hemodialysis patients

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    Inoue Junko

    2012-12-01

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

  4. Tuberculous Peritonitis in Hemodialysis Patients with Chronic Liver Disease

    OpenAIRE

    Al Shohaib Saad

    2000-01-01

    Tuberculous peritonitis (TBP) remains a major medical problem in many developing countries, wherein the incidence of tuberculosis (TB) is still high. Since the clinical presentation may be insidious and variable, diagnosis of TBP may be delayed or missed, resulting in undue patient morbidity and mortality. Tests frequently associated with TB such as chest radiograph and Mantoux test are not usually sensitive enough for the diagnosis of TBP. The diagnosis becomes all the more difficult in the ...

  5. Vitamin E tocotrienol supplementation improves lipid profiles in chronic hemodialysis patients

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    Daud ZAM

    2013-11-01

    Full Text Available Zulfitri A Mat Daud,1 Boniface Tubie,2 Marina Sheyman,2 Robert Osia,2 Judy Adams,2 Sharon Tubie,2 Pramod Khosla1 1Department of Nutrition and Food Science, Wayne State University, Detroit, MI, USA; 2Great Lake Dialysis Clinic, LLC, Detroit, MI, USA Purpose: Chronic hemodialysis patients experience accelerated atherosclerosis contributed to by dyslipidemia, inflammation, and an impaired antioxidant system. Vitamin E tocotrienols possess anti-inflammatory and antioxidant properties. However, the impact of dietary intervention with Vitamin E tocotrienols is unknown in this population. Patients and methods: A randomized, double-blind, placebo-controlled, parallel trial was conducted in 81 patients undergoing chronic hemodialysis. Subjects were provided daily with capsules containing either vitamin E tocotrienol-rich fraction (TRF (180 mg tocotrienols, 40 mg tocopherols or placebo (0.48 mg tocotrienols, 0.88 mg tocopherols. Endpoints included measurements of inflammatory markers (C-reactive protein and interleukin 6, oxidative status (total antioxidant power and malondialdehyde, lipid profiles (plasma total cholesterol, triacylglycerols, and high-density lipoprotein cholesterol, as well as cholesteryl-ester transfer protein activity and apolipoprotein A1. Results: TRF supplementation did not impact any nutritional, inflammatory, or oxidative status biomarkers over time when compared with the baseline within the group (one-way repeated measures analysis of variance or when compared with the placebo group at a particular time point (independent t-test. However, the TRF supplemented group showed improvement in lipid profiles after 12 and 16 weeks of intervention when compared with placebo at the respective time points. Normalized plasma triacylglycerols (cf baseline in the TRF group were reduced by 33 mg/dL (P=0.032 and 36 mg/dL (P=0.072 after 12 and 16 weeks of intervention but no significant improvement was seen in the placebo group. Similarly

  6. Effects of L-Carnitine Added to Erythropoietin in Anemic Chronic Renal Failure Patients on Hemodialysis.

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    N Taheri

    2006-10-01

    Full Text Available Introduction: Chronic renal disease (C.R.D is a pathophysiological process due to progressive and irreversible decrease in number and function of nephrons in the kidney. Anemia is one of the most important complications in CRD patients. Anemia is caused mainly due to diminished production of erythropoietin (EPO, which is treated by weekly injection of the EPO. L-carnitine added to EPO can increase the efficacy of EPO. Methods: Present study, from March 2003 until September 2004 (18 months, evaluates the effects of L-carnitine added to EPO in 30 patients at Shaheed Rahnemon hemodialysis center of Yazd. Each patient was administered one oral table (250 mg of L-carnitine, twice a day along with EPO for 90 days. EPO was in the form of injection 2000 iu/sc after dialysis.(three times per week. One questionnaire was completed for each patient, which included demographic characteristics, type of disease, duration of the hemodialysis, Hb and Hct levels, transferrin saturation and ferritin levels. Hb ,Hct and transferrin saturations were measured on days 1, 45 and 90. Results were analyzed by paired t test and analysis of variance. Results: Results of this study showed that the mean Hb levels and Hct were significantly raised up to 1.1 mg/dl (P.value<0.001 and 2.7% (P.Value<0.001, respectively. In addition, significant decrease of 5.75% in transferrin (P.Value< 0.001 and 121ng/ml in ferritin levels (P.Value< 0.001 was observed. Efficacy of EPO plus L-carnitine was affected only by duration of hemodialysis and not by age, sex or causes of CRD. Conclusion: L-carnitine added to EPO increases the efficacy of EPO after 3 months.

  7. Efficacy and safety of Cinacalcet on secondary hyperparathyroidism in Chinese chronic kidney disease patients receiving hemodialysis.

    Science.gov (United States)

    Mei, Changlin; Chen, Nan; Ding, Xiaoqiang; Yu, Xueqing; Wang, Li; Qian, Jiaqi; Wang, Mei; Jiang, Gengru; Li, Xuemei; Hou, Fanfan; Zuo, Li; Wang, Niansong; Liu, Hong

    2016-10-01

    Introduction Secondary hyperparathyroidism (SHPT) develops in patients with chronic renal failure. Cinacalcet hydrochloride has been used successfully in U.S., Europe, and Japan in the treatment of SHPT, while maintaining serum levels of calcium and phosphorus. The efficacy and safety profile of Cinacalcet treatment vs. conventional treatments has been of great interest in clinical practice. In this recent phase III study conducted in China, efficacy and safety of a calcimimetic agent, Cinacalcet (Kyowa Hakko Kirin Co., Ltd.), were assessed for SHPT treatment in stable chronic renal disease patients on hemodialysis. Methods In this double-blind, multicenter, placebo-controlled, randomized phase III study, 238 subjects were enrolled in 12 centers and randomly divided into a Cinacalcet group and a placebo group. The percentage of patients achieving a serum parathyroid hormone (PTH) level ≤250 pg/mL was the primary efficacy end point. Serum calcium and phosphorus levels were measured. Adverse events and serious adverse events were recorded, and causal analysis performed. Findings In primary analysis, 25.4% of the Cinacalcet group and 3.5% of the placebo group achieved the primary end point (PTH ≤250 pg/mL). Calcium and phosphorus levels and calcium-phosphorus product were lower in the Cinacalcet group compared with the placebo group. Eleven serious adverse events were reported and considered to be not related to study drugs. Mild to moderate hypocalcemia and reduced calcium levels were reported and considered to be Cinacalcet related. Discussion This phase III study demonstrated that Cinacalcet is effective and well tolerated in treating SHPT in Chinese chronic kidney disease patients on hemodialysis, and in a patient population with much higher baseline PTH levels.

  8. Improving volume status by comprehensive dietary and dialytic sodium management in chronic hemodialysis patients.

    Science.gov (United States)

    Penne, E Lars; Levin, Nathan W; Kotanko, Peter

    2010-01-01

    Chronic volume overload is highly prevalent in chronic hemodialysis patients and leads to hypertension, left ventricular hypertrophy and increased hospitalization and mortality rates. Volume overload is caused primarily by a positive sodium balance and can be improved by sodium restriction. The main sources of sodium excess are a high-sodium diet in the interdialytic period and a positive sodium balance during dialysis. Here we discuss different approaches to achieve neutral or negative sodium balance, including reducing dietary sodium intake, individualizing dialysate sodium prescription, abandonment of sodium profiling, and reducing saline infusion for treatment of intradialytic symptoms and as part of dialyzer rinsing and priming procedures. All of these approaches should be combined for a maximal reduction of volume overload.

  9. Prevalence of chronic kidney disease of non-traditional causes in patients on hemodialysis in southwest Guatemala.

    Science.gov (United States)

    Laux, Timothy S; Barnoya, Joaquin; Cipriano, Ever; Herrera, Erick; Lopez, Noemi; Polo, Vicente Sanchez; Rothstein, Marcos

    2016-04-01

    Objective To document the prevalence of patients on hemodialysis in southwestern Guatemala who have chronic kidney disease (CKD) of non-traditional causes (CKDnt). Methods This cross-sectional descriptive study interviewed patients on hemodialysis at the Instituto Guatemalteco de Seguridad Social on their health and occupational history. Laboratory serum, urine and vital sign data at the initiation of hemodialysis were obtained from chart reviews. Patients were classified according to whether they had hypertension or obesity or neither. The proportion of patients with and without these traditional CKD risk factors was recorded and the association between demographic and occupational factors and a lack of traditional CKD risk factors analyzed using multivariate logistic regression. Results Of 242 total patients (including 171 non-diabetics) enrolled in hemodialysis in southwestern Guatemala, 45 (18.6% of total patients and 26.3% of non-diabetics) lacked traditional CKD risk factors. While agricultural work history was common, only travel time greater than 30 minutes and age less than 50 years old were significantly associated with CKD in the absence of traditional risk factors. Individuals without such risk factors lived throughout southwestern Guatemala's five departments. Conclusions The prevalence of CKDnT appears to be much lower in this sample of patients receiving hemodialysis in Southwestern Guatemala than in hospitalized patients in El Salvador. It has yet to be determined whether the prevalence is higher in the general population and in patients on peritoneal dialysis.

  10. Evaluation of pulmonary function in renal transplant recipients and chronic renal failure patients undergoing maintenance hemodialysis

    Directory of Open Access Journals (Sweden)

    Mohamed E. Abdalla

    2013-01-01

    Conclusion: There is impairment of lung function in patients with CRF undergoing hemodialysis. The main changes are small airway obstruction, reduction in carbon monoxide transfer and diminished 6MWT that were not completely improved in the kidney transplant patients.

  11. Relationships between registered nurse staffing, processes of nursing care, and nurse-reported patient outcomes in chronic hemodialysis units.

    Science.gov (United States)

    Thomas-Hawkins, Charlotte; Flynn, Linda; Clarke, Sean P

    2008-01-01

    Little attention has been given to the effects of registered nurse (RN) staffing and processes of nursing care on patient outcomes in hemodialysis units. This research examined the effects of patient-to-RN ratios and necessary tasks left undone by RNs on the likelihood of nurse-reported frequent occurrences of adverse patient events in chronic hemodialysis units. Study findings revealed that high patient-to-RN ratios and increased numbers of tasks left undone by RNs were associated with an increased likelihood of frequent occurrences of dialysis hypotension, skipped dialysis treatments, shortened dialysis treatments, and patient complaints in hemodialysis units. These findings indicate that federal, state, and dialysis organization policies must foster staffing structures and processes of care in dialysis units that effectively utilize the invaluable skills and services of professional, registered nurses.

  12. Randomized crossover study comparing the phosphate-binding efficacy of calcium ketoglutarate versus calcium carbonate in patients on chronic hemodialysis

    DEFF Research Database (Denmark)

    Bro, S; Rasmussen, R A; Handberg, J

    1998-01-01

    The objective of the study was to evaluate the phosphate-binding efficacy, side effects, and cost of therapy of calcium ketoglutarate granulate as compared with calcium carbonate tablets in patients on chronic hemodialysis. The study design used was a randomized, crossover open trial, and the main...

  13. Markers of endothelial damage in patients with chronic kidney disease on hemodialysis.

    Science.gov (United States)

    Carmona, Andrés; Agüera, Maria Luisa; Luna Ruiz, Carlos; Buendia, Paula; Calleros, Laura; Garcia-Jerez, Andrea; Rodríguez-Puyol, Manuel; Arias, Manuel; Arias-Guillen, Marta; de Arriba, Gabriel; Ballarin, Jose; Bernis, Carmen; Fernandez, Elvira; Garcia-Rebollo, Sagrario; Mancha, Javier; Del Peso, Gloria; Perez, Estefania; Poch, Esteban; Portoles, Jose M; Rodriguez-Puyol, Diego; Sánchez-Villanueva, Rafael; Sarro, Felipe; Torres, Armando; Martin-Malo, Alejandro; Aljama, Pedro; Ramirez, Rafael; Carracedo, Julia

    2017-01-11

    Patients with stage 5 chronic kidney disease who are on hemodialysis (HD) remain in a chronic inflammatory state, characterized by the accumulation of uremic toxins that induce endothelial damage and cardiovascular disease (CVD). Our aim was to examine microvesicles (MVs), monocyte subpopulations, and angiopoietins to identify prognostic markers in HD patients with or without diabetes mellitus (DM). A total of 160 prevalent HD patients from 10 centers across Spain were obtained from the Biobank of the Nephrology Renal Network (REDinREN, Madrid): 80 patients with diabetes mellitus (DM) and 80 patients without DM who were matched for clinical and demographic criteria. MVs from plasma and several monocyte subpopulations (CD14++/CD16+, CD14+/CD16++) were analyzed by flow cytometry, and the plasma concentrations of angiopoietin (Ang)1 and Ang2 were quantified by ELISA. Data on cardiovascular disease were gathered over the 5.5 years after these samples were obtained. MV level, monocyte subpopulations (CD14+/CD16++ and CD14++/CD16+), and Ang2/Ang1 ratios increased in HD patients with DM compared with non-DM patients. Moreover, MV level above the median (264 MVs/µl) were associated independently with greater mortality. MVs, monocyte subpopulations, and Ang2/Ang1 ratio can be used as predictors for CVD. In addition, MV level have potential predictive value in the prevention of CVD in HD patients. These parameters undergo more extensive changes in patients with DM.

  14. Serum Hepcidin Predicts Uremic Accelerated Atherosclerosis in Chronic Hemodialysis Patients with Diabetic Nephropathy

    Institute of Scientific and Technical Information of China (English)

    Han Li; Su-Juan Feng; Lu-Lu Su; Wei Wang; Xiao-Dong Zhang; Shi-Xiang Wang

    2015-01-01

    Background:Hepcidin,as a regulator of body iron stores,has been recently discovered to play a critical role in the pathogenesis of anemia of chronic disease.Atherosclerotic cardiovascular disease is the most common complication and the leading cause of death in chronic hemodialysis (CHD) patients.In the current study,we aimed to explore the relationship between serum hepcidin and uremic accelerated atherosclerosis (UAAS) in CHD patients with diabetic nephropathy (CHD/DN).Methods:A total of 78 CHD/DN and 86 chronic hemodialyzed nondiabetic patients with chronic glomerulonephritis (CHD/non-DN) were recruited in this study.The level of serum hepcidin-25 was specifically measured by liquid chromatography-tandem mass spectrometry.Serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were measured by enzyme-linked immunosorbent assay.Results:High serum level ofhepcidin-25 was seen in CHD patients.Serum hepcidin-25 in CHD/DN was significantly higher than that in CHD/non-DN patients.Serum hepcidin-25 was positively correlated with ferritin,high-sensitivity C-reactive protein (hs-CRP),TNF-α,and IL-6 in CHD/DN patients.CHD/DN patients exhibited higher common carotid artery intima media thickness (CCA-IMT),hs-CRP,and hepcidin-25 levels than that in CHD/non-DN patients.Moreover,in CHD/DN patients,CCA-IMT was positively correlated with serum hepcidin,hs-CRP,and low-density lipoprotein-cholesterol.On multiple regression analysis,serum hepcidin and hs-CRP level exhibited independent association with IMT in CHD/DN patients.Conclusions:These findings suggest possible linkage between iron metabolism and hepcidin modulation abnormalities that may contribute to the development of UAAS in CHD/DN patients.

  15. [Quality of life in patients with chronic renal failure under high-efficiency hemodialysis].

    Science.gov (United States)

    Romão, Maria Aparecida Fadil; Romão Junior, João Egidio; Belasco, Angélica Gonçalves Silva; Barbosa, Dulce Aparecida

    2006-12-01

    This study aimed at assessing the quality of life (QL) of patients with chronic kidney failure under high efficiency hemodialysis. The Medical Outcomes Study 36 Item Short Form Health Survey (SF36) was applied, and the results were correlated with social-demographic profile, clinical and laboratorial data, Karnofsky's Scale and Depression Cognitive Index (DCI). The sample consisted of 50 patients with an average age of 37 and mean treatment duration of 50.6 months. LQ changes were evidenced by correlations of SF36 scores with social-demographic aspects, clinical data, Karnofsky's Scale, and DCI. It was concluded that the individual use of SF36 may aid the assessment of therapeutic conduct.

  16. Anti-HBs seroconversion during treatment with entecavir in a patient with chronic hepatitis B virus infection on hemodialysis.

    Science.gov (United States)

    Spaziante, Martina; Biliotti, Elisa; Grieco, Stefania; Palazzo, Donatella; Esvan, Rozenn; Taliani, Gloria

    2014-01-01

    Hepatitis B (HBV) virus infection is one of the most important causes of liver disease in patients with end-stage renal failure on hemodialysis. The natural history of chronic HBV infection acquired in childhood starts with an immune tolerant phase, followed by an immune clearance phase that may lead to the inactive carrier state or the development of chronic liver disease. Information on antiviral therapy administered very early during the immune clearance phase are lacking and no data exist on the treatment of early immune activation in the hemodialysis setting. This report describes the case of a patient affected by end-stage renal failure and HBeAg-positive chronic HBV virus infection treated very early during the immune clearance phase of HBV infection with an adjusted-dose of nucleoside analogue entecavir. The patient achieved a very rapid HBV-DNA undetectability, anti-HBe, and anti-HBs seroconversion. This is the first report of antiviral therapy with entecavir started during the immune reactive phase of HBV infection in a patient on hemodialysis and it suggests that antiviral treatment can enhance the effects of host immune activation resulting in biochemical, serological, and viral response, even in end-stage renal failure patients with partial immunodeficiency. Antiviral therapy with entecavir in the setting of hemodialysis was safe and well tolerated.

  17. A multidisciplinary program for achieving lipid goals in chronic hemodialysis patients

    Directory of Open Access Journals (Sweden)

    McMillan Robichaud J

    2002-11-01

    Full Text Available Abstract Background There is little information on how target lipid levels can be achieved in end stage renal disease (ESRD patients in a systematic, multidisciplinary fashion. Methods We retrospectively reviewed a pharmacist-directed hyperlipidemia management program for chronic hemodialysis (HD patients. All 26 adult patients on chronic HD at a tertiary care medical facility were entered into the program. A clinical pharmacist was responsible for laboratory monitoring, patient counseling, and the initiation and dosage adjustment of an appropriate 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA reductase inhibitor (statin using a dosing algorithm and monitoring guidelines. The low-density lipoprotein (LDL cholesterol goal was ≤ 100 mg/dl. A renal dietitian provided nutrition counseling and the nephrologist was notified of potential or existing drug interactions or adverse drug reactions (ADRs. Patients received a flyer containing lipid panel results to encourage compliance. Data was collected at program initiation and for 6 months thereafter. Results At the start of the program, 58% of patients were at target LDL cholesterol. At 6 months, 88% had achieved target LDL (p = 0.015. Mean LDL cholesterol decreased from 96 ± 5 to 80 ± 3 mg/dl (p Conclusions Our findings demonstrate both feasibility and efficacy of a multidisciplinary approach in management of hyperlipidemia in HD patients.

  18. Renin-angiotensin system stimulates erythropoietin secretion in chronic hemodialysis patients.

    Science.gov (United States)

    Vlahakos, D V; Balodimos, C; Papachristopoulos, V; Vassilakos, P; Hinari, E; Vlachojannis, J G

    1995-01-01

    A series of observations suggests an interrelationship between the renin-angiotensin system (RAS) and erythropoietin (EPO) secretion. To further evaluate the role of RAS in erythropoiesis of chronic hemodialysis patients, we studied two groups of such patients: Group A consisted of 16 patients (14 male and 2 female, 54.7 +/- 3.3 years old), who maintained a target hematocrit value of 0.30 (0.32 +/- 0.01), without recombinant human EPO (rhEPO) supplementation. Group B consisted of 14 patients (7 male and 7 female, 50 +/- 5.3 years old), who required subcutaneous injections of rhEPO (90.8 +/- 10 IU.kg-1.week-1), to maintain the same target hematocrit value of 0.30 (30 +/- 0.01). Plasma renin activity (PRA) was found to be the major feature to distinguish patients in these two Groups and it was five times higher in Group A (10 +/- 2 ng.ml-1.h-1) compared to Group B patients (1.8 +/- 0.6 ng.ml-1.h-1) (p < 0.001). Moreover, activation of RAS in Group A patients by volume depletion (2.2 +/- 0.2 l) during hemodialysis resulted in a 118 +/- 33 percent increment of PRA (p < 0.01) which was accompanied by a 69 +/- 25 percent increment of serum EPO levels (p < 0.05). Repetition of the same protocol after inhibiting the converting enzyme with 50 mg of Captopril prior to dialysis session, resulted in a 315 +/- 64 percent increment of PRA (p < 0.001), while at the same time completely blocked the expected rise in serum EPO levels (1.25 +/- 12.5 percent increment).(ABSTRACT TRUNCATED AT 250 WORDS)

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

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

    2014-01-01

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

  1. Efficacy and safety of pegylated-interferon α-2a in hemodialysis patients with chronic hepatitis C

    Institute of Scientific and Technical Information of China (English)

    Celal Ayaz; Mustafa Kemal Celen; Ugur Nedim Yuce; Mehmet Faruk Geyik

    2008-01-01

    AIM: To evaluate the efficacy and safety of pegylated-interferon alpha-2a in hemodialysis patients with chronic hepatitis C.METHODS: Thirty-six hemodialysis patients with chronic hepatitis C were enrolled in a controlled and prospective study. All patients were treatment naive, positive tested for anti-HCV antibodies, and positive tested for serum HCV-RNA. Twenty-two patients received 135 μg peglyated-interferon α-2a weekly for 48 wk (group A).The remaining patients were left untreated, eleven refused therapy, and three were not candidates for kidney transplantation and were allocated to the control group (group B). At the end of the treatment biochemical and virological response was evaluated, and 24 wk after completetion of therapy sustained virological response (SVR) was assessed. Side effects were monitored.RESULTS: Of 22 hemodialysis patients, 12 were male and 10 female, with a mean age of 35.2 ± 12.1 years.Virological end-of-treatment response was observed in 14 patients (82.4%) in group A and in one patient (7.1%)in group B (P = 0.001). Sustained virological response was observed in 11 patients (64.7%) in group A and in one patient in group B (7.1%). Biochemical response parameters normalized in 10/14 patients (71.4%) at the end of the treatment. ALT levels in group B were initially high in six patients and normalized in one of them (25%)at the end of the 48 wk. In five patients (22.7%) therapy had to be stopped at mo 4 due to complications of weakness, anemia, and bleeding.CONCLUSION: SVR could be achieved in 64.7% of patients on hemodialysis with chronic hepatitis C by a treatment with peglyated-interferon α-2a. Group A had a significantly better efficacy compared to the control group B, but the side effects need to be concerned.

  2. Effect of renal function and hemodialysis on the serum tumor markers in patients with chronic kidney disease

    Institute of Scientific and Technical Information of China (English)

    YU Xiaofang; XU Xialian; YE Zhibin

    2007-01-01

    In patients with chronic renal failure,whether they have had hemodialysis or not,the specificity of some of the serum tumor markers for the diagnosis of the corresponding tumors is decreased while others remain as valuable as they are in patients with norrnal kidney function.The detection of tumor markers is extensively used for the diagnosis of corresponding tumors.It has been recently shown that some tumor markers are higher in patients with chronic kidney disease(END)than in the normal population.The effects of renal function and hemodialysis were examined on serum levels of some of the tumor markers including CEA,CA199,CA125,AFP,CA153,CA724,CYFRA21-1,NSE,SCC-Ag,PSA,and fPSA.The 232 non-dialysis patients with CKD and 37 chronic uremic patients treated with maintenance hemodialysis were enrolled in this study.The 232 non-dialysis patients were divided into three groups according to their Ccr.In group 1,Ccr was≤25 mL/min.In group 2,Ccr was between 25 and 50 mL/min.In group 3,Ccr was≥50 mL/min.The male patients were also divided into three groups to compare the serum levels of PSA and fPSA among the three groups.Nine tumor markers in 37 uremic patients were tested.For comparison.37 non-dialysis patients with similar Ccr of the same age and gender served as controls.There existed significant difierences in serum levels of CEA,CA199,CYFRA21.1,NSE,and SCC-Ag among different Ccr groups and the markers bore a negative correlation with Ccr.There were no significant differences among the three groups in the serum concentrations of CA125,AFP,CA153,CA724,PSA and fPSA.The serum levels of CA125 and NSE were significantly higher(P<0.01)in hemodialysis patients than in the nondialysis control patients.In patients with chronic renal failure,who were or were not on hemodialysis,the specificity of serum CEA,CA199,CYFRA21-1,NSE,CA125 and SCC-Ag for the diagnosis of the corresponding tumors was decreased while serum AFP,CA153,CA724,PSA and fPSA were as valuable as they were in

  3. High Neutrophil-to-Lymphocyte Ratio Predicts Cardiovascular Mortality in Chronic Hemodialysis Patients

    Science.gov (United States)

    Xiong, Ruifang

    2017-01-01

    The neutrophil-to-lymphocyte ratio (NLR) is a novel simple biomarker of inflammation. It has emerged as a predictor of poor prognosis in cancer and cardiovascular disease in general population. But little was known of its prognostic value in chronic hemodialysis (HD) patients. Here we investigated the association between NLR and cardiovascular risk markers, including increased pulse pressure (PP), left ventricular mass index (LVMI) and intima-media thickness (IMT), and mortality in HD patients. Two hundred and sixty-eight HD patients were enrolled in this study and were followed for 36 months. The primary end point was all-cause mortality and cardiovascular mortality. Multivariable Cox regression was used to calculate the adjusted hazard ratios for NLR on all-cause and cardiovascular survival. We pinpointed that higher NLR in HD patients was a predictor of increased PP, LVMI, and IMT; HD patients with higher NLR had a lower survival at the end of the study; furthermore, high NLR was an independent predictor of all-cause and cardiovascular mortality when adjusted for other risk factors. In conclusion, higher NLR in HD patients was associated with cardiovascular risk factors and mortality.

  4. Telomere Length in Peripheral Blood Mononuclear Cells of Patients on Chronic Hemodialysis Is Related With Telomerase Activity and Treatment Duration.

    Science.gov (United States)

    Stefanidis, Ioannis; Voliotis, Georgios; Papanikolaou, Vassilios; Chronopoulou, Ioanna; Eleftheriadis, Theodoros; Kowald, Axel; Zintzaras, Elias; Tsezou, Aspasia

    2015-09-01

    Telomere shortening to a critical limit is associated with replicative senescence. This process is prevented by the enzyme telomerase. Oxidative stress and chronic inflammation are factors accelerating telomere loss. Chronic hemodialysis, typically accompanied by oxidative stress and inflammation, may be also associated with replicative senescence. To test this hypothesis, we determined telomere length and telomerase activity in peripheral blood mononuclear cells (PBMCs) in a cross-sectional study. Hemodialysis patients at the University Hospital Larissa and healthy controls were studied. Telomere length was determined by the TeloTAGGG Telomere Length Assay and telomerase activity by Telomerase PCR-ELISA (Roche Diagnostics GmbH, Mannheim, Germany). We enrolled 43 hemodialysis patients (17 females; age 65.0 ± 12.7 years) and 23 controls (six females; age 62.1 ± 15.7 years). Between the two groups, there was no difference in telomere length (6.95 ± 3.25 vs. 7.31 ± 1.96 kb; P = 0.244) or in telomerase activity (1.82 ± 2.91 vs. 2.71 ± 3.0; P = 0.085). Telomere length correlated inversely with vintage of hemodialysis (r = -0.332, P = 0.030). In hemodialysis patients, positive telomerase activity correlated with telomere length (r = 0.443, P = 0.030). Only age, and neither telomere length nor telomerase activity, was an independent survival predictor (hazard ratio 1.116, 95% confidence interval 1.009-1.234, P = 0.033). In this study, telomere length and telomerase activity in PBMCs are not altered in hemodialysis patients compared with healthy controls. Long duration of hemodialysis treatment is associated with telomere shortening and positive telomerase activity with an increased telomere length in PBMCs of hemodialysis patients. The underlying mechanism and clinical implications of our findings require further investigation.

  5. Effects of Diabetes Mellitus, Age, and Duration of Dialysis on Parathormone in Chronic Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Nasri Hamid

    2008-01-01

    Full Text Available Secondary hyperparathyroidism (SHPTH can develop early in the course of chronic renal failure and becomes more prominent as kidney function declines. We studied the effect of diabetes, age, and dialysis on parathyroid function in 60 (21 women, 39 males; 44 non-diabetic, 16 diabetic hemodialysis (HD patients. Serum intact PTH (iPTH, calcium, phosphorus, alkaline phosphatase (ALP, and magnesium (Mg were measured. Adequacy of HD was evaluated by calculating the urea reduction rate (URR. There were significantly lower values of serum iPTH, ALP, and dialysis adequacy among diabetic than non-diabetes HD patients. In addition, there were an inverse correlation of age and serum iPTH (r= -0.27, p= 0.034 as well as age and serum phosphorus (r= -0.28, p= 0.031. There was also a positive correlation between serum iPTH with the duration (r= 0.001, p=0.42 and doses of dialysis treatment (r= 0.38, p= 0.002. We conclude that a significant negative correlation between age and serum phosphorus and lower parathyroid activity in diabetic HD patients, which implies more prevalence of bone disease in elderly diabetic HD patients. Further study of bone disease in this group of patients is required to evaluate its effect on outcome and different therapeutic interventions.

  6. Whole body protein metabolism in chronic hemodialysis

    NARCIS (Netherlands)

    Veeneman, Jorden Marcus

    2004-01-01

    To summarise, evidence suggests that protein-energy malnutrition is associated with mor-bidity and mortality in chronic hemodialysis patients. Urea kinetics are used as a clinical marker for protein intake and oxidation. Chapter 2 focuses on the relation between pro-tein and urea metabolism, which i

  7. The clinical factors′ prediction of increased intradialytic qt dispersion on the electrocardiograms of chronic hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Dina Oktavia

    2013-01-01

    Full Text Available Ventricular arrhythmias and sudden death are common in patients on maintenance hemodialysis (HD. The increase in QT dispersion (QTd on the electrocardiogram (ECG reflects increased tendency for ventricular repolarization that predisposes to arrhythmias. The purpose of the study was to identify the clinical factors that may predict the increased intradialytic QTd and to assess differences in QTd before and after HD. Each of 61 chronic HD patients underwent 12-lead ECG and blood pressure (BP measurement before and every 1 h during a single HD session. The QT intervals were corrected for heart rate using Bazett′s formula. Intradialytic QTd increased in 30 (49% patients. There was no correlation between the increased QTd and the clinical factors including hypertension, pulse pressure, intradialytic hypotension, left ventricular hypertrophy, old myocardial infarct, diabetes mellitus, and nutritional status. The means of QT interval and QTd increased after HD session (from 382 ± 29 to 444 ± 26 ms, P <0.05; and from 74 ± 21 to 114 ± 53 ms, respectively, P <0.05. We conclude that the increased intradialytic QTd could not be predicted by any of the clinical factors evaluated in this study. There was significant difference in the means of QTd before and after HD session.

  8. Sevelamer carbonate in the treatment of hyperphosphatemia in patients with chronic kidney disease on hemodialysis.

    Science.gov (United States)

    Savica, Vincenzo; Santoro, Domenico; Monardo, Paolo; Mallamace, Agostino; Bellinghieri, Guido

    2008-08-01

    Sevelamer carbonate is an anion exchange pharmaceutical, developed to improve on the performance of the non-absorbable, non-calcium, and metal-free phosphate binder sevelamer hydrochloride. Sevelamer carbonate is expected not to worsen metabolic acidosis, as previously reported during long-term treatment with sevelamer hydrochloride in hemodialysis (HD) patients. Carbonate is the alternate counterion to chloride on the sevelamer polymeric backbone, but the active poly(allylamine) responsible for phosphate (PO₄) binding remains unaltered. Therefore, sevelamer carbonate is expected to reduce elevated serum phosphorus level, similarly to sevelamer hydrochloride. Sevelamers are prescribed in uremic HD patients to control hyperphosphatemia, but the carbonate has also been proposed for the treatment of chronic kidney disease (CKD) non-dialysis patients. Although hyperphosphatemia is regarded as a main contributor to increased mortality in the HD population because of cardiovascular calcification, metabolic acidosis has also been advocated as a major player in the increased mortality in this population, by engendering malnutrition, negative nitrogen balance, and inflammation. This paper reviews the evidence showing that sevelamer carbonate is as good as sevelamer hydrochloride in terms of hyperphosphatemia control in CKD, but with a better outcome in serum bicarbonate balance.

  9. Extreme hyperglycemia with ketoacidosis and hyperkalemia in a patient on chronic hemodialysis.

    Science.gov (United States)

    Gupta, Arvin; Rohrscheib, Mark; Tzamaloukas, Antonios H

    2008-10-01

    A patient on hemodialysis for end-stage renal disease secondary to diabetic nephropathy was admitted in a coma with Kussmaul breathing and hypertension (232/124 mmHg). She had extreme hyperglycemia (1884 mg/dL), acidosis (total CO(2) 4 mmol/L), hyperkalemia (7.2 mmol/L) with electrocardiographic abnormalities, and hypertonicity (330.7 mOsm/kg). Initial treatment with insulin drip resulted in a decrease in serum potassium to 5.3 mmol/L, but no significant change in mental status or other laboratory parameters. Hemodialysis of 1.75 hours resulted in rapid decline in serum glucose and tonicity and rapid improvement of the acidosis, but no change in mental status, which began to improve slowly after the hemodialysis was stopped, but with ongoing treatment with continuous insulin infusion. The rate of decline in tonicity during hemodialysis (14.5 mOsm/kg/h) was high, raising concerns about neurological complications. In this case, extreme hyperglycemia with ketoacidosis, hyperkalemia, and coma developing in a hemodialysis patient responded to insulin infusion. Monitoring of the clinical status and the pertinent laboratory values is required to assess the need for other therapeutic measures including volume and potassium replacement and emergency dialysis. The indications for and risks of emergency dialysis in this setting are not clearly defined.

  10. Occult hepatitis B among patients with chronic renal failure on hemodialysis from a capital city in northeast Brazil.

    Science.gov (United States)

    Fontenele, Andrea Martins Melo; Gainer, Juliana Braga Furtado; da Silva E Silva, Daniel Viana; Cruz Santos, Max Diego; Salgado, João Victor; Salgado Filho, Natalino; Ferreira, Adalgisa Sousa Paiva

    2015-07-01

    Occult hepatitis B (OHB) is characterized by the presence of HBV-DNA in the absence of HBsAg in the serum of patients. Hemodialysis patients are at high risk for hepatitis B virus and there are few data on the prevalence of OHB in this population, mainly in Brazil. Thus, the aim of this study was to determine the prevalence of OHB in patients undergoing hemodialysis. A cross-sectional study was performed, including 301 patients on chronic hemodialysis at two dialysis centers in São Luís (Maranhão), northeast Brazil. Serological tests were performed for HBsAg, anti-HBc, anti-HBs, and anti-HCV using enzyme immunoassays (ELISA); HBV-DNA and HCV-RNA were studied by real-time PCR. The mean age was 49 ± 15 years, and 128 (42%) were female. Serological tests confirmed that all samples were HBsAg negative. Anti-HBc was positive in 114 (38%) patients, anti-HBc and anti-HBs were simultaneously positive in 104 (35%), and anti-HBc alone was positive in 10 (3%). Tests were negative for anti-HBc and anti-HBs in 55 patients (18%). Anti-HBs was the only positive marker in 132 (44%) patients. Anti-HCV was positive in 15 (5%) patients with HCV-RNA present in 14 of them (93%). HBV-DNA was positive in seven cases (2.3%). There was no association of HBV-DNA with age, gender, time on dialysis, previous kidney transplant, or HBV serological pattern, but there was a positive correlation with the presence of anti-HCV (P < 0.001). OHB in chronic renal failure patients on hemodialysis appears to be a relevant finding, suggesting that studying HBV-DNA in this population using sensitive molecular tests should be a recommended course of action, especially in candidates for renal transplant.

  11. Cutaneous Manifestations in Patients with Chronic Kidney Disease on Maintenance Hemodialysis

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    Kolla, Praveen Kumar; Desai, Madhav; Pathapati, Ram Mohan; Mastan Valli, B.; Pentyala, Suneetha; Madhusudhan Reddy, G.; Vijaya Mohan Rao, A.

    2012-01-01

    Cutaneous disorders can precede or follow the initiation of hemodialysis treatment. We evaluated the prevalence of various dermatological manifestations in patients undergoing hemodialysis at least twice a week for minimum of three months at our center. Patients were excluded if they were undergoing hemodialysis less than twice a week or on hemodialysis secondary to ESRD following graft dysfunction. One hundred and forty-three patients were evaluated. Among them, there were 113 male and 30 females. Among the skin changes, pruritus accounted for 56%, Xerosis was observed in 52%, Diffuse blackish hyper pigmentation was seen in 40%. Skin infections was seen in 53% of patients, of these fungal, bacterial and viral infections were 27.2%, 14.6%, and 11.2%, respectively. Kyrle's disease was observed only in 6.9%. Other skin manifestations include eczema 4.8%, psoriasis 2.7%, and drug rash 2.1%. Nail changes were observed in 46 patients of whom 27 patients had onychomycosis. Other changes include discoloration, onycholysis, and splinter hemorrhages. Hair changes were observed in 21.7%. Mucosal changes were seen in 27.3%. In our study, pruritus, xerosis, and pigmentation were higher among skin changes. Recognition and management of some of these dermatological manifestations vastly reduce the morbidity and improve the quality of life. PMID:22830039

  12. The role of oral L-Carnitine therapy in chronic hemodialysis patients

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    Sabry Alaa

    2010-01-01

    Full Text Available To evaluate the effects of L-carnitine oral supplementation on anemia and cardiac function in patients on maintenance hemodialysis (HD, we studied 55 adult chronic HD patients at our center during the period from January 2006 to June 2006 and divided them into two groups; a group of 20 patients who received 1,500 mg/day oral L-carnitine and a control group of 35 patients. Both groups were on erythropoietin therapy. Echogardiographic studies were performed before and at the end of the study. The mean hemoglobin levels were comparable in the L--carnitine group and the control group at the start and after 6 months of therapy (8.63 ± 1.77 and 9.39 ± 2.02 gm/dL, P= 0.18; 10.49 ± 1.65 and 10.92 ± 2.48 gm/dL, P= 0.76, respectively. The mean weekly maintenance dose of erythropoietin was not statistically significantly different in L-carnitine group (80.16 ± 35.61 units/kg and the control group (91.9 ± 38.21 units/kg, P= 0.20. In addition no significant improvement could be observed in the echogardiographic findings in the L-carnitine group after therapy. We conclude that our study revealed no significant improvement in hemoglobin, erythropoietin dose and echocardiographic findings after six months of therapy. Long-term studies including larger number of patients are required to clarify the questionable role of L-carnitine in the HD patients.

  13. Longitudinal associations of depressive symptoms and pain with quality of life in patients receiving chronic hemodialysis.

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    Belayev, Linda Y; Mor, Maria K; Sevick, Mary Ann; Shields, Anne Marie; Rollman, Bruce L; Palevsky, Paul M; Arnold, Robert M; Fine, Michael J; Weisbord, Steven D

    2015-04-01

    Depressive symptoms and pain are common in patients on chronic hemodialysis (HD), yet their associations with quality of life (QOL) are not fully understood. We sought to characterize the longitudinal associations of these symptoms with QOL. As part of a trial comparing two symptom management strategies in patients receiving chronic HD, we assessed depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9), and pain using the Short Form McGill Pain Questionnaire (SF-MPQ) monthly over 24 months. We assessed health-related QOL (HR-QOL) quarterly using the Short Form 12 (SF-12) and global QOL (G-QOL) using a single-item survey. We used random effects linear regression to analyze the independent associations of depressive symptoms and pain, scaled based on 5-point increments in symptom scores, with HR-QOL and G-QOL. Overall, 286 patients completed 1417 PHQ-9 and SF-MPQ symptom assessments, 1361 SF-12 assessments, and 1416 G-QOL assessments. Depressive symptoms were independently and inversely associated with SF-12 physical HR-QOL scores (β = -1.09; 95% confidence interval [CI]: -1.69, -0.50, P < 0.001); SF-12 mental HR-QOL scores (β = -4.52; 95% CI: -5.15, -3.89, P < 0.001); and G-QOL scores (β = -0.64; 95%CI: -0.79, -0.49, P < 0.001). Pain was independently and inversely associated with SF-12 physical HR-QOL scores (β = -0.99; 95% CI: -1.30, -0.68, P < 0.001) and G-QOL scores (β = -0.12; 95%CI: -0.20, -0.05, P = 0.002); but not with SF-12 mental HR-QOL scores (β = -0.16; 95%CI: -0.050, 0.17, P = 0.34). In patients receiving chronic HD, depressive symptoms and to a lesser extent pain, are independently associated with reduced HR-QOL and G-QOL. Interventions to alleviate these symptoms could potentially improve patients' HR-QOL and G-QOL.

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

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

    2007-08-15

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

  15. Evaluation of Anti-Toxoplasma gondii Antibodies in Hemodialysis Patients with Chronic Kidney Disease in Sari, Iran

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    Seyyedpour, Seyyed Hosein; Afshar, Parvaneh; Barzegarnejad, Ayoub; Kalhori, Shamsi; Agah, Reza

    2016-01-01

    Background Toxoplasma gondii has worldwide distribution and is one of the most prevalent infectious agents in humans. Objectives The aim of this study was to determine the prevalence of anti-Toxoplasma gondii antibodies in hemodialysis patients with chronic kidney disease (CKD) in the hemodialysis unit of Fatemeh Zahra hospital at the Mazandaran University of Medical Sciences in Sari, Iran. Methods Seventy-three patients with CKD and 145 healthy volunteers were assessed for anti-Toxoplasma gondii (IgG, IgM, and IgA) antibodies using a conventional ELISA technique. Results The anti-Toxoplasma gondii IgG antibody was detected in 80.8% of the cases in the patient group, while 31.5% of the cases in the CKD patient group and 31.8% in the control group were found to be positive for the anti-Toxoplasma gondii IgA antibody. All the patients in the CKD group were negative for the anti-Toxoplasma gondii IgM antibody, although 2.76% of the healthy volunteers were found to be positive. The present study suggests that there was no significant difference between the hemodialysis patient group and the healthy volunteers. Conclusions The epidemiological data collected in this study could serve as a reference for future studies and may be useful in developing preventive and educational strategies, and consequently reducing healthcare expenditure. PMID:27896240

  16. Prevalence, severity, and importance of physical and emotional symptoms in chronic hemodialysis patients.

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    Weisbord, Steven D; Fried, Linda F; Arnold, Robert M; Fine, Michael J; Levenson, David J; Peterson, Rolf A; Switzer, Galen E

    2005-08-01

    The prevalence, severity, and clinical significance of physical and emotional symptoms in patients who are on maintenance hemodialysis remain incompletely characterized. This study sought to assess symptoms and their relationship to quality of life and depression. The recently developed Dialysis Symptom Index was used to assess the presence and the severity of 30 symptoms. The Illness Effects Questionnaire and Beck Depression Inventory were used to evaluate quality of life and depression, respectively. Correlations among symptom burden, symptom severity, quality of life, and depression were assessed using Spearman correlation coefficient. A total of 162 patients from three dialysis units were enrolled. Mean age was 62 y, 48% were black, 62% were men, and 48% had diabetes. The median number of symptoms was 9.0 (interquartile range 6 to 13). Dry skin, fatigue, itching, and bone/joint pain each were reported by > or =50% of patients. Seven additional symptoms were reported by >33% of patients. Sixteen individual symptoms were described as being more than "somewhat bothersome." Overall symptom burden and severity each were correlated directly with impaired quality of life and depression. In multivariable analyses adjusting for demographic and clinical variables including depression, associations between symptoms and quality of life remained robust. Physical and emotional symptoms are prevalent, can be severe, and are correlated directly with impaired quality of life and depression in maintenance hemodialysis patients. Incorporating a standard assessment of symptoms into the care provided to maintenance hemodialysis patients may provide a means to improve quality of life in this patient population.

  17. Drug disposition model of radiolabeled etelcalcetide in patients with chronic kidney disease and secondary hyperparathyroidism on hemodialysis.

    Science.gov (United States)

    Wu, Liviawati; Melhem, Murad; Subramanian, Raju; Wu, Benjamin

    2017-02-01

    Etelcalcetide (AMG 416) is an allosteric activator of the calcium-sensing receptor for treatment of secondary hyperparathyroidism in patients with chronic kidney disease (CKD) on hemodialysis. To characterize the time course of etelcalcetide in different matrices (plasma, dialysate, urine, and feces), a drug disposition model was developed. Nonlinear mixed-effect modeling was used to describe data from six adults with CKD on hemodialysis who received a single intravenous dose of [(14)C]etelcalcetide (10 mg; 710 nCi) after hemodialysis (study NCT02054572). A three-compartment model with the following attributes adequately described the observed concentration-time profiles of etelcalcetide in the different matrices: biotransformation in the central compartment; elimination in dialysate, urine, and feces; and a nonspecific elimination process. The terminal half-life of total C-14 in plasma was approximately 56 days. The ratio of conjugation-deconjugation rate constants between etelcalcetide and biotransformed products was 11.3. Simulations showed that three hemodialysis sessions per week for 52 weeks would contribute to 60.1% of the total clearance of etelcalcetide following single-dose intravenous etelcalcetide administration. Minimal amounts were eliminated in urine (2.5%) and feces (5.7%), whereas nonspecific elimination accounted for 31.2% of total elimination. In addition to removal of etelcalcetide, ~10% of small-molecular weight biotransformed products was estimated to have been removed through hemodialysis and in urine. This model provided a quantitative approach to describe biotransformation, distribution, and elimination of etelcalcetide, a unique synthetic D-amino acid peptide, in the relevant patient population.

  18. Development of a symptom assessment instrument for chronic hemodialysis patients: the Dialysis Symptom Index.

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    Weisbord, Steven D; Fried, Linda F; Arnold, Robert M; Rotondi, Armando J; Fine, Michael J; Levenson, David J; Switzer, Galen E

    2004-03-01

    Little is known about the prevalence, severity, or impact of symptoms in hemodialysis patients because of the lack of a validated symptom assessment instrument. We systematically developed an index to assess physical and emotional symptom burden in this patient population. We employed four steps in the generation of this index: a review of dialysis quality-of-life instruments, three focus groups, experts' content validity assessment, and test-retest reliability measurement. Seventy-five symptoms were identified. Of these, 46 appeared in > or = 4 of the instruments/focus groups and were considered for inclusion. Twelve were grouped into other symptom constructs and experts judged four of the remaining items not to be pertinent, leaving 30 items in the new index. Overall kappa statistic was 0.48+/-0.22. These steps allowed the systematic development of a 30-item symptom assessment index for hemodialysis patients. Additional reliability and validity testing is needed prior to its widespread use.

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

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    Mehrdad Sheikhvatan

    2010-05-01

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

  20. Life Quality of Hemodialysis Patients

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    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.

  1. Are PTH levels related to oxidative stress and inflammation in chronic kidney disease patients on hemodialysis?

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    Marcel Jaqueto

    Full Text Available Abstract Introduction: Patients at end stage renal disease have higher levels of inflammation and oxidative stress than the general population. Many factors contribute to these issues, and the parathyroid hormone (PTH is also implicated. Objective: The study was conducted in order to assess the relationship between PTH levels and inflammation and oxidative stress in hemodialysis patients. Methods: Cross-sectional study with patients of two hemodialysis facilities in Londrina, Brazil. Patients with other conditions known to generate oxidative stress and inflammation were excluded. Blood levels of PTH and biochemical parameters of inflammation (interleukins 1 and 6, tumor necrosis factor-alpha and oxidative stress (total plasma antioxidant capacity, malonic dialdehyde, lipid hydroperoxidation, advanced oxidation protein products, quantification of nitric oxide metabolites, and 8-isoprostane were measured before a dialysis session. Then, we made correlation analyses between PTH levels - either as the continuous variable or categorized into tertiles-, and inflammatory and oxidative stress biomarkers. Results: PTH did not show any correlation with the tested inflammation and oxidative stress parameters, nor as continuous variable neither as categorical variable. Conclusion: In this descriptive study, the results suggest that the inflammation and oxidative stress of hemodialysis patients probably arise from mechanisms other than secondary hyperparathyroidism.

  2. Methodology of a randomized clinical trial of symptom management strategies in patients receiving chronic hemodialysis: the SMILE study.

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    Weisbord, Steven D; Shields, Anne Marie; Mor, Maria K; Sevick, Mary Ann; Homer, Marcia; Peternel, Janet; Porter, Patricia; Rollman, Bruce L; Palevsky, Paul M; Arnold, Robert M; Fine, Michael J

    2010-09-01

    Despite the high prevalence of pain, sexual dysfunction, and depression in patients on chronic hemodialysis, these symptoms are often unrecognized and under-treated by renal providers. This report describes the rationale and methodology of the SMILE study (Symptom Management Involving End-Stage Renal Disease), a multi-center, randomized clinical trial comparing the effectiveness of two strategies for implementing treatment for these symptoms in patients receiving chronic hemodialysis. Approximately 250 patients from nine outpatient dialysis units will participate. Over a 2-12 month observational phase, participants complete monthly surveys characterizing their pain, sexual dysfunction, and depression. Following this observational period, subjects are randomized to one of two study arms to receive a 12-month intervention. In one study arm (feedback intervention), patients continue to complete the same three symptom surveys, and the presence and severity of the symptoms reported on these surveys is mailed to the patient's renal provider along with evidence-based algorithms outlining treatment options for these symptoms. Decisions on treatment are left at the discretion of the provider. Patients randomized to the other study arm (management intervention) also continue to complete the same monthly symptom surveys and are evaluated by a symptom management nurse trained in the management of these symptoms. This nurse then discusses the patient's symptoms with the renal provider, provides specific recommendations for treatment, and facilitates the implementation of treatment. The primary endpoints are changes in scores on pain, erectile dysfunction, and depression surveys. This report describes the rationale and methodology of this clinical trial.

  3. Severe pulmonary hypertension in a young patient with end-stage renal disease on chronic hemodialysis

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    Sharma Satyavan

    2010-01-01

    Full Text Available Severe pulmonary hypertension in a teenager with end-stage renal disease on chronic hemodialysis via arteriovenous access is reported. Clinical presentation included persistent volume overload and pericardial effusion. Serial hemodynamic data obtained at cardiac catheterization confirmed the diagnosis. In addition, detailed biochemical and imaging data (echo- Doppler, computed tomography of chest, computed tomographic pulmonary angiography, VQ lung scan, etc. were obtained to find out the mechanism. The exact cause of pulmonary hypertension remains unclear, and a multi- factorial mechanism is postulated. This rare case is presented to highlight the role of aggressive dialysis, pericardiocentesis, and use of sildenafil and bosentan in the management.

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

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    El-Nakib GA

    2013-08-01

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

  5. Long-term L-Carnitine Administration reduces Erythropoietin Resistance in Chronic Hemodialysis Patients with Thalassemia Minor

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    Biagio R. Di Iorio

    2007-01-01

    Full Text Available Background and Aim: Both thalassemia and carnitine deficiency represent independent causes of erythropoietin resistance, and thus anemia, in uremic patients. We evaluated the unknown long-term effects of L-carnitine administration in β-thalassemic on chronic hemodialysis.Methods: We studied twelve subjects (M = 8; F = 4 affected by β-thalassemia minor (β-thal; HbA2 level = 6.6 ± 0.6% and forty non-thalassemic subjects (M = 24; F = 16 as controls (C, on chronic hemodialysis treatment. Patients and controls were at target hemoglobin levels (11–12g/dl prior to the study and underwent to i.v. L-carnitine administration for a one year period-time.Results: Groups were comparable for age, gender, serum levels of hemoglobin (Hb, iron, ferritine, PTH and aluminum, transferrin saturation, and dialysis modalities. During the study both groups showed signifi cant Hb increase and erythropoietin (EPO decrease; as a difference, such changes emerged at the 3rd month in C but at the 8th month in β-thal. At start, during the dialysis session the erythrocyte MCV reduced in C but not in β-thal (65.3 ± 3.2 to 65.5 ± 3.2 fl ; NS; along carnitine administration period, however, MCV during dialysis decreased also in β-thal, starting since the 9th month of treatment.Conclusion: This study provides evidence of the lowering of EPO resistance in β-thalassemia patients on hemodialysis due to long-term carnitine administration. Thus, prolonged carnitine supplementation should be suggested to patients on dialysis affected by β-thalassemia with poorly responsive anemia, or requiring large doses of erythropoietin.

  6. The Effects of Oral L-Carnitine Supplementation on Physical Capacity and Lipid Metabolism in Chronic Hemodialysis Patients

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    Yasuo Kudoh

    2014-03-01

    Full Text Available Background: It is well known that the physical activity in chronic hemodialysis patients decreases compared to that in normal subjects. In order to investigate the effects of L-carnitine on physical capacity and lipid metabolism, a cardiopulmonary exercise test using a bicycle ergometer was performed before and after 3 months of oral L-carnitine supplementation under double-blind conditions. Methods and Results: A total of 20 stable outpatients undergoing hemodialysis treatment were randomly divided into 2 groups: controls receiving placebo and patients receiving 900 mg L-carnitine p.o. daily. The levels of free and acyl carnitine increased significantly from 22.9 ± 7.3 to 149.9 ± 51.8 μmol/l and from 16.0 ± 2.8 to 100.3 ± 50.2 μmol/l, respectively, in the L-carnitine group; however, there was no significant change in other plasma lipid profiles. The exercise time was decreased and the heart rate at the anaerobic threshold was increased in the control group 3 months after the study period, but there were no such changes observed in the L-carnitine group. The minute ventilation/CO2 output slope increased significantly from 38.9 ± 7.8 to 43.8 ± 11.8 in the L-carnitine group. It has been speculated that a shift in the energy source occurs from carbohydrate to lipid, in terms of an increase of oxygen demand. Conclusion:L-Carnitine supplementation might have some beneficial effects on the physical capacity of chronic hemodialysis patients due to the improvement of the lipid metabolism in the muscle.

  7. Water and sodium restriction on cardiovascular disease in young chronic hemodialysis patients

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    LIANG Xue; WANG Wei; LI Han

    2013-01-01

    Background Left ventricular hypertrophy (LVH) is an independent predictor of morbidity and mortality in chronic hemodialysis (CHD) patients.It remains unclear whether efforts to correct fluid overload in young CHD can reverse LVH.This prospective single-center cohort study evaluated left ventricular masses index (LVMI) evolution in fluid overloaded young CHD patients with or without water-sodium control.Methods A total of t06 young patients aged between 22 and 44 years on CHD were enrolled in this prospective,control study.Patients were divided into three groups according to the percentage of interdialytic weight gain (PIDWG (%) =100% × (predialysis weight-dry weight)/dry weight) at baseline.Thirty-six patients with PIDWG more than 5% received health education to restrict water-sodium intake strictly (Group I).Other 36 patients with comparable fluid status levels (the PIDWG more than 5%) did not receive health education to restrict water-sodium intake strictly (Group Ⅱ) and those with PIDWG less than 5% (Group Ⅲ,n=34) were served as controls.Echocardiographic studies were performed to evaluate LVMI at baseline and then after 1,3 and 6 months.The total follow-up time was 6 months.Results There was no significant difference in clinical data (such as age,gender,aetiology of renal failure and nutritional state,etc.) among the three groups at baseline.At baseline,the prevalence of LVH in Group Ⅰ,Ⅱ and Ⅲ was 75.0%,72.2% and 55.9%,respectively.LVMI was directly correlated with PIDWG (r =0.779,P <0.01).After 6 months,the PIDWG in Group I decreased in mean by (3.77±1.09)%,and LVMI decreased in mean by (27.59±12.15) g/m2.The prevalence of LVH decreased in mean by 25.0%,and the blood pressure decreased in mean by (14.69±11.50) mmHg/(7.14±7.51) mmHg.The medication category and total medication frequency of hypotensive drugs significantly decreased in Group I at 6 months.However the urine volume and the levels of serum creatinine and serum

  8. Hematological profile of chronic kidney disease (CKD patients in Iran, in pre-dialysis stages and after initiation of hemodialysis

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    Afshar Reza

    2010-01-01

    Full Text Available Anemia is a common sequealae of chronic kidney disease (CKD, associated with significant morbidity. A cross-sectional study was conducted on 100 CKD patients (54 hemodia-lyzed, 46 pre-dialyzed. Data including, complete blood count, BUN, creatinine, creatinine clea-rance, underlying diseases and hemodialysis duration were collected by a questionnaire. The most frequent morphologic features were normochromic-normocytic (80%, hypochromic-microcytic (15% and macrocytic (5%. The frequency of anemia in hemodialyzed and pre-dialyzed patients (with mean Hgb level of 10.27 and 11.11 g/dL were 85% and 75%. Hemoglobin concentration was positively correlated to calculated creatinine clearance (P < 0.001. The severity of anemia among hemodialyzed patients was mild (Hgb > 10 g/dL in 5%, moderate in 70% and severe (Hgb < 7 g/dL in 25%, while in pre-dialyzed was mild in 45% and moderate in 55%. There was no correlation between the anemia and CKD causes or hemodialysis duration. In conclusion, data shows that anemia in our patients with CKD is a predominant manifestation, with high frequency but of moderate degree. The most likely cause is inadequate erythropoietin production.

  9. A comparison of sleep disturbances and sleep apnea in patients on hemodialysis and chronic peritoneal dialysis

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    Hamdan Al-Jahdali

    2011-01-01

    Full Text Available Studies have shown that sleep disorders are common among dialysis patients; however, few studies have compared the prevalence of different sleep disorders in patients on peritoneal dialysis (PD and hemodialysis (HD. We used questionnaires to assess the prevalence of common sleep disorders in dialysis patients. We compared the prevalence of sleep apnea (SA risk, restless legs syndrome (RLS, insomnia, and excessive daytime sleepiness (EDS, as well as sleep quality, in both groups. Of the 227 patients who were enrolled in the study, the total number of patients on HD was 188 (82%, while the total number of patients on PD was 39 (18%. There were no significant differences between the two groups regarding age, neck size, or duration on dialysis (all P >0.05. The estimated overall prevalence of SA was significantly higher in PD patients in comparison with HD patients (92% and 67%, respectively; P <0.05. The prevalence of insomnia was similar in both groups. The prevalence of RLS was significantly greater in PD than in HD patients (69% and 46%, respectively; P <0.05. In addition, EDS was significantly higher in PD than in HD patients (77% and 37%, respectively; P <0.05. Our study shows that sleep disorders are common in dialysis patients; however, SA, EDS, and RLS were more common in PD patients than in HD pa-tients. Poor sleep quality and insomnia were comparable in both groups.

  10. Randomized crossover study comparing the phosphate-binding efficacy of calcium ketoglutarate versus calcium carbonate in patients on chronic hemodialysis.

    Science.gov (United States)

    Bro, S; Rasmussen, R A; Handberg, J; Olgaard, K; Feldt-Rasmussen, B

    1998-02-01

    The objective of the study was to evaluate the phosphate-binding efficacy, side effects, and cost of therapy of calcium ketoglutarate granulate as compared with calcium carbonate tablets in patients on chronic hemodialysis. The study design used was a randomized, crossover open trial, and the main outcome measurements were plasma ionized calcium levels, plasma phosphate levels, plasma intact parathyroid hormone (PTH) levels, requirements for supplemental aluminum-aminoacetate therapy, patient tolerance, and cost of therapy. Nineteen patients on chronic hemodialysis were treated with a dialysate calcium concentration of 1.25 mmol/L and a fixed alfacalcidol dose for at least 2 months. All had previously tolerated therapy with calcium carbonate. Of the 19 patients included, 10 completed both treatment arms. After 12 weeks of therapy, the mean (+/-SEM) plasma ionized calcium level was significantly lower in the ketoglutarate arm compared with the calcium carbonate arm (4.8+/-0.1 mg/dL v 5.2+/-0.1 mg/dL; P = 0.004), whereas the mean plasma phosphate (4.5+/-0.3 mg/dL v 5.1+/-0.1 mg/dL) and PTH levels (266+/-125 pg/mL v 301+/-148 pg/mL) did not differ significantly between the two treatment arms. Supplemental aluminum-aminoacetate was not required during calcium ketoglutarate treatment, while two patients needed this supplement when treated with calcium carbonate. Five of 17 (29%) patients were withdrawn from calcium ketoglutarate therapy within 1 to 2 weeks due to intolerance (anorexia, vomiting, diarrhea, general uneasiness), whereas the remaining 12 patients did not experience any side effects at all. The five patients with calcium ketoglutarate intolerance all had pre-existing gastrointestinal symptoms; four of them had received treatment with cimetidine or omeprazol before inclusion into the study. Calculations based on median doses after 12 weeks showed that the cost of the therapy in Denmark was 10 times higher for calcium ketoglutarate compared with calcium

  11. Quality of life/spirituality, religion and personal beliefs of adult and elderly chronic kidney patients under hemodialysis

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    Suzana Gabriela Rusa

    2014-12-01

    Full Text Available OBJECTIVE: to assess the quality of life of chronic kidney patients undergoing hemodialysis, using the WHOQOL-bref and WHOQOL-SRPB.METHOD: a descriptive and cross-sectional study was undertaken at a kidney replacement therapy service in the interior of the state of SP. The 110subjects who complied with the inclusion criteria answered the Subject Characterization Instrument, the WHOQOL-bref and WHOQOL-SRPB.RESULTS: most of the respondents were male (67.27%, with a mean age of 55.65 years, Catholic (55.45%, with unfinished primary education (33.64% and without formal occupation (79.08%. The WHOQOL-bref domains with the highest and lowest mean score were, respectively, "psychological" (µ=74.20 and "physical" (µ=61.14. The WHOQOL-SRPB domains with the highest and lowest mean score were, respectively, "completeness and integration" (µ=4.00 and "faith" (µ=4.40.CONCLUSIONS: the respondents showed high quality of life scores, specifically in the dimensions related to spirituality, religion and personal beliefs. Losses were evidenced in the physical domain of quality of life, possibly due to the changes resulting from the chronic kidney disease and hemodialysis treatment.

  12. Prevalence and severity of pain in adult end-stage renal disease patients on chronic intermittent hemodialysis: a systematic review

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    Brkovic T

    2016-06-01

    Full Text Available Tonci Brkovic,1 Eliana Burilovic,2 Livia Puljak3 1Department of Internal Medicine, Division of Nephrology, 2Department of Psychiatry, University Hospital Split, 3Department of Anatomy, Histology and Embryology, Laboratory for Pain Research, University of Split School of Medicine, Split, Croatia Objectives: Understanding the epidemiology of pain in patients on hemodialysis (HD is crucial for further improvement in managing pain. The aim of this study was to systematically review available evidence on the prevalence and severity of pain in adult end-stage renal disease patients on chronic intermittent HD. Materials and methods: We carried out a systematic review of the literature and developed a comprehensive search strategy based on search terms on pain and HD. We searched the databases MEDLINE, Scopus, PsycINFO, and CINAHL from the earliest date of each database to July 24, 2014. Manuscripts in all languages were taken into consideration. Two authors performed each step independently, and all disagreements were resolved after discussion with the third author. The quality of studies was estimated using the STROBE checklist and Cochrane risk-of-bias tool.Results: We included 52 studies with 6,917 participants. The prevalence of acute and chronic pain in HD patients was up to 82% and 92%, respectively. A considerable number of patients suffered from severe pain. Various locations and causes of pain were described, with most of the studies reporting pain in general, pain related to arteriovenous access, headache, and musculoskeletal pain.Conclusion: The findings of this systematic review indicate high prevalence of pain in HD patients and considerable gaps and limitations in the available evidence. Pain in this population should be recognized as a considerable health concern, and the nephrology community should promote pain management in HD patients as a clinical and research priority to improve patients’ quality of life and pain

  13. Aerobic Exercise Improves Signs of Restless Leg Syndrome in End Stage Renal Disease Patients Suffering Chronic Hemodialysis

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    Mojgan Mortazavi

    2013-01-01

    Full Text Available Background. Restless leg syndrome (RLS is one of the prevalent complaints of patients with end stage renal diseases suffering chronic hemodialysis. Although there are some known pharmacological managements for this syndrome, the adverse effect of drugs causes a limitation for using them. In this randomized clinical trial we aimed to find a nonpharmacological way to improve signs of restless leg syndrome and patients’ quality of life. Material and Methods. Twenty-six patients were included in the study and divided into 2 groups of control and exercise. The exercise group used aerobic exercise during their hemodialysis for 16 weeks. The quality of life and severity of restless leg syndrome were assessed at the first week of study and final week. Data were analyzed using SPSS software. Results. The difference of means of RLS signs at the first week of study and final week was in exercise group and in control group. There was not any statistical difference between control group and exercise group in quality of life at the first week of study and final week. Conclusions. We suggest using aerobic exercise for improving signs of restless leg syndrome, but no evidence was found for its efficacy on patient’s quality of life.

  14. Radiation safety protocol for high dose 131I therapy of thyroid carcinoma in patients on hemodialysis for chronic renal failure.

    Science.gov (United States)

    Modarresifar, Homayoun; Almodovar, Samuel; Bass, William B; Ojha, Buddhiwardhan

    2007-02-01

    Iodine ablation therapy for thyroid cancer on patients receiving dialysis poses unique radiation safety challenges. Exposure to gamma and beta negative particles by the hemodialysis (HD) staff is a concern that has not been well studied. A 53-y-old male patient on HD for chronic renal failure was scheduled for 131I high dose therapy as treatment for thyroid papillary carcinoma. The patient was on HD every other day, prior to ablation. A high dose of 131I (3,607.5 MBq) was required. The patient was admitted for 131I therapy, and continued HD. Thyroid cancer ablation therapy was administered according to our institutional protocol. New radiation safety measures were developed and implemented in order to give the patient an optimal treatment dose, reduce radiation to the patient (critical organs and whole body), and to protect the HD personnel. This included placing two lead shields between the patient and the HD nurse, and HD monitoring by two alternating nurses to reduce their radiation exposure. Film badges were used to measure radiation exposure to the nursing staff. Dosimetry calculations were obtained to determine radiation absorbed doses by the optic lens, skin, and whole body. Quality control verification for this shielding arrangement proved to be effective in protecting the HD staff against gamma and beta negative radiation from recent 131I high dose therapy. Implementation of this model proved to be an effective and adequate radiation safety protocol for limiting radiation exposure to the HD staff. The patient was given 3607.5 MBq for optimal treatment after HD. Hemodialysis was repeated after approximately 48 and 96 h to remove excess 131I and reduce radiation to the patient.

  15. [Chagas' disease in patients in chronic hemodialysis. Prevalence and risk of transmission by blood transfusion].

    Science.gov (United States)

    Lorca, M; Lorca, E; Atías, A; Plubins, L

    1989-06-01

    A serologic study of Chagas disease was performed in 110 patients submitted to chronic hemodialisis and blood transfusions. Immunofluorescence antibody testing (IgG and IgM) was positive in 6 out of 62 patients receiving multiple blood transfusions (9.7%), but negative in all 48 subjects without transfusions. Thus, repeated blood transfusion is a significant risk for T cruzi infection in chronic hemodialized patients.

  16. EVALUATION OF ODONTO-PERIODONTAL PARAMETERS IN PATIENTS WITH CHRONIC RENAL INSUFFICIENCY (IRC TREATED BY HEMODIALYSIS (HD

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    Cerasella Dorina Şincar

    2012-09-01

    Full Text Available The scope of the study was to evaluate the odontoperiodontal modifications observed in patients with renal pathology in terminal stage, installed as a result of several chronic systemic pathologies, subjected to either dialysis or transplants. Materials and method. The group of patients suffering from IRC included 42 persons (30 men and 12 women, with an average age of 42.6 ± 9.2 years, while the control group was formed of 88 patients (36 men and 52 women, with an average age of 41.3 ± 8.4 years. 28 patients with IRC were treated by HD – hemodialysis, 8 by DPAC – continuous ambulatory peritoneal dialysis, and 6 by CCPD – continuous assisted cycle of peritoneal dialysis. The investigation was developed in the Specialized Policlinics of the „Sf. Apostol Andrei” Urgency Hospital of Galaţi. Results and discussion. The distribution of dialysed patients affected with IRC according to the type of therapy applied is the following: the highest ratio – 59% – is recorded for the patients treated by hemodialysis, followed by those subjected to ambulatory continuous peritoneal dialysis (DPAC and by those with continuous cycle assisted by peritoneal dialysis (CCDP. A statistically significant association was observed between the number of teeth covered by dental plaque or scale and the number of elements with bleeding on probing (r = 0.543, P<0.001 and r = 0.568, P<0.001, respectively. Conclusions: The study shows that the dialysed patients suffering from IRC are more susceptible to periodontal diseases, comparatively with those without IRC, which shows that maintaining of an optimum oral hygiene is essential.

  17. Exploring the impact of a decision support intervention on vascular access decisions in chronic hemodialysis patients: study protocol

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    Donnelly Sandra

    2011-02-01

    Full Text Available Abstract Background In patients with Stage 5 Chronic Kidney Disease who require renal replacement therapy a major decision concerns modality choice. However, many patients defer the decision about modality choice or they have an urgent or emergent need of RRT, which results in them starting hemodialysis with a Central Venous Catheter. Thereafter, efforts to help patients make more timely decisions about access choices utilizing education and resource allocation strategies met with limited success resulting in a high prevalent CVC use in Canada. Providing decision support tailored to meet patients' decision making needs may improve this situation. The Registered Nurses Association of Ontario has developed a clinical practice guideline to guide decision support for adults living with Chronic Kidney Disease (Decision Support for Adults with Chronic Kidney Disease. The purpose of this study is to determine the impact of implementing selected recommendations this guideline on priority provincial targets for hemodialysis access in patients with Stage 5 CKD who currently use Central Venous Catheters for vascular access. Methods/Design A non-experimental intervention study with repeated measures will be conducted at St. Michaels Hospital in Toronto, Canada. Decisional conflict about dialysis access choice will be measured using the validated SURE tool, an instrument used to identify decisional conflict. Thereafter a tailored decision support intervention will be implemented. Decisional conflict will be re-measured and compared with baseline scores. Patients and staff will be interviewed to gain an understanding of how useful this intervention was for them and whether it would be feasible to implement more widely. Quantitative data will be analyzed using descriptive and inferential statistics. Statistical significance of difference between means over time for aggregated SURE scores (pre/post will be assessed using a paired t-test. Qualitative analysis

  18. Hepatitis C in hemodialysis patients

    Institute of Scientific and Technical Information of China (English)

    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.

  19. A systematic review of sleep disorders in patients with chronic kidney disease undergoing hemodialysis

    Science.gov (United States)

    Fonseca, Nina Teixeira; Urbano, Jessica Julioti; Nacif, Sergio Roberto; Silva, Anderson Soares; Peixoto, Roger Andre Oliveira; Urbano, Giovanni Julioti; Oliveira, Ezequiel Fernandes; Santos, Israel Reis; Oliveira, Claudia Santos; Insalaco, Giuseppe; Oliveira, Luis Vicente Franco

    2016-01-01

    The purpose of this study was to conduct a systematic review of the available evidence on sleep disorders in patients with end stage renal disease (ESRD) undergoing hemodialysis (HD). [Subjects and Methods] Two independent reviewers performed a computer-assisted search of the MEDLINE, SciELO, LILACS, and BIREME Virtual Health Library medical databases from their inception to November 2015. [Results] One thousand one hundred twenty-six articles were found that met the inclusion criteria. Articles were excluded if they were not in English, the patients did not undergo HD, or the studies were not cross-sectional or clinical trials. After reading the full text, a further 300 studies were excluded because they did not use polysomnography. The remaining 18 studies with ESRD patients undergoing HD comprised 8 clinical trials and 10 cross-sectional studies. This systematic review followed the criteria outlined by the PRISMA declaration. [Conclusion] In this systematic review, a high prevalence of sleep disorders was observed in ESRD, including sleep-disordered breathing. This knowledge may enable health professionals to devise new strategies for the diagnosis and treatment of these patients, in order to reduce morbidity and mortality and improve their quality of life. PMID:27512289

  20. Music for Hemodialysis patients

    DEFF Research Database (Denmark)

    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...

  1. Occult HBV infection status among chronic hepatitis C and hemodialysis patients in Northeastern Egypt: regional and national overview

    Directory of Open Access Journals (Sweden)

    Mohamed Mandour

    2015-06-01

    Full Text Available INTRODUCTION: Occult hepatitis B infection (OBI is considered to be one of the major risks for patients suffering from end-stage renal disease (ESRD on regular hemodialysis (HD and patients with chronic hepatitis C virus (HCV infection. This study compared the prevalence of OBI among these two high-risk groups in the Suez Canal region, Northeastern Egypt, to obtain a better national overview of the magnitude of OBI in this region. METHODS: Serum samples were collected from 165 HD patients and 210 chronic HCV-infected patients. Anti-HCV antibody, hepatitis B surface antigen (HBsAg, total hepatitis B core (anti-HBc antibody, and hepatitis B surface antibody (anti-HBs were detected by enzyme-linked immunosorbent assay (ELISA. HCV RNA was detected using a quantitative real-time RT-PCR assay, and HBV was detected using a nested PCR. RESULTS: All patients were negative for HBsAg. A total of 49.1% and 25.2% of the patients in the HD and HCV groups, respectively, were anti-HBc-positive. In addition, more anti-HBs-positive patients were detected in the HD group compared to the HCV group (52.1% and 11.4%, respectively. Three cases were positive for HBV DNA in the HD group, while eighteen positive cases were detected in the HCV group. Both study groups showed significant differences in serum alanine aminotransferase (ALT and aspartate aminotransferase (AST level as well as anti-HBc, anti-HBs and HBV-DNA positivity. CONCLUSIONS: OBI was more prevalent among chronic HCV patients than HD patients in the Suez Canal region, Egypt, with rates of 8.5% and 1.8%, respectively. However, more precise assessment of this infection requires regular patient follow-up using HBV DNA detection methods.

  2. The Evaluation of Red Cell Distribution Width in Chronic Hemodialysis Patients

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    Hikmet Tekce

    2014-01-01

    Full Text Available Background. Red cell distribution width (RDW has been used as a marker of iron deficiency; however, it is accepted as a marker of cardiovascular survival. We aimed to study RDW levels in hemodialysis (HD patients and the association between RDW and inflammatory, nutritional, and volume markers. Methods. We included 296 HD patients with sufficient iron storage and without anemia or hypervolemia. We grouped patients into four groups according to clinical parameters, albumin, and C-reactive protein (CRP. Results. The lowest RDW levels were found in group 1 (13.2%. Although RDW of group 2 was higher than that of group 1, it was still in normal range (14.7% versus 13.2%, P=0.028. RDW levels of groups 3 (17.8% and 4 (18.5% were significantly higher than those of groups 1 and 2 and above normal range. A positive correlation was detected between RDW and HD duration, interdialytic weight gain (IDWG, serum phosphate, and CRP levels and a negative correlation was detected with serum albumin. HD duration, CRP, IDWG, and serum albumin have been found as independent predictors of RDW elevation. Conclusions. Results of the present study reflect adverse effects of inflammation, malnutrition, and excess IDWG on RDW elevation in an HD study cohort with sufficient iron storage and without anemia and hypervolemia.

  3. The A736V TMPRSS6 polymorphism influences hepcidin and iron metabolism in chronic hemodialysis patients: TMPRSS6 and hepcidin in hemodialysis

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    Pelusi Serena

    2013-02-01

    Full Text Available Abstract Background Aim of this study was to evaluate whether the A736V TMPRSS6 polymorphism, a major genetic determinant of iron metabolism in healthy subjects, influences serum levels of hepcidin, the hormone regulating iron metabolism, and erythropoiesis in chronic hemodialysis (CHD. Methods To this end, we considered 199 CHD patients from Northern Italy (157 with hepcidin evaluation, and 188 healthy controls without iron deficiency, matched for age and gender. Genetic polymorphisms were evaluated by allele specific polymerase chain reaction assays, and hepcidin quantified by mass spectrometry. Results Serum hepcidin levels were not different between the whole CHD population and controls (median 7.1, interquartile range (IQR 0.55-17.1 vs. 7.4, 4.5-17.9 nM, respectively, but were higher in the CHD subgroup after exclusion of subjects with relative iron deficiency (p = 0.04. In CHD patients, the A736V TMPRSS6 polymorphism influenced serum hepcidin levels in individuals positive for mutations in the HFE gene of hereditary hemochromatosis (p 30 ng/ml; n = 86, hepcidin was associated with lower mean corpuscular volume (p = 0.002, suggesting that it contributed to iron-restricted erythropoiesis. In line with previous results, in patients without acute inflammation and severe iron deficiency the “high hepcidin” 736 V TMPRSS6 variant was associated with higher erythropoietin maintenance dose (p = 0.016, independently of subclinical inflammation (p = 0.02. Conclusions The A736V TMPRSS6 genotype influences hepcidin levels, erythropoiesis, and anemia management in CHD patients. Evaluation of the effect of TMPRSS6 genotype on clinical outcomes in prospective studies in CHD may be useful to predict the outcomes of hepcidin manipulation, and to guide treatment personalization by optimizing anemia management.

  4. Hepcidin-25 in chronic hemodialysis patients is related to residual kidney function and not to treatment with erythropoiesis stimulating agents.

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    Neelke C van der Weerd

    Full Text Available Hepcidin-25, the bioactive form of hepcidin, is a key regulator of iron homeostasis as it induces internalization and degradation of ferroportin, a cellular iron exporter on enterocytes, macrophages and hepatocytes. Hepcidin levels are increased in chronic hemodialysis (HD patients, but as of yet, limited information on factors associated with hepcidin-25 in these patients is available. In the current cross-sectional study, potential patient-, laboratory- and treatment-related determinants of serum hepcidin-20 and -25, were assessed in a large cohort of stable, prevalent HD patients. Baseline data from 405 patients (62% male; age 63.7 ± 13.9 [mean SD] enrolled in the CONvective TRAnsport STudy (CONTRAST; NCT00205556 were studied. Predialysis hepcidin concentrations were measured centrally with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Patient-, laboratory- and treatment related characteristics were entered in a backward multivariable linear regression model. Hepcidin-25 levels were independently and positively associated with ferritin (p<0.001, hsCRP (p<0.001 and the presence of diabetes (p = 0.02 and inversely with the estimated glomerular filtration rate (p = 0.01, absolute reticulocyte count (p = 0.02 and soluble transferrin receptor (p<0.001. Men had lower hepcidin-25 levels as compared to women (p = 0.03. Hepcidin-25 was not associated with the maintenance dose of erythropoiesis stimulating agents (ESA or iron therapy. In conclusion, in the currently studied cohort of chronic HD patients, hepcidin-25 was a marker for iron stores and erythropoiesis and was associated with inflammation. Furthermore, hepcidin-25 levels were influenced by residual kidney function. Hepcidin-25 did not reflect ESA or iron dose in chronic stable HD patients on maintenance therapy. These results suggest that hepcidin is involved in the pathophysiological pathway of renal anemia and iron availability in these patients, but

  5. A prospective echocardiographic evaluation of pulmonary hypertension in chronic hemodialysis patients in the United States: prevalence and clinical significance

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    Kumudha Ramasubbu

    2010-09-01

    Full Text Available Kumudha Ramasubbu1, Anita Deswal1, Cheryl Herdejurgen2, David Aguilar1, Adaani E Frost21Section of Cardiology, Michael E DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA; 2Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USABackground: Pulmonary hypertension (PH, a disease which carries substantial morbidity and mortality, has been reported to occur in 25%–45% of dialysis patients. No prospective evaluation of the prevalence or clinical significance of PH in chronic dialysis patients in the United States (US has been undertaken.Methods: Echocardiograms were performed prospectively in chronic hemodialysis patients prior to dialysis at a single dialysis center. PH was defined as a tricuspid regurgitant jet ≥2.5 m/s and “more severe PH” as ≥3.0 m/s. Clinical outcomes recovered were all-cause hospitalizations and death at 12 months.Results: In a cohort of 90 patients, 42 patients (47% met the definition of PH. Of those, 18 patients (20% met the definition of more severe PH. At 12 months, mortality was significantly higher in patients with PH (26% compared with patients without PH (6%. All-cause hospitalizations were similar in patients with PH and without PH. Echocardiographic findings suggesting impaired left ventricular function and elevated pulmonary capillary wedge pressure were significantly associated with PH.Conclusion: This prospective cross-sectional study of a single dialysis unit suggests that PH may be present in nearly half of US dialysis patients and when present is associated with increased mortality. Echocardiographic findings demonstrate an association between elevated filling pressures, elevated pulmonary artery pressures, and higher mortality, suggesting that the PH may be secondary to diastolic dysfunction and compounded by volume overload.Keywords: renal failure, pulmonary hypertension, diastolic dysfunction

  6. Evaluation of D-dimer test in patients on chronic hemodialysis

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    Vurusic Branimir

    2013-07-01

    Full Text Available Determining the value of D-Dimer is a routine test in case of suspecting thromboembolic event. In patients on chronic dialysis, baseline concentrations for biomarkers have changed in widespread clinical use, which prompted us to measure the concentration of D-dimer, due to disorders of hemostasis in chronic kidney failure. From the evaluation of the findings of D-dimer in 67 patients and the available literature we can conclude that the value of the test in the diagnosis of thromboembolic events has significantly decreased.

  7. Dialysis - hemodialysis

    Science.gov (United States)

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

  8. Effect of hemodiafiltration with endogenous reinfusion on overt idiopathic chronic inflammation in maintenance hemodialysis patients: a multicenter longitudinal study.

    Science.gov (United States)

    Borrelli, Silvio; Minutolo, Roberto; De Nicola, Luca; De Simone, Emanuele; De Simone, Walter; Zito, Bruno; Guastaferro, Pasquale; Nigro, Filippo; Iulianiello, Giuseppe; Credendino, Olga; Bassi, Antonio; Leone, Luigi; Capuano, Maria; Auricchio, Maria Rita; Conte, Giuseppe

    2014-10-01

    Chronic inflammation is widely diffuse in maintenance hemodialysis (MHD) patients and is associated with poor survival. Hemodiafiltration with endogenous reinfusion (HFR) is a dialysis technique, highly biocompatible, able to adsorb proinflammatory cytokines and to decrease amino acids and antioxidants loss. These features could be helpful in MHD patients affected by idiopathic chronic inflammation, but this issue remains to be elucidated. We performed a multicenter longitudinal study to assess the effect of the switching from bicarbonate HD to HFR in patients with serum C-reactive Protein (CRP) > 5 mg/L coupled with albumin inflammation. At baseline, serum levels of CRP (18.7[7.0-39.4] mg/L) and albumin (3.5[3.3-3.7] g/dL) were significantly correlated (r = -0.49; P = 0.028). The effect on CRP and albumin was almost evident in the first 4 months and remained stable until to eighth month. A strict correlation (R = -0.49; 0.040) between percentage change of CRP (-35%) and albumin (+14%) after 8 months of HFR. These effects were associated with the reduction of IL-6, IL-1β, and TNF-α and the increment of pre-albumin and leptin, whereas the serum levels of Branched Chain Amino Acid (BCAA) remained unchanged. In MHD patients affected by idiopathic chronic inflammation the switching from BHD to HFR is associated with improvement of inflammation. Whether these favorable effects may modify the outcomes of these high-risk patients needs to be confirmed by studies ad hoc.

  9. A cross-sectional study of dialysis practice-patterns in patients with chronic kidney disease on maintenance hemodialysis.

    Science.gov (United States)

    Kulkarni, Manjunath Jeevanna; Jamale, Tukaram; Hase, Niwrutti K; Jagdish, Pradeep Kiggal; Keskar, Vaibhav; Patil, Harsha; Shete, Abhijeet; Patil, Chetan

    2015-09-01

    We studied the dialysis practice-patterns with regard to various aspects of chronic kidney disease (CKD) stage 5D, like anemia, mineral bone disease, vaccination, hospitalization, hypertension and cost of therapy. Four hundred and sixty-four adult hemodialysis (HD) patients from various dialysis centers of Mumbai were included in the study. The mean age of the study patients was 47.2 years. Temporary dialysis catheters were the most common initial vascular access. Thirteen percent of prevalent HD patients were on temporary catheters; 33% of patients had history of failure of arterio-venous fistula. The most common cause of failure was access thrombosis. About 75% of the patients had hemoglobin quality of life than the general population. The therapy itself brings with it a unique set of problems, such as vascular access-related complications, which cause significant mortality and morbidity. This study was a study of the current HD practices. The primary goal of this cross-sectional observational study is to understand dialysis practices and obtain data that can be used to improve care in the future.

  10. Studies on treatment of renal anemia in patients on chronic hemodialysis

    OpenAIRE

    Bergur V. Stefánsson

    2011-01-01

    Abstract: In patients with chronic kidney disease, treatment with erythropoiesis-stimulating agents (ESA) effectively corrects anemia. Most of these patients also need supplementation with regular iron injections to secure iron availability for proper erythropoiesis. Following intravenous iron injection, non-transferrin bound iron (NTBI) can appear in the circulation, capable of inducing harmful oxidative reactions. Direct measurement of free iron with the robust technique electron s...

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

    Directory of Open Access Journals (Sweden)

    Gede Andry Nicolas

    2013-04-01

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

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

    Science.gov (United States)

    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.

  13. Comparison of baseline data between chronic kidney disease patients starting hemodialysis who live near and far from the dialysis center

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    Paulo Roberto Santos

    2014-09-01

    Full Text Available Introduction: The treatment offered to chronic kidney disease (CKD patients before starting hemodialysis (HD impacts prognosis. Objective: We seek differences among incident HD patients according to the distance between home and the dialysis center. Methods: We included 179 CKD patients undergoing HD. Patients were stratified in two groups: "living near the dialysis center" (patients whose hometown was in cities up to 100 km from the dialysis center or as "living far from the dialysis center" (patients whose hometown was more than 100 km from the dialysis center. Socioeconomic status, laboratory results, awareness of CKD before starting HD, consultation with nephrologist before the first HD session, and type of vascular access when starting HD were compared between the two groups. Comparisons of continuous and categorical variables were performed using Student's t-test and the Chi-square test, respectively. Results: Ninety (50.3% patients were classified as "living near the dialysis center" and 89 (49.7% as "living far from the dialysis center". Patients living near the dialysis center were more likely to know about their condition of CKD than those living far from the dialysis center, respectively 46.6% versus 28.0% (p = 0.015. Although without statistical significance, patients living near the dialysis center had more frequent previous consultation with nephrologists (55.5% versus 42.6%; p = 0.116 and first HD by fistula (30.0% versus 19.1%; p = 0.128 than those living far from the dialysis center. Conclusion: There are potential advantages of CKD awareness, referral to nephrologists and starting HD through fistula among patients living near the dialysis center.

  14. The clinical spectrum of renal osteodystrophy in 57 chronic hemodialysis patients: a correlation between biochemical parameters and bone pathology findings.

    Science.gov (United States)

    Chazan, J A; Libbey, N P; London, M R; Pono, L; Abuelo, J G

    1991-02-01

    Fifty-nine chronic hemodialysis patients who had been on dialysis for an average of 77 months underwent bone biopsies and the pathologic findings were correlated with biochemical and demographic data. All but two had evidence of renal osteodystrophy, 23 with osteitis fibrosa (OF), 19 with osteomalacia and/or adynamic disease (OM/AD), and 15 with mixed osteodystrophy (MOD). Patients in each group were similar with regard to age, sex distribution, duration of dialysis, unstimulated serum aluminum, calcium and phosphorus. Patients with osteitis fibrosa (OF) had statistically higher DFO stimulated aluminum, alkaline phosphatase and PTHC levels than the other two groups although there was marked individual variation. The bone biopsies were also evaluated for the amount of aluminum deposited in the osteoid seam. All 23 of the patients with OF and 11 of the 15 patients with MOD had no, mild, or minimal aluminum deposition but 12 of the 19 patients with OM/AD had moderate to marked aluminum deposition. Patients with minimal to mild aluminum deposition were similar in age, duration of dialysis, sex distribution, unstimulated and DFO stimulated aluminum levels, calcium, phosphorus, alkaline phosphatase to those with moderate to marked deposition but had significantly higher parathormone levels. All patients had been treated in a similar fashion regarding diet, oral phosphate binders and vitamin D; therefore, the observed differences in bone pathology were not readily explicable. However, patients who were found to have osteitis fibrosa and those with minimal to mild aluminum deposition had significantly higher parathormone levels when compared with patients in the other groups at the inception of dialysis.

  15. Antierythropoietin Antibodies in Hemodialysis Patients Treated with Recombinant Erythropoietin

    OpenAIRE

    Savaş ÖZTÜRK; Alper GÜMÜŞ; Vecihi MEMİLİ; Muhammet Emin DÜZ; Egemen CEBECİ; Macit KOLDAŞ; Rümeyza KAZANCIOĞLU

    2014-01-01

    OBJECTIVE: Erythropoietin resistance is a serious problem in patients treated with recombinant erythropoietin. Antierythropoietin antibodies are considered to be one of the causes of this resistance. MATERIAL and ME THODS: We investigated antierythropoietin antibodies in chronic hemodialysis patients and compared the results with healthy controls by means of establishing an ELISA method. A total of 121 chronic hemodialysis patients receiving recombinant erythropoietin were included in the ...

  16. Effect of Shenkang injection combined with hemodialysis treatment on renal function, renal anemia and cytokine levels in patients with chronic renal failure

    Institute of Scientific and Technical Information of China (English)

    Rui Liu

    2016-01-01

    Objective:To study the effect of Shenkang injection combined with hemodialysis treatment on renal function, renal anemia and cytokine levels in patients with chronic renal failure. Methods: A total of 68 patients with chronic renal failure who received hemodialysis treatment in our hospital during between October 2013 and February 2016 were selected and randomly divided into two groups, the observation group received Shenkang injection treatment in the process of dialysis, and the control group only received conventional symptomatic and supportive treatment. 8 weeks after treatment, serum was collected to determine the levels of renal function indexes, nutritional status indexes, anemia indexes and cytokines, and urine was collected to determine renal function indexes.Results:β2-MG, UA, Cr, phosphorus, IL-17, IL-23, CTGF, TGF-β1, FGF-2 and FGF-23 levels in serum as well as NGAL, KIM-1 and RBP levels in urine of observation group were significantly lower than those of control group, and TP, Alb, PA, calcium, Hb, EPO, Fe, TRF and FER levels in serum were significantly higher than those of control group.Conclusion:Shenkang injection combined with hemodialysis treatment helps to improve renal function, nutritional status and renal anemia, and reduce the synthesis of inflammation and renal interstitial fibrosis-related cytokines in patients with chronic renal failure.

  17. Erectile dysfunction in hemodialysis patients

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    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.

  18. Influence of Hemodialysis on Lipid Peroxidation, Enzymatic and Non-Enzymatic Antioxidant Capacity in Chronic Renal Failure Patients

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    Zargari

    2015-07-01

    Full Text Available Background Free radical induced damages are thought to be involved in chronic kidney disease (CKD, especially in patients who are on hemodialysis (HD for prolonged periods. Hemodialysis can influence multiple biochemical factors, several of which are useful, although the rest can be harmful and increase the severity of disease. Objectives The purpose of this study was to evaluate the effect of the HD membrane polysulfone on oxidative stress markers, by measuring the level of lipid peroxidation and total antioxidant activity (TAC, in the blood of HD patients. Patients and Methods This study was carried out on 31 HD patients and 31 healthy persons, matched for age and sex, as control group. Blood samples were drawn before and after HD from arteriovenous fistulas, and once from the controls. Superoxide dismutase (SOD, catalase (CAT and thiobarbituric acid-reactive substance (TBARS in blood hemolyzate, Glutathione peroxidase (GpX of whole blood and TAC of plasma were measured, respectively. Then, we investigated the association between TAC of plasma, measured by ferric reducing antioxidant power (FRAP, and lipid peroxidation level with its related parameters, in HD patients. Results The SOD, GpX and CAT were decreased after HD (P < 0.05. Also, FRAP was shown to decrease after HD (P < 0.05. However, erythrocyte TBARS levels (μmol/gr of Hb were increased after HD, in comparison with controls, and before HD (P < 0.05. There was a significant negative correlation between TBARS and antioxidant indices, such as SOD (r = -0.67, P = 0.001, GpX (r = -0.76, P = 0.001, CAT (r = -0.63, P = 0.001 and FRAP (r = -0.84, P = 0.001. The FRAP was significantly and directly correlated with uric acid (r = +0.62, P = 0.001, SOD (r = +0.72, P = 0.001, GpX (r = +0.87, P = 0.001 and CAT (r = +0.84, P = 0.001. Conclusions The results of our study proposed that there is a loss or inactivation of antioxidant factors, coupled with increased lipid peroxidation during the

  19. One year efficacy and safety of lanthanum carbonate for hyperphosphatemia in Japanese chronic kidney disease patients undergoing hemodialysis.

    Science.gov (United States)

    Shigematsu, Takashi

    2010-02-01

    Lanthanum carbonate is a non-calcium-based phosphate binder for hyperphosphatemia in patients with chronic kidney disease (CKD). The efficacy and safety of lanthanum carbonate (LaC) on hyperphosphatemia in patients has been well documented in clinical trials in Western countries and recent relatively short-term clinical trials in Japan. Evidence supporting its safety and efficacy in Japanese patients for longer-term treatment is now desired for clinical practice. A non-controlled, open-label, multicenter, one year study of LaC to assess safety and its effect on the levels of serum phosphate, serum calcium and parathyroid hormone was performed with Japanese dialysis patients. Lanthanum carbonate was administered to patients at variable doses for a period of 46-52 weeks. Evaluation of the safety and efficacy of LaC in reducing serum phosphate was performed, in addition to extensive and systematic monitoring of the laboratory parameters related to bone turnover and cardiac health. A significant reduction in the serum phosphate level was demonstrated throughout the treatment period (P < 0.05), without any increase in the frequency or severity of drug-related adverse events such as vomiting, nausea, and stomach discomfort. There was no clinically relevant change in vital signs, or electrocardiograms for a period. The profiles for parathyroid hormone, bone alkaline phosphates, and osteocalcin were stable in the patients concomitantly treated with vitamin D. This study provides further evidence that the administration of LaC over a period of one year is safe and effective for the reduction of serum phosphate levels in CKD patients undergoing hemodialysis.

  20. Heparin versus low molecular weight heparin K 2165 in chronic hemodialysis patients: a randomized cross-over study.

    Science.gov (United States)

    Borm, J J; Krediet, R; Sturk, A; ten Cate, J W

    1986-01-01

    Ten patients on chronic intermittent hemodialysis treatment received either unfractionated heparin or low molecular weight (LMW) heparin K 2165 in a single-blinded randomized cross-over study to assess: effects on hemostasis and ex vivo platelet functions, and effectiveness, i.e. prevention of fibrin formation in the extracorporeal circuit. The 20 dialysis treatments were without untoward side effects, for both drugs used. The variation in the plasma anti-Xa activities was significantly less during K 2165 treatment than during heparinization. No differences between the drugs were observed regarding the Ivy bleeding time, platelet count and platelet aggregation (spontaneous, and induced by ADP and collagen). Plasma platelet factor 4 levels did not increase under K 2165 to such an extent as under heparin. Both drugs did not influence the plasma levels of beta-thromboglobulin, thromboxane B2 and platelet serotonin content. K 2165 did not affect platelet adhesion to collagen, in contrast to heparin which substantially inhibited platelet adhesion. Under both treatments, 4 minor clots were observed in 4 artificial kidneys, despite plasma anti-Xa levels in between 0.19 and 0.46 U/ml. K 2165 may therefore be considered as effective an anticoagulant as heparin, with less effects on ex vivo platelet functions.

  1. Depression, 5HTTLPR and BDNF Val66Met polymorphisms, and plasma BDNF levels in hemodialysis patients with chronic renal failure

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    Wang LJ

    2014-07-01

    Full Text Available Liang-Jen Wang,1,* Chih-Ken Chen,2,3,* Heng-Jung Hsu,3,4 I-Wen Wu,3,4 Chiao-Yin Sun,3,4 Chin-Chan Lee3,41Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 2Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, Taiwan; 3Chang Gung University School of Medicine, Taoyuan, Taiwan; 4Department of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan *LJW and CKC are joint first authors and contributed equally to this manuscriptObjective: Depression is the most prevalent comorbid psychiatric disease among hemodialysis patients with end-stage renal disease. This cross-sectional study investigated whether depression in hemodialysis patients is associated with the polymorphism of the 5' flanking transcriptional region (5-HTTLPR of the serotonin transporter gene, the valine (Val-to-methionine (Met substitution at codon 66 (Val66Met polymorphism of the brain-derived neurotrophic factor (BDNF gene, or plasma BDNF levels.Methods: A total of 188 participants (mean age: 58.5±14.0 years; 89 men and 99 women receiving hemodialysis at the Chang Gung Memorial Hospital were recruited. The diagnosis of major depressive disorder (MDD was confirmed using the Chinese version of the Mini International Neuropsychiatric Interview. The genotypes of 5-HTTLPR and BDNF Val66Met were conducted using polymerase chain reactions plus restriction fragment length polymorphism analysis. The plasma BDNF levels were measured using an enzyme-linked immunosorbent assay kit.Results: Forty-five (23.9% patients fulfilled the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR criteria for a MDD. There were no significant effects of the 5-HTTLPR or BDNF Val66Met gene polymorphism on MDD among the hemodialysis patients. The plasma BDNF levels correlated significantly with age (P=0.003 and sex (P=0.047 but not with depression, the genotypes of 5

  2. Hemodialysis access - self care

    Science.gov (United States)

    Kidney failure - chronic-hemodialysis access; Renal failure - chronic-hemodialysis access; Chronic renal insufficiency - hemodialysis access; Chronic kidney failure - hemodialysis access; Chronic renal failure - ...

  3. Rosuvastatin in diabetic hemodialysis patients

    DEFF Research Database (Denmark)

    Holdaas, Hallvard; Holme, Ingar; Schmieder, Roland E;

    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...

  4. Determination of creatinine-related molecules in saliva by reversed-phase liquid chromatography with tandem mass spectrometry and the evaluation of hemodialysis in chronic kidney disease patients.

    Science.gov (United States)

    Suzuki, Mayu; Furuhashi, Mitsuyoshi; Sesoko, Shogo; Kosuge, Kazuhiro; Maeda, Toshio; Todoroki, Kenichiro; Inoue, Koichi; Min, Jun Zhe; Toyo'oka, Toshimasa

    2016-03-10

    The serum concentrations of creatinine (Cre) and urea are used for the determination of the renal function. However, the use of blood is not always suitable due to the invasive, hygienic and infection problems during its sample collection and handling. In contrast, saliva is relatively clean and the samples can be quickly and noninvasively collected and easily stored. Therefore, the simultaneous determination of Arginine (Arg), creatine (Cr) and Cre in the saliva of chronic kidney disease (CKD) patients was performed by UPLC-ESI-MS/MS together with the saliva of healthy volunteers. The evaluation of hemodialysis of CKD patients was also carried out by the determinations before and after the dialysis. An HS-F5 column was used for the simultaneous determination of Arg, Cr and Cre in the saliva. These molecules were rapidly separated within 4 min and sensitively determined by the multiple reaction monitoring (MRM) of the precursor ion [M+H](+) → product ions (m/z 175.1 → 70.1 for Arg; m/z 132.0 → 44.1 for Cr; m/z 114.0 → 44.1 for Cre). The concentration of Cre in the CKD patients was higher than that in the healthy persons. The concentrations of Cre in the saliva of the patients before hemodialysis were moderately correlated with the serum Cre concentrations (R(2) = 0.661). Furthermore, the concentration in the saliva obviously decreased after hemodialysis (before 0.73 mg/dL, after 0.25 mg/dL; p saliva by UPLC-MS/MS is useful for the evaluation of the renal function in CKD patients. The present method offers a new option for monitoring the hemodialysis of CKD patients.

  5. [Assessing the effect of health belief, knowledge, and social support on compliance behaviors in chronic hemodialysis patients].

    Science.gov (United States)

    Lin, C C; Ko, N Y; Tsai, L C; Chen, C H

    1995-08-01

    The purposes of this study were to investigate the effects of hemodialysis patients' health belief, knowledge on uremia, and social support upon their compliance behavior. The convenience sample of 330 hemodialysis (HD) patients was obtained at HD centers in southern Taiwan. With the use of a questionnaire developed by the researcher, all subjects were interviewed during hemodialysis. Data analyses were processed by a personal computer with SPSS/PC. Pearson correlation, ANOVA, chi-square, multiple regression and factor analysis were selected as the analysis methods for this study. The results indicated: (1) The average overall rate of compliance was 72.1% by patient self report for fluid limit, diet restriction and taking PBM. (2) Two factors of subject's health belief were identified by factor analysis. (3) Those who had more positive motivation for compliance with therapeutic regiments, more knowledge on uremia and stronger social support were positively correlated with compliance behaviors. (4) The best predictive variables of compliance behaviors of HD patients included positive motivation, knowledge on uremia, educational level, current daily urine amount and age; these five variables explained 23% of variance in compliance behaviors. (5) The instruments with a satisfactory validity and reliability developed by the researcher could provide a valuable basis for relevant future research. Implications of these findings for nursing practice are also discussed.

  6. The Language of Coping: Understanding Filipino Geriatric Patients' Hemodialysis Lived Experiences

    Science.gov (United States)

    de Guzman, Allan B.; Chy, Mark Anthony S.; Concepcion, April Faye P.; Conferido, Alvin John C.; Coretico, Kristine I.

    2009-01-01

    The majority of patients with chronic kidney disease (CKD) are undergoing maintenance hemodialysis. Hemodialysis is a process of removing metabolic waste, other poisons, and excess fluids from the blood and replacing essential blood constituents through a dialysis machine. With hemodialysis causing stress not only to physical status but also to…

  7. Comparing risk of new onset diabetes mellitus in chronic kidney disease patients receiving peritoneal dialysis and hemodialysis using propensity score matching.

    Directory of Open Access Journals (Sweden)

    Che-Yi Chou

    Full Text Available Chronic kidney disease (CKD patients are at risk for developing new-onset diabetes mellitus (NODM even after hemodialysis (HD and peritoneal dialysis (PD treatment. It is not clear if the incidence for NODM is different in CKD patients receiving HD and PD. This study compared the risk of NODM in PD patients and HD patients.All HD and PD patients in Taiwan Renal Registry Database from 1997 to 2005 were included and all patients were followed to December 31, 2008. The risk of NODM was analyzed in PD patients and propensity score matched HD patients using logistic regression for early type NODM (6 months after dialysis.A total of 2548 PD patients and 10192 HD patients who had no diabetes on the initiation of dialysis were analyzed. The incidence for NODM was 3.7 per 100 patient/year for HD and 2.4 for PD patients. HD patients are more at risk for developing early type NODM (p<0.001 with an adjusted odds ratio of 1.41 [95% confidence interval (CI 1.12-1.78]. HD patients are more at risk for late type NODM (p<0.001 with an adjusted hazard ratio of 2.01 (95% CI: 1.77-2.29. Patient's age was negatively associated with risk of early type of NODM (p<0.001 but positively associated with risk of late type NODM (p<0.001.Chronic kidney disease patients receiving hemodialysis are more at risk for developing new-onset diabetes mellitus compared to those receiving peritoneal dialysis.

  8. The determinants of hepcidin level in chronic kidney disease and hemodialysis Saudi patients

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    Tarek Mohamed Ali

    2014-06-01

    Conclusions: Hepcidin levels are correlated to the glycemic status in CKD and HD patients and hepcidin levels in hemodialysed patients were significantly correlated with eGFR but it is not considered as an independent predictor for hepcidin level in these patients.

  9. Malnutrition-Inflammation Score in Hemodialysis Patients

    OpenAIRE

    Behrooz Ebrahimzadehkor; Atamohammad Dorri; Abdolhamed Yapan-Gharavi

    2014-01-01

    Background: Malnutrition is a prevalent complication in patients on maintenance hemodialysis. Malnutrition-inflammation score (MIS), comprehensive nutritional assessment tool, as the reference standard was used to examine protein-energy wasting (PEW) and inflammation in hemodialysis patients. Materials and Methods: In this descriptive- analytical study, 48 hemodialysis patients were selected with random sampling. All the patients were interviewed and the MIS of the patients was recorded. T...

  10. Blastocystis sp. and other intestinal parasites in hemodialysis patients

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    Rose Anne Kulik

    2008-08-01

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

  11. Percutaneous Intervention in Axillary Loop-Configured Arteriovenous Grafts for Chronic Hemodialysis Patients

    Energy Technology Data Exchange (ETDEWEB)

    Park, Beom Jin; Chung, Hwan Hoon; Sung, Deuk Jae; Park, Sang Joon; Son, Ho Sung; Jo, Sang Kyung; Kim, Yun Hwan; Cho, Sung Bum [College of Medicine, Korea University, Seoul (Korea, Republic of); Kim, Hyoung Rae [Kangwon National University, Chuncheon (Korea, Republic of)

    2010-04-15

    The purpose of this study was to evaluate the fistulographic features of malfunctioning axillary loop-configured arteriovenous grafts and the efficacy of percutaneous interventions in failed axillary loop-configured arteriovenous grafts. Ten patients with axillary loop-configured arteriovenous grafts were referred for evaluation of graft patency or upper arm swelling. Fistulography and percutaneous intervention, including thrombolysis, percutaneous transluminal angioplasty and stent placement, were performed. Statistical analysis of the procedure success rate and the primary and secondary patency rates was done. Four patients had graft related and subclavian venous stenosis, two patients had graft related stenosis and another four patients had subclavian venous stenosis only. Sixteen sessions of interventional procedures were performed in eight patients (average: 2 sessions / patient) until the end of follow-up. An interventional procedure was not done in two patients with central venous stenosis. The overall procedure success rate was 69% (11 of 16 sessions). The post-intervention primary and secondary patency rates were 50% and 63% at three months, 38% and 63% at six months and 25% and 63% at one year, respectively. Dysfunctional axillary loop-configured arteriovenous grafts almost always had subclavian venous and graft-related stenosis. Interventional treatments are helpful to overcome this and these treatments are expected to play a major role in restoring and maintaining the axillary loop-configured arteriovenous loop grafts

  12. Relationship between appetite levels and anxiety symptoms in chronic hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Elihud Salazar

    2012-06-01

    Very poor or poor appetite level was associated with female sex, older age, lower creatinine, lower DRI, and higher anxiety symptoms. Intervention of anxiety with cognitive behavioral therapy could improve nutritional treatment among vulnerable patients.

  13. Bone fragility fractures in hemodialysis patients: Croatian surveys.

    Science.gov (United States)

    Šimunović, Iva; Pavlović, Draško; Kudumija, Boris; Mihaljević, Dubravka; Lovčić, Vesna; Jakić, Marko

    2015-03-01

    Disturbances of bone mineral metabolism are common complications of chronic kidney disease with bone fractures as one of the most important consequences. The aim of this study was to estimate prevalence of bone fractures among Croatian hemodialysis patients and to determine the possible fracture risk. The study was carried out in 767 hemodialysis patients from nine Croatian hemodialysis centers. Demographic, laboratory and bone fracture data were collected from medical records as well as therapy with vitamin D analogs. Fragility fractures were defined according to the World Health Organization definition. In 31 patient a total of 36 fractures were recorded. The prevalence of patients with bone fractures was 4.0%. The mean age of patients with fractures was 68.6 years. There were 9 male and 22 female patients with frac- tures. The mean hemodialysis duration was 63.3 months. Among all fractures the most common were hip fractures (39%) followed by forearm fractures (22%). This is the first study regarding epidemiology of bone fractures in Croatian hemodialysis patients. The prevalence of patients with bone fractures in our group of hemodialysis patients is high. Fractures were more frequent among women and older patients, patients who have been longer on dialysis and in patients with higher concentration of PTH.

  14. Influence of hemoperfusion combined with hemodialysis on inflammatory factors, serum hcy, PTH and β2-MG of patients with chronic renal failure

    Institute of Scientific and Technical Information of China (English)

    Yu Yin; Rui Li; Jian-Rong Hao

    2015-01-01

    Objective:To analyze the influence of hemoperfusion combined with hemodialysis on serum inflammatory factors, homocysteine (Hcy), parathyroid hormone (PTH) andβ2microglobulin (β2-MG) and other indexes in patients with chronic renal failure.Methods:94 cases with chronic renal failure from December 2013 to January 2015 in our hospital were randomly divided into two groups, according to the order of treatment. The control group of 47 patients with regular hemodialysis treatment, the observation group of 47 cases with blood perfusion combined with hemodialysis treatment. The serum interleukin-1 (IL-1), interleukin-6 (IL-6), tumor necrosis factorβ (TNF-β), high sensitive C reactive protein (hs-CRP), phosphorus (P), Hcy, PTH, BUN,β2-MG and Scr indexes of two groups of patients before and after treatment were detected.Results:After treatment, serum IL-1, IL-6, TNF-β and hs-CRP levels of observation group were (1.72±0.16) ng/L, (12.38±1.67) ng/L, (1.26±0.31) mg/L, (6.78±1.42) ng/mL, were significantly decreased compared with the group before treatmentand control group after treatment (P<0.05). After treatment, serum PTH, Hcy and P levels of observation group were (24.53±4.82) μmol/L, (21.65±2.38) pmol/L, (1.50±0.29) mmol/L, were significantly decreased compared with the group before treatment and control group after treatment (P<0.05). After treatment,β2-MG, BUN, Scr levels of observation group were (1.92±0.26) mg/L,(6.76±1.23) mmol/L, (410.62±13.20) μmol/L, were significantly decreased compared with the group before treatment and control group after treatment. The skin itching relieving rate of observation group was 91.49% (43/47) was significantly higher than the control groups’ 59.57% (19/47), the differences were statistically significant.Conclusion:The curative effect of blood perfusion combined with hemodialysis in the treatment of chronic renal failure is significant, can effectively reduce the serum level of inflammatory factors, can clean out

  15. Vitamin D deficiency in hemodialysis patients

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    Beena Bansal

    2012-01-01

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

  16. Increased cerebral water content in hemodialysis patients.

    Directory of Open Access Journals (Sweden)

    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.

  17. Hemodialysis-refractory metformin-associated lactate acidosis with hypoglycemia, hypothermia, and bradycardia in a diabetic patient with belated diagnosis and chronic kidney disease
.

    Science.gov (United States)

    Zibar, Lada; Zibar, Karin

    2017-01-30

    Metformin is a first-line oral antidiabetic therapy for patients with type 2 diabetes mellitus. Metformin-associated lactate acidosis (MALA) is a well-known, life-threatening, but rare side effect of metformin therapy. Chronic kidney disease (CKD) patients have a much greater risk of MALA. We report the case of a severe refractory MALA despite hemodialysis (HD) treatment, associated with hypoglycemia, hypothermia, and bradycardia in a neglected and thus untimely-recognized CKD patient with type 2 diabetes mellitus. Despite the recent rehabilitation of metformin as a treatment of choice for type 2 diabetes mellitus, the drug should be prescribed with caution as it can be associated with life-threatening refractory acidosis, particularly in CKD patients. Moreover, HD treatment could occasionally be ineffective, resulting in a fatal outcome.
.

  18. Hemodialysis versus peritoneal dialysis: a case control study of survival in patients with chronic kidney disease stage 5

    DEFF Research Database (Denmark)

    Maier, Alexandra; Stocks, Franziska; Pommer, Wolfgang;

    2009-01-01

    It is still controversial whether the mode of dialysis or preexisting comorbidities may influence the prognosis of patients with chronic kidney disease stage 5. Therefore, we performed a prospective case control study to evaluate whether the mode of dialysis may influence outcome. We found 25 cases......, predicted death in patients with chronic kidney disease. It is concluded that age and comorbidities but not mode of dialysis are important to predict survival in patients with chronic kidney disease stage 5....

  19. Cognitive function in Stage 5 chronic kidney disease patients on hemodialysis: no adverse effects of lanthanum carbonate compared with standard phosphate-binder therapy.

    Science.gov (United States)

    Altmann, P; Barnett, M E; Finn, W F

    2007-02-01

    Patients with Stage 5 chronic kidney disease who have hyperphosphatemia require treatment with phosphate binders to lower serum phosphorus levels. Existing binders are effective but may be associated with important safety disadvantages. Lanthanum carbonate is a phosphate binder with demonstrated efficacy, safety, and tolerability in clinical trials. Changes in cognitive function were evaluated over time using the Cognitive Drug Research computerized cognitive assessment system (Simple Reaction Time, Digit Vigilance Task, Choice Reaction Time, Numeric Working Memory, and Delayed Picture Recognition) in 360 hemodialysis patients who were enrolled in a 2-year, multicenter, comparative study of lanthanum carbonate versus standard therapy. A decline in cognitive function from baseline was observed in both groups. The deterioration in cognitive function was similar in both the lanthanum carbonate and standard therapy groups. One parameter - Numeric Working Memory - showed a statistically significant between-group difference in favor of lanthanum carbonate (P=0.02). Given the magnitude of the changes, however, and the differences that were observed at baseline between treatment groups, the clinical significance of this difference is doubtful. This study demonstrates that cognitive function deteriorates in hemodialysis patients over a 2-year time period. Use of lanthanum carbonate as a phosphate binder does not adversely affect cognitive function compared with standard therapy.

  20. Neurotoxicity caused by valacyclovir in a patient on hemodialysis

    NARCIS (Netherlands)

    Linssen-Schuurmans, CD; van Kan, EJM; Feith, GW; Uges, DRA

    1998-01-01

    The authors report toxicity caused by valacyclovir in a patient on hemodialysis. After initial recuperation resulting from treatment with hemodialysis, the patient experienced a relapse of neurologic symptoms, again necessitating hemodialysis. Although acyclovir and its analogues are generally safe

  1. Correlations between spiritual beliefs and health-related quality of life of chronic hemodialysis patients in Taiwan.

    Science.gov (United States)

    Kao, Tze-Wah; Chen, Pau-Chung; Hsieh, Chia-Jung; Chiang, Hong-Wei; Tsang, Lap-Yuen; Yang, Ing-Fang; Tsai, Tun-Jun; Chen, Wan-Yu

    2009-07-01

    This study evaluated the correlations between spiritual beliefs and health-related quality of life (HRQOL) of hemodialysis (HD) patients in Taiwan. Participants had to complete two questionnaires: the 36-item Short Form Health Survey Questionnaire and the Royal Free Interview for Spiritual and Religious Beliefs. They were then divided into three groups according to their strength of spiritual beliefs-having no, weak, or strong beliefs. Demographic, clinical, and laboratory data among groups were compared. Correlations between spiritual beliefs and HRQOL were then determined by the analysis of covariance and the post hoc Scheffe tests. Six hundred thirty-three patients completed the study. There were more women in the group of patients with strong beliefs (P = 0.005) and more less-educated patients in the group of patients with weak beliefs (P = 0.005). Patients with no or with strong spiritual beliefs had higher role physical (P = 0.01) and social functioning (SF) (P = 0.001) scores than patients with weak beliefs. After adjustment for gender, age, marital status, education, comorbidities, and time on dialysis, patients with no or with strong spiritual beliefs were found to have higher SF scores (P = 0.02) than patients with weak beliefs. HD patients with no or strong spiritual beliefs had higher SF HRQOL than those with weak spiritual beliefs.

  2. 维持性血液透析患者血浆容量与血压关系的研究%Clinical study on relationship between plasma volume and blood pressure in patients undergoing chronic hemodialysis

    Institute of Scientific and Technical Information of China (English)

    方燕; 张伟明; 严玉澄; 陆任华; 王咏梅; 朱铭力; 倪兆慧; 钱家麒

    2011-01-01

    目的 探讨维持性血液透析患者透析过程中血浆容量变化与血压的关系.方法 36例维持性血液透析患者根据透析前血压水平分为正常血压组(n=16)和高血压组(n=20).记录透析前后患者的血压和体质量,检测血清总蛋白水平并计算血浆容量变化值(△Pv).所有数据采用SPSS 13.0软件进行统计学分析.结果 在正常血压组,透析前后收缩压分别为(123.3±19.9) mmHg(1 mmHg=0.133 kPa)和(122.3±27.0) mmHg,舒张压分别为(69.6+9.2) mmHg和(70.9+17.0) mmHg,透析前后收缩压和舒张压比较差异均无统计学意义(P>0.05);透析过程中,体质量变化值为(2.7±1.4)kg,△PV为(14.7±10.8)%.在高血压组,透析前后收缩压分别为(162.6±16.2) mmHg和(148.2±31.1) mmHg,透析前后舒张压分别为(86.6±9.6) mmHg和(82.1±14.4) mmHg,透析后收缩压较透析前显著下降(P<0.05),而透析前后舒张压比较差异无统计学意义(P>0.05);透析过程中,体质量变化值为(3.2±1.3)kg,△PV为(20.4±14.4)%.相关性分析结果显示:正常血压组和高血压组患者透析前后血压与透析过程中的△PV和体质量变化均无显著相关性(P>0.05).结论 透析过程中,血浆容量改变未对患者透析前后血压变化产生显著影响;体质量下降尚不足以确切反映患者血浆容量状态,且用于预示透析前后血压变化的作用有限.%Objective To explore the association between plasma volume and blood pressure during hemodialysis in patients undergoing chronic hemodialysis. Methods Thirty-six patients undergoing chronic hemodialysis were divided into normotensive group (n = 16) and hypertensive group (n = 20) according to blood pressure before hemodialysis. The blood pressure and body weight before hemodialysis and after hemodialysis were recorded, and serum total protein concentrations were measured to determine the changes of plasma volumes ( APV). Statistical analysis was performed with SPSS 13. 0

  3. Angiopoietin-2 in chronic renal failure patients on hemodialysis: Relationship with glomerular filtration rate in the predialysis stages

    Directory of Open Access Journals (Sweden)

    Fatma A Attia

    2013-01-01

    Conclusion Circulating angiopoietin-2 is a putative marker and potential mediator of atherosclerosis, is inversely related to glomerular filtration rate, and is increased with advanced chronic kidney disease. Normolipidemia in chronic kidney disease patients does not prevent atherosclerotic burden; this is because of the presence of other markers such as angiopoietin-2.

  4. Changes of Serum Total and Free Testosterone Concentrations in Male Chronic Hemodialysis Patients with Secondary Hyperparathyroidism in Response to Cinacalcet Treatment

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    Piotr Kuczera

    2016-01-01

    Full Text Available Background/Aims: Calcium sensing receptor (CaSR is expressed, among others also in testis. Cinacalcet binds to the CaSR, increases sensitivity of CaSR to serum calcium and is used in the treatment of secondary hyperparathyroidism (sHPT in chronic hemodialysis patients (HDP. In most of male HDP, serum testosterone concentration is lower than in healthy males. The aim of this study was to assess the influence of six-month treatment with cinacalcet on the serum total and free testosterone concentration in male HDP with sHPT. Methods: 38 male, hemodialysed CKD patients with sHPT (PTH>300 pg/ml were enrolled into the study. In each patient serum PTH, total testosterone (TT and free testosterone (FT concentrations were assessed before the first dose of cinacalcet and then after 3 and 6 months of treatment. The results are presented as means with 95% confidence interval. Results: In 33 patients who completed the study cinacalcet treatment caused significant decrease of serum PTH from 1143 pg/ml (828 - 1458 pg/ml at the baseline, to 809 pg/ml (487 - 1132pg/ml after 3 month of treatment (p = 0.002, and to 607 pg/ml (281 - 934pg/ml; p Conclusion: Treatment with cinacalcet decreases serum total and free testosterone concentration in male hemodialysed patients with chronic kidney disease and secondary hyperparathyroidism.

  5. Oral manifestation and salivary changes in renal patients undergoing hemodialysis

    Science.gov (United States)

    Honarmand, Marieh; Nakhaee, Alireza; Sargolzaie, Fahimeh

    2017-01-01

    Background Salivary changes in hemodialysis patients may result in various oral manifestations. This research intended to determine oral manifestations and some salivary markers in hemodialysis patients. Material and Methods This cross-sectional study was conducted on 30 hemodialysis patients (the patient group) and 30 healthy individuals (the control group). Saliva urea and calcium levels and pH values of the participants were measured, and oral manifestations such as pale mucosa, xerostomia, halitosis, changes in the sense of taste, increased calculus formation, gingival bleeding, etc. were recorded in the information collection form. The data was analyzed using T-test and chi-square, and pHalitosis, xerostomia, and increased calculus were the most prevalent manifestations, and gum bleeding was the least prevalent among the patients. Conclusions Advanced chronic renal insufficiency can increase salivary urea level, pH value, halitosis, xerostomia, and calculus formation, and may cause pale mucosa. Key words:Renal dialysis, biomarkers, oral manifestation, saliva. PMID:28210437

  6. Second-Degree Interatrial Block in Hemodialysis Patients

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    Andres Enriquez

    2015-01-01

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

  7. Second-Degree Interatrial Block in Hemodialysis Patients

    Science.gov (United States)

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

    2015-01-01

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

  8. Left atrial calcification in a hemodialysis patient with cor triatriatum.

    Science.gov (United States)

    Peces, R; Pobes, A; Rodriguez, M; Simarro, C; Iglesias, G; Simarro, E

    2000-05-01

    Myocardial calcification is a rare manifestation of abnormal calcium metabolism seen in some patients with chronic renal failure. This report describes the transesophageal echocardiographic and spiral computed tomography (CT) findings in a young hemodialysis female with severe secondary hyperparathyroidism. These findings included calcification of the multiperforated membrane of a cor triatriatum and the wall of the left atrium.

  9. Self-Care Ability in Hemodialysis Patients

    OpenAIRE

    Atashpeikar, Soulmaz; Jalilazar, Tahereh; Heidarzadeh, Mehdi

    2012-01-01

    Introduction: Considering the numerous physical and psychological problems in hemo-dialysis patients, they are dependent on others in some daily activities and in fact, they do not have full self-care ability. A few studies have ever been done, particularly in Iran, on self-care ability of hemodialysis patients. The present study aimed to determine self-care ability of these patients in addition to evaluate its association with some demo-graphic characteristics. Methods: Thi...

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    Batchoun, Raymond G; Al-Najdawi, Malek A; Al-Taamary, Sameh

    2011-07-01

    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, these

  12. Phenylacetic acid and arterial vascular properties in patients with chronic kidney disease stage 5 on hemodialysis therapy

    DEFF Research Database (Denmark)

    Scholze, Alexandra; Jankowski, Vera; Henning, Lars;

    2007-01-01

    Phenylacetic acid (PAA) is a recently described uremic toxin that inhibits inducible nitric oxide synthase expression and plasma membrane calcium ATPase and may therefore also be involved in remodeling of arteries. Such vascular effects have not been evaluated yet in patients with chronic kidney...

  13. Dissecting aortic aneurysm in maintenance hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Ounissi M

    2009-01-01

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

  14. [Oxidative stress in patients on regular hemodialysis and peritoneal dialysis].

    Science.gov (United States)

    Vostálová, J; Galandáková, A; Strebl, P; Zadražil, J

    2012-06-01

    Hemodialysis and peritoneal dialysis are methods of blood purification, which partially replaced excretory renal function in patients with chronic renal failure, which was depleted regime, dietary and pharmaco-therapeutic remedy, and who are not eligible for kidney transplantation. Both two methods are accompanied by increased oxidative stress. In peritoneal dialysis particularly the composition of dialysis solution contributes to oxidative stress. In extracorporeal hemodialysis the oxidative stress is associated with the character of hemodialysis membranes, non-specific loss of low molecular weight antioxidants, activation of leukocytes (oxidative burst), feroteraphy, supplementation with low molecular weight antioxidants and other factors. To improve and maintain the quality of life of dialysis patients, the continuous monitoring of oxidative stress-related parameters as non-traditional risk factors for cardiovascular complications development is suitable.

  15. Falls in elderly hemodialysis patients.

    Science.gov (United States)

    Abdel-Rahman, E M; Turgut, F; Turkmen, K; Balogun, R A

    2011-10-01

    The elderly, (age ≥ 65 years) hemodialysis (HD) patient population is growing rapidly across the world. The risk of accidental falls is very high in this patient population due to multiple factors which include aging, underlying renal disease and adverse events associated with HD treatments. Falls, the most common cause of fatal injury among elderly, not only increase morbidity and mortality, but also increase costs to the health system. Prediction of falls and interventions to prevent or minimize fall risk and associated complications will be a major step in helping these patients as well as decreasing financial and social burdens. Thus, it is vital to learn how to approach this important problem. In this review, we will summarize the epidemiology, risk factors, pathophysiology and complications of falls in elderly HD patients. We will also focus on available methods to assess and predict the patients at higher risk of falling and will provide recommendations for interventions to reduce the occurrence of falls in this population.

  16. Cultural comparison of symptoms in patients on maintenance hemodialysis.

    Science.gov (United States)

    Weisbord, Steven D; Bossola, Maurizio; Fried, Linda F; Giungi, Stefania; Tazza, Luigi; Palevsky, Paul M; Arnold, Robert M; Luciani, Giovanna; Kimmel, Paul L

    2008-10-01

    Although symptoms are common and frequently severe in patients on maintenance hemodialysis, little is known about the relationship between cultural background and symptom burden. The aim of this study was to explore differences in the prevalence and severity of symptoms between American and Italian hemodialysis patients. We administered the 30-item Dialysis Symptom Index to American and Italian patients receiving maintenance hemodialysis during routine dialysis sessions. The prevalence and severity of individual symptoms were compared between patient populations, adjusting for multiple comparisons. Multivariable logistic regression and ordinal logistic regression were used to assess the independent associations of cultural background with the prevalence and severity of symptoms, respectively. We enrolled 75 American and 61 Italian patients. American patients were more likely to be black (36% vs. 0%, P<0.001) and diabetic (53% vs. 13%, P<0.001). Italian patients were more likely to report decreased interest in sex, decreased sexual arousal, feeling nervous, feeling irritable, and worrying (P<0.001, respectively). Adjustment for demographic and clinical variables had no impact on these cultural differences in symptom prevalence. The median severity of 11 symptoms including muscle soreness, muscle cramps, and itching was greater among Americans (P<0.001, respectively), although nearly all of these differences were rendered nonstatistically significant with adjustment for race, diabetes, and/or Kt/V. Italian patients receiving chronic hemodialysis report a greater burden of symptoms than American patients, particularly those related to sexual dysfunction and psychosocial distress. These findings suggest that cultural background may affect adaptation to chronic hemodialysis therapy.

  17. The Cause and Effect Correlation Analysis between Body weight & Blood Flows and Adequacy of Hemodialysis with Clinic Condition of Chronic Maintenance Hemodialysis Patients%血液透析患者体重和血流量与透析充分性的因果关系分析

    Institute of Scientific and Technical Information of China (English)

    门雯瑾; 丁致民

    2011-01-01

    通过测定维持性血液透析患者的体重和在线血流量、采用在线尿素清除率监测(on-line clearance monitoring,OCM)法测Kt/V值及单室尿素动力模型DaugirdasⅡ公式计算Kt/V值的两种方法,探讨患者体重和血流量与透析充分性之间的因果关系.结论为两种方法测得的血液透析患者的体重和血流量均与Kt/V密切相关,彼此之间存在因果关系,较低的体重,较高的血流量是保证透析充分性的重要指标.%To understand the cause and effect correlation analysis between body weight & blood flow and adequacy of hemo-dialysis with clinic condition of chronic maintenance hemodialysis patients. The body weight & blood flow of the chronic maintenance hemodialysis patients is a valuable reference for the hemodialysis quality. There is a cause and effect correlation between the body weight & blood flows and adequacy of dialysis

  18. Epidemiology investigation of initial hemodialysis patients in Shanxi province during 2010-2011

    Institute of Scientific and Technical Information of China (English)

    李静

    2013-01-01

    Objective To investigate the incidence,primary disease and vascular access of the initial hemodialysis patients in Shanxi province during 2010-2011.Methods A total of 3434 chronic renal failure(CRF) patientsstarting

  19. Is there a relationship between tryptophan dietary intake and plasma levels of indoxyl sulfate in chronic kidney disease patients on hemodialysis?

    Directory of Open Access Journals (Sweden)

    Jessyca Sousa de Brito

    Full Text Available Abstract Introduction: Gut microbiota is involved in generation of uremic toxins in chronic kidney disease (CKD patients on hemodialysis (HD, like indoxyl sulfate (IS that is originated from tryptophan amino acid fermentation. Objective: To evaluate the tryptophan intake by chronic renal failure patients on HD and its possible relationship with IS plasma levels. Methods: Participated of the study 46 patients with CKD on HD regular program (56.5% men; 52.7 ± 10.3 years; 63 (32.2-118.2 months on HD; BMI 25.6 ± 4.9 kg/m2. The tryptophan intake was evaluated by a 24-hours dietary recall (R-24h performed on 3 different days. Routine biochemical tests and anthropometric measurements were evaluated. IS plasma levels were determined by High Performance Liquid Chromatography (HPLC with fluorescent detection and the interleukin-6 (IL-6 plasma levels by immunoenzymatic method (ELISA, Enzyme Linked Immunosorbent Assay. Results: The average of tryptophan intake was according to recommendation, but IS plasma levels (35.0 ± 11.9 mg/L were elevated, however according to the EUTox values for uremic individuals. There was no correlation between the tryptophan intake and IS plasma levels. However, there was positive correlation between protein intake and tryptophan and variables used to evaluate lean body mass, and moreover, IS levels were positively associated with IL-6 (r = 0.6: p = 0.01. Conclusion: The present study suggests that tryptophan dietary intake may not be a determinant factor to IS levels. However, it suggests that gut microbiota may play an important role in systemic inflammation in patients with CKD.

  20. Fibromyalgia syndrome in Turkish hemodialysis patients.

    Science.gov (United States)

    Leblebici, Berrin; Özelsancak, Rüya; Yılmaz, Emine Ece; Doruk, Pınar

    2016-01-01

    The aim of our study was to evaluate the frequency of fibromyalgia syndrome (FMS) in hemodialysis (HD) patients and to assess whether this syndrome is associated with gender, age, duration of HD, or various laboratory parameters. This study was composed of 221 chronic HD patients (99 females and 122 males), and we recorded each participant's age, gender, causes of kidney failure, HD duration, education level, and symptoms related to FMS, which was diagnosed according to the 2010 American College of Rheumatology criteria. We documented the laboratory parameters for all patients. In addition, patients with FMS filled out the Fibromyalgia Impact Questionnaire. Twenty-two patients met the diagnostic criteria for FMS (9%), and there were no statistically significant differences related to age, gender, or HD duration between FMS and non-FMS groups (P > 0.05). In addition, the education levels were lower in patients diagnosed with FMS (P  0.05). There was a higher prevalence of FMS in HD patients than in the general population. Sleep disturbances, fatigue, education level, and cognitive symptoms were associated with FMS, but there was no correlation between the laboratory parameters and this condition.

  1. Late acceleration of glomerular filtration rate decline is a risk for hemodialysis catheter use in patients with established nephrology chronic kidney disease care.

    Science.gov (United States)

    Chin, Andrew I; Nguyen, Tuan A; Dinesh, Kumar P; Morfin, José A

    2015-07-01

    Chronic kidney disease (CKD) patients with established nephrology care have a high rate of tunneled dialysis catheters (TDC) as first vascular access when transitioning to hemodialysis (HD). We sought to identify factors associated with this problem. Patients who started HD and had prior CKD care within our renal clinic were categorized according to access type at incident HD. Clinical factors, all estimated glomerular filtration rates (eGFR), renal clinic attendance records, hospital admissions in the 6 months preceding HD start, and patient participation in predialysis education course were analyzed. Three hundred thirty-eight patients initiated HD, 107 received pre-HD CKD care within our clinics. Seventy patients started with a TDC. All groups started HD at similar eGFR values. The trajectory of eGFR decline in the 6 months prior to HD start was significantly more rapid in the TDC group. Patients in the TDC group had more acute health events in the prior 6 months. Multivariate modeling showed that failure to attend a predialysis education course and having a more rapid rate of eGFR decline in the 6 months prior to dialysis initiation were both associated with TDC use. Patients with CKD nephrology care who initiated HD with a TDC as first vascular access had a more rapid rate of decline in eGFR in the months preceding dialysis start and were less likely to have attended our predialysis education course. This appears to correspond with the observed increased number of emergency and hospital visits in the 6 months prior to end-stage renal disease.

  2. Restless legs syndrome in patients on chronic hemodialysis in a Brazilian city: frequency, biochemical findings and comorbidities

    Directory of Open Access Journals (Sweden)

    Goffredo Filho Gilberto S.

    2003-01-01

    Full Text Available OBJECTIVE: To evaluate the frequency of restless legs syndrome (RLS in patients with chronic renal failure (CRF in Petrópolis, Brazil, and investigate associations between the syndrome and: demographic characteristics, biochemical variables and comorbidities. METHOD: A cross-sectional study in which we interviewed 176 patients on dialytic therapy based on criteria elaborated by the International Restless Legs Syndrome Study Group, and compared data of patients with and without RLS. RESULTS: The frequency was 14.8 %. There were no significant differences between the two groups in demographic and biochemical variables investigated (iron, creatinine, intact parathyroid hormone, hemoglobin, calcium, phosphate. We found no association between RLS and the most common comorbidities, except for chronic glomerulonephritis (CGN (OR = 3.84, p < 0.01. CONCLUSION: In the studied population RLS is a common disorder, and is not associated with the investigated biochemical abnormalities. A higher frequency of RLS in subjects with CGN is a finding that needs further investigation.

  3. Opportunistic intestinal parasites in hemodialysis patients - a systematic literature review

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    Solimar Almeida de Oliveira

    2013-12-01

    Full Text Available The objective of this systematic literature review was to identify the occurrence of opportunistic enteric parasites in chronic kidney patient undergoing hemodialysis. The review consisted on searching articles published on MEDLINE, LILACS, SciELO, and PubMed databases between 1991 and 2013. A total 178 articles were identified, ten of which were considered relevant for the present study. In the referred studies, the researchers demonstrated that immunosuppressed patients undergoing hemodialysis are potentially infected by opportunistic enteric agents. Further studies are needed on this topic, as there is a growing global concern with chronic kidney diseases and the potential for these patients contracting opportunistic diseases, which, inclusively, could contaminate hospital environments with opportunistic enteric protozoa. Descriptors: Renal Dialysis; Blastocystis hominis; Cryptosporidium; Cyclospora; Isospora.

  4. DETERMINATION OF PROTEIN CATABOLIC RATE IN PATIENTS ON CHRONIC INTERMITTENT HEMODIALYSIS - UREA OUTPUT MEASUREMENTS COMPARED WITH DIETARY-PROTEIN INTAKE AND WITH CALCULATION OF UREA GENERATION RATE

    NARCIS (Netherlands)

    STEGEMAN, CA; HUISMAN, RM; DEROUW, B; JOOSTEMA, A; DEJONG, PE

    1995-01-01

    We assessed the agreement between different methods of determining protein catabolic rate (PCR) in hemodialysis patients and the possible influence of postdialysis urea rebound and the length of the interdialytic interval on the PCR determination. Protein catabolic rate derived from measured total u

  5. An assessment of the quality of life in hemodialysis patients using the WHOQOL-BREF questionnaire.

    Science.gov (United States)

    Sathvik, B S; Parthasarathi, G; Narahari, M G; Gurudev, K C

    2008-10-01

    A cross-sectional study was conducted to evaluate the quality of life (QOL) of hemodialysis patients. An attempt was made to compare the QOL of hemodialysis patients with the QOL of the general population, renal transplant patients, and patients with a chronic disease, in this case, asthma. The WHOQOL-BREF questionnaire was used to assess the quality of life. Hemodialysis patients who had completed three months of maintenance hemodialysis (n = 75) were enrolled into the study. The quality of life of hemodialysis patients was found to be significantly impaired (P WHOQOL-BREF domains. Only in the environmental dimension was the quality of life of hemodialysis patients found to be significantly lower than that of the asthma patients. Female hemodialysis patients showed significantly (P WHOQOL-BREF. A positive association was seen between higher education and the psychological functioning and the environmental dimensions of WHOQOL-BREF. Thus, the quality of life of hemodialysis patients was found to be considerably impaired when compared to that of healthy individuals of the general population as well as of renal transplant patients.

  6. Inhibition of gastric secretion by omeprazole and efficiency of calcium carbonate on the control of hyperphosphatemia in patients on chronic hemodialysis.

    Science.gov (United States)

    Hardy, P; Sechet, A; Hottelart, C; Oprisiu, R; Abighanem, O; Said, S; Rasombololona, M; Brazier, M; Moriniere, P; Achard, J M; Pruna, A; Fournier, A

    1998-07-01

    Contradictions exist in the literature regarding the effect of gastric secretion inhibition on phosphate absorption. In healthy controls, omeprazole would decrease the hyperphosphatemia or the hyperphosphaturia induced by an acute phosphate load, suggesting an inhibition of phosphate absorption. In chronic hemodialysis patients, gastric hypersecretion is associated with hyperphosphatemia, but inhibition of gastric hypersecretion by ranitidine in those receiving calcium carbonate (CaCO3) as a phosphate binder would paradoxically exacerbate their hyperphosphatemia. Because of these conflicting observations, we performed an open crossover study on 16 chronic stable hemodialyzed patients with a daily mean intake of 9.4+/-4 g of CaCO3, and we compared the plasmatic predialysis levels of phosphate, calcium, protides, bicarbonates, intact parathyroid hormone (PTH), urea, and creatininemia during 2 successive periods of 2 months, the first one without omeprazole and the second one with 20 mg omeprazole intake in the morning. Phosphatemia increased with omeprazole but not significantly from 1.80+/-0.38 to 1.89+/-0.42 mM whereas corrected calcemia decreased significantly (p = 0.04) from 2.41+/-0.18 to 2.36+/-0.16 mM as did bicarbonatemia from 26.7+/-3.5 to 25.7+/-3.1 mM (p omeprazole increases the plasmatic phosphate predialytic level but in a nonsignificant way. This increase may be explained by a slight but significant concomitant decrease of calcemia and bicarbonatemia. These results do not support the phosphate binding efficiency of CaCO3 being decreased by the inhibition of gastric acid secretion.

  7. Epidemiology of hemodialysis patients in Aleppo city

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    Moukeh Ghamez

    2009-01-01

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

  8. Experiences of health care of the diabetic chronic renal failure patients treated with hemodialysis%糖尿病性慢性肾功能衰竭的血液透析护理

    Institute of Scientific and Technical Information of China (English)

    黄郢荷

    2012-01-01

    Objective; To study the health care of the diabetic chronic renal failure patients treated with hemodialysis. Methods: From February 2009 to May 2011 , 105 cases of diabetic chronic renal failure treated with hemodialysis in our hospital were collected and the routine care was used. Results; The patients make good progress in hemodialysis treatment. During hemodialysia, complications such as 10 cases of hypotension, 5 cases of hypertension and 3 cases of imbalance syndrome were also observed. Conclusion: Health care can significantly improve patients' ability to resist disease, to reduce the incidence of complications of hemodialysis and health care costs, to increase and improve patient quality of life.%[目的]:总结糖尿病性慢性肾功能衰竭的血液透析护理要点.[方法]:选取2009年2月~2011年5月我院进行血液透析的105例糖尿病性慢性肾功能衰竭患者,认真细致做好透析前、透析时、透析后护理.[结果]:患者均安全完成血液透析疗程.透析过程中10例出现低血压,5例出现高血压,3例出现失衡综合征,1例出现体温升高,1例出现血液分层、凝血,1例出现心肌梗死.[结论]:细致周到的护理可提高患者抵御疾病的能力,降低透析并发症的发生和医疗成本,提高并改善患者的生活质量.

  9. Investigation of chronic pain in maintenance hemodialysis patients%维持性血液透析患者慢性疼痛的调查

    Institute of Scientific and Technical Information of China (English)

    高芳; 刘功俭; 孙东

    2011-01-01

    目的 调查维持性血液透析( MHD)患者慢性疼痛的发生率,并探讨疼痛发生的原因及其对生活质量的影响.方法 以徐州医学院附属医院血液净化中心70例MHD患者为对象,根据是否有慢性疼痛,分为疼痛组32例和非疼痛组38例.疼痛组应用疼痛数字分级法(NRS,1~10)判定疼痛强度.检测两组患者的甲状旁腺素(PTH)、骨密度(BMD)和β2微球蛋白(β2-MG)水平;用贝克德抑郁指数(BDI)自评量表判断抑郁程度;用匹兹堡睡眠质量指数( PSQI)判断失眠程度.对疼痛组患者疼痛强度与PTH、BMD、β2-MG、BDI和PSQI评分进行相关性分析.结果 MHD患者疼痛的发生率为45.7%;NRS值为5.71±1.86 (95%CI,5.04~6.38).两组的PTH、BMD和β2-MG、BDI评分、PSQI评分差异均有统计学意义(均P<0.01).疼痛组的疼痛强度与PTH、β2-MG、PSQI评分、BDI评分均呈正相关,与BMD呈负相关.结论 MHD患者常常有慢性疼痛,疼痛的部位不同定,且大多数表现为中度疼痛.慢性疼痛加重患者的抑郁、失眠.疼痛的发生可能与PTH、β2-MG和BMD水平变化有关.%Objective To investigate the incidence and the cause of chronic pain in maintenance hemodialysis (MHD) patients,and the effect of chronic pain on quality of life.Methods Seventy MHD patients in dialysis centre of our hospital were enrolled in the study and divided into 2 groups according to pain symptoms.There were 32 patients with chronic pain in pain group,and 38 patients without chronic pain in painless group.Pain degree was evaluated by numerical rating scale (NRS,1 to 10) in pain group.Parathyroid hormone (PTH),β2-microglobulin (β2-MG) and bone mineral density (BMD) of all the patients were measured.Depression and insomnia degrees were examined by Beck depression index (BDI) and Pittsburgh sleep quality index (PSQI) respectively.Correlations were performed among parameters. Results The incidence of chronic pain in MHD patients was 45.7% and the

  10. Increasing Vaccination Rates in a Pediatric Chronic Hemodialysis Unit.

    Science.gov (United States)

    Geer, Jessica J

    2016-01-01

    Children with chronic kidney disease (CKD) are at an increased risk for serious complications from vaccine-preventable childhood diseases. Despite this risk, vaccination rates remain low. The barriers to vaccination in the pediatric population on dialysis are multifactorial. The advanced practice registered nurse (APRN) is well poised to serve as a wellness champion for this chronic population. This article chronicles an APRN-led quality improvement project to increase vaccination rates to 100% in an outpatient pediatric population on hemodialysis. A quality improvement system was created to systematically review immunizations upon admission to the hemodialysis unit and annually thereafter. Over a two-year period, immunization rates improved significantly.

  11. Evaluation of Ulnar neuropathy on hemodialysis patients

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    Babak Vahdatpour

    2012-01-01

    Full Text Available 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 involvement prevalence during dialysis. Materials and Methods: This cross-sectional study started in June 2011 and completed in December 2011. The patients receiving dialysis with at least one symptom or sign of ulnar nerve involvement underwent nerve conduction studies. Electromyography testing (EMG performed to confirm the ulnar neuropathy. To review the ulnar nerve, patients must be in supine position with arm in 90° abduction and elbow in 135° flexion. We stimulated the ulnar nerve at three different points, including 6 cm above and 4 cm below the elbow and over the wrist. According to the electrophysiological data, the intensity of nerve entrapment and possibility of associated polyneuropathy determined. Results: Clinically and electrodiagnostically, evidence confirmed that ulnar neuropathy was present in 11 (27.5% of 40 hemodialysis patients and in 10 (25% of 40 peritoneal patients (P value: 0.83. Also, the prevalence of median neuropathy in hemodialysis and peritoneal dialysis patients was 14 (35% and 10 (25%, respectively (P value: 0.33. Conclusion: The frequency of median and ulnar neuropathy in hemodialysis patients is more than peritoneal dialysis, but this different is not significant. In addition, comparing sitting position with prolonged elbow flexion and supine position with elbow extension during hemodialysis, recommended doing hemodialysis in later position with using an elbow pad.

  12. Occult hepatitis B virus infection in Egyptian hemodialysis patients with or without hepatitis C virus infection

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    Hisham Ismail

    2010-08-01

    Full Text Available Hisham Ismail1*, Mohamed Soliman2, Nahed Ismail31Department of Molecular Diagnosis, GEBR Institute, 2Department of Clinical Pathology, College of Medicine, Menoufia University, Menoufia, Egypt; 3Department of Pathology and Department of Microbiology and Immunology, Meharry Medical College, Nashville, Tennessee, USA *Current affiliation: College of Medicine, Qassim University, Saudi ArabiaAbstract: Hepatitis B virus (HBV and hepatitis C virus (HCV infections are frequent in patients with end-stage renal disease who are on maintenance hemodialysis. There are limited data about the prevalence of occult HBV infection in patients on long-term hemodialysis. Occult HBV is defined as positive HBV DNA in the blood in the absence of hepatitis B surface ­antigen in the serum. In this study, we determined the prevalence of occult HBV in hemodialysis patients with or without HCV infection. The study included 116 patients with end-stage renal disease on chronic hemodialysis, of whom 64 patients were HCV RNA positive (Group 1, and 52 were HCV RNA negative (Group 2. We found that four of 64 (6.3% hemodialysis patients with HCV infection (Group 1 had occult HBV, while only two of 52 (3.8% hemodialysis patients without HCV (Group 2 had occult HBV. We then examined whether gender-matched ­hemodialysis patients with positive HBV DNA in the two hemodialysis groups differed in specific parameters, ie, age, degree of liver dysfunction, and presence of ­coinfection with schistosomiasis, a common parasitic infection of the liver. We found no significant difference between the groups having positive HBV DNA with regard to serum levels of liver enzymes, aspartate transaminase, albumin, and hepatitis B core antigen (P > 0.05. However, we detected significantly higher levels of alanine transaminase, a prolonged duration of hemodialysis, and higher levels of schistosomal antibodies in Group 1 than in Group 2. Interestingly, we found that the presence of schistosomal

  13. Perceived illness intrusion among patients on hemodialysis

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    Bapat Usha

    2009-01-01

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

  14. Prevalence of Secondary Hyper Parathyroidism in Hemodialysis Patients

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    F Behzad

    2007-04-01

    Full Text Available Introduction: Osteodystrophy is one of the long term complications of chronic renal failure and is expressed in two forms;low turn over and high turn over. It is an important cause of morbidity in patients with renal failure and if diagnosed and managed properly, many problems of these patients can be resolved. In this study we evaluated the prevalence of hyperparathyroidism in hemodialysis patients and its correlation with different factors. Methods: This study was an analytic, observational study that was done by the cross- sectional method. We formatted a questionnaire for hemodialysis patients who were enrolled in the study over a period of 6 months. Fasting blood samples (5-10c.c were drawn to measure levels of PTH(parathyroid hormone ,calcium, phosphorous and alkaline phosphatase. Skull and wrist X-rays were also taken and the radiologist evaluated them with regards to hyperparathyroidism. Results: In the 80 patients studied, prevalence of hyperparathyroidism was 45% (36 patients. 44 patients were diabetics. Among different factors, hyperparathyroidism did not correlate with frequency and duration of dialysis, age, sex ,familial history, diabetes, hypertension , bone pains, muscle weakness, purities and level of calcium and phosphorous. But there was a significant relationship between hyperparathyroidism and alkaline phosphatase levels and radiological findings. Conclusion: We can use alkaline phosphatase levels and/or radiographic changes for evaluation of renal osteodystrophy in hemodialysis patients and prevent complications by early diagnosis and proper management.

  15. Lentidão cognitiva e psicomotora em hemodialisados crônicos Cognitive and psychomotor slowing in chronic hemodialysis patients

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    Wagner Martignoni de Figueiredo

    2007-09-01

    Full Text Available FUNDAMENTOS: A encefalopatia urêmica subclínica pode levar a comprometimento ocupacional de difícil diagnóstico por requerer o emprego de medidas sensíveis. PROPÓSITO: Testar as hipóteses de que (1 pacientes em hemodiálise crônica (HDC se saem pior do que controles normais em uma bateria de desempenho, (2 um dia extra de uremia comprometeria ainda mais o comprometimento neuropsicológico desses pacientes, e (3 a uremia dificultaria a melhora do desempenho em uma segunda sessão de testes. MÉTODO: A agilidade cognitiva e motora de 28 pacientes em HDC foi avaliada com os testes de Trilhas (A e B, Algarismos e Símbolos, e Stroop. RESULTADOS: (1a o desempenho cognitivo e motor se encontravam mais lento nos pacientes, (2a um dia a mais de uremia comprometeu o desempenho na Parte B do Teste de Trilhas, e (3a pacientes em HDC apresentaram redução da capacidade de aprender novos procedimentos. CONCLUSÃO: Pacientes em HDC podem apresentar uma "encefalopatia subclínica" cuja detecção pode requerer a aplicação de testes sensíveis. A agilidade mental e motora, e a capacidade de aprender novas rotinas estão comprometidas em, pelo menos, alguns pacientes em HDC com cognição global normal.BACKGROUND: The diagnosis of "subclinical uremic encephalopathy" may need the administration of sensitive tests. PURPOSE: To test the hypotheses that (1 patients on chronic hemodialysis (CHD fare worse than normal controls on a brief performance battery, (2 one extra-day of uremia further jeopardizes the neuropsychological performance of CHD patients, and (3 uremia impairs improvement on a second testing session. METHOD: The cognitive and motor agility of 28 patients on CHD were assessed with the Trails A and B, Digit Symbol, and Stroop tests. RESULTS: (1a cognitive and psychomotor performance were slowed in patients, (2a one extra-day of uremia impaired performance further on Trail Making B, and (3a CHD patients had a decreased ability to learn novel

  16. Near-Death Experience in Patients on Hemodialysis.

    Science.gov (United States)

    Johnson, Sharona

    2015-01-01

    Near-death experience (NDE) is a phenomenon that occurs when a person loses consciousness and senses a disconnection from the world around them. Patients on hemodialysis can experience multiple NDEs over their lifetime. An NDE during a hemodialysis session while connected to a hemodialysis machine can present challenges to this patient population and the nurses caring for them. The purpose of this article is to discuss the potential after effects of NDE in patients who experience this phenomenon while connected to a hemodialysis machine and to propose that nurses lead the healthcare team in addressing the after effects of NDE in patients on hemodialysis.

  17. Subjective sleep efficiency of hemodialysis patients

    NARCIS (Netherlands)

    B.C.P. Koch; J.E. Nagtegaal; E.C. Hagen; W.Th. van Dorp; J.B.S. Boringa; G.A. Kerkhof; P.M. ter Wee

    2008-01-01

    Background: Sleep disturbances have a major influence on quality of life. A commonly used measure of sleep disturbances is sleep efficiency. The purpose of this study was to investigate the prevalence of decreased subjective sleep efficiency in hemodialysis patients. An additional goal was to identi

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

    Science.gov (United States)

    2014-10-09

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

  19. Evaluation of Conner′s Continuous Performance Test in Hemodialysis Patients

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    Najafi Mostafa

    2008-01-01

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

  20. Sleep Disorders in ESRD Patients Undergoing Hemodialysis

    OpenAIRE

    Mohammad Reza Abassi; Amin Safavi; Masoumeh Haghverdi; Babak Saedi

    2016-01-01

    Kidney failure affects different aspects of normal life. Among different manifestations, sleep problem can be considered as a common complaint of ESRD (End Stage Renal Disease) patients. In this study, we aimed to investigate the interrelationship between sleep disorders in ESRD patients and their characteristics. Through a cross-sectional study (2010-2011), 88 ESRD patients undergoing maintenance hemodialysis thrice weekly were recruited to enter the study. We used a self-administered questi...

  1. Hypoalbuminemia and oxidative stress in patients on renal hemodialysis program

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    Lais Lima de Castro

    Full Text Available Introduction: Albumin is considered an important extracellular antioxidant molecule. hypoalbuminemia is a strong and independent predictor of mortality in patients on hemodialysis. The present study evaluated the relation between hypoalbuminemia and oxidative stress by comparing superoxide dismutase activity, lipid peroxidation and antioxidant micronutrient consumption in chronic renal failure patients. Methods: A case-control study was carried out with 64 patients of both sexes aged 18 to 59 years. The patients with hypoalbuminemia (ALB <3.5 g/dL were defined as case (n = 26 and control (n = 38 those with ALB ≥ 3.5 g/dL. Determinations of activity superoxide dismutase (SOD and nitric oxide production by the contraction of nitrite in erythrocytes, concentration of malondialdehyde (MDA in plasma, lipid profile and micronutrient antioxidants intake were performed. For comparisons between groups, the Student t test was used. Possible associations between variables were tested using the chi-square test and Pearson correlation test. Results: Consumption of copper was significantly lower (p < 0.05 in the group with hypoalbuminemia. There was a positive correlation between the concentrations of albumin and intake copper (r = 0.280. Negative correlation was found between albumin and MDA concentrations. Conclusion: Hypoalbuminemia is associated with increased lipid peroxidation, and can contribute to oxidative stress in chronic renal failure patients. Additionally, patients with chronic renal disease undergoing hemodialysis evaluated in this study had reduced consumption of cooper.

  2. Immune disorders in hemodialysis patients.

    Science.gov (United States)

    Sharif, Mohammad Reza; Chitsazian, Zahra; Moosavian, Mehdi; Raygan, Fariba; Nikoueinejad, Hassan; Sharif, Ali Reza; Einollahi, Behzad

    2015-03-01

    Immunologically, End Stage renal Disease (ESRD) is associated with some disorders in both innate and adaptive immune system in such a form that there is a coexistence of both immune activation and immune suppression. Although these disorders are complex yet thoroughly unknown, there is a close relation between the progressively defective immune system with side effects as well as mortality causes including cardiovascular problems, infections, and malignancies. From the other point, chronic inflammation as a major determinant of "dialysis syndrome" (including malnutrition, cachexia, and vasculopathy) is considered as the main factor of inability and mortality in dialysis patients. Such inflammation is generally arisen from immune system response to uremia and individual's repetitive contact with dialysis instruments and, in the long term, leads to premature aging via intensifying tissue degeneration. Therefore, the immune system is known as one of the most important therapeutic targets to reduce morbidity and mortality in uremic and dialysis patients.   This review addresses different aspects as well as mechanisms of immune system dysfunction and possible therapeutics in dialysis patients.

  3. Does pharmacotherapy improve cardiovascular outcomes in hemodialysis patients?

    Science.gov (United States)

    Mittal, Mayank; Aggarwal, Kul; Littrell, Rachel L; Agrawal, Harsh; Alpert, Martin A

    2015-10-01

    Cardiovascular disease (CVD) occurs commonly in patients with chronic kidney disease (CKD) including those treated with hemodialysis (HD), and is associated with poor outcomes in this population. Pharmacologic management of hypertension, dyslipidemia, acute and chronic coronary artery disease, and atrial fibrillation in the general population is supported by the results of high-quality, randomized, controlled clinical trials. Pharmacotherapy of these disorders in the general population is effective in improving clinical outcomes. In contrast, information concerning the effect of pharmacotherapy on mortality and cardiovascular outcomes in patients with CKD, and particularly in HD patients, is limited. Available data suggest that, in general, pharmacotherapy of hypertension and dyslipidemia, anti-platelet therapy of CVD, and anticoagulant therapy in patients with atrial fibrillation are less effective in HD patients than in the general population or even in patients with early stage of CKD.

  4. Uterus neuroendocrine tumor - a severe prognostic factor in a female patient with alcoholic cirrhosis undergoing chronic hemodialysis.

    Science.gov (United States)

    Sinescu, Ruxandra Diana; Niculae, Andrei; Peride, Ileana; Vasilescu, Florina; Bratu, Ovidiu Gabriel; Mischianu, Dan Liviu Dorel; Jinga, Mariana; Checheriţă, Ionel Alexandru

    2015-01-01

    There is increased evidence that end-stage renal disease patients, especially the hemodialyzed population, may present various unexpected forms of complications, contributing to a poor prognosis. Furthermore, neuroendocrine tumors, rarely encountered in daily practice, present in dialyzed individuals can significantly exacerbate the inflammatory condition with negative impact on patients' quality of life. We present an unusual case of uterus neuroendocrine tumor with multiple metastases in a 49-year-old female hemodialyzed patient with a history of alcoholic liver cirrhosis and uterus fibromatous. Multiple endoscopic techniques (e.g., upper endoscopy, colonoscopy, upper and lower echoendoscopy), histological evaluation of biopsy samples from involved areas (the operatory piece) were performed in order to complete and refine the diagnosis.

  5. Prevalence and Severity of Anemia in Pediatric Hemodialysis Patients; A Single Center Study

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    Alaleh Ghasari

    2007-04-01

    Full Text Available Objective: To determine the prevalence and severity of anemia in children and adolescents on chronic hemodialysis and to identify independent predictor for anemia in children on hemodialysis. Material & Methods: A cross sectional study was performed between September 2005 and January 2006. The study population consisted of 25 patients aged 7−20 years on chronic hemodialysis from pediatric hemodialysis centers in Isfahan, Iran. Findings: A total of 22 (82% patients had hemoglobin level of 200 pg/ml in 16 patients (66% and >400 pg/ml in 9 patients (37.5%. There was a reverse correlation between PTH level>200 pg/ml and hemoglobin level (r=-0.505, P=0.046. Conclusion: The prevalence of anemia in children on hemodialysis in Isfahan appears to be higher than that reported in the other studies in spite of extensive use of rHuEPO and iron supplementation. We found this to be especially true for patients new on hemodialysis (less than 6 months, low albumin and severe hyperparathyroidism.

  6. Nutritional Status in Children with Chronic Renal Failure on Hemodialysis

    OpenAIRE

    Zaki, Moushira Erfan; Hassan, Mona Mamdouh; Bazaraa, Hafez Mahmoud; Ahmed, Hany Fathy; Mahmoud Badr, Ahmed Mohamed

    2014-01-01

    Background and Aim: Growth retardation is still an important manifestation of children with chronic renal failure (CRF). The aim of this study is to evaluate the growth in relation to nutritional status in Egyptian children with CRF on hemodialysis.Subjects and Methods: The study included 30 Egyptian children above the age of six years on regular haemodialysis at the Haemodialysis Unit of the Centre of Pediatric Nephrology and Transplantation of Cairo University. Anthropometry, biochemical pa...

  7. Functional Status of Patients on Maintenance Hemodialysis

    Directory of Open Access Journals (Sweden)

    Akash Nabil

    1999-01-01

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

  8. Antierythropoietin Antibodies in Hemodialysis Patients Treated with Recombinant Erythropoietin

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    Savaş ÖZTÜRK

    2014-05-01

    Full Text Available OBJECTIVE: Erythropoietin resistance is a serious problem in patients treated with recombinant erythropoietin. Antierythropoietin antibodies are considered to be one of the causes of this resistance. MATERIAL and ME THODS: We investigated antierythropoietin antibodies in chronic hemodialysis patients and compared the results with healthy controls by means of establishing an ELISA method. A total of 121 chronic hemodialysis patients receiving recombinant erythropoietin were included in the study. The patients were subdivided according to the type of recombinant erythropoietin (erythropoietin-α or erythropoietin-β they had been treated with in the last six months. RESULTS: The absorbance values of patients were compared with the absorbance values of the control group by a specific and reproducible method. LOD (limit of detection and LOQ (limit of quantitation values were also calculated. The difference in the absorbance values between the therapy and control groups was statistically significant. CONCLUSION: Both erythropoietin-α and erythropoietin-β induce production of antibodies against erythropoietin. Anti rh-EPO antibodies may play a role in EPO resistance.

  9. Serum Protein Profile Alterations in Hemodialysis Patients

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-11-18

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

  10. Barriers to adult hemodialysis patients' self-management of oral medications.

    Science.gov (United States)

    Browne, Teri; Merighi, Joseph R

    2010-09-01

    Hemodialysis patients use a variety of oral medications on a daily basis to control their kidney disease and comorbid illnesses. Under the new paradigm of kidney disease care for dialysis units outlined in the 2008 US Centers for Medicare & Medicaid Services Conditions for Coverage, there has been a formal shift in the role of the hemodialysis patient from a passive participant in care planning to a fully collaborative member of the interdisciplinary team. In the chronic disease care field, the focus from patient compliance or patient adherence to patient self-management complements this paradigm shift in dialysis care. In this narrative review, we discuss key barriers to adult hemodialysis patient self-management of oral medications that include pill burden, demographic and socioeconomic variables, psychosocial factors, health literacy, patient satisfaction, and health beliefs. We further examine these barriers in the context of the 2008 Medicare Conditions for Coverage. To promote hemodialysis patients' self-management of oral medication regimens, additional research and behavioral interventions are needed to help hemodialysis patients overcome obstacles that impede their ability to effectively manage chronic illness and improve health outcomes.

  11. Pregnancy in End Stage Renal Disease Patients on Hemodialysis

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    Rohina Swaroop

    2009-07-01

    Full Text Available Pregnancy in patients suffering from chronic renal failure is still rare due to numerous factors that impairfertility. Even if pregnancy does occur pregnancy outcome with a live birth has a low success rate.Moreover there is a significant risk of worsening of renal disease in the mother.The purpose of hemodialysisis not only to maintain life but also to make the quality of life as normal as possible for the patient.Propogation of life is basic to all life forms and the ability to do so can be considered as a success in apatient of chronic renal failure. As patients of End stage renal disease rarely complain about sexual orgynecological problems ,considering them trivial as compared to their more life threatening renal condition,it is the physicians role to be attentive to these aspects of the disease.We hereby report 2 cases ofsuccessful pregnancy managed on hemodialysis by Northwest Louisiana Nephrology

  12. Effects of distance between residence and hemodialysis unit on cardiovascular complications and treatments of maintenance hemodialysis patients

    Institute of Scientific and Technical Information of China (English)

    袁静

    2013-01-01

    Objective To explore the effects of etiological classification and the distance between residence and hemodialysis unit on cardiovascular complications and treatments in maintenance hemodialysis (MHD) patients.Methods A total of 756 MHD patients were collected from 12 hemodialysis centers of Guiyang,China between January

  13. Higher Serum Levels of Free ĸ plus λ Immunoglobulin Light Chains Ameliorate Survival of Hemodialysis Patients

    DEFF Research Database (Denmark)

    Thilo, Florian; Caspari, Christina; Scholze, Alexandra;

    2011-01-01

    Background/Aims: Impaired immune function is common in patients with chronic renal failure. Now, we determined whether serum levels of free immunoglobulin light chains predict mortality in patients with chronic kidney disease stage 5 on hemodialysis. Methods: We performed a prospective cohort study...... of 160 hemodialysis patients with a median follow-up of 15 months (interquartile range, 3-44 months). Serum levels of free κ and λ immunoglobulin light chains were measured at the start of the study. The primary end point was mortality from any cause. Results: In survivors, median serum levels of free κ....../l (χ(2) = 5.91; p = 0.015 by log-rank, Mantel-Cox, test). We performed univariate and multivariate regression analysis showing that older age and lower serum levels of free κ plus λ immunoglobulin light chains predicted mortality in hemodialysis patients. Conclusion: Higher serum levels of free κ plus...

  14. 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

    OpenAIRE

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

    2011-01-01

    Introduction: Chronic kidney disease promotes changes in the zinc nutritional status and in the antioxidant defense system. This study assessed the relationship between the parameters of the zinc nutritional status and the activity of superoxide dismutase in patients with chronic renal failure who are receiving hemodialysis. Methods: 134 individuals, aged between 18 and 85 years, were divided into two groups: case group (hemodialyzed patients, n = 63) and control group (n = 71). Zinc concentr...

  15. Prevalence and risk factors of hepatitis B and C viruses among hemodialysis patients in Isfahan, Iran

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    Hamid Kalantari

    2014-01-01

    Full Text Available Background: The aim of this study was to assess the prevalence of hepatitis B virus (HBV and hepatitis C virus (HCV and their associated risk factors among hemodialysis patients in Isfahan, Iran in 2011. Materials and Methods : In this cross-sectional study, a total of 499 chronic hemodialysis patients from eight governmental hemodialysis centers were tested. Demographic information, time duration on hemodialysis, history of blood transfusion, and the number of transfused blood units as risk factors to HBV and HCV infections were calculated. The status of HBsAg and anti-HCV was assessed by serological testing. Results: The overall prevalence of HBV-positive and HCV-positive among study population was 1.2% and 5.2%, respectively. Age, sex, and time duration on hemodialysis were not statistically significant in HBV- and HCV-patients compared with other hemodialysis patients (P0 > 0.05. History of blood transfusion and the number of transfused blood units in HBV infected patients were similar to other patients (P > 0.05. The main risk factors in hemodialysis patients infected by HCV were history of blood transfusion and the number of transfused blood units (P < 0.0001. Conclusion: In conclusion, the prevalence of HBV and HCV infections in hemodialysis centers in Isfahan is lower than in some other cities of Iran. History of blood transfusion and the number of blood units transfused might be a risk factor for HCV gaining. However, further studies are needed to assess the role of other demographic and clinical risk factors in these patients.

  16. Restless legs syndrome in hemodialysis patients

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    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.

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

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    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.

  18. Epidemiology, surveillance, and prevention of hepatitis C virus infections in hemodialysis patients.

    Science.gov (United States)

    Patel, Priti R; Thompson, Nicola D; Kallen, Alexander J; Arduino, Matthew J

    2010-08-01

    Hepatitis C virus (HCV) infection is the most common chronic blood-borne infection in the United States; the prevalence in maintenance hemodialysis patients substantially exceeds that in the general population. In hemodialysis patients, HCV infection has been associated with increased occurrence of cirrhosis and hepatocellular carcinoma and increased mortality. Injection drug use and receipt of blood transfusions before 1992 has accounted for most prevalent HCV infections in the United States. However, HCV transmission among patients undergoing hemodialysis has been documented frequently. Outbreak investigations have implicated lapses in infection control practices as the cause of HCV infections. Preventing these infections is an emerging priority for renal care providers, public health agencies, and regulators. Adherence to recommended infection control practices is effective in preventing HCV transmission in hemodialysis facilities. In addition, adoption of routine screening to facilitate the detection of incident HCV infections and hemodialysis-related transmission is an essential component of patient safety and infection prevention efforts. This article describes the current epidemiology of HCV infection in US maintenance hemodialysis patients and prevention practices to decrease its incidence and transmission.

  19. Fibroblast growth factor-23 levels in maintenance hemodialysis patients in India

    Science.gov (United States)

    Anandh, U.; Mandavkar, P.; Das, B.; Rao, S.

    2017-01-01

    Fibroblast growth factor-23 (FGF-23) levels start rising early in patients with chronic kidney disease and is implicated in cardiovascular and overall mortality of hemodialysis patients. We conducted a prospective observational cohort study in stable dialysis patients looking into the levels of FGF-23 in hemodialysis patients and its association with various demographic and biochemical variables and mortality. A total of 91 patients were enrolled in the study. The mean FGF-23 levels were very high (1152.7 pg/ml). FGF-23 levels were significantly associated with serum phosphorus and parathyroid hormone (PTH) levels in univariate and multivariate analysis. No significant association between FGF-23 and cardiovascular comorbidities and overall mortality was seen. FGF-23 levels rise exponentially in maintenance hemodialysis patients. There is a strong association between FGF-23 and phosphorus and PTH levels. No association between FGF-23 and mortality was noted in our patients. PMID:28182071

  20. Pro-calcitonin and inflammation in chronic hemodialysis

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    Hernán Trimarchi

    2013-10-01

    Full Text Available Procalcitonin (PCT has emerged as a marker of infection, a frequent complication in hemodialysis (HD. We analyzed PCT levels in chronic non-acutely infected HD subjects, assessed its correlation with inflammatory and nutritional markers and propose a PCT reference value for non-infected HD patients.In an observational cross-sectional study, 48 chronic HD patients and 36 controls were analyzed. Variables: age, gender, time on HD; diabetes; vascular access, PCT, C-reactive protein (CRP, albumin, malnutrition inflammatory score (MIS, hematocrit, leukocyte count, and body mass index (BMI. Subsequently, control (G1, n = 36, 43% vs. non-infected patients (G2, n = 48, 57% groups were compared. In control subjects (G1, age: 54.3 ± 13.7 years, range (r: 30-81; males: 19 (53%; median PCT 0.034 ng/ml (r: 0.02-0.08; median CRP 0.80 mg/dl (r: 0.36-3.9; p95 PCT level: 0.063 ng/ml. In G2, age: 60.2 ± 15.2 years; males 32 (67%, time on HD: 27.0 ± 24.4; diabetics: 19 (32%; median PCT: 0.26 ng/ml (r: 0.09-0.82; CRP: 1.1 mg/dl (r: 0.5-6.2; p95 PCT level: 0.8 ng/ml. In control subjects, PCT and CRP were significantly lower than in G2: PCT: 0.034 vs. 0.26 ng/ml, p = 0.0001; CRP: 0.8 vs. 1.1 mg/dl, p = 0.0004. PCT-CRP correlation in G2: ρ = 0.287, p = 0.048. PCT and CRP concentrations are elevated in chronic non-acutely infected HD subjects, independently of infection, diabetes and vascular access. A p95 PCT level of 0.8 ng/ml may be considered as the upper normal reference value in non-acutely infected HD subjects. The PCT cut-off level in HD is yet to be determined in HD.

  1. Five months of physical exercise in hemodialysis patients

    DEFF Research Database (Denmark)

    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...... of HD patients' physical capacity, self-rated health and risk factors for cardiovascular disease. METHODS: 33 HD patients were included in the study. INCLUSION CRITERIA: HD for more than 3 months, age >18 years. EXCLUSION CRITERIA: Diabetes mellitus, symptomatic cardiovascular disease, musculoskeletal...... limitations, severe peripheral polyneuropathy, inability to speak Danish or English, dementia or other mental disorders. The patients were randomly assigned to an exercise group (EG, n = 22) or a control group (CG, n = 11). Prior to randomization, baseline testing was performed. The effects were measured...

  2. The Fate of Patients Who Started Hemodialysis during Childhood or Adolescence: Results of an Interregional Moroccan Survey

    Science.gov (United States)

    Souilmi, F. Z.; Sqalli Houssaini, T.; EL Bardai, G.; Kabbali, N.; Arrayhani, M.; Hida, M.

    2014-01-01

    Hemodialysis is the most used renal replacement therapy for children in Morocco. The objective of this study was to determine the prevalence of patients who started hemodialysis in childhood and study their characteristics and specificities of their care. For this we conducted a multicentric descriptive cross-sectional study of all chronic hemodialysis patients who started dialysis in pediatric age, in hemodialysis centers in four of the sixteen regions of Morocco. We collected 2066 patients undergoing dialysis in 39 hemodialysis centers; from these, only 72 patients (3.48%) started hemodialysis in childhood. The average age of patients was 20.64 ± 6.5 years with a sex ratio of 1.9. Duration of dialysis was 78.2 ± 56 months. The cause of end stage renal disease was urological abnormalities in 18% of cases and glomerulopathy in 12.5% of cases; however, it remains unknown in half of the patients. Over 18 years, 74% of patients are without profession, it is active in 13% of cases, and pursuing studies are only in 13% of cases. Patients under 5 years and those with a low weight are rarely taken care of in chronic hemodialysis with little individualization of prescription. Greater attention should be paid to renal transplantation that is desired by the majority of these patients (92%). PMID:27355073

  3. The effect of trancscutaneus electrical acupoint stimulation (TEAS on fatigue reduction in hemodialysis patients

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    Fateme Hadadian

    2011-07-01

    Full Text Available Background: Fatigue is one of the common complications in hemodialysis patients and may affect quality of life. The purpose of the study was to assess the effectiveness of Trancscutaneus Electrical Acupoint Stimulation (TEAS on fatigue in these patients.Methods: In this quasi-experimental study all chronic hemodialysis patients referred into Hemodialysis unit during the study period were recruited. Among all patients, 45 subjects were selected fulfilling study criteria. Demographic data and Brief Fatigue Inventory (BFI were collected before, after 5 and 10 session interventions. TEAS performed using ACUHEALTH set on 2.5 Hz for 5 minutes in Heugu, Saninjiao and Zusunlee acupoints within 10 sessions among dialysis treatment. Data was analyzed using Mc Nemar, Wilcoxcon and paired T test.Results: The results of study indicated that there was significant difference between averages of fatigue intensity, pretreatment, after 5 and 10 sessions of TEAS sequence (P<0 .0001 and P=0.001.Conclusion: Performing TEAS may decrease fatigue in chronic hemodialysis patients. This noninvasive and simple applicable method by nursing staffs for hemodialysis patient highly recommended to be used.

  4. Depression and anxiety disorders in chronic hemodialysis patients and their quality of life: A cross-sectional study about 106 cases in the northeast of morocco.

    Science.gov (United States)

    El Filali, Abdelilah; Bentata, Yassamine; Ada, Naima; Oneib, Bouchra

    2017-01-01

    Hemodialysis (HD) has a severe impact on the life of HD patients. The aim of this work was to assess the prevalence of depression and anxiety disorders, suicidal ideation, and the quality of life among HD patients. Associated factors were also studied. A cross-sectional study was carried out among 103 HD patients treated at the HD Center of Al Farabi Hospital of Oujda during a period of six months in 2015. The Mini-International Neuropsychiatric Interview and European Quality of Life-5 Dimensions (EQ-5D) were used for the assessment. Major depressive episode (MDE) was found in 34% of our patients, whereas anxiety disorder was observed in 25.2%. Suicidal ideation was found in 16.5% and 1.9% of our patients planned their suicide. The EQ-5D index was 0.41 ± 0.36 and the EQ-Visual Analog Scale score was 45.73 ± 14. Multivariate analysis showed that MDEs were associated with three factors: marital status, pain, and anxiety disorder. There was also an association between anxiety disorder and age and EQ-Visual Analog Scale score. Suicidal ideation was associated with marital status and anxiety disorders. Together, these results underline the importance of the collaboration between nephrologists and psychiatrists for a better care of HD patients.

  5. La hiperhomocisteinemia como factor de riesgo vascular en hemodializados crónicos Hyperhomocysteinemia as a vascular risk factor in chronic hemodialysis patients

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    Hernán Trimarchi

    2005-12-01

    -cisteína en los pacientes renales crónicos y comenzar un tratamiento precoz para mantener homocisteinemias de 10±5 mmol/l.Homocysteine is an independent risk factor for cardiovascular disease in the general population. In addition, it plays a main role in the development of atherogenesis and thrombosis, particularly in end-stage renal disease patients. Therefore, hemodialysis patients are under the burden of homocysteine toxic effects, present in nearly 90% of dialysis patients. Our group found that folic acid is an efficient therapeutic approach to decrease homocysteine levels, and the addition of intravenous methylcobalamin potentiates this effect; however, methylcobalamin alone was unsuccessful to normalize homocysteine levels. With time a group of patients required a higher dose of folic acid to reduce hyperhomocysteinemia. Patients homozygous and, to a lesser extent heterozygous, to the C677T thermolabile variant of methylenetetrahydrofolate reductase (MTHFR presented a reduced catalytic activity and required a higher folic acid dose. Vascular-access thrombotic events were similar in all patients according to the variants of the enzyme, suggesting that treating hyperhomocysteinemia was the key to lower the risk of thromboses. Noteworthy, hypohomocysteinemia, generally acompanying malnourishment, is associated to higher mortality. Albeit hyper-homocysteinemia is considered a vascular risk factor in renal failure patients, it has not yet been established in this population if its correction is associated with a decrease in the rate of vascular disease and thrombosis. However, given the mentioned evidence about the low risk and good tolerance of vitamin therapy, we believe it useful to know folate, cobalamin and homocysteine blood levels in chronic renal patients and start a prompt treatment, which may proof adequate to maintain homocysteine levels of 10±5 mmol/l.

  6. Quality of life and sleep in hemodialysis patients

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    Mahnaz Edalat-Nejad

    2013-01-01

    Full Text Available The purpose of this study was to determine the quality of life and sleep of chronic hemodialysis (HD patients. Quality of sleep was measured using the Pittsburgh Sleep Quality Index (PSQI and quality of life (QoL was measured using the Medical Outcomes Study 36-item Short Form (SF-36 in 115 HD patients. One hundred (87% patients were "poor sleepers" (global PSQI ≥5. The SF-36 mental component summary and physical component summary (PCS scores were higher than 50 only in 43% and 32% of the subjects, respectively. No significant differences were found in QoL and sleep according to the patient′s gender, presence of diabetes and time on HD. Correlation between total SF-36 score and global PSQI was statistically significant (r = -0.227, P <0.05. Poor sleep is common in dialysis patients and is associated with lower QoL, especially with mental health component of life quality.

  7. Successful Treatment with Infliximab for Refractory Uveitis in a Hemodialysis Patient with Behçet's Disease and a Review of the Literature for Infliximab Use in Patients on Hemodialysis.

    Science.gov (United States)

    Kurata, Izumi; Tsuboi, Hiroto; Takahashi, Hidenori; Abe, Saori; Ebe, Hiroshi; Hagiwara, Shinya; Umeda, Naoto; Kondo, Yuya; Ogishima, Hiroshi; Suzuki, Takeshi; Matsumoto, Isao; Hoshi, Sujin; Oshika, Tetsuro; Sumida, Takayuki

    2015-01-01

    A 36-year-old man with a 16-year history of refractory Behçet's disease (BD)-associated uveitis and chronic renal failure requiring hemodialysis suffered from frequent ocular attacks despite treatment with systemic corticosteroids and cyclosporine A. Following infliximab administration, the patient's BD ocular attack score 24 and visual acuity improved. Although he developed mild acute gastroenteritis, he did not experience any other adverse events. In our review of the literature, we identified seven patients on hemodialysis with inflammatory disease successfully treated with infliximab. Infliximab may be effective and safe in cases of BD and other diseases, including in patients under hemodialysis.

  8. Treinamento aeróbico melhora a capacidade funcional de pacientes em hemodiálise crônica Aerobic exercise improves physical capacity in patients under chronic hemodialysis

    Directory of Open Access Journals (Sweden)

    Diane Michela Nery Henrique

    2010-06-01

    of physical activity. OBJECTIVE: To evaluate the effect of aerobic exercise during hemodialysis on the physical capacity and blood pressure of patients with chronic renal failure. METHODS: We evaluated 14 patients with chronic kidney disease under hemodialysis, before and after 12 weeks of aerobic exercise performed during hemodialysis sessions. Patients underwent ambulatory blood pressure monitoring for 24 hours, 6-minute walk test and cardiopulmonary exercise test before and after the exercise period. RESULTS: After the exercise, there was a significant increase in the distance walked during the 6-minute walk test from 509 ± 91.9 m to 555 ± 105.8 m, and a significant reduction in systolic blood pressure of 151 ± 18.4 mmHg to 143 ± 14.7 mmHg, diastolic blood pressure of 94 ± 10.5 mmHg to 91 ± 9.6 mmHg and average arterial pressure from 114 ± 13.0 mmHg to 109 ± 11.4 mmHg. CONCLUSION: Aerobic exercise conducted during hemodialysis sessions contributed to the improvement of physical capacity and control of hypertension in patients with chronic kidney disease.

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

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    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

  10. Relationships Between Malnutrition, Inflammation, Sleep Quality, and Restless Legs Syndrome in Hemodialysis Patients.

    Science.gov (United States)

    Kaya, Tezcan; Acar, Bilgehan Atılgan; Sipahi, Savaş; Cinemre, Hakan; Acar, Türkan; Varım, Ceyhun; Tamer, Ali

    2015-10-01

    Restless legs syndrome (RLS) is a common neurologic sensorimotor disorder. It is also seen in hemodialysis patients in whom the mechanism is not thoroughly understood. The aim of this study was to evaluate the association between malnutrition-inflammation score (MIS), sleep quality, and RLS in chronic hemodialysis patients. This cross-sectional study included 232 adult stable chronic hemodialysis patients (mean age 60.9 ± 14.1 years, 56.5% male). RLS frequency, MIS, Pittsburgh Sleep Quality Index (PSQI), laboratory data of patients as well as severity of RLS were evaluated. Thirty-seven patients (15.9%) were diagnosed with RLS. Mean MIS of patients with or without RLS were similar. PSQI of patients with RLS was significantly higher than patients without RLS (P = 0.002). There was a significant positive correlation between RLS severity and PSQI (r = 0.445, P = 0.006). A significant positive correlation was also found between PSQI and MIS in patients with RLS (r = 0.419, P = 0.010). RLS severity was positively correlated with some inflammatory parameters such as white blood cell count and C-reactive protein (r = 0.427, P = 0.008 and r = 0.418 P = 0.010). PSQI was found as an independent significant predictor of RLS (odds ratio [OR] = 1.15 (1.06-1.25), P = 0.001) in multivariate logistic regression analysis. Our study revealed that there was no significant relationship between RLS and MIS in chronic hemodialysis patients. However, RLS severity is correlated with inflammatory parameters. Also, sleep quality in chronic hemodialysis patients with RLS is negatively associated with MIS.

  11. HBV Vaccination in Chronic Renal Failure Patients

    OpenAIRE

    Mir-davood Omrani; Mohammad Hassan Khadem Ansari

    2006-01-01

    HBV infection in chronic renal failure (CRF) becomes chronic in 30 to 60% compared with less than 10% in nonuremic patients. Immunological dysfunction in patients on hemodialysis may be related to imbalanced cytokine systems, such as tumor necrosis factor (TNF-|α|) and interleukin (IL) 6,1 by retention of renal metabolite in uremia and chronic inflammation and have a poor immunological reaction to T-cell-dependent antigens, like hepatitis B vaccination. Immunocompromised patients who are unre...

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

    OpenAIRE

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

    2010-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Marcos Frank Bastiani

    2014-10-01

    Full Text Available Introduction and Objective: This study aimed at determining the prevalence of hepatitis C among 649 patients diagnosed with chronic or acute kidney disease − patients were undergoing hemodialysis treatment at a large hemodialysis center in Porto Alegre-RS, from January through December, 2012 –, as well as relating our data to that presented in the national census, reporting cases of coinfection by hepatitis C and human immunodeficiency virus (HIV, and defining the demographic profile of these patients. Method: An observational cross-sectional study was conducted and data was obtained from information in patients’ electronic medical records. Result and conclusion: The prevalence of hepatitis C in this study was 10.17% of the sampled population. However, further analysis of other liver centers would be required to estimate an accurate prevalence rate of infection caused by the hepatitis C virus in patients undergoing hemodialysis in Porto Alegre.

  14. Researching of cardos activity for chronic heart failure treatment in case of concomitant chronic kidney disease (stage V, conventional hemodialysis

    Directory of Open Access Journals (Sweden)

    Chepurina N.G.

    2011-06-01

    Full Text Available Aim: comparative investigation of cardos (antibodies to angiotensin II receptor subtype 1 (AT., C-terminal fragment, diovan (Valsartan or both drug combination effects (changing of clinical picture, physical exertion tolerance and quality of life for treatment chronic heart failure (CHF patients. Methods. 12-month open-label randomized research was performed. CHF patients (NYHA Class l-ll, n=30 with concomitant chronic kidney disease (stage V, conventional hemodialysis were randomized (10 patients in each group for 6-month treatment by cardos (group I, average dose 1,8g/day, diovan (group II, average dose 80mg/dayorboth drug combination (group III, cardos 1,8g/day and diovan 80mg/day. CHD basic treatment was prescribed for all patients. In a 6-month drug crossover between groups I and I was performed, group III was divided into 2 subgroups (subgroup IIIA— cardos, subgroup NIB — diovan followed by next 6-month treatment. Results. Long-term treatment by cardos has improved functional class (NYHA of CHF patients with concomitant chronic kidney disease (stage V, conventional hemodialysis. cardos, diovan and both drug combination have demonstrated improvement of physical exertion tolerance, quality of life and patient clinical status during 6-min walking test. Conclusion. Cardos and diovan have shown the same efficacy. Cardos can be used as real alternative in case of ARA administration necessity

  15. Effect of an Educational Program on Adherence to Therapeutic Regimen among Chronic Kidney Disease Stage5 (CKD5) Patients under Maintenance Hemodialysis

    Science.gov (United States)

    Deif, Hala I. Abo; Elsawi, Khiria; Selim, Mohga; NasrAllah, Mohamed M.

    2015-01-01

    The burden of chronic disease on health care services worldwide is growing and the increased development of educational interventions which help patients to better manage their conditions is evident internationally. It has been recognized that poor adherence can be a serious risk to the health and wellbeing of patients. Adherence to fluid…

  16. Intradialytic Exercise is Medicine for Hemodialysis Patients.

    Science.gov (United States)

    Parker, Kristen

    2016-01-01

    When a person's kidneys fail, hemodialysis (HD) is the most common treatment modality. With a growing number of patients requiring this life-sustaining treatment, and with evidence illustrating the significant physical dysfunction of this population, encouraging exercise is essential. The use of intradialytic exercise, as a novel and efficient use of time during HD, is well established in Australia and some European nations; however, it is slower to start in North America. While a large number of small studies have demonstrated numerous benefits and safe delivery of intradialytic exercise training for patients with end-stage kidney disease, intradialytic exercise is rarely delivered as standard of care. It is of utmost importance for health care staff to overcome barriers and bring theory into practice. Included in this report are current recommendations from governing bodies, expert opinion, as well as established policies and procedures from a successful intradialytic exercise program in Canada.

  17. Sudden cardiac death in hemodialysis patients: an in-depth review.

    Science.gov (United States)

    Green, Darren; Roberts, Paul R; New, David I; Kalra, Philip A

    2011-06-01

    Sudden cardiac death (SCD) is the leading cause of death in hemodialysis patients, accounting for death in up to one-quarter of this population. Unlike in the general population, coronary artery disease and heart failure often are not the underlying pathologic processes for SCD; accordingly, current risk stratification tools are inadequate when assessing these patients. Factors assuming greater importance in hemodialysis patients may include left ventricular hypertrophy, electrolyte shift, and vascular calcification. Knowledge regarding SCD in hemodialysis patients is insufficient, in part reflecting the lack of an agreed-on definition of SCD in this population, although epidemiologic studies suggest the most common times for SCD to occur are toward the end of the long 72-hour weekend interval between dialysis sessions and in the 12 hours immediately after hemodialysis. Accordingly, it is hypothesized that the dialysis procedure itself may have important implications for SCD. Supporting this is recognition that hemodialysis is associated with both ventricular arrhythmias and dynamic electrocardiographic changes. Importantly, echocardiography and electrocardiography may show changes that are modifiable by alterations to dialysis prescription. The most effective preventative strategy in the general population, implanted cardioverter-defibrillator devices, are less effective in the presence of chronic kidney disease and have not been studied adequately in dialysis patients. Last, many dialysis patients experience SCD despite not fulfilling current criteria for implantation, making appropriate allocation of defibrillators uncertain.

  18. Therapeutic efficacy of a biosimilar epoetin alfa in hemodialysis patients

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    Amel Harzallah

    2015-01-01

    Full Text Available Anemia is a frequent complication in patients with chronic kidney disease. However, human recombinant erythropoietin (rHu-EPO has revolutionized the management of anemia in chronically dialyzed patients. Epomax ® is a new rHu-EPO alfa manufactured in Tunisia (Medis Laboratories. The aim of this study was to evaluate the efficacy and tolerance of Epomax ® in chronic hemodialysis (HD patients in a phase-III, multicenter, clinical trial. Fiftythree HD patients (mean age 47.7 ± 13 years who received a stable dose of rHu-EPO (Hemax ® , a rHu-EPO alfa manufactured by Biosidus Laboratories subcutaneously were switched to Epomax ® via the same route of administration. At baseline, the mean systolic pressure was 132 ± 18 mm Hg and the mean diastolic pressure was 79 ± 8 mm Hg. The mean blood hemoglobin was 10.2 g/dL and the median ferritin level was 667 ng/mL. After a follow-up of 43 days, the mean blood hemoglobin was 10.5 g/dL under the effect of Epomax ® . There was no significant difference in the mean hemoglobin levels between the treatments with both drugs. Few adverse events were reported during the study. We conclude that Epomax ® was effective at maintaining the hemoglobin levels at target concentrations and was well tolerated in HD patients.

  19. [DOPPS estimate of patient life years attributable to modifiable hemodialysis practices in France].

    Science.gov (United States)

    Canaud, Bernard; Combe, Christian; Bragg-Gresham, Jennifer L; Eichleay, Margaret A; Pisoni, Ronald L; Port, Friedrich K

    2008-07-01

    In this study, we used a prevalent cross-sectional sample of French hemodialysis patients from Dialysis Outcomes and Practice Patterns Study (DOPPS) 2 (2002-2004) to determine the percentage of patients whose values failed to meet targets in six different areas of hemodialysis practice (dialysis dose, anemia, serum phosphorus (PO(4)), serum calcium (Ca), serum albumin and catheter use for vascular access). Cox survival models, with adjustments for patient characteristics, were used for these analyses to estimate mortality hazard ratios (HR). Based on the mortality HR, the fraction of patients outside each target and the total HD population in France, we estimated the number of patient life years that could potentially be gained if every chronic, in-center hemodialysis patient in France who is currently outside of the specified target was able to achieve it. The proportion of patients failing to meet one of the six practice targets in France varied from 15% (dialysis dose) to 75% (albumin) while the percentage of patients complying with all six targets was restricted to 1.2%. The relative risk of mortality (RR) associated with being outside these targets varied from 1.12 to 1.46. Based on these two measures the life-years survival was estimated. The projected number of patients and life years potentially gained from adherence to the six targets was estimated close to 10,600 years-patient. In conclusion, this study suggests large opportunities to improve hemodialysis patient care in France still exist. Compliance with two major practice targets, such as albumin and restriction of catheter use will save highly significant life years of hemodialysis patient. Implementing and strict adherence to national and international guidelines should serve as a basic inspiration for continual improvement of hemodialysis patient care.

  20. Prevalence and severity of anemia in pediatric hemodialysis patients, a single center study

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    Afshin Azhir

    2006-12-01

    Full Text Available BACKGROUNDS: This study was conducted to determine the prevalence and severity of anemia in children and adolescents on chronic hemodialysis, and to identify independent predictors of anemia in children on hemodialysis. METHODS: This cross-sectional study was performed between September 2005 and January 2006. The study population consisted of 25 patients aged 7−20 years on chronic hemodialysis from pediatric hemodialysis centers in Isfahan. RESULTS: A total of 22 (88% patients had hemoglobin levels of <11 g/dL (anemic and 12 patients (48% had hemoglobin levels of <8 g/dL (severe anemia. The mean age of these patients was 15.5 ± 3.7 years. Mean time on chronic dialysis was 20.44 ± 15.25 months. Anemia was more common and more severe among children who were on dialysis for less than 6 months. There was an inverse relationship between the severity of anemia and duration of hemodialysis (P = 0.019, r = – 0.465. Nearly all patients were treated with erythropoietin, Children with more severe anemia received slightly higher dose of erythropoietin (P = 0.09, r = 0.202. There was a significant difference between serum albumin values in anemic patients and patients without anemia (P = 0.023. There was a correlation between serum albumin and hemoglobin level (r = 0.511, P = 0.01. Intact PTH levels were >200 pg/ml in 16 patients (66% and >400 pg/ml in 9 patients (37. 5%. There was a reverse correlation between intact PTH level >200 pg/ml and hemoglobin level (r = -0.505, P = 0.046. CONCLUSIONS: The prevalence of anemia in hemodialysis children in Isfahan appears to be higher than that reported in the other studies in spite of extensive use of rHuEPO and iron supplementation. We found this to be especially true for patients new on hemodialysis (less than 6 months and in those with low albumin and severe hyperparathyroidism. KEY WORDS: Hemodialysis, anemia, children.

  1. Determining the Levels of Vitamin D and Parathyroid Hormone in Patients on Hemodialysis

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    Mihaylov R.

    2016-03-01

    Full Text Available Vitamin D deficiency is fequently observed in chronic kidney disease. We conducted this study to determine the concentration of the above-mentioned parameters and the correlation between them in order to optimize therapy with vitamin D in patients with end-stage renal disease (ESRD on hemodialysis. In 53 patients on hemodialysis due to ESRD, vitamin D [Calcidiol (25(OHD], parathyroid hormone (PTH, calcium, phosphorus, albuminuria, albumin:creatinine ratio (ACR and other parameters have been followed up. Analysis of the levels of vitamin D has been carried out by High Performance Liquid Chromatography (HPLC, the PTH is determined by the system Centaur XP, Siemens Diagnostic, Electro-chemiluminescence immunoassay (ECLIA, and for albumin in urine we used immunological method [Miltigent microalbumin assay (Abbott Laboratories Diagnostics. We found out deficiency and insufficiency of vitamin D in 56.6% and 37.7%, as well as average 4.5 times increase in the PTH, hyperphosphatemia, hypocalcemia, albuminuria (A2 or A3, over 10 times increase in the ACR, secondary hyperparathyroidism. We registered a negative correlation between vitamin D and PTH. We confirmed the increase in creatinine and cystatin C in the patients on hemodialysis. There are few literature data for patients on hemodialysis, however, regarding the extent of the vitamin deficiency and its relationship with PTH, albuminuria, calcium, phosphorus, etc. Our data have indicated that patients on hemodialysis due to ESRD are associated with high incidence of vitamin D insufficiency or deficiency.

  2. A clinical analysis of treating arrhythmia in patients with chronic renal failure after hemodialysis%慢性肾衰患者血液透析并发心律失常的临床治疗分析

    Institute of Scientific and Technical Information of China (English)

    李蕊

    2016-01-01

    目的:对慢性肾衰血液透析并发心律失常患者的临床治疗方法进行研究。方法:46例慢性肾衰患者为我院于2012年10月-2013年9月收治,均应用维持性血液透析疗法,治疗后对心律失常事件发生率进行准确记录。结果:共透析654例次,发生106例次心律失常;年龄越大,患者的心律失常发生率就越高,经对比具有统计学意义,P<0.05;显效30例,有效12例,无效4例,总有效率为91.3%。结论:对慢性肾衰患者进行血液透析治疗过程中采取针对性的预防、治疗措施能够降低心律失常发生率,并提高患者生命质量。%Objective: To investigate treaifng methoals of arrhythmia in patients with chronic renal failure after hemodialysis. Methods: 46 patients were given hemodialysis. After treatment, the incidence of arrhythmic events were accurately recorded. Results: In 654 times, 106 times shows arrhythmia. There is a positive correlation between the incidence of arrhythmia and the patient’s age (P<0.05). 30 cases of markedly effective, effective in 12 cases, 4 cases of ineffective, the total effciency was 91.3%. Conclusion: During hemodialysis process, giving patients targeted prevention and treatment could reduce the incidence of arrhythmia, and improve the quality of life.

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

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    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

  4. [An association between forms of coping and the socio-demographic variables of people on chronic hemodialysis].

    Science.gov (United States)

    Bertolin, Daniela Comelis; Pace, Ana Emilia; Kusumota, Luciana; Haas, Vanderlei

    2011-10-01

    This sectional study was performed with the objective to verify the association between the forms of coping used by people on chronic hemodialysis and their socio-demographic variables. A semi-structured instrument and the Folkman and Lazarus' Coping Strategies Inventory were used. The sample consisted of 107 adults, mostly male (62.4%), on ambulatory hemodialysis for over six months. The most commonly referred forms of coping were related to the positive reevaluation factor (coping centered on emotions); with the highest mean scores among women for all factors and for people who reported having a partner, living with their families and receiving support in their treatment, and the highest scores were common for the factors control, self-control, and social support. Knowing the forms of coping prepares nurses to reinforce or seek, with patients on hemodialysis, choosing positive forms of coping and propose actions that permit patients to develop adaptive mechanisms.

  5. 慢性肾衰竭患者进入血液透析的时机及趋势分析%The time for initiation of hemodialysis in chronic renal failure patients and its trends

    Institute of Scientific and Technical Information of China (English)

    钟小仕; 覃丹平; 陈文璇; 刘岩

    2011-01-01

    目的 分析慢性肾衰竭患者进入血液透析的时机及变化趋势.方法 回顾性研究2007年1月1日至2009年12月31日在广州市红十字会医院新进入血液透析的慢性肾衰竭的忠者144例,登记收集首次透析的生化参数包括尿素氮、肌酐、血清白蛋白等数据,并计算肾小球滤过率(glomerular filtration rate,GFR).结果 全部慢性肾衰竭患者进入血液透析时的GFR为(6.01±0.59)ml/(min·1.73m2),9例患者GFR>10 ml/(min·1.73m2),74例患者GFR为5~10 ml/(min·1.73m2),61例患者GFR<5 ml/(min·1.73m2).糖尿病患者进入血液透析治疗时的GFR明显比非糖尿病患者高,分别为(7.41±0.47)ml/(min·1.73m2)和(5.22±0.44)ml/(min·1.73m2),差异有统计学意义(t=28.49,P<0.05).慢性肾衰竭患者进入血液透析时的GFR水平,随着时间的推移呈现出越来越高的趋势.结论 本组患者开始血液透析时机通常较迟,明显低于肾脏病预后质量指南要求;特别是非糖尿病患者.糖尿病患者及非糖尿病患者对尿毒症的耐受的差异需要进一步的研究和探讨.%Objective To analysis the time for initiation of hemodialysis in chronic renal failure patients and its trends. Methods A retrospective study was performed in 144 patients newly treated with hemodialysis in Guangzhou Red-Cross Hospital during Jan. 1, 2007 to Dec. 31, 2009. The biochemical parameters just before the first dialysis session were retrieved, including blood urea nitrogen, serum albumin, and serum creatinine, from which glomerular filtration rate (GFR) was then calculated. Results In the 144 patients, the mean GFR at the time for initiation of hemodialysis was 6.01±0.59 ml/min· l.73m2. The initial mean GFR was > 10ml/min· 1.73m2 in 9 patients, 5 to 10ml/min·l.73m2 in 74 patients, and < 5ml/min·1.73m2 in 61 patients. Diabetic patients had higher initial GFR than non-diabetic patients (7.41±0.47 vs. 5.22±0.44, t=28.49, P < 0.05). The trend of higher GFP at the

  6. Sublethal microcystin exposure and biochemical outcomes among hemodialysis patients

    Science.gov (United States)

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

  7. Relação do sexo e da idade com nível de qualidade de vida em renais crônicos hemodialisados Relationship between gender and age with quality of life in chronic hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Paulo Roberto Santos

    2006-10-01

    Full Text Available OBJETIVO: A taxa de mortalidade estacionada na última década e o aumento da prevalência de idosos entre hemodialisados motivaram o presente estudo que teve por objetivo determinar a relação do sexo e da idade com o nível de qualidade de vida (QV em portadores de insuficiência renal crônica sob terapia hemodialítica. MÉTODOS: Em uma amostra de 107 indivíduos submetidos à hemodiálise regular em uma Unidade de Diálise no interior do estado do Ceará, o Medical Outcomes Study Questionaire 36-Item Short Form Health Survey (SF-36 foi utilizado para medida da QV. Foi calculado o coeficiente de correlação de Pearson para estimar e testar a correlação linear entre idade e as pontuações geradas pelo SF-36, e as pontuações de acordo com o sexo foram comparadas pelo teste t e de Mann-Whitney quando indicado. RESULTADOS: Não houve diferença entre as pontuações de acordo com o sexo. Foi encontrada correlação linear e negativa entre a idade e as dimensões de QV nomeadas capacidade funcional (r=-0,289, p=0,003, limitação por aspectos físicos (r=-0,224, p=0,020, dor (r=0,252, p=0,008, estado geral de saúde (r=-0,245, pBACKGROUND: The stagnant mortality rate of the last decade and the increased prevalence of aged people among hemodialysis patients motivated the present study to determine the relation of gender and age with the quality of life (QL of patients with chronic kidney failure treated with hemodialysis. METHODS: From the sample of 107 individuals who underwent regular hemodialysis in a Dialysis Unit in the interior of the state of Ceará, Brazil, the Medical Outcomes Study Questionnaire 36-Item Short Form Health Survey (SF-36 was used to assess quality of life. Pearson's correlation coefficient was used to calculate and to test the linear correlation between age and the score generated by the SF-36. The score for gender was compared by the t test and the Mann-Whitney when indicated. RESULTS: There was no difference

  8. Occult Hepatitis C Virus Infection among Hemodialysis Patients

    OpenAIRE

    G. Barril; Castillo, I.; Arenas, M.D. (María Dolores); Espinosa, M; Garcia-Valdecasas, J. (Juan); Garcia-Fernandez, N. (Nuria); E Gonzalez-Parra; Alcazar, J.M. (José María); Sanchez, C.; Diez-Baylon, J.C. (José Carlos); P. MARTINEZ; Bartolome, J; Carreño, V

    2008-01-01

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

  9. Zidovudine disposition during hemodialysis in a patient with acquired immunodeficiency syndrome.

    Science.gov (United States)

    Tartaglione, T A; Holeman, E; Opheim, K; Smith, T; Collier, A C

    1990-01-01

    Zidovudine (azidothymidine, AZT) disposition was examined during a hemodialysis session in an HIV-infected male with mesangial proliferative glomerulonephritis. Serum concentrations of zidovudine and its glucuronidated inactive metabolite (G-ZDV) were measured by HPLC. Zidovudine pharmacokinetics were similar to previous reports in patients with normal renal function, however, G-ZDV concentrations were significantly elevated (23-440 times zidovudine concentration). Hemodialysis did not appreciably reduce zidovudine or G-ZDV levels. Significance of chronically elevated G-ZDV levels is unknown.

  10. Diabetic kidney disease patients on hemodialysis: a retrospective survival analysis across different socioeconomic groups

    OpenAIRE

    Vijayan, Madhusudan; Radhakrishnan, Saranya; Abraham, Georgi; Mathew, Milly; Sampathkumar, Krishnaswamy; Mancha, Nevin Philip

    2016-01-01

    Background Diabetic kidney disease is the leading cause of stage 5 chronic kidney disease (CKD) in India. Renal replacement therapy (RRT) is accessible to very few patients because of socioeconomic deprivation. We studied the effect of diabetes and socioeconomic status on the outcome of patients on maintenance hemodialysis (MHD). Methods We retrospectively analyzed the outcome of 897 patients (629 males/268 females; mean age ± standard deviation 48.69 ± 14.27 years) initiated on MHD from 2003...

  11. Electrocardiographic manifestations of hyperkalemia in hemodialysis patients

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    Nemati Eghlim

    2010-01-01

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

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

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    Francisca Monsalve-Castillo

    2012-02-01

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

  13. 老年慢性肾功能衰竭血液透析临床分析%Clinical analysis of the effect of hemodialysis on elderly patients with chronic renal failure

    Institute of Scientific and Technical Information of China (English)

    邓德宏; 王兰; 张勇强

    2013-01-01

    目的 分析总结老年慢性肾功能衰竭(CRF)血液透析治疗的临床经验.方法 收集行维持性血液透析的老年CRF患者共105例,对其临床资料进行回顾性分析.结果 105例患者通过个体化血液透析治疗后,心血管并发症明显减少,临床症状显著改善,生活质量提高.结论 根据老年CRF患者的具体情况,制定个体化的血液透析治疗方案可减少心血管并发症,降低死亡率,提高生存质量.%Objective To analyze and summary the clinical experience of hemodialysis (HD) on elderly patients with chronic renal failure (CRF).Methods 105 patients on maintenance HD from January 2007 to December 2011 in our hospital were retrospectively analyzed.Results The cardiovascular complications of 105 patients through individualized HD therapy significantly reduced,the clinical symptoms were ameliorated markedly.The quality of life was improved.Conclusion With individualized HD plan according to concrete condition of elderly patients with CRF,we can decrease the cardiovascular complications,decrease the mortality and improve the life quality.

  14. Structural visualization of expert nursing: Hemodialysis patient education program "behavior modification program for hemodialysis patients".

    Science.gov (United States)

    Oka, Michiyo; Kamiya, Chizuru; Sagawa, Mieko; Yamana, Eiko; Tsuru, Satoko

    2006-01-01

    Behavior modification programs (BMP) have been suggested to be useful for the self-management of hemodialysis (HD) patients. To provide more systematic care, we structured the procedure of the thinking process and care in BMPs as an algorithm. BMP developers produced a temporary algorithm based on previous studies, discussed it with nurses with BMP experience, and added and revised necessary items. As a result, an algorithm of BMP with high reproducibility that allows maintenance of consistent quality for the self-management of HD patients could be developed.

  15. Rationale for Antioxidant Supplementation in Hemodialysis Patients

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    Morena Marion

    2001-01-01

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

  16. 高通量血液透析与高通量血液透析滤过对慢性肾病患者骨及矿物质代谢的影响分析%Influence analysis of high flux hemodialysis and high flux hemodialysis filtration on bone and mineral metabolism of chronic kidney disease pa-tient

    Institute of Scientific and Technical Information of China (English)

    李金成

    2016-01-01

    Objective To explore the influence of high flux hemodialysis and high flux hemodialysis filtration on bone and mineral metabolism of chronic kidney disease patient.Methods 75 patients with chronic kidney disease from Octo-ber 2013 to October 2015 in our hospital were selected and randomly divided into the control group (38 cases) and the observation group (37 cases).The control group was given high flux hemodialysis,the observation group was given high flux hemodialysis filtration.The level of BUN,Scr,ALB,blood calcium,Blood phosphorus and parathyroid hormone before and after treatment in the two groups was compared.Results The level of BUN,Scr after treatment for 1,6 months in the two groups was lower than that before treatment,the level of ALB after treatment for 1,6 months in the two groups was higher than that before treatment,with significant difference (P﹤0.05).There was no significant difference in the level of BUN,Scr,ALB after treatment between the two groups (P﹥0.05).There was no significant difference in the level of blood calcium,blood phosphorus and parathyroid hormone after treatment for 1 month between the two groups (P﹥0.05).The level of blood calcium after treatment for 6 months in the observation group was higher than that in the control group, the level of blood phosphorus and parathyroid hormone after treatment for 6 months in the observation group was lower than that in the control group,with significant difference (P﹤0.05).Conclusion Both of high flux hemodialysis and high flux hemodialysis filtration can obvious improve renal function and bone and mineral metabolism of patients with chronic kidney disease.In comparison,the effect of high flux hemodialysis filtration is better.%目的:探讨高通量血液透析与高通量血液透析滤过对患者骨及矿物质代谢的影响。方法选取2013年10月~2015年10月本院收治的75例慢性肾病患者作为研究对象,随机分为对照组(38例)和观察组(37例)。对照组

  17. Avaliação da condição bucal em pacientes renais crônicos submetidos à hemodiálise Evaluation of oral condition of patients with chronic renal failure submitted to hemodialysis

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    Cláudia Régia de Souza Dias

    2007-01-01

    Full Text Available OBJETIVOS: Avaliar a condição bucal dos pacientes com insuficiência renal crônica submetidos à hemodiálise, no município de São Luís, comparando os três centros de referência da cidade e os tempos de hemodiálise. MÉTODOS: A amostra foi constituída por 107 pacientes, nos quais analisou-se o índice de placa (IP e a prevalência de cárie dentária (CPO-D. Os pacientes foram categorizados em três grupos, de acordo com o tempo de hemodiálise (3 meses a 3 anos. Os dados obtidos foram submetidos aos testes estatísticos ANOVA e Kruskal-Wallis, com nível de significância de 5%. RESULTADOS: As médias/desvios padrão do IP nos grupos foram, respectivamente, 0.91±0.61; 1.04±0.60 e 1.25±0.67. Quanto ao CPO-D destes grupos, as médias/desvios padrão foram 13.63±8.91; 13.89±8.12 e 16.79±7.31. Não houve diferenças significativas entre os centros, nem entre os tempos de hemodiálise estudados. CONCLUSÃO: O tempo de tratamento da doença não alterou ou interferiu no acúmulo de placa bacteriana e na prevalência de cárie dentária. Houve uniformidade na condição bucal dos pacientes nos três centros estudados.BACKGROUND: Evaluate the oral conditions of patients with chronic renal failure submitted to hemodialysis in the city of São Luís, by comparing three reference centers and the times of hemodialysis. METHODS: The sample consisted of 107 patients, distributed among the centers. Plaque Index (IP and Dental Caries Prevalence (DMF-T were evaluated. Patients were subdivided into three groups according to time of hemodialysis (3 months to 3 years. Data were analyzed using the ANOVA and the Kruskal-Wallis test with a level of significance of 5%. RESULTS: Plaque index averages in the groups were respectively, 0.91±0.67; 1.04±0.60; 1.25±0.61. The averages of DMF-T in the respective groups were 13.63±8.91; 13.89±8.12; 16.79±7.31. There were no significant differences between the centers of reference and the times of

  18. Restless legs syndrome in patients on hemodialysis

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    Saleh Mohammad Yaser Salman

    2011-01-01

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

  19. High fluoride exposure in hemodialysis patients.

    Science.gov (United States)

    Bello, V A; Gitelman, H J

    1990-04-01

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

  20. Interleukin-2 deficit in hemodialysis patients. Role of prostaglandins.

    Science.gov (United States)

    Glez-Gutiérrez, M; de Francisco, A L; Sanz de Castro, S; Ruiz, J C; Prieto, M; García Fuentes, M; Arias, M

    1992-01-01

    Uremic patients suffer from various immunological alterations, whose pathogenesis is still unknown. Here, we studied 37 hemodialysis patients in order to investigate the role of prostaglandins (PGs) in uremic immunological deficiency, specifically in relation to interleukin-2 (IL-2) synthesis. We confirmed previous published data on deficient response to PHA in chronic renal failure patients (cpm, mean +/- SEM: 15,400 +/- 2,100 in uremics vs. 29,500 +/- 3,380 in controls, p < 0.04) and established a correlation between this deficiency and diminished IL-2 synthesis (r = 0.619, p < 0.05). The direct measurement of PGs in lymphocyte cultures showed greatly increased concentrations in the presence of uremic serum (US). We found that PGs synthesis can be inhibited by up to 80% if cultures are supplemented with indomethacin (IND--a cyclooxigenase inhibitor) or by removal of monocytes (producers of PGs). Both methods situated the uremic proliferative response within the normal range in cultures with FCS, and close to the normal range in cultures with US. We observed a deficit of IL-2 in hemodialysis patients (means +/- SD: 8,940 +/- 6,420 in uremics vs. 16,900 +/- 3,890 in controls). Addition of exogenous IL-2 normalized lymphocyte response even in US cultures, with no additive effect between PGs inhibition and exogenous IL-2 except in US cultures. It is suggested that IL-2 deficit of uremics depends, at least in part, on an increase in PGs synthesis induced by US.(ABSTRACT TRUNCATED AT 250 WORDS)

  1. 口服药用炭对血液透析患者尿毒症皮肤瘙痒的治疗%Oral activated charcoal on uremic pruritus in chronic hemodialysis patients

    Institute of Scientific and Technical Information of China (English)

    邓英辉; 林娜; 付文静; 张沛; 贾强

    2011-01-01

    目的 观察口服药用炭对维持性血液透析患者尿毒症皮肤瘙痒的疗效.方法 合并中重度尿毒症皮肤瘙痒(视觉模拟评分法VAS≥6分)的血液透析患者35例,予口服药用炭(1.5g/次,3次/d)治疗,持续4周.观察治疗前后VAS评分及皮肤瘙痒程度的变化,并比较肾功能及血清钙、磷、全段甲状旁腺素(iPTH)水平的变化.结果 口服药用炭4周后,患者VAS评分较前明显下降[(4.80±2.62)vs.(8.173±1.22),P<0.01],皮肤瘙痒程度减低.血清肌酐、尿素、尿酸水平较前下降(P<0.01或P<0.05);血磷及钙磷乘积较前降低(P<0.01);血钙及iPTH水平未见显著变化.结论 口服药用炭对尿毒症皮肤瘙痒具有较为明显的缓解作用,其机制可能与药用炭对尿毒症毒素的清除和降低血磷有关.%Objective To investigate the effect of oral activated charcoal on uremic pruritus in patients undergoing hemodialysis. Methods Thirty-five chronic uremic patients on maintenance hemodialysis and suffering from moderate to severe pruritus(visual analog scales,VAS≥6) were treated with activated charcoal (4.5 g daily p.o.) for 4weeks. The serum creatinine, urea, uric acid, calcium, phosphorus, the product of calcium and phosphorous (Ca x P), intact parathyroid hormone(iPTH) of all patients were examined before and after the treatment and the intensity of cutaneous prurtius(VAS)were recorded before and after treatment. Results Compared with pretreatment, the intensity of cutaneous pruritus of patients after treatment was obviously alleviated (4.80±2.62 vs 8.17±1.22, P < 0.01)compared with that before the treatment. Patients' serum creatinine, urea and uric acid were declined(P < 0.01 or P < 0.05) after treatment. Serum levels of phosphorus and Ca x P were lower after treatment compared to that before the treatment (P < 0.01), but the levels of calcium and iPTH did not changed obviously. Conclusion Oral activated charcoal could alleviate the intensity of

  2. Sleep Disorders in ESRD Patients Undergoing Hemodialysis

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    Mohammad Reza Abassi

    2016-04-01

    Full Text Available Kidney failure affects different aspects of normal life. Among different manifestations, sleep problem can be considered as a common complaint of ESRD (End Stage Renal Disease patients. In this study, we aimed to investigate the interrelationship between sleep disorders in ESRD patients and their characteristics. Through a cross-sectional study (2010-2011, 88 ESRD patients undergoing maintenance hemodialysis thrice weekly were recruited to enter the study. We used a self-administered questionnaire into which the data were reflected. The patients selected their specific sleep disorders using a nine-item scale while the Epworth Sleepiness Scale (ESS determined both the presence and severity of sleep disorders. The data was finally analyzed with their baseline characteristics, dialysis characteristics, medication/stimulants use, and clinical and biochemical parameters. Over 95% of the patients had, at least, one specific sleep disorder while the ESS revealed 36.36% of patients as normal, 59.09% as having mild sleep disorders, and 4.54% as having moderate to severe sleep disorders. Sleep disorders were significantly correlated with older ages (P=0.035, dialysis dose (P=0.001, blood creatinine levels (P=0.037, upper airways obstruction (P=0.035, hepatomegaly (P=0.006, hepatic failure (P=0.001, higher blood TSH levels (P=0.039, history of hypothyroidism (P=0.005, and the use of levodopa (P=0.004, anti-hypertensive medications (P=0.006, benzodiazepines (P=0.006, Eprex (Erythropoietin (P=0.001, Venofer (Iron Sucrose Injection (P=0.013, and phosphate-binders agents (P=0.018. Sleep disorders are common findings among ESRD patients and seem to be a more complicated issue than a simple accumulation of the wastes products in the body. Whatever the causes of sleep disorders are, disorder-specific treatments should be considered.

  3. Seizure occurrence in patients with chronic renal insufficiency in regular hemodialysis program Ocorrência de crises epilépticas em pacientes com insuficiência renal crônica em programa dialítico regular

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    Fulvio Alexandre Scorza

    2005-09-01

    Full Text Available Hemodialysis-associated seizure is a complication of hemodialysis. This report describes the occurrence of seizures in patients with end stage renal disease on dialysis therapy at the Nephrology Institute of Mogi das Cruzes, São Paulo State, Brazil. A retrospective medical history of 189 patients was reviewed to investigate the occurrence of convulsive seizures during dialytic program. Seven patients with history of seizures were selected but five of them were included in our study. Three patients presented generalized tonic-clonic seizures, one had partial seizure with secondary generalization, and one presented unclassified seizure. Three patients presented seizure just during the dialysis (unique seizure and one of them presented convulsive status epilepticus. The two other patients had already presented seizures prior the beginning of dialysis. We conclude that seizures in renal failure could be considered as occasional events that do not usually become chronic.Convulsões durante o tratamento dialítico podem constituir uma complicação da hemodiálise. Esse artigo descreve a ocorrência de crises em pacientes em estágio final de insuficiência renal crônica sob tratamento dialítico no Instituto de Nefrologia de Mogi das Cruzes, São Paulo, Brasil. Foram revistos os prontuários de 189 pacientes, com o objetivo de investigar a ocorrência de crises convulsivas durante o tratamento dialítico. Dos sete pacientes selecionados com história de crises, cinco concordaram em participar de nosso estudo. Três pacientes apresentaram crises generalizadas tônico-clônicas, um apresentou crise parcial com generalização subseqüente e um apresentou crise inclassificada. Três pacientes apresentaram crises apenas durante o processo dialítico (crise única sendo que um deles apresentou status epilepticus convulsivo. Os outros dois pacientes já haviam apresentado crises antes do início do tratamento dialítico. Nós concluímos que as crises

  4. Assessment of subjective and hemodynamic tolerance of different high- and low-flux dialysis membranes in patients undergoing chronic intermittent hemodialysis: a randomized controlled trial.

    Science.gov (United States)

    Bianchi, Giorgia; Salvadé, Vanja; Lucchini, Barbara; Schätti-Stählin, Sibylle; Salvadé, Igor; Burnier, Michel; Gabutti, Luca

    2014-10-01

    Clinical experience and experimental data suggest that intradialytic hemodynamic profiles could be influenced by the characteristics of the dialysis membranes. Even within the worldwide used polysulfone family, intolerance to specific membranes was occasionally evoked. The aim of this study was to compare hemodynamically some of the commonly used polysulfone dialyzers in Switzerland. We performed an open-label, randomized, cross-over trial, including 25 hemodialysis patients. Four polysulfone dialyzers, A (Revaclear high-flux, Gambro, Stockholm, Sweden), B (Helixone high-flux, Fresenius), C (Xevonta high-flux, BBraun, Melsungen, Germany), and D (Helixone low-flux, Fresenius, Bad Homburg vor der Höhe, Germany), were compared. The hemodynamic profile was assessed and patients were asked to provide tolerance feedback. The mean score (±SD) subjectively assigned to dialysis quality on a 1-10 scale was A 8.4 ± 1.3, B 8.6 ± 1.3, C 8.5 ± 1.6, D 8.5 ± 1.5. Kt/V was A 1.58 ± 0.30, B 1.67 ± 0.33, C 1.62 ± 0.32, D 1.45 ± 0.31. The low- compared with the high-flux membranes, correlated to higher systolic (128.1 ± 13.1 vs. 125.6 ± 12.1 mmHg, P mmHg; P mmHg/mL; P 20 mmHg) were 70 with A, 87 with B, 73 with C, and 75 with D (P < 0.01 B vs. A, 0.05 B vs. C and 0.07 B vs. D). The low-flux membrane correlated to higher blood pressure levels compared with the high-flux ones. The Helixone high-flux membrane ensured the best efficiency. Unfortunately, the very same dialyzer correlated to a higher incidence of hypotensive episodes.

  5. Low serum leptin predicts mortality in patients with chronic kidney disease stage 5

    DEFF Research Database (Denmark)

    Scholze, Alexandra; Rattensperger, Dirk; Zidek, Walter

    2007-01-01

    Leptin, secreted from adipose tissue, regulates food intake, energy expenditure, and immune function. It is unknown whether leptin predicts mortality in patients with chronic kidney disease stage 5 on hemodialysis therapy.......Leptin, secreted from adipose tissue, regulates food intake, energy expenditure, and immune function. It is unknown whether leptin predicts mortality in patients with chronic kidney disease stage 5 on hemodialysis therapy....

  6. Anorexia in hemodialysis patients: an update.

    Science.gov (United States)

    Bossola, M; Tazza, L; Giungi, S; Luciani, G

    2006-08-01

    Anorexia, defined as the loss of the desire to eat, is relatively common in hemodialysis (HD) patients, occurring in one-third of cases. The pathogenesis is essentially unknown. It has been proposed that uremic toxins as middle molecules, inflammation, altered amino-acid pattern, leptin, ghrelin, and neuropeptide Y are involved. Anorexia reduces oral energy and protein intakes, thus contributing to the development of malnutrition and cachexia. Unquestionably, it contributes to poor quality of life. The clinical relevance of anorexia as an independent prognostic factor in HD patients is a matter of debated issue. The treatment of this debilitating condition is based on a therapeutic strategy which may include daily dialysis sessions and nutritional counseling. Normalization of plasma branched-chain amino acids through branched-chain amino acids supplementation may decrease anorexia and improve energy and protein intake. The role of megestrol acetate as appetite stimulant needs to be validated through adequate randomized trials. Subcutaneous ghrelin administration and melanocortin-receptor antagonists appear promising therapeutic interventions.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-05-15

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

  8. Cardiovascular risk factors in hemodialysis and peritoneal dialysis patients

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    Helal Imed

    2010-01-01

    Full Text Available Cardiovascular diseases are a major cause of morbidity and mortality in patients with end-stage renal disease (ESRD. The aim of our investigation was the evaluation of an extensive cardiovascular profile in hemodialysis (HD and peritoneal dialysis (PD patients. We studied 74 patients with ESRD (38 males, 36 females, maintained either on chronic HD (n= 50 or chronic PD (n= 24 and age and sex matched 20 healthy subjects as controls. The lipid profile, homo-cysteine (Hcy and C reactive protein (CRP were measured. When compared to a healthy popu-lation, HD patients displayed a marked atherogenic profile, as attested by increased levels of total cholesterol (TC, triglycerides (TG, low-density lipoprotein-cholesterol (LDL-C, apolipoprotein A (Apo A, CRP, Hcy and lower concentrations of high-density lipoprotein-cholesterol (HDL-C, Apo B, albumin (ALB. A significant difference was noted concerning the rates of Apo B, HDL-C, TC, ALB and Hcy. Same biological disorders that those found at HD patients were noted in these PD patients. One also noted lower concentration in Apo A. there were a significant diffe-rence with the reference group concerning the rates of albumin, Apo A, HDL-Cl and Hcy. When compared to PD patients, HD patients had significantly decreased concentration of LDL-C. The peculiar metabolic changes observed in the present study confirm the marked tendency of patients with impaired renal function for developing cardiovascular diseases, irrespectively of the type of dialysis. We suggest including uremia-related risk factors in the panel for evaluation of cardio-vascular risk in dialysis patients.

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

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    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

  10. Effects of Oral L-Carnitine Supplementation on Lipid Profile, Anemia, and Quality of Life in Chronic Renal Disease Patients under Hemodialysis: A Randomized, Double-Blinded, Placebo-Controlled Trial

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    Afsoon Emami Naini

    2012-01-01

    Full Text Available In patients on maintenance hemodialysis several factors reduce the body stored carnitine which could lead to dyslipidemia, anemia, and general health in these patients. We evaluated the effect of oral L-carnitine supplementation on lipid profiles, anemia, and quality of life (QOL in hemodialysis patients. In a randomized, double-blinded, placebo-controlled trial, end-stage renal disease (ESRD patients on hemodialysis received either L-carnitine 1 g/d (n=24 or placebo (27 patients for 16 weeks. At the end of the study, there was a significant decrease in triglyceride (-31.1±38.7 mg/dL, P=0.001 and a significant increase in HDL (3.7±2.8 mg/dL, P0.05. Erythropoietin dose was significantly decreased in both the carnitine (-4750±5772 mg, P=0.001 and the placebo group (-2000±4296 mg, P<0.05. No improvement was observed in QOL scores of two groups. In ESRD patients under maintenance hemodialysis, oral L-carnitine supplementation may reduce triglyceride and cholesterol and increase HDL and hemoglobin and subsequently reduce needed erythropoietin dose without effect on QOL.

  11. Cryptococcal pleuritis developing in a patient on regular hemodialysis.

    Science.gov (United States)

    Kinjo, K; Satake, S; Ohama, T

    2009-09-01

    A 64-year-old male on regular hemodialysis who was a human T lymphotrophic virus Type I (HTLV-I) carrier developed cryptococcal pleuritis. The initial manifestations of the present case were a persistent cough and the accumulation of unilateral pleural effusion. A culture of the pleural fluid of the patient grew cryptococcus neoformans and a test for antigens against cryptococcus neoformans in the pleural fluid was also positive, therefore, cryptococcal pleuritis was diagnosed. Pleural cryptococcosis per se is rare and it is extremely rare for a dialysis patient to develop pleural cryptococcosis. To our knowledge, only a few cases of cryptococcal pleuritis have so far been reported in patients on dialysis. Furthermore, an isolated occurrence of cryptococcal pleuritis with no cryptococcal pulmonary parenchymal lesions, as was seen in the present case, is rare because cryptococcal pleuritis is usually associated with underlying cryptococcal pulmonary parenchymal lesions. Patients on chronic dialysis are susceptible to developing pleural effusion from many etiologies such as congestive heart failure, infection (tuberculosis, bacterial, viral, parasitic, fungal), collagen vascular disease, drug reaction, metastasis, or uremia itself. Cryptococcal pleuritis developing in a dialysis patient is extremely rare, but physicians should consider cryptococcal infection as a possible cause when pleural effusion develops in a dialysis patient and no other cause is identified, as occurred in the present case.

  12. Dose adjustment of carboplatin in patients on hemodialysis.

    Science.gov (United States)

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

    2014-03-01

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

  13. Rosuvastatin and cardiovascular events in patients undergoing hemodialysis

    DEFF Research Database (Denmark)

    Fellström, Bengt C; Jardine, Alan G; Schmieder, Roland E;

    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, NCT00240331.)...

  14. Comparative Assessment of Quality of Life in Hemodialysis and Kidney Transplant Patients

    Directory of Open Access Journals (Sweden)

    A Abbaszadeh

    2010-12-01

    Full Text Available Introduction: Quality of life(QOL is a state of complete physical, mental, social and spiritual well-being and may be affected by sociodemographic variables, chronic illnesses, psychiatric and physical conditions. End stage renal diseases and treatments lead to many problems in patients including physical, mental and socioeconomic problems thus affecting their overall QOL. This study evaluated and compared QOL in hemodialysis and kidney transplant patients. Methods: In a descriptive analytic study, SF36 questionnaire was used to examine QOL in 120 patients (60 hemodialysis and 60 kidney transplant patients in Kerman. Results: The mean QOL score in hemodialysis patients was 49.83±17.56, while in kidney transplant patients, it was 60.95±16.60. Although difference between the two groups was significant (p≤o.o5, the difference in three dimensions pain, physical and social function was not significant (p≥0.05. In hemodialysis patients, minimum score was in vitality dimension and maximum score in physical function. In kidney transplant patients, minimum score was in general health and maximum score was in role limitation due to physical problem dimension. Conclusion: Although QOL in both groups is lower than public communities, kidney transplantation can improve QOL, especially in role restriction due to physical problems. Based on results, it seems that age, blood creatinine levels and personal perception are the most important factors affecting QOL of hemodialysis patients and only creatinine levels and personal perception can be modified. So, in this group of patients, by maintaining creatinine levels and assuring dialysis quality, QOL can be improved. On the other hand, recognition of patient’s defiance mechanisms can improve adaptation and life satisfaction.

  15. Clinical Significance of Measurement on the Changes of Plasma Leptin and Serum VEGF, HGF Levels After Hemodialysis in Patients with Chronic Renal Failure%慢性肾功能衰竭患者血透前后血浆leptin和血清VEGF、HGF检测的临床意义

    Institute of Scientific and Technical Information of China (English)

    顾涛

    2012-01-01

    Objective To explor the clinical significance of changes on plasma leptin and serum VEGF,HGF levels after hemodi-alysis in patients with chronic renal failure. Methods Plasma leptin (with RIA) , serum VEGF, HGF(with ELISA) levels were measured in 32 patients with chronic renal failure both before and after hemodialysis as well as in 35 normal healthy controls. Results Before hemodialysis plasma leptin and serum VEGF,HGF levels were significantiy higher in the patients than those in controls (P < 0.05). Conclusion The levels of leptin, VEGF and HGF were significantly increased in patients with chronic renal failure. Hemodialysis could increase the clearance rate of leptin, VEGF and HGF and might be useful for clinical assessment.%目的:探讨了慢性肾功能衰竭(CRF)患者血透前后血浆leptin和血清VEGF、HGF水平的变化及意义.方法:应用放射免疫分析和酶联法对32例CRF患者进行了血透前后血浆leptin和血清VEGF、HGF检测,并与35名正常健康人作比较.结果:CRF在血透前血浆leptin和血清VEGF、HGF水平非常显著地高于正常人组(P<0.01).结论:CRF患者存在高leptin、VEGF、HGF血症.血透可增加leptin、VEGF和HGF的清除率,具有重要的临床价值.

  16. Uremic pruritus in hemodialysis patients: treatment with desloratidine versus gabapentin

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    Diego Marquez

    2012-06-01

    Full Text Available INTRODUCTION: Uremic pruritus is common among dialysis patients. Effective treatments are not readily available. Early evidence with antihistamines and gabapentin indicate variable effects. OBJECTIVE: To compare the efficacy and side effects of gabapentin and desloratadine in patients with dialysis pruritus. METHODS: Prospective, open-label, cross-over clinical trial in 22 patients on chronic hemodialysis with sustained pruritus over a period of at least 60 days. After a one-week run-in period, we assigned patients to three weeks of either gabapentin 300 mg thrice weekly or desloratadine 5 mg thrice weekly. After a one-week washout period, each patient crossed-over to the alternate regimen for three more weeks. The primary endpoint of the study was the change in the visual analogue pruritus score (VAS. RESULTS: Nineteen subjects completed the two treatment blocks and were available for analysis. VAS scores decreased with both treatments (5.95 to 4.6 with gabapentin, p = 0.07; 5.89 to 3.4 with desloratadine, p = 0.004, but only desloratadine reached statistical significance. There were no differences when comparing the final pruritus score with gabapentin and desloratadine (4.6 versus 3.4, p = 0.16 Excessive sedation was common with gabapentin. Desloratadine was well tolerated. CONCLUSION: Desloratadine provides significant relief of uremic pruritus compared with no therapy. gabapentin has marginal efficacy. Desloratadine is better tolerated than gabapentin.

  17. Hepatitis C Is Less Aggressive in Hemodialysis Patients than in Nonuremic Patients

    Science.gov (United States)

    Trevizoli, Jose Eduardo; de Paula Menezes, Raissa; Ribeiro Velasco, Lara Franciele; Amorim, Regina; de Carvalho, Mauro Birche; Mendes, Liliana Sampaio; Neto, Columbano Junqueira; de Deus Macedo, José Roberto; de Assis, Francisco; Neves, Rocha

    2008-01-01

    Background and objectives: The severity of liver disease among hepatitis C patients on hemodialysis is controversial. The aim of this study was to compare the clinical, biochemical, and liver histologic characteristics of hepatitis C virus (HCV) in hemodialysis patients and in those with normal renal function. Design, setting, participants, & measurements: A case-control study was carried out with 36 HCV patients on hemodialysis and 37 HCV patients with normal renal function matched for gender, age at infection, and estimated time of infection. Results: HCV patients on hemodialysis had lower levels of alanina aminotransferase and lower viral load. Hepatic fibrosis was significantly higher in the patients with normal renal function (73%) than in hemodialysis patients (47.2%, P < 0.025); the same was observed for inflammatory activity (control group 59.5% versus hemodialysis patients 27.7%, P = 0.003). In addition, the risk of tissue inflammation was four times lower in hemodialysis patients (odds ratio = 0.23, P < 0.004), and severe inflammatory activity on biopsy was the only independent risk factor for fibrosis (P < 0.001). Conclusions: The lower biochemical and inflammatory activities observed in hemodialysis patients suggest that hemodialysis and uremia may have a protective role against progression of the disease caused by HCV. PMID:18650408

  18. Food intake in patients on hemodialysis

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    Inaiana Marques Filizola Vaz

    2014-12-01

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

  19. Epidemiology, surveillance, and prevention of bloodstream infections in hemodialysis patients.

    Science.gov (United States)

    Patel, Priti R; Kallen, Alexander J; Arduino, Matthew J

    2010-09-01

    Infections cause significant morbidity and mortality in patients undergoing hemodialysis. Bloodstream infections (BSIs) are particularly problematic, accounting for a substantial number of hospitalizations in these patients. Hospitalizations for BSI and other vascular access infections appear to have increased dramatically in hemodialysis patients since 1993. These infections frequently are related to central venous catheter (CVC) use for dialysis access. Regional initiatives that have shown successful decreases in catheter-related BSIs in hospitalized patients have generated interest in replicating this success in outpatient hemodialysis populations. Several interventions have been effective in preventing BSIs in the hemodialysis setting. Avoiding the use of CVCs in favor of access types with lower associated BSI risk is among the most important. When CVCs are used, adherence to evidence-based catheter insertion and maintenance practices can positively influence BSI rates. In addition, facility-level surveillance to detect BSIs and stimulate examination of vascular access use and care practices is essential to a comprehensive approach to prevention. This article describes the current epidemiology of BSIs in hemodialysis patients and effective prevention strategies to decrease the incidence of these devastating infections.

  20. Total body and regional bone mineral content in hemodialysis patients

    Energy Technology Data Exchange (ETDEWEB)

    Hagiwara, Satoshi; Aratani, Hideyui; Miki, Takami; Nishizawa, Yoshiki; Okamura, Terue; Koizumi, Yoshiko; Ochi, Hironobu; Morii, Hirotoshi (Osaka City Univ. (Japan). Faculty of Medicine)

    1994-02-01

    Bone mineral content (BMC) in the total body and lumbar spine was evaluated in 126 hemodialysis patients (60 males, 66 females) by dual photon absorptiometry with the Norland DBD 2600. Measurements of: (1) total body BMC divided by lean body mass (BMC[sub TB]/LBM), (2) bone mineral density (BMD) of total body, (3) BMD of four regional sections (head, trunk, pelvis, and legs), and (4) BMD of lumbar spine, generally showed a significant decrease in the hemodialysis patients compared to the reference population. However, arm BMD did not show a significant difference between patients and control populations. The z-score of BMC[sub TB]/LBM declined significantly throughout the duration of hemodialysis, although that of the lumbar spine BMD did not. It should be noted that the degree of decrease in BMC was more prominent in the total body measurement than in the lumbar spine measurement. There was preferential osteopenia of the total body in the hemodialysis patients. Although the lumbar spine BMD showed a lower value than the control population, the lumbar spine is not the recommended region to monitor the BMD change in hemodialysis patients. (author).

  1. Effect of hs-CRP level and nutritional status on pulmonary function in patients with maintenance hemodialysis

    Institute of Scientific and Technical Information of China (English)

    Ru Lei

    2016-01-01

    Objective:To explore the effect of hs-CRP level and nutritional status on the pulmonary function in patients with maintenance hemodialysis (MHD). Methods: A total of 30 patients with chronic renal failure (CRF) who were admitted in our hospital from August, 2014 to August, 2015 for hemodialysis were included in the study. A volume of 4mL morning fasting elbow venous blood before and after hemodialysis was extracted, and was then centrifuged for serum. The levels of Hb, Alb, and PA were detected. VC, FVC, FEV1, FEV1/FVC, PEF, and MMEF were determined. Results: The levels of Hb, Alb, and PA after hemodialysis were significantly higher than those before hemodialysis (P<0.05). VC, FVC, FEV1, FEV1/FVC, PEF, and MMEF after hemodialysis were significantly improved when compared with before treatment (P<0.05). The comparison of VC, FVC, FEV1, FEV1/FVC, PEF, and MMEF among patients with different levels of hs-CRP was statistically significant (P<0.05). Conclusions:The reduction of pulmonary function in different degrees exists in MHD patients. MHD is kind of effective method to improve the pulmonary function in patients with CRF. The effective improvement of nutritional status and the reduction of in vivo inflammatory reaction in patients with CRF in the clinic can relieve the deterioration of pulmonary function to a certain degree so that to improve the ventilation function and enhance the living quality.

  2. Successful afatinib treatment of advanced non-small-cell lung cancer patients undergoing hemodialysis.

    Science.gov (United States)

    Imai, Hisao; Kaira, Kyoichi; Naruse, Ichiro; Hayashi, Hideki; Iihara, Hirotoshi; Kita, Yutaro; Mizusaki, Naoki; Asao, Takayuki; Itoh, Yoshinori; Sugiyama, Tadashi; Minato, Koichi; Yamada, Masanobu

    2017-01-01

    The treatment for patients with lung cancer undergoing hemodialysis, who are frequently elderly and have poor performance status, becomes a more important subject. However, the feasibility of afatinib in patients with chronic renal failure undergoing hemodialysis has not, so far, been reported. Here, afatinib was administered to three patients with NSCLC harboring EGFR mutation and chronic renal failure undergoing hemodialysis. Pharmacokinetic (PK) data of afatinib supported the safety of afatinib treatment. After receiving their written informed consent from all patients, they were administered 30 mg afatinib daily with HD three times a week. We performed PK analyses of afatinib on days 1, 2, 10, and 11 after initial administration of afatinib. All three patients exhibited a partial response without any serious adverse events during the administration of afatinib. These PK data were similar to those of patients with normal organ function, which were previously reported. Our findings may be particularly useful given the current opportunity to use afatinib as a first-line treatment for EGFR-mutated NSCLC patients, providing an additional option for patients with impaired renal function.

  3. Effect of cryotherapy on arteriovenous fistula puncture-related pain in hemodialysis patients

    OpenAIRE

    P. B., Sabitha; Khakha, D. C.; Mahajan, S.; Gupta, S; M. Agarwal; Yadav, S. L.

    2008-01-01

    Pain during areteriovenous fistula (AVF) cannulation remains a common problem in hemodialysis (HD) patients. This study was undertaken to assess the effect of cryotherapy on pain due to arteriovenous fistula puncture in hemodialysis patients. A convenience sample of 60 patients (30 each in experimental and control groups) who were undergoing hemodialysis by using AVF, was assessed in a randomized control trial. Hemodialysis patients who met the inclusion criteria, were randomly assigned to ex...

  4. No difference between alfacalcidol and paricalcitol in the treatment of secondary hyperparathyroidism in hemodialysis patients: a randomized crossover trial

    DEFF Research Database (Denmark)

    Hansen, Ditte; Rasmussen, Knud; Danielsen, Henning

    2011-01-01

    Alfacalcidol and paricalcitol are vitamin D analogs used for the treatment of secondary hyperparathyroidism in patients with chronic kidney disease, but have known dose-dependent side effects that cause hypercalcemia and hyperphosphatemia. In this investigator-initiated multicenter randomized...... were equally effective in the suppression of secondary hyperparathyroidism in hemodialysis patients while calcium and phosphorus were kept in the desired range...

  5. EVALUATION OF NUTRITIONAL STATUS IN HEMODIALYSIS PATIENTS

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    Amel Harzallah

    2016-08-01

    Full Text Available Malnutrition is a common problem among hemodialysis patients. This factor leads to increased morbidity and mortality. This study evaluates the nutritional status of patients on dialysis and analyses the various parameters used for assessing malnutrition. It is a cross-sectional study of 35 patients aged 18 years and up who have undergone dialysis three days a week for more than a year. The following were analysed: overall subjective assessment technique, Body Mass Index, anthropometric data and biological parameters (serum albumin, serum cholesterol, rate of alkaline reserves and C-reactive protein levels with a dietary three-day survey. Analysis of food survey data was performed using the software Bilnut. The patients’ average age was 46.7 years with a sex ratio of 1.18. Average waist size was 92.7±16.68 cm. Average arm circumference was 27.2±5.6 cm and average calf circumference was 32.03±5.87 cm. Malnutrition was found in 48% of cases according to SGA. Average BMI was 24.4 kg/m2. It was less than 23 Kg/m2 in 48% of cases. Average serum albumin concentration was 33.6 g/l and average CRP level was 6.16 mg/l. The average energy intake (Kcal/Kg/day was 30.87±11.92 the day of dialysis, 27.98±9.31 on a resting day and 29.93±9.42 on another day and the average protein intake (g/kg/day was 1.02±0.44 the day of dialysis, 0.94±0.36 a resting day and 1.04±0.36 on the other day. Malnutrition was frequent among our patients. The assessment of nutritional status in patients on dialysis requires simultaneous combination of several clinical, biologic and dietetic markers. Dietary management is mainly based on food survey regularly established.

  6. Obese and diabetic patients with end-stage renal disease: Peritoneal dialysis or hemodialysis?

    Science.gov (United States)

    Ekart, Robert; Hojs, Radovan

    2016-07-01

    Obesity is a chronic disease that is increasingly prevalent around the world and is a well-recognized risk factor for type 2 diabetes and hypertension, leading causes of end-stage renal disease (ESRD). The obese diabetic patient with ESRD is a challenge for the nephrologist with regard to the type of renal replacement therapy that should be suggested and offered to the patient. There is no evidence that either peritoneal dialysis or hemodialysis is contraindicated in obese ESRD patients. In the literature, we can find a discrepancy in the impact of obesity on mortality among hemodialysis vs. peritoneal dialysis patients. Several studies in hemodialysis patients suggest that a higher BMI confers a survival advantage - the so-called "reverse epidemiology". In contrast, the literature among obese peritoneal dialysis patients is inconsistent, with various studies reporting an increased risk of death, no difference, or a decreased risk of death. Many of these studies only spanned across a few years, and this is probably too short of a time frame for a realistic assessment of obesity's impact on mortality in ESRD patients. The decision for dialysis modality in an obese diabetic patient with ESRD should be individualized. According to the results of published studies, we cannot suggest PD or HD as a better solution for all obese diabetic patients. The obese patient should be educated about all their dialysis options, including home dialysis therapies. In this review, the available literature related to the dialysis modality in obese patients with diabetes and ESRD was reviewed.

  7. Clinical effect of high flux hemodialysis in the treatment of uremic patients with chronic renal failure%高通量透析治疗慢性肾衰竭尿毒症患者的效果评价

    Institute of Scientific and Technical Information of China (English)

    王敬

    2016-01-01

    Objective:To observe the clinical effects of high flux hemodialysis in the treatment of uremic patients with chronic renal failure. Methods:One hundred and twenty uremic patients with chronic renal failure were randomly divided into the observation group and control group. The observation group and control group were treated with high flux dialysis and conventional hemodialysis, respectively. Results:The total effective rate in observation group ( 90. 0%) was higher than that in control group after treatment (70. 0%)(P<0. 01). The levels of BUN,Scr,β2-MG and PTH in two groups after dialysis were significantly lower than those in before dialysis(P<0. 01). BUN、β2-MG and PTH in observation group decreased significantly higher than the control group(P<0. 01) after dialysis,while the Scr is oppsite(P<0. 01). After dialysis,the number of cases with body mass index increasing in observation group was significantly higher than that in control group(P<0. 01). and the incidence rates of bone and joint pain,fatigue and skin pruritus in observation group were lower than those in control group(P<0. 05 to P<0. 01). Conclusions:The treatment of uremia patients with chronic renal failure with high flux dialysis can improve the therapeutic effect,strongly clear the large,middle and small molecules,reduce the incidence rate of adverse reactions and improve the life quality of patients,which is worthy of promoting in clinic use.%目的:观察高通量透析治疗慢性肾衰竭尿毒症患者的临床效果.方法:选择120例慢性肾衰竭尿毒症患者,随机分为观察组和对照组,观察组患者给予高通量透析治疗,对照组给予普通血液透析治疗.比较2组患者的治疗效果.结果:观察组患者经治疗后总有效率为90.0%,高于常规透析治疗的总有效率70.0%(P<0.01).2组患者透析后尿素氮(BUN)、血肌酐(Scr)、β2微球蛋白(β2-MG)和甲状旁腺素(PTH)均较各自透析前显著降低(P<0.01).观

  8. Pulse contour-derived cardiac output in hemodialysis patients

    DEFF Research Database (Denmark)

    Cordtz, Joakim; Ladefoged, Soeren D

    2010-01-01

    analysis, namely the Finometer monitor (FNM) for further use on patients dialyzing on a central vascular catheter. Fifty simultaneous cardiac output measurements were obtained during hemodialysis sessions in 25 patients. The internal variability of the FNM measurements was assessed by comparing 24 pairs...

  9. Efeito do exercício resistido intradialítico em pacientes renais crônicos em hemodiálise Effect of resistance exercise intradialytic in renal patients chronic in hemodialysis

    Directory of Open Access Journals (Sweden)

    Ronaldo Ribeiro

    2013-03-01

    Full Text Available INTRODUÇÃO: Pacientes com doença renal crônica (DRC quando submetidos ao exercício resistido (ER apresentam substancial melhorias de muitas funções, em especial os relacionados ao sistema cardiovascular, respiratório, muscular e na qualidade de vida (QV. Não existem avaliações do impacto de exercício simples e factíveis em pacientes com DRC associada ao Diabetes Mellitus (DM durante o período intradialítico. OBJETIVO: Estudar o papel do exercício resistido no tratamento e na qualidade de vida em pacientes submetidos à hemodiálise crônica (HD. Assim, submetemos pacientes com DRC e DM ao ER durante a hemodiálise. MÉTODOS: Quinze pacientes em cada grupo: 1: DM com DRC submetidos ao ER; 2: DM com DRC sedentários; 3: DRC e ER e, 4: DRC sedentários. Avaliações durante oito semanas, com ER três vezes na semana. Avaliação laboratorial, teste de força muscular (FM e QV (SF-36. RESULTADOS: O ER induziu melhoria na glicemia e na FM com discretas, mas significantes alterações na uréia e, K (p INTRODUCTION: Patients with chronic kidney disease (CKD when subjected to resistance exercise (RE show substantial improvements in many functions, especially those related to the cardiovascular system, respiratory, muscular and quality of life (QOL. There are no evaluations of the impact of exercise simple and feasible in patients with CKD associated with Diabetes Mellitus (DM during the intradialytic period. Thus, patients with CKD and submit to the DM + RE during hemodialysis. OBJECTIVE: To study the role of resistance exercise in the treatment and quality of life in patients undergoing chronic hemodialysis (HD. METHODS: 15 patients in each group: 1: DM with CKD and RE; 2: DM + CKD sedentary; 3: CKD + RE and 4: DRC sedentary. They were evaluated during eight weeks, with RE three times a week. Parameters: Laboratory assessments, muscle strength testing (FM and QV (SF-36. RESULTS: RE induced improvement in glucose and FM with subtle but

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

    Institute of Scientific and Technical Information of China (English)

    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.

  11. Occult hepatitis C virus infection among hemodialysis patients.

    Science.gov (United States)

    Barril, Guillermina; Castillo, Inmaculada; Arenas, María Dolores; Espinosa, Mario; Garcia-Valdecasas, Juan; Garcia-Fernández, Nuria; González-Parra, Emilio; Alcazar, José María; Sánchez, Carmen; Diez-Baylón, José Carlos; Martinez, Pilar; Bartolomé, Javier; Carreño, Vicente

    2008-12-01

    Occult hepatitis C virus (HCV) infection (i.e., detectable HCV-RNA in the liver or peripheral blood mononuclear cells) in the absence of both serum HCV-RNA and anti-HCV antibodies has not been investigated in hemodialysis patients. In this study, real-time PCR and in situ hybridization was used to test for the presence of genomic and antigenomic HCV-RNA in peripheral blood mononuclear cells of 109 hemodialysis patients with abnormal levels of liver enzymes. Occult HCV infection, determined by the presence of genomic HCV-RNA, was found in 45% of the patients; 53% of these patients had ongoing HCV replication, indicated by the presence of antigenomic HCV-RNA. Patients with occult HCV infection had spent a significantly longer time on hemodialysis and had significantly higher mean alanine aminotransferase levels during the 6 mo before study entry. Logistic regression analysis revealed that mortality was associated with age >60 yr (odds ratio 3.30; 95% confidence interval 1.05 to 10.33) and the presence of occult HCV infection (odds ratio 3.84; 95% confidence interval 1.29 to 11.43). In conclusion, the prevalence of occult HCV infection is high among hemodialysis patients with persistently abnormal values of liver enzymes of unknown cause. The clinical significance of occult HCV infection in these patients requires further study.

  12. Association of serum lipids with levels of leptin in hemodialysis patients

    Science.gov (United States)

    Rafieian-Kopaei, Mahmoud; Nasri, Hamid

    2013-01-01

    To consider the correlation of serum leptin with dyslipidemia in hemodialysis patients. For maintenance hemodialysis patients levels of serum, lipid profiles and serum leptin were measured. Stable hemodialysis patients enrolled to the study. In all patients (36) a near significant,inverse correlation of serum leptin with serum LDL-C was seen. In male hemodialysis group a near significant positive correlation of serum leptin with serum triglyceride level was seen. The association of leptin with cholestrol and triglycerid levels could show the impact of leptin on nutrition status of hemodialysis patients.

  13. Depression in hemodialysis patients: the role of dialysis shift

    Directory of Open Access Journals (Sweden)

    Flavio Teles

    2014-03-01

    Full Text Available OBJECTIVE: Depression is the most important neuropsychiatric complication in chronic kidney disease because it reduces quality of life and increases mortality. Evidence demonstrating the association between dialysis shift and depression is lacking; thus, obtaining such evidence was the main objective of this study. METHOD: This cross-sectional study included patients attending a hemodialysis program. Depression was diagnosed using Beck's Depression Inventory. Excessive daytime sleepiness was evaluated using the Epworth Sleepiness Scale. RESULTS: A total of 96 patients were enrolled (55 males, age 48±14 years. Depression and excessive daytime sleepiness were observed in 42.7% and 49% of the patients, respectively. When comparing variables among the three dialysis shifts, there were no differences in age, dialysis vintage, employment status, excessive daytime sleepiness, hemoglobin, phosphorus levels, or albumin levels. Patients in the morning shift were more likely to live in rural areas (p<0.0001, although patients in rural areas did not have a higher prevalence of depression (p= 0.30. Patients with depression were more likely to be dialyzed during the morning shift (p= 0.008. Independent risk factors for depression were age (p<0.03, lower levels of hemoglobin (p<0.01 and phosphorus (p<0.01, and dialysis during the morning shift (p= 0.0009. The hospitalization risk of depressive patients was 4.5 times higher than that of nondepressive patients (p<0.008. CONCLUSION: These data suggest that depression is associated with dialysis shift, higher levels of phosphorus, and lower levels of hemoglobin. The results highlight the need for randomized trials to determine whether this association occurs by chance or whether circadian rhythm disorders may play a role.

  14. STRESS AND MENTAL DISORDERS IN HEMODIALYSIS PATIENTS

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    SH AKOOCHEKIAN

    2002-12-01

    Full Text Available Introduction. Chronic renal failure and dialysis are complicated situations that affect on somatic and mental status of patients. In this study, relation between stress, renal diseas, dialysis and mental disorders was determined. Methods. In a case control study in Noor hospital"s dialysis ward (affiliated to Isfahan University of Medical Sciences and Health Services the mental status of 30 end stage renal disease (ESRD patients were compaired with well matched control group by MMPI. Results. Hypochondriasis (Hs, depression (D, hysteria (Hy psychastenia (Pt and schizophrenia (Sc were observed in ESRD patients more than controls (P < 0.05. Means of sociopathy (Pd, paranoia (Pa and hypomania (Ma had no difference between groups (P > 0.05. Realy sadness and dysphoria, rumintion with illness, obsession, anxiety, compulsion, impaired process of thinking, isolation tendency and odd sensation in patients were more than control group (P < 0.05. Discussion. Chronic diseases have psychological complication and as a stress must cope and adjust with it. So, these patients and their families must be educated about coping mechanism. When the patients and their families have good coping mechanism, they would be able tolerate these streses.

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

    DEFF Research Database (Denmark)

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

    2009-01-01

    interval, 1.2-3.5) of death attributable to infection; after multivariable adjustment, this relationship remained statistically significant (odds ratio, 3.7; 95% confidence interval, 1.2-11.2). CONCLUSIONS: In individuals initiating chronic hemodialysis, low baseline levels of hCAP18, a vitamin D...... with end-stage renal disease, we hypothesized that low hCAP18 levels would identify those who are at increased risk of death attributable to infection while undergoing hemodialysis. METHODS: We performed a case-control study nested in a prospective cohort of patients (n = 10,044) initiating incident...... hemodialysis. Case patients (n = 81) were those who died of an infectious disease within 1 year; control patients (n = 198) were those who survived at least 1 year while undergoing dialysis. RESULTS: Mean (+/-SD) baseline levels of hCAP18 in case patients and control patients were 539 +/- 278 ng/mL and 650...

  16. Efeito de uma sessão de hemodiálise sobre o estresse oxidativo sistêmico de pacientes renais crônicos terminais Effect of a hemodialysis session on oxidative stress of chronic kidney disease patients

    Directory of Open Access Journals (Sweden)

    Patrícia Dall'Agnol Bianchi

    2009-09-01

    Full Text Available OBJETIVO: Avaliar a repercussão de uma sessão de hemodiálise (HD sobre o estresse oxidativo sistêmico de pacientes renais crônicos. MÉTODOS E RESULTADOS: Foram avaliados 17 pacientes (10 mulheres com média de idade de 39,9 ± 13,5 anos em tratamento hemodialítico na Unidade de Nefrologia do HCPA, e o grupo controle formado por 18 indivíduos saudáveis (4 mulheres, com média de idade de 34,8 ± 10,1 anos. O sangue dos doentes renais foi coletado antes e após a sessão de HD. As médias foram analisadas pelo teste t de Student (p OBJECTIVE: To assess the effect of a hemodialysis (HD session on systemic oxidative stress of chronic renal patients. METHODS AND RESULTS: The study comprised 17 patients (10 women and 7 men with mean age of 39.9 ± 13.5 years undergoing hemodialytic treatment at the Unit of Nephrology of Hospital de Clínicas de Porto Alegre, and a control group formed by 18 healthy individuals (4 women and 14 men with mean age of 34.8 ± 10.1 years. Renal patients had blood samples withdrawn before and after HD session. Means were analyzed by Student t test (p < 0.05. In red blood cells, the activity of the antioxidant enzymes superoxide dismutase (SOD and catalase (CAT was assessed. In plasma, the non-enzymatic antioxidant system was assessed by measuring the total reactive antioxidant potential (TRAP. No significant differences were observed between the values of SOD and CAT before and after HD. Comparison with the control group showed a significant reduction in the activity of those enzymes. After HD session, a significant reduction in TRAP was observed. Oxidative damage to membrane lipids was assessed through chemiluminescence (CL, and the damage to proteins through carbonyl assay. No significant difference was observed in the values of CL and carbonyls after HD. However, when compared with the control group, a significant difference was observed, indicating a greater damage to membrane lipids and proteins in renal

  17. Left and right ventricular diastolic function in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Rudhani Ibrahim

    2010-01-01

    Full Text Available The aim of this prospective study was the assessment of left ventricular and right ventricular diastolic function in patients on hemodialysis (HD and the correlation of this func-tion with the duration of HD. The study included 42 patients (22 females and 20 males with chro-nic renal failure (CRF, treated with HD, and 40 healthy subjects (24 females and 16 males with no history of cardiovascular disease and with normal renal function, who constituted the control group. The groups were matched for age and sex. All study patients and control subjects under-went detailed history taking and physical examination. They also underwent electrocardiogram, echocardiography and biochemical and hematological blood analyses. Significant differences were noted between the two groups in the two-dimensional and M-mode echocardiography findings concerning aortic root dimension, transverse diameter of the left atrium, thickness of the inter-ventricular septum, thickness of the left ventricular posterior wall, left ventricular diastolic diameter, left ventricular systolic diameter, shortening fraction, ejection fraction as well as findings from the pulse Doppler study, including E wave, A wave, E/A ratio, deceleration time of E wave (DT-E, acceleration time of E wave (AT-E, tricuspid E and A waves (E tr and A tr and E tr /A tr , ratio. There were significant changes in HD patients without arterial hypertension as well in the control group subjects. Our study suggests that the left ventricular and left atrial dimensions as well as the left ventricular wall thickness are augmented in patients with CRF treated with HD compared with the control group. Additionally, the left and right ventricular diastolic function is also reduced in these patients. These differences were also noted in patients with CRF without arterial hypertension. Left ventricular diastolic dysfunction had no correlation with the duration of HD.

  18. Left and right ventricular diastolic function in hemodialysis patients.

    Science.gov (United States)

    Rudhani, Ibrahim Destan; Bajraktari, Gani; Kryziu, Emrush; Zylfiu, Bejtush; Sadiku, Shemsedin; Elezi, Ymer; Rexhepaj, Nehat; Vitia, Arber; Emini, Merita; Abazi, Murat; Berbatovci-Ukimeraj, M; Kryeziu, Kaltrina; Hsanagjekaj, Venera; Korca, Hajrije; Ukimeri, Aferdita

    2010-11-01

    The aim of this prospective study was the assessment of left ventricular and right ventricular diastolic function in patients on hemodialysis (HD) and the correlation of this function with the duration of HD. The study included 42 patients (22 females and 20 males) with chronic renal failure (CRF), treated with HD, and 40 healthy subjects (24 females and 16 males) with no history of cardiovascular disease and with normal renal function, who constituted the control group. The groups were matched for age and sex. All study patients and control subjects underwent detailed history taking and physical examination. They also underwent electrocardiogram, echocardiography and biochemical and hematological blood analyses. Significant differences were noted between the two groups in the two-dimensional and M-mode echocardiography findings concerning aortic root dimension, transverse diameter of the left atrium, thickness of the interventricular septum, thickness of the left ventricular posterior wall, left ventricular diastolic diameter, left ventricular systolic diameter, shortening fraction, ejection fraction as well as findings from the pulse Doppler study, including E wave, A wave, E/A ratio, deceleration time of E wave (DT-E), acceleration time of E wave (AT-E), tricuspid E and A waves (E tr and A tr ) and E tr /A tr , ratio. There were significant changes in HD patients without arterial hypertension as well in the control group subjects. Our study suggests that the left ventricular and left atrial dimensions as well as the left ventricular wall thickness are augmented in patients with CRF treated with HD compared with the control group. Additionally, the left and right ventricular diastolic function is also reduced in these patients. These differences were also noted in patients with CRF without arterial hypertension. Left ventricular diastolic dysfunction had no correlation with the duration of HD.

  19. A shield against a monster: Hepatitis C in hemodialysis patients

    Institute of Scientific and Technical Information of China (English)

    Seyed-Moayed Alavian

    2009-01-01

    Hepatitis C virus (HCV) infection is highly prevalent among patients on hemodialysis (HD). The prevalenceof HCV infection in HD patients varies markedly from country to country. Some factors are especially related to these high prevalence rates, such as blood transfusions and length of dialysis time. Nosocomial routes of transmission including the use of contaminated equipment and patient-to-patient exposure is considered more important. Several prophylactic measures have been suggested to avoid infection by HCV in the HD environment.

  20. Evaluation of Ulnar neuropathy on hemodialysis patients

    OpenAIRE

    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...

  1. Frequency of nursing care of vascular access in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Iman Taghizade Firoozjayi

    2016-03-01

    Full Text Available Background: Hemodialysis is a critical treatment method, which depends on the vascular access route. Lack of care for the vascular access route could diminish its efficiency in a short time. Regarding this, the present study aimed to evaluate the frequency of nursing care for vascular access route in the hemodialysis patients. Methods: This cross-sectional study was conducted on 20 nurses and 120 hemodialysis patients, who referred to the Hemodialysis Department of Shahid Beheshti Hospital, Babol, Iran, in 2015. The method of nursing care for vascular access route was evaluated using a researcher-made checklist. The data analysis was performed using the descriptive statistics in the SPSS version 16. Results: In total, 14 cases of nursing care were evaluated, in 100% of which all the caring steps, including wearing gloves and a mask, early bolus injections of heparin, washing the catheter tubing, frequent monitoring of blood pressure, rinsing the catheter tubing, returning the blood to the body after hemodialysis, and sterile covering of the puncture site, were observed. However, some of the other techniques, such as the care related to appropriate pump speed when starting the dialysis machine (81.66%, observance of the needle distance from fistula (75.83%, appropriate placement of catheter (75%, pressing the injection site (54.17%, blood pressure monitoring at the end of dialysis (50%, and change of the needle site between two sessions (27.5%, were not adhered to by the nurses. Conclusion: According to the results of this study, some of the nursing care steps, which are necessary in the beginning and end of the hemodialysis, were not accurately followed by the nurses. It is recommended that constant training courses be held for the nurses in this regard.

  2. Comparison of methodologies to define hemodialysis patients hyporesponsive to epoetin and impact on counts and characteristics

    Directory of Open Access Journals (Sweden)

    Gilbertson David T

    2013-02-01

    Full Text Available Abstract Background Some hemodialysis patients require large doses of erythropoiesis-stimulating agents (ESAs to manage anemia. These patients, termed “ESA hyporesponsive,” have been characterized using various definitions. We applied three definitions of hyporesponsiveness to a large, national cohort of hemodialysis patients to assess the impact of definition on counts and on characteristics associated with hyporesponsiveness. Methods We studied point-prevalent hemodialysis patients on May 1, 2008, with Medicare as primary payer, who survived through December 31, 2008. Included patients received recombinant human erythropoietin (EPO in each month, August-December. Hyporesponsiveness definitions were: above the ninetieth percentile of total monthly EPO dose; above the ninetieth percentile of total monthly EPO dose divided by weight in kg; above the ninetieth percentile of total monthly EPO dose divided by hemoglobin level. Hyporesponsiveness was further classified as chronic, acute, or other. Comorbid conditions were assessed before and concurrent with the hyporesponsive period. Results Women, African Americans, and patients aged Conclusions As associations were similar between patient characteristics and three methods of characterizing EPO hyporesponsiveness, the simplest definition using EPO dose can be used.

  3. 慢性肾功能衰竭患者血透前后血浆leptin和血清IL-10、IL-18检测的临床意义%Clinical Significance of Determination the Changes on Plasma Leptin and Serum IL-10,IL-18 Levels Both Before and After Hemodialysis in Patients with Chronic Renal Failure

    Institute of Scientific and Technical Information of China (English)

    蔡伟

    2013-01-01

    Objective To explore the clinical significance of changes on plasma leptin and serum IL-10, IL-18 levels both before and after hemodialysis in patients with chronic renal failure.Methods Plasma leptin and seium IL-10 ( with RIA) , IL-18 ( with ELISA) levels were measured both before and after hemodialysis in 32 patients with chronic renal failure as well as in 35 normal health-y controls. Results Before hemodialysis, plasma leptin and serum IL-10, IL-18 levels were significantly higher in the patients than those in contiols(P<0.01). After hemodialysis for 2 weeks the levels dropped markedlly, but still remained significantly higher than thecontrols(P<0.05). Conclusion Measuring the changes of plasma leptin and serum IL-10, IL-18 levels in patients with chronic renal failure both before and after hemodialysis, provide definite clinical value to realize of pathosis, therapeutic efficacy and prognosis.%目的:探讨慢性肾功能衰竭患者血透前后血浆leptin和血清IL-10、IL-18水平的变化及临床意义.方法:应用放射免疫分析和酶联法对32例慢性肾功能衰竭患者进行了血透前后血浆leptin和血清IL-10、IL-18水平的检测,并与35名正常健康人作比较.结果:慢性肾功能衰竭患者在血透前血浆leptin和血清IL-10、IL-18水平非常显著地高于正常人组(P<0.01),血透2周后,呈明显下降,与正常人组比较仍有显著性差异(P<0.05).结论:检测慢性肾功能衰竭患者血透前后血浆leptin和血清IL-10、IL-18水平的变化对了解病情、观察疗效和预后均有一定的临床价值.

  4. Evaluation of Health-related Quality of Life in Regular Hemodialysis Patients Using the KDQOL-SFTM Questionnaire

    Directory of Open Access Journals (Sweden)

    Eliseo Capote Leyva

    2015-09-01

    Full Text Available Background: in end-stage chronic renal failure, treatments like hemodialysis induce substantial changes in lifestyle. Such therapies aim to achieve functional improvement by reducing symptoms and/or slowing disease progression. Objective: to evaluate the health-related quality of life in patients undergoing regular hemodialysis. Methods: a cross-sectional study was conducted in chronic renal failure patients undergoing regular hemodialysis in the hemodialysis and peritoneal dialysis service of the Dr. Carlos J. Finlay Military Hospital from January through February 2013. The Kidney Disease Quality of Life Short Form version 1.3 was used to evaluate the health-related quality of life. Results: generic dimensions with lower scores were the physical role, general health perception and emotional role. The specific dimensions with lower scores were the burden of kidney disease, employment status and sexual function while dimensions with higher scores were specific: relationship with the dialysis staff (85.62 points, cognitive function (84.33 points and quality of social relationship (82.88 points. Conclusion: As in other countries, the KDQOL-SF enables the evaluation of health-related quality of life in regular hemodialysis patients in Cuba, since it allows effectively identifying the dimensions and areas most affected.

  5. 慢性肾功能衰竭患者血液透析前后血管活性因子的变化及临床意义%The changes and significance of the plasma levels of nitric oxide,endothelin,atrial natriuretic peptide and angiotensinⅡ in chronic renal failure patients receiving hemodialysis therapy

    Institute of Scientific and Technical Information of China (English)

    黄桂芬; 崔志强; 孙亦兵

    2001-01-01

    Objective:To investigate the changes and clinical significance of plasma levels of nitric oxide (NO),endothelin(ET),atrial natriuretic peptide(ANP),plasma renin activity(PRA) and angiotensinⅡ(ATⅡ) before and after hemodialysis in patients with chronic renal failure(CRF).Methods:Sixty patients with CRF(30 patients with uncompensated chronic renal dysfunction and the other 30 patients with chronic renal failure) were included in the study.Thirty healthy volunteer were chosen as normal control.Blood samples were collected before and after hemodialysis.The plasma NO was assayed using colorimetry and the plasma ET,ANP,PRA and ATⅡ were determined by radioimmunoassay.Results:The plasma levels of NO,ET,ANP,PRA and ATⅡ in the group of CRF were significant higher than those of control (P0.05)。结论:血液透析可使CRF患者血浆NO、ANP降低,PRA、ATⅡ升高,提示ET升高可增加ANP和PRA水平,ANP浓度可抑制ATⅡ的分泌。

  6. Dialysis membranes and PTH changes during hemodialysis in patients with secondary hyperparathyroidism.

    Science.gov (United States)

    De Francisco, A L; Amado, J A; Prieto, M; Alcalde, G; Sanz de Castro, S; Ruiz, J C; Morales, P; Arias, M

    1994-01-01

    Changes in parathyroid hormone (PTH) during hemodialysis have been explained by the influence of ionized calcium changes on PTH secretion. In this study we have investigated the influence of dialysis membranes of different permeability on PTH changes during hemodialysis. Five chronic renal failure patients underwent three consecutive hemodialysis sessions with cuprophane (CUP) polysulfone (PS) and polyacrylonitrile (PAN). Two hours of isolated ultrafiltration were followed by 3 h dialysis. A significant decrease in carboxy terminal PTH (COOH PTH) was observed with PAN (p < 0.05) but not with CUP or PS. Intact PTH decreased (p < 0.001) with all three membranes, following a significant increase in ionized calcium (p < 0.001). Sieving coefficients for COOH PTH were significantly lower with CUP than with PS (p < 0.05) or PAN (p < 0.001). Intact PTH sieving coefficients were near zero for all three membranes. COOH PTH and intact PTH clearance rates were significantly higher with PAN (p < 0.001) than with PS or CUP, either in isolated ultrafiltration or with dialysis fluid. Thus PTH changes during hemodialysis do not only depend on the increase in calcium but also on the nature of the dialysis membrane. Adsorption of PTH to the PAN membrane surface explain the high PTH clearance rates achieved with this filter.

  7. Geriatric nutritional risk index: A mortality predictor in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Mahnaz Edalat-Nejad

    2015-01-01

    Full Text Available Recently, the Geriatric Nutritional Risk Index (GNRI has been introduced as a valuable tool to assess the nutritional status of hemodialysis (HD patients. To determine the predictive value of the GNRI score for death in HD, we studied 145 chronic HD patients (%53 men, mean age 60 ± 16 years. The GNRI score was estimated by an equation involving serum albumin and individual′s weight and height. According to the highest positive likelihood and risk ratios, the cut-off value of the GNRI for mortality was set at 100. The survival of patients on HD was examined with the Cox proportional hazards model. Mortality was monitored prospectively over an 18-month period, during which 35 patients died. The GNRI (mean 102.6 ± 5.5 was significantly positively correlated with lean body mass, hematocrit, serum lipids and presence of metabolic syndrome. Multivariate Cox proportional hazards analysis demonstrated that the GNRI <100, serum ferritin ≥ 500 μ g/L and age 65 years or older were significant predictors for mortality (hazard ratio 3.691, 95% CI 1.751-7.779, P = 0.001; hazard ratio 3.105, 95% CI 1.536-6.277, P = 0.002; and hazard ratio 2.806, 95% CI 1.297-6.073, P = 0.009, respectively, after adjustment to gender and vintage time. It can be concluded that, in addition to old age, malnutrition (low GNRI and inflammation (high ferritin are identified as significant independent risk factors that predict all-cause mortality in HD patients.

  8. Is hepcidin-25 a predictor of atherosclerosis in hemodialysis patients?

    Science.gov (United States)

    Kali, Alaaddin; Yayar, Ozlem; Erdogan, Bulent; Eser, Baris; Buyukbakkal, Mehmet; Ercan, Zafer; Merhametsiz, Ozgur; Haspulat, Ayhan; Gök Oğuz, Ebru; Canbakan, Basol; Ayli, Mehmet D

    2016-04-01

    Atherosclerotic cardiovascular disease is an important cause of mortality and morbidity in hemodialysis patients. Iron accumulation in arterial wall macrophages is increased in atherosclerotic lesions. Hepcidin is a key hepatic hormone regulating iron balance. It inhibits iron release from macrophages and iron absorption from enterocytes by binding and inactivating the cellular iron exporter ferroportin. The aim of this study is to investigate the relation of hepcidin-25, iron parameters, and atherosclerosis measured by carotid intima media thickness (CIMT) in hemodialysis patients. Eighty-two hemodialysis patients were enrolled in this cross-sectional study. Predialysis blood samples were centrifuged at 1500 g and 4°C for 10 minutes and stored at -80°C for the measurement of hepcidin-25. DRG hepcidin enzyme-linked immunosorbent assay kit was used for the measurement of hepcidin-25. Ultrasonographical B-mode imaging of bilateral carotid arteries was performed with a high-resolution real-time ultrasonography (Mindray DC7). Mean age of the study population was 57.90 ± 16.08 years and 43.9% were men. Total study population was grouped into two according to median value of hepcidin-25. There was no difference between groups with respect to age, dialysis vintage, and C-reactive protein. CIMT was found to be statistically significantly higher in low hepcidin-25 group. In correlation analysis, CIMT was found to be correlated with age (P < 0.01, R = 0.33) and hepcidin-25 (P < 0.01, R = 0.46). In linear regression analysis, age (β = 0.31) and hepcidin-25 (β = 0.44) were found to be the determinants of CIMT in hemodialysis patients. Our results implicate that hepcidin may take part in pathophysiology of atherosclerosis and cardiovascular disease in hemodialysis patients.

  9. 延续性护理对慢性肾衰竭血液透析患者自我管理能力及生活质量的影响%Influence of Continuity Nursing on Self Management Ability and Quality of Life in Patients With Chronic Renal Failure Hemodialysis

    Institute of Scientific and Technical Information of China (English)

    杨薇

    2016-01-01

    Objective To analyze the influence of continuity nursing on self management ability and quality of life in patients with chronic renal failure hemodialysis.Methods 100 patients with chronic renal failure hemodialysis were treated in our hospital. The patients were divided into two groups by random number table method,compared the effect of routine nursing (control group,n=50)and continuity nursing(observation group,n=50). Results After intervention,the self management ability and quality of life score in the observation group were better than those in the control group (P<0.05).Conclusion Continuity nursing can improve self management ability and quality of life in patients with chronic renal failure undergoing hemodialysis.%目的:探讨慢性肾衰竭血液透析患者应用延续性护理模式对自我管理能力及生活质量的影响。方法选取慢性肾衰竭血液透析患者100例,采用随机数字表法分组,就常规护理(对照组,n=50)与延续性护理(观察组,n=50)效果展开对比。结果观察组自我管理能力、生活质量评分在干预后均优于对照组(P<0.05)。结论对慢性肾衰竭血液透析患者行延续性护理可提高患者自我管理能力及生活质量。

  10. Encephalopathy secondary to isoniazid in patients on hemodialysis

    OpenAIRE

    2013-01-01

    We report isoniazid (INH)-induced encephalopathy in two male patients on hemodialysis. One of them had tuberculous adenitis, and the other had pulmonary tuberculosis. Both were given rifampicin, INH, pyrazinamide, and ethambutol with pyridoxine 40 mg/day. Two patients developed disturbances in consciousness. After excluding other causes, INH-induced encephalopathy was suspected so the drug was stopped and dose of pyridoxine increased. Both patients retained their consciousness within 1 week a...

  11. Efficacy of crushed lanthanum carbonate for hyperphosphatemia in hemodialysis patients undergoing tube feeding.

    Science.gov (United States)

    Kitajima, Yukie; Takahashi, Taeko; Sato, Yuzuru; Nakaya, Yutaka

    2011-08-01

    Lanthanum carbonate (LaC) is a non-calcium-based phosphate binder used to treat hyperphosphatemia in patients with chronic kidney disease. Oral administration of LaC is difficult in patients undergoing tube feeding or those who are of advanced age because it is essential to chew the LaC tablet sufficiently before swallowing it. We report two cases in whom crushed LaC was used in hemodialysis patients undergoing tube feeding. In both cases, previously crushed LaC was mixed into enteral nutrients. We found that LaC administered this way was effective for decreasing serum phosphorus levels.

  12. Dialysis Disequilibrium Syndrome-Induced Cerebral Edema in a Patient with Uremia Following Hemodialysis: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jung Min; Kim, Heung Cheol [Dept. of Radiology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon (Korea, Republic of)

    2012-03-15

    Dialysis disequilibrium syndrome is a metabolic complication that can be caused by rapid removal of plasma urea during hemodialysis. Dialysis disequilibrium syndrome can lead to osmotic demyelinating syndrome. This case report describes one case of encephalopathy accompanied by dialysis disequilibrium syndrome with imaging findings acquired immediately after hemodialysis in a 55-year-old woman with chronic renal failure. The patient was observed to present repetitive seizures and sudden deterioration of consciousness immediately after hemodialysis. Shortly after the onset of symptoms, the patient underwent a CT scan. The imaging findings of the CT scan reveal symmetrical diffuse white matter edema of bilateral cerebral hemispheres that extends to the pons along the internal capsule. A follow-up MRI taken two years later shows that reversible changes without damage have occurred in the lesions. The patient can thus be seen to present symptoms characteristically associated with dialysis disequilibrium syndrome, while brain imaging reveals dif-fuse reversible brain edema.

  13. Osteoprotegerin and mortality in hemodialysis patients with cardiovascular disease

    DEFF Research Database (Denmark)

    Winther, Simon; Christensen, Jeppe Hagstrup; Flyvbjerg, Allan

    2013-01-01

    Abstract BACKGROUND: Patients treated with hemodialysis (HD) have an increased mortality, mainly caused by cardiovascular disease (CVD). Osteoprotegerin (OPG) is a glycoprotein involved in the regulation of the vascular calcification process. Previous studies have demonstrated that OPG.......08; in the adjusted analyses, the p-value for trend was 0.03. CONCLUSIONS: In a high-risk population of hemodialysis patients with previously documented cardiovascular disease, a high level of OPG was an independent risk marker of all-cause mortality....... is a prognostic marker of mortality. The aim of this study was to investigate if OPG was a prognostic marker of all-cause mortality in high-risk patients with end-stage renal disease and CVD. METHODS: We prospectively followed 206 HD patients with CVD. OPG was measured at baseline and the patients were followed...

  14. Impact of carotid intima-media thickness on long-term outcome in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Munna Lal Patel

    2015-01-01

    Full Text Available Background: Chronic kidney disease (CKD patients on hemodialysis are highly prone to cardiovascular disease, which accounts for roughly half of the mortality in these patients. Atherosclerosis begins many years before the development of clinical manifestations. Measurement of carotid intima-media thickness (CIMT is a noninvasive procedure to detect early atherosclerotic changes. Aims: The aim of the study was to evaluate the correlation between CIMT and cardiovascular risk factors and to investigate its prognostic significance in CKD patients on hemodialysis. Materials and Methods: This was a prospective study carried out over a period of 18 months. Total 88 patients on hemodialysis and 50 healthy controls were enrolled in the study. Biochemical assay and CIMT was assessed using the high resolution 7.5 MHz sonography technique in all subjects. Results: Significant positive correlation was found with age, blood urea, serum creatinine, serum triglyceride, low-density lipoprotein, serum phosphorus, serum calcium-phosphorus product, serum uric acid, 24 h urine protein, systolic blood pressure, diastolic blood pressure, and body mass index. Negative correlation was found with estimated glomerular filtration rate. Adjusted hazards ratios of all cause and cardiovascular mortality for an increase of 0.1 mm in CIMT was 1.16 (95% confidence interval 0.15-9.09. Patients with CIMT value 0.97 mm had a renal survival rate of 16.5%. Conclusion: Uremia is an additive risk factors in those subjects who have raised CIMT despite of traditional cardiovascular risk factors.

  15. Costs and Outcomes in Hemodialysis and Hemodiafiltration

    NARCIS (Netherlands)

    Mazairac, A.H.A.

    2011-01-01

    Both survival and quality of life (QoL) are poor in patients on hemodialysis. Earlier studies have shown their QoL to be lower than in patients with for instance chronic heart failure, arthritis and metastatic colon cancer. Hemodialysis patients do not only face the symptoms of end-stage renal disea

  16. Acute hepatitis C in patients receiving hemodialysis.

    Science.gov (United States)

    Griveas, I; Germanidis, G; Visvardis, G; Morice, Y; Perelson, A S; Pawlotsky, J M; Papadopoulou, D

    2007-01-01

    Hepatitis C virus (HCV) infection is frequent in patients with end-stage renal disease treated by chronic dialysis, with a prevalence varying from 10-65% according to the geographical data. The prevalence is significantly associated with the duration of dialysis and the number of transfused blood products[1,2] and has dramatically declined with efficient blood screening.[3] We studied patients with acute HCV infection in a dialysis unit. The diagnosis was based on both anti-HCV detection and HCV-RNA detection. Other virological tools including HCV genotype determination was also used to tailor treatment to the individual patient and determine its efficacy for a one-year follow-up period. Seventeen patients (7 male and 10 female, mean age: 63.7 +/- 11.6 SD) with acute hepatitis C were enrolled to our study. All of them were followed up for a period of one year after the diagnosis was established. Phylogenetic analysis distinguished two separate HCV subtypes 1b, which were both responsible for this acute infection (see Figure 1). These types did not differ in their behavior on the clinical situation of our patients, as confirmed by the fact that in both groups of patients, there was only one patient who presented with acute illness. Six patients of our study group, three months after the acute infection, received pegylated interferon (Peg-IFNa2a) 135 mug for a six-month period. Four of them responded very well to therapy and at the first determination HCV RNA was below the cutoff point. One of our patients with very high HCV levels (HCV RNA > 50,000,000 IU/mL), despite receiving the same therapy, did not respond well and developed cirrhosis. In conclusion, it is clear from our experience that better information is needed about the current incidence, prevalence, and risk factors for HCV infection in dialysis patients. Algorithms for the diagnosis and management of hepatitis C should be developed by academic societies. Routine screening for hepatitis C also would allow

  17. Maintenance hemodialysis patients have high cumulative radiation exposure.

    LENUS (Irish Health Repository)

    Kinsella, Sinead M

    2010-10-01

    Hemodialysis is associated with an increased risk of neoplasms which may result, at least in part, from exposure to ionizing radiation associated with frequent radiographic procedures. In order to estimate the average radiation exposure of those on hemodialysis, we conducted a retrospective study of 100 patients in a university-based dialysis unit followed for a median of 3.4 years. The number and type of radiological procedures were obtained from a central radiology database, and the cumulative effective radiation dose was calculated using standardized, procedure-specific radiation levels. The median annual radiation dose was 6.9 millisieverts (mSv) per patient-year. However, 14 patients had an annual cumulative effective radiation dose over 20 mSv, the upper averaged annual limit for occupational exposure. The median total cumulative effective radiation dose per patient over the study period was 21.7 mSv, in which 13 patients had a total cumulative effective radiation dose over 75 mSv, a value reported to be associated with a 7% increased risk of cancer-related mortality. Two-thirds of the total cumulative effective radiation dose was due to CT scanning. The average radiation exposure was significantly associated with the cause of end-stage renal disease, history of ischemic heart disease, transplant waitlist status, number of in-patient hospital days over follow-up, and death during the study period. These results highlight the substantial exposure to ionizing radiation in hemodialysis patients.

  18. Habitual Coffee Consumption Enhances Attention and Vigilance in Hemodialysis Patients

    OpenAIRE

    Nikić, Petar M.; Andrić, Branislav R.; Stojimirović, Biljana B.; Jasna Trbojevic-Stanković; Zoran Bukumirić

    2014-01-01

    Objective. Coffee drinking is the main source of caffeine intake among adult population in the western world. It has been reported that low to moderate caffeine intake has beneficial effect on alertness and cognitive functions in healthy subjects. The aim of this study is to evaluate the impact of habitual coffee consumption on cognitive function in hemodialysis patients. Methods. In a cross-sectional study, 86 patients from a single-dialysis centre underwent assessment by the Montreal Cognit...

  19. Effect of calcium carbonate combined with calcitonin on hypercalcemia in hemodialysis patients.

    Science.gov (United States)

    Wei, Yong; Kong, Xiang Lei; Li, Wen Bin; Wang, Zun Song

    2014-12-01

    This short-term study assessed the efficacy and safety of calcium carbonate combined with calcitonin in the treatment of hypercalcemia in hemodialysis patients. Patients (n=64) on hemodialysis for chronic kidney disease for more than 6 months were included based on total serum calcium more than 10.5 mg/dL. All patients were randomized (1:1) to receive calcium carbonate combined with calcitonin (Group I) or lanthanum carbonate (Group II) for 12 weeks. Blood levels of calcium, phosphorus and intact parathyroid hormone (iPTH) were measured every month, bone mass density (BMD) and coronary artery calcium scores (CACS) were measured at 3 months. During the study period, serum calcium decreased from 10.72 ± 0.39 to 10.09 ± 0.28 mg/dL (P carbonate combined with calcitonin and lanthanum carbonate were equally effective in the suppression of hypercalcemia in hemodialysis patients. There were no serious treatment-related adverse events in treatment with calcium carbonate combined with calcitonin.

  20. Detection and sequence analysis of TT virus in hemodialysis patients

    Institute of Scientific and Technical Information of China (English)

    NI Wu; REN Hao; MIAO Xiao-hui; QI Zhong-tian

    2001-01-01

    To study the prevalence and pathogenesis of transfusion-transmitted virus (TTV) in hemodialysis patients. Methods: Serum TTV DNA was tested in 69 hemodialysis patients from our hospital by nested-PCR using primers from a conservative region of TTV genenome, gene sequence analysis and detection of hepatitis C virus antibody (anti-HCV) and the levels of alanine transaminase (ALT) were determined simultaneously. Results: The overall prevalence of TTV viremia was 27.5%. The PCR-amplified gene fragment from one patient was sequenced, and its sequence homologies with TTV-GH1, TTV-TA278, TTVCHN1 and TTVCHN2 ranged from 89% to 100%, and its deduced amino acid sequence homologies with these 4 isolates ranged from 87% to 100%. There was no significant difference in TTV prevalence between anti-HCV positive and negative patients (P>0.05). No significant elevation of ALT is found in all patients. Conclusion: High prevalence of TTV infection is found among hemodialysis patients, and TTV infection has no significant association with HCV infection or elevation of ALT.

  1. Acetate intolerance and an inhibitor of acetate utilization in hemodialysis patients

    Energy Technology Data Exchange (ETDEWEB)

    Egan, J.D.; Wells, I.C.

    1979-03-01

    Diminished ability to utilize acetate (acetate intolerance) developed in a male patient on chronic hemodialysis after five years of maintenance dialysis. His ability to utilize lactate was also subnormal. We studied acetate metabolism in vitro by isolating lymphocytes from the patient's blood before dialysis and measuring their ability to convert (1-/sub 14/C)acetate to /sub 14/CO2. His cells metabolized acetate only 35% as well as did lymphocytes from normal adults. The inhibition appeared when the patient's lymphocytes were cultured, and the ability of normal lymphocytes to oxidize acetate decreased after they had been incubated in the patient's plasma. We conclude that an inhibitor of acetate utilization is present in the plasma and in (or on) the cells of this acetate-intolerant patient. The diminished ability of the patient to utilize lactate and the presence of normal concentrations of pyruvate, citrate, and ketone bodies in his blood suggest that the inhibitor functions at the cell surface to impede the entrance of acetate into the cells. The inhibitor appears to be dialyzable; its nature is unknown. Its accumulation in the plasma of chronic hemodialysis patients has not been thus far associated with any deleterious effects other than prolonging the metabolic acidosis of such patients.

  2. Pregnancy in End Stage Renal Disease Patients, Treatment with Hemodialysis: A Case Report

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    Savaş SİPAHİ

    2012-01-01

    Full Text Available Occasionally, pregnancy can occur in patients receiving hemodialysis due to chronic kidney disease. Despite successful pregnancies reported in the literature, high complication rates and progression of renal disease can be observed. Major risk factors are maternal age, type of renal disease, dialysis prior to pregnancy, age at the time of dialysis, dialysis modality, hemoglobin, blood urea nitrogen, creatinine levels during pregnancy and dialysis dose. Improvements in dialysis technology and patient follow-up and multidisciplinary approach in the last years have lead to higher rates of fertilisation and succesful pregnancies with live births.

  3. Ralstonia pickettii bacteremia in hemodialysis patients: a report of two cases

    Science.gov (United States)

    Tejera, Darwin; Limongi, Gino; Bertullo, Mauricio; Cancela, Mario

    2016-01-01

    Ralstonia pickettii is a low-virulence gram-negative bacillus that may be associated with infections related to health care and may cause bacteremia. Ralstonia pickettii bacteremia is uncommon but is related to the contamination of medical products, mainly in immunodepressed patients. We present two cases of patients on chronic hemodialysis with Ralstonia pickettii bacteremia linked to contamination of the dialysis water. Similar cases have been published with links to intravenous fluid administration, medication ampules, and the use of extracorporeal oxygenation membranes, among other factors. The detection of Ralstonia pickettii bacteremia should provoke suspicion and a search for contaminated medical products, fluids, and/or medications. PMID:27410414

  4. PREVALENCE, SEROCONVERSION AND RISK FACTORS OF HEPATITIS B AND C INFECTION IN PATIENTS ON MAINTENANCE HEMODIALYSIS

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    Vikas

    2014-10-01

    Full Text Available : BACKGROUND: HBV and HCV infections pose a great threat to patients on hemodialysis and studies have been conducted regarding the prevalence and seroconversion rates. The present study was conducted to demonstrate the prevalence and seroconversion rate in patients with chronic hemodialysis and also the incidence of liver function derangement in patients with Hepatitis B and C. METHODS: HBV and HCV status of patients who were on hemodialysis irrespective of serological status and etiology of renal failure were observed. 205 patients were followed up for a period of one year and the incidence, prevalence and seroconversion of HBV and HCV was estimated through HbsAg and Anti-HCV ELISA tests. T-test was used to compare different biochemical and other parameters among two groups (Reactive and Non-reactive. Linear regression was used to calculate the relationship between the parameters and seroconversion rates. RESULTS: 205 patients were observed in the study. The prevalence and seroconversion rates were 11.22% and 4.8% in HBV patients and 18.54% and 6.8% in HCV patients respectively, at the end of the study. There was a significant correlation of the prevalence with average number of blood transfusion and elevated ALT levels in HbsAg reactive patients. Additionally, anti-HCV reactive patients correlated significantly with average number of blood transfusion and elevated ALT levels. There was significant correlation with mean duration of haemodialysis and i.v drug abuse in anti-HCV reactive patients. Regarding the seroconversion status only the average number of blood transfusions was having a significant correlation in both HbsAg and anti-HCV reactive patients. CONCLUSION: The prevalence and seroconversion rates were 11.22% and 4.8% in HBV patients and 18.54% and 6.8% in HCV patients respectively. Safety can be improved with the availability of more sensitive tests, increasing use of erythropoietin, timely vaccination for hepatitis B and adopting

  5. Cognitive dysfunction in patients with renal failure requiring hemodialysis

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    Rohini Thimmaiah

    2012-01-01

    Full Text Available Background and Objectives: Renal failure patients show significant impairment on measures of attention and memory, and consistently perform significantly better on neuropsychological measures of memory and attention, approximately 24 hours after hemodialysis treatment. The objectives are to determine the cognitive dysfunction in patients with renal failure requiring hemodialysis. Materials and Methods: A total of 60 subjects comprising of 30 renal failure patients and 30 controls were recruited. The sample was matched for age, sex, and socioeconomic status. The tools used were the Standardized Mini-Mental State Examination and the Brief Cognitive Rating Scale. Results: The patients showed high cognitive dysfunction in the pre-dialysis group, in all the five dimensions (concentration, recent memory, past memory, orientation and functioning, and self-care, and the least in the 24-hour post dialysis group. This difference was found to be statistically significant (P=0.001. Conclusion: Patients with renal failure exhibited pronounced cognitive impairment and these functions significantly improved after the introduction of hemodialysis.

  6. Association of Processed Meat Intake with Hypertension Risk in Hemodialysis Patients: A Cross-Sectional Study.

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    Pei-Yu Wu

    Full Text Available In this cross-sectional study, we hypothesized that hemodialysis patients consuming greater processed meat is associated with hypertension risk, which can be partly explained by the high sodium content in processed meat. From September 2013 to May 2014, one hundred and four patients requiring chronic hemodialysis treatment were recruited from hemodialysis centers. Data on systolic blood pressure and diastolic blood pressure before receiving dialysis, and 3-day dietary records of the recruited patients were collected. HD patients with systolic and diastolic blood pressures greater than140 mmHg and higher than 90 mmHg, respectively, were considered hypertension risk. Protein foods were divided into 4 categories: red meat, white meat, soybeans, and processed meat (e.g., sausage and ham. In a model adjusted for energy intake and hypertension history, additional servings of processed meats was positively associated to systolic blood pressure >140 mmHg (odds ratio [95% confidence interval]: 2.1 [1.0-4.3], and diastolic blood pressure > 90 mmHg (odds ratio: 2.5 [1.2-5.5]. After adjustment for dietary sodium contents or body mass index (BMI, most associations were substantially attenuated and were no longer significant. In systolic blood pressure greater than140 mmHg, one serving per day of red meats (β = -1.22, P < .05 and white meats (β = -0. 75, P = .05 was associated with a reduced risk compared with one serving per day of processed meats. Similarly, compared with one serving per day of processed meat, a reduced risk of diastolic blood pressure higher than 90 mmHg was associated with one serving per day of red meat (β = -1. 59, P < .05, white meat (β = -0. 62, P < .05. Thus, in these hemodialysis patients, intake of processed meat is significantly positively associated with higher blood pressure risk, and both sodium contents in processed meat and BMI significantly contributes to this association.

  7. [The experience using the ADOPT problem-solving training protocol in a hemodialysis patient with poor IDWG control].

    Science.gov (United States)

    Song, Yi-Chun; Lin, Chiu-Chu

    2011-06-01

    The health problems of hemodialysis patient are complex, involving physical, mental and social aspects. Those with chronic conditions must be able to resolve disease and treatment problems on their own expectation in order to maintain life quality. This case report describes how the authors applied the ADOPT (Attitude, Definition, Open mind, Planning, Try it out) problem-solving training model to care for a hemodialysis patient with poor interdialytic weight gain (IDWG) control. Nursing care was provided to this patient from November 3rd to December 8th, 2008. This case demonstrated ADOPT model efficacy at improving the patient's problem solving abilities in various daily life situations. The authors hope this theory-based intervention can help establish an innovative and effective care model for patients with chronic conditions.

  8. Sudden cardiac death in hemodialysis patients: a comprehensive care approach to reduce risk.

    Science.gov (United States)

    Pun, Patrick H; Middleton, John P

    2012-01-01

    Sudden cardiac death is a major problem in hemodialysis patients, and our understanding of this disease is underdeveloped. The lack of a precise definition tailored for use in the hemodialysis population limits the reliability of epidemiologic reports. Efforts should be directed toward an accurate classification of all deaths that occur in this vulnerable population. The traditional paradigm of disease pathophysiology based on known cardiac risk factors appears to be inadequate to explain the magnitude of sudden cardiac death risk in chronic kidney disease, and numerous unique cofactors and exposures appear to determine risk in this population. Well-designed cohort studies will be needed for a basic understanding of disease pathophysiology and risk factors, and randomized intervention trials will be needed before best management practices can be implemented. This review examines available data to describe the characteristics of the high-risk patient and suggests a comprehensive common sense approach to prevention using existing cardiovascular medications and reducing and monitoring potential dialysis-related arrhythmic triggers. Other unproven cardiovascular therapies such as implantable cardioverter defibrillators should be used on a case-by-case basis, with recognition of the associated hazards that these devices carry among hemodialysis patients.

  9. Body composition, fitness score and arterial stiffness assesment in a chronic hemodialysis population

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    Adelina Mihăescu

    2011-12-01

    Full Text Available Patients undergoing long-term hemodialysis have a high risk of cardiovascular disease. Arterial stiffness is highly prevalent in this type of patients. The aim of our study was to analyse the relationship between body composition, blood chemistries and arterial stiffness in a poorly fit population of chronic hemodialysed patients. Patients and methods involved measuring body composition and fitness score by multifrequence bioimpedance with the body composition analyzer InBody720 and arterial stiffness by the measurement of aortic Pulse Wave Velocity (PWVao and Aortic Augmentation Index (Aix using an oscillometric method on 65 HD patients; measurements were made before a midweek dialysis session. Results: PWVao correlated significantly with weight (p=0.01, r2=1.14, body fat mass (p=0.007, r2=0.14, abdominal circumference (p=0.01, r2=0.12 and with fitness score (p=0.01, r2=0.11. Aix correlated with weight (p<0.05, r2=0.25, intracellular, extracellular- and total body water (p<0.05, r2=0.24 with body protein, soft lean mass, minerals, fat free mass and skeletal muscle mass (p<0.05, r2= 0.3 and with serum calcium (p=0.005, r2=0.2. Conclusions: Arterial stiffness is a common feature of the hemodialysed patients, significantly related to the blood calcium, fitness score and the body composition, especially fat body mass.

  10. Aldosterone and mortality in hemodialysis patients: role of volume overload.

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    Szu-Chun Hung

    Full Text Available BACKGROUND: Elevated aldosterone is associated with increased mortality in the general population. In patients on dialysis, however, the association is reversed. This paradox may be explained by volume overload, which is associated with lower aldosterone and higher mortality. METHODS: We evaluated the relationship between aldosterone and outcomes in a prospective cohort of 328 hemodialysis patients stratified by the presence or absence of volume overload (defined as extracellular water/total body water >48%, as measured with bioimpedance. Baseline plasma aldosterone was measured before dialysis and categorized as low (280 pg/mL. RESULTS: Overall, 36% (n = 119 of the hemodialysis patients had evidence of volume overload. Baseline aldosterone was significantly lower in the presence of volume overload than in its absence. During a median follow-up of 54 months, 83 deaths and 70 cardiovascular events occurred. Cox multivariate analysis showed that by using the low aldosterone as the reference, high aldosterone was inversely associated with decreased hazard ratios for mortality (0.49; 95% confidence interval, 0.25-0.76 and first cardiovascular event (0.70; 95% confidence interval, 0.33-0.78 in the presence of volume overload. In contrast, high aldosterone was associated with an increased risk for mortality (1.97; 95% confidence interval, 1.69-3.75 and first cardiovascular event (2.01; 95% confidence interval, 1.28-4.15 in the absence of volume overload. CONCLUSIONS: The inverse association of aldosterone with adverse outcomes in hemodialysis patients is due to the confounding effect of volume overload. These findings support treatment of hyperaldosteronemia in hemodialysis patients who have achieved strict volume control.

  11. Prevalence of malnutrition and associated factors in hemodialysis patients

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    Ana Tereza Vaz de Souza Freitas

    2014-06-01

    Full Text Available OBJECTIVE: To assess the prevalence of malnutrition and associated factors in hemodialysis patients. METHODS: This is a cross-sectional study of 344 hemodialysis patients from Goiânia, Goiás aged 18 years or more. The dependent variable, malnutrition, was investigated by the Subjective Global Assessment. The independent variables included socioeconomic, demographic, and lifestyle data, clinical history, and energy and protein intakes. The patients underwent anthropometric measurements and laboratory tests. Multiple Poisson regression determined the associated factors (p60 months (PR=1.08, 95%CI=1.01-1.16, Kt/V>1.2 (RP=1.12, 95%CI=1.03-1.22, calorie intake <35 kcal/kg/day (PR=1.22, 95%CI=1.10-1.34, and normalized protein nitrogen appearance <1.0 g/kg/day (PR=1.13, 95%CI=1.05-1.21. CONCLUSION: The prevalence of malnutrition in this population was high, corroborating the literature. The prevalence was higher in patients aged less than 29 years and those with low family income, longer hemodialysis vintage, higher Kt/V, and inadequate protein and calorie intakes. Strategies to reverse this situation should include more nutritional care.

  12. Occult hepatitis C virus infection among Egyptian hemodialysis patients.

    Science.gov (United States)

    Abdelrahim, Soha S; Khairy, Rasha; Esmail, Mona Abdel-Monem; Ragab, Mahmoud; Abdel-Hamid, Mohamed; Abdelwahab, Sayed F

    2016-08-01

    Occult hepatitis C virus (HCV) infection (OCI) was reported in an apparently disease-free state in the absence of liver disease, anti-HCV and HCV-RNA in the serum. The existing data examining the clinical significance of OCI and its potential as a source of HCV infection among hemodialysis patients are very limited. We examined the presence of OCI among patients on maintenance hemodialysis at Minia Governorate, Egypt; an HCV endemic country. A total of 81 subjects with negative markers for HCV were enrolled. HCV-RNA was tested in PBMCs by real-time PCR. For the 81 subjects, the average dialysis duration was 32.7 ± 21.7 months and the average ALT level (±SD) was 26 ± 12 U/L while that of AST was 29 ± 16 U/L. Out of the 81 subjects, three (3.7%) were HCV-RNA positive in PBMCs in the absence of serum anti-HCV and HCV-RNA indicating OCI. The viral load of the OCI subjects ranged from 172 to 4150 IU/ml. History of liver disease was positive in one of the three positive patients. These results highlight the potential risk of HCV transmission from patients within hemodialysis units in Egypt. J. Med. Virol. 88:1388-1393, 2016. © 2016 Wiley Periodicals, Inc.

  13. Recurrent focal myositis in a patient on maintenance hemodialysis

    OpenAIRE

    2015-01-01

    Focal myositis is a benign inflammatory process involving a single group of muscles. It may resolve with conservative measures or may be a harbinger for polymyositis. Very few focal myosites are recurrent, and recurrence in patients with end-stage renal disease on hemodialysis is extremely rare. Clinical examination, electromyography, and magnetic resonance imaging help in identifying this entity. Muscle biopsy and histopathological evaluation are mandatory in diagnosis. It often responds to ...

  14. Overhydration, Cardiac Function and Survival in Hemodialysis Patients

    OpenAIRE

    Mihai Onofriescu; Dimitrie Siriopol; Luminita Voroneanu; Simona Hogas; Ionut Nistor; Mugurel Apetrii; Laura Florea; Gabriel Veisa; Irina Mititiuc; Mehmet Kanbay; Radu Sascau; Adrian Covic

    2015-01-01

    RESEARCH ARTICLE Overhydration, Cardiac Function and Survival in Hemodialysis Patients Mihai Onofriescu1☯, Dimitrie Siriopol1☯, Luminita Voroneanu1, Simona Hogas1, Ionut Nistor1, Mugurel Apetrii1, Laura Florea1, Gabriel Veisa1, Irina Mititiuc1, Mehmet Kanbay3, Radu Sascau2, Adrian Covic1* 1 Department of Nephrology, University of Medicine and Pharmacy “Gr. T. Popa”, Iasi, Romania, 2 Department of Cardiology, University of Medicine and Pharmacy “Gr. T. Popa”, Iasi, Romania...

  15. Effects of high-flux hemodialysis on plasma adrenomedullin and sustained hypotension in elderly hemodialysis patients

    Institute of Scientific and Technical Information of China (English)

    ZHANG Dong; SUN Xue-feng; MA Zhi-fang; ZHU Han-yu; WANG Yuan-da; CHEN Xiang-mei

    2011-01-01

    Background Sustained hypotension during hemodialysis (HD) is an important clinical issue. Plasma adrenomedullin (AM) is increased in HD patients with sustained hypotension, but little is known about whether removing AM can improve hypotension. The objective of this study was to investigate the beneficial effects of hemodialysis using a high-flux dialyzer on removal of increased plasma AM levels and improving low blood pressure in elderly HD patients with sustained hypotension.Methods Forty-eight elderly patients (age 65 or older) who had undergone maintenance HD for more than one year were recruited and studied. We evaluated plasma levels of AM in sustained hypotension (SH; n=28) and normotensive (NT; n=20) patients. The patients with hypotension were further divided into two subgroups and treated with eitherhigh-flux dialyzer or low-flux dialyzer for 3 months. Plasma adrenomedullin levels and blood pressure were analyzed at days 0 and 181.Results Plasma levels of AM were significantly higher in SH than in NT patients ((24.92±3.7) ng/L vs. (15.52±6.01) ng/L,P<0.05), and were inversely correlated with mean arterial blood pressure (MAP) at pre-HD. After 3 months, the level of plasma AM in high-flux group was decreased ((24.58±4.36) ng/L vs. (16.18±5.08) ng/L, P <0.05), but MAP was increased ((67.37±4.31) mmHg vs. (74.79±3.59) mmHg, P<0.05). There was no obvious change in low-flux group.Conclusions Plasma AM levels were significantly elevated in elderly HD patients with SH. High-flux dialyzer therapy can decrease plasma AM level and improve hypotension.

  16. Insertion of central venous catheters for hemodialysis using angiographic techniques in patients with previous multiple catheterizations

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    Kotsikoris, Ioannis, E-mail: gkotsikoris@gmail.com [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Zygomalas, Apollon, E-mail: azygomalas@upatras.gr [Department of General Surgery, University Hospital of Patras (Greece); Papas, Theofanis, E-mail: pfanis@otenet.gr [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Maras, Dimitris, E-mail: dimmaras@gmail.com [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Pavlidis, Polyvios, E-mail: polpavlidis@yahoo.gr [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Andrikopoulou, Maria, E-mail: madric@gmail.com [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Tsanis, Antonis, E-mail: atsanis@gmail.com [Department of Interventional Radiology, “Erythros Stauros” General Hospital (Greece); Alivizatos, Vasileios, E-mail: valiviz@hol.gr [Department of General Surgery and Artificial Nutrition Unit, “Agios Andreas” General Hospital of Patras (Greece); Bessias, Nikolaos, E-mail: bessias@otenet.gr [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece)

    2012-09-15

    Introduction: Central venous catheter placement is an effective alternative vascular access for dialysis in patients with chronic renal failure. The purpose of this study was to evaluate the insertion of central venous catheters for hemodialysis using angiographic techniques in patients with previous multiple catheterizations in terms of efficacy of the procedure and early complications. Materials and methods: Between 2008 and 2010, the vascular access team of our hospital placed 409 central venous catheters in patients with chronic renal failure. The procedure was performed using the Seldinger blind technique. In 18 (4.4%) cases it was impossible to advance the guidewire, and so the patients were transported to the angiography suite. Results: Using the angiographic technique, the guidewire was advanced in order to position the central venous catheter. The latter was inserted into the subclavian vein in 12 (66.6%) cases, into the internal jugular vein in 4 (22.2%) and into the femoral vein in 2 (11.1%) cases. There was only one complicated case with severe arrhythmia in 1 (5.5%) patient. Conclusion: Our results suggest that insertion of central venous catheters using angiographic techniques in hemodialysis patients with previous multiple catheterizations is a safe and effective procedure with few complications and high success rates.

  17. Effect of dialysate temperature on hemodynamic stability among hemodialysis patients

    OpenAIRE

    Azar Ahmad

    2009-01-01

    Cooling the dialysate below 36.5°C is an important factor that contributes to hemody-namic stability in patients during hemodialysis (HD). In this study, the effect of dialysate tempe-rature on hemodynamic stability, patients′ perception of dialysis discomfort and post dialysis fatigue were assessed in a group of patients on HD. A total of 50 patients, all of whom were on 3-times-per-week dialysis regimen, were studied. Patients were assessed during six dialysis sessions; in thr...

  18. Occult hepatitis C virus infection in Iranian hemodialysis patients

    OpenAIRE

    Eslamifar, Ali; Ramezani, Amitis; Ehteram, Hassan; Razeghi, Effat; Ahmadi, Farrokhlagha; Amini, Manouchehr; Banifazl, Mohammad; Etemadi, Gelavizh; Keyvani, Hossein; Bavand, Anahita; Aghakhani, Arezoo

    2015-01-01

    Background: Occult hepatitis C virus (HCV) infection is defined as the presence of HCV-RNA in liver or peripheral blood mononuclear cells (PBMCs) in the absence of detectable hepatitis C antibody (anti-HCV) or HCV-RNA in the serum. Low concentrations of HCV-RNA may be detected in PBMCs of hemodialysis (HD) patients and this could have a great impact on the management of HD patients. Objectives: The aim of this study was to detect the occult HCV infection in Iranian HD patients. Patients and M...

  19. Non-cuffed dual lumen catheters in the external jugular veins versus other central veins for hemodialysis patients.

    Science.gov (United States)

    Moini, Majid; Rasouli, Mohammad R; Kenari, Mohammad Mahmoodzadeh; Mahmoodi, Hamid Reza

    2009-01-01

    To compare prospective between insertion of non-cuffed dual lumen catheter in the external jugular vein and other central veins for hemodialysis (HD), we studied 68 chronic dialysis patients randomly allocated into two groups: one with external jugular vein catheterization as access for HD and another with other central venous catheterization, internal jugular or subclavian vein. Our results showed there were no significant differences regarding successful cannulation, com-plications, total numbers of dialysis, development of pain and infection at the site of cannulation, patency rate of the catheters, and efficacy of hemodialysis between both groups. In addition, the patency of the catheter in the external jugular vein was not affected by previous cannulation of other central veins. In contrast, there was a significant correlation between numbers of attempts for cannulation in both groups and development of hematoma and infection, (pvein may be an alternative for other central veins for insertion of temporary non-cuffed hemodialysis catheter.

  20. Prevalence of hepatitis C virus infection among hemodialysis patients in a single center in Yemen

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    Selm Salem

    2010-01-01

    Full Text Available To evaluate the prevalence of anti-hepatitis C virus (HCV among the hemodia-lysis patients and to identify the risk factors of infection in relation to age, sex, blood transfusions, duration of dialysis and primary cause of end stage-kidney disease. We studied 51 patients who were on chronic hemodialysis (HD at the Al-Gamhourea Teaching Hospital, Aden, Yemen, du-ring Jan-Dec 2007. All the patients were tested for anti-HCV antibody, and we used 100 healthy blood donors as controls. The anti-HCV antibody prevalence rate among the HD patients was found to be significantly higher than that in the control group (62.7% and 0.8%, respectively. The prevalence rate of anti-HCV antibody was higher among men (64% than that in women (35%. The anti-HCV antibody-positive patients were significantly older than the anti-HCV-anti-body-negative patients (66.5 ± 14.4 years versus 57.5 ± 15.4 years; P = 0.01. Diabetic nephro-pathy was a more frequent cause of end-stage renal disease among the anti-HCV antibody-positive patients (30% than among the anti-HCV antibody-negative patients (19%. Among the anti-HCV-positive patients, 80% had received a blood transfusion, which was significantly higher than the 20% rate among the anti-HCV antibody-negative patients (P < 0.001.

  1. Identificação de ponto de corte no nível sérico da alanina aminotransferase para rastreamento da hepatite C em pacientes com insuficiência renal crônica em hemodiálise Identification of the cutoff value for serum alanine aminotransferase in hepatitis C screening of patients with chronic renal failure on hemodialysis

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    Ericson Cavalcanti Gouveia

    2004-02-01

    Full Text Available Pacientes com insuficiência renal crônica em hemodiálise apresentam níveis séricos mais baixos de alanina aminotransferase. Para estabelecer melhor ponto de corte nos níveis de ALT, no diagnóstico da hepatite C, avaliaram-se mensalmente, durante 6 meses os níveis desta enzima em 235 pacientes em hemodiálise, sendo excluídos aqueles que apresentassem média acima do limite superior da normalidade. O ponto de corte foi identificado através da construção de curva ROC. Entre 202 pacientes, 15 (7,4% apresentavam anti-VHC positivo e 187 (92,6% negativo, com média de ALT de 0,7 e de 0,5 do limite superior (p The patients with chronic renal failure in hemodialysis present low levels of serum alanine aminotransferases. In order to establish a better cutoff value for ALT in hepatitis C screening of hemodialysis patients, the ALT levels were measured monthly in 235 patients, being excluded those that presented average above the upper limit of normality. The cutoff value was identified by construction of a ROC curve (receiver operating characteristic. Among 202 patients, 15 (7.4% presented antibodies to hepatitis C virus (anti-HCV and 187 (92.6% were anti-HCV negative , with an ALT average of 0.7 and of 0.5 from ULN (p <0.0001, respectively. The better cutoff value for ALT was at 0.6 from ULN, with sensitivity of 67% and specificity of 75% in anti-HCV screening. These results suggest that ULN of ALT could be reduced for 60% from conventional limit, when we are evaluating patients with CRF in hemodialysis.

  2. Overhydration, Cardiac Function and Survival in Hemodialysis Patients.

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    Mihai Onofriescu

    Full Text Available Chronic subclinical volume overload occurs very frequently and may be ubiquitous in hemodialysis (HD patients receiving the standard thrice-weekly treatment. It is directly associated with hypertension, increased arterial stiffness, left ventricular hipertrophy, heart failure, and eventually, higher mortality and morbidity. We aimed to assess for the first time if the relationship between bioimpedance assessed overhydration and survival is maintained when adjustments for echocardiographic parameters are considered.A prospective cohort trial was conducted to investigate the impact of overhydration on all cause mortality and cardiovascular events (CVE, by using a previously reported cut-off value for overhydration and also investigating a new cut-off value derived from our analysis of this specific cohort. The body composition of 221 HD patients from a single center was assessed at baseline using bioimpedance. In 157 patients supplemental echocardiography was performed (echocardiography subgroup. Comparative survival analysis was performed using two cut-off points for relative fluid overload (RFO: 15% and 17.4% (a value determined by statistical analysis to have the best predictive value for mortality in our cohort.In the entire study population, patients considered overhydrated (using both cut-offs had a significant increased risk for all-cause mortality in both univariate (HR = 2.12, 95%CI = 1.30-3.47 for RFO>15% and HR = 2.86, 95%CI = 1.72-4.78 for RFO>17.4%, respectively and multivariate (HR = 1.87, 95%CI = 1.12-3.13 for RFO>15% and HR = 2.72, 95%CI = 1.60-4.63 for RFO>17.4%, respectively Cox survival analysis. In the echocardiography subgroup, only the 17.4% cut-off remained associated with the outcome after adjustment for different echocardiographic parameters in the multivariate survival analysis. The number of CVE was significantly higher in overhydrated patients in both univariate (HR = 2.46, 95%CI = 1.56-3.87 for RFO >15% and HR = 3

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

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    Mitra Mahdavimazdeh

    2009-09-01

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

  4. Edema, Hyperpigmentation, Induration: 3 Skin Signs Heralding Danger in Patients on Maintenance Hemodialysis.

    Science.gov (United States)

    Becker, Stefan; Walter, Stefan; Witzke, Oliver; Körber, Andreas; Bienholz, Anja; Kottmann, Tanja; Kribben, Andreas; Kaiser, Gernot; Mitchell, Anna

    2016-03-01

    Skin changes are common in patients on dialysis. This study focused on putative associations of specific skin findings with comorbidities and mortality.We performed a retrospective analysis of data from 508 patients on maintenance hemodialysis therapy in 7 centers in the German State of North Rhine Westphalia. Data had been collected by interview, from patient files, and from targeted physical examination in an earlier prospective study screening hemodialysis patients for the presence of nephrogenic systemic fibrosis. While on dialysis, patients' extremities had been examined for any of the following: edematous skin at the lower extremities, hyperpigmentation, induration, and xerosis cutis. Our present data analyses focused on associated mortality and comorbidities.Five hundred eight patients (median age 71 years, range 20.0-95.9; n = 292 men) had agreed to participate in the initial study: 48% (n = 243) were diabetics and 46% (n = 232) had been diagnosed with coronary heart disease. On examination, 86% of patients (n = 439) presented with at least 1 of the prespecified skin changes. Skin edema (n = 89; 18%), hyperpigmentation (n = 74; 15%), and induration (n = 9; 2%) were independently associated with increased mortality over 24 months (P < 0.002, P < 0.030, and P < 0.020, respectively).In our study, prespecified skin changes indicated an increased mortality risk in patients on chronic hemodialysis. Routinely assessing the skin of dialysis patients represents a simple, reliable, and cost effective means of identifying those at greatest risk.

  5. An analysis of caregiver burden of patients with hemodialysis and peritoneal dialysis.

    Science.gov (United States)

    Cantekin, Işın; Kavurmacı, Mehtap; Tan, Mehtap

    2016-01-01

    Since caregivers have roles and responsibilities in all phases from the diagnosis of the disease to discharge and homecare, their care burdens increase. The problems experienced by caregivers, whose care burden increase and accordingly whose life quality is deteriorated, complicate the treatment-receiving patient's adaptation to the disease. This study was performed to determine the burden to primary caregivers of patients undergoing dialysis. This descriptive study was conducted with the family caregivers of 114 patients from Erzurum Ataturk University's Medical Faculty Nephrology Department: 54 were relatives of patients receiving hemodialysis and 60 were relatives of patients receiving peritoneal dialysis during August to December 2014. The percentage of the patients with low levels of caregiver burden is 13% in the hemodialysis group, while it is 35% in the peritoneal dialysis group. These findings are statistically significant. To conclude, chronic diseases affect not only patients, but also their relatives who care for them. Nursing care needs to include both patients and their relatives and support them. It is hoped that this study will guide nursing care in this direction.

  6. Promotion and support of physical activity in elderly patients on hemodialysis: a case study

    Science.gov (United States)

    Shiota, Kotomi; Hashimoto, Toshihiko

    2016-01-01

    [Purpose] The aim of this study was to ascertain the optimum strategy for implementing a physical activity intervention in patients on hemodialysis by investigating the physical characteristics of elderly patients on hemodialysis, and their attitude to physical activity and level of daily activity. [Subjects] The Subject were 10 elderly patients on hemodialysis. [Methods] They wore a physical activity monitor for 1 week. Data obtained were analyzed for hemodialysis and non- hemodialysis days, and two-way analysis of variance was used to compare the number of steps and activity levels. A questionnaire was administered to investigate the stage of psychological preparedness for exercise and attitudes toward/awareness of exercise. [Results] There was no significant difference in the number of steps or exercise levels on hemodialysis and non- hemodialysis days. However, on both types of days, subjects spent long periods not engaged in any activity. Most of their activity was either inactivity or sedentary behavior. [Conclusion] Patients on hemodialysis with low physical activity levels are considered to have poor physical function and exercise tolerance. To maintain and improve the physical function of patients on hemodialysis, it will be necessary to reduce their time spent in inactive, and comprehensive care that covers psychosocial aspects should be provided to promote the proactive improvement of physical activity and their attitudes to exercise. PMID:27190487

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

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    Dimković Nada

    2006-01-01

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

  8. Cinacalcet Lowers Serum Alkaline Phosphatase in Maintenance Hemodialysis Patients

    Science.gov (United States)

    Belozeroff, Vasily; Goodman, William G.; Ren, Lulu; Kalantar-Zadeh, Kamyar

    2009-01-01

    Background and objectives: Studies suggest an association between elevated serum alkaline phosphatase (AP) and increased mortality in hemodialysis patients, but the effect of existing therapies on AP is not fully understood. We assessed the effects of cinacalcet on AP in a secondary analysis of controlled trial data. Design, setting, participants, & measurements: This was a post hoc analysis of data from three 26-wk randomized, double-blind, placebo-controlled, phase 3 trials and a 26-wk double-blind, placebo-controlled extension trial that investigated cinacalcet in secondary hyperparathyroidism treatment in dialysis patients. Hemodialysis patients (n = 890) with intact parathyroid hormone ≥300 pg/ml and serum calcium ≥8.4 mg/dl received cinacalcet plus standard therapy or standard therapy alone for up to 52 wk. Total, not bone-specific, AP was assessed (proportion of cinacalcet/control subjects achieving a ≥20% or any AP reduction from baseline; the proportion of subjects with AP ≥120 U/L) at baseline; the end of titration; and study weeks 26, 42, and 52. Results: At 52 wk, a greater proportion of cinacalcet-treated patients had either a ≥20% (39 versus 18%) or any (58 versus 36%) AP reduction compared with control subjects, respectively. The likelihood of achieving either a ≥20% or any AP reduction (determined by relative proportion) was 2.33 (95% confidence interval 1.50 to 3.61) and 1.74 (95% confidence interval 1.31 to 2.31), respectively, at week 52. Cinacalcet treatment tended toward a decreased percentage of patients with AP ≥120 U/L (baseline, 42.6%; week 52, 30.6%) compared with control (35.0 to 48.6%, respectively). Conclusions: In this combined analysis of controlled trials of patients who were receiving hemodialysis, cinacalcet lowered total serum AP. PMID:19261825

  9. Challenges in blood pressure measurement in patients treated with maintenance hemodialysis.

    Science.gov (United States)

    Roberts, Matthew A; Pilmore, Helen L; Tonkin, Andrew M; Garg, Amit X; Pascoe, Elaine M; Badve, Sunil V; Cass, Alan; Ierino, Francesco L; Hawley, Carmel M

    2012-09-01

    The association between blood pressure and cardiovascular outcomes in patients undergoing hemodialysis remains controversial. This may relate in part to the technique and device used and the timing of the blood pressure measurement in relation to the hemodialysis procedure. Emerging evidence indicates that standardized hemodialysis unit blood pressure measurements or measurements obtained at home, either by the patient or using an ambulatory blood pressure monitor, may offer advantages over routine hemodialysis unit blood pressure measurements for determining cardiovascular risk and treatment. This review discusses the available evidence and implications for clinicians and clinical trials.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1988-04-01

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

  11. Related factors and predictors of cognitive dysfunction in chronic kidney disease on maintenance hemodialysis in Nigeria

    Directory of Open Access Journals (Sweden)

    Lukman Femi Owolabi

    2016-01-01

    Full Text Available Background: Previous studies suggest a high frequency of cognitive impairment (CI in persons with chronic kidney disease (CKD; however, factors associated with CI and predictors of CI in persons with CKD remain largely unclear. The aim of this study was to determine the factors associated with CI and predictors of CI in CKD patients on maintenance hemodialysis. Materials and Methods: The first stage of the study included recruitment of 100 apparently healthy participants aimed at determining the reference values. The second stage of the study included eighty CKD patients on maintenance hemodialysis. The iron psychology (FEPSY was used to assess the memory, psychomotor speed, concentration, and attention using simple auditory reaction time (ART and visual reaction time (VRT tasks, recognition memory tests (RMT, finger tapping task (FTT, and binary choice task (BCT. Results: Using normative values generated in this study, 41 (51.3% and 43 (53.8% CKD patients had abnormal scores on ART dominant (D and nondominant (ND sides, respectively. Forty (50% and 42 (52.5% patients had abnormal scores on VRT D and ND sides, respectively. Twenty-one (26.3% and 68 (85% had abnormal scores on BCT and computer-assisted visual scanning task, respectively. Sixty-four (80% and 65 (81.3% had abnormal scores on RMT (words and RMT, respectively. Fifty-two (65% and 48 (60% patients had abnormal scores on D and ND sides of (FTT, respectively. Factors associated with psychomotor speed impairment were duration of CKD from diagnosis (P = 0.0001 and 0.043 in D and ND ART, respectively, duration on dialysis (P = 0.0001 across board in D and ND ART as well as in D and ND VRT, respectively, and plasma urea (PU and plasma creatinine (PCr (P < 0.05. Factors found to be associated with memory impairment included age (P = 0.045 and 0.025 on words and figures RMT, respectively, PU (P = 0.002 and 0.005 on words and figures RMT, respectively, and PCr (P = 0.012 and 0.040 on words and

  12. Physical Activity in Hemodialysis Patients Measured by Triaxial Accelerometer

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    Edimar Pedrosa Gomes

    2015-01-01

    Full Text Available Different factors can contribute to a sedentary lifestyle among hemodialysis (HD patients, including the period they spend on dialysis. The aim of this study was to evaluate characteristics of physical activities in daily life in this population by using an accurate triaxial accelerometer and to correlate these characteristics with physiological variables. Nineteen HD patients were evaluated using the DynaPort accelerometer and compared to nineteen control individuals, regarding the time spent in different activities and positions of daily life and the number of steps taken. HD patients were more sedentary than control individuals, spending less time walking or standing and spending more time lying down. The sedentary behavior was more pronounced on dialysis days. According to the number of steps taken per day, 47.4% of hemodialysis patients were classified as sedentary against 10.5% in control group. Hemoglobin level, lower extremity muscle strength, and physical functioning of SF-36 questionnaire correlated significantly with the walking time and active time. Looking accurately at the patterns of activity in daily life, HDs patients are more sedentary, especially on dialysis days. These patients should be motivated to enhance the physical activity.

  13. Laboratory Variables and Treatment Adequacy in Hemodialysis Patients in Iran

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    Pourfarziani Vahid

    2008-01-01

    Full Text Available This study aims to evaluate the laboratory variables in Iranian hemodialysis pa-tients. We studied 338 patients in 6 dialysis centers around the country. Sixty four percent of the patients were anemic, and the mean of hemoglobin levels in the patients was 9.6 ± 1.9 g/dL. Women had a significantly higher prevalence of anemia (p= 0.004; however, considering the absolute hemoglobin values, there was no significant difference between genders (p> 0.05. The mean urea reduction ratio (URR and Kt/V in the patients were 62.6 ± 12.8 and 1.17 ± 0.31, respectively. Hyperphosphatemia and hyperkalemia were observed in 50% and 58%, respectively. We conclude that our study demonstrated a relatively high prevalence of anemia and hyper-phosphatemia, however, a surprisingly good dialysis urea clearance in the Iranian hemodialysis patients. We should exploit more effort to maintain hemoglobin and serum phosphate levels with-in the target ranges.

  14. Two additional cases of metformin-associated encephalopathy in patients with end-stage renal disease undergoing hemodialysis.

    Science.gov (United States)

    Kang, Yeo-Jin; Bae, Eun Jin; Seo, Jong Woo; Jeon, Dae-Hong; Cho, Hyun Seop; Kim, Hyun-Jung; Chang, Se-Ho; Park, Dong Jun

    2013-01-01

    We report on two additional cases of metformin-associated encephalopathy in patients with end-stage renal disease (ESRD) undergoing hemodialysis. Two patients were seen at our hospital with abnormal neurological signs and symptoms. Magnetic resonance imaging (MRI) revealed the same pattern of high signal intensity in both basal ganglia in T2-weighted images in the two patients. The two patients had started taking metformin 5 and 6 weeks earlier at the same dose of 1000 mg per day. Metformin was immediately stopped, and regular hemodialysis was conducted. Their signs and symptoms resolved completely after these measures. The high signal intensity in both ganglia in T2-weighted MRI also disappeared. We should suspect metformin-induced encephalopathy and withdraw the drug when presented with diabetic patients with chronic kidney disease and neurological signs and symptoms of unknown cause.

  15. Differences in quality of life of hemodialysis patients between dialysis centers

    NARCIS (Netherlands)

    Mazairac, Albert H. A.; Grooteman, Muriel P. C.; Blankestijn, Peter J.; Penne, E. Lars; van der Weerd, Neelke C.; den Hoedt, Claire H.; van den Dorpel, Marinus A.; Buskens, Erik; Nube, Menso J.; ter Wee, Piet M.; de Wit, G. Ardine; Bots, Michiel L.

    2012-01-01

    Purpose Hemodialysis patients undergo frequent and long visits to the clinic to receive adequate dialysis treatment, medical guidance, and support. This may affect health-related quality of life (HRQOL). Although HRQOL is a very important management aspect in hemodialysis patients, there is a paucit

  16. Differences in quality of life of hemodialysis patients between dialysis centers.

    NARCIS (Netherlands)

    Mazairac, A.H.; Grooteman, M.P.C.; Blankestijn, P.J.; Lars Penne, E.; Weerd, N.C. van der; Hoedt, C.H. den; Dorpel, M.A. van den; Buskens, E.; Nube, M.J.; Wee, P.M. ter; Wit, G.A. de; Bots, M.L.; Hamersvelt, H.W. van

    2012-01-01

    PURPOSE: Hemodialysis patients undergo frequent and long visits to the clinic to receive adequate dialysis treatment, medical guidance, and support. This may affect health-related quality of life (HRQOL). Although HRQOL is a very important management aspect in hemodialysis patients, there is a pauci

  17. Differences in quality of life of hemodialysis patients between dialysis centers

    NARCIS (Netherlands)

    A.H.A. Mazairac (Albert); M.P.C. Grooteman (Muriel); P.J. Blankestijn (Peter); E. Lars Penne; N.C. van der Weerd (Neelke); C.H. den Hoedt (Claire); M.A. van den Dorpel (Marinus); E. Buskens (Erik); M.J. Nubé (Menso); P.M. ter Wee (Piet); G.A. de Wit (Ardine); M.L. Bots (Michiel)

    2011-01-01

    textabstractPurpose: Hemodialysis patients undergo frequent and long visits to the clinic to receive adequate dialysis treatment, medical guidance, and support. This may affect health-related quality of life (HRQOL). Although HRQOL is a very important management aspect in hemodialysis patients, ther

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

    DEFF Research Database (Denmark)

    Pakpour, Amir H; Nourozi, Saeedeh; Molsted, Stig

    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....

  19. Frequency of and risk factors for poor cognitive performance in hemodialysis patients

    Science.gov (United States)

    There are few detailed data on cognition in patients undergoing dialysis. We evaluated the frequency of and risk factors for poor cognitive performance using detailed neurocognitive testing. In this cross-sectional cohort study, 314 hemodialysis patients from 6 Boston-area hemodialysis units underwe...

  20. Low expression of thiosulfate sulfurtransferase (rhodanese) predicts mortality in hemodialysis patients

    DEFF Research Database (Denmark)

    Krueger, Katharina; Koch, Kathrin; Jühling, Anja;

    2010-01-01

    To test the hypothesis that impaired expression of the thiosulfate sulfurtransferase rhodanese is associated with oxidative stress and may predict mortality in hemodialysis patients.......To test the hypothesis that impaired expression of the thiosulfate sulfurtransferase rhodanese is associated with oxidative stress and may predict mortality in hemodialysis patients....

  1. The Relationship between Iron Deficiency and Restless Legs Syndrome in Hemodialysis Patients

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    R Ghanei Gheshlagh

    2012-10-01

    Full Text Available Introduction: Restless legs syndrome is a neurological disorder; hemodialysis patients seem to suffer more from this syndrome. Although the pathophysiology of restless legs syndrome is still unknown, assessment of factors associated with this syndrome can help to develop medical knowledge in this field. The present study assessed the relationship between restless legs syndrome, serum iron, and serum ferritin levels in patients on hemodialysis. Methods: This descriptive study was carried out with purposive sampling method on 168 hemodialysis patients who referred to the Urmia Taleghani Hospital Hemodialysis Unit. Data were gathered using restless legs syndrome questionnaire and laboratory Index of serum iron and ferritin. Data were analyzed using descriptive and inferential statistical tests. Results: The study results revealed that 38.7 percent of samples complained from restless legs syndrome whose average score serum iron was 78±29.3 μg. Results showed in hemodialysis patients with restless legs syndrome, serum iron and serum ferritin levels were significantly lower than hemodialysis patients without restless legs syndrome (p=0. 02, p=0.005. Conclusion: Considering the high prevalence of restless legs syndrome in patients with hemodialysis, identification of factors associated with this syndrome and providing the necessary solutions for modifying or eliminating the factors, seem to be necessary. Since the relationship between indicators of iron and ferritin and restless legs syndrome in hemodialysis patients is confirmed, the results can be helpful in the treatment and management of these patients.

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

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    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.

  3. FGF-23 and cognitive performance in hemodialysis patients.

    Science.gov (United States)

    Drew, David A; Tighiouart, Hocine; Scott, Tammy M; Lou, Kristina V; Fan, Li; Shaffi, Kamran; Weiner, Daniel E; Sarnak, Mark J

    2014-01-01

    Although cognitive impairment is common in hemodialysis patients, the etiology of and risk factors for its development remain unclear. Fibroblast growth factor 23 (FGF-23) levels are elevated in hemodialysis patients and are associated with increased mortality and left ventricular hypertrophy. Despite FGF-23 being found within the brain, there are no prior studies assessing whether FGF-23 levels are associated with cognitive performance. We measured FGF-23 in 263 prevalent hemodialysis patients in whom comprehensive neurocognitive testing was also performed. The cross-sectional association between patient characteristics and FGF-23 levels was assessed. Principal factor analysis was used to derive two factors from cognitive test scores, representing memory and executive function, which carried a mean of 0 and a standard deviation of 1. Multivariable linear regression adjusting for age, sex, education status, and other relevant covariates was used to explore the relationship between FGF-23 and each factor. Mean age was 63 years, 46% were women and 22% were African American. The median FGF-23 level was 3098 RU/mL. Younger age, lower prevalence of diabetes, longer dialysis vintage, and higher calcium and phosphorus were independently associated with higher FGF-23 levels. Higher FGF-23 was independently associated with a lower memory score (per doubling of FGF-23, β = -0.08 SD [95% confidence interval, CI: -0.16, -0.01]) and highest quartile vs. lowest quartile (β = -0.42 SD [-0.82, -0.02]). There was no definite association of FGF 23 with executive function when examined as a continuous variable (β = -0.03 SD [-0.10, 0.04]); however, there was a trend in the quartile analysis (β = -0.28 SD [-0.63, 0.07], P = 0.13, for 4th quartile vs. 1st quartile). FGF-23 was associated with worse performance on a composite memory score, including after adjustment for measures of mineral metabolism. High FGF-23 levels in hemodialysis patients may contribute to

  4. Habitual Coffee Consumption Enhances Attention and Vigilance in Hemodialysis Patients

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    Petar M. Nikić

    2014-01-01

    Full Text Available Objective. Coffee drinking is the main source of caffeine intake among adult population in the western world. It has been reported that low to moderate caffeine intake has beneficial effect on alertness and cognitive functions in healthy subjects. The aim of this study is to evaluate the impact of habitual coffee consumption on cognitive function in hemodialysis patients. Methods. In a cross-sectional study, 86 patients from a single-dialysis centre underwent assessment by the Montreal Cognitive Assessment tool and evaluation for symptoms of fatigue, mood, and sleep disorders by well-validated questionnaires. The habitual coffee use and the average daily caffeine intake were estimated by participants’ response to a dietary questionnaire. Results. Sixty-seven subjects (78% consumed black coffee daily, mostly in low to moderate dose. Cognitive impairment was found in three-quarters of tested patients. Normal mental performance was more often in habitual coffee users (25% versus 16%. Regular coffee drinkers achieved higher mean scores on all tested cognitive domains, but a significant positive correlation was found only for items that measure attention and concentration (P=0.024. Conclusions. Moderate caffeine intake by habitual coffee consumption could have beneficial impact on cognitive function in hemodialysis patients due to selective enhancement of attention and vigilance.

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

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    Daniel Ducuara

    2013-05-01

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

  6. Central Venous Disease in Hemodialysis Patients: An Update

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    Modabber, Milad, E-mail: mmodabber@gmail.com [McMaster University, Michael G. DeGroote School of Medicine (Canada); Kundu, Sanjoy [Scarborough Hospital and Scarborough Vascular Ultrasound, The Vein Institute of Toronto (Canada)

    2013-08-01

    Central venous occlusive disease (CVD) is a common concern among the hemodialysis patient population, with the potential to cause significant morbidity. Endovascular management of CVD, comprising percutaneous balloon angioplasty and bare-metal stenting, has been established as a safe alternative to open surgical treatment. However, these available treatments have poor long-term patency, requiring close surveillance and multiple repeat interventions. Recently, covered stents have been proposed and their efficacy assessed for the treatment of recalcitrant central venous stenosis and obstruction. Moreover, newly proposed algorithms for the surgical management of CVD warrant consideration. Here, we seek to provide an updated review of the current literature on the various treatment modalities for CVD.

  7. Recurrent focal myositis in a patient on maintenance hemodialysis

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    Manjusha Yadla

    2015-04-01

    Full Text Available Focal myositis is a benign inflammatory process involving a single group of muscles. It may resolve with conservative measures or may be a harbinger for polymyositis. Very few focal myosites are recurrent, and recurrence in patients with end-stage renal disease on hemodialysis is extremely rare. Clinical examination, electromyography, and magnetic resonance imaging help in identifying this entity. Muscle biopsy and histopathological evaluation are mandatory in diagnosis. It often responds to conservative treatment with anti-inflammatory drugs and physiotherapy, but occasionally it requires therapy with steroids.

  8. Recurrent symptomatic intraocular pressure spikes during hemodialysis in a patient with unilateral anterior uveitis

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    Lim Su-Ho

    2013-02-01

    Full Text Available Abstract Background The relationship between intraocular pressure (IOP changes and hemodialysis has been evaluated for several decades. However, no report on an IOP rise in uveitis patients during hemodialysis has been previously documented. This report describes the case of an uveitis patient with repetitive IOP spikes associated with severe ocular pain during hemodialysis sessions, which resolved after glaucoma filtering surgery. Case presentation A 47-year-old male with diabetes and hypertension had complained of recurrent ocular pain in the left eye during hemodialysis sessions. A slit-lamp examination showed diffuse corneal epithelial edema with several white keratic precipitates and inflammatory cells (Grade 3+ in the anterior chamber of the left eye. No visible neovascularization or synechiae were visible on the iris or angle. Topical glaucoma eye-drops and intravenous mannitol before hemodialysis did not prevent subsequent painful IOP spikes in the left eye. At the end of hemodialysis, IOP averaged ~40 mmHg. After trabeculectomy with mitomycin C in the left eye, his IOP stabilized in the low-teens (range, 10–14 mmHg and no painful IOP spikes occurred during hemodialysis over the first postoperative year. Conclusion We present a case of recurrent painful IOP spikes during hemodialysis in a patient with unilateral anterior uveitis unresponsive to conventional medical treatment prior to hemodialysis. To our knowledge, this is the first case report of repetitive symptomatic IOP rise during hemodialysis in an uveitic glaucoma patient. This case highlights the importance of the awareness of the possibility that IOP may rise intolerably during hemodialysis in uveitis patients with a compromised outflow facility.

  9. Absence of peripheral blood mononuclear cells priming in hemodialysis patients

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    Santos B.C.

    2003-01-01

    Full Text Available As a consequence of the proinflammatory environment occurring in dialytic patients, cytokine overproduction has been implicated in hemodialysis co-morbidity. However, there are discrepancies among the various studies that have analyzed TNF-alpha synthesis and the presence of peripheral blood mononuclear cell (PBMC priming in this clinical setting. We measured bioactive cytokine by the L929 cell bioassay, and evaluated PBMC TNF-alpha production by 32 hemodialysis patients (HP and 51 controls. No difference in TNF-alpha secretion was observed between controls and HP (859 ± 141 vs 697 ± 130 U/10(6 cells. Lipopolysaccharide (5 µg/ml did not induce any further TNF-alpha release, showing no PBMC priming. Paraformaldehyde-fixed HP PBMC were not cytotoxic to L929 cells, suggesting the absence of membrane-anchored TNF-alpha. Cycloheximide inhibited PBMC cytotoxicity in HP and controls, indicating lack of a PBMC TNF-alpha pool, and dependence on de novo cytokine synthesis. Actinomycin D reduced TNF-alpha production in HP, but had no effect on controls. Therefore, our data imply that TNF-alpha production is an intrinsic activity of normal PBMC and is not altered in HP. Moreover, TNF-alpha is a product of de novo synthesis by PBMC and is not constitutively expressed on HP cell membranes. The effect of actinomycin D suggests a putative tighter control of TNF-alpha mRNA turnover in HP. This increased dependence on TNF-alpha RNA transcription in HP may reflect an adaptive response to hemodialysis stimuli.

  10. Pharmacological and non-pharmacological treatment options for depression and depressive symptoms in hemodialysis patients

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    Stefania S. Grigoriou

    2015-04-01

    Full Text Available Depression is a mental disorder with a high prevalence among patients with end stage renal disease (ESRD. It is reported that depression afflicts approximately 20-30% of this patient population, being associated, amongst other, with high mortality rate, low adherence to medication and low perceived quality of life. There is a variety of medications known to be effective for the treatment of depression but due to poor adherence to treatment as well as due to the high need for medications addressing other ESRD comorbidities, depression often remains untreated. According to the literature, depression is under-diagnosed and undertreated in the majority of the patients with chronic kidney disease. In the current review the main pharmacological and non-pharmacological approaches and research outcomes for the management of depressive symptoms in hemodialysis patients are discussed.

  11. Got Milk? Breastfeeding and Milk Analysis of a Mother on Chronic Hemodialysis.

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    Michael S Balzer

    Full Text Available Women on dialysis rarely become pregnant. However, the overall rate of successful pregnancies is increasing in this patient population and breastfeeding becomes an option for mothers on dialysis. In this study we performed a systematic breast milk composition analysis of a mother on chronic hemodialysis (HD.Specimens of breast milk and blood were collected in regular intervals before and after HD from a 39-year old woman starting on day 10 postpartum. Samples were analyzed for electrolytes, retention solutes, nutrients and other laboratory measurements. Breast milk samples from low-risk mothers matched for postpartum age were used as controls.Significantly higher levels of creatinine and urea were found in pre-HD breast milk when compared to post-HD. A similar post-dialytic decrease was only found for uric acid but not for any other investigated parameter. Conversely, sodium and chloride were significantly increased in post-HD samples. Compared to controls creatinine and urea were significantly higher in pre-HD samples while the difference remained only significant for post-HD creatinine. Phosphate was significantly lower in pre- and post-HD breast milk when compared to controls, whereas calcium showed no significant differences. In terms of nutrient components glucose levels showed a strong trend for a decrease, whereas protein, triglycerides and cholesterol did not differ. Similarly, no significant differences were found in iron, potassium and magnesium content.To the best of our knowledge this is the first report on a breastfeeding mother on chronic dialysis. Although we found differences in creatinine, urea, sodium, chloride and phosphate, our general analysis showed high similarity of our patient's breast milk to samples from low-risk control mothers. Significant variations in breast milk composition between pre- and post-HD samples suggest that breastfeeding might be preferably performed after dialysis treatment. In summary, our findings

  12. Association of Processed Meat Intake with Hypertension Risk in Hemodialysis Patients: A Cross-Sectional Study.

    Science.gov (United States)

    Wu, Pei-Yu; Yang, Shwu-Huey; Wong, Te-Chih; Chen, Tzen-Wen; Chen, His-Hsien; Chen, Tso-Hsiao; Chen, Yu-Tong

    2015-01-01

    In this cross-sectional study, we hypothesized that hemodialysis patients consuming greater processed meat is associated with hypertension risk, which can be partly explained by the high sodium content in processed meat. From September 2013 to May 2014, one hundred and four patients requiring chronic hemodialysis treatment were recruited from hemodialysis centers. Data on systolic blood pressure and diastolic blood pressure before receiving dialysis, and 3-day dietary records of the recruited patients were collected. HD patients with systolic and diastolic blood pressures greater than140 mmHg and higher than 90 mmHg, respectively, were considered hypertension risk. Protein foods were divided into 4 categories: red meat, white meat, soybeans, and processed meat (e.g., sausage and ham). In a model adjusted for energy intake and hypertension history, additional servings of processed meats was positively associated to systolic blood pressure >140 mmHg (odds ratio [95% confidence interval]: 2.1 [1.0-4.3]), and diastolic blood pressure > 90 mmHg (odds ratio: 2.5 [1.2-5.5]). After adjustment for dietary sodium contents or body mass index (BMI), most associations were substantially attenuated and were no longer significant. In systolic blood pressure greater than140 mmHg, one serving per day of red meats (β = -1.22, P processed meat, a reduced risk of diastolic blood pressure higher than 90 mmHg was associated with one serving per day of red meat (β = -1. 59, P processed meat is significantly positively associated with higher blood pressure risk, and both sodium contents in processed meat and BMI significantly contributes to this association.

  13. Hemodialysis without systemic anticoagulation: a prospective randomized trial to evaluate 3 strategies in patients at risk of bleeding.

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    Bruno Guéry

    Full Text Available OBJECTIVE: In this clinical trial, we aimed to compare three means of performing chronic hemodialysis in patients with contra-indication to systemic heparinization. METHODS: This open-label monocentric randomized « n-of-one » trial, conducted in a single tertiary care center, recruited chronic hemodialysis patients with a contra-indication to systemic heparinization for at least 3 consecutive sessions. All patients underwent hemodialysis with an AN69ST dialyzer, and were administered three alternative dialysis procedures in a random sequence: intermittent saline flushes, constant saline infusion, or pre-dialysis heparin coating of the membrane. The primary outcome was the need to interrupt the dialysis session because of clotting events due to either (i a complete coagulation of the circuit; (ii a partial coagulation of the circuit; (iii a>50% rise over baseline in the venous pressure. RESULTS: At the end of the inclusion period (May, 2007 to December, 2008, the number of patients to include (n=75 was not reached: only 46 patients were included and underwent randomization. The study was terminated, and statistical analysis took into account 224 hemodialysis sessions performed in 44 patients with analyzable data. Heparin adsorption was associated with a significant reduction of the need to interrupt the dialysis session because of clotting events: odds ratio 0.3 (CI 95% 0.2 to 0.6; p3 h dialysis sessions and for having complete blood restitution. There were no significant effects of the dialysis procedure on weight loss, online ionic dialysance, and adverse events. CONCLUSION: Heparin-coated AN69ST dialysis membrane is a safe and effective method to avoid or delay per-dialytic clotting events in patients with contra-indication to systemic anticoagulation. However, results are not generalizable safely to patients with active bleeding, since weak heparinemia, not assessed in this study, may occur. TRIAL REGISTRATION: ClinicalTrials.gov NCT

  14. Dietary intakes and some biochemical markers in hemodialysis patients

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    Emine Yassibas

    2016-03-01

    Full Text Available Purpose: Intake of energy and some nutrients is frequently inadequate in dialysis patients because of eating and appetite disorders due to uremic syndrome. Inadequate energy and protein intake cause to malnutrition. Anthropometric measurements, biochemical markers and dietary intake records have great importance in determining the nutritional status of hemodialysis (HD patients. Therefore this study was planned to determination of daily energy, nutrient intake and some biochemical markers of adult hemodialysis patients. Method and Material:  A hundred and thirty six (male = 73, female = 63 clinically stable HD patients were enrolled in this study. All patients were taken 24-hour dietary recall. The daily energy and nutrient intakes of patients were calculated by food consumption records and anthropometric measurements were taken. Results: The mean age was found 45.5±13.51 years. The ratio of patients with body mass index (BMI below 18.5 kg/m2 was 7.4% and 25 kg/m2 or upper was 16.9%. Blood hemoglobin, hematocrit, albumin and total protein levels were below the normal levels. The daily dietary energy and protein intakes were found under the recommended level in the study period. A significant positive correlation was found between daily protein intake and serum albumin levels (r=0.210, p=0.014, daily protein intake and serum total protein levels (r=0.201, p=0.019, daily energy intake and serum total protein levels (r=0.178, p=0.039. Conclusions: HD patients often have low protein and energy intakes and most of them suffer from malnutrition. Therefore nutritional status of patients should be evaluated and periodically nutrition education should be given for improving eating habits and increasing dietary compliance is recommended.

  15. Anatomic brain disease in hemodialysis patients: a cross-sectional study

    Science.gov (United States)

    Although dialysis patients are at high risk of stroke and have a high burden of cognitive impairment, there are few reports of anatomic brain findings in the hemodialysis population. Using magnetic resonance imaging of the brain, we compared the prevalence of brain abnormalities in hemodialysis pati...

  16. Parathyroidectomy Improves Restless Leg Syndrome in Patients on Hemodialysis.

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    Roberto Sávio Silva Santos

    Full Text Available Restless leg syndrome (RLS is a sleep disorder with high prevalence among patients on hemodialysis. It has been postulated that high phosphate and high parathyroid hormone may be implicated in its pathogenesis. Standard international criteria and face-to-face interview are not always applied.this was an interventional prospective study in which 19 patients (6 men, aged 48±11 years with severe hyperparathyroidism were evaluated. RLS diagnosis and rating scale were accessed based on the International RLS Study Group pre- and post-parathyroidectomy. Patients also underwent standard polysomnography.At baseline, RLS was present in 10 patients (52.6%, and pain was the most reported symptom associated with the diagnosis. Patients with RLS had higher serum phosphate (p = 0.008 that remained independently associated with RLS in a logistic regression model, adjusted for hemoglobin, age and gender (HR = 7.28;CI = 1.14-46.3, p = 0.035. After parathyroidectomy, there was a reduction of serum parathyroid hormone, phosphate, calcium and alkaline phosphatase, and an increase of 25(OH-vitamin D, and Fetuin-A. Parathyroidectomy alleviated RLS (from 52% to 21%; p = 0.04, which was accompanied by a decrease in severity scale, in association with relief of pain and pruritus. Polysomnography in these patients showed an improvement of sleep parameters as measured by sleep efficiency, sleep latency and percentage of REM sleep.RLS is associated with high levels of phosphate in patients with severe secondary hyperparathyroidism on hemodialysis. Pain is most reported complain in these patients. Parathyroidectomy provided an opportunity to relief RLS. Whether the reduction of serum phosphorus or parathyroid hormone contributed to this improvement merits further investigation.

  17. Parathyroidectomy Improves Restless Leg Syndrome in Patients on Hemodialysis

    Science.gov (United States)

    Santos, Roberto Sávio Silva; Coelho, Fernando Morgadinho Santos; da Silva, Bruno Caldin; Graciolli, Fabiana Giorgeti; Dominguez, Wagner Velasquez; de Menezes Montenegro, Fabio Luiz; Jorgetti, Vanda; Moysés, Rosa Maria Affonso; Elias, Rosilene Motta

    2016-01-01

    Background Restless leg syndrome (RLS) is a sleep disorder with high prevalence among patients on hemodialysis. It has been postulated that high phosphate and high parathyroid hormone may be implicated in its pathogenesis. Standard international criteria and face-to-face interview are not always applied. Methods this was an interventional prospective study in which 19 patients (6 men, aged 48±11 years) with severe hyperparathyroidism were evaluated. RLS diagnosis and rating scale were accessed based on the International RLS Study Group pre- and post-parathyroidectomy. Patients also underwent standard polysomnography. Results At baseline, RLS was present in 10 patients (52.6%), and pain was the most reported symptom associated with the diagnosis. Patients with RLS had higher serum phosphate (p = 0.008) that remained independently associated with RLS in a logistic regression model, adjusted for hemoglobin, age and gender (HR = 7.28;CI = 1.14–46.3, p = 0.035). After parathyroidectomy, there was a reduction of serum parathyroid hormone, phosphate, calcium and alkaline phosphatase, and an increase of 25(OH)-vitamin D, and Fetuin-A. Parathyroidectomy alleviated RLS (from 52% to 21%; p = 0.04), which was accompanied by a decrease in severity scale, in association with relief of pain and pruritus. Polysomnography in these patients showed an improvement of sleep parameters as measured by sleep efficiency, sleep latency and percentage of REM sleep. Conclusion RLS is associated with high levels of phosphate in patients with severe secondary hyperparathyroidism on hemodialysis. Pain is most reported complain in these patients. Parathyroidectomy provided an opportunity to relief RLS. Whether the reduction of serum phosphorus or parathyroid hormone contributed to this improvement merits further investigation. PMID:27196740

  18. The perspectives of Aboriginal patients and their health care providers on improving the quality of hemodialysis services: a qualitative study.

    Science.gov (United States)

    Rix, Elizabeth F; Barclay, Lesley; Stirling, Janelle; Tong, Allison; Wilson, Shawn

    2015-01-01

    Chronic kidney disease has a higher prevalence in Indigenous populations globally. The incidence of end-stage kidney disease in Australian Aboriginal people is eight times higher than non-Aboriginal Australians. Providing services to rural and remote Aboriginal people with chronic disease is challenging because of access and cultural differences. This study aims to describe and analyze the perspectives of Aboriginal patients' and health care providers' experience of renal services, to inform service improvement for rural Aboriginal hemodialysis patients. We conducted a thematic analysis of interviews with Aboriginal patients (n = 18) receiving hemodialysis in rural Australia and health care providers involved in their care (n = 29). An overarching theme of avoiding the "costly" crisis encompassed four subthemes: (1) Engaging patients earlier (prevent late diagnosis, slow disease progression); (2) flexible family-focused care (early engagement of family, flexibility to facilitate family and cultural obligations); (3) managing fear of mainstream services (originating in family dialysis experiences and previous racism when engaging with government organizations); (4) service provision shaped by culture (increased home dialysis, Aboriginal support and Aboriginal-led cultural education). Patients and health care providers believe service redesign is required to meet the needs of Aboriginal hemodialysis patients. Participants identified early screening and improving the relationship of Aboriginal people with health systems would reduce crisis entry to hemodialysis. These strategies alongside improving the cultural competence of staff would reduce patients' fear of mainstream services, decrease the current emotional and family costs of care, and increase efficiency of health expenditure on a challenging and increasingly unsustainable treatment system.

  19. [Association of hypercalcemia, elevated levels of calcitriol and tuberculosis in patients on hemodialysis].

    Science.gov (United States)

    Peces, R; Díaz Corte, C

    2000-01-01

    Hypercalcemia is associated with numerous chronic granulomatous processes and chronic infections. Increased production of calcitriol by activated macrophages has been shown to be the cause in most cases. In this article, we describe three cases of hypercalcemia associated with inappropriately elevated calcitriol levels and suppressed PTH in hemodialysis. In addition to conventional techniques for tuberculosis diagnosis we used Ligase Chain Reaction (LCR) to detect mycobacterial DNA in pleural effusion with acid-fast stain and culture negativity. Antituberculous therapy was associated with a decrease in the levels of calcium, as well as in serum calcitriol concentrations, and a substantial increase in the levels of iPTH. The serum levels of 25(OH)D3 remained unchanged. These findings suggested ectopic production of calcitriol. The discussion reviews the previously reported cases of hypercalcemia and tuberculosis that occurred during hemodialysis, and concludes that ectopic production of calcitriol by tuberculous granulomas is extremely unusual and its demonstration requires a high index of suspicion. Molecular techniques are a potentially useful approach for early and rapid diagnosis of tuberculous infection in dialysis patients.

  20. Superior vena cava syndrome in hemodialysis patient

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    Azeb Molhem

    2011-01-01

    Full Text Available Obstruction of blood flow in the superior vena cava (SVC results in symptoms and signs of SVC syndrome. SVC obstruction can be caused either by invasion or external compression of the SVC by contagious pathologic processes involving the right lung, lymph nodes, and other mediastinal structures, or by thrombosis of blood within the SVC. Occasionally, both mechanisms co-exist. We hereby report a case of a 28-year-old male, Saudi patient who was diagnosed with end-stage renal disease and was maintained on regular hemodiaysis via right jugular vein dual lumen catheter for ten months. Three years later, the patient presented with signs and symptoms suggestive of SVC obstruction that was successfully managed with SVC stenting.

  1. Effect of personalized nutritional counseling in maintenance hemodialysis patients.

    Science.gov (United States)

    Garagarza, Cristina Antunes; Valente, Ana Tentúgal; Oliveira, Telma Sobral; Caetano, Cristina Guerreiro

    2015-07-01

    Monitoring nutritional parameters is an integral part of hemodialysis (HD) patient treatment program. The purpose of this study was to evaluate the impact of the personalized nutritional counseling (PNC) on calcium-phosphorus metabolism, potassium, albumin, protein intake, interdialytic weight gain (IDWG), body composition parameters and fluid overload in HD patients. This was a multicenter longitudinal intervention study with 6 months of follow-up and 731 patients on maintenance HD from 34 dialysis units in Portugal were enrolled. Biochemical and body composition parameters were measured at baseline, 1, 3 and 6 months after the PNC. Patient's mean age was 64.9 (95% confidence interval [CI]: 63.8-66.0) years and mean HD time was 59.8 (95% CI: 55.3-64.3) months. Regarding data comparison collected before PNC vs. 6 months after, we obtained, respectively, the following results: patients with normalized protein catabolic rate (nPCR) ≥ 1 g/kg/day = 66.5% vs. 73.5% (P = 0.002); potassium > 5.5 mEq/L = 52% vs. 35.8% (P  4.5% = 22.3% vs. 18.2% (P = 0.068). PNC resulted in a significant decrease in the prevalence of hyperkalemia, hypophosphatemia and also showed amelioration in Ca/P ratio, nPCR and an increase in P of hyphosphatemic patients. Our study suggests that dietetic intervention contributes to the improvement of important nutritional parameters in patients receiving hemodialysis treatment.

  2. Exploring the opinion of hemodialysis patients about their dialysis unit.

    Science.gov (United States)

    Donia, Ahmed Farouk; Elhadedy, Mohamed Ahmed; El-Maghrabi, Hanzada Mohamed; Abbas, Mohamed Hamed; Foda, Mohamed Ashraf

    2015-01-01

    Hemodialysis (HD) patients are subjected to a number of physical and mental stresses. Physicians might be unaware of some of these problems. We assessed our patients' opinion about the service provided at the dialysis unit. Our unit has 89 patients on HD. A questionnaire exploring our patients' opinion relative to the service provided was prepared. The patients were asked to fill-in the questionnaire in a confidential manner. Questionnaires were then collected and examined while unaware of patient identities. Sixty-nine patients (77.5%) responded to the questionnaire. Eight patients (11.6%) revealed their names on the questionnaire. According to the questionnaire, the patients were asked to assess the service of each service by choosing one of the following grades: "excellent," "mediocre" or "bad." For the whole group of contributing patients, there were 563 "excellent," 85 "mediocre" and five "bad" choices in addition to 37 blank "no comment" choices. Food service had the least percentage (68%) of evaluation as "excellent," while doctor' performance got the highest excellent evaluation (85.5%). Thirty-five patients (50.7%) added further comment(s). An audit meeting was conducted to discuss these results. Exploring the opinion of patients on HD might uncover some areas of dissatisfaction and help in improving the provided service. We recommend widespread usage of questionnaires to assess patient satisfaction as well as to assess other health-care aspects.

  3. Efeitos do exercício físico durante a hemodiálise em indivíduos com insuficiência renal crônica: uma revisão Effects of physical exercise during hemodialysis in patients with chronic renal insufficiency: a literature review

    Directory of Open Access Journals (Sweden)

    Regina Márcia Faria de Moura

    2008-01-01

    Full Text Available As principais alterações observadas em indivíduos com insuficiência renal crônica são anemia, hipertensão arterial sistêmica e atrofia muscular, que levam à baixa capacidade aeróbica e perda de força muscular. Assim, parte do tratamento desses indivíduos consiste em programas de exercício físico. O objetivo desta revisão da literatura foi documentar os efeitos agudos e as adaptações crônicas, cardiovasculares e musculares em indivíduos no estágio final da doença renal, submetidos a programas de exercício físico durante a hemodiálise. Foram selecionados artigos científicos nas bases eletrônicas Medline, Lilacs e PEDro, assim como no acervo de periódicos da biblioteca da Faculdade de Medicina da UFMG. Foram analisados 13 artigos envolvendo exercício físico aeróbico associado ou não a fortalecimento muscular durante a hemodiálise, variando quanto à intensidade, freqüência e duração da intervenção. A maioria demonstrou que exercícios físicos realizados durante a hemodiálise promovem efeitos benéficos na melhora da capacidade aeróbica, força muscular e no controle dos fatores de risco cardiovasculares, auxiliando a remoção dos solutos durante a hemodiálise. Embora o tema seja ainda pouco explorado, a literatura disponível evidencia benefícios do exercício durante a hemodiálise sobre a capacidade aeróbica e força muscular dos pacientes.Main alterations seen in patients with chronic renal insufficiency are anemia, systemic arterial hypertension, and muscular atrophy, which lead to low aerobic capacity and loss of muscle strength. Hence part of these patients treatment consists in programs of physical exercise. The purpose of this literature review was to assess muscle and cardiovascular acute effects and chronic adaptations in end-stage renal disease patients submitted to physical exercise during hemodialysis. After browsing through Medline, Lilacs and PEDro databases, as well as searching for

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

    DEFF Research Database (Denmark)

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

    2010-01-01

    Plasma paraoxonase (PON) is an enzyme that hydrolyzes organic phosphate and aromatic carboxylic acid esters. Reduced activity is associated with early events of atherogenesis. The relevance of PON phenotypes is not well characterized in hemodialysis patients. In a cross-sectional study we measured...... phenotypes. 74% of hemodialysis patients showed PON phenotype 1, 21% PON phenotype 2, and 5% PON phenotype 3. Compared to hemodialysis patients with PON 1, patients with PON 2 or 3 showed higher conversion rates for 4-nitrophenylacetate. We observed a significant reduction of PON ratio with increasing...

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

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    Hamed Enas A

    2012-10-01

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

  6. Serum soluble Klotho level is associated with abdominal aortic calcification in patients on maintenance hemodialysis

    Institute of Scientific and Technical Information of China (English)

    蔡宏

    2013-01-01

    Objective To determine the relationship between serum soluble Klotho(sKL) level and abdominal aortic calcification in maintenance hemodialysis(MHD) patients.Methods One hundred and twenty nine cases of MHD patients were

  7. Features of Hemodialysis in Cirrhotic Patients: Single Center Experience

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    Süleyman KÖZ

    2015-09-01

    Full Text Available OBJECTIVE: End-stage kidney disease and advanced cirrhosis are sometimes seen concomitantly. Our purpose was to compare hemodialysis (HD sessions in critically ill cirrhotic patients from ICU versus stable cirrhotic patients from outpatient clinic, and observe endurance of both stable and acutely ill cirrhotic patients to intermittent HD. MATERIAL and METHODS: All of the Child-Pugh class B or C cirrhotic patients requiring renal replacement therapy during a period of three years were included in the study. If hypotension, arrhythmia, bleeding, or any other health problems were present during dialysis, the dialysis session was regarded as a troubled session. RESULTS: There were two groups of patients. All of the stable patients lived more than three months, whereas all patients in the ICU group died within a month. Mean ultrafiltration volume per session was 1786±210 ml in ICU and 1616±266 ml in stable patients (p>0.05. The number of the troubled sessions was 24 in ICU and 1 in stable patients (p<0.0001. Bleeding was a problem in a minority of the patients. CONCLUSION: Intermittent HD may be an acceptable choice for stable cirrhotic dialysis patients. Hypotension is a frequent complication of intermittent HD in ICU patients.

  8. Effect of type II diabetes mellitus on intact parathyroid hormone level in end stage renal disease patients on maintenance hemodialysis

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    Subhasish Dan

    2013-10-01

    Full Text Available Introduction: Osteodystrophy is more common among hemodialysis patients than normal population. Earlier the higher incidence of osteodystrophy among maintenance hemodialysis (MHD patients was attributed to high Intact Parathyroid Hormone (iPTH level (150-300 pg/ml. Osteodystrophy due to high iPTH level is called High Turnover Bone Disease (HTBD. It was later found that another type of osteodystrophy, which can be attributed to low iPTH level and called Low Turnover Bone Disease (LTBD, also afflicts a subset of hemodialysis population, the diabetic End Stage Renal Disease (ESRD patients. In our study, we propose to ascertain if diabetic ESRD patients on MHD have lower iPTH level than their non-diabetic counterparts. Methods: Total 193 patients were enrolled into the study. Of them, 98 had diabetic nephropathy as primary cause of ESRD, 69 had Chronic Glomerulonephritis, 13 had Hypertensive Nephropathy, 8 had Polycystic Kidney Disease, 3 had Urolithiasis and 2 had Drug Induced Nephrotoxicity as primary cause of ESRD. All of them had been on MHD for more than 6 months. We measured the iPTH level of all the patients enrolled in the study. Result. Serum iPTH level was significantly lower in diabetic group than in non-diabetic group (P < 0.001. Conclusion: Type 2 Diabetes Mellitus contributes towards relatively low iPTH level in diabetic ESRD patients on MHD.

  9. Edema, Hyperpigmentation, Induration: 3 Skin Signs Heralding Danger in Patients on Maintenance Hemodialysis

    OpenAIRE

    2016-01-01

    Abstract Skin changes are common in patients on dialysis. This study focused on putative associations of specific skin findings with comorbidities and mortality. We performed a retrospective analysis of data from 508 patients on maintenance hemodialysis therapy in 7 centers in the German State of North Rhine Westphalia. Data had been collected by interview, from patient files, and from targeted physical examination in an earlier prospective study screening hemodialysis patients for the presen...

  10. Exploring the opinion of hemodialysis patients about their dialysis unit

    Directory of Open Access Journals (Sweden)

    Ahmed Farouk Donia

    2015-01-01

    Full Text Available Hemodialysis (HD patients are subjected to a number of physical and mental stresses. Physicians might be unaware of some of these problems. We assessed our patients′ opinion about the service provided at the dialysis unit. Our unit has 89 patients on HD. A questionnaire exploring our patients′ opinion relative to the service provided was prepared. The patients were asked to fill-in the questionnaire in a confidential manner. Questionnaires were then collected and examined while unaware of patient identities. Sixty-nine patients (77.5% responded to the questionnaire. Eight patients (11.6% revealed their names on the questionnaire. According to the questionnaire, the patients were asked to assess the service of each service by choosing one of the following grades: "excellent," "mediocre" or "bad." For the whole group of contributing patients, there were 563 "excellent," 85 "mediocre" and five "bad" choices in addition to 37 blank "no comment" choices. Food service had the least percentage (68% of evaluation as "excellent," while doctor′ performance got the highest excellent evaluation (85.5%. Thirty-five patients (50.7% added further comment(s. An audit meeting was conducted to discuss these results. Exploring the opinion of patients on HD might uncover some areas of dissatisfaction and help in improving the provided service. We recommend widespread usage of questionnaires to assess patient satisfaction as well as to assess other health-care aspects.

  11. Biotin ameliorates muscle cramps of hemodialysis patients: a prospective trial.

    Science.gov (United States)

    Oguma, Shiro; Ando, Itiro; Hirose, Takuo; Totsune, Kazuhito; Sekino, Hiroshi; Sato, Hiroshi; Imai, Yutaka; Fujiwara, Masako

    2012-01-01

    Patients with renal failure undergoing hemodialysis often have muscle cramps during and after the dialysis therapy. Muscle cramps are defined as the sudden onset of a prolonged involuntary muscle contraction accompanied with severe pain, resulting in early termination of a HD session and inadequate dialysis. The etiology of the cramps is unknown and effective anti-cramp medicine is not available. We have hypothesized that water-soluble vitamins are deficient in HD patients. Accordingly, we administrated biotin to 14 patients who had frequent muscle cramps during HD sessions. Oral administration of 1 mg/day biotin promptly reduced the onset and the severity of cramps in 12 patients both during and after HD. Then, the plasma biotin levels were measured by an enzyme-linked immunosorbent assay method (ELISA) in HD patients, including 14 patients with cramps and 13 patients without cramps, and 11 healthy volunteers. Plasma biotin levels were elevated in 27 HD patients at baseline compared with healthy volunteers [451 (377 - 649) vs. 224 (148 - 308) ng/l, median (lower-upper quartiles); p cramp patients, the biotin levels were significantly higher in biotin-ineffective 7 patients than biotin-effective 7 patients [1,064 (710 - 1,187) vs. 445 (359 - 476) ng/l; p muscle cramps regardless of their elevated plasma biotin levels.

  12. Effect of long intermittent hemodialysis on improving dialysis adequacy of maintenance hemodialysis patients

    Institute of Scientific and Technical Information of China (English)

    DAI Wen-di; ZHANG Dong-liang; CUI Wen-ying; LIU Wen-hu

    2013-01-01

    Background With the increase in hemodialysis (HD) patients,the blood dialysis patient's quality of life (QoL) and longterm survival are still a challenge for clinicians.Recent studies have found that most of the HD patients have sleep disorders,which have a certain correlation with long-term survival and QoL.But there are few studies of Chinese in this field.This study aimed to investigate whether increasing the dialysis dose can improve sleep quality,so we treated HD patients on long intermittent hemodialysis (LIHD).Methods Forty patients who were treated by conventional HD at the Beijing Friendship Hospital Blood Purification Center were offered the option of LIHD.The patients' laboratony data,medication use,and questionnaire answers were analyzed.Conventional HD was delivered thrice weekly with 4 hours per treatment,and LIHD was delivered thrice weekly with 8 hours per treatment.The study lasted 6 months.Questionnaires included sleep quality survey and QoL SF-36; the former includes the Athens Insomnia Scale,Pittsburgh Sleep Quality Index (PSQI),and Epworth Sleepiness Scale (ESS).Results After conversion to LIHD the dialysis efficiency (Kt/V) significantly increased than before (P <0.05) and clearance rate of urea nitrogen also increased from 67 to 78% (P <0.01).After conversion,median values for Hb increased from 108.95 to 126.55 g/L (P <0.01); albumin increased from 38.85 to 40.05 g/L (P <0.01).Phosphorus decreased from 2.69 to 1.54 mmol/L (P <0.01),but there was no alteration in blood calcium; phosphorus and calcium-phosphate product levels were under more control,but parathyroid hormone (iPTH) level did not change after conversion to LIHD.After conversion,blood pressure (BP) was better controlled than before and the mean number of antihypertensive drugs prescribed declined from 2.9 to 0.5 (P <0.01).There was a significant reduction in the use of erythropoietin-stimulating agent of 5250 U/w (P<0.01).Sleep quality significantly improved in the

  13. HBV Vaccination in Chronic Renal Failure Patients

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    Mir-davood Omrani

    2006-12-01

    Full Text Available HBV infection in chronic renal failure (CRF becomes chronic in 30 to 60% compared with less than 10% in nonuremic patients. Immunological dysfunction in patients on hemodialysis may be related to imbalanced cytokine systems, such as tumor necrosis factor (TNF-|α| and interleukin (IL 6,1 by retention of renal metabolite in uremia and chronic inflammation and have a poor immunological reaction to T-cell-dependent antigens, like hepatitis B vaccination. Immunocompromised patients who are unresponsive to hepatitis B vaccination seem to be unable to enhance IL-10 synthesis for control of monokine overproduction. Moreover, human leukocyte antigen (HLA genes, which play a major role in the antigen presentation to immunocompetent cells, have also been shown to modulate this immune response. Unfortunately, seroconversion to anti-HBS has been reported to occur in only 40 to 50% of the vaccine, a significantly lower rate than that observed in healthy adults. Various methods including adjutants such as zinc, gamma interferon, thymopentine, GM-CSF and Levamisol for improving immune responses have been advised. Experience with Pres1/s2, third-generation vaccines is limited and they have not been proven more effective than intradermally (ID administered second-generation S antigen vaccines. Both intramuscular (IM and intradermal (ID vaccinations against hepatitis B have variable efficiency in hemodialysis and non-responders should be retreated by ID route.

  14. Plasma levels of catecholamines and asymmetric dimethylarginine levels as predictive values of mortality among hemodialysis patients

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    Dziedzic Marcin

    2014-06-01

    Full Text Available The aim of the study was to assess plasma concentration of catecholamines and asymmetric dimethyl arginine levels and a possible relationship to predict the mortality rates among hemodialysis patients. The study population comprised 27 subjects, aged 65-70 years. Each patient underwent dialysis thrice a week. Furthermore, the median duration of hemodialysis was 3.5 years. Based on the conducted research, it can be concluded that the concentrations of adrenaline and the level of asymmetric dimethylarginine have predictive value of mortality among hemodialysis patients. Of note, lowering plasma asymmetric dimethylarginine concentration may represent therapeutic target for prevention of progressive renal damage.

  15. An Evaluation of the Quality of Nursing Care Provided for Vascular Access in Hemodialysis Patients

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    Hamid Reza Chamanzari

    2015-10-01

    Full Text Available Introduction: Care for vascular access of patients undergoing hemodialysis is a critical issue. Inflammation and subsequent infection are the major factors which threaten patients' health and diminish effectiveness of hemodialysis. Therefore, this study aimed to evaluate the severity and incidence of inflammation of vascular access in hemodialysis patients. Materials and Methods: This cross-sectional study was conducted on 90 patients undergoing hemodialysis in Emam Reza and Montazerie Hospitals in Mashhad, June, 2014. Evaluation of inflammation severity over the course of one month (12 hemodialysis sessions was performed by means of an inflammation tool designed by the Board of Nursing. Data were analyzed using SPSS version 16, and performing descriptive and Chi-square tests.  Results:The mean and standard deviation of incidence of inflammation in the first session of hemodialysis was 3.2±1.3 cases. The mean and standard deviation of the intensity of inflammation was 12.5±4.7. Conclusion: Since inflammation of vascular access in hemodialysis patients impairs their safety and health improvement, necessary measures to reduce this complication must be taken.

  16. Personal abilities in patients undergoing peritoneal dialysis and hemodialysis. A pilot study using the existence scale.

    Science.gov (United States)

    Schwaiger, Johannes P; Kopriva-Altfahrt, Gertrude; Söllner, Wolfgang; König, Paul

    2007-01-01

    Personality psychology is increasingly used in various clinical medicine settings to help in decision-making in difficult situations, especially in chronic disease. Patients with chronic renal disease are very dependent on modern medicine, and psychological aspects could help give answers in certain circumstances. Logotherapy and Existence analysis, after Viktor Frankl (Third Viennese School of Psychotherapy), is the theory of the possibilities and conditions for a fulfilled existence and evaluates a different aspect of personality psychology, namely meaning (in life). We used the existence scale questionnaire in this pilot study to investigate the personal abilities self-distancing, self-transcendence, freedom and responsibility in dialysis patients and compared a group of hemodialysis (HD) patients with patients treated with continuous ambulatory peritoneal dialysis (CAPD). We studied a mixed dialysis cohort (24 HD, 24 CAPD) at two Austrian centers (Innsbruck Medical University Hospital and Wilhelminenspital of the City of Vienna). Overall, results for dialysis patients (n = 48) were very close to those reported for healthy persons; however, CAPD patients scored significantly better than HD patients (p = 0.017) on the subscale self-distancing. This significant difference was also seen in the overall scores (p = 0.045). Our results might indicate that contented CAPD patients have personal abilities that predestine them for this type of treatment. The existence scale might help decide between CAPD and HD treatment alternatives.

  17. ANEMIA IN HEMODIALYSIS PATIENTS: DIABETIC VS NON DIABETIC PATIENTS

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    SH SHAHIDI

    2002-12-01

    Full Text Available Introduction. One of the characteristic signs of uremic syndrome is anemia. One of major factors that affects on severity of anemia in ESRD is underlying diseas. The porpuse of this study is to compaire anemia between diabetic and non diabetic ESRD patients. Methods. In a case control study we compared the mean valuse of Hb, Het, MCV, MCH, MCHC, BUN, Cr and duration of dialysis between diabetic and nondiabetic patients on chronic hemodialyis. some variables (such as age, sex, use of erythropoietin, nonderolone decaonats, folic acid, ferrous sulfate, transfusion and blood loss in recent three months and acquired kidney cysts were matched between cases and controls. Results. Means of Hb were 9±1.3 and 8 ± 1.7 in diabetic and non diabetic patients (P<0.05. Mean corposcular volume in diabetic patients (91±3.1 fl was more higher than non diabetic ones (87.1 ± 8.9 (P < 0.05. Other indices had no differences between two groups (P > 0.05. Discussion. Severity of anemia in patients with diabetic nephropathy is milder that other patients with ESRD. So, Anemia as an indicator of chronocity of renal disease in diabetics is missleading.

  18. Solute clearance effect of citrate anticoagulation hemodialysate for hemodialysis in patients with high risk of bleeding

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Objective To study the solute clearance effect of the new concentrated anticoagulation hemodialysate of citrate for hemodialysis in patients with high risk of bleeding. Methods Forty-two kidney failure patients with high risk of bleeding were divided into two groups (Group A and Group B) according to their hemodialysis manners. Patients in Group A were hemodialyzed with bicarbonate hemodialysate with low-molecular-weight heparin (dalteparin) anticoagulation and those in Group B with the new citrate anticoag...

  19. Epidemiology of viral hepatitis among patients undergoing hemodialysis at nephrology center Benghazi

    OpenAIRE

    Vinay Rao; Prasannalakshmi Rao

    2014-01-01

    Introduction: During hemodialysis, patients are at-risk of acquiring blood-borne viruses and pathogenic bacteria. Within dialysis units, prevention of infection is of paramount importance. The nursing staff must take adequate precaution to prevent the spread of infection within this high-risk environment. Patients and Methods: All patients undergoing hemodialysis for the period of 7 days were interviewed once during dialysis, using a closed-ended questionnaire. Patients′ files were checked fo...

  20. Factors affecting response to hepatitis b vaccine among hemodialysis patients in a large Saudi Hemodialysis Center

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    Khalid Al Saran

    2014-01-01

    Full Text Available The aim of this study is to determine the response to hepatitis B virus (HBV vaccination in patients on hemodialysis (HD and to identify the factors that could affect this response. This retrospective study was carried out during the period from January 2009 to December 2009 in the Prince Salman Center for Kidney Diseases (PSCKD, Riyadh, and included 144 patients (78 males and 66 females on regular HD, all of whom received hepatitis B vacci-nation. Patients were divided into two groups according to the level of hepatitis B surface antibodies (HBsAb: Responders group (>10 IU/L and non-responders group (<10 IU/L. The study looked at the factors that may affect the responsiveness to hepatitis B vaccination, like gender, age, co-existence of hepatitis C virus (HCV infection, dialysis adequacy that was evaluated by urea reduction ratio (URR and Kt/V, hemoglobin level, albumin level, protein catabolic rate (PCR, body mass index (BMI, subjective global nutritional status (SGA and HbA1c. There were 129 patients (89.6% in the responders group including 69 males and 60 females and 15 patients (10.4% in the non-responders group including nine males and six females. The mean age in the responders group and the non-responders group was 50.56 ± 15.35 and 56.87 ± 12.52 years, respectively (P = 0.128. The mean value of the PCR was 1.03 ± 0.17 and 0.88 ± 0.17 g/kg/day in the responders group and non-responders group, respectively (P = 0.002. There was no statically significant difference between the two groups regarding the presence or absence of HCV infection, age, gender, diabetes mellitus, URR, Kt/V, hemoglobin level and albumin level. We report a high response rate (89% for HBV vaccination in our HD patients. The PCR was the only factor that affected the response to HBV vaccination in these patients.

  1. Retinol and Alpha-Tocopherol Levels Among Hemodialysis Patients.

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    Awatif M. Abd El Maksoud*, Asmaa M. Abd Allah*, Waleed Massoud

    2004-06-01

    Full Text Available Plasma retinol, alpha tocopherol, total cholesterol and triglycerides were measured in 40 patients aged 27-65 years, under regular hemodialysis (HD for 1.8-13 years at Ahmed Maher teaching Hospital and in 28 healthy age and sex matched control. Predialysis and postdialysis measurements were also, done for a subset of 13 hemodialytic patients. Among hemodialytic patients ,all values ( Plasma retinol ,alpha- tocopherol, total cholesterol and triglycerides were significantly higher ( p 100 ug /dl except for one patient . On the other hand ,alpha-tocopherol level in hemodialytic patients was ranged between deficiency ( 1080 ug/dl. Comparing predialysis and postdialysis measurements , the hemodialytic patients showed non significant difference concerning retinol level , while alpha tocopherol was significantly decreased in postdialytic state .In conclusion ; further studies are needed to answer, if hemodialytic patients are at risk for symptomatic vitamin A toxicity?. Even with normal or low plasma vitamin E, it is needed as an antioxidant accessory therapy in hemodialytic patients.

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

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

    2010-12-01

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

  3. Associação dos antígenos leucocitários humanos com a ausência de resposta humoral à vacina da hepatite B em pacientes renais crônicos hemodialisados Association of humans leucocitary antigens with humoral nonresponsive to hepatitis B vaccine in chronic hemodialysis patients

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    Joaquim Xavier de Sousa Júnior

    2004-02-01

    Full Text Available A vacinação com antígeno de superfície do vírus da hepatite B não tem eficácia satisfatória em pacientes hemodialisados. O objetivo do estudo foi investigar uma possível associação entre antígenos leucocitários humanos e a baixa capacidade de produção de anticorpos protetores (anti-HbS contra o antígeno de superfície do vírus da hepatite B em pacientes renais crônicos de programa de hemodiálise. Os antígenos HLA DR e DQ foram determinados em 76 pacientes hemodialisados por meio da técnica clássica de microlinfocitotoxicidade. Os resultados demonstraram que 34,2% dos pacientes eram não-respondedores à vacina VHB. As especificidades HLA mais freqüentes foram: HLA-DR3, DR7 e DQ2, com associação significante para a especificidade HLA-DR3 (p=0,0025; OR 5,1; IC95% 1,36-19,10. Estes dados sugerem a associação dos genes HLA de classe II com a incapacidade de resposta humoral à vacina VHB.Vaccination using surface antigen from hepatitis B virus has not been successfully responded by hemodialysis patients. The present study was aimed at assessing a possible relationship between human leukocyte antigens and the low production of protective antibodies (anti-HbS against the surface antigen from hepatitis B by patients with chronic renal failure submitted to hemodialysis programs. The antigens HLA-DR and HLA-DQ were identified in 76 hemodialysis patients through classic microlymphotoxicity. Our results showed that 34.2% of the patients were non-responsive to the vaccine VHB. The most frequent HLA specificity were: HLA-DR3, DR-7 and DQ2 with a significant association for HLA-DR3 (p=0.0025; OR 5.1; IC 95% 1.36-19.10. Such data suggest an association between genes from HLA class II antigens and the humoral non-response to the vaccine VHB.

  4. Is there something special about cardiovascular abnormalities and sudden unexpected death in epilepsy among patients with chronic renal insufficiency in regular hemodialysis program? Existe algo de especial a respeito das anormalidades cardíacas e morte súbita e inesperada na epilepsia nos pacientes com insuficiência renal crônica no programa regular de hemodiálise?

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    Rui A. Gomes

    2009-06-01

    Full Text Available Of the many risk factors suggested for sudden unexpected death in epilepsy (SUDEP, higher frequency of seizures is a very consistent issue. Following this reasoning, it has been established that hemodialysis-associated seizure is a complication of dialysis procedure. Based on these facts, this study investigated a possible association between cardiovascular abnormalities and SUDEP among patients with chronic renal insufficiency in regular hemodialysis program. For that, a retrospective medical history of 209 patients was reviewed to investigate the occurrence of convulsive seizures and EKG abnormalities during dialytic program. Three patients presented generalized tonic-clonic seizures, one had partial seizure with secondary generalization, and one presented unclassified seizure. Any EKG abnormalities and SUDEP event were found in all patients evaluated. In conclusion, the present findings demonstrated uncommon the occurrence of seizures and also SUDEP. Probably, the main justification to not allow us to demonstrated a direct relation between SUDEP and cardiovascular diseases in hemodialysis are the reduced number of cases examined.Um dos principais fatores de risco para a morte súbita e inesperada na epilepsia (SUDEP é a alta freqüência de crises epilépticas. Seguindo este raciocínio, tem sido estabelecido que as crises epilépticas associadas à hemodiálise seja uma complicação do procedimento dialítico. Baseado neste fato, este estudo investigou uma possível associação entre anormalidades cardiovasculares e SUDEP nos pacientes com insuficiência renal crônica em um programa regular de hemodiálise. Para isto, um histórico médico retrospectivo de 209 pacientes foi revisado para avaliar a ocorrência de crises epilépticas e possíveis anormalidades no ECG durante o programa de diálise. Três pacientes apresentaram crises tônico-clonica generalizadas, um apresentou crise parcial com generalização secundária e um apresentou

  5. Assessment of inflammatory factors and cardiac troponin T in hemodialysis patients

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    Falaknazi Kianoosh

    2009-01-01

    Full Text Available Hemodialysis (HD patients suffer from chronic inflammations which make them at increased risk of cardiovascular diseases. The purpose of this study was to see if there is a significant association between inflammatory factors such as ferritin and C-reactive protein (CRP as well as troponin T in patients on HD. We assessed these serum factors as well as other known cardiac risk factors in 53 patients on HD. The serum ferritin and CRP levels were measured by chemiluminescence′s immune assay while troponin T levels were measured by electrochemist luminescence immune assay. We found that serum concentrations of CRP and ferritin were not significantly higher in patients on HD with known cardiac risk factors (compared with the control group (p< 0.05. However, the serum troponin T levels in HD patients with cardiovascular risk factors were significantly higher than the control group. Our study suggests that elevated serum troponin T levels can play an important role as a predictor of cardiovascular disease in HD patients. Also, inflammatory factors such as CRP and ferritin may be influenced by chronic inflammation or nutritional status of these patients.

  6. Pathogenicity of GB virus C on virus hepatitis and hemodialysis patients

    Institute of Scientific and Technical Information of China (English)

    Wan-Fu Zhu; Li-Min Yin; Peng Li; Jian Huang; Hui Zhuang

    2003-01-01

    AIM: To determine the pathogenicity of GB virus C (GBV-C)on liver and the effects of its co-infection on the clinical features and prognosis of patients with hepatitis B and C.METHODS: Cross-sectional study was carried out in 413patients with acute, chronic hepatitis B or liver cirrhosis,and in 67 hemodialysis patients. A 20-month prospective cohort study was carried out in 95 hepatitis B and 80 hepatitis C patients. A reverse transcriptase nested polymerase chain reaction (RT-nPCR) of the 5′-noncoding region was used to detect circulating GBV-C RNA. Liver function was determined by an automated analyzer for all patients.RESULTS: The prevalence of GBV-C in the high-risk populations with the virus transmitted via blood was high,ranging from 16.2 to 28.8%. Co-infection with GBV-C in hepatitis B patients did not affect the clinical features of the disease or liver function. The dialysis patients infected with GBV-C alone did not develop functional changes to the liver.Prospective cohort study showed that GBV-C co-infection did not affect the clinical features, prognosis or negative serum conversion rate of chronic hepatitis B and C.CONCLUSION: The results suggest that GBV-C has no marked pathogenicity on liver, so it may not be a hepatitis virus.

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

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    Lorraine S Dias

    2011-01-01

    Full Text Available The treatment of baclofen overdose is primarily supportive. There have been case reports of hemodialysis being used in patients with chronic kidney disease with baclofen overdose. A case report of hemodialysis in a baclofen-overdose patient with normal renal function is presented. Review of literature has also been provided.

  8. Advanced thymic cancer treated with carboplatin and paclitaxel in a patient undergoing hemodialysis.

    Science.gov (United States)

    Miura, Satoru; Kagamu, Hiroshi; Sakai, Takehito; Nozaki, Koichiro; Asakawa, Katsuaki; Moro, Hiroshi; Okajima, Masaaki; Watanabe, Satoshi; Yamamoto, Suguru; Iino, Noriaki; Goto, Shin; Kazama, Junichiro James; Yoshizawa, Hirohisa; Narita, Ichiei

    2015-01-01

    A 53-year-old man with an asymptomatic anterior mediastinal tumor undergoing hemodialysis was referred to our institution. He was diagnosed with thymic basaloid carcinoma based on the findings of a chest tomography-guided biopsy and successfully treated with carboplatin (300 mg/m(2)/day) and paclitaxel (200 mg/m(2)/day) on day 1 for six three-week cycles. To our knowledge, this is the first report regarding the efficiency of a carboplatin dose-definition method based on the body surface area with paclitaxel in a hemodialysis patient. This report may therefore be useful for treating hemodialysis patients who are candidates for carboplatin and paclitaxel therapy.

  9. Prognostic impact of peritonitis in hemodialysis patients: A national-wide longitudinal study in Taiwan

    Science.gov (United States)

    Lee, Cheng-Chia; Wu, Patricia W.; Chang, Chee-Jen; Tian, Ya-Chung; Yang, Chih-Wei

    2017-01-01

    Background Peritonitis has been independently associated with increased morbidity and mortality in peritoneal dialysis patients. However, there are few reports on peritonitis in hemodialysis patients. We aim at investigating both the risk profiles and prognostic impact of peritonitis in hemodialysis patients. Methods This nation-wide longitudinal study uses claims data obtained from the Taiwan National Health Insurance Research Database. A total of 80,733 incident hemodialysis patients of age ≥ 20 years without a history of peritonitis were identified between January 1, 1998 and December 31, 2009. Predictors of peritonitis events were estimated using Cox proportional hazard models. Time-dependent Cox proportional hazard models were used to estimate hazard ratio for mortality attributed to peritonitis exposure. Results Of 80,733 incident hemodialysis patients over a 13-year study period, peritonitis was diagnosed in 935 (1.16%), yielding an incidence rate of 2.91 per 1000 person-years. Female gender, liver cirrhosis and polycystic kidney disease were three of the most significant factors for peritonitis in both non-diabetic and diabetic hemodialysis patients. The cumulative survival rate of patients with peritonitis was 38.8% at 1 year and 10.1% at 5 years. A time-dependent Cox multivariate analysis showed that peritonitis had significantly increased hazard ratio for all cause mortality. Additionally, the risk of mortality remained significantly higher for non-diabetic hemodialysis patients that experienced peritonitis. Conclusions The risk of peritonitis in hemodialysis patients is higher in female gender, liver cirrhosis and polycystic kidney disease. Although peritonitis is a rare condition, it is associated with significantly poorer outcome in hemodialysis patients. PMID:28301536

  10. Factors Affecting Hemodialysis Patients' Satisfaction with Their Dialysis Therapy

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    M. Al Eissa

    2010-01-01

    Full Text Available Aim. To assess the degree of satisfaction among hemodialysis patients and the factors influencing this satisfaction. Methods. Patients were recruited from 3 Saudi dialysis centers. Demographic data was collected. Using 1 to 10 Likert scale, the patients were asked to rate the overall satisfaction with, and the overall impact of, their dialysis therapy on their lives and to rate the effect of the dialysis therapy on 15 qualities of life domains. Results. 322 patients were recruited (72.6% of the total eligible patients. The mean age was 51.7 years (±15.4; 58% have been on dialysis for >3 years. The mean Charlson Comorbidity Index was 3.2 (±2, and Kt/V was 1.3 (±0.44. The mean satisfaction score was (7.41 ± 2.75 and the mean score of the impact of the dialysis on the patients' lives was 5.32 ± 2.55. Male patients reported worse effect of dialysis on family life, social life, energy, and appetite. Longer period since the commencement of dialysis was associated with adverse effect on finances and energy. Lower level of education was associated with worse dialysis effect on stress, overall health, sexual life, hobbies, and exercise ability. Conclusion. The level of satisfaction is affected by gender, duration on dialysis, educational level, and standard of care given.

  11. Effect of dialysate temperature on hemodynamic stability among hemodialysis patients.

    Science.gov (United States)

    Azar, Ahmad Taher

    2009-07-01

    Cooling the dialysate below 36.5 degrees C is an important factor that contributes to hemodynamic stability in patients during hemodialysis (HD). In this study, the effect of dialysate temperature on hemodynamic stability, patients' perception of dialysis discomfort and post dialysis fatigue were assessed in a group of patients on HD. A total of 50 patients, all of whom were on 3-times-per-week dialysis regimen, were studied. Patients were assessed during six dialysis sessions; in three sessions, the dialysate temperature was normal (37 degrees C) and in three other sessions, the dialysate temperature was low (35 degrees C). Specific scale questionnaires were used in each dialysis session, to evaluate the symptoms during the dialysis procedure as well as post-dialysis fatigue, and respective scores were noted. The results showed that usage of low dialysate temperature was associated with the following: higher post dialysis systolic blood pressure (Pperceptions were measured by a questionnaire, which showed that 76% of them felt more energetic after dialysis with cool dialysate and requested to be always dialyzed with cool dialysate. Low temperature dialysate is particularly beneficial for highly symptomatic patients, improves tolerance to dialysis in hypotensive patients and helps increase ultrafiltration while maintaining hemodynamic stability during and after dialysis.

  12. Malnourished patients on hemodialysis improve after receiving a nutritional intervention

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    Adaiane Calegari

    2011-12-01

    Full Text Available INTRODUCTION: Malnutrition is multifactorial and may be modified by nutritional intervention. We aimed to assess the impact of an intervention on the nutritional status of malnourished hemodialysis patients and their acceptance of a non-industrialized nutritional supplement. METHODS: 18 patients were studied, they were selected from a previous nutritional assessment where nutritional risk was defined as: subjective global assessment > 15 plus one criterion for malnutrition. The following variables were assessed: anthropometric parameters, subjective global assessment, dietary intake, six-minute walking test, quality of life (SF-36, and biochemical tests. Patients were randomized to either Control or Intervention Groups. The Intervention Group received a dietetic supplement during dialysis containing 355 kcal, prepared from simple ingredients. After three months, subjects from the Control Group and other patients also considered at nutritional risk underwent the same intervention. The study groups were compared after three months, and all patients were analyzed before and after the intervention. RESULTS: Fifteen men and three women, aged 56.4 ± 15.6 years-old, nine in each group, were studied. The Intervention Group showed an improvement in the subjective global assessment (p = 0.04. There were differences in role physical and bodily pain domains of SF-36, with improvement in the Intervention Group and worsening in the Control Group (p = 0.034 and p = 0.021. Comparisons before and after intervention for all patients showed improvement in the subjective global assessment (16.18 ± 4.27 versus 14.37 ± 4.20, p = 0.04, and in the six-minute walking test (496.60 ± 132.59 versus 547.80 ± 132.48 m; p = 0.036. The nutritional supplement was well tolerated by all patients, and it did not cause side effects. CONCLUSIONS: The nutritional intervention improved the subjective global assessment and quality of life of hemodialysis patients at short-term. A

  13. Exploration of a reasonable dialysate temperature setting in hemodialysis for patients with hypertension

    Institute of Scientific and Technical Information of China (English)

    Lin-Fang Xu; Chun-Lei Wu; Hong-Mei Sun; Tong-Qiang Liu

    2016-01-01

    Objective: This study aims to investigate the effect of 4 different dialysate temperatures on blood pressure during hemodialysis for patients with hypertension. Methods: Using a self-controlled method, the patients' body temperature was set as T. Accordingly, the dialysate temperature was set as 37 ℃, Tþ0.5 ℃, T, and T-0.5 ℃. The changes in blood pressure, heart rate, mean arterial pressure and dialysis-induced adverse reactions at the 4 different dialysate temper-atures were consistently monitored. Results: Patients who received hemodialysis with 37 ℃ and Tþ0.5 ℃ dialysate demonstrated an un-stable blood pressure and a higher incidence of adverse reactions. Patients who received hemodialysis with T and T-0.5 ℃ dialysate showed a relatively stable blood pressure, heart rate, and mean arterial pressure during dialysis. In particular, dialysate at T-0.5 ℃ resulted in the most stable blood pressure, the fewest adverse reactions and the best self-assessed comfort scores (P Conclusions: The dialysate temperature during hemodialysis for patients with hypertension should be set to a temperature based on patients' preoperative body temperate T or 0.5 ℃ below T. This practice is suggested to enhance the stability of patients' blood pressure and heart rate during hemodialysis, reduce complications and improve patients' tolerance of hemodialysis.

  14. Levamisole Usage as an Adjuvant to Hepatitis B Vaccine in Hemodialysis Patients, Yes or No?

    Science.gov (United States)

    Sanadgol, Houshang

    2012-01-01

    Background Hepatitis B virus (HBV) infection is much more common in hemodialysis patients than the general population. These patients have an impaired immune response to HBV vaccination; to that end there are certain studies that have evaluated levamisole as an immunomodulator agent improving HBV vaccination response rate in hemodialysis patients. Objectives In the current review, we have assembled all of the results to determine whether lavamisole is of value as an adjuvant to HBV vaccination in hemodialysis patients. Materials and Methods Science Direct (Elsevier), ProQuest, Springer, MD Consult, BMJ Journals, Pubmed and Wiley were searched for levamisole application to HBV vaccination in hemodialysis patients. All studies revealed a seroconversion response level between levamisole plus HBV vaccine versus HBV vaccine alone. Results From 10 relevant studies, 5 studies fulfilled our inclusion criteria. Three of them suggested the significant benefit of adding levamisole to the HBV vaccine to increase augment seroprotection level in hemodialysis patients. Another study reported a decrease in seroprotection level and another study showed no significant difference caused by levamisole administration. Conclusions Due to the limited number of studies evaluated, it is challenging to perform a definite decision about routinely administering levamisole in addition to the HBV vaccine for all hemodialysis patients. However, it does seem reasonable to recommend administration of levamisole for impaired immune response patients. PMID:23577329

  15. The lived experience of giving spiritual care: a phenomenological study of nephrology nurses working in acute and chronic hemodialysis settings.

    Science.gov (United States)

    Deal, Belinda; Grassley, Jane S

    2012-01-01

    The purpose of this study was to explore the lived experiences of nephrology nurses giving spiritual care in acute and chronic hemodialysis settings. Ten nurses were interviewed. Five themes were identified: a) drawing close, b) drawing from the well of my spiritual resources, c), sensing the pain of spiritual distress, d) lacking resources to give spiritual care, and e) giving spiritual care is like diving down deep. The study findings suggest that patients and nurses draw close during the giving of spiritual care, that nurses have spiritual resources they use to prepare for and give spiritual care, and that giving spiritual care can have an emotional cost. These findings have implications for nursing practice, nursing education, and nursing research.

  16. Epidemiology of erectile dysfunction in hemodialysis patients using IIEF questionnaire

    Directory of Open Access Journals (Sweden)

    Leila Malekmakan

    2011-01-01

    Full Text Available Erectile dysfunction (ED is defined as the inability to attain or maintain an erec-tion sufficient for satisfactory sexual performance. This cross-sectional study was conducted on pa-tients on hemodialysis (HD in Shiraz, Iran, using the International Index of Erectile Dysfunction questionnaire for determination of the frequency and severity of ED in these patients. We used the Chi-square, Mann-Whitney, Kruskal-Wallis and Pearson′s correlation coefficient tests for statis-tical analysis. A total of 73 patients were enrolled into this study. The mean score of ED was 10.3 ± 6.3 (total score 25. The prevalence of ED of various degrees was 87.7%. There was a signi-ficant correlation between different degrees of ED and age (P = 0.002; it was significantly higher in patients older than 50 years (P = 0.005. Also, ED was more common in patients whose Kt/V was <1.2 (P = 0.04. Our study suggests that ED is a major health concern in patients on HD. Improvement of ED may improve their quality of life. Our results can give the basic data for future research in this field.

  17. Depression, insomnia and sleep apnea in patients on maintenance hemodialysis

    Science.gov (United States)

    Rai, M.; Rustagi, T.; Rustagi, S.; Kohli, R.

    2011-01-01

    Depression and sleep disorders are more frequent in patients on maintenance hemodialysis (HD) than the general population, and are associated with reduced quality of life and increased mortality risk. The purpose of this study was to assess the prevalence of depression, sleep apnea, insomnia in patients on HD as well as depression in their primary caregiver and to correlate these with the demographic profile. A cross-sectional study was conducted among 69 patients on maintenance HD for more than 3 months. There was high p revalence of depression (47.8%), insomnia (60.9%), increased risk of sleep apnea (24.6%) and depression in caregiver (31.9%). Depression was significantly more in patients with low monthly income (P=0.03), those on dialysis for more than 1 year (P=0.001) and the unemployed (P=0.009). High-risk patients for sleep apnea tended to be males with low monthly income (P=0.02). Insomnia was significantly higher in patients who were on dialysis for more than 1 year (P=0.003). PMID:22022080

  18. Extracorporal hemodialysis with acute or decompensated chronical hepatic failure

    Directory of Open Access Journals (Sweden)

    Wasem, Jürgen

    2006-04-01

    Full Text Available Background: Conventional diagnostic procedures and therapy of acute liver failure (ALF and acute-on-chronic liver failure (ACLF focus on to identify triggering events of the acute deterioration of the liver function and to avoid them. Further objectives are to prevent the development respectively the progression of secondary organ dysfunctions or organ failure. Most of the times the endocrinological function of the liver can to a wide extent be compensated, but the removal of toxins can only marginally be substituted by conventional conservative therapy. To improve this component of the liver function is the main objective of extracorporal liver support systems. The following principles of liver support systems can be differentiated: Artificial systems, bioartifical systems and extracorporal liver perfusion systems. This HTA report focuses on artificial systems (e.g. BioLogic-DT/-DTPF, MARS, Prometheus, because only these approaches currently are relevant in the German health care system. In 2004 a category "Extracorporal liver assist device" was introduced in the list of "additional payments" in the German DRG-system, which makes reimbursement for hospitals using the technology in inpatient care possible, based on an hospital's individual contract with statutory sickness funds. Objectives: To report the present evidence and future research need on medical efficacy and economic effectiveness of extracorporal liver support devices for treatment of patients with ALF or ACLF based on published literature data. Are artificial liver support systems efficient and effective in the treatment of ALF or ACLF? Methods: An extensive, systematic literature search in medical, economic, and HTA literature data bases was performed. Relevant data were extracted and synthesised. Results: Relevant controlled trials were detected for BioLogic-DT and MARS. No randomised controlled trial on Prometheus was found. None of the included studies on BioLogic-DT showed

  19. The Effect of Massage With Lavender Oil on Restless Leg Syndrome in Hemodialysis Patients: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Hashemi

    2015-12-01

    Full Text Available Background Restless leg syndrome (RLS is a common problem in patients with chronic renal failure. It can reduce the quality of life and sleep disturbances. This disorder is usually treated pharmacologically. Recently, complementary medicine methods have been suggested because of chemical drugs adverse effects. There is not enough evidence about the effect of aromatherapy on RLS. Objectives The aim of this study was to determine the effects of massage with lavender oil on RLS symptoms in hemodialysis patients. Patients and Methods This randomized clinical trial study included 70 hemodialysis patients with RLS that were randomly assigned into two groups in 2014. The experimental group received effleurage massage using lavender oil and control group received routine care for three weeks. Data was collected with RLS questionnaire and analyzed using independent and paired t-test and Chi-square test. Results The mean RLS scores were not significantly different in the two groups at the start of study (22.41 ± 7.67 vs. 22.90 ± 4.38, P = 0.76. At the end of study, the mean RLS score significantly decreased in the intervention group, while this score remained relatively un-changed in the control group (12.41 ± 5.49 vs. 23.23 ± 4.52, P < 0.0001. Conclusions Lavender oil massage was effective to improve RLS in hemodialysis patients. It has no adverse effects, is practical and cost-effective. It is suggested to be used along with routine treatment of RLS in hemodialysis patients.

  20. No significant effect of angiotensin II receptor blockade on intermediate cardiovascular end points in hemodialysis patients

    DEFF Research Database (Denmark)

    Peters, Christian D; Kjaergaard, Krista D; Jensen, Jens D;

    2014-01-01

    Agents blocking the renin-angiotensin-aldosterone system are frequently used in patients with end-stage renal disease, but whether they exert beneficial cardiovascular effects is unclear. Here the long-term effects of the angiotensin II receptor blocker, irbesartan, were studied in hemodialysis...... the study period significantly correlated with changes in both left ventricular mass and arterial stiffness. Thus, significant effects of irbesartan on intermediate cardiovascular end points beyond blood pressure reduction were absent in hemodialysis patients....

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

    DEFF Research Database (Denmark)

    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.......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....

  2. Effect of Two Different Iron Supplementation on the Quality of Life of Uremic Hemodialysis Patients

    Institute of Scientific and Technical Information of China (English)

    刘雪梅; 刘子栋; 朱忠华; 邓安国

    2004-01-01

    UREMIC RENAL FAILURE is a common chronicdisease. Hemodialysis therapy has increased thelifespan of uremic patients significantly. Patientquality of life (QL), however, is also an importantindicator of the effectiveness of the medical carethat patients receive and therapies that prolonglifespan may actually compromise quality of life.1In recent years, intravenous iron has been studiedas an adjunctive therapy for anemia in hemodialysispatients. Based on protocols published previously,we selected hemodialysis ...

  3. Association of conjunctival and corneal calcification with vascular calcification among hepatitis-C-seropositive hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Khaled AbouSeif

    2016-01-01

    Full Text Available Disorders associated with the hepatitis C virus (HCV have been reported including cardiovascular, metabolic, and central nervous system diseases. Since chronic HCV infections may be curable, their identification as causal contributors to cardiovascular risk could offer new perspectives in the prevention of cardiovascular disease. The aim of this study is to investigate the association between HCV and aortic arch calcification (AAC and corneal and conjunctival calcification (CCC in maintenance hemodialysis (MHD patients; further, we assessed the correlation of CCC with vascular calcification. A total of 100 patients undergoing hemodialysis (HD in our hospital were included in this study. Patients underwent a complete ocular examination including intraocular pressure, and CCC was looked for by slit lamp and fundoscopy. CCC was graded according to modified Porter and Crombie classification system described by Tokuyama et al. Helical computerized tomographic chest examination was used to evaluate the grading of AAC. Demographic, hematological, biochemical, and dialysis-related data were obtained. There was significant difference between seropositive (n = 51 and seronegative patients (n = 49 regarding grading of AAC and CCC (P <0.001. Significant positive correlation was found between grading of CCC, AAC, age (P <0.001, duration on HD (P <0.001, HCV-antibody positivity (P <0.001, serum calcium level (P <0.001, serum phosphorus level (P <0.001, calcium × phosphorus product (P <0.001, and i-parathormone level (P < 0.001. In addition, CCC grading positively correlated with AAC. Our results suggest that patients undergoing HD infected with the HCV have high degree of CCC, AAC, and mineral metabolism disorder. The strong correlation between CCC and AAC indicates that CCC evaluation is an easy, fast, non-invasive method, and might be used as an indirect indicator to detect vascular calcification in patients undergoing MHD.

  4. Clinical correlates and treatment of bone/joint pain and difficulty with sexual arousal in patients on maintenance hemodialysis.

    Science.gov (United States)

    Carreon, Myra; Fried, Linda F; Palevsky, Paul M; Kimmel, Paul L; Arnold, Robert M; Weisbord, Steven D

    2008-04-01

    Bone/joint pain and difficulty with sexual arousal are prevalent, frequently severe, and potentially treatable in patients on maintenance hemodialysis. However, the mediators and adequacy of treatment for these symptoms have been less well studied. We sought to assess the clinical correlates and treatment of these symptoms in patients receiving chronic hemodialysis. Using the Dialysis Symptom Index, we assessed the presence and severity of bone/joint pain and difficulty with sexual arousal in 75 patients on chronic hemodialysis. Associations of demographic and clinical variables with these 2 symptoms were assessed. We also recorded the use of analgesics for bone/joint pain and, among men, phosphodiesterase-5 inhibitors for difficulty with sexual arousal. Twenty-eight patients (37%) reported bone/joint pain, of whom 20 (71%) described it as moderate to severe. Nineteen of 50 male patients (38%) reported difficulty with sexual arousal, which was described as moderate to severe by 15 (79%). Patients' demographic and clinical characteristics were not correlated with bone/joint pain. Among men, there were no correlations between patients' demographic and clinical characteristics and difficulty with sexual arousal. Only 48% of patients with bone/joint pain were receiving analgesics, while 21% of men who described difficulty with sexual arousal were receiving phosphodiesterase-5 inhibitors. Demographic, clinical, and dialysis-related variables are poorly correlated with bone/joint pain and difficulty with sexual arousal. However, these symptoms are prevalent and under-treated, which should spur efforts to assess the impact of improving provider assessment and treatment of these symptoms on patient outcomes, including health-related quality of life.

  5. Cortical porosity not superior to conventional densitometry in identifying hemodialysis patients with fragility fracture

    Science.gov (United States)

    Patsch, Janina M.; Fischer, Lukas; Bojic, Marija; Winnicki, Wolfgang; Weber, Michael; Cejka, Daniel

    2017-01-01

    Hemodialysis (HD) patients face increased fracture risk, which is further associated with elevated risk of hospitalization and mortality. High-resolution peripheral computed tomography (HR-pQCT) has advanced our understanding of bone disease in chronic kidney disease by characterizing distinct changes in both the cortical and trabecular compartments. Increased cortical porosity (Ct.Po) has been shown to be associated with fracture in patients with osteopenia or in postmenopausal diabetic women. We tested whether the degree of Ct.Po identifies hemodialysis patients with prevalent fragility fractures in comparison to bone mineral density (BMD) assessed by dual X-ray absorptiometry (DXA). We performed a post-hoc analysis of a cross-sectional study in 76 prevalent hemodialysis patients. Markers of mineral metabolism, coronary calcification score, DXA-, and HR-pQCT-data were analyzed, and Ct.Po determined at radius and tibia. Ct.Po was significantly higher in patients with fracture but association was lost after adjusting for age and gender (tibia p = 0.228, radius p = 0.5). Instead, femoral (F) BMD neck area (p = 0.03), F T-score neck area (p = 0.03), radius (R) BMD (p = 0.03), R T-score (p = 0.03), and cortical HR-pQCT indices such as cortical area (Ct.Ar) (tibia: p = 0.01; radius: p = 0.02) and cortical thickness (Ct.Th) (tibia: p = 0.03; radius: p = 0.02) correctly classified patients with fragility fractures. Area under receiver operating characteristic curves (AUC) for Ct.Po (tibia AUC: 0.711; p = 0.01; radius AUC: 0.666; p = 0.04), Ct.Ar (tibia AUC: 0.832; p<0.001; radius AUC: 0.796; p<0.001), and F neck BMD (AUC: 0.758; p = 0.002) did not differ significantly among each other. In conclusion, measuring Ct.Po is not superior to BMD determined by DXA for identification of HD patients with fragility fracture. PMID:28199411

  6. Association of CKD-MBD Markers with All-Cause Mortality in Prevalent Hemodialysis Patients: A Cohort Study in Beijing

    Science.gov (United States)

    Li, Duo; Zhang, Ling; Zuo, Li; Jin, Cheng Gang; Li, Wen Ge; Chen, Jin-Bor

    2017-01-01

    The relationships between all-cause mortality and serum intact parathyroid hormone (iPTH), calcium, and phosphate are fairly diverse in patients on maintenance hemodialysis according to prior studies. This study evaluated the association of chronic kidney disease-mineral and bone disorder (CKD-MBD) markers with all-cause mortality in prevalent hemodialysis patients from 2007 to 2012 in Beijing, China. A cohort, involving 8530 prevalent hemodialysis patients who had undergone a 6–70 months follow-up program (with median as 40 months) was formed. Related data was recorded from the database in 120 hemodialysis centers of Beijing Health Bureau (2007 to 2012). Information regarding baseline demographics, blood CKD-MBD markers and all-cause mortality was retrospectively reviewed. By using multivariate Cox regression model analysis, patients with a low iPTH level at baseline were found to have greater risk of mortality (<75pg/ml, HR = 1.36, 95% confidence interval (CI) 1.16–1.60) than those with a baseline iPTH level within 150–300 pg/ml. Similarly, death risk showed an increase when the baseline serum calcium presented a low level (<2.1mmol/L, HR = 1.54; 95% CI 1.37–1.74). Levels of baseline serum phosphorus were not associated with the risk of death. Similar results appeared through the baseline competing risks regression analysis. Patients with a lower level of serum iPTH or calcium are at a higher risk of all-cause mortality compared with those within the range recommended by Kidney Disease Outcome Quality Initiative (KDOQI) guidelines. PMID:28045985

  7. Removal of Dolutegravir by Hemodialysis in HIV-Infected Patients with End-Stage Renal Disease.

    Science.gov (United States)

    Moltó, José; Graterol, Fredzzia; Miranda, Cristina; Khoo, Saye; Bancu, Ioana; Amara, Alieu; Bonjoch, Anna; Clotet, Bonaventura

    2016-04-01

    Data on dolutegravir removal by hemodialysis are lacking. To study this, we measured dolutegravir plasma concentrations in samples of blood entering and leaving the dialyzer and of the resulting dialysate from 5 HIV-infected patients with end-stage renal disease. The median dolutegravir hemodialysis extraction ratio was 7%. The dolutegravir concentrations after the dialysis session remained far above the protein-binding-adjusted inhibitory concentration. Our results show minimal dolutegravir removal by hemodialysis, with no specific dolutegravir dosage adjustments required in this setting. (This study is registered at ClinicalTrials.gov under registration number NCT02487706.).

  8. The Effect of Two Educational Methods on Knowledge and Adherence to Treatment in Hemodialysis Patients: Clinical Trial

    Directory of Open Access Journals (Sweden)

    Kobra Parvan

    2015-03-01

    Full Text Available Introduction: Patients with chronic renal disease (CRD deal with many potential problems with hemodialysis for all their life. Regarding the importance of preventing dialysis adverse effects, which are in close connection with lack of knowledge and report on how to train the patients? This study aims at comparing the impact of two methods of face to face training and training pamphlet on complying and informing of hemodialysis treatments. Methods: This clinical trial study was conducted on 58 hemodialysis patients who visited Shahid Rahnemun Teaching hospital, Yazd, Iran, and had required conditions of the research. Data were collected through a questionnaire including personal-social information, several questions to assess the level of compliance and to inform the treatment method. The quantitative analysis of this study used the Statistical Package for Social Sciences SPSS version 13 and descriptive (frequency, mean, standard deviation and inferential (Chi-square, paired t-test, ANOVA, ANCOVA statistics were employed. Results: The mean scores for informing both groups (face to face and training pamphlet were significantly increased. The mean score for adherence to treatments was also significant.Conclusion: In this research, face to face training was found to be more effective than training pamphlet. It seemed to have more strong effect on increasing the level of information and adherence to treatment. To train these people, face to face training should be, thus, preferred.

  9. Serum anti-hepatitis B surface antigen in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Rafieian-Kopaei Mahmoud

    2012-01-01

    Full Text Available To evaluate the immune response to hepatitis B vaccination in stable hemodialysis (HD patients, a retro-prospective investigation was conducted on 68 HD patients. Participants were vaccinated against hepatitis B virus with an intramuscular hepatitis B vaccination schedule, 40 micrograms at 0, 1, and 6 months. The serum antibody level against hepatitis B surface antigen (HBs in HD patients was 35±55. In this study, no significant differences of Anti-HBs antibody between diabetic and non-diabetics or male and female subjects were observed. There were not any significant correlation between antibody against HBs-Ag and serum albumin. There was not significant correlation between anti-HBs antibody and age, proportion of HD, duration of HD or dialysis efficacy. In this study, there was not significant correlation between serum antibody level against hepatitis B surface antigen and some demographic indices of HD patients, however, these findings need to re-test in other centers with more participants.

  10. Warfarin use in hemodialysis patients: what is the risk?

    LENUS (Irish Health Repository)

    Phelan, P J

    2011-03-01

    Background: There is a paucity of data concerning the risks associated with warfarin in hemodialysis (HD) patients. We compared major bleeding episodes in this group with HD patients not receiving warfarin and with a cohort of non-HD patients receiving warfarin. Methods: A retrospective review of 141 HD patients on warfarin (HDW), 704 HD patients not on warfarin (HDNW) and 3,266 non-dialysis warfarin patients (NDW) was performed. Hospital admissions for hemorrhagic events and ischemic strokes were examined as was hospital length of stay and blood product use. INR variability was also assessed. Results: The incidence rates for major hemorrhage per 100 patient years was 10.8 in the HDW group as compared to 8.0 in the HDNW (p = 0.593) and 2.1 in the NDW (p < 0.001) groups. Mean units of red blood cell transfusions required was higher in patients on dialysis with no significant difference between HDW and HDNW groups. The risk of ischemic stroke per 100 patient years was 1.7 in the HDW group as compared to 0.7 in the HDNW groups (p = 0.636) and 0.4 in the NDW (p = 0.003). The HDW group had higher inter-measurement INR variability compared to the NDW group (p = 0.034). In patients with atrial fibrillation, HDW group had a higher incidence of ischemic stroke than the NDW group (2.2 versus 0.4 events per 100 patient years; p = 0.024). Conclusions: This study confirms the higher bleeding risk associated with HD\\/ESRD but suggests that warfarin use in these patients may not add significantly to this risk. We also demonstrated high rates of ischemic stroke in HD patients despite warfarin use. Summary: Our study compares the frequency of major hemorrhage and secondarily, ischemic stroke in HD patients receiving or not receiving warfarin, with non-HD patients receiving warfarin. The major finding was that frequency of hemorrhage was higher in HD patients receiving warfarin than in non-HD patients receiving warfarin, but not different in HD patients with or without warfarin. A

  11. Warfarin use in hemodialysis patients: what is the risk?

    LENUS (Irish Health Repository)

    Phelan, P J

    2012-02-01

    BACKGROUND: There is a paucity of data concerning the risks associated with warfarin in hemodialysis (HD) patients. We compared major bleeding episodes in this group with HD patients not receiving warfarin and with a cohort of non-HD patients receiving warfarin. METHODS: A retrospective review of 141 HD patients on warfarin (HDW), 704 HD patients not on warfarin (HDNW) and 3,266 non-dialysis warfarin patients (NDW) was performed. Hospital admissions for hemorrhagic events and ischemic strokes were examined as was hospital length of stay and blood product use. INR variability was also assessed. RESULTS: The incidence rates for major hemorrhage per 100 patient years was 10.8 in the HDW group as compared to 8.0 in the HDNW (p = 0.593) and 2.1 in the NDW (p < 0.001) groups. Mean units of red blood cell transfusions required was higher in patients on dialysis with no significant difference between HDW and HDNW groups. The risk of ischemic stroke per 100 patient years was 1.7 in the HDW group as compared to 0.7 in the HDNW groups (p = 0.636) and 0.4 in the NDW (p = 0.003). The HDW group had higher inter-measurement INR variability compared to the NDW group (p = 0.034). In patients with atrial fibrillation, HDW group had a higher incidence of ischemic stroke than the NDW group (2.2 versus 0.4 events per 100 patient years; p = 0.024). CONCLUSIONS: This study confirms the higher bleeding risk associated with HD\\/ESRD but suggests that warfarin use in these patients may not add significantly to this risk. We also demonstrated high rates of ischemic stroke in HD patients despite warfarin use. SUMMARY: Our study compares the frequency of major hemorrhage and secondarily, ischemic stroke in HD patients receiving or not receiving warfarin, with non-HD patients receiving warfarin. The major finding was that frequency of hemorrhage was higher in HD patients receiving warfarin than in non-HD patients receiving warfarin, but not different in HD patients with or without warfarin. A

  12. Hemoglobin Variability Does Not Predict Mortality in European Hemodialysis Patients

    Science.gov (United States)

    Kim, Joseph; Kronenberg, Florian; Aljama, Pedro; Anker, Stefan D.; Canaud, Bernard; Molemans, Bart; Stenvinkel, Peter; Schernthaner, Guntram; Ireland, Elizabeth; Fouqueray, Bruno; Macdougall, Iain C.

    2010-01-01

    Patients with CKD exhibit significant within-patient hemoglobin (Hb) level variability, especially with the use of erythropoiesis stimulating agents (ESAs) and iron. Analyses of dialysis cohorts in the United States produced conflicting results regarding the association of Hb variability with patient outcomes. Here, we determined Hb variability in 5037 European hemodialysis (HD) patients treated over 2 years to identify predictors of high variability and to evaluate its association with all-cause and cardiovascular disease (CVD) mortality. We assessed Hb variability with various methods using SD, residual SD, time-in-target (11.0 to 12.5 g/dl), fluctuation across thresholds, and area under the curve (AUC). Hb variability was significantly greater among incident patients than prevalent patients. Compared with previously described cohorts in the United States, residual SD was similar but fluctuations above target were less frequent. Using logistic regression, age, body mass index, CVD history, dialysis vintage, serum albumin, Hb, angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) use, ESA use, dialysis access type, dialysis access change, and hospitalizations were significant predictors of high variability. Multivariable adjusted Cox regression showed that SD, residual SD, time-in-target, and AUC did not predict all-cause or CVD mortality during a median follow-up of 12.4 months (IQR: 7.7 to 17.4). However, patients with consistently low levels of Hb (<11 g/dl) and those who fluctuated between the target range and <11 g/dl had increased risks for death (RR 2.34; 95% CI: 1.24 to 4.41 and RR 1.74; 95% CI: 1.00 to 3.04, respectively). In conclusion, although Hb variability is common in European HD patients, it does not independently predict mortality. PMID:20798262

  13. Outcomes of arteriovenous fistula for hemodialysis in Sudanese patients: Single-center experience

    Directory of Open Access Journals (Sweden)

    Gamal Mustafa Ahmed

    2012-01-01

    Full Text Available A well-functioning arteriovenous fistula (AVF is essential for the maintenance of hemodialysis (HD in patients with chronic renal failure. Our aim is to review our experience of creating AVF and to asses its success rate and common complication. A prospective, hospital-based study was conducted on 73 patients (48 males and 25 females on chronic HD in Gezira Hospital for Renal Diseases and Surgery, from January to July 2007. Their mean age was 43.9 years (range from 18 to 72 years. Seventy-one (97.3% of the study subjects had been dialyzed before creation of the AVF, 67 (91.8% of them having undergone HD with temporary access. All patients (n=73 had a native AVF as the permanent vascular access (VA. A primary radiocephalic AVF was created in 78.1% of the patients, cubital fossa in 20.5% and one case had left snuff box AVF (1.4%. Percentage of AVF maturation was reported in 67.1% of the cases within the first six weeks and in 9.6% of the cases AVF never matured. Failure of AVF function occurred in 26% of the cases, due to thrombosis in 20.5% (n=15 and aneurysm in 5.5% of the cases. We conclude that an optimum outcome is likely when there is a multidisciplinary team approach, and early referral to vascular surgery is paramount.

  14. Coping strategies and socio-demographic characteristics among Jordanian caregivers of patients receiving hemodialysis

    Directory of Open Access Journals (Sweden)

    Eman Alnazly

    2016-01-01

    Full Text Available Individuals who care for family members receiving chronic hemodialysis (HD are likely to experience burdens that may adversely impact their patients. Effective coping strategies are shaped by various factors, including sociodemographic characteristics. To assess the relationship between caregivers and their patients, we studied 225 family-member caregivers of chronic HD patients through answering the Ways of Coping Questionnaire-Revised. Sociodemographic data, including caregiver age, gender, educational level, relationship to the patients, length of care time and weekly hours of caregiving were analyzed using the t-test, analysis of variance and least-significant difference post hoc test. Of the eight coping strategies investigated, seven were significantly related to at least one of the analyzed sociodemographic variables; these were confrontive coping, distancing, self-controlling, seeking social support, accepting responsibility, planful problem solving and positive reappraisal. The findings of the present study may be useful for administering dialysis by nurses for identifying coping strategies among caregivers and for establishing plans of care that would promote coping strategies in relation to the caregiver′s sociodemographic characteristics.

  15. Development and validation of a theory-based multimedia application for educating Persian patients on hemodialysis.

    Science.gov (United States)

    Feizalahzadeh, Hossein; Tafreshi, Mansoureh Zagheri; Moghaddasi, Hamid; Farahani, Mansoureh A; Khosrovshahi, Hamid Tayebi; Zareh, Zahra; Mortazavi, Fakhrsadat

    2014-05-01

    Although patients on hemodialysis require effective education for self-care, several issues associated with the process raise barriers that make learning difficult. Computer-based education can reduce these problems and improve the quality of education. This study aims to develop and validate a theory-based multimedia application to educate Persian patients on hemodialysis. The study consisted of five phases: (1) content development, (2) prototype development 1, (3) evaluation by users, (4) evaluation by a multidisciplinary group of experts, and (5) prototype development 2. Data were collected through interviews and literature review with open-ended questions and two survey forms that consisted of a five-level scale. In the Results section, patient needs on hemodialysis self-care and related content were categorized into seven sections, including kidney function and failure, hemodialysis, vascular access, nutrition, medication, physical activity, and living with hemodialysis. The application designed includes seven modules consisting of user-controlled small multimedia units. During navigation through this application, the users were provided step-by-step information on self-care. Favorable scores were obtained from evaluations by users and experts. The researchers concluded that this application can facilitate hemodialysis education and learning process for the patients by focusing on their self-care needs using the multimedia design principles.

  16. Thrombosis of the great cerebral vein in a hemodialysis patient.

    Science.gov (United States)

    Ratkovic, Marina; Basic-Jukic, Nikolina; Gledovic, Branka; Radunovic, Danilo

    2014-01-01

    Cerebral venous thrombosis is a rare condition with various clinical presentations which may delay diagnosis. It is frequently associated with severe consequences. We present the first documented case of thrombosis of the great cerebral vein in a hemodialysis patient. A 29-year-old female patient with end-stage renal disease of unknown etiology was admitted to a hospital with altered consciousness and nausea. Severe headache in the right parietal area had started 2 days before. On examination, she was in the poor overall condition, dysartric, with a severe nystagmus. Urgent brain multislice computerized tomography and magnetic resonance imaging revealed thrombosis of the great cerebral vein with hypodense zones in hypothalamus, thalamus and basal ganglia. She was treated with heparin bolus of 25000 IU with a favorable outcome. Detailed examination demonstrated increased lupus anticoagulant (LA) 1 and LA2 and increased LA1/LA2. Control magnetic resonance imaging performed 1 year later revealed multiple vascular lesions within the brain. Acetylsalicylate was introduced in therapy. Thrombosis of the cerebral veins should be suspected in patients with end-stage renal disease, altered neurological status and signs of increased intracranial pressure.

  17. New Options for Iron Supplementation in Maintenance Hemodialysis Patients.

    Science.gov (United States)

    Vaziri, Nosratola D; Kalantar-Zadeh, Kamyar; Wish, Jay B

    2016-03-01

    End-stage renal disease results in anemia caused by shortened erythrocyte survival, erythropoietin deficiency, hepcidin-mediated impairment of intestinal absorption and iron release, recurrent blood loss, and impaired responsiveness to erythropoiesis-stimulating agents (ESAs). Iron malabsorption renders oral iron products generally ineffective, and intravenous (IV) iron supplementation is required in most patients receiving maintenance hemodialysis (HD). IV iron is administered at doses far exceeding normal intestinal iron absorption. Moreover, by bypassing physiologic safeguards, indiscriminate use of IV iron overwhelms transferrin, imposing stress on the reticuloendothelial system that can have long-term adverse consequences. Unlike conventional oral iron preparations, ferric citrate has recently been shown to be effective in increasing serum ferritin, hemoglobin, and transferrin saturation values while significantly reducing IV iron and ESA requirements in patients treated with HD. Ferric pyrophosphate citrate is a novel iron salt delivered by dialysate; by directly reaching transferrin, its obviates the need for storing administered iron and increases transferrin saturation without increasing serum ferritin levels. Ferric pyrophosphate citrate trials have demonstrated effective iron delivery and stable hemoglobin levels with significant reductions in ESA and IV iron requirements. To date, the long-term safety of using these routes of iron administration in patients receiving HD has not been compared to IV iron and therefore awaits future investigations.

  18. Nutritional assessment and its correlation with anthropometric measurements in hemodialysis patients.

    Science.gov (United States)

    Koor, Behrooz Ebrahimzadeh; Nakhaie, Mohammad Reza; Babaie, Saied

    2015-01-01

    One of the most important problems in patients on hemodialysis (HD) is chronic malnutrition. This study is aimed to assess the prevalence of malnutrition using a subjective global assessment (SGA) in HD patients referred to the Valie ASR Hospital, Arak, Iran. In this descriptive analysis study, 190 HD patients were selected with random sampling. SGA and anthropometric and biochemical measurements were assessed in all patients. Data were analyzed with the Chi-square and t-tests and Pearson correlation coefficient. P correlation of SGA score with patient's weight (r = -0.147) and patient's body mass index (BMI) (r = -0.238). Also, it correlated significantly with duration of dialysis treatment (years) (r = 0.404). The SGA score showed a significant negative correlation with mid-arm circumference (MAC) (r = - 0.152). No significant correlation was found between SGA score and mid-arm muscle area. Our study showed that >50% of patients on maintenance HD had mild or moderate malnutrition. There was no case of severe malnutrition. Duration of dialysis treatment and some anthropometric indices (weight, BMI and MAC) also showed a significant correlation with SGA score, which are important to determine the nutritional status of HD patients.

  19. Improvement of autonomic neuropathy after mecobalamin treatment in uremic patients on hemodialysis.

    Science.gov (United States)

    Taniguchi, H; Ejiri, K; Baba, S

    1987-01-01

    The effect of mecobalamin on autonomic neuropathy was evaluated in 20 hemodialyzed uremic patients; their mean age was 53 years and the duration of hemodialysis was 6.5 years; 14 were women. The cardiac beat-to-beat variation (BBV) was used as the measure of autonomic neuropathy. Twelve patients with normal BBV test results were either given 1,500 micrograms of mecobalamin daily for three months (six patients) or were untreated (six patients). The BBV test results did not change significantly over the three months in either the treated or untreated group, nor were there any significant between-group differences. Eight patients with abnormal results on the BBV test were given 1,500 micrograms of mecobalamin daily for six months. The mean BBV values increased significantly from 3.3 beats/min before treatment to 5.8 beats/min at six months (P less than 0.005); five of these patients (including three of the four patients with diabetes) showed normal BBV values by three months. It is concluded that mecobalamin can be used in the treatment of autonomic and peripheral neuropathy in both diabetic and nondiabetic patients with chronic renal failure.

  20. Optimal blood pressure level and best measurement procedure in hemodialysis patients

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    Annie Saint-Remy

    2005-10-01

    Full Text Available Annie Saint-Remy, Jean-Marie KrzesinskiNephrology-Hypertension/Dialysis Unit, University Hospital of Liège, Liège, BelgiumAbstract: Hypertension occurs frequently among hemodialysis (HD patients and can be due to many factors, such as salt intake, elevated sympathetic tone, and uremic toxins. It is responsible for the high cardiovascular risk associated with renal disease. Generally, in HD patients, while there is an elevation of systolic blood pressure (BP, diastolic BP seems to decrease, and the resultant effect is high pulse pressure, which can have a deleterious effect on the cardiovascular system. Although controversial, in the HD population the relationship between BP and risk of death seems to be U shaped, probably because of pre-existing cardiac disease in patients with the lowest BP. In chronic kidney disease, BP lower than 130/80 mmHg is recommended, but an appropriate target for BP in the HD population remains to be established. Moreover, there is no consensus regarding which routine peridialysis BP (pre- or post-dialysis BP, or both can ensure the diagnosis of hypertension in this population. Ambulatory BP monitoring remains the gold standard to quantify the integrated BP load applied to the cardiovascular system. As well, home BP assessment could contribute to improve the definition of an optimal BP in the HD population. An ideal goal for post-dialysis systolic BP seems to be a value higher than 110 mmHg and lower than 150 mmHg. However, HD patients are generally old and often have cardiac complications, so a reasonable pre-dialysis target systolic BP could be 150 mmHg. It is prudent to suggest that an improvement in BP control is necessary in the HD population, first by slow and smooth removal of extracellular volume (dry weight and thereafter by the use of appropriate antihypertensive medication.Keywords: hemodialysis, hypertension, blood pressure measurement, peridialysis blood pressure, blood pressure control

  1. Kinetic studies of atherogenic lipoproteins in hemodialysis patients: do they tell us more about their pathology?

    Science.gov (United States)

    Kronenberg, Florian; Ikewaki, Katsunori; Schaefer, Juergen R; König, Paul; Dieplinger, Hans

    2007-01-01

    Patients with chronic kidney disease have one of the highest risks for atherosclerotic complications. Several large epidemiological studies described an opposite association of total and low density lipoprotein (LDL) cholesterol with cardiovascular complications and total mortality compared to the general population, a circumstance often called "reverse epidemiology." Many factors might contribute to this reversal such as interaction with malnutrition/inflammation, pronounced fluctuations of atherogenic lipoproteins during the course of renal disease, heterogeneity of lipoprotein particles with preponderance of remnant particles, and chemical modification of lipoproteins caused by the uremic environment. A vicious cycle has been suggested in uremia in which the decreased catabolism of atherogenic lipoproteins such as LDL, IDL and Lp(a) leads to their increased plasma residence time and further modification of these lipoproteins by oxidation, carbamylation, and glycation. Using stable isotope techniques, it has been shown recently that the plasma residence time of these particles is more than twice as long in hemodialysis patients as in nonuremic subjects. This reduced catabolism, however, is masked by the decreased production of LDL, resulting in near-normal plasma levels of LDL. The production rate of Lp(a) in hemodialysis patients is similar to that in controls which together with the doubled residence time results in elevated Lp(a) levels. An increased clearance of these altered lipoproteins via the scavenger receptors of macrophages leads to the transformation of macrophages into foam cells in the vascular wall and might contribute to the pronounced risk for cardiovascular complications of these patients. These observations suggest that the real danger of these particles is not reflected by the measured concentrations but by their metabolic qualities.

  2. Depression and quality of sleep in maintenance hemodialysis patients

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    Trbojević-Stanković Jasna

    2014-01-01

    Full Text Available Introduction. Sleep disorders and psychological disturbances are common in end-stage renal disease (ESRD patients. However, despite their frequency and importance, such conditions often go unnoticed, since all patients do not clearly manifest fully expressed symptoms. Objective. This study aimed to determine the prevalence of depression and poor sleep quality and to examine the association between these disorders and demographic, clinical and treatment-related characteristics of ESRD patients on hemodialysis (HD. Methods. The study included 222 patients (132 men and 90 women, mean age 57.3±11.9 years, from 3 HD centers in Central Serbia, which provided us with biochemical parameters and demographic data. Sleep quality and depression were assessed using the Pittsburgh Sleep Quality Index (PSQI and Beck Depression Inventory (BDI, respectively. Results. The average BDI was 16.1±11.3. Depressed patients were significantly older (p=0.041, had a significantly lower dialysis adequacy (p=0.027 and a significantly worse quality of sleep (p<0.001, while they did not show significant difference as regarding sex, employment, marital status, comorbidities, dialysis type, dialysis vintage, shift and laboratory parameters. The average PSQI was 7.8±4.5 and 64.2% of patients were poor sleepers. Poor sleepers were significantly older (p=0.002, they were more often females (p=0.027 and had a significantly higher BDI (p<0.001, while other investigated variables were not correlated with sleep quality. A statistically significant positive correlation was found between BDI and PSQI (r=0.604; p<0.001. Conclusion. Depression and poor sleep quality are frequent and interrelated among HD patients.

  3. Clinical consequences of infected arteriovenous grafts in hemodialysis patients.

    Science.gov (United States)

    Minga, T E; Flanagan, K H; Allon, M

    2001-11-01

    Arteriovenous (AV) graft infection is a serious adverse event in hemodialysis patients; however, there is little published literature describing its consequences. We identified prospectively all AV graft infections occurring at our institution during a 4.5-year period. We analyzed immediate complications, as well as long-term consequences, including the need for subsequent vascular-access procedures and duration of catheter-dependent dialysis therapy. Ninety graft infections were identified in 78 patients, yielding a rate of 8.2 infections/100 graft-years. Patients with graft infection were much more likely to have a low serum albumin level (<3.5 g/dL) in the month preceding the infection compared with noninfected controls (73% versus 18%; P < 0.001). Infections occurred within 1 month of graft placement in 15%, at 1 to 12 months in 44%, and longer than 1 year from surgery in 41%. The pathogen was a gram-positive coccus in 97% of cases, particularly Staphylococcus aureus (60%) and Staphylococcus epidermidis (22%). The initial graft infection entailed hospitalization for a mean of 7.5 days. Eleven patients (12%) developed a total of 17 major complications, including death (5 patients), clinical sepsis requiring vasopressors (4 patients), septic arthritis (3 patients), epidural abscess (1 patient), endocarditis (1 patient), osteomyelitis (1 patient), myocardial infarction (1 patient), and cerebrovascular accident (1 patient). After removal of an infected graft, patients were catheter dependent for a median of 3.8 months. The duration of catheter dependence was less than 3 months in 36%, 3 to 6 months in 38%, 6 to 12 months in 14%, and greater than 1 year in 12%. During the period of catheter dependence, patients required a mean of 9.7 access procedures, including graft removal (1.0 procedure), nontunneled dialysis catheters (4.4 procedures), tunneled dialysis catheters (3.0 procedures), and new permanent accesses (1.4 procedures). In addition, patients averaged 0

  4. Prevalence of Parasitic Infections in Iranian Stable Hemodialysis Patients

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    Shiva SEYRAFIAN

    2011-09-01

    Full Text Available Background: Hemodialysis (HD patients are prone to infections as a result of impaired immune system. Early detection of disease helps to prevent complications. The aim of this study was to evaluate the prevalence of intestinal parasite infections in HD patients and compare it with control groups. Methods: In a cross sectional study, the stool sample of 155 HD patients, and 294 controls were examined for parasitic contaminations. Control groups included: 130 patients’ family, 16 staffs of three HD wards and 148 normal populations. 3 stool samples were taken from each participant. After perceiving the appearance of the samples and preceding the stages of concentration with Formaline-ether method, direct smear were prepared and inspected by trichrome staining. Then, groups were compared with SPSS version12 by chi-square and T-test methods. Results: 43.9% of 155 HD patients were infected by intestinal parasites. There was 40% parasite infection in non diabetic and 45% in diabetic case groups with no significant difference between the 2 groups (P>0.05. There was no relation between parasite infection with sex, HD duration and use of immunosuppressive drugs. 43.1% of control group was also infected. No significant difference was seen between the 2 groups (P>0.05.The most common parasite was Blastocystis hominis in the 2 groups. Conclusion: This study could not show increased parasite infection in HD patients compared to control groups. The high prevalence of intestinal parasites in HD patients and control groups, may indicate that population hygiene status is not well controlled, and emphasizes more health care providers’ attention.

  5. Effect of dialysate temperature on hemodynamic stability among hemodialysis patients

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    Azar Ahmad

    2009-01-01

    Full Text Available Cooling the dialysate below 36.5°C is an important factor that contributes to hemody-namic stability in patients during hemodialysis (HD. In this study, the effect of dialysate tempe-rature on hemodynamic stability, patients′ perception of dialysis discomfort and post dialysis fatigue were assessed in a group of patients on HD. A total of 50 patients, all of whom were on 3-times-per-week dialysis regimen, were studied. Patients were assessed during six dialysis sessions; in three sessions, the dialysate temperature was normal (37°C and in three other sessions, the dialysate tem-perature was low (35°C. Specific scale questionnaires were used in each dialysis session, to evaluate the symptoms during the dialysis procedure as well as post-dialysis fatigue, and respective scores were noted. The results showed that usage of low dialysate temperature was associated with the fol-lowing: higher post dialysis systolic blood pressure (P< 0.05 and lower post dialysis heart rate (P< 0.01, with similar ultrafiltration rates, better intra-dialysis symptoms score and post-dialysis fatigue scores (P< 0.001, and P < 0.001, respectively, shorter post-dialysis fatigue period (P< 0.001 as well as higher urea removal (P< 00001 and Kt/V (P< 0.0001. Patients′ perceptions were measured by a questionnaire, which showed that 76% of them felt more energetic after dialysis with cool dialysate and requested to be always dialyzed with cool dialysate. Low temperature dialysate is particularly beneficial for highly symptomatic patients, improves tolerance to dialysis in hypotensive patients and helps increase ultrafiltration while maintaining hemodynamic stability during and after dialysis.

  6. Quality of life in patients with chronic renal failure

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    Petrović Lada

    2006-01-01

    Full Text Available Introduction. Hemodialysis and transplantation are performed not only to replace renal function, but also to improve patients' quality of life. The aim of our investigation was to compare the quality of life in patients with chronic renal failure (CRF before and after the introduction of active therapy. Material and methods. We tested 76 patients (pts: 20 pts on conservative therapy (CT, 21 pts on chronic hemodialysis and 35 pts with renal transplantation. A questionnaire (combining two questionnaires was used to investigate the physical, emotional and social aspects of health. Results. In regard to physical health of transplantation patients (TP it was established that work capacity and activities were less damaged, whereas physical activity was highest in pts on CT. Social activity was limited in a higher percentage in TP (40% than in hemodialysis patients (HD (19%, while family relationships were most damaged in pts on HD (28.57%. Discomforts were most common in pts on HD. The highest percentage of pts estimated their health status as good or average, but their health status improved after transplantation in 82.86% that is in 57.14% after HD. It was similar with the quality of life: 28.57% of kidney transplant patients rated their quality of life as very good, and 54.28% rated it as good; 38.09% of HD patients rated their quality of life as very good, whereas only 5% of CT patients rated it as very good, and 20% as good. .

  7. Longitudinal study of serum zinc and copper levels in hemodialysis patients and their relation to biochemical markers.

    Science.gov (United States)

    Navarro-Alarcon, M; Reyes-Pérez, A; Lopez-Garcia, H; Palomares-Bayo, M; Olalla-Herrera, M; Lopez-Martinez, M C

    2006-12-01

    A 6-mo longitudinal study of 48 hemodialysis patients (HPs) with chronic renal failure was performed. Three blood samplings were done. Samples of whole blood from each patient were collected during hemodialysis sessions after passing through the artificial kidney. Zinc and copper levels were measured by atomic absorption spectrometry. Additionally, 36 biochemical indexes were evaluated during the study. Fifty-two healthy matched controls were also considered. Mean serum zinc and copper concentrations in HPs were significantly decreased (Zn) and increased (Cu), when compared with healthy controls (p < 0.01). Zinc concentrations found in the first and second blood samplings from patients were significantly lower than those measured for the third sampling (p < 0.01). The etiology of chronic renal failure influenced the statistically serum Zn levels of patients (p < 0.05). Serum copper levels of HPs were significantly diminished by the existence of secondary associated diseases (p < 0.01). Uric acid and parathyroid hormone, and total-cholesterol and glutamic-pyruvic-transaminase levels were significantly (p < 0.05) and linearly related with serum zinc and copper concentrations, respectively. From all of indexes, creatinine, direct bilirubin, magnesium, calcium, parathyroid hormone, transferrin, and albumin were statistically modified along the longitudinal study (p < 0.05). Transferrin serum levels were significantly diminished in the third blood sampling, indicating the tendency toward anemia in the patients. This result is reinforced by low levels of biochemical and hematological indexes related with iron body staus.

  8. Predictive Factors of One-Year Mortality in a Cohort of Patients Undergoing Urgent-Start Hemodialysis

    Science.gov (United States)

    Magalhães, Luciene P.; dos Reis, Luciene M.; Graciolli, Fabiana G.; Pereira, Benedito J.; de Oliveira, Rodrigo B.; de Souza, Altay A. L.; Moyses, Rosa M.; Elias, Rosilene M.; Jorgetti, Vanda

    2017-01-01

    Background Chronic kidney disease (CKD) affects 10–15% of adult population worldwide. Incident patients on hemodialysis, mainly those on urgent-start dialysis at the emergency room, have a high mortality risk, which may reflect the absence of nephrology care. A lack of data exists regarding the influence of baseline factors on the mortality of these patients. The aim of this study was to evaluate the clinical and laboratory characteristics of this population and identify risk factors that contribute to their mortality. Patients and methods We studied 424 patients who were admitted to our service between 01/2006 and 12/2012 and were followed for 1 year. We analyzed vascular access, risk factors linked to cardiovascular disease (CVD) and mineral and bone disease associated with CKD (CKD-MBD), and clinical events that occurred during the follow-up period. Factors that influenced patient survival were evaluated by Cox regression analysis. Results The patient mean age was 50 ± 18 years, and 58.7% of them were male. Hypertension was the main cause of primary CKD (31.8%). Major risk factors were smoking (19.6%), dyslipidemia (48.8%), and CVD (41%). Upon admission, most patients had no vascular access for hemodialysis (89.4%). Biochemical results showed that most patients were anemic with high C-reactive protein levels, hypocalcemia, hyperphosphatemia, elevated parathyroid hormone and decreased 25-hydroxy vitamin D. At the end of one year, 60 patients died (14.1%). These patients were significantly older, had a lower percentage of arteriovenous fistula in one year, and low levels of 25-hydroxy vitamin D. Conclusions The combined evaluation of clinical and biochemical parameters and risk factors revealed that the mortality in urgent-start dialysis is associated with older age and low levels of vitamin D deficiency. A lack of a permanent hemodialysis access after one year was also a risk factor for mortality in this population. PMID:28045952

  9. Comparison of Toxoplasma gondii seropositivity in hemodialysis and peritoneal dialysis patients

    Institute of Scientific and Technical Information of China (English)

    Faezeh Hamidi; Jalal Etemadi; Nader Ghabouli Mehrabani; Mahmoud Mahami Oskouei; Roza Motavalli; Mohammad RezaArdalan

    2015-01-01

    Objective: To compare the seropositivity of Toxoplasma gondii in a group of peritoneal dialysis patients with hemodialysis patients and a general local population as a control group in Tabriz, Northwest Iran. Methods: A total of 176 individuals were participated in the present study. Among them, 42 were peritoneal dialysis patients, 84 were hemodialysis patients and 50 were healthy volunteers. Anti-Toxoplasma immunoglobulin G and immunoglobulin M serologic study was administered on the collected serums and then the obtained data were analyzed using statistical methods. Results: In the present research, 70.2% of hemodialysis patients, 66.6% of peritoneal dialysis patients and 68% of control group had positive results for anti-Toxoplasma immunoglobulin G antibody. All individuals of the groups had negative serologic results for anti-Toxoplasma immunoglobulin M antibody. There was no significant difference between Toxoplasma gondii seropositivity in hemodialysis patients and peritoneal dialysis patients and general population (P> 0.05). Conclusions: The findings showed that either peritoneal dialysis or hemodialysis doesn’t increase the risk of Toxoplasma seropositivity in our region (Northwest Iran). It could be explained by the fact that the present research is carried out in a high seroprevalent area scale in which the majority of normal population had previous exposure to this parasitical infection.

  10. L-carnitine supplementation and EPO requirement in children on chronic hemodialysis.

    Science.gov (United States)

    Aoun, Bilal; Bérard, Etienne; Vitkevic, Renata; Dehée, Axelle; Bensman, Albert; Ulinski, Tim

    2010-03-01

    L-carnitine supplementation has been the subject of heated discussion in the context of the treatment of pediatric hemodialysis patients. The aim of this study was to analyze the effect of intravenous L-carnitine supplementation on the erythropoetin (EPO) requirement in six pediatric hemodialysis patients. All patients were on intravenous L-carnitine (2.5 g per session for patients >30 kg and 1 g for those carnitine supplementation, the EPO requirement was 1.15 +/- 0.22 (range 0.37-1.75) microg/kg darbepoetin alpha. Free carnitine (FC) levels were measured before (40.4 +/- 4.9 micromol/l), immediately after the 9-month L-carnitine supplementation period (378.5 +/- 77.3 micromol/l), and 4 months after withdrawal of L-carnitine (95.6 +/- 4.0 micromol/l). After 9 months, the EPO dose was 0.47 +/- 0.10 microg/kg (p carnitine supplementation, FC levels were higher and persisted longer than expected. This rise was associated with increased Hb levels and decreased EPO requirement. Since controls were missing for this study, prospective long-term multi-center studies on a large number of patients are required to provide solid answers to the controversial question of L-carnitine supplementation in hemodialyzed children.

  11. Health self-assessment by hemodialysis patients in the Brazilian Unified Health System

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    Tiago Ricardo Moreira

    2016-01-01

    Full Text Available ABSTRACT OBJECTIVE To examine whether the level of complexity of the services structure and sociodemographic and clinical characteristics of patients in hemodialysis are associated with the prevalence of poor health self-assessment. METHODS In this cross-sectional study, we evaluated 1,621 patients with chronic terminal kidney disease on hemodialysis accompanied in 81 dialysis services in the Brazilian Unified Health System in 2007. Sampling was performed by conglomerate in two stages and a structured questionnaire was applied to participants. Multilevel multiple logistic regression was used for data analysis. RESULTS The prevalence of poor health self-assessment was of 54.5%, and in multivariable analysis it was associated with the following variables: increasing age (OR = 1.02; 95%CI 1.01–1.02, separated or divorced marital status (OR = 0.62; 95%CI 0.34–0.88, having 12 years or more of study (OR = 0.51; 95%CI 0.37–0.71, spending more than 60 minutes in commuting between home and the dialysis service (OR = 1.80; 95%CI 1.29–2.51, having three or more self-referred diseases (OR = 2.20; 95%CI 1.33–3.62, and reporting some (OR = 2.17; 95%CI 1.66–2.84 or a lot of (OR = 2.74; 95%CI 2.04–3.68 trouble falling asleep. Individuals in treatment in dialysis services with the highest level of complexity in the structure presented less chance of performing a self-assessment of their health as bad (OR = 0.59; 95%CI 0.42–0.84. CONCLUSIONS We showed poor health self-assessment is associated with age, years of formal education, marital status, home commuting time to the dialysis service, number of self-referred diseases, report of trouble sleeping, and also with the level of complexity of the structure of health services. Acknowledging these factors can contribute to the development of strategies to improve the health of patients in hemodialysis in the Brazilian Unified Health System.

  12. Hepatitis B viral infection in maintenance hemodialysis patients: A three year follow-up

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To observe the prevalence of hepatitis B virus (HBV)infection in maintenance hemodialysis patients.METHODS: Eighty-eight hemodialysis patients who had been receiving hemodialysis regularly for an average of 39.45 ± 7.57 (range from 36 to 49) mo were enrolled in this study. HBV markers were measured in these patients before hemodialysis and in 100 healthy controls by the chemiluminescent microparticle immunoassay(CMI) method in order to compare the incidence of HBV infection in hemodialysis patients versus normal healthy people. All patients were then divided into two groups:patients positive for HBV markers (I.e. Those positive for HBsAg, anti-HBc, HBeAg, anti-Hbe, with or without positive anti-HBs) (n = 33), and patients negative for HBV markers (including those only positive anti-HBs)(n = 55). The following information was obtained for all patients: socio-demographic data, number of blood transfusions and some laboratory investigations. After 39.45± 7.57 mo follow-up, HBV markers were measured in these patients by CMI.RESULTS: The incidence of HBV infection in maintenance hemodialysis patients was 37.5%, which was higher than in controls (9%). In the patients positive for HBV markers, there were 13 patients (39.4%) who had a history of blood transfusion, which was more than the number [12 (21.8%), P = 0.04] of patients negative for HBV markers. Eight of the 88 patients negative for HBV markers turned out to be positive, while three of the 33 patients positive for HBV markers turned out to be negative. There was no cirrhosis of the liver or hepatoma occurring in these patients.CONCLUSION: Maintenance hemodialysis patients have a higher risk of HBV infection than the average population. The number of blood transfusions is associated with an increased prevalence of HBV. While it is hard for hemodialysis patients to eliminate HBV, the prognosis of patients with positive HBV markers is good.

  13. Observation of nutrition supporting treatment's improvement in daily living ability of patients with long-term hemodialysis%营养支持改善长期血液透析患者日常生活活动能力观察

    Institute of Scientific and Technical Information of China (English)

    左巍

    2001-01-01

    @@Background:The body state of patients with long-term hemodialysis must have been decreased,of whom malnutrition are seen commonly,which affects patients' living activity ability and living quality directly,so nutrition supporting is very essential for patients with long-term hemodialysis. Objective:To observe the condition of nutrition supporting's improvement in ability of daily living(ADL) and nutrition condition of patients with long-term hemodialysis. Design:To evaluate ADL and nutrition condition of 30 cases patients with long-term hemodialysis before and after nutrition supporting.ADL Mark is according to reformed index marking graph. Unit:Internal Renal Department of General Hospital of Shenyang Military Region Subject:30 patients suffering from chronic renal failure and accepting long-term hemodialysis,male 13 cases,female 17 cases,average age(50.23± 3.41)years.

  14. Non-cuffed dual lumen catheters in the external jugular veins versus other central veins for hemodialysis patients

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    Moini Majid

    2009-01-01

    Full Text Available To compare prospective between insertion of non-cuffed dual lumen catheter in the external jugular vein and other central veins for hemodialysis (HD, we studied 68 chronic dialysis patients randomly allocated into two groups: one with external jugular vein catheterization as access for HD and another with other central venous catheterization, internal jugular or subclavian vein. Our results showed there were no significant differences regarding successful cannulation, com-plications, total numbers of dialysis, development of pain and infection at the site of cannulation, patency rate of the catheters, and efficacy of hemodialysis between both groups. In addition, the patency of the catheter in the external jugular vein was not affected by previous cannulation of other central veins. In contrast, there was a significant correlation between numbers of attempts for cannulation in both groups and development of hematoma and infection, (p< 0.05. In conclusion, our results showed that the external jugular vein may be an alternative for other central veins for insertion of temporary non-cuffed hemodialysis catheter.

  15. Relationship of skin autofluorescence to cardiovascular disease in Japanese hemodialysis patients.

    Science.gov (United States)

    Tanaka, Kenichi; Katoh, Tetsuo; Asai, Jun; Nemoto, Fumihiko; Suzuki, Hodaka; Asahi, Koichi; Sato, Keiji; Sakaue, Michiaki; Miyata, Toshio; Watanabe, Tsuyoshi

    2010-06-01

    Advanced glycation end products (AGE) are significantly increased in end-stage renal disease patients and it has been suggested that AGE accumulation is related to the progression of cardiovascular disease. An autofluorescence reader non-invasively assesses AGE accumulation using skin autofluorescence under ultraviolet light. Skin autofluorescence has been reported to be an independent predictor of mortality in Caucasian hemodialysis patients. The aim of this study was to assess whether skin autofluorescence in Japanese hemodialysis patients is related to the presence of cardiovascular disease. In this cross-sectional study, patients on maintenance hemodialysis (N = 128; 59 men, 69 women) were included. AGE accumulation was assessed by skin autofluorescence using an autofluorescence reader. Associations between skin autofluorescence, cardiovascular disease, and other parameters were studied. Skin autofluorescence correlated with age (r = 0.32, P reader might have the potential to be a useful assessment of cardiovascular risk in these patients.

  16. Association of serum leptin with serum C-reactive protein in hemodialysis patients

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    Rastegari Ebrahim

    2012-04-01

    Full Text Available Introduction: Recent investigations have shown that leptin is cleared principally by the kidney. Objectives: To examine whether and how in patients on hemodialysis the level of C-reactive protein level correlate with serum leptin. Patients and Methods: The total patients were 36. The mean patients’ age were 46 (16 years. The median length of the time patients were on hemodialysis were 19 months. Results: The mean serum C-reactive protein was 8.7 (6.6 mg/l (median: 8 mg/l. The mean serum leptin was 9.4 (14 ng/ml (median: 5.75 ng/ml. In this study we found a significant inverse correlation of serum leptin with serum C-reactive protein (r= -0.57, p= 0.041 was seen. Conclusion: Our data supports, the positive effect of leptin on nutrition and support the theory of protective effects (reverse epidemiology of leptin in hemodialysis patients.

  17. Course of Encephalopathy in a Cirrhotic Dialysis Patient Treated Sequentially with Peritoneal and Hemodialysis

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    Suleyman Koz

    2015-01-01

    Full Text Available End-stage kidney disease and advanced cirrhosis are sometimes seen concomitantly. There is no consensus on dialysis modality in terms of determining the optimal way of treating these patients. It has been suggested that peritoneal dialysis is a better choice for these patients, but efficacy of hemodialysis in stable cirrhotic patients has not been evaluated sufficiently. We report a case with advanced cirrhosis and end-stage kidney disease who was faced with hepatic encephalopathy episodes up on starting renal replacement therapy. The case is also interesting in that it reveals effects of hemodialysis and peritoneal dialysis on hepatic encephalopathy episodes and quality of life of the patient.

  18. Cardiovascular effects of growth hormone in adult hemodialysis patients: results from a randomized controlled trial

    DEFF Research Database (Denmark)

    Køber, Lars; Rustom, Rana; Wiedmann, Jonas;

    2010-01-01

    The high morbidity and mortality rates in hemodialysis (HD) patients are due, at least in part, to their increased risk for cardiovascular diseases (CVD). This prospective study evaluated the effect of growth hormone (GH) on a number of CVD risk markers in adult patients on HD.......The high morbidity and mortality rates in hemodialysis (HD) patients are due, at least in part, to their increased risk for cardiovascular diseases (CVD). This prospective study evaluated the effect of growth hormone (GH) on a number of CVD risk markers in adult patients on HD....

  19. A study of the main determinants of sexual dysfunction in women aged 15-45 years on chronic hemodialysis

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    Reza Hekmat

    2016-01-01

    Full Text Available Sexual dysfunction (SD is a common problem in patients with the end-stage renal disease. In contrast to SD in males, relatively little work has been performed in the field of SD in females. In this study, we tried to identify the main determinants of SD in women aged 15-45year-old on chronic hemodialysis (HD. One hundred-forty female patients aged 15-45-year-old on chronic HD were studied in the winter of the year 2013. Healthy relatives of the patients were chosen as controls and matched for age, level of education, marital status, and income. Both cases and controls were interviewed by the same female interviewer. The Arizona Sexual Experiences Scale (ASEX was used as a questionnaire. A significant correlation was found between the total ASEX score and age and duration on HD (r = 0.599, P = 0.003 and r = 0.434, P = 0.043, respectively. No correlation was found between serum hemoglobin, parathormone, creatinine, iron, calcium, phosphorus, and urea reduction ratio and the ASEX score. Moreover, the correlation between the ASEX score and socioeconomic parameters like level of education and monthly income was not significant (all P >0.1. There was a significant difference in the total ASEX score between cases and controls (16.31 ± 2.50 vs. 9.80 ± 4.21, P <0.001. Our study suggests that sexual function in chronic hemodialyzed female patients is mainly impacted by age and duration on HD.

  20. Predictors of quality of life in hemodialysis patients

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    Magda Bayoumi

    2013-01-01

    Full Text Available Quality of Life (QoL is a consistent and powerful predictor that affects the out-come in end-stage renal disease (ESRD patients on dialysis. This study was undertaken to identify the factors that might predict QoL scores among ESRD patients on hemodialysis (HD. The study was conducted at three HD units in Saudi Arabia from January 2007 to January 2008. We studied 100 HD patients (53 males and 47 females and used the SF-36 and KDQoL-SF forms covering six domains of QoL, namely physical, emotional, social, illness impact, medical and financial satisfaction, and overall general health. The mean age of the study patients was 47.5 ± 13.8 years and the mean duration of dialysis was 77.2 ± 75.5 months. The QoL scores were 45.8 ± 17.1 for general health, 53.1 ± 32.0 for physical QoL, 50.5 ± 14.8 for emotional QoL, 54.9 ± 18.1 for social QoL, 46.5 ± 13.7 for illness impact, and 45.9 ± 12.2 for the medical and financial domain. The total QoL score was 49.5 ± 13.7. The male patients had statistically significantly reduced QoL and younger patients had better QoL scores. The QoL scores revealed a decreasing trend with decreasing level of education; they were elevated among employed patients. Multiple linear regression analysis demonstrated that age, dialysis duration, and male sex were negative predictors of QoL score. We conclude from our study that QoL is reduced in all the health domains of HD patients. Older age, male gender, unemployment, and duration of dialysis adversely affected the QoL scores. Adequate management of some of these factors could influence patient outcomes.

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

    Science.gov (United States)

    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 serum ferritin levels, low-density lipoprotein levels, and 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.

  2. Endovascular stent placement in the treatment of upper extremity central venous obstruction in hemodialysis patients

    Energy Technology Data Exchange (ETDEWEB)

    Aytekin, Cueneyt E-mail: cuneytaytekin@hotmail.com; Boyvat, Fatih; Yagmurdur, Mahmut Can; Moray, Goekhan; Haberal, Mehmet

    2004-01-01

    Objective: To evaluate the efficacy of stent placement for treating upper extremity central venous obstruction in chronic hemodialysis patients. Methods and Material: Between January 1999 and October 2001, we inserted metallic stents into the upper extremity central veins of 14 patients with shunt dysfunction and/or arm swelling. The indications for stent placement were stenosis or occlusion of the central vein in the upper extremity used for dialysis. Six of the individuals were diagnosed with subclavian vein stenosis, and 5 with brachiocephalic vein stenosis. Of the remaining 3 patients, 2 had subclavian vein occlusion, and 1 had left brachiocephalic vein occlusion. Results: All the stent placement procedures were technically successful, and there were no major complications. Follow-up ranged from 2 weeks to 29 months. The 1-, 3-, 6- and 12-month primary stent patency rates were 92.8, 85.7, 50 and 14.3%, respectively. Repeat interventions, including percutaneous transluminal angioplasty and additional stent placement, were required in 9 patients. The 3-, 6-, 12-month, and 2-year assisted primary stent patency rates were 100, 88.8, 55.5 and 33.3%, respectively. Conclusion: Endovascular stent placement is an effective alternative to surgery in patients with shunt dysfunction due to obstruction of an upper extremity central vein. Repeated interventions are usually required to prolong stent patency.

  3. Factors associated with irritable bowel syndrome symptoms in hemodialysis patients

    Institute of Scientific and Technical Information of China (English)

    Bartosz Fiderkiewicz; Alicja Rydzewska-Rosolowska; Michal My(s)liwiec; Magdalena Birecka; Bo(z)enna Kaczanowska; Gra(z)yna Rydzewska; Andrzej Rydzewski

    2011-01-01

    AIM: To investigate clinical characteristics associated with the presence of irritable bowel syndrome (IBS) symptoms in hemodialysis (HD) patients.METHODS: This was a cross-sectional study. A ques-tionnaire based on the Bowel Disease Questionnaire that records gastrointestinal symptoms was given to 294 patients in 4 dialysis centers. A total of 196 (67%) subjects returned the survey. A multivariable logistic regression model was used to identify factors signifi-cantly associated with IBS symptoms. RESULTS: Symptoms compatible with IBS were present in 27 (13.8%) subjects and independently associated with low post-dialysis serum potassium [OR = 0.258, 95% CI (0.075-0.891), P = 0.032], paracetamol use [OR = 3.159, 95% CI (1.214-8.220), P = 0.018], and Kidney Disease Quality of Life (KDQOL) cognitive function score [OR = 0.977, 95% CI (0.956-0.999), P = 0.042]. Univari-ate regressions were also performed and the reported significance is for multivariate analysis. No association was detected for age, gender, depressed mood, smoking (present or past), body mass index, albumin level, Kt/V, sodium pre- or post-dialysis level, change in potassium level during HD, proton pump inhibitor or H2 blocker use, aspirin use, residual diuresis, hepatitis B or C infection, diabetes mellitus, marital status and education level.CONCLUSION: This study examined potential risk factors for symptoms compatible with IBS in HD pa-tients and identified an association with paracetamol use, post-dialysis potassium level and KDQOL-cognitive function score.

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

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    Azar BARADARAN

    2011-12-01

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