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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. Intradialytic Hypoxemia in Chronic Hemodialysis Patients.

    Science.gov (United States)

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

    2016-01-01

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

  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. 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.

  6. Anti-Brucella Antibodies in Chronic Hemodialysis Patients

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    Esmaeli H

    2013-03-01

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

  7. 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...... frequent and underdiagnosed comorbidity in patients on chronic hemodialysis. Spirometry should be considered in all patients on dialysis in order to address dyspnea adequately. Hemodialysis induced a small fall in mean FEV1 and FVC, which was more pronounced in patients with little or no fluid removal, but...

  8. Non invasive assessment of liver fibrosis in chronic hemodialysis patients with viral hepatitis C

    OpenAIRE

    Arrayhani, Mohamed; Sqalli, Tarik; Tazi, Nada; El Youbi, Randa; Chaouch, Safae; Aqodad, Nourdin; Ibrahimi, Sidi Adil

    2015-01-01

    The liver biopsy has long been the "gold standard" for assessing liver fibrosis in patients with hepatitis C. It's an invasive procedure which is associated with an elevated bleeding, especially in chronic hemodialysis patients. Main goal is to assess liver fibrosis in chronic hemodialysis with HCV by Fibroscan and by biological scores (APRI, Forns and Fib-4), and to measure the correlation between these tests. Cross-sectional study including all chronic hemodialysis patients with hepatitis C...

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

    Science.gov (United States)

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

    2016-01-01

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

  10. Intradialytic parenteral nutrition improves protein and energy homeostasis in chronic hemodialysis patients

    OpenAIRE

    Pupim, Lara B.; Flakoll, Paul J.; Brouillette, John R.; Levenhagen, Deanna K.; Hakim, Raymond M.; Ikizler, T Alp

    2002-01-01

    Decreased dietary protein intake and hemodialysis-associated protein catabolism are among several factors that predispose chronic hemodialysis (CHD) patients to protein calorie malnutrition. Since attempts to increase protein intake by dietary counseling are usually ineffective, intradialytic parenteral nutrition (IDPN) has been proposed as a potential therapeutic approach in malnourished CHD patients. In this study, we examined protein and energy homeostasis during hemodialysis in seven CHD ...

  11. Decrease rate of the renal diameter in chronic hemodialysis patients.

    Science.gov (United States)

    Aoyagi, Teiichiro; Tachibana, Masaaki; Naganuma, Shinji

    2013-01-01

    We here present the results of ultrasonographic (US) evaluations on the alteration of renal diameter of chronic HD patients. Of 109 outpatient HD patients who had neither severe acquired cystic disease of the kidney nor hereditary polycystic kidney disease, we performed US two or three times to measure their maximum renal diameter (mean of both kidneys), and the yearly alteration rate was calculated. The average interval of the two measurements was 35.9 months, and the average HD duration from the HD induction to the first measurement was 29.5 months. The average decrease rate of renal diameter was 4.34 ± 0.4 (SE) mm/year. No statistical difference was seen on the decrease rate in relation to gender, age and original disease (among three groups, glomerulonephritis and IgA nephropathy, diabetes, and others including hypertension). However, the decrease rate was large when the first measurement was close to the induction of hemodialysis, suggesting that the alteration rate reduced according to the hemodialysis vintage (5.3 ± 0.8 mm/year, first measurement not more than 10 months after induction of HD and 1.5 ± 1.6 mm/year, first measurement more than 80 months after induction of HD). Renal diameter decreased approximately 4.3 mm each year, and the decrease rate slowed as the length of time on dialysis increased. PMID:24967236

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

    OpenAIRE

    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...

  13. Psychological characteristics of patients treated by chronic maintenance hemodialysis.

    Science.gov (United States)

    Pop-Jordanova, Nada D; Polenakovic, Momir H

    2013-02-01

    Studies related to psychological aspects of dialysis patients show that depression and anxiety are the most common characteristics. The aim of our study was to analyze the personality profile in patients on chronic maintenance dialysis and to evaluate more specifically the level of depression. The total number of patients was 68 (30 females and 38 males), with mean age 62.3 and 56.5 for females and males respectively. Mean duration of dialysis was 6.73 years for females and 6.68 years for men (the period varied from 0.5 to 18 years). For the evaluation of psychological characteristics, we used two psychometric instruments: Minnesota Multiphase Personality Inventory (MMPI- 201) and Beck Depression Inventory. The obtained results confirmed the presence of depression in patients treated with hemodialysis. The level of depression is variable (minimal is present in 21.43%; mild in 35.71%; moderate in 17.85% and severe in 14.28% of patients). The depression is significantly positively correlated with age (panxiety, low level of hostility, but very high passive aggression which destroys their social communications. Some response measures for depression such as relaxation training, psychological support, music therapy, or peripheral biofeedback are recommended. PMID:23335381

  14. Standardized Peridialytic Blood Pressures for Diagnosing Arterial Hypertension in Patients on Chronic Hemodialysis

    OpenAIRE

    Raluca Moldovan; Mirela Gherman-Căprioară

    2014-01-01

    Background. The relevance of peridialytic blood pressures for diagnosing hypertension is controversial. Standardized peridialytic BPs have not yet been evaluated for the positive diagnosis and evaluation of hypertension severity in chronic hemodialysis patients.Aim. To evaluate the utility of standardized peridialytic BP for diagnosing hypertension, defined according to the results of 24-hour ambulatory blood pressure monitoring(ABPM).Methods. Thirty-five chronic hemodialysis patients with a ...

  15. Serum leptin level and its significance in chronic renal failure hemodialysis patients

    International Nuclear Information System (INIS)

    To study serum leptin level in chronic renal failure (CRF) hemodialysis patients and the relationship between serum leptin level and residue renal function, body composition, and indices of malnutrition, 31 end-stage CRF hemodialysis patients and 38 healthy people were enrolled. Serum leptin levels were detected by radioimmunoassay. BMI, %Fat and LBM were measured by bioelectrical impedance analysis device. Alb, Chol, Hgb, BUN, SCr and Ccr of the patients were also examined. Results showed that Serum leptin level in end-stage CRF hemodialysis patients was markedly higher than that in healthy controls (P0.05). Conclusion: Hyperleptinemia existed in end-stage CRF hemodialysis patients and might cause the loss of LBM. The leptin level was not correlated with residue renal function, but it could reflect the fat content. However, serum leptin did not play a significant role in protein malnutrition in end-stage CRF hemodialysis patients

  16. 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.

  17. Impact of hepcidin, interleukin 6, and other inflammatory markers with respect to erythropoietin on anemia in chronic hemodialysis patients

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    Ihab A. Ibrahim

    2014-01-01

    Conclusion Serum hepcidin levels were associated with iron status and inflammation in maintenance hemodialysis patients, and the high hepcidin serum levels, found in hemodialysis (HD patients, are dependent on the magnitude of the inflammatory process and on recombinant human erythropoietin doses. Hepcidin and its regulatory pathways are potential therapeutic targets, which could lead to effective treatment of anemia in chronic hemodialysis.

  18. Non invasive assessment of liver fibrosis in chronic hemodialysis patients with viral hepatitis C.

    Science.gov (United States)

    Arrayhani, Mohamed; Sqalli, Tarik; Tazi, Nada; El Youbi, Randa; Chaouch, Safae; Aqodad, Nourdin; Ibrahimi, Sidi Adil

    2015-01-01

    The liver biopsy has long been the "gold standard" for assessing liver fibrosis in patients with hepatitis C. It's an invasive procedure which is associated with an elevated bleeding, especially in chronic hemodialysis patients. Main goal is to assess liver fibrosis in chronic hemodialysis with HCV by Fibroscan and by biological scores (APRI, Forns and Fib-4), and to measure the correlation between these tests. Cross-sectional study including all chronic hemodialysis patients with hepatitis C virus, in two public hemodialysis centers of Fez. All patients were evaluated for liver fibrosis using noninvasive methods (FibroScan and laboratory tests). Subsequently, the correlation between different tests has been measured. 95 chronic hemodialysis were studied, twenty nine patients (30.5%) with chronic hepatitis C. The average age was 52.38 ± 16.8 years. Nine liver fibrosis cases have been concluded by forns score. Fibroscan has objectified significant fibrosis in 6 cases. On the other side APRI has objectified sgnifivant fibrosis only in 3 cases. The Fib-4 showed severe fibrosis in five cases. The results have been most consistent between APRI and Fib-4, followed by Fibroscan and Forns, then APRI and FibroScan. PMID:26958136

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

    Science.gov (United States)

    Kharlamova, U V; Il'icheva, O E

    2012-01-01

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

  20. 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

  1. 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.

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

    Science.gov (United States)

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

    2016-01-01

    The objectives of this study were to assess the prevalence of chronic obstructive pulmonary disease (COPD) in hemodialysis patients with spirometry and to examine the effects of fluid removal by hemodialysis on lung volumes. Patients ≥18 years at two Danish hemodialysis centers were included. 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 centers, 255 patients (69%) completed spirometry before dialysis and 242 of these (65%) repeated the test after. In the initial test, 117 subjects (46%) had airflow limitation indicative of COPD with GOLD criteria and 103 subjects (40.4%) with lower limit of normal criteria; COPD was previously diagnosed in 24 patients (9%). Mean FVC and FEV1 decreased mildly after dialysis (FVC: 2.84 to 2.79 L, P Spirometry should be considered in all patients on dialysis in order to address dyspnea adequately. Hemodialysis induced a small fall in mean FEV1 and FVC, which was more pronounced in patients with little or no fluid removal, but the FEV1 /FVC ratio and the number of subjects with airflow limitation indicative of COPD were not affected by dialysis. PMID:26245152

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

    OpenAIRE

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

    2014-01-01

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

  4. 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.

  5. 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.

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

    OpenAIRE

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

    2014-01-01

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

  7. Risk and Prognosis of Bloodstream Infections among Patients on Chronic Hemodialysis: A Population-Based Cohort Study.

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    Lars Skov Dalgaard

    Full Text Available Infections are common complications among patients on chronic hemodialysis. This population-based cohort study aims to estimate risk and case fatality of bloodstream infection among chronic hemodialysis patients.In this population-based cohort study we identified residents with end-stage renal disease in Central and North Jutland, Denmark who had hemodialysis as first renal replacement therapy (hemodialysis patients during 1995-2010. For each hemodialysis patient, we sampled 19 persons from the general population matched on age, gender, and municipality. Information on positive blood cultures was obtained from regional microbiology databases. All persons were observed from cohort entry until first episode of bloodstream infection, emigration, death, or end of hemodialysis treatment, whichever came first. Incidence-rates and incidence-rate ratios were computed and risk factors for bloodstream infection assessed by Poisson regression. Case fatality was compared by Cox regression.Among 1792 hemodialysis patients and 33 618 matched population controls, we identified 461 and 1126 first episodes of bloodstream infection, respectively. Incidence rates of first episode of bloodstream infection were 13.7 (95% confidence interval (CI, 12.5-15.0 per 100 person-years among hemodialysis patients and 0.53 (95% CI, 0.50-0.56 per 100 person-years among population controls. In hemodialysis patients, the most common causative microorganisms were Staphylococcus aureus (43.8% and Escherichia coli (12.6%. The 30-day case fatality was similar among hemodialysis patients and population controls 16% (95% CI, 13%-20% vs. 18% (95% CI, 15%-20%.Hemodialysis patients have extraordinary high risk of bloodstream infection while short-term case fatality following is similar to that of population controls.

  8. Risk and Prognosis of Bloodstream Infections among Patients on Chronic Hemodialysis: A Population-Based Cohort Study

    Science.gov (United States)

    Skov Dalgaard, Lars; Nørgaard, Mette; Jespersen, Bente; Jensen-Fangel, Søren; Østergaard, Lars Jørgen; Schønheyder, Henrik Carl; Søgaard, Ole Schmeltz

    2015-01-01

    Background and Objectives Infections are common complications among patients on chronic hemodialysis. This population-based cohort study aims to estimate risk and case fatality of bloodstream infection among chronic hemodialysis patients. Methods In this population-based cohort study we identified residents with end-stage renal disease in Central and North Jutland, Denmark who had hemodialysis as first renal replacement therapy (hemodialysis patients) during 1995–2010. For each hemodialysis patient, we sampled 19 persons from the general population matched on age, gender, and municipality. Information on positive blood cultures was obtained from regional microbiology databases. All persons were observed from cohort entry until first episode of bloodstream infection, emigration, death, or end of hemodialysis treatment, whichever came first. Incidence-rates and incidence-rate ratios were computed and risk factors for bloodstream infection assessed by Poisson regression. Case fatality was compared by Cox regression. Results Among 1792 hemodialysis patients and 33 618 matched population controls, we identified 461 and 1126 first episodes of bloodstream infection, respectively. Incidence rates of first episode of bloodstream infection were 13.7 (95% confidence interval (CI), 12.5–15.0) per 100 person-years among hemodialysis patients and 0.53 (95% CI, 0.50–0.56) per 100 person-years among population controls. In hemodialysis patients, the most common causative microorganisms were Staphylococcus aureus (43.8%) and Escherichia coli (12.6%). The 30-day case fatality was similar among hemodialysis patients and population controls 16% (95% CI, 13%–20%) vs. 18% (95% CI, 15%–20%). Conclusions Hemodialysis patients have extraordinary high risk of bloodstream infection while short-term case fatality following is similar to that of population controls. PMID:25910221

  9. Cytosine arabinoside and daunorubicin induction therapy in a patient with acute myeloid leukemia on chronic hemodialysis.

    Science.gov (United States)

    Krashin, Eilon; Dolberg, Osnat J; Hellmann, Ilana; Huitema, Alwin D R; Rosing, Hilde; Ellis, Martin

    2016-09-01

    The combination of daunorubicin and cytarabine is the cornerstone of induction therapy for acute myeloid leukemia (AML). Little data are available on the optimal chemotherapy regimen for patients with AML and advanced renal failure, with some authors recommending administration of reduced daunorubicin doses. We report the case of a 54-year-old AML patient on chronic hemodialysis who was treated with a modified induction regimen with reduced-dose daunorubin. Daunorubicin levels were measured during the treatment schedule. Although daunorubicin terminal t1/2 appears to be unaffected in hemodialysis patients, the estimated 0-23 h area under the curve was comparable with that of patients receiving full-dose daunorubicin. Therefore, dose adjustment in this patient group may be prudent. PMID:27254285

  10. Clinical significance of determination of plasma homocysteine (HCY) levels in chronic renal failure patients on hemodialysis

    International Nuclear Information System (INIS)

    Objective: To explore the relationship between the plasma homocysteine (HCY) level and the development of cardio-vascular complication in chronic renal failure (CRF) patients on hemodialysis. Methods: Plasma HCY levels were measured in 38 renal failure patients on hemodialysis both before and after 8 weeks oral administration of folic acid (5 mg tid) and VitB12 (500 μg tid) as well as in 40 controls. Results: The plasma levels of HCY in CRF patients on dialysis before taking folic acid and VitB12 (25.12 ± 12.51 μmol/L) were significantly higher than those in controls (8.2 ± 4.5 μmol/L) (P12 were significantly lowered (13.2 ± 5.74 μmol/L, vs before treatment, P12 might be beneficial in lessening the complications. (authors)

  11. 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.

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

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    Jayanta Paul

    2012-01-01

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

  13. [Analysis of hemodialysis and graft representations in patients with chronic renal failure: an anthropological approach].

    Science.gov (United States)

    Desseix, Aurélie; Merville, Pierre; Couzi, Lionel

    2010-04-01

    Hemodialysis and kidney transplant are two treatments for renal failure, which lead to numerous changes in the patients' way of life. We have questioned ourselves on the different ways they could deal with those changes by studying the representations and the ritualisation that surrounds the sick. From 2005 to 2007, qualitative interviews, based on the method of life stories, were conducted with 35 patients with chronic renal failure in three Aquitaine's centres. The results show three main groups of representation both in pre-transplant and in post-transplant. Specific behaviours are tied to each group of representation that are beneficial or deleterious with respect to treatment or the patient's social life. We will show that, on the one hand, the patients who see the hemodialysis treatment as a traditional rite of passage cope with the situation more easily and on the other hand, we will stress that this representation is closely linked to how the patients will later accept the kidney transplant. So, we have been able to link the representations of hemodialysis patients and transplant experience. Then these results have a practical consequence for the caregivers who can use the tools of anthropology (the interview guide, analysis grid) through a program of therapeutic education, to precociously take care of patients who are likely to come up against issues after their kidney transplant. PMID:20299298

  14. Depression in hemodialysis patients

    International Nuclear Information System (INIS)

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

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

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    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

  16. Effect of thermal therapy using hot water bottles on brain natriuretic peptide in chronic hemodialysis patients

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    Yoko Uchiyama-Tanaka

    2013-02-01

    Full Text Available Introduction: The use of repeated thermal therapy for improving the symptoms of chronic heart failure (CHF has been recently demonstrated. Usually, thermal therapy requires an infrared dry sauna. However, it is difficult for small clinics to acquire such an expensive and extensive system. The author assessed the efficacy of its substitution with hot water bottles. Moreover, there are no prior studies demonstrating the efficacy of thermal therapy in hemodialysis patients with chronic heart failure. Methods: The author evaluated plasma brain natriuretic peptide (BNP levels in 98 hemodialysis patients in a clinic. A total of nine patients whose BNP levels were more than 500 pg/mL agreed to be enrolled in this study and received thermal therapy using hot water bottles. Results: Plasma BNP levels, a potential marker for CHF, tended to decrease (891 ± 448 pg/mL to 680 ± 339 pg/mL, but the difference was not significant (P = 0.0845. The oral temperature changed from 36.44℃± 0.45℃ to 37.04℃ ± 0.48℃ (+0.597℃, P

  17. 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.

  18. Does the Spiritual Well-Being of Chronic Hemodialysis Patients Differ from that of Pre-dialysis Chronic Kidney Disease Patients?

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    Areewan Cheawchanwattana

    2014-12-01

    Full Text Available Spiritual well-being is viewed as an essential component of health-related quality of life (HRQOL in the modernized biopsychosocial-spiritual model of health. Understanding spiritual well-being should lead to better treatment plans from the patients’ point of view, and improved patient adherence. There are numerous studies of traditional HRQOL, physical, mental, and social well-being; however, studies of spiritual well-being in chronic kidney disease (CKD patients are limited. Thus, this study compared spiritual well-being of chronic hemodialysis patients and pre-dialysis CKD patients. A total of 31 chronic hemodialysis and 63 pre-dialysis CKD patients were asked for consent and then interviewed for spiritual well-being using the Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being (FACIT-Sp. Analysis of covariance was applied to compare FACIT-Sp scores between pre-dialysis CKD and chronic hemodialysis groups that were adjusted by patient characteristics. The FACIT-Sp scores of pre-dialysis CKD patients were non-significantly greater than those of chronic hemodialysis patients after adjustment for gender, age, and marital status. However, all FACIT-Sp scores of males were significantly lower than those of females [FACIT Meaning −1.59 (p = 0.024, FACIT Peace −2.37 (p = 0.004, FACIT Faith −2.87 (p = 0.001, FACIT Total Score −6.83 (p = 0.001]. The spiritual well-being did not significantly differ by stages of chronic kidney disease; however, patient gender was associated with spiritual well-being instead. To improve spiritual well-being, researchers should consider patient gender as a significant factor.

  19. 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.

  20. Clinical significance of measurement of changes of plasma leptin and serum NPY levels after hemodialysis in patients with chronic renal failure

    International Nuclear Information System (INIS)

    Objective: To explore the clinical significance of changes of plasma leptin and serum NPY levels after hemodialysis in patients with chronic renal failure. Methods: Plasma leptin and serum NPY levels were measured with RIA both before and after hemodialysis in 31 patients with chronic renal failure as well as in 35 controls. Results: Before hemodialysis,plasma leptin and serum NPY levels were significantly higher in the patients than those in controls (P<0.01). After hemodialysis for 1 week the levels, though dropped markedly, still remained significantly higher than those in controls (P<0.05). Conclusion: The levels of leptin and NPY were significantly increased in patients with chronic renal failare. Hemodialysis could increase, the clearance rate of leptin and NPY and partially correct the levels with important clinical value. (authors)

  1. Color Doppler Indices of Orbital Arterial Flow in End-Stage Renal Disease Patients; Are the Changes Related to Chronic Hemodialysis or Chronic Renal Failure?

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    Hadi Rokni Yazdi

    2012-03-01

    Full Text Available Background: Endothelial injury is a well-known complication in chronic kidney disease (CKD and hemodialysis. One of the sites in which early vascular changes may be detected is the retina. Of course, these flow changes may not be detected in ophthalmologic exams, but it seems that color Doppler sonography of retinal arteries may be helpful in these cases.Objectives: In previous studies on CKD patients who underwent chronic hemodialysis, hemodynamic changes were noted in retinal arteries, but no study has been performed to determine which of the two processes (CKD or chronic hemodialysis can produce these changes. In this study, we tried to answer this question.Patients and Methods: Doppler ultrasonography of the orbital vasculature including the ophthalmic artery and the central retinal artery was carried out in 17 patients (34 eyes with chronic renal failure (CRF who underwent hemodialysis, 17 patients (34 eyes with CRF without a history of hemodialysis and 17 normal patients (34 eyes. The peak systolic velocity (PSV, end diastolic velocity (EDV and resistance index were measured excluding hypertensive, diabetic patients and patients with cardiovascular disease.Results: The mean PSV and EDV were lower only in the ophthalmic artery of CRF patients irrespective of the history of hemodialysis (PSV was 35.2 in hemodialysis, 38.8 in CRF and 51.6 in normal patients, P value = 0.001 and EDV was 7.4, 9.4, 11.8, respectively, P value = 0.001 with no significant difference in the resistance index of the ophthalmic artery and other parameters [EDV, PSV, Resistance Index (RI] in the central retinal artery.Conclusions: The mean PSV and DSV in the ophthalmic artery were lower only in the ophthalmic artery of CRF patients regardless of the history of hemodialysis. No significant difference in the resistance index of the ophthalmic artery and other parameters (EDV, PSV of the central retinal artery were noted between different groups.These findings suggest

  2. Color Doppler Indices of Orbital Arterial Flow in End-Stage Renal Disease Patients; Are the Changes Related to Chronic Hemodialysis or Chronic Renal Failure?

    International Nuclear Information System (INIS)

    Endothelial injury is a well-known complication in chronic kidney disease (CKD) and hemodialysis. One of the sites in which early vascular changes may be detected is the retina. Of course, these flow changes may not be detected in ophthalmologic exams, but it seems that color Doppler sonography of retinal arteries may be helpful in these cases. In previous studies on CKD patients who underwent chronic hemodialysis,hemodynamic changes were noted in retinal arteries, but no study has been performed to determine which of the two processes (CKD or chronic hemodialysis) can produce these changes. In this study, we tried to answer this question. Doppler ultrasonography of the orbital vasculature including the ophthalmic artery and the central retinal artery was carried out in 17 patients (34 eyes) with chronic renal failure (CRF) who underwent hemodialysis, 17 patients (34 eyes)with CRF without a history of hemodialysis and 17 normal patients (34 eyes). The peak systolic velocity (PSV), end diastolic velocity (EDV) and resistance index were measured excluding hypertensive, diabetic patients and patients with cardiovascular disease. The mean PSV and EDV were lower only in the ophthalmic artery of CRF patients irrespective of the history of hemodialysis (PSV was 35.2 in hemodialysis, 38.8 in CRF and 51.6 in normal patients, P value = 0.001 and EDV was 7.4, 9.4, 11.8, respectively, P value =0.001) with no significant difference in the resistance index of the ophthalmic artery and other parameters [EDV, PSV, Resistance Index (RI)] in the central retinal artery. The mean PSV and DSV in the ophthalmic artery were lower only in the ophthalmic artery of CRF patients regardless of the history of hemodialysis. No significant difference in the resistance index of the ophthalmic artery and other parameters (EDV, PSV) of the central retinal artery were noted between different groups. These findings suggest that microvascular disease and endothelial cell dysfunction of the orbital

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

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    Ana Carolina Ottaviani

    2014-04-01

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

  4. 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.

  5. 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

  6. Chronic Hemodialysis in Small Children.

    Science.gov (United States)

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

    2016-06-01

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

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

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    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. Sleep disorders in hemodialysis patients

    OpenAIRE

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

    2010-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2007-08-15

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

  10. Destructive spondyloarthropathy in hemodialysis patients

    International Nuclear Information System (INIS)

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

  11. Vitamin D deficiency in hemodialysis patients

    OpenAIRE

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

    2012-01-01

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

  12. Long-Term Oral Nutrition Supplementation Improves Outcomes in Malnourished Patients With Chronic Kidney Disease on Hemodialysis

    OpenAIRE

    Sezer, Siren; Bal, Zeynep; Tutal, Emre; Uyar, Mehtap Erkmen; Acar, Nurhan Ozdemir

    2014-01-01

    Background: There is no consensus on the type, time of initiation, or duration of use of enteral nutrition in patients with chronic kidney disease (CKD). This study aimed to compare the effects of a renal-specific oral nutrition supplement (RS-ONS) and a standard recommended nutrition regime on biochemical and nutrition markers in malnourished patients with CKD on hemodialysis. Methods: Sixty-two malnourished patients with CKD, divided into experimental (RS-ONS; n = 32; mean [SD] age, 62.0 [1...

  13. Life Quality of Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Noorallah Tahery

    2013-05-01

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

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

    International Nuclear Information System (INIS)

    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

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

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    El-Nakib GA

    2013-08-01

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

  16. Correlation between carotid parameters measured by ultrasonography and cerebral infarction or left ventricular diastolic function in chronic hemodialysis patients

    International Nuclear Information System (INIS)

    Many studies have reported that carotid parameters measured by ultrasonography are predictors for cerebral infarction in nondialysis patients. Using a cross-sectional design, this study investigated whether those carotid parameters are also associated with cerebral infarction and left ventricular diastolic function in chronic hemodialysis (HD) patients. We studied 63 HD patients aged 61.4±11.5 years who underwent regular hemodialysis in Hidaka Hospital. All subjects underwent carotid ultrasound measurements when they performed brain magnetic resonance imaging (MRI) or computed tomography (CT). Cerebral infarction was detected significantly more frequently in patients with max intima-media thickness of common carotid artery (IMT) >2.2 mm (Odds ratio=3.14, 95% confidence interval (CI)=1.11-8.92). There was a positive correlation between PS and E/E' (r=0.322, p=0.009). These findings suggest that max IMT is significantly associated with the presence of cerebral infarction, while PS is related to left ventricular diastolic function in chronic HD patients. (author)

  17. 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.

  18. 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 disease - hemodialysis

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

    Institute of Scientific and Technical Information of China (English)

    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

  20. Thoracic endovascular aortic repair for complicated chronic type B aortic dissection in a patient on hemodialysis with recurrent ischemic colitis.

    Science.gov (United States)

    Miyazaki, Yuko; Furuyama, Tadashi; Matsubara, Yutaka; Yoshiya, Keiji; Yoshiga, Ryosuke; Inoue, Kentaro; Matsuda, Daisuke; Aoyagi, Yukihiko; Kato, Masaaki; Matsumoto, Takuya; Maehara, Yoshihiko

    2016-12-01

    We present a successful case of thoracic endovascular aortic repair (TEVAR) for chronic Stanford type B aortic dissection (B-AD) with recurrent ischemic colitis. The patient was a 56-year-old woman with abdominal pain as the main complaint who had two operations previously: the total arch replacement 8 years ago and the Bentall 7 years ago for acute Stanford type A aortic dissection. Her abdominal pain worsened as her blood pressure became low during her hemodialysis treatment. An enhanced computed tomography scan was performed on the patient and showed chronic B-AD that occurred from the distal anastomotic part of the total arch graft to the bilateral common iliac arteries. The celiac artery and superior mesenteric artery (SMA) arose from the true lumen, and these were compressed by the expanded false lumen. Her complicated chronic B-AD was treated with the Zenith Dissection Endovascular System, and its procedure was performed as her proximal entry tear was covered by a proximal tapered Zenith TX2 stent graft, supplemented by a noncovered aortic stent extending across both renal arteries, the SMA, and the celiac artery. Seven days after this operation, enhanced computed tomography showed that the patient's true lumen was expanded and her blood flow to the true lumen and SMA was improved. On the other hand, her false lumen tended to be thrombosed. Consequently, she was discharged 10 days after the operation without any postoperative complications as she had no abdominal complaints even though she underwent hemodialysis three times per week after the operation. We believe that TEVAR supplemented by a noncovered aortic stent is an effective treatment, even for highly chronic B-AD in dialysis patients. PMID:27090121

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

    Directory of Open Access Journals (Sweden)

    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.

  2. 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

  3. 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.

  4. Effect of relative hypoparathyroidism on the responsiveness to recombinant human erythropoietin in chronic hemodialysis patients: A single Saudi center experience

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    Khalid Al Saran

    2013-01-01

    Full Text Available Anemia is a common concomitant disorder in dialysis patients. The responsiveness to recombinant human erythropoietin in hemodialysis (HD patients with relative hypoparathyroidism [4 ≤ intact parathyroid hormone (iPTH ≤16.5 pmol/L] remains undetermined. We retrospectively studied 70 chronic hemodialysis patients who were divided into two groups: Group A (32 patients had 16.5 ≤ iPTH levels <33.5 pmol/L and Group B (38 patients had 4 ≥ iPTH≤16.5 pmol/L during the preceding six months without 1- (OH Vitamin D3 administration. The percentage of female gender was significantly higher in Group B compared with Group A (P = 0.018. In Groups A and B, the mean weekly recombinant human erythropoietin dose (U/kg/ week was 227.96 ± 95.24 vs. 154.1 ± 84.9 (P = 0.001 and the mean hemoglobin level was 11.15 ± 0.63 g/dL versus 11.62 ± 0.63 g/dL (P = 0.008. There was no significant statistical difference regarding the other biochemical markers (serum ferritin, iron saturation, serum Ca, serum alkaline phosphatase, C-reactive protein, serum B12, serum folate levels, residual renal function and Kt/v between the groups. If other factors related to anemia are excluded in chronic HD patients, the lower the iPTH level (relative hypoparathyroidism the better the responsiveness to recombinant human erythropoietin.

  5. 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

  6. 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.

  7. 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...

  8. 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.

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

    Directory of Open Access Journals (Sweden)

    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

  10. Effect of hemodialysis on visual acuity, intraocular pressure, and macular thickness in patients with chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Chelala E

    2015-01-01

    Full Text Available Elias Chelala,1,2,* Ali Dirani,1,2,* Ali Fadlallah,1,2 Elise Slim,1,2 Youssef Abdelmassih,1,2 Henry Fakhoury,3 Patrick Baz,1,2 Riad Bejjani1,2 1Faculty of Medicine, Saint-Joseph University, 2Hôtel-Dieu de France Hospital, Saint-Joseph University, 3Eye and Ear Hospital, Beirut, Lebanon *These two authors contributed equally to this work Background: The aim of this study was to evaluate the effects of hemodialysis (HD on visual acuity, intraocular pressure (IOP, and central foveal thickness (CFT in patients with chronic kidney disease.Materials and methods: Forty-nine eyes from 49 chronic kidney-disease patients were analyzed. Causes of chronic kidney disease included diabetes mellitus (n=9 patients, hypertensive nephrosclerosis (n=15 patients, and other causes (n=25 patients. All patients underwent HD in the Dialysis Unit of Hôtel-Dieu de France Hospital. Best-corrected visual acuity, CFT, and IOP were evaluated before and after HD. CFT was measured with spectral domain optical coherence tomography, and IOP was measured with Goldmann applanation tonometry.Results: Neither decimal best-corrected visual acuity (pre-HD 0.71±0.32, post-HD 0.72±0.31; P=0.877 nor CFT (pre-HD 251.39±39.29, post-HD 253.09±39.26; P=0.272 significantly changed after HD. However, mean IOP significantly decreased from 13.99±2.48 before HD to 12.65±2.41 mmHg after HD (P=0.001. IOP change was significantly correlated with serum albumin levels (P=0.008 and weight changes (P=0.047.Conclusion: HD can affect various ocular parameters. This is particularly true of IOP, which decreases significantly following HD. Keywords: chronic kidney disease, hemodialysis, visual acuity, central macular thickness, intraocular pressure

  11. Transcriptome Analysis in Patients with Chronic Kidney Disease on Hemodialysis Disclosing a Key Role for CD16+CX3CR1+ Monocytes

    OpenAIRE

    Schepers, Eva; Houthuys, Erica; Dhondt, Annemieke; De Meyer, Grimbert; Neirynck, Nathalie; Bernaert, Pascal; Van den Bergh, Rafael; Brouckaert, Peter; Vanholder, Raymond; Glorieux, Griet

    2015-01-01

    The risk for cardiovascular morbidity and mortality is increased in chronic kidney disease; in this process micro-inflammation plays an essential role. Responsible mechanisms remain to a large extent unidentified. In this pilot study transcriptome analysis of peripheral blood monocytes was used to identify in an unprejudiced manner which factors could be discriminative for cardiovascular disease in patients with chronic kidney disease on hemodialysis. Forty gender- and age-matched, non-diabet...

  12. 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.

  13. 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.

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

    Directory of Open Access Journals (Sweden)

    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

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

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    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.

  16. 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. PMID:27085471

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

    OpenAIRE

    Morishita, Yoshiyuki; Kusano, Eiji; Nagata, Daisuke

    2014-01-01

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

  18. 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.

  19. 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. PMID:2019018

  20. 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 ...

  1. 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.

  2. 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

  3. Sleep disorders in hemodialysis patients.

    Science.gov (United States)

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

    2010-03-01

    The prevalence of sleep disorders is higher in patients with kidney failure than the general population. We studied the prevalence of sleep disorders in 88 (mean age; 41.59 +/- 16.3 years) chronic hemodialysis (HD) patients at the Urology and Nephrology Center, Mansoura University, Egypt over 4-month period. The investigated sleep disorders included insomnia, restless leg syndrome (RLS), obstructive sleep apnea syndrome (OSAS), excessive daytime sleepiness (EDS), narcolepsy and sleep walking, and we used a questionnaire in accordance with those of the International Restless Legs Syndrome Study Group, the Berlin questionnaire, Italian version of Epworth Sleepiness Scale, International Classification of Sleep Disorders, and the specific questions of Hatoum's sleep questionnaire. The prevalence of sleep disorders was 79.5% in our patients, and the most common sleep abnormality was insomnia (65.9%), followed by RLS (42%), OSAS (31.8%), snoring (27.3%), EDS (27.3%), narcolepsy (15.9%), and sleep walking (3.4%). Insomnia correlated with anemia (r=0.31, P= 0.003), anxiety (r=0.279, P= 0.042), depression (r=0.298, P= 0.24) and RLS (r=0.327, P= 0.002). Also, RLS correlated with hypoalbuminemia (r=0.41, P= Sleep disorders are quite common in the HD patients, especially those who are anemic and hypoalbuminemic. Assessment of sleep quality, preferably with polysomnography, is necessary to confirm our results. Interventional studies for management of sleep disorders in HD patients are warranted. PMID:20228517

  4. Rosuvastatin in diabetic hemodialysis patients

    DEFF Research Database (Denmark)

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

    2011-01-01

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

  5. [Arterial hypertension in patients with chronic kidney insufficiency in hemodialysis with erythropoietin].

    Science.gov (United States)

    Martins Prata, M; Teixeira de Sousa, F; Barbas, J; Vinhaś, J; Marques da Costa, A

    1990-02-01

    The purpose of this study was to evaluate the effect of the partial correction of anaemia with recombinant human erythropoietin (rHuEPO) on the blood pressure (BP) of patients on chronic haemodialysis (HD). A group of 50 patients (26 men and 24 woman, mean age of 50 +/- 19.0 and range of 21 to 67) with basal levels of haemoglobin (Hb) less than or equal to 8 g/dl was evaluated before and during treatment with rHuEPO. Recombinant erythropoietin was started at 50 U/kh I.V. 3 times a week, immediately after each session of HD, for 4 weeks, and this dose was increased in steps of 25 U/kg until and Hb level of 12 g/dl or a maximum dose of 100 U/kg were reached. Before the administration of rHuEPO 33 patients (67.3%) were normotensives and 16 (32.6%) were hypertensives treated and well controlled. During the period of administration of rHuEPO 10 of the normotensives (30.3%) and 5 (31.3%) of the hypertensives patients showed an increase in the B.P. There was no correlation between the frequency of increase in B.P. and sex, age, length of time on HD and previous levels of B.P., but that frequency was higher in the patients with the lowest basal levels of haematocrit (Hct) and with the greatest increases in Hct (delta Hct). An immediate effect of I.V. administration of rHuE-PO on B.P. levels was not found. Finally we discuss the etiopathologic factors eventually responsible for the increase in BP and suggest some rules to be observed in the therapeutic use of rHuEPO. PMID:2346662

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

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    Sérgio Aparecido Torres

    2010-06-01

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

  7. [Work capacity in patients on hemodialysis].

    Science.gov (United States)

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

    2004-01-01

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

  8. Sleep disorders in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Sabry Alaa

    2010-01-01

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

  9. Contributions of myocardial scintigraphy in coronary heart disease in chronic hemodialysis: A prospective study of 52 cases

    International Nuclear Information System (INIS)

    We propose in this work to assess the prevalence of cardiovascular risk factors in the chronic hemodialysis as well as diagnostic and prognostic performance of myocardial SPECT. We conducted a prospective study over a period of 5 years (1999-2004) assemble 52 chronic hemodialysis patients, 73 pour cent were treated at the hemodialysis unit of the principal Hospital Military - Tunis and 27 pour cent the hemodialysis unit of the polyclinic CNSS El Khadhra. The conventional periodic hemodialysis bicarbonate was the dialysis technique used in all our patients.

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

    Directory of Open Access Journals (Sweden)

    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.

  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. Surgical Fracture Repair in Chronic Renal Failure Patients on Hemodialysis An Analysis of Complications and Hospital Quality Measures.

    Science.gov (United States)

    Vaswani, Ravi; Manoli, Arthur; Goch, Manoli; Egol, Kenneth

    2016-06-01

    In end stage renal disease (ESRD) patients on hemodialysis (HD), it is known that renal bone disease has a negative impact on postoperative complication rate of fracture repair compared to non-ESRD patients. Previous studies have examined complications following surgical hip fracture repair in ESRD patients on HD. However, there is paucity of information outside of hip fracture repair. This study was undertaken to investigate complications associated with surgical fracture repair in ESRD patients on hemodialysis and to compare quality measures with a control group for various fracture types. Data of all consecutive ESRD patients on HD was collected prospectively starting in 2013. Charts of 2,558 ESRD patients on HD from 2010 to 2013 were also reviewed. Thirty-four patients who underwent surgical fracture repair were included in the study. Additionally, 1,000 patients without ESRD who underwent fracture repair were also identified, and a random sample of 267 patients was selected for inclusion as a control group. Primary outcomes were major complications as defined by the Clavien-Dindo complication rating system for orthopaedic surgery. Secondary outcomes were minor complications, defined by the same method. Demographic information and hospital quality measures, such as hospital length of stay (LOS) and discharge disposition, were also collected. There were no differences between the two groups in terms of BMI, ethnicity, or gender distribution. The ESRD patients were older than control patients (62.6 versus 46.8 years; p > 0.01). Overall, the complication rate in the ESRD group was 14.7% compared to 3% in the control group (p payment initiatives for orthopaedic trauma patients. PMID:27281322

  13. Pulmonary Hypertension in Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Mahdavi-Mazdeh Mitra

    2008-01-01

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

  14. 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.

  15. Increased cerebral water content in hemodialysis patients.

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    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.

  16. Transcriptome analysis in patients with chronic kidney disease on hemodialysis disclosing a key role for CD16+CX3CR1+ monocytes.

    Directory of Open Access Journals (Sweden)

    Eva Schepers

    Full Text Available The risk for cardiovascular morbidity and mortality is increased in chronic kidney disease; in this process micro-inflammation plays an essential role. Responsible mechanisms remain to a large extent unidentified. In this pilot study transcriptome analysis of peripheral blood monocytes was used to identify in an unprejudiced manner which factors could be discriminative for cardiovascular disease in patients with chronic kidney disease on hemodialysis. Forty gender- and age-matched, non-diabetic, non-smoking subjects with CRP 60 mL/min/1.73m2 and a history of cardiovascular event (CVE, 10 patients with chronic kidney disease stage 5 on hemodialysis without previous cardiovascular event (CKD5HD and 10 with a previous cardiovascular event (CKD5HD/CVE. Monocytes were isolated and their mRNA was submitted to focused transcriptome analysis using a macroarray platform containing ca. 700 genes associated with macrophage functional capacity. The macroarray data indicated 9 genes (8 upregulated and 1 downregulated with a significant differential expression in CKD5HD/CVE vs. CVE alone, after excluding genes differentially expressed in CKD5HD vs.For FCGR3A (CD16 and CX3CR1 (chemokine receptor the upregulation vs. control and vs. CVE could be confirmed by quantitative RT-PCR for all CKD5HD patients. Furthermore, CX3CR1 relative expression on monocytes correlated with CRP. Flow cytometric analysis of purified monocytes confirmed a significant increase in the percentage of CD16 positive monocytes in all CKD5HD patients vs. control and CVE. The present study indicates the importance of a specific pro-inflammatory monocyte subpopulation, positive for CD16 and the co-expressed chemokine receptor, CX3CR1, discriminative for CKD5HD patients.

  17. 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...... dialysis, 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....

  18. Hyperhomocysteinemia and cardiovascular risks in hemodialysis patients.

    Science.gov (United States)

    Sagheb, Mohammad Mahdi; Ostovan, Mohammad Ali; Sohrabi, Zahra; Atabati, Elham; Raisjalai, Ghanbar Ali; Roozbeh, Jamshid

    2010-09-01

    The risk of premature and progressive occlusive vascular disease is high in chronic uremic patients, and it accounts for more than 40% of the mortality in dialysis patients. End stage renal failure (ESRF) patients exhibit elevated plasma homocystein levels, about four fold as much as those in the controls, and it is now considered as a causative factor for increased risk of cardiovascular death among these patients. The aim of this study was to evaluate the relationship of total plasma homocysteine level and echocardiographic abnormalities as a surrogate of cardiac disease outcome in hemodialysis patients. 123 adult patients on maintenance hemodialysis and having echocardiography done during January till November 2006 were enrolled in this cross-sectional study. Plasma homocysteine level was directly related to the presence of aortic regurgitation r= 0.27 P= 0.009. There were negative correlations between ejection fraction (EF), left ventricular systolic dimension (LV.S) (r= - 0.71, P= 0.0001), left ventricular diastolic dimension (LV.D) (r= -0.23 p= 0.01) and age (r= - 0.021 P= 0.02). In conclusion we did not find the paradoxical reverse epidemiology in our patients and plasma total homocysteine level was in direct correlation with cardiac risk factors such as left ventricular mass index and aortic regurgitation. PMID:20814121

  19. Hyperhemocysteinemia and cardiovascular risks in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Sagheb Mohammad

    2010-01-01

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

  20. [Seroconversion and immune response after anti-HBV vaccination in patients on chronic hemodialysis: comparison of two vaccines].

    Science.gov (United States)

    Polito, Pasquale; Di Lullo, Luca; Iannacci, Giuseppe Roberto; Cecilia, Annalisa; Galderisi, Cristina; Gorini, Antonio

    2011-01-01

    ESRD patients on hemodialysis (HD) have a high risk of HBV infections. Primary prevention through vaccination is a first choice to reduce the morbidity from HBV. Prevention can be accomplished by two types of vaccines. The aim of this study was to evaluate the serological response to HBV vaccination in a population of HD patients who were randomized to Fendrix or Engerix B according to common administration protocols. Ninety-two HD patients were randomized to Fendrix or Engerix B immunization protocols. Patients in the Fendrix arm received four intramuscular administrations of 20 micron g, while patients in the Engerix arm received three intramuscular administrations of 40 micron g with an optional booster dose at two months from the last administration in nonresponders. The seroconversion rates were higher in the Fendrix group than the Engerix group, with faster responses, higher titers and longer duration of immune memory. Fendrix seems to be more effective than the older vaccine, Engerix, especially in patients at high infection risk like those making up our study population. Other crucial factors for good outcomes in patient immunization were biological and dialysis age. This underlines the importance of early immunization protocols such as already discussed by many nephrologists. PMID:22028266

  1. Trace Elements in Hemodialysis Patients: A Systematic Review and Meta-Analysis

    OpenAIRE

    Manns Braden; Field Catherine; Klarenbach Scott; Hemmelgarn Brenda; Wiebe Natasha; Tonelli Marcello; Thadhani Ravi; Gill John

    2009-01-01

    Abstract Background Hemodialysis patients are at risk for deficiency of essential trace elements and excess of toxic trace elements, both of which can affect health. We conducted a systematic review to summarize existing literature on trace element status in hemodialysis patients. Methods All studies which reported relevant data for chronic hemodialysis patients and a healthy control population were eligible, regardless of language or publication status. We included studies which measured at ...

  2. A randomized, double-blind, placebo-controlled, dose-ranging study using Genz-644470 and sevelamer carbonate in hyperphosphatemic chronic kidney disease patients on hemodialysis

    Directory of Open Access Journals (Sweden)

    Moustafa M

    2014-04-01

    phosphorus lowering per gram of binder compared with sevelamer carbonate. Overall tolerability was similar between active treatment groups. The tolerability of sevelamer carbonate was consistent with prior studies and with the established safety profile of sevelamer. Conclusion: Both Genz-644470 and sevelamer carbonate effectively lowered serum phosphate levels in a dose-dependent fashion in patients with chronic kidney disease on hemodialysis. However, Genz-644470 did not provide any advantage over sevelamer carbonate in phosphate lowering in vivo, as had been demonstrated in vitro. Keywords: sevelamer carbonate, clinical trial, serum phosphorus, hemodialysis

  3. Anterior ischemic optic neuropathy in patients undergoing hemodialysis

    NARCIS (Netherlands)

    DoorenbosBot, ACC; Geerlings, W; Houtman, IA

    1996-01-01

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

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

    NARCIS (Netherlands)

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

    2015-01-01

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

  5. Clinical study of cerebral infarction in hemodialysis patients

    International Nuclear Information System (INIS)

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

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

    Directory of Open Access Journals (Sweden)

    Raymond G Batchoun

    2011-01-01

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

  7. 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.

  8. 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.

  9. The Impact of Chronic Kidney Disease - Mineral and Bone Disorder on the Locomotor System and Quality of Life in Hemodialysis Patients

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    Mohamed FOUAD

    2015-12-01

    Full Text Available OBJECTIVE: Chronic kidney disease - mineral and bone disorder (CKD -BMD is a worldwide challenge in hemodialysis patients (HD. Widespread use and improved methods of HD may have changed the spectrum of locomotor system disorders in this population. Locomotor system disorders have an impact on health-related quality of life (QOL. The objective of this study was to assess the effect of CKD-BMD on the locomotor system (bone, joint, muscle, tendon and bursa and document the prevalence of locomotor system disorders in HD populations and its impact in QOL. MATERIAL and METHODS: 550 HD patients were enrolled in this study. Each HD patient received complete locomotor system examination and specific diagnostic investigation. iPTH level classified study population into three groups. Group 1. (149 patients iPTH level 300 pg/ mL, high turnover bone disease. Patients were offered a self-administered QOL questionnaire, which assessed various QOL variables. RESULTS: 75% of hemodialysis patients suffered from one or more locomotor system disorders and the commonest was bone pain 60%, followed by muscle cramps 36%, proximal muscle weakness 30%, osteoarthritis 25%, osteoporosis 16%, rotator cuff syndrome15%, gout pre-HD 12.5%, carpal tunnel syndrome 12%, bone fracture 7%, fibromyalgia 7%, tenosynovitis 6%, periarticular calcification 5%, Dupuytren’s contracture 2%, septic arthritis 0.9% and osteomyelitis 0.9%. The three studied groups were represented by 27%, 23% and 50% respectively. The prevalence of osteoarthritis, muscle cramps, bone pain, spontaneous bone fracture and osteoporosis were higher in the third group. 30% of our HD patients completed the QOL questionnaire without assistance and their mean functional status, psychological status, pain scale, fatigue scale, global assessment and joint count were 3.24±2.24, 3.13 ±1.67, 4.07 ±1.7, 4.95 ±1. 8, 3.97 ±1.55 and 9.65±9.95 respectively. QOL variables pronouncedly worsen in HD patients, however the

  10. 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...... disease stage 5....

  11. Index of dental risk for pretransplant renal hemodialysis patients

    OpenAIRE

    Maria Letícia de Moura Gonçalves Schwab PUPO; Gabriella Antunes PARIZOTO; Gonzaga, Carla Castiglia; Maria da Graça Kfouri LOPES

    2010-01-01

    Introduction: Patients with chronic renal failure (CRF) have lowimmunity due to the medicines they use, their clinical condition and the treatment itself. For this reason, any infection, including oral infections,present a higher risk for this group of patients. Objective: To develop and implement an index of dental risk according to the severity of the lesions present in the oral cavity of pretransplant hemodialysis patients. Material and methods: The most prevalent infectious processes in t...

  12. Myocardial Stunning with Hemodialysis: Clinical Challenges of the Cardiorenal Patient

    OpenAIRE

    Zuidema, Mozow Y.; Dellsperger, Kevin C.

    2012-01-01

    We discuss the current state of knowledge related to the pathogenesis of myocardial stunning as well as the potential mechanisms responsible for the clinical presentation of myocardial stunning in hemodialysis patients. We suggest future research areas for this critical and clinically important condition in this high-risk patient population. In consideration of acute and chronic changes secondary to dialysis, especially in patients with risk for coronary artery disease, the prevalence of myoc...

  13. Lower serum prohepcidin levels associated with lower iron and erythropoietin requirements in hemodialysis patients with chronic hepatitis C

    Directory of Open Access Journals (Sweden)

    Caliskan Yasar

    2012-07-01

    Full Text Available Abstract Background Patients with chronic HCV infection have increased liver iron. Recently identified protein hepcidin synthesized in the liver, is thought to be a key regulator for iron homeostasis and is induced by infection and inflammation. Lower erythropoietin and iron supplementation requirements were previously reported in HD patients with HCV infection. We investigated the association of prohepcidin with inflammation and iron parameters in HD patients with and without chronic HCV infection. Methods Sixty patients (27 male, 33 female, mean age 50 ±15 years on chronic HD were included. Parameters related to iron metabolism (ferritin, serum iron and total iron binding capacity (TIBC, inflammation (hs-CRP, TNF-α and IL-6 and prohepcidin levels were measured. The response to treatment (erythropoiesis-stimulating agent (ESA resistance index was assessed from the ratio of the weekly erythropoietin (rhuEPO dose to hemoglobin (Hb per unit weight. Results Serum prohepcidin levels of HCV positive patients (135 ± 25 ng/mL were significantly lower than HCV negative patients [148 ± 18 ng/mL, (p = 0.025]. Serum IL-6 levels of HCV positive patients were also significantly lower than HCV negative patients (p = 0.016. Serum prohepcidin levels were positively correlated with ferritin (r = 0.405, p = 0.001 and IL-6 (r = 0.271, p = 0.050 levels in HD patients. In the HCV positive group, serum prohepcidin levels significantly correlated with ferritin levels (r = 0.514 p = 0.004. In the HCV negative group, serum prohepcidin levels significantly correlated with serum IL-6 levels (r = 0.418, p = 0.027. In multiple regression analysis performed to predict prohepcidin in HCV positive patients, serum ferritin was found to be an independent variable (r = 0.28, p = 0.008. Conclusions HCV positive HD patients have low levels of serum prohepcidin and IL-6 which might account for iron accumulation

  14. 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

  15. Effect of aromatherapy on pruritus relief in hemodialysis patients

    OpenAIRE

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

    2010-01-01

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

  16. Does L-carnitine improve endothelial function in hemodialysis patients?

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    Mohammad Reza Sabri

    2012-01-01

    Full Text Available Background: Atherosclerosis is the leading cause of death in hemodialysis patients. These patients are also very prone to L-carnitine deficiency due to kidney disease. In this clinical trial, we investigated the effect of oral L-carnitine on endothelial function of these patients. Materials ans Methods : We studied 31 adult chronic hemodialysis patients in our center and divided them into two groups. The first group (n = 20 received 1500 mg/dialysis interval (every other day oral L-carnitine. The control group (n = 11 received placebo for one month. Ultrasonographic measurements of flow mediated dilation and carotid intima-media thickness were performed before and after one month of L-carnitine and placebo therapy. Results: This study showed that after one month of L-carnitine or placebo therapy there was no significant improvement in flow mediated dilation (p = 0.80 and p = 0.59, respectively or decrease in carotid intima-media thickness (p = 0.12 and p = 0.50, respectively. Conclusions: Our study revealed that one month of oral L-carnitine therapy did not improve endothelial function in hemodialysis patients. Long-term studies with large sample size using intravenous form and higher doses of the drug are required to clarify the questionable role of L-carnitine in hemodialysis patients.

  17. 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.

  18. The association of uremic toxins and inflammation in hemodialysis patients.

    Directory of Open Access Journals (Sweden)

    Heng-Jung Hsu

    Full Text Available Cardiovascular disease is the leading cause of mortality in hemodialysis patients and is associated with chronic inflammation. Elevation of uremic toxins, particular protein-bound uremic toxins, is a possible cause of hyper-inflammation in hemodialysis patients. But the association between uremic toxins and inflammatory markers in hemodialysis is still unclear.We conducted a cross-sectional study to evaluate the association of the serum uremic toxins and inflammatory markers in hemodialysis patients.The uremic toxins were not associated with inflammatory markers--including high sensitivity C-reactive protein, IL(Interleukin -1β, IL-6, tumor necrosis factor-α. In multiple linear regression, serum levels of total p-cresol sulfate (PCS were independently significantly associated with serum total indoxyl sulfate (IS (standardized coefficient: 0.274, p<0.001, and co-morbidity of diabetes mellitus (DM (standardized coefficient: 0.342, p<0.001 and coronary artery disease (CAD (standardized coefficient: 0.128, p = 0.043. The serum total PCS levels in hemodialysis with co-morbidity of DM and CAD were significantly higher than those without co-morbidity of DM and CAD (34.10±23.44 vs. 16.36±13.06 mg/L, p<0.001. Serum levels of total IS was independently significantly associated with serum creatinine (standardized coefficient: 0.285, p<0.001, total PCS (standardized coefficient: 0.239, p = 0.001, and synthetic membrane dialysis (standardized coefficient: 0.139, p = 0.046.The study showed that serum levels of total PCS and IS were not associated with pro-inflammatory markers in hemodialysis patients. Besides, serum levels of total PCS were independently positively significantly associated with co-morbidity of CAD and DM.

  19. 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.

  20. Staphylococcus aureus bacteremia in hemodialysis patients.

    Science.gov (United States)

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

    1977-01-01

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

  1. Quality of Sleep and its Relationship to Quality of Life in Hemodialysis Patients

    OpenAIRE

    Kobra Parvan; Sima lakdizaji; Fariborz Roshangar; Mahtab Mostofi

    2013-01-01

    Introduction: Despite many advances in the treatment of chronic renal failure, the quality of sleep in patients who suffer from this disease is at the risk. The high prevalence of sleep disorders in hemodialysis patients, which is concomitant with physical, behavioral, and psychological problems, has always affected these patients' quality of life (QOL). This study aimed to determine the relationship between quality of sleep and quality of life in hemodialysis patients. Meth...

  2. Video-assisted thoracoscopic lobectomy for non-small cell lung cancer: a morbidity limiting approach in a patient on chronic hemodialysis and double agent antiplatelet therapy.

    Science.gov (United States)

    Caroli, Guido; Dolci, Giampiero; Dell'Amore, Andrea; Asadi, Nizar; Greco, Domenico; Chadi, Ammari; Bini, Alessandro; Stella, Franco

    2015-03-01

    Patients with end-stage renal disease on hemodialysis undergoing surgery for lung cancer represent a high-risk group because of electrolyte imbalance, anemia, hemodynamic instability, bleeding tendency, and immunocompromised state. We describe a patient on hemodialysis with three lung adenocarcinoma of the right lower lobe as an incidental finding during the clinical course of a myocardial infarction treated with drug-eluting stent implantation and double-agent antiplatelet therapy. Considering patient comorbidities, we decided to perform a right lower lobectomy and complete lymph node dissection by a minimally invasive technique. In our experience, the thoracoscopic approach allowed us to perform lobectomy with complete lymph nodes dissection without morbidity. The use of ultrasound scalpel permits a complete lymph node dissection minimizing bleeding even in a double antiplatelet therapy patient. PMID:23884666

  3. 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; Meyer-Hofmann, Helmut; Bacevicius, Egidijus; Lauridsen, Thomas Guldager; Madsen, Jens Kristian; Tougaard, Birgitte G; Marckmann, Peter; Thye-Roenn, Peter; Nielsen, Jørgen Erik; Kreiner, Svend; Brandi, Lisbet

    2011-01-01

    clinical trial, we originally intended two crossover study periods with a washout interval in 86 chronic hemodialysis patients. These patients received increasing intravenous doses of either alfacalcidol or paricalcitol for 16 weeks, until parathyroid hormone was adequately suppressed or calcium or...... were equally effective in the suppression of secondary hyperparathyroidism in hemodialysis patients while calcium and phosphorus were kept in the desired range...

  4. Perceived illness intrusion among patients on hemodialysis

    International Nuclear Information System (INIS)

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

  5. Perceived illness intrusion among patients on hemodialysis

    Directory of Open Access Journals (Sweden)

    Bapat Usha

    2009-01-01

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

  6. Survival analysis of patients on maintenance hemodialysis.

    Science.gov (United States)

    Chandrashekar, A; Ramakrishnan, S; Rangarajan, D

    2014-07-01

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

  7. Prevalence of Secondary Hyper Parathyroidism in Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    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.

  8. Successful medical treatment of emphysematous pyelonephritis in chronic hemodialysis.

    Science.gov (United States)

    Vlachopanos, Georgios; Kassimatis, Theodoros; Zerva, Adamantia; Kokkona, Anastasia; Stavroulaki, Eirini; Zacharogiannis, Charilaos; Agrafiotis, Athanasios

    2015-10-01

    Emphysematous pyelonephritis (EPN) is a life-threatening renal infection caused by gas-producing bacteria and fungi. It usually occurs in patients with diabetes and patients with urinary tract obstruction. A combination of systemic antibiotics, percutaneous catheter drainage, or open nephrectomy is typically required to achieve cure. Because of grim prognosis, resorting to interventional methods is frequently inevitable. We report the case of a 77-year-old woman with diabetes and end-stage renal disease on chronic hemodialysis that presented with fever and left flank pain. A bubbly gas pattern inside the left kidney was demonstrated on abdominal computed tomography scan and blood cultures grew Escherichia coli. She was successfully treated solely with systemic antibiotics. This highlights the fact that prompt recognition of imaging findings associated with benign prognosis is essential for a favorable outcome. It allows for an effective management avoiding high-risk interventions, especially in frail patients with multiple comorbidities. Finally, we review all published cases of EPN in chronic dialysis patients. PMID:25643771

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

    OpenAIRE

    Kawate, Susumu; Takeyoshi, Izumi; Morishita, Yasuo

    2006-01-01

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

  10. Radiology of the kidneys in patients under maintenance hemodialysis

    International Nuclear Information System (INIS)

    The kidneys of patients with chronic renal failure undergoing maintenance hemodialysis may show different variances or complications. Most common are secondarily acquired renal cysts, which my be found in as many as 92% of patients after 8 years of hemodialysis. Single (in 12.5% of patients) or multiple (8.3%) cysts with bleeding are common; additionally, hematuria or ruptured cysts may be found. Bleeding into cysts is more common in patients with autosomal dominant polycystic kidney disease. Due to the decreasing urinary production development of kidney stones is very uncommon, but calcification in or around cysts can be found in 71% of patients. Kidney tumors occur 41 times more often in patients with chronic renal failure than in patients without kidney disease. We detected tumors in 4.2% of our patients on long-term dialysis. Diagnostic differentiation of the relatively slow growing and fairly late metastasizing malignant tumors from adenomas is not possible. Nevertheless, we screen our patients every 3-4 years. Computed tomography is superior to ultrasonography for this purpose, because ultrasonography lacks the necessary sensitivity in this group of patients. (orig.)

  11. Restless legs syndrome in hemodialysis patients in Iran.

    Science.gov (United States)

    Rohani, Mohammad; Aghaei, Mahbubeh; Jenabi, Arya; Yazdanfar, Sharare; Mousavi, Delaram; Miri, Shahnaz

    2015-05-01

    Restless legs syndrome (RLS) is a common sleep disorder that can present secondary to medical conditions such as renal failure. This study aimed to evaluate RLS frequency and its related factors in chronic renal failure patients treated with hemodialysis. In a cross-sectional design, 163 patients with chronic renal failure were consecutively enrolled from hemodialysis center at Rasool-Akram hospital. Demographics, clinical and laboratory data were recorded. Patients were screened for presence and severity of RLS according to the four International Restless Legs Syndrome Group (IRLSSG) diagnostic criteria and severity scale. Patients with and without RLS were compared using SPSS statistical software (Version 16.0). Sixty-one patients (37.4 %) were diagnosed with RLS. Mean age in RLS group was significantly higher (65.2 ± 9.3 years) than RLS-negative group (59.0 ± 14.7 years; P = 0.004). Serum creatinine level was significantly higher in patients with RLS (7.6 ± 2.1 mg/dl vs. 6.7 ± 1.8 mg/dl; P = 0.009). Glomerular filtration rate in RLS patients was lower than other patients (9.2 ± 3.1 ccs/min vs. 11.6 ± 4.8 ccs/min; P = 0.0001). Patients with RLS had shorter sleep duration, and higher incidence of insomnia, daytime sleepiness, and sedative-hypnotic medication usage (P < 0.05). There was no significant difference between RLS-positive and RLS-negative patients in terms of renal failure pathology, dialysis frequency per week, dose of dialysis, duration of dialysis, renal transplantation, and history of diabetes and hypertension. Hemodialysis patients have a high prevalence of RLS which deserves special attention and specific treatment. PMID:25471049

  12. Melatonin improves sleep quality in hemodialysis patients

    OpenAIRE

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

    2013-01-01

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

  13. Periodontal status in patients undergoing hemodialysis

    OpenAIRE

    Parkar, S. M.; C G Ajithkrishnan

    2012-01-01

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

  14. Uremic Neuropathy: Epiemiological Study in Hemodialysis Patients

    OpenAIRE

    Ricci, Davide

    2012-01-01

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

  15. "Quality of life in hemodialysis patients "

    OpenAIRE

    Nabaie B; Shahidzadeh A; Dabiran S

    2001-01-01

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

  16. Effect of acupressure on fatigue in patients on hemodialysis

    OpenAIRE

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

    2013-01-01

    Background: Fatigue is considered as a major problem in hemodialysis patients and can impair their quality of life. The purpose of this study was to investigate the effectiveness of acupressure on fatigue in hemodialysis patients. Materials and Methods: This is a clinical trial study in which 96 hemodialysis patients participated. Patients were randomly assigned into acupressure, placebo, and control groups (32 subjects fulfilling the inclusion criteria assigned to each group). The measures i...

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

    OpenAIRE

    El-Nakib GA; Mostafa TM; Abbas TM; El-Shishtawy MM; Mabrouk MM; Sobh MA

    2013-01-01

    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 eff...

  18. 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

    , 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...

  19. Analysis of the Effect of Music on the Complication of Hemodialysis in Patients with Chronic Renal Failure%音乐对慢性肾衰患者血透并发症的效果研究

    Institute of Scientific and Technical Information of China (English)

    蔡影

    2015-01-01

    Objective To investigate the ef ect of music on the complications of hemodialysis in patients with chronic renal failure.Methods In September 2014 suf ering from chronic renal failure (CRF)of 60 patients with hemodialysis,were randomly divided to observation group and control group.Observe the beginning of the group in the hemodialysis process of the 3 hours to 30 minutes of music,while control group was not given.The use of questionnaire and visual analog scale to assess the patient's blood dialysis process pain,nausea,vomiting,cramps.Results The pain and nausea scores in the observation group were lower than those in the control group, the dif erence was statistical y significant ( <0.05).Conclusion Music can reduce the complications of hemodialysis in patients with chronic renal failure.%目的:探讨音乐对慢性肾衰患者血液透析过程中并发症的效果。方法选取2014年6月~9月患慢性肾衰的进行血液透析的患者60例,随机分为对照组和观察组,观察组在血液透析过程中的第3h开始时听30min音乐,对照组不给予。使用调查表和视觉模拟评分法评估患者血液透析过程中疼痛、恶心、呕吐、痉挛。结果观察组疼痛和恶心得分均低于对照组,差异有统计学意义(<0.05)。结论音乐可以减少慢性肾衰患者的血液透析中的并发症。

  20. 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. PMID:26193237

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

    Directory of Open Access Journals (Sweden)

    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.

  2. 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.

  3. 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.

  4. Antierythropoietin Antibodies in Hemodialysis Patients Treated with Recombinant Erythropoietin

    Directory of Open Access Journals (Sweden)

    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.

  5. "Quality of life in hemodialysis patients "

    Directory of Open Access Journals (Sweden)

    Nabaie B

    2001-06-01

    Full Text Available To determine quality of life and various factors affecting it , we conducted a cross-sectional survery among 103 hemodialysis patients in four teaching hospitals of Tehran University of Medical Sciences.A quality of life questionnaire (QLQ. Containing various items relating to physical, psychological and social aspects of life was filled by interviewing each patient and a total score ranging from 70 to 300 was assigned to denote overall life quality. We also determined the most common underlying renal diseases and comorbid conditions in these patients.The most common underlying renal diseases were found to be primary glomeruloarteriolar disease, interstitial disease, diabetes mellitus and essential hypertension. Common comorbid conditions in this study were musculoskeletal diseases (osteoarhritis, spinal disorders, gastrointestinal, cardjovascular and endocrine problems. Moreover, restricted social life, financial difficulties, loss of independence and family/marital strain emerged as major psychosocial problems affecting the lives of our patients.The percentage of patients who had reached a satisfactory level of adaptation with dialysis therapy (46% was distinctly lower than that reported from the United States. Advanced age and the presence of comorbid diseases were found to have a negative impact on the patients’ life quality, while a psositive association was recorded between quality of life and longer duration of dialysis treatment.Overall, these findings indicate a significant degree of psychosocial impairment in our patients and emphasize the importance of providing effective counseling and rehabiliation services to hemodialysis patients

  6. Trace elements in hemodialysis patients: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Manns Braden

    2009-05-01

    Full Text Available Abstract Background Hemodialysis patients are at risk for deficiency of essential trace elements and excess of toxic trace elements, both of which can affect health. We conducted a systematic review to summarize existing literature on trace element status in hemodialysis patients. Methods All studies which reported relevant data for chronic hemodialysis patients and a healthy control population were eligible, regardless of language or publication status. We included studies which measured at least one of the following elements in whole blood, serum, or plasma: antimony, arsenic, boron, cadmium, chromium, cobalt, copper, fluorine, iodine, lead, manganese, mercury, molybdenum, nickel, selenium, tellurium, thallium, vanadium, and zinc. We calculated differences between hemodialysis patients and controls using the differences in mean trace element level, divided by the pooled standard deviation. Results We identified 128 eligible studies. Available data suggested that levels of cadmium, chromium, copper, lead, and vanadium were higher and that levels of selenium, zinc and manganese were lower in hemodialysis patients, compared with controls. Pooled standard mean differences exceeded 0.8 standard deviation units (a large difference higher than controls for cadmium, chromium, vanadium, and lower than controls for selenium, zinc, and manganese. No studies reported data on antimony, iodine, tellurium, and thallium concentrations. Conclusion Average blood levels of biologically important trace elements were substantially different in hemodialysis patients, compared with healthy controls. Since both deficiency and excess of trace elements are potentially harmful yet amenable to therapy, the hypothesis that trace element status influences the risk of adverse clinical outcomes is worthy of investigation.

  7. Burden and quality of life of caregivers for hemodialysis patients.

    Science.gov (United States)

    Belasco, Angelica G; Sesso, Ricardo

    2002-04-01

    The aim of this study is to describe the characteristics of caregivers of chronic hemodialysis patients, assess their perceived burden and health-related quality of life, and investigate factors influencing this burden. We studied 100 hemodialysis patients and their respective primary caregivers for more than 4 months, measuring quality of life by the Medical Outcomes Survey 36-Item Short-Form Health Survey (SF-36). Subjective burden on caregivers was assessed by the Caregiver Burden scale (score range, 1 to 4; higher values indicate a greater effect). The majority of caregivers were women (84%), married (66%), with a mean age of 46 +/- 2 (SE) years, and of low socioeconomic level. Their main types of relationship with patients were wives (38%) and sons or daughters (27%). Caregiver Mental Health and Vitality were the most affected emotional dimensions on the SF-36 (mean scores, 64.4 +/- 1.8 and 66.6 +/- 1.7, respectively). Mean score of total burden experienced was 2.07 +/- 0.05. Multiple regression analysis showed that independent and significant predictors of burden were Mental Health of the caregiver (R2 = 24%), Vitality of the patient (R2 = 10%), type of relationship of the caregiver (female spouse) (R2 = 5%), and Pain of the caregiver (R2 = 3%). Caregivers of hemodialysis patients may experience a significant burden and an adverse effect on their quality of life. Emotional aspects of caregivers (particularly female spouses) and patients are important predictors of burden. Social support and psychological interventions should be considered to improve caregiver life and patient outcomes. PMID:11920347

  8. Restless legs syndrome in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  10. Coping strategies and socio-demographic characteristics among Jordanian caregivers of patients receiving hemodialysis

    OpenAIRE

    Eman Alnazly

    2016-01-01

    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...

  11. Pro-calcitonin and inflammation in chronic hemodialysis

    Directory of Open Access Journals (Sweden)

    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.

  12. Comparison of Intradialytic Parenteral Nutrition with Glucose or Amino Acid Mixtures in Maintenance Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Yan Liu

    2016-06-01

    Full Text Available Many long-term maintenance hemodialysis patients have symptoms of protein-energy wasting caused by malnutrition. Each session of hemodialysis removes about 10 to 12 g of amino acids and 200 to 480 kcal of energy. Patients receiving hemodialysis for chronic kidney disease may be undernourished for energy, protein consumption, or both. Non-diabetic hemodialysis patients were randomized to three treatment groups: oral supplementation, oral supplementation plus high-concentration glucose solution (250 mL containing 50% glucose and these two interventions plus 8.5% amino acids solution. The post-treatment energy status of the glucose group was significantly higher than its baseline level, whereas the control group’s status was significantly lower. The glucose group had significantly higher concentrations of asparagine, glutamine, glycine, alanine, and lysine after treatment. All treatment groups had significantly increased hemoglobin levels but significantly decreased transferrin levels after treatment compared to baseline. After treatment, the amino acid group had significantly higher albumin level compared to the glucose group (p = 0.001 and significantly higher prealbumin level compared to the control group (p = 0.017. In conclusion, long-term intervention with high-concentration glucose solution at each hemodialysis session is a simple and cheap method that replenished energy stores lost during hemodialysis of non-diabetic patients.

  13. 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...... by aerobic capacity, '2-min stair climbing', 'squat test', self-rated health (SF36), blood pressure and lipids. All tests were carried out by blinded testers. The intervention consisted of 1 h of physical exercise twice a week for 5 months. RESULTS: 20 patients completed the intervention. Attendance was 74......: Physical exercise twice a week for 5 months increases physical function and aerobic capacity in HD patients. An exercise program with only two exercise sessions per week seems easy to implement in clinical practice with high attendance among participants. Further investigation is needed to determine...

  14. 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.

  15. 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

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

    OpenAIRE

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

    2007-01-01

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

  17. 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.

  18. Effects of a six-month intradialytic physical ACTIvity program and adequate NUTritional support on protein-energy wasting, physical functioning and quality of life in chronic hemodialysis patients: ACTINUT study protocol for a randomised controlled trial

    OpenAIRE

    Magnard, Justine; Deschamps, Thibault; Cornu, Christophe; Paris, Anne; Hristea, Dan

    2013-01-01

    Background Protein-energy wasting (PEW) is common in hemodialysis patients and is a powerful predictor of morbidity and mortality. Although much progress has been made in recent years in identifying the causes and pathogenesis of PEW in hemodialysis patients, actual management by nutritional interventions is not always able to correct PEW. Some investigators suggest that physical exercise may increase the anabolic effects of nutritional interventions, and therefore may have a potential to rev...

  19. Mechanism of Prominent Trimethylamine Oxide (TMAO Accumulation in Hemodialysis Patients.

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    Xin Hai

    Full Text Available Large size, protein binding and intracellular sequestration are well known to limit dialytic removal of compounds. In studying the normal renal and dialytic handling of trimethylamine oxide (TMAO, a molecule associated with cardiovascular disease in the general population, we discovered two largely unrecognized additional limitations to sustained reduction of a solute by chronic hemodialysis. We measured solute levels and handling in subjects on chronic hemodialysis (ESRD, n = 7 and compared these with levels and clearance in normal controls (NLS, n = 6. The ESRD patients had much higher peak predialysis plasma levels of TMAO than NLS (77 ± 26 vs 2±1 μM, mean ± SD, p0.05. However, TMAO has a volume of distribution about one half that of urea. Also in NLS the urinary clearance of TMAO was high (219±78 ml/min compared to the urinary urea and creatinine clearances (55±14 and 119±21 ml/min, respectively. Thus, TMAO levels achieve multiples of normal much greater than those of urea due mainly to 1 TMAO's high clearance by the normal kidney relative to urea and 2 its smaller volume of distribution. Modelling suggests that only much more frequent dialysis would be required to lower levels Thus, additional strategies such as reducing production should be explored. Furthermore, using urea as the sole marker of dialysis adequacy may be misleading since a molecule, TMAO, that is dialyzed readily accumulates to much higher multiples of normal with urea based dialysis prescriptions.

  20. 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.

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

    OpenAIRE

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

    2016-01-01

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

  2. 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. PMID:27399824

  3. 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.

  4. 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...

  5. Index of dental risk for pretransplant renal hemodialysis patients

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    Maria Letícia de Moura Gonçalves Schwab PUPO

    2010-03-01

    Full Text Available Introduction: Patients with chronic renal failure (CRF have lowimmunity due to the medicines they use, their clinical condition and the treatment itself. For this reason, any infection, including oral infections,present a higher risk for this group of patients. Objective: To develop and implement an index of dental risk according to the severity of the lesions present in the oral cavity of pretransplant hemodialysis patients. Material and methods: The most prevalent infectious processes in the oral cavity were classified according to their severity, and an index of dental risk was developed for pretransplant renal patients. Thirteen patients of the Pro-Renal Foundation of Curitiba were selected and submitted to clinical and radiographic examination for the determination of the index of dental risk proposed in this study. Results: According to the pathologies diagnosed, the index of dental risk of the patientscan be classified as low, medium or high, which indicates the need fordental treatment prior to renal transplantation. 38% of the 13 patients submitted to clinical and radiographic examination were classified as high-risk patients. Conclusion: This index may present great value to health professionals in the evaluation, treatment and control of the oral health conditions of chronic renal failure patients.

  6. 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.

  7. 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…

  8. 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

  9. 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.

  10. 延续护理在慢性肾衰竭患者血液透析中的应用%Application on transitional care in hemodialysis of chronic renal failure patients

    Institute of Scientific and Technical Information of China (English)

    蔡晓燕; 潘蓉; 刘玉玲

    2013-01-01

    Objective To study the application effect of transitional care in hemodialysis of chronic renal failure patients. Methods 45 patients with chronic renal failure were treated by transitional care in the process of hemodialysis, and follow—upping the self care ability, level attained of disease's knowledge and changes of each index. Results There were significant difference in inurine, blood urea nitrogen, serum creatinine, systolic blood pressure in 24 h, 1 month, 3 months after patients leave hospital (P 0.05). There were significant differences in the self nursing competencies of patients between different times (P < 0.01). Conclusion Transitional care can improve the self—care ability of chronic renal failure, and promote the health of patients. It is worthy in clinical promotion and application.%目的 探讨延续性护理在慢性肾衰竭患者血液透析中的应用效果.方法 对我院收治的45例慢性肾衰竭血液透析患者采用延续护理,并对患者的自我护理能力、疾病知识的掌握情况和各指标的变化情况进行随访.结果 患者出院24 h、1个月、3个月时尿量、血肌酐、尿素氮、收缩压的比较,差异有统计学意义(P < 0.05);舒张压比较差异无统计学意义(P > 0.05).患者不同时段的自我护理能力测定情况比较,差异均有高度统计学意义(均P < 0.01).结论 延续护理可提高慢性肾衰竭患者的护理自理能力,促进患者的健康,值得临床推广应用.

  11. 维持性血液透析患者慢性疼痛的研究进展%Progress in study of chronic pain in maintenance hemodialysis patients

    Institute of Scientific and Technical Information of China (English)

    杨新华; 祝胜郎

    2011-01-01

    维持性血液透析(MHD)是终末期肾脏病(ESRD)患者维持生命的一种常用治疗方法,慢性疼痛是MHD患者常见的症状.本文就MHD患者慢性疼痛的流行病学及病因、评估方法、对MHD患者生活质量的影响以及慢性疼痛的管理和治疗方面的研究进展做一综述.%Maintenance hemodialysis (MHD) is commonly used in treatment of patients with the end-stage renal diseases (ESRD). Chronic pain is a common symptom in MHD patients. Through summarizing relative literatures in recent years, the paper expounds the progress in study of epidemiology and cause, the assessment methods, the effects on quality of life, and management and treatment of chronic pain in MHD patients.

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

    OpenAIRE

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

    2015-01-01

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

  13. Previous PICC Placement May Be Associated With Catheter-Related Infections in Hemodialysis Patients

    International Nuclear Information System (INIS)

    Background: Catheter-related infections (CRIs) are a significant source of morbidity and mortality in hemodialysis patients. The identification of novel, modifiable risk factors for CRIs may lead to improved outcomes in this population. Peripherally inserted central catheters (PICCs) have been hypothesized to compromise vascular access due to vascular damage and venous thrombosis, whereas venous thrombosis has been linked to the development of CRIs. Here we examine the association between PICC placement and CRIs. Methods: A retrospective review was performed of all chronic hemodialysis catheter placements and exchanges performed at a large university hospital from September 2003 to September 2008. History of PICC line use was determined by examining hospital radiologic records from December 1993 to September 2008. Catheter-related complications were assessed and correlated with PICC line history. Results: One hundred eighty-five patients with 713 chronic tunneled hemodialysis catheter placements were identified. Thirty-eight of those patients (20.5%) had a history of PICC placement; these patients were more likely to have CRIs (odds ratio = 2.46, 95% confidence interval = 1.71–3.53, p < .001) compared with patients without a history of PICC placement. There was no difference between the two groups in age or number of catheters placed. Conclusion: Previous PICC placement may be associated with catheter-related infections in hemodialysis patients.

  14. Comparison of the Complications of Central Vein Catheters and Arterio-Venous Fistulae in Children on Chronic Hemodialysis

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    F Ghane Sherbaf

    2006-08-01

    Full Text Available Background: Complications related to vascular access are among the most important causes of morbidity in children chronically on hemodialysis. This study was designed to determine the prevalence of the central vein catheters (CVC and arterio-venous fistulae (AVF in children on chronic hemodialysis. Methods: This study includes 68 children who have been treated with hemodialysis in Dr. Sheikh Hospital, Mashhad, Iran, during 2000-2005. Physical examination, clinical and paraclinical findings were recorded in special charts. Findings: Out of 68 patients treated with hemodialysis 29 (42.6% were female and 39 (57.3% male. The average duration time of hemodialysis was 15.8 months. Before performing AVF, the central venous catheters were placed in subclavian vein in 28 patients (41.1% and internal jugular vein in 26 patients (38.2%. The fistula placed was radio-cephalic in 29 (42.6% and brachio-basilic in 33 children (48.5%. 48 patients (77.4% underwent only one surgery for AVF. The most frequent complications of central venous catheters were: catheter infection (48.1%, inadvertent extraction of the catheters (7.4%, cardiac arrhythmia (1.8% and hemothorax (1.8%. The most common complications of AVF in decreasing order of frequency were: non-functional fistula due to thrombosis or hematoma (20.9%, infection (12.9%, aneurysms (11.2% and ischemia of the hand presenting as paresthesia, dysesthesia and pain (11.2%. Overall, 10 (18.5% patients were hospitalized due to the complications of CVC and 20 (29.4% for the complications of AVF. Conclusion: The most frequently observed complications of CVC and AVF were catheter infection and non-functional fistula. The risk factors for AVF dysfunction were young age, hypotension and hemodialysis without administration of heparin.

  15. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  17. Skin Perfusion Pressure Is a Prognostic Factor in Hemodialysis Patients

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    Shingo Hatakeyama

    2012-01-01

    Full Text Available Peripheral arterial disease (PAD is common in hemodialysis patients and predicts a poor prognosis. We conducted a prospective cohort study to identify risk factors for PAD including skin perfusion pressure (SPP in hemodialysis patients. The cohort included 373 hemodialysis patients among 548 patients who received hemodialysis at Oyokyo Kidney Research Institute, Hirosaki, Japan from August 2008 to December 2010. The endpoints were lower limb survival (peripheral angioplasty or amputation events and overall survival of 2 years. Our results showed that <70 mmHg SPP was a poor prognosis for the lower limb survival and overall survival. We also identified age, history of cardiovascular disease, presence of diabetes mellitus, smoking history, and SPP < 70 mmHg as independent risk factors for lower limb survival and overall survival. Then, we constructed risk criteria using the significantly independent risk factors. We can clearly stratify lower limb survival and overall survival of the hemodialysis patients into 3 groups. Although the observation period is short, we conclude that SPP value has the potential to be a risk factor that predicts both lower limb survival and the prognosis of hemodialysis patients.

  18. 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

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    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

  19. 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.

  20. Pulmonary Hypertension in Hemodialysis Patients Following Repeated Endovascular Thrombectomy

    Science.gov (United States)

    Hsieh, Mu-Yang; Lin, Lin; Chen, Tsung-Yan; Wang, Ren-Huei; Huang, Su-Chin; Liu, HsiuChiao; Lai, Chao-Lun; Pu, Shih-Yen; Tsai, Kuei-Chin; Wu, Chih-Cheng

    2016-01-01

    Background The prevalence of pulmonary hypertension is unusually high in Taiwanese patients with end-stage renal disease. Thrombosis of hemodialysis grafts is common and pulmonary embolism has been reported after endovascular thrombectomy. The aim of this study was to evaluate the relationship between pulmonary hypertension and endovascular thrombectomy of hemodialysis grafts. Methods One hundred and ten patients on hemodialysis via arteriovenous grafts were enrolled in our study. The mean pulmonary artery pressure (PAP) was measured by right heart catheterization. Clinical information was collected by review of medical records. Comorbid cardiopulmonary disease was evaluated by echocardiography and chest X-ray. The history of patient vascular access thrombosis was reviewed from database, hemodialysis records, and interviews with staff at hemodialysis centers. Results Fifty-two participants (47%) had pulmonary hypertension diagnosed by right heart catheterization. There was no difference in the number of thrombectomy procedures between patients with and without pulmonary hypertension. Based on multivariate analysis, the number of prior endovascular thrombectomy procedures did not correlate with mean PAP (F-value = 1.10, p = 0.30) nor was it associated with pulmonary hypertension (odds ratio = 0.92, p = 0.17). Conclusions Prior endovascular arteriovenous graft thrombectomies were not associated with pulmonary hypertension or increased mean PAP in end-stage renal disease patients on maintenance hemodialysis.

  1. 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; Tepel, Martin

    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 plus λ immunoglobulin light chains were significantly higher compared with nonsurvivors (p <0.05). Survival was significantly longer in those patients who had serum levels of free κ plus λ immunoglobulin light chains above the median compared with patients with serum levels below the median of...

  2. Quality of Sleep and its Relationship to Quality of Life in Hemodialysis Patients

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    Kobra Parvan

    2013-11-01

    Full Text Available Introduction: Despite many advances in the treatment of chronic renal failure, the quality of sleep in patients who suffer from this disease is at the risk. The high prevalence of sleep disorders in hemodialysis patients, which is concomitant with physical, behavioral, and psychological problems, has always affected these patients’ quality of life (QOL. This study aimed to determine the relationship between quality of sleep and quality of life in hemodialysis patients. Methods: By using a descriptive and correlational design, this study was conducted on 245 hemodialysis patients in 2012. Patients were selected by convenience sampling from the hemodialysis ward of four training hospitals of Tabriz and Maragheh. Quality of sleep was measured by the Pittsburgh Sleep Quality Index (PSQI, and the quality of life for patients was measured by the Kidney Disease Quality Of Life questionnaire (KDQOL-SF. Results: 83.3% of hemodialysis patients had poor quality of sleep. Poor quality of life was significantly associated with poor quality of sleep. There was a significant negative correlation between global PSQI and important aspects of quality of life including physical health, symptoms and problems, the impact of kidney disease on daily life, burden of kidney disease, mental health, social support, and sexual function. Conclusion: The low quality of sleep in hemodialysis patients has an effect on the deterioration of their quality of life. Therefore, training, counseling, and advocacy programs should be developed to improve the patients’ quality of sleep and quality of life, especially those with lower education level and income, and older people.

  3. 长期血液透析患者抑郁症相关因素分析%Analysis on related factors of depression in chronic hemodialysis patients

    Institute of Scientific and Technical Information of China (English)

    张敬锋; 郭明

    2013-01-01

    目的 探讨长期血液透析患者抑郁症的相关社会经济因素.方法 收集2008年12月至2009年2月北京东方医院、望京医院透析时间超过3个月、维持血液透析患者122例,按患者病情分为抑郁症组41例、非抑郁症组81例,采用问卷调查的方式,从经济状况、文化程度、社会交往情况、兴趣爱好、调查期间抽烟与否等方面,分析抑郁症的相关因素.结果 ①与非抑郁证组比较,抑郁证组患者的经济状况、社会交往、文化程度、兴趣爱好等均不同,差异有统计学意义(x2值分别为14.671、6.256、6.744、6.390,P均<0.05).②与非抑郁证组比较,抑郁证组的性别、喝酒与否、家庭关系、职业、住房条件、社会地位、出生季节、照料人等方面差异无统计学意义(x2值分别为3.651、0.765、2.034、3.093、0.772、5.956、2.687、5.138,P>0.05).结论 经济条件较差、文化程度低、社交活动较少、兴趣爱好少、不吸烟的血液透析患者易患抑郁症.%Objective To explore the social economic factors related to depressive in patients with long-term hemodialysis.Methods A total of 122 patients with hemodialysis for more than 3 months from December 1st 2008 to February 1st 2009 in Dongfang Hospital and Wangjin Hospital,were divided into a depression group (41 cases) and a non-depressed group (81 cases).Informations such as economic status,social interaction,education,hobbies,etc were collected by questionnaire and the relationship between these factors and depression was analyzed.Results There was significant difference between the two groups in the factors of economic status,social interaction,education,and hobbies (x2 values were 14.671 、6.256、6.744、6.390,P<0.05).There was no significant difference in the factors of gender,drinking,relationship of family,profession,the condition of housing,social status,seasons of born,and careers,etc (x2 values were 3.651、0.765、2.034、3.093、0.772

  4. 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.

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

    Directory of Open Access Journals (Sweden)

    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

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

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    Cláudia Maria Pereira Alves

    2010-06-01

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

  7. HBV-DNA in hemodialysis patients infected by HCV

    International Nuclear Information System (INIS)

    End-stage renal disease patients on chronic hemodialysis (HD) patients are at risk for both hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, and they may coexist. To determine the prevalence and clinical impact of HBV and HCV infection, we studied poly chain reaction (PCR) and reverse transcription (RT)-PCR on the blood samples of 90 HD patients in Kerman, Iran. ELISA test was used to detect anti-HBc, anti-HBs and HBs Ag. We found that 30 out of 90 (33.3%) patients were PCR-RT-PCR positive for HCV-RNA. No HBV-DNA (0%) was detected through the PCR study in both positive and negative HCV-RNA patient groups. Though none of the samples was HBsAg positive, 10 (33.3%) HCV-RNA positive patients were anti-HBc positive, and 12 (40.7%) were anti-HBs positive. We conclude that prevalence of hepatitis C infection is high in HD patients in our region, but not associated with active HBV infection. (author)

  8. HBV-DNA in hemodialysis patients infected by HCV

    Directory of Open Access Journals (Sweden)

    Arababadi Mohammad

    2009-01-01

    Full Text Available End-stage renal disease patients on chronic hemodialysis (HD patients are at risk for both hepatitis B virus (HBV and hepatitis C virus (HCV infection, and they may coexist. To de-termine the prevalence and clinical impact of HBV and HCV infection, we studied poly chain reaction (PCR and reverse transcription (RT-PCR on the blood samples of 90 HD patients in Kerman, Iran. ELISA test was used to detect anti-HBc, anti-HBs and HBsAg. We found that 30 out of 90 (33.3% patients were PCR-RT-PCR positive for HCV-RNA. No HBV-DNA (0% was detected through the PCR study in both positive and negative HCV-RNA patient groups. Though none of the samples was HBsAg positive, 10 (33.3% HCV-RNA positive patients were anti-HBc positive, and 12 (40.7% were anti-HBs positive. We conclude that prevalence of hepatitis C infection is high in HD patients in our region, but not associated with active HBV infection.

  9. Hemodialysis

    Science.gov (United States)

    ... Us You are here Home » Hemodialysis Click to watch a video on this topic Healthy kidneys clean ... 05/2016 - 10:00am Philadelphia, PA Kidney Camp Sun, 07/17/2016 - 6:00pm Ingleside, IL Register ...

  10. Association between allopurinol and mortality among Japanese hemodialysis patients: results from the DOPPS

    OpenAIRE

    Tsuruta, Yuki; Nitta, Kosaku; Akizawa, Tadao; Fukuhara, Shunichi; Saito, Akira; Karaboyas, Angelo; Li, Yun; Port, Friedrich K.; Robinson, Bruce M.; Pisoni, Ronald L.; Akiba, Takashi

    2014-01-01

    Purpose Allopurinol, for treating hyperuricemia, is associated with lower mortality among hyperuricemic patients without chronic kidney disease (CKD). Greater allopurinol utilization in hemodialysis (HD) in Japan versus other countries provides an opportunity for understanding allopurinol-related HD outcomes. Methods Data from 6,252 Japanese HD patients from phases 1–3 of the Dialysis Outcomes and Practice Patterns Study (1999–2008) at ~60 facilities per phase were analyzed. Mortality was com...

  11. Functional deficiency of vitamin K in hemodialysis patients in Upper Silesia in Poland

    OpenAIRE

    Wyskida, Katarzyna; Żak-Gołąb, Agnieszka; Wajda, Jarosław; Klein, Dariusz; Witkowicz, Joanna; Ficek, Rafał; Rotkegel, Sylwia; Spiechowicz, Urszula; Kocemba Dyczek, Joanna; Ciepał, Jarosław; Olszanecka-Glinianowicz, Magdalena; Więcek, Andrzej; Chudek, Jerzy

    2016-01-01

    Purpose Functional vitamin K deficiency (both K1 and K2) is postulated to be one of the most relevant links between chronic kidney disease and vascular calcification in hemodialysis (HD) patients. Recommended dietary restrictions in HD patients superimposed on diversity of eating habits across the countries may affect the prevalence of functional vitamin K deficiency. The aim of this study was to determine the level of functional vitamin K deficiency and its relation to vitamin K1 intake in H...

  12. 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.

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

    International Nuclear Information System (INIS)

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

  14. 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.

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

    Directory of Open Access Journals (Sweden)

    Janssen IM

    2015-06-01

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

  16. 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

    Directory of Open Access Journals (Sweden)

    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.

  17. Rosuvastatin and cardiovascular events in patients undergoing hemodialysis

    DEFF Research Database (Denmark)

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

    2009-01-01

    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...

  18. 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....

  19. 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.

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

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    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.

  1. Long term follow up in hemodialysis patients with parathyroidectomy

    International Nuclear Information System (INIS)

    A retrospective study was performed in 41 patients, in chronic hemodialysis with severe hyperparathyroidism (HPT), who underwent surgery during time period from 1985 to 1997. 22 females, 19 males, aged 50 and 14 years, with PTHI 1345 and 604 pg/ml were followed up 32 and 22 months. Three surgical methods we evaluated: group I) total para thyroidectomy(PTX) with Implants(n=24); group II) subtotal PTX(n=14) and group III) total PTX(n=3). It considered recurrence of HPT when PTH levels were higher than upper range of normal, after 6 months post surgery. persistence was defined when there was no standardization of PTH levels. In group I, 9 patients had normal parathyroid function, 7 had persistent hypoparathyroidism and had hyperparathyroidism (7 recurrences). Group II patients had parathyroid over function in 5 cases (4 persistence s), 5 were normal and 4 hypoparathyroidism. All patients of the third group had hypoparathyroidism. Long term normalization of parathyroid gland activity was achieved in one third of troduccion patients (34,1%) whereas 34,1% permanent hypoparathyroidism and 31,8% hyperparathyroidism. It found no differences in recurrence and histological subtype of parathyroid gland in the different groups. In conclusion, similar long term clinical results were obtained with the different groups. The surgical ideal treatment is controversial. We think that in the long run, the evolution of parathyroid status is mostly influenced by the persistence of uremic state rather than the type of surgery performed

  2. Associated factors and prevalence of erectile dysfunction in hemodialysis patients

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    Marcio Rodrigues Costa

    2014-01-01

    Full Text Available Purpose: The proposal of this study was to determine the prevalence and the associated factors of erectile dysfunction (ED among hemodialysis (HD patients. Materials and Methods: This was a cross-sectional study based on data collected from HD male patients. Clinical, demographic and laboratory data of all patients were collected in three HD clinics from December 2010 to June 2011. Patients answered questions of erectile function domain from International Index of Erectile Function. Data were evaluated by descriptive analysis and by univariate (ULRA and multivariate logistic regression analysis (MLRA. Results: Three hundred and five patients participated of the study. The prevalence of ED was 68.19%. ED was associated with diabetes (DM, benign prostatic hyperplasia, glomerulonephritis as cause of chronic renal failure (CRF, smoking habits, lower creatinine levels (ULRA, use of calcium channel blocker (MLRA, aging, lower education level, alcohol consumption, DM (as cause of CRF and coronary insufficiency (ULRA and MLRA. Conclusions: ED was highly prevalent in the HD men. It was independently associated with aging, current use of alcohol, long alcohol use (even for those who do not drink more, lower education level, diabetes as cause of CRF, coronary insufficiency and use of channel blockers calcium.

  3. 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.

  4. Predictive factors of restless leg syndrome in hemodialysis patients

    Science.gov (United States)

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

    2016-01-01

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

  5. 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.

  6. Esvaziamento gástrico nos pacientes com insuficiência renal crônica submetidos à hemodiálise Gastric emptying study in patients with chronic renal failure on hemodialysis

    Directory of Open Access Journals (Sweden)

    Eunice Sizue Hirata

    2008-09-01

    Full Text Available RACIONAL: Queixas dispépticas são comuns em pacientes com insuficiência renal crônica. As mais frequentemente relatadas são anorexia, náusea, vômito, sensação de plenitude gástrica e dor epigástrica. A possibilidade destes sinais e sintomas estarem associadas ao retardo no esvaziamento gástrico é atraente. OBJETIVO: Estudar o esvaziamento gástrico de uma refeição sólida padronizada, em pacientes com insuficiência renal crônica em tratamento dialítico. MÉTODO: Foram estudados 31 pessoas de ambos os sexos com idade variável de 18 à 60 anos, sendo 14 com insuficiência renal crônica em hemodiálise há mais de 6 meses e 17 sadios. Foram excluídos pacientes com diabetes mellitus, amiloidose, doenças do colágeno, doenças dispépticas e/ou submetidos à operação gástrica, pacientes em uso de drogas pró-cinéticas gástricas e grávidas. O método do esvaziamento gástrico foi a cintilografia, através de câmara de cintilação de dois cabeçotes. A refeição teste padronizada consistiu de omelete de três ovos de galinha preparado com mistura de enxofre coloidal marcado com 185 MBq de tecnécio-99m. Foram estudados a curva de retenção gástrica total e o T½ do esvaziamento gástrico. Os testes estatísticos utilizados foram o de c2 e o de Kruskal Wallis. RESULTADOS: Os resultados confirmaram a homogeneidade dos grupos quanto à idade e o sexo. Não houve diferença estatisticamente significativa em relação às curvas de retenção gástrica total e o T½, semelhantes nos dois grupos. CONCLUSÃO: O esvaziamento gástrico de pacientes urêmicos em tratamento hemodialítico há mais de seis meses é igual ao de indivíduos sadios.BACKGROUND: Dyspeptic symptoms are frequent in renal patients. They are anorexia, nausea, vomit, pain and epigastric distension. These symptoms can be related to the delay in gastric emptying. AIM: To investigate gastric emptying in patients with chronic renal failure on hemodialysis

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

    OpenAIRE

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

    2016-01-01

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

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

    OpenAIRE

    Nobahar, Monir; Tamadon, Mohammad Reza

    2016-01-01

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

  9. Does the adequacy parameter Kt/V-urea reflect uremic toxin concentrations in hemodialysis patients?

    OpenAIRE

    Eloot, Sunny; van Biesen, Wim; Glorieux, Griet; Neirynck, Nathalie; Dhondt, Annemieke; Vanholder, Raymond

    2013-01-01

    Hemodialysis aims at removing uremic toxins thus decreasing their concentrations. The present study investigated whether Kt/Vurea, used as marker of dialysis adequacy, is correlated with these concentrations. Predialysis blood samples were taken before a midweek session in 71 chronic HD patients. Samples were analyzed by colorimetry, HPLC, or ELISA for a broad range of uremic solutes. Solute concentrations were divided into four groups according to quartiles of Kt/Vurea, and also of different...

  10. Let Them Eat During Dialysis: An Overlooked Opportunity to Improve Outcomes in Maintenance Hemodialysis Patients

    OpenAIRE

    Kalantar-Zadeh, Kamyar; T Alp Ikizler

    2013-01-01

    In individuals with chronic kidney disease surrogates of protein-energy wasting (PEW) including a relatively low serum albumin and fat or muscle wasting are by far the strongest death risk factor than any other condition. There are data to indicate that hypoalbuminemia responds to nutritional interventions, which may save lives in the long run. Monitored, in-center provision of high-protein meals and/or oral nutritional supplements during hemodialysis is a feasible, inexpensive and patient-fr...

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

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    Rahimi A

    2008-12-01

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

  12. 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. PMID:27067614

  13. 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 of...

  14. 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.

  15. Prevalence of Helicobacter pylori infection in maintenance hemodialysis patients with non-ulcer dyspepsia

    International Nuclear Information System (INIS)

    The purpose of this prospective study is to determine the prevalence of Helicobacter pylori (H. pylori) infection among stable chronic hemodialysis (HD) patients having non ulcer dyspepsia. The study was carried out on 80 patients consisting of 40 patients with dyspepsia and 40 consecutive control subjects without renal disease and dyspepsic symptoms. Mean age of patients were 56 +- 14 and 47 +- 15 respectively. This study showed no significant difference of H. pylori infection between the two groups. Tissue examination of gastric antrum showed higher localization of H. pylori in HD patients in contrast to controls. This finding has not been reported before and needs further confirmation and evaluation for its significance. (author)

  16. 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

  17. 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.

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

    Directory of Open Access Journals (Sweden)

    Mitsue FUJIMAKI

    1998-04-01

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

  19. Correlations between Plasma Levels of Anionic Uremic Toxins and Clinical Parameters in Hemodialysis Patients.

    Science.gov (United States)

    Ichimura, Yuichi; Takamatsu, Hiroyuki; Ideuchi, Hideki; Oda, Masako; Takeda, Kiyotaka; Saitoh, Hiroshi

    2016-01-01

    When the kidney is seriously impaired, various uremic toxins (UTs) accumulate in the body, often exerting unfavorable effects on physiological functions and drug pharmacokinetics. To prevent this, it is important to determine plasma UT levels accurately in chronic kidney disease patients. Although attempts to predict plasma UT levels using biomarkers have been made, the correlation between UT levels and the markers is not yet fully understood. In this study, we assessed the correlations among plasma levels of indoxyl sulfate (IS), indoleacetic acid (IA), and 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid (CMPF) in 20 hemodialysis patients and evaluated the relationship between the plasma levels of UTs and clinical parameters, such as serum creatinine (Scr), blood urea nitrogen, and estimated glomerular filtration rate (eGFR), with special focus on IS. There were no correlations among the plasma levels of the three UTs before and immediately after hemodialysis. However, a significant correlation was observed between plasma IS levels and Scr before hemodialysis (r=0.643, p=0.002), with the correlation becoming much stronger when using the data obtained immediately after hemodialysis (r=0.744, pScr values, although the precise mechanism behind the correlation remains to be clarified. PMID:27477735

  20. 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

  1. Evaluation of Ulnar neuropathy on hemodialysis patients

    OpenAIRE

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

    2012-01-01

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

  2. 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.

  3. 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.

  4. 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.

  5. Depression, insomnia and sleep apnea in patients on maintenance hemodialysis

    OpenAIRE

    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 t...

  6. Comparison of Nutritional Parameters among Adult and Elderly Hemodialysis Patients

    OpenAIRE

    Gülperi Çelik, Bahar Oc, Inci Kara, Mümtaz Yılmaz, Ali Yuceaktas, Seza Apiliogullari

    2011-01-01

    Aim: The aim of this study was to compare the nutritional biochemical parameters, prealbumin levels, and bioimpedance analysis parameters of adult and elderly hemodialysis (HD) patients.Methods: This prospective cross-sectional study included 50 adult HD patients (42.0 % female). Nutritional status was assessed by post-dialysis multifrequency bioimpedance analysis (BIA), serum prealbumin and other nutritional biochemical parameters.Results: Mean age of patients was 57.4±15.1 years (range...

  7. Comparison of Nutritional Parameters among Adult and Elderly Hemodialysis Patients

    OpenAIRE

    Çelik, Gülperi; Oc, Bahar; Kara, Inci; Yılmaz, Mümtaz; Yuceaktas, Ali; Apiliogullari, Seza

    2011-01-01

    Aim: The aim of this study was to compare the nutritional biochemical parameters, prealbumin levels, and bioimpedance analysis parameters of adult and elderly hemodialysis (HD) patients. Methods: This prospective cross-sectional study included 50 adult HD patients (42.0 % female). Nutritional status was assessed by post-dialysis multifrequency bioimpedance analysis (BIA), serum prealbumin and other nutritional biochemical parameters. Results: Mean age of patients was 57.4±15.1 years (range: 3...

  8. Effect of intravenous ascorbic acid in hemodialysis patients with anemia and hypeferritinemia

    Directory of Open Access Journals (Sweden)

    Shahrbanoo Keyhanian

    2008-01-01

    Full Text Available Hemodialysis (HD patients with functional iron deficiency (FID often develop resistance to recombinant human erythropoietin (Epo. The contributory role of chronic infla-mmation and oxidative stress in its pathogenesis is poorly understood. We assessed the effect of vitamin C, an antioxidant, on Epo-hyporesponsive anemia in hemodialysis patients with un-explained hyperferritinemia levels. Thirty-one of 132 with Hb < 11 g/dL were prospectively fo-llowed up after exclusion of reasons for Epo hyporesponsiveness. Patients were randomly divided into two groups: 15 patients received standard care and 300 mg of intravenous vitamin C with each dialysis session (group 1 and 15 patients received standard care (group 2. After 3 months, Hb and transferrin saturation levels significantly increased in group 1 but not in group 2 (p < 0.05%. Hemoglobin content in reticulocyte and serum ferritin decreased significantly in group 1 but not in control group. In conclusion, hemodialysis patients with refractory anemia and ade-quate iron stores, vitamin C improved responsiveness to Epo by augmenting iron mobilization and possibly via antioxidant effect.

  9. 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...

  10. Comparison of prognostic value of atrial fibrillation versus sinus rhythm in patients on long-term hemodialysis.

    Science.gov (United States)

    Vázquez, Eduardo; Sánchez-Perales, Carmen; Lozano, Cristóbal; García-Cortés, Ma José; Borrego, Francisco; Guzmán, Manuel; Pérez, Pilar; Pagola, Carlos; Borrego, Ma José; Pérez, Vicente

    2003-10-01

    The influence of atrial fibrillation (AF) on the clinical pattern of patients with chronic renal insufficiency on hemodialysis remains unknown despite the cardiovascular pathology in these patients being well documented and being the primary cause of death in this patient population. The objective of this study was to compare the long-term outcome in those patients on our dialysis unit in sinus rhythm with those in AF. PMID:14516897

  11. 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.

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

    International Nuclear Information System (INIS)

    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. Association between plasma endocannabinoids and appetite in hemodialysis patients: A pilot study.

    Science.gov (United States)

    Friedman, Allon N; Kim, Jeffrey; Kaiser, Shaun; Pedersen, Theresa L; Newman, John W; Watkins, Bruce A

    2016-07-01

    Uremia-associated anorexia may be related to altered levels of long chain n-6 and n-3 polyunsaturated fatty acid (PUFA) derived circulating endocannabinoids (EC) and EC-like compounds that are known to mediate appetite. Our study's hypothesis was that such molecules are associated with appetite in patients with end-stage renal disease. A cross-sectional observational study was performed in 20 chronic hemodialysis patients (9 females, 11 males) and 10 healthy female controls in whom appetite was assessed using the Simplified Nutritional Appetite Questionnaire (SNAQ) and blood drawn in the fasting (and when applicable) pre-dialysis state. Blood levels of PUFA and EC were also measured. Higher blood levels of the long chain n-6 fatty acid 20:4n6 (arachidonic acid) and lower levels of the long chain n-3 fatty acid 20:5n3 (eicosapentaenoic acid) were observed in female hemodialysis patients compared to controls. No differences were observed between male and female patients. In female study participants strong correlations between specific EC-like compounds and total SNAQ scores were noted, including with the n-6 PUFA derived linoleoyl ethanolamide (L-EA; ρ=-0.60, Psupport a link between circulating EC and appetite in hemodialysis patients. PMID:27333956

  14. C- Reactive protein, cardiac troponin T and low albumin are predictors of mortality in hemodialysis patients

    OpenAIRE

    Bagheri Nazila; Taziki Omolbanin; Falaknazi Kianoosh

    2009-01-01

    Overall and cardiovascular mortality are significantly higher in hemodialysis patients with elevated C-reactive protein (CRP). The aim of study was to determine whether CRP, low albumin and troponin are markers of overall and cardiovascular mortality in hemodialysis patients. 138 stable hemodialysis patients were divided into 2 groups n= 66 patients with coronary disease equivalent (known coronary or peripheral vascular disease or diabetes mellitus) and n= 72 patients without it. The two grou...

  15. Use of herbal remedies among patients undergoing hemodialysis.

    Science.gov (United States)

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

    2013-11-01

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

  16. Prevention of sudden cardiac death in hemodialysis patients.

    Science.gov (United States)

    O'Shaughnessy, Michelle M; O'Regan, John A; Lavin, Peter J

    2014-01-01

    One quarter of all hemodialysis patients will succumb to sudden cardiac death (SCD), a rate far exceeding that observed in the general population. A high prevalence of atherosclerotic coronary artery disease amongst patients with end-stage kidney disease (ESKD) partly explains this exaggerated risk. However, uremia and dialysis related factors are also of critical importance. Interventions aimed at preventing SCD have been inadequately studied in patients with ESKD. Data extrapolated from non-renal populations cannot necessarily be applied to hemodialysis patients, who possess relatively unique risk factors for SCD including "uremic cardiomyopathy", electrolyte shifts, fluctuations in intravascular volume and derangements of mineral and bone metabolism. Pending data derived from proposed randomized controlled clinical trials, critical appraisal of existing evidence and the selective application of guidelines developed for the general population to dialysis patients are required if therapeutic nihilism, or excessive intervention, are to be avoided. We discuss the evidence supporting a role for medical therapies, dialysis prescription refinements, revascularization procedures and electrical therapies as potential interventions to prevent SCD amongst hemodialysis patients. Based on current best available evidence, we present suggested strategies for the prevention of arrhythmia-mediated death in this highly vulnerable patient population. PMID:24720456

  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. Electrocardiographic Abnormalities and QTc Interval in Patients Undergoing Hemodialysis

    Science.gov (United States)

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

    2016-01-01

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

  19. 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.

  20. The Clinical study of hemodialysis on senile patients with chronic renail failure%高龄慢性肾功能衰竭患者血液透析的临床探讨

    Institute of Scientific and Technical Information of China (English)

    张锋; 陈丽君; 吴芳; 李彬

    2009-01-01

    Objective To evaluate the effects of hemodilysis in senile patients with chronic renal failure (CRF) .Methods Observed and summarized the clinical data of 62 senile patients with CRF were treated by hemodialysis,analyzed the survival rate,the cause of death,the complications during dialysis.index of the dialysis adequacy and nutritional condition. Results The long term survival rate of senile patients in-creased gradually. The main factors of the death were cardiac vascular events , infection and malnutrition. Hy-potension was the most common cardiovascular complication. Serum albumin was singnificanfly lower than that non-senile patients. Conclusions providing individual HD treatment, improving nutritional stutus and con-trolling infection may contribute to the increasing of survival rate and the reduction of the complications.%目的 评估高龄肾功能衰竭患者血液透析的临床疗效.方法 观察总结62例高龄肾功能衰竭患者血液透析治疗后的生存率和死亡原因,心脑血管并发症的发生情况及与透析充分性和营养状况相关的指标.结果 高龄血液透析患者的长期存活率逐步提高,死亡原因主要为心血管疾病、感染及严重营养不良,常见心血管并发症为低血压.低白蛋白血症发生率仍明显高于非老年组.结论 施行个体化的透析和治疗,积极改善营养,减少感染,有助于减少高龄透析患者的并发症发生和提高生存率.

  1. Implementing Benson's Relaxation Training in Hemodialysis Patients: Changes in Perceived Stress, Anxiety, and Depression

    OpenAIRE

    Ali Mahdavi; Mohammad Ali Heidari Gorji; Ali Morad Heidari Gorji; Jamshid Yazdani; Maryam Didehdar Ardebil

    2013-01-01

    Background: Hemodialysis patients usually experience high levels of psychological stress, anxiety, and depression. Reducing these matters in patients provides more psychological resources to cope with their physical situation. Aim: The present study aimed to explore the efficacy of Benson′s relaxation technique for stress, anxiety, and depression of patients with hemodialysis. Materials and Methods: Eighty hemodialysis patients were selected from two hospitals as an intervention and control g...

  2. Nonoxidized, biologically active parathyroid hormone determines mortality in hemodialysis patients

    DEFF Research Database (Denmark)

    Tepel, Martin; Armbruster, Franz Paul; Grön, Hans Jürgen; Scholze, Alexandra; Reichetzeder, Christoph; Roth, Heinz Jürgen; Hocher, Berthold

    2013-01-01

    Background: It was shown that nonoxidized PTH (n-oxPTH) is bioactive, whereas the oxidation of PTH results in a loss of biological activity. Methods: In this study we analyzed the association of n-oxPTH on mortality in hemodialysis patients using a recently developed assay system. Results......: Hemodialysis patients (224 men, 116 women) had a median age of 66 years. One hundred seventy patients (50%) died during the follow-up period of 5 years. Median n-oxPTH levels were higher in survivors (7.2 ng/L) compared with deceased patients (5.0 ng/L; P = .002). Survival analysis showed an increased survival......-oxPTH levels. Conclusions: The predictive power of n-oxPTH and iPTH on the mortality of hemodialysis patients differs substantially. Measurements of n-oxPTH may reflect the hormone status more precisely. The iPTH-associated mortality is most likely describing oxidative stress-related mortality....

  3. Association of inflammatory biomarkers with sleep disorders in hemodialysis patients.

    Science.gov (United States)

    Razeghi, Effat; Sahraian, Mohammad Ali; Heidari, Rouhollah; Bagherzadeh, Mohammad

    2012-03-01

    The aim of this study was to investigate the relationship between sleep disorders and C-reactive protein (CRP), hallmark of inflammation, and other biomarkers which may alter in hemodialysis patients. Our study included 108 patients who were dialyzed at least for 3 months. Before hemodialysis, blood samples were collected and serum levels of CRP, ferritin, albumin, phosphorus, parathyroid hormone, and hemoglobin were measured. Sleep disorders were confirmed by the presence of at least one of following criteria: insomnia, restless leg syndrome (RLS), obstructive sleep apnea syndrome (OSAS), narcolepsy, nightmare, sleepwalking, and poor sleep. 82.4% of patients demonstrated sleep disorders; insomnia (50%), RLS (32.4%), OSAS (7.4%), narcolepsy (15.7%), nightmare (15.7%), sleepwalking (0.9%), and poor sleep (71.3%). Our results revealed that CRP ≥3.8 μg/ml and advanced age were significantly associated with sleep disorders in these patients (p = 0.004 and p = 0.006, respectively). We concluded that inflammation has a close relation with sleep disorders in hemodialysis patients. PMID:22427289

  4. Cognitive dysfunction in patients with renal failure requiring hemodialysis

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  6. [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. PMID:21678270

  7. 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. PMID:26743014

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

    OpenAIRE

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

    2015-01-01

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

  9. 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...

  10. The best method of hepatitis B vaccination in hemodialysis patients?

    OpenAIRE

    Momeni Ali

    2013-01-01

    Implication for health policy/practice/research/medical education:After a long time, the efficacy of vaccination against hepatitis B could be decreased and thus for maintenance of protective antibody titer, booster dose of vaccine is required. It seems that additional studies with different dose of vaccine, duration and method are necessary for finding of the best method of vaccination in terms of safety, effectiveness and convenience application of vaccine among hemodialysis patients.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  13. Comparison of C-reactive protein and high-sensitivity C-reactive protein levels in patients on hemodialysis

    OpenAIRE

    Imed Helal; Lilia Zerelli; Madiha Krid; Fethi ElYounsi; Hedi Ben Maiz; Bechir Zouari; Jaouida Adelmoula; Adel Kheder

    2012-01-01

    Chronic inflammation is highly prevalent in patients on hemodialysis (HD), as evidenced by increased levels of C-reactive protein (CRP). We compared CRP to high-sensitivity C-reactive protein (hs-CRP) to determine whether it has any clinical implications and prognostic significance in terms of mortality. CRP was measured using a standard immunoturbidometric assay on the COBAS; INTEGRA system and hs-CRP was measured using the Dade Behring on the Konelab Nephelometer in 50 patients on HD. CRP (...

  14. Sericin cream reduces pruritus in hemodialysis patients: a randomized, double-blind, placebo-controlled experimental study

    OpenAIRE

    Aramwit Pornanong; Keongamaroon Orathai; Siritientong Tippawan; Bang Nipaporn; Supasyndh Ouppatham

    2012-01-01

    Abstract Background Uremic pruritus (UP) is a significant complication in ESRD patients and substantially impairs their quality of life. UP is considered to be a skin manifestation of chronic inflammation. Because sericin can suppress the release of pro-inflammatory cytokines, the purpose of this study was to investigate the short-term safety and efficacy of sericin cream for treating UP in hemodialysis patients. Methods This study used a double-blind design to investigate the effects of rand...

  15. Association of a high normalized protein catabolic rate and low serum albumin level with carpal tunnel syndrome in hemodialysis patients.

    Science.gov (United States)

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

    2016-06-01

    Carpal tunnel syndrome (CTS) is the most common mononeuropathy in patients with end-stage renal disease (ESRD). The association between chronic inflammation and CTS in hemodialysis (HD) patients has rarely been investigated. HD patients with a high normalized protein catabolic rate (nPCR) and low serum albumin level likely have adequate nutrition and inflammation. In this study, we assume that a low serum albumin level and high nPCR is associated with CTS in HD patients. We recruited 866 maintenance hemodialysis (MHD) patients and divided them into 4 groups according to their nPCR and serum albumin levels: (1) nPCR MHD patients, nPCR ≥1.29 g/kg/d and serum albumin 7.5 years were associated with CTS. A high nPCR and low serum albumin level, which likely reflect adequate nutrition and inflammation, were associated with CTS in MHD patients. PMID:27368039

  16. Sobrevida em hemodiálise crônica: estudo de uma coorte de 1.009 pacientes em 25 anos Survival in chronic hemodialysis: study of a cohort of 1,009 patients in 25

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    Luiz Alberto Michet da Silva

    2009-09-01

    Full Text Available INTRODUÇÃO: A maioria dos pacientes com doença renal crônica terminal depende de hemodiálise (HD para a manutenção de sua vida. A análise dos fatores que influenciam na sobrevida pode auxiliar na busca contínua por melhores resultados. MÉTODOS: Analisamos 1.009 pacientes tratados por HD crônica em três unidades de diálise de Santa Maria, RS, Brasil, durante 25 anos (1982-2007. RESULTADOS: A sobrevida (método de Kaplan-Meier em 1, 2 e 5 anos foi de 91%, 84% e 64%, respectivamente. No modelo proporcional de Cox, tiveram influência estatisticamente significativa sobre o risco de mortalidade: idade ao iniciar HD (aumento de 4,5% por ano a mais; p = 0,0001, presença de diabetes (aumento de 56%; p = 0,001 e ano de início da HD (redução de 5,2% por ano mais tarde; p = 0,0001. A sobrevida foi significativamente melhor para pacientes que iniciaram HD de 1997 a 2007 do que para os que iniciaram de 1982 a 1996, tanto em diabéticos (54% versus 41% em 5 anos; p = 0,01 como não diabéticos (72% versus 65% em 5 anos; p = 0,045, embora, nestes, a idade tenha sido significativamente maior no período mais recente. CONCLUSÕES: A presença de diabete e cada ano a mais na idade determinaram risco significativamente aumentado. Cada ano subsequente do calendário trouxe um risco significativamente menor. Nos anos mais recentes, a melhora de sobrevida foi maior para pacientes diabéticos e idosos, sendo atribuída a avanços diagnósticos e terapêuticos e melhor qualidade global do programa dialítico.INTRODUCTION: Most patients with end-stage renal disease depend on hemodialysis (HD for life maintenance. Analysis of factors influencing survival can assist in the continuous search for better results. METHODS: We analysed 1,009 patients treated with chronic HD in three dialysis units in the city of Santa Maria, RS, Brazil, for 25 years (1982-2007. RESULTS: Survival (Kaplan-Meier method at 1, 2, and 5 years was 91%, 84%, and 64%, respectively. In

  17. Obesity and metabolic syndrome in hemodialysis patients: Single center experience

    Directory of Open Access Journals (Sweden)

    Khalid Al Saran

    2011-01-01

    Full Text Available Recent evidence highlights the relationship between metabolic syndrome (MS and increased risk of cardiovascular (CV diseases. The overall prevalence of the MS is increased in hemodialysis population. To evaluate the prevalence of the MS and obesity in our hemodialysis (HD patients, we studied 234 HD patients and 34 patients were excluded from the study due to incomplete data at the time of analysis. For the remaining 200 patients, 92% were below the age of 70 years old, 162 (81% were hypertensive, 90(45% were diabetic, 54 (27% had ischemic heart diseases, and 116 (58% had MS. The incidence of MS in the male and female patients was 50% and 67%, respectively, with a mean abdominal girth more than 94 cm in males and only 14% of the patients revealed abdominal girth measurement below 80 cm in females. We conclude that there is a high prevalence of obesity and MS in our HD patients. Such patients may be at risk of developing morbidities and may benefit from therapy such as lifestyle changes including weight reduction and increased physical activity.

  18. Hypercalcemia after transplant nephrectomy in a hemodialysis patient: a case report

    Directory of Open Access Journals (Sweden)

    Quack Ivo

    2007-12-01

    Full Text Available Abstract Introduction Hypercalcemia is a complication often seen in chronic hemodialysis patients. A rare cause of this condition is sarcoidosis. Its highly variable clinical presentation is challenging. Especially in patients suffering chronic kidney graft failure the nonspecific constitutional symptoms of sarcoidosis like fever, weight loss, arthralgia and fatigue may be easily misleading. Case presentation A 51 year old male developed hypercalcemia, arthralgia and B-symptoms after explantation of his kidney graft because of suspected acute rejection. The removed kidney showed vasculopathy and tubulointerstitial nephritis, which had not been overt in the biopsy taken half a year earlier. Despite explantation and withdrawal of the immunosuppression the patient's general condition deteriorated progressively. A rapid rise in serum calcium finally provoked us to check for sarcoidosis. CT scans of the lungs, broncho-alveolar-lavage and further lab tests confirmed the diagnosis. Conclusion This case demonstrates that withdrawal of immunosuppressive drugs sometimes unmasks sarcoidosis. It should be considered as differential diagnosis even in hemodialysis patients, in whom other reasons for hypercalcemia are much more common.

  19. Blood volume-monitored regulation of ultrafiltration in fluid-overloaded hemodialysis patients: study protocol for a randomized controlled trial

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    Hecking Manfred

    2012-06-01

    Full Text Available Abstract Background Data generated with the body composition monitor (BCM, Fresenius show, based on bioimpedance technology, that chronic fluid overload in hemodialysis patients is associated with poor survival. However, removing excess fluid by lowering dry weight can be accompanied by intradialytic and postdialytic complications. Here, we aim at testing the hypothesis that, in comparison to conventional hemodialysis, blood volume-monitored regulation of ultrafiltration and dialysate conductivity (UCR and/or regulation of ultrafiltration and temperature (UTR will decrease complications when ultrafiltration volumes are systematically increased in fluid-overloaded hemodialysis patients. Methods/design BCM measurements yield results on fluid overload (in liters, relative to extracellular water (ECW. In this prospective, multicenter, triple-arm, parallel-group, crossover, randomized, controlled clinical trial, we use BCM measurements, routinely introduced in our three maintenance hemodialysis centers shortly prior to the start of the study, to recruit sixty hemodialysis patients with fluid overload (defined as ≥15% ECW. Patients are randomized 1:1:1 into UCR, UTR and conventional hemodialysis groups. BCM-determined, ‘final’ dry weight is set to normohydration weight −7% of ECW postdialysis, and reached by reducing the previous dry weight, in steps of 0.1 kg per 10 kg body weight, during 12 hemodialysis sessions (one study phase. In case of intradialytic complications, dry weight reduction is decreased, according to a prespecified algorithm. A comparison of intra- and post-dialytic complications among study groups constitutes the primary endpoint. In addition, we will assess relative weight reduction, changes in residual renal function, quality of life measures, and predialysis levels of various laboratory parameters including C-reactive protein, troponin T, and N-terminal pro-B-type natriuretic peptide, before and after the first study

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

    Science.gov (United States)

    Shiota, Kotomi; Hashimoto, Toshihiko

    2016-04-01

    [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

  1. The NKF-NUS hemodialysis trial protocol - a randomized controlled trial to determine the effectiveness of a self management intervention for hemodialysis patients

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    Krishnan Deby

    2011-01-01

    Full Text Available Abstract Background Poor adherence to treatment is common in patients on hemodialysis which may increase risk for poor clinical outcomes and mortality. Self management interventions have been shown to be effective in improving compliance in other chronic populations. The aim of this trial is to evaluate the effectiveness of a recently developed group based self management intervention for hemodialysis patients compared to standard care. Methods/Design This is a multicentre parallel arm block randomized controlled trial (RCT of a four session group self management intervention for hemodialysis patients delivered by health care professionals compared to standard care. A total of 176 consenting adults maintained on hemodialysis for a minimum of 6 months will be randomized to receive the self management intervention or standard care. Primary outcomes are biochemical markers of clinical status and adherence. Secondary outcomes include general health related quality of life, disease-specific quality of life, mood, self efficacy and self-reported adherence. Outcomes will be measured at baseline, immediately post-intervention and at 3 and 9 months post-intervention by an independent assessor and analysed on intention to treat principles with linear mixed-effects models across all time points. A qualitative component will examine which aspects of program participants found particularly useful and any barriers to change. Discussion The NKF-NUS intervention builds upon previous research emphasizing the importance of empowering patients in taking control of their treatment management. The trial design addresses weaknesses of previous research by use of an adequate sample size to detect clinically significant changes in biochemical markers, recruitment of a sufficiently large representative sample, a theory based intervention and careful assessment of both clinical and psychological endpoints at various follow up points. Inclusion of multiple dependent

  2. Effects of a single, high oral dose of 25-hydroxycholecalciferol on the mineral metabolism markers in hemodialysis patients.

    Science.gov (United States)

    Merino, Jose Luis; Teruel, Jose Luis; Fernández-Lucas, Milagros; Villafruela, Juan José; Bueno, Blanca; Gomis, Antonio; Paraíso, Vicente; Quereda, Carlos

    2015-06-01

    Vitamin D deficiency is common in dialysis patients with chronic kidney disease. Low levels have been associated with increased cardiovascular risk and mortality. We evaluated the administration of a high, single oral dose of 25-OH cholecalciferol (3 mg of Hidroferol, 180 000 IU) in patients on chronic hemodialysis. The 94 chronic hemodialysis patients with vitamin D deficiency 25 (OH)D mEq/L) were modified. Of the 86 patients who finished the study, 42 were in the treated group and 44 in the control group. An increase in 25(OH)D levels was observed in the treated group that persisted after 16 weeks and was associated with a significant decrease in parathyroid hormone (PTH) levels during the 8 weeks post-treatment. Baseline 1,25(OH)2 D levels of the treated group increased two weeks after treatment (5.9 vs. 21.9 pg/mL, Preduced to 8.4 at week 16. The administration of a single 3 mg dose of 25-OH cholecalciferol seems safe in patients on hemodialysis and maintains sufficient levels of 25(OH)D with a decrease in PTH for 3 months. PMID:25656524

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

    DEFF Research Database (Denmark)

    Krueger, Katharina; Koch, Kathrin; Jühling, Anja; Tepel, Martin; Scholze, Alexandra

    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....

  4. 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.

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

    DEFF Research Database (Denmark)

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

    2011-01-01

    The aim of the study was to assess the validity and reliability of the SF-12 questionnaire in a sample of Iranian patients undergoing hemodialysis.......The aim of the study was to assess the validity and reliability of the SF-12 questionnaire in a sample of Iranian patients undergoing hemodialysis....

  6. Color Doppler Ultrasound Assessment of Well Functioning Arteriovenous Fistulas in Hemodialysis Patients

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    Hamid Tayebi Khosroshahi

    2010-05-01

    Full Text Available Background/Objective: A well-functioning arteriovenous fistula (AVF is essential for the maintenance of hemodialysis in patients with chronic renal failure. The most common reason of fistula failure is thrombosis caused by stenosis. Color Doppler ultrasonography has proven to be effective in the assessment of anatomical vascular features. The majority of studies were done in patients with clinically presumed AVF complications. However, only limited data are available about the well-functioning mature arteriovenous fistulas. The present study was to evaluate completely asymptomatic AVFs with color Doppler ultrasound."nPatients and Methods: In an analytic-descriptive cross-sectional study, 50 patients with clinically well-functioning AVFs were evaluated during a 14-month period in Tabriz Imam Khomeini Hospital. The AVFs were assessed by Color Doppler ultrasound and the flow parameters and probable associated complications were investigated. "nResults: Fifty patients, 30 men and 20 women with a mean age of 51.58±20.27 (16-84 years were recruited. The mean duration of hemodialysis was 47.88±36.61 (2-18 months. The mean flow volume was 1009.76±561.84 ml/min. The mean resistive index was 0.51±0.08 in the studied population. The mean pulsative index was 0.89±0.16 with a mean peak systolic velocity of 87.90±33.65 cm/s and an average mean diastolic velocity of 56.28±18.36 cm/s. Aneurysm, stricture or hematoma was present in 4% of the studied AVFs. Accordingly, the overall presence rate of any complication was 12% in the AVFs."nConclusion: Based on our results, color Doppler ultrasound may be used for evaluationof AVFs in hemodialysis patients. The rate of occult complications in apparently normal-functioning AVFs is considerable and routine screening schedules might be helpful.

  7. 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 pollutants such as NO2 and CO might be associated with UP in patients with MHD.

  8. Practical ways to deal with the high burden of cardiovascular disease in hemodialysis patients.

    Science.gov (United States)

    Lima, José Jayme Galvão de

    2006-01-01

    Cardiovascular disease is the main cause of death among hemodialysis patients. Although uremia by itself may be considered to be a cardiovascular risk factor, a significant proportion of dialysis patients die because of cardiovascular disease not directly attributable to uremia. Indeed, many of the cardiovascular diseases and cardiovascular risk factors in these patients are common to those occurring in the general population and are amenable to intervention. Lack of proper medical care during the early stages of renal insufficiency and present-day dialysis routines, by failing to correct hypertension, hypervolemia and left ventricular hypertrophy in many patients, may also add to the cardiovascular burden. The author suggests that, in addition to early treatment and referral to a specialist, chronic renal failure patients should undergo intensive cardiovascular screening and treatment, and correction of cardiovascular risk factors based on guidelines established for the general population. PMID:16612461

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2002-02-01

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

  10. Central Venous Disease in Hemodialysis Patients: An Update

    Energy Technology Data Exchange (ETDEWEB)

    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.

  11. Central Venous Disease in Hemodialysis Patients: An Update

    International Nuclear Information System (INIS)

    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

  12. 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.

  13. 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.

  14. Fatal cerebritis and brain abscesses following a nontraumatic subdural hematoma in a chronic hemodialyzed patient.

    Science.gov (United States)

    Mesquita, Maria; Damry, Nasroolla; Gazagnes, Marie D

    2008-10-01

    Staphylococcus aureus is the leading cause of bacteremia in hemodialysis-dependent patients that can lead to metastatic abscesses with poor outcome. We report a case of a 65-year-old chronic hemodialyzed male patient who developed cerebritis and brain abscesses complicating a spontaneous subdural hematoma, following Staphylococcus aureus bacteremia related to infected arteriovenous fistula. In spite of adequate antibiotherapy and several surgical brain drainages, our patient did not survive. Prevention of S. aureus is highly important in hemodialysis patients. PMID:19090864

  15. 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.

  16. 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.

  17. 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

  18. Hepcidin and regulation of iron homeostasis in maintenance hemodialysis patients

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    Dawlat Sany

    2014-01-01

    Full Text Available Hepcidin may play a critical role in the response of patients with anemia to iron and erythropoiesis-stimulating agent therapy. To evaluate the factors affecting serum hepcidin levels and their relation to other indexes of anemia, iron metabolism and inflammation, as well as the dose of erythropoietin, we studied 80 maintenance hemodialysis (MHD patients treated with recombinant human erythropoietin and their serum hepcidin levels were specifically measured by using a competitive enzyme-linked immunosorbent assay. In linear regression analysis, ferritin was found to be a significant predictor of hepcidin levels in all the study patients. In the absence of apparent inflammation, serum hepcidin levels correlated exclusively with ferritin levels in MHD patients, and it was also an independent marker of inflammation as highly sensitive C-reactive protein.

  19. Pregnancy-associated plasma protein-A in patients on Maintenance Hemodialysis

    International Nuclear Information System (INIS)

    A high level of serum pregnancy associated plasma protein-A (PAPP-A) has been observed in patients suffering from renal impairment. The aim of the present study is to evaluate the level of PAPP-A and to elucidate its relationship with renal osteodystrophy and renal functions in patients maintained on hemodialysis (HD). Intact parathyroid hormone (i-PTH), calcium (Ca) and phosphorus (P) levels and alkaline phosphatase activity (ALP) were measured in the serum as markers of renal osteodystrophy while the level of blood urea and serum creatinine were evaluated as markers of renal functions. The results obtained showed that for patients maintained on HD, the levels of PAPP-A, i-PTH, P, urea and creatinine, were significantly higher than controls. Significant positive correlations were obtained between PAPP-A and each of i-PTH, ALP and creatinine in the same group. After dialysis session, the level of PAPP-A increased significantly, compared to its pre -dialysis level. According to the results obtained in the current study, it could be concluded that the increase in PAPP-A level in the serum of patients maintained on hemodialysis is probably the result of chronic inflammation and impairment of kidney functions rather than renal osteodystrophy

  20. 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...

  1. 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

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

    OpenAIRE

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

    1987-01-01

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

  3. 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.

  4. Quality of life in patients with chronic kidney disease

    OpenAIRE

    Maria Carolina Cruz; Carolina Andrade; Milton Urrutia; Sergio Draibe; Luiz Antônio Nogueira-Martins; Ricardo de Castro Cintra Sesso

    2011-01-01

    AIM: To compare the dimensions of quality of life in the stages of chronic kidney disease and the influence of sociodemographic, clinical and laboratory data. INTRODUCTION: The information available on the quality of life of patients on conservative treatment and the relationship between the quality of life and glomerular filtration rate is limited. METHODS: 155 patients in stages 1-5 of chronic kidney disease and 36 in hemodialysis were studied. Quality of life was rated by the Medical Outco...

  5. 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. PMID:25056441

  6. 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. PMID:25056441

  7. 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. PMID:25579719

  8. 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

  9. Transcatheter thrombolysis treatment of acute A-V internal fistula thrombogenesis in hemodialysis patients

    International Nuclear Information System (INIS)

    Objective: To investigate the value of transcatheter thrombolysis treatment of acute A-V internal fistula thrombogenesis in hemodialysis patients. Methods: The acute A-V fistula thrombogenesis in 32 hemodialysis patients with chronic renal failure were treated with transcatheter pulse-spray pharmacomechanical thrombolysis (PSPMT). Results: Acute A-V fistula thrombogenesis was verified in all 32 patients by angiography and treated with transcatheter PSPMT. the immediate clinical success rate of thrombolysis was achieved in 97% except for one case. The A-V fistulas were proved to reopen by post-treatment angiography. Recurrent thrombosis was found in 4 cases, reopening with transcatheter PSPMT was achieved in 2 of them and the rest 2 cases were undergone PTA because of localized vascular stenosis. All the 32 A-V fistulae were reopened after treatment without serious complications such as hemorrhage, pulmonary embolism and others. Conclusions: Transcatheter PSPMT is a safe, effective and microinvasive treatment for acute A-V fistula thrombolysis with higher immediate reopening rate. Transcatheter PSPMT combined with PTA and intravascular stent grafting can improve long-term patency rate

  10. 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.

  11. Detection and adequacy evaluation of erythrocyte glutathione transferase on levels of circulating toxins in hemodialysis patients.

    Science.gov (United States)

    Yin, Rui; Qiu, Hui; Zuo, Huaiyun; Cui, Min; Zhai, Nailiang; Zheng, Hongguang; Zhang, Dewei; Huo, Ping; Hong, Min

    2016-08-01

    To explore detection and adequacy evaluation of erythrocyte glutathione S transferase (GST) on levels of circulating toxins in hemodialysis patients in Qinhuangdao region in China, this study divided 84 cases of long-term, end-stage hemodialysis patients into 2 groups: one group of 33 cases of adequate hemodialysis (spKt/V ≥ 1.3) and another group of 51 cases of inadequate hemodialysis (spKt/V GST, creatinine, high sensitivity C-reactive protein (hs-CRP), transferrin saturation (TSAT), parathyroid hormone (PTH), interleukin-2,6,8 (IL-2,6,8) and tumor necrosis factor-a (TNF-a) in the hemodialysis group were significantly higher than those in the control group (P GST, IL-2, 6, 8, and TNF-a levels in the inadequate hemodialysis group were significantly higher than in the adequate hemodialysis group (P GST and spKt/V, IL-2, IL-6, IL-8, and TNF-a have a positive correlation (P 0.05). There were 23 patients with levels of spKt/V ≥ 1.3 after adjusting the dialysis solution for 51 cases of inadequate hemodialysis patients, and the GST level after the adjustment was significantly lower than that before the adjustment, but still higher than that in the adequate dialysis group. This concludes that the maintenance of hemodialysis in patients has certain relevance on spKt/V and associated inflammatory factors. Through the study, it can be determined that GST can effectively respond to adequate hemodialysis, which has a guiding significance on adjusting the blood dialysis solution in clinical practice. PMID:27121915

  12. Hemodialysis outcomes in a global sample of children and young adult hemodialysis patients: the PICCOLO MONDO cohort

    OpenAIRE

    Ferris, Maria; Gibson, Keisha; Plattner, Brett; Gipson, Debbie S.; Kotanko, Peter; Marcelli, Daniele; Marelli, Cristina; Etter, Michael; Carioni, Paola; von Gersdorff, Gero; Xu, Xiaoqi; Kooman, Jeroen P.; Xiao, Qingqing; van der Sande, Frank M.; Power, Albert

    2016-01-01

    Background The aim of this study was to describe the experience of pediatric and young adult hemodialysis (HD) patients from a global cohort. Methods The Pediatric Investigation and Close Collaborative Consortium for Ongoing Life Outcomes for MONitoring Dialysis Outcomes (PICCOLO MONDO) study provided de-identified electronic information of 3244 patients, ages 0–30 years from 2000 to 2012 in four regions: Asia, Europe, North America and South America. The study sample was categorized into ped...

  13. Association of serum leptin with serum C-reactive protein in hemodialysis patients

    OpenAIRE

    Rastegari Ebrahim; Nasri Hamid

    2012-01-01

    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:...

  14. Comparison of Toxoplasma gondii seropositivity in hemodialysis and peritoneal dialysis patients

    OpenAIRE

    Faezeh Hamidi; Jalal Etemadi; Nader Ghabouli Mehrabani; Mahmoud Mahami Oskouei; Roza Motavalli; Mohammad Reza Ardalan

    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 administ...

  15. Sex hormones and erectile dysfunction in hemodialysis patients

    International Nuclear Information System (INIS)

    Objective: To determine the prevalence of Erectile Dysfunction (ED) in hemodialysis patients (HD) and to study the associated changes in sex hormones in these patients. Methodology: This is a hospital based cross sectional study conducted at hemodialysis units of Shalamar and Mayo Hospitals, Lahore from January to March 2008. All male patients with ESRD on maintenance (HD), whose spouses were alive and able to perform intercourse, were included in the study. Patients with cognitive and communication deficits were excluded from study. International index of erectile function-5(IIEF-5), adopted in Urdu was used for determination of prevalence of ED. Demographic data was collected and sex hormones (total testosterone, Dihydroepiandrosteronediones (DHEA), Follicle Stimulating Hormone (FSH), Leutinizing Hormone (LH) and serum Prolactin) were measured. Results: A total number of fifty patients were included in the study. The major cause of ESRD was diabetes mellitus 28 (56%). The prevalence of ED was 86% with a mean IIEF-5 score 10.36 + 7.13. The majority of patients, 33 (66%), were suffering from a severe degree of ED. The total testosterone level was low in 30 (60%) patients and DHEA were low normal in most of patients, 46 (92%). Compared to patients with non-ED, those with ED had a significantly lower DHEA (1.93 +- 0.73 vs 0.81 +- 0.11, p value = 0.007). Total testosterone and DHEA had a negative correlation with age and diabetes mellitus. FSH showed a variable response in these patients, it was low ( 9.74 mIU/ ml) in eight patients. LH was low ( 7.8 mIU/ml) in fifteen patients. FSH and LH showed a positive correlation with duration of dialysis. Prolactin level was low in 21(42%) patients. Total testosterone, FSH, LH and Prolactin had no association with ED. Conclusion: The majority of the patients suffering from ESRD, on maintenance HD had ED. DHEA was significantly lower in patients with ED, compared to those with no-ED. Total testosterone and DHEA had an inverse

  16. 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

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    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

  17. 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.

  18. 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.

  19. Prevalence of Hepatitis B and C Infection in Hemodialysis Patients of Rasht (Center of Guilan Province, Northern Part of Iran

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    Fariborz Mansour-Ghanaei

    2009-02-01

    Full Text Available and Aims: Hepatitis B virus (HBV and hepatitis C virus (HCV infections are significant health problems, as they can lead to chronic active hepatitis, liver cirrhosis, and hepatic carcinoma. Factors associated with HBV propagation include blood and derivates transfusion, duration and frequency of hemodialysis, equipment contamination and contact among patients as well as between them and health-care workers. Transmission of HCV through dialysis units has shown a progressive increase worldwide, ranging from 5% in some western countries to 70% in some developing countries. The aim of this study was to determine the prevalence of HBV and HCV infections in hemodialysis patients of Rasht (center of Guilan province, North of Iran.Methods: A cross-sectional analysis was performed on 163 chronic (>6 months hemodialysis patients. Patients from the hemodialysis unit of Rasht were interviewed. The following data was collected: name, age, gender, occupation, duration of dialysis and cause of End Stage Renal Disease. Blood samples were collected and screened for HBsAg and anti-HCV antibodies by a third-generation enzyme-linked immunosorbent assay (ELISA. Qualitative HCV determination in ELISA positive cases (after two tests was performed by QIAGEN OneStep RT-PCR kit (assay sensitivity 100 copies/mL.Results: Five patients were HBsAg positive (3.06% and 30 were anti HCV antibody positive by ELISA (18.40%. HCV positivity was confirmed by PCR in 17(10.42% patients. All patients had a minimum of two to a maximum of three dialysis sessions per week. Mean age in HBsAg positive cases was 47.3 years and all of them were male. Duration of dialysis was 8-12 years in all five HBsAg positive patients. Mean age in HCV positive patients was 42.3 years. 66% of HCV positive patients were male and 33.33% of them were female. Duration of dialysis was 0-4 years in 33.33 % of HCV positive patients, 4-8 years in 26.66% of cases, 8-12 years in 20% and 12-16 years in 20% of them

  20. A Better Diet Quality is Attributable to Adequate Energy Intake in Hemodialysis Patients

    OpenAIRE

    Kim, Hyerang; Lim, Hyunjung; Choue, Ryowon

    2015-01-01

    Poor diet quality is one of strong predictors of subsequent increased mortality in hemodialysis patients. To determine diet quality and to define major problems contributing to poor diet quality in hemodialysis patients, a cross-sectional study was conducted between June 2009 and October 2010. Sixty-three hemodialysis patients (31 men, 32 women; aged 55.3 ± 11.9 years) in stable condition were recruited from the Artificial Kidney Center in Kyung Hee University, Seoul, Korea. Three-day diet re...

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

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    Karine Kleine Figueiredo dos Santos

    2016-04-01

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

  2. Simple methods for nutritional status assessment in patients treated with repeated hemodialysis

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    Tirmenštajn-Janković Biserka

    2004-01-01

    Full Text Available Introduction Protein-energy malnutrition is common in chronic hemodialysis patients and is strongly associated with increased morbidity and mortality. While determination of the nutritional status is often based on objective measurements such as biochemical parameters and anthropometric measurements, there is no single measurement that can reliably identify risk for malnutrition. Material and methods A subjective global assessment (SGA was performed to evaluate the nutritional status in 43 chronic dialysis patients (27 men and 16 women. Anthropometric measurements including body weight (BW, body mass index (BMI, skin-fold thickness (triceps-TS, biceps-BS, subscapular-SSS, suprailiac-SIS, mid-arm circumference (MAC; mid-arm muscle circumference (MAMC; body fat percentage (%BF; total body fat (TBF; lean body mass (LBM and laboratory parameters (total proteins, albumins, transferrin, hemoglobin, lymphocytes. Results According to SGA, patients were divided into three groups: first group of 23 pts with a normal nutritional status, second group of 11 pts with mild malnutrition and third group of 9 pts with moderate or severe malnutrition. In examined groups there was a significant decrease in total protein (p = 0.02, serum albumin (p = 0.000 and hemoglobin (p = 0.04 levels with an increase in SGA scores (oneway ANOVA. In the same way, SGA was correlated with the number of anthropometric parameters (BW, BMI, TS, SSS, SIS, MAC, MAMC, % BF, TBF, LBM. Conclusion Our data confirmed a high prevalence of malnutrition in hemodialysis patients and showed that SGA closely correlated with more objective measures. Being an inexpensive method of well-proven realibility, SGA can be recommended for a more frequent assessment of nutritional status in dialysis patients.

  3. 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.

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

    OpenAIRE

    Petković Nenad; Ristić Siniša; Stošović Milan; Đukanović Ljubica

    2013-01-01

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

  5. Fetuin-A, inflammation, and coronary artery calcification in hemodialysis patients

    OpenAIRE

    Turkmen, K.; Gorgulu, N.; M Uysal; Ozkok, A.; Sakaci, T.; Unsal, A.; YILDIZ, A.

    2011-01-01

    Hemodialysis patients have extremely increased cardiovascular mortality. Vascular calcification, inflammation, and low serum fetuin-A levels are implicated for increased mortality. In this study, relationship between coronary artery calcification, inflammation, and serum fetuin-A levels were investigated. Seventy-eight hemodialysis patients (38 male, 40 female, mean age: 52±14.5 years) were included. All patients were on dialysis for more than 6 months. Coronary artery calcium scores (CACS) a...

  6. Volume Control by Using the Body Composition Monitor in a Puerperal Patient on Hemodialysis

    OpenAIRE

    Chung, Wookyung; Choi, Shung Han; Sung, Jiyoon; Jung, Eul Sik; Shin, Dong Su; Jung, Ji Yong; Chang, Jae Hyun; Lee, Hyun Hee; Lee, Seung-Ho; Kim, Sejoong

    2011-01-01

    Accurate measurement of the volume status in hemodialysis patients is important as it can affect mortality. However, no studies have been conducted regarding volume management in cases where a sudden change of body fluid occurs, such as during puerperium in hemodialysis patients. This report presents a case in which the patient was monitored for her body composition and her volume status was controlled using a body composition monitor (BCM) during the puerperal period. This case suggests that...

  7. 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.

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

    Institute of Scientific and Technical Information of China (English)

    姚洁; 诸伟红; 葛玉英; 陈科威; 王秋妹

    2015-01-01

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

  9. 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.

  10. 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.

  11. Can Serum Gdf-15 be Associated with Functional Iron Deficiency in Hemodialysis Patients?

    Science.gov (United States)

    Yilmaz, Hakki; Cakmak, Muzaffer; Darcin, Tahir; Inan, Osman; Bilgic, Mukadder Ayse; Bavbek, Nuket; Akcay, Ali

    2016-06-01

    Functional iron deficiency (FID) incidence is gradually increasing in hemodialysis (HD) patients. Recently, high levels of GDF-15 supressed the iron regulatory protein hepcidin and GDF-15 expression increased in iron-deficient patients. The relationship between FID, GDF-15, and hepcidin is currently unknown. The present study aimed to evaluate the association between GDF-15, hepcidin, and FID in chronic HD patients. Serum GDF-15 and hepcidin concentrations were measured in 105 HD patients and 40 controls. FID is defined as serum ferritin >800 ng/mL, TSAT Serum GDF-15 and hepcidin levels were increased significantly in HD patients with FID, compared to HD patients without anemia and controls. GDF-15 correlated with ferritin, hepcidin, and CRP in the entire cohort. GDF-15 was related to ferritin and CRP in HD patients with FID. GDF-15 is better diagnostic marker than hepcidin for detection of FID [AUC = 0.982 (0.013) versus AUC = 0.921 (0.027); P = 0.0324]. GDF-15 appears to be a promising tool for detection of FID. High levels of ferritin and CRP correlated with GDF-15. Our results support GDF-15 as a new mediator of FID via hepcidin, chronic inflammation, or unknown pathways. PMID:27065587

  12. Assessment of inflammatory factors and cardiac troponin T in hemodialysis patients

    International Nuclear Information System (INIS)

    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 chemiluminescences 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. (author)

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

    OpenAIRE

    Dias, Lorraine S.; Vivek, G; M Manthappa; Acharya, Raviraja V

    2011-01-01

    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.

  14. 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.

  15. Parathyroid hormone-related peptide plasma concentrations in patients on hemodialysis

    DEFF Research Database (Denmark)

    Nordholm, Anders; Rix, M.; Olgaard, K.;

    2014-01-01

    90 patients and in 15 healthy subjects. Plasma PTH was determined in order to examine the possible relationship between the two peptides. RESULTS: In hemodialysis patients mean plasma PTHrP, 4.2 +/- 2.1, was significantly lower than that of healthy subjects, 8.3 +/- 1.1 pmol/L, p <0.0001. No...... the same receptor, the PTH1R, and it has been shown experimentally that PTHrP enhances the PTH secretory response to hypocalcemia, indicating a link between the two hormones. METHODS: Together with a number of parameters involved in mineral homeostasis plasma PTHrP was measured before hemodialysis in...... relationship was found between plasma PTHrP and PTH in hemodialysis patients. Gender, PTX, specific treatments and diagnoses had no impact on PTHrP concentrations. CONCLUSION: Thus PTHrP is measurable in hemodialysis patients, but its secretion might not be part of a regulated mineral homeostatic process and...

  16. Greater Epoetin alfa Responsiveness Is Associated With Improved Survival in Hemodialysis Patients

    OpenAIRE

    Kilpatrick, Ryan D.; Critchlow, Cathy W; Fishbane, Steven; Besarab, Anatole; Stehman-Breen, Catherine; Krishnan, Mahesh; Bradbury, Brian D.

    2008-01-01

    Background and objectives: Among hemodialysis patients, achieved hemoglobin is associated with Epoetin alfa dose and erythropoietin responsiveness. A prospective erythropoietin responsiveness measure was developed and its association with mortality evaluated.

  17. The interventional treatment of arteriovenous fistula stenosis or occlusion in upper extremity in hemodialysis patients

    International Nuclear Information System (INIS)

    Objective: To investigate the clinical effect of percutaneous balloon angioplasty for the treatment of arteriovenous fistula stenosis or occlusion in upper extremity in hemodialysis patients. Methods: Percutaneous balloon angioplasty was performed in 14 hemodialysis patients with arteriovenous fistula stenosis or occlusion in upper extremity. The preoperative and post operative clinical manifestations, the color Doppler ultrasonographic findings, the blood flow during hemodialysis and the angiographic demonstrations were recorded and compared. Results: After balloon dilatation, the constricted segment was remarkably dilated and the occluded site was re-opened in all patients. Angiographic findings showed that the degree of stenosis was less than 30%. Conclusion: As a simple, mini-invasive and safe technique with remarkable short-term effectiveness, percutaneous balloon angioplasty is an valuable therapy for arteriovenous fistula stenosis or occlusion in upper extremity in hemodialysis patients. (authors)

  18. 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....

  19. Antibodies to Platelet Factor 4–Heparin Complex and Outcome in Hemodialysis Patients with Diabetes

    OpenAIRE

    Krane, Vera; Berger, Mario; Lilienthal, Jürgen; Winkler, Karl; Schambeck, Christian; Wanner, Christoph

    2010-01-01

    Background and objectives: Hemodialysis patients with type 2 diabetes exhibit an excessive cardiovascular risk and regularly receive heparin. We tested whether antibodies to the platelet factor 4–heparin complex (PF4-H-AB) contribute to outcome.

  20. 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

    Directory of Open Access Journals (Sweden)

    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.

  1. 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?

    Directory of Open Access Journals (Sweden)

    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

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

    Directory of Open Access Journals (Sweden)

    Reneta Yovcheva Koycheva

    2015-12-01

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

  3. 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.

  4. Distribution of hepatitis C virus genotypes among hemodialysis patients in Tehran--a multicenter study.

    Science.gov (United States)

    Hosseini-Moghaddam, Seyed Mohammadmehdi; Keyvani, Hossein; Kasiri, Hossein; Kazemeyni, Seyed Mohammad; Basiri, Abbas; Aghel, Nazanin; Alavian, Seyed-Moayed

    2006-05-01

    Hepatitis C virus has substantial heterogeneity of genotypes throughout the world. The aim of this study was to determine the frequency of HCV genotypes, risk factors and clinical implications in cases of hemodialysis living in Tehran. A total of 155 patients treated by hemodialysis, who had been identified to be anti-HCV positive at 45 medical centers in Tehran, were enrolled. Genotyping was using restriction fragment length polymorphism (RFLP) on HCV-RNA positive samples. HCV-RNA was detected in 66 (42.6%) patients. Genotyping of HCV-RNA positive serum samples demonstrated that subtypes 3a and 1a were predominant accounting for 30.3 and 28.8%, respectively. The distribution of other HCV genotypes showed genotype 1b, 18.2%; genotype 4, 16.7%; mixed genotypes 1a and 1b, 3%; and genotype 3b, 3%. Genotype 2 was not detected in this study. Statistically significant differences were identified between HCV infected and non-HCV infected patients regarding history of hemodialysis unit changes more than two times (P = 0.01), and history of hemodialysis for more than 20 years (P = 0.02). However, blood transfusion, mean duration of hemodialysis therapy and the history of solid organ transplantation did not differ between these two groups. This study indicates that the dominant HCV genotypes among patients treated by hemodialysis living in Tehran were 3a and 1a, and considering previous reports from the general population, genotype 4 was strongly associated with hemodialysis. The duration of treatment by hemodialysis and, in turn, more hemodialysis unit changes will lead to more frequent HCV infections. PMID:16555284

  5. Indices of adrenal deficiency involved in brain plasticity and functional control reorganization in hemodialysis patients with polysulfone membrane: BOLD-fMRI study.

    Science.gov (United States)

    Belaïch, Rachida; Boujraf, Saïd; Benzagmout, Mohammed; Maaroufi, Mustapha; Housni, Abdelkhalek; Batta, Fatima; Tizniti, Siham; Magoul, Rabia; Sqalli, Tarik

    2016-06-01

    This work purpose was to estimate the implication of suspected adrenal function deficiencies, which was influenced by oxidative stress (OS) that are generating brain plasticity, and reorganization of the functional control. This phenomenon was revealed in two-hemodialysis patients described in this paper. Blood oxygenation level dependent functional magnetic resonance imaging (BOLD-fMRI) revealed a significant activation of the motor cortex. Hemodialysis seems to originate an inflammatory state of the cerebral tissue reflected by increased OS, while expected to decrease since hemodialysis eliminates free radicals responsible for OS. Considering adrenal function deficiencies, sensitivity to OS and assessed hyponatremia and hypercalcemia, adrenal function deficiencies is strongly suspected in both patients. This probably contributes to amplify brain plasticity and a reorganization of functional control after hemodialysis that is compared to earlier reported studies. Brain plasticity and functional control reorganization was revealed by BOLD-fMRI with a remarkable sensitivity. Brain plastic changes are originated by elevated OS associating indices of adrenal function deficiencies. These results raise important issues about adrenal functional deficiencies impact on brain plasticity in chronic hemodialysis-patients. This motivates more global studies of plasticity induced factors in this category of patients including adrenal functional deficiencies and OS. PMID:27301905

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

    International Nuclear Information System (INIS)

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

  7. 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.

  8. Feelings of burden and perceived social support among relatives of hemodialysis patients

    OpenAIRE

    SEZEN ADEM; SENYURT AHMET Y.; DIKMEN AHMET C.; TAPAN BIRKAN; SEZEN ERENGÜL

    2015-01-01

    Caregivers are vulnerable to physical, psychological, and economical problems. Caregivers of hemodialysis patients should deal with economical difficulties due to job loss, or social life difficulties due to time strain of dialysis treatment. It is a fact that caregivers of hemodialysis patients suffer from caregiver burden. Our study aims to discover risk and protective factors of caregiver burden. For this aim, Multidimensional Scale of Perceived Social Support (MSPSS), Ways of Coping Quest...

  9. 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 ...

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

    OpenAIRE

    R Ghanei Gheshlagh; M Hemmati Maslakpak; HABIBZADEH, H.

    2012-01-01

    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 w...

  11. Blood Transfusion, Serum Ferritin, and Iron in Hemodialysis Patients in Africa

    OpenAIRE

    Leonard Kouegnigan Rerambiah; Laurence Essola Rerambiah; Armel Mbourou Etomba; Rose Marlène Mouguiama; Phanie Brunelle Issanga; Axel Sydney Biyoghe; Batchelili Batchilili; Sylvestre Akone Assembe; Joel Fleury Djoba Siawaya

    2015-01-01

    Background and Objectives. There is no data analyzing the outcome of blood transfusions and oral iron therapy in patients with kidneys failure in sub-Saharan Africa. The present study aimed to fill that gap and assess the value of ferritin in the diagnosis of iron overload and deficiency. Design. From January to February 2012, we prospectively studied 85 hemodialysis patients (78% of males and 22% of females aged 20 to 79 years) attending the Gabonese National Hemodialysis Centre. Results. Co...

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

    OpenAIRE

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

    2011-01-01

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

  13. Serum magnesium level and vascular stiffness in children with chronic kidney disease on regular hemodialysis.

    Science.gov (United States)

    Zaher, Manal Mohamed; Abdel-Salam, Manal; Abdel-Salam, Ragaa; Sabour, Randa; Morsy, Amal Abd El-Aleem; Gamal, Dina

    2016-01-01

    Chronic kidney disease (CKD) patients have a high prevalence of vascular calcifications, and cardiovascular disease is the leading cause of death in this population. Magnesium (Mg) depletion may be the missing link between multiple cardiovascular risk factors and the development of atherosclerosis. In this study, we aimed to assess the relationship between serum Mg levels and vascular stiffness in children with CKD on regular hemodialysis (HD). The study included 25 children with CKD on regular HD in our center; the study included also 25 healthy children age-and sex-matched as a control group. Serum Mg levels were measured, and Doppler ultrasound assessment of the intima-media thickness (IMT) and the peak systolic velocities (PSVs) of the main arteries including the (aorta, carotid, and femoral) arteries were recorded in the study patients. There were significantly lower serum Mg levels in children on regular HD than in the controls (1.7 ± 0.43 mg/dL vs. 2.31 ± 0.12 mg/dL, respectively, P = 0.001). There was a significant increase in the aorta and carotid IMT in the study group than in the controls (0.45 ± 0.07 mm vs. 0.40 ± 0.09 mm; 0.98 ± 0.57 mm vs. 0.55 ± 0.1 mm, P = 0.034 and 0.001, respectively), whereas there were no significant differences regarding the PSV of the carotid, aorta, and femoral arteries between the study patients and the controls (P >0.05). A negative correlation was found between serum Mg level with aortic IMT (AIMT) (r = -0.682; P = 0.000). In addition, a significant negative correlation was found between the AIMT with systolic and diastolic blood pressure (r = 0.447, P = 0.025, 0.472, P = 0.017), respectively. We conclude that lower serum Mg levels were associated with vascular calcification in chronic HD children. Confirmation of our results warrants further study. PMID:26997375

  14. Extracorporal hemodialysis with acute or decompensated chronical hepatic failure

    OpenAIRE

    Wasem, Jürgen; Caspary, Wolfgang; Siebert, Uwe; Schnell-Inderst, Petra; Grabein, Kristin; Hessel, Franz

    2006-01-01

    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 onl...

  15. Comparison of Nutritional Parameters among Adult and Elderly Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Gülperi Çelik, Bahar Oc, Inci Kara, Mümtaz Yılmaz, Ali Yuceaktas, Seza Apiliogullari

    2011-01-01

    Full Text Available Aim: The aim of this study was to compare the nutritional biochemical parameters, prealbumin levels, and bioimpedance analysis parameters of adult and elderly hemodialysis (HD patients.Methods: This prospective cross-sectional study included 50 adult HD patients (42.0 % female. Nutritional status was assessed by post-dialysis multifrequency bioimpedance analysis (BIA, serum prealbumin and other nutritional biochemical parameters.Results: Mean age of patients was 57.4±15.1 years (range: 30-83 years and mean dialysis duration was 68.3 ± 54.5 months (range: 3-240 months. When the patients were divided into two groups according to age of patients (<65 and ≥65, prealbumin (p=0.003, blood urea nitrogen (BUN (p=0.000, serum creatinine (p=0.013, albumin (p=0.016, protein catabolic rate per normalized body weight (nPCR (p=0.001, intracellular water (ICW/total body weight (0.003 , body fat mass (p00.000, lean body mass (p=0.031, lean dry mass (p=0.001, illness marker (p=0.005, basal metabolism (p=0.007, body mass index (BMI (p=0.028, body fat mass index (BFMI (p=0.000, fat free mass index (FFMI (p=0.040 values were significantly different between the groups. In the elderly patients (age ≥65, body fat mass, illness marker, BMI, BFMI were higher compared to adult patients (age <65. Additionally, in the elderly patients, prealbumin, BUN, creatinine, albumin, nPCR, ICW/ total body weight, lean body weight, lean dry weight, basal metabolism and FFMI were lower than adult patients.Conclusions: Our results indicate that BFMI were higher, albumin, prealbumin, nPCR and lean body mass and FFMI were lower in elderly patients compared to adults. These results imply that elderly HD patients may be prone sarcopenic obesity and may require special nutritional support.

  16. 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

  17. The role of erythrocyte enzyme glucose-6-phosphate dehydrogenase (G6PD) deficiency in the pathogenesis of anemia in patients on hemodialysis

    OpenAIRE

    Elshazali Widaa Ali; Emad Eldean Mohammed Ahmed

    2013-01-01

    Anemia is a common feature among patients with chronic renal failure (CRF). Low activity of the erythrocyte enzyme glucose-6-phosphate dehydrogenase (G6PD), which plays a major role in protecting red blood cells against oxidative agents, has been described as one of the contributing factors to anemia in patients with CRF treated with hemodialysis (HD). In this study, blood samples were randomly collected from 65 patients on HD and investigated for G6PD deficiency using the methemoglobin reduc...

  18. Safety and Efficacy of PDpoetin for Management of Anemia in Patients with end Stage Renal Disease on Maintenance Hemodialysis: Results from a Phase IV Clinical Trial

    OpenAIRE

    Abbas Norouzi Javidan; Heshmatollah Shahbazian; Amirhossein Emami; Mir Saeed Yekaninejad; Hassan Emami-Razavi; Masoumeh Farhadkhani; Ahmad Ahmadzadeh; Fazel Gorjipour

    2014-01-01

    Recombinant human erythropoietin (rHuEPO) is available for correcting anemia. PDpoetin, a new brand of rHuEPO, has been certified by Food and Drug Department of Ministry of Health and Medical Education of Iran for clinical use in patients with chronic kidney disease. We conducted this post-marketing survey to further evaluate the safety and efficacy of PDpoetin for management of anemia in patients on maintenance hemodialysis. Patients from 4 centers in Iran were enrolled for this multicenter,...

  19. Nurses' perceptions of patient participation in hemodialysis treatment.

    Science.gov (United States)

    Aasen, Elin Margrethe; Kvangarsnes, Marit; Heggen, Kåre

    2012-05-01

    The aim of this study is to explore how nurses perceive patient participations of patients over 75 years old undergoing hemodialysis treatment in dialysis units, and of their next of kin. Ten nurses told stories about what happened in the dialysis units. These stories were analyzed with critical discourse analysis. Three discursive practices are found: (1) the nurses' power and control; (2) sharing power with the patient; and (3) transferring power to the next of kin. The first and the predominant discursive practice can be explained with an ideology of paternalism, in which the nurses used biomedical explanations and the ethical principle of benefice to justify their actions. The second can be explained with an ideology of participation, in which the nurses used ethical narratives as a way to let the patients participate in the treatment. The third seemed to involve autonomous decision-making and the ethical principle of autonomy for the next of kin in the difficult end-of-life decisions. PMID:22323398

  20. Pulmonary Function in Patients with End-Stage Renal Disease: Effects of Hemodialysis and Fluid Overload.

    Science.gov (United States)

    Yılmaz, Süreyya; Yildirim, Yasar; Yilmaz, Zülfükar; Kara, Ali Veysel; Taylan, Mahsuk; Demir, Melike; Coskunsel, Mehmet; Kadiroglu, Ali Kemal; Yilmaz, Mehmet Emin

    2016-01-01

    BACKGROUND Respiratory system disorders are one of the most prevalent complications in end-stage renal disease patients on hemodialysis. However, the pathogenesis of impaired pulmonary functions has not been completely elucidated in these patients. We designed a study to investigate acute effects of hemodialysis treatment on spirometry parameters, focusing on the relationship between pulmonary function and fluid status in hemodialysis patients. MATERIAL AND METHODS We enrolled 54 hemodialysis patients in this study. Multifrequency bioimpedance analysis (BIA) was used to assess fluid status before and 30 min after the midweek of hemodialysis (HD). Overhydration (OH)/extracellular water (ECW)% ratio was used as an indicator of fluid status. Fluid overload was defined as OH/ECW ≥7%. Spirometry was performed before and after hemodialysis. RESULTS Forced vital capacity (FVC), FVC%, and forced expiratory volume in the first second (FEV1) levels were significantly increased after hemodialysis. FVC, FVC%, FEV1, FEV1%, mean forced expiratory flow between 25% and 75% of the FVC (FEF25-75), FEF25-75%, peak expiratory flow rate (PEFR), and PEFR% were significantly lower in patients with fluid overload than in those without. OH/ECW ratio was negatively correlated with FVC, FVC%, FEV1, FEV1%, FEF25-75, FEF25-75%, PEFR, and PEFR%. Stepwise multiple regression analysis revealed that male sex and increased ultrafiltration volume were independently associated with higher FVC, whereas increased age and OH/ECW ratio were independently associated with lower FVC. CONCLUSIONS Fluid overload is closely associated with restrictive and obstructive respiratory abnormalities in HD patients. In addition, hemodialysis has a beneficial effect on pulmonary function tests, which may be due to reduction of volume overload. PMID:27497672

  1. 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

  2. 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

  3. 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.

  4. Obesity, Diabetes and Survival in Maintenance Hemodialysis Patients

    Science.gov (United States)

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

    2016-01-01

    Increased body mass index (BMI) confers a survival advantage in maintenance hemodialysis (MHD) patients. Diabetic (DM) patients undergoing MHD have worse survival. There are limited studies examining the effect of obesity on the risk of death among MHD patients with diabetes. Ninety-eight MHD patients were studied for median follow-up time of 78 months. Patients were classified according to the presence of obesity (BMI ≥ 30 kg/m2) or DM. Primary outcome was all-cause mortality. Cox regression was used to evaluate the effect of obesity on time to death. Effect modification and mediation analysis were also performed. Mean age was 49 ± 13 years, 66% were male, 48% were obese and 34% were diabetic. Mortality rates (per 100 person years) were: 3.4 for non-diabetic obese, 8.6 for non-diabetic non-obese, 14.3 for diabetic non-obese and 18.1 for diabetic obese patients. Log-rank comparing diabetic obese versus non diabetic obese was significant (p=0.007). Diabetes was associated with an increased risk of mortality after adjustment for potential mediators. Effect modification of obesity in the mortality risk was different between patients with and without diabetes. With adjustment for adipokines, a greater effect modification by diabetes was observed whereas adjustment for inflammatory marker did not influence the effect modification. Diabetic obese MHD patients have increased mortality risk compared to non-diabetic obese. Obesity does not offer survival benefits in Diabetic obese MHD patients and potentially may have detrimental effects. Larger studies evaluating the effect of adipokines and obesity in outcomes in the diabetic MHD population need to be undertaken. PMID:24467439

  5. Coping strategies and socio-demographic characteristics among Jordanian caregivers of patients receiving hemodialysis.

    Science.gov (United States)

    Alnazly, Eman

    2016-01-01

    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. PMID:26787574

  6. 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.

  7. 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.

  8. Prevalence and Diagnostic Approach to Sleep Apnea in Hemodialysis Patients: A Population Study

    OpenAIRE

    Valentina Forni Ogna; Adam Ogna; Menno Pruijm; Isabelle Bassi; Emilie Zuercher; Georges Halabi; Olivier Phan; Roberto Bullani; Daniel Teta; Thierry Gauthier; Anne Cherpillod; Claudine Mathieu; Alexandra Mihalache; Francoise Cornette; José Haba-Rubio

    2015-01-01

    Background. Previous observations found a high prevalence of obstructive sleep apnea (OSA) in the hemodialysis population, but the best diagnostic approach remains undefined. We assessed OSA prevalence and performance of available screening tools to propose a specific diagnostic algorithm. Methods. 104 patients from 6 Swiss hemodialysis centers underwent polygraphy and completed 3 OSA screening scores: STOP-BANG, Berlin’s Questionnaire, and Adjusted Neck Circumference. The OSA predictors were...

  9. Sevelamer as a phosphate binder in adult hemodialysis patients: an evidence-based review of its therapeutic value

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    Carole Nadin

    2005-03-01

    Full Text Available Carole NadinCore Medical Publishing, Knutsford, UKIntroduction: Patients on hemodialysis require phosphate binders to reduce dietary phosphate absorption and control serum phosphate. The standard therapy, calcium salts, can be associated with elevated serum calcium (hypercalcemia. Concern has been raised that hypercalcemia, especially combined with elevated serum phosphate, may be associated with arterial calcification, and this may contribute to increased risk of cardiovascular mortality and morbidity. Sevelamer is a nonmetal, nonabsorbed phosphate binder.Aims: This review assesses the evidence for the therapeutic value of sevelamer as a phosphate binder in adult hemodialysis patients.Evidence review: Strong evidence shows that sevelamer is as effective as calcium salts in controlling serum phosphate and calcium–phosphate product, has less risk of inducing hypercalcemia and is more effective at lowering lipid levels. Some evidence indicates that sevelamer reduces arterial calcification progression and loss of bone mineral density, but it may be more likely to induce metabolic acidosis, compared with calcium salts. Sevelamer-containing regimens may improve calcific uremic arteriolopathy, although the evidence is weak. Evidence is divided on whether the incidence of gastrointestinal adverse events with sevelamer is similar to or higher than that with calcium salts. Retrospective and modeling studies suggest lower cardiovascular morbidity and mortality with sevelamer than with calcium salts, with incremental cost-effectiveness of $US1100–2200 per life-year gained. Further direct evidence is needed on mortality, quality of life, and cost-effectiveness.Place in therapy: Sevelamer is effective in controlling serum phosphate and lowering lipid levels in hemodialysis patients without inducing hypercalcemia, and may have beneficial effects on arterial calcification.Key words: sevelamer, calcium salts, phosphate binder, hemodialysis, chronic kidney

  10. 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.

  11. Comparison of Toxoplasma gondii seropositivity in hemodialysis and peritoneal dialysis patients

    Directory of Open Access Journals (Sweden)

    Faezeh Hamidi

    2015-08-01

    Full Text Available 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.

  12. Nitinol stent implantation for femoropopliteal disease in patients on hemodialysis: results of the 3-year retrospective multicenter APOLLON study.

    Science.gov (United States)

    Fujihara, Masahiko; Higashimori, Akihiro; Kato, Yoshihiro; Taniguchi, Hiromasa; Iwasaki, Yusuke; Amano, Tomonori; Sumiyoshi, Akinori; Nishiya, Daisuke; Yokoi, Yoshiaki

    2016-09-01

    The clinical outcomes of nitinol stents for femoropopliteal arterial (FP) disease in patients on hemodialysis were assessed. Endovascular therapy (EVT) is accepted for symptomatic FP disease. However, the clinical outcomes of patients on dialysis are not well known. A multicenter retrospective study was conducted with data between November 2010 and August 2013. A total of 484 consecutive patients who successfully underwent EVT for FP disease with nitinol stents were recruited and analyzed. Patients were categorized into the hemodialysis group (N = 161) and non-hemodialysis group (N = 323). The primary measure was primary patency verified by duplex ultrasound at a rest peak systolic velocity (PSVR) of >2.5, and secondary measures were freedom from target lesion revascularization (TLR) and major amputation-free survival (AFS). Average follow-up duration was 19.5 ± 13.5 months. The primary patency rate at 3 years was significantly lower in the hemodialysis group than the non-hemodialysis group (33.8 vs. 43.7 %; p = 0.036). Freedom from TLR at 3 years was 55.0 % in the hemodialysis group and 66.1 % in the non-hemodialysis group (p = 0.032). The hemodialysis group showed a significantly lower AFS rate at 3 years than the non-hemodialysis group (86.4 vs. 58.2 %; p < 0.001). In hemodialysis patients, nitinol stent use resulted in a lower patency rate, higher TLR rate, and lower AFS rate compared to non-hemodialysis patients. These data suggest that nitinol stent implantation for FP arteries in hemodialysis patient needs to be reconsidered. PMID:26337619

  13. Close association of arterial plaques with left ventricular hypertrophy and ejection fraction in hemodialysis patients

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    Mowlaie Morteza

    2014-01-01

    Full Text Available Introduction: In renal failure patients, cardiovascular complications are a major clinical problem. Objectives: This study aimed to test, the possible association of left ventricular hypertrophy and ejection fraction with plaques of carotid and femoral artery hemodialysis. Patients and Methods: Sixty-one patients, who were on regular hemodialysis were selected. For all patients echocardiography and B-mode Ultrsonographic assessment of carotid-femoral arteries for plaque occurrence were conducted. Results: In this study there was a positive correlation between left ventricular hypertrophy with the duration of hemodialysis treatment (p<0.05. Significant positive association between left ventricular hypertrophy and plaque score and also a significant positive association between left ventricular hypertrophy with presence of chest pain was found (p<0.05. Association of diabetes mellitus with the presence of chest pain was positive. Positive correlation between hypertension with plaque score was demonstrated too (p<0.05. Also an inverse association of plaque score with left ventricular ejection fraction was detected too (p<0.05. Furthermore, the correlation of plaque score with the presence of diabetes mellitus was positive. Conclusion: The present investigations, documents parallel cardiac and vascular adaptation in hemodialysis patients and shows the potential contribution of structural and functional large artery alteration to the pathogenesis of left ventricular hypertrophy which needs more attention in patients on hemodialysis.

  14. Intradialytic Massage for Leg Cramps Among Hemodialysis Patients: a Pilot Randomized Controlled Trial

    Science.gov (United States)

    Mastnardo, Diane; Lewis, Janice M.; Hall, Kristi; Sullivan, Catherine M.; Cain, Katrice; Theurer, Jacqueline; Huml, Anne; Sehgal, Ashwini R.

    2016-01-01

    Background Patients on hemodialysis often experience muscle cramps that result in discomfort, shortened treatment times, and inadequate dialysis dose. Cramps have been associated with adversely affecting sleep and health-related quality of life, depression and anxiety. There is limited evidence available about massage in dialysis; however, massage in cancer patients has demonstrated decreases in pain, inflammation, and feelings of anxiety. These correlations indicate massage may be an effective treatment modality for hemodialysis-related lower extremity cramping. Purpose To determine the effectiveness of intradialytic massage on the frequency of cramping among hemodialysis patients prone to lower extremity cramping. Participants 26 maintenance hemodialysis patients with frequent lower extremity cramps. Setting three outpatient hemodialysis centers in Northeast Ohio. Research Design randomized controlled trial. Intervention The intervention group received a 20-minute massage of the lower extremities during each treatment (three times per week) for two weeks. The control group received usual care by dialysis center staff. Main Outcome Measure change in frequency of lower leg cramping. Results Patient reported cramping at home decreased by 1.3 episodes per week in the intervention group compared to 0.2 episodes per week in the control group (p=.005). Patient reported cramping during dialysis decreased by 0.8 episodes in the intervention group compared to 0.4 episodes in the control group (p=0.44). Conclusion Intradialytic massage appears to be an effective way to address muscle cramping. Larger studies with longer duration should be conducted to further examine this approach. PMID:27257445

  15. Effects of a respiratory physiotherapy protocol on pulmonary capacity, functional capacity and quality of life in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Bruna Taynara dos Santos Ribeiro

    2014-10-01

    Full Text Available Chronic kidney disease and own dialysis can result in changes in almost all body systems. In the respiratory system, the changes affect the respiratory drive, lung mechanics, muscle strength and gas exchange. Respiratory physiotherapy may be an important strategy in improving lung function and welfare and satisfaction of patients. The aim of the study was to determine the effects of a program of respiratory physiotherapy in lung capacity, functional capacity and quality of life of patients with chronic kidney disease on hemodialysis. The lung capacity, functional capacity and quality of life were evaluated by the manovacuometer, chest cirtometry, functional capacity's questionnaire (HAQ-20 and specific questionnaire of quality of life for kidney disease (KDOQOL-SF. Patients were evaluated before and after eight weeks of application of respiratory physiotherapy protocol, performed once a week. The study included five patients, four men and one woman, mean age 60 ± 11,29 and an average of hemodialysis treatment of 24 ± 20.35 months. The values obtained in lung capacity and functional capacity presented unchanged. It was observed that the respiratory physiotherapy influenced the improvement of the KDQOL-SF's scores, of the dimensions "Sleep", "Dialysis Staff Encouragement" and "Physical Functioning".

  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. 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. .

  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; Kappelgaard, Anne-Marie; El Nahas, Meguid; Feldt-Rasmussen, Bo

    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. Predictors of quality of life in hemodialysis patients.

    Science.gov (United States)

    Bayoumi, Magda; Al Harbi, Ali; Al Suwaida, Abdulkareem; Al Ghonaim, Mohammed; Al Wakeel, Jamal; Mishkiry, Adel

    2013-03-01

    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. PMID:23538347

  20. Computer assisted sound analysis of arteriovenous fistula in hemodialysis patients.

    Science.gov (United States)

    Malindretos, Pavlos; Liaskos, Christos; Bamidis, Panagiotis; Chryssogonidis, Ioannis; Lasaridis, Anastasios; Nikolaidis, Pavlos

    2014-02-01

    The purpose of this study was to reveal the unique sound characteristics of the bruit produced by arteriovenous fistulae (AVF), using a computerized method. An electronic stethoscope (20 Hz to 20 000 Hz sensitivity) was used, connected to a portable laptop computer. Forty prevalent hemodialysis patients participated in the study. All measurements were made with patients resting in supine position, prior to the initiation of mid-week dialysis session. Standard color Doppler technique was used to estimate blood flow. Clinical examination revealed the surface where the perceived bruit was more intense, and the recording took place at a sample rate of 22 000 Hz in WAV lossless format. Fast Fourier Transform (FFT) mathematical algorithm, was used for the sound analysis. This algorithm is particularly useful in revealing the periodicity of sound data as well as in mapping its frequency behavior and its strength. Produced frequencies were divided into 40 frequency intervals, 250 Hz apart, so that the results would be easier to plot and comprehend. The mean age of the patients was 63.5 ± 14 years; the median time on dialysis was 39.6 months (mean 1 month, max. 200 months). The mean blood flow was 857.7 ± 448.3 ml/min. The mean sound frequency was approximately 5 500 Hz ± 4 000 Hz and the median, which is also expressing the major peak of sound data, was 750 Hz, varying from 250 Hz to 10 000 Hz. A possible limitation of the study is the relatively small number of participants. PMID:24619890

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

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    Azar BARADARAN

    2011-12-01

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

  2. 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

    2016-01-01

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

  3. 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 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.

  4. 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

    2016-01-01

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

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

    International Nuclear Information System (INIS)

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

  6. Magnesium carbonate for phosphate control in patients on hemodialysis. A randomized controlled trial

    OpenAIRE

    Tzanakis, Ioannis P.; Papadaki, Antonia N.; Wei, Mingxin; Kagia, Stella; Spadidakis, Vlassios V.; Kallivretakis, Nikolaos E.; Oreopoulos, Dimitrios G

    2008-01-01

    Background Magnesium salts bind dietary phosphorus, but their use in renal patients is limited due to their potential for causing side effects. The aim of this study was to evaluate the efficacy and safety of magnesium carbonate (MgCO3) as a phosphate-binder in hemodialysis patients. Methods Forty-six stable hemodialysis patients were randomly allocated to receive either MgCO3 (n = 25) or calcium carbonate (CaCO3), (n = 21) for 6 months. The concentration of Mg in the dialysate bath was 0.30 ...

  7. Positive correlations between the health locus of control and self-management behaviors in hemodialysis patients in Xiamen

    Directory of Open Access Journals (Sweden)

    Jia-Li Fan

    2016-03-01

    Conclusion: The results of this study provided evidence that there is a strong relationship between the health locus of control and self-management behaviors in hemodialysis patients. This study provides important information for medical professionals as they design strategies to educate hemodialysis patients on their health locus of control and self-management behaviors.

  8. Complete en bloc urinary exenteration for synchronous multicentric transitional cell carcinoma with sarcomatoid features in a hemodialysis patient

    Directory of Open Access Journals (Sweden)

    Tiberio M. Siqueira Jr

    2006-10-01

    Full Text Available The incidence of transitional cell carcinoma (TCC in patients submitted to hemodialysis is low. The presence of TCC with sarcomatoid features in this cohort is even scarcer. Herein, we describe a very rare case of synchronous multicentric muscle invasive bladder carcinoma with prostate invasion in a hemodialysis patient, submitted to complete en bloc urinary exenteration.

  9. [Surgical preparation planning of hemodialysis candidates].

    Science.gov (United States)

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

    1975-03-01

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

  10. Role of T-regulatory cells in the response to hepatitis B vaccine in hemodialysis patients.

    Science.gov (United States)

    Mathew, Roy O; Mason, Darius L; Song, Renjie; Tryniszewski, Tiffany; Kennedy, Jeffrey S

    2016-04-01

    Human disease elicits a complex array of biological processes that results in long-term protective immunological memory to infectious agents. Chronic kidney disease is known to impair induction of sustained immunological memory to hepatitis B vaccine (HBVax) antigens. We asked the question: Does end-stage renal disease promote changes in subtypes of regulatory T (Treg) cells that correlate with diminished amnestic response to HBVax antigen compared to healthy controls? The study design and setting was a prospective observational cohort at a veterans affairs medical center. End-stage renal disease patients on hemodialysis (HD) were compared with individuals with self-reported normal kidney function. All subjects received HBVax. Peripheral blood was sampled for assessment for Treg cells pre and post vaccination. CD4+ FOXP3 Treg numbers were similar between HD and healthy subjects during a 14-day time period post vaccination. HD subjcts had lower anti-HBSag antibody than CON (control) subjects (330 ± 108.7 vs. 663.1 ± 129.7 IU/mL; P = 0.063). Hemodialysis subjects with resting Tregs higher than the median value in our cohort demonstrated a significantly lower change in HBsAB at 30 days post booster vaccination (P = 0.030). No such relationship was found for the activated Treg subset among HD subjects, or either subset among CON subsets. In our limited comparison study of 11 HD and 8 CON subjects, Treg subsets did not differ between the two groups; but differences in the suppressive Treg numbers in the HD group could explain the altered antibody response to HBVax and is worthy of further study. PMID:26104830

  11. Uremic Restless Legs Syndrome (RLS and Sleep Quality in Patients With End-Stage Renal Disease on Hemodialysis: Potential Role of Homocysteine and Parathyroid Hormone

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    Katrin Gade

    2013-10-01

    Full Text Available Background: The aetiology of uremic restless legs syndrome (RLS remains unclear. Our research investigated whether an elevated plasma concentration of the excitatory amino acid homocysteine might be associated with RLS occurrence in patients with chronic renal insufficiency on hemodialysis. Methods: Total plasma homocysteine as well as creatinine, urea, folate, parathyroid hormone, hemoglobin, iron, ferritin, phosphate, calcium, magnesium, and albumin levels were compared between 26 RLS-affected (RLSpos and 26 non-affected (RLSneg patients on chronic hemodialysis. We further compared subjective sleep quality between RLSpos and RLSneg patients using the Pittsburgh-Sleep-Quality-Index and investigated possible relationships between laboratory parameters and sleep quality. Results: Taking individual albumin concentrations into account, a significant positive correlation between total plasma homocysteine and RLS occurrence was observed (r= 0.246; p=0.045. Sleep quality was significantly more reduced in RLSpos compared to RLSneg patients and RLS severity correlated positively with impairment of sleep quality. Bad sleep quality in all patients was associated with higher concentrations of parathyroid hormone. Conclusion: Our results suggest a possible aetiological role of homocysteine in uremic RLS. They confirm that uremic RLS is an important factor causing sleep impairment in patients on hemodialysis. Higher parathyroid hormone levels might also be associated with bad sleep quality in these patients.

  12. Nail Changes in End-Stage Renal Failure Patients on Hemodialysis

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    Jamal Arshad

    2000-01-01

    Full Text Available To evaluate the fingernail changes in patients with end-stage renal failure (ESRF on regular hemodialysis (HD, we reviewed 69 patients (male 25, female 44; age 40 ± 14.8 years who have been on HD at Samtah General Hospital, Gizan, Kingdom of Saudi Arabia for a mean of 4.3 ± 3.06 years. They were free from congenital, systemic or primary skin disorders contributing to nail changes. The patients were also free from ornamental dyes like henna, traumatic injuries or infections in the fingernails. They were also clinically free from features suggestive of the carpal tunnel syndrome or vascular steal syndrome secondary to arteriovenous fistula (AVF created for vascular access. Their nails were examined under bright day light by the authors independently. The findings consistent among all three observers were taken for analysis. Hemoglobin and serum albumin levels were also estimated. We compared these changes according to age, sex, and duration on chronic hemodialysis, AVF, and the levels of serum albumin and hemoglobin. One or more nail changes were observed in 44/69 (64% patients. The commonest abnormality was the so-called "Half-and-half nail changes", which was observed in the finger nails of 18/69 (26% of the study patients (males to female ratio was 2:1. Typically, the half-and-half nails are nails where the distal portion of the nail bed is red, pink or brown, occupies 20-60% of the total nail length and is always sharply demarcated with the proximal portion. The latter has a dull whitish ground glass appearance and when pressure is applied, the distal discoloration does not fade completely. Non-specific nail changes were observed 26/69 (38% patients. The hemoglobin and serum albumin levels were not significantly different of those with ′half-and-half′ nail, non-specific nail changes or no nail changes. We conclude that various fingernail changes are observed in ESRF patients on HD. These nail changes are independent of the age of the

  13. Bioimpedance Spectroscopy for the Detection of Hypervolemia in Hemodialysis Patients

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    Ender HÜR

    2011-09-01

    Full Text Available INTRODUCTION: A practical, inexpensive and reliable method is needed for assessment of volume status in hemodialysis (HD patients. In this study the efficiency of bioimpedance spectroscopy (BIS for detection of hypervolemia was investigated. MATERIAL and METHODS: A total of 172 prevalent HD patients were enrolled from 2 centers. Echocardiography, 48-hours ambulatory blood pressure (BP measurement, and body composition analysis using the BIS technique (50 frequencies (Body Composition Monitor were performed. Overhydration (OH and extracellular water (ECW in liters, and the OH/ECW ratio were used as volume indices. RESULTS: The mean age was 52±13 years and HD duration 60±43 months. Of the cases, 41% were female, 17% were diabetic. The mean left ventricular mass index (LVMi was 159±42 gr/m2 and 77% of the patients had left ventricular hypertrophy (LVH. The mean OH and OH/ECW ratio were 2.1±1.6 L and 11±8%, respectively. OH/ECW ratio was correlated with day-time systolic BP (r:0.383, p<0.0001, night-time systolic BP (r:0.380, p<0.0001, pulse pressure-48h (r:0.413, p<0.0001, left atrium index (LAi (r:0.301, p<0.0001, LVMi (r:0.378, p<0.0001 and ejection fraction (EF (r:-0.239, p:0.002. Patients with OH/ECW ratio lower than 5% had favorable cardiovascular risk profile. On linear regression analysis, the OH/ECW ratio was an independent risk factor for LAi (t:3.00, p:0.003, LVMi (t:2.77, p:0.006 and EF (t:-2.34, p:0.02. CONCLUSION: Bioimpedance spectroscopy is a reliable method to evaluate volume status in HD patients. OH/ECW measured by BIS is a major determinant of left atrial diameter, left ventricular mass and ejection fraction. An OH/ECW value less than 5% is associated with acceptable blood pressure control and better cardiac condition.

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

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    Seyed-Moayed Alavian

    2008-02-01

    dialysis patients has decreased over the years as a result of routine screening of blood products for HBsAg, the advent of recombinant human erythropoietin, HBV vaccination and the implementation of infection control measures (7, 8. However, the prevalence and incidence rates of HBsAg positivity are still high among patients undergoing maintenance hemodialysis in the less developed countries (9.Transmission of HDV is similar to HBV, via blood and blood fluids containing the virus, and infection occurs by parenteral routs (10. Dialysis patients may acquire HDV infection as they are at risk of hepatitis B infection. The information on the epidemiology of HDV infection in the dialysis patients is limited. This may be in part related to limited use or availability of delta testing. In European countries, such as France, Sweden, and the USA, HDV infection is restricted to high risk group of drug addicts and has decreased during recent years (11. There are some reports of acute and fulminant hepatitis or symptom-free transmission in dialysis patients with HBV and HDV infections (12-14. The prevalence was different from zero to 44.5% in hemodialysis patients (15, 16. The prevalence of HDV in different groups is related to routs of transmission. In Iran, the main route for HBV transmission was vertical in past (6, 17 and the difference between the prevalence of HDV infection in hemodialysis patients (44.5% and asymptomatic carriers (2.5% is meaningful (15.Delta virus is of particular potential concern in hemodialysis units where segregation of HBsAg positive atients to minimize hepatitis B transmission to susceptible patients may facilitate the transmission of delta agent (18. HDV infection is not important in developed countries, but may be a major risk for fulminant hepatitis in hemodialysis patients with HBV infection in developing countries. The importance of HDV is rising due to immigration phenomenon from area of developing countries. I recommend periodic testing for HDV

  15. Factors Affecting Successful use of Erythropoietin in the Treatment of Anemia in Patients on Hemodialysis: Experience in Hajjah Region, Yemen

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    AL-Rohani Muhamed

    2001-01-01

    Full Text Available The use of recombinant human erythropoietin (rHuEpo became an essential part of the treatment of anemia in patients with end stage renal failure (ESRF. Our experience at the Hajjah region, Yemen, confirms that the use of rHuEpo significantly increases the level of hemoglobin (HB and hematocrit (Hct, improves work tolerance and overall quality of life of patients on hemodialysis. The observable improvement occurred in 87.5% of patients. The most prominent factors that caused deterioration in the increment of HB and Hct were infection with malaria and chronic infection. Failure of patients′ compliance, largely due to lack of education, was another important factor effecting the results. Many of our patients did not understand the importance of diet and drug regime. It is very important to spend more time on educating such patients.

  16. Immunohistochemical screening for neurochemical markers in uremic patients on maintenance hemodialysis.

    Science.gov (United States)

    Johansson, O; Hilliges, M; Han, S W; Ståhle-Bäckdahl, M; Hägermark, O

    1988-01-01

    The epidermis and dermis of 12 uremic patients on maintenance hemodialysis were investigated utilizing the indirect immunofluorescence technique as a tool to study the distribution of neurochemical markers, such as neuropeptides. No differences between controls and the patients were revealed. PMID:3078417

  17. Determinants of Left Ventricular Mass and Hypertrophy in Hemodialysis Patients Assessed by Cardiac Magnetic Resonance Imaging

    OpenAIRE

    Patel, Rajan K.; Oliver, Scott; Patrick B. Mark; Powell, Joanna R.; McQuarrie, Emily P.; Traynor, James P.; Dargie, Henry J; Jardine, Alan G

    2009-01-01

    Background and objectives: Left ventricular hypertrophy (LVH) is an independent risk factor for premature cardiovascular death in hemodialysis (HD) patients and one of the three forms of uremic cardiomyopathy. Cardiovascular magnetic resonance (CMR) is a volume-independent technique to assess cardiac structure. We used CMR to assess the determinants of left ventricular mass (LVM) and LVH in HD patients.

  18. Anthropometry-based equations overestimate the urea distribution volume in hemodialysis patients

    NARCIS (Netherlands)

    Kloppenburg, Wybe; Stegeman, CA; de Jong, PE; Huisman, P.

    2001-01-01

    Background. Protein intake in hemodialysis patients can be estimated indirectly from the protein equivalent of total nitrogen appearance (PNA) during the interdialytic period. A reliable estimate of the patient's urea distribution volume (UDV) is required to assess protein intake from PNA values. UD

  19. The relationship between changes of blood pressure during dialysis and mortality in maintenance hemodialysis patients

    Institute of Scientific and Technical Information of China (English)

    蔡宏

    2014-01-01

    Objective To determine the relationship between changes of blood pressure(BP)during dialysis and mortality in maintenance hemodialysis(MHD)patients.Methods A total of 364 cases of MHD patients were collected prospectively and the relationship between changes of blood pressure during dialysis and mortality was as-

  20. Spontaneous rupture of the spleen: A rare complication in a patient with lupus nephritis on hemodialysis

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    Nadri Quaid

    2010-01-01

    Full Text Available Rupture of the spleen is a life threatening condition. We report a 40-year-old fe-male patient, a known case of lupus nephritis receiving hemodialysis, who developed spontaneous rupture of the spleen during the course of her illness. The patient was managed conservatively with gradual regression of hematoma without further complications.

  1. The incidence of aspirin resistance and relevant influencing factors in patients on maintenance hemodialysis

    Institute of Scientific and Technical Information of China (English)

    张春华

    2014-01-01

    Objective To explore aspirin resistance(AR)and its relevant influencing factors in patients on maintenance hemodialysis(MHD).Methods Patients on MHD who visited Beijing Chaoyang Hospital from June 1 to 30,2011 were enrolled in this study.A total of 150 age and gender matched individuals with normal renal function were taken as control group.Anthropometric data,bio-

  2. Home hemodialysis for a patient with morbid obesity: lower cost, greater efficacy.

    Science.gov (United States)

    Marroquin, Kyla Hancock

    2011-01-01

    Home hemodialysis for persons with morbid obesity requires an extra level of commitment for both the patient and family. It can, however, lead to a significantly higher quality of life for the patient and yield tremendous cost savings for payers. PMID:21520697

  3. NT-proBNP as a predictor of intradialytichypotension among maintaining hemodialysis patients

    Institute of Scientific and Technical Information of China (English)

    余金波

    2012-01-01

    Objective To assess the risk factors of intradialytichypotension (IDH) among maintaining hemodialysis (MHD) patients and to explore the relation between NTproBNP and IDH,thus to provide clinical evidence for the prevention and treatment of IDH. Methods A total of 202 MHD patients during March

  4. Related factors and prognostic significance of intradialytic blood pressure variability in patients on maintenance hemodialysis

    Institute of Scientific and Technical Information of China (English)

    谷立杰

    2013-01-01

    Objective To evaluate intradialytic blood pressure variability (BPV) in patients on maintenance hemodialysis (MHD) ,and to investigate the correlated factors of BPV in MHD process and its correlation with prognosis.Methods Patients with end stage renal disease on MHD before January 1,2009 were enrolled and analyzed retro-

  5. Evaluation of the effect of pentoxifylline on erythropoietin-resistant anemia in hemodialysis patients

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    Amir-Hooshang Mohammadpour

    2014-01-01

    Full Text Available Use of recombinant human erythropoietin (rh-Epo improves hemoglobin (Hgb in 90-95% of the cases of anemia of chronic kidney disease (CKD. However, it is known that pro-inflammatory cytokines such as interferon-gamma (IFN-γ, tumor necrosis factor-alfa (TNF-α and interleukin-1 (IL-1 suppress erythropoiesis, resulting in inadequate response to rh-Epo. Pentoxifylline has been shown to have modulatory effects on the immune system. This prospec-tive study to evaluate the effect of pentoxyphylline on erythropoeisis was performed on 15 (eight males, seven females clinically stable patients who had been on hemodialysis for at least six months with anemia (Hgb of <10.7 g/dL unresponsive to rh-Epo despite high doses. They were treated with 400 mg pentoxifylline tablets once daily for 12 weeks. Hgb increased after one and two months of drug administration, but significant changes were observed in eight (53% patients after three months (P <0.05. Our study illustrates a probable new use for an old medicine. Three months treatment with pentoxifylline was seen to increase Hgb significantly in rh-Epo-resistant patients. More prospective studies with a larger sample size are needed to determine the inhi-bitory role of cytokines on hematopoiesis and exploring new drugs or new drug indications to overcome anemia in advanced renal failure.

  6. Lower creatinine as a marker of malnutrition and lower muscle mass in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Yildiz A

    2015-10-01

    Full Text Available Abdulmecit Yildiz,1 Fatih Tufan2 1Department of Nephrology, Uludag University School of Medicine, Bursa, 2Department of Geriatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, TurkeyWe read the recently published and well-designed study of Lee et al that suggests that bioimpedance analysis (BIA gives relevant information about hydration status and malnutrition in hemodialysis patients. The authors recommend that utilization of BIA routinely in hemodialysis patients would be rational. We would like to make a few comments about their study.View original paper by Lee et al.

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

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    Yanet Parodis López

    2006-03-01

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

  8. C- Reactive protein, cardiac troponin T and low albumin are predictors of mortality in hemodialysis patients

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    Bagheri Nazila

    2009-01-01

    Full Text Available Overall and cardiovascular mortality are significantly higher in hemodialysis patients with elevated C-reactive protein (CRP. The aim of study was to determine whether CRP, low albumin and troponin are markers of overall and cardiovascular mortality in hemodialysis patients. 138 stable hemodialysis patients were divided into 2 groups n= 66 patients with coronary disease equivalent (known coronary or peripheral vascular disease or diabetes mellitus and n= 72 patients without it. The two groups were then stratified by biomarkers [cardiac troponin T and Albumin and highly sensitive CRP (hs-CRP] and followed for 30 months. The primary outcome was all causes mortality. Patients with coronary disease equivalents had 3.5 fold greater annual mortality compared to controls (24%% vs 6.9%, P value = 0.005. Elevated troponin T had a further increase in the risk for death while hs-CRP and low albumin were not associated with risk of death In conclusion, circu-lating cardiac troponin-T was associated with poor prognosis especially in hemodialysis patients with coronary risk factors.

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

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

    2002-09-01

    Full Text Available Background: Decreased bone mineral density (BMD is a known complication for the uremic state antedating dialysis / renal transplantation (RTx. The issue of stabilized versus continued decrease of BMD especially on long-term basis, continues to be unresolved. Patients and Methods: !"#"hemodialysis (HD-#" $% " &'( &'(-group had been evaluated for metabolic bone changes by calcium homeostasis parameters (serum calcium, phosphorus, alkaline phosphatase "ALP" and vitamin D "calcitriol", markers of bone formation (bone alkaline phosphatase "BAP", osteocalcin "OC", N-terminal propeptide of collagen type I "PINP", bone resorption markers (pyridoline "PYL" and deoxypyridoline "DPYL", and intact parathyroid hormone (iPTH. Also, BMD had been assessed by dual energy x-ray absorptiometry (DEXA twice, at inclusion time and * ! "" Results: comparing both groups regarding calcium homeostasis, markers of bone turnover and iPTH showed non significant difference. However, there was a significant drop of BMD (as evidenced by T-score at follow up in the HD group, compared to stabilization of T-score for the RTx-group. Furthermore, annual T-score change was significantly more in HD-group, compared to RTx-group. Results also showed that, the best marker correlating with T-score annual changes and iPTH to be PINP. Irrespective of normal calcium homeostasis parameters, low BMD is a prevalent disorder among patients on regular HD and renal transplants.Conclusion: Follow up for * ! " %+ ,- ." % """"!to continued bone loss in patients on regular HD. This could raise recommendation for calcium and calcitriol supplementation, especially in the predialysis period, early post transplantation period, and continued guided replacement for those on maintenance HD. Serum PINP showed best correlations with BMD changes and iPTH and could be considered a reliable marker reflecting bone formation in those patients. Keywords: hemodialysis, renal transplantation, markers of bone

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

    Science.gov (United States)

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

    2016-08-01

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

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

    Science.gov (United States)

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

    2016-06-01

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

  12. What is the Role of HbA1c in Diabetic Hemodialysis Patients?

    Science.gov (United States)

    Coelho, Silvia

    2016-01-01

    The definition of a good glycemic control in patients with diabetes mellitus on hemodialysis is far from settled. In the general population, hemoglobin A1c is highly correlated with the average glycemia of the last 8-12 weeks. However, in hemodialysis patients, the correlation of hbA1c with glycemia is weaker as it also reflects changes in hemoglobin characteristics and red blood cells half-life. As expected, studies show that the association between HbA1c and outcomes in these patients differ from the general population. Therefore, the value of HbA1c in the treatment of hemodialysis patients has been questioned. Guidelines are generally cautious in their recommendations about possible targets of HbA1c in this population. Indeed, the risk of not treating hyperglycemia should be weighed against the particularly high risk of precipitating hypoglycemia in dialysis patients. In this review, a critical analysis of the current role of HbA1c in the care of hemodialysis patients is presented. PMID:26138753

  13. Bilateral spontaneous perirenal hemorrhage in an acquired cystic kidney disease hemodialysis patient.

    Science.gov (United States)

    Hirohama, Daigoro; Miyakawa, Hiroshi

    2012-01-01

    Acquired cystic kidney disease (ACKD) is a well-known late stage complication of chronic kidney disease. Cysts tend to grow with time on dialysis and could lead to malignant transformation, and intra- or perirenal hemorrhage is a rare complication of ACKD. Here we describe one case of bilateral spontaneous perirenal hemorrhage of ACKD in a 44-year-old man, on hemodialysis for 15 years. One was due to cyst rupture, and the other was due to aneurism rupture, both were controlled with transcatheter arterial embolization. In renal arteriography at the second rupture, we demonstrated extravasation from an aneurysm being present at the periphery of right renal artery. Several spontaneous perirenal hemorrhage cases were reported but its clinical information is limited, moreover, bilateral cases were extremely rare. Furthermore, to our knowledge, this is the first report of spontaneous perirenal hemorrhage caused by intraparenchymal renal artery aneurysm rupture in ACKD patients. We report this case because of its rarity and significance with respect to the complication of dialysis patients, review reported bilateral cases, and discuss some clinical characteristics. PMID:24533199

  14. Daptomycin antibiotic lock therapy for hemodialysis patients with Gram-positive bloodstream infections following use of tunneled, cuffed hemodialysis catheters: retrospective single center analysis.

    Science.gov (United States)

    Yen, Hung-Wen; Yang, Wu-Chang; Tarng, Der-Cherng; Yang, Chih-Yu; Chuang, Chiao-Lin; Huang, Ling-Ju; Lin, Pei-Yu; Wang, Chih-Chun; Li, Szu-Yuan

    2016-04-01

    Catheter-related blood stream infection (CRBSI) is a major complication in hemodialysis patients. We assessed the efficacy of systemic daptomycin (DPT) plus DPT antibiotic lock therapy (DPT-ALT) for catheter salvage in patients with Gram-positive CRBSIs. This is a retrospective study of hemodialysis patients with tunneled and cuffed hemodialysis catheters. All patients were from a single institution in Taipei and received systemic DPT plus DPT-ALT for the treatment of Gram-positive CRBSI. Successful resolution of CRBSI was implemented. Resolution of fever within 48 hours, negative result of repeated blood cultures after resolution of fever, no clinical evidence of CRBSI relapse and no need for catheter removal were measured. Fifteen hemodialysis patients received DPT-ALT for CRBSI, nine with coagulase-negative Staphylococcus (CONS), two with methicillin-resistant Staphylococcus aureus (MRSA), three with methicillin-sensitive Staphylococcus aureus (MSSA) and one with polymicrobial infections. Systemic DPT plus DPT-ALT cured 11 patients (73.3%). Treatment failed in all three MRSA cases (two with MRSA and one with MRSA + Enterococcus faecalis). Retrospective design and small sample size were the limitations of this study. Systemic DPT plus DPT-ALT appears to be a promising treatment for CRBSI from CONS and MSSA, but not for MRSA CRBSI. Systemic DPT plus DPT-ALT should be considered for patients with CRBSIs caused by certain species. PMID:26549513

  15. Does N-acetylcysteine modulate posttranslational modifications of transthyretin in hemodialysis patients?

    DEFF Research Database (Denmark)

    Henze, Andrea; Raila, Jens; Scholze, Alexandra; Zidek, Walter; Tepel, Martin; Schweigert, Florian J

    2013-01-01

    plasma of hemodialysis patients in a randomized, placebo-controlled study. TTR was selected due to its low molecular weight and the free cysteine residue in the polypeptide chain, which is known to be extensively modified by formation of mixed disulfides. The intravenous application of N......-acetylcysteine during a hemodialysis session resulted in a substantial increase of native TTR from median 15% (range 8.8-30%) to median 40% (37-50) and reduction of S-cysteinylated TTR [51% (44-60) vs. 6.6% (2.4-10)]. Additionally the pronounced formation of a TTR-N-acetylcysteine adduct was detected. However, all...

  16. Prevalence of hepatitis C virus (HCV infection and HCV genotypes of hemodialysis patients in Salvador, Northeastern Brazil

    Directory of Open Access Journals (Sweden)

    Silva L.K.

    2006-01-01

    Full Text Available Hepatitis C virus (HCV infection has been identified as the major cause of chronic liver disease among patients on chronic hemodialysis (HD, despite the important reduction in risks obtained by testing candidate blood donors for anti-HCV antibodies and the use of recombinant erythropoietin to treat anemia. A cross-sectional study was performed to estimate the prevalence of HCV infection and genotypes among HD patients in Salvador, Northeastern Brazil. Anti-HCV seroprevalence was determined by ELISA in 1243 HD patients from all ten different dialysis centers of the city. HCV infection was confirmed by RT-PCR and genotyping was performed by restriction fragment length polymorphism. Anti-HCV seroprevalence among HD patients was 10.5% (95% CI: 8.8-12.3 (Murex anti-HCV, Abbott Murex, Chicago, IL, USA. Blood samples for qualitative HCV detection and genotyping were collected from 125/130 seropositive HD patients (96.2%. HCV-RNA was detected in 92/125 (73.6% of the anti-HCV-positive patients. HCV genotype 1 (77.9% was the most prevalent, followed by genotype 3 (10.5% and genotype 2 (4.6%. Mixed infections of genotypes 1 and 3 were found in 7.0% of the total number of patients. The present results indicate a significant decrease in anti-HCV prevalence from 23.8% detected in a study carried out in 1994 to 10.5% in the present study. The HCV genotype distribution was closely similar to that observed in other hemodialysis populations in Brazil, in local candidate blood donors and in other groups at risk of transfusion-transmitted infection.

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

    OpenAIRE

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

    2013-01-01

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

  18. Comparison of Azithromycin and Clarithromycin Triple Therapy Regimens for Helicobacter Pylori Eradication in Hemodialysis Patients

    OpenAIRE

    Jalalzadeh, Mojgan; Nazarian, Morteza; Vafaeimanesh, Jamshid; Mirzamohammadi, Fatemeh

    2012-01-01

    Background Helicobacter pylori eradication with clarithromycin is more expensive than with azithromycin. Objectives This study aimed to compare the effectiveness of these two antibiotics in eradicating H. pylori in hemodialysis (HD) patients. Patients and Methods This is a prospective, randomized, double-blinded clinical trial analysis of HD patients. Patients who had dyspepsia and showed positive results for two of three tests, anti-H. pylori serology, H. pylori stool antigen (HpSAg), or Ure...

  19. Demographic factors affecting quality of life of hemodialysis patients – Lahore, Pakistan

    OpenAIRE

    Anees, Muhammad; Malik, Muzammil Riaz; Abbasi, Tanzeel; Nasir, Zeeshan; Hussain, Yasir; Ibrahim, Muhamamd

    2014-01-01

    Objective: The objective of the study was to determine the demographic factors affecting Quality Of Life (QOL) of hemodialysis (HD) patients. Methods: This observational study was conducted at Shalamar Hospital, Lahore. Patients of End Stage Renal Disease (ESRD) and on maintenance HD for more than three months were included during the period March to June 2012. Patient of ESRD not on dialysis and Acute Renal Failure were excluded. One hundred and twenty five patients who fulfilled the criteri...

  20. The efficacy of relaxation training on stress, anxiety, and pain perception in hemodialysis patients

    OpenAIRE

    M A Heidari Gorji; Davanloo, A. Abbaskhani; Heidarigorji, A. M.

    2014-01-01

    Patients on dialysis experience psychological distress, which can impact pain perception. Reduction of stress and anxiety in patients provides psychological resources to cope with their physical condition. We examined the efficacy of relaxation training on stress, anxiety, and pain perception of hemodialysis (HD) patients. eighty HD patients were randomized into two groups (intervention and control). Benson relaxation training was implemented in the intervention group for 15 min twice daily d...

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

    Science.gov (United States)

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

    2016-06-01

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

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

    DEFF Research Database (Denmark)

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

    2010-01-01

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

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

    DEFF Research Database (Denmark)

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

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Humberto Kukhyun Choi

    2003-01-01

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

  5. Sericin cream reduces pruritus in hemodialysis patients: a randomized, double-blind, placebo-controlled experimental study

    Directory of Open Access Journals (Sweden)

    Aramwit Pornanong

    2012-09-01

    Full Text Available Abstract Background Uremic pruritus (UP is a significant complication in ESRD patients and substantially impairs their quality of life. UP is considered to be a skin manifestation of chronic inflammation. Because sericin can suppress the release of pro-inflammatory cytokines, the purpose of this study was to investigate the short-term safety and efficacy of sericin cream for treating UP in hemodialysis patients. Methods This study used a double-blind design to investigate the effects of random topical administration of sericin cream and cream base (placebo on either the right or left extremities of hemodialysis patients for 6 weeks. Skin hydration, irritation and pigmentation were evaluated every 2 weeks using Skin Diagnostic SD27. The visual analog scale for itching was also evaluated every 2 weeks, and the Kidney Disease Quality of Life Short Form was performed on the day of each patient’s enrollment and after 6 weeks of treatment. Results Fifty dialysis patients were enrolled, 47 of which completed the study. The hydration of the skin of the patients’ extremities increased significantly after administration of sericin cream; significant differences were found between sericin treatment and control after 6 weeks of treatment (p = 0.041 for arms and p = 0.022 for legs, respectively. Moreover, a significant difference was also found in skin irritation between the two treatments (p = 0.013 for arms and p = 0.027 for legs, respectively. At the end of the study, the skin pigmentation level was significantly reduced on both the arms (p = 0.032 and legs (p = 0.021 of the sericin-treated side compared with the side treated with cream base. The mean itching score decreased significantly from moderate to severe at the time of enrollment to mild pruritus after 6 weeks of treatment (p = 0.002. A better quality of life was found in all domains tested although statistically significant differences before and after

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

    Directory of Open Access Journals (Sweden)

    Saifan C

    2013-07-01

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

  7. Impact of dialyzer membrane flux on metal clearance in hemodialysis patients.

    Science.gov (United States)

    Mortada, Wael I; Nabieh, Kareem A; Donia, Ahmed F; Ismail, Amani M; Kenawy, Ibrahim M M

    2016-07-01

    Deficiency of essential trace elements (such as Cu or Zn) and accumulation of potentially toxic trace elements (as Cd or Pb) are both known to have adverse effects in hemodialysis (HD) patients. Up to our knowledge, no studies about the permeability of low and high flux polysulfone membranes on metal ions during hemodialysis are available. Therefore, the aim of the present study was to address this issue. Forty one hemodialysis patients (19 were using high flux polysulfone membrane while the remaining were using low flux one) participated in the study. Blood levels of Cu, Zn, Cd and Pb were determined by graphite furnace atomic absorption spectrometry among HD patients, before and after dialysis session, as well as among matched 40 healthy persons. Blood concentrations of Cu and Zn in the whole hemodialysis group was significantly lower than those of the healthy control group, on the other hand the toxic metals (Cd and Pb) levels were observed to be significantly higher among HD patients compared to the normal persons. Among the hemodialysis group, there were no significant differences between the low and high flux dialyzer groups in terms of pre-dialysis blood levels of Cu, Zn, Cd and Pb. In addition, significantly decreased levels of all metal ions were observed after dialysis sessions using either low or high flux membranes. An exception was Pb which did not show any difference between pre-dialysis and post-dialysis values in the low flux groupIn conclusion Zn and Cu deficiencies should be considered in the treatment of these patients. High flux membranes are more efficient than low flux ones in removing excess Cd and Pb. Therefore, when high flux membranes are used, chelation therapy might not be required for Cd and Pb overload. PMID:27259352

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

    Directory of Open Access Journals (Sweden)

    Siminelakis Stavros N

    2010-03-01

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

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

    Science.gov (United States)

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

    2016-05-01

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

  10. Magnetic resonance-determined sodium removal from tissue stores in hemodialysis patients

    OpenAIRE

    Dahlmann, Anke; Dörfelt, Kathrin; Eicher, Florian; Linz, Peter; Kopp, Christoph; Mössinger, Irina; Horn, Stephan; Büschges-Seraphin, Beatrix; Wabel, Peter; Hammon, Matthias; Cavallaro, Alexander; Eckardt, Kai-Uwe; Kotanko, Peter; Levin, Nathan W.; Johannes, Bernd

    2014-01-01

    We have previously reported sodium is stored in skin and muscle. The amounts stored in hemodialysis (HD) patients are unknown. We determined whether 23Na magnetic resonance imaging (sodium-MRI) allows assessment of tissue sodium and its removal in 24 HD patients, and 27 age-matched healthy controls. We also studied 20 HD patients before and shortly after HD with a batch dialysis system with direct measurement of sodium in dialysate and ultrafiltrate. Age was associated with higher tissue sodi...

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

    OpenAIRE

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

    2012-01-01

    Insomnia and limb pain are common problems in dialysis patients. In addition, restless leg syndrome (RLS) as a specific cause of insomnia and limb pain has been reported in many studies. The purpose of this study was to estimate incidence of insomnia and RLS as a cause of insomnia in these patients. Twenty-six patients undergoing hemodialysis were investigated for insomnia, limb pain and RLS as per the defined criteria. They were evaluated for dialysis quality, dialysis duration, hemoglobin, ...

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

    OpenAIRE

    Theofilou, Paraskevi

    2011-01-01

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

  13. Factors affecting effectiveness of vaccination against hepatitis B virus in hemodialysis patients

    OpenAIRE

    Eleftheriadis, Theodoros; PISSAS, GEORGIOS; Antoniadi, Georgia; Liakopoulos, Vassilios; Stefanidis, Ioannis

    2014-01-01

    Hepatitis B virus (HBV) is a major global health problem. Despite the success of the general measures against blood transmitted infections in hemodialysis (HD) units, the prevalence of HBV infection among the HD patients is still high. Thus vaccination against HBV is indicating in this population. However, compared with the general population the seroprotection achieved in HD patients remains relatively low, at about 70%. In this review patient, HD procedure and vaccine-associated factors tha...

  14. Evaluation of hepatitis B vaccine responsiveness in hemodialysis and peritoneal dialysis patients

    OpenAIRE

    Salama Elsayed Farag; Tarek A Ghonemy; Sameh A. Soliman; Ahmed Bihery

    2015-01-01

    Background: Hepatitis B Virus (HBV) infection is considered as a major cause of liver cirrhosis and hepatocellular carcinoma. Patients with End Stage Renal Disease (ESRD) are a risk group for HBV infection. The vaccine of hepatitis B has been recommended for prevention of HBV infection in ESRD patient especially on renal replacement therapy. Methods: Eighty seven patients with ESRD on peritoneal dialysis and hemodialysis requiring primary hepatitis B vaccination were enrolled in the stud...

  15. Factors associated with quality of life among hemodialysis patients in Malaysia.

    Directory of Open Access Journals (Sweden)

    Nor Baizura Md Yusop

    Full Text Available Although hemodialysis treatment has greatly increased the life expectancy of end stage renal disease patients, low quality of life among hemodialysis patients is frequently reported. This cross-sectional study aimed to determine the relationship between medical history, hemodialysis treatment and nutritional status with the mental and physical components of quality of life in hemodialysis patients. Respondents (n=90 were recruited from Hospital Kuala Lumpur and dialysis centres of the National Kidney Foundation of Malaysia. Data obtained included socio-demography, medical history, hemodialysis treatment and nutritional status. Mental and physical quality of life were measured using the Mental Composite Summary (MCS and Physical Composite Summary (PCS of the Short-Form Health Survey 36-items, a generic core of the Kidney Disease Quality of Life Short Form. Two summary measures and total SF-36 was scored as 0-100, with a higher score indicating better quality of life. Approximately 26 (30% of respondents achieved the body mass index (24 kg/m(2 and more than 80% (n=77 achieved serum albumin level (>35.0 mg/dL recommended for hemodialysis patients. The majority of respondents did not meet the energy (n=72, 80% and protein (n=68,75% recommendations. The total score of SF-36 was 54.1 ± 19.2, while the score for the mental and physical components were 45.0 ± 8.6 and 39.6 ± 8.6, respectively. Factors associated with a higher MCS score were absence of diabetes mellitus (p=0.000 and lower serum calcium (p=0.004, while higher blood flow (p=0.000, higher serum creatinine (p=0.000 and lower protein intake (p=0.006 were associated with a higher PCS score. To improve the overall quality of life of hemodialysis patients, a multidisciplinary intervention that includes medical, dietetic and psychosocial strategies that address factors associated with mental and physical quality of life are warranted to reduce further health complications and to improve quality

  16. Mortality Trend Among Hemodialysis Patients During the Islamic Month of Ramadan: A 24 Years Retrospective Study

    International Nuclear Information System (INIS)

    Objective: The effect of month of Ramadan on the mortality in hemodialysis patients, and to compare it with that in all other Islamic months. Study Design: A descriptive study. Place and Duration of Study: Hemodialysis Unit, The Kidney Center, Karachi, from January 1989 to December 2012. Methodology: All those patients who were diagnosed to have end stage kidney disease and on maintenance hemodialysis for more than 3 months, regardless of underlying cause of kidney failure were included. Patients with acute kidney injury were excluded. Status of the patients was recorded at the end of the study period. The fasting status of the patients was not mentioned. The deaths of the patients were further evaluated and frequencies of death in all twelve Islamic months were calculated. Results: A total of 1,841 patients were registered, out of whom 897 (48.7%) died, and 269 (14.6%) survived till the end of the study. One thousand and fifty six (57.3%) were males, 651 (35.4%) were diabetic. Total number of 143 (7.76%) events occurred in Ramadan, out of which 94 patients died which make nearly 11% of the total deaths distributed in 12 Islamic months. Frequency of death was higher in Ramadan when compared with other months. Conclusion: Ramadan reflected a higher frequency of death. Therefore, there is a need to evaluate the risk factors in a prospective study so that the dialysis patients can be better managed during this period. (author)

  17. The relationship between depression and quality of life among hemodialysis patients in Chaharmahal and Bakhtiari province in the year 2011

    OpenAIRE

    Hemati, Zaynab; Alidosti, Massomeh; Sharifirad, Golamreza; Kargar, Mehdy

    2013-01-01

    Introduction: Although hemodialysis is therapeutic, it causes numerous physical and psychological tensions, which affect the quality of life of patients. Assessing the quality of life helps to consider clients’ problems; basically, the relationship between depression and quality of life of patients has been observed in this study. Materials and Methods: This was an analytic–descriptive study in which the patients received hemodialysis in Chaharmahal and Bakhtiari province. They were monitored...

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

    OpenAIRE

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

    2016-01-01

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

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

    OpenAIRE

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

    2010-01-01

    Introduction: To evaluate the relationship between various biochemical, nutritional and demographic factors with immune response to hepatitis B vaccine in maintenance hemodialysis (HD) patients. Material and Methods: A retro-prospective study was carried out on 68 patients undergoing maintenance hemodialysis .Patients were vaccinated against hepatitis B virus with an intramuscular hepatitis B vaccination schedule, 40 micrograms at 0, 1, and 6 months. We also selected 32 age matched normal he...

  20. Salud oral en pacientes con insuficiencia renal crónica hemodializados después de la aplicación de un protocolo estomatológico Oral health in patients with chronic renal failure under hemodialysis after the implementation of an stomatological protocol

    Directory of Open Access Journals (Sweden)

    M. Rebolledo Cobos

    2012-04-01

    Full Text Available Objetivo: Evaluar la salud oral de los pacientes con insuficiencia renal crónica (IRC hemodializados antes y después de aplicar un protocolo de atención estomatológica basado en la evidencia, en una unidad renal de Cartagena. Metodología: Estudio cuasiexperimental con 120 pacientes, se aplicó una encuesta determinando las características socio demográficas e información que tenían acerca de asociación de IRC con lesiones orales. Posteriormente se efectuó un examen clínico y se aplicó el protocolo de manejo, con posteriores controles clínicos determinando cambios estomatológicos resultantes. La información se condensó mediante paquete estadístico Epi Info versión 5.0 y se realizó un análisis descriptivo para las variables nominales y ordinales. Transcurrido 3 meses se ejecutó una nueva valoración clínica para determinar los cambios. Se valoró el efecto de la intervención mediante la prueba estadística de McNemar. Resultados: En la valoración inicial se diagnosticaron en promedio 7 lesiones estomatológicas asociadas por paciente y en la reevaluación 3, (pObjective: To evaluate the oral health of patients with chronic renal failure (CRF under hemodialysis treatment before and after applying a dental care protocol based on the evidence in a renal unit in the city of Cartagena. Methodology: A quasi-experimental study with 120 patients, a survey determined the sociodemographic characteristics and information they had about CRF association with oral lesions. Subsequently it was performed a clinical examination and applied management protocol, with subsequent monitoring dental changes resulting determining clinical. The information was condensed by statistical package Epi Info version 5.0 and performed a descriptive analysis of nominal and ordinal variables. After 3 months, implemented a new clinical assessment to determine changes. Were evaluated the effect of intervention by the McNemar test statistic. Results: In the

  1. Combined Alkaline Phosphatase and Phosphorus Levels as a Predictor of Mortality in Maintenance Hemodialysis Patients

    Science.gov (United States)

    Chang, Jia-Feng; Feng, Ying-Feng; Peng, Yu-Sen; Hsu, Shih-Ping; Pai, Mei-Fen; Chen, Hung-Yuan; Wu, Hon-Yen; Yang, Ju-Yeh

    2014-01-01

    Abstract Hyperphosphatemia-induced vascular calcification and higher alkaline phosphatase (ALP) levels-related high-turnover bone diseases are linked to mortality among patients with chronic kidney disease (CKD). Nonetheless, no large epidemiological study in patients with CKD has been conducted to investigate the interaction and joint effect of hyperphosphatemia and higher ALP levels on mortality. We analyzed 11,912 maintenance hemodialysis patients from January 2005 to December 2010. Unadjusted and adjusted hazard ratios (aHRs) of death were calculated for different categories of serum phosphorus and ALP using the Cox regression model. The modification effect between serum phosphorus and ALP on mortality was determined using an interaction product term. Both hypophosphatemia (7.0 mg/dL) were associated with incremental risks of death (aHR: 1.25 [95% confidence intervals (CIs): 1.09–1.44], and 1.15 [95% CI: 1.01–1.31], respectively) compared to the lowest hazard ratio (HR) group (5 mg/dL ≤ phosphorus  150 U/L). In the stratified analysis, patients with combined higher ALP (>150 U/L) and hyperphosphatemia (>7.0 mg/dL) had the greatest mortality risk (aHR: 2.25 [95% CI: 1.69–2.98] compared to the lowest HR group (ALP ≤ 60 U/L and 4 mg/dL ≤ phosphorus phosphorus levels and mortality was not limited to higher ALP levels. Regardless of serum ALP levels, we may control serum phosphorus levels merely toward the normal range. While considering the joint effect of ALP and hyperphosphatemia on mortality, the optimal phosphorus range should be stricter. PMID:25319440

  2. Measuring pain self-efficacy and health related quality of life among hemodialysis patients in Greece: a cross-sectional study

    OpenAIRE

    Paraskevi Theofilou; Adamantia Aroni; Sophia Zyga

    2013-01-01

    Patients suffering from end-stage kidney disease often complain about pain. It is also known that the presence of chronic pain greatly impacts upon patients’ quality of life (QOL) and can play a crucial role in the co-morbidity of mental health symptoms such as depression and anxiety. The main aim of this study protocol is the investigation of pain self-efficacy, QOL as well as their relation in patients undergoing hemodialysis treatment. The final sample size will be around 70-80 patients. E...

  3. ACUTE SYMPTOMS AND COMPLICATIONS OF HEMODIALYSIS

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    Bárbara Paula Magalhães de Deus

    2015-07-01

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

  4. Fetuin-A and vitamin D receptor gene polymorphisms in hemodialysis patients

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    Shahnam Valizadeh-Shahbazloo

    2014-08-01

    Full Text Available Introduction: Vascular calcification is a common complication in the chronic kidney disease (CKD patients and the leading cause of morbidity and mortality in this patient. The aim of the present study was to evaluate a possible correlation between vitamin D receptor (VDR gene FokI and ApaI polymorphisms with the expression of calcification biomarkers such as Fetuin-A and intact parathyroid hormone (iPTH in hemodialysis (HD patients. Methods: In this cross-sectional study, serums were obtained from 46 stable chronic HD patients. The serum levels of iPTH, Fetuin-A, vitamin D, calcium, phosphorus, and VDR genotyping were determined by standard methods. Results: Serum levels of Fetuin-A, calcium, and phosphorus did not differ between males and females, but significant differences in iPTH and vitamin D levels was found in the study patients [(336.8 ± 139.0 pg/dl vs. (414.7 ± 111.8 pg/dl, P = 0.040 and (24.5 ± 7.6 ng/ml vs. (19.9 ± 4.8 ng/ml, P = 0.020 respectively]. A significant correlations were found between serum phosphorus and levels of serum calcium (r = –0.4; P = 0.002, vitamin D (r = –0.5; P = 0.001 and iPTH (r = 0.4; P = 0.001. iPTH level in FokI polymorphism, were different between genotype groups in study patient (P = 0.020. There was a significant positive correlation between vitamin D and iPTH levels in patients with aa genotype (P = 0.020, r = 0.4. Conclusion: These findings suggest that FokI (rs2228570 polymorphism in exon-2 of the VDR gene may play a role in iPTH levels. Fetuin-A deficiency or high level of iPTH and its association with VDR gene polymorphisms may be useful to identify the high-risk group susceptible to renal failure and atherosclerosis. Although VDR gene FokI and ApaI polymorphisms could affect the levels of Fetuin-A and vitamin D, their direct role on atherosclerosis needs further studies in the future.

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

    Institute of Scientific and Technical Information of China (English)

    张晓娟

    2013-01-01

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

  6. Significance of serum troponin T and Creactive protein in the long-term prognosis of hemodialysis patients

    Institute of Scientific and Technical Information of China (English)

    毛永辉

    2013-01-01

    Objective To investigate the long-term prognostic factors and the significance of serum cardiac troponin T(cTnT) and C-reactive protein(CRP) in maintenance hemodialysis(MHD) patients.Methods Clinical data of

  7. Functional Polymorphisms in Matrix Metalloproteinases-1, -3, -9 are Associated with Arteriovenous Fistula Patency in Hemodialysis Patients

    OpenAIRE

    Lin, Chih-Ching; Yang, Wu-Chang; Chung, Ming-yi; Lee, Pui-Ching

    2010-01-01

    Background and objectives: Matrix metalloproteinases (MMPs) are risk factors for cardiovascular diseases. This study evaluated the association of genotype polymorphisms of MMPs and tissue inhibitors of metalloproteinases (TIMPs) in hemodialysis (HD) patients with arteriovenous fistula (AVF) failure.

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

    OpenAIRE

    Santos Paulo Roberto; Arcanjo Francisco Plácido Nogueira

    2013-01-01

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

  9. Carotid ultrasonographic parameters as markers of atherogenesis and mortality rate in patients on hemodialysis

    OpenAIRE

    Stolić Radojica; Trajković Goran; Jovanović Aleksandar; Stolić Dragica; Perić Vladan; Sovtić Saša; Šubarić-Gorgieva Gordana

    2010-01-01

    Background/Aim. Vascular endothelium plays an important role in atherogenesis. The aim of this study was to estimate the correlation of endothelium malfunction and arteriosclerosis in patients on hemodialysis. Methods. The investigation was designed as a clinical, non-randomized, fiveyear study in the 'Kragujevac' Clinical Center and included 146 patients. We evaluated demographic characteristics, smoking, duration of dialysis, existence of tissue calcification and duplex ultrasound parameter...

  10. Association of Relatives of Hemodialysis Patients with Metabolic Syndrome, Albuminuria and Framingham Risk Score

    OpenAIRE

    Huang, Jiun-Chi; Chen, Szu-Chia; Lin, Ming-Yen; Chang, Jer-Ming; Hwang, Shang-Jyh; Tsai, Jer-Chia; Chen, Hung-Chun

    2014-01-01

    Background and Aim Metabolic syndrome (MetS), albuminuria, and the Framingham Risk Score (FRS) are significant predictors for cardiovascular disease (CVD). However, the relationship and clinical significance of these CVD predictors in individuals with a family history of end-stage renal disease (ESRD) are unclear. We investigated the association of relatives of hemodialysis (HD) patients with MetS, albuminuria, and the FRS. Methods One hundred and sixty-six relatives of HD patients and 374 ag...

  11. OPPORTUNITYTM: a large-scale randomized clinical trial of growth hormone in hemodialysis patients

    DEFF Research Database (Denmark)

    Kopple, Joel D; Cheung, Alfred K; Christiansen, Jens Sandahl;

    2011-01-01

    Adult maintenance hemodialysis (MHD) patients experience high mortality and morbidity and poor quality of life (QoL). Markers of protein-energy wasting are associated with these poor outcomes. The OPPORTUNITY™ Trial examined whether recombinant human growth hormone (hGH) reduces mortality in...... hypoalbuminemic MHD patients. Secondary end points were effects on number of hospitalizations, cardiovascular events, lean body mass (LBM), serum proteins, exercise capacity, QoL and adverse events....

  12. OPPORTUNITY™: a large-scale randomized clinical trial of growth hormone in hemodialysis patients

    DEFF Research Database (Denmark)

    Kopple, Joel D; Cheung, Alfred K; Christiansen, Jens Sandahl;

    2011-01-01

    Adult maintenance hemodialysis (MHD) patients experience high mortality and morbidity and poor quality of life (QoL). Markers of protein-energy wasting are associated with these poor outcomes. The OPPORTUNITY™ Trial examined whether recombinant human growth hormone (hGH) reduces mortality in...... hypoalbuminemic MHD patients. Secondary end points were effects on number of hospitalizations, cardiovascular events, lean body mass (LBM), serum proteins, exercise capacity, QoL and adverse events....

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

    Science.gov (United States)

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

    2016-02-01

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

  14. Vitamin K_2 Alters Bone Metabolism Markers in Hemodialysis Patients with a Low Serum Parathyroid Hormone Level

    OpenAIRE

    Ochiai, Mariko; Nakashima, Ayumu; Takasugi, Norihisa; Kiribayashi, Kei; KAWAI, Toru; Usui, Koji; Shigemoto, Kenichiro; HAMAGUCHI, Naoki; Kohno, Nobuoki; Yorioka, Noriaki

    2011-01-01

    Background: A low level of intact parathyroid hormone (PTH) is an indicator of adynamic bone disease in hemodialysis patients, and is associated with a significant increase of all-cause mortality. Thus, effective treatment for adynamic bone disease is required. We previously investigated the effect of vitamin K2 on adynamic bone disease. In this study, we assessed the efficacy of oral vitamin K2 in a controlled trial. Methods: Forty hemodialysis patients with low intact PTH levels (

  15. The Relationship Between Social Support and Adherence of Dietary and Fluids Restrictions among Hemodialysis Patients in Iran

    OpenAIRE

    Shahnaz Ahrari; Mahdi Moshki; Mahnaz Bahrami

    2014-01-01

    Introduction: Patient’s noncompliance dietary and fluids intake can lead to a build-up of toxic fluids and metabolic end-products in the blood stream which may result in an increased morbidity and premature death. The aim of the study is investigate relationship between the social support and adherence to dietary and fluid restrictions in hemodialysis patients. Methods: In this correlational study upon 237 hemodialysis patients, the data was collected with the dialysis diet and fluids non-adh...

  16. Socio-Economic Factors, Food Habits and Phosphorus Levels in Patients on Hemodialysis

    Directory of Open Access Journals (Sweden)

    Santoro

    2015-07-01

    Full Text Available Background Hyperphosphoremia is one of the most important risk factors for morbidity and mortality for chronic kidney disease (CKD patients, and also, for the general population. Excessive dietary intake of phosphate (P is one of the key factors. In particular, P in its inorganic form, which is contained in food additives, is more readily absorbed. Unfortunately, these food additives are mostly present in convenience so called “fast foods” (pre-cooked, soft drinks, which represent the typical food consumed by our hemodialysis (HD population, composed by elderly people, mostly low-socio economic class, who often live alone. Objectives We performed an observational retrospective multicenter study to find any association between social, cultural and economic situation, as well as food habits, and P levels in a cohort of patients on HD. Secondarily; we also examined the association between the fast food consumption and increased P levels, as well as patient compliance for P binding products. Patients and Methods To explore the association between socio-economic factors and serum P levels, we enrolled 100 patients on periodic HD treatment from three different units. Information on social, cultural, economic, diet habits, therapy for hyperphosphoremia and hematological and clinical parameters had been collected through specific questionnaires, administered by a physician. Results Results showed serum P level was reduced in patients who live alone compared to patients in family (P = 0.04, in self-sufficient (P = 0.05 and in patients belonging to middle-upper class, versus low-class (P = 0.003. Fast foods intake correlates with increase in P serum levels (P = 0.002, whilst the same correlation was not found for cheese intake. Our data show that socio-economic status and food habits are useful predictors of P serum levels. Conclusions In conclusion, dietary counseling of patients on HD is mandatory. Interventions that consider the socio

  17. Ischemic brain injury in hemodialysis patients: which is more dangerous, hypertension or intradialytic hypotension?

    Science.gov (United States)

    McIntyre, Christopher W; Goldsmith, David J

    2015-06-01

    Abnormalities of cognitive function and high levels of depression incidence are characteristic of hemodialysis patients. Although previously attributed to the humoral effects of uremia, it is becoming increasingly appreciated that many elements of the overall disease state in CKD patients contribute to functional disturbances and physical brain injury. These factors range from those associated with the underlying primary diseases (cardiovascular, diabetes etc.) to those specifically associated with the requirement for dialysis (including consequences of the hemodialysis process itself). They are, however, predominantly ischemic threats to the integrity of brain tissue. These evolving insights are starting to allow nephrologists to appreciate the potential biological basis of dependency and depression in our patients, as well as develop and test new therapeutic approaches to this increasingly prevalent and important issue. This review aims to summarize the current understanding of brain injury in this setting, as well as examine recent advances being made in the modification of dialysis-associated brain injury. PMID:25853331

  18. Awareness and beliefs towards organ donation in chronic kidney disease patients in western India

    OpenAIRE

    Balwani Manish R; Kute Vivek B.; Patel Himanshu; Shah Pankaj R.; Goswami Jitendra; Ghule Pravin; Shah Maulin; Gattani Vipul; Trivedi Hargovind L

    2015-01-01

    Introduction: There is a wide discrepancy between demand for and availability of donor organs for organ transplantation. There is no study on awareness about organ donation in chronic kidney disease (CKD) patients in India. Objectives: To study the awareness and beliefs towards organ donation in CKD patients on hemodialysis in western India. Patients and Methods: Authors conducted a cross sectional study among 85 CKD patients to evaluate knowledge about and attitude towards ...

  19. Serum Lipoprotein (a) Levels in Chronic Renal Failure and Liver Cirrhosis Patients. Relationship with Atherosclerosis

    OpenAIRE

    Essam Mady; Gehane Wissa; Ali Khalifa; Mahmoud El-Sabbagh

    1999-01-01

    This study was carried out to investigate the relationship between lipoprotein (a) levels and the development of atherosclerosis in chronic renal failure (CRF) patients with the possible role of the liver. Serum Lp (a) levels were measured in samples from 20 CRF patients on hemodialysis (HD), 20 liver cirrhosis (LC) patients, 20 patients having both CRF and LC and undergoing HD, and 20 normal control subjects. Renal function (blood urea nitrogen (BUN) and creatinine), hepatic function (transa...

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

    Directory of Open Access Journals (Sweden)

    Petković Nenad

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Vasantha Janardhan

    2011-01-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  3. Massive catheter-related thrombosis of vena cava superior protruding into the right atrium in a hemodialysis patient.

    Science.gov (United States)

    Mach, Lukas; Ondruskova, Olga; Nemec, Petr; Orban, Marek

    2015-10-01

    A 36-year-old man with chronic renal insufficiency secondary to type 1 diabetes mellitus was on hemodialysis via central venous catheter (CVC), newly placed into the right subclavian vein after his arteriovenous fistula became dysfunctional. Seven days after CVC insertion, the patient developed fever and on day 11 echocardiography showed a large nearly occluding thrombus in the superior vena cava (SVC) extending into the right atrium (RA). Emergency surgical thrombectomy was successfully performed and an 11 cm long thrombus extending from the RA cranially into the SVC occupying majority of the vein's lumen was removed. Cultures from the thrombus and CVC were negative, but polymerase chain reaction was positive for Staphylococcus aureus. This particular case was interesting for a marked discrepancy between large SVC occluding thrombosis and a relatively mild clinical presentation with fever, and it highlights the importance of correct timing of echocardiography exam which might prevent potentially fatal consequences such as pulmonary embolism. PMID:25645521

  4. Proteinuria and its relation to diverse biomarkers and body mass index in chronic hemodialysis

    Directory of Open Access Journals (Sweden)

    Trimarchi H

    2013-06-01

    Full Text Available Hernán Trimarchi,1 Alexis Muryan,2 María-Soledad Raña,1 Pedro Paggi,2 Fernando Lombi,1 Mariano Forrester,1 Vanesa Pomeranz,1 Alejandra Karl,1 Mirta Alonso,2 Pablo Young,3 Mariana Dicugno2 1Department of Nephrology, 2Department of Biochemistry, 3Department of Internal Medicine Services, Hospital Británico de Buenos Aires, Buenos Aires, Argentina Background: Certain adipokines exert direct effects on proteinuria, a cardiovascular risk factor ignored in hemodialysis. We measured different adipokines according to body mass index (BMI in relation to proteinuria. Methods: Patients numbered 57: group A (GA, BMI 30, n = 20. There were no statistical differences in age, sex, time on dialysis, cause of renal failure, diabetes, hypertension, C-reactive protein, or nutritional status. Measures were taken of 24-hour diuresis and proteinuria, ultrafiltration, albumin, pro-brain natriuretic peptide (Pro-BNP, insulin, adiponectin, leptin, and ghrelin. Results: Proteinuria was significantly higher in GC versus (vs GA (1.5 g/day, range 0.30–14 vs 0.72 g/day, range 0.1–2.7; P 0.05. In GA, elevated levels of Pro-BNP, adiponectin, and ghrelin were associated with lower degrees of proteinuria. Significant correlations were found between adiponectin and leptin (ρ = -0.54, P = 0.03, and adiponectin and Pro-BNP (ρ= 0.59, P = 0.02. Though not significant, there were more diabetics in GC (GA four, GB three, GC ten. As BMI increased in GB and GC, Pro-BNP, adiponectin, and ghrelin levels decreased significantly, while proteinuria, insulin, and homeostasis model assessment of insulin resistance increased. Leptin levels were significantly elevated in GC vs GA and GB. In GC, ghrelin correlated significantly with Pro-BNP (ρ= 0.51, P = 0.03, while leptin correlation with Pro-BNP was inverse and significant in GA (ρ = -0.74, P > 0.001 and inverse and nonsignificant in GB and GC. Conclusion: In patients with BMI < 25, higher adiponectin, ghrelin, and Pro-BNP levels

  5. Effectiveness of Problem-Focused Coping Strategies on the Burden on Caregivers of Hemodialysis Patients

    Science.gov (United States)

    Ghane, Golnar; Ashghali Farahani, Mansoureh; Seyedfatemi, Naima; Haghani, Hamid

    2016-01-01

    Background Studies have shown that family caregivers of hemodialysis patients experience high levels of burden. However, these caregivers are often neglected, and no studies are available on the effectiveness of coping strategies on the burden of care among these caregivers. Objectives This study aimed to examine the effectiveness of problem-focused coping strategies (communication skills, anger management, and deep breathing) on the burden on caregivers of hemodialysis patients. Patients and Methods A randomized controlled clinical trial was conducted on 76 family caregivers of hemodialysis patients referred to Shahid Hasheminejad hemodialysis center in Tehran, Iran. The subjects were equally allocated into two groups of 38. Through a coin-tossing method, caregivers of patients who referred on even or odd days of the week were randomly assigned into the intervention group or the control group, respectively. The intervention group received four training sessions on problem-focused coping strategies, but the control group did not receive any intervention. Both groups answered the caregiver’s burnout inventory at the start and six weeks after the last educational session. Descriptive statistics, chi-square, Fisher’s exact test, independent-samples t-test, and Mann-Whitney U test were used to analyze the data. Results The majority of caregivers (54%) were in the age range of 35 - 55 years, female (68.4%), and married (70%). No significant difference was found between the baseline mean caregivers’ burden scores of the intervention and control groups (88.56 ± 11.74 vs. 84.97 ± 15.13, P = 0.308). However, the mean caregivers’ burden in the intervention group decreased, and the two groups were significantly different at the end of the study (58.77 ± 6.64 vs. 87.84 ± 11.74, P educational programs, such as the program implemented in the current study, into the country’s healthcare system. PMID:27556058

  6. Ensaio sobre a cegueira: mortalidade de pacientes com doença renal crônica em hemodiálise de emergência Study on blindness: mortality of patients with chronic kidney disease during non-elective hemodialysis

    Directory of Open Access Journals (Sweden)

    Letícia Krauss Silva

    2012-11-01

    Full Text Available A doença renal crônica (DRC leva à falência renal e à necessidade de terapia renal substitutiva (TRS. A prevenção secundária pode retardar em muitos anos a evolução da doença. O presente estudo, retrospectivo, objetivou analisar os fatores prognósticos e estimar a mortalidade de portadores de doença renal crônica (DRC secundária à hipertensão ou diabetes que iniciam a TRS por hemodiálise de emergência, desde a admissão hospitalar até a transferência para clínica-satélite ou óbito, no Rio de Janeiro. A taxa de mortalidade foi de 35,1%. Houve diferença significativa entre as curvas de sobrevida até o óbito, por doença de base (log-rank e Peto, p = 0,02 e por presença de fístula funcional (log-rank, p = 0,0099; Peto, p = 0,0090. A análise multivariada (modelo de Cox mostrou aumento no risco de óbito de 7% (p = 0,002 por ano de idade; a presença de fístula funcional foi associada a uma redução de 81% no risco (p = 0,03. Conclui-se que um terço dos pacientes portadores de DRC por hipertensão e diabetes, que iniciam a TRS de forma não planejada, morrem no período entre a admissão hospitalar e a transferência para clínicas-satélites, o que indica baixo acesso à prevenção secundária na DRC, inclusive à cirurgia para a confecção da fístula arteriovenosa.Chronic kidney disease (CKD leads to renal failure and the need for renal replacement therapy (RRT. Secondary prevention may postpone CKD for many years. This retrospective study sought to analyze prognostic factors and estimate the mortality of patients with CKD secondary to diabetes mellitus and to hypertension that initiate RRT through non-elective hemodialysis at an emergency hospital unit in Rio de Janeiro, from hospital admission until transfer to referral units. The mortality rate was 35.1%. The study detected a significant difference between the survival curves according to disease etiology (log-rank and Peto, p=0.02 and the presence of

  7. Acquired cystic disease and renal cell carcinoma in hemodialysis patients: A case report on three patients

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    Mijušković Mirjana

    2015-01-01

    Full Text Available Introduction. Renal cell carcinoma (RCC is derived from renal tubular epithelial cells and represents approximately 3.8% of all malignancies in adults. The incidence of renal cell carcinoma has been growing steadily and ranging from 0.6 to 14.7 for every 100,000 inhabitants. Patients with end-stage renal disease and acquired cystic kidney disease are at increased risk of developing RCC while undergoing dialysis treatment or after renal transplantation. Case report. We presented 3 patients undergoing hemodialysis, with acquired cystic kidney disease accompanied by the development of RCC. In all the patients tumor was asymptomatic and discovered through ultrasound screening in 2 patients and in 1 of the patients by post-surgery pathohistological analysis of the tissue of the kidney excised using nephrectomy. All the three patients had organ-limited disease at the time of the diagnosis and they did not require additional therapy after surgical treatment. During the follow- up after nephrectomy from 6 months to 7 years, local recurrence or metastasis of RCC were not diagnosed. Conclusion. Acquired cystic kidney disease represents a predisposing factor for the development of renal cell carcinoma in dialysis patients and requires regular ultrasound examinations of the abdomen aimed at early diagnosis of malignancies. Prognosis for patients with endstage renal disease and RCC is mostly good because these tumors are usually of indolent course.

  8. Surgical management of aneurysms of arteriovenous fistulae in hemodialysis patients: A case series

    OpenAIRE

    Valentine,

    2010-01-01

    Christopher SP Valentine, Olugbenga AworantiDepartment of Surgery, Cornwall Regional Hospital, Montego Bay, JamaicaBackground: One of the complications of arteriovenous (AV) fistulae used for hemodialysis is aneurysm formation and subsequent risk for rupture. Surgery is one of the modalities utilised to treat this condition.Methods: A retrospective review of medical records was done to identify patients managed surgically at our institution over a four-year period. The surgical procedures var...

  9. THE EFFECTS OF ACUPRESSURE ON DEPRESSION IN HEMODIALYSIS PATIENTS: SYSTEMATIC REVIEW

    OpenAIRE

    Alev Y

    2015-01-01

    Purpose: This study is systematic review conducted in order to evaluate the acupressure application on hemodialysis patients and its effects on depression.Method: In this review, Ulakbim, Turkish Medline, PubMed, Ebscohost databases were checked and titles that met the inclusion and exclusion criteria were taken under review (n=80). Repeating studies were identified and deleted (n=14). (n=61) studies that were off-topic were excluded from the review. The studies that were suitable for the pur...

  10. A clinical approach to the nutritional care process in protein-energy wasting hemodialysis patients

    OpenAIRE

    Mar Ruperto; Sánchez-Muniz, Francisco J; Guillermina Barril

    2014-01-01

    Introduction: Malnutrition/wasting/cachexia are complex-disease conditions that frequently remain undiagnosed and/or untreated in up to 75% of prevalent hemodialysis (HD) patients. The nutrition care process (NCP) based on assessment, diagnosis, intervention and monitoring of nutritional status is a systematic method that nutrition professionals use to make decisions in clinical practice. Objective: This review examines from a clinical-nutritional practice point of view: a) nutritional status...

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

    OpenAIRE

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

    2002-01-01

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

  12. Is There a Correlation between Vitamin C Status and Catecholamines Concentrations in Hemodialysis Patients?

    OpenAIRE

    Coquet, Isaline; Doise, Jean-Marc; Guilland, Jean-Claude; Vergely, Catherine; Mousson, Christiane; Rochette, Luc

    2008-01-01

    It is well established that there is a high incidence of cardiovascular diseases in hemodialysis patients, and involvement of oxidative stress has been hypothesised in these phenomena. Plasma norepinephrine is an independent predictor of many causes of mortality in general, and high norepinephrine levels predict cardiovascular complications in end stage renal disease. The aim of our study was to evaluate the potential link between vitamin C status, a marker of oxidative stress, and catecholam...

  13. Correlation of serum magnesium with dyslipidemia in patients on maintenance hemodialysis

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    Muhammad Rafique Ansari

    2012-01-01

    Full Text Available This study was performed to determine the correlation between serum magnesium (Mg and dyslipidemia in patients on maintenance hemodialysis (MHD. This hospital-based cross-sectional observational study was conducted at the Department of Nephro-Urology, Liaquat University Hospital, Hyderabad, Pakistan, from April 2008 to June 2008. Fifty patients with end-stage kidney disease on MHD treatment (33 males and 17 females were studied. The mean duration on HD was 7.58 ± 2.05 years, with frequency being two to three sessions/week, and each session lasted for four hours. After obtaining informed written consent, the general information of each patient was recorded on a proforma. After overnight fasting, blood samples was drawn from the arterio-venous fistula for lipid profile, lipoprotein, serum Mg, serum creatinine, blood urea, serum calcium and serum phosphorus. Dyslipidemia was defined as presence of total cholesterol (TC, triglyceride (TG or low-density lipoprotein (LDL levels more then 95 th percentile for age and gender or high-density lipoprotein (HDL levels less then 35 mg/dL. Descriptive and inferential statistical analyses were performed using SPSS version 16.0. The mean age of the study patients was 45.68 ± 13.97 years. There was a significant positive correlation between serum Mg and serum lipoprotein-a (LP-a (r = 0.40, P < 0.007, serum HDL (r = 0.31, P < 0.01 and serum TG (r = 0.35, P < 0.005. There was no significant correlation between serum Mg and serum LDL-c and serum TC. The serum TG and LP-a levels were significantly increased while HDL-c was significantly lower in MHD patients. The serum TC, LDL-c and very low-density lipoprotein-c were not significantly elevated. We conclude that patients with chronic kidney disease undergoing MHD show positive correlation between serum Mg and serum HDL, LP-a and TG. The abnormalities of lipid metabolism, such as hyper-triglyceridemia, elevated LP-a and low HDL-c, could contribute to

  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

    Directory of Open Access Journals (Sweden)

    R. C. Noleto Magalhães

    2011-12-01

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

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

    International Nuclear Information System (INIS)

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

  16. Epidemiology of healthcare-associated infections among patients from a hemodialysis unit in southeastern Brazil

    Directory of Open Access Journals (Sweden)

    Silvia Eduara Kennerly de Albuquerque

    2014-06-01

    Full Text Available Patients submitted to hemodialysis are at a high risk for healthcare-associated infections (HAI. Presently there are scarce data to allow benchmarking of HAI rates in developing countries. Also, most studies focus only on bloodstream infections (BSI or local access infections (LAI. Our study aimed to provide a wide overview of HAI epidemiology in a hemodialysis unit in southeastern Brazil. We present data from prospective surveillance carried out from March 2010 through May 2012. Rates were compared (mid-p exact test and temporally analyzed in Shewhart control charts for Poisson distributions. The overall incidence of BSI was 1.12 per 1000 access-days. The rate was higher for patients performing dialysis through central venous catheters (CVC, either temporary (RR = 13.35, 95% CI = 6.68-26.95 or permanent (RR = 2.10, 95% CI = 1.09-4.13, as compared to those with arteriovenous fistula. Control charts identified a BSI outbreak caused by Pseudomonas aeruginosa in April 2010. LAI incidence was 3.80 per 1000 access-days. Incidence rates for other HAI (per 1000 patients-day were as follows: upper respiratory infections, 1.72; pneumonia, 1.35; urinary tract infections, 1.25; skin/soft tissues infections, 0.93. The data point out to the usefulness of applying methods commonly used in hospital-based surveillance for hemodialysis units.

  17. A PDA-based dietary self-monitoring intervention to reduce sodium intake in an in-center hemodialysis patient

    OpenAIRE

    Sevick, Mary Ann; Stone, Roslyn A.; Novak, Matthew; Piraino, Beth; Snetselaar, Linda; Marsh, Rita M; Hall, Beth; Lash, Heather; Bernardini, Judith; Burke, Lora E.

    2008-01-01

    Objective The purpose of the BalanceWise-hemodialysis study is to determine the efficacy of a dietary intervention to reduce dietary sodium intake in patients receiving maintenance, in-center hemodialysis (HD). Personal digital assistant (PDA)-based dietary self-monitoring is paired with behavioral counseling. The purpose of this report is to present a case study of one participant’s progression through the intervention. Methods The PDA was individually programmed with the nutritional require...

  18. Symptomatic Central Venous Stenosis in a Hemodialysis Patient Leading to Loss of Arteriovenous Access: A Case Report and Literature Review

    OpenAIRE

    Tatapudi, Vasishta S.; Spinowitz, Noam; Goldfarb, David S.

    2014-01-01

    Central venous stenosis is a well-described sequel to the placement of hemodialysis catheters in the central venous system. The presence of an ipsilateral arteriovenous fistula or graft often leads to severe venous dilatation, arm edema and recurrent infections. Vascular access thrombosis, compromised blood flow and inadequate dialysis delivery are dreaded complications that eventually render the access unusable. We report the case of a 58-year-old male hemodialysis patient who developed symp...

  19. Discrepancy between Serological and Virological Analysis of Viral Hepatitis in Hemodialysis Patients

    OpenAIRE

    Chang, Jer-Ming; Huang, Chung-Feng; Chen, Szu-Chia; Dai, Chia-Yen; Yeh, Ming-Lun; Huang, Jee-Fu; Kuo, Hsing-Tao; Chuang, Wan-Long; Yu, Ming-Lung; Hwang, Shang-Jyh; Chen, Hung-Chun

    2014-01-01

    Background and Aim: Viral hepatitis is a health threat for hemodialysis (HD) patients and it may be transmitted during treatment. Some patients categorized to have viral hepatitis were found to be non-viremic. To clarify the discrepancy between the serological tests in HD patients, we conducted the study. Methods: A total of 1681 HD patients was included. Blood samples were analyzed for hepatitis B surface antigen (HBsAg) and anti-hepatitis C antibody (anti-HCV). Detection of hepatitis B viru...

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

    Directory of Open Access Journals (Sweden)

    Bonet J

    2013-09-01

    Full Text Available Josep Bonet1, Albert Martinez-Castelao2, Beatriz Bayés11Department of Nephrology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; 2Department of Nephrology, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, SpainPurpose: Metabolic syndrome is a cluster of biochemical abnormalities including cardiovascular and diabetes risk factors. The development of diabetes mellitus after renal transplant represents a major posttransplant complication that may adversely affect graft/patient survival. The aim of this study was to assess the role of metabolic syndrome in patients on hemodialysis as a risk factor for the incidence of new-onset diabetes mellitus after renal transplant.Patients and methods: This was a prospective observational epidemiologic study carried out in adult nondiabetic patients undergoing chronic hemodialysis and on the renal transplant waiting list between November 2008 and April 2009. Patients were followed up from Visit 1 (baseline to 6 months after the renal transplant. The analysis of the role of metabolic syndrome in hemodialysis patients as a risk factor for the incidence of new-onset diabetes mellitus after renal transplant included the estimation of relative risk and its 95% confidence interval (CI.Results: A total of 383 evaluable patients were entered into the study (mean age, 52.7 years; male, 57.7%; Caucasian, 90.1%. The prevalence of metabolic syndrome on hemodialysis was 30.4% (95% CI, 25.8%–35.4%. Hypertension was the most prevalent criterion for metabolic syndrome (65.0%, followed by low levels of high-density lipoprotein cholesterol (52.7%, abdominal obesity (36.2%, hypertriglyceridemia (32.4%, and impaired glucose (8.9%. After the renal transplant, the prevalence of metabolic syndrome was still 25.8%. During the posttransplant period, the incidence of new-onset diabetes mellitus reached 13.0% (95% CI, 7.8%–20.6% and patients with pretransplant metabolic syndrome were 2

  1. Plasma acylated ghrelin, obestatin and leptin in different stages of chronic kidney disease patients

    OpenAIRE

    Öner-İyidoğan, Yıldız; Öner, Pernur; Gürdöl, Figen; Koçak, Hikmet; Çetinalp-Demircan, Pınar; Çalışkan, Yaşar; KOÇAK, Taner; Aydın TÜRKMEN

    2009-01-01

    Objective: Malnutrition and loss of appetite remain a frequent problem in patients with chronic kidney disease (CKD). These patients have inflammation accompanied by high levels of plasma leptin, an appetite-modulating hormone. A newly described hormone ghrelin is also involved in regulation food intake and energy balance. In patients with end-stage renal disease and hemodialysis, high plasma ghrelin concentration has been reported, but the metabolic impact of ghrelin in CKD is unknown. The a...

  2. Hepatitis B Vaccination in Chronic Kidney Disease: Review of Evidence in Non-Dialyzed Patients

    OpenAIRE

    Grzegorzewska, Alicja E

    2012-01-01

    Context Hepatitis B vaccination of hemodialysis patients is performed all over the world. There are also recommendations from world health organizations to vaccinate patients with chronic kidney disease (CKD) prior dialysis commencement, but the implementation of a hepatitis B vaccination program is less common and not well organized. Evidence Acquisition This review article summarizes data indicating why, when and how to vaccinate CKD patients before they start renal replacement therapy. Pub...

  3. Association between serum bicarbonate and pH with depression, cognition and sleep quality in hemodialysis patients.

    Science.gov (United States)

    Afsar, Baris; Elsurer, Rengin

    2015-07-01

    Metabolic acidosis is a common feature in chronic renal failure patients, worsening progressively as renal function declines. There are conflicting data in hemodialysis (HD) patients with regard to acidosis, alkalosis and mortality. In HD patients, cognitive impairment, depression, sleep disorders and impaired quality of life are very common. Besides, these conditions are related with increased morbidity and mortality. However, no previous study investigated the relationship between pH, venous bicarbonate and anion gap with depression, sleep problems and cognitive function in HD patients. In this study we investigated these relationships. In total, 65 HD patients were included. The demographic parameters and laboratory parameters including bicarbonate, pH and anion gap was measured for all patients. Depressive symptoms, sleep quality and cognitive function, were measured by Beck depression inventory, The Pittsburgh Sleep Quality Index and by Mini Mental State Examination, respectively. We found that, sleep quality but not cognitive function or depression was independently related with venous pH and bicarbonate. Anion gap has no independent relationship with sleep quality, cognitive function and depression. In conclusion, metabolic acidosis and bicarbonate levels were independently related with sleep quality in HD patients. However, there was no association between metabolic acidosis and bicarbonate levels with cognitive function and depression. PMID:25894326

  4. Administration of N-acetylcysteine causes beneficial posttranslational modifications of transthyretin in hemodialysis patients

    DEFF Research Database (Denmark)

    Scholze, Alexandra

    2013-01-01

    INTRODUCTION AND AIMS: The thiol antioxidant N-acetylcysteine (NAC) may mediate interactions with protein-associated cysteine residues, however, information on protein level in vivo are missing. Therefore, in the present study we aimed to analyze N-acetylcysteine-induced modifications of the...... protein transthyretin (TTR) in plasma from hemodialysis patients in a randomized, placebo-controlled study in vivo and after administration to plasma in vitro. TTR was selected due to its low molecular weight and the free cysteine residue in the polypeptide chain, which is known to be extensively modified...... software flexAnalysis. TTR variants were expressed as relative amounts of the summed intensity of all observed TTR variants. RESULTS: The administration of NAC during a hemodialysis session resulted in a substantial increase of native TTR from median 15% (range 8.8-30%) to median 40% (37-50) and a...

  5. Potassium dynamics are attenuated in hyperkalemia and a determinant of QT adaptation in exercising hemodialysis patients

    DEFF Research Database (Denmark)

    Tran, Cao Thach; Bundgaard, Henning; Ladefoged, Søren Daustrand; Haunsø, Stig; Kjeldsen, Keld

    2013-01-01

    Disturbances in plasma potassium concentration (pK) are well known risk factors for the development of cardiac arrhythmia. The aims of the present study were to evaluate the effect of hemodialysis on exercise pK dynamics and QT hysteresis, and whether QT hysteresis is associated with the p......K decrease following exercise. Twenty-two end-stage renal disease patients exercised on a cycle ergometer with incremental work load before and after hemodialysis. ECG was recorded and pK was measured during exercise and recovery. During exercise, pK increased from 5.1 ± 0.2 to 6.1 ± 0.2 mM (mean ± SE; P...

  6. Changes in the Conformational State of Hemoglobin in Hemodialysed Patients with Chronic Renal Failure

    Directory of Open Access Journals (Sweden)

    Anna Pieniazek

    2015-01-01

    Full Text Available The aim of this study was to evaluate the properties of internal components of erythrocytes in chronic renal failure (CRF patients undergoing hemodialysis (HD in comparison to control subjects. For investigation of conformational state of hemoglobin and nonheme proteins (NHP the maleimide spin label (MSL in electron paramagnetic resonance (EPR was applied. The studies were performed using MSL in whole cells and hemolysate as well as proteins separated by ion exchange chromatography and checked by electrophoresis. Additionally the level of –SH groups in hemolysate and isolated internal proteins of CRF erythrocytes was determined using 4,4′-dithiodipyridine. All measurements were performed before and after hemodialysis. Oxidative stress accompanying CRF/hemodialysed patients caused a significant decrease in the mobility of internal components inside erythrocytes indicated by MSL (P < 0.02. The significant decrease in mobility of spin labeled HbA1c and HbA both before and after HD (P < 0.0002 as well as in nonheme proteins before hemodialysis (P < 0.05 versus control was indicated. Decrease in mobility of internal components of erythrocytes was accompanied by loss of thiols before and after hemodialysis versus control in NHP (P < 0.05, HbA1c (P < 0.0002, and HbA (P < 0.0005. These findings showed oxidative influence of hemodialysis on hemoglobins and internal nonheme proteins in erythrocytes of CRF patients.

  7. Cost of installing and turning off hemodialysis on patients with central venous catheters

    Directory of Open Access Journals (Sweden)

    Gillene Santos Ferreira

    2014-12-01

    Full Text Available The objective was to identify the average total cost (ATC for installing and turning off hemodialysis on patients with central venous catheters. This quantitative, exploratory, and descriptive research, in the mode of a single-case study, was conducted in a public university hospital. The non-probabilistic sample corresponded to the observation of 100 installations and 100 terminations of hemodialysis on 42 patients during 23 days of collection. The ATC was calculated by multiplying the time spent by nurses by the unit cost of direct labor, and adding the cost of materials, solutions, and medications. The Brazilian currency (R$ was used for the calculations. The ATC for installation was R$ 80.10 and for shutting off was R$ 13.04, totaling R$ 93.14 per hemodialysis session. The results obtained will facilitate a better planning of the allocation of human, material, and financial resources enabling the increase of managerial strategies aimed at economic efficiency. doi: 10.5216/ree.v16i4.23044.

  8. Safety and Efficacy of PDpoetin for Management of Anemia in Patients with end Stage Renal Disease on Maintenance Hemodialysis: Results from a Phase IV Clinical Trial.

    Science.gov (United States)

    Javidan, Abbas Norouzi; Shahbazian, Heshmatollah; Emami, Amirhossein; Yekaninejad, Mir Saeed; Emami-Razavi, Hassan; Farhadkhani, Masoumeh; Ahmadzadeh, Ahmad; Gorjipour, Fazel

    2014-08-26

    Recombinant human erythropoietin (rHuEPO) is available for correcting anemia. PDpoetin, a new brand of rHuEPO, has been certified by Food and Drug Department of Ministry of Health and Medical Education of Iran for clinical use in patients with chronic kidney disease. We conducted this post-marketing survey to further evaluate the safety and efficacy of PDpoetin for management of anemia in patients on maintenance hemodialysis. Patients from 4 centers in Iran were enrolled for this multicenter, open-label, uncontrolled phase IV clinical trial. Changes in blood chemistry, hemoglobin and hematocrit levels, renal function, and other characteristics of the patients were recorded for 4 months; 501 of the patients recruited, completed this study. Mean age of the patients was 50.9 (±16.2) years. 48.7% of patients were female. Mean of the hemoglobin value in all of the 4 centers was 9.29 (±1.43) g/dL at beginning of the study and reached 10.96 (±2.23) g/dL after 4 months and showed significant increase overall (Pcase of immunological reactions to PDpoetin was observed. Our study, therefore, showed that PDpoetin has significantly raised the level of hemoglobin in the hemodialysis patients (about 1.7±0.6 g/dL). Anemia were successfully corrected in 49% of patients under study. Use of this biosimilar was shown to be safe and effective for the maintenance of hemoglobin in patients on maintenance hemodialysis. PMID:25317316

  9. Safety and efficacy of PDpoetin for management of anemia in patients with end stage renal disease on maintenance hemodialysis: results from a phase IV clinical trial

    Directory of Open Access Journals (Sweden)

    Abbas Norouzi Javidan

    2014-09-01

    Full Text Available Recombinant human erythropoietin (rHuEPO is available for correcting anemia. PDpoetin, a new brand of rHuEPO, has been certified by Food and Drug Department of Ministry of Health and Medical Education of Iran for clinical use in patients with chronic kidney disease. We conducted this post-marketing survey to further evaluate the safety and efficacy of PDpoetin for management of anemia in patients on maintenance hemodialysis. Patients from 4 centers in Iran were enrolled for this multicenter, open-label, uncontrolled phase IV clinical trial. Changes in blood chemistry, hemoglobin and hematocrit levels, renal function, and other characteristics of the patients were recorded for 4 months; 501 of the patients recruited, completed this study. Mean age of the patients was 50.9 (±16.2 years. 48.7% of patients were female. Mean of the hemoglobin value in all of the 4 centers was 9.29 (±1.43 g/dL at beginning of the study and reached 10.96 (±2.23 g/dL after 4 months and showed significant increase overall (P<0.001. PDpoetin dose was stable at 50-100 U/kg thrice weekly. Hemorheologic disturbancesand changes in blood electrolytes was not observed. No case of immunological reactions to PDpoetin was observed. Our study, therefore, showed that PDpoetin has significantly raised the level of hemoglobin in the hemodialysis patients (about 1.7±0.6 g/dL. Anemia were successfully corrected in 49% of patients under study. Use of this biosimilar was shown to be safe and effective for the maintenance of hemoglobin in patients on maintenance hemodialysis.

  10. Analysis of serum phosphate control and phosphate binder utilization in incident hemodialysis patients

    OpenAIRE

    Gibson, Fernando

    2014-01-01

    Kimberly F Farrand,1 J Brian Copley,1 Jamie Heise,1 Moshe Fridman,2 Michael S Keith,1 Lynne Poole3 1Shire, Wayne, PA, USA; 2AMF Consulting, Los Angeles, CA, USA; 3Shire, Basingstoke, UK Abstract: The purpose of this study was to conduct a retrospective analysis of serum phosphate level variability in patients new to hemodialysis (HD) and to identify patient characteristics associated with this variability. The medical records of 47,742 incident HD patients attending US outpatient dialysis ce...

  11. 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

    patients in a double-blind randomized placebo-controlled 1-year intervention trial using a predefined systolic blood pressure target of 140 mm Hg (SAFIR study). Each group of 41 patients did not differ in terms of age, blood pressure, comorbidity, antihypertensive treatment, dialysis parameters, and......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...

  12. Potential Cardiovascular Risk Protection of Bilirubin in End-Stage Renal Disease Patients under Hemodialysis

    OpenAIRE

    Maria do Sameiro-Faria; Michaela Kohlova; Sandra Ribeiro; Petronila Rocha-Pereira; Laetitia Teixeira; Henrique Nascimento; Flávio Reis; Vasco Miranda; Elsa Bronze-da-Rocha; Alexandre Quintanilha; Luís Belo; Elísio Costa; Alice Santos-Silva

    2014-01-01

    We evaluated the potential cardiovascular risk protection of bilirubin in hemodialysis (HD) patients. An enlarged set of studies were evaluated in 191 HD patients, including hematological study, lipid profile, iron metabolism, nutritional, inflammatory markers, and dialysis adequacy. The TA duplication screening in the UDP-glucuronosyltransferase 1 A1 (UGT1A1) promoter region was also performed. The UGT1A1 genotype frequencies in HD patients were 49.2%, 42.4%, and 8.4% for 6/6, 6/7, and 7/7 g...

  13. 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

    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...

  14. Significant Association Between Bone-Specific Alkaline Phosphatase and Vascular Calcification of the Hand Arteries in Male Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Eiji Ishimura

    2014-09-01

    Full Text Available Background/Aims: Bone-specific alkaline phosphatase (BAP hydrolyzes pyrophosphate, which inhibits vascular calcification. We examined association between serum BAP and vascular calcification of male hemodialysis patients. Methods: Hand roentgenography of 167 male maintenance hemodialysis patients was conducted, and visible vascular calcification of the hand arteries was evaluated. Serum levels of 3 bone formation markers (BAP, osteocalcin, and N-terminal propeptide of type I collagen and 2 bone resorption markers (C-terminal telopeptide of type I collagen, and cross-linked N-telopeptide of type I collagen were measured, along with serum intact parathyroid hormone (PTH. Results: Of 167 patients, visible vascular calcification was seen in 37 patients. Among the bone formation and resorption markers, serum BAP was significantly higher in patients with vascular calcification than in those without (pConclusions: Higher serum BAP, but not other bone markers, is significantly associated with the presence of vascular calcification in male hemodialysis patients.

  15. Blood Transfusion, Serum Ferritin, and Iron in Hemodialysis Patients in Africa

    Directory of Open Access Journals (Sweden)

    Leonard Kouegnigan Rerambiah

    2015-01-01

    Full Text Available Background and Objectives. There is no data analyzing the outcome of blood transfusions and oral iron therapy in patients with kidneys failure in sub-Saharan Africa. The present study aimed to fill that gap and assess the value of ferritin in the diagnosis of iron overload and deficiency. Design. From January to February 2012, we prospectively studied 85 hemodialysis patients (78% of males and 22% of females aged 20 to 79 years attending the Gabonese National Hemodialysis Centre. Results. Correlation studies showed (a a strong positive linear relationship between the number of blood transfusions and high serum ferritin in hemodialysis patient (Spearman r:0.74; P value: 0.0001; (b a weak association between the number of blood transfusions and serum iron concentrations (Spearman r:0.32; P value: 0.04; (c a weak association between serum ferritin and serum iron (Spearman r:0.32; P value: 0.003. Also, the strength of agreement beyond chance between the levels of ferritin and iron in the serum was poor (κ=0.14. The prevalence of iron overload was 10.6%, whereas the prevalence of iron deficiency was 2.3%, comparing (1 patients with a maximum of one transfusion not on iron therapy; (2 patients with a maximum of one transfusion on iron therapy; (3 polytransfused patients not on iron therapy; and (4 polytransfused patients on oral iron therapy. The “Kruskal-Wallis test” showed that ferritin levels varied significantly between the groups (P value: 0.0001. Conclusion. Serum ferritin is not reliable as a marker of iron overload. For patients undergoing regular transfusion we recommend routine serum ferritin measurement and yearly measurement of LIC.

  16. 5-year Mortality in Hemodialysis Patients: A Single Center Study in Tripoli

    Directory of Open Access Journals (Sweden)

    Buargub Mahdia

    2008-01-01

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

  17. A systematic review on randomized control trials on rennin angiotensin aldosterone system inhibitors role in managing hypertension among hemodialysis patients.

    Science.gov (United States)

    Aftab, Raja Ahsan; Khan, Amer Hayat; Adnan, Azreen Syazril; Jannah, Nurul

    2016-01-01

    Randomized control trials (RCTs) are considered as most rigors way of determining the cause-effect relationship of a treatment and outcome. Activation of rennin angiotensin aldosterone system (RAAS) is an important contributor to hypertension in hemodialysis patients. The prevalence of hypertension in hemodialysis patients varies from 60% to 80% and hypertension management alone with conventional hemodialysis is insufficient. Hence, the current review was aimed to investigate the effect of RAAS inhibitors in managing hypertension among hemodialysis patients in a randomized control trial. Using PUBMED and EMBASE databases, randomized control trial with primary or secondary outcomes related to the effect of RAAS inhibitors on blood pressure among hemodialysis patients were included for analysis. The current review also assessed the quality of reporting of RCT. A total of eight RCT met inclusion criteria for current review. According to modified jaded scale, one (12.5%) study scored four points for quality reporting, whereas two (25%) studies scored one point that was the least score. The mean score for all included studies was 2.25. Six (75%) of the eight RCT included, involved ARB in hypertension management among hemodialysis patients, whereas two (25%) studies involved angiotensin-converting enzyme (ACE) inhibitors. Of the siz RCT involving ARB, two (33.3%) RCT also included ACE inhibitors comparison group. Altogether six (75%) studies report a reduction in blood pressure with the use of RAAS inhibitors compared to control group; however, of the six studies, two (33.3%) reported that the reduction in blood pressure was not significant. Whereas, two (25%) studies reported no reduction in blood pressure compared to the control group. The findings from current review do not indicate a clear pattern for a role of RAAS inhibitors for hypertension control among hemodialysis patients. PMID:26853680

  18. Hepatitis C Prevalence in Hemodialysis Patients in Mazandaran, Iran: A Survey by Polymerase Chain Reaction and Serological Methods

    Directory of Open Access Journals (Sweden)

    2008-01-01

    Full Text Available Patients on maintenance hemodialysis are known to have an elevated risk of acquiring Hepatitis C Virus (HCV infection. The reported prevalence among hemodialysis patients in the United States ranges from 8-10% and is considerably higher in many European and Middle Eastern countries. Therefore, a reliable diagnosis of HCV infection is essential in order to prevent the spread of the disease in dialysis units. All hemodialysis patients (n = 186 were interviewed in 2 dialysis units in Imam Khomeini and Fatemeh Zahra hospitals of Sari and Valiasr hospital of Ghaemshahr city / Iran, Between June and august 2006.. Blood samples were collected and serum samples screened for anti-HCV antibodies by Enzyme-Linked Immunosorbent Assay (ELISA. Positive samples were retested for confirmation with Polymerase Chain Reaction (PCR.Statistical analysis was done by means of SPSS (11 software. A total of 186 hemodialysis patients (mean age 58.86±16.9 years were studied. Mean duration of hemodialysis was 3.07±0.3 years. Mean of SGOT and SGPT were 30.64±6 and 32.01±8, respectively. 39 (21% patients were found to be seropositive by ELISA and 12 were confirmed positive by PCR, resulting in an anti-HCV prevalence of 6.5%. association between duration of hemodialysis andHCV seropositivity was statistically significant (p = 0.0001 but there were no significant correlation between number of transfusions and HCV seropositivity. Despite the growing demand for cost-effectiveness in the health system, tight control of HCV infection by PCR and ELISA examination must remain an essential part of the routine screening in hemodialysis patients.

  19. Evaluating the Imbalance Between Increasing Hemodialysis Patients and Medical Staff Shortage After the Great East Japan Earthquake: Report From a Hemodialysis Center Near the Fukushima Nuclear Power Plants.

    Science.gov (United States)

    Koshiba, Takaaki; Nishiuchi, Takamitsu; Akaihata, Hidenori; Haga, Nobuhiro; Kojima, Yoshiyuki; Kubo, Hajime; Kasahara, Masato; Hayashi, Masayuki

    2016-04-01

    The Great East Japan Earthquake in 2011 caused an unprecedented imbalance between an increasing number of hemodialysis patients and medical staff shortage in the Sousou area, the site of the Fukushima nuclear power plants. In 2014, capacity of our hemodialysis center reached a critical limit due to such an imbalance. We attempted to evaluate the effort of medical staff to clarify to what extent their burden had increased post-disaster. The ratio of total dialysis sessions over total working days of medical staff was determined as an approximate indicator of effort per month. The mean value of each year was compared. Despite fluctuations of the ratio, the mean value did not differ from 2010 to 2013. However, the ratio steadily increased in 2014, and there was a significant increase in the mean value. This proposed indicator of the effort of medical staff appears to reflect what we experienced, although its validity must be carefully examined in future studies. PMID:26935477

  20. Chronic Kidney Disease-Mineral Bone Disorder in the Elderly Peritoneal Dialysis Patient

    DEFF Research Database (Denmark)

    Heaf, James Goya

    2015-01-01

    PURPOSE: The purpose of this paper was to review the literature concerning the treatment of chronic kidney disease-mineral bone disorder (CKD-MBD) in the elderly peritoneal dialysis (PD) patient. ♦ RESULTS: Chronic kidney disease-mineral bone disorder is a major problem in the elderly PD patient......, with its associated increased fracture risk, vascular calcification, and accelerated mortality fracture risk. Peritoneal dialysis, however, bears a lower risk than hemodialysis (HD). The approach to CKD-MBD prophylaxis and treatment in the elderly PD patient is similar to other CKD patients, with some...... to other dialysis patient groups, physicians should be aware of the special problems of the elderly group....

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

    Directory of Open Access Journals (Sweden)

    Majid Malaki

    2012-01-01

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

  2. Patient experiences and preferences on short daily and nocturnal home hemodialysis.

    Science.gov (United States)

    Xi, Wang; Singh, P Mony; Harwood, Lori; Lindsay, Robert; Suri, Rita; Brown, Judith Belle; Moist, Louise M

    2013-04-01

    Quotidian/intensive hemodialysis (short daily and nocturnal) has variable effects on health-related quality of life (HRQOL) as measured by standard HRQOL tools. We sought to understand the perceived benefits and limitations of quotidian dialysis by interviewing patients who had switched from conventional to home quotidian dialysis. We used a qualitative, phenomenological approach to explore the perceived benefits of quotidian dialysis from 10 patients using either short daily or nocturnal hemodialysis at a tertiary health care center in London, Canada. The patients varied in gender, age, employment status, home support, physical capacity, primary cause of kidney disease, previous forms of renal replacement therapy, and level of education. Four major themes emerged: (1) improvement in physical and mental well-being including better blood pressure and concentration, (2) increased control over patient's own life including time availability, choosing when to dialyze, and dialyzing at home, (3) decreased perception of being sick including returning to regular employment and avoiding sicker patients who must have in-center dialysis, and (4) identification of the competencies and supports required for quotidian dialysis including ability to provide self-care, supportive family, and medical support. Our findings suggest when patients' willingness and physical ability to use quotidian dialysis are coupled with education and support systems to assist patients' and families' self-directed care, patients qualitatively perceive benefits of both increased physical and mental health, both measures of health-related quality of life. PMID:22882752

  3. An Important Problem Among Hemodialysis Patients: Uremic Pruritus and Affecting Factors

    Directory of Open Access Journals (Sweden)

    Nazan KILIÇ AKÇA

    2014-09-01

    Full Text Available OBJECTIVE: This study was conducted in order to determine the incidence of uremic pruritus in hemodialysis patients and to explore the associated factors. MATERIAL and METHODS: This descriptive study included 204 patients. Official permissions from the institutions and informed consents of the patients were obtained. The data were gathered using a questionnaire form designed by the investigators and the Visual Analogue Scale (VAS. The t test, one-way ANOVA and logistic regression analysis were used for the statistical analyses of the data. RESULTS: We found that 75.5% of the patients suffered from pruritus after hemodialysis treatment was initiated and 64.2% of them had an average level of pruritus (6.0±2.0 at the time of the study. It was noted that 37.4% had wounds caused by pruritus and 61.1% woke up from their sleep due to pruritus. Patients who were aged ≥ 65 were 3.91 times more likely to suffer from very severe pruritus compared to other age groups and patients with dry skin were 9.90 times more likely to suffer from very severe pruritus as compared to those with normal skin (p<0.05 CONCLUSION: In light of these results, it may be recommended that patients who suffer from uremic pruritus should be provided with the necessary care and training programs, taking into account their individual and disease-related characteristics.

  4. Occult hepatitis C virus infection is more common than hepatitis B infection in maintenance hemodialysis patients

    Institute of Scientific and Technical Information of China (English)

    Pankaj Jain; Sandeep Nijhawan

    2008-01-01

    Patients of end stage renal disease on maintenance hemodialysis were enrolled to study the prevalence of occult and dual hepatitis B virus (HBV) and hepatitis C virus (HCV) infection and non-occult hepatitis B and C virus infection. One hundred and two patients were enrolled. Thirty patients had HCV infection, three of them were positive in anti-HCV. So, 27 (90%) of HCVpositive patients had occult HCV infection. Eleven (11%)patients had HBV infection. Five patients were positive in anti-HBc or HBV-DNA, but negative in HBsAg (occult HBV infection). Three (3%) patients had dual HBV and HCV infection. None of the patients showed changes in viral markers during the follow-up of 8 mo on average (1-12 mo).

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

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    Carlos E. Figueroa Castro

    2008-12-01

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

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

    Science.gov (United States)

    Castro, Carlos E Figueroa; Madariaga, Miguel G

    2008-12-01

    Poor immune status, the use of a vascular access different from an AV fistula, and intravenous drug use (IDU) may favor increased rates of vascular access infections among HIV infected patients on hemodialysis. Staphylococcus spp. and Streptococcus spp. are the main cause of these infections, but Gram-negative rods and fungi have been found as well. Using an AV fistula when possible, and eliciting a history of IVDU on every visit may prevent this type of infection. When infections are present, coverage for both Gram-positive and negative organisms is recommended. Additional studies specifically addressing the issue of vascular access infection in HIV infected patients are required. PMID:19287844

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

    OpenAIRE

    Savcı, Ünsal; Bulut, Yunus

    2015-01-01

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

  8. Cytogenetic studies in patients with uremia before hemodialysis (A preliminary study)

    OpenAIRE

    ÖZTAŞ, Sıtkı; KESKİNLER, Figen; TATAR, A. Gani; TURGUT, Kamuran; BATAT, İrfan

    2001-01-01

    This study has been planned to elucidate the effect of uremia on human genome. For this purpouse, on the mitotic metaphases obtained from the cultured periferic blood samples of 18 patient with uremia to be given hemodialysis treatment for the first time and 15 healthy control subjects. Sister Chromatid Exchange (SCE) rates, numeric and structural chromosomal anomalies have been screened. SCE rate in patients with uremia was 9,48$\\pm$0,29 per metaphase where it was observed as 6,51$\\pm$0,24 p...

  9. Chronic hemodialysis in children weighing less than 10 kg.

    LENUS (Irish Health Repository)

    Quinlan, Catherine

    2013-05-01

    Hemodialysis (HD) in infants is usually used when peritoneal dialysis (PD) has failed. We describe our experience with HD, outlining the morbidity, complications, and outcomes for infants weighing less than 10 kg managed with HD for more than 6 months over a 10-year period.

  10. Potential Inhibitory Effects of l-Carnitine Supplementation on Tissue Advanced Glycation End Products in Patients with Hemodialysis

    OpenAIRE

    Fukami, Kei; Yamagishi, Sho-ichi; Sakai, Kazuko; Kaida, Yusuke; Adachi, Takeki; Ando, Ryotaro; Okuda, Seiya

    2013-01-01

    Background and Aims: Advanced glycation end products (AGEs) contribute to cardiovascular disease in patients with hemodialysis (HD). We have recently found that carnitine levels are inversely associated with skin AGE levels in HD patients. We examined whether l-carnitine supplementation reduced skin AGE levels in HD patients with carnitine deficiency.

  11. Effect of L-carnitine supplementation on red blood cells deformability in hemodialysis patients.

    Science.gov (United States)

    Nikolaos, S; George, A; Telemachos, T; Maria, S; Yannis, M; Konstantinos, M

    2000-01-01

    Anemia is a serious problem in hemodialysis patients, the main cause of which is erythropoietin deficiency. After the discovery of recombinant human erythropoietin (rHuEpo) at the end of the last decade, the hematological profile of hemodialysis patients improved significantly but at considerable expense. The deformability of red blood cells (RBC) influences their microcirculation and tissue oxygen delivery along with their life span. We investigated the deformabilty of RBCs in 15 hemodialysis patients before and after three months on L-carnitine supplementation (30 mg/Kg body wt/dialysis session). We excluded from the study all patients who received blood transfusions three months before or during the study, patients who had hemorrhagic episodes, those with hyperparathyroidism or infections, and any who required surgical intervention during the study. The serum iron, folic acid and vitamin B-12 levels were kept normal during the duration of the study. The erythropoietin dose taken before the beginning of L-cartnitine supplementation was not changed. The deformability of RBCs before and after dialysis, prior to and following three months on L-carnitine was determined and compared to the deformability of RBCs from a control group. Hematocrit levels were measured before entry into the study and every month for three months. We found that the deformability of RBCs before the dialysis session was significantly greater than that found in the control group (t-test, p < 0.00001), and that there was a further increase after the end of the dialysis session. Three months following L-carnitine supplementation, we found a significant reduction of RBCs deformability (paired t-test, p < 0.004), and a significant increase in the hematocrit (ANOVA, p < 0.0001). We concluded that abnormalities in the deformability of RBCs improved after L-carnitine and that this was responsible for the increase in the hematocrit. This may allow a substantial reduction in rHuEpo dose. PMID:10718283

  12. Left Ventricular Hypertrophy in Chronic Kidney Disease Patients: From Pathophysiology to Treatment

    OpenAIRE

    Di Lullo, Luca; Gorini, Antonio; Russo, Domenico; Santoboni, Alberto; Ronco, Claudio

    2015-01-01

    Cardiovascular diseases represent the main causes of morbidity and mortality in patients with chronic kidney disease (CKD). According to a well-established classification, cardiovascular involvement in CKD can be set in the context of cardiorenal syndrome type 4. Left ventricular hypertrophy (LVH) represents a key feature to provide an accurate picture of systolic-diastolic left heart involvement in CKD patients. Cardiovascular involvement is present in about 80% of prevalent hemodialysis pat...

  13. Evaluation of an electronic warfarin nomogram for anticoagulation of hemodialysis patients

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    MacKay Elizabeth

    2011-09-01

    Full Text Available Abstract Background Warfarin nomograms to guide dosing have been shown to improve control of the international normalized ratio (INR in the general outpatient setting. However, the effectiveness of these nomograms in hemodialysis patients is unknown. We evaluated the effectiveness of anticoagulation using an electronic warfarin nomogram administered by nurses in outpatient hemodialysis patients, compared to physician directed therapy. Methods Hemodialysis patients at any of the six outpatient clinics in Calgary, Alberta, treated with warfarin anticoagulation were included. Two five-month time periods were compared: prior to and post implementation of the nomogram. The primary endpoint was adequacy of anticoagulation (proportion of INR measurements within range ± 0.5 units. Results Overall, 67 patients were included in the pre- and 55 in the post-period (with 40 patients in both periods. Using generalized linear mixed models, the adequacy of INR control was similar in both periods for all range INR levels: in detail, range INR 1.5 to 2.5 (pre 93.6% (95% CI: 88.6% - 96.5%; post 95.6% (95% CI: 89.4% - 98.3%; p = 0.95; INR 2.0 to 3.0 (pre 82.2% (95% CI: 77.9% - 85.8%; post 77.4% (95% CI: 72.0% - 82.0%; p = 0.20; and, INR 2.5 to 3.5 (pre 84.3% (95% CI: 59.4% - 95.1%; post 66.8% (95% CI: 39.9% - 86.0%; p = 0.29. The mean number of INR measurements per patient decreased significantly between the pre- (30.5, 95% CI: 27.0 - 34.0 and post- (22.3, 95% CI: 18.4 - 26.1 (p = 0.003 period. There were 3 bleeding events in each of the periods. Conclusions An electronic warfarin anticoagulation nomogram administered by nurses achieved INR control similar to that of physician directed therapy among hemodialysis patients in an outpatient setting, with a significant reduction in frequency of testing. Future con