Stressors and coping methods among chronic haemodialysis patients in Hong Kong.

Science.gov (United States)

Mok, E; Tam, B

2001-07-01

The purpose of the study was to determine the stressors and coping methods of chronic haemodialysis patients in Hong Kong. Relationships among treatment-related stressors, coping methods and length of time on haemodialysis were explored. Fifty subjects completed the Haemodialysis Stressor Scale (HSS) and Jalowiec Coping Scale (JCS). Results revealed that limitation of fluid was the most frequently identified stressor, followed by limitation of food, itching, fatigue and cost. The most common coping methods are 'accepted the situation because very little could be done', followed by 'told oneself not to worry because everything would work out fine' and 'told oneself that the problem was really not that important.' It was found that the traditional philosophies of the Chinese--Confucianism, Buddhism, and Taoism--share an approach to the understanding and management of life stressors as different from that adopted by Western philosophies. The findings of this study can further facilitate nurse practitioners in providing support, information, and alternative solutions when assisting patients in coping with long-term haemodialysis.

Association of versican turnover with all-cause mortality in patients on haemodialysis

DEFF Research Database (Denmark)

Genovese, Federica; Karsdal, Morten A; Leeming, Diana J

2014-01-01

with cardiovascular diseases. The objective of the study was to investigate the association of versican turnover assessed in plasma with survival in haemodialysis patients. METHODS: A specific matrix metalloproteinase-generated neo-epitope fragment of versican (VCANM) was measured in plasma of 364 haemodialysis...... patients with a 5-years follow-up, using a robust competitive enzyme-linked immunosorbent assays. Association between VCANM plasma concentration and survival was assessed by Kaplan-Meier analysis and adjusted Cox model. RESULTS: Haemodialysis patients with plasma VCANM concentrations in the lowest quartile...

Revealed access to haemodialysis facilities in northeastern Iran: Factors that matter in rural and urban areas.

Science.gov (United States)

Kiani, Behzad; Bagheri, Nasser; Tara, Ahmad; Hoseini, Benyamin; Tabesh, Hamed; Tara, Mahmood

2017-11-07

Poor access to haemodialysis facilities is associated with high mortality and morbidity rates. This study investigated factors affecting revealed access to the haemodialysis facilities considering patients living in rural and urban areas without any haemodialysis facility (Group A) and those living urban areas with haemodialysis facilities (Group B). This study is based on selfreported Actual Access Time (AAT) to referred haemodialysis facilities and other information regarding travel to haemodialysis facilities from patients. All significant variables on univariate analysis were entered into a univariate general linear model in order to identify factors associated with AAT. Both spatial (driving time and distance) and non-spatial factors (sex, income level, caregivers, transportation mode, education level, ethnicity and personal vehicle ownership) influenced the revealed access identified in Group A. The non-spatial factors for Group B patients were the same as for Group A, but no spatial factor was identified in Group B. It was found that accessibility is strongly underestimated when driving time is chosen as accessibility measure to haemodialysis facilities. Analysis of revealed access determinants provides policymakers with an appropriate decision base for making appropriate decisions and finding solutions to decrease the access time for patients under haemodialysis therapy. Driving time alone is not a good proxy for measuring access to haemodialysis facilities as there are many other potential obstacles, such as women's special travel problems, poor other transportation possibilities, ethnicity disparities, low education levels, low caregiver status and low-income.

Haemodialysis in a rural area: a demanding form of treatment.

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Brammah, A; Young, G; Allan, A; Robertson, S; Norrie, J; Isles, C

2001-09-01

To determine distances travelled and time spent waiting for transport among hospital haemodialysis patients living in a rural area. Cross sectional survey comparing the subregional dialysis unit in south west Scotland with 12 of the other 13 Scottish Adult Renal Units. Forty three Dumfries and Galloway patients and 935 other Scottish patients receiving hospital haemodialysis in November 1999. At the time of the survey 8/43 (19%) Dumfries patients travelled in excess of 100 miles per dialysis day (15,000 miles per year) solely for the purpose of dialysis, compared to 20/935 (2%) elsewhere in Scotland (p Scottish Units relied on hospital car, Patient Transport Service bus or ambulance for the journey home after treatment. Dumfries patients who travelled by Patient Transport Service or hospital ambulance had to wait twice as long before they left the renal unit as patients using a dedicated hospital car or private car. Haemodialysis in a rural area has every reason to be considered a demanding form of treatment. Greater promotion of home based treatment would improve the quality of life for many of these patients, while dedicated hospital cars would reduce 'car to needle time' for those who remain on hospital haemodialysis.

Rationale and design for SHAREHD: a quality improvement collaborative to scale up Shared Haemodialysis Care for patients on centre based haemodialysis.

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Fotheringham, James; Barnes, Tania; Dunn, Louese; Lee, Sonia; Ariss, Steven; Young, Tracey; Walters, Stephen J; Laboi, Paul; Henwood, Andy; Gair, Rachel; Wilkie, Martin

2017-11-24

The study objective is to assess the effectiveness and economic impact of a structured programme to support patient involvement in centre-based haemodialysis and to understand what works for whom in what circumstances and why. It implements a program of Shared Haemodialysis Care (SHC) that aims to improve experience and outcomes for those who are treated with centre-based haemodialysis, and give more patients the confidence to dialyse independently both at centres and at home. The 24 month mixed methods cohort evaluation of 600 prevalent centre based HD patients is nested within a 30 month quality improvement program that aims to scale up SHC at 12 dialysis centres across England. SHC describes an intervention where patients who receive centre-based haemodialysis are given the opportunity to learn, engage with and undertake tasks associated with their treatment. Following a 6-month set up period, a phased implementation programme is initiated across 12 dialysis units using a randomised stepped wedge design with 6 centres participating in each of 2 steps, each lasting 6 months. The intervention utilises quality improvement methodologies involving rapid tests of change to determine the most appropriate mechanisms for implementation in the context of a learning collaborative. Running parallel with the stepped wedge intervention is a mixed methods cohort evaluation that employs patient questionnaires and interviews, and will link with routinely collected data at the end of the study period. The primary outcome measure is the number of patients performing at least 5 dialysis-related tasks collected using 3 monthly questionnaires. Secondary outcomes measures include: the number of people choosing to perform home haemodialysis or dialyse independently in-centre by the end of the study period; end-user recommendation; home dialysis establishment delay; staff impact and confidence; hospitalisation; infection and health economics. The results from this study will provide

HCV viraemia in anti-HCV-negative haemodialysis patients: Do we need HCV RNA detection test?

Science.gov (United States)

Papadopoulos, Nikolaos; Griveas, Ioannis; Sveroni, Eirini; Argiana, Vasiliki; Kalliaropoulos, Antonios; Martinez-Gonzalez, Beatriz; Deutsch, Melanie

2018-03-01

Hepatitis C virus (HCV) infection is still common among dialysis patients, but the natural history of HCV in this group is not completely understood. The KDIGO HCV guidelines of 2009 recommend that chronic haemodialysis patients be screened for HCV antibody upon admission to the dialysis clinic and every 6 months thereafter if susceptible to HCV infection. However, previous studies have shown the presence of HCV viraemia in anti-HCV-negative haemodialysis patients as up to 22%. To evaluate the presence of HCV viraemia, using HCV RNA detection, among anti-HCV-negative haemodialysis patients from a tertiary dialysis unit in Athens. We enrolled 41 anti-HCV-negative haemodialysis patients diagnosed with third-generation enzyme immunoassay. HCV viraemia was evaluated using a sensitive (cut-off: 12 IU/mL) reverse transcriptase polymerase chain reaction (COBAS AmpliPrep/TaqMan system) for HCV RNA. None of the 41 anti-HCV-negative haemodialysis patients were shown to be viraemic. Routine HCV RNA testing appears not to be necessary in anti-HCV-negative haemodialysis patients.

NURSE STAFFING AND RENAL ANAEMIA OUTCOMES IN HAEMODIALYSIS CARE.

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Erlingmark, Julia; Hedström, Mariann; Lindberg, Magnus

2016-09-01

Current trends in renal anaemia management place greater emphasis, and thus increased workload, on the role of the nurse in haemodialysis settings. However, there is little evidence that demonstrates the relationship between nurse staffing and patient outcomes. To describe nurse staffing in haemodialysis settings, its relationship with target levels of renal anaemia management and to describe target level achievement for different ways of organising anaemia management. Cross-sectional audit. Forty (out of 78) haemodialysis centres in Sweden reported quality assurance data. The numbers of bedside registered nurses, licensed nurse assistants and patients undergoing haemodialysis during a predefined morning shift; type of anaemia management and achieved target levels of anaemia management. The mean patient:registered nurse ratio was 2.4 and the mean patient:nurse assistant ratio was 12.8. There were no significant relationships between registered nurse staffing and target level achievement. On average, 45.6% of the patients had haemoglobin within the target levels at centres applying nurse-driven anaemia management, compared with 47.3% at physician-driven centres. These cross-sectional data suggest that renal anaemia outcomes are unrelated to the patient:registered nurse ratio. There is, however, room for improvement in renal anaemia management in the units included in this study, particularly the achievement of target levels of haemoglobin and transferrin saturation. © 2016 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Evaluation of spiritual well-being in haemodialysis patients.

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Reig-Ferrer, Abilio; Arenas, M Dolores; Ferrer-Cascales, Rosario; Fernández-Pascual, M Dolores; Albaladejo-Blázquez, Natalia; Gil, M Teresa; de la Fuente, Vanesa

2012-01-01

Spirituality can be defined as a personal search for meaning and purpose in life that may or may not encompass religion. In this article we report on the development and testing of an instrument for measuring spiritual well-being within a sample of haemodialysis patients. The main instrument, a 21-item Meaning in Life Scale (MiLS), comprises four scales: Life Perspective, Purpose and Goals, Confusion and Lessened Meaning, Harmony and Peace, and Benefits of Spirituality. A total score for spiritual well-being is also produced. We also used the following variables: clinical (time on haemodialysis, modified Charlson comorbidity index), sociodemographic (age, gender), and self-assessments of health, quality of life (general and recent), personal happiness, religiosity, and belief in the afterlife. A cross-sectional study was carried out on 94 haemodialysis patients. This study demonstrates that the MiLS-Sp is a psychometrically sound measure of spiritual well-being for dialysis patients (reliability, validity) as they manage the complex demands of a chronic illness. Spiritual well-being was significantly associated with various quality of life variables, health status, personal happiness, or religiosity in patients on dialysis. There was no relationship between spirituality scores and comorbidity, HD duration, gender, or age. Spiritual well-being is relatively low in dialysis patients. Spirituality may play an important role on psychological well-being, quality of life, and self-rated health for patients on haemodialysis. Spiritual well-being in these patients is relatively low. Results suggest that assessing and addressing spiritual well-being in dialysis patients may be helpful in clinical practice.

Economic evaluation of centre haemodialysis and continuous ambulatory peritoneal dialysis in Ministry of Health hospitals, Malaysia.

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Hooi, Lai Seong; Lim, Teck Onn; Goh, Adrian; Wong, Hin Seng; Tan, Chwee Choon; Ahmad, Ghazali; Morad, Zaki

2005-02-01

This is a multi-centre study to determine cost efficiency and cost effectiveness of the Ministry of Health centre haemodialysis and continuous ambulatory peritoneal dialysis (CAPD) programme. Forty-four haemodialysis and 11 CAPD centres were enrolled in this study in 2001. Sixty patients, 30 from each modality, were evaluated. Micro-costing was used to determine costs. The number of haemodialyses conducted ranged from 402 to 23,000 procedures per year, while for CAPD, output ranged from 70 to 2300 patient months/year. Cost ranged from RM79.61 to RM475.79 per haemodialysis treatment, with a mean cost of RM169 per HD (USD 1 = RM 3.80). The cost of CAPD treatment ranged from RM1400 to RM3200 per patient month, with a mean of RM2186. Both modalities incurred similar outpatient costs. The cost of erythropoeitin per year is RM4500 and RM2500 for haemodialysis and CAPD, respectively. The number of life years saved is 10.96 years for haemodialysis and 5.21 years for CAPD. Cost per life year saved is RM33 642 for haemodialysis and RM31 635 for CAPD. The cost for land, building, equipment, overheads, and staff were higher for haemodialysis, while consumables and hospitalization cost more for CAPD. Sensitivity analysis was performed for two discount rates (3 and 5%), varying erythropoietin doses and maximum and minimum overheads. Relative cost effectiveness of haemodialysis and CAPD was unchanged in all sensitivity scenarios, except for overhead costs, which influenced the cost effectiveness of HD. It is economically viable to promote the use of both CAPD and haemodialysis because the cost effectiveness of both are nearly equal.

Haemodialysis is an effective treatment in acute metabolic decompensation of maple syrup urine disease

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P.S. Atwal

2015-09-01

Full Text Available Acute metabolic decompensation in maple syrup urine disease can occur during intercurrent illness and is a medical emergency. A handful of reports in the medical literature describe the use of peritoneal dialysis and haemodialysis as therapeutic inventions. We report the only patient from our centre to have haemodialysis performed in this setting. Combined with dietary BCAA restriction and calorific support, haemodialysis allows rapid reduction in plasma leucine concentrations considerably faster than conservative methods.

A STUDY ON INCIDENCE OF ACUTE CARDIOVASCULAR COMPLICATIONS DURING MAINTENANCE HAEMODIALYSIS OF END-STAGE RENAL FAILURE PATIENTS

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Darimireddi Siva Kumar

2016-09-01

Full Text Available BACKGROUND To study the incidence of acute cardiovascular complications during haemodialysis in patients with chronic kidney disease with end-stage renal failure on maintenance haemodialysis. METHODS Patients with chronic kidney disease with end-stage renal failure on maintenance haemodialysis at King George Hospital, Andhra Medical College, Visakhapatnam, India, were studied during the period of June 2015 to August 2016. In our study, all the 100 patients underwent 8510 haemodialysis sessions during 1-year period of study. RESULTS Cardiovascular complications are the most common intradialytic complications occurred during the study. Hypotension is the commonest of all the intradialytic as well as cardiovascular complications with a frequency of 1278, which account for 15.01% of the haemodialysis sessions. This was followed by 879 episodes of hypertension (10.32%, 190 episodes of cardiac arrhythmias (2.23%, which include complex ventricular arrhythmias and supraventricular arrhythmias and 162 episodes of chest pain (1.90%. Of the 100 patients, 37% of patients developed cardiac arrhythmias during haemodialysis. The frequency of arrhythmic episodes was 190 (2.23%. Among these, Supraventricular Arrhythmias (SVA and Complex Ventricular Arrhythmic (CVA episodes account for 159 (83.68% and 31 (16.31%, respectively. CVA and SVA occurred in 29% and 19% of patients in the study group, respectively. Both CVA and SVA occurred in 12% of patients. CONCLUSION Intradialytic hypotension is the most common acute intradialytic complication in patients with chronic kidney disease with endstage renal failure undergoing maintenance haemodialysis. This is followed by intradialytic hypertension. Sudden cardiac arrest is the most common cause of death during haemodialysis in patients with end-stage renal disease on haemodialysis. Mortality is high in patients with end-stage renal failure in maintenance haemodialysis with ischaemic heart disease.

PLASMA CYTOKINES LEVELS IN PATIENTS UNDERGOING LONG-TERM HAEMODIALYSIS

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D. S. Polyakov

2011-01-01

Full Text Available Аbstract.  Patients  with  end-stage  renal  disease  need  their  kidney  functions  to  be  replaced.  Chronic haemodialysis represents a most common method of such substitution treatment. This procedure results in successful survival of such patients for years. Chronic haemodialysis is accompanied by a complication which is known as β2-microglobulin amyloidosis. In this case, amyloid substance consisting of β2-microglobulin (β2-MG accumulates in bones, ligaments and joints. Biological causes of β2-MG amyloidosis are still not established. To elucidate the role of inflammation in the pathogenesis of β2-MG amyloidosis, the levels of  IL-2,  IL-4,  IL-6,  IL-8,  IL-10,  GM-CSF,  IFNγ, TNFα were quantified in plasma of patients undergoing  long-term haemodialysis. Mean amounts of all the mentioned cytokines in haemodialysis patients proved to be significantly higher than in control group consisting of healthy subjects. When comparing a group receiving standard  dialysis  procedure  versus  a  subgroup  receiving  haemodiafiltration,  a  single  reliable  difference  was revealed for GM-CSF levels (p < 0.04, without any differences shown for other cytokines. With increasing terms of chronic haemodialysis, the levels of IL-2, IL-4, IL-6, IL-8, GM-CSF, IFNγ, TNFα were increased, or, at least, they did not decrease. After three years of dialysis, IL-10 concentrations were statistically indistinguishable from normal levels. In patients undergoing haemodiafiltration, plasma levels of IL-2, IL-4, IL-8, GM-CSF, IFNγ, TNFα did not drop with increasing terms of dialysis. The levels of IL-6 and IL-10 decreased after three years of dialysis, to near-normal levels.In general, these results suggest that IL-10 and IL-6 may be regarded as candidates for further studies as potential markers of β2-microglobulin amyloidosis. (Med. Immunol., 2011, vol. 13, N 2-3, pp 211-218

Continuing education: online monitoring of haemodialysis dose.

Science.gov (United States)

Vartia, Aarne

2018-01-25

Kt/V urea reflects the efficacy of haemodialysis scaled to patient size (urea distribution volume). The guidelines recommend monthly Kt/V measurements based on blood samples. Modern haemodialysis machines are equipped with accessories monitoring the dose online at every session without extra costs, blood samples and computers. To describe the principles, devices, benefits and shortcomings of online monitoring of haemodialysis dose. A critical literature overview and discussion. UV absorbance methods measure Kt/V, ionic dialysance Kt (product of clearance and treatment time; cleared volume without scaling). Both are easy and useful methods, but comparison is difficult due to problems in scaling of the dialysis dose to the patient's size. The best dose estimation method is the one which predicts the quality of life and survival most accurately. There is some evidence on the predictive value of ionic dialysance Kt, but more documentation is required on the UV method. Online monitoring is a useful tool in everyday quality assurance, but blood samples are still required for more accurate kinetic modelling. After reading this article the reader should be able to: Understand the elements of the Kt/V equation for dialysis dose. Compare and contrast different methods of measurement of dialysis dose. Reflect on the importance of adequate dialysis dose for patient survival and life quality. © 2018 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Effect of plasma colloid osmotic pressure on intraocular pressure during haemodialysis

OpenAIRE

Tokuyama, T.; Ikeda, T.; Sato, K.

1998-01-01

BACKGROUND—In a previous case report, it was shown that an increase in plasma colloid osmotic pressure induced by the removal of fluid during haemodialysis was instrumental in decreasing intraocular pressure. The relation between changes in intraocular pressure, plasma osmolarity, plasma colloid osmotic pressure, and body weight before and after haemodialysis is evaluated.
METHODS—Intraocular pressure, plasma osmolarity, plasma colloid osmotic pressure, and body weight were evaluated before a...

Starting on haemodialysis: a qualitative study to explore the experience and needs of incident patients.

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Lai, Alden Yuanhong; Loh, Angela Ping Ping; Mooppil, Nandakumar; Krishnan, Deby Sarojiuy Pala; Griva, Konstadina

2012-01-01

Dialysis can be very stressful with the initial months onto treatment being highly critical in terms of both adaptation and mortality. This qualitative study aimed to explore the lived experiences of incident haemodialysis patients in Singapore. Topics related to the end-stage renal disease diagnosis and haemodialysis treatment were raised with 13 incident haemodialysis patients in the form of semi-structured interviews, and interpretative phenomenological analysis was undertaken as the framework for data analysis. Emotional distress, treatment-related concerns and social support emerged as main issues following a critical review of themes. Our study revealed that incident haemodialysis patients have emotional and informational needs, highlighting the importance of intervention programmes in particular to this patient group to promote better psychosocial adjustment to the disease and its treatment.

Beware: The femoral haemodialysis catheter – a surgeon’s perspective

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Tinus du Toit

2017-06-01

Full Text Available The ability to identify and address factors that threaten the optimal utilisation of donor organs is quintessential in obtaining satisfactory transplant outcomes. We share our concerns regarding the prolonged use of femoral haemodialysis catheters and its potential to jeopardise successful renal transplantation. Despite a paucity of literature on the topic, we review relevant aspects related to this pernicious form of vascular access and clarify its limited role in the modern haemodialysis unit, particularly in patients who are still considered for transplantation.

Haemodialysis work environment contributors to job satisfaction and stress: a sequential mixed methods study.

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Hayes, Bronwyn; Bonner, Ann; Douglas, Clint

2015-01-01

Haemodialysis nurses form long term relationships with patients in a technologically complex work environment. Previous studies have highlighted that haemodialysis nurses face stressors related to the nature of their work and also their work environments leading to reported high levels of burnout. Using Kanters (1997) Structural Empowerment Theory as a guiding framework, the aim of this study was to explore the factors contributing to satisfaction with the work environment, job satisfaction, job stress and burnout in haemodialysis nurses. Using a sequential mixed-methods design, the first phase involved an on-line survey comprising demographic and work characteristics, Brisbane Practice Environment Measure (B-PEM), Index of Work Satisfaction (IWS), Nursing Stress Scale (NSS) and the Maslach Burnout Inventory (MBI). The second phase involved conducting eight semi-structured interviews with data thematically analyzed. From the 417 nurses surveyed the majority were female (90.9 %), aged over 41 years of age (74.3 %), and 47.4 % had worked in haemodialysis for more than 10 years. Overall the work environment was perceived positively and there was a moderate level of job satisfaction. However levels of stress and emotional exhaustion (burnout) were high. Two themes, ability to care and feeling successful as a nurse, provided clarity to the level of job satisfaction found in phase 1. While two further themes, patients as quasi-family and intense working teams, explained why working as a haemodialysis nurse was both satisfying and stressful. Nurse managers can use these results to identify issues being experienced by haemodialysis nurses working in the unit they are supervising.

Haemodialysis followed by continuous veno-venous haemodiafiltration in lithium intoxication; a model and a case

NARCIS (Netherlands)

Meertens, John H J M; Jagernath, Danny R; Eleveld, Douglas J; Zijlstra, Jan G; Franssen, Casper F M

2009-01-01

For severe lithium intoxication haemodialysis is recommended to lower serum lithium levels rapidly. Frequently, serum lithium levels rebound after dialysis and repeated dialysis is needed. This is the first report of an adult patient with severe lithium intoxication who underwent haemodialysis (HD)

The effects of lavender essential oil aromatherapy on anxiety and depression in haemodialysis patients

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Masoumeh Bagheri-Nesami

2017-05-01

Full Text Available This study was intended to examine the effects of lavender essential oil aromatherapy on anxiety and depression in haemodialysis patients. This randomised clinical trial was conducted on 72 haemodialysis patients divided into control and experimental groups. The control group only received the routine care. The experimental group received aromatherapy with 3 drops of lavender essential oil 5% for 10 minutes every time they underwent haemodialysis for a period of one month. Anxiety and depression were measured in both groups at baseline and by the end of the second and fourth weeks during the first hour of a dialysis session. The rANOVA showed no significant difference between the two groups in terms of the severity of anxiety before the intervention and by the end of the second and fourth weeks (p  =  0.783. However, the  rANOVA revealed a significant difference with respect to the severity of depression between the two groups (p  =  0.005. Current research suggests that we need various concentrations of lavender essential oil to relieve anxiety compared to depression. In sum, future studies are required to investigate different concentrations of lavender essential oil at different times during haemodialysis sessions to obtain specific doses for lavender essential oil to be used on haemodialysis patients suffering from anxiety and depression.

A Modified Technique of Basilic Vein Transposition for Haemodialysis

International Nuclear Information System (INIS)

Chaudhary, F. A.; Parvez, Z.

2014-01-01

Objective: To modify the technique of basilic vein transposition for vascular accesss for haemodialysis aiming at better maturation rate, longer survival of fistula and lesser complications. Study Design: Case series. Place and Duration of Study: Shaikh Zayed Hospital and Omer Hospital, Lahore, from February 2008 to July 2011. Methodology: Patients referred for basilic vein transposition for haemodialysis vascular access were prospectively enrolled. The surgical technique included small tracking incisions, an extra 3 - 4 cm of vein length harvesting to avoid tension in the vein in its new course, an oval arteriotomy and a smooth curved pathway, away from vein harvesting incision to avoid entrapment of vein in the scar. Maturation rate, fistula survival and other complications were noted. Results: There was no immediate failure in 51 patients. The complications during follow-up period were infection and thrombosis, bleeding and non-development of basilic vein in 2 patients each; and false aneurysm formation in one. Four patients died during follow-up period. The maturation time was 4.9 A +- 1.1 weeks. The early patency rate was 92.2%, same at 6 months and 90.7% at 12 months. Conclusion: Arteriovenous fistula constructed with modified technique of basilic vein transposition is an acceptable and valid option of vascular access for haemodialysis. (author)

Haemodialysis patients and end-of-life decisions: a theory of personal preservation.

Science.gov (United States)

Calvin, Amy Olivier

2004-06-01

Lack of knowledge about the end-of-life treatment preferences of patients undergoing haemodialysis is problematic in the acute care setting as, often, patients are unable to communicate their treatment wishes effectively and have not previously documented their desires in the form of advance directives. Existing theoretical models offer an incomplete explanation of end-of-life treatment decisions in haemodialysis patients. This paper reports a study exploring decisions about end-of-life treatment (e.g. cardiopulmonary resuscitation, mechanical ventilation) in people with kidney failure undergoing haemodialysis. Grounded theory was used. Theoretical sampling led to selection of 20 haemodialysis patients (11 men and nine women with a mean age of 56) who attended three dialysis outpatient centres in central Texas. They were interviewed about end-of-life treatment plans and the use of advance directives (i.e. living wills and durable powers of attorney for health care). Interviews, transcripts and field notes from the first 12 patients were analysed by making constant comparisons. The remaining eight interviews were used for validation purposes. Data collection and analysis spanned the years 1997-2000. When prompted to think about and discuss end-of-life treatments, haemodialysis patients chose to focus on living rather than dying. A substantive theory of 'personal preservation' was developed. This consists of three phases: knowing the odds for survival, defining individuality (beating the odds, discovering meaning, being optimistic and having faith in a higher force) and personal preservation (being responsible and taking chances). The theory of personal preservation furthers understanding of illness behaviour and the process by which patients make decisions about end-of-life treatments. It can be used to sensitize health care professionals to patients' desires and to enhance patient-professional communication.

Plasma concentrations of alpha-melanocyte-stimulating hormone are elevated in patients on chronic haemodialysis.

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Airaghi, L; Garofalo, L; Cutuli, M G; Delgado, R; Carlin, A; Demitri, M T; Badalamenti, S; Graziani, G; Lipton, J M; Catania, A

2000-08-01

Clinical and/or laboratory signs of systemic inflammation occur frequently in patients undergoing long-term haemodialysis. It is likely, therefore, that a compensatory release of endogenous anti-inflammatory molecules occurs to limit host reactions. The aim of the present research was to determine if the potent anti-inflammatory peptide alpha-melanocyte-stimulating hormone (alpha-MSH), a pro-opiomelanocortin derivative, is increased in plasma of haemodialysis patients. Because endotoxin and cytokines induce alpha-MSH in vivo and in vitro, we also measured plasma concentrations of endotoxin, interleukin-6 (IL-6), and tumour necrosis factor alpha (TNF-alpha), and the two circulating products of activated monocytes, nitric oxide (NO) and neopterin. Thirty-five chronic haemodialysis patients, 20 patients with chronic renal failure not yet on dialysis, and 35 normal controls were included in the study. In the haemodialysis group, blood samples were obtained before and at the end of a dialysis session. Plasma alpha-MSH was measured using a double antibody radioimmunoassay, and IL-6, TNF-alpha, and neopterin using specific enzyme-linked immunosorbent assays. Plasma nitrites were determined by a colorimetric method, and endotoxin with the quantitative chromogenic LAL (limulus amoebocyte lysate) method. Mean plasma alpha-MSH was higher in haemodialysis patients than in control subjects, with the peptide concentrations being particularly elevated in dialysed patients with detectable endotoxin. High alpha-MSH concentrations were observed in the pre-dialysis samples, with no substantial change at the end of the dialysis session. Plasma concentrations of IL-6, TNF-alpha, neopterin, and NO were generally elevated in chronic haemodialysis patients and there was a negative correlation between circulating alpha-MSH and IL-6. In patients with renal failure not yet on dialysis, mean plasma alpha-MSH was similar to that of normal subjects. alpha-MSH is increased in the circulation of

The effect of aromatherapy on haemodialysis patients' pruritus.

Science.gov (United States)

Cürcani, Mehtap; Tan, Mehtap

2014-12-01

To determine the effect of aromatherapy on pruritus observed in haemodialysis patients. Although the prevalence of pruritus in kidney failure has decreased in the recent years, pruritus is a difficult and serious problem which concerns the majority of haemodialysis patents and is hard to cure. A prospective, pretest-post-test quasi-experimental design was used. The research is quasi-experimental clinical trial conducted as pretest and post-test with control groups between January 2011-April 2012, in haemodialysis units of hospitals in Erzurum. The collection of the data is achieved using a questionnaire to detect the patients' individual and pruritus score scale and to clarify certain laboratory parameters regarding the pruritus. Chi-square analysis and t-test are used for the analysis of data. The experimental group's mean post-test pruritus scores (7·20 ± 3·14) were found to be lower than that of control group patients (10·00 ± 2·47), and a highly significant difference was found between the groups (p aromatherapy was found to decrease the pruritus problem of haemodialyses patients and led to positive changes in some laboratory parameters related to pruritus. One of the roles of health professionals is to advise individuals, who are living on this problem, using the nonpharmacological methods in checking the itching. By preventing or reducing uraemic pruritus, aromatherapy may also improve quality of life in this patient group. © 2014 John Wiley & Sons Ltd.

Impact of high-flux haemodialysis on the probability of target attainment for oral amoxicillin/clavulanic acid combination therapy.

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Hui, Katrina; Patel, Kashyap; Kong, David C M; Kirkpatrick, Carl M J

2017-07-01

Clearance of small molecules such as amoxicillin and clavulanic acid is expected to increase during high-flux haemodialysis, which may result in lower concentrations and thus reduced efficacy. To date, clearance of amoxicillin/clavulanic acid (AMC) during high-flux haemodialysis remains largely unexplored. Using published pharmacokinetic parameters, a two-compartment model with first-order input was simulated to investigate the impact of high-flux haemodialysis on the probability of target attainment (PTA) of orally administered AMC combination therapy. The following pharmacokinetic/pharmacodynamic targets were used to calculate the PTA. For amoxicillin, the time that the free concentration remains above the minimum inhibitory concentration (MIC) of ≥50% of the dosing period (≥50%ƒT >MIC ) was used. For clavulanic acid, the time that the free concentration was >0.1 mg/L of ≥45% of the dosing period (≥45%ƒT >0.1 mg/L ) was used. Dialysis clearance reported in low-flux haemodialysis for both compounds was doubled to represent the likely clearance during high-flux haemodialysis. Monte Carlo simulations were performed to produce concentration-time profiles over 10 days in 1000 virtual patients. Seven different regimens commonly seen in clinical practice were explored. When AMC was dosed twice daily, the PTA was mostly ≥90% for both compounds regardless of when haemodialysis commenced. When administered once daily, the PTA was 20-30% for clavulanic acid and ≥90% for amoxicillin. The simulations suggest that once-daily orally administered AMC in patients receiving high-flux haemodialysis may result in insufficient concentrations of clavulanic acid to effectively treat infections, especially on days when haemodialysis occurs. Copyright © 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

Haemodialysis and Transplantation Facilities in South Africa

African Journals Online (AJOL)

1974-04-13

Apr 13, 1974 ... The provIsion of services in South Africa for patients suffering from chronic renal failure is inadequate in terms· of nationai requirements. A survey of the available facili- ties made in July 1973 showed that 14 maintenance haemodialysis centres had a total of 39 dialysing stations capable of treating 143 ...

Use of vascular access for haemodialysis in Europe

DEFF Research Database (Denmark)

Noordzij, Marlies; Jager, Kitty J; van der Veer, Sabine N

2014-01-01

BACKGROUND: Although arteriovenous fistulas (AVFs) are actively promoted, their use at the start of haemodialysis (HD) seems to be decreasing worldwide. In this paper, we describe recent trends in incidence and prevalence of vascular access types in Europe from 2005 to 2009 and their relationship...

The effect of reflexology applied on haemodialysis patients with fatigue, pain and cramps.

Science.gov (United States)

Ozdemir, Gülistan; Ovayolu, Nimet; Ovayolu, Ozlem

2013-06-01

The research was conducted to evaluate the effect of foot reflexology on fatigue, pain and cramps in haemodialysis patients. The sample consisted of 80 patients in total, 40 intervention and 40 control patients, receiving treatment in the haemodialysis units of two institutions. Data were collected by using a questionnaire, Piper Fatigue Scale and visual analogue scale for measuring the severity of cramp and pain. The intervention group received reflexology treatment for 1 week in three sessions following haemodialysis, each session lasting approximately 30 min. Parametric and non-parametric tests were used in data analysis. It was determined that reflexology reduced the fatigue subscale scores and total scale scores as well as pain and cramp mean scores in the intervention group. The research results revealed that the severity of fatigue, pain and cramp decreased in patients receiving reflexology. © 2013 Wiley Publishing Asia Pty Ltd.

Factors influencing the quality of life of haemodialysis patients according to symptom cluster.

Science.gov (United States)

Shim, Hye Yeung; Cho, Mi-Kyoung

2018-05-01

To identify the characteristics in each symptom cluster and factors influencing the quality of life of haemodialysis patients in Korea according to cluster. Despite developments in renal replacement therapy, haemodialysis still restricts the activities of daily living due to pain and impairs physical functioning induced by the disease and its complications. Descriptive survey. Two hundred and thirty dialysis patients aged >18 years. They completed self-administered questionnaires of Dialysis Symptom Index and Kidney Disease Quality of Life instrument-Short Form 1.3. To determine the optimal number of clusters, the collected data were analysed using polytomous variable latent class analysis in R software (poLCA) to estimate the latent class models and the latent class regression models for polytomous outcome variables. Differences in characteristics, symptoms and QOL according to the symptom cluster of haemodialysis patients were analysed using the independent t test and chi-square test. The factors influencing the QOL according to symptom cluster were identified using hierarchical multiple regression analysis. Physical and emotional symptoms were significantly more severe, and the QOL was significantly worse in Cluster 1 than in Cluster 2. The factors influencing the QOL were spouse, job, insurance type and physical and emotional symptoms in Cluster 1, with these variables having an explanatory power of 60.9%. Physical and emotional symptoms were the only influencing factors in Cluster 2, and they had an explanatory power of 37.4%. Mitigating the symptoms experienced by haemodialysis patients and improving their QOL require educational and therapeutic symptom management interventions that are tailored according to the characteristics and symptoms in each cluster. The findings of this study are expected to lead to practical guidelines for addressing the symptoms experienced by haemodialysis patients, and they provide basic information for developing nursing

Development of certified environmental management in hospital and outpatient haemodialysis units.

Science.gov (United States)

García Vicente, Sergio; Morales Suárez-Varela, María; Martí Monrós, Anna; Llopis González, Agustín

2015-01-01

The environmental impact of haemodialysis is very high. Institutional activity in this sense is important, even in the production of references. Voluntary environmental management systems (EMS), environmental management and auditing systems (EMAS) and the International Organization for Standardization standards (ISO 14001) are important tools for environmental protection, together with legislation, taxation and tax benefits. To determine the degree of implementation of EMS in hospital units and outpatient haemodialysis in the Spanish National Health System to provide a group of reference centres in environmental management in this healthcare activity. Development of a list by autonomous communities showing hospital and outpatient dialysis units using an EMAS and/or ISO 14001 in 2012-2013. The sources of information were the Spanish National Catalogue of Hospitals, Spanish Registry of Healthcare Certification and Accreditation, European and regional EMAS records, world ISO registrations, dialysis centre lists from scientific societies and patients, responses from accredited entities in Spain for environmental certification and the institutional website of each haemodialysis centre identified. Of the 210 hospitals with a dialysis unit, 53 (25%) have the ISO 14001 and 15 of these also have an EMAS). This constitutes 30% of all hospital dialysis chairs in Spain: 1,291 (of 4,298). Only 11 outpatient clinics are recorded, all with the ISO 14001. There is no official documentation of the implementation of EMS in dialysis units. Making this list provides an approach to the situation, with special reference to haemodialysis because of its significant environmental impact. Copyright © 2015 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

Pulp Stone, Haemodialysis, End-stage Renal Disease, Carotid Atherosclerosis

OpenAIRE

Patil, Santosh; Sinha, Nidhi

2013-01-01

Objectives: The aim of this study was to determine the relationship between the presence of pulp calcification and carotid artery calcification on the dental panoramic radiographs in End Stage Renal Disease (ESRD) patients who were on haemodialysis.

Effect of a self-efficacy promotion training programme on the body weight changes in patients undergoing haemodialysis.

Science.gov (United States)

Aliasgharpour, Mansooreh; Shomali, Maryam; Moghaddam, Masoumeh Zakeri; Faghihzadeh, Sograt

2012-09-01

Haemodialysis is the most common form of medical management of patients affected by end-stage renal disease (ESRD). For haemodialysis to be successful, strict fluid and weight control is recommended. Education, in terms of self-care activities, is an important intervention for improving patients' outcomes. A self-efficacy promotion training programme can be an effective strategy to bring about behavioural change. The aim of this study was to investigate the effect of a self-efficacy promotion training programme on the body weight changes in patients undergoing haemodialysis. In this single-blind quasi-experimental study, we recruited a convenience sample of 63 patients undergoing haemodialy-sis from two teaching hospitals and allocated them randomly to the experimental or control group. Patients in the experimental group received a six-session self-efficacy promotion training programme while the control group received the routine care of the institute. Mean body weight gain and self-efficacy were measured before, immediately and two months after the study. The groups did not differ significantly regarding the study variable before the study. However, immediately and two months after the study, the mean body weight gain and self-efficacy in the experimental group were significantly lower and higher, respectively, than the control group (p training programme is effective in decreasing weight gain and increasing self-efficacy in patients undergoing haemodialysis. Nurses in haemodialysis units can use self-efficacy promotion training programmes as an effective intervention for improving patients' outcomes. © 2012 European Dialysis and Transplant Nurses Association/European Renal Care Association.

COPING SKILLS OF IRANIAN FAMILY CAREGIVERS' IN CARETAKING OF PATIENTS UNDERGOING HAEMODIALYSIS: A QUALITATIVE STUDY.

Science.gov (United States)

Eslami, Ahmad Ali; Rabiei, Leili; Abedi, Heidar Ali; Shirani, Majid; Masoudi, Reza

2016-09-01

Coping skills enable caregivers to establish and maintain supportive relationships with the haemodialysis patients they care for. These skills are very important in terms of social support, promotion of mental health and social and family relations. The aim of this study is to investigate the coping skills of Iranian family caregivers as they take care of patients undergoing haemodialysis. Twenty participants were selected for the study through purposive sampling. The data gathering techniques used for the research were in-depth and unstructured interviews. The researchers used an inductive thematic analysis approach to analyse the data generated from the interviews. Four main themes emerged from the data: help-seeking skills, self-nurturing skills, time management skills and stress management skills. The focus of attention was on the stress management coping skills of the caregivers of haemodialysis patients together with their ability to cope with complex problems. Healthcare providers, by taking into account these skills and strategies of empowerment, can help other caregivers of haemodialysis patients cope with their heavy care conditions and better define their purposes in caretaking. © 2016 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Clinical, analytical and bioimpedance characteristics of persistently overhydrated haemodialysis patients.

Science.gov (United States)

Castellano, Sandra; Palomares, Inés; Molina, Manuel; Pérez-García, Rafael; Aljama, Pedro; Ramos, Rosa; Merello, J Ignacio

2014-11-17

Fluid overload is an important and modifiable cardiovascular risk factor for haemodialysis patients. So far, the diagnosis was based on clinical methods alone. Nowadays, we have new tools to assess more objectively the hydration status of the patients on haemodialysis, as BCM (Body Composition Monitor). A Relative Overhydration (AvROH) higher than 15% (it means, Absolute Overhydration or AWOH higher than 2.5 Litres) is associated to greater risk in haemodialysis. However, there is a group of maintained hyperhydrated patients. The aim of the present study is to identify the characteristics of patients with maintained hyperhydrated status (AvROH higher than 15% or AWOH higher than 2.5 liters). The secondary aim is to show the hemodynamic and analytical changes that are related to the reduction in hyperhydration status. Longitudinal cohort study during six months in 2959 patients in haemodialysis (HD) that are grouped according to their hydration status by BCM. And we compare their clinical, analytical and bioimpedance spectroscopy parameters. The change in overhydration status is followed by a decrease in blood pressure and the need for hypotensive drugs (AHT) and erythropoiesis stimulating agents (ESA). The target hydration status is not reached by two subgroups of patients. First, in diabetic patients with a high comorbidity index and high number of hypotensive drugs (AHT) but a great positive sodium gradient during dialysis sessions; and, younger non-diabetic patients with longer time on hemodialysis and positive sodium gradient, lower fat tissue index (FTI) but similar lean tissue index (LTI) and albumin than those with a reduction in hyperhydration status. Those patients with a reduction in hyperhydration status, also show a better control in blood pressure and anemia with less number of AHT and ESA. The maintained hyperhydrated patients, diabetic patients with many comorbidities and young men patients with longer time on hemodialysis and non-adherence treatment

Patient satisfaction with in-centre haemodialysis care: an international survey.

Science.gov (United States)

Palmer, Suetonia C; de Berardis, Giorgia; Craig, Jonathan C; Tong, Allison; Tonelli, Marcello; Pellegrini, Fabio; Ruospo, Marinella; Hegbrant, Jörgen; Wollheim, Charlotta; Celia, Eduardo; Gelfman, Ruben; Ferrari, Juan Nin; Törok, Marietta; Murgo, Marco; Leal, Miguel; Bednarek-Skublewska, Anna; Dulawa, Jan; Strippoli, Giovanni F M

2014-05-19

To evaluate patient experiences of specific aspects of haemodialysis care across several countries. Cross-sectional survey using the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) questionnaire. Haemodialysis clinics within a single provider in Europe and South America. 2748 adults treated in haemodialysis. The primary outcome was patient satisfaction with overall care. Secondary outcomes included patient experiences of individual aspects of dialysis care. 2145 (78.1%) adults responded to the questionnaire. Fewer than half (46.5% (95% CI 44.5% to 48.6%)) rated their overall care as excellent. Global perceptions of care were uninfluenced by most respondent characteristics except age and depressive symptoms; older respondents were less critical of their care (adjusted OR for excellent rating 1.44 (1.01 to 2.04)) and those with depressive symptoms were less satisfied (0.56 (0.44 to 0.71)). Aspects of care that respondents most frequently ranked as excellent were staff attention to dialysis vascular access (54% (52% to 56%)); caring of nurses (53% (51% to 55%)); staff responsiveness to pain or discomfort (51% (49% to 53%)); caring, helpfulness and sensitivity of dialysis staff (50% (48% to 52%)); and ease of reaching dialysis staff by telephone (48% (46% to 50%)). The aspects of care least frequently ranked as excellent were information provided when choosing a dialysis modality (23% (21% to 25%)), ease of seeing a social worker (28% (24% to 32%)), information provided about dialysis (34% (32% to 36%)), accuracy of information from nephrologist (eg, about prognosis or likelihood of a kidney transplant; 37% (35% to 39%)) and accuracy of nephrologists' instructions (39% (36% to 41%)). Haemodialysis patients are least satisfied with the complex aspects of care. Patients' expectations for accurate information, prognosis, the likelihood of kidney transplantation and their options when choosing dialysis treatment need to be considered when

The effect of holiday haemodialysis treatments on patient mood, adverse symptoms and subjective wellbeing using the Big Red Kidney Bus.

Science.gov (United States)

Sims, Jane; Bennett, Paul N; Ockerby, Cherene; Ludlow, Marie; Fairbairn, Jo; Wilson, Anne; Kerr, Peter G

2017-02-01

People with end-stage kidney disease receiving haemodialysis are restricted to holidays where dialysis services are readily available. Holiday dialysis in regional, rural and remote areas is particularly challenging. The aims of this study were to evaluate the wellbeing of those who received dialysis in a holiday haemodialysis bus and to measure patient well-being with that of a comparable cohort of haemodialysis patients. A three machine haemodialysis bus, the Big Red Kidney Bus, was built to enable people, their families and carers to take holidays across a range of tourist destinations in Victoria, Australia. Measures included pre-post subjective well-being, dialysis symptoms and mood questionnaires complemented by post semi-structured telephone interviews. Participating holidaymakers were positive about the haemodialysis bus service and the standard of care experienced. They reported decreased dialysis side effects of fatigue, muscle cramp and dry skin. The overall number of reported symptoms decreased, and the perceived level of bother associated with symptoms also decreased. No changes in subjective well-being and mood were detected. Mean Personal Wellbeing Index scores were significantly higher than in a comparative haemodialysis sample. The Big Red Kidney Bus provided a safe and feasible holiday dialysis service. Holidaymakers' well-being was reflected by the decreased dialysis patient side effects. © 2016 Asian Pacific Society of Nephrology.

Psychosocial influencers and mediators of treatment adherence in haemodialysis patients.

Science.gov (United States)

Oh, Hyun Soo; Park, Ji Suk; Seo, Wha Sook

2013-09-01

This article is a report of the development and testing of the hypothetical model that illustrates relationships between treatment adherence and its psychosocial influencing factors and to elucidate the direct and indirect (mediating) effects of factors on treatment adherence. Poor adherence has been consistently reported in haemodialysis patients. Much research has showed various influencing factors of adherence, but these studies have failed to identify consistent influencing factors. This study was performed using a non-experimental, cross-sectional design. The study subjects were 150 end-stage renal failure patients on haemodialysis at a university hospital located in Incheon, South Korea. Data were collected over 10 months (June 2010-April 2011). The hypothetical model provided a good fit with data. Haemodialysis-related knowledge, perceived barrier to adherence, self-efficacy on adherence, and healthcare provider support had significant effects on adherence. Self-efficacy was found to mediate barrier-adherence and family support-adherence relationships. Self-efficacy in combination with barrier, family support, and healthcare provider support was found to mediate the depression-adherence relationship. Strategies aimed at the development of successful adherence interventions should focus on reducing perceived barriers and enhancing self-efficacy and knowledge. It can be suggested that efforts to improve the healthcare provider-patient relationship would enhance adherence. In depressive patients, strategies that promote self-efficacy and the support of family or healthcare providers could diminish the negative impact of depression on adherence. © 2013 Blackwell Publishing Ltd.

Flash pulmonary oedema after relief of haemodialysis graft stenosis.

Science.gov (United States)

Vélez-Martínez, Mariella; Weinberg, Brent D; Mishkin, Joseph D

2013-08-01

Heart failure (HF) and chronic kidney disease (CKD) are undoubtedly very much interrelated, especially in patients with end-stage renal disease (ESRD) who are dependent on renal replacement therapy. Haemodialysis (HD) is of particular interest in cardiovascular patients due to the creation of a haemodialysis vascular access and the haemodynamic changes associated with it. Adequate HD though is very dependent on a properly functioning vascular access. Unfortunately, these surgical vascular accesses are vulnerable to stenoses and occlusions. Percutaneous endovascular treatment of these stenoses is often performed and has been found to be safe and effective. Despite its frequent use, acute medical complications of this percutaneous procedure have not been well-documented. In this report, we describe a patient who developed flash pulmonary oedema after balloon angioplasty treatment of an arteriovenous graft (AVG) stenosis. Copyright © 2012 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Nursing Care For Patients Experiencing Clinical Complications During Haemodialysis

Directory of Open Access Journals (Sweden)

Viviane Queiroga Linhares

2017-02-01

Full Text Available Introduction: Patients with chronic renal disease treated by haemodialysis experience various changes in their daily lives, which they and their families need to adapt to and cope with. Objective: To analyse the nursing care of patients with chronic renal failure on haemodialysis who experience clinical complications. Method: A descriptive, exploratory study was conducted, using a quantitative approach. Data collection was performed using a sample of 73 patients at the Hemodialysis Center located at city of Patos-PB. The sample comprised 73 patients. Results: 27 (37.0% were female, aged between 20 and 88 years old. It was found that employees are 49.3% of respondents, in consonance to farmers with 31.5%. The most common complications were weakness (76.7%, headache (46.6%, cramp (43.8% and pain (32.9%. Conclusion: The trusting relationship between professionals and patients is paramount, because helps to improve adherence to treatment and, consequently, the reduction of complications; furthermore, educational and preventive actions are facilitated.

Thinking ahead – the need for early Advance Care Planning for people on haemodialysis: A qualitative interview study

Science.gov (United States)

Horsley, Helen L; Shepherd, Kate; Brown, Heather; Carey, Irene; Matthews, Beverley; O’Donoghue, Donal; Vinen, Katie; Murtagh, Felicity EM

2015-01-01

Background: There is a need to improve end-of-life care for people with end-stage kidney disease, particularly due to the increasingly elderly, frail and co-morbid end-stage kidney disease population. Timely, sensitive and individualised Advance Care Planning discussions are acceptable and beneficial for people with end-stage kidney disease and can help foster realistic hopes and goals. Aim: To explore the experiences of people with end-stage kidney disease regarding starting haemodialysis, its impact on quality of life and their preferences for future care and to explore the Advance Care Planning needs of this population and the timing of this support. Study design: Semi-structured qualitative interview study of people receiving haemodialysis. Interviews were analysed using thematic analysis. Recruitment ceased once data saturation was achieved. Setting/participants: A total of 20 patients at two UK National Health Service hospitals, purposively sampled by age, time on haemodialysis and symptom burden. Results: Themes emerged around: Looking Back, emotions of commencing haemodialysis; Current Experiences, illness and treatment burdens; and Looking Ahead, facing the realities. Challenges throughout the trajectory included getting information, communicating with staff and the ‘conveyor belt’ culture of haemodialysis units. Participants reported a lack of opportunity to discuss their future, particularly if their health deteriorated, and variable involvement in treatment decisions. However, discussion of these sensitive issues was more acceptable to some than others. Conclusion: Renal patients have considerable unmet Advance Care Planning needs. There is a need to normalise discussions about preferences and priorities in renal and haemodialysis units earlier in the disease trajectory. However, an individualised approach is essential – one size does not fit all. PMID:25527527

A holistic approach to factors affecting depression in haemodialysis patients.

Science.gov (United States)

Gerogianni, Georgia; Kouzoupis, Anastasios; Grapsa, Eirini

2018-05-19

Depression in dialysis populations is affected by co-morbid diseases, such as cardiovascular disease, diabetes, and immune dysfunction, and it also includes high suicide risk and frequent hospitalizations. Depressive disorders have a close association with malnutrition and chronic inflammation, as well as with cognitive impairment. Impaired cognitive function may be manifested as low adherence to dialysis treatment, leading to malnutrition. Additionally, chronic pain and low quality of sleep lead to high rates of depressive symptoms in haemodialysis patients, while an untreated depression can cause sleep disturbances and increased mortality risk. Depression can also lead to sexual dysfunction and non-adherence, while unemployment can cause depressive disorders, due to patients' feelings of being a financial burden on their family. The present review provides a holistic approach to the factors affecting depression in haemodialysis, offering significant knowledge to renal professionals.

Successful delivery of chemotherapy to treat small-cell prostate cancer in a patient undergoing haemodialysis

OpenAIRE

McPartlin, Andrew; Grimaldo, Claudia; Lyons, Jeanette; Burke, Daniel; Mitra, Sandip; Choudhury, Ananya

2014-01-01

We report on the successful treatment of small-cell prostate cancer in a patient undergoing haemodialysis. The therapeutic regimen included 300 mg/m2 of carboplatin and 50 mg/m2 of etoposide coupled with radical radiotherapy. Adjustments to the patient's haemodialysis prescription included the use of high flux, a larger dialyser surface area and an increased dialysis time. The parameters used aided tolerance to the drug, allowing the delivery of safe, effective treatment. At an interval of ov...

The prehistory of haemodialysis as a treatment for uraemia.

Science.gov (United States)

Cameron, J Stewart

2016-02-01

Less is generally known about the ideas, events and personalities which drove developments permitting the evolution of haemodialysis as a clinically useful form of palliation and treatment, than its subsequent success and failures. This pre-history of haemodialysis is summarized here. One must remember that with hindsight we can now discern connections between ideas and developments which were not perceptible in their time, and that progress towards any new idea, material or piece of hardware was usually random and undirected, and outcomes uncertain. We must also remember the many blind alleys we can now safely ignore, to give a spurious continuity to the development of ideas. The prehistory of dialysis begins with study of the diffusion of solute and solvent in osmosis in living systems and experimental settings, and the retention of potentially toxic substances in kidney failure, during the 18th and early 19th centuries. These two areas came together in work in the mid-19th century on diffusion of gases and liquids, and showed that natural and synthetic membranes could selectively hinder different solutes. This explained osmosis and allowed semi-permeable membranes to be used and designed. These ideas underpinned the subsequent history of both dialysis using body cavities such as the peritoneum (not discussed here) and ex vivo dialysis of blood. To perform this, new membranes and anticoagulants were needed. These led to the first attempts in animals in 1912-3, and human patients in 1924-8, but only the purification and synthesis of newer materials such as cellulose and heparin allowed practical and successful haemodialysis to evolve in the 1940s.

Illness perceptions predict survival in haemodialysis patients.

Science.gov (United States)

Chilcot, Joseph; Wellsted, David; Farrington, Ken

2011-01-01

Illness perceptions have been shown to be important determinants of functional and psychosocial outcomes, including quality of life and treatment adherence in end-stage renal disease patients. The aim of this prospective study was to determine whether haemodialysis patients' illness perceptions impact upon survival. Haemodialysis patients from a UK renal service completed the Revised Illness Perception Questionnaire. Over the study period (May 2007 to December 2010), all-cause mortality was recorded as the endpoint. 223 patients were followed up for a median of 15.9 months (min. 10 days, max. 42.7 months). The median dialysis vintage was 17.6 months (min. 4 days, max. 391.3 months). Treatment control perceptions demonstrated a significant association with mortality (HR = 0.91, 95% CI: 0.83-0.99, p = 0.03). After controlling for covariates, including age, albumin, extra renal comorbidity and depression scores, perception of treatment control remained a significant predictor of mortality (HR = 0.89, 95% CI: 0.80-0.99, p = 0.03). Patients' perceptions of treatment control (dialysis therapy) predict survival independently of survival risk factors, including comorbidity. Studies are required to test whether psychological interventions designed to modify maladaptive illness perceptions influence clinical outcomes in this patient setting. Copyright © 2011 S. Karger AG, Basel.

Development of certified environmental management in hospital and outpatient haemodialysis units

Directory of Open Access Journals (Sweden)

Sergio García Vicente

2015-11-01

Discussion: There is no official documentation of the implementation of EMS in dialysis units. Making this list provides an approach to the situation, with special reference to haemodialysis because of its significant environmental impact.

Association of quality of sleep with cognitive decline among the patients of chronic kidney disease undergoing haemodialysis

International Nuclear Information System (INIS)

Zubair, U.B.; Butt, B.

2017-01-01

This study was conducted to determine the association between the subjective quality of sleep and cognitive decline among the patients of chronic kidney disease (CKD) undergoing haemodialysis. Methods: In this cross-sectional study 106 patients of chronic kidney disease (CKD) undergoing haemodialysis at a tertiary care hospital in Rawalpindi, Pakistan were included in the final analysis. Cognitive decline was measured by British Columbia Cognitive Complaints Inventory (BC-CCI). Sleep quality was measured by using the Pittsburgh Sleep Quality Index (PSQI). Relationship of age, gender, marital status, education, occupation, BMI, duration of dialysis, dialysis count per week, family income, tobacco smoking and use of naswar was assessed with the cognitive decline. Results: Out of 106 patients screened through BC-CCI and PSQI, 13.1% had no cognitive decline while 86.9% had significant cognitive decline. Relationship between quality of sleep and cognitive decline was significant on binary logistic regression. Conclusion: This study showed significant relationship between the sleep quality and cognitive decline among the patients of CKD undergoing haemodialysis. The findings of our study also call for a greater degree of understanding of the physical and psychological state of patients of CKD undergoing haemodialysis. (author)

Infective endocarditis in patients on haemodialysis - possible strategies for prevention.

Science.gov (United States)

Oun, Hadi A; Price, Andrew J; Traynor, Jamie P

2016-05-01

Infective endocarditis is an important cause of morbidity and mortality in patients receiving haemodialysis for established renal failure. We carried out a prospective audit of patients developing infective endocarditis in a single renal unit. From 1 January 2000 to 31 December 2013, we collected data on all cases of endocarditis occurring in patients receiving haemodialysis at Monklands Hospital, Airdrie. Twenty-nine patients developed endocarditis during our audit period. Twenty-three (79.3%) of the patients had pre-existing cardiac valve abnormalities such as regurgitation or calcification. Staphylococcus aureus was the most common microorganism cultured from the blood of 22 patients (75.9%). MRSA bacteraemia was identified in eight of these patients and all eight patients died during that first presentation. Different strategies were introduced within the unit during the audit period aiming to reduce the rate of bacteraemia. Since 2011, a successful strategy has been introduced under the auspices of the Scottish Patient Safety Programme. This led to our Staph aureus bacteraemia rate related to non-tunnelled venous catheters going from an average of 15 days between episodes to having had no episodes between 2 December 2011 and the end of the study period (760 days). This also appears to have had a positive impact on reducing the rate of endocarditis. Infective endocarditis remains a devastating consequence of bacteraemia in patients receiving haemodialysis. An effective strategy aimed at reducing the rate of bacteraemia appears to have a similar effect on the rate of endocarditis. © The Author(s) 2016.

The Impact of Exercising During Haemodialysis on Blood Pressure, Markers of Cardiac Injury and Systemic Inflammation - Preliminary Results of a Pilot Study

Directory of Open Access Journals (Sweden)

Maurice Dungey

2015-11-01

Full Text Available Background/Aims: Patients requiring haemodialysis have cardiovascular and immune dysfunction. Little is known about the acute effects of exercise during haemodialysis. Exercise has numerous health benefits but in other populations has a profound impact upon blood pressure, inflammation and immune function; therefore having the potential to exacerbate cardiovascular and immune dysfunction in this vulnerable population. Methods: Fifteen patients took part in a randomised-crossover study investigating the effect of a 30-min bout of exercise during haemodialysis compared to resting haemodialysis. We assessed blood pressure, plasma markers of cardiac injury and systemic inflammation and neutrophil degranulation. Results: Exercise increased blood pressure immediately post-exercise; however, 1 hour after exercise blood pressure was lower than resting levels (106±22 vs. 117±25 mm Hg. No differences in h-FABP, cTnI, myoglobin or CKMB were observed between trial arms. Exercise did not alter circulating concentrations of IL-6, TNF-α or IL-1ra nor clearly suppress neutrophil function. Conclusions: This study demonstrates fluctuations in blood pressure during haemodialysis in response to exercise. However, since the fall in blood pressure occurred without evidence of cardiac injury, we regard it as a normal response to exercise superimposed onto the haemodynamic response to haemodialysis. Importantly, exercise did not exacerbate systemic inflammation or immune dysfunction; intradialytic exercise was well tolerated.

Estimation of quality of life in haemodialysis patients.

Science.gov (United States)

Abraham, S; Ramachandran, A

2012-11-01

Since haemodialysis is an expensive treatment modality for chronic renal failure patients, it is very essential to assess the outcome of therapy in terms of quality of life. The primary objective of the study was to estimate the effect of patient counselling in quality of life of end stage renal disease patients opting haemodialysis using World Health Organisation Quality of life scale and to assess the variables affecting the quality of life of these patients. Quality of life was determined by World Health Organisation Quality of life scale questionnaire comprised of 26 items which measures four domains: physical, psychological, social and environmental domain. A total of 81 patients were selected and divided into test and control group and the test group patients received counselling regarding their disease, use of medications, importance of adherence and the complications experienced during and after dialysis. The quality of life data was collected at the interval of 1, 2, 3, 6 and 12 months and the patients were counselled at each interval. The demographic profiles revealed that majority of the patients were in the age group of 31-50 and there exists a male predominance. About the socioeconomic status, upper middle class people were mostly affected. Assessment of impact of patient counselling in the quality of life of haemodialysis indicated a significant improvement in each domain after counselling. And also found that the psychological domain showed a significant increase in the score compared to others. Patient counselling helped to gain benefits in terms of improvement in quality of life and delayed progression of renal failure. Early recognition and prevention is necessary to improve the quality of life of chronic renal failure patients. Patient counselling should be made mandatory by incorporating clinical pharmacist in the nephrology team to make the patient understand his illness and modifications in lifestyle also create a positive environment and

Duplex sonography in the planning and evaluation of arteriovenous fistulae for haemodialysis

International Nuclear Information System (INIS)

Kerr, S.F.; Krishan, S.; Lapham, R.C.; Weston, M.J.

2010-01-01

This paper describes how to perform duplex sonography in the planning and evaluation of arteriovenous fistulae in haemodialysis patients, discusses its roles in these settings, and presents a review of commonly encountered complications.

Defining the culture and attitude towards dietary management actions in people undergoing haemodialysis.

Science.gov (United States)

Onbe, Hiromi; Oka, Michiyo; Shimada, Mikiko; Motegi, Emiko; Motoi, Yuji; Okabe, Ayako

2013-06-01

The present study was designed to clarify the structure of culture and the three components of attitude in a desirable attitude toward dietary management actions in outpatient haemodialysis patients who are in the maintenance phase of treatment. The participants in the study included nine patients undergoing chronic maintenance haemodialysis who have received guidance related to diet and had good test results. Ethnography, by means of participant observation and semi-structured interviews, was chosen as the research method. Desirable attitude of haemodialysis patients in dietary management actions was found to have a chronological progression in one of the components of attitude: propensity of behaviour. Change in behaviour was influenced by affect and cognition. At the base of the structure of attitude lay three factors: valuing cooking with seasonal ingredients and creating special meals for seasonal occasions; family draws near, shows care and gives support; and belief in information perceived to be good for the health, which was influenced by three components of attitude: affect, cognition, and propensity of behaviour, as well as culture. Participants continue to value the food culture that they grew up with, which involves their affect towards, and cognition of, dietary management. © 2013 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Medtronic Freestyle aortic bioprosthesis: a potential option for haemodialysis patients†.

Science.gov (United States)

Hegazy, Yasser Y; Rayan, Amr; Sodian, Ralf; Hassanein, Wael; Ennker, Jürgen

2016-04-01

End-stage renal disease patients on regular haemodialysis are at higher risk of calcification. Therefore, many surgeons have concerns regarding the implantation of bioprostheses in such patients. The haemodynamic advantages of stentless aortic bioprostheses support their use; however, these have not been studied yet in end-stage renal disease patients. We studied accordingly the early and mid-term outcomes of aortic valve replacement (AVR) using Medtronic Freestyle stentless aortic bioprostheses in this subset of patients in comparison with stented aortic bioprostheses. We retrospectively studied two groups of consecutive patients on regular haemodialysis who required AVR between 2007 and 2013. Non-Freestyle (NFS) group received stented aortic bioprostheses (36 patients) and Freestyle (FS) group received Medtronic Freestyle aortic bioprostheses (48 patients). Follow-up ranged from 2 to 76 months with a mean follow-up of 36.3 ± 25 months. Patients in both groups showed similar demographic characters regarding age (76.4 ± 8.1 vs 74.9 ± 7.2 years; P = 0.35), male gender (58 vs 60%; P = 0.57) and diabetes mellitus (42 vs 48%; P = 0.57). Smaller aortic bioprostheses were implanted in the NFS (23.3 ± 1.2 vs 25.4 ± 2.1; P < 0.001) with consequently higher postoperative mean gradients (14.1 ± 4.1 vs 11.9 ± 5.3 mmHg; P = 0.004). No significant differences were noted regarding postoperative neurological disorder (8 vs 12%; P = 0.73), deep sternal wound infection (3 vs 4%; P = 0.68), re-exploration (8 vs 8%; P = 0.91) and in-hospital mortality (6 vs 4%; P = 0.92). Mid-term follow-up showed higher prosthetic valve calcification and/or sclerosis in NFS group (25 vs 6%; P = 0.015), whereas no significant differences were noticed between the two groups regarding stroke (0 vs 8%; P = 0.13), endocarditis (0 vs 4%; P = 0.50), 36- and 72-month survival (51 ± 2%, 14 ± 4% vs 55 ± 2%, 19 ± 3%, respectively; P = 0.45). Aortic bioprostheses are a good option for haemodialysis

Poor value of surveillance cultures for prediction of septicaemia caused by coagulase-negative staphylococci in patients undergoing haemodialysis with central venous catheters

DEFF Research Database (Denmark)

Nielsen, J; Kolmos, H J; Rosdahl, V T

1998-01-01

Surveillance cultures for the demonstration of coagulase-negative staphylococci in patients on catheter haemodialysis were performed in an attempt to predict dialysis catheter-related septicaemia. In all, 43 patients with 67 haemodialysis catheters were followed for a 1-y period. Once a week, swab...

A user-friendly tool for incremental haemodialysis prescription.

Science.gov (United States)

Casino, Francesco Gaetano; Basile, Carlo

2018-01-05

There is a recently heightened interest in incremental haemodialysis (IHD), the main advantage of which could likely be a better preservation of the residual kidney function of the patients. The implementation of IHD, however, is hindered by many factors, among them, the mathematical complexity of its prescription. The aim of our study was to design a user-friendly tool for IHD prescription, consisting of only a few rows of a common spreadsheet. The keystone of our spreadsheet was the following fundamental concept: the dialysis dose to be prescribed in IHD depends only on the normalized urea clearance provided by the native kidneys (KRUn) of the patient for each frequency of treatment, according to the variable target model recently proposed by Casino and Basile (The variable target model: a paradigm shift in the incremental haemodialysis prescription. Nephrol Dial Transplant 2017; 32: 182-190). The first step was to put in sequence a series of equations in order to calculate, firstly, KRUn and, then, the key parameters to be prescribed for an adequate IHD; the second step was to compare KRUn values obtained with our spreadsheet with KRUn values obtainable with the gold standard Solute-solver (Daugirdas JT et al., Solute-solver: a web-based tool for modeling urea kinetics for a broad range of hemodialysis schedules in multiple patients. Am J Kidney Dis 2009; 54: 798-809) in a sample of 40 incident haemodialysis patients. Our spreadsheet provided excellent results. The differences with Solute-solver were clinically negligible. This was confirmed by the Bland-Altman plot built to analyse the agreement between KRUn values obtained with the two methods: the difference was 0.07 ± 0.05 mL/min/35 L. Our spreadsheet is a user-friendly tool able to provide clinically acceptable results in IHD prescription. Two immediate consequences could derive: (i) a larger dissemination of IHD might occur; and (ii) our spreadsheet could represent a useful tool for an ineludibly

Factors associated with early failure of arteriovenous fistulae for haemodialysis access.

Science.gov (United States)

Wong, V; Ward, R; Taylor, J; Selvakumar, S; How, T V; Bakran, A

1996-08-01

The radiocephalic arteriovenous fistula remains the method of choice for haemodialysis access. In order to assess their suitability for fistula formation, the radial arteries and cephalic veins were examined preoperatively by ultrasound colour flow scanner in conjunction with a pulse-generated run-off system. Intraoperative blood flow was measured after construction of the fistulae. Post-operative follow-up was performed at various intervals to monitor the development of the fistulae. Radial artery and cephalic vein diameter less than 1.6 mm was associated with early fistula failure. The intraoperative fistula blood flow did not correlate with the outcome of the operation probably due to vessel spasm from manipulation. However, blood flow velocities measured non-invasively 1 day after the operation were significantly lower in fistulae that failed early compared with those that were adequate for haemodialysis. Most of the increase in fistula diameter and blood flow occur within the first 2 weeks of surgery.

An Approach to Optimise Therapeutic Vancomycin Dosage in a Haemodialysis Population

LENUS (Irish Health Repository)

Gunning, H

2016-10-01

Haemodialysis patients are at risk of gram-positive bacteraemia and commonly require intravenous vancomycin. Intravenously administered vancomycin is primarily excreted by the kidney and exhibits complex pharmacokinetics in haemodialysis patients; achieving therapeutic levels can be challenging. An audit in our unit showed current practises of vancomycin administration resulted in a high proportion of sub-therapeutic levels. A new protocol was developed with fixed weight-based loading and subsequent dosing guided by pre-dialysis levels, target levels were 10-20mg\\/L. Its effectiveness was prospectively evaluated between 24th September 2012, and 8th February 2013. During this period 25 patients commenced vancomycin, 15 were included. In total, 112 vancomycin levels were taken, 94 (84%) were therapeutic, this was a significant improvement compared to previous practise (odds ratio 5.4, CI 3.1-9.4, p < 0.0001). In conclusion, our study shows this protocol can consistently and reliably achieve therapeutic vancomycin levels

Successful delivery of chemotherapy to treat small-cell prostate cancer in a patient undergoing haemodialysis.

Science.gov (United States)

McPartlin, Andrew; Grimaldo, Claudia; Lyons, Jeanette; Burke, Daniel; Mitra, Sandip; Choudhury, Ananya

2014-12-01

We report on the successful treatment of small-cell prostate cancer in a patient undergoing haemodialysis. The therapeutic regimen included 300 mg/m(2) of carboplatin and 50 mg/m(2) of etoposide coupled with radical radiotherapy. Adjustments to the patient's haemodialysis prescription included the use of high flux, a larger dialyser surface area and an increased dialysis time. The parameters used aided tolerance to the drug, allowing the delivery of safe, effective treatment. At an interval of over 12 months post-treatment the patient shows no clinical evidence of recurrent disease. This case provides evidence to encourage the use of chemotherapy in otherwise potentially undertreated haemodialysed patients.

Spanish Clinical Guidelines on Vascular Access for Haemodialysis.

Science.gov (United States)

Ibeas, José; Roca-Tey, Ramon; Vallespín, Joaquín; Moreno, Teresa; Moñux, Guillermo; Martí-Monrós, Anna; Del Pozo, José Luis; Gruss, Enrique; Ramírez de Arellano, Manel; Fontseré, Néstor; Arenas, María Dolores; Merino, José Luis; García-Revillo, José; Caro, Pilar; López-Espada, Cristina; Giménez-Gaibar, Antonio; Fernández-Lucas, Milagros; Valdés, Pablo; Fernández-Quesada, Fidel; de la Fuente, Natalia; Hernán, David; Arribas, Patricia; Sánchez de la Nieta, María Dolores; Martínez, María Teresa; Barba, Ángel

2017-11-01

Vascular access for haemodialysis is key in renal patients both due to its associated morbidity and mortality and due to its impact on quality of life. The process, from the creation and maintenance of vascular access to the treatment of its complications, represents a challenge when it comes to decision-making, due to the complexity of the existing disease and the diversity of the specialities involved. With a view to finding a common approach, the Spanish Multidisciplinary Group on Vascular Access (GEMAV), which includes experts from the five scientific societies involved (nephrology [S.E.N.], vascular surgery [SEACV], vascular and interventional radiology [SERAM-SERVEI], infectious diseases [SEIMC] and nephrology nursing [SEDEN]), along with the methodological support of the Cochrane Center, has updated the Guidelines on Vascular Access for Haemodialysis, published in 2005. These guidelines maintain a similar structure, in that they review the evidence without compromising the educational aspects. However, on one hand, they provide an update to methodology development following the guidelines of the GRADE system in order to translate this systematic review of evidence into recommendations that facilitate decision-making in routine clinical practice, and, on the other hand, the guidelines establish quality indicators which make it possible to monitor the quality of healthcare. Copyright © 2017 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

Internal jugular vein access for the interventional management of nonfunctioning artero-venous haemodialysis fistulas

Energy Technology Data Exchange (ETDEWEB)

Basile, A. E-mail: antodoc@yahoo.com; Garcia Medina, J.; Lupattelli, T.; Garcia Medina, V.; Leal, R

2004-12-01

We report our experience and results with the use of internal jugular vein as secondary approach for the endovascular treatment of twelve nonfunctioning artero-venous (AV) fistulas in haemodialysis patients.

A care study exploring a patient's non-compliance to haemodialysis.

Science.gov (United States)

Murphy, Fiona

This care study is based on the nursing assessment of a 26-year-old man (MT) who attends a local haemodialysis unit for treatment using Gordon's (1994) functional health patterns. There will be a discussion of this framework and the methods used to assess this patient including an exploration of one of the problem areas identified--that of non-compliance.

The effects of aromatherapy with lavender essential oil on fatigue levels in haemodialysis patients: A randomized clinical trial.

Science.gov (United States)

Bagheri-Nesami, Masoumeh; Shorofi, Seyed Afshin; Nikkhah, Attieh; Espahbodi, Fatemeh; Ghaderi Koolaee, Fahimeh-Sadat

2016-02-01

This study was intended to examine the efficacy of lavender essential oil for the alleviation of fatigue in haemodialysis patients. This randomized clinical trial was conducted on 59 haemodialysis patients in two groups. The routine care group received the routine care, but the experimental group inhaled lavender essence 5% for 10 min, three times a week for 4 consecutive weeks. The Fatigue Severity Scale was used to assess fatigue before the intervention and after the last intervention in the second and fourth weeks. No statistically significant differences were observed between the two groups in terms of the fatigue scores before, and after the last intervention in the second and fourth weeks. Our result does not support other studies suggesting that lavender essential oil is effective on fatigue in haemodialysis patients. This conflicting result can mostly be ascribed to a variety of factors such as duration of aromatherapy and differences in concentrations of lavender essential oil. Copyright © 2015 Elsevier Ltd. All rights reserved.

Peritoneal dialysis vs. haemodialysis in the management of paediatric acute kidney injury in Kano, Nigeria: a cost analysis.

Science.gov (United States)

Obiagwu, Patience N; Abdu, Aliyu

2015-01-01

To determine the cost of the dialytic management of paediatric acute kidney injury in a low-income country. All children under the age of 15 years, who had either peritoneal dialysis or haemodialysis for acute kidney injury in Aminu Kano Teaching Hospital over a 1-year period, were studied. The average cost of each dialysis modality was estimated. Of 20 children, who had dialysis for acute kidney injury, 12 (60%) had haemodialysis and 8 (40%) had peritoneal dialysis. The mean cost for haemodialysis exceeded that of peritoneal dialysis ($363.33 vs. $311.66, t = 1.04, P = 0.313) with the mean cost of consumables significantly accounting for most of the cost variation ($248.49 vs. $164.73, t = 2.91, P = 0.009). Mean costs of nephrologist visit and nursing were not found to be significant. Peritoneal dialysis is the less costly alternative for managing acute kidney injury in children in our environment. © 2014 John Wiley & Sons Ltd.

A 12-year review of Staphylococcus aureus bloodstream infections in haemodialysis patients: more work to be done.

LENUS (Irish Health Repository)

Fitzgerald, S F

2012-02-01

Staphylococcus aureus bloodstream infections (BSI) are a significant cause of morbidity and mortality in haemodialysis patients. This study describes a 12-year retrospective review of S. aureus BSI in a large haemodialysis centre in a tertiary referral hospital. The overall rate of S. aureus BSI was 17.9 per 100 patient-years (range 9.7-36.8). The rate of meticillin-resistant S. aureus (MRSA) BSI was 5.6 per 100 patient-years (range 0.9-13.8). Infective complications occurred in 11% of episodes, the most common being infective endocarditis (7.6%). Ten percent of patients died within 30 days of S. aureus being isolated from blood. Most cases of S. aureus BSI (83%) were related to vascular catheters. The provision of lower-risk vascular access, such as arteriovenous fistulae, and reduced use of intravascular catheters should be priorities in all haemodialysis units. Where alternative vascular access cannot be established, interventions to reduce the risk of catheter-related infections should be implemented to reduce morbidity and mortality in this vulnerable patient group.

The cost-utility of haemodiafiltration versus haemodialysis in the Convective Transport Study

NARCIS (Netherlands)

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

2013-01-01

BACKGROUND: Despite the growing interest in haemodiafiltration (HDF), there is no information on the costs and cost-utility of this dialysis modality yet. It was therefore our objective to study the cost-utility of HDF versus haemodialysis (HD). METHODS: A cost-utility analysis was performed using a

The cost-utility of haemodiafiltration versus haemodialysis in the Convective Transport Study

NARCIS (Netherlands)

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

Background. Despite the growing interest in haemodiafiltration (HDF), there is no information on the costs and cost-utility of this dialysis modality yet. It was therefore our objective to study the cost-utility of HDF versus haemodialysis (HD). Methods. A cost-utility analysis was performed using a

The effects of intermittent fasting during the month of Ramadan in chronic haemodialysis patients in a tropical climate country.

Science.gov (United States)

Wan Md Adnan, Wan Ahmad Hafiz; Zaharan, Nur Lisa; Wong, Mun Hoe; Lim, Soo Kun

2014-01-01

Chronic kidney disease is an emerging problem in the majority Muslim countries. Despite the uncertainties of the risks involved, some Muslim patients undergoing chronic haemodialysis choose to observe intermittent fasting during the month of Ramadan. This study aims to investigate the effect of Ramadan fasting in haemodialysis patients residing in a tropical climate country. This prospective cross sectional study recruited Muslim patients on regular haemodialysis from three haemodialysis centres in Kuala Lumpur from 15th July 2011 to 29th August 2011. Patients who fasted for any number of days were included (n = 35, 54% female, age 54±11 years). 89% of patients fasted for more than 15 days and 49% were diabetics. Dialysis parameters and blood samples were obtained one week prior to Ramadan and during the last week of Ramadan. The differences in dialysis parameters and biochemical values pre- and end-Ramadan were examined using paired t-test. Both pre- and post-dialysis weight were significantly decreased during Ramadan fasting compared to the month prior (p = <0.001). There was a significant decrease in the amount of ultrafiltration (p = 0.002). There were no significant differences in dry weight, inter-dialytic weight gain, mean urea reduction ratio or blood pressure measurements comparing pre- and end of Ramadan fasting. There was a significant increase in serum albumin level (p = 0.006) and decrease in serum phosphate level (p = 0.02) at the end of Ramadan. Ramadan fasting is associated with reduced weight, improved serum albumin and phosphate level in our population of haemodialysis patients. A larger multi-centre study will allow us to understand more about the effects of fasting in this population.

The effects of intermittent fasting during the month of Ramadan in chronic haemodialysis patients in a tropical climate country.

Directory of Open Access Journals (Sweden)

Wan Ahmad Hafiz Wan Md Adnan

Full Text Available BACKGROUND: Chronic kidney disease is an emerging problem in the majority Muslim countries. Despite the uncertainties of the risks involved, some Muslim patients undergoing chronic haemodialysis choose to observe intermittent fasting during the month of Ramadan. This study aims to investigate the effect of Ramadan fasting in haemodialysis patients residing in a tropical climate country. METHODS: This prospective cross sectional study recruited Muslim patients on regular haemodialysis from three haemodialysis centres in Kuala Lumpur from 15th July 2011 to 29th August 2011. Patients who fasted for any number of days were included (n = 35, 54% female, age 54±11 years. 89% of patients fasted for more than 15 days and 49% were diabetics. Dialysis parameters and blood samples were obtained one week prior to Ramadan and during the last week of Ramadan. The differences in dialysis parameters and biochemical values pre- and end-Ramadan were examined using paired t-test. RESULTS: Both pre- and post-dialysis weight were significantly decreased during Ramadan fasting compared to the month prior (p = <0.001. There was a significant decrease in the amount of ultrafiltration (p = 0.002. There were no significant differences in dry weight, inter-dialytic weight gain, mean urea reduction ratio or blood pressure measurements comparing pre- and end of Ramadan fasting. There was a significant increase in serum albumin level (p = 0.006 and decrease in serum phosphate level (p = 0.02 at the end of Ramadan. CONCLUSION: Ramadan fasting is associated with reduced weight, improved serum albumin and phosphate level in our population of haemodialysis patients. A larger multi-centre study will allow us to understand more about the effects of fasting in this population.

Non-contrast-enhanced imaging of haemodialysis fistulas using quiescent-interval single-shot (QISS) MRA: a feasibility study

International Nuclear Information System (INIS)

Okur, A.; Kantarci, M.; Karaca, L.; Yildiz, S.; Sade, R.; Pirimoglu, B.; Keles, M.; Avci, A.; Çankaya, E.; Schmitt, P.

2016-01-01

Aim: To assess the efficiency of a novel quiescent-interval single-shot (QISS) technique for non-contrast-enhanced magnetic resonance angiography (MRA) of haemodialysis fistulas. Materials and methods: QISS MRA and colour Doppler ultrasound (CDU) images were obtained from 22 haemodialysis patients with end-stage renal disease (ESRD). A radiologist with extensive experience in vascular imaging initially assessed the fistulas using CDU. Two observers analysed each QISS MRA data set in terms of image quality, using a five-point scale ranging from 0 (non-diagnostic) to 4 (excellent), and lumen diameters of all segments were measured. Results: One hundred vascular segments were analysed for QISS MRA. Two anastomosis segments were considered non-diagnostic. None of the arterial or venous segments were evaluated as non-diagnostic. The image quality was poorer for the anastomosis level compared to the other segments (p<0.001 for arterial segments, and p<0.05 for venous segments), while no significant difference was determined for other vascular segments. Conclusion: QISS MRA has the potential to provide valuable complementary information to CDU regarding the imaging of haemodialysis fistulas. In addition, QISS non-enhanced MRA represents an alternative for assessment of haemodialysis fistulas, in which the administration of iodinated or gadolinium-based contrast agents is contraindicated. - Highlights: • Close monitoring and early intervention in hemodialysis fistulas may prolong longevity fistulas. • DopplerUS, contrast enhanced CT and MRI are using assessment of hemodialysis fistulas. • QISS nonenhanced MR angiography represents an alternative for assessment of hemodialysis fistulas.

MALNUTRITION SCREENING IN AN IN-CENTRE HAEMODIALYSIS UNIT: APPETITE FOR CHANGE?

Directory of Open Access Journals (Sweden)

Lauren Dasey

2012-06-01

Asking patients to rate their appetite on a five point scale appears to be an effective way to screen for malnutrition in the haemodialysis population. In centres with limited dietitian support, this may be preferable to screening with albumin due to the reduced number of inappropriate referrals and therefore enabling the priority to lie with the patients with malnutrition.

Prognostic significance of stress myocardial ECG-gated perfusion imaging in asymptomatic patients with diabetic chronic kidney disease on initiation of haemodialysis

Energy Technology Data Exchange (ETDEWEB)

Momose, Mitsuru; Kondo, Chisato; Kobayashi, Hideki; Kusakabe, Kiyoko [Tokyo Women' s Medical University, School of Medicine, Department of Radiology, Shinjuku-ku, Tokyo (Japan); Babazono, Tetsuya [Tokyo Women' s Medical University, School of Medicine, Diabetes Centre, Shinjuku-ku, Tokyo (Japan); Nakajima, Takatomo [Tokyo Women' s Medical University, School of Medicine, Department of Cardiology, Shinjuku-ku, Tokyo (Japan)

2009-08-15

Diabetic patients with chronic kidney disease (CKD) frequently develop cardiac events within several years of the initiation of haemodialysis. The present study assesses the prognostic significance of stress myocardial ECG-gated perfusion imaging (MPI) in patients with diabetic CKD requiring haemodialysis. Fifty-five asymptomatic patients with diabetic stage V CKD and no history of heart disease scheduled to start haemodialysis were enrolled in this study (56{+-}11 years old; 49 with type 2 diabetes mellitus). All patients underwent {sup 201}Tl stress ECG-gated MPI 1 month before or after the initiation of haemodialysis to assess myocardial involvement. We evaluated SPECT images using 17-segment defect scores graded on a 5-point scale, summed stress score (SSS) and summed difference scores (SDS). The patients were followed up for at least 2 years (42{+-}15 months) to determine coronary intervention (CI) and heart failure (HF) as soft events and acute myocardial infarction (AMI) and all causes of deaths as hard events. The frequencies of myocardial ischaemia, resting perfusion defects, low ejection fraction and left ventricular (LV) dilatation were 24,20,29 and 49%, respectively. Ten events (18%) developed during the follow-up period including four CI, one HF, one AMI and four sudden deaths. Multivariate Cox analysis selected SDS (p=0.0011) and haemoglobin A{sub 1c} (HbA{sub 1c}) (p=0.0076) as independent prognostic indicators for all events. Myocardial ischaemia, in addition to glycaemic control, is a strong prognostic marker for asymptomatic patients with diabetic CKD who are scheduled to start haemodialysis. Stress MPI is highly recommended for the management and therapeutic stratification of such patients. (orig.)

Preliminary study of an exercise programme for reducing fatigue and improving sleep among long-term haemodialysis patients

Science.gov (United States)

Maniam, Radha; Subramanian, Pathmawathi; Singh, Surindar Kaur Surat; Lim, Soo Kun; Chinna, Karuthan; Rosli, Roshaslina

2014-01-01

INTRODUCTION Fatigue and quality of sleep are the main factors that contribute to a poor quality of life among patients on long-term haemodialysis. Studies have also emphasised the importance of exercise for improving the wellbeing of dialysis patients. This study aimed to determine the effectiveness of a predialysis low-to-moderate-intensity exercise programme for reducing fatigue and improving sleep disorders among long-term haemodialysis patients. METHODS In this quasi-experimental study, an exercise programme was conducted three times a week for 12 weeks before long-term haemodialysis patients underwent dialysis at two centres. The patients were categorised into either the exercise group (n = 28) or control group (n = 27). The latter was asked to maintain their current lifestyles. Assessments of fatigue and sleep disorder levels were performed for both groups using self-reported questionnaires at baseline and after intervention. The patients’ perception of the exercise programme was also determined using self-reported questionnaires. RESULTS Paired sample t-test indicated improvements in fatigue level in the exercise group (mean fatigue score: post-treatment 40.5 ± 7.9 vs. pre-treatment 30.0 ± 10.9). Improvements in sleep disorders were also observed in the exercise group (mean score: post-treatment 7.6 ± 3.3 vs. pre-treatment 10.1 ± 3.8). However, sleep quality deteriorated in the control group (mean score: post-treatment 10.7 ± 2.9 vs. pre-treatment 9.3 ± 2.9). CONCLUSION Simple low-to-moderate-intensity exercise is effective for improving fatigue, sleep disorders and the overall quality of life among haemodialysis patients. PMID:25273932

More hostile dyslipidaemia in chronic kidney disease patients on maintenance haemodialysis than on conservative management.

Science.gov (United States)

Rathi, Teerath Kumar; Dhrolia, Murtaza Fakhruddin; Imtiaz, Salman

2016-08-01

To study the pattern of dyslipidaemia in patients with stage-V chronic kidney disease on conservative management and those on maintenance haemodialysis. This comparative observational study was conducted at the Jinnah Postgraduate Medical Centre, Karachi, from February to July, 2008, and comprised stage-V chronic kidney disease patients. The patients were divided in two groups. Those who were on conservative management were placed in Group A, and those who were on maintenance haemodialysis were in Group B. Serum total lipid, cholesterol, triglycerides and high-density lipoprotein for both groups were assayed on chemical analyser and low-density lipoprotein was calculated by Friedwald equation. SPSS 17 was used for data analysis. Of the 120 patients, there were 60(50%) in each group. The mean age of patients in Group A was 46.33±14.56 years and in Group B was 43.4±14.1years. Of all, 64(53.3%) were men and 56(46.7%) were women. Mean systolic and diastolic blood pressure was 134±19.58mmHg and 83.6±14.14mmHg in Group A and 129±19.7mmHg and 79.7±12.1mmHg in Group B. Mean serum total lipid was significantly higher (pmaintenance haemodialysis was more hostile than those on conservative management, and posed increased risk of coronary heart disease.

Comparison of haemodialysis patients and non-haemodialysis patients with respect to clinical characteristics and 3-year clinical outcomes after sirolimus-eluting stent implantation: insights from the Japan multi-centre post-marketing surveillance registry.

Science.gov (United States)

Otsuka, Yoritaka; Ishiwata, Sugao; Inada, Tsukasa; Kanno, Hiroyuki; Kyo, Eisho; Hayashi, Yasuhiko; Fujita, Hiroshi; Michishita, Ichiro

2011-04-01

Long-term outcomes after sirolimus-eluting stent (SES) implantation in haemodialysis (HD) patients have remained controversial. We investigated the impact of HD on outcomes after SES implantation. We analysed the data on 2050 patients who underwent SES implantation in a multi-centre prospective registry in Japan. Three-year clinical outcomes were compared between the HD group (n = 106) and the non-haemodialysis (NH) group (n = 1944). At the 3-year clinical follow-up, the rates of unadjusted cardiac mortality (HD: 16.3 vs. NH: 2.3%) and target-lesion revascularization (TLR) (HD: 19.4 vs. NH: 6.6%) were significantly higher in the HD group than the NH group (P statistical significance. Using Cox's proportional-hazard models with propensity score adjustment for baseline differences, the HD group had higher risks of TLR [HD: 16.3 vs. NH: 6.1%; hazard ratio, 2.83; 95% confidence interval (CI): 1.62-4.93, P = 0.0003] and cardiac death (HD: 12.3 vs. NH: 2.3%; hazard ratio, 5.51; 95% CI: 2.58-11.78, P < 0.0001). The consistent results of analyses, whether unadjusted or adjusted for other baseline clinical and procedural differences, identify HD as an independent risk factor for cardiac death and TLR. Percutaneous coronary intervention with SES in HD patients has a higher incidence of repeat revascularization and mortality compared with those in NH patients. Haemodialysis appears to be strongly associated with mortality and repeat revascularization even after SES implantation.

Isolation as a strategy for controlling the transmission of hepatitis C virus (HCV) infection in haemodialysis units.

Science.gov (United States)

Bravo Zuñiga, Jessica I; Loza Munárriz, César; López-Alcalde, Jesús

2016-08-11

The hepatitis C virus (HCV) infection affects about 2% of the world's population and can cause chronic liver infection and persistent long-term sequelae such as cirrhosis and liver cancer.The prevalence of HCV infection among people on haemodialysis is often higher than the general population. The virus is easily transmitted parenterally, and blood transfusions have previously played a significant role in transmission; however, erythropoietin therapy has reduced the need for transfusions, and coupled with improved screening of donated blood, has significantly decreased transmission by transfusion. Although control of hospital-acquired infection has improved with the advent of biosafety measures, stopping HCV transmission in haemodialysis units remains challenging.Isolating people infected with HCV involves physical separation from others to limit direct or indirect transmission and includes a number of strategies during dialysis. The evidence for isolating people infected with HCV during haemodialysis is sparse with some inconsistencies. To evaluate the benefits and harms of isolation of HCV-infected patients during haemodialysis on the transmission of HCV to other patients. We searched the Cochrane Kidney and Transplant Specialised Register to 26 November 2015 through contact with the Information Specialist using search terms relevant to this review. We also searched the Latin American and Caribbean Health Sciences Literature Database (LILACS) (1982 to 2015), Web of Science Conference Proceedings Citation Index-Science (CPCI-S, 1990 to 2015), ProQuest Dissertations & Theses Database (1990 to 2015), and Open Grey (1990 to 2015). We included randomised controlled trials (RCTs), quasi-RCTs and cluster RCTs evaluating the clinical benefits and harms of isolating HCV-infected patients during haemodialysis on the transmission of HCV to other patients. We considered incidence of dialysis-acquired HCV infection, all-cause mortality, and adverse effects associated with

Reprinted article "Factors associated with early failure of arteriovenous fistulae for haemodialysis access".

Science.gov (United States)

Wong, V; Ward, R; Taylor, J; Selvakumar, S; How, T V; Bakran, A

2011-09-01

The radiocephalic arteriovenous fistula remains the method of choice for haemodialysis access. In order to assess their suitability for fistula formation, the radial arteries and cephalic veins were examined preoperatively by ultrasound colour flow scanner in conjunction with a pulse-generated run-off system. Intraoperative blood flow was measured after construction of the fistulae. Post-operative follow-up was performed at various intervals to monitor the development of the fistulae. Radial artery and cephalic vein diameter less than 1.6 mm was associated with early fistula failure. The intraoperative fistula blood flow did not correlate with the outcome of the operation probably due to vessel spasm from manipulation. However, blood flow velocities measured non-invasively 1 day after the operation were significantly lower in fistulae that failed early compared with those that were adequate for haemodialysis. Most of the increase in fistula diameter and blood flow occur within the first 2 weeks of surgery. Copyright © 2011. Published by Elsevier Ltd.

The effects of a simulated laughter programme on mood, cortisol levels, and health-related quality of life among haemodialysis patients.

Science.gov (United States)

Heo, Eun Hwa; Kim, Sehyun; Park, Hye-Ja; Kil, Suk Yong

2016-11-01

This study aimed to evaluate the effects of a simulated laughter programme on mood, cortisol levels, and health-related quality of life among haemodialysis patients. Forty participants were randomly assigned to a laughter group (n = 20) or a control group (n = 20). Eleven participants completed the laughter programme after haemodialysis sessions and 18 control participants remained. The 4-week simulated laughter programme included weekly 60 min group sessions of simulated laughter, breathing, stretching exercises, and meditation, as well as daily 15 s individual laughter sessions administered via telephone. Mood, cortisol levels, and health-related quality of life were analysed using the rank analysis of covariance, and Wilcoxon's signed rank test. The laughter group exhibited improvements in mood, symptoms, social interaction quality, and role limitations due to physical health. The simulated laughter programme may help improve mood and health-related quality of life among haemodialysis patients. Copyright © 2016 Elsevier Ltd. All rights reserved.

Effectiveness of direct-acting antivirals in Hepatitis C virus infection in haemodialysis patients

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Soraya Abad

2017-03-01

In summary, we conclude that new DAAs for the treatment of HCV in haemodialysis patients are highly effective with minimal adverse effects; it is a very important advance in HCV management. These patients are therefore expected to have a much better prognosis than they have had until very recently.

Barriers to successful implementation of care in home haemodialysis (BASIC-HHD):1. Study design, methods and rationale.

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Jayanti, Anuradha; Wearden, Alison J; Morris, Julie; Brenchley, Paul; Abma, Inger; Bayer, Steffen; Barlow, James; Mitra, Sandip

2013-09-17

Ten years on from the National Institute of Health and Clinical Excellence' technology appraisal guideline on haemodialysis in 2002; the clinical community is yet to rise to the challenge of providing home haemodialysis (HHD) to 10-15% of the dialysis cohort. The renal registry report, suggests underutilization of a treatment type that has had a lot of research interest and several publications worldwide on its apparent benefit for both physical and mental health of patients. An understanding of the drivers to introducing and sustaining the modality, from organizational, economic, clinical and patient perspectives is fundamental to realizing the full benefits of the therapy with the potential to provide evidence base for effective care models. Through the BASIC-HHD study, we seek to understand the clinical, patient and carer related psychosocial, economic and organisational determinants of successful uptake and maintenance of home haemodialysis and thereby, engage all major stakeholders in the process. We have adopted an integrated mixed methodology (convergent, parallel design) for this study. The study arms include a. patient; b. organization; c. carer and d. economic evaluation. The three patient study cohorts (n = 500) include pre-dialysis patients (200), hospital haemodialysis (200) and home haemodialysis patients (100) from geographically distinct NHS sites, across the country and with variable prevalence of home haemodialysis. The pre-dialysis patients will also be prospectively followed up for a period of 12 months from study entry to understand their journey to renal replacement therapy and subsequently, before and after studies will be carried out for a select few who do commence dialysis in the study period. The process will entail quantitative methods and ethnographic interviews of all groups in the study. Data collection will involve clinical and biomarkers, psychosocial quantitative assessments and neuropsychometric tests in patients. Organizational

AN EXPERIENCE OF HANDLING MICROBIAL CONTAMINATION OF PRODUCT WATER AT A HAEMODIALYSIS UNIT IN NORTH KARNATAKA OF INDIA

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Archana Aravindrao Dambal

2017-09-01

Full Text Available BACKGROUND Dialysis units need regular prophylactic disinfection of the dialysis water production and distribution circuit without which there can be chronic inflammation among patients using the facility. The aim of the study is to present here our experience in containing an episode of microbial contamination of dialysis water. MATERIALS AND METHODS Our haemodialysis unit had a single pass reverse osmosis plant with facility for pretreatment of raw water and a distribution loop of medical grade PVC (polyvinyl chloride feeding haemodialysis machines, bicarbonate preparation and dialyser reprocessing areas. After installation, the Reverse Osmosis (RO membranes and distribution loop were disinfected every fortnight using formalin. Cultures of product water were sent from various sites in the product water loop every month. RESULTS From January to April 2011, 15 water samples out of 52 water samples grew Pseudomonas aeruginosa with a colony count over 200 Colony-Forming Units (CFU. The average monthly number of haemodialysis was reduced from 84.75 to 65. Two patients had intradialytic pyrexia and two others had mild lower respiratory infection. So, the reverse osmosis plant and product water distribution system were repeatedly disinfected using 2% formalin and 1% bleach ensuring contact time and thorough rinsing to address persistent cultures. When these measures could not eradicate microbial growth, the system was sanitised with Gramicid (48% w/w H2O2 + 500 ppm Ag and all traces of the disinfectant were rinsed away before resuming haemodialysis. CONCLUSION The microbial contamination of dialysis water was eradicated by Gramicid and not by bleach or formalin without any adverse effects after thorough rinsing.

Assessing skin hydration status in haemodialysis patients using terahertz spectroscopy: a pilot / feasibility study

Czech Academy of Sciences Publication Activity Database

Kadlec, Filip; Berta, Milan; Kužel, Petr; Lopot, F.; Polakovič, V.

2008-01-01

Roč. 53, č. 24 (2008), 7063-7071 ISSN 0031-9155 R&D Projects: GA MŠk LC512 Institutional research plan: CEZ:AV0Z10100520 Keywords : terahertz radiation * haemodialysis * skin turgor * epidermis Subject RIV: BM - Solid Matter Physics ; Magnetism Impact factor: 2.784, year: 2008

Successful use of haemodialysis to treat phenobarbital overdose.

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Hoyland, Kimberley; Hoy, Michael; Austin, Richard; Wildman, Martyn

2013-11-21

A 50-year-old woman presented with coma caused by a phenobarbital overdose, requiring intubation and admission to critical care. She was an international visitor and had been prescribed the drug for night-sedation. Phenobarbital is a long-acting barbiturate, which in an overdose can cause central nervous system depression, respiratory failure and haemodynamic instability; these patients can remain obtunded for many days. After initial supportive therapy, she was dialysed to help in the elimination of the drug. Haemodialysis resulted in a markedly reduced plasma level of phenobarbital, which decreased the length of intubation and stay in the critical care unit and aided full recovery.

Impact of hydration status on body composition as measured by dual energy X-ray absorptiometry in normal volunteers and patients on haemodialysis

International Nuclear Information System (INIS)

Horber, F.F.; Thomi, F.; Casez, J.P.; Fonteille, J.; Jaeger, Ph.

1992-01-01

To evaluate the influence of hydration status on the estimation of body composition using dual-energy X-ray absorptiometry (DXA), six normal volunteers and seven patients on maintenance haemodialysis were investigated using two different DXA machines (Lunar DPX, Hologic QDR 1000/W). Normal volunteers were studied (Hologic QDR 1000/W) before and 1 h after ingestion of breakfast, lunch and dinner (drinking various amounts of liquids at each meal, 0.5-2.4 kg). Whereas bone mineral content and body fat mass did not change, lean body mass of the trunk increased as a consequence of the meals. Conversely in patients on haemodialysis (Lunar DPX), lean body mass decreased in all segments of the body as a consequence of removal of 0.9-4.4 kg of salt-containing fluid by haemodialysis (trunk 61%, legs 30%, arms 5.5% and rest of the body 3.5%), whereas bone mineral content and body fat mass remained unchanged. (author)

Gender differences in the effect of fish oil on appetite, inflammation and nutritional status in haemodialysis patients.

Science.gov (United States)

Zabel, R; Ash, S; King, N; Naslund, E; Bauer, J

2010-08-01

Haemodialysis patients show signs of chronic inflammation and reduced appetite, which is associated with a worse clinical status and an increased mortality risk. Fish oil has anti-inflammatory properties and may be useful as a therapeutic treatment. There is limited evidence to indicate the feasibility and efficacy of this intervention in dialysis patients. The present study aimed to compare the effect of 12 weeks of supplementation with fish oil on markers of appetite and inflammation in male and female haemodialysis patients. The study was conducted in 28 haemodialysis patients. All patients were prescribed 3 g of fish oil per day for 12 weeks. Changes in appetite, plasma fatty acid profiles and inflammatory markers were measured at baseline and at 12 weeks. The mean (SD) increase in percent plasma eicosapentaenoic acid was statistically significant [1.1 (0.8) to 4.1 (2.2), P appetite and certain inflammatory markers (although no change in dietary intake) and this effect was more pronounced in males. However, the levels of some inflammatory markers increased in females and this requires further study. The high level of adherence achieved indicates that an intervention requiring patients to consume four fish oil capsules per day is achievable. This was a short-term study and the effects need to be confirmed in a randomised controlled trial.

Haemodialysis in an emerging centre in a developing country: a two year review and predictors of mortality

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Ikpeme Enobong E

2011-10-01

Full Text Available Abstract Background Haemodialysis is the most common form of renal replacement therapy in Nigeria. The high cost of haemodialysis has made optimal therapy of end-stage renal disease difficult in Nigeria. This paper is a review of data collected over two years of provision of dialysis services in a new tertiary hospital in Southern Nigeria. Methods This retrospective analysis is done on data obtained from the patient case files and dialysis records in the first two years of provision of dialysis services in our centre. A gender comparison of the patients' baseline sociodemographic, clinical and biochemical was performed and a logistic regression model used to assess the predictors of mortality. Results A total of 98 patients had 471 sessions in the two years under review. Males and females had similar characteristics at baseline except for a higher median serum urea in the males. The commonest causes of end-stage renal disease were chronic glomerulonephritis (34.5%, hypertension (32.1% and diabetes mellitus (17.9%. The main predictor of mortality was under treatment with haemodialysis due to inability to pay for more than a few dialysis sessions. Conclusions This study has highlighted the unchanging demographics of our advanced kidney failure patients. Efforts should be aimed at subsidizing the cost of dialysis for our teeming population of dialysis dependent chronic kidney disease patients.

Use of vascular access for haemodialysis in Europe: a report from the ERA-EDTA Registry

NARCIS (Netherlands)

Noordzij, Marlies; Jager, Kitty J.; van der Veer, Sabine N.; Kramar, Reinhard; Collart, Frederic; Heaf, James G.; Stojceva-Taneva, Olivera; Leivestad, Torbjørn; Buturovic-Ponikvar, Jadranka; Benítez Sánchez, Manuel; Moreso, Fransesc; Prütz, Karl G.; Severn, Alison; Wanner, Christoph; Vanholder, Raymond; Ravani, Pietro

2014-01-01

Although arteriovenous fistulas (AVFs) are actively promoted, their use at the start of haemodialysis (HD) seems to be decreasing worldwide. In this paper, we describe recent trends in incidence and prevalence of vascular access types in Europe from 2005 to 2009 and their relationship with patient

Cognitive-behavioural therapy (CBT) for renal fatigue (BReF):a feasibility randomised-controlled trial of CBT for the management of fatigue in haemodialysis (HD) patients

OpenAIRE

Picariello, Federica; Moss-Morris, Rona; Macdougall, Iain C.; Norton, Sam; Da Silva-Gane, Maria; Farrington, Ken; Clayton, Hope; Chilcot, Joseph

2018-01-01

Introduction Fatigue is one of the most common and disabling symptoms in end-stage kidney disease, particularly among in-centre haemodialysis patients. This two-arm parallel group feasibility randomised controlled trial will determine whether a fully powered efficacy trial is achievable by examining the feasibility of recruitment, acceptability and potential benefits of a cognitive-behavioural therapy (CBT)-based intervention for fatigue among in-centre haemodialysis patients.Methods We aim t...

[Recurrent vascular access trombosis associated with the prothrombin mutation G20210A in a adult patient in haemodialysis].

Science.gov (United States)

Quintana, L F; Coll, E; Monteagudo, I; Collado, S; López-Pedret, J; Cases, A

2005-01-01

Vascular access-related complications are a frequent cause of morbidity in haemodialysis patients and generate high costs. We present the case of an adult patient with end-stage renal disease and recurrent vascular access thrombosis associated with the prothrombin mutation G20210A and renal graft intolerance. The clinical expression of this heterozygous gene mutation may have been favoured by inflammatory state, frequent in dialysis patients. In this patient, the inflammatory response associated with the renal graft intolerance would have favored the development of recurrent vascular access thrombosis in a adult heterozygous for prothrombin mutation G20210A. In the case of early dysfunction of haemodialysis vascular access and after ruling out technical problems, it is convenient to carry out a screening for thrombophilia.

Contributing factors for therapeutic diet adherence in patients receiving haemodialysis treatment: an integrative review.

Science.gov (United States)

Oquendo, Lissete González; Asencio, José Miguel Morales; de Las Nieves, Candela Bonill

2017-12-01

The objective of this integrative review is to identify the factors that contribute to diet adherence in people suffering from kidney disease who are receiving haemodialysis treatment. Adherence to the therapeutic regimen determines therapeutic success, quality of life and survival in patients on haemodialysis. Lack of diet adherence ranges from 25%-86% in patients receiving haemodialysis treatment and affects patient morbidity and mortality. An integrative literature review was conducted based on the criteria of Whittemore & Knafl. A literature review was performed by two members of the team using twelve databases including PubMed, CUIDEN, CINAHL, The Cochrane Library and ScienceDirect. The main issues identified after analysing the results were as follows: the intrinsic barriers (age, dialysis time, motivation, perceived benefit, distorted perception of adherence) and facilitators (self-efficacy, perception of disease, perception of control), extrinsic barriers (family dysfunction, lack of social support, cultural patterns of consumption of food) and facilitators (social support, relationship with healthcare providers), and interventions to encourage diet adherence, such as the use of motivational interviewing in educational interventions, and the training and education of relevant professionals in communication skills. Diet nonadherence remains a serious health problem and suffers from a lack of solid criteria to identify this condition. The onset of depression signs and the level of social support available to the patient should be assessed, because these are important factors that determine adherence to treatment. Professionals should be trained in health education and communication techniques to contribute to the patient's self-management and motivation for diet adherence. Controlled and randomised clinical studies involving predialysis stages should be performed to investigate the impact of the assessment and control of barriers to diet adherence. © 2017

The management of xerostomia in patients on haemodialysis : Comparison of artificial saliva and chewing gum

NARCIS (Netherlands)

Bots, CP; Brand, HS; Veerman, ECI; Valentijn-Benz, M; Van Amerongen, BM; Amerongen, AVN; Valentijn, RM; Vos, PI; Bijlsma, JA; ter Wee, PM

2005-01-01

Many patients on haemodialysis (HD) therapy suffer from a dry mouth and xerostomia. This can be relieved by mechanical and gustatory stimulation or palliative care. The aim of this crossover study was to investigate the effect and preferences of a sugar-free chewing gum (Freedent White(TM)) and a

The management of xerostomia in patients on haemodialysis: comparison of artificial saliva and chewing gum

NARCIS (Netherlands)

Bots, Casper P.; Brand, Henk S.; Veerman, Enno C. I.; Valentijn-Benz, Marianne; van Amerongen, Barbara M.; Nieuw Amerongen, Arie V.; Valentijn, Robert M.; Vos, Pieter F.; Bijlsma, Joost A.; Bezemer, Pieter D.; ter Wee, Piet M.

2005-01-01

Many patients on haemodialysis (HD) therapy suffer from a dry mouth and xerostomia. This can be relieved by mechanical and gustatory stimulation or palliative care. The aim of this crossover study was to investigate the effect and preferences of a sugar-free chewing gum (Freedent White) and a

Impact of extracorporeal blood flow rate on blood pressure, pulse rate and cardiac output during haemodialysis

DEFF Research Database (Denmark)

Schytz, Philip Andreas; Mace, Maria Lerche; Soja, Anne Merete Boas

2015-01-01

BACKGROUND: If blood pressure (BP) falls during haemodialysis (HD) [intradialytic hypotension (IDH)] a common clinical practice is to reduce the extracorporeal blood flow rate (EBFR). Consequently the efficacy of the HD (Kt/V) is reduced. However, only very limited knowledge on the effect...

[Thrombosis in vascular accesses for haemodialysis: rescue treatment using invasive vascular radiological techniques].

Science.gov (United States)

García Medina, J; Lacasa Pérez, N; Muray Cases, S; Pérez Garrido, I; García Medina, V

2009-01-01

The purpose of this paper is to communicate our experience in the salvage of thrombosed haemodialysis vascular accesses using interventional radiology techniques. In the last four years, we have treated, by radiological means, 101 thrombosed haemodialysis vascular accesses. There were 44 autologous arteriovenous fistulas (43.56%) and 57 PTFE grafts (56.44%). There were 69 men (68.3%) and 32 women (31.7%). The mean age was 67.73 years (range 33-84). The mean vascular access age was 23.79 months (range 1-132). Manual catheter-directed aspiration was used. Fragmented, triturated or pushed the thrombus against the pulmonary circulation was avoided in all cases. 78 accesses were salvaged (77.2%). Autologous fistulas average and PTFE grafts success rate were 84.44% and 71.42% respectively. Angioplasty in one or more lesions after thromboaspiration was performed in all accesses, except six (5.9%). Metallic endoprostheses were implanted in 14 accesses (13.9%). Mean follow-up was 9 months (range 0-44). Primary patency was 42.3% +/- 5 at 6 months and 32% +/- 4 at one year. Autologous fistulas patency was better than PTFE grafts patency (p better than PTFE grafts. This justifies interventional radiology techniques in these situations.

A qualitative study of treatment burden among haemodialysis recipients.

Science.gov (United States)

Karamanidou, Christina; Weinman, John; Horne, Rob

2014-04-01

This study aims to explore the experience of renal patients undergoing dialysis treatment focusing on beliefs about their illness, prescribed treatment and the challenge of adherence. Interpretative phenomenological analysis was used to analyse the accounts of seven haemodialysis patients. Patients have a range of beliefs about their illness and their treatment consistent with the self-regulatory model of illness, that is, identity, cause, consequences, timeline and cure. Patients sometimes consciously did not act in accordance to advice when they considered an aspect of treatment less important or less easy to adhere to. Psychological factors like beliefs might play a role in non-adherence behaviour.

Comparison of amino acid oxidation and urea metabolism in haemodialysis patients during fasting and meal intake

NARCIS (Netherlands)

Veeneman, JM; Kingma, HA; Stellaard, F; de Jong, PE; Reijngoud, DJ; Huisman, RM

Background. The PNA (protein equivalent of nitrogen appearance) is used to calculate protein intake from urea kinetics. One of the essential assumptions in the calculation of PNA is that urea accumulation in haemodialysis (HD) patients is equivalent to amino acid oxidation. However, urea is

Looking into the effect of Diabetes Mellitus on Vascular Access in Haemodialysis Patients

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Stavroula Tsinikori

2017-03-01

Full Text Available Introduction: The creation and maintenance of a good vascular access is mandatory for a successful haemodialysis sessions and the survival of a Chronic Kidney Disease patient. Aim: The aim of the present cross-sectional study was to look into the vascular access complications in haemodialysed patients with or without Diabetes Mellitus (DM and to find any possible correlation of these complications with Diabetes Mellitus. Methods: For this cross-sectional study data from patients’ records of private Dialysis Unit (n=77 and a big General Hospital in a Northern Greece city (n=33 were studied. Demographics, data on medication therapy and vascular access (area, type, dialysis parameters and complications were recorded. Statistical analysis was performed with SPSS 20.0. Results: The sample was 66.7 (±12.5 years old, mainly male (58%, n=58 and on dialysis for 37.3 (±34.3 months. DM was the primary disease of 53% (n=53 of the patients and Hypertension for 13% (n=13,whereas the mean of comorbidities was 5,3 (±2,6. Thirty-seven patients (37% had more than one VA created or placed. On the total of the sample (n=100 156 VA were accessed with the 63% (n=63 of them with arteriovenous fistula (AVF, 35% (n=35 with central venous catheter (CVC and 2% (n=2 with arteriovenous graft (AVG. A statistical significance (U=2560,5, p=0,1 was found regarding the number of VA of the two group of patients (DM=2,2 VA, non DM=1,8. On survival analysis it was found that DM increases the relative risk of “death” of a VA with odds ratio of 1,7 (95% confidence interval 1,1-2,6. Conclusions: DM, as primary disease or co-morbidity, in haemodialysis patients affects negatively the VA survival. Effective blood glucose control, management and methods of puncturing VA play a crucial role in maintaining the VA in DM haemodialysis patients.

Low-dose cholecalciferol supplementation and dual vitamin D therapy in haemodialysis patients.

Science.gov (United States)

Dusilová-Sulková, Sylvie; Šafránek, Roman; Vávrová, Jaroslava; Horáček, Jiří; Pavlíková, Ladislava; Palička, Vladimír

2015-01-01

Traditionally, secondary hyperparathyroidism (SHPT) due to low calcitriol synthesis in failing kidneys has been treated with synthetic vitamin D receptor (VDR) activators. Recently, also the importance of low native vitamin D status beyond the issue of SHPT has been recognized in these patients. The aim of this work was to evaluate the effect of cholecalciferol supplementation in haemodialysis patients with low vitamin D serum levels. Another aim was to evaluate dual vitamin D therapy (cholecalciferol supplementation plus paricalcitol) in haemodialysis patients with vitamin D deficiency and concomitant SHPT. Ninety clinically stable maintenance haemodialysis patients were included. Supervised cholecalciferol supplementation was administered due to low vitamin D status. Patients with SHPT were also treated with synthetic VDR activator. Two pre hoc subgroups for statistical analysis were formed: patients treated solely with cholecalciferol (N=34; 5,000 IU once weekly) and patients treated with a combination of cholecalciferol (identical dose, i.e. 5,000 IU/week) plus paricalcitol (N=34, median dose 10 μg/week). Follow-up visit was scheduled 15 weeks later. Serum concentrations of calcidiol (25-D), parathyroid hormone (PTH) and beta-cross laps (CTX) were assessed at baseline and at follow-up. Serum calcium, phosphate and alkaline phosphatase (ALP) were monitored monthly. Only non-calcium gastrointestinal phosphate binders were administered. Dialysate calcium was 1.5 mmol/L in all patients, and no oral calcium-containing preparations were prescribed. Depending on data distribution, parametric or nonparametric statistical methods were used for comparison within each group (i.e. baseline vs. follow-up data) as well as between groups. In the whole group of 90 patients, mean baseline 25-D serum level was 20.3 (standard deviation 8.7) nmol/L, and it increased to 66.8 (19) nmol/L (pvitamin D supplementation was almost identical. In cholecalciferol monotherapy, 25-D levels

[Cervical disc hernia decompensation complicated by postoperative transitory tetraparesia about long-term haemodialysis patient].

Science.gov (United States)

Caltot, E; Hélaine, L; Cadic, A; Muller, C; Arvieux, C-C

2011-01-01

We report a case of a 51-year-old man who underwent a third kidney transplantation that was complicated by tetraparesia due to a C5-C6 cervical disc hernia decompensation in the immediate postoperative period. Preoperative consultation for long-term haemodialysis patients could be perfected by further neurological investigation and additional imagery. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

BIOIMPEDANCE ANALYSIS IN HAEMODIALYSIS PRACTICE: SHORT REVIEW AND SINGLE CENTER EXPERIENCE

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A.G. Strokov

2012-01-01

Full Text Available Bioimpedance analysis has been widely used to estimate a hydration state, lean and fat mass in haemodialysis patients. The aim of our study was to investigate the validity and usefulness of bioimpedance analysis in routine dialysis practice. Last two years we used the body composition monitoring (BCM, Fresenius Medical Care, method based on whole body multifrequency bioimpedance spectroscopy (BIS, compared with traditional clinical data. For BIS data verification, hydration status of 32 stable HD patients with dialysis vintage more than 3 years and clinically well established dry weight were studied. Only in three cases BIS data seems underestimated in serial measurements. Next step, 28 healthy subjects and 116 dialysis patients were studied. Total body water and extracellular volume (ECV were significantly higher in dialysis group (P<0.01, and there was not any difference in intracellular volume (ICV. Mean AP was similar in patients with moderate (<15% and massive (>15% relative overhydration (RO = overhydration / ECV, at the same time, average number of antihypertensive medications was significantly higher in more overhydrated patients (3.1 vs 1.2. In clinical practice RO is more convenient indicator as compared to standard overhydration volume /dry weight ratio. Mutual application of the BIS and blood volume monitoring allows more rapid and safe dry weight achievement. BIS was useful tool for hydration status monitoring in routine haemodialysis practice, and further work need to be done to clarify BIS validity for nutritional status estimation. 

Outcomes of AV Fistulas and AV Grafts after Interventional Stent-Graft Deployment in Haemodialysis Patients

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Schmelter, Christopher, E-mail: christopher.schmelter@klinikum-ingolstadt.de; Raab, Udo, E-mail: udo.raab@klinikum-ingolstadt.de [Klinikum Ingolstadt, Department of Diagnostic and Interventional Radiology (Germany); Lazarus, Friedrich, E-mail: friedrich.lazarus@klinikum-ingolstadt.de [Klinikum Ingolstadt, Department of Nephrology (Germany); Ruppert, Volker, E-mail: volker.ruppert@klinikum-ingolstadt.de [Klinikum Ingolstadt, Department of Vascular Surgery (Germany); Vorwerk, Dierk, E-mail: dierk.vorwerk@klinikum-ingolstadt.de [Klinikum Ingolstadt, Department of Diagnostic and Interventional Radiology (Germany)

2015-08-15

PurposeThe study was designed to assess outcomes of arteriovenous (AV) accesses after interventional stent-graft deployment in haemodialysis patients.Materials and Methods63 haemodialysis patients with 66 AV fistulas and AV grafts were treated by interventional stent-graft deployment from 2006 to 2012 at our hospital. Data of these patients were retrospectively analysed for location of deployed stent-grafts, occurrence and location of (re-)stenosis and (re-)thrombosis. Complex stenosis was the most frequent indication for stent-graft deployment (45.5 %), followed by complications of angioplasty with vessel rupture or dissection (31.8 %).ResultsA high rate of procedural success was achieved (98.5 %). The most frequent location of the deployed stent-graft was the draining vein (66.7 %). Stent-graft deployment was more frequent in AV grafts than in AV fistulas. Primary patency was 45.5 % at 6 month, 31.3 % at 12 month and 19.2 % at 24 month. Primary patency was significantly better for AV fistulas than for AV grafts with deployed stent-grafts. Patency of the deployed stent-graft was much better than overall AV access primary patency with deployed stent-graft. Re-stenosis with thrombosis was the most frequent indication for re-intervention. Most frequent location of re-stenosis was the draining vein (37.1 %), followed by stenosis at the AV access (29.5 %) and the deployed stent-graft (23.5 %).ConclusionRe-stenosis and re-thrombosis remain frequent in AV fistulas and AV grafts in haemodialysis patients despite stent-graft deployment. Re-stenosis of the deployed stent-graft is, only in the minority of the cases, responsible for AV access dysfunction.

Analysis of nutrition and nutritional status of haemodialysis patients

Science.gov (United States)

Bogacka, Anna; Sobczak-Czynsz, Anna; Kucharska, Elżbieta; Madaj, Małgorzata; Stucka, Katarzyna

2018-01-01

Chronic kidney disease (CKD) is a common disease of civilization where nutrition is part of the treatment. Diet therapy is difficult as it is necessary to control the intake of: energy, protein and minerals – Na, K, Ca and P in the daily food rations (DFR). The aim of the study was to assess the nutritional status and diets of haemodialysis (HD) patients. The study involved 141 haemodialysis patients, at the average age of 65.9. The patients were divided into groups taking into consideration their sex and diagnosis for diabetes. The information on the diets were collected using a 7-day dietary recall. In the DFRs the amount of energy and 22 nutrients were calculated. Obtained results were compared with requirements for HD patients. Appropriate nutritional status (measured with BMI) was reported for majority of women (70.6%) and almost half of men, however, excessive weight was recognized in every third female patient and more than half male patients, and type I obesity was noted in 7.8% of men. The analysis of the results showed that diets of all examined patients were deficient in energy and protein (except women with diabetes), whereas the consumption of fat was appropriate in both groups of women. The recommendations with respect to the amount of cholesterol were met but dietary fibre was too low. Intake of vitamins B1, D, C, folates and Ca and Mg was lower and intake of vitamin B12 was higher than recommended. Assessment of the coverage of the demand on nutrients in HD patients should not be based on the analysis of their nutritional status (BMI) only but also on the analysis of diets, especially in case of diabetes.

Studies on kinetics of albumin in uraemic patients on chronic haemodialysis: evidence of interstitial albumin wash-down

DEFF Research Database (Denmark)

Hildebrandt, P; Jensen, H A; Henriksen, Jens Henrik Sahl

1983-01-01

Albumin-kinetic studies were performed in nine uraemic patients without oedema on chronic haemodialysis and in seven normal controls in order to determine microvascular leakiness and thereby, during steady state, lymph drainage of albumin. Transvascular escape rate of albumin [TERalb i.......e. the fraction of intravascular mass (IVMalb) passing into, or returning from, the extravascular space per unit time] and the distribution ratio (DRalb) between IVMalb and total albumin mass were determined from intravenously injected radioiodinated serum albumin. Before haemodialysis, TERalb was significantly...... with respect to controls (mean 0 X 44, range 0 X 42-0 X 48, P less than 0 X 01), and the extravascular mass of albumin was significantly decreased (mean 27 X 9 mumol kg-1, range 14.1 - 41.2 v. mean 35.9, range 27.1 - 43.8, P less than 0.05). We interpret the results as to indicate increased transvascular...

Dental and periodontal health, and microbiological and salivary conditions in patients with or without diabetes undergoing haemodialysis.

Science.gov (United States)

Schmalz, Gerhard; Schiffers, Nora; Schwabe, Sandra; Vasko, Radovan; Müller, Gerhard A; Haak, Rainer; Mausberg, Rainer F; Ziebolz, Dirk

2017-06-01

The aim of this cross-sectional study was to evaluate the dental and periodontal health, as well as the microbiological and salivary conditions, of patients with and without diabetes mellitus (DM) who are receiving haemodialysis. One-hundred and fifty-nine haemodialysis patients were included and divided into groups according to the pre-existing diabetes status: DM or no DM. The oral examination included dental findings and assessment of the periodontal situation. The periodontal condition was classified as healthy/mild, moderate or severe periodontitis. Subgingival biofilm samples were analysed using the polymerase chain reaction. The salivary diagnostics included measurement of unstimulated and stimulated salivary flow, pH and buffer capacity. Statistical analyses used Fisher's test, the t-test and the Mann-Whitney U-test (α = 5%). The dental findings showed no significant difference between patients with and without DM (P = 0.44). The prevalence of periodontitis was high (96% in patients with DM and 97% in patients who did not have DM) and there was no significant difference between the groups (P = 0.71). There was a higher prevalence of Porphyromonas gingivalis, Parvimonas micros, Eubacterium nucleatum and Capnocytophaga spp. in patients without DM (P salivary pH was significantly higher in patients without DM (P salivary pH were detected between the groups, the dental and periodontal status was comparable between patients with and without DM. Accordingly, DM appears to have no decisive influence on the oral health in patients treated with haemodialysis who have well-controlled diabetes. © 2017 FDI World Dental Federation.

Increased brain iron deposition is a risk factor for brain atrophy in patients with haemodialysis: a combined study of quantitative susceptibility mapping and whole brain volume analysis.

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Chai, Chao; Zhang, Mengjie; Long, Miaomiao; Chu, Zhiqiang; Wang, Tong; Wang, Lijun; Guo, Yu; Yan, Shuo; Haacke, E Mark; Shen, Wen; Xia, Shuang

2015-08-01

To explore the correlation between increased brain iron deposition and brain atrophy in patients with haemodialysis and their correlation with clinical biomarkers and neuropsychological test. Forty two patients with haemodialysis and forty one age- and gender-matched healthy controls were recruited in this prospective study. 3D whole brain high resolution T1WI and susceptibility weighted imaging were scanned on a 3 T MRI system. The brain volume was analyzed using voxel-based morphometry (VBM) in patients and to compare with that of healthy controls. Quantitative susceptibility mapping was used to measure and compare the susceptibility of different structures between patients and healthy controls. Correlation analysis was used to investigate the relationship between the brain volume, iron deposition and neuropsychological scores. Stepwise multiple regression analysis was used to explore the effect of clinical biomarkers on the brain volumes in patients. Compared with healthy controls, patients with haemodialysis showed decreased volume of bilateral putamen and left insular lobe (All P brain iron deposition is negatively correlated with the decreased volume of bilateral putamen (P brain iron deposition and dialysis duration was risk factors for brain atrophy in patients with haemodialysis. The decreased gray matter volume of the left insular lobe was correlated with neurocognitive impairment.

Validity and reliability of Turkish Caregiver Burden Scale among family caregivers of haemodialysis patients.

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Cil Akinci, Ayse; Pinar, Rukiye

2014-02-01

To investigate the validity and reliability of the Caregiver Burden Scale in family members who provide primary care for haemodialysis patients. In Turkey, there is a need for a multi-dimensional instrument to evaluate the caregiver burden in people who provide care for patients with chronic diseases. A methodological study. The study sample consisted of 161 family members who provide primary care for haemodialysis patients. The forward-backward translation method was used to develop the Turkish Caregiver Burden Scale. The reliability was based on internal consistency investigated by Cronbach's alpha and item-total correlation. The factorial construct validity of the scale was tested with confirmatory factor analysis. By means of convergent and divergent validity, correlation between Caregiver Burden Scale and 36-Item Short Form Health Survey (SF-36) and correlation between Caregiver Burden Scale and the Maslach Burnout Scale were investigated. Cronbach's alpha and item-total correlations results suggested that there was good internal reliability. We found five underlying factors similar to original Scale's five-factor solution. The confirmatory factor analysis five-factor model represented an acceptable fit. Factor loadings were significant, with standardised loadings ranging from 0·43-0·81. By means of divergent validity, all sub-dimension scores and the total score of the Caregiver Burden Scale were negatively correlated with the SF-36, whereas there was a positive correlation with the emotional exhaustion and depersonalisation subscales of the Maslach Burnout Scale as expected. These results suggest that the Caregiver Burden Scale is a reliable and valid instrument which can be used with confidence in Turkish caregivers for haemodialysis patients to screen caregiver burden. The burden experienced by people who provide care for patients with chronic diseases can be evaluated with the Caregiver Burden Scale. Additionally, the Caregiver Burden Scale can be used

Altering plasma sodium concentration rapidly changes blood pressure during haemodialysis.

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Suckling, Rebecca J; Swift, Pauline A; He, Feng J; Markandu, Nirmala D; MacGregor, Graham A

2013-08-01

Plasma sodium is increased following each meal containing salt. There is an increasing interest in the effects of plasma sodium concentration, and it has been suggested that it may have direct effects on blood pressure (BP) and possibly influences endothelial function. Experimental increases of plasma sodium concentration rapidly raise BP even when extracellular volume falls. Ten patients with end-stage renal failure established on haemodialysis were studied during the first 2 h of dialysis without fluid removal during this period. They were randomized to receive haemodialysis with (i) dialysate sodium concentration prescribed to 135 mmol/L and (ii) 145 mmol/L in random order in a prospective, single-blinded crossover study. BP measurements and blood samples were taken every 30 min. Pre-dialysis sitting BP was 137/76 ± 7/3 mmHg. Lower dialysate sodium concentration (135 mmol/L) reduced plasma sodium concentration [139.49 ± 0.67 to 135.94 ± 0.52 mmol/L (P area under the curve (AUC) 15823.50 ± 777.15 (mmHg)min] compared with 145 mmol/L [AUC 17018.20 ± 1102.17 (mmHg)min], mean difference 1194.70 ± 488.41 (mmHg)min, P < 0.05. There was a significant positive relationship between change in plasma sodium concentration and change in systolic BP. This direct relationship suggests that a fall of 1 mmol/L in plasma sodium concentration would be associated with a 1.7 mmHg reduction in systolic BP (P < 0.05). The potential mechanism for the increase in BP seen with salt intake may be through small but significant changes in plasma sodium concentration.

[The relationship between the oral health and socioeconomic characteristics of chronic kidney disease patients undergoing haemodialysis treatment or kidney transplant].

Science.gov (United States)

Navia-Jutchenko, María F; Muñoz-López, Eliana E; López-Soto, Olga P

2013-01-01

Characterising the oral health of patients undergoing different types of dialysis or kidney transplant. This was a descriptive study which involved multivariate analysis of information taken from an initial database regarding 336 patients; 49 % were receiving haemodialysis, 34 % peritoneal dialysis, 7 % pre-dialysis and 10 % kidney transplant. Illustrative variables were age, gender, marital status, occupation, education, oral hygiene and gingival indexes, flossing, decayed, missing, and filled teeth (DMFT) index, renal disease aetiology and type of dialysis being received. A hierarchical clustering method was used. Four groups of patients were identified. Class 1 (37.8 %) consisted of unmarried men having had secondary education and having good oral hygiene, very high DMFT, with haemodialysis but no stomatological pathology. Class 2 (20.24 %) included haemodialysis patients who had received elementary education, were unemployed, had inadequate oral hygiene, severe gingivitis, very high DMF rate and high Candida frequency. Class 3 (31.2 %) included women undergoing peritoneal dialysis who were over 70 years old, had received elementary education, were housewives, edentulous and who had loss of vertical dimension. Class 4 (10.7 %) included men who had received renal transplant, secondary education and were employees; one third of them were edentulous and had soft tissue alterations. Multivariate analysis indicated a possible relationship between the type of dialysis received and patients' socioeconomic characteristics regarding oral health status.

Influence of Erythropoiesis-Stimulating Agents on HbA1c and Fructosamine in Patients with Haemodialysis.

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Rasche, Franz Maximilian; Ebert, Thomas; Beckmann, Julia; Busch, Volker; Barinka, Filip; Rasche, Wilma Gertrud; Lindner, Tom H; Schneider, Jochen G; Schiekofer, Stephan

2017-06-01

HbA1c is the most accepted laboratory parameter for the long term observation of glucose control. There is still much of a debate about the use of HbA1c as a metabolic indicator in diabetic patients (DM) on haemodialysis (HD) and erythropoiesis-stimulating agent (ESA) therapy because of the altered erythrocyte turn over in patients with chronic kidney disease and haemodialysis (CKD5D). In 102 CKD5 patients with and without diabetes mellitus, we examined the dose dependent variability in HbA1c and fructosamine levels under haemodialysis and treated with epoetin α (n=48) and a new generation agent with continuous stimulation of methoxy polyethylene glycol epoetin beta (C.E.R.A.; n=54). HbA1c levels were affected by therapy with ESA treatments. ESA dose was inversely correlated with HbA1c and an escalation of 10.000 IU per week induced an estimated decrease of HbA1c of 0.6 percent. In addition, the increase of reticulocyte number as a marker for erythropoiesis was significantly inversely correlated with the increase of ΔHbA1c. ESA treatments had no such effect on the alternative metabolic parameter fructosamine. When compared, both therapeutic agents had comparable success in attaining haemoglobin (Hb) target values. C.E.R.A. showed better correlation and was more effective over a longer dose interval. Our results show that HbA1c levels in patients should be carefully interpreted based on interfering factors. Nevertheless, HbA1c is currently the most consistent parameter for use ascertaining metabolic status of patients suffering from diabetes mellitus. © Georg Thieme Verlag KG Stuttgart · New York.

Serratia marcescens bacteraemia outbreak in haemodialysis patients with tunnelled catheters due to colonisation of antiseptic solution. Experience at 4 hospitals.

Science.gov (United States)

Merino, José L; Bouarich, Hanane; Pita, Mª José; Martínez, Patricia; Bueno, Blanca; Caldés, Silvia; Corchete, Elena; Jaldo, Mª Teresa; Espejo, Beatriz; Paraíso, Vicente

The application of antiseptic solution for handling tunnelled catheters is recommended in patients undergoing haemodialysis. These routine antiseptic procedures in handling catheters are crucial to avoid complications. We report an outbreak of Serratia marcescens (S. marcescens) bacteraemia in numerous haemodialysis units of the Community of Madrid. The first cases of bacteraemia due to S. marcescens were isolated in December 2014. The Preventive Medicine Services were informed of the detection of an atypical pathogen in several patients, suspecting a probable nosocomial outbreak. Information from 4 centres with similar S. marcescens bacteraemia was analysed. Twenty-one cases of bacteraemia related to S. marcescens were identified. The mean age of affected patients was 72±10 years. The mean time on haemodialysis of affected patients was 33±13 months (range: 3-83 months), the median time of tunnelled catheter was 22±13 months. In 11 cases the clinical picture was similar, with hypotension and general malaise during the haemodialysis session. Fever was present in a further 7 cases. In 3 cases the presentation was asymptomatic and was detected by blood cultures. All patients had tunnelled catheters (12 patients with catheter in the right jugular vein, 5 in the left jugular, 2 in the right femoral artery and 2 in the left subclavian artery). Gentamicin intravenous doses (1mg/kg) with catheter lock solution with ciprofloxacin post-dialysis were administered for 3 weeks in 6 patients. In 12 patients the treatment was ceftazidime (2g IV) plus catheter lock solution with the same antibiotic, for 2 weeks. Four patients received oral ciprofloxacin for 2 weeks, in one case together with IV vancomycin. The patients were asymptomatic and without new episodes 48hours after the treatment. No major complications were observed. The teams informed the health authorities of the situation, which then reported the presence of batches of antiseptic (chlorhexidine 0.05 and 2

Estimated dietary sodium intake in haemodialysis patients using food frequency questionnaires.

Science.gov (United States)

Gkza, Anastasia; Davenport, Andrew

2017-10-01

In clinical practice, dietary sodium assessment requires reliable and rapid screening tools. We wished to evaluate the usefulness of food frequency questionnaires (FFQ) in estimating dietary sodium intakes in haemodialysis patients. We used the Derby Salt Questionnaire (DSQ), and Scored Sodium Questionnaire (SSQ) to estimate sodium intake. Body composition was determined by bioimpedance. In total, 139 haemodialysis patients (95 men) completed the FFQs, with mean ± standard deviation age 67 ± 15 years. The mean FFQ scores were DSQ 3.5 ± 2.0 and SSQ 68.4 ± 24.5. Men had higher estimated dietary sodium intakes [DSQ median (range) 3.6 (0.6-10.1) versus female 2.2 (0.5-9.1), P = 0.007)]. Younger patients and those aged >75 years had the higher SSQ dietary sodium scores; 70.7 ± 27.8 and 76.8 ± 24.6 versus those aged 55-75 years, 61.8 ± 22.3, P = 0.04. Patients with greater estimated sodium intake had higher extracellular water (ECW) to intracellular water (ICW) ratios pre-dialysis [75.1 ±12.5 versus 67.7 ± 4.8, P sodium group (0.9 ± 13.7% versus 6.5 ± 14.1%, P = 0.04). Both questionnaires were acceptable to patients and identified higher estimated dietary sodium intake for men, those with greater ECW and, somewhat surprisingly, we found that older patients had a greater dietary sodium intake than expected. © The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA.

An exploration of the relationship between fatigue and physical functioning in patients with end stage renal disease receiving haemodialysis.

Science.gov (United States)

O'Sullivan, Dawn; McCarthy, Geraldine

2007-11-01

To measure fatigue and physical functioning in patients with end stage renal disease (ESRD) receiving haemodialysis and to investigate the relationships between fatigue and physical functioning. Fatigue and reduced physical functioning are among the most bothersome symptoms experienced by individuals receiving haemodialysis for ESRD. Research has shown that increasing activity levels has resulted in decreased fatigue levels and improved physical functioning in individuals with cancer. Establishing whether or not a relationship exists between both concepts in haemodialysis patients is a preliminary step in identifying potential fatigue reducing strategies necessary for improved wellbeing. A quantitative exploratory correlational design was used with 46 individuals completing the Multi-dimensional Fatigue Inventory, the Medical Outcomes Study Short-Form 36-item questionnaire and a Demographic Questionnaire. Results indicated fatigue was prevalent with highest scores achieved for physical fatigue; reduced activity and general fatigue. Substantial limitations in physical functioning were found. A significant moderate negative relationship between general fatigue and physical functioning indicated that, as physical functioning levels increased, fatigue levels decreased. A significant difference was also found between general fatigue scores for males and females. Significant relationships were found between overall physical functioning, older age and employment status. The research indicates the prevalence of fatigue and limitations in physical functioning in individuals with ESRD. However, as physical functioning increased fatigue decreased; a finding relevant to clinical nursing. Understanding the levels of fatigue and the value of exercise is of relevance to clinical practice thus assessment of fatigue and physical functioning ability in the clinical setting is necessary.

Clearance of glucoregulatory peptide hormones during haemodialysis and haemodiafiltration in non-diabetic end-stage renal disease patients

DEFF Research Database (Denmark)

Jørgensen, Morten B; Idorn, Thomas; Knop, Filip K

2015-01-01

BACKGROUND: Patients with end-stage renal disease (ESRD) have increased fasting concentrations and disturbed postprandial responses of several glucoregulatory hormones. We aimed to evaluate the impact of high-flux haemodialysis (HD) and high-volume haemodiafiltration (HDF) on fasting and postpran......BACKGROUND: Patients with end-stage renal disease (ESRD) have increased fasting concentrations and disturbed postprandial responses of several glucoregulatory hormones. We aimed to evaluate the impact of high-flux haemodialysis (HD) and high-volume haemodiafiltration (HDF) on fasting...... and postprandial plasma levels of glucoregulatory pancreatic and gut peptide hormones in ESRD patients. METHODS: Ten non-diabetic HD-treated ESRD patients were included to undergo a 3-h standardized liquid mixed meal test 1 h into an HD and an HDF, respectively. On a third, optional, examination day, the meal test...... during HDF and four completed the optional meal test without dialysis. All plasma hormone concentrations declined significantly during the first fasting hour of dialysis with no differences between HD and HDF. Significant clearance of the investigated hormones was observed for both dialysis modalities...

Barriers and facilitators to healthcare professional behaviour change in clinical trials using the Theoretical Domains Framework: a case study of a trial of individualized temperature-reduced haemodialysis.

Science.gov (United States)

Presseau, Justin; Mutsaers, Brittany; Al-Jaishi, Ahmed A; Squires, Janet; McIntyre, Christopher W; Garg, Amit X; Sood, Manish M; Grimshaw, Jeremy M

2017-05-22

Implementing the treatment arm of a clinical trial often requires changes to healthcare practices. Barriers to such changes may undermine the delivery of the treatment making it more likely that the trial will demonstrate no treatment effect. The 'Major outcomes with personalized dialysate temperature' (MyTEMP) is a cluster-randomised trial to be conducted in 84 haemodialysis centres across Ontario, Canada to investigate whether there is a difference in major outcomes with an individualized dialysis temperature (IDT) of 0.5 °C below a patient's body temperature measured at the beginning of each haemodialysis session, compared to a standard dialysis temperature of 36.5 °C. To inform how to deploy the IDT across many haemodialysis centres, we assessed haemodialysis physicians' and nurses' perceived barriers and enablers to IDT use. We developed two topic guides using the Theoretical Domains Framework (TDF) to assess perceived barriers and enablers to IDT ordering and IDT setting (physician and nurse behaviours, respectively). We recruited a purposive sample of haemodialysis physicians and nurses from across Ontario and conducted in-person or telephone interviews. We used directed content analysis to double-code transcribed utterances into TDF domains, and inductive thematic analysis to develop themes. We interviewed nine physicians and nine nurses from 11 Ontario haemodialysis centres. We identified seven themes of potential barriers and facilitators to implementing IDTs: (1) awareness of clinical guidelines and how IDT fits with local policies (knowledge; goals), (2) benefits and motivation to use IDT (beliefs about consequences; optimism; reinforcement; intention; goals), (3) alignment of IDTs with usual practice and roles (social/professional role and identity; nature of the behaviour; beliefs about capabilities), (4) thermometer availability/accuracy and dialysis machine characteristics (environmental context and resources), (5) impact on workload (beliefs

YKL-40 in patients with end-stage renal disease receiving haemodialysis

DEFF Research Database (Denmark)

Nielsen, Ture Lange; Plesner, Louis Lind; Warming, Peder Emil

2018-01-01

PURPOSE: This study aimed to determine serum YKL-40 in patients with end-stage renal disease (ESRD) on haemodialysis (HD) and to evaluate the prognostic value of serum YKL-40. METHODS: Patients >18 years on maintenance HD were included. Serum YKL-40 was measured using ELISA before and after...... a single HD treatment. RESULTS: A total of 306 patients were included. Median serum YKL-40 concentration was 238 µgL-1(IQR: 193-291 µgL-1) before HD treatment and 198 µgL-1(IQR: 147-258 µgL-1) after HD treatment, which corresponded to age-corrected 93th percentile in healthy subjects. All-cause mortality...

Comparison of malnutrition inflammation score, anthropometry and biochemical parameters in assessing the difference in protein-energy wasting between normal weight and obese patients undergoing haemodialysis.

Science.gov (United States)

Alipoor, Elham; Hosseinzadeh-Attar, Mohammad Javad; Mahdavi-Mazdeh, Mitra; Yaseri, Mehdi; Zahed, Narges S

2017-07-01

Protein-energy wasting (PEW) is prevalent in haemodialysis. Obesity is an independent risk factor of kidney insufficiency, but it is proposed to have beneficial roles in better outcomes in the final stage of disease. Better nutritional status and body reserves are among probable mechanisms, but direct examinations are limited. The present study aimed to investigate whether obese patients have preferable nutritional status compared to normal weight patients based on malnutrition inflammation score (MIS) and other PEW parameters in haemodialysis. This case-control study investigated 52 normal weight (18.5 < body mass index (BMI) < 25 kg/m 2 ) and 48 obese (BMI≥30 kg/m 2 ) patients on regular haemodialysis. PEW was assessed based on anthropometric and biochemical factors, recent weight changes, appetite, anorexia, dietary intake and MIS. Obese patients had better MIS compared with the normal weight group (P < 0.001), although varying degrees of wasting were prevalent among this group too (75% mild and 25% moderate wasting). The obese group had less significant weight loss (4.2 vs 8%) and anorexia and better appetite. However, a considerable percentage of patients in both groups showed muscle (94.6% of normal weight and 19.5% of obese) and peripheral fat tissue (89.2% of normal weight and 31.7% of obese) losses compared to the 50th percentile. Biochemical parameters were not significantly different between groups except for triglyceride (P = 0.001), transferrin and total iron-binding capacity (P = 0.028). MIS was significantly better in obese patients; however, both groups showed degrees of wasting based on MIS and other PEW parameters. Nutritional status of obese haemodialysis patients should be monitored regularly because of high risk of PEW like other BMI categories. © 2017 Dietitians Association of Australia.

Low vitamin K1 intake in haemodialysis patients.

Science.gov (United States)

Fusaro, Maria; D'Alessandro, Claudia; Noale, Marianna; Tripepi, Giovanni; Plebani, Mario; Veronese, Nicola; Iervasi, Giorgio; Giannini, Sandro; Rossini, Maurizio; Tarroni, Giovanni; Lucatello, Sandro; Vianello, Alberto; Santinello, Irene; Bonfante, Luciana; Fabris, Fabrizio; Sella, Stefania; Piccoli, Antonio; Naso, Agostino; Ciurlino, Daniele; Aghi, Andrea; Gallieni, Maurizio; Cupisti, Adamasco

2017-04-01

Vitamin K acts as a coenzyme in the γ-carboxylation of vitamin K-dependent proteins, including coagulation factors, osteocalcin, matrix Gla protein (MGP), and the growth arrest-specific 6 (GAS6) protein. Osteocalcin is a key factor for bone matrix formation. MGP is a local inhibitor of soft tissue calcification. GAS6 activity prevents the apoptosis of vascular smooth muscle cells. Few data on vitamin K intake in chronic kidney disease patients and no data in patients on a Mediterranean diet are available. In the present study, we evaluate the dietary intake of vitamin K1 in a cohort of patients undergoing haemodialysis. In this multi-centre controlled observational study, data were collected from 91 patients aged >18 years on dialysis treatment for at least 12 months and from 85 age-matched control subjects with normal renal function. Participants completed a food journal of seven consecutive days for the estimation of dietary intakes of macro- and micro-nutrients (minerals and vitamins). Compared to controls, dialysis patients had a significant lower total energy intake, along with a lower dietary intake of proteins, fats, carbohydrates, fibres, and of all the examined minerals (Ca, P, Fe, Na, K, Zn, Cu, and Mg). With the exception of vitamin B12, vitamins intake followed a similar pattern, with a lower intake in vitamin A, B1, B2, C, D, E, folates, K1 and PP. These finding were confirmed also when normalized for total energy intake or for body weight. In respect to the adequate intakes recommended in the literature, the prevalence of a deficient vitamin K intake was very high (70-90%) and roughly double than in controls. Multivariate logistic model identified vitamin A and iron intake as predictors of vitamin K deficiency. Haemodialysis patients had a significantly low intake in vitamin K1, which could contribute to increase the risk of bone fractures and vascular calcifications. Since the deficiency of vitamin K intake seems to be remarkable, dietary

Fatal outcomes among patients on maintenance haemodialysis in sub-Saharan Africa: a 10-year audit from the Douala General Hospital in Cameroon.

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Halle, Marie Patrice; Ashuntantang, Gloria; Kaze, Francois Folefack; Takongue, Christian; Kengne, Andre-Pascal

2016-11-03

End-Stage Renal disease (ESRD) is associated with increased morbidity and mortality. We assessed the occurrence, time-trend and determinants of fatal outcomes of haemodialysis-treated ESRD patients over a 10-year period in a major referral hospital in Cameroon. Medical records of ESRD patients who started chronic haemodialysis at the Douala General Hospital between 2002 and 2012 were reviewed. Baseline characteristics and fatal outcomes on dialysis were recorded. Accelerated-failure time and logistic regression models were used to investigate the determinants of death. A total of 661 patients with 436 (66 %) being men were included in the study. Mean age at dialysis initiation was 46.3 ± 14.7 years. The median [25 th -75 th percentiles] duration on dialysis was 187 [34-754] days. A total of 297 (44.9 %) deaths were recorded during follow-up with statistical difference over the years (p risk of mortality, relative to hypertension alone. Mortality in dialysis is excessively high in this setting. Because most of these premature deaths are potentially preventable, additional efforts are needed to offset the risk and maximise the benefits from the ongoing investments of the government to defray the cost of haemodialysis. Potential actions include sensitisation of the population and healthcare practitioners, early detection and referral of individuals with CKD; and additional subsidies to support the cost of managing co-morbidities in patients with CKD in general.

Self-rated health and employment status in chronic haemodialysis patients

DEFF Research Database (Denmark)

Molsted, Stig; Aadahl, Mette; Schou, Lone

2004-01-01

OBJECTIVE: Along with survival and other types of clinical outcome, physical, mental and social well-being are important indicators of the effectiveness of the medical care that haemodialysis (HD) patients receive. The present cross-sectional study was designed to assess self-rated health in HD...... patients were included. They were asked to complete the Short Form 36 (SF-36) questionnaire and additional questions concerning education and employment status. The SF-36 consists of eight scales representing physical, social, mental and general health. Clinical, biochemical and dialysis adequacy data were...... patients from a large Danish HD centre compared to a Danish general population sample with similar sex and age distributions. Furthermore, employment status and associations between self-rated health and clinical, social and demographic factors were investigated. MATERIAL AND METHODS: A total of 150...

Application of FTIR-ATR Spectroscopy to Determine the Extent of Lipid Peroxidation in Plasma during Haemodialysis

Directory of Open Access Journals (Sweden)

Adam Oleszko

2015-01-01

Full Text Available During a haemodialysis (HD, because of the contact of blood with the surface of the dialyser, the immune system becomes activated and reactive oxygen species (ROS are released into plasma. Particularly exposed to the ROS are lipids and proteins contained in plasma, which undergo peroxidation. The main breakdown product of oxidized lipids is the malondialdehyde (MDA. A common method for measuring the concentration of MDA is a thiobarbituric acid reactive substances (TBARS method. Despite the formation of MDA in plasma during HD, its concentration decreases because it is removed from the blood in the dialyser. Therefore, this research proposes the Fourier Transform Infrared Attenuated Total Reflectance (FTIR-ATR spectroscopy, which enables determination of primary peroxidation products. We examined the influence of the amount of hydrogen peroxide added to lipid suspension that was earlier extracted from plasma specimen on lipid peroxidation with use of TBARS and FTIR-ATR methods. Linear correlation between these methods was shown. The proposed method was effective during the evaluation of changes in the extent of lipid peroxidation in plasma during a haemodialysis in sheep. A measurement using the FTIR-ATR showed an increase in plasma lipid peroxidation after 15 and 240 minutes of treatment, while the TBARS concentration was respectively lower.

Impact of low- or high-flux haemodialysis and online haemodiafiltration on inflammatory markers and lipid profile in chronic haemodialysis patients.

Science.gov (United States)

Akoglu, Hadim; Dede, Fatih; Piskinpasa, Serhan; Falay, Mesude Y; Odabas, Ali Riza

2013-01-01

We aimed to evaluate the impact of low- or high-flux haemodialysis (HD) and online haemodiafiltration (OL-HDF) on inflammation and the lipid profile in HD patients. 50 HD patients were assigned to two groups for HD with low-flux (n = 25) or high-flux (n = 25) polysulphone dialysers for 6 weeks. Subsequently, all patients were haemodialysed with a low-flux polysulphone dialyser for 6 weeks, then transferred to OL-HDF for another 6 weeks. Blood samples for lipids and inflammatory markers (IL-6, IL-8, TNF-α, hs-CRP) were obtained at baseline and every 6 weeks. Changes in inflammatory markers and lipids from baseline to the 6-week dialysis period did not differ between low- and high-flux groups. When patients were transferred from low-flux HD to OL-HDF, IL-6, IL-8, and TNF-α levels significantly decreased whereas HDL and LDL cholesterol significantly increased. Low- and high-flux polysulphone membranes had similar effects on lipids and inflammatory markers, whereas OL-HDF potently reduced pro-inflammatory cytokines. Copyright © 2013 S. Karger AG, Basel.

11C-methionine PET/CT in 99mTc-sestamibi-negative hyperparathyroidism in patients with renal failure on chronic haemodialysis

International Nuclear Information System (INIS)

Rubello, Domenico; Fanti, Stefano; Nanni, Cristina; Farsad, Mohsen; Castellucci, Paolo; Boschi, Stefano; Franchi, Roberto; Mariani, Giuliano; Fig, Lorraine M.; Gross, Milton D.

2006-01-01

Scintigraphic localisation of parathyroid glands is often unsuccessful in patients with renal failure on chronic haemodialysis who have secondary hyperparathyroidism (HPT). The purpose of this study was to investigate the use of 11 C-methionine PET/CT to detect hyperfunctioning parathyroid glands in patients with renal failure on chronic haemodialysis who had 99m Tc-sestamibi-negative HPT. 11 C-methionine PET/CT was performed in 18 patients (11 women and 7 men, aged 42-79 years; mean age 57.8 years) on haemodialysis for renal failure (2-14 years' duration), with normo-, hypo- or hypercalcaemia and HPT not localised by either dual-tracer 99m Tc-pertechnetate/ 99m Tc-sestamibi subtraction scans or dual-phase 99m Tc-sestamibi scans. In three of ten patients with normo- or hypocalcaemic HPT there was increased 11 C-methionine accumulation in one gland. Seven of eight patients with hypercalcaemic HPT showed increased uptake: in five of these patients increased 11 C-methionine accumulation was present in one gland, while in two it was demonstrated in two glands. All patients also had high-resolution ultrasound of the neck and were treated with subtotal parathyroidectomy, leaving a remnant of the smallest of the four glands. Regardless of their size, all glands with abnormal 11 C-methionine parathyroid uptake were removed, and all demonstrated parathyroid hyperplasia. All patients developed post-parathyroidectomy hypoparathyroidism and one patient with normocalcaemic HPT relapsed 8 months after surgery. These data suggest that 11 C-methionine PET/CT may be used to identify hyperfunctioning parathyroid glands in non-primary HPT, and especially hypercalcaemic HPT, when conventional 99m Tc-sestamibi imaging is non-localising. (orig.)

Tunnelled haemodialysis catheter and haemodialysis outcomes: a retrospective cohort study in Zagreb, Croatia.

Science.gov (United States)

Pašara, Vedran; Maksimović, Bojana; Gunjača, Mihaela; Mihovilović, Karlo; Lončar, Andrea; Kudumija, Boris; Žabić, Igor; Knotek, Mladen

2016-05-17

Studies have reported that the tunnelled dialysis catheter (TDC) is associated with inferior haemodialysis (HD) patient survival, in comparison with arteriovenous fistula (AVF). Since many cofactors may also affect survival of HD patients, it is unclear whether the greater risk for survival arises from TDC per se, or from associated conditions. Therefore, the aim of this study was to determine, in a multivariate analysis, the long-term outcome of HD patients, with respect to vascular access (VA). Retrospective cohort study. This retrospective cohort study included all 156 patients with a TDC admitted at University Hospital Merkur, from 2010 to 2012. The control group consisted of 97 patients dialysed via AVF. The groups were matched according to dialysis unit and time of VA placement. The site of choice for the placement of the TDC was the right jugular vein. Kaplan-Meier analysis with log-rank test was used to assess patient survival. Multivariate Cox regression analysis was used to determine independent variables associated with patient survival. Patient survival with respect to VA. The cumulative 1-year survival of patients who were dialysed exclusively via TDC was 86.4% and of those who were dialysed exclusively via AVF, survival was 97.1% (p=0.002). In multivariate Cox regression analysis, male sex and older age were independently negatively associated with the survival of HD patients, while shorter HD vintage before the creation of the observed VA, hypertensive renal disease and glomerulonephritis were positively associated with survival. TDC was an independent risk factor for survival of HD patients (HR 23.0, 95% CI 6.2 to 85.3). TDC may be an independent negative risk factor for HD patient survival. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Central venous stenosis in haemodialysis patients without a previous history of catheter placement.

Science.gov (United States)

Oguzkurt, Levent; Tercan, Fahri; Yildirim, Sedat; Torun, Dilek

2005-08-01

To evaluate dialysis history, imaging findings and outcome of endovascular treatment in six patients with central venous stenosis without a history of previous catheter placement. Between April 2000 and June 2004, six (10%) of 57 haemodialysis patients had stenosis of a central vein without a previous central catheter placement. Venography findings and outcome of endovascular treatment in these six patients were retrospectively evaluated. Patients were three women (50%) and three men aged 32-60 years (mean age: 45 years) and all had massive arm swelling as the main complaint. The vascular accesses were located at the elbow in five patients and at the wrist in one patient. Three patients had stenosis of the left subclavian vein and three patients had stenosis of the left brachiocephalic vein. The mean duration of the vascular accesses from the time of creation was 25.1 months. Flow volumes of the vascular access were very high in four patients who had flow volume measurement. The mean flow volume was 2347 ml/min. One of three patients with brachiocephalic vein stenosis had compression of the vein by the brachiocephalic artery. All the lesions were first treated with balloon angioplasty and two patients required stent placement on long term. Number of interventions ranged from 1 to 4 (mean: 2.1). Symptoms resolved in five patients and improved in one patient who had a stent placed in the left BCV. Central venous stenosis in haemodialysis patients without a history of central venous catheterization tends to occur or be manifested in patients with a proximal permanent vascular access with high flow rates. Balloon angioplasty with or without stent placement offers good secondary patency rates in mid-term.

A novel bioactive haemodialysis system using dissolved dihydrogen (H2) produced by water electrolysis: a clinical trial.

Science.gov (United States)

Nakayama, Masaaki; Nakano, Hirofumi; Hamada, Hiromi; Itami, Noritomo; Nakazawa, Ryoichi; Ito, Sadayoshi

2010-09-01

Chronic inflammation in haemodialysis (HD) patients indicates a poor prognosis. However, therapeutic approaches are limited. Hydrogen gas (H(2)) ameliorates oxidative and inflammatory injuries to organs in animal models. We developed an HD system using a dialysis solution with high levels of dissolved H(2) and examined the clinical effects. Dialysis solution with H(2) (average of 48 ppb) was produced by mixing dialysate concentrates and reverse osmosis water containing dissolved H(2) generated by a water electrolysis technique. Subjects comprised 21 stable patients on standard HD who were switched to the test HD for 6 months at three sessions a week. During the study period, no adverse clinical signs or symptoms were observed. A significant decrease in systolic blood pressure (SBP) before and after dialysis was observed during the study, and a significant number of patients achieved SBP <140 mmHg after HD (baseline, 21%; 6 months, 62%; P < 0.05). Changes in dialysis parameters were minimal, while significant decreases in levels of plasma monocyte chemoattractant protein 1 (P < 0.01) and myeloperoxidase (P < 0.05) were identified. Adding H(2) to haemodialysis solutions ameliorated inflammatory reactions and improved BP control. This system could offer a novel therapeutic option for control of uraemia.

Novel Use of a Pneumatic Compression Device for Haemostasis of Haemodialysis Fistula Access Catheterisation Sites

Energy Technology Data Exchange (ETDEWEB)

O’Reilly, Michael K., E-mail: moreilly1@mater.ie; Ryan, David; Sugrue, Gavin; Geoghegan, Tony; Lawler, Leo P.; Farrelly, Cormac T. [Mater Misericordiae University Hospital, Department of Interventional Radiology (Ireland)

2016-12-15

PurposeTransradial pneumatic compression devices can be used to achieve haemostasis following radial artery puncture. This article describes a novel technique for acquiring haemostasis of arterio-venous haemodialysis fistula access sites without the need for suture placement using one such compression device.Materials and MethodsA retrospective review of fistulograms with or without angioplasty/thrombectomy in a single institution was performed. 20 procedures performed on 12 patients who underwent percutaneous intervention of failing or thrombosed arterio-venous fistulas (AVF) had 27 puncture sites. Haemostasis was achieved using a pneumatic compression device at all access sites. Procedure details including size of access sheath, heparin administration and complications were recorded.ResultsTwo diagnostic fistulograms, 14 fistulograms and angioplasties and four thrombectomies were performed via access sheaths with an average size (±SD) of 6 Fr (±1.12). IV unfractionated heparin was administered in 11 of 20 procedures. Haemostasis was achieved in 26 of 27 access sites following 15–20 min of compression using the pneumatic compression device. One case experienced limited bleeding from an inflow access site that was successfully treated with reinflation of the device for a further 5 min. No other complication was recorded.ConclusionsHaemostasis of arterio-venous haemodialysis fistula access sites can be safely and effectively achieved using a pneumatic compression device. This is a technically simple, safe and sutureless technique for acquiring haemostasis after AVF intervention.

Body composition analysis and adipocytokine concentrations in haemodialysis patients: abdominal fat gain as an additional cardiovascular risk factor.

Science.gov (United States)

González, Elena; Díez, Juan J; Pérez Torres, Almudena; Bajo, María Auxiliadora; Del Peso, Gloria; Sánchez-Villanueva, Rafael; Grande, Cristina; Rodríguez, Olaia; Coronado, Mónica; Gómez Candela, Carmen; Díaz-Almirón, Mariana; Iglesias, Pedro; Selgas, Rafael

Abdominal fat and its increment over time in particular has become a cardiovascular risk factor in uraemic patients. To analyse changes in abdominal fat in haemodialysis patients over one year and study their possible correlation with the variation in adipocytokine serum levels. As a secondary objective, we tried to validate the data obtained by bioelectrical impedance analysis (BIA) with data obtained by dual X-ray absorptiometry (DXA). A prospective one-year study was performed in 18 patients on haemodialysis (HD). In each patient, body composition by BIA and DXA was estimated at baseline and after one year. Several adipocytokine and biochemical parameters were determined. A significant increase in phase angle [4.8° (4.1-5.6) vs. 5.2° (4.4-5.8), Pfat measured by DXA [1.00 (0.80-1.26) vs. 1.02 (0.91-1.30), Pfat mass measured by BIA, as well as the abdominal fat percentage estimated by DXA, was found (Pfat mass over time, especially in the abdomen, evidenced by an increased A/G ratio. These findings might explain the increased cardiovascular risk in these patients. Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

Specific balance training included in an endurance-resistance exercise program improves postural balance in elderly patients undergoing haemodialysis.

Science.gov (United States)

Frih, Bechir; Mkacher, Wajdi; Jaafar, Hamdi; Frih, Ameur; Ben Salah, Zohra; El May, Mezry; Hammami, Mohamed

2018-04-01

The purpose of this study was to evaluate the effects of 6 months of specific balance training included in endurance-resistance program on postural balance in haemodialysis (HD) patients. Forty-nine male patients undergoing HD were randomly assigned to an intervention group (balance training included in an endurance-resistance training, n = 26) or a control group (resistance-endurance training only, n = 23). Postural control was assessed using six clinical tests; Timed Up and Go test, Tinetti Mobility Test, Berg Balance Scale, Unipodal Stance test, Mini-Balance Evaluation Systems Test and Activities Balance Confidence scale. All balance measures increased significantly after the period of rehabilitation training in the intervention group. Only the Timed Up and Go, Berg Balance Scale, Mini-Balance Evaluation Systems Test and Activities Balance Confidence scores were improved in the control group. The ranges of change in these tests were greater in the balance training group. In HD patients, specific balance training included in a usual endurance-resistance training program improves static and dynamic balance better than endurance-resistance training only. Implications for rehabilitation Rehabilitation using exercise in haemodialysis patients improved global mobility and functional abilities. Specific balance training included in usual endurance resistance training program could lead to improved static and dynamic balance.

Central venous stenosis in haemodialysis patients without a previous history of catheter placement

International Nuclear Information System (INIS)

Oguzkurt, Levent; Tercan, Fahri; Yildirim, Sedat; Torun, Dilek

2005-01-01

Objective: To evaluate dialysis history, imaging findings and outcome of endovascular treatment in six patients with central venous stenosis without a history of previous catheter placement. Material and methods: Between April 2000 and June 2004, six (10%) of 57 haemodialysis patients had stenosis of a central vein without a previous central catheter placement. Venography findings and outcome of endovascular treatment in these six patients were retrospectively evaluated. Patients were three women (50%) and three men aged 32-60 years (mean age: 45 years) and all had massive arm swelling as the main complaint. The vascular accesses were located at the elbow in five patients and at the wrist in one patient. Results: Three patients had stenosis of the left subclavian vein and three patients had stenosis of the left brachiocephalic vein. The mean duration of the vascular accesses from the time of creation was 25.1 months. Flow volumes of the vascular access were very high in four patients who had flow volume measurement. The mean flow volume was 2347 ml/min. One of three patients with brachiocephalic vein stenosis had compression of the vein by the brachiocephalic artery. All the lesions were first treated with balloon angioplasty and two patients required stent placement on long term. Number of interventions ranged from 1 to 4 (mean: 2.1). Symptoms resolved in five patients and improved in one patient who had a stent placed in the left BCV. Conclusion: Central venous stenosis in haemodialysis patients without a history of central venous catheterization tends to occur or be manifested in patients with a proximal permanent vascular access with high flow rates. Balloon angioplasty with or without stent placement offers good secondary patency rates in mid-term

Job satisfaction, stress and burnout associated with haemodialysis nursing: a review of literature.

Science.gov (United States)

Hayes, Bronwyn; Bonnet, Ann

2010-12-01

Job dissatisfaction, stress and burnout are linked to high rates of nurses leaving the profession, poor morale and poor patient outcomes. Haemodialysis (HD) nursing is uniquely characterised by the intense-prolonged interaction with patients who require complex technological care. A review of nine papers found that factors affecting job satisfaction were aspects of nursing care, organisational factors and length of time that a nurse has been working in nephrology nursing. Factors affecting job stress and burnout were due to interpersonal relationships with physicians, patient care activities, violence and abuse from patients, organisational factors and a lack of access to ongoing education. © 2010 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Economic evaluations of interventions to manage hyperphosphataemia in adult haemodialysis patients: A systematic review.

Science.gov (United States)

Rizk, Rana; Hiligsmann, Mickaël; Karavetian, Mirey; Evers, Silvia Maa

2016-03-01

Managing hyperphosphataemia in haemodialysis patients is resource-intensive. A search for cost-effective interventions in this field is needed to inform decisions on the allocation of healthcare resources. NHSEED, MEDLINE, EMBASE and CINAHL were searched for full economic evaluations of hyperphosphataemia-managing interventions in adult haemodialysis patients, published between 2004 and 2014, in English, French, Dutch or German. Incremental cost-effectiveness ratios of the interventions were up-rated to 2013US$ using Purchasing Power Parity conversion rates and Consumer Price Indices. The quality of included studies was assessed using the Extended Consensus on Health Economic Criteria List. Twelve out of the 1681 retrieved records fulfilled the inclusion criteria. They reported only on one aspect of hyperphosphataemia management, which is the use of phosphate binders (calcium-based and calcium-free, in first-line and sequential use). No economic evaluations of other phosphorus-lowering interventions were found. The included articles derived from five countries and most of them were funded by pharmaceutical companies. The incremental cost-effectiveness ratios of phosphate binders ranged between US$11 461 and US$157 760 per quality-adjusted life-year gained. Calcium-based binders (especially calcium acetate) appear to be the optimal cost-effective first- and second-line therapy in prevalent patients, while the calcium-free binder, lanthanum carbonate, might provide good value for money, as second-line therapy, in incident patients. The studies' overall quality was suboptimal. Drawing firm conclusions was not possible due to the quality heterogeneity and inconsistent results. Future high-quality economic evaluations are needed to confirm the findings of this review and to address other interventions to manage hyperphosphataemia in this population. © 2015 Asian Pacific Society of Nephrology.

Identification of the needs of haemodialysis patients using the concept of Maslow's hierarchy of needs.

Science.gov (United States)

Bayoumi, Magda

2012-03-01

Along with basic survival and other clinical outcomes, patients' quality of life is an important indicator to reflect the needs of these patients. Human needs are classified in Maslow's hierarchy, where the most essential basic physiological need provides the base, and self actualisation is at the top of pyramid. The aim of this study is to identify the patients' needs who are on maintenance haemodialysis using concept of Maslow's hierarchy. The descriptive study was conducted in the dialysis unit of Suez Canal University Hospitals. The study included 50 patients attending the dialysis unit. The findings showed that the patients' highest need was for self-esteem (92.0%), whereas the lowest was for love and belonging (38.0%). Statistically significant relationships were revealed between the identified love and belonging needs and patients' age and the duration of dialysis (p = 0.008). The total needs score was lower with the longer duration of dialysis (59.6 ± 7.3), compared to those with a duration less than 24 months (65.7 ± 8.1), p = 0.02. Based on the main study findings it is concluded that haemodialysis patients' highest need was for self-esteem, and the lowest was for love and belonging. These needs increased with longer duration of dialysis. Nurses need to be aware of these findings in order to be able to supply the necessary support to help the patient regain his/her self-concept. © 2011 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Effect of prescribing a high protein diet and increasing the dose of dialysis on nutrition in stable chronic haemodialysis patients : a randomized, controlled trial

NARCIS (Netherlands)

Kloppenburg, Wybe; Stegeman, CA; Kremer Hovinga, T; Vastenburg, G; Vos, P; de Jong, PE; Huisman, RM

Background. Protein requirements in stable, adequately dialysed haemodialysis patients are not known and recommendations vary. It is not known whether increasing the dialysis dose above the accepted adequate level has a favourable effect on nutrition. The aim of this study was to determine whether

Successful use of combined high cut-off haemodialysis and bortezomib for acute kidney injury associated with myeloma cast nephropathy.

LENUS (Irish Health Repository)

Ward, F

2012-05-01

We present the case of a 58-year old female with de novo dialysis-dependent acute kidney injury (AKI) secondary to myeloma cast nephropathy. The patient underwent extended high cut-off haemodialysis (HCO-HD), in conjunction with bortezomib-based chemotherapy, and soon became dialysis independent with normal renal function. To our knowledge, this is the first time this treatment strategy has been employed successfully in an Irish centre.

Nutritional status of vegetarians on maintenance haemodialysis.

Science.gov (United States)

Wu, Tai-Te; Chang, Chieh-Ying; Hsu, Wei-Min; Wang, I-Kwan; Hsu, Chih-Hao; Cheng, Shu-Hwa; Liang, Chih-Chia; Chang, Chiz-Tzung; Huang, Chiu-Ching

2011-08-01

Vegetarian diets have long been thought of as beneficial to health. However, vegetarian diets are often low in protein, which is contradictory to the high protein diet guideline for uraemia patients. The purpose of the study was to investigate the impact of a vegetarian diet on the nutritional status of haemodialysis (HD) patients. Patients on chronic HD for over 6 months were included in the study. The normalized protein catabolic rate (nPCR) was used to reflect daily protein intake. Biochemical markers of nutrition, anthropometric parameters, subjective global assessment (SGA) and functional activity of daily living were assessed to evaluate the nutritional status of vegetarians on chronic HD. Nineteen out of 318 HD patients were vegetarians. The nPCR was lower in the vegetarian group (1.20 ± 0.24 vs 1.10 ± 0.29 g/kg per day, non-Veg vs Veg, P strength evaluated by the hand-grip test, SGA and activities of daily living were similar in vegetarians and non-vegetarians. The present study revealed that HD patients on vegetarian diets might have a smaller BMI, but SGA and function of daily activities were similar to those of the non-vegetarians. The haematocrit of vegetarians can be maintained with a higher erythropoietin dose. © 2011 The Authors. Nephrology © 2011 Asian Pacific Society of Nephrology.

Effectiveness of an educational intervention and physical exercise on the functional capacity of patients on haemodialysis.

Science.gov (United States)

Molina-Robles, Esmeralda; Colomer-Codinachs, Marta; Roquet-Bohils, Marta; Chirveches-Pérez, Emilia; Ortiz-Jurado, Pep; Subirana-Casacuberta, Mireia

2018-03-02

To describe the impact of a standard hospital educational intervention including active physical exercises on personal well-being, functional capacity and knowledge of the benefits of prescribed physical activity for patients undergoing haemodialysis. An uncontrolled, quasi-experimental, before-and-after study with repeated measures of response variables at 4, 8 and 12 weeks after participating in an educational and physical exercise hospital intervention. It was performed at the Nephrology Unit at the Hospital Complex in Vic within september and december 2014. The patients' well-being, functional capacity and knowledge were assessed. Assessment tools: NOC nursing indicators, Barthel index scale, FAC Holden, Timed Get Up and Go test and Daniels scale. We included 68 (80.0%) patients and 58 (85.3%) completed, with a mean age of 70.16±13.5 years; 62.1% were males. After 12 weeks, the patients had better scores of personal well-being (2.33±1.2, 3.88±0.8), more autonomy to perform activities of daily living (Barthel: 92.8±12.8; 93.5±13.9), more muscle strength (Daniels Scale: 3.81±0.7, 4.19±0.6) and walked more briskly (Get Up and Go test: 14.98±8.5; 15.65±10.5). All of the score differences were statistically significant (P<05) except the Barthel Index. The standard educational intervention and active exercise performed at hospital level improved the personal well-being, knowledge and functional capacity of patients on haemodialysis. Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

Assessment of insulin, lectin and vitamin C in chronic renal failure patients before and after haemodialysis

International Nuclear Information System (INIS)

Ahmed, A.M.; El-Yamani, N.A.; Youssif, Z.A.; Abdel-Razik, D.E.

2006-01-01

The present study was carried out to investigate the relative interaction between insulin, leptin and vitamin C in male patients with chronic renal failure and undergo regular haemodialysis (3 times/week). The study was carried out on 20 healthy volunteers as control (group I) and 20 with chronic renal failure (group II) which were studied before dialysis (A) and after dialysis (B). The serum results showed significant increases in creatinine, insulin and leptin levels in patient groups as compared to the control. On the other hand, significant decreases in the levels of glucose and vitamin C were recorded

Cost effectiveness of paricalcitol versus cinacalcet with low-dose vitamin D for management of secondary hyperparathyroidism in haemodialysis patients in the USA.

Science.gov (United States)

Sharma, Amit; Marshall, Thomas S; Khan, Samina S; Johns, Beverly

2014-02-01

The IMPACT SHPT [Improved Management of Intact Parathyroid Hormone (iPTH) with Paricalcitol-Centered Therapy Versus Cinacalcet Therapy with Low-Dose Vitamin D in Hemodialysis Patients with Secondary Hyperparathyroidism] study compared the effectiveness of paricalcitol and cinacalcet in the management of secondary hyperparathyroidism in haemodialysis patients but did not report the costs or cost effectiveness of these treatments. The aim of this study was to compare the cost effectiveness of a paricalcitol-based regimen versus cinacalcet with low-dose vitamin D for management of secondary hyperparathyroidism in haemodialysis patients from a US payer perspective, using a 1-year time horizon. This was a post hoc cost-effectiveness analysis of data collected for US patients enrolled in the IMPACT SHPT study-a 28-week, randomized, open-label, phase 4, multinational study (ClinicalTrials.gov identifier: NCT00977080). Patients eligible for the IMPACT SHPT study were aged≥18 years with stage 5 chronic kidney disease, had been receiving maintenance haemodialysis three times weekly for at least 3 months before screening and were to continue haemodialysis during the study. Only US patients who reached the evaluation period (weeks 21-28) were included in this secondary analysis. US subjects in the IMPACT SHPT study were randomly assigned to receive intravenous paricalcitol, or oral cinacalcet plus fixed-dose intravenous doxercalciferol, for 28 weeks. Patients in the paricalcitol group could also receive supplemental cinacalcet for hypercalcaemia. The primary effectiveness endpoint in the IMPACT SHPT study was the proportion of subjects who achieved a mean intact parathyroid hormone (iPTH) level of 150-300 pg/mL during the evaluation period. In this secondary analysis, we estimated the incremental cost-effectiveness ratio (ICER), comparing paricalcitol-treated patients with cinacalcet-treated patients on the basis of this primary endpoint and several secondary endpoints

Trivalent influenza vaccine in patients on haemodialysis: impaired seroresponse with differences for A-H3N2 and A-H1N1 vaccine components

NARCIS (Netherlands)

W.E.Ph. Beyer (Walter); D.J. Versluis; P. Kramer; P.P.N.M. Diderich (Philip); W. Weimar (Willem); N. Masurel (Nic)

1987-01-01

textabstractOne hundred and one patients on haemodialysis, 21 patients on peritoneal dialysis and 30 healthy controls received a trivalent split vaccine containing 15 micrograms haemagglutinin of a recent influenza A-H3N2, influenza A-H1N1 and influenza B strain, respectively. Antibody production

Effects of haemodialysis on taste for salt in relation to changes in blood constituents.

Science.gov (United States)

Farleigh, C A; Shepherd, R; Jevons, S; Pryor, J S

1987-11-01

Taste sensitivity and preference for sodium chloride in bread and pea soup were assessed before and after haemodialysis in 12 female chronic renal failure patients. Blood samples were also taken pre- and post-dialysis and analysed for zinc, sodium and renin. The patients demonstrated an increased sensitivity to, and decreased preference for, sodium chloride in both bread and pea soup following dialysis. These taste changes were found to correlate with pre- to post-dialysis changes in the zinc levels in the blood. Patients receiving a more severely sodium-restricted diet showed a greater sensitivity to the taste of sodium chloride in the foods tested. Renin levels dropped in all patients following dialysis, the size of the change correlating with the size of the change in body weight.

Renal unit practitioners’ knowledge, attitudes and practice regarding the safety of unfractionated heparin for chronic haemodialysis

Directory of Open Access Journals (Sweden)

Debra Ockhuis

2015-09-01

Full Text Available Background: Chronic haemodialysis for adult patients with end-stage kidney failure requires a patent extracorporeal circuit, maintained by anticoagulants such as unfractionated heparin (UFH. Incorrect administration of UFH has safety implications for patients. Objectives: Firstly, to describe renal practitioners’ self-reported knowledge, attitudes and practice (KAP regarding the safe use of UFH and its effects; secondly, to determine an association between KAP and selected independent variables. Method: A cross-sectional descriptive survey by self-administered questionnaire and non-probability convenience sampling was conducted in two tertiary hospital dialysis units and five private dialysis units in 2013. Results: The mean age of 74/77 respondents (96.1%, was 41.1 years. Most (41/77, 53.2% had 0–5 years of renal experience. The odds of enrolled nurses having poorer knowledge of UFH than registered nurses were 18.7 times higher at a 95% Confidence Interval (CI (1.9–187.4 and statistically significant (P = 0.013. The odds of delivering poor practice having ≤ five years of experience and no in-service education were 4.6 times higher at a 95% CI (1.4–15.6, than for respondents who had ≥ six years of experience (P = 0.014 and 4.3 times higher (95% CI 1.1–16.5 than for respondents who received in-service education (P = 0.032, the difference reaching statistical significance in both cases. Conclusion: Results suggest that the category of the professional influences knowledge and, thus, safe use of UFH, and that there is a direct relationship between years of experience and quality of haemodialysis practice and between having in-service education and quality of practice.

The treatment of secondary hyperparathyroidism in haemodialysis patients' refractory to alfacalcidol

Directory of Open Access Journals (Sweden)

L V Egshatyan

2012-06-01

Full Text Available Background. Secondary hyperparathyroidism (sHPT is one of the serious complications in chronic kidney disease and is associated with progressive bone disease and vascular calcification.The objective of the study was to determine the impact of Mimpara (Cinacalcet HCl on mineral disorder, bone turnover and bone mineral density (BMD versus parathyroidectomy (PTx in haemodialysis patients’ refractory to alfacalcidol. Materials and methods. 62 haemodialysis patients with sHPT were enrolled in this 6=months prospective study. All of them had surgical indications for PTx. Surgical indications was established according to clinical or biological assessment. 40 patients underwent Mimpara treatment. Dose of Mimpara was titrated every 4 weeks. Sequential doses included 30–180 (mean 59.1 ± 34.2 mg/day. 22 patients underwent PTx. The surgical technique was depended on quantity of hyperplastic parathyroid glands.Results. In 6 months mean iPTH, Ca, Са×Р, CTx and OC levels significantly decreased by 55.7%, 13.8%,34.3%, 21.4 and 1.4% in the Mimpara group vs. 90.7%, 14%, 55.5%, 58.7% and 26.9% in the PTx group. Median serum iPTH level decreased by 30% after initiation of Mimpara in 94.3% patients, from them by 50%in 74.3%. Achieved the KDOQI treatment targets for PTH in 28.6% patients.In 6 months after PTx median serum iPTH level was <100 pg/ml in 50% patients, achieved the KDOQI treatment targets in 27.3%, <300 pg/ml in 18.2%. Median serum 25(ОНD after PTx significantly increase by 127.3% vs 6.72% in the Mimpara group. In 6 months active restoration of BMD was found in the PTx patients, and patients treated with Cinacalcet showed stabilization of BMD.Mimpara therapy led to a reduction in glandular volume during the course of the study: in both glands with a baseline volume <500 mm3 and with a baseline volume ≥500 mm3. Conclusions. PTx and Cinacalcet therapy improves phosphorus=calcium homeostasis, bone turnover, but bone resorption and formation

Use of complementary and alternative medicine by patients with end-stage renal disease on haemodialysis in Trinidad: A descriptive study.

Science.gov (United States)

Bahall, Mandreker

2017-05-04

Despite the paucity of scientific evidence, complementary and alternative medicine (CAM) is widely used for the prevention and treatment of illness, holistic care, and counteracting the adverse effects of conventional medicine (CM). This study investigates the use of CAM by patients with end-stage renal disease (ESRD) on haemodialysis. This quantitative study was conducted from November 1, 2014 to December 31, 2014 in the haemodialysis unit at San Fernando General Hospital (San Fernando, Trinidad). Face-to-face questionnaire-based interviews were held with101of 125 eligible patients (response rate, 80.5%) at the chairside during haemodialysis. The completed questionnaires were entered into a secure computer database. Data analysis included descriptive analysis, χ 2 tests, and binary logistic regression analysis. A minority of the patients were CAM users (n = 19; 18.8%). All 19 CAM users took medicinal herbs, 78.9% (n = 15) used spiritual therapy, and 10.5% (n = 2) used alternative systems. Medicinal tea (n = 15; 78.9%), garlic (Allium sativum) (n = 17; 73.7%), and ginger (Zingiber officinale roscoe) (n = 13; 68.4%) were the most commonly used medicinal herbs. Seven (36.8%) patients used Chinese herbal medicines and 3 (15.8%) patients used Aloe vera. All CAM users were willing to use CAM without supervision or monitoring by their doctors while receiving CM. The use of CAM could not be predicted by age, sex, ethnicity, education, religion, marital status, or employment. Nearly all (98%) patients were satisfied with CAM. More than one-third (36.8%) of patients did not disclose their use of CAM to their doctors, who were generally indifferent to such therapy. The use of CAM by patients with ESRD was relatively infrequent. All patients used medicinal herbs, most patients used spiritual therapy, and a minority of patients used alternative systems. Complementary and alternative medicine was primarily used for spiritual reasons and the likelihood of its use

Association of vascular access flow with short-term and long-term mortality in chronic haemodialysis patients: a retrospective cohort study

OpenAIRE

Wu, Chung-Kuan; Wu, Chia-Lin; Lin, Chia-Hsun; Leu, Jyh-Gang; Kor, Chew-Teng; Tarng, Der-Cherng

2017-01-01

Objectives To investigate the impact of vascular access flow (Qa) on vascular and all-cause mortality in chronic haemodialysis (HD) patients. Design Observational cohort study. Setting Single centre. Participants Adult chronic HD patients at the HD unit of Shin Kong Wu Ho-Su Memorial Hospital between 1 January 2003 and 31 December 2003 were recruited. Patients were excluded if they had arteriovenous fistula or arteriovenous graft failure within 3 months before the date of Qa measurement, were...

Ultrasound-Guided Angioplasty of Dysfunctional Vascular Access for Haemodialysis. The Pros and Cons

Energy Technology Data Exchange (ETDEWEB)

García-Medina, J., E-mail: josegmedina57@gmail.com [“Reina Sofia” University Hospital, Vascular and Interventional Radiology Unit, Department of Radiology (Spain); García-Alfonso, J. J., E-mail: juanjozarandieta@gmail.com [University of Murcia, Faculty of Medicine (Spain)

2017-05-15

PurposeTo describe the benefits and the disadvantages of angioplasty in dialysis fistulas using only ultrasound guidance.Materials and MethodsThis is a prospective study in 132 failing or non-maturing arteriovenous accesses that underwent 189 ultrasound-guided balloon angioplasties. The technical success was defined as non-use of X-ray fluoroscopy during the procedure.Results127 procedures (67%) were successfully completed without fluoroscopy. Most failures were due to difficulty to traverse aneurismal segments, as well as anastomotic stenoses. Including initial failures, the primary patency rates at 6, 12 months and 2 years were 75 ± 3, 41 ± 3 and 14 ± 2%, respectively.ConclusionEndovascular repair of the dysfunctional vascular access for haemodialysis under ultrasound guidance is feasible and safe in roughly two-thirds of cases.

The effect of L-carnitine on lipid metabolism in patients on chronic haemodialysis

DEFF Research Database (Denmark)

Yderstræde, Knud Bonnet; Pedersen, Fritz Bangsgaard; Dragsholt, C.

1987-01-01

Twenty-one patients (median 49 years; range 20-72 years) on chronic haemodialysis (median: 54 months; range 16-154 months) were examined in a clinical controlled trial for the effect of carnitine on hyperlipoproteinaemia. Initial values of serum carnitine were within the normal range. Carnitine...... was added to the dialysis fluid to a final concentration of 100 mumol/l. The trial was carried out for 6 months, and the serum of fasting patients was analysed at monthly intervals for carnitine, triglycerides, HDL-cholesterol, LDL-cholesterol and apolipoprotein A and B. The loss of carnitine...... to the dialysis fluid also was examined, as was the retained amount in those receiving carnitine. We could not confirm the findings of others that carnitine produces lowering of serum triglycerides and increases of serum HDL-cholesterol. The study was extended for another year with ten patients; however...

Evidence of improved fluid management in patients receiving haemodialysis following a self-affirmation theory-based intervention: A randomised controlled trial.

Science.gov (United States)

Wileman, Vari; Chilcot, Joseph; Armitage, Christopher J; Farrington, Ken; Wellsted, David M; Norton, Sam; Davenport, Andrew; Franklin, Gail; Da Silva Gane, Maria; Horne, Robert; Almond, Mike

2016-01-01

Haemodialysis patients are at risk of serious health complications; yet, treatment non-adherence remains high. Warnings about health risks associated with non-adherence may trigger defensive reactions. We studied whether an intervention based on self-affirmation theory reduced resistance to health-risk information and improved fluid treatment adherence. In a cluster randomised controlled trial, 91 patients either self-affirmed or completed a matched control task before reading about the health-risks associated with inadequate fluid control. Patients' perceptions of the health-risk information, intention and self-efficacy to control fluid were assessed immediately after presentation of health-risk information. Interdialytic weight gain (IDWG), excess fluid removed during haemodialysis, is a clinical measure of fluid treatment adherence. IDWG data were collected up to 12 months post-intervention. Self-affirmed patients had significantly reduced IDWG levels over 12 months. However, contrary to predictions derived from self-affirmation theory, self-affirmed participants and controls did not differ in their evaluation of the health-risk information, intention to control fluid or self-efficacy. A low-cost, high-reach health intervention based on self-affirmation theory was shown to reduce IDWG over a 12-month period, but the mechanism by which this apparent behaviour change occurred is uncertain. Further work is still required to identify mediators of the observed effects.

Psychosocial factors and adherence to drug treatment in patients on chronic haemodialysis.

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Huertas-Vieco, María P; Pérez-García, Rafael; Albalate, Marta; de Sequera, Patricia; Ortega, Mayra; Puerta, Marta; Corchete, Elena; Alcázar, Roberto

2014-11-17

The daily pill burden in hemodialysis patients is one of the highest reported to date in any chronic disease. The adherence to prescribed treatment has implications on the quality of life, the survival of patients, and the economic cost of their treatment, this being a priority public health issue. To evaluate the adherence to pharmacological treatment examining, among the possible causes of non-adherence, psychosocial factors such as depression, anxiety, cognitive impairment and social support. Transversal-observational study of thirty five patients that suffer from chronic renal disease and who are on manteinance hemodialysis, evaluated by self-reported measures. Non-adherent patients have significant higher depression index than adherent patients. Anxiety, cognitive impairment and social support do not show a significant relation with the degree of adherence or compliance with farmacological treatment. These results suggest that psychological intervention in chronic haemodialysis patients with a severe depression index could increase the degree of fulfillment and general well-being of renal patients.

Nutrition and dietary intake and their association with mortality and hospitalisation in adults with chronic kidney disease treated with haemodialysis: protocol for DIET-HD, a prospective multinational cohort study

NARCIS (Netherlands)

Palmer, S.C.; Ruospo, M.; Campbell, K.L.; Garcia Larsen, V.; Saglimbene, V.; Natale, P.; Gargano, L.; Craig, J.C.; Johnson, D.W.; Tonelli, M.; Knight, J.; Bednarek-Skublewska, A.; Celia, E.; Castillo, D. Del; Dulawa, J.; Ecder, T.; Fabricius, E.; Frazao, J.M.; Gelfman, R.; Hoischen, S.H.; Schon, S.; Stroumza, P.; Timofte, D.; Torok, M.; Hegbrant, J.; Wollheim, C.; Frantzen, L.; Strippoli, G.F.; Steiner, K.; et al.,

2015-01-01

INTRODUCTION: Adults with end-stage kidney disease (ESKD) treated with haemodialysis experience mortality of between 15% and 20% each year. Effective interventions that improve health outcomes for long-term dialysis patients remain unproven. Novel and testable determinants of health in dialysis are

Comparison of Volume Status in Asymptomatic Haemodialysis and Peritoneal Dialysis Outpatients

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Eugenia Papakrivopoulou

2012-03-01

Full Text Available Background: The majority of haemodialysis (HD patients gain weight between dialysis sessions and thereby become volume overloaded, whereas peritoneal dialysis (PD is a more continuous technique. Cardiovascular mortality and hypertension is increased with both treatment modalities. We therefore wished to compare volume status in PD and HD to determine whether PD patients are chronically volume overloaded, as a risk factor for cardiovascular mortality. Study Design, Setting and Participants:We retrospectively audited 72 healthy HD patients and 115 healthy PD patients attending a university hospital dialysis centre for routine outpatient treatment, who had multi-frequency bioimpedance measurements of extracellular water to total body water (ECW/TBW. Results: The groups were well matched for age, sex, weight and ethnicity, PD patients had greater urine output [1,075 (485–1,613 vs. 42.5 (0–1,020 ml/day, p Conclusions: Overhydration is common in healthy stable PD outpatients, and ECW volumes in PD patients are not dissimilar to those of pre-dialysis HD patients. The role of chronic volume overload as a risk factor for cardiovascular disease needs further investigation.

Vascular access and infection prevention and control: a national survey of routine practices in Irish haemodialysis units.

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McCann, Margaret; Clarke, Michael; Mellotte, George; Plant, Liam; Fitzpatrick, Fidelma

2013-04-01

National and international guidelines recommend the use of effective vascular access (VA) and infection prevention and control practices within the haemodialysis environment. Establishing an arterio-venous fistula (AVF) and preventing central venous catheter (CVC)-related infections are ongoing challenges for all dialysis settings. We surveyed VA and routine infection prevention and control practices in dialysis units, to provide national data on these practices in Ireland. A descriptive survey was emailed to nurse managers at all adult (n = 19) and children (n = 1) outpatient haemodialysis units in the Republic of Ireland. Data collected included AVF formation, CVC insertion and maintenance practices, VA use and surveillance of infection and screening protocols. Nineteen of the 20 units responded to the survey. The AVF prevalence was 49% for 1370 patients in 17 units who provided these data [mean prevalence per unit: 45.7% (SD 16.2)]; the CVC mean prevalence per unit was 52.5% (SD 16.0). Fourteen dialysis units experienced inadequate access to vascular surgical procedures either due to a lack of dedicated theatre time or hospital beds. Six units administered intravenous prophylactic antimicrobials prior to CVC insertion with only two units using a CVC insertion checklist at the time of catheter insertion. In general, dialysis units in Ireland show a strong adherence to national guidelines. Compared with the 12 countries participating in the Dialysis Outcomes Practice Patterns Study (DOPPS 4), in 2010, AVF prevalence in Irish dialysis units is the second lowest. Recommendations include establishing an AVF national prevalence target rate, discontinuing the administration of intravenous prophylactic antimicrobials prior to CVC insertion and promoting the use of CVC insertion checklists.

Eco-dialysis: the financial and ecological costs of dialysis waste products: is a 'cradle-to-cradle' model feasible for planet-friendly haemodialysis waste management?

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Piccoli, Giorgina Barbara; Nazha, Marta; Ferraresi, Martina; Vigotti, Federica Neve; Pereno, Amina; Barbero, Silvia

2015-06-01

Approximately 2 million chronic haemodialysis patients produce over 2,000,000 tons of waste per year that includes about 600,000 tons of potentially hazardous waste. The aim of the present study was to analyse the characteristics of the waste that is produced through chronic haemodialysis in an effort to identify strategies to reduce its environmental and financial impact. The study included three dialysis machines and disposables for bicarbonate dialysis, haemodiafiltration (HFR) and lactate dialysis. Hazardous waste is defined as waste that comes into contact with bodily fluids. The weight and cost of waste management was evaluated by various policies of differentiation, ranging from a careful-optimal differentiation to a careless one. The amount of time needed for optimal management was recorded in 30 dialysis sessions. Non-hazardous materials were assessed for potential recycling. The amount of plastic waste that is produced per dialysis session ranges from 1.5 to 8 kg (from 1.1 to 8 kg of potentially hazardous waste), depending upon the type of dialysis machine and supplies, differentiation and emptying policies. The financial cost of waste disposal is high, and is mainly related to hazardous waste disposal, with costs ranging from 2.2 to 16 Euro per session (2.7-21 USD) depending on the waste management policy. The average amount of time needed for careful, optimal differentiation disposal is approximately 1 minute for a haemodialysis session and 2 minutes for HFR. The ecological cost is likewise high: less than one-third of non-hazardous waste (23-28%) is potentially recyclable, while the use of different types of plastic, glues, inks and labels prevents the remaining materials from being recycled. Acknowledging the problem of waste management in dialysis could lead to savings of hundreds of millions of Dollars and to the reuse and recycling of hundreds of tons of plastic waste per year on a world-wide scale with considerable financial and ecological savings

Mycobacterium aquaticum sp. nov., a rapidly growing species isolated from haemodialysis water.

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Hashemi Shahraki, Abdolrazagh; Trovato, Alberto; Droz, Sara; Haidarieh, Parvin; Borroni, Emanuele; Mirsaeidi, Mehdi; Mannino, Roberta; Hashemzadeh, Mohamad; Mariottini, Alessandro; Cirillo, Daniela Maria; Tortoli, Enrico

2017-09-01

The characterization of five Iranian isolates, four from hospital haemodialysis water and one from the sputum of a patient, led to the detection of a novel mycobacterium species. The strains were characterized by mucoid colonies developing in 3-5 days at temperatures ranging from 25 to 37 °C. The biochemical test pattern was unremarkable while the HPLC profile of mycolic acids resembled that of Mycobacterium fortuitum. The sequences of three major housekeeping genes (16S rRNA, hsp65 and rpoB) were unique and differed from those of any other mycobacterium. Mycobacterium brisbanense, which is the species that shared the highest 16S rRNA gene sequence similarity (99.03 %), was distinct, as shown by the average nucleotide identity and by the genome to genome distance values (91.05 and 43.10 %, respectively). The strains are thus considered to represent a novel species of the genus Mycobacterium, for which the name Mycobacterium aquaticum sp. nov. is proposed. The type strain is RW6T (=DSM 104277T=CIP111198T).

Comparison of FLIXENE™ and standard PTFE arteriovenous graft for early haemodialysis.

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Chiang, Nathaniel; Hulme, Katherine Ria; Haggart, Paul Charles; Vasudevan, Thodur

2014-01-01

The purpose is to compare the outcomes of FLIXENE™ arteriovenous graft (AVG) to standard polytetrafluoroethylene (PTFE) AVG for early haemodialysis. This is a prospective observational study of all AVGs placed over a 40-month period between 2008 and 2011 at our vascular unit. Primary outcome was to examine early cannulation rates for FLIXENE™. Secondary outcomes included patency rates, usability of grafts, complications in particular infections, interventions and death in comparison to standard PTFE grafts. Forty-five FLIXENE™ and 19 standard PTFE AVGs were placed in the study period; 89% of FLIXENE™ grafts were used for dialysis, with 78% cannulated within 3 days. At 18 months, primary patency (FLIXENE™ 34% vs standard PTFE 24%), primary assisted patency (35% vs 36%) and secondary patency rate (51% vs 48%) were not statistically different; 20.2% of FLIXENE™ grafts were infected at 18 months requiring explantation compared with 40.3% of standard PTFE grafts (p=0.14). FLIXENE™ can be cannulated for dialysis within 3 days. It has similar patency and complication rates as other prosthetic grafts in the market. In patients who have no access and require urgent dialysis, FLIXENE™ is a viable option.

Risk factors associated with xerostomia in haemodialysis patients.

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López-Pintor, R-M; López-Pintor, L; Casañas, E; de Arriba, L; Hernández, G

2017-03-01

To determine the prevalence of xerostomia and hyposalivation in Haemodialysis (HD) patients, to clarify risk factors, assess patient's quality of life, and to establish a possible correlation among interdialytic weight gain (IDWG) and xerostomia. This study was performed on a group of 50 HD patients. Data were collected using a questionnaire containing demographic and clinical variables, a visual analogue scale (VAS) for xerostomia, IDWG, and an oral health impact profile questionnaire (OHIP-14). Unstimulated whole saliva (UWS) and stimulated whole saliva (SWS) were collected. A total of 28 HD patients (56%) suffered xerostomia. Dry mouth was associated with hypertension (OR, 5.24; 95% CI, 1.11-24.89) and benzodiazepine consumption (OR, 5.96; 95% CI, 1.05-33.99). The mean xerostomia VAS and OHIP-14 scores were 31.74±14.88 and 24.38±11.98, respectively. No significant correlation was observed between IDWG% and VAS and OHIP total score. Nonetheless, a positive correlation between VAS level of thirst and IDWG% was found (r=0.48 p=0.0001). UWS and SWS means (determined in 30 patients) were 0.16±0.17 and 1.12±0.64, respectively. Decreased values of UWS and SWS were reported in 53.33% and 36.66% of HD patients. Xerostomia in HD has a multifactorial aetiology due to accumulative risks as advanced age, systemic disorders, drugs, fluid intake restriction, and salivary parenchymal fibrosis and atrophy. Therefore, it is important to detect possible xerostomia risk factors to treat correctly dry mouth in HD patients and avoid systemic complications.

Haemodialysis prescription, adherence and nutritional indicators in five European countries: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS).

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Hecking, Erwin; Bragg-Gresham, Jennifer L; Rayner, Hugh C; Pisoni, Ronald L; Andreucci, Vittorio E; Combe, Christian; Greenwood, Roger; McCullough, Keith; Feldman, Harold I; Young, Eric W; Held, Philip J; Port, Friedrich K

2004-01-01

The Dialysis Outcomes and Practice Patterns Study (DOPPS) is a prospective, observational study designed to evaluate practice patterns in random samples of haemodialysis facilities and patients across three continents. Participating countries include France, Germany, Italy, Spain and the UK (Euro-DOPPS), Japan and the USA. DOPPS data collection has used the same questionnaires and protocols across all participating countries to assess components of dialysis therapy and outcomes. This study focuses on dialysis prescription, adherence and nutrition among the Euro-DOPPS countries. In each Euro-DOPPS country, patients were selected randomly from 20-21 representative facilities. Simple means and frequencies were calculated to compare relevant data elements to gain insights into differences in therapeutic aspects among nationally representative patients. Participants entering the study within 90 days of beginning dialysis therapy were excluded from these analyses. Among the five countries, mean delivered dose as measured by normalized urea clearance (Kt/V) varied from 1.28 to 1.50 and was accompanied by differences in dialysis prescription components, including blood flow rates, treatment times, and dialyser membrane and flux characteristics. By country, a nearly 2-fold difference was observed in indicators of patient adherence and management (skipping and shortening dialysis, hyperkalaemia, hyperphosphataemia and high interdialytic weight gain). Indicators of malnutrition varied substantially. This study demonstrates differences in the management of haemodialysis patients across Euro-DOPPS and offers opportunities for improving dialysis dose, adherence and nutrition. Correlation of differences in practice patterns at the dialysis unit level with patient outcomes will offer new insights into improving dialysis therapy.

Nutritional parameters as mortality predictors in haemodialysis: Differences between genders.

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

2017-06-01

Malnutrition is common in patients undergoing haemodialysis (HD). Several studies have described different nutritional parameters as mortality predictors but few have studied whether there are differences between genders. This study aimed to evaluate which nutrition parameters may be associated with mortality in patients undergoing long-term HD depending on their gender. Longitudinal prospective multicentre study with 12 months of follow-up. Anthropometric and laboratory measures were obtained from 697 patients. Men who died were older, had lower dry weight, body mass index, potassium, phosphorus and albumin, compared with male patients who survived. Female patients who died had lower albumin and nPCR compared with survivors. Kaplan-Meier analysis displayed a significantly worse survival in patients with albumin mortality was related to body mass index mortality risk continued to be significant after adjustments for age, length of time on dialysis and diabetes for males. However, in women, only albumin persisted as an independent predictor of death. Depending on the gender, different parameters such as protein intake, potassium, phosphorus, body mass index and albumin are associated with mortality in patients undergoing HD. Albumin mortality predictor in both genders, whereas a body mass index <23 kg/m 2 is an independent predictor of death, but only in men. © 2017 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Relations between diabetes, blood pressure and aortic pulse wave velocity in haemodialysis patients

DEFF Research Database (Denmark)

Peters, Christian Daugaard; Kjærgaard, Krista Dybtved; Dzeko, Mirela

(HD) and 32 HD patients with DM (HD+DM). The SphygmoCor system was used for estimation of PWV. HD-duration, age, gender and BP medication were similar in the two groups. Mean DM-duration was 23±11 years and 25(78%) had type 2 DM. HD+DM had higher BMI (26±5 vs. 29±5 kg/m2, p=0.02), systolic BP (142......Diabetes (DM) is common in haemodialysis (HD) patients and affects both blood pressure (BP) and arterial stiffness. Carotid femoral pulse wave velocity (PWV) reflects the stiffness of the aorta and is regarded as a strong risk factor for cardiovascular (CV) mortality in HD patients. However, PWV......±20 vs. 152±21 mmHg, p=0.02) and pulse pressure (65±17 vs. 80±18 mmHg, p2.5 in HD and 12.3±3.1 m/s in HD+DM. The mean PWV difference HD vs. HD+DM was 3.1(1.9-4.3)m/s, p

The management of xerostomia in patients on haemodialysis: comparison of artificial saliva and chewing gum.

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Bots, Casper P; Brand, Henk S; Veerman, Enno C I; Valentijn-Benz, Marianne; Van Amerongen, Barbara M; Nieuw Amerongen, Arie V; Valentijn, Robert M; Vos, Pieter F; Bijlsma, Joost A; Bezemer, Pieter D; ter Wee, Piet M

2005-04-01

Many patients on haemodialysis (HD) therapy suffer from a dry mouth and xerostomia. This can be relieved by mechanical and gustatory stimulation or palliative care. The aim of this crossover study was to investigate the effect and preferences of a sugar-free chewing gum (Freedent White) and a xanthan gum-based artificial saliva (Xialine) in the management of xerostomia in chronic HD patients. Sixty-five HD patients participated in a 6-week crossover trial. The artificial saliva was rated significantly lower than the chewing gum for effectiveness, taste and a global assessment. No preference differences were found for gender and age, although older subjects rated the artificial saliva with a higher mark. Thirty-nine subjects (60%) preferred chewing gum, 15% (n=10) preferred the artificial saliva. Therefore, both chewing gum and artificial saliva could play an important role in the palliative care of xerostomia in HD patients.

Uremic Toxins and Lipases in Haemodialysis: A Process of Repeated Metabolic Starvation

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Bernd Stegmayr

2014-04-01

Full Text Available Severe kidney disease results in retention of uremic toxins that inhibit key enzymes for lipid breakdown such as lipoprotein lipase (LPL and hepatic lipase (HL. For patients in haemodialysis (HD and peritoneal dialysis (PD the LPL activity is only about half of that of age and gender matched controls. Angiopoietin, like protein 3 and 4, accumulate in the uremic patients. These factors, therefore, can be considered as uremic toxins. In animal experiments it has been shown that these factors inhibit the LPL activity. To avoid clotting of the dialysis circuit during HD, anticoagulation such as heparin or low molecular weight heparin are added to the patient. Such administration will cause a prompt release of the LPL and HL from its binding sites at the endothelial surface. The liver rapidly degrades the release plasma compound of LPL and HL. This results in a lack of enzyme to degrade triglycerides during the later part of the HD and for another 3–4 h. PD patients have a similar baseline level of lipases but are not exposed to the negative effect of anticoagulation.

Rationale and design of the HEALTHY-CATH trial: A randomised controlled trial of Heparin versus EthAnol Lock THerapY for the prevention of Catheter Associated infecTion in Haemodialysis patients

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Broom Jennifer K

2009-08-01

Full Text Available Abstract Background Catheter-related bacteraemias (CRBs contribute significantly to morbidity, mortality and health care costs in dialysis populations. Despite international guidelines recommending avoidance of catheters for haemodialysis access, hospital admissions for CRBs have doubled in the last decade. The primary aim of the study is to determine whether weekly instillation of 70% ethanol prevents CRBs compared with standard heparin saline. Methods/design The study will follow a prospective, open-label, randomized controlled design. Inclusion criteria are adult patients with incident or prevalent tunneled intravenous dialysis catheters on three times weekly haemodialysis, with no current evidence of catheter infection and no personal, cultural or religious objection to ethanol use, who are on adequate contraception and are able to give informed consent. Patients will be randomized 1:1 to receive 3 mL of intravenous-grade 70% ethanol into each lumen of the catheter once a week and standard heparin locks for other dialysis days, or to receive heparin locks only. The primary outcome measure will be time to the first episode of CRB, which will be defined using standard objective criteria. Secondary outcomes will include adverse reactions, incidence of CRB caused by different pathogens, time to infection-related catheter removal, time to exit site infections and costs. Prospective power calculations indicate that the study will have 80% statistical power to detect a clinically significant increase in median infection-free survival from 200 days to 400 days if 56 patients are recruited into each arm. Discussion This investigator-initiated study has been designed to provide evidence to help nephrologists reduce the incidence of CRBs in haemodialysis patients with tunnelled intravenous catheters. Trial Registration Australian New Zealand Clinical Trials Registry Number: ACTRN12609000493246

Quality of life, mental health and health beliefs in haemodialysis and peritoneal dialysis patients: Investigating differences in early and later years of current treatment

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Tomaras V

2008-11-01

Full Text Available Abstract Background The study examines differences regarding quality of life (QoL, mental health and illness beliefs between in-centre haemodialysis (HD and continuous ambulatory peritoneal dialysis (CAPD/PD patients. Differences are examined between patients who recently commenced treatment compared to patients on long term treatment. Methods 144 End-Stage Renal Disease (ESRD patients were recruited from three treatment units, of which 135 provided full data on the variables studied. Patients consisted of: a 77 in-centre haemodialysis (HD and 58 continuous ambulatory peritoneal dialysis (CAPD/PD patients, all currently being treated by dialysis for varied length of time. Patients were compared for differences after being grouped into those who recently commenced treatment ( 4 years. Next, cases were selected as to form two equivalent groups of HD and CAPD/PD patients in terms of length of treatment and sociodemographic variables. The groups consisted of: a 41 in-centre haemodialysis (HD and b 48 continuous ambulatory peritoneal dialysis (CAPD/PD patients, fitting the selection criteria of recent commencement of treatment and similar sociodemographic characteristics. Patient-reported assessments included: WHOQOL-BREF, GHQ-28 and the MHLC, which is a health locus of control inventory. Results Differences in mean scores were mainly observed in the HD patients with > 4 years of treatment, providing lower mean scores in the QoL domains of physical health, social relationships and environment, as well as in overall mental health. Differences in CAPD/PD groups, between those in early and those in later years of treatment, were not found to be large and significant. Concerning the analysis on equivalent groups derived from selection of cases, HD patients indicated significantly lower mean scores in the QoL domain of environment and higher scores in the GHQ-28 subscales of anxiety/insomnia and severe depression, indicating more symptoms in these areas

Two years experience with tunneled dialysis catheters in patients requiring haemodialysis

International Nuclear Information System (INIS)

Raheem, A.; Rana, A. I.; Ramzan, M.; Shah, R. A.; Mehmood, S. N.; Naseem, S.

2014-01-01

Objective: To look for survival rate and major reasons behind the failure of tunnelled dialysis catheters in patients on haemodialysis. Methods: The retrospective study was conducted at the Department of Interventional Radiology, Shifa International Hospital, Islamabad, and comprised records of 100 consecutive subjects from a list of patients in whom tunnelled cuffed catheters were placed from February 2009 to January 2011 and were followed up for two years. Data was collected on a proforma from the hospital database and medical records of patients. SPSS 19 was used for statistical analysis. Results: Of the total 122 catheters placed in 100 patients, 49(40.16%) were lost to follow-up. Of the remaining 73(59.83%) catheters, 38(52%) had achieved their desired function, while 35(48%) failed to achieve the target duration. Among the reasons of catheter failure, infection was the commonest at 13(37.14%) with infection rate of 0.24 per 1000 catheter days. According to Kaplan Meier analysis, catheter survival rates at 60, 90 and 180 days were 89%, 77% and 64% respectively. Mean effective duration of catheter was 129+-117 days. Conclusion: Tunnelled dialysis catheters can be safely used as vascular access till the maturation of fistula and may be an alternative to Arterio-Venous Fistula or graft for long-term vascular access if indicated. (author)

Quality of life and well-being of people receiving haemodialysis treatment in Scotland: a cross-sectional survey.

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Alshraifeen, Ali; McCreaddie, May; Evans, Josie M M

2014-10-01

End-stage renal disease is a complex, progressive and debilitating illness that affects patients' quality of life, physical and mental health, well-being, social functioning and emotional health. A cross-sectional survey was carried out in renal dialysis centres in Scotland to assess patients' health status and the impact of haemodialysis treatment on quality of life and well-being. Participants scored considerably lower than the UK general population in all domains of health-related quality of life, although mental health components were nearer to general population norms than physical health components. However, nearly half of the participants achieved a score on a general well-being questionnaire that was indicative of stress and anxiety. Increasing age was associated with better overall mental health but worse physical functioning. Increasing levels of hope and support were associated with improved general well-being. © 2013 Wiley Publishing Asia Pty Ltd.

Usefulness of questionnaires on advance directives in haemodialysis units.

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Jornet, Angel Rodríguez; Castellanos, Loreley Ana Betancourt; Contador, Maria Isabel Bolós; Morera, Juan Carlos Oliva; López, José Antonio Ibeas

2017-10-01

As renal replacement therapy has become universal practice in medicine, there is a need to consider whether this treatment is suitable for elderly people. These patients have high comorbidity and may require dialysis withdrawal in certain clinical circumstances. Advance directives (ADs) drawn up by patients facilitate treatment-related decisions if they lose cognitive capacity. Questionnaires dealing with possible extreme clinical circumstances can thus help clinicians and relatives reach pertinent decisions in such cases. We studied the usefulness of questionnaires on ADs in patients who started periodic haemodialysis over a period of 10 years. Telephone interviews were conducted to assess satisfaction level among relatives/representatives of deceased patients who had been advised to limit therapeutic efforts in certain clinical situations. The questionnaire was assessed using a six-factor degree of satisfaction. Four hundred and forty-three questionnaires were distributed over a period of 10 years. A total of 41.3% of patients stated that they wished to limit therapeutic efforts in the serious clinical situations presented; 37.9% refused to complete the questionnaire; 14.7% expressed their wishes without any written confirmation; and 6.1% expressed their wish to continue on dialysis in all situations. Two hundred and twenty-four patients had died by the study end date. The cause of death in 20.2% was scheduled dialysis withdrawal. Representatives reported an extremely high degree of satisfaction with the questionnaire (94.7%). Younger people, however, were more reluctant to consider and answer questionnaires on ADs. Questionnaires on ADs are a useful tool in daily nephrology practice and should be distributed to those patients willing to consider the limitation of therapeutic efforts in extreme clinical circumstances. In general terms, these questionnaires should be given to all elderly patients. © The Author 2017. Published by Oxford University Press on

Thyroid hormone levels in patients with chronic renal failure under haemodialysis

International Nuclear Information System (INIS)

Khalid, Ahmed Shukralla M.

1998-06-01

This study was conducted with three main objectives, to study thyroid hormones (T 4 , T 3 ) and TSH levels in patients with CRF under haemodialysis and to compare them with normal subjects, to study best means of treatment and to compare these findings with results from other parts of the world. This study was done on 61 patients with renal failure in Khartoum dialysis and kidney transplant centre U of K, 45 males and 16 females with ages ranging from 17-75 years and 42 symptoms-free subjects 14 males and 23 females with age ranging from 16-60 years. The radioimmunoassay (RIA) technique was used for the determination of serum T 4 , T 3 and TSH. By using t-test found that the mean concentrations of T 4 , T 3 of normal subjects were much higher than those of the patients (p 0.05). These results also illustrated that 45.9% of patients with renal failure of low T 4 , and 91.8%, 90.26 of patients had T 3 and TSH hormone levels in the normal range, respectively. No significant difference was observed in the mean of thyroid hormones (T 4 , T 3 ) and thyroid-stimulating hormones between males and females (p>0.05). The T 3 and T '4 concentrations in patients at all age groups (year) was less than the age groups of the control group, and this decrease was statistically significant (p 0.05).(Author)

Non-matured arteriovenous fistulae for haemodialysis: diagnosis, endovascular and surgical treatment

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Marko Malovrh

2010-04-01

Full Text Available Non-maturation is a feature of autologous vascular access. The autologous arteriovenous fistula needs time to mature and for the vein to enlarge to a size where it can be needled for dialysis. A fistula that fails early is one that either never develops adequately to support dialysis or fails within the first three months of its use. Two variables are required for fistula maturation. Firstly, the fistula should have adequate blood flow to support dialysis and secondly, it should have enough size to allow for successful repetitive cannulation. Three main reasons for maturation failure are: arterial and venous problems and the presence of accessory veins. Early diagnostics and intervention for fistula maturation minimizes catheter use and its associated complications. The identification of immature fistulae is relatively simple. Physical examination has been highlighted to be a valuable tool in assessing fistula. Any fistula that fails to mature adequately and demonstrates abnormal physical findings should be studied aggressively. Ultrasonography can successfully identify candidates who fail to meet the recently developed criteria for immature fistulae. In recent years, digital subtraction angiography and contrast-enhanced magnetic resonance angiography has been introduced for assessment of dysfunctional haemodialysis conduits, including immature fistulae. A great majority of non-matured fistulae can be successfully salvaged using percutaneous techniques. In addition to endovascular techniques, surgical intervention can also be an option. This paper reviews the process of fistula maturation and presents information regarding how to obtain a mature fistula.

Cephalic Arch Stenosis in Autogenous Haemodialysis Fistulas: Treatment With the Viabahn Stent-Graft

International Nuclear Information System (INIS)

Shawyer, Andrew; Fotiadis, Nicos I.; Namagondlu, Girish; Iyer, Arun; Blunden, Mark; Raftery, Martin; Yaqoob, Magdi

2013-01-01

Cephalic arch stenosis (CAS) is an important and common cause of dysfunction in autogenous haemodialysis fistulas that requires multiple reinterventions and aggressive surveillance. We evaluated the safety and efficacy of the Viabahn stent-graft for the management of CAS. Between April 2005 and October 2011, 11 consecutive patients [four men and seven women (mean age 56.7 years)] with CAS and dysfunctional fistulas were treated with insertion of 11 Viabahn stent-grafts. Six stent-grafts were inserted due to residual stenosis after angioplasty and five for fistuloplasty-induced rupture. No patient was lost to follow-up. The technical and clinical success rate was 100 %. Primary access patency rates were 81.8 % [95 % confidence interval (CI) 0.482–0.977] at 6 months and 72.7 % (95 % CI 0.390–0.939) at 12 months. Secondary access patency rates were 90.9 % at 6 months (95 % CI 0.587–0.997). There were no procedure-related complications. Mean follow-up was 543.8 days (range 156–2,282). The use of the Viabahn stent-graft in the management of CAS is technically feasible and, in this small series, showed patency rates that compare favorably with historical data of angioplasty and bare stents.

Cephalic Arch Stenosis in Autogenous Haemodialysis Fistulas: Treatment With the Viabahn Stent-Graft

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Shawyer, Andrew, E-mail: andrew.shawyer@bartsandthelondon.nhs.uk [The Royal London Hospital, Radiology Department (United Kingdom); Fotiadis, Nicos I., E-mail: fotiadis.nicholas@gmail.com [Royal Marsden Hospital, Radiology Department, The Royal Marsden NHS Foundation Trust (United Kingdom); Namagondlu, Girish, E-mail: girish.namagondlu@bartsandthelondon.nhs.uk [The Royal London Hospital, Renal Medicine Department (United Kingdom); Iyer, Arun, E-mail: arun.iyer@bartsandthelondon.nhs.uk [The Royal London Hospital, Radiology Department (United Kingdom); Blunden, Mark, E-mail: mark.blunden@bartsandthelondon.nhs.uk; Raftery, Martin, E-mail: martin.raftery@bartsandthelondon.nhs.uk; Yaqoob, Magdi, E-mail: magdi.yaqoob@bartsandthelondon.nhs.uk [The Royal London Hospital, Renal Medicine Department (United Kingdom)

2013-02-15

Cephalic arch stenosis (CAS) is an important and common cause of dysfunction in autogenous haemodialysis fistulas that requires multiple reinterventions and aggressive surveillance. We evaluated the safety and efficacy of the Viabahn stent-graft for the management of CAS. Between April 2005 and October 2011, 11 consecutive patients [four men and seven women (mean age 56.7 years)] with CAS and dysfunctional fistulas were treated with insertion of 11 Viabahn stent-grafts. Six stent-grafts were inserted due to residual stenosis after angioplasty and five for fistuloplasty-induced rupture. No patient was lost to follow-up. The technical and clinical success rate was 100 %. Primary access patency rates were 81.8 % [95 % confidence interval (CI) 0.482-0.977] at 6 months and 72.7 % (95 % CI 0.390-0.939) at 12 months. Secondary access patency rates were 90.9 % at 6 months (95 % CI 0.587-0.997). There were no procedure-related complications. Mean follow-up was 543.8 days (range 156-2,282). The use of the Viabahn stent-graft in the management of CAS is technically feasible and, in this small series, showed patency rates that compare favorably with historical data of angioplasty and bare stents.

Colour Doppler ultrasound assessment of well-functioning mature arteriovenous fistulas for haemodialysis access

International Nuclear Information System (INIS)

Pietura, Radoslaw; Janczarek, Marzena; Zaluska, Wojciech; Szymanska, Anna; Janicka, Lucyna; Skublewska-Bednarek, Anna; Szczerbo-Trojanowska, Malgorzata

2005-01-01

Background: A well-functioning mature arteriovenous fistula is essential for the maintenance of haemodialysis in patients with chronic renal failure. The Brescia-Cimino arteriovenous fistula has the best survival characteristics and low rate of complications. The most common reason of fistula failure is thrombosis caused by stenosis. Colour 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 arteriovenous fistula complications. However, only limited data are available about the well-functioning mature arteriovenous fistulas. The purpose of the present study was to evaluate completely asymptomatic, mature arteriovenous fistulas with colour Doppler ultrasound. Materials and methods: From July 2001 to April 2003, we examined 139 patients with the end-stage renal disease. They were in the range of 19-79 years of age (mean, 46.7 years). The study included only the patients who met the following criteria: (1) no difficulties with haemodialysis (as reported by nurses); (2) normal venous diastolic blood pressure (<150 mmHg) at monthly evaluation; (3) normal urea clearance x time/urea volume of distribution; (4) blood cells count, plasma electrolytes, and liver function at monthly evaluation. The mean fistula age was 26 months (S.D. = 21.9). The mean time of dialysis therapy was 49 months. Thirty-eight percent patients had primary fistulas, 23%-secondary, 11%-third and 11%-fourth, 4%-fifth, 5%-sixth, and 8% patients had more than sixth. Results: There was no correlation between: (1) patient's age and fistula age; (2) patient's age and number of fistulas in one patient; (3) fistula age and number of fistulas in one patient; (4) localization of fistula and fistula age. There was a strong correlation between dialysis therapy period and number of fistulas in one patient. The mean flow volume was 1204.1 ml/min (S.D. = 554). It was significantly higher in the

Investigations of the folic acid content in plasma and erythrocytes by RIA, with special regard to the effects of oral contraceptives, chronic alcohol abuse, and constant haemodialysis

International Nuclear Information System (INIS)

Poblotzki, E.

1978-01-01

With the aid of a new radioassay using 3 H folic acid as tracer and folic acid as standard, 500 folic acid as tracer and folic acid as standard, 500 folic acid measurements have been carried out in plasma and in the erythrocytes of normal persons and patients with chronic alcoholism, haemodialysis patients, patients with idiopathic sprue, and women taking oral contraceptives. According to the findings, folic acid therapy seems to be necessary in chronic alcoholics, patients with renal insufficiency under constant haemolysis, and in patients with idiopathic sprue. (AJ) [de

Impaired exercise performance and muscle Na(+),K(+)-pump activity in renal transplantation and haemodialysis patients.

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Petersen, Aaron C; Leikis, Murray J; McMahon, Lawrence P; Kent, Annette B; Murphy, Kate T; Gong, Xiaofei; McKenna, Michael J

2012-05-01

We examined whether abnormal skeletal muscle Na(+),K(+)-pumps underlie impaired exercise performance in haemodialysis patients (HDP) and whether these are improved in renal transplant recipients (RTx). Peak oxygen consumption ( O(2peak)) and plasma [K(+)] were measured during incremental exercise in 9RTx, 10 HDP and 10 healthy controls (CON). Quadriceps peak torque (PT), fatigability (decline in strength during thirty contractions), thigh muscle cross-sectional area (TMCSA) and vastus lateralis Na(+),K(+)-pump maximal activity, content and isoform (α(1)-α(3), β(1)-β(3)) abundance were measured. O(2peak) was 32 and 35% lower in RTx and HDP than CON, respectively (P Na(+),K(+)-pump activity was 28 and 31% lower in RTx and HDP, respectively than CON (P Na(+),K(+)-pump activity (r = 0.45, P = 0.02). O(2peak) and muscle Na(+),K(+)-pump activity were depressed and muscle fatigability increased in HDP, with no difference observed in RTx. These findings are consistent with the possibility that impaired exercise performance in HDP and RTx may be partially due to depressed muscle Na(+),K(+)-pump activity and relative TMCSA.

Haemodialysis for post-traumatic acute renal failure - factors predicting outcome.

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Machemehl, Thomas; Hsu, Peter; Pahad, Hussein; Williams, Paul; Yilmaz, Tugba H; Vassiliu, Pantelis; Boffard, Kenneth D; Degiannis, Elias; Doll, Dietrich

2013-07-29

Post-traumatic acute renal failure requiring renal replacement therapy in an intensive care unit (ICU) is associated with high mortality. To assess indicators of improved survival. This was a retrospective cohort study of 64 consecutive trauma patients (penetrating and blunt trauma and burns) who underwent haemodialysis (HD) over a period of 5 years. Information on pre-hospital and in-hospital resuscitation, trauma scores and physiological scores and daily ICU records were collected. The majority of the patients were dialysed with continuous venovenous haemofiltration in the early years of the study and later with sustained low-efficiency dialysis. Of the 64 patients 47 died, giving an overall mortality rate of 73%. Mortality was highest in the burns patients (84%). Survival in all patients, irrespective of injury, was unrelated to the Revised Trauma Score, Injury Severity Score, Acute Physiology and Chronic Health Evaluation Score or Trauma Injury Severity Score. The duration of HD did not differ significantly between the three trauma groups, and age was not a significant predictor of survival. Patients who were polyuric at the time of the initiation of HD had a lower mortality rate than those who were oliguric, anuric or normouric, although this did not reach statistical significance (p=0.09). Acute renal failure in trauma patients is associated with a low survival rate. Controversial conclusions have been presented in the literature. In this study, none of the parameters previously reported to affect survival proved to be valid, although the number of patients was comparable with those in other studies. Since understanding of the predictors and course of renal failure in trauma patients is still at an early stage, there is a need for multicentre prospective studies.

Streptococcus uberis and Staphylococcus aureus forefoot and blood stream co-infection in a haemodialysis patient: a case report.

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Valentiny, Christine; Dirschmid, Harald; Lhotta, Karl

2015-05-28

Streptococcus uberis, the most frequent cause of mastitis in lactating cows, is considered non-pathogenic for humans. Only a few case reports have described human infections with this microorganism, which is notoriously difficult to identify. We report the case of a 75-year-old male haemodialysis patient, who developed a severe foot infection with osteomyelitis and bacteraemia. Both Streptococcus uberis and Staphylococcus aureus were identified in wound secretion and blood samples using mass spectrometry. The presence of Streptococcus uberis was confirmed by superoxide dismutase A sequencing. The patient recovered after amputation of the forefoot and antibiotic treatment with ampicillin/sulbactam. He had probably acquired the infection while walking barefoot on cattle pasture land. This is the first case report of a human infection with Streptococcus uberis with identification of the microorganism using modern molecular technology. We propose that Staphylococcus aureus co-infection was a prerequisite for deep wound and bloodstream infection with Streptococcus uberis.

Assessing the Association between Serum Ferritin, Transferrin Saturation, and C-Reactive Protein in Northern Territory Indigenous Australian Patients with High Serum Ferritin on Maintenance Haemodialysis

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Sandawana William Majoni

2017-01-01

Full Text Available Objective. To determine the significance of high serum ferritin observed in Indigenous Australian patients on maintenance haemodialysis in the Northern Territory, we assessed the relationship between ferritin and transferrin saturation (TSAT as measures of iron status and ferritin and C-reactive protein (CRP as markers of inflammation. Methods. We performed a retrospective cohort analysis of data from adult patients (≥18 years on maintenance haemodialysis (>3 months from 2004 to 2011. Results. There were 1568 patients. The mean age was 53.9 (11.9 years. 1244 (79.3% were Indigenous. 44.2% (n=693 were male. Indigenous patients were younger (mean age [52.3 (11.1 versus 57.4 (15.2, p<0.001] and had higher CRP [14.7 mg/l (7–35 versus 5.9 mg/l (1.9–17.5, p<0.001], higher median serum ferritin [1069 µg/l (668–1522 versus 794.9 µg/l (558.5–1252.0, p<0.001], but similar transferrin saturation [26% (19–37 versus 28% (20–38, p=0.516]. We observed a small positive correlation between ferritin and TSAT (r2=0.11, p<0.001, no correlation between ferritin and CRP (r2 = 0.001, p<0.001, and positive association between high serum ferritin and TSAT (p<0.001, Indigenous ethnicity (p<0.001, urea reduction ratio (p=0.001, and gender (p<0.001 after adjustment in mixed regression analysis. Conclusion. Serum ferritin and TSAT may inadequately reflect iron status in this population. The high ferritin was poorly explained by inflammation.

Phosphate, urea and creatinine clearances: haemodialysis adequacy assessed by weekly monitoring.

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Debowska, Malgorzata; Wojcik-Zaluska, Alicja; Ksiazek, Andrzej; Zaluska, Wojciech; Waniewski, Jacek

2015-01-01

The specific distribution of phosphate and the control mechanisms for its plasma level makes phosphate kinetics during haemodialysis (HD) considerably different from those of urea and creatinine and makes the quantitative evaluation of adequacy of phosphate removal difficult. We propose the application of equivalent continuous clearance (ECC) as a phosphate adequacy parameter and compare it with ECC for creatinine and urea. Three consecutive dialysis sessions were evaluated for 25 patients on maintenance HD. Concentrations of phosphate, urea and creatinine in plasma were measured every 1h during the treatment and 45 min after, and every 30 min in dialysate. ECC was calculated using the removed solute mass assessed in dialysate and weekly solute profile in plasma. Similar calculations were performed also for the midweek dialysis session only. Different versions of the reference concentration for ECC were applied. ECC with peak average reference concentration was 5.4 ± 1.0 for phosphate, 7.0 ± 1.0 for urea and 4.7 ± 1.0 mL/min for creatinine. ECC for urea and creatinine were well correlated in contrast to the correlations of ECC for phosphate versus urea and creatinine. Midweek ECC were higher than weekly ECC, but they were well correlated for urea and creatinine, but only weakly for phosphate. HD adequacy monitoring for phosphate may be performed using ECC, but it is less predictable than similar indices for urea and creatinine. The values of ECC for phosphate are within the range expected for its molecular size compared with those for urea and creatinine. © The Author 2014. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Improving distress in dialysis (iDiD): a feasibility two-arm parallel randomised controlled trial of an online cognitive behavioural therapy intervention with and without therapist-led telephone support for psychological distress in patients undergoing haemodialysis.

Science.gov (United States)

Hudson, Joanna L; Moss-Morris, Rona; Game, David; Carroll, Amy; McCrone, Paul; Hotopf, Matthew; Yardley, Lucy; Chilcot, Joseph

2016-04-12

Psychological distress is common in end-stage kidney disease (ESKD) and is associated with poorer health outcomes. Cognitive behavioural therapy (CBT) is recommended in UK clinical guidelines for the management of depression in people with long-term conditions. Access to skilled therapists competent in managing the competing mental and physical health demands of ESKD is limited. Online CBT treatments tailored to the needs of the ESKD population offers a pragmatic solution for under-resourced services. This study examines the feasibility and acceptability of implementing a two-arm parallel randomised controlled trial of online CBT with (intervention arm) and without (control arm) therapist support to improve psychological distress in patients undergoing haemodialysis. Patients will be screened for depression and anxiety while attending for their haemodialysis treatments. We aim to recruit 60 adult patients undergoing haemodialysis who meet criteria for mild to moderately severe symptoms of depression and/or anxiety. Patients will be randomised individually (using a 1:1 computerised sequence ratio) to either online CBT with therapist telephone support (intervention arm), or online CBT with no therapist (control arm). Outcomes include feasibility and acceptability descriptive data on rates of recruitment, randomisation, retention and treatment adherence. Self-report outcomes include measures of depression (Patient Health Questionnaire-9), anxiety (Generalised Anxiety Disorder-7), quality of life (Euro-QoL), service use (client service receipt inventory) and illness cognitions (brief illness perception questionnaire). A qualitative process evaluation will also be conducted. The statistician will be blinded to treatment allocation. A National Health Service (NHS) research ethics committee approved the study. Data from this study will provide essential information for the design and testing of further interventions to ameliorate distress in patients undergoing dialysis

Midterm Experience of Ipsilateral Axillary-Axillary Arteriovenous Loop Graft as Tertiary Access for Haemodialysis

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J. P. Hunter

2014-01-01

Full Text Available Objectives. To present a series of ipsilateral axillary artery to axillary vein loop arm grafts as an alternative vascular access procedure for haemodialysis in patients with difficult access. Design. Retrospective case series. Methods. Patients who underwent an axillary loop arteriovenous graft from September 2009 to September 2012 were included. Preoperative venous imaging to exclude central venous stenosis and to image arm/axillary veins was performed. A cuffed PTFE graft was anastomosed to the distal axillary artery and axillary vein and looped on the arm. Results. 25 procedures were performed on 22 patients. Median age was 51 years, with 9 males and 13 females. Median number of previous access procedures was 3 (range 0–7. Median followup was 16.4 months (range 1–35. At 3 months and 1 year, the primary and secondary patency rates were 70% and 72% and 36% and 37%, respectively. There were 11 radiological interventions in 6 grafts including 5 angioplasties and 6 thrombectomies. There were 19 surgical procedures in 10 grafts, including thrombectomy, revision, repair for bleeding, and excision. Conclusions. Our series demonstrates that the axillary loop arm graft yields acceptable early patency rates in a complex group of patients but to maintain graft patency required high rates of surgical and radiological intervention, in particular graft thrombectomy.

Effects of angiotensin II blockade on intermediate cardiovascular endpoints in haemodialysis patients: a randomised double-blind placebo-controlled one-year intervention trial (SAFIR study)

DEFF Research Database (Denmark)

Peters, Christian Daugaard; Kjærgaard, Krista Dybtved; Jensen, Jens Dam

Agents blocking the renin-angiotensin-aldosterone system are frequently used in end-stage renal disease patients, but whether they exert beneficial cardiovascular (CV) effects is unclear. The long-term effects of the angiotensin II receptor blocker irbesartan was investigated in 82 haemodialysis...... renal function. Brachial BP decreased significantly in both groups, but there was no significant difference between placebo and irbesartan treated. Use of additional antihypertensive medication, ultrafiltration volume, and dialysis dosage were not different in the two groups. Intermediate CV endpoints...... such as central aortic BP, carotid-femoral pulse wave velocity, left ventricular mass index, N-terminal prohormone of brain natriuretic peptide, heart rate variability, and plasma catecholamines were not significantly affected by irbesartan treatment. Changes in systolic BP during the study period correlated...

The carbon footprint of an Australian satellite haemodialysis unit.

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Lim, Allan E K; Perkins, Anthony; Agar, John W M

2013-06-01

This study aimed to better understand the carbon emission impact of haemodialysis (HD) throughout Australia by determining its carbon footprint, the relative contributions of various sectors to this footprint, and how contributions from electricity and water consumption are affected by local factors. Activity data associated with HD provision at a 6-chair suburban satellite HD unit in Victoria in 2011 was collected and converted to a common measurement unit of tonnes of CO2 equivalents (t CO2-eq) via established emissions factors. For electricity and water consumption, emissions factors for other Australian locations were applied to assess the impact of local factors on these footprint contributors. In Victoria, the annual per-patient carbon footprint of satellite HD was calculated to be 10.2t CO2-eq. The largest contributors were pharmaceuticals (35.7%) and medical equipment (23.4%). Throughout Australia, the emissions percentage attributable to electricity consumption ranged from 5.2% to 18.6%, while the emissions percentage attributable to water use ranged from 4.0% to 11.6%. State-by-state contributions of energy and water use to the carbon footprint of satellite HD appear to vary significantly. Performing emissions planning and target setting at the state level may be more appropriate in the Australian context. What is known about the topic? Healthcare provision carries a significant environmental footprint. In particular, conventional HD uses substantial amounts of electricity and water. In the UK, provision of HD and peritoneal dialysis was found to have an annual per-patient carbon footprint of 7.1t CO2-eq. What does this paper add? This is the first carbon-footprinting study of HD in Australia. In Victoria, the annual per-patient carbon footprint of satellite conventional HD is 10.2t CO2-eq. Notably, the contributions of electricity and water consumption to the carbon footprint varies significantly throughout Australia when local factors are taken into

Incidencia y tipo de efectos adversos durante el procedimiento de hemodiálisis Incidence and type of adverse effects during the haemodialysis procedure

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Estela María Matarán Robles

2013-03-01

organizations. Objective: To describe the incidence and types of adverse effects deriving from haemodialysis in a nephrology unit. Methodology: Design: Transversal study in 28-bed haemodialysis unit. Variables: as a dependent variable, the present of adverse effects and typology was considered, using the International Classification for Patient Safety. Statistical analyses: a description of the sample was carried out, using graphs (histograms, bar diagrams, and dispersion diagrams and also percentages, means, standard deviations, medians, etc. Results: During the period studied a total of 4797 haemodialysis procedures were carried out, with adverse effects arising in a total of 681 sessions, which represents an incidence rate of 141.96 per 1000 dialyses. As far as severity is concerned, 97.5% of the adverse effects were classified as mild, compared to 1.8% and 0.7% which were considered moderate and serious, respectively. Conclusions: Our incidence rate and severity of adverse effects is similar to other centres. This study lets us identify safety problems in our Unit and in a second phase establish a joint protocol which will allow us to reduce the current incident rate. Hypotension was the most common adverse effect.

UK National Survey of Practice Patterns of Fluid Volume Management in Haemodialysis Patients: A Need for Evidence.

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Dasgupta, Indranil; Farrington, Ken; Davies, Simon J; Davenport, Andrew; Mitra, Sandip

2016-01-01

Fluid management in haemodialysis (HD) affects patient experience, morbidity and mortality. Standards for best practice are lacking. A national survey of the United Kingdom was undertaken to define prevalent practice. An online questionnaire was distributed to all UK renal centres. Forty-five of 74 centres (173 dialysis units), serving 62% (n = 14,697) of UK HD population responded. Seventy-eight per cent had no agreed policy for managing fluid balance in patients on HD; 44% did not assess fluid status routinely. Clinical assessment was the norm; 27% used bio-impedance-based device. To achieve a target-weight, 53% reduced weight as far as tolerated. Twenty-two per cent measured residual renal function (RRF). Ninety-one per cent had no policy for fluid overload. Sixty-four per cent restricted salt and water. Ninety-three per cent used diuretics in patients with RRF. Thirty-eight per cent felt management was adequate; 77% felt there was a need for better evidence. Ninety-one per cent would participate in a study addressing this. There is an urgent need for establishing an evidence base on the optimal approaches to fluid management. © 2016 S. Karger AG, Basel.

Anti-parathyroid treatment effectiveness and persistence in incident haemodialysis patients with secondary hyperparathyroidism.

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de Francisco, Angel Luis Martín; Gillespie, Iain Andrew; Gioni, Ioanna; Floege, Jürgen; Kronenberg, Florian; Marcelli, Daniele; Wheeler, David Collins; Froissart, Marc; Drueke, Tilman Bernhard

2016-01-01

Anti-parathyroid treatment initiation and discontinuation are important decisions in chronic haemodialysis (HD) patients, where pill burden is often excessive. The present study aimed to describe secondary hyperparathyroidism (sHPT) drug therapy changes in HD patients. Retrospective observational cohort study of incident European HD patients with sHPT who were prescribed calcitriol or alfacalcidol (alpha calcitriol), paricalcitol or cinacalcet. Treatment-naïve patients prescribed alpha calcitriol (N=2259), paricalcitol (N=1689) and cinacalcet (N=1245) were considered for analysis. Serum intact parathyroid hormone (iPTH) levels decreased post-initiation with all treatment modalities; serum calcium and phosphate levels increased in response to activated vitamin D derivatives but decreased with cinacalcet. Approximately one-third of alpha calcitriol and paricalcitol patients but less than one-quarter of cinacalcet patients discontinued treatment. Although the three groups had comparable serum iPTH control at the time of treatment discontinuation, they differed in terms of calcium and phosphate levels. Following discontinuation, the evolution of laboratory parameters differed by treatment modality: whilst iPTH increased for all three treatment groups, calcium and phosphate decreased in patients who were being treated with alpha calcitriol and paricalcitol at the time of discontinuation, and increased in those who had been treated with cinacalcet. In conditions of daily clinical practice, attaining and maintaining recommended biochemical control of sHPT appears to be more frequently achievable with cinacalcet than with activated vitamin D compounds. Copyright © 2015 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

Clinicians' and researchers' perspectives on establishing and implementing core outcomes in haemodialysis: semistructured interview study.

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Tong, Allison; Crowe, Sally; Gill, John S; Harris, Tess; Hemmelgarn, Brenda R; Manns, Braden; Pecoits-Filho, Roberto; Tugwell, Peter; van Biesen, Wim; Wang, Angela Yee Moon; Wheeler, David C; Winkelmayer, Wolfgang C; Gutman, Talia; Ju, Angela; O'Lone, Emma; Sautenet, Benedicte; Viecelli, Andrea; Craig, Jonathan C

2018-04-20

To describe the perspectives of clinicians and researchers on identifying, establishing and implementing core outcomes in haemodialysis and their expected impact. Face-to-face, semistructured interviews; thematic analysis. Twenty-seven centres across nine countries. Fifty-eight nephrologists (42 (72%) who were also triallists). We identified six themes: reflecting direct patient relevance and impact (survival as the primary goal of dialysis, enabling well-being and functioning, severe consequences of comorbidities and complications, indicators of treatment success, universal relevance, stakeholder consensus); amenable and responsive to interventions (realistic and possible to intervene on, differentiating between treatments); reflective of economic burden on healthcare; feasibility of implementation (clarity and consistency in definition, easily measurable, requiring minimal resources, creating a cultural shift, aversion to intensifying bureaucracy, allowing justifiable exceptions); authoritative inducement and directive (endorsement for legitimacy, necessity of buy-in from dialysis providers, incentivising uptake); instituting patient-centredness (explicitly addressing patient-important outcomes, reciprocating trial participation, improving comparability of interventions for decision-making, driving quality improvement and compelling a focus on quality of life). Nephrologists emphasised that core outcomes should be relevant to patients, amenable to change, feasible to implement and supported by stakeholder organisations. They expected core outcomes would improve patient-centred care and outcomes. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Drug Utilisation Pattern and Adverse Events in Patients with Chronic Kidney Disease Undergoing Maintenance Haemodialysis at a Tertiary Care Hospital of Odisha

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P. Ansuman Abhisek

2017-10-01

Full Text Available Introduction: The number of patients receiving renal replacement therapy in the form of dialysis or transplant has been increasing in recent years. Increased frequency of monitoring due to complex therapeutic regimen and inappropriate use of drugs may lead to increased Adverse Events (AEs, hospital stay, cost of treatment as well as increased morbidity and mortality. Aim: To analyse utilisation pattern of drugs and AEs in Chronic Kidney Disease (CKD patients undergoing maintenance haemodialysis. Materials and Methods: This prospective, observational study was conducted in the Department of Pharmacology in collaboration with Department of Nephrology, SCB Medical College and Hospital, Cuttack, from 1st June to 31st December, 2015. Demographic, clinical and medicine details were collected from patients’ case sheet, matched with nursing case records and tabulated in a predesigned case study form. The data were analysed in a descriptive manner using percentage calculation and Spearman’s correlation, multiple logistic regression using trial version SPSS v24. Results: A total number of 115 cases were included in this study. Average number of drugs used, per prescription was 12.8 during the dialysis and non-dialysis days. Most frequently used drugs were antihypertensives, 25% dextrose and heparin (before dialysis and on dialysis days were prescribed to all patients followed by haematinics in 90.43% of the patients and proton pump inhibitors were prescribed in 70.43% of the patients. Among 1472 drugs prescribed, 40.96% of the drugs were prescribed in generic name. It was observed that 72.62% of the prescribed drugs were from National List of Essential Medicine. AEs were observed with varying severity in all the patients. Frequently observed AEs as per the laboratory investigations were hyperphosphataemia, hyponatraemia, metabolic acidosis, hyperkalemia, hypoglycaemia, hypocalcaemia and hypokalemia. AEs were statistically significant with age group

Association of vascular access flow with short-term and long-term mortality in chronic haemodialysis patients: a retrospective cohort study.

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Wu, Chung-Kuan; Wu, Chia-Lin; Lin, Chia-Hsun; Leu, Jyh-Gang; Kor, Chew-Teng; Tarng, Der-Cherng

2017-09-24

To investigate the impact of vascular access flow (Qa) on vascular and all-cause mortality in chronic haemodialysis (HD) patients. Observational cohort study. Single centre. Adult chronic HD patients at the HD unit of Shin Kong Wu Ho-Su Memorial Hospital between 1 January 2003 and 31 December 2003 were recruited. Patients were excluded if they had arteriovenous fistula or arteriovenous graft failure within 3 months before the date of Qa measurement, were aged Short-term and long-term vascular (cardiovascular or cerebrovascular) and all-cause mortality. Qa was positively correlated with CI ( r =0.48, plong-term all-cause mortality (adjusted HR, 1.62; 95% CI 1.11 to 2.37; p=0.013); however, the risk of vascular mortality did not significantly increase after adjustment for confounders. Qa is moderately correlated with cardiac function, and a Qa level of short-term and long-term all-cause mortality in chronic HD patients. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Linezolid extracorporeal removal during haemodialysis with high cut-off membrane in critically ill patients.

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Villa, Gianluca; Cassetta, Maria Iris; Tofani, Lorenzo; Valente, Serafina; Chelazzi, Cosimo; Falsini, Silvia; De Gaudio, Angelo Raffaele; Novelli, Andrea; Ronco, Claudio; Adembri, Chiara

2015-10-01

Continuous venovenous haemodialysis with high cut-off membrane (HCO-CVVHD) is often used in critically ill septic patients with acute kidney injury (AKI) to sustain renal function and to remove circulating inflammatory mediators. The aim of this study was to analyse the extracorporeal removal of linezolid and related alterations in pharmacokinetic/pharmacodynamic (PK/PD) parameters during HCO-CVVHD. Three critically ill septic patients with AKI, treated with linezolid and HCO-CVVHD, were prospectively observed. To calculate the extracorporeal clearance of linezolid and the PK parameters, effluent, pre-filter and post-filter samples were contemporaneously collected before linezolid infusion, just after 1-h infusion (maximum serum concentration; C(max)), at 3 h and 6 h after dosing, and before the next dose (trough serum concentration; C(min)). Linezolid C(max) and C(min) (pre-filter) ranged from 10.4-23.5 mg/L and from 2.9-10.3 mg/L. The dialysate saturation coefficient was 0.66-0.85 and the extracorporeal clearance with a diffusive dose of 35 m L/kg/h ranged from 2.1-2.5 L/h. Total linezolid clearance was between 1.7 L/h and 6.3 L/h. The total area under the plasma concentration-time curve (AUC0-∞) ranged from 95.1 mgh/L to 352.9 mgh/L, in accordance with the different clinical conditions. AUCfree/MIC ratios were always linezolid total clearance, the clinical features of critically ill septic patients appear to be mainly responsible for the high variability of linezolid serum concentrations. Copyright © 2015. Published by Elsevier B.V.

Sex and gender differences in chronic kidney disease: progression to end-stage renal disease and haemodialysis.

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Cobo, Gabriela; Hecking, Manfred; Port, Friedrich K; Exner, Isabella; Lindholm, Bengt; Stenvinkel, Peter; Carrero, Juan Jesús

2016-07-01

Sex and gender differences are of fundamental importance in most diseases, including chronic kidney disease (CKD). Men and women with CKD differ with regard to the underlying pathophysiology of the disease and its complications, present different symptoms and signs, respond differently to therapy and tolerate/cope with the disease differently. Yet an approach using gender in the prevention and treatment of CKD, implementation of clinical practice guidelines and in research has been largely neglected. The present review highlights some sex- and gender-specific evidence in the field of CKD, starting with a critical appraisal of the lack of inclusion of women in randomized clinical trials in nephrology, and thereafter revisits sex/gender differences in kidney pathophysiology, kidney disease progression, outcomes and management of haemodialysis care. In each case we critically consider whether apparent discrepancies are likely to be explained by biological or psycho-socioeconomic factors. In some cases (a few), these findings have resulted in the discovery of disease pathways and/or therapeutic opportunities for improvement. In most cases, they have been reported as merely anecdotal findings. The aim of the present review is to expose some of the stimulating hypotheses arising from these observations as a preamble for stricter approaches using gender for the prevention and treatment of CKD and its complications. © 2016 The Author(s). Published by Portland Press Limited on behalf of the Biochemical Society.

Circulating Interferon-λ3, Responsiveness to HBV Vaccination, and HBV/HCV Infections in Haemodialysis Patients

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Alicja E. Grzegorzewska

2017-01-01

Full Text Available The IFN-λ3 gene (IFNL3 plays a role in HCV clearance. We investigated circulating IFN-λ3 and IFNL3 SNPs in haemodialysis patients who differed in their response to HBV vaccination and their HBV/HCV infection status. In 201 patients, plasma IFN-λ3 was determined using ELISA. IFNL3 SNPs (rs12979860, rs8099917 were genotyped using HRM analysis. Differences in IFN-λ3 levels were shown between responders and nonresponders to HBV vaccination and between HBsAg-positive patients and those who developed anti-HBs after infection and became HBsAg negative. HBV vaccine responders without HCV resolution revealed lower IFN-λ3 than noninfected responders. HBsAg/HCV RNA-positive subjects showed lower IFN-λ3 than patients positive only for HCV RNA or subjects who resolved both infections. Circulating IFN-λ3 correlated positively with anti-HBs and negatively with positive HCV RNA testing in the adjusted regression analyses. HBV vaccine nonresponders, HBsAg-positive patients, and subjects with replicating HCV composed a group with unfavourable outcomes. Responders to HBV vaccination, subjects who became HBsAg negative, and those who cleared HCV were analysed as having favourable outcomes. The latter showed higher IFN-λ3 but did not differ in distribution of IFNL3 SNPs compared with subjects with unfavourable outcomes. Higher IFN-λ3 concentrations are associated with response to HBV vaccination, self-limited HBV infection, and HCV resolution.

The role of religion and spirituality in coping with kidney disease and haemodialysis in Thailand.

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Yodchai, Kantaporn; Dunning, Trisha; Savage, Sally; Hutchinson, Alison M

2017-06-01

People with chronic kidney disease (CKD) face various problems including psychological, socioeconomic and physical effects associated with CKD and its treatment. They need to develop strategies to help them cope with CKD and life challenges. Religion and spirituality are important coping strategies, but their role in helping people cope with CKD and haemodialysis (HD) in Thailand is relatively unknown. To investigate the role of religion and spirituality in coping with CKD and its treatment in Thailand. An exploratory, qualitative approach was undertaken using semistructured individual interviews. Purposive sampling was used to recruit participants. Face-to-face, in-depth individual interviews using open questions were conducted during January and February 2012. Interviews were audio-recorded and transcribed verbatim. Data were analysed using the framework method of qualitative data analysis. Twenty people receiving HD participated: age range 23-77 years, mean 53.7 (±16.38 SD). Ten were women. Participants reported use of religious and spiritual practices to cope with CKD and its treatment, including religious and spiritual explanations for developing CKD, karmic disease, making merit, reading Dharma books, praying and chanting to save life and making a vow to Pran-Boon. Religion and spirituality provide powerful coping strategies that can help Thai people with CKD overcome the associated distress and difficulties. Religion and spirituality cannot be separated in Thai culture because Thai people are both religious and spiritual. © 2016 Nordic College of Caring Science.

Apolipoprotein A-IV concentrations and clinical outcomes in haemodialysis patients with type 2 diabetes mellitus--a post hoc analysis of the 4D Study.

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Kollerits, B; Krane, V; Drechsler, C; Lamina, C; März, W; Ritz, E; Wanner, C; Kronenberg, F

2012-12-01

Apolipoprotein A-IV (apoA-IV) is an anti-atherogenic and anti-oxidative plasma glycoprotein involved in reverse cholesterol transport. The aim of this study was to examine the association between apoA-IV and all-cause mortality, cardiovascular endpoints and parameters of protein-energy wasting and nutrition in haemodialysis patients. This post hoc analysis was performed in the German Diabetes Dialysis Study (4D Study) evaluating atorvastatin in 1255 haemodialysis patients with type 2 diabetes mellitus, followed for a median of 4 years. The association between apoA-IV and relevant outcomes was analysed using Cox proportional hazards regression analyses. Body mass index (BMI) was used as a marker of protein-energy wasting. In addition, a definition of extended wasting was applied, combining median values of BMI, serum albumin, creatinine and sensitive C-reactive protein, to classify patients. Mean (±SD) apoA-IV concentration was 49.8 ± 14.2 mg dL(-1). Age- and gender-adjusted apoA-IV concentrations were strongly associated with the presence of congestive heart failure at baseline [odds ratio = 0.81, 95% confidence interval (CI) 0.74-0.88 per 10 mg dL(-1) increase; P 1). During the prospective follow-up, the strongest association was found for all-cause mortality [hazard ratio (HR) = 0.89, 95% CI 0.85-0.95, P = 0.001), which was mainly because of patients with BMI > 23 kg m(-2) (HR = 0.87, 95% CI 0.82-0.94, P 1) and those in the nonwasting group according to the extended definition (HR = 0.89, 95% CI 0.84-0.96, P = 0.001). This association remained significant after additionally adjusting for parameters associated with apoA-IV at baseline. Further associations were observed for sudden cardiac death. ApoA-IV was less strongly associated with atherogenic events such as myocardial infarction. Low apoA-IV levels seem to be a risk predictor of all-cause mortality and sudden cardiac death. This association might be modified by nutritional status. © 2012 The Association

A comparison of self-reported quality of life for an Australian haemodialysis and haemodiafiltration cohort.

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Hill, Kathleen E; Kim, Susan; Crail, Susan; Elias, Tony J; Whittington, Tiffany

2017-08-01

Haemodiafiltration (HDF) has been widely studied for evidence of superior outcomes in comparison with conventional haemodialysis (HD), and there is increasing interest in determining if HDF confers any benefit in relation to quality of life. Studies have been conducted with randomized incident patients; however, little is known regarding HDF and quality of life for prevalent patients. This study examined and compared self-reported quality of life at two time points, 12 months apart in a cohort of satellite HD and HDF patients, using a disease specific questionnaire to determine if HDF conferred an advantage. A longitudinal study with a linear mixed-effect model measuring quality of life in a cohort of 171 patients (HD, n = 85, HDF, n = 86) in seven South Australian satellite dialysis centres. Factors associated with significant reduction across the Kidney Disease Quality Of Life™ domains measured were younger age (- 20 to - 29) and comorbid diabetes (- 4.8 to - 11.1). HDF was not associated with moderation of this reduction at either time point (P > 0.05). Baseline physical functioning was reported as very low (median 33.9) and further reduced at time point two. In addition, dialysing for more than 12 h per week in a satellite dialysis unit was associated with reduced quality of life in relation to the burden of kidney disease (- 13.69). This study has demonstrated that younger age and comorbid diabetes were responsible for a statistically significant reduction in quality of life, and HDF did not confer any advantage. © 2016 Asian Pacific Society of Nephrology.

Peripheral i.v. analysis (PIVA) of venous waveforms for volume assessment in patients undergoing haemodialysis.

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Hocking, K M; Alvis, B D; Baudenbacher, F; Boyer, R; Brophy, C M; Beer, I; Eagle, S

2017-12-01

The assessment of intravascular volume status remains a challenge for clinicians. Peripheral i.v. analysis (PIVA) is a method for analysing the peripheral venous waveform that has been used to monitor volume status. We present a proof-of-concept study for evaluating the efficacy of PIVA in detecting changes in fluid volume. We enrolled 37 hospitalized patients undergoing haemodialysis (HD) as a controlled model for intravascular volume loss. Respiratory rate (F0) and pulse rate (F1) frequencies were measured. PIVA signal was obtained by fast Fourier analysis of the venous waveform followed by weighing the magnitude of the amplitude of the pulse rate frequency. PIVA was compared with peripheral venous pressure and standard monitoring of vital signs. Regression analysis showed a linear correlation between volume loss and change in the PIVA signal (R2=0.77). Receiver operator curves demonstrated that the PIVA signal showed an area under the curve of 0.89 for detection of 20 ml kg-1 change in volume. There was no correlation between volume loss and peripheral venous pressure, blood pressure or pulse rate. PIVA-derived pulse rate and respiratory rate were consistent with similar numbers derived from the bio-impedance and electrical signals from the electrocardiogram. PIVA is a minimally invasive, novel modality for detecting changes in fluid volume status, respiratory rate and pulse rate in spontaneously breathing patients with peripheral i.v. cannulas. © The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Atrial fibrillation in patients on haemodialysis in Andalusia. Prevalence, clinical profile and therapeutic management

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Carmen Sánchez Perales

2018-05-01

Full Text Available Atrial fibrillation (AF represents an important social and healthcare problem. There is wide variability in the prevalence of this arrhythmia in studies analysing patients on haemodialysis (HD. Objective: To investigate the prevalence, clinical profile and therapeutic management of patients with AF on HD in Andalusia. Methods: We asked the public healthcare system of Andalusia to provide us with the number of patients who were being treated with HD. We asked attending nephrologists from all hospital and outpatient centers in 5 of the 8 Andalusian provinces to perform an electrocardiogram and to fill out a questionnaire on patients selected by simple random sampling. Results: A total of 2348 patients were being treated with HD in the 5 provinces included in the study. The estimated sample size was 285 patients. We obtained an electrocardiogram and information from 252 patients (88.4%; mean age 65.3 ± 16 years; 40.9% women. Sixty-three patients (25% had AF. Of these, 36 (14.3% had AF in the recorded ECG and in the rest it had been documented previously. In the multivariate analysis, older age (OR: 1.071; 95% CI: 1.036–1.107; p = 0.000 and greater time on HD (OR: 1.009; 95% CI: 1.004–1.014; p = 0.000 were independently associated with the presence of AF. Of the patients with AF, 41.3% were on anticoagulant treatment at the time of the study; and 41.2% were on antiplatelet agents. Conclusions: AF in dialysis units is an important finding. Establishing the risk–benefit ratio of anticoagulant treatment constitutes a real challenge. Well-designed clinical trials are pivotal in order to define the rational use of antithrombotic drugs. Resumen: La fibrilación auricular (FA es un importante problema social y sanitario. Existe una amplia variación en la prevalencia de esta arritmia en los estudios que analizan a los pacientes en hemodiálisis (HD. Objetivo: Investigar la prevalencia, perfil clínico y manejo terapéutico de los pacientes con

How to set the stage for a full-fledged clinical trial testing 'incremental haemodialysis'.

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Casino, Francesco Gaetano; Basile, Carlo

2017-07-21

Most people who make the transition to maintenance haemodialysis (HD) therapy are treated with a fixed dose of thrice-weekly HD (3HD/week) regimen without consideration of their residual kidney function (RKF). The RKF provides an effective and naturally continuous clearance of both small and middle molecules, plays a major role in metabolic homeostasis, nutritional status and cardiovascular health, and aids in fluid management. The RKF is associated with better patient survival and greater health-related quality of life. Its preservation is instrumental to the prescription of incremental (1HD/week to 2HD/week) HD. The recently heightened interest in incremental HD has been hindered by the current limitations of the urea kinetic model (UKM), which tend to overestimate the needed dialysis dose in the presence of a substantial RKF. A recent paper by Casino and Basile suggested a variable target model (VTM), which gives more clinical weight to the RKF and allows less frequent HD treatments at lower RKF as opposed to the fixed target model, based on the wrong concept of the clinical equivalence between renal and dialysis clearance. A randomized controlled trial (RCT) enrolling incident patients and comparing incremental HD (prescribed according to the VTM) with the standard 3HD/week schedule and focused on hard outcomes, such as survival and health-related quality of life of patients, is urgently needed. The first step in designing such a study is to compute the 'adequacy lines' and the associated fitting equations necessary for the most appropriate allocation of the patients in the two arms and their correct and safe follow-up. In conclusion, the potentially important clinical and financial implications of the incremental HD render it highly promising and warrant RCTs. The UKM is the keystone for conducting such studies. © The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Atrial fibrillation in patients on haemodialysis in Andalusia. Prevalence, clinical profile and therapeutic management.

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Sánchez Perales, Carmen; Vázquez Sánchez, Teresa; Salas Bravo, Daniel; Ortega Anguiano, Sonia; Vázquez Ruiz de Castroviejo, Eduardo

Atrial fibrillation (AF) represents an important social and healthcare problem. There is wide variability in the prevalence of this arrhythmia in studies analysing patients on haemodialysis (HD). To investigate the prevalence, clinical profile and therapeutic management of patients with AF on HD in Andalusia. We asked the public healthcare system of Andalusia to provide us with the number of patients who were being treated with HD. We asked attending nephrologists from all hospital and outpatient centres in 5 of the 8 Andalusian provinces to perform an electrocardiogram and to fill out a questionnaire on patients selected by simple random sampling. A total of 2,348 patients were being treated with HD in the 5provinces included in the study. The estimated sample size was 285 patients. We obtained an electrocardiogram and information from 252 patients (88.4%); mean age 65.3±16 years; 40.9% women. Sixty-three patients (25%) had AF. Of these, 36 (14.3%) had AF in the recorded ECG and in the rest it had been documented previously. In the multivariate analysis, older age (OR: 1.071; 95% CI: 1.036-1.107; P=0.000) and greater time on HD (OR: 1.009; 95% CI: 1.004-1.014; P=0.000) were independently associated with the presence of AF. Of the patients with AF, 41.3% were on anticoagulant treatment at the time of the study; and 41.2% were on antiplatelet agents. AF in dialysis units is an important finding. Establishing the risk-benefit ratio of anticoagulant treatment constitutes a real challenge. Well-designed clinical trials are pivotal in order to define the rational use of antithrombotic drugs. Copyright © 2017 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

Nutrition and dietary intake and their association with mortality and hospitalisation in adults with chronic kidney disease treated with haemodialysis: protocol for DIET-HD, a prospective multinational cohort study.

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Palmer, Suetonia C; Ruospo, Marinella; Campbell, Katrina L; Garcia Larsen, Vanessa; Saglimbene, Valeria; Natale, Patrizia; Gargano, Letizia; Craig, Jonathan C; Johnson, David W; Tonelli, Marcello; Knight, John; Bednarek-Skublewska, Anna; Celia, Eduardo; Del Castillo, Domingo; Dulawa, Jan; Ecder, Tevfik; Fabricius, Elisabeth; Frazão, João Miguel; Gelfman, Ruben; Hoischen, Susanne Hildegard; Schön, Staffan; Stroumza, Paul; Timofte, Delia; Török, Marietta; Hegbrant, Jörgen; Wollheim, Charlotta; Frantzen, Luc; Strippoli, G F M

2015-03-20

Adults with end-stage kidney disease (ESKD) treated with haemodialysis experience mortality of between 15% and 20% each year. Effective interventions that improve health outcomes for long-term dialysis patients remain unproven. Novel and testable determinants of health in dialysis are needed. Nutrition and dietary patterns are potential factors influencing health in other health settings that warrant exploration in multinational studies in men and women treated with dialysis. We report the protocol of the "DIETary intake, death and hospitalisation in adults with end-stage kidney disease treated with HaemoDialysis (DIET-HD) study," a multinational prospective cohort study. DIET-HD will describe associations of nutrition and dietary patterns with major health outcomes for adults treated with dialysis in several countries. DIET-HD will recruit approximately 10,000 adults who have ESKD treated by clinics administered by a single dialysis provider in Argentina, France, Germany, Hungary, Italy, Poland, Portugal, Romania, Spain, Sweden and Turkey. Recruitment will take place between March 2014 and June 2015. The study has currently recruited 8000 participants who have completed baseline data. Nutritional intake and dietary patterns will be measured using the Global Allergy and Asthma European Network (GA(2)LEN) food frequency questionnaire. The primary dietary exposures will be n-3 and n-6 polyunsaturated fatty acid consumption. The primary outcome will be cardiovascular mortality and secondary outcomes will be all-cause mortality, infection-related mortality and hospitalisation. The study is approved by the relevant Ethics Committees in participating countries. All participants will provide written informed consent and be free to withdraw their data at any time. The findings of the study will be disseminated through peer-reviewed journals, conference presentations and to participants via regular newsletters. We expect that the DIET-HD study will inform large pragmatic

DETECTION OF MALNUTRITION IN PATIENTS UNDERGOING MAINTENANCE HAEMODIALYSIS: A QUANTITATIVE DATA ANALYSIS ON 12 PARAMETERS.

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Nafzger, Sonja; Fleury, Lea-Angelica; Uehlinger, Dominik E; Plüss, Petra; Scura, Ninetta; Kurmann, Silvia

2015-09-01

Protein-energy-malnutrition (PEM) is common in people with end stage kidney disease (ESKD) undergoing maintenance haemodialysis (MHD) and correlates strongly with mortality. To this day, there is no gold standard for detecting PEM in patients on MHD. The aim of this study was to evaluate if Nutritional Risk Screening 2002 (NRS-2002), handgrip strength measurement, mid-upper arm muscle area (MUAMA), triceps skin fold measurement (TSF), serum albumin, normalised protein catabolic rate (nPCR), Kt/V and eKt/V, dry body weight, body mass index (BMI), age and time since start on MHD are relevant for assessing PEM in patients on MHD. The predictive value of the selected parameters on mortality and mortality or weight loss of more than 5% was assessed. Quantitative data analysis of the 12 parameters in the same patients on MHD in autumn 2009 (n = 64) and spring 2011 (n = 40) with paired statistical analysis and multivariate logistic regression analysis was performed. Paired data analysis showed significant reduction of dry body weight, BMI and nPCR. Kt/Vtot did not change, eKt/v and hand grip strength measurements were significantly higher in spring 2011. No changes were detected in TSF, serum albumin, NRS-2002 and MUAMA. Serum albumin was shown to be the only predictor of death and of the combined endpoint "death or weight loss of more than 5%". We now screen patients biannually for serum albumin, nPCR, Kt/V, handgrip measurement of the shunt-free arm, dry body weight, age and time since initiation of MHD. © 2015 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Why take the chance? A qualitative grounded theory study of nocturnal haemodialysis recipients who decline kidney transplantation.

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Rosenthal, Meagen M; Molzahn, Anita E; Chan, Christopher T; Cockfield, Sandra L; Kim, S Joseph; Pauly, Robert P

2016-05-18

The objective of this study was to examine the factors that influence decision-making to forgo transplantation in favour of remaining on nocturnal haemodialysis (NHD). A grounded theory approach using in-depth telephone interviewing was used. Participants were identified from 2 tertiary care renal programmes in Canada. The study participants were otherwise eligible patients with end-stage renal disease who have opted to remain off of the transplant list. A total of 7 eligible participants were interviewed. 5 were male. The mean age was 46 years. A constant comparative method of analysis was used to identify a core category and factors influencing the decision-making process. In this grounded theory study of people receiving NHD who refused kidney transplantation, the core category of 'why take a chance when things are going well?' was identified, along with 4 factors that influenced the decision including 'negative past experience', 'feeling well on NHD', 'gaining autonomy' and 'responsibility'. This study provides insight into patients' thought processes surrounding an important treatment decision. Such insights might help the renal team to better understand, and thereby respect, patient choice in a patient-centred care paradigm. Findings may also be useful in the development of education programmes addressing the specific concerns of this population of patients. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Daily intake and serum concentration of menaquinone-4 (MK-4) in haemodialysis patients with chronic kidney disease.

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Wyskida, Katarzyna; Żak-Gołąb, Agnieszka; Łabuzek, Krzysztof; Suchy, Dariusz; Ficek, Rafał; Pośpiech, Kornel; Olszanecka-Glinianowicz, Magdalena; Okopień, Bogusław; Więcek, Andrzej; Chudek, Jerzy

2015-12-01

Decreased concentration of menaquinone-4 (MK-4) seems to be an important risk factor of vascular calcification in haemodialysis (HD) patients. Optimal dietary intake, as well as serum MK-4 reference range, in HD has not been determined, yet. The aim of the present study was to assess daily vitamin K1 and MK-4 intakes and their relation to serum MK-4 concentration in HD patients. Daily vitamin K1 and MK-4, micro- and macronutrients and energy intakes were assessed using 3-day food diary completed by patients and serum MK-4 concentration was measured by HPLC [limit of quantification (LOQ): 0.055 ng/mL] in 85 HD patients (51 males) and 22 apparently healthy subjects. Daily MK-4 intake was significantly lower (by 29%) among HD, while K1 consumption was similar in both groups. Daily MK-4 intake was associated with fat and protein consumption in HD (r=0.43, pintakes were weaker in HD (r=0.38 and r=0.30 respectively) than in the control group (r=0.47 and r=0.45, respectively). In multiple regression analysis the variability of serum MK-4 concentrations in HD patients was explained by its daily intake. Decreased serum MK-4 concentration in HD patients is caused by lower dietary MK-4 intake, mainly due to diminished meat consumption, and in addition, probably reduced K1 conversion. Copyright © 2015 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

VALIDITY AND RELIABILITY OF THE SPIRITUAL COPING STRATEGIES SCALE ARABIC VERSION IN SAUDI PATIENTS UNDERGOING HAEMODIALYSIS.

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Cruz, Jonas P; Baldacchino, Donia R; Alquwez, Nahed

2016-06-01

Patients often resort to religious and spiritual activities to cope with physical and mental challenges. The effect of spiritual coping on overall health, adaptation and health-related quality of life among patients undergoing haemodialysis (HD) is well documented. Thus, it is essential to establish a valid and reliable instrument that can assess both the religious and non-religious coping methods in patients undergoing HD. This study aimed to assess the validity and reliability of the Spiritual Coping Strategies Scale Arabic version (SCS-A) in Saudi patients undergoing HD. A convenience sample of 60 Saudi patients undergoing HD was recruited for this descriptive, cross-sectional study. Data were collected between May and June 2015. Forward-backward translation was used to formulate the SCS-A. The SCS-A, Muslim Religiosity Scale and the Quality of Life Index Dialysis Version III were used to procure the data. Internal consistency reliability, stability reliability, factor analysis and construct validity tests were performed. Analyses were set at the 0.05 level of significance. The SCS-A showed an acceptable internal consistency and strong stability reliability over time. The EFA produced two factors (non-religious and religious coping). Satisfactory construct validity was established by the convergent and divergent validity and known-groups method. The SCS-A is a reliable and valid tool that can be used to measure the religious and non-religious coping strategies of patients undergoing HD in Saudi Arabia and other Muslim and Arabic-speaking countries. © 2016 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Diagnosis and prevalence of protein-energy wasting and its association with mortality in Japanese haemodialysis patients.

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Kanazawa, Yoshie; Nakao, Toshiyuki; Murai, Seizo; Okada, Tomonari; Matsumoto, Hiroshi

2017-07-01

The International Society of Renal Nutrition and Metabolism (ISRNM) has proposed the diagnostic criteria for protein-energy wasting (PEW). We studied Japanese haemodialysis (HD) patients to verify the diagnostic method, especially with respect to the body mass index (BMI) criterion, as well as the prevalence of PEW and its association with mortality. Japanese patients receiving maintenance HD at three outpatient clinics in Tokyo (n = 210) were enrolled, and prospectively followed-up for 3 years. PEW was diagnosed at baseline, according to the four categories (serum chemistry, body mass, muscle mass and dietary intake) recommended by the ISRNM. For the category of body mass, we select a body mass index (BMI) and set up three thresholds, energy wasting, when the threshold of a BMI among the diagnostic criteria was defined as <18.5 kg/m 2 , was recognized as an independent risk factor for mortality. However, PEW was not recognized as a risk factor when the BMI diagnostic criterion was set at <20.0 or <23.0 kg/m 2 . Overall, 14.8% of the patients had PEW. The survival rate of PEW patients was significantly lower than that of non-PEW patients (log rank, P < 0.001). The diagnosis algorithm of PEW proposed by an expert panel of the ISRNM strongly associates with mortality. However, given differences in body size in Japan, we suggest to revise the BMI criterion from <23.0 kg/m 2 to <18.5 kg/m 2 . © 2016 Asian Pacific Society of Nephrology.

Comparison of resting energy equations and total energy expenditure in haemodialysis patients and body composition measured by multi-frequency bioimpedance.

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Oliveira, Ben; Sridharan, Sivakumar; Farrington, Ken; Davenport, Andrew

2017-07-13

Waste products of metabolism are retained in haemodialysis (HD) patients. Cellular metabolism generates energy, and patients with greater energy expenditure may therefore require more dialysis. To determine the amount of dialysis required, equations estimating resting and total energy expenditure (REE,TEE) are required. We compared estimates of REE in HD patients using established equations with a novel equation recently validated in HD patients (HD equation). TEE was derived from REE (HD equation) and estimates of physical activity obtained by questionnaire. REE and TEE relationships with bioimpedance measured body composition were then determined. We studied 317 HD patients; 195 males (61.5%), 123 diabetic (38.9%), mean age 65.0 ± 15.3 and weight 73.1 ± 16.8 kg. REE from HD Equation was 1509 ± 241 kcal/day, which was greater than for Mifflin St Joer 1384 ± 259, Harris-Benedict 1437 ± 244, Katch-McArdle 1345 ± 232 (all p employment (β 406.5, p appearance (β 2.7, p = 0.015), and negatively with age (β -7.9, p appearance, lower co-morbidity, age, and dialysis vintage, and the employed. More metabolically active patients may require greater dialytic clearances. This article is protected by copyright. All rights reserved.

Washout of water-soluble vitamins and of homocysteine during haemodialysis: effect of high-flux and low-flux dialyser membranes.

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Heinz, Judith; Domröse, Ute; Westphal, Sabine; Luley, Claus; Neumann, Klaus H; Dierkes, Jutta

2008-10-01

Vitamin deficiencies are common in patients with end-stage renal disease (ESRD) owing to dietary restrictions, drug-nutrient interactions, changes in metabolism, and vitamin losses during dialysis. The present study investigated the levels of serum and red blood cell (RBC) folate, plasma pyridoxal-5'-phosphate (PLP), serum cobalamin, blood thiamine, blood riboflavin, and plasma homocysteine (tHcy) before and after haemodialysis treatment. Vitamin and tHcy blood concentrations were measured in 30 patients with ESRD before and after dialysis session either with low-flux (n = 15) or high-flux (n = 15) dialysers. After the dialysis procedure, significantly lower concentrations of serum folate (37%), plasma PLP (35%), blood thiamine (6%) and blood riboflavin (7%) were observed. No significant changes were found for serum cobalamin or for RBC folate. There were no differences in the washout of water-soluble vitamins between treatments with low-flux and high-flux membranes. Furthermore, a 41% lower concentration in tHcy was observed. The percentage decrease in tHcy was significantly greater in the patients treated with high-flux dialysers (48% vs 37%; P vitamins measured (r =-0.867, P water-soluble vitamins after dialysis, independently of the dialyser membrane. The monitoring of the vitamin status is essential in patients treated with high-flux dialysers as well as in patients treated with low-flux dialysers.

A phase 3, multicentre, randomized, double-blind, placebo-controlled, parallel-group study to evaluate the efficacy and safety of etelcalcetide (ONO-5163/AMG 416), a novel intravenous calcimimetic, for secondary hyperparathyroidism in Japanese haemodialysis patients.

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Fukagawa, Masafumi; Yokoyama, Keitaro; Shigematsu, Takashi; Akiba, Takashi; Fujii, Akifumi; Kuramoto, Takuto; Odani, Motoi; Akizawa, Tadao

2017-10-01

Secondary hyperparathyroidism (SHPT) is a major complication associated with chronic kidney disease. We evaluated the efficacy and safety of etelcalcetide (ONO-5163/AMG 416), a novel intravenous calcimimetic, in Japanese haemodialysis patients with SHPT. In this phase 3, multicentre, randomized, double-blind, placebo-controlled, parallel-group study, etelcalcetide was administered three times per week at an initial dose of 5 mg, and subsequently adjusted to doses between 2.5 and 15 mg at 4-week intervals for 12 weeks. A total of 155 SHPT patients with serum intact parathyroid hormone (iPTH) levels ≥300 pg/mL were assigned to receive etelcalcetide (n = 78) or placebo (n = 77). The primary endpoint was the proportion of patients with decreased serum iPTH to the target range proposed by the Japanese Society for Dialysis Therapy (60-240 pg/mL). The major secondary endpoint was the proportion of patients with ≥30% reductions in serum iPTH from baseline. The proportion of patients meeting the primary endpoint was significantly higher for etelcalcetide (59.0%) versus placebo (1.3%). Similarly, the proportion of patients meeting the major secondary endpoint was significantly higher for etelcalcetide (76.9%) versus placebo (5.2%). Serum albumin-corrected calcium, phosphorus and intact fibroblast growth factor-23 levels were decreased in the etelcalcetide group. Nausea, vomiting and symptomatic hypocalcaemia were mild with etelcalcetide. Serious adverse events related to etelcalcetide were not observed. This study demonstrated the efficacy and safety of etelcalcetide. As the only available intravenous calcium-sensing receptor agonist, etelcalcetide is likely to provide a new treatment option for SHPT in haemodialysis patients. © The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA.

The Effect of Haemodialysis Access Types on Cardiac Performance and Morbidities in Patients with Symptomatic Heart Disease.

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Chuang, Min-Kai; Chang, Chin-Hao; Chan, Chih-Yang

2016-01-01

Little is known about whether the arteriovenous type haemodialysis access affects cardiac function and whether it is still advantageous to the uremic patient with symptomatic heart disease. We conducted a retrospective comparative study. Patients with heart disease and end-stage renal disease that had a new chronic access created between January 2007 and December 2008 and met the inclusion criteria were assessed. The endpoint was major adverse event (MAE)-free survivals of arteriovenous access (AVA) and tunneled cuffed double-lumen central venous catheter (CVC) groups. Whether accesses worsened heart failure was also evaluated. There were 43 CVC patients and 60 AVA patients. The median follow-up time from access creation was 27.6 months (IQR 34.7, 10.9~45.6). Although CVC patients were older than AVA patients (median age 78.0, IQR 14.0 vs. 67.5, IQR 16.0, respectively, p = .009), they manifested non-inferior MAE-free survival (mean 17.1, 95% CI 10.3~24.0 vs. 12.9, 95% CI 8.5~17.4 months in CVC and AVA patients, respectively, p = .290). During follow-up, more patients in the AVA group than in the CVC group deteriorated in heart failure status (35 of 57 vs. 10 of 42, respectively, odds ratio 5.1, p heart disease and end stage renal disease (ESRD), CVC patients showed non-inferior MAE-free survival in comparison to those in the AVA group. AV type access could deteriorate heart failure. Accordingly, uremic patients with symptomatic heart disease are not ideal candidates for AV type access creation.

Bioimpedancia vectorial y espectroscópica: valoración del estado de hidratación con ambos métodos en hemodiálisis Bioimpedance vector and spectroscopic analysis: assessing hydration status using both methods in haemodialysis

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Ruth Ros Nogales

2013-03-01

de hiperhidratación prediálisis tienen una equivalencia aceptable y sus resultados pueden ser intercambiables.Bioimpedance analysis is a useful tool for determining the nutritional and hydration status of haemodialysis patients. The two most commonly used systems are bioimpedance vector single frequency analysis and bioimpedance spectroscopic multiple frequency analysis, which use different criteria to classify the hydration status of the dialysed patient. The single frequency bioimpedance vector system uses a scale of 7 points ranging from a value of 3 (most hydration to a value of -3 (most dehydration, defining hyperhydration when the vector is on the hydration axis below the tolerance ellipse of 75% (values 3 and 2 on the scale. Multi-frequency spectroscopy uses two criteria to define the pre-dialysis state of hyperhydration: OH more than 2.5 litres or more than 15% of the extracellular water volume. The aim of this study was to analyse the degree of concordance between the two systems of bioimpedance in defining the state of hyperhydration of haemodialysis patients. A transversal study was carried out on 54 patients undergoing haemodialysis, performing a bioimpedance analysis with single frequency vector and multi-frequency spectroscopic monitors immediately before a haemodialysis session. The degree of equivalence in the definition of hyperhydration between the two monitors was greater when the criterion of OH>15% of extracellular water was used in the multi-frequency monitor (kappa index 0.81, excellent concordance than when the criterion of OH>2.5 litres was used (kappa index 0.71, acceptable concordance. Conclusions: There is a good relationship between the hydration vector scale and OH value (excess hydration. The criteria used by the single-frequency vector and multi-frequency spectroscopic monitors show acceptable equivalence and their results can be interchangeable.

Ranking of factors determining potassium mass balance in bicarbonate haemodialysis.

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Basile, Carlo; Libutti, Pasquale; Lisi, Piero; Teutonico, Annalisa; Vernaglione, Luigi; Casucci, Francesco; Lomonte, Carlo

2015-03-01

One of the most important pathogenetic factors involved in the onset of intradialysis arrhytmias is the alteration in electrolyte concentration, particularly potassium (K(+)). Two studies were performed: Study A was designed to investigate above all the isolated effect of the factor time t on intradialysis K(+) mass balance (K(+)MB): 11 stable prevalent Caucasian anuric patients underwent one standard (∼4 h) and one long-hour (∼8 h) bicarbonate haemodialysis (HD) session. The latter were pair-matched as far as the dialysate and blood volume processed (90 L) and volume of ultrafiltration are concerned. Study B was designed to identify and rank the other factors determining intradialysis K(+)MB: 63 stable prevalent Caucasian anuric patients underwent one 4-h standard bicarbonate HD session. Dialysate K(+) concentration was 2.0 mmol/L in both studies. Blood samples were obtained from the inlet blood tubing immediately before the onset of dialysis and at t60, t120, t180 min and at end of the 4- and 8-h sessions for the measurement of plasma K(+), blood bicarbonates and blood pH. Additional blood samples were obtained at t360 min for the 8 h sessions. Direct dialysate quantification was utilized for K(+)MBs. Direct potentiometry with an ion-selective electrode was used for K(+) measurements. Study A: mean K(+)MBs were significantly higher in the 8-h sessions (4 h: -88.4 ± 23.2 SD mmol versus 8 h: -101.9 ± 32.2 mmol; P = 0.02). Bivariate linear regression analyses showed that only mean plasma K(+), area under the curve (AUC) of the hourly inlet dialyser diffusion concentration gradient of K(+) (hcgAUCK(+)) and AUC of blood bicarbonates and mean blood bicarbonates were significantly related to K(+)MB in both 4- and 8-h sessions. A multiple linear regression output with K(+)MB as dependent variable showed that only mean plasma K(+), hcgAUCK(+) and duration of HD sessions per se remained statistically significant. Study B: mean K(+)MBs were -86.7 ± 22.6 mmol

[Surgical learning curve for creation of vascular accesses for haemodialysis: value of medico-radio-surgical collaboration].

Science.gov (United States)

Van Glabeke, Emmanuel; Belenfant, Xavier; Barrou, Benoît; Adhemar, Jean-Pierre; Laedrich, Joëlle; Mavel, Marie-Christine; Challier, Emmanuel

2005-04-01

Creation of a vascular access (VA) for haemodialysis is a surgical procedure which comprises a failure rate related to the quality of the vessels and the operator's experience. The authors report the first 2 years of a young urologist's experience with this procedure in a local hospital in collaboration with the nephrology team. Patients undergoing creation of VA were divided into 2 chronological groups. The patient's age and gender, the cause of renal failure, the presence of diabetes, clinical examination of the upper limb, preoperative assessment of upper limb vessels, the type of anaesthesia, the operating time and the start of dialysis after the operation, as well as the functional results of the VA at 6 months were studied. Results concerning the patients of the first period were discussed by the operator and the nephrology team. During the first 9 months, 28 patients were operated, corresponding to 36 operations including 32 direct fistulas. Over the following 15 months, 61 patients were operated, with the creation of 63 VAs, including 55 direct fistulas. The failure rate (thrombosis or non-functioning VA) decreased from 32.1% to 11.1% (p=0.07), while the 2 groups were globally comparable. Evaluation of a new surgical procedure shows a number of failures, as for all learning curves. However, it helps to improve the results. Collaboration with nephrologists must comprise a discussion allowing the acceptance of certain failures, as they reflect compliance with a strategy of preservation of the vascular capital and a rational attempt to avoid a non-essential proximal access or bypass graft. The support of a motivated radiology team (preoperative assessment and management of complications) and the assistance of a more experienced operator are essential.

Age- and weight-based differences in haemodialysis prescription and delivery in children, adolescents and young adults.

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Gotta, Verena; Marsenic, Olivera; Pfister, Marc

2018-04-18

Limited systematic data are available on prescription and dosing of haemodialysis (HD) in children and adolescents compared with adults. We aimed to characterize age- and weight-based differences in HD delivery in children, adolescents and young adults. This is a retrospective observational study including 1852 patients aged 1-18 years; weight range 8.3-168 kg). Median individual prescriptions per year were calculated and overall 50% (IQR) and 90% distribution ranges over age and weight were derived. Repeated measurements analysis of variance assessed differences between age and weight groups. Prescriptions significantly differed among age and weight groups (P range, IQR) weight-normalized blood flow rate (highest in 100 kg: QB/kg = 3.1-4.0 mL/min/kg, spKt/V = 1.22-1.47, respectively). Adolescents had significantly lower QB/kg, KD/kg and spKt/V (1.34-1.71) compared with adults (1.45-1.79) and children range of 25th percentiles: 1.37-1.44). Dialytic clearance derived from a mechanistic equation underpredicted KD in children but not in young adults. Significant growth retardation was observed, with the proportion of patients age) decreasing from 71% (1-2 years) to 15% (>18 years). Delivered HD treatment varies with age and weight and is more intensified in children aged young adults, who appear to be at highest risk of receiving suboptimal treatment. Still, delivery of target or higher spKt/V values did not result in appropriate growth in these children, questioning the value of spKt/V as a measure of HD adequacy in children. Provided ranges of outpatient HD prescription can help clinicians and researchers in personalizing and optimizing delivery of dialysis treatment.

A Systematic Review and Meta-Analysis of Circulating Biomarkers Associated with Failure of Arteriovenous Fistulae for Haemodialysis.

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Susan K Morton

Full Text Available Arteriovenous fistula (AVF failure is a significant cause of morbidity and expense in patients on maintenance haemodialysis (HD. Circulating biomarkers could be valuable in detecting patients at risk of AVF failure and may identify targets to improve AVF outcome. Currently there is little consensus on the relationship between circulating biomarkers and AVF failure. The aim of this systematic review was to identify circulating biomarkers associated with AVF failure.Studies evaluating the association between circulating biomarkers and the presence or risk of AVF failure were systematically identified from the MEDLINE, EMBASE and Cochrane Library databases. No restrictions on the type of study were imposed. Concentrations of circulating biomarkers of routine HD patients with and without AVF failure were recorded and meta-analyses were performed on biomarkers that were assessed in three or more studies with a composite population of at least 100 participants. Biomarker concentrations were synthesized into inverse-variance random-effects models to calculate standardized mean differences (SMD and 95% confidence intervals (CI.Thirteen studies comprising a combined population of 1512 participants were included after screening 2835 unique abstracts. These studies collectively investigated 48 biomarkers, predominantly circulating molecules which were assessed as part of routine clinical care. Meta-analysis was performed on twelve eligible biomarkers. No significant association between any of the assessed biomarkers and AVF failure was observed.This paper is the first systematic review of biomarkers associated with AVF failure. Our results suggest that blood markers currently assessed do not identify an at-risk AVF. Further, rigorously designed studies assessing biological plausible biomarkers are needed to clarify whether assessment of circulating markers can be of any clinical value. PROSPERO registration number CRD42016033845.

The Effect of Polyphenol-Rich Interventions on Cardiovascular Risk Factors in Haemodialysis: A Systematic Review and Meta-Analysis.

Science.gov (United States)

Marx, Wolfgang; Kelly, Jaimon; Marshall, Skye; Nakos, Stacey; Campbell, Katrina; Itsiopoulos, Catherine

2017-12-11

End-stage kidney disease is a strong risk factor for cardiovascular-specific mortality. Polyphenol-rich interventions may attenuate cardiovascular disease risk factors; however, this has not been systematically evaluated in the hemodialysis population. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the following databases were searched: Cochrane Library (http://www.cochranelibrary.com/), MEDLINE (https://health.ebsco.com/products/medline-with-full-text), Embase (https://www.elsevier.com/solutions/embase-biomedical-research), and CINAHL (https://www.ebscohost.com/nursing/products/cinahl-databases/cinahl-complete). Meta-analyses were conducted for measures of lipid profile, inflammation, oxidative stress, and blood pressure. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias tool and quality of the body of evidence was assessed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. Twelve studies were included for review. Polyphenol-rich interventions included soy, cocoa, pomegranate, grape, and turmeric. Polyphenol-rich interventions significantly improved diastolic blood pressure (Mean Difference (MD) -5.62 mmHg (95% Confidence Interval (CI) -8.47, -2.78); I ² = 2%; p = 0.0001), triglyceride levels (MD -26.52 mg/dL (95% CI -47.22, -5.83); I ² = 57%; p = 0.01), and myeloperoxidase (MD -90.10 (95% CI -135.84, -44.36); I ² = 0%; p = 0.0001). Included studies generally had low or unclear risks of bias. The results of this review provide preliminary support for the use of polyphenol-rich interventions for improving cardiovascular risk markers in haemodialysis patients. Due to the limited number of studies for individual polyphenol interventions, further studies are required to provide recommendations regarding individual polyphenol intervention and dose.

Intradialytic Laughter Yoga therapy for haemodialysis patients: a pre-post intervention feasibility study.

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Bennett, Paul N; Parsons, Trisha; Ben-Moshe, Ros; Neal, Merv; Weinberg, Melissa K; Gilbert, Karen; Ockerby, Cherene; Rawson, Helen; Herbu, Corinne; Hutchinson, Alison M

2015-06-09

Laughter Yoga consists of physical exercise, relaxation techniques and simulated vigorous laughter. It has been associated with physical and psychological benefits for people in diverse clinical and non-clinical settings, but has not yet been tested in a haemodialysis setting. The study had three aims: 1) to examine the feasibility of conducting Laughter Yoga for patients with end stage kidney disease in a dialysis setting; 2) to explore the psychological and physiological impact of Laughter Yoga for these patients; and 3) to estimate the sample size required for future research. Pre/post intervention feasibility study. Eighteen participants were recruited into the study and Laughter Yoga therapists provided a four week intradialytic program (30-min intervention three times per week). Primary outcomes were psychological items measured at the first and last Laughter Yoga session, including: quality of life; subjective wellbeing; mood; optimism; control; self-esteem; depression, anxiety and stress. Secondary outcomes were: blood pressure, intradialytic hypotensive episodes and lung function (forced expiratory volume). Dialysis nurses exposed to the intervention completed a Laughter Yoga attitudes and perceptions survey (n = 11). Data were analysed using IBM SPSS Statistics v22, including descriptive and inferential statistics, and sample size estimates were calculated using G*Power. One participant withdrew from the study for medical reasons that were unrelated to the study during the first week (94 % retention rate). There were non-significant increases in happiness, mood, and optimism and a decrease in stress. Episodes of intradialytic hypotension decreased from 19 pre and 19 during Laughter Yoga to 4 post Laughter Yoga. There was no change in lung function or blood pressure. All nurses agreed or strongly agreed that Laughter Yoga had a positive impact on patients' mood, it was a feasible intervention and they would recommend Laughter Yoga to their patients. Sample

Single- and multi-frequency bioelectrical impedance analyses to analyse body composition in maintenance haemodialysis patients: comparison with dual-energy x-ray absorptiometry

International Nuclear Information System (INIS)

Donadio, C; Halim, A Ben; Caprio, F; Grassi, G; Khedr, B; Mazzantini, M

2008-01-01

The aim of this study was to evaluate the adequacy of single-frequency (sf-BIA) and multi-frequency bioelectrical impedance analyses (mf-BIA), in comparison with dual-energy x-ray absorptiometry (DXA), to evaluate body composition in maintenance haemodialysis (MHD) patients. Body composition of 27 adult MHD patients (9 f, 18 m), BMI 17.5–34.4 kg m −2 , was examined with DXA and BIA, with two different sf-BIA and 1 mf-BIA analysers. Biochemical markers of nutritional status and adequacy of dialytic treatment were also determined. Fat mass (FM) estimated by the different BIA analysers was found to be slightly but significantly higher than FM measured by DXA. In contrast, fat-free mass (FFM) obtained with BIA was found to be slightly but significantly lower than FFM DXA. No significant differences were found between LBM-DXA (that is FFM-DXA minus bone mass) and the different FFM BIA. The lowest mean prediction error versus DXA values was found with sf1BIA. In any case, a close correlation was found between all BIA values and DXA values, particularly for FFM. Furthermore, FFM and LBM results were significantly correlated with serum creatinine, which in MHD patients is an indicator of muscle mass. These results indicate that BIA can be used to evaluate body composition in MHD patients

Influence of religiosity and spiritual coping on health-related quality of life in Saudi haemodialysis patients.

Science.gov (United States)

Cruz, Jonas Preposi; Colet, Paolo C; Alquwez, Nahed; Inocian, Ergie P; Al-Otaibi, Raid Salman; Islam, Sheikh Mohammed Shariful

2017-01-01

Patients undergoing haemodialysis (HD) are frequently troubled by psychiatric disorders and coping problems, which can pose a serious threat to their physical and mental well-being. Using religious and spiritual interventions as a means of coping with physical and mental challenges is widely recognized. Although this topic has been well studied, in the Middle East regions, where Islam is the dominant religion, studies are limited. Thus, this study was performed to explore the influence of religiosity and spiritual coping (SC) on the health-related quality of life (HRQoL) of Saudi patients receiving HD. A total of 168 HD patients from three hospitals in Saudi Arabia formed a convenient sample for this descriptive, cross-sectional hospital-based study. Data collection was done via questionnaire-guided interviews using the Muslim Religious Index as well as the Arabic Versions of the Spiritual Coping Strategies scale and Quality of Life Index Dialysis. Regression analysis enabled identification of the factors influencing HRQoL. Older patients were found to reveal higher levels of religiosity, whereas the younger ones expressed a lesser degree of religious and nonreligious coping. Unemployed patients reported greater involvement in religious practices (RP) and more frequently used religious coping than those employed. The latter showed lower intrinsic religiosity and nonreligious coping usage than the unemployed. The respondents reported the greatest satisfaction scores on their psychological/spiritual dimension and the least scores on the social and economic dimension. Therefore, the factors that could influence the HRQoL of the respondents were identified as involvement in RP, intrinsic religious beliefs, religious coping usage and age. This study revealed significant findings regarding the importance of religiosity and SC on the HRQoL of the Saudi HD patients. Therefore, it has been highly recommended to integrate religiosity into the health-care process for such

Incidencia de las demencias en hemodiálisis: Apoyo al cuidador principal Incidence of dementia in haemodialysis: Support for the main carer

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Mª Ángeles Sánchez Lamolda

2013-03-01

Full Text Available Las demencias, aparecen cada día con más frecuencia en pacientes con tratamiento de hemodiálisis; la edad de entrada al tratamiento dialítico ha aumentado en los últimos años, influenciada por el aumento de la esperanza de vida. El deterioro en el estilo de vida del paciente afecta tanto a familiares como cuidadores, presentándose una situación compleja y difícil de manejar. En la actualidad, constituye un serio problema de salud con una repercusión social y económica a gran escala, por la pérdida de independencia del paciente y la carga física y psicológica que sufre la familia. Objetivo: Conocer la incidencia de las demencias y su relación con la edad, sexo, nivel de estudios, patologías asociadas. Material y método: Estudio descriptivo y transversal. Para conocer la incidencia de las demencias utilizamos el cuestionario: (short portable mental status questionarire Pfeiffer. Variables: sexo, edad, nivel de estudios, Convivencia, Hipertensión arterial, Diabetes. Resultados: el 28% de los pacientes presentan demencia, 36% se encuentra entre 75-79 años, afectando considerablemente al sexo femenino. El 58% no han terminado los estudios primarios. Hipertensión arterial no es estadísticamente significativa, Diabetes Mellitus aparece en el 48% de los pacientes que presentan demencia. Conclusión: La edad de los pacientes en hemodiálisis ha aumentado considerablemente, dando lugar a la aparición de las demencias, de ahí la necesidad de establecer las intervenciones de enfermería adecuadas para mejorar la calidad asistencial, ofrecer la información adecuada a familiares y cuidadores sobre las medidas a tener en cuenta en cada situación.Dementia appears with increasing frequency in patients undergoing haemodialysis: the age of starting dialysis treatment has increased in recent years, influenced by the increase in life expectancy. The deterioration in the patient's lifestyle affects both relatives and carers, creating a

The Effect of Polyphenol-Rich Interventions on Cardiovascular Risk Factors in Haemodialysis: A Systematic Review and Meta-Analysis

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Wolfgang Marx

2017-12-01

Full Text Available End-stage kidney disease is a strong risk factor for cardiovascular-specific mortality. Polyphenol-rich interventions may attenuate cardiovascular disease risk factors; however, this has not been systematically evaluated in the hemodialysis population. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA guidelines, the following databases were searched: Cochrane Library (http://www.cochranelibrary.com/, MEDLINE (https://health.ebsco.com/products/medline-with-full-text, Embase (https://www.elsevier.com/solutions/embase-biomedical-research, and CINAHL (https://www.ebscohost.com/nursing/products/cinahl-databases/cinahl-complete. Meta-analyses were conducted for measures of lipid profile, inflammation, oxidative stress, and blood pressure. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias tool and quality of the body of evidence was assessed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE methodology. Twelve studies were included for review. Polyphenol-rich interventions included soy, cocoa, pomegranate, grape, and turmeric. Polyphenol-rich interventions significantly improved diastolic blood pressure (Mean Difference (MD −5.62 mmHg (95% Confidence Interval (CI −8.47, −2.78; I2 = 2%; p = 0.0001, triglyceride levels (MD −26.52 mg/dL (95% CI −47.22, −5.83; I2 = 57%; p = 0.01, and myeloperoxidase (MD −90.10 (95% CI −135.84, −44.36; I2 = 0%; p = 0.0001. Included studies generally had low or unclear risks of bias. The results of this review provide preliminary support for the use of polyphenol-rich interventions for improving cardiovascular risk markers in haemodialysis patients. Due to the limited number of studies for individual polyphenol interventions, further studies are required to provide recommendations regarding individual polyphenol intervention and dose.

CT-Guided Superior Vena Cava Puncture: A Solution to Re-Establishing Access in Haemodialysis-Related Central Venous Occlusion Refractory to Conventional Endovascular Techniques

Energy Technology Data Exchange (ETDEWEB)

Khalifa, Mohamed, E-mail: mkhalifa@nhs.net; Patel, Neeral R., E-mail: neeral.patel06@gmail.com; Moser, Steven, E-mail: steven.moser@imperial.nhs.uk [Hammersmith Hospital, Department of Radiology, Imperial College Healthcare NHS Trust (United Kingdom)

2016-04-15

PurposeThe purpose of this technical note is to demonstrate the novel use of CT-guided superior vena cava (SVC) puncture and subsequent tunnelled haemodialysis (HD) line placement in end-stage renal failure (ESRF) patients with central venous obstruction refractory to conventional percutaneous venoplasty (PTV) and wire transgression, thereby allowing resumption of HD.MethodsThree successive ESRF patients underwent CT-guided SVC puncture with subsequent tract recanalisation. Ultrasound-guided puncture of the right internal jugular vein was performed, the needle advanced to the patent SVC under CT guidance, with subsequent insertion of a stabilisation guidewire. Following appropriate tract angioplasty, twin-tunnelled HD catheters were inserted and HD resumed.ResultsNo immediate complications were identified. There was resumption of HD in all three patients with a 100 % success rate. One patient’s HD catheter remained in use for 2 years post-procedure, and another remains functional 1 year to the present day. One patient died 2 weeks after the procedure due to pancreatitis-related abdominal sepsis unrelated to the Tesio lines.ConclusionCT-guided SVC puncture and tunnelled HD line insertion in HD-related central venous occlusion (CVO) refractory to conventional recanalisation options can be performed safely, requires no extra equipment and lies within the skill set and resources of most interventional radiology departments involved in the management of HD patients.

Effect of levocarnitine/iron saccharate combination on renal ...

African Journals Online (AJOL)

renal anaemia and oxidative stress in patients undergoing haemodialysis ... erythropoietin (EPO) can relieve anaemic symptom in ... haemodialysis 2 or 3 times per week, who had a ... informed consent form (themselves or a family member) ...

Plasma Levels of Middle Molecules to Estimate Residual Kidney Function in Haemodialysis without Urine Collection.

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Enric Vilar

Full Text Available Residual Kidney Function (RKF is associated with survival benefits in haemodialysis (HD but is difficult to measure without urine collection. Middle molecules such as Cystatin C and β2-microglobulin accumulate in renal disease and plasma levels have been used to estimate kidney function early in this condition. We investigated their use to estimate RKF in patients on HD.Cystatin C, β2-microglobulin, urea and creatinine levels were studied in patients on incremental high-flux HD or hemodiafiltration(HDF. Over sequential HD sessions, blood was sampled pre- and post-session 1 and pre-session 2, for estimation of these parameters. Urine was collected during the whole interdialytic interval, for estimation of residual GFR (GFRResidual = mean of urea and creatinine clearance. The relationships of plasma Cystatin C and β2-microglobulin levels to GFRResidual and urea clearance were determined.Of the 341 patients studied, 64% had urine output>100 ml/day, 32.6% were on high-flux HD and 67.4% on HDF. Parameters most closely correlated with GFRResidual were 1/β2-micoglobulin (r2 0.67 and 1/Cystatin C (r2 0.50. Both these relationships were weaker at low GFRResidual. The best regression model for GFRResidual, explaining 67% of the variation, was: GFRResidual = 160.3 · (1/β2m - 4.2. Where β2m is the pre-dialysis β2 microglobulin concentration (mg/L. This model was validated in a separate cohort of 50 patients using Bland-Altman analysis. Areas under the curve in Receiver Operating Characteristic analysis aimed at identifying subjects with urea clearance≥2 ml/min/1.73 m2 was 0.91 for β2-microglobulin and 0.86 for Cystatin C. A plasma β2-microglobulin cut-off of ≤19.2 mg/L allowed identification of patients with urea clearance ≥2 ml/min/1.73 m2 with 90% specificity and 65% sensitivity.Plasma pre-dialysis β2-microglobulin levels can provide estimates of RKF which may have clinical utility and appear superior to cystatin C. Use of cut-off levels

Fluid overload correction and cardiac history influence brain natriuretic peptide evolution in incident haemodialysis patients.

Science.gov (United States)

Chazot, Charles; Vo-Van, Cyril; Zaoui, Eric; Vanel, Thierry; Hurot, Jean Marc; Lorriaux, Christie; Mayor, Brice; Deleaval, Patrick; Jean, Guillaume

2011-08-01

Brain natriuretic peptide (BNP) is a cardiac peptide secreted by ventricle myocardial cells under stretch constraint. Increased BNP has been shown associated with increased mortality in end-stage renal disease patients. In patients starting haemodialysis (HD), both fluid overload and cardiac history are frequently present and may be responsible for a high BNP plasma level. We report in this study the evolution of BNP levels in incident HD patients, its relationship with fluid removal and cardiac history as well as its prognostic value. Forty-six patients (female/male: 21/25; 68.6 ± 14.5 years old) surviving at least 6 months after HD treatment onset were retrospectively analysed. Plasma BNP (Chemoluminescent Microparticule ImmunoAssay on i8200 Architect Abbott, Paris, France; normal value < 100 pg/mL) was assessed at HD start and during the second quarter of HD treatment (Q2). At dialysis start, the plasma BNP level was 1041 ± 1178 pg/mL (range: 14-4181 pg/mL). It was correlated with age (P = 0.0017) and was significantly higher in males (P = 0.0017) and in patients with cardiac disease history (P = 0.001). The plasma BNP level at baseline was not related to the mortality risk. At Q2, predialysis systolic blood pressure (BP) decreased from 140.5 ± 24.5 to 129.4 ± 20.6 mmHg (P = 0.0001) and the postdialysis body weight by 7.6 ± 8.4% (P < 0.0001). The BNP level decreased to 631 ± 707 pg/mL (P = 0.01) at Q2. Its variation was significantly correlated with systolic BP decrease (P = 0.006). A high BNP level was found associated with an increased risk of mortality. Hence, plasma BNP levels decreased during the first months of HD treatment during the dry weight quest. Whereas initial BNP values were not associated with increased mortality risk, the BNP level at Q2 was independently predictive of mortality. Hence, BNP is a useful tool to follow patient dehydration after dialysis start. Initial fluid overload may act as a confounding factor for its value as a

Relationship between plasma levels of zonulin, bacterial lipopolysaccharides, D-lactate and markers of inflammation in haemodialysis patients.

Science.gov (United States)

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

2017-04-01

Increased permeability of the intestinal wall and intestinal dysbiosis may contribute to chronic systemic inflammation, one of the causes of accelerated atherosclerosis and cardiovascular morbidity and mortality burden in patients with chronic kidney disease. The aim of this study was to evaluate the association between markers of intestinal permeability and inflammation in haemodialysis (HD) patients. Plasma concentration of zonulin, haptoglobin, TNFα, IL6, D-lactates and bacterial lipopolysaccharides (LPS) was assessed in blood samples obtained after overnight fast before midweek morning HD session in 150 stable, prevalent HD patients. Daily intake of energy and macronutrients was assessed on the basis of a food frequency questionnaire. Serum hsCRP level was increased in over 70% of patients. Plasma levels of zonulin [11.6 (10.9-12.3) vs 6.8 (5.8-7.8) ng/mL], IL6 [6.2 (1.0-10.3) vs 1.3 (1.0-2.0) pg/mL] and TNFα [5.9 (2.9-11.8) vs 1.6 (1.3-1.8) pg/mL], but not LPS and D-lactates were significantly higher in HD than in healthy controls. D-lactates and LPS levels were weakly associated with IL6 (R = 0.175; p = 0.03, and R = 0.241; p = 0.003). There was a borderline correlation between plasma zonulin and serum hsCRP (R = 0.159; p = 0.07), but not with IL6, LPS and D-lactates. In multiple regression, both serum CRP and plasma IL6 variability were explained by LPS (β = 0.143; p = 0.08 and β = 0.171; p = 0.04, respectively), only. The weak association between plasma D-lactate, LPS and IL6 levels indicates that intestinal flora overgrowth or increased intestinal permeability contributes very slightly to the chronic inflammation development in HD patients.

Changes in fibroblast growth factor 23 during treatment of secondary hyperparathyroidism with alfacalcidol or paricalcitol

DEFF Research Database (Denmark)

Hansen, D.; Rasmussen, K.; Brandi, L.

2012-01-01

of secondary hyperparathyroidism (SHPT) with alfacalcidol or paricalcitol in haemodialysis patients. Methods. Intravenous alfacalcidol and paricalcitol were compared in haemodialysis patients with SHPT in a randomized 2 × 16-week cross-over study, with 6 weeks washout period preceding treatment and between...

Suicide by severing the arterio-venous subclavian dialysis catheter.

Science.gov (United States)

Edirisinghe, P A S; Busuttil, A

2006-02-01

Haemodialysis access is an essential requirement for haemodialysis treatment in end-stage renal disease. The common forms are arteriovenous fistula (AVF) and arteriovenous grafts in ante-cubital fossa, forearm and upper thigh. Sometimes temporary or immediate access is created via a subclavian catheter or internal jugular catheter. This report is on a 79-year-old man who was suffering from chronic renal failure with a non-functional peripheral AVF; he was being dialysed through a permanent subclavian catheter and he became depressed due to continuing deterioration of his health. He used the easily accessible haemodialysis site as the method of suicide by cutting the tube that connected with the main vessel in his chest and bled to death. This highlights the requirement to assess carefully the patient's mental state in those on chronic haemodialysis, even though very few similar fatal cases have been previously reported.

Defected red blood cell membranes and direct correlation with the uraemic milieu: the connection with the decreased red blood cell lifespan observed in haemodialysis patients

International Nuclear Information System (INIS)

Stamopoulos, D; Manios, E; Gogola, V; Grapsa, E; Bakirtzi, N

2012-01-01

Together with impaired production of erythropoietin and iron deficiency, the decreased lifespan of red blood cells (RBCs) is a main factor contributing to the chronic anaemia observed in haemodialysis (HD) patients. Atomic force microscopy is employed in this work to thoroughly survey the membrane of intact RBCs (iRBCs) of HD patients in comparison to those of healthy donors, aiming to obtain direct information on the structural status of RBCs that can be related to their decreased lifespan. We observed that the iRBC membrane of the HD patients is overpopulated with extended circular defects, termed ‘orifices’, that have typical dimension ranging between 0.2 and 1.0 μm. The ‘orifice’ index—that is, the mean population of ‘orifices’ per top membrane surface—exhibits a pronounced relative increase of order 54 ± 12% for the HD patients as compared to healthy donors. Interestingly, for the HD patients, the ‘orifice’ index, which relates to the structural status of the RBC membrane, correlates strongly with urea concentration, which is a basic index of the uraemic milieu. Thus, these results indicate that the uraemic milieu downgrades the structural status of the RBC membrane, possibly triggering biochemical processes that result in their premature elimination from the circulation. This process could decrease the lifespan of RBCs, as observed in HD patients. (paper)

Social relationships and their impact on health-related outcomes in peritoneal versus haemodialysis patients: a prospective cohort study.

Science.gov (United States)

Neumann, Denise; Lamprecht, Juliane; Robinski, Maxi; Mau, Wilfried; Girndt, Matthias

2018-01-23

Social relationships are important determinants of health-related outcomes for patients with chronic conditions. However, the effects of social networks and social support on health outcomes of dialysis patients in different treatment modalities have been under studied. We surveyed peritoneal dialysis (PD) and haemodialysis (HD) patients in the Choice of Renal Replacement Therapy project about their social relationships and health-care outcomes at baseline and 1-year follow-up. Two propensity score-matched groups (n = 353; HD = 200, PD = 153) with similar age, comorbidity level, education and employment status were compared. We used an ego-centred Network Generator to assess quantitative and qualitative aspects of social networks and the Berlin Social Support Scales to evaluate dimensions of social support, and analysed the effects of the social variables on anxiety, depression, autonomy preferences, and physical and psychological quality of life. Over time, the non-family networks (e.g. friends) of both groups decreased (P = 0.04) and the absolute number of types of relationships increased (P = 0.01). The family-network size, quality of relationships and social support remained stable. Larger social networks were associated with higher participation-seeking preferences (B = 1.39, P = 0.002) and lower anxiety (B = -0.11, P = 0.03). Closer and more satisfying relationships were associated with better psychological well-being (B = 3.41, P = 0.003). PD patients had larger networks, more types of relationships and received more social support than HD patients (P ≤ 0.05). These differences may reflect the degree of autonomy and self-care associated with the different treatment modalities. In practice, our findings suggest that the early identification and inclusion of persons providing social support for patients may have a positive effect on different aspects of their care and quality of life. © The Author(s) 2018

Results of a Seven-Year, Single-Centre Experience of the Long-Term Outcomes of Bovine Ureter Grafts Used as Novel Conduits for Haemodialysis Fistulas

International Nuclear Information System (INIS)

Das, Neelan; Bratby, Mark J.; Shrivastava, Vivek; Cornall, Alison J.; Darby, Christopher R.; Boardman, Philip; Anthony, Susan; Uberoi, Raman

2011-01-01

Purpose: To report the long-term outcomes of bovine ureter grafts as novel conduits for haemodialysis fistulas. Materials and Methods: Thirty-five patients underwent placement of a total of 40 SynerGraft 100 (SG100; CryoLife Europa ® , Guildford, UK) bovine ureter grafts between April 2002 and February 2009. Prospective data were collected on all patients, including active surveillance with blood flow studies and 6-monthly duplex ultrasound studies. Main outcome measures were primary and secondary patency rates. Results: Mean follow-up time was 97 weeks (range 4–270). Thirteen patients died from unrelated causes during the study period; 12 of these patients had a functioning graft at the time of death. Five patients underwent transplantation, and all had a functioning graft at transplantation. Twelve patients had a functioning graft at the end of the study period. One hundred and ten stenoses were detected, and 97 venoplasty procedures were performed. Of the stenoses, 41.8% were located at the venous anastomosis, 12.7% within the graft, 17.3% in the outflow veins, and 28.1% in central veins. No arterial stenoses were detected. Primary patency rates were 53% at 6 months and 14% at 1 year. Secondary patency rates were 81% at 6 months, 75% at 1 year, and 56% at 2 years. Conclusions: Active surveillance and intervention was able to achieve satisfactory long-term secondary patency for these novel conduits compared with those made of PTFE seen in other studies.

Epidemiology of chronic kidney diseases in the Republic of Guinea; future dialysis needs.

Science.gov (United States)

Bah, Alpha Oumar; Lamine, Cisse; Balde, Mamadou Cellou; Bah, Mamadou Lamine Yaya; Rostaing, Lionel

2015-10-01

Chronic kidney disease (CKD) is increasing worldwide and can lead to end-stage renal disease (ESRD). Because few patients with ESRD in the Republic of Guinea have access to haemodialysis, we retrospectively evaluated the prevalence of CKD, ESRD and access to supportive therapies. 579 CKD patients (304 males; mean age: 44 ± 16 years) were admitted into Conakry nephrology department, the only centre in the Republic of Guinea, between 2009 and 2013. Most patients (63%) resided within Conakry (the capital), 12.5% came from lower Guinea, 11.7% from middle Guinea, 7.9% from upper Guinea and 4.8% from forest Guinea. Reasons for referral were increased serum creatinine (49.5%), hypertension (27%) and diffuse edema (17%). Also, 11% were diabetic, 12.5% were smokers, 17% were HIV-positive, 8.3% were HBV-positive and 15% were HCV-positive. The most frequent symptom at admission was nausea/vomiting (56%). Upon admission, 70.5% of patients already had ESRD. Although no kidney biopsies were performed it was assumed that 34% and 27% of patients had vascular nephropathy and chronic glomerulonephritis, respectively. Of the 385 ESRD patients, only 140 (36.3%) had access to haemodialysis (two sessions/week, 4 hours each). Most patients that received haemodialysis resided within the Conakry region (P Conakry, plus four new nephrology/haemodialysis centres within the Republic of Guinea, each holding ≥30 haemodialysis machines.

Effect of continuous ambulatory peritoneal dialysis on a British renal unit.

Science.gov (United States)

Morgan, A G; Burden, R P

1986-10-11

Experience in the use of continuous ambulatory peritoneal dialysis (CAPD) for the treatment of end stage renal failure in Nottingham was reviewed. During six years 150 patients aged from 11 to 73 received this type of treatment. At three years patient actuarial survival was 69% and CAPD technique survival was 41%. Although CAPD was satisfactory as a first treatment for many patients, its long term use was possible in only a few. Actuarial survival of patients who changed to haemodialysis was 64% at one year after the change, suggesting that unsuccessful CAPD increased the risk of death. Hospital haemodialysis was the only suitable form of treatment for most patients in whom CAPD had been abandoned. British renal units have adopted CAPD to a much greater extent than those in Europe, but care in the selection of patients is necessary to reduce mortality, and many patients may eventually need hospital haemodialysis. Greater numbers of hospital haemodialysis places will probably have to be made available to meet this extra demand.

Creatinine index as a surrogate of lean body mass derived from urea Kt/V, pre-dialysis serum levels and anthropometric characteristics of haemodialysis patients.

Directory of Open Access Journals (Sweden)

Bernard Canaud

Full Text Available BACKGROUND AND OBJECTIVES: Protein-energy wasting is common in long-term haemodialysis (HD patients with chronic kidney disease and is associated with increased morbidity and mortality. The creatinine index (CI is a simple and useful nutritional parameter reflecting the dietary skeletal muscle protein intake and skeletal muscle mass of the patient. Because of the complexity of creatinine kinetic modeling (CKM to derive CI, we developed a more simplified formula to estimate CI in HD patients. DESIGN, SETTING, PARTICIPANTS & MEASUREMENTS: A large database of 549 HD patients followed over more than 20 years including monthly CKM-derived CI values was used to develop a simple equation based on patient demographics, predialysis serum creatinine values and dialysis dose (spKt/V using mixed regression models. RESULTS: The equation to estimate CI was developed based on age, gender, pre-dialysis serum creatinine concentrations and spKt/V urea. The equation-derived CI correlated strongly with the measured CI using CKM (correlation coefficient  = 0.79, p-value <0.001. The mean error of CI prediction using the equation was 13.47%. Preliminary examples of few typical HD patients have been used to illustrate the clinical relevance and potential usefulness of CI. CONCLUSIONS: The elementary equation used to derive CI using demographic parameters, pre-dialysis serum creatinine concentrations and dialysis dose is a simple and accurate surrogate measure for muscle mass estimation. However, the predictive value of the simplified CI assessment method on mortality deserves further evaluation in large cohorts of HD patients.

Allergic reaction to polysulphone membrane dialyser masquerading as infection.

Science.gov (United States)

Mukaya, Japheth E; Jacobson, Mitchell S; Esprit, Don; Ajayi, Tokunbo

2015-02-18

Hypersensitivity reactions during haemodialysis are well documented in the literature. Most dialysis membrane reactions occur with ethylene oxide or non-biocompatible membranes and less frequently with biocompatible membranes. The symptoms are non-specific except for the temporal relationship typically occurring during the haemodialysis. Patients who present with the non-classic type of reaction pose a diagnostic challenge and clinicians must have a high index of suspicion. We present a non-classic presentation of a hypersensitivity reaction to a polysulfone membrane dialyser with recurrent fevers during and after haemodialysis, initially thought to be due to infection. After a series of negative work ups for infection, dialysis membrane reaction was considered and the patient improved after change of the membrane. 2015 BMJ Publishing Group Ltd.

Myths in peritoneal dialysis.

Science.gov (United States)

Lee, Martin B; Bargman, Joanne M

2016-11-01

To clarify misconceptions about the feasibility and risks of peritoneal dialysis that unnecessarily limit peritoneal dialysis uptake or continuation in patients for whom peritoneal dialysis is the preferred dialysis modality. The inappropriate choice of haemodialysis as a result of these misconceptions contributes to low peritoneal dialysis penetrance, increases transfer from peritoneal dialysis to haemodialysis, increases expenditure on haemodialysis and compromises quality of life for these patients. Peritoneal dialysis is an excellent renal replacement modality that is simple, cost-effective and provides comparable clinical outcomes to conventional in-centre haemodialysis. Unfortunately, many patients are deemed unsuitable to start or continue peritoneal dialysis because of false or inaccurate beliefs about peritoneal dialysis. Here, we examine some of these 'myths' and critically review the evidence for and against each of them. We review the feasibility and risk of peritoneal dialysis in patients with prior surgery, ostomies, obesity and mesh hernia repairs. We examine the fear of mediastinitis with peritoneal dialysis after coronary artery bypass graft surgery and the belief that the use of hypertonic glucose dialysate causes peritoneal membrane failure. By clarifying common myths about peritoneal dialysis, we hope to reduce overly cautious practices surrounding this therapy.

Recombinant human growth hormone treatment in short children with renal disease: Our first experience

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Spasojević-Dimitrijeva Brankica

2010-01-01

Full Text Available Introduction. Growth retardation is a hallmark of chronic illnesses such as chronic kidney disease in children, and it is associated with increased morbidity and mortality. The growth hormone (GH resistance observed in uraemia can be overcome by supraphysiological doses of exogenous GH. Objective. We would like to present our first results of recombinant human growth hormone (rhGH treatment, mainly in children on haemodialysis. Methods. Sixteen children, aged 4.5-17.1 years (mean age 11.25±3.57 with height below -2.0 standard deviation score (SDS for age or height velocity below -2.0 SDS for age, were selected to receive rhGH therapy at our Nephrology and Haemodialysis Department. Most of them were on haemodialysis (14 children with mean spent time 2.88±2.68 years (0-9 years before the initiation of rhGH therapy. One half of patients were prepubertal (8 children and the second half were in early puberty (testicular volume between 4 and 8 ml for boys and breast development B2 or B3 in girls. All patients received 28-30IU/m² rhGH per week by daily subcutaneous injection. The year before rhGH therapy served as a control period. Results. During the first year of treatment, mean height velocity in haemodialysis patients increased from 2.25 cm/year to 6.59 cm/year (p<0.0001 and in the second year it was 5.25 cm/ year (p=0.004. The mean height SDS in haemodialysis children did not improve significantly during the first year of rhGH treatment (from -3.01 SDS to -2.77 SDS, p=0.063. Neither weight nor the body mass index varied compared with the pretreatment period. Two patients developed worsened secondary hyperparathyroidism and were excluded from the study, but the relationship with rhGH remains uncertain. Conclusion. Mean height velocity significantly improved during rhGH therapy in haemodialysis patients. No significant side-effects were observed in children during three-year treatment with GH.

Tailored online cognitive behavioural therapy with or without therapist support calls to target psychological distress in adults receiving haemodialysis: A feasibility randomised controlled trial.

Science.gov (United States)

Hudson, Joanna L; Moss-Morris, Rona; Norton, Sam; Picariello, Federica; Game, David; Carroll, Amy; Spencer, Jonathan; McCrone, Paul; Hotopf, Matthew; Yardley, Lucy; Chilcot, Joseph

2017-11-01

Psychological distress is prevalent in haemodialysis (HD) patients yet access to psychotherapy remains limited. This study assessed the feasibility and acceptability of online cognitive-behavioural therapy (CBT) tailored for HD patients, with or without therapist support, for managing psychological distress. This feasibility randomised controlled trial recruited patients from a UK HD centre. Following psychological distress screens, patients with mild-moderate psychological distress (Patient Health Questionnaire PHQ-9; score: 5-19 and/or Generalised Anxiety Disorder; GAD-7 score: 5-14) who met remaining inclusion criteria were approached for consent. Consenters were individually randomised (1:1) to online-CBT or online-CBT plus three therapist support calls. Outcomes included recruitment, retention, and adherence rates. Exploratory change analyses were performed for: psychological distress, quality of life (QoL), illness perceptions, and costs. The statistician was blinded to allocation. 182 (44%) out of 410 patients approached completed psychological distress screens. 26% found screening unacceptable; a further 30% found it unfeasible. Psychological distress was detected in 101 (55%) patients, 60 of these met remaining inclusion criteria. The primary reason for ineligibility was poor computer literacy (N=17, 53%). Twenty-five patients were randomised to the supported (N=18) or unsupported arm (N=7); 92% were retained at follow-up. No differences in psychological distress or cost-effectiveness were observed. No trial adverse events occurred. Online CBT appears feasible but only for computer literate patients who identify with the label psychological distress. A definitive trial using the current methods for psychological distress screening and online care delivery is unfeasible. ClinicalTrials.gov Identifier: NCT02352870. Copyright © 2017 Elsevier Inc. All rights reserved.

Pseudoporfyri er et symptomkompleks

DEFF Research Database (Denmark)

Velander, Marie Juul; Þorsteinsdóttir, Sunna; Bygum, Anette

2015-01-01

Pseudoporphyria is a photosensitive bullous disease, which resembles porphyria cutanea tarda. Normal porphyrin levels in urine, stool and blood define pseudoporphyria. Pseudoporphyria is associated with chronic renal failure, haemodialysis, a variety of drugs (e.g. naproxen, nabumetone, furosemid......, ciprofloxacin, voriconazole, acitretin), tanning beds and UVA exposure. Treatment consists of UV protection and cessation of suspected agents. Patients in haemodialysis can benefit from treatment with N-acetylcysteine or glutathione....

(131)I treatment in Differentiated Thyroid Cancer and End-Stage Renal Disease.

Science.gov (United States)

Ortega, A J M; Vázquez, R G; Cuenca, J I C; Brocca, M A M; Castilla, J; Martínez, J M M; González, E N

2016-01-01

Radioiodine (RAI) is a cornerstone in the treatment of Differentiated Thyroid Cancer (DTC). In patients on haemodialysis due to End-Stage Renal Disease (ESRD), it must be used cautiously, considering the renal clearance of this radionuclide. Also, the safety of the procedure and subsequent long-term outcome is still not well defined. In 2001, we described a dosimetric method and short-term results in three patients, with a good safety profile. We hypothesize that our method is safe in a long-term scenario without compromising the prognosis of both renal and thyroid disease. Descriptive-retrospective study. A systematic search was carried out using our clinical database from 2000 to 2014. DTC and radioiodine treatment while on haemodialysis. peritoneal dialysis. Final sample n=9 patients (n=5 males), age 48 years (median age 51 years males, 67 years female group); n=8 papillary thyroid cancer, n=1 follicular thyroid cancer; n=5 lymph node invasion; n=1 metastatic disease. Median RAI dose administered on haemodialysis 100mCi. 7.5 years after radioiodine treatment on haemodialysis, n=7 deemed free of thyroid disease, n=1 persistent non-localised disease. No complications related to the procedure or other target organs were registered. After 3.25 years, n=4 patients underwent successful renal transplantation; n=4 patients did not meet transplantation criteria due to other conditions unrelated to the thyroid disease or its treatment. One patient died due to ischemic cardiomyopathy (free of thyroid disease). Radioiodine treatment during haemodialysis is a long-term, safe procedure without worsening prognosis of either renal or thyroid disease. Copyright © 2015 Elsevier España, S.L.U. and SEMNIM. All rights reserved.

Types of vicarious learning experienced by pre-dialysis patients

OpenAIRE

McCarthy, Kate; Sturt, Jackie; Adams, Ann

2015-01-01

Objective: Haemodialysis and peritoneal dialysis renal replacement treatment options are in clinical equipoise, although the cost of haemodialysis to the National Health Service is £16,411/patient/year greater than peritoneal dialysis. Treatment decision-making takes place during the pre-dialysis year when estimated glomerular filtration rate drops to between 15 and 30 mL/min/1.73 m2. Renal disease can be familial, and the majority of patients have considerable health service experience when ...

Strategies to increase patient safety in haemodialysis: Application of the modal analysis system of errors and effects (FEMA system

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María Dolores Arenas Jiménez

2017-11-01

Full Text Available Background: Haemodialysis (HD patients are a high-risk population group. For these patients, an error could have catastrophic consequences. Therefore, system that ensures the safety of these patients in an environment with high technology and great interaction of the human factor is a requirement. Objectives: To show a systematic working approach, reproducible in any HD unit, which consists of recording the complications and errors that occurred during the HD session; defining which of those complications could be considered adverse event (AE, and therefore preventable; and carrying out a systematic analysis of them, as well as of underlying real or potential errors, evaluating their severity, frequency and detection; as well as establishing priorities for action (Failure Mode and Effects Analysis system [FMEA systems]. Methods: Retrospective analysis of the graphs of all HD sessions performed during one month (October 2015 on 97 patients, analysing all recorded complications. The consideration of these complications as AEs was based on a consensus among 13 health professionals and 2 patients. The severity, frequency and detection of each AE were evaluated by the FMEA system. Results: We analysed 1303 HD treatments in 97 patients. A total of 383 complications (1 every 3.4 HD treatments were recorded. Approximately 87.9% of them were deemed AEs and 23.7% complications related with patients’ underlying pathology. There was one AE every 3.8 HD treatments. Hypertension and hypotension were the most frequent AEs (42.7 and 27.5% of all AEs recorded, respectively. Vascular-access related AEs were one every 68.5 HD treatments. A total of 21 errors (1 every 62 HD treatments, mainly related to the HD technique and to the administration of prescribed medication, were registered. The highest risk priority number, according to the FMEA, corresponded to errors related to patient body weight; dysfunction/rupture of the catheter; and needle extravasation

Pneumoconiosis and liver cirrhosis are not risk factors for tuberculosis in patients with pulmonary infection

Energy Technology Data Exchange (ETDEWEB)

Wu, H.P.; Pan, Y.H.; Hua, C.C.; Shieh, H.B.; Jiang, B.Y.; Yu, T.J. [Chang Gung Memorial Hospital, Chilung (Taiwan)

2007-05-15

It is unclear whether patients with liver cirrhosis and coal miners with pneumoconiosis are at increased risk of developing pulmonary tuberculosis (TB). Furthermore, little is known of the likelihood of pneumonia in patients with bronchiectasis, haemodialysis, diabetes mellitus or advanced lung cancer being due to TB. To answer these questions, patients with these clinical comorbidities were analysed. The study was retrospective and included 264 TB patients, 478 non-TB pneumonia patients, and as negative controls, 438 subjects without pneumonia. The parameters analysed were age, gender and the presence of pneumoconiosis, bronchiectasis, liver cirrhosis, haemodialysis, diabetes mellitus and advanced lung cancer. Male gender was the only significant factor increasing the risk of pulmonary TB. When compared with non-TB pneumonia and control patients, the odds ratios were 1.862 and 2.182, respectively. Patients with liver cirrhosis did not show an increased risk of pulmonary TB after regression analysis. Pneumoconiosis resulted in a 2.260 (P = 0.003) odds ratio for pulmonary TB, compared with the controls. However, there was no difference in pneurmoconiosis between TB and non-TB pneumonia patients. Patients with bronchiectasis, lung cancer and those receiving haemodialysis had a lower risk for pulmonary TB in lower respiratory tract infection, with odds ratios of 0.342, 0.311 and 0.182, respectively. Physicians should first consider non-TB bacterial infection rather than Mycobacterium tuberculosis infection in pneumonia in patients with bronchiectasis, lung cancer or those receiving haemodialysis.

A randomised controlled trial of Heparin versus EthAnol Lock THerapY for the prevention of Catheter Associated infecTion in Haemodialysis patients – the HEALTHY-CATH trial

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Broom Jennifer K

2012-11-01

Full Text Available Abstract Background Tunnelled central venous dialysis catheter use is significantly limited by the occurrence of catheter-related infections. This randomised controlled trial assessed the efficacy of a 48 hour 70% ethanol lock vs heparin locks in prolonging the time to the first episode of catheter related blood stream infection (CRBSI. Methods Patients undergoing haemodialysis (HD via a tunnelled catheter were randomised 1:1 to once per week ethanol locks (with two heparin locks between other dialysis sessions vs thrice per week heparin locks. Results Observed catheter days in the heparin (n=24 and ethanol (n=25 groups were 1814 and 3614 respectively. CRBSI occurred at a rate of 0.85 vs. 0.28 per 1000 catheter days in the heparin vs ethanol group by intention to treat analysis (incident rate ratio (IRR for ethanol vs. heparin 0.17; 95%CI 0.02-1.63; p=0.12. Flow issues requiring catheter removal occurred at a rate of 1.6 vs 1.4 per 1000 catheter days in the heparin and ethanol groups respectively (IRR 0.85; 95% CI 0.20-3.5 p =0.82 (for ethanol vs heparin. Conclusions Catheter survival and catheter-related blood stream infection were not significantly different but there was a trend towards a reduced rate of infection in the ethanol group. This study establishes proof of concept and will inform an adequately powered multicentre trial to definitively examine the efficacy and safety of ethanol locks as an alternative to current therapies used in the prevention of catheter-associated blood stream infections in patients dialysing with tunnelled catheters. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12609000493246

Cure of chronic hepatitis C virus infection in an HIV-coinfected patient with multiple comorbidities and drug interaction challenges.

Science.gov (United States)

Álvarez, Hortensia; Mariño, Ana; Valcarce, Nieves; Khoo, Saye; Bhagani, Sanjay; Schapiro, Jonathan; Llibre, Josep M

2018-01-01

Curing hepatitis C virus (HCV) infection in patients harbouring multiple severe comorbidities is a medical challenge. Evidence-based data are lacking regarding HCV treatment with direct-acting antiviral regimens in particular populations of HCV/HIV-coinfected patients with cirrhosis and chronic kidney disease on haemodialysis. Here, we present the HCV treatment challenges facing a patient with HIV coinfection, prior failure of both HIV-1 and HCV therapy, cirrhosis, end-stage renal failure on haemodialysis, as well as management of drug-drug interactions, especially given the need to receive long-term amiodarone therapy.

Intermittent intravenous followed by intermittent oral 1 alpha(OH)D3 treatment of secondary hyperparathyroidism in uraemia

DEFF Research Database (Denmark)

Brandi, L; Daugaard, H; Egsmose, C

1996-01-01

OBJECTIVES: To examine whether intermittent oral 1 alpha(OH)D3 treatment of patients on haemodialysis with secondary hyperparathyroidism (HPT) was able to maintain the marked suppression of PTH, which previously had been induced by an intermittent intravenous administration of 1 alpha(OH)D3....... Simultaneously, the effect of the different routes of administration of 1 alpha(OH)D3 on the circulating levels of N- and C-terminal PTH fragments was measured. DESIGN: An open study of patients on chronic haemodialysis. SETTING: Renal division, Rigshospitalet, Copenhagen, Denmark. SUBJECTS: A total of 26...

Non-convulsive status epilepticus and consciousness disturbance after star fruit (Averrhoa carambola) ingestion in a dialysis patient.

Science.gov (United States)

Chang, Chung-Hsin; Yeh, Jiann-Horng

2004-12-01

Star fruit ingestion may induce severe neurological complications in chronic renal failure patients. We present a case on maintenance dialysis therapy who developed a consciousness disturbance without convulsion after eating star fruit. The symptoms became aggravated after haemodialysis. The brain computed tomography scan showed no abnormal findings, but the electroencephalogram found active focal sharp waves in the left central regions and diffusion-weighted magnetic resonance imaging also showed hyperintense lesions in the left central regions that were compatible with non-convulsive status epilepticus. His condition improved dramatically after anticonvulsant therapy and regular haemodialysis. The patient was discharged 20 days later without neurological sequela.

Validation of the kidney disease quality of life-short form: a cross-sectional study of a dialysis-targeted health measure in Singapore.

Science.gov (United States)

Joshi, Veena D; Mooppil, Nandakumar; Lim, Jeremy Fy

2010-12-20

In Singapore, the prevalence of end-stage renal disease (ESRD) and the number of people on dialysis is increasing. The impact of ESRD on patient quality of life has been recognized as an important outcome measure. The Kidney Disease Quality Of Life-Short Form (KDQOL-SF™) has been validated and is widely used as a measure of quality of life in dialysis patients in many countries, but not in Singapore. We aimed to determine the reliability and validity of the KDQOL-SF™ for haemodialysis patients in Singapore. From December 2006 through January 2007, this cross-sectional study gathered data on patients ≥21 years old, who were undergoing haemodialysis at National Kidney Foundation in Singapore. We used exploratory factor analysis to determine construct validity of the eight KDQOL-SF™ sub-scales, Cronbach's alpha coefficient to determine internal consistency reliability, correlation of the overall health rating with kidney disease-targeted scales to confirm validity, and correlation of the eight sub-scales with age, income and education to determine convergent and divergent validity. Of 1980 haemodialysis patients, 1180 (59%) completed the KDQOL-SF™. Full information was available for 980 participants, with a mean age of 56 years. The sample was representative of the total dialysis population in Singapore, except Indian ethnicity that was over-represented. The instrument designers' proposed eight sub-scales were confirmed, which together accounted for 68.4% of the variance. All sub-scales had a Cronbach's α above the recommended minimum value of 0.7 to indicate good reliability (range: 0.72 to 0.95), except for Social function (0.66). Correlation of items within subscales was higher than correlation of items outside subscales in 90% of the cases. The overall health rating positively correlated with kidney disease-targeted scales, confirming validity. General health subscales were found to have significant associations with age, income and education

Effect of Membrane Permeability on Cardiovascular Risk Factors and β2m Plasma Levels in Patients on Long-Term Haemodialysis: A Randomised Crossover Trial.

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Chazot, Charles; Kirchgessner, Judith; Pham, Jenny; Vo-Van, Cyril; Lorriaux, Christie; Hurot, Jean-Marc; Zaoui, Eric; Grassmann, Aileen; Jean, Guillaume; Marcelli, Daniele

2015-01-01

Survival of haemodialysis (HD) patients is influenced by many factors. Mortality is mainly of cardiovascular (CV) origin and related to both traditional and nontraditional CV risk factors. Low plasma Beta2-microglobulin (β2m) levels are associated with improved HD patient survival. HD session times that are longer than the conventional 4 h (i.e., extended dialysis) provide better middle molecule clearance and are also associated with a survival advantage. In this crossover randomised trial, we investigated the effect of membrane flux on CV risk factors and on β2m plasma levels in patients treated with extended dialysis. Dialysis session duration was between 5 and 8 h for all patients. Patients were randomly assigned to the treatment sequences low-flux/high-flux dialysis versus high-flux/low-flux dialysis in a crossover design after a 3-month run-in period, with each phase lasting 9 months. Of the initially enrolled 168 patients, 155 patients started the study after the run-in period, 117 patients completed Phase 1, and 83 patients completed the whole study. Lp(a), homocystein, LDL cholesterol, HDL cholesterol and serum albumin were comparable in the low-flux and high-flux treatments. The average β2m level was 43.3 ± 11.1 mg/l at the end of the low-flux phase. Independent of sequence assignation, average β2m was significantly lower at the end of the high-flux phase (27.5 ± 76.0 mg/l, p < 0.0001 versus end of low-flux phase). Both phosphate and nPNA were significantly lower at the end of the high-flux phase compared to the low-flux phase (p = 0.045 and p = 0.002, respectively). Inclusion of those patients who completed Phase 1 and who dropped out of the study during Phase 2 did not significantly change the results. In conclusion, this study did not find an influence of high-flux filters on several traditional CV risk factors in a population of HD patients treated with extended dialysis. However, high-flux filters are necessary to optimise middle molecule

Intoxication by star fruit (Averrhoa carambola) in 32 uraemic patients: treatment and outcome.

Science.gov (United States)

Neto, Miguel Moyses; da Costa, José Abrão Cardeal; Garcia-Cairasco, Norberto; Netto, Joaquim Coutinho; Nakagawa, Beatriz; Dantas, Marcio

2003-01-01

Clinical symptoms and outcomes of uraemic patients ingesting star fruit are quite variable and may progress to death. The purpose of the present report was to discuss the neurotoxic effects of star fruit intoxication in uraemic patients and to present the efficacy of different therapeutic approaches. We studied a total of 32 uraemic patients who had ingested star fruit. Before the intoxication episodes, 20 patients were on regular haemodialysis, eight were on peritoneal dialysis and four were not yet undergoing dialysis. Two patients were analysed retrospectively from their charts, 17 were directly monitored by our clinic and 13 were referred by physicians from many areas throughout the country, allowing us to follow their outcome from a distance. Intoxicated patients were given different therapeutic approaches (haemodialysis, peritoneal dialysis and supportive treatment), and their outcomes were analysed. The most common symptoms were persistent and intractable hiccups in 30 patients (93.75%), vomiting in 22 (68.7%), variable degrees of disturbed consciousness (mental confusion, psychomotor agitation) in 21 (65.6%), decreased muscle power, limb numbness, paresis, insomnia and paresthesias in 13 (40.6%) and seizures in seven (21.8%). Patients who were promptly treated with haemodialysis, including those with severe intoxication, recovered without sequelae. Patients with severe intoxication who were not treated or treated with peritoneal dialysis did not survive. Haemodialysis, especially on a daily basis, is the ideal treatment for star fruit intoxication. In severe cases, continuous methods of replacement therapy may provide a superior initial procedure, since rebound effects are a common event. Peritoneal dialysis is of no use as a treatment, especially when consciousness disorders ensue.

Assessment of leptin and some Antioxidants in Blood of Chronic Renal Failure Patients

International Nuclear Information System (INIS)

Ahmed, A.M.

2004-01-01

The aim of the present work is to study the effect of haemodialysis on the state of the antioxidants glutathione peroxidase (GPx) and vitamin C and the role of leptin hormone on the redox homeostasis in patients with chronic renal failure (CRF). This study was carried out on 25 patients (15 females and 10 males) with CRF,aged 19-55 years, in addition to 25 healthy control (10 females and 15 males). Patients were subjected to regular haemodialysis for 4 hours three times weekly and blood samples were collected before haemodialysis. In this study, plasma leptin was significantly increased in CRF group than normal control. Vitamin C and GPx were decreased significantly in CRF group in comparison with normal control. There was non-significant difference in serum leptin level between males and females in both control and patient groups. Patients showed significant lower body mass index (BMI) and albumin and higher cholesterol. In the control group, serum leptin levels showed significant positive correlation with BMI, while CRF group had significant negative correlation. In CRF group, serum leptin showed significant negative correlation with serum albumin and non-significant negative correlation with both creatinine and cholesterol. This is probably due to malnutrition status commonly occurs in renal failure. Serum leptin levels showed non-significant negative correlation between both GPx and Vitamin C in control group while in patient group, leptin showed significant positive correlation with GPx and vitamin C. In conclusion leptin acts on energy metabolism and plays a role in the modulation of cellular redox balance while the oxidative stress plays a role in many disease states. These diseases had increased incidence in uremia and particularly in haemodialysis

Chemical characterization and quality of the waters used for hemodialyses in the INEF from 2002 to 2004

International Nuclear Information System (INIS)

Alberro Macias, N.; Pupo Gonzalez, I.; Valcarcel Rojas, L.; Frias Fonseca, D.; Estevez Alvarez, J.R.; Lopez Sanchez, D.; Montero Alvarez, A.; Simon Perez, D.; Isaac Tejera, M.A.; Perez Oliva, J.F.

2006-01-01

The quality of the potable and purified for haemodialysis waters used in the National Institute of Nephrology was evaluated since 2002 up to now. A total of 20 chemical components were analyzed. The analytical results were compared with the admissible maximum concentrations according to the Cuban Standard NC 92-02:85 for potable water and with the Spanish Standard UNE 111-301-90, related to the quality of water for use in haemodialysis. The quality of both types of water was found to comply with the Standards regulations. The CEADEN analytical chemistry laboratory operates a quality management system since 1992, that was credited according to ISO/IEC 17025 requirements. (author)

Interventional radiology in the provision and maintenance of long-term central venous access

International Nuclear Information System (INIS)

Lyon, S.M.; Given, M.; Marshall, N.L.

2008-01-01

Establishing and maintaining venous access forms an increasing proportion of the workload in interventional radiology. Several patient groups require medium-term to long-term venous catheters for a variety of purposes, including chemotherapy, long-term antimicrobials, parenteral nutrition, short-term access for haemodialysis or exhausted haemodialysis. Often, these catheters are required for treatment and frequent blood testing, which can quickly exhaust the peripheral veins. Venous access devices include implantable catheters (ports), tunnelled catheters and peripherally inserted central catheters, which have different functions, advantages and limitations. Imaging-guided placement is the preferred method of insertion in many institutions because of higher success rates and radiologists are well suited to address catheter complications.

Initial Systolic Time Interval (ISTI) as a Predictor of Intradialytic Hypotension (IDH)

International Nuclear Information System (INIS)

Biesheuvel, J D; Verdaasdonk, R M; Meijer, JH; Vervloet, M G

2013-01-01

In haemodialysis treatment the clearance and volume control by the kidneys of a patient are partially replaced by intermittent haemodialysis. Because this artificial process is performed on a limited time scale, unphysiological imbalances in the fluid compartments of the body occur, that can lead to intradialytic hypotensions (IDH). An IDH endangers the efficacy of the haemodialysis session and is associated with dismal clinical endpoints, including mortality. A diagnostic method that predicts the occurrence of these drops in blood pressure could facilitate timely measures for the prevention of IDH. The present study investigates whether the Initial Systolic Time Interval (ISTI) can provide such a diagnostic method. The ISTI is defined as the time difference between the R-peak in the electrocardiogram (ECG) and the C-wave in the impedance cardiogram (ICG) and is considered to be a non-invasive assessment of the time delay between the electrical and mechanical activity of the heart. This time delay has previously been found to depend on autonomic nervous function as well as preload of the heart. Therefore, it can be expected that ISTI may predict an imminent IDH caused by a low circulating blood volume. This ongoing observational clinical study investigates the relationship between changes in ISTI and subsequent drops in blood pressure during haemodialysis. A registration of a complicated dialysis showed a significant correlation between a drop in blood pressure, a decrease in relative blood volume and a substantial increase in ISTI. An uncomplicated dialysis, in which also a considerable amount of fluid was removed, showed no correlations. Both, blood pressure and ISTI remained stable. In conclusion, the preliminary results of the present study show a substantial response of ISTI to haemodynamic instability, indicating an application in optimization and individualisation of the dialysis process.

Polyurethane foam pica in a patient with excessive interdialytic weight gain

Science.gov (United States)

Iyasere, Osasuyi; Allington, Ying; Cafferkey, Michele

2010-01-01

Maintaining fluid balance in haemodialysis patients is important because of the adverse effects of excessive interdialytic weight gain. This often requires fluid restriction that patients often struggle with. We report a case of a 31-year-old female diabetic patient on haemodialysis with repeated excessive interdialytic weight gains despite fluid restriction and dry weight adjustment. It was subsequently discovered that she devised an unusual, albeit unsuccessful, strategy of eating the polyurethane foam from her dialysis chair while increasing her fluid intake hoping that it would absorb excess water in the gut! This under-diagnosed phenomenon known as pica has been reported in renal patients with substances such as ice, clay and baking soda. PMID:22767521

Prevalence of symptoms of depression among patients with chronic ...

African Journals Online (AJOL)

Depression is characterized by both cognitive and somatic ... between treatment category (pre-dialysis and haemodialysis) ... students. Demographic and clinical data were documented. The glomerular .... Psychology and rehabilitation.

Natural disasters and dialysis care in the Asia-Pacific.

Science.gov (United States)

Gray, Nicholas A; Wolley, Martin; Liew, Adrian; Nakayama, Masaaki

2015-12-01

The impact of natural disasters on the provision of dialysis services has received increased attention in the last decade following Hurricane Katrina devastating New Orleans in 2005. The Asia-Pacific is particularly vulnerable to earthquakes, tsunami, typhoons (also known as cyclones and hurricanes) or storms and flooding. These events can seriously interrupt provision of haemodialysis with adverse effects for patients including missed dialysis, increased hospitalization and post-traumatic stress disorder. Furthermore, haemodialysis patients may need to relocate and experience prolonged periods of displacement from family and social supports. In contrast to haemodialysis, most literature suggests peritoneal dialysis in a disaster situation is more easily managed and supported. It has become apparent that dialysis units and patients should be prepared for a disaster event and that appropriate planning will result in reduced confusion and adverse outcomes should a disaster occur. Numerous resources are now available to guide dialysis units, patients and staff in preparation for a possible disaster. This article will examine the disaster experiences of dialysis units in the Asia-Pacific, the impact on patients and staff, methods employed to manage during the disaster and suggested plans for reducing the impact of future disasters. © 2015 Asian Pacific Society of Nephrology.

Validation of the Kidney Disease Quality of Life-Short Form: a cross-sectional study of a dialysis-targeted health measure in Singapore

Directory of Open Access Journals (Sweden)

Mooppil Nandakumar

2010-12-01

Full Text Available Abstract Background In Singapore, the prevalence of end-stage renal disease (ESRD and the number of people on dialysis is increasing. The impact of ESRD on patient quality of life has been recognized as an important outcome measure. The Kidney Disease Quality Of Life-Short Form (KDQOL-SF™ has been validated and is widely used as a measure of quality of life in dialysis patients in many countries, but not in Singapore. We aimed to determine the reliability and validity of the KDQOL-SF™ for haemodialysis patients in Singapore. Methods From December 2006 through January 2007, this cross-sectional study gathered data on patients ≥21 years old, who were undergoing haemodialysis at National Kidney Foundation in Singapore. We used exploratory factor analysis to determine construct validity of the eight KDQOL-SF™ sub-scales, Cronbach's alpha coefficient to determine internal consistency reliability, correlation of the overall health rating with kidney disease-targeted scales to confirm validity, and correlation of the eight sub-scales with age, income and education to determine convergent and divergent validity. Results Of 1980 haemodialysis patients, 1180 (59% completed the KDQOL-SF™. Full information was available for 980 participants, with a mean age of 56 years. The sample was representative of the total dialysis population in Singapore, except Indian ethnicity that was over-represented. The instrument designers' proposed eight sub-scales were confirmed, which together accounted for 68.4% of the variance. All sub-scales had a Cronbach's α above the recommended minimum value of 0.7 to indicate good reliability (range: 0.72 to 0.95, except for Social function (0.66. Correlation of items within subscales was higher than correlation of items outside subscales in 90% of the cases. The overall health rating positively correlated with kidney disease-targeted scales, confirming validity. General health subscales were found to have significant

Changes in plasma osmolality and anion gap: potential predictors of ...

African Journals Online (AJOL)

Changes in plasma osmolality and anion gap: potential predictors of ... PROMOTING ACCESS TO AFRICAN RESEARCH ... Objective: To determine the relationship of mortality to plasma osmolality and anion gap inpatients on haemodialysis.

JUNE NJCP 2009 FINAL sp.cdr

African Journals Online (AJOL)

User

ARE THE SYMPTOMS OF DIABETIC PERIPHERAL NEUROPATHY IN ... to detect early those with genuine PN and are at risk of foot ulceration from. PN. ... neuropathy - patients on haemodialysis for chronic ..... peripheral vascular disease.

Must patients over 65 be haemodialysed?

Science.gov (United States)

Rotellar, E; Lubelza, R A; Rotellar, C; Martinez-Camps, E; Alea, M V; Valls, R

1985-01-01

This manuscript consists of a study of the results of 26 end stage renal failure (ESRF) patients, who commenced regular haemodialysis treatment (RHDT) from the age of 65 onwards (65-85) and who have been undergoing this treatment for periods ranging from 7 years to 3 months. These results are to be compared with those obtained from another group of 26 patients whose age ranged between 40 and 55 and who were treated with the same policy. The following parameters are compared: mortality, morbidity, life-style, cardiovascular situation, hypotension in haemodialysis, vascular access, anaemia, osteoarticular and peripheral nervous disorders, hypertension. We have not found any significant differences between both groups, besides a higher morbidity for patients over 65. Therefore, we recommend the inclusion of the older patients into RHDT programmes.

Translation, cultural adaptation assessment, and both validity and reliability testing of the kidney disease quality of life - short form version 1.3 for use with Iranian patients

DEFF Research Database (Denmark)

Pakpour, Amir; Yekaninejad, Mirsaeed; Mølsted, Stig

2011-01-01

AIM: The aims of the study were to translate the Kidney Disease Quality of Life--Short Form version 1.3 (KDQOL-SF ver. 1.3) questionnaire into Iranian (Farsi), and to then assess it in terms of validity and reliability on Iranian patients. METHODS: The questionnaire was first translated into Farsi...... a larger group (212 patients with end-stage renal disease on haemodialysis). Afterwards, reliability was estimated by internal consistency, and validity was assessed using known group comparisons and constructs for the patient group as a whole. Finally, the factor structure of the questionnaire...... be summarized into an 11 factor structure that jointly accounted for 79.81% of the variance. CONCLUSION: The Iranian version of the KDQOL-SF questionnaire is both highly reliable and valid for use with Iranian patients on haemodialysis....

[Just-in-time initiation of optimal dialysis].

Science.gov (United States)

Cornelis, Tom; Kooman, Jeroen P; van der Sande, Frank M

2010-01-01

The IDEAL trial shows that the decision to start renal replacement treatment should not depend on GFR alone, but should be taken on the basis of clinical parameters. Quality of Life (QoL) questionnaires and bio-impedance analysis are potential tools for detecting subtle changes in the predialysis clinic. Too early an initiation of dialysis may be deleterious for the patient and the healthcare system. We are convinced that ESRD patients should be informed about intensive haemodialysis (HD), especially nocturnal (home) HD, as the best available dialysis modality. There is substantial evidence which shows that intensive HD improves clinical, biochemical and biological parameters, and may even prolong survival. We believe that 'just-in-time delivery of intensive haemodialysis' may result in optimised QoL and reduced economic burden.

Native valve endocarditis due to Candida parapsilosis in an adult ...

African Journals Online (AJOL)

. Blood cultures were positive for C. parapsilosis. β-D-glucan assay levels were elevated. An echocardiogram showed large, friable vegetations on the mitral valve. C. parapsilosis was cultured from the haemodialysis tip and the vegetations.

and interleukin-6 (-174G/C)

African Journals Online (AJOL)

Mona Hussein Kandil

2013-05-26

May 26, 2013 ... Egyptian patients on maintenance haemodialysis. Mona Hussein Kandil a ..... that -511T of IL-1beta was a significant risk factor for atherogenesis in the ..... cardiovascular disease in Spanish patients with rheumatoid · arthritis.

Illness perception, coping and adherence to treatment among patients with chronic kidney disease.

Science.gov (United States)

Vélez-Vélez, Esperanza; Bosch, Ricardo J

2016-04-01

To analyse the predictive value of illness representations on treatment adherence and coping strategies in a group of patients on haemodialysis. Understanding the cognitive and emotional factors that influence adherence behaviour and coping strategies and determining their relationship to sociodemographic factors remain a challenge; meeting this challenge would encourage comprehensive patient care, thereby improving their quality of life Cross-sectional study with predictive means in a sample of 135 patients on haemodialysis. Data collection occurred from September 2010-January 2012 and tools included the following: sociodemographic data, Illness Perception Questionnaire-Revised, the Cuestionario de Afrontamiento del Estrés and the Morisky-Green test to study adherence to treatment. Being a woman, having a greater knowledge of the disease and having a poorer sense of personal control affected adherence to treatment on controlling for each factor. 'Identity', 'personal control' and 'adherence' were associated with a proactive coping strategy, whereas 'evolution' and 'gender' were related independently to avoidance coping strategies; those who believed that their illness had a chronic course were more likely to cope by avoiding the problem and this tendency was stronger among women. This study provides evidence supporting the role of gender, knowledge about the disease and sense of personal control in adherence to therapeutic regimens of patients in chronic haemodialysis. The identification and characterization of patients' perception of chronic illness may represent a useful framework to influence disease outcomes such as adherence. © 2015 John Wiley & Sons Ltd.

Pseudoporfyri er et symptomkompleks

DEFF Research Database (Denmark)

Velander, Marie Juul; Thorsteinsdóttir, Sunna; Bygum, Anette

2015-01-01

Pseudoporphyria is a photosensitive bullous disease, which resembles porphyria cutanea tarda. Normal porphyrin levels in urine, stool and blood define pseudoporphyria. Pseudoporphyria is associated with chronic renal failure, haemodialysis, a variety of drugs (e.g. naproxen, nabumetone, furosemide...

High convection volume in online post-dilution haemodiafiltration : relevance, safety and costs

NARCIS (Netherlands)

Mostovaya, Ira M; Grooteman, Muriel P C; Basile, Carlo; Davenport, Andrew; de Roij van Zuijdewijn, Camiel L M; Wanner, Christoph; Nubé, Menso J; Blankestijn, Peter

Increasing evidence suggests that treatment with online post-dilution haemodiafiltration (HDF) improves clinical outcome in patients with end-stage kidney disease, if compared with haemodialysis (HD). Although the primary analyses of three large randomized controlled trials (RCTs) showed

Salicylate removal by charcoal heamoperfusion in experimental intoxication in dogs. An assessment of efficacyd and safety

Energy Technology Data Exchange (ETDEWEB)

Brookings, C H [Saint George' s Hospital Medical School, London (UK). Dept. of Medicine; Ramsey, J D [Saint George' s Hospital Medical School, London (UK). Toxicology Lab.

1975-11-01

The removal of salicylate by extracorporeal circulation of blood through a column of encapsulated charcoal (haemoperfusion) has been studied experimentally in intoxicated dogs (greyhounds). The average time taken to reduce the whole blood salicylate level to one-half of the initial equilibrium level in 30 kg dogs was 2 hrs. A half-life of 3 hrs is predicted for salicylate removal by haemoperfusion in a 70 kg man and this rate of removal is shown to be comparable to that reported for haemodialysis. No unacceptable adverse physiological, biochemical, or haematological effects were found to result from haemoperfusion. The possible use of this technique in the management of severe salicylate poisoning in man is discussed. Haemoperfusion is foreseen as providing a method of rapid removal of salicylate in circumstances where forced diuresis is contra-indicated or inadequate and haemodialysis is not readily available.

Dialysis access, infections, and hospitalisations in unplanned dialysis start patients

DEFF Research Database (Denmark)

Machowska, Anna; Alscher, Mark Dominik; Vanga, Satyanarayana Reddy

2017-01-01

Introduction: Unplanned dialysis start (UPS) associates with worse clinical outcomes, higher utilisation of healthcare resources, lower chances to select dialysis modality and UPS patients typically commenced in-centre haemodialysis (HD) with central venous catheter (CVC). We evaluated patient ou...

Depression and quality of life in patients on long term hemodialysis ...

African Journals Online (AJOL)

Depression and quality of life in patients on long term hemodialysis at a national ... Quality of Life instrument were used to assess depression and quality of life. ... Haemodialysis patients who obtained low scores on quality of life measures ...

Increasing fill volume reduces cardiac performance in peritoneal dialysis

DEFF Research Database (Denmark)

Ivarsen, Per; Povlsen, Johan V; Jensen, Jens Dam

2007-01-01

BACKGROUND: It is generally accepted that peritoneal dialysis (PD) affects systemic haemodynamics less than haemodialysis, but little is known about changes in haemodynamics during PD. It is unknown if increasing PD volume causes changes in cardiovascular haemodynamics possibly increasing...

ORIGINAL ARTICLES Seroprevalence of hepatitis B and C in ...

African Journals Online (AJOL)

Six of the HBsAg-positive patients were on haemodialysis, the other 2 on continuous ambulatory peritoneal dialysis (CAPD). There was no coexistence of HBV and HCV markers. ..... It may be noted that blood donors were school and college.

Mortality reduction by post-dilution online-haemodiafiltration : A cause-specific analysis

NARCIS (Netherlands)

Nubé, Menso J.; Peters, Sanne A E; Blankestijn, Peter J.; Canaud, Bernard; Davenport, Andrew; Grooteman, Muriel P C; Asci, Gulay; Locatelli, Francesco; Maduell, Francisco; Morena, Marion; Ok, Ercan; Torres, Ferran; Bots, Michiel L.; Moreso, Francesc; Pons, Mercedes; Ramos, Rosa; Mora-Macià, Josep; Carreras, Jordi; Soler, Jordi; Campistol, Josep M.; Martinez-Castelao, Alberto; Insensé, B.; Perez, C.; Feliz, T.; Barbetta, M.; Soto, C.; Mora, J.; Juan, A.; Ibrik, O.; Foraster, A.; Nin, J.; Fernández, A.; Arruche, M.; Sánchez, C.; Vidiella, J.; Barbosa, F.; Chiné, M.; Hurtado, S.; Llibre, J.; Ruiz, A.; Serra, M.; Salvó, M.; Poyuelo, T.; Maduell, F.; Carrera, M.; Fontseré, N.; Arias, M.; Merín, A.; Ribera, L.; Galceran, J. M.; Mòdol, J.; Moliner, E.; Ramirez, A.; Aguilera, J.; Alvarez, M.; De La Torre, B.; Molera, M.; Casellas, J.; Martín, G.; Andres, E.; Coll, E.; Valles, M.; Martínez, C.; Castellote, E.; Casals, J. M.; Gabàs, J.; Romero, M.; Martinez-Castelao, A.; Fulladosa, X.; Ramirez-Arellano, M.; Fulquet, M.; Pelegrí, A.; El Manouari, M.; Ramos, N.; Bartolomé, J.; Sans, R.; Fernández, E.; Sarró, F.; Compte, T.; Marco, F.; Mauri, R.; Bronsoms, J.; Arnaiz, J. A.; Beleta, H.; Pejenaute, A.; Ríos, J.; Lara, J.; Ter Wee, P. M.; Van Den Dorpel, M. A.; Dorval, M.; Lévesque, R.; Koopman, M. G.; Konings, C. J A M; Haanstra, W. P.; Kooistra, M.; Van Jaarsveld, B.; Noordzij, T.; Feith, G. W.; Peltenburg, H. G.; Van Buren, M.; Offerman, J. J G; Hoogeveen, E. K.; De Heer, F.; Van De Ven, P. J.; Kremer Hovinga, T. K.; Bax, W. A.; Groeneveld, J. O.; Lavrijssen, A. T J; Schrander-Van Der Meer, A. M.; Reichert, L. J M; Huussen, J.; Rensma, P. L.; Schrama, Y.; Van Hamersvelt, H. W.; Boer, W. H.; Van Kuijk, W. H.; Vervloet, M. G.; Wauters, I. M P M J; Sekse, I.; Toz, Huseyin; Ok, Ebru Sevinc; Kircelli, Fatih; Yilmaz, Mumtaz; Hur, Ender; Demirci, Meltem Sezis; Demirci, Cenk; Duman, Soner; Basci, Ali; Adam, Siddig Momin; Isik, Ismet Onder; Zengin, Murat; Suleymanlar, Gultekin; Yilmaz, Mehmet Emin; Ergin, Mehmet Ozkahya Pinar; Sagdic, Alfert; Kayali, Erkan; Boydak, Can; Colak, Taskin; Caliskan, Sihli; Kaplan, Hakan; Ulas, Hasibe; Kirbiyik, Sait; Berktas, Hakan; Dilbaz, Necati; Cristol, Jean Paul; Leray-Moragues, Hélène; Chenine, Leïla; Picot, Marie Christine; Jaussent, Audrey; Belloc, Claire; Lagarrigue, Mélodie; Chalabi, Lotfi; Debure, Alain; Ouziala, Messaoud; Lefevre, Jean Jacques; Thibaudin, Damien; Mohey, Hesham; Broyet, Christian; Afiani, Aida; Serveaux, Marie Odile; Patrier, Laure; Maurice, François; Rivory, Jean Pierre; Nicoud, Philippe; Durand, Claude; Normand, Michel; Seigneuric, Bruno; Magnant, Eric; Azzouz, Lynda; Islam, Mohamed Shariful; Vido, Sandor; Nzeyimana, Hilaire; Simonin, Danièle; Azymah, Yamina; Farah, Ibrahim; Coindre, Jean Philippe; Puyoo, Olivier; Chabannier, Marie Hélène; Ibos, Richard; Rouleau, Fabienne; Vela, Carlos; Joule, Josiane; Combarnous, François; Turc-Baron, Cécile; Ducret, Francis; Pointet, Philippe; Rey, Isabelle; Potier, Jacky; Bendini, Jean Christophe; Perrin, Franck; Kunz, Kristian; Lefrancois, Gaëlle; Colin, Angélique; Parahy, Sophie; Dancea, Irima; Coupel, Stéphanie; Testa, Angelo; Brunet, Philippe; Lebrun, Gaétan; Jaubert, Dominique; Delcroix, Catherine; Lavainne, Frédéric; Lefebvre, Anne; Guillodo, Marie Paule; Le Grignou, Dominique; Djema, Assia; Maaz, Mehadji; Chiron, Sylvie; Hoffmann, Maxime; Depraetre, Pascale; Haddj-Elmrabet, Atman; Joyeux, Véronique; Fleury, Dominique; Vrigneaud, Laurence; Lemaitre, Vincent; Aguilera, Didier; Guerraoui, Abdallah; Cremault, Alain; Laradi, Achour; Babinet, Francois

Background. From an individual participant data (IPD) meta-analysis from four randomized controlled trials comparing haemodialysis (HD) with post-dilution online-haemodiafiltration (ol-HDF), previously it appeared that HDF decreases all-cause mortality by 14% (95% confidence interval 25; 1) and

Succesfuld behandling af svær dabigatranoverdosering med idarucizumab hos en patient med nyresvigt

DEFF Research Database (Denmark)

Poulsen, Christina Gjerlev; Bestle, Morten; Boesby, Lene

2017-01-01

In the course of an uncomplicated sigmoidostomy a 63-year-old male who had severe comorbidity developed a critical bleeding due to dabigatran intoxication induced by acute kidney injury. Massive blood transfusions, tranexamic acid, Octaplex and haemodialysis were not effective. Administration...

Haemodiafiltration and mortality in end-stage kidney disease patients : a pooled individual participant data analysis from four randomized controlled trials

NARCIS (Netherlands)

Peters, Sanne A. E.; Bots, Michiel L.; Canaud, Bernard; Davenport, Andrew; Grooteman, Muriel P. C.; Kircelli, Fatih; Locatelli, Francesco; Maduell, Francisco; Morena, Marion; Nube, Menso J.; Ok, Ercan; Torres, Ferran; Woodward, Mark; Blankestijn, Peter J.

BACKGROUND: Mortality rates remain high for haemodialysis (HD) patients and simply increasing the HD dose to remove more small solutes does not improve survival. Online haemodiafiltration (HDF) provides additional clearance of larger toxins compared with standard HD. Randomized controlled trials

SUCCESSFUL SURGICAL-TREATMENT OF PARATHYROID CARCINOMA IN 2 HEMODIALYSIS-PATIENTS

NARCIS (Netherlands)

RADEMAKER, P; MEIJER, S; OOSTERHUIS, JW; VERMEY, A; ZWIERSTRA, R; VANDERHEM, G; GEERLINGS, W

Parathyroid carcinoma is rare, occurring in less than 2-3% of the patients with clinical features of primary hyperparathyroidism. In haemodialysis patients parathyroid carcinoma has only once been described, although secondary hyperparathyroidism in these patients is common. We discuss two female

Efficacy of blood flow restriction exercise during dialysis for end stage kidney disease patients: protocol of a randomised controlled trial.

Science.gov (United States)

Clarkson, Matthew J; Fraser, Steve F; Bennett, Paul N; McMahon, Lawrence P; Brumby, Catherine; Warmington, Stuart A

2017-09-11

Exercise during haemodialysis improves strength and physical function. However, both patients and clinicians are time poor, and current exercise recommendations add an excessive time burden making exercise a rare addition to standard care. Hypothetically, blood flow restriction exercise performed during haemodialysis can provide greater value for time spent exercising, reducing this time burden while producing similar or greater outcomes. This study will explore the efficacy of blood flow restriction exercise for enhancing strength and physical function among haemodialysis patients. This is a randomised controlled trial design. A total of 75 participants will be recruited from haemodialysis clinics. Participants will be allocated to a blood flow restriction cycling group, traditional cycling group or usual care control group. Both exercising groups will complete 3 months of cycling exercise, performed intradialytically, three times per week. The blood flow restriction cycling group will complete two 10-min cycling bouts separated by a 20-min rest at a subjective effort of 15 on a 6 to 20 rating scale. This will be done with pressurised cuffs fitted proximally on the active limbs during exercise at 50% of a pre-determined limb occlusion pressure. The traditional cycling group will perform a continuous 20-min bout of exercise at a subjective effort of 12 on the same subjective effort scale. These workloads and volumes are equivalent and allow for comparison of a common blood flow restriction aerobic exercise prescription and a traditional aerobic exercise prescription. The primary outcome measures are lower limb strength, assessed by a three repetition maximum leg extension test, as well as objective measures of physical function: six-minute walk test, 30-s sit to stand, and timed up and go. Secondary outcome measures include thigh muscle cross sectional area, body composition, routine pathology, quality of life, and physical activity engagement. This study will

Study of Red Cell Fragility in Different Stages of Chronic Kidney Disease in Relation to Parathyroid Hormone.

Science.gov (United States)

Panda, Suchismita; Mishra, Anuva; Jena, Manoranjan; Rout, Sashi Bhusan; Mohapatra, Srikrushna

2017-08-01

Anaemia is one of the common complications associated with Chronic Kidney Disease (CKD) responsible for the increase in the morbidity and mortality in such patients. Several factors have been attributed to cause renal anaemia, amongst which hyperparathyroidism is one of the less recognised reasons. Most studies have been conducted in this regard in CKD patients undergoing haemodialysis. The level of PTH in early stages of chronic kidney disease has not been much studied. The excess amount of Parathyroid Hormone (PTH) secondary to CKD has been suggested to be a causative factor for anaemia. To evaluate the serum PTH level in CKD patients before haemodialysis and to study the association of the haemoglobin status with the parathyroid hormone. Forty CKD patients above 18 years of age before haemodialysis and 25 age and sex matched healthy controls were included in the study. Routine biochemical and haematological parameters such as Routine Blood Sugar (RBS), urea, creatinine, Na + , K + , Ca 2+ , PTH and Hb% were perfomed. Red cell osmotic fragility was measured by serial dilutions of whole blood with varying concentrations of sodium chloride ranging from 0.1% to 0.9%. The study revealed a significant fall in Hb%, along with a rise in Median Osmotic Fragility (MOF) and PTH in the CKD patients when compared to the control group. Linear regression of PTH with Hb% revealed significant negative association between both the parameters with a R 2 value of 0.677. Multilinear regression analysis of MOF and other independent variables such as Hb%, Na + , K + , Ca 2+ , urea, PTH and creatinine highlighted the variance of MOF by 72%, maximal variance contributed by PTH. Receiver Operating Curve (ROC) analysis revealed an area under the curve of 0.980 with a sensitivity of 100% and specificity of 87% in detecting osmotic fragility at a cut off value of PTH ≥100 pg/ml. The underlying cause of anaemia should be identified early in the CKD patients before haemodialysis. Secondary

Natriumpolystyreensulfonaat (Resonium A) als mogelijke oorzaak van rectaal bloedverlies

NARCIS (Netherlands)

Schiere, S; Karrenbeld, A; Tulleken, J E; van der Werf, T S; Zijlstra, J G

1997-01-01

A 67-year-old man underwent laparotomy for a ruptured aneurysm of the abdominal aorta. Postoperatively he was treated with haemodialysis because of perioperatively developed acute renal failure. Hyperkalaemia was temporarily treated with sodium polystyrene sulfonate (Resonium A) after which he lost

Chronic renal failure and sexual functioning: clinical status versus objectively assessed sexual response

NARCIS (Netherlands)

Toorians, A. W.; Janssen, E.; Laan, E.; Gooren, L. J.; Giltay, E. J.; Oe, P. L.; Donker, A. J.; Everaerd, W.

1997-01-01

BACKGROUND: Sexual dysfunctions are common among patients with chronic renal failure. The prevalence was assessed in a population of 281 patients (20-60 years), and it was attempted to determine whether their mode of treatment (haemodialysis, peritoneal dialysis, or kidney transplantation), or

Laparoscopic versus open peritoneal dialysis catheter insertion, the LOCI-trial: A study protocol

NARCIS (Netherlands)

S.M. Hagen (Sander); A.M. van Alphen (Adriaan); J.N.M. IJzermans (Jan); F.J.M.F. Dor (Frank)

2011-01-01

textabstractBackground: Peritoneal dialysis (PD) is an effective treatment for end-stage renal disease. It allows patients more freedom to perform daily activities compared to haemodialysis. Key to successful PD is the presence of a well-functioning dialysis catheter. Several complications, such as

EPIDEMIOLOGY AND ETIOLOGICAL FACTORS OF ERECTILE DYSFUNCTION IN PATIENTS ON DIALYSIS AND AFTER RENAL TRANSPLANTATION

Directory of Open Access Journals (Sweden)

E. A. Efremov

2011-01-01

Full Text Available Today the problem of better life quality of patients with end stage renal disease and after renal transplantation and their sexual adaptation is considered to be more impotent. The clinical part of the investigation is the obser- vation of 205 patients – men with terminal stage renal disease. Erectile dysfunction is represented in 91,4% (64 of patients getting haemodialysis, 92,3% (24 of patients getting peritoneal dialysis, 61,5% (67 of patients after renal transplantation. According to International Index of Erectile Function the mean score of erectile function is 16,7 ± 5,2 in haemodialysis patients, 19,46 ± 3,6 in peritoneal dialysis patients, 21,9 ± 5,6 in patients after renal transplantation. The analysis revealed great prevalence of erectile dysfunction and interest in improvement among the patients with end stage renal disease and after renal transplantation. 

Salicylate removal by charcoal heamoperfusion in experimental intoxication in dogs

International Nuclear Information System (INIS)

Brookings, C.H.; Ramsey, J.D.

1975-01-01

The removal of salicylate by extracorporeal circulation of blood through a column of encapsulated charcoal (haemoperfusion) has been studied experimentally in intoxicated dogs (greyhounds). The average time taken to reduce the whole blood salicylate level to one-half of the initial equilibrium level in 30 kg dogs was 2 hrs. A half-life of 3 hrs is predicted for salicylate removal by haemoperfusion in a 70 kg man and this rate of removal is shown to be comparable to that reported for haemodialysis. No unacceptable adverse physiological, biochemical, or haematological effects were found to result from haemoperfusion. The possible use of this technique in the management of severe salicylate poisoning in man is discussed. Haemoperfusion is foreseen as providing a method of rapid removal of salicylate in circumstances where forced diuresis is contra-indicated or inadequate and haemodialysis is not readily available. (orig.) [de

Are Diuretics Underutilized in Dialysis Patients?

Science.gov (United States)

Trinh, Emilie; Bargman, Joanne M

2016-09-01

While oral diuretics are commonly used in patients with chronic kidney disease for the management of volume and blood pressure, they are often discontinued upon initiation of dialysis. We suggest that diuretics are considerably underutilized in peritoneal dialysis and haemodialysis patients despite numerous potential benefits and few side effects. Moreover, when diuretics are used, optimal doses are not always prescribed. In peritoneal dialysis, the use of diuretics can improve volume status and minimize the need for higher glucose-containing solutions. In patients on haemodialysis, diuretics can help lessen interdialytic weight gain, resulting in decreased ultrafiltration rates and fewer episodes of intradialytic hypotension. This paper will review the mechanism of action of diuretics in patients with renal insufficiency, quantify the risk of side effects and elaborate on the potential advantages of diuretic use in peritoneal dialysis and hemodialysis patients with residual kidney function. © 2016 Wiley Periodicals, Inc.

Design and development of an impedimetric-based system for the remote monitoring of home-based dialysis patients.

Science.gov (United States)

Montalibet, Amalric; Arkouche, Walid; Bogónez Franco, Paco; Bonnet, Stéphane; Clarion, Antoine; Delhomme, Georges; Géhin, Claudine; Gharbi, Sadok; Guillemaud, Régis; Jallon, Pierre; Massot, Bertrand; Pham, Pascale; Ribbe-Cornet, Eva; McAdams, Eric

2016-01-01

A key clinical challenge is to determine the desired 'dry weight' of a patient in order to terminate the dialysis procedure at the optimal moment and thus avoid the effects of over- and under-hydration. It has been found that the effects of haemodialysis on patients can be conveniently monitored using whole-body bioimpedance measurements. The identified need of assessing the hydrational status of patients undergoing haemodialysis at home gave rise to the present Dialydom (DIALYse à DOMicile) project. The aim of the project is to develop a convenient miniaturised impedance monitoring device for localised measurements (on the calf) in order to estimate an impedimetric hydrational index of the home-based patient, and to transmit this and other parameters to a remote clinical site. Many challenges must be overcome to develop a robust and valid home-based device. Some of these are presented in the paper.

The Lectin Pathway of Complement and Biocompatibility

DEFF Research Database (Denmark)

Hein, Estrid; Garred, Peter

2015-01-01

In modern health technologies the use of biomaterials in the form of stents, haemodialysis tubes, artificial implants, bypass circuits etc. is rapidly expanding. The exposure of synthetic, foreign surfaces to the blood and tissue of the host, calls for strict biocompatibility in respect to contac...

An echocardiographic evaluation of pulmonary pressures in ...

African Journals Online (AJOL)

Background: A high prevalence of pulmonary hypertension (PH) in patients with end-stage renal disease (ESRD) has been noted. In these patients, PH increases morbidity and mortality and worsens prognosis post-renal transplant. Its aetiopathogenesis may be multifactorial, involving the process of haemodialysis itself.

Advances in peritoneal dialysis

NARCIS (Netherlands)

Krediet, R. T.

2007-01-01

New peritoneal dialysis (PD) patients have a better survival than new haemodialysis (HD) patients in the first years on dialysis. During long-term treatment, this changes into a survival advantage for HD. The superior initial survival on PD is related to a better preservation of residual renal

PHARMACOKINETICS OF ROCURONIUM BROMIDE IN PATIENTS WITH AND WITHOUT RENAL-FAILURE

NARCIS (Netherlands)

COOPER, RA; MIRAKHUR, RK; WIERDA, JMKH; MADDINENI, VR

We studied the onset and duration of action and pharmacokinetics of rocuronium bromide during anaesthesia with nitrous oxide, fentanyl and isoflurane after a single bolus dose of rocuronium (0.6 mg kg(-1)) in nine patients with chronic renal failure requiring regular haemodialysis, and in nine

A New "online" Method to Measure Increased Exhaled Isoprene in end-stage Renal Failure

Czech Academy of Sciences Publication Activity Database

Davies, S.; Španěl, Patrik; Smith, D.

2001-01-01

Roč. 16, - (2001), s. 836-839 ISSN 0931-0509 R&D Projects: GA ČR GA203/97/P130 Institutional research plan: CEZ:AV0Z4040901 Keywords : biocompatibility * haemodialysis * SIFT-MS Subject RIV: CF - Physical ; Theoretical Chemistry Impact factor: 2.432, year: 2001

Is the decline of renal function different before and after the start of dialysis?

NARCIS (Netherlands)

de Jager, Dinanda J.; Halbesma, Nynke; Krediet, Raymond T.; Boeschoten, Elisabeth W.; le Cessie, Saskia; Dekker, Friedo W.; Grootendorst, Diana C.; Apperloo, A. J.; Bijlsma, J. A.; Boekhout, M.; Boer, W. H.; van der Boog, P. J. M.; Büller, H. R.; van Buren, M.; de Charro, F. Th; Doorenbos, C. J.; van den Dorpel, M. A.; van Es, A.; Fagel, W. J.; Feith, G. W.; de Fijter, C. W. H.; Frenken, L. A. M.; van Geelen, J. A. C. A.; Gerlag, P. G. G.; Grave, W.; Gorgels, J. P. M. C.; Huisman, R. M.; Jager, K. J.; Jie, K.; Koning-Mulder, W. A. H.; Koolen, M. I.; Hovinga, T. K. Kremer; Lavrijssen, A. T. J.; Luik, A. J.; van der Meulen, J.; Parlevliet, K. J.; Raasveld, M. H. M.; van der Sande, F. M.; Schonck, M. J. M.; Schuurmans, M. M. J.; Siegert, C. E. H.; Stegeman, C. A.; Stevens, P.; Thijssen, J. G. P.; Valentijn, R. M.; Vastenburg, G. H.; Verburgh, C. A.; Vincent, H. H.; Vos, P. F.

2013-01-01

The presence of glomerular filtration in dialysis patients is associated with improved survival and quality of life. This study explores the time course of the glomerular filtration rate (GFR) between 1 year before and 1 year after the start of haemodialysis (HD) and peritoneal dialysis (PD). This

The radiological management of the thrombosed arteriovenous dialysis fistula

Energy Technology Data Exchange (ETDEWEB)

Bent, C.L., E-mail: clare_bent@yahoo.co.u [Royal Bournemouth and Christchurch Hospitals, Bournemouth (United Kingdom); Sahni, V.A. [Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women' s Hospital, Harvard Medical School, Boston (United States); Matson, M.B. [Barts and The London NHS Trust, London (United Kingdom)

2011-01-15

Patent vascular access is a prerequisite for adequate haemodialysis, and is a major determinant of quality of life and long-term survival of patients with end-stage renal disease. Autogenous haemodialysis fistulas (AVFs) have demonstrated superior clinical outcome when compared to synthetic grafts, but both types of access remain susceptible to venous stenoses, and consequent thrombotic occlusion. Recent publications have reported primary patency rates of up to 100% following percutaneous de-clotting of AVFs incorporating techniques such as pharmacological thrombolysis, mechanical thrombectomy, and thrombo-aspiration. Endovascular management also provides information regarding the underlying cause of access thrombosis, with option to treat. Consequently, there has been a paradigm shift in the management of fistula thrombosis, with interventional radiology assuming a lead role in initial salvage procedures. This article will attempt to provide the reader with an insight into the multiple radiological techniques that can be employed to salvage a thrombosed AVF based on current published literature.

The radiological management of the thrombosed arteriovenous dialysis fistula

International Nuclear Information System (INIS)

Bent, C.L.; Sahni, V.A.; Matson, M.B.

2011-01-01

Patent vascular access is a prerequisite for adequate haemodialysis, and is a major determinant of quality of life and long-term survival of patients with end-stage renal disease. Autogenous haemodialysis fistulas (AVFs) have demonstrated superior clinical outcome when compared to synthetic grafts, but both types of access remain susceptible to venous stenoses, and consequent thrombotic occlusion. Recent publications have reported primary patency rates of up to 100% following percutaneous de-clotting of AVFs incorporating techniques such as pharmacological thrombolysis, mechanical thrombectomy, and thrombo-aspiration. Endovascular management also provides information regarding the underlying cause of access thrombosis, with option to treat. Consequently, there has been a paradigm shift in the management of fistula thrombosis, with interventional radiology assuming a lead role in initial salvage procedures. This article will attempt to provide the reader with an insight into the multiple radiological techniques that can be employed to salvage a thrombosed AVF based on current published literature.

Symptomatic Plaque Form Gastric Candidiasis in a Patient with ...

African Journals Online (AJOL)

We report the occurrence of diffuse plaque deposits of candida in the gastric antrum of a 36 year old female patient with chronic kidney disease (CKD) on maintenance haemodialysis who presented with epigastric pain, nausea, vomiting and passage of black stools for two weeks. Upper gastrointestinal endoscopy revealed ...

Effects of listening to Holy Qur'an recitation and physical training on ...

African Journals Online (AJOL)

Fifty-three male haemodialysis patients were randomly assigned to an intervention group (listening to Holy Qur'an recitation in combination with endurance–resistance training, n = 28) or a control group (endurance–resistance training only, n = 25). Functional capacity was assessed using the Timed Up and Go test (TUG) ...

Morbidity and mortality of black HIV-positive patients with end-stage ...

African Journals Online (AJOL)

in HIV-positive patients receiving chronic haemodialysis, but survival ... had continued for at least 6 months were eligible for inclusion in the ... Values for each year ... the case of more than one value an annual average was calculated; .... not accurately reflect the socioeconomic ... consent would increase the recruitment.

Morbidity and mortality of black HIV-positive patients with end-stage ...

African Journals Online (AJOL)

Methods. This retrospective study compared the incidences of vascular and infectious morbidity and mortality in black HIV-positive patients with those in a group of HIV-negative patients matched for ethnicity, age and gender. All the patients were receiving chronic haemodialysis in the medically insured healthcare sector of ...

Native valve endocarditis due to Corynebacterium group JK.

Science.gov (United States)

Moffie, B G; Veenendaal, R A; Thompson, J

1990-12-01

We report a case of a 32-yr-old woman on chronic intermittent haemodialysis, who developed endocarditis due to a Corynebacterium group JK, involving both the native aortic and mitral valves. Despite a four-week treatment with vancomycin, an aortic root abscess developed. The diagnosis was confirmed on autopsy.

Anticoagulant effect of low molecular weight heparin on central ...

African Journals Online (AJOL)

Purpose: To analyse the effect of low molecular weight heparin on venous catheters in haemodialysis patients. Methods: This study included 140 eligible patients who were randomly and evenly divided into two groups, viz, a study group that received low molecular weight heparin and a control group that received ...

Impact of viral infections on urea and creatinine levels in patients ...

African Journals Online (AJOL)

Background: Chronic kidney disease (CKD) has emerged as a world-wide public health problem with substantial morbidity and mortality. Chronic viral infection is associated with a higher risk of death in patients with CKD undergoing haemodialysis. Objective: To evaluate the impact of viral infections on urea and creatinine ...

Impact of pay for performance on access at first dialysis in Queensland.

Science.gov (United States)

Haarsager, Jennie; Krishnasamy, Rathika; Gray, Nicholas A

2018-05-01

Commencement of haemodialysis with an arteriovenous fistula (AVF) or arteriovenous graft (AVG) is associated with improved survival compared with commencement with a central venous catheter. In 2011-2012, Queensland Health made incentive payments to renal units for early referred patients who commenced peritoneal dialysis (PD), or haemodialysis with an AVF/AVG. The aim of this study was to determine if pay for performance improved clinical care. All patients who commenced dialysis in Australia between 2009 and 2014 and were registered with the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) were included. A multivariable regression model was used to compare rates of commencing dialysis with a PD catheter or permanent AVF/AVG during the pay-for-performance period (2011-2012) with periods prior (2009-2010) and after (2013-2014). A total of 10 858 early referred patients commenced dialysis during the study period, including 2058 in Queensland. In Queensland, PD as first modality increased with time (P pay-for-performance period as reference, the odds ratio for commencement with PD or haemodialysis with an AVF/AVG in Queensland was 1.02 (95% CI 0.81-1.29) in 2009-2010 and 1.28 (95% CI 1.01-1.61) in 2013-2014. There was no change for the rest of Australia (0.97 95% CI 0.87-1.09 in 2009-2010 and 1.00 95% CI 0.90-1.11 in 2013-14). Pay for performance did not improve rates of commencement of dialysis with PD or an AVF/AVG during the payment period. A lag effect on clinical care may explain the improvement in later years. © 2017 Asian Pacific Society of Nephrology.

Plasma and erythrocyte relationship of catecholamines in hemodialysis patients

Directory of Open Access Journals (Sweden)

Marcin Dziedzic

2014-09-01

Full Text Available The function of the autonomic nervous system is based on reciprocal interaction between the sympathetic and parasympathetic parts, most frequently in the form of antagonistic action on target organs. The main mediators of the sympathetic nervous system in the effectors part are catecholamines (CA, which are involved in various physiological processes. Moreover, CA also has a profound effect on the kidneys, being factors that impact on renal haemodynamics, and have been reported to be altered in pathological disorders, e.g. extracellular volume expression, hypertension and cardiovascular complications. The increased sympathetic nerve activity, at least in part, can explain the raised in plasma CA observed in chronic kidney diseases. Furthermore, plasma CA levels in ureamic patients cannot be considered a reliable index of sympathetic activity, due to existence of many factors which may affect their values. In addition, CA released into the circulation, as one of many substances, may penetrate across the cellular membranes of erytrocytes (RBC. Taking these observations together, the aim of the presented study was to investigate for the first time the plasma and erythrocyte relationship of catecholamines in haemodialysis. The studies were performed among 37 haemodialysed patients who were inhabitants of the Lublin commune. Plasma and intracellular concentration of CA were measured prior to and following haemodialysis by high performance liquid chromatography with electrochemical detection. The results suggest that RBC are able to accumulate CA at the stage of terminal renal failure; in addition, the levels of adrenaline and dopamine in RBC depend on the accumulation of urea in plasma. It was also found that the dynamic changes in concentration of RBC adrenaline are an independent predictor of mortality in haemodialysis patients.

The anaemia control model: Does it help nephrologists in therapeutic decision-making in the management of anaemia?

Science.gov (United States)

Bucalo, María Laura; Barbieri, Carlo; Roca, Susana; Ion Titapiccolo, Jasmine; Ros Romero, Maria Soledad; Ramos, Rosa; Albaladejo, Mercedes; Manzano, Diana; Mari, Flavio; Molina, Manuel

2018-06-03

Anaemia is common in haemodialysis patients and treating it with erythropoiesis-stimulating agents (ESAs) is complex due to many factors. To assess the usefulness of the Anaemia Control Model (ACM) in the treatment of anaemia in haemodialysis. ACM is a software that predicts the optimal dose of darbepoetin and iron sucrose to achieve target haemoglobin (Hb) and ferritin levels, and makes prescription suggestions. Study conducted in dialysis clinics lasting 18months with two intervention phases (IPs) with ACM (IP1, n:213; IP2, n:218) separated by a control phase (CP, n:219). The primary outcome was the percentage of Hb in range and the median dose of ESAs, and the secondary outcomes were transfusion, hospitalisation and cardiovascular events. Clinical and patient analyses were performed. Hb variability was assessed by the standard deviation (SD) of the Hb. We also analysed the patients with most of the suggestions confirmed (ACM compliant group). ACM increased the percentage of Hb in range: 80.9% in IP2, compared with 72.7% in the CP and reduced the intake of darbepoetin (IP1: 20 [70]; CP 30 [80] μg P=0.032) with less Hb fluctuation (0.91±0.49 in the CP to 0.82±0.37g/dl in IP2, P<0.05), improving in the ACM compliant group. The secondary outcomes decreased with the use of ACM. ACM helps to obtain better anaemia results in haemodialysis patients, minimising the risks of treatment with ESAs and reducing costs. Copyright © 2018 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

The determinants of health related quality of life of patients on ...

African Journals Online (AJOL)

Background: Health related quality of life (HRQOL) is increasingly being recognised as a primary outcome measure in the treatment of end stage renal disease. In addition to being an important surrogate marker of quality of care in patients on maintenance haemodialysis, HRQOL measures have being shown to be robust ...

Clinical experience with Repotin, a locally produced recombinant ...

African Journals Online (AJOL)

Setting. Renal units at several teaching hospitals in. South Africa. Participants. Haemodialysis patients with haemoglobin. (Hb) levels less than 8.0 g/dl were recruited. The first stage examined 26 patients during a 12-week period in which the dose of intravenous rHuEPO was adjusted according to haematological response.

Effect of levocarnitine/iron saccharate combination on renal ...

African Journals Online (AJOL)

Purpose: To investigate the effect of a combination of levocarnitine and iron saccharate on the treatment of renal anaemia and oxidative stress in patients undergoing haemodialysis. Methods: A total of 156 patients with renal anaemia were divided randomly into control (78 cases) and test groups (78 cases). Patients in the ...

Carbon monoxide in chronic uraemia related to erythropoietin treatment and smoking habits

DEFF Research Database (Denmark)

Thunedborg, P; Nielsen, A L; Brinkenfeldt, H

1995-01-01

In 69 patients on chronic haemodialysis, blood sampled randomly during dialysis was analyzed for carboxyhaemoglobin (COHb). The median value was 1.40% (range 0.9-2.3) in non-smoking patients and (1.4-7.5) in smokers. In non-smokers treated with erythropoietin (EPO) correlation was found between C...

ORIGINAL ARTICLES

African Journals Online (AJOL)

hepatitis B carriers in the South African population, the reduction in the number of patients at risk of infection, ... among British and American haemodialysis patients respectively,'·" prompted studies which ..... in antiquity, and the nature of tumours reported, are reviewed. P 0 Box 29521, Danhof, 9310. Francois P Retief, MD, ...

Experience with Chronic Haemodialysis in Johannesburg

African Journals Online (AJOL)

1974-09-07

Sep 7, 1974 ... (Present address: Albert Einstein Memorial Centre, New. York). T. O. VAN DEN HEEVER, :\\1.B. CH.B., Part-time Medical. Officer. Date received: 22 May 1974. Reprint requests 10: Dr B. Goldberg. 614 Tower Hill, KOlze Street,. Hillbrow, Johannesburg. The treatment for patients with end-stage renal disease ...

Experience with Chronic Haemodialysis in Johannesburg

African Journals Online (AJOL)

1974-09-07

Sep 7, 1974 ... renal disease in Johannesburg has primarily been renal transplantation. This has ... Head of Unit. Krugersdorp ... RESULTS. Dialysis Deaths ... All RHD patients were maintained on a high calorie (at least 2000 calories/day) diet with a protein content of 1 ... bilateral renal artery occlusion after trauma, 1 with.

77 FR 50114 - Food and Drug Administration Modernization Act of 1997: Modifications to the List of Recognized...

Science.gov (United States)

2012-08-20

... Testing of Metallic Stemmed Hip Arthroplasty Femoral Components with Torsion. 11-203 ASTM F1541-02... optics. 9-76 Water for haemodialysis ISO 13959 Second and related therapies. edition 2009-04-15. 9-77...-- ISO 7206-6 First Partial and total hip edition 1992-03-l5. joint prostheses--Part 6: Determination of...

[10 years of external quality assurance in dialysis in Germany: Results and future prospects].

Science.gov (United States)

Büchtemann, Dorothea; Meinhold, Stefan; Follert, Peter

2017-10-01

In 2006, the Federal Joint Committee introduced a quality assurance programme for ambulatory dialysis treatment in Germany. Regarding the impact of chronic dialysis treatment on the quality of life of patients and on health care costs, quality assurance in dialysis is considered highly relevant. The directive on Quality Assurance in Dialysis (QSD-RL) established an external quality assurance programme on the basis of the assessment of certain quality parameters combined with an internal quality management system based on benchmarking parameters in all dialysis practices and centres. Data on quality parameters are collected and analysed quarterly. Regional associations of statutory health insurance physicians take responsibility for quality improvement measures and sanctions. This article aims to provide an overview of the development of quality parameters from 2008 to 2015. We analysed the summarised annual quality reports published on the website of the Federal Joint Committee between 2009 and 2016. We present results on the so-called core quality parameters duration and frequency of dialysis sessions (both for haemodialysis patients), wKt/V for peritoneal dialysis patients, and percentage of haemodialysis patients with central venous catheters which has only been measured since 2014. In 2015, 92,000 patients received outpatient dialysis. Between 2008 and 2015, the results for the core quality parameters duration and frequency of haemodialysis improved while the results for wKt/V seemingly show an unfavourable trend. The percentage of patients with central venous catheters appears to be quite high, and thus indicates that there is potential for quality improvement. For the future, the Federal Joint Committee has resolved to merge the quality assurance programmes in dialysis and in kidney transplantation into a newly designed programme that has the potential to follow patients through all stages and kinds of renal replacement therapy and to focus on further aspects

Assessing the impact of budget controls on the prescribing behaviours of physicians treating dialysis-dependent patients.

Science.gov (United States)

Chang, Ray-E; Tsai, Ya-Hsing; Myrtle, Robert C

2015-11-01

This study examined whether outpatient haemodialysis providers changed their treatment practices with the establishment of an outpatient dialysis global budget (ODGB) through analysing the outpatient visits and medication received by those patients. A sample of 4668 observations (patient year) of 1350 haemodialysis with hypertension (HH) patients and 4668 observations of 1436 non-HH (NHH) patients were drawn from the National Health Insurance Research Database over the years from 1999 to 2005. The impact of ODGB on hypertension-related outpatient utilization of HH was estimated using the difference in difference (DID) method and examined in three stages: (1) the fee for service stage, the pre-ODGB (2000), (2) the phase-in stage (2001-2002) and (3) the post-ODGB stage (2003-2005). ODGB implementation did not affect the number of dialysis visits for HH patients. However, it did lead to a reduction in fees for antihypertension drugs used by haemodialysis facilities. There was an increase of 4.06 visits per patient per year (P < 0.001) in the number of non-dialysis outpatient with antihypertensive drugs visits for HH patients compared with the control group. The total fees for antihypertensive drugs for HH patients increased by New Taiwan Dollars (NT$)13 008 (P < 0.001) per patient per year relative to the control group after the implementation of ODGB. As ODGB was implemented, HH patients received fewer antihypertensive drugs during their dialysis visit. In addition, there was an increase in the number of non-dialysis outpatient visits by HH patients as well as increased payment in the drugs associated with their non-dialysis outpatient visits compared with the control group. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Conflict when making decisions about dialysis modality.

Science.gov (United States)

Chen, Nien-Hsin; Lin, Yu-Ping; Liang, Shu-Yuan; Tung, Heng-Hsin; Tsay, Shiow-Luan; Wang, Tsae-Jyy

2018-01-01

To explore decisional conflict and its influencing factors on choosing dialysis modality in patients with end-stage renal diseases. The influencing factors investigated include demographics, predialysis education, dialysis knowledge, decision self-efficacy and social support. Making dialysis modality decisions can be challenging for patients with end-stage renal diseases; there are pros and cons to both haemodialysis and peritoneal dialysis. Patients are often uncertain as to which one will be the best alternative for them. This decisional conflict increases the likelihood of making a decision that is not based on the patient's values or preferences and may result in undesirable postdecisional consequences. Addressing factors predisposing patients to decisional conflict helps to facilitate informed decision-making and then to improve healthcare quality. A predictive correlational cross-sectional study design was used. Seventy patients were recruited from the outpatient dialysis clinics of two general hospitals in Taiwan. Data were collected with study questionnaires, including questions on demographics, dialysis modality and predialysis education, the Dialysis Knowledge Scale, the Decision Self-Efficacy scale, the Social Support Scale, and the Decisional Conflict Scale. The mean score on the Decisional Conflict Scale was 29.26 (SD = 22.18). Decision self-efficacy, dialysis modality, predialysis education, professional support and dialysis knowledge together explained 76.4% of the variance in decisional conflict. Individuals who had lower decision self-efficacy, did not receive predialysis education on both haemodialysis and peritoneal dialysis, had lower dialysis knowledge and perceived lower professional support reported higher decisional conflict on choosing dialysis modality. When providing decisional support to predialysis stage patients, practitioners need to increase patients' decision self-efficacy, provide both haemodialysis and peritoneal dialysis

Patients' perceptions of information and education for renal replacement therapy: an independent survey by the European Kidney Patients' Federation on information and support on renal replacement therapy.

Directory of Open Access Journals (Sweden)

Wim Van Biesen

Full Text Available Selection of an appropriate renal replacement modality is of utmost importance for patients with end stage renal disease. Previous studies showed provision of information to and free modality choice by patients to be suboptimal. Therefore, the European Kidney Patients' Federation (CEAPIR explored European patients' perceptions regarding information, education and involvement on the modality selection process.CEAPIR developed a survey, which was disseminated by the national kidney patient organisations in Europe.In total, 3867 patients from 36 countries completed the survey. Respondents were either on in-centre haemodialysis (53% or had a functioning graft (38% at the time of survey. The majority (78% evaluated the general information about kidney disease and treatment as helpful, but 39% did not recall being told about alternative treatment options than their current one. Respondents were more often satisfied with information provided on in-centre haemodialysis (90% and transplantation (87% than with information provided on peritoneal dialysis (79% or home haemodialysis (61%, and were more satisfied with information from health care professionals vs other sources such as social media. Most (75% felt they had been involved in treatment selection, 29% perceived they had no free choice. Involvement in modality selection was associated with enhanced satisfaction with treatment (OR 3.13; 95% CI 2.72-3.60. Many respondents (64% could not remember receiving education on how to manage their kidney disease in daily life. Perceptions on information seem to differ between countries.Kidney patients reported to be overall satisfied with the information they received on their disease and treatment, although information seemed mostly to have been focused on one modality. Patients involved in modality selection were more satisfied with their treatment. However, in the perception of the patients, the freedom to choose an alternative modality showed room for

UK Renal Registry 18th Annual Report: Chapter 11 2014 Multisite Dialysis Access Audit in England, Northern Ireland and Wales and 2013 PD One Year Follow-up: National and Centre-specific Analyses.

Science.gov (United States)

Rao, Anirudh; Evans, Rebecca; Wilkie, Martin; Fluck, Richard; Kumwenda, Mick

2016-01-01

Data are presented from the third combined vascular and peritoneal dialysis access audit. In 2014, 53 centres in England, Wales and Northern Ireland (out of 62) returned data on first access from 4,339 incident haemodialysis (HD) patients and 1,090 incident peritoneal dialysis (PD) patients. Of the 5,429 incident patients, 20.1% started dialysis on PD, 27.8% started with an arteriovenous fistula (AVF), 1.0% with an arteriovenous graft (AVG), 27.1% on a tunnelled line (TL) and 24.0% on a non-tunnelled line (NTL). Older patients (565 years) were more likely to start haemodialysis using AVF compared to their younger counterparts (36.2% vs. 32.8%). Thirteen of the nineteen centres (68%) using the physician led percutaneous insertion technique had over 20% of their incident patients starting on PD when compared to only seven out of fourteen centres (50%) which used single technique (open surgical or laparoscopic) for their PD catheter insertion. Wide variations were apparent between centres for use of AVF as the first haemodialysis access ranging from 10–54%. Eight of the 49 centres were achieving close to the 65% target for AV fistula in their incident patients. Length of time known to nephrology services and likelihood of commencing dialysis using either an AVF or a PD catheter are strongly associated. Patients who were known to a nephrologist for over one year were more likely to start dialysis with AVF, as compared to those who were referred between 90–365 days (39.2% vs. 24.6%). Similarly, patients who were known to a nephrologist between 90 days and one year were more likely to start on PD when compared to patients who were referred report demonstrates wide variations in practice between centres across several domains in the provision of dialysis access and further work will be required to understand the underlying reasons.

MTHFR and HFE, but not preproghrelin and LBP, polymorphisms as risk factors for all-cause end-stage renal disease development.

Science.gov (United States)

Bloudíčková, S; Kuthanová, L; Hubáček, J A

2014-01-01

End-stage renal disease (ESRD) is a serious health problem worldwide. The high prevalence of cardiovascular diseases and chronic inflammation remains a major cause of morbidity and mortality in haemodialysed patients. Beside some external factors, genetic predisposition both to renal failure and poor prognosis has been assumed. We have collected a total of 1,014 haemodialysed patients and 2,559 unrelated healthy Caucasians. Single-nucleotide polymorphisms (SNPs) in genes for preproghrelin (GHRL), lipopolysaccharide-binding protein (LBP), HFE and MTHFR were genotyped. In the group of patients, significantly more carriers presented the MTHFR T667T (P = 0.002) and HFE Asp63Asp (P = 0.001) and Cys282Cys (P = 0.01) genotypes. The frequencies of individual SNPs within GHRL and LBP genes did not differ between the patients and controls. The trends in genotype frequencies did not differ between the subgroups of patients with different time on haemodialysis. Common variants in MTHFR and HFE could be a risk factor for all-cause ESRD development, but are not predictors for the survival on haemodialysis.

Thyroid function in sudanese patients with chronic renal failure

International Nuclear Information System (INIS)

Khalid, A.Sh.; Mohamed, S.A.; Abdalla, B.A.; Suliman, S.M.; Abadi, R.S.

2003-01-01

This study deals with the determination of thyroid related hormones (T4,T3 and TSH) levels in sudanese patients with end-stage renal disease (ESRD) and under haemodialysis to determine the best means of treatment. This is the first time in Sudan to investigate thyroid related hormones on patients with chronic renal failure and was done on 61 patients and 60 symptoms-free subjects as controls. Radioimmunoassay (RIA) technique is used for the determination of serum total T4 and T3,whereas, TSH was determination using immunoradiometric assay (IRMA). T-test calculation revealed that the mean concentrations of total T4 and T3 of the patients were much lower than that of the normal subjects (p 0.05).These results revealed that, serum total T4 levels tent to decline after long term treatment with haemodialysis. Serum total T3 level fluctuate in lower margin of the normal range in haemodialyzed patients. As serum total thyroxine (T4) tends to decline in haemodialyzed patients, the use of thyroxine replacement therapy is highly recommended. (Author)

Unusual Presentation of Uncommon Disease: Anorexia Nervosa Presenting as Wernicke-Korsakoff Syndrome—A Case Report from Southeast Asia

OpenAIRE

Mushtaq, Raheel; Shoib, Sheikh; Shah, Tabindah; Bhat, Mudasir; Singh, Randhir; Mushtaq, Sahil

2014-01-01

Anorexia nervosa presenting as Wernicke-Korsakoff syndrome is rare. The causes of Wernicke-Korsakoff syndrome are multiple like alcohol abuse, thyrotoxicosis, haemodialysis, severe malnutrition because of gastric carcinoma and pyloric obstruction, hyperemesis gravidarum, and prolonged parenteral feeding. We report a case of anorexia nervosa, who presented with Wernicke's encephalopathy and progressed to Korsakoff's syndrome. Knowledge, awareness, and early intervention of anorexia nervosa...

Incineration: why this may be the most environmentally sound method of renal healthcare waste disposal.

Science.gov (United States)

James, Ray

2010-09-01

The environment and 'green' issues are currently being promoted in the healthcare sector through recently launched initiatives. This paper considers aspects of healthcare waste management, with particular reference to waste generated in dialysis units. With dialysis being dependent upon large amounts of disposables, it generates considerable volumes of waste. This paper focuses upon a typical haemodialysis unit, evaluating and quantifying the volumes and categories of waste generated. Each haemodialysis patient on thrice weekly dialysis generates some 323 kg per year of waste, of which 271 kg is classified as clinical. This equates to 1626 kg of (solid) clinical waste per dialysis bed, which is around three times the volume of clinical waste generated per general hospital bed. Waste disposal routes are considered and this suggests that present healthcare waste paradigms are outmoded. They do not allow for flexible approaches to solving what is a dynamic problem, and there is a need for new thinking models in terms of managing the unsustainable situation of disposal in constantly growing landfills. Healthcare waste management must be considered not only in terms of the environmental impact and potential long-term health effects, but also in terms of society's future energy requirements.

Dietary and fluid adherence among haemodialysis patients ...

African Journals Online (AJOL)

comparison with major infectious diseases such as AIDS, tuberculosis ... dietary and fluid adherence is of crucial importance to the quality of life and survival of ... behaviours such as medication adherence among psychiatric ... or nursing sister and introduced to one of the study personnel who .... Children per household. 61.

[Acute oliguric renal failure and haemolytic anaemia following infectious mononucleosis].

Science.gov (United States)

Brkovic, Natasa; Jørgensen, Kit Riegels; Rosenbæk, Jeppe Bakkestrøm; Pedersen, Erling Bjerregaard

2015-11-09

A 19-year-old man was admitted to hospital due to fatigue, nausea, abdominal pain and faint. He was pale and icteric, awake with sufficient respiration and circulation. He had infectious mononucleosis complicated with acute oliguric renal failure and severe haemolytic anaemia with a positive Coombs test. He had a cold agglutinin syndrome. The treatment comprised intermittent haemodialysis, plasmapheresis and heating. He recovered completely after two months.

Medicinudløst hudkløe, sår og blærer hos tre patienter med pseudoporfyri

DEFF Research Database (Denmark)

Þorsteinsdóttir, Sunna; Velander, Marie Juul; Bygum, Anette

2015-01-01

Pseudoporphyria cutanea tarda is a well described bullous skin disorder which resembles porphyria cutanea tarda. However, the levels of porphyrins in plasma, urine and faeces are normal. We present three cases of patients with classical symptoms of pseudoporhyria. Two of the patients developed ps...... pseudoporphyria after the combination of intensive sunbathing and medications well known to cause pseudoporphyria. The third case received haemodialysis and furosemide....

Medicinudløst hudkløe, sår og blærer hos tre patienter med pseudoporfyri

DEFF Research Database (Denmark)

Thorsteinsdóttir, Sunna; Velander, Marie Juul; Bygum, Anette

2015-01-01

Pseudoporphyria cutanea tarda is a well described bullous skin disorder which resembles porphyria cutanea tarda. However, the levels of porphyrins in plasma, urine and faeces are normal. We present three cases of patients with classical symptoms of pseudoporphyria. Two of the patients developed p...... pseudoporphyria after the combination of intensive sunbathing and medications well known to cause pseudoporphyria. The third case received haemodialysis and furosemide....

Cognitive function and advanced kidney disease: longitudinal trends and impact on decision-making

OpenAIRE

Iyasere, Osasuyi; Okai, David; Brown, Edwina

2017-01-01

Background: Cognitive impairment commonly affects renal patients. But little is known about the influence of dialysis modality on cognitive trends or the influence of cognitive impairment on decision-making in renal patients. This study evaluated cognitive trends amongst chronic kidney disease (CKD), haemodialysis (HD) and peritoneal dialysis (PD) patients. The relationship between cognitive impairment and decision-making capacity (DMC) was also assessed. Methods: Patients were recruited from...

Intensive Nutritional Counselling And Support And Clinical Outcomes In Hemodialysis Patients

OpenAIRE

Alessio Molfino; Alessandro Laviano; Maria Grazia Chiappini; Thomas Amman; Filippo Rossi Fanelli; Maurizio Muscaritoli

2012-01-01

Protein-energy wasting is frequently found in haemodialysis (HD) patients. Anorexia and hypophagia contribute to malnutrition, increased morbidity and mortality, but the clinical impact of correcting hypophagia remains uncertain. We evaluated whether correction of hypophagia influences morbidity and mortality in anorexic HD patients. Thirty-four HD patients were enrolled in a 2-year follow-up programme including regular nutritional assessment. Patients not meeting nutritional requirements dur...

Phrenic neuropathy in chronic renal failure.

OpenAIRE

Zifko, U.; Auinger, M.; Albrecht, G.; Kästenbauer, T.; Lahrmann, H.; Grisold, W.; Wanke, T.

1995-01-01

BACKGROUND--Peripheral neuropathy and alterations in diaphragmatic muscle function are frequently caused by uraemia. Phrenic nerve function in patients with end stage renal failure, however, has not been examined to date. METHODS--An electrophysiological study of the phrenic nerve was performed to determine its possible involvement in 32 nondiabetic patients with end stage renal disease undergoing chronic haemodialysis. RESULTS--Seventeen patients had electrophysiological signs of peripheral ...

Propensity score matching and persistence correction to reduce bias in comparative effectiveness: the effect of cinacalcet use on all-cause mortality.

Science.gov (United States)

Gillespie, Iain A; Floege, Jürgen; Gioni, Ioanna; Drüeke, Tilman B; de Francisco, Angel L; Anker, Stefan D; Kubo, Yumi; Wheeler, David C; Froissart, Marc

2015-07-01

The generalisability of randomised controlled trials (RCTs) may be limited by restrictive entry criteria or by their experimental nature. Observational research can provide complementary findings but is prone to bias. Employing propensity score matching, to reduce such bias, we compared the real-life effect of cinacalcet use on all-cause mortality (ACM) with findings from the Evaluation of Cinacalcet Therapy to Lower Cardiovascular Events (EVOLVE) RCT in chronic haemodialysis patients. Incident adult haemodialysis patients receiving cinacalcet, recruited in a prospective observational cohort from 2007-2009 (AROii; n = 10,488), were matched to non-exposed patients regardless of future exposure status. The effect of treatment crossover was investigated with inverse probability of censoring weighted and lag-censored analyses. EVOLVE ACM data were analysed largely as described for the primary composite endpoint. AROii patients receiving cinacalcet (n = 532) were matched to 1790 non-exposed patients. The treatment effect of cinacalcet on ACM in the main AROii analysis (hazard ratio 1.03 [95% confidence interval (CI) 0.78-1.35]) was closer to the null than for the Intention to Treat (ITT) analysis of EVOLVE (0.94 [95%CI 0.85-1.04]). Adjusting for non-persistence by 0- and 6-month lag-censoring and by inverse probability of censoring weight, the hazard ratios in AROii (0.76 [95%CI 0.51-1.15], 0.84 [95%CI 0.60-1.18] and 0.79 [95%CI 0.56-1.11], respectively) were comparable with those of EVOLVE (0.82 [95%CI 0.67-1.01], 0.83 [95%CI 0.73-0.96] and 0.87 [95%CI 0.71-1.06], respectively). Correcting for treatment crossover, we observed results in the 'real-life' setting of the AROii observational cohort that closely mirrored the results of the EVOLVE RCT. Persistence-corrected analyses revealed a trend towards reduced ACM in haemodialysis patients receiving cinacalcet therapy. Copyright © 2015 John Wiley & Sons, Ltd.

A CASE SERIES ON FISH BILE TOXICITY

Directory of Open Access Journals (Sweden)

Dwijen

2015-08-01

Full Text Available A case series of 3 cases of fish bile poisoning are reported. After ingestion of gall bladder of Labeo rohita for alleged vision improvement, generally presented with gastrointestinal symptoms such as cramping pain abdomen, nausea and vomiting within 12 hours after ingestion. Subsequently rena l and hepatic dysfunctions were found in all the three cases. The patient recovered fully with conservative treatment and supportive haemodialysis.

Enfermedad arterial periférica y pié diabético en pacientes en programa de hemodiálisis Peripheral arterial disease and diabetic foot in patients on haemodialysis programme

Directory of Open Access Journals (Sweden)

Azucena García Viejo

2012-12-01

and prevention of ulcers and amputations of lower limbs. Material and methods: Transversal descriptive observational study. Carried out with 51 patients included in the haemodialysis programme of the Unit in Segovia. Analyses were carried out of the different risk factors that influence the presence of arteriopathy and diabetic foot, and the different relationships between them as well as a stratification of the risk in the population studied. Results: 45% of the patients present peripheral arterial disease and 58% have sensitivity alterations. Diabetes firstly and cardiovascular diseases are the factors that have the most influence in these problems. Conclusions: Categorizing our patients according to risk will make it possible to plan strategies to prevent the appearance of these complications. The absence of previous examination shows inadequate monitoring. The high prevalence of these pathologies makes protocolized monitoring necessary.

Page Kidney in Wunderlich Syndrome Causing Acute Renal Failure and Urosepsis: Successful Timely Minimally Invasive Management of a Devastating Clinical Entity.

Science.gov (United States)

Vijayganapathy, Sundaramoorthy; Karthikeyan, Vilvapathy Senguttuvan; Mallya, Ashwin; Sreenivas, Jayaram

2017-06-01

Wunderlich Syndrome (WS) is an uncommon condition where acute onset of spontaneous bleeding occurs into the subcapsular and perirenal spaces. It can prove fatal if not recognized and treated aggressively at the appropriate time. A 32-year-old male diagnosed elsewhere as acute renal failure presented with tender left loin mass, fever and hypovolemic shock with serum creatinine 8.4 mg/dl. He was started on higher antibiotics and initiated on haemodialysis. Ultrasonogram (USG), Non-Contrast Computed Tomography (NCCT) and Magnetic Resonance Imaging (MRI) showed bilateral perirenal subcapsular haematomas - right 3.6 x 3.1 cm and left 10.3 x 10.3 cm compressing and displacing left kidney, fed by capsular branch of left renal artery on CT angiogram. Initial aspirate was bloody but he persisted to have febrile spikes, renal failure and urosepsis and he was managed conservatively. Repeat NCCT 10 days later revealed left perinephric abscess and Percutaneous Drainage (PCD) was done. Patient improved, serum creatinine stabilized at 2 mg/dl without haemodialysis and PCD was removed after two weeks. To conclude, bilateral idiopathic spontaneous retroperitoneal haemorrhage with renal failure is a rare presentation. This case highlights the need for high index of suspicion, the role of repeated imaging and successful minimally invasive management with timely PCD and supportive care.

Myoglobinuria following the use of succinylcholine.

OpenAIRE

Bhave C; Gadre K; Gharpure B

1993-01-01

Eight hours following tympanoplasty performed under general anaesthesia (sodium pentothal and trichloroethylene), a 30 year old male complained of muscular weakness and dark coloured urine. Urinalysis revealed myoglobin pigment. A rise in BUN (47mg%), serum creatinine (5.7mg%), creatinine phosphokinase (15,500 U/L) and CPK-MB fraction (4690 U/L) was noticed 36 hrs later. The patient developed acute renal failure, and recovered after haemodialysis. From a history of use of succin...

Unusual presentation of uncommon disease: anorexia nervosa presenting as wernicke-korsakoff syndrome-a case report from southeast Asia.

Science.gov (United States)

Mushtaq, Raheel; Shoib, Sheikh; Shah, Tabindah; Bhat, Mudasir; Singh, Randhir; Mushtaq, Sahil

2014-01-01

Anorexia nervosa presenting as Wernicke-Korsakoff syndrome is rare. The causes of Wernicke-Korsakoff syndrome are multiple like alcohol abuse, thyrotoxicosis, haemodialysis, severe malnutrition because of gastric carcinoma and pyloric obstruction, hyperemesis gravidarum, and prolonged parenteral feeding. We report a case of anorexia nervosa, who presented with Wernicke's encephalopathy and progressed to Korsakoff's syndrome. Knowledge, awareness, and early intervention of anorexia nervosa by mental health professionals can prevent development of Wernicke-Korsakoff syndrome.

Unusual Presentation of Uncommon Disease: Anorexia Nervosa Presenting as Wernicke-Korsakoff Syndrome—A Case Report from Southeast Asia

Science.gov (United States)

Mushtaq, Raheel; Shah, Tabindah; Bhat, Mudasir; Mushtaq, Sahil

2014-01-01

Anorexia nervosa presenting as Wernicke-Korsakoff syndrome is rare. The causes of Wernicke-Korsakoff syndrome are multiple like alcohol abuse, thyrotoxicosis, haemodialysis, severe malnutrition because of gastric carcinoma and pyloric obstruction, hyperemesis gravidarum, and prolonged parenteral feeding. We report a case of anorexia nervosa, who presented with Wernicke's encephalopathy and progressed to Korsakoff's syndrome. Knowledge, awareness, and early intervention of anorexia nervosa by mental health professionals can prevent development of Wernicke-Korsakoff syndrome. PMID:24963430

9. The Contribution of Animal Experiments to Kidney Transplantation

OpenAIRE

Botting, Jack Howard

2016-01-01

Haemodialysis is life-saving and curative in acute renal failure. By reversing the build-up of metabolic products normally excreted by a functioning kidney, dialysis enables the temporarily affected kidneys to heal and resume normal function. In chronic renal failure however, the burden of regular dialysis is necessary unless a healthy kidney from a donor can be grafted. Chronic Renal Failure Chronic renal failure (CRF) due to glomerulonephritis, pyelonephritis or polycystic kidney disease is...

A rare case of enteric and systemic Yersinia enterocolitica infection in a chronic, not iron-overloaded dialysis patient

Directory of Open Access Journals (Sweden)

Jari Intra

2017-03-01

Full Text Available We present herein a case of bacterial gastroenteritis due to Yersinia enterocolitica, occurred in a young woman undergoing haemodialysis with a previous history positive for prolonged (20 years immunosuppressive therapy for glomerulonephritis before and for kidney transplant later. The patient’s outcome was favourable after a third-generation cephalosporin treatment without complications. The possible pathophysiological association between patient clinical condition and Yersinia bacteraemia is discussed, along with the review of literature.

Behandling af metforminassocieret laktatacidose med hæmodialyse

DEFF Research Database (Denmark)

Schousboe, Karin; El Fassi, Daniel; Secher, Erik Lilja

2012-01-01

Metformin-associated lactate acidosis is rare but serious and characterized by metabolic acidosis and elevated lactate. We describe a single-institution experience of four cases in one year. Despite pH levels of 6.85 to 7.12 and lactate levels of 11-28 mmol/l three of the patients survived. Two o...... of the patients had normal kidney function previous to hospitalization. Treatment includes fluid replacement, IV sodium bicarbonate and haemodialysis....

Influencia de la sobrecarga de calcio sobre el metabolismo óseo y mineral en 55 centros de hemodiálisis de Lima

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Pedro Méndez-Chacón

2018-05-01

Full Text Available Resumen: Antecedentes: Las alteraciones del metabolismo óseo y mineral son complicaciones frecuentes de los pacientes de hemodiálisis que presentan una gran variabilidad geográfica. Objetivos: El objetivo del presente estudio fue evaluar por primera vez dichas alteraciones en pacientes de hemodiálisis de Perú. Métodos: El estudio incluyó 1.551 pacientes de hemodiálisis de 55 centros concertados con el seguro social de salud de Perú, pertenecientes a la ciudad de Lima. De cada paciente se recogieron datos demográficos, comorbilidades, tratamientos y parámetros bioquímicos. Los valores de calcio, fósforo y PTH fueron categorizados según los rangos recomendados en las guías KDOQI y KDIGO. Resultados: La edad media de los pacientes fue de 59,5 ± 15,6, con tiempo medio en hemodiálisis de 58,0 ± 54,2 meses. Todos los pacientes se dializaban con una concentración de calcio en el líquido de diálisis de 3,5 mEq/l y el 68,9% recibían captores de fósforo (98,4% carbonato de calcio. Se observó un alto porcentaje de pacientes con calcio sérico por encima y fósforo sérico por debajo de los rangos recomendados en las guías KDOQI (32,8% y 37,3% respectivamente. Más de la mitad de los pacientes tenían valores de PTH por debajo de los rangos recomendados, tanto en KDOQI como en KDIGO (56,4% y 51,6% respectivamente. Conclusiones: Los pacientes incluidos en el presente estudio se caracterizaron por ser más jóvenes que los de otros estudios y por tener hipofosforemia y PTH suprimida, probablemente debido a una excesiva sobrecarga de calcio a través del líquido de diálisis y el empleo de captores de fósforo con calcio. Abstract: Background: Mineral and bone metabolism disorders are common complications in haemodialysis patients that present significant geographical variability. Objectives: The objective of this study was to assess these disorders for the first time in haemodialysis patients from Peru. Methods: The study

Setting the standard, implementation and auditing within haemodialysis.

Science.gov (United States)

Jones, J

1997-01-01

With an ever increasing awareness of the need to deliver a quality of care that is measurable in Nursing, the concept of Standards provides an ideal tool (1). Standards operate outside the boundaries of policies and procedures to provide an audit tool of authenticity and flexibility. Within our five Renal Units, while we felt confident that we were delivering an excellent standard of care to our patients and continually trying to improve upon it, what we really needed was a method of measuring this current level of care and highlighting key areas where we could offer improvement.

Changes in antioxidant status associated with haemodialysis in ...

African Journals Online (AJOL)

Oxidative stress has been implicated in the pathogenesis, progression of chronic kidney disease (CKD) and development of cardiovascular complications. Hemodialysis (HD) has also been described to contribute significantly to oxidative stress in CKD patients, though reports are conflicting. Objective: We evaluated the ...

Haemodialysis at home: review of current dialysis machines.

Science.gov (United States)

Haroon, Sabrina; Davenport, Andrew

2018-04-26

Only a minority of patients with chronic kidney disease treated by hemodialysis are currently treated at home. Until relatively recently, the only type of hemodialysis machine available for these patients was a slightly smaller version of the standard machines used for in-center dialysis treatments. Areas covered: There are now an alternative generation of dialysis machines specifically designed for home hemodialysis. The home dialysis patient wants a smaller machine, which is intuitive to use, easy to trouble shoot, robust and reliable, quick to setup and put away, requiring minimal waste disposal. The machines designed for home dialysis have some similarities in terms of touch-screen patient interfaces, and using pre-prepared cartridges to speed up setting up the machine. On the other hand, they differ in terms of whether they use slower or standard dialysate flows, prepare batches of dialysis fluid, require separate water purification equipment, or whether this is integrated, or use pre-prepared sterile bags of dialysis fluid. Expert commentary: Dialysis machine complexity is one of the hurdles reducing the number of patients opting for home hemodialysis and the introduction of the newer generation of dialysis machines designed for ease of use will hopefully increase the number of patients opting for home hemodialysis.

Tuberculosis in haemodialysis patients: A single centre experience

Directory of Open Access Journals (Sweden)

T Manmadha Rao

2013-01-01

Full Text Available We prospectively followed-up new patients of tuberculosis while on maintenance hemodialysis at a State Government-run tertiary care institute. Between 2000 and 2010, 1237 new patients were initiated on maintainence hemodialysis. The number of patients diagnosed with tuberculosis after initiation of hemodialysis was 131 (10.5% of 1237. The age was 46.4 ± 10.4 (range 8-85 years and there were 90 (68.7% males. The number of patients diagnosed with tuberculosis on the basis of organ involvement were: Pulmonary-60, pleural effusion-31, lymph node-21, meningitis-8, pericardial effusion-7, peritoneum-2, latent tuberculosis-2. The incidence of tuberculosis in hemodialysis was found to be 105.9 per 1000 patient years. Male gender, diabetes mellitus, past history of tuberculosis, mining as an occupation, low serum albumin, and duration of hemodialysis more than 24 months, and unemployment were found to be significant risk-factors on univariate analysis.

Relative survival of peritoneal dialysis and haemodialysis patients

DEFF Research Database (Denmark)

Heaf, James G; Wehberg, Sonja

2014-01-01

INTRODUCTION: Epidemiological studies consistently show an initial survival advantage for PD patients compared to HD. It has recently been suggested that this is due to the fact that many HD patients are referred late, and start dialysis on an acute, in-patient basis. The present study was perfor...

Unusual Presentation of Uncommon Disease: Anorexia Nervosa Presenting as Wernicke-Korsakoff Syndrome—A Case Report from Southeast Asia

Directory of Open Access Journals (Sweden)

Raheel Mushtaq

2014-01-01

Full Text Available Anorexia nervosa presenting as Wernicke-Korsakoff syndrome is rare. The causes of Wernicke-Korsakoff syndrome are multiple like alcohol abuse, thyrotoxicosis, haemodialysis, severe malnutrition because of gastric carcinoma and pyloric obstruction, hyperemesis gravidarum, and prolonged parenteral feeding. We report a case of anorexia nervosa, who presented with Wernicke's encephalopathy and progressed to Korsakoff's syndrome. Knowledge, awareness, and early intervention of anorexia nervosa by mental health professionals can prevent development of Wernicke-Korsakoff syndrome.

A case of cutaneous Rhodotorula infection mimicking cryptococcosis.

Science.gov (United States)

George, S M C; Quante, M; Cubbon, M D; MacDiarmaid-Gordon, A R; Topham, E J

2016-12-01

Rhodotorula is a ubiquitous environmental and commensal yeast, and an emerging opportunistic pathogen, particularly in immunocompromised individuals. Clinical infections with Rhodotorula have been increasingly recognized over the past 30 years; however, infections in solid-organ transplant recipients are uncommon, and cutaneous manifestations have rarely been reported. We describe a 59-year-old male renal transplant recipient, who developed cutaneous infection with Rhodotorula upon failure of his graft and commencement of haemodialysis. © 2016 British Association of Dermatologists.

Human exposure to cyanotoxins and their effects on health.

Science.gov (United States)

Drobac, Damjana; Tokodi, Nada; Simeunović, Jelica; Baltić, Vladimir; Stanić, Dina; Svirčev, Zorica

2013-06-01

Cyanotoxins are secondary metabolites produced by cyanobacteria. They pose a threat to human health and the environment. This review summarises the existing data on human exposure to cyanotoxins through drinking water, recreational activities (e.g., swimming, canoeing or bathing), the aquatic food web, terrestrial plants, food supplements, and haemodialysis. Furthermore, it discusses the tolerable daily intake and guideline values for cyanotoxins (especially microcystins) as well as the need to implement risk management measures via national and international legislation.

A study of the impact of disease burden in quality of life of people with pre-End-Stage and End-Stage Renal Disease

Directory of Open Access Journals (Sweden)

Helen Georgiadou

2017-10-01

Full Text Available Introduction: Diabetes Mellitus (DM is a common chronic disease accompanied by severe complications. It is the leading cause of End-Stage Renal Disease (ESRD requiring management either by haemodialysis (HD or peritoneal dialysis (PD. The chronicity of the disease, and its complications, affects the psychological, family and social life of the patients and their Quality of Life (QoL. Aim: of the present study was to estimate the disease burden of patients with diabetic nephropathy (DN during pre-ESRD and during End-Stage Renal Disease. Methods: A sample of 103 patients with DN treated at the General Hospital of Veria were studied during May and June 2016. The study was conducted using the Dialysis Symptoms Index (DSI for the assessment of Chronic Kidney Disease (CKD symptom load and the European Quality of Life (EuroQol questionnaire for assessing the QoL of patients in the Renal Outpatient Clinic, Haemodialysis and Peritoneal Dialysis Unit. Results: It was found that the Renal Replacement Method (HD or PD, the presence of DM and CKD’s stage affect significantly the patients’ self-assessment regarding painful symptoms of DN. Furthermore, the above factors have major impact on some aspects of patients’ QoL, such as mobility and self-care. Conclusions: Pre-End Stage patients experience more severe painful symptoms of DN compared to patients on Renal Replacement Therapies.

Diffusion-weighted imaging of the kidneys in haemolytic uraemic syndrome

International Nuclear Information System (INIS)

Herrmann, Jochen; Wenzel, Ulrich; Galler, Stephanie; Schoennagel, Bjoern P.; Bannas, Peter; Yamamura, Jin; Groth, Michael; Adam, Gerhard; Busch, Jasmin D.; Tozakidou, Magdalini; Petersen, Kay U.; Joekel, Michaela; Habermann, Christian R.

2017-01-01

To evaluate the kidneys of patients with haemolytic uraemic syndrome (HUS) using diffusion-weighted imaging (DWI) and Doppler ultrasound (US) compared with healthy controls. Fifteen patients (mean age 33.3 years; three male; 12 female) with diarrhoea-positive HUS and 15 healthy volunteers were prospectively evaluated with DWI and Doppler US. A total apparent diffusion coefficient (ADC TOT ), and ADCs predominantly reflecting microperfusion (ADC LOW ) and diffusion (ADC HIGH ) were calculated. Doppler US evaluated renal vascularity and flow. When compared with controls, kidneys affected by HUS showed reduced cortical ADC values (ADC TOT 1.79±0.22 vs. 2.04±0.1x10 -3 mm 2 /s, P 0.001), resulting in either low corticomedullary differences (11/15 patients) or an inverted corticomedullary pattern (4/15 patients). Reduction of cortical ADC values was associated with a decrease of cortical vascularity on Doppler US (ADC TOT , P<0.001; ADC LOW , P 0.047). Kidneys with complete absence of the cortical vasculature on Doppler US (four patients) also demonstrated limited diffusion (ADC HIGH , P 0.002). Low glomerular filtration rate, requirement for haemodialysis during hospitalization, and longer duration of haemodialysis were associated with decreased cortical diffusivity (ADC TOT: P 0.04, 0.007, and <0.001, respectively). DWI shows qualitative and quantitative abnormalities in kidneys affected by HUS, thereby extending the non-invasive assessment of renal parenchymal damage. (orig.)

RELATIVE DOSING OF PHOSPHATE BINDERS FOR EFFECTIVE MANAGEMENT OF PHOSPHATE AND PROTEIN INTAKE IN CHRONIC KIDNEY DISEASE

OpenAIRE

Brian Copley, J; Heise, Jamie

2012-01-01

Patients with chronic kidney disease undergoing haemodialysis have a maximum recommended dietary phosphate (P) intake of 1000 mg/day and a recommended protein intake of 1.2 g/kg/day. Achieving this level of protein intake is associated with the best patient outcomes. However, protein-containing foods also contain P, and elevated serum P is associated with increased all-cause mortality. It is therefore important to manage the levels of serum P while maintaining adequate levels of nutrition. ...

Type I procollagen propeptide in patients on CAPD

DEFF Research Database (Denmark)

Joffe, P; Heaf, J G; Jensen, L T

1995-01-01

Serum procollagen type I carboxyterminal propeptide (PICP) has been shown to be a useful marker of bone formation in patients undergoing haemodialysis. However, PICP levels has not been evaluated in depth in patients maintained on continuous ambulatory peritoneal dialysis (CAPD). Therefore serum...... and dialysate levels of PICP, its peritoneal clearance (Clp), mass transfer (MTp), and its possible relationship with osteocalcin, parathyroid hormone (PTH), and bone histomorphometry were studied in a group of CAPD patients. Serum PICP was just above the normal range with significant amounts detected...

Perceptions and experiences of financial incentives: a qualitative study of dialysis care in England.

Science.gov (United States)

Abma, Inger; Jayanti, Anuradha; Bayer, Steffen; Mitra, Sandip; Barlow, James

2014-02-12

The objective of the study was to understand the extent to which financial incentives such as Payment by Results and other payment mechanisms motivate kidney centres in England to change their practices. The study followed a qualitative design. Data collection involved 32 in-depth semistructured interviews with healthcare professionals and managers, focusing on their subjective experience of payment structures. Participants were kidney healthcare professionals, clinical directors, kidney centre managers and finance managers. Healthcare commissioners from different parts of England were also interviewed. Participants worked at five kidney centres from across England. The selection was based on the prevalence of home haemodialysis, ranging from low (8%) prevalence, with at least one centre in each one of these categories at the time of selection. While the tariff for home haemodialysis is not a clear incentive for its adoption due to uncertainty about operational costs, Commissioning for Quality and Innovation (CQUIN) targets and the Best Practice Tariff for vascular access were seen by our case study centres as a motivator to change practices. The impact of financial incentives designed at a policy level is influenced by the understanding of cost and benefits at the local operational level. In a situation where costs are unclear, incentives which are based on the improvement of profit margins have a smaller impact than incentives which provide an additional direct payment, even if this extra financial support is relatively small.

Diffusion-weighted imaging of the kidneys in haemolytic uraemic syndrome

Energy Technology Data Exchange (ETDEWEB)

Herrmann, Jochen [University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Hamburg (Germany); University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Section of Pediatric Radiology, Hamburg (Germany); Wenzel, Ulrich [University Medical Center Hamburg-Eppendorf, III. Department of Internal Medicine, Hamburg (Germany); Galler, Stephanie; Schoennagel, Bjoern P.; Bannas, Peter; Yamamura, Jin; Groth, Michael; Adam, Gerhard [University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Hamburg (Germany); Busch, Jasmin D.; Tozakidou, Magdalini [University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Section of Pediatric Radiology, Hamburg (Germany); Petersen, Kay U. [University Hospital of Tuebingen, Department for Psychiatry and Psychotherapy, Section for Addiction Research and Therapy, Tuebingen (Germany); Joekel, Michaela [Siemens AG Healthcare, Hamburg (Germany); Habermann, Christian R. [Katholisches Marienkrankenhaus Hamburg, Department of Diagnostic and Interventional Radiology, Hamburg (Germany)

2017-11-15

To evaluate the kidneys of patients with haemolytic uraemic syndrome (HUS) using diffusion-weighted imaging (DWI) and Doppler ultrasound (US) compared with healthy controls. Fifteen patients (mean age 33.3 years; three male; 12 female) with diarrhoea-positive HUS and 15 healthy volunteers were prospectively evaluated with DWI and Doppler US. A total apparent diffusion coefficient (ADC{sub TOT}), and ADCs predominantly reflecting microperfusion (ADC{sub LOW}) and diffusion (ADC{sub HIGH}) were calculated. Doppler US evaluated renal vascularity and flow. When compared with controls, kidneys affected by HUS showed reduced cortical ADC values (ADC{sub TOT} 1.79±0.22 vs. 2.04±0.1x10{sup -3} mm{sup 2}/s, P 0.001), resulting in either low corticomedullary differences (11/15 patients) or an inverted corticomedullary pattern (4/15 patients). Reduction of cortical ADC values was associated with a decrease of cortical vascularity on Doppler US (ADC{sub TOT}, P<0.001; ADC{sub LOW}, P 0.047). Kidneys with complete absence of the cortical vasculature on Doppler US (four patients) also demonstrated limited diffusion (ADC{sub HIGH}, P 0.002). Low glomerular filtration rate, requirement for haemodialysis during hospitalization, and longer duration of haemodialysis were associated with decreased cortical diffusivity (ADC{sub TOT:} P 0.04, 0.007, and <0.001, respectively). DWI shows qualitative and quantitative abnormalities in kidneys affected by HUS, thereby extending the non-invasive assessment of renal parenchymal damage. (orig.)

Haemocompatibility and ion exchange capability of nanocellulose polypyrrole membranes intended for blood purification

Science.gov (United States)

Ferraz, Natalia; Carlsson, Daniel O.; Hong, Jaan; Larsson, Rolf; Fellström, Bengt; Nyholm, Leif; Strømme, Maria; Mihranyan, Albert

2012-01-01

Composites of nanocellulose and the conductive polymer polypyrrole (PPy) are presented as candidates for a new generation of haemodialysis membranes. The composites may combine active ion exchange with passive ultrafiltration, and the large surface area (about 80 m2 g−1) could potentially provide compact dialysers. Herein, the haemocompatibility of the novel membranes and the feasibility of effectively removing small uraemic toxins by potential-controlled ion exchange were studied. The thrombogenic properties of the composites were improved by applying a stable heparin coating. In terms of platelet adhesion and thrombin generation, the composites were comparable with haemocompatible polymer polysulphone, and regarding complement activation, the composites were more biocompatible than commercially available membranes. It was possible to extract phosphate and oxalate ions from solutions with physiological pH and the same tonicity as that of the blood. The exchange capacity of the materials was found to be 600 ± 26 and 706 ± 31 μmol g−1 in a 0.1 M solution (pH 7.4) and in an isotonic solution of phosphate, respectively. The corresponding values with oxalate were 523 ± 5 in a 0.1 M solution (pH 7.4) and 610 ± 1 μmol g−1 in an isotonic solution. The heparinized PPy–cellulose composite is consequently a promising haemodialysis material, with respect to both potential-controlled extraction of small uraemic toxins and haemocompatibility. PMID:22298813

Streptococcal peritonitis in Australian peritoneal dialysis patients: predictors, treatment and outcomes in 287 cases

Directory of Open Access Journals (Sweden)

McDonald Stephen P

2009-07-01

Full Text Available Abstract Background There has not been a comprehensive, multi-centre study of streptococcal peritonitis in patients on peritoneal dialysis (PD to date. Methods The predictors, treatment and clinical outcomes of streptococcal peritonitis were examined by binary logistic regression and multilevel, multivariate poisson regression in all Australian PD patients involving 66 centres between 2003 and 2006. Results Two hundred and eighty-seven episodes of streptococcal peritonitis (4.6% of all peritonitis episodes occurred in 256 individuals. Its occurrence was independently predicted by Aboriginal or Torres Strait Islander racial origin. Compared with other organisms, streptococcal peritonitis was associated with significantly lower risks of relapse (3% vs 15%, catheter removal (10% vs 23% and permanent haemodialysis transfer (9% vs 18%, as well as a shorter duration of hospitalisation (5 vs 6 days. Overall, 249 (87% patients were successfully treated with antibiotics without experiencing relapse, catheter removal or death. The majority of streptococcal peritonitis episodes were treated with either intraperitoneal vancomycin (most common or first-generation cephalosporins for a median period of 13 days (interquartile range 8–18 days. Initial empiric antibiotic choice did not influence outcomes. Conclusion Streptococcal peritonitis is a not infrequent complication of PD, which is more common in indigenous patients. When treated with either first-generation cephalosporins or vancomycin for a period of 2 weeks, streptococcal peritonitis is associated with lower risks of relapse, catheter removal and permanent haemodialysis transfer than other forms of PD-associated peritonitis.

UK Renal Registry 17th Annual Report: Chapter 10 2013 Multisite Dialysis Access Audit in England, Northern Ireland and Wales and 2012 PD One Year Follow-up: National and Centre-specific Analyses.

Science.gov (United States)

Rao, Anirudh; Pitcher, David; Fluck, Richard; Kumwenda, Mick

2015-01-01

Dialysis access should be timely, minimize complications and maintain functionality. The aim of the second combined vascular and peritoneal dialysis access audit was to examine practice patterns with respect to dialysis access and highlight variations in practice between renal centres. The UK Renal Registry collected centre-specific information on incident vascular and peritoneal dialysis access outcome measures in patients from England, Wales and Northern Ireland (EW&NI), including patient demographics, dialysis access type (at start of dialysis and three months after start of dialysis), surgical assessment and access functionality. Centres who had reported data on incident PD patients for the previous 2012 audit were additionally asked to provide one year follow up data for this group. The findings were compared to the audit measures stated in Renal Association clinical practice guidelines for dialysis access. Fifty-seven centres in EW&NI (representing 92% of all centres) returned data on first access from 3,663 incident HD patients and 1,022 incident PD patients. A strong relationship was seen between surgical assessment and the likelihood of starting HD with an arteriovenous fistula (AVF). Twenty-four centres were at least two standard deviations below the 65% target for incident patients starting haemodialysis on AVF and only eight centres (14%) were within two standard deviations of the 85% target for prevalent haemodialysis patients on AVF. There was wide practice variation across the UK in provision of both HD and PD access which requires further exploration.

Haemodialysis for post-traumatic acute renal failure – factors ...

African Journals Online (AJOL)

Background. Post-traumatic acute renal failure requiring renal replacement therapy in an intensive care unit (ICU) is associated with high mortality. Objective. To assess indicators of improved survival. Methods. This was a retrospective cohort study of 64 consecutive trauma patients (penetrating and blunt trauma and burns) ...

The Biocarbon vascular access device (DiaTAB) for haemodialysis.

Science.gov (United States)

Smits, P J; Slooff, M J; Lichtendahl, D H; van der Hem, G K

1985-01-01

The Biocarbon vascular access device (DiaTAB) is a relatively new method in secondary access surgery. Punctures, often the cause of complications can be avoided because it is a no-needle method of dialysis. However thrombosis due to stenosis of the venous anastomosis or of the efferent vein is a continuing problem. A new experience is the fibrin flap formation under the plug of the device, which can be removed easily.

Catheter Related Escherichia hermannii Sepsis in a Haemodialysis Patient

DEFF Research Database (Denmark)

Utke Rank, Cecilie; Kristensen, Peter Lommer; Hansen, Dennis Schrøder

2016-01-01

Escherichia hermannii is an extremely rare etiological agent of invasive infection, and thus, the bacterium was initially considered non-pathogenic. However, in five previously reported case reports E. hermannii has been implicated as the sole pathogen. Our case report describes blood stream infe...

A Rare Presentation of the Klinefelter’s Syndrome

OpenAIRE

Hezarkhani, Sharabeh; Moujerloo, Mohammad; Sedighi, Sima; Taheri, Negar Sadat

2012-01-01

A 16 years old boy with Chronic Renal Failure (CRF) was not suspected of having Klinefelter’s syndrome until he complained of painful gynecomastia. He was under haemodialysis for 2 years. At first, he was in an approximately full pubertal development (P5, G5), but he had a small and a firm testis (length 2.2cm) and some degree of facial male pattern hair. He also had a decreased upper to lower body segment ratio and despite having chronic renal failure, he was taller than his parents and sibl...

Myoglobinuria following the use of succinylcholine.

Directory of Open Access Journals (Sweden)

Bhave C

1993-07-01

Full Text Available Eight hours following tympanoplasty performed under general anaesthesia (sodium pentothal and trichloroethylene, a 30 year old male complained of muscular weakness and dark coloured urine. Urinalysis revealed myoglobin pigment. A rise in BUN (47mg%, serum creatinine (5.7mg%, creatinine phosphokinase (15,500 U/L and CPK-MB fraction (4690 U/L was noticed 36 hrs later. The patient developed acute renal failure, and recovered after haemodialysis. From a history of use of succinylcholine as a muscle relaxant during operation, myoglobinuria appears to be secondary to muscle damage caused by succinylcholine.

Hereditary onchyo-osteo-arthrodysplasia (nail-patella syndrome) with progressive renal failure

International Nuclear Information System (INIS)

Stellamor, K.; Anzboeck, W.

1989-01-01

A case of a fully developed hereditary onycho-osteo-arthrodysplasia (nail-patella syndrome) is presented. The typical signs, such as the iliac horns or variations of the knees, cubitals and nails should be familiar to every radiologist. The associated nephropathy seems to be caused by typical changes in the glomerular basement membrane seen in electron microscopy. Asymptomatic proteinuria is found in about 60% of the cases, in 5,5-8% the disease leads to the necessity of haemodialysis because of renal insufficiency. Hence, early diagnosis is very important. (orig.) [de

Incremental value of a combination of cardiac troponin T, N-terminal pro-brain natriuretic peptide and C-reactive protein for prediction of mortality in end-stage renal disease

DEFF Research Database (Denmark)

Hallén, Jonas; Madsen, Lene Helleskov; Ladefoged, Søren

2011-01-01

Abstract Objective. To determine the relative prognostic merits of C-reactive protein (CRP), cardiac troponin T (cTnT) and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) for prediction of all-cause death in patients with end-stage renal disease (ESRD) receiving haemodialysis. Material...... and methods. This prospective, controlled cohort study included 109 patients. Biomarkers were sampled at inclusion and considered as categorical and continuous variables in Cox proportional hazard models. Results. Mean follow-up ± SD was 926 ± 385 days, during which 52 patients (48%) died. All three markers...

Acute hydrothorax from peritoneal dialysis successfully treated with new dialysis regime

International Nuclear Information System (INIS)

Lim, C.T.S.; Thong, K.M.

2015-01-01

Hydrothorax is a rare and often unrecognized complication associated with peritoneal dialysis (PD). This is usually due to the presence of pleuroperitoneal fistula. Most nephrologist will choose to cease the peritoneal dialysis and rest the peritoneum. More than often surgical interventions include pleurodesis or thoracotomy will be required. In this report, we reported a patient who developed pleural effusion after starting continuous ambulatory peritoneal dialysis. She was successfully managed by the use of low volume exchange during daytime with avoidance of conversion to haemodialysis or any surgical intervention. (author)

Function- and localisation diagnosis on hyperparathyroidism by radioimmunological parathormone determination and by nuclear scintigraphy

International Nuclear Information System (INIS)

Hrubesch, M.; Wagner, H.; Vosberg, H.; Loew, H.; Hauss, W.H.

1974-01-01

A function and localization diagnosis of hyperparathyroidism can be made using the RIA and core memory scintigraphy. The combination of these two methods is an important improvement of the diagnostic possibilities in hyperthyroidism. The functional state at the time of investigation can be checked by serum PTH determination. Scintigraphy is important in localization diagnostics in first and third stage hyperparathyroidism but is limited to the cervical region. Second stage hyperparathyroidism as a regulative disturbance - indicated by the drop of the PTH level during haemodialysis - requires conservative therapy. (GSE/AK) [de

Metals and Nicotine Level in Preparations of Rubisco Purified from Cuban Tobacco Varieties, for Chronic Renal Insufficiency Patients

International Nuclear Information System (INIS)

Geada, D.; Ares, D.; Del Castillo, N.; Valdes, R.; Gonzalez, M.; Rodriguez, D.; Ferro, W.; Gomez, L.; Padilla, S.; Roman, M. R.; Hidalgo, A.; Zamora, A.

2003-01-01

Full Text: Foods are the major source of metals accumulation in the humans. Plants contain large quantities of Rubisco to attain reasonable rates of photosynthesis, and thus, is the most abundant protein on Earth. Rubisco could be used as additive in nutrition for people with renal insufficiency, comatose state and severely restrict Na and K because the absence of these metals can greatly reduce the frequency of haemodialysis. Our purpose was to measure the metal levels and estimate the potential intake of copper, iron, zinc and manganese in patients under haemodialysis treatment and coma. Additionally we also studied sodium, potassium, calcium and magnesium quantities. Intakes of these metals were estimated, attending to the quantity of protein by person, from their daily diets and compared with the Provisional Tolerable Weekly Intakes (PTWI) as established by the FAO/WHO and the US Recommended Daily Allowances (RDA) or the US Safe and Adequate Daily Dietary Intakes (ESADDI). All the determinations of these metals were done using atomic absorption spectrometry and none of them exceeds PTWI, RDA and ESADDI values; nevertheless they were higher than the values previously obtained. The highest metal value, respect the daily allowances, was obtained for iron. Lowest values were reported for sodium, potassium and copper which support the protein use as a nutritional supplement. On the other hand, nicotine is a very harmful alkaloid in tobacco plants and the LD 50 oral is 40mg in humans. The nicotine contents were analyzed by gas chromatography and it does not exceed the 7ug/ml

Seroprevalence of Human herpesvirus 8 (HHV-8 and incidence of Kaposi's sarcoma in Iran

Directory of Open Access Journals (Sweden)

Nategh Rakhshandeh

2011-04-01

Full Text Available Abstract Seroepidemiological surveys show that the prevalence of human herpesvirus 8 (HHV-8 infection mostly varies in various geographical areas and reflects the local incidence of classic and endemic KS, being widespread in sub-Saharan Africa and Mediterranean countries and uncommon in the USA and Northern Europe. In the Middle East only few populations, such as Ashkenazi and Sephardic groups in Israel, have been adequately evaluated for HHV-8 seroprevalence. Among Iranian population a striking higher seroprevalence of HHV8 has been reported among haemodialysis (16.9%, renal transplant recipients (25% and HIV (45.7% patients compared to blood donors (2%. Kaposi's sarcoma (KS is the rarest cancer in Iran, with an annual age-standardized incidence varying from 0.10 to 0.17 per 100,000 in males and from 0.06 to 0.08 per 100,000 in females. KS, however, is one of the most important malignancies in Iranian renal transplanted patients affecting up to 2.4% of organ recipients. The epidemiology of HHV8 and KS in Iran needs further evaluation. While the high prevalence of HHV-8 antibodies in HIV positive and haemodialysis individuals may be attributed to high-risk sexual behavior and polytransfusions, respectively, unknown determinants may be responsible for high seroprevalence of HHV8 and high incidence of KS in solid organ recipients. A global survey on HHV8 seroprevalence in Iran is mandatory to define co-factors associated with HHV8 infection and KS risk in the general Iranian population and in specific patient groups.

Renal replacement therapy for autosomal dominant polycystic kidney disease (ADPKD) in Europe

DEFF Research Database (Denmark)

Spithoven, Edwin M; Kramer, Anneke; Meijer, Esther

2014-01-01

on RRT prevalence and survival on RRT in 12 European countries with 208 million inhabitants. We studied four 5-year periods (1991-2010). Survival analysis was performed by the Kaplan-Meier method and by Cox proportional hazards regression. RESULTS: From the first to the last study period, the prevalence...... for non-ADPKD subjects. Improved survival was noted for all RRT modalities: haemodialysis [adjusted hazard ratio for mortality during the last versus first time period 0.75 (95% confidence interval 0.61-0.91), peritoneal dialysis 0.55 (0.38-0.80) and transplantation 0.52 (0.32-0.74)]. Cardiovascular...

Staphylococcus aureus carriage and infections among patients in four haemo- and peritoneal-dialysis centres in Denmark. The Danish Study Group of Peritonitis in Dialysis (DASPID)

DEFF Research Database (Denmark)

Zimakoff, J; Bangsgaard Pedersen, F; Bergen, L

1996-01-01

A three-month prospective surveillance study was undertaken in four dialysis centres to establish the prevalence of Staphylococcus aureus carriage in a Danish population of patients on haemodialysis (HD) or on continuous ambulatory peritoneal dialysis (CAPD). General data such as sex, age.......4 and 4.7%). Approximately one third (36.6 and 40.7%) of infections were caused by S. aureus. Although diabetics were not significantly more frequent carriers (60.5%) than non-diabetics (55.0%), the incidence of infection was much higher (26.3% vs. 10.3%, P = 0.004). In CAPD, peritonitis and tunnel...

Various musculoskeletal manifestations of chronic renal insufficiency

International Nuclear Information System (INIS)

Lim, C.Y.; Ong, K.O.

2013-01-01

Musculoskeletal manifestations in chronic renal insufficiency are caused by complex bone metabolism alterations, now described under the umbrella term of chronic kidney disease mineral- and bone-related disorder (CKD-MBD), as well as iatrogenic processes related to renal replacement treatment. Radiological imaging remains the mainstay of disease assessment. This review aims to illustrate the radiological features of CKD-MBD, such as secondary hyperparathyroidism, osteomalacia, adynamic bone disease, soft-tissue calcifications; as well as features associated with renal replacement therapy, such as aluminium toxicity, secondary amyloidosis, destructive spondyloarthropathy, haemodialysis-related erosive arthropathy, tendon rupture, osteonecrosis, and infection

Baking soda induced severe metabolic alkalosis in a haemodialysis patient.

Science.gov (United States)

Solak, Yalcin; Turkmen, Kultigin; Atalay, Huseyin; Turk, Suleyman

2009-08-01

Metabolic alkalosis is a rare occurence in hemodialysis population compared to metabolic acidosis unless some precipitating factors such as nasogastric suction, vomiting and alkali ingestion or infusion are present. When metabolic alkalosis develops, it may cause serious clinical consequences among them are sleep apnea, resistent hypertension, dysrhythmia and seizures. Here, we present a 54-year-old female hemodialysis patient who developed a severe metabolic alkalosis due to baking soda ingestion to relieve dyspepsia. She had sleep apnea, volume overload and uncontrolled hypertension due to metabolic alkalosis. Metabolic alkalosis was corrected and the patient's clinical condition was relieved with negative-bicarbonate hemodialysis.

Development and validation of the Consumer Quality index instrument to measure the experience and priority of chronic dialysis patients.

Science.gov (United States)

van der Veer, Sabine N; Jager, Kitty J; Visserman, Ella; Beekman, Robert J; Boeschoten, Els W; de Keizer, Nicolette F; Heuveling, Lara; Stronks, Karien; Arah, Onyebuchi A

2012-08-01

Patient experience is an established indicator of quality of care. Validated tools that measure both experiences and priorities are lacking for chronic dialysis care, hampering identification of negative experiences that patients actually rate important. We developed two Consumer Quality (CQ) index questionnaires, one for in-centre haemodialysis (CHD) and the other for peritoneal dialysis and home haemodialysis (PHHD) care. The instruments were validated using exploratory factor analyses, reliability analysis of identified scales and assessing the association between reliable scales and global ratings. We investigated opportunities for improvement by combining suboptimal experience with patient priority. Sixteen dialysis centres participated in our study. The pilot CQ index for CHD care consisted of 71 questions. Based on data of 592 respondents, we identified 42 core experience items in 10 scales with Cronbach's α ranging from 0.38 to 0.88; five were reliable (α ≥ 0.70). The instrument identified information on centres' fire procedures as the aspect of care exhibiting the biggest opportunity for improvement. The pilot CQ index PHHD comprised 56 questions. The response of 248 patients yielded 31 core experience items in nine scales with Cronbach's α ranging between 0.53 and 0.85; six were reliable. Information on kidney transplantation during pre-dialysis showed most room for improvement. However, for both types of care, opportunities for improvement were mostly limited. The CQ index reliably and validly captures dialysis patient experience. Overall, most care aspects showed limited room for improvement, mainly because patients participating in our study rated their experience to be optimal. To evaluate items with high priority, but with which relatively few patients have experience, more qualitative instruments should be considered.

Types of vicarious learning experienced by pre-dialysis patients

Directory of Open Access Journals (Sweden)

Kate McCarthy

2015-04-01

Full Text Available Objective: Haemodialysis and peritoneal dialysis renal replacement treatment options are in clinical equipoise, although the cost of haemodialysis to the National Health Service is £16,411/patient/year greater than peritoneal dialysis. Treatment decision-making takes place during the pre-dialysis year when estimated glomerular filtration rate drops to between 15 and 30 mL/min/1.73 m2. Renal disease can be familial, and the majority of patients have considerable health service experience when they approach these treatment decisions. Factors affecting patient treatment decisions are currently unknown. The objective of this article is to explore data from a wider study in specific relation to the types of vicarious learning experiences reported by pre-dialysis patients. Methods: A qualitative study utilised unstructured interviews and grounded theory analysis during the participant’s pre-dialysis year. The interview cohort comprised 20 pre-dialysis participants between 24 and 80 years of age. Grounded theory design entailed thematic sampling and analysis, scrutinised by secondary coding and checked with participants. Participants were recruited from routine renal clinics at two local hospitals when their estimated glomerular filtration rate was between 15 and 30 mL/min/1.73 m2. Results: Vicarious learning that contributed to treatment decision-making fell into three main categories: planned vicarious leaning, unplanned vicarious learning and historical vicarious experiences. Conclusion: Exploration and acknowledgement of service users’ prior vicarious learning, by healthcare professionals, is important in understanding its potential influences on individuals’ treatment decision-making. This will enable healthcare professionals to challenge heuristic decisions based on limited information and to encourage analytic thought processes.

Types of vicarious learning experienced by pre-dialysis patients.

Science.gov (United States)

McCarthy, Kate; Sturt, Jackie; Adams, Ann

2015-01-01

Haemodialysis and peritoneal dialysis renal replacement treatment options are in clinical equipoise, although the cost of haemodialysis to the National Health Service is £16,411/patient/year greater than peritoneal dialysis. Treatment decision-making takes place during the pre-dialysis year when estimated glomerular filtration rate drops to between 15 and 30 mL/min/1.73 m(2). Renal disease can be familial, and the majority of patients have considerable health service experience when they approach these treatment decisions. Factors affecting patient treatment decisions are currently unknown. The objective of this article is to explore data from a wider study in specific relation to the types of vicarious learning experiences reported by pre-dialysis patients. A qualitative study utilised unstructured interviews and grounded theory analysis during the participant's pre-dialysis year. The interview cohort comprised 20 pre-dialysis participants between 24 and 80 years of age. Grounded theory design entailed thematic sampling and analysis, scrutinised by secondary coding and checked with participants. Participants were recruited from routine renal clinics at two local hospitals when their estimated glomerular filtration rate was between 15 and 30 mL/min/1.73 m(2). Vicarious learning that contributed to treatment decision-making fell into three main categories: planned vicarious leaning, unplanned vicarious learning and historical vicarious experiences. Exploration and acknowledgement of service users' prior vicarious learning, by healthcare professionals, is important in understanding its potential influences on individuals' treatment decision-making. This will enable healthcare professionals to challenge heuristic decisions based on limited information and to encourage analytic thought processes.

Calciphylaxis: Beyond CKD-MBD.

Science.gov (United States)

Fernández, María; Morales, Enrique; Gutierrez, Eduardo; Polanco, Natalia; Hernández, Eduardo; Mérida, Eva; Praga, Manuel

Calcific uraemic arteriolopathy (CUA), also called calciphylaxis, is a rare but potentially fatal vascular disorder that almost exclusively affects patients with chronic renal failure. The objective of this study was to analyse various risk factors for developing CUA and its subsequent clinical course according to the treatment received. A retrospective study that included patients diagnosed with CUA from December 1999 to December 2015. Various risk factors, clinical course and treatment options were analysed. A total of 28 patients (53.6% females) with a mean age of 67.2±11.8 (38-88) years were included. At the time of diagnosis, 53.6% were on haemodialysis, 25% were kidney transplant patients and 21.4% had normal renal function. The use of steroids (100%, P=.001) was the main risk factor in renal transplant patients. Skin lesions resolved in 60.7% (especially in those receiving multitargeted therapy). Patient survival at 12 months was 29% in transplant patients, 57% in haemodialysis patients and 100% in normal renal function patients (log-rank 6.88, P=.032). Chronic renal failure (P=.03) and hypoalbuminaemia (P=.02) were the main risk factor for CUA mortality. Although the incidence of CUA remains low, CUA mortality is very high, Special attention to its occurrence in kidney transplant patients and «non-renal» CUA forms is required. Oral anticoagulants and steroids appear to be the main risk factors, CUA is a challenge; a registry of patients and determining standard therapy are required. Copyright © 2017 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

Dyslipidaemia among renal transplant recipients: cyclosporine versus tacrolimus.

Science.gov (United States)

Fazal, Muhammad Asim; Idrees, Muhammad Khalid; Akhtar, Syed Fazal

2014-05-01

To compare new onset dyslipidaemia in live-related renal transplant recipients taking cyclosporine versus tacrolimus after 3 months of therapy. The randomised controlled trial was conducted at the Sindh Institute of Urology and Transplantation (SIUT) Karachi, from September 2010 to April 2011, and included 182 End Stage Renal Disease patients on maintenance haemodialysis with pre-transplant normal lipid profile. The patients, who had live-related renal transplant, were randomly allocated to two equal groups using lottery. Group A received cyclosporine (3 mg/kg) and group B was treated with tacrolimus (0.1 mg/kg). All patients had pre-transplant fasting lipid profile checked when they were on maintenance haemodialysis and 3 months after renal transplantation. Serum fasting lipid profile was collected by taking 5 ml blood by venipuncture after an overnight fast of 9-12 hours. SPSS 10 was used for statistical analyses. Of the 182 patients, 144 (79.1%) were males and 38 (20.9%) were females. The overall mean age was 30.18 +/- 9.57 years, and the mean weight was 54.41 +/- 11.144 kg. Significant difference was not observed between the two groups regarding age and weight of the patients. Dyslipidaemia was found in 115(63.2%) subjects; 61(67%) in group A and 54 (59.3%) in group B. There was no statistical difference (p=0.28) when comparison was done after 3 months of therapy. The occurrence of new onset hyperlipidaemia is similar in renal transplant recipients receiving either cyclosporine or tacrolimus in first 3 months post-transplant, but there is room for more research in this field as dyslipidaemia following successful renal transplantation is a frequent and persistent complication.

Hepatitis C Virus Epidemiology in Djibouti, Somalia, Sudan, and Yemen: Systematic Review and Meta-Analysis.

Science.gov (United States)

Chaabna, Karima; Kouyoumjian, Silva P; Abu-Raddad, Laith J

2016-01-01

To characterize hepatitis C virus (HCV) epidemiology and assess country-specific population-level HCV prevalence in four countries in the Middle East and North Africa (MENA) region: Djibouti, Somalia, Sudan, and Yemen. Reports of HCV prevalence were systematically reviewed as per PRISMA guidelines. Pooled HCV prevalence estimates in different risk populations were conducted when the number of measures per risk category was at least five. We identified 101 prevalence estimates. Pooled HCV antibody prevalence in the general population in Somalia, Sudan and Yemen was 0.9% (95% confidence interval [95%CI]: 0.3%-1.9%), 1.0% (95%CI: 0.3%-1.9%) and 1.9% (95%CI: 1.4%-2.6%), respectively. The only general population study from Djibouti reported a prevalence of 0.3% (CI: 0.2%-0.4%) in blood donors. In high-risk populations (e.g., haemodialysis and haemophilia patients), pooled HCV prevalence was 17.3% (95%CI: 8.6%-28.2%) in Sudan. In Yemen, three studies of haemodialysis patients reported HCV prevalence between 40.0%-62.7%. In intermediate-risk populations (e.g.. healthcare workers, in patients and men who have sex with men), pooled HCV prevalence was 1.7% (95%CI: 0.0%-4.9%) in Somalia and 0.6% (95%CI: 0.4%-0.8%) in Sudan. National HCV prevalence in Yemen appears to be higher than in Djibouti, Somalia, and Sudan as well as most other MENA countries; but otherwise prevalence levels in this subregion are comparable to global levels. The high HCV prevalence in patients who have undergone clinical care appears to reflect ongoing transmission in clinical settings. HCV prevalence in people who inject drugs remains unknown.

The value of scintimetry compared with histomorphology, parathormone assay, densitometry and radiology in renal osteopathy

International Nuclear Information System (INIS)

Lingg, G.; Nebel, G.; Dorr, S.; Allgemeines Krankenhaus Barmbek, Hamburg

1982-01-01

The value of scintimetry compared with histomorphology, parathormone assay, densitometry and radiology in renal osteopathy. The distribution of sup(99m)Tc-Sn-MDP in the thigh was estimated according to two different indices 60 normal patients, 21 patients undergoing haemodialysis and one who had had a renal transplant. Deviation of the indices in these patients from the normal are significant. The indices were correlated with respect to their accuracy in detecting renal osteopathy with histomorphometry (as the reference method), radiological diagnosis, densitometry, parathormone assay and other laboratory tests. Accuracy of the method is high and, like histomorphometry, is over 9O%. (orig.) [de

Value of scintimetry compared with histomorphology, parathormone assay, densitometry and radiology in renal osteopathy

Energy Technology Data Exchange (ETDEWEB)

Lingg, G.; Nebel, G.; Dorr, S.

1982-01-01

The value of scintimetry is compared with histomorphology, parathormone assay, densitometry and radiology in renal osteopathy. The distribution of sup(99m)Tc-Sn-MDP in the thigh was estimated according to two different indices in 60 normal patients, 21 patients undergoing haemodialysis and one who had had a renal transplant. Deviation of the indices in these patients from the normal are significant. The indices were correlated with respect to their accuracy in detecting renal osteopathy with histomorphometry (as the reference method), radiological diagnosis, densitometry, parathormone assay and other laboratory tests. Accuracy of the method is high and, like histomorphometry, is over 9O%.

Potential role of coenzyme Q10 in facilitating recovery from statin-induced rhabdomyolysis.

Science.gov (United States)

Wang, L W; Jabbour, A; Hayward, C S; Furlong, T J; Girgis, L; Macdonald, P S; Keogh, A M

2015-04-01

Rhabdomyolysis is a rare, but serious complication of statin therapy, and represents the most severe end of the spectrum of statin-induced myotoxicity. We report a case where coenzyme Q10 facilitated recovery from statin-induced rhabdomyolysis and acute renal failure, which had initially persisted despite statin cessation and haemodialysis. This observation is biologically plausible due to the recognised importance of coenzyme Q10 in mitochondrial bioenergetics within myocytes, and the fact that statins inhibit farnesyl pyrophosphate production, a biochemical step crucial for coenzyme Q10 synthesis. Coenzyme Q10 is generally well tolerated, and may potentially benefit patients with statin-induced rhabdomyolysis. © 2015 Royal Australasian College of Physicians.

Grado de adherencia terapéutica a los fármacos del metabolismo óseo-mineral: ¿toman nuestros pacientes la medicación prescrita? Degree of therapeutic adherence to bone mineral metabolism drugs: Do our patients take the prescribed medication?

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María Nieves Cazorla Santana

2013-03-01

Full Text Available Los fármacos del metabolismo óseo-mineral tienen gran importancia el tratamiento de los pacientes de hemodiálisis, pero desconocemos las preferencias, y el grado de conocimiento de estos fármacos. Los objetivos del estudio fueron conocer el grado de adherencia terapéutica a los fármacos del metabolismo oseo-mineral, e identificar los factores más relevantes que influyen en la adherencia a este tipo de tratamiento. Pacientes y métodos: Se realizó un estudio transversal en un Centro de hemodiálisis, incluyendo 106 pacientes. Utilizamos el cuestionario simplificado de adherencia a la medicación (SMAQ¹ y un cuestionario específico sobre cumplimiento y preferencias, para conocer el grado de adherencia. Resultados: El 37,7% de los pacientes fue incumplidor según el cuestionario SMAQ. De ellos, el 34% no tomaba la medicación a la misma hora (PBone mineral metabolism drugs are of great importance in treating haemodialysis patients, but we are unaware of their preferences and degree of knowledge of these drugs. The aims of the study were to find out the degree of therapeutic adherence to bone mineral metabolism drugs and to identify the most relevant factors that influence adherence to this type of treatment. Patients and methods: A transversal study was carried out at a haemodialysis centre, including 106 patients. We used the simplified medication adherence questionnaire (SMAQ¹ and a specific questionnaire on compliance and preferences, in order to find out the degree of adherence. Results: 37.7% of the patients were non-compliant, according to the SMAQ. Of these, 34% did not take the medication at the same time (P<0.000, 5.7% did not comply with the treatment at weekends (P<0.010, 13.2% stop taking the medication when they feel unwell (P<0.010; and in the last week, 18% acknowledged that they forgot the treatment 1 day (P= 0.001 and between 2-3 days (12,5%. 52% did not have preferences for any phosphorus chelant and 60.4% knew about

¿Existe el síndrome de burnout en los profesionales de la salud de las unidades de hemodiálisis de la región de Murcia? Does burnout syndrome exist in healthcare professionals in the haemodialysis units in the Murcia region?

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Isabel Fernández Guzmán

2012-03-01

Full Text Available El contacto directo y continuo con pacientes renales en tratamiento sustitutivo con hemodiálisis así como con situaciones dónde el dolor, sufrimiento y desesperanza están presentes puede convertirse en una fuente de estrés y conducir al desarrollo de lo que se ha denominado "síndrome de estar quemado" o Burnout. El objetivo principal de este estudio fue medir el nivel de Burnout, la ansiedad y depresión en los profesionales de todas las unidades de diálisis de la Región de Murcia, así como su relación con la edad, tipo de unidad en la que se trabaja (pública o privada concertada y tiempo en la profesión. Resulta necesaria la prevención y detección de este síndrome por las consecuencias que puede llegar a tener en el profesional. El estudio realizado es de tipo descriptivo, transversal y multicéntrico. Los instrumentos utilizados fueron el Cuestionario para la Evaluación del Síndrome de Quemarse por el Trabajo de Gil-Monte, el Inventario de Ansiedad Rasgo-Estado de Spielberger y el Inventario de Depresión de Beck. El análisis de los resultados obtenidos pone de manifiesto que el nivel global de burnout entre los profesionales de la nefrología de la Región de Murcia se sitúa en un nivel medio-bajo (Mdn=1.13, encontrándose diferencias marginalmente significativas (p=.082 entre aquellos que trabajan en unidades públicas y los que desarrollan su profesión en clínicas concertadas, que presentaron un promedio ligeramente superior. Asimismo se constatan diferencias significativas (pDirect, continuous contact with renal patients undergoing replacement therapy involving haemodialysis and with situations where pain, suffering and despair are present can become a source of stress and lead to the development of what has been called "burnout syndrome". The main object of this study was to measure the level of burnout, anxiety and depression in the professionals in all the dialysis units in the Murcia Region, and the relationship

Echocardiographic findings in haemodialysis patients according to their state of hydration

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María Cristina Di Gioia

2017-01-01

Conclusions: We found that left atrial volume index determined by echocardiographic Area-length method, but not left ventricle hypertrophy or dimensions of cavities, are related on hydration status based on bioimpedance measured time-averaged fluid overload (TAFO, and not with FO/ECW.

Echocardiographic findings in haemodialysis patients according to their state of hydration.

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Cristina Di Gioia, María; Gascuena, Raul; Gallar, Paloma; Cobo, Gabriela; Camacho, Rosa; Acosta, Nuria; Baranyi, Zsofia; Rodriguez, Isabel; Oliet, Aniana; Ortega, Olimpia; Fernandez, Inmaculada; Mon, Carmen; Ortiz, Milagros; Manzano, Mari C; Herrero, Juan C; Martinez, José I; Palma, Joaquín; Vigil, Ana

Chronic fluid overload is frequent in hemodialysis patients (P) and it associates with hypertension, left ventricular hypertrophy (LVH) and higher mortality. Moreover, echocardiographic data assessing fluid overload is limited. Our aim was to evaluate the relationship between fluid overload measured by bioimpedance spectroscopy (BIS) and different echocardiographic parameters. Cross-sectional observational study including 76 stable patients. Dry weight was clinically assessed. BIS and echocardiography were performed. Weekly time-averaged fluid overload (TAFO) and relative fluid overload (FO/ECW) were calculated using BIS measurements. Based on TAFO three groups were defined: A- dehydrated, TAFO 1.5 l: 18 (24%). We found significant correlation between TAFO and left atrial volume index (LAVI) (r: 0.29; p=0.013) but not with FO/ECW (r 0.06; p=0.61). TAFO, but not FO/ECW kept a significant relationship with LAVI (p=0.03) using One-Way ANOVA test and linear regression methods. LVH was present in 73.7% (concentric 63.2%, eccentric in 10.5%). No differences between groups in the presence of LVH or left ventricular mass index were found. We found that left atrial volume index determined by echocardiographic Area-length method, but not left ventricle hypertrophy or dimensions of cavities, are related on hydration status based on bioimpedance measured time-averaged fluid overload (TAFO), and not with FO/ECW. Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

DEVELOPING LIFE SKILLS IN HAEMODIALYSIS USING THE GUIDED SELF-DETERMINATION METHOD

DEFF Research Database (Denmark)

Finderup, Jeanette; Bjerre, Tina; Soendergaard, Aase

2016-01-01

to develop and test a full-scale GSD for this patient group (GSD-HD). Objectives: To study how a full-scale GSD-HD influenced the quality of relatedness between the patient and the GSD-HD nurse and the patients' ability to live well with end stage renal disease (ESRD). Methods: GSD-HD was developed through...... participatory research and evaluated qualitatively at five dialysis units in Denmark involving 31 patients and 16 nurses. The intervention lasted four months and comprised six sessions. Data consisting of semi-structured interviews with 13 patients were analysed using a mix of inductive and deductive thematic...... and their self-management of ESRD: Deeper and more meaningful relationships, self-exploration of self-selected challenges, self-understanding as a condition for meaningful knowledge, ability to act in a self-determined way, feedback from action that accords with daily life skills and decision-making from...

Orofacial Disorders of Patients with End Stage Renal Disease Undergoing Haemodialysis

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Yohana Gowara

2015-05-01

Full Text Available Several orofacial disorders in patients with end stage renal disease (ESRD undergoing hemodialysis have been reported. However, up to the present, particularly in Indonesia, such data still limited. Objective: the purpose of this study was to assess the orofacial disorders in patients with ESDR undergoing hemodialysis at Cipto Mangunkusumo Hospital, Indonesia. Methods: The study was conducted through observation using a cross-sectional design. The subjects were selected by consecutive sampling. Ninety-three patients fulfilled the inclusion criteria and enrolled in this study. They participated in the structural interview-using questionnaire assessing subjective complaints; clinical examinations; and salivary measurements. Results: Xerostomia (82.8% dysgeusia (66.7%, metal taste (57%, perioral anesthesia (24.7% were the common symptoms. Clinical findings consisted of tongue coating (100%, calculus deposits (97.8%, pallor of oral mucous (94.6%, sialosis (75.3%, uremic odor (40,9%, haemorrhagic spot (39.8%, angular cheilitis (37.7%, gingival bleeding (15.1%, and oral candidiasis (3.2% were also found. Salivary changes showed the increase of salivary viscosity (86%, pH (80.6%, buffer capacity (76.3% whereas decrease of mucous hydration level (79.6% and the flow rates of unstimulated (22.6% and stimulated (31.2% whole saliva were observed. Conclusion: The findings of orofacial disorders required attention and further comprehensive management to enhance the quality of life of patients with ESDR.DOI: 10.14693/jdi.v21i3.262

Total Artificial Heart and Chronic Haemodialysis: A Possible Bridge to Transplantation?

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Demiselle, Julien; Besson, Virginie; Sayegh, Johnny; Subra, Jean-François; Augusto, Jean-François

2016-01-01

Total artificial heart (TAH) device is sometimes necessary to treat end stage heart failure (HF). After surgery, renal impairment can occur with the need of renal replacement therapy. We report the case of a 51-year-old man who was treated with conventional hemodialysis (HD) while on support with TAH. The patient underwent HD while on TAH support during 14 months. He benefited from conventional HD, 6 sessions per week. HD sessions were well tolerated, and patient's condition and quality of life improved significantly. The main difficulty was to maintain red blood cell level because of chronic hemolysis due to TAH, which required repetitive blood transfusions, resulting in a high rate of human leukocyte antigen sensitization. Unfortunately, the patient died of mesenteric ischemia due to anticoagulation under dosing. We conclude that HD treatment is possible despite TAH and should be considered in patients with both end stage renal and HF. © 2016 S. Karger AG, Basel.

Depression in Hemodialysis Patients

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Badema Čengić

2010-04-01

Full Text Available Depression is the most frequent psychological complication of haemodialysis (HD patients (pts and has been associated with impaired Quality of Life (QoL. The aim of our study was to investigate the prevalence of depression in HD pts in relation to sociodemographic factors and the relationship between depression and QoL.200 pts from Clinic for haemodialysis in Sarajevo, B&H were participating in the study. Mean age was S7,26±13,78 years and mean HD duration was 64’26±58,18 months. From the test material we applied BDI and SF-36.51% of our pts have shown depression (BDI>11 in various degrees (30%-mild depression, 8,5%-moderate depression and 12,5%-severe depression. As we could expect, the most emphasized symptoms of depression were somatic symptoms. 55,5% of pts have shown QoL lower then average. Sociodemographic data such as gender, marital status and HD duration did not influence significantly on pt’s QoL and occurrence of depression (p>0,05. As the age of the pts increased, level of depression increased too and QoL significantly decreased (p<0,05. Employed pts have shown significantly better QoL and lower level of depression in relation to unemployed pts (p<0,05. As the educational level of pts increased, QoL increased too and level of depression significantly decreased (p<0,05. Pts in 1st HD shift were significantly more depressed and have significantly worse mental health in compare to pts in 3rd HD shift (p<0,05. Our results showed a high prevalence of depressive symptoms among the study group that was linked to trend of poor QoL.

Renal telemedicine through video-as-a-service delivered to patients on home dialysis: A qualitative study on the renal care team members' experience.

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Ditchburn, Jae-Llane; Marshall, Alison

2017-09-01

The Lancashire Teaching Hospitals NHS Trust in the UK has been providing renal care through video-as-a-service (VAAS) to patients since 2013, with support from the North West NHS Shared Infrastructure Service, a collaborative team that supports information and communication technology use in the UK National Health Service. Renal telemedicine offered remotely to patients on home dialysis supports renal care through the provision of a live high-quality video link directly to unsupported patients undergoing haemodialysis at home. Home haemodialysis is known to provide benefits to patients, particularly in making them more independent. The use of a telemedicine video-link in Lancashire and South Cumbria, UK, further reduces patient dependence on the professional team. The purpose of this paper is to present the perspectives of the renal care team members using the renal telemedicine service to understand the perceived benefits and issues with the service. Ten semi-structured interviews with members of the renal care team (two renal specialists, one matron, two renal nurses, one business manager, one renal technical services manager, two IT technicians and one hardware maintenance technician) were conducted. Thematic analysis was undertaken to analyse the qualitative data. A range of incremental benefits to the renal team members were reported, including more efficient use of staff time, reduced travel, peace of mind and a strong sense of job satisfaction. Healthcare staff believed that remote renal care through video was useful, encouraged concordance and could nurture confidence in patients. Key technological issues and adjustments which would improve the renal telemedicine service were also identified. The impact of renal telemedicine was positive on the renal team members. The use of telemedicine has been demonstrated to make home dialysis delivery more efficient and safe. The learning from staff feedback could inform development of services elsewhere. © 2017

EARLY APPLICATION OF HIGH CUT-OFF HAEMODYALISIS FOR DE-NOVO MYELOMA NEPHROPATHY IS ASSOCIATED WITH LONG-TERM DIALYSIS-INDEPENDENCY AND RENAL RECOVERY

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Alhossain A. Khalafallah

2013-01-01

Full Text Available Background Multiple myeloma (MM is a haematological malignancy associated with kidney injury resulting from cast nephropathy, which can be caused by monoclonal free light chains (FLC. It has been demonstrated that reduction of FLC can lead to a higher proportion of patients recovering renal function with a better outcome, especially if extended high cut-off haemodialysis (HCO-HD combined with chemotherapy is used. Patients and Methods In this study, four cases of MM nephropathy were treated with HCO-HD and chemotherapy at a single institution during the period from August 2009 to August 2011. All of the patients presented with acute renal failure and high serum FLC. All patients underwent a bone marrow biopsy to confirm the diagnosis of MM, according to the WHO criteria. Three patients had de-novo MM and one patient had relapsed light chain myeloma disease. All patients underwent HCO-HD concomitantly with specific myeloma therapy once the diagnosis or relapse of MM was established. Results After a median follow up of 26 months, (range, 13-36 our data showed that all patients had a significant decrease in serum FLC through HCO-HD, proving the effectiveness of HCO-HD in managing MM. De-novo MM patients restored their renal function and achieved low-level FLC early on the treatment and become dialysis-independent. One patient with relapsed myeloma remained dialysis dependant. Conclusion Our study suggests that if myeloma nephropathy associated with light-chain disease, HCO-HD should be initiated as early as possible. At the same time a specific MM treatment should be initiated to gain control of the disease and salvage the kidneys in order to achieve dialysis-independency. Further trials to confirm our results are warranted. Key Words: Multiple myeloma, renal failure, High cut-off haemodialysis, chemotherapy, outcome.

Hepatitis C Virus Epidemiology in Djibouti, Somalia, Sudan, and Yemen: Systematic Review and Meta-Analysis.

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Karima Chaabna

Full Text Available To characterize hepatitis C virus (HCV epidemiology and assess country-specific population-level HCV prevalence in four countries in the Middle East and North Africa (MENA region: Djibouti, Somalia, Sudan, and Yemen.Reports of HCV prevalence were systematically reviewed as per PRISMA guidelines. Pooled HCV prevalence estimates in different risk populations were conducted when the number of measures per risk category was at least five.We identified 101 prevalence estimates. Pooled HCV antibody prevalence in the general population in Somalia, Sudan and Yemen was 0.9% (95% confidence interval [95%CI]: 0.3%-1.9%, 1.0% (95%CI: 0.3%-1.9% and 1.9% (95%CI: 1.4%-2.6%, respectively. The only general population study from Djibouti reported a prevalence of 0.3% (CI: 0.2%-0.4% in blood donors. In high-risk populations (e.g., haemodialysis and haemophilia patients, pooled HCV prevalence was 17.3% (95%CI: 8.6%-28.2% in Sudan. In Yemen, three studies of haemodialysis patients reported HCV prevalence between 40.0%-62.7%. In intermediate-risk populations (e.g.. healthcare workers, in patients and men who have sex with men, pooled HCV prevalence was 1.7% (95%CI: 0.0%-4.9% in Somalia and 0.6% (95%CI: 0.4%-0.8% in Sudan.National HCV prevalence in Yemen appears to be higher than in Djibouti, Somalia, and Sudan as well as most other MENA countries; but otherwise prevalence levels in this subregion are comparable to global levels. The high HCV prevalence in patients who have undergone clinical care appears to reflect ongoing transmission in clinical settings. HCV prevalence in people who inject drugs remains unknown.

Dyslipidaemia among renal transplant recipients: cyclosporine versus tacrolimus

International Nuclear Information System (INIS)

Fazal, M. A.; Idrees, M. K.; Akhtar, S. F.

2014-01-01

Objectives: To compare new onset dyslipidaemia in live-related renal transplant recipients taking cyclosporine versus tacrolimus after 3 months of therapy. Methods: The randomised controlled trial was conducted at the Sindh Institute of Urology and Transplantation (SIUT) Karachi, from September 2010 to April 2011, and included 182 End Stage Renal Disease patients on maintenance haemodialysis with pre-transplant normal lipid profile. The patients, who had live-related renal transplant, were randomly allocated to two equal groups using lottery. Group A received cyclosporine (3mg/kg) and group B was treated with tacrolimus (0.1mg/kg). All patients had pre-transplant fasting lipid profile checked when they were on maintenance haemodialysis and 3 months after renal transplantation. Serum fasting lipid profile was collected by taking 5ml blood by venipuncture after an overnight fast of 9-12 hours. SPSS 10 was used for statistical analyses. Results: Of the 182 patients, 144(79.1%) were males and 38(20.9%) were females. The overall mean age was 30.18+-9.57 years, and the mean weight was 54.41+- 11.144kg. Significant difference was not observed between the two groups regarding age and weight of the patients. Dyslipidaemia was found in 115(63.2%) subjects; 61(67%) in group A and 54(59.3%) in group B. There was no statistical difference (p=0.28) when comparison was done after 3 months of therapy. Conclusions: The occurrence of new onset hyperlipidaemia is similar in renal transplant recipients receiving either cyclosporine or tacrolimus in first 3 months post-transplant, but there is room for more research in this field as dyslipidaemia following successful renal transplantation is a frequent and persistent complication. (author)

Significant air embolism: A possibility even with collapsible intravenous fluid containers when used with rapid infuser system

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Deepanjali Pant

2010-01-01

Full Text Available Significant venous air embolism may develop acutely during the perioperative period due to a number of causes such as during head and neck surgery, spinal surgery, improper central venous and haemodialysis catheter handling, etc. The current trend of using self collapsible intravenous (IV infusion bags instead of the conventional glass or plastic bottles has several advantages, one of thaem being protection against air embolism. We present a 56-year-old man undergoing kidney transplantation, who developed a near fatal venous air embolism during volume resuscitation with normal saline in collapsible IV bags used with rapid infuser system. To our knowledge, this problem with collapsible infusion bags has not been reported earlier.

Significant air embolism: A possibility even with collapsible intravenous fluid containers when used with rapid infuser system

Science.gov (United States)

Pant, Deepanjali; Narani, Krishan Kumar; Sood, Jayashree

2010-01-01

Significant venous air embolism may develop acutely during the perioperative period due to a number of causes such as during head and neck surgery, spinal surgery, improper central venous and haemodialysis catheter handling, etc. The current trend of using self collapsible intravenous (IV) infusion bags instead of the conventional glass or plastic bottles has several advantages, one of thaem being protection against air embolism. We present a 56-year-old man undergoing kidney transplantation, who developed a near fatal venous air embolism during volume resuscitation with normal saline in collapsible IV bags used with rapid infuser system. To our knowledge, this problem with collapsible infusion bags has not been reported earlier. PMID:20532073

Spontaneous tumour lysis syndrome in a case of multiple myeloma – A rare occurrence

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Kavitha Saravu

2013-03-01

Full Text Available We describe a case of a 40-year-old male patient who was found to have multiple myeloma with spontaneous tumour lysis syndrome (TLS, following a compression fracture of the L–2 vertebrae. Multiple myeloma was confirmed by bone marrow analysis and the M–band on serum protein electrophoresis. Hyperuricaemia (26.2 mg/dL, hyperkalaemia (> 7.0 mEq/L, hyperphosphatemia (16.2 mg of phosphorus/dL, normocalcemia and acute kidney injury, prior to anticancer treatment suggested spontaneous TLS. Inciting events for tumour lysis, such as chemotherapy, dehydration and exposure to steroids were absent. Patient received hydration, hypourecemic drugs and haemodialysis. This case report highlights the rare presentation of multiple myeloma with spontaneous TLS.

Emerging health issues of cyanobacterial blooms

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Maura Manganelli

2012-12-01

Full Text Available This paper describes emerging issue related to cyanobacterial dynamics and toxicity and human health risks. Data show an increasing cyanobacteria expansion and dominance in many environments. However there are still few information on the toxic species fitness, or on the effects of specific drivers on toxin production. Open research fields are related to new exposure scenario (cyanotoxins in water used for haemodialysis and in food supplements; to new patterns of co-exposure between cyanotoxins and algal toxins and/or anthropogenic chemicals; to dynamics affecting toxicity and production of different cyanotoxin variants under environmental stress; to the accumulation of cyanotoxins in the food web. In addition, many data gaps exist in the characterization of the toxicological profiles, especially about long term effects.

Low-dosage epoetin in maintenance haemodialysis: costs and quality-of-life improvement.

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Harris, D C

1994-01-01

Decisions about epoetin (recombinant human erythropoetin) dosage and target haematocrit in dialysis patients have been determined largely by the high acquisition cost of epoetin, but are made with incomplete knowledge about which target haematocrit gives the optimum clinical benefit. Haematopoietic response to epoetin may be determined by pharmacodynamic factors such as rate and frequency of administration, as well as by individual patient characteristics such as ethnicity. Resistance to epoetin may be due to iron or vitamin deficiency, natural or exogenous inhibitors of erythropoiesis and bone marrow fibrosis. The high acquisition cost of epoetin must be considered along with a number of other factors that can influence the true cost of epoetin treatment. Hidden costs of epoetin treatment include administration costs, changes in other treatments, extra laboratory tests and adverse events. Administration costs and extra laboratory surveillance add little to overall cost. Depletion of iron stores, hypertension, increased blood coagulability and reduced dialyser efficiency resulting from epoetin treatment may all add a small additional component to the true cost. Severe complications with significant cost implications are rare. Amongst the various components of true cost, only the acquisition cost can definitely be reduced by low dosage treatment. Balanced against the true and potential costs of epoetin are a number of benefits which can result in potential savings. The need for blood transfusion is all but abolished, avoiding the cost of transfusion and its complications. Sensitisation against histocompatibility antigens is reduced by avoiding transfusion, and so the waiting time for cadaveric transplantation may be reduced. Rates of hospitalisation for all causes, especially those associated with anaemia, may be reduced by epoetin treatment. By improving well-being, epoetin may allow patients to be transferred to minimal-care units or home where dialysis can be performed much more cheaply. Amongst the various potential benefits of epoetin, the one with the greatest potential to save money for society is improved productivity. To date, productivity improvements with epoetin have been demonstrated only in small studies. If the acquisition costs of epoetin are reduced by low dosage therapy, these potential benefits can cover a large proportion of the total cost of epoetin. Epoetin undoubtedly improves quality of life and activity, but it is not clear which level of haematocrit gives optimum improvement.(ABSTRACT TRUNCATED AT 400 WORDS)

Serum Osteoprotegerin level and the extent of cardiovascular calcification in haemodialysis patients

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Waleed Ammar

2014-03-01

Conclusion: There is strong positive relationship between osteoprotegerin and both vascular and valvular calcification in hemodialysis patients. This positive correlation may open the gate for routine estimation of this agent as a surrogate marker of cardiovascular calcification in hemodialysis patients.

A POPULATION-BASED STUDY ON CHRONIC KIDNEY DISEASE IN KANYAKUMARI GOVERNMENT MEDICAL COLLEGE

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Ponnaian John Christopher

2016-12-01

Full Text Available BACKGROUND Chronic kidney disease encompasses a spectrum of different pathophysiologic processes associated with abnormal kidney function and a progressive decline in glomerular filtration rate. Our study deals with the risk factors, stages and the management among the general population of Kanyakumari district who came to Kanyakumari Government Medical College during the period of 2014-2015. MATERIALS AND METHODS The newly-diagnosed CKD patients who were admitted as inpatients in the Department of General Medicine in the period of 2014-2015 were studied retrospectively. Those who came as outpatients as well as previously diagnosed ESRD patients who had repeated admissions for maintenance haemodialysis were excluded from our study. We documented the age, sex, previous history of diabetes, hypertension, the mean duration of diabetes or hypertension, eGFR of the patient, stage of CKD and the treatment given. RESULTS The number of CKD patients admitted in our hospital during 2014-2015 were 314 of which newly detected CKD cases were 212. The most frequent cause of CKD in this population is diabetic nephropathy secondary to type 2 diabetes mellitus (90%. CKD is most common among males in this population. The mean age of association of diabetes in this population is 9-12 years. Patients with newly-diagnosed CKD often present with hypertension. eGFR was calculated for all CKD patients by CockgraftGault Equation. 18 out of 212 newly-diagnosed CKD patients (8.5% presented with ESRD (eGFR <15 mL/min./1.73 m2 and haemodialysis was initiated. Most evident complications among this patients were anaemia, easy fatigability, decreased appetite, progressive malnutrition and electrolyte abnormalities. CONCLUSION Diabetes, glomerulonephritis and hypertension associated CKD are the leading categories of aetiologies of CKD. When no overt evidence for a primary glomerular disease or tubulointerstitial disease process is present, CKD is often attributed to

Cultural adaptation and validation of the Filipino version of Kidney Disease Quality of Life--Short Form (KDQOL-SF version 1.3).

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Bataclan, Rommel P; Dial, Ma Antonietta D

2009-10-01

Chronic kidney disease is the 10th leading cause of death among Filipinos. Those with chronic kidney disease are exposed to stressors which effect their daily lives. Therefore, assessment of health-related quality of life is important in these patients. The objective of the present study was to translate the Kidney Disease Quality of Life--Short Form version 1.3 (KDQOL-SF ver. 1.3) into Filipino and measure its validity and reliability. Translation and cultural adaptation began with two translations into Filipino, with reconciliation of the forward translators. Pretesting with 10 renal patients, review by experts (nephrologist, translator and dialysis nurse) and back-translation was also done. The final questionnaire was administered to 80 patients with chronic renal disease undergoing haemodialysis for at least 3 months, who could understand Filipino, and were without life-threatening or terminal conditions at the time of the test. A convenience sample of 30 patients from the group had a repeat test 10-14 days after to determine test-retest reliability. Test-retest reliability was assessed by intraclass correlation coefficient and internal consistency reliability was measured by determining the Cronbach's alpha value. Validity was measured using Pearson's correlation between the overall health rating scale and the items from the questionnaire. All of the items showed good test-retest reliability (intraclass correlation coefficient >0.40), ranging from 0.58 (social interaction) to 0.98 (role--emotional). Internal consistency reliability values were acceptable, with Cronbach's alpha ranging from 0.60 (cognitive function) to 0.80 (physical functioning and role--physical). Regarding construct validity, overall health rating in kidney disease-targeted scales was significantly correlated with symptoms/problems, effects of kidney disease and burden of kidney disease. All items in the SF 36 scales had significant correlation with overall health rating (P < 0.05) except

Protein Losses and Urea Nitrogen Underestimate Total Nitrogen Losses in Peritoneal Dialysis and Hemodialysis Patients.

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Salame, Clara; Eaton, Simon; Grimble, George; Davenport, Andrew

2018-04-28

Muscle wasting is associated with increased mortality and is commonly reported in dialysis patients. Hemodialysis (HD) and peritoneal dialysis (PD) treatments lead to protein losses in effluent dialysate. We wished to determine whether changes in current dialysis practice had increased therapy-associated nitrogen losses. Cross-sectional cohort study. Measurement of total protein, urea and total nitrogen in effluent dialysate from 24-hour collections from PD patients, and during haemodiafiltration (HDF) and haemodialysis (HD) sessions. One hundred eight adult dialysis patients. Peritoneal dialysis, high-flux haemodialysis and haemodiafiltration. Total nitrogen and protein losses. Dialysate protein losses were measured in 68 PD and 40 HD patients. Sessional losses of urea (13.9 [9.2-21.1] vs. 4.8 [2.8-7.8] g); protein (8.6 [7.2-11.1] vs. 6.7 [3.9-11.1] g); and nitrogen (11.5 [8.7-17.7] vs. 4.9 [2.6-9.5] g) were all greater for HD than PD, P losses were lower with HD 25.9 (21.5-33.4) versus 46.6 (27-77.6) g/week, but nitrogen losses were similar. We found no difference between high-flux HD and HDF: urea (13.5 [8.8-20.6] vs. 15.3 [10.5-25.5] g); protein (8.8 [7.3-12.2] vs. 7.6 [5.8-9.0] g); and total nitrogen (11.6 [8.3-17.3] vs. 10.8 [8.9-22.5] g). Urea nitrogen (UN) only accounted for 45.1 (38.3-51.0)% PD and 63.0 (55.3-62.4)% HD of total nitrogen losses. Although sessional losses of protein and UN were greater with HD, weekly losses were similar between modalities. We found no differences between HD and HDF. However, total nitrogen losses were much greater than the combination of protein and UN, suggesting greater nutritional losses with dialysis than previously reported. Copyright © 2018 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Relative blood volume monitoring during hemodialysis in end stage renal disease patients.

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Ion Titapiccolo, Jasmine; Ferrario, Manuela; Garzotto, Francesco; Cruz, Dinna; Moissl, Ulrich; Tetta, Ciro; Ronco, Claudio; Signorini, Maria G; Cerutti, Sergio

2010-01-01

A crucial point in the haemodialysis (HD) treatment is the reliable assessment of hydration status. An inadequate removed volume may lead to chronic fluid overload which can lead to hypertension, left ventricular hypertrophy and heart failure. Therefore, the estimation of the hydration state and the management of a well-tolerated water removal is an important challenge. This exploratory study aims at identifying new parameters obtained from continuous Blood Volume Monitoring (BVM) allowing a qualitative evaluation of hydration status for verifying the adequacy of HD setting parameters (e.g UFR, target dry weight). The percentage of blood volume reduction (BVR%) during HD was compared against a gold standard method for hydration status assessment. The slope of the first 30 minute of blood volume reduction (BVR) was proposed as a useful parameter to identify overhydrated patients.

Scientific results of the work group for nutrient research research in biomedicine

International Nuclear Information System (INIS)

Braetter, P.; Behne, D.; Gawlik, D.; Roesick, U.

1980-02-01

In 1979 contributions were given out for the following tasks set: appraisal of aminotic water analysis for the diagnosis of fetal conditions; establishment of the normal dissermunation as well as of a pathological divergence from the nutrient content in aminotic water, meconium and blood serum; metabolism of selenium and cadmium during pregnancy and lactation; storage and distribution of nutrients in bone tissue and their mobilisation from the skeleton system during pregnancy and lactation; introduction of trace analysis methods for the therapeutic control of metabolic bone disorders and control of haemodialysis; methodology of the prelimary treatment of biological tests for determining nutrients in a nanogram field; isolation and characterisation of nutrient protein complexes in body fluids; methodology and use of in vivo neutron activation analysis for examining mineral metabolism. (orig./MG) [de

Relapsing peritonitis with Bacillus cereus in a patient on continuous ambulatory peritoneal dialysis

DEFF Research Database (Denmark)

Magnussen, Eyð Tausen; Vang, Amanda Gratton; á Steig, Torkil

2016-01-01

We present a case where Bacillus cereus was determined to be the causative agent of relapsing peritonitis in a patient on continuous ambulatory peritoneal dialysis (CAPD). The patient, a 70-year-old man from the Faroe Islands, was admitted with relapsing peritonitis four times over a 3-month period....... Peritoneal cultures were positive for growth of B. cereus, a rare bacterial cause of peritonitis. The cultures demonstrated susceptibility to vancomycin, and therefore the patient was treated with intraperitoneal vancomycin, intraperitoneal gentamycin and oral ciprofloxacin. As a result of the relapsing B....... cereus peritonitis diagnosis and a CT scan showing contraction of the peritoneum after longstanding inflammation, the peritoneal catheter was removed and the patient converted to haemodialysis. To date, the patient has not been readmitted due to peritonitis. A lack of proper hygiene when changing...

Anti-parathyroid treatment effectiveness and persistence in incident haemodialysis patients with secondary hyperparathyroidism

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Angel Luis Martín de Francisco

2016-03-01

Conclusions: In conditions of daily clinical practice, attaining and maintaining recommended biochemical control of sHPT appears to be more frequently achievable with cinacalcet than with activated vitamin D compounds.

[Investigation into the relationship between outpatient haemodialysis centres and referring hospitals in Spain].

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Arenas, M D; Bernat, A; Ramos, R; Berdud, I; Blanco, A

2009-01-01

To guarantee continuity and equity in the clinical assistance of patients on hemodialysis in extrahospitalary centers (EC) a close relationship and a good level of communication between them and their reference hospitals (RH) is essential. The aim of this study was to assess the present situation of this relationship in our country (Spain) so as to be able to detect improvement opportunities. Descriptive and transversal study using two self-report anonymous surveys: one for EC (81 questions) and one for RH (56 questions) sent by e-mail to all Spanish EC and RH registered in the Spanish Society of Nephrology. We received answers from 80 EC and 30 RH. 70% of the EC were managed by multinational companies; only 16 % EC were placed in a hospital. 64% of the EC need to employ non-nephrological medical staff. Nearly 40% of the EC nephrologists also go on duty at their RH. More than three quarters of the EC nephrologists are alone during their workday. Bidirectional telephone communication is very frequent between EC and RH. Around a third of the patients sent from RH to EC arrive without current viral serology and/or without a functioning vascular access. Most of the patients sent from EC to RH bring an up-to-date complete medical report. 41,3 % of the EC answered that they were usually consulted by their RH doctor colleagues about decisions to be taken regarding their patients. Routine blood and other medical protocol tests of CE are well defined in the formal agreement with their RH in 65 % of the cases, although they can be modified by the EC through consensus with the RH in more than 50 % of the cases. 60 % of the EC can directly consult other specialists in the RH but more than 50 % need to do so through the RH nephrologist. Parenteral medication used in the ECs is mostly supplied by their RH, but a third of ECs have some limitations with uncommon or not concert-specified parenteral drugs. RHs refer that most of the vascular accesses are done in the hospital, whereas ECs say that this is true only in half of the cases. More than a third of the fistulae of predialysis patients are done in the ECs as part of their collaboration with RHs. The majority of ECs can share the decision about patients' inclusion in renal transplant waiting list. In only a fifth of the cases is there a common database between CE and RH, and less than half share common protocols or objectives. 62,5% of CEs participate with RHs in clinical trials. More than half of the dialysis private companies provide continuous training and education to their ECs personnel, either directly through the company or facilitating assistance to courses or congresses. Some of the relationship aspects that appear to be clearly improvable are: CEs nephrologist solitude and their limited access to continuous training and education, an adequate referral of the patients from the RHs, CEs nephrologist's autonomy at making consultations to specialists or their limitations when asking for hospital medications. A closer relationship between CEs and RHs is of the utmost importance in guaranteeing continuity and equity in the clinical assistance of our hemodialysis patients. The creation of a debate forum would favour discussion and common resolution of such aspects.

STUDY OF CENTRAL VENOUS CATHETER RELATED BLOOD STREAM INFECTIONS IN PATIENTS ON HAEMODIALYSIS

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Pranjal Pankaj

2018-01-01

Full Text Available BACKGROUND Temporary and permanent central venous catheters are used in majority of patients of CKD when initiated on hemodialysis and mostly these catheters act as bridge before permanent AV fistula assess could be obtained. Blood stream infections related to these central venous catheters are an important cause of morbidity and mortality in these patients. Appropriate antiseptic precautions while inserting central venous catheter and early identification of catheter related blood stream infections (CRBSI are of utmost importance for reducing hospital stay, cost of therapy and mortality. MATERIALS AND METHODS A total of 50 patients of CKD were included in the study who had central venous catheter in situ (internal jugular or subclavian and developed symptoms related to blood stream infections. Blood cultures were obtained from the catheter lumen and a separate venous site 1 hour apart. All the culture sensitivity reports were obtained from department of microbiology of our institute. Inclusion Criteria- Known case of CKD patients aged more than 18yrs on hemodialysis with symptoms and signs of catheter related blood stream infections were included in the study. Exclusion Criteria- Patients with other associated comorbid infections like Koch’s, urinary tract infection or others mimicking symptoms of CRBSI. RESULTS The cultures were found positive in 38 patients (76% while in rest 24% cases positive cultures could not be obtained. Out of culture positive patients 52.63% cases were found to have gram positive infections while 44.74% had gram negative infections. In 2.63% patients, fungus was isolated to be the causative organism. Among the gram positive organisms 50% had CoNS, 30% had MSSA and 20% had MRSA infections. Among the gram negative group, 47.06% had klebsiella, 23.53% had acinetobacter, 17.65% had E.coli and 11.76% had pseudomonas as the causative organisms. Mortality was observed in 14% patients out of which 28.57% were culture negative and the rest culture positive. No mortality was observed in patients with gram positive cultures and E.Coli infections. Mortality in culture positive group was predominantly in klebsiella (40%, Acinetobacter (40% and pseudomonas (20% CONCLUSION CRBSI related bacteremia and sepsis pose a major cause of morbidity and mortality among CKD patients and also increase the cost of therapy and financial burden of healthcare. Simple handwashing techniques, proper handling of CVCs during dialysis, antiseptic and antibiotic locking of catheters remain gold standard to reduce CRBSIs. CRBSIs are certainly not inevitable completely but preventable to a significant extent.

Prevalence of occult hepatitis B virus infection in haemodialysis patients from central Greece

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Mina, Paraskevi; Georgiadou, Sarah P; Rizos, Christos; Dalekos, George N; Rigopoulou, Eirini I

2010-01-01

AIM: To assess the hepatitis B virus (HBV)-DNA and the prevalence of occult HBV infection in end-stage renal failure (ESRF) patients from Central Greece. METHODS: Sera from 366 ESRF patients attending five out of six dialysis units from Central Greece were investigated for HBV-DNA by real-time polymerase chain reaction. Only serum samples with repeatedly detectable HBV-DNA were considered positive. IgG antibodies to hepatitis C virus (anti-HCV) were tested by a third generation enzyme linked immunosorbent assay (ELISA), while IgG antibodies to hepatitis E virus (anti-HEV) were tested by two commercially available ELISAs. RESULTS: HBV-DNA was detected in 15/366 patients (4.1%) and HBsAg in 20/366 (5.5%). The prevalence of occult HBV infection was 0.9% (3/346 HBsAg-negative patients). Occult HBV was not associated with a specific marker of HBV infection or anti-HCV or anti-HEV reactivity. There was no significant difference in HBV-DNA titres, demographic and biochemical features, between patients with occult HBV infection and those with HBsAg-positive chronic HBV infection. CONCLUSION: In central Greece, 4% of ESRF patients had detectable HBV-DNA, though in this setting, the prevalence of occult HBV seems to be very low (0.9%). PMID:20066742

Increased red cell 2,3-diphosphoglycerate levels in haemodialysis patients treated with erythropoietin.

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Horina, J H; Schwaberger, G; Brussee, H; Sauseng-Fellegger, G; Holzer, H; Krejs, G J

1993-01-01

The efficacy of recombinant human erythropoietin (rHuEpo) for the treatment of renal anaemia is well established. To assess the effect of rHuEpo treatment on physical performance we evaluated physical working capacity, oxygen uptake and red cell 2,3-diphosphoglycerate (DPG) values at rest and during and after exercise on a bicycle spiroergometer in eight chronically haemodialysed patients. Follow-up examination was carried out after a mean of 14 weeks (range 9-19 weeks), when mean haemoglobin had increased from 7.8 to a stable value of 13.0 g/dl in response to rHuEpo treatment (P level without rHuEpo treatment than after correction of anaemia. Therefore rHuEpo treatment results both in better oxygen transport capacity and reduced intraerythrocytic oxygen affinity, which is followed by improved oxygen delivery to tissues per unit of haemoglobin. These effects may explain the improvement of exercise capacity observed in dialysis patients after rHuEpo treatment.

Protocol adherence and the ability to achieve target haemoglobin levels in haemodialysis patients.

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Chan, Kevin; Moran, John; Hlatky, Mark; Lafayette, Richard

2009-06-01

Anemia management remains complicated in patients with endstage renal disease on hemodialysis. We wished to evaluate the effect of protocol adherence to EPO and intravenous iron dosing on achieving the desired range of hemoglobin levels. A cohort of hemodialysis patients was studied to evaluate the rate of adherence to EPO and iron dosing protocols over a 5 month period. A database was completed to evaluate all known comorbidities, demographic factors, and facility issues that might affect hemoglobin levels. A logistic regression model was employed to evaluate the effect of adherence to the anemia protocols on the probability of achieving a hemoglobin level below, within or above the targeted range of 11-12.5 g/dl. Among 2114 patients, we found that adherence to both the EPO and iron dosing protocol resulted in the greatest probability of achieving the target hemoglobin range (56 +/- 5% in anemia protocol adherent patients versus 42 +/- 7% in non adherent patients). This was predominantly due to a lowered risk of having above target hemoglobin levels rather than below. The use of the anemia protocols was associated with lower rates of hospitalization (9 +/- 0.7 visits/100 months in adherent group vs 15 +/- 2 in non adherent group) and lower utilization of both EPO and intravenous iron. Furthermore, patients in the adherent groups had less variability of their hemoglobin levels month by month, at least as judged by standard deviation. Adherence to anemia protocols, as practiced in the dialysis units included in this cohort, may improve hemodialysis patients' ability to achieve target hemoglobin levels, and by avoiding above target hemoglobin values, lower drug utilization and reduce variability of hemoglobin levels.

Facility factors dominate the ability to achieve target haemoglobin levels in haemodialysis patients.

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Chan, Kevin E; Lafayette, Richard A; Whittemore, Alice S; Hlatky, Mark A; Moran, John

2008-09-01

Our objective was to determine whether patient factors, processes of care and measures of erythropoietin (EPO) responsiveness were associated with successful anemia management at the individual patient level. We retrospectively reviewed laboratory and demographic data from 1499 patients receiving hemodialysis in 15 units operated by the same dialysis provider. We performed univariate and multivariate logistic regression analysis to determine predictors of an average 3-month hemoglobin level below or above the target interval of 11.0-12.5 g/dL. To explain the effect of facility on anemia performance, we calculated correlations between measures of EPO responsiveness and the probability of achieving the target interval by facility. Patients above the target hemoglobin range demonstrated an association with parathyroid hormone (PTH) (OR = 0.96 per 100 pg/mL increase), female gender (OR = 0.68), EPO protocol use (OR = 0.94 per 10% increase in use) and facility (range of OR = 0.26-2.59 for 15 participating sites). Patients below the target hemoglobin range demonstrated an association with CRP (OR = 1.10 per mg/L increase), PTH (OR = 1.07 per 100 pg/mL increase), iron deficiency (OR = 1.07 per 10% increase), EPO protocol use (OR = 0.89 per 10% increase in use), iron protocol use (OR = 0.93 per 10% increase in use) and facility (range of OR = 0.58-3.41 over 15 units). EPO index (r = 0.71), EPO dose (r = 0.73), hemoglobin (r = -0.60) and EPO per unit weight (r = 0.76) were significantly correlated with the probability of achieving the target hemoglobin by facility. The facility significantly influences the outcome of anemia management in patients with ESRD. In part, this is due to the patients' EPO responsiveness, which may be influenced by facility care patterns.

Validation of The Fluid Intake Appraisal Inventory for patients on haemodialysis in Denmark

DEFF Research Database (Denmark)

Pahus, Jytte; Lindberg, Magnus; Finderup, Jeanette

) evaluates patients’ SE with regard to fluid intake. FIAI can be used as a screening instrument or as an evaluation tool. Objectives The aim of this study was to translate and validate the FIAI for use in Denmark. Methods Following the steps of forward and backward translation, the Swedish version of FIAI...... FIAI had high internal consistency with Cronbach’s alpha of 0.97 for the total scale. The reliability of the scale was tested with Spearman’s rho and was -0.141 (p=0.05) for the total scale. Conclusions Primarily findings indicate that the Danish FIAI can be used in clinical practice as a screening...

Benefits of a low intensity exercise programme during haemodialysis sessions in elderly patients

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Vicent Esteve Simo

2015-07-01

Conclusions: (1 An adapted low intensity exercise programme improved muscle strength, functional capacity and health-related quality of life in our elderly patients on HD. (2 Our results highlight the benefits from exercise in HD patients even in this elderly population. (3 In elderly patients on HD, it is worth considering an adapted low intensity intradialytic exercise programme as a part of a comprehensive care.

Central venous obstruction in the thorax

International Nuclear Information System (INIS)

Collin, G.; Jones, R.G.; Willis, A.P.

2015-01-01

Central venous stenosis and occlusion can occur secondary to a spectrum of conditions ranging from aggressive malignancy to benign extrinsic anatomical compression in otherwise healthy individuals. Irrespective of aetiology, significant morbidity in the acute setting and long term can occur unless prompt accurate diagnosis and appropriate management is initiated, the radiologist being central to both. The present review will provide radiologists with a thorough illustration and explanation of the range of central venous conditions in the thorax (including deep vein thrombosis, thoracic outlet syndrome, haemodialysis, and malignancy related causes), the salient imaging findings and interventional management using case examples from the authors' practice. - Highlights: • We show a range of causes of central venous disease in the thorax. • We provide information about different imaging and management strategies. • We show several cases with successes and complications of endovascular management

Dialysis catheter-related septicaemia--focus on Staphylococcus aureus septicaemia

DEFF Research Database (Denmark)

Nielsen, J; Ladefoged, S D; Kolmos, H J

1998-01-01

BACKGROUND: Dialysis catheters are a common cause of nosocomial septicaemia in haemodialysis units usually due to staphylococci, of which Staphylococcus aureus is the most pathogenic. In this study, the epidemiology and pathogenesis of dialysis catheter-related infections were studied, and methods...... to infection were measured. After catheter insertion, all patients were screened for nasal carriage of S. aureus, and a culture was taken from the skin overlying the catheter insertion site. Once a week, cultures were taken from the insertion site and from the hub, and aerobic and anaerobic blood cultures were...... drawn from the catheter. If clinical signs of septicaemia occurred, peripheral blood cultures were also performed, when it was possible. RESULTS: The incidence of septicaemia was 49% (21/43) in patients, and 56% of all cases were caused by S. aureus. The mortality was 14% (3/21) and the incidence...

Thirty-five cases of S-carboxymethylcysteine use in paraquat poisoning.

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Lugo-Vallín, Nelly; Maradei-Irastorza, Idania; Pascuzzo-Lima, Carmine; Ramírez-Sánchez, Manuel; Montesinos, Claudia

2003-02-01

The herbicide paraquat is associated with a high mortality rate. It produces multiorgan damage through the induction of acute oxidative stress, by generation of reactive oxygen species that cause oxidative damage to biomolecules. In addition to general supportive measures, the management of paraquat poisoning includes gastric washing, forced diuresis, haemodialysis and the use of antioxidants, such as N-acetylcysteine. However, this drug is rather unavailable in Venezuela and S-carboxymethylcysteine has been used. We report 35 patients with mild to severe paraquat poisoning, which beside standard supportive treatment received 1500 mg S-carboxymethylcysteine, up to 2-3 w. The mortality rate was 22.86% (8 deaths/35 cases) and was related to the severity of paraquat poisoning (as assessed by urine dithionite tests). We conclude that S-carboxymethylcysteine is a reliable alternative in managing patients with paraquat poisoning.

Liver transplantation in polycystic liver disease

DEFF Research Database (Denmark)

Krohn, Paul S; Hillingsø, Jens; Kirkegaard, Preben

2008-01-01

OBJECTIVE: Polycystic liver disease (PLD) is a rare, hereditary, benign disorder. Hepatic failure is uncommon and symptoms are caused by mass effects leading to abdominal distension and pain. Liver transplantation (LTX) offers fully curative treatment, but there is still some controversy about...... whether it is a relevant modality considering the absence of liver failure, relative organ shortage, perioperative risks and lifelong immunosuppression. The purpose of this study was to review our experience of LTX for PLD and to compare the survival with the overall survival of patients who underwent LTX...... from 1992 to 2005. MATERIAL AND METHODS: A retrospective study of the journals of 440 patients, who underwent 506 LTXs between 1992 and 2005, showed that 14 patients underwent LTX for PLD. All patients had normal liver function. Three were receiving haemodialysis and thus underwent combined liver...

Prevalence of hepatitis B and C virus in surgical patients

International Nuclear Information System (INIS)

Ali, S.A.; Shah, F.A.; Ahmed, S.K.

2006-01-01

To assess the current prevalence of Hepatitis B and C virus in our set up. All patients who were operated during the study period. The detailed information about each patient was entered on a pre-designed questionnaire, including age, sex, type of operation, HBV and HCV screening test results, and presence of risk factors like: history of drug addiction, blood transfusion, family history of hepatitis, tattooing, viral vaccination, hospitalization, previous surgery, haemodialysis, etc. Amongst the total 275 patients, 27 (9.8%) had the Hepatitis virus: HBV-10, HCV-14 and HBV and HCV-3. Infection was more common among male patients and those between the ages of 41-50 years. Knowledge about Hepatitis risk factors is deficient, hence there should be more emphasis on public mass education programmes. Besides HBV vaccination should be carried out to reduce Hepatitis transmission. (author)

Guía Clínica Española del Acceso Vascular para Hemodiálisis

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José Ibeas

2017-11-01

Full Text Available RESUMEN: El acceso vascular para hemodiálisis es esencial para el enfermo renal tanto por su morbimortalidad asociada como por su repercusión en la calidad de vida. El proceso que va desde la creación y mantenimiento del acceso vascular hasta el tratamiento de sus complicaciones constituye un reto para la toma de decisiones debido a la complejidad de la patología existente y a la diversidad de especialidades involucradas. Con el fin de conseguir un abordaje consensuado, el Grupo Español Multidisciplinar del Acceso Vascular (GEMAV, que incluye expertos de las cinco sociedades científicas implicadas (nefrología [S.E.N.], cirugía vascular [SEACV], radiología vascular e intervencionista [SERAM-SERVEI], enfermedades infecciosas [SEIMC] y enfermería nefrológica [SEDEN], con el soporte metodológico del Centro Cochrane Iberoamericano, ha realizado una actualización de la Guía del Acceso Vascular para Hemodiálisis publicada en 2005. Esta guía mantiene una estructura similar, revisando la evidencia sin renunciar a la vertiente docente, pero se aportan como novedades, por un lado, la metodología en su elaboración, siguiendo las directrices del sistema GRADE con el objetivo de traducir esta revisión sistemática de la evidencia en recomendaciones que faciliten la toma de decisiones en la práctica clínica habitual y, por otro, el establecimiento de indicadores de calidad que permitan monitorizar la calidad asistencial. ABSTRACT: Vascular access for haemodialysis is key in renal patients both due to its associated morbidity and mortality and due to its impact on quality of life. The process, from the creation and maintenance of vascular access to the treatment of its complications, represents a challenge when it comes to decision-making, due to the complexity of the existing disease and the diversity of the specialities involved. With a view to finding a common approach, the Spanish

Pro-inflammatory cytokines and leukocyte oxidative burst in chronic kidney disease: culprits or innocent bystanders?

Science.gov (United States)

Neirynck, Nathalie; Glorieux, Griet; Schepers, Eva; Dhondt, Annemieke; Verbeke, Francis; Vanholder, Raymond

2015-06-01

Pro-inflammatory cytokines are elevated in chronic kidney disease (CKD), a condition characterized by microinflammation with oxidative stress as key feature. However, their role in the inflammatory response at uraemic concentrations has not yet been defined. In this study, the contribution of cytokines on induction of leukocyte oxidative stress was investigated. Whole blood from healthy donors was incubated with 20-1400 pg/mL TNFα, 5-102.8 pg/mL IL-6, 20-400 pg/mL IL-1β and 75-1200 pg/mL IL-18 separately or in combination. Oxidative burst was measured, at baseline and after stimulation with fMLP (Phagoburst™). The effect of the TNFα blocker, adalimumab (Ada), was evaluated on TNFα-induced ROS production. Finally, the association between TNFα and the composite end point all-cause mortality or first cardiovascular event was analysed in a CKD population stage 4-5 (n = 121). While interleukin (IL)-6, IL-1β and IL-18 alone induced no ROS activation of normal leukocytes, irrespective of concentrations, TNFα induced ROS activation at baseline (P < 0.01) and after fMLP stimulation (P < 0.05), but only at uraemic concentrations in the high range (400 and 1400 pg/mL). A similar pattern was observed with all cytokines in combination, but already at intermediate uraemic concentrations (all P < 0.05, except for monocytes after fMLP stimulation: n.s.), suggesting synergism between cytokines. ROS production induced by TNFα (400 pg/mL) and the cytokine combination was blocked with Ada. Uraemia-related oxidative stress in leukocytes of haemodialysis patients was however not blocked by Ada. In patients, TNFα was not associated to adverse events (HR: 1.52, 95% CI 0.81-2.85, P = 0.13). Among several pro-inflammatory cytokines, TNFα alone was pro-oxidative but only at high-range uraemic concentrations. Adding a TNFα blocker, Ada, blocked this ROS production, but not the oxidative stress in blood samples from haemodialysis patients, suggesting that other uraemic toxins than

Tricuspid valve endocarditis following central venous cannulation: The increasing problem of catheter related infection

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Suresh Babu Kale

2013-01-01

Full Text Available A central venous catheter (CVC is inserted for measurement of haemodynamic variables, delivery of nutritional supplements and drugs and access for haemodialysis and haemofiltration. Catheterization and maintenance are common practices and there is more to the technique than routine placement as evident when a procedure-related complication occurs. More than 15% of the patients who receive CVC placement have some complications and infectious endocarditis involving the tricuspid valve is a rare and serious complication with high morbidity and mortality. Overenthusiastic and deep insertion of the guide wire and forceful injection through the CVC may lead to injury of the tricuspid valve and predispose to bacterial deposition and endocarditis. We report a case of tricuspid valve endocarditis, probably secondary to injury of the anterior tricuspid leaflet by the guide wire or the CVC that required open heart surgery with vegetectomy and repair of the tricuspid valve.

Accuracy of nursing diagnosis "readiness for enhanced hope" in patients with chronic kidney disease.

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Silva, Renan Alves; Melo, Geórgia Alcântara Alencar; Caetano, Joselany Áfio; Lopes, Marcos Venícios Oliveira; Butcher, Howard Karl; Silva, Viviane Martins da

2017-07-06

To analyse the accuracy of the nursing diagnosis readiness for enhanced hope in patients with chronic kidney disease. This is a cross-sectional study with 62 patients in the haemodialysis clinic conducted from August to November 2015. The Hearth Hope Scale was used to create definitions of the defining characteristics of the North American Nursing Diagnosis Association International. We analysed the measures of sensitivity, specificity, predictive value, likelihood ratio, and odds ratio of the defining characteristics of the diagnosis. Of the characteristics, 82.22% presented the diagnosis. The defining characteristics "Expresses the desire to enhance congruency of expectations with desires" and "Expresses the desire to enhance problem solving to meet goals" increased the chance of having the diagnosis by eleven and five, respectively. The characteristics, "Expresses desire to enhance congruency of expectations with desires" and "Expresses desire to enhance problem solving to meet goals" had good accuracy measures.

Psychosocial adjustment and adherence to dialysis treatment regimes.

Science.gov (United States)

Brownbridge, G; Fielding, D M

1994-12-01

Sixty children and adolescents in end-stage renal failure who were undergoing either haemodialysis or continuous ambulatory peritoneal dialysis at one of five United Kingdom dialysis centres were assessed on psychosocial adjustment and adherence to their fluid intake, diet and medication regimes. Parental adjustment was also measured and data on sociodemographic and treatment history variables collected. A structured family interview and standardised questionnaire measures of anxiety, depression and behavioural disturbance were used. Multiple measures of treatment adherence were obtained, utilising children's and parents' self-reports, weight gain between dialysis, blood pressure, serum potassium level, blood urea level, dietitians' surveys and consultants' ratings. Correlational analyses showed that low treatment adherence was associated with poor adjustment to diagnosis and dialysis by children and parents (P adherence than younger children, P dialysis (P treatment of this group of children. Future research should develop and evaluate psychosocial interventions aimed at improving treatment adherence.

Depression, anxiety and stress among patients with dialysis and the association with quality of life.

Science.gov (United States)

Bujang, Mohamad A; Musa, Ramli; Liu, Wen J; Chew, Thian F; Lim, Christopher T S; Morad, Zaki

2015-12-01

Studies addressing the nature of relationship between psychological symptoms and quality of life among dialysis patients in Malaysia are scarce. Hence, this study is intended to investigate the association between psychological symptoms such as depression, anxiety and stress on the quality of life in dialysis patients. A cross sectional multicentre study was conducted from May to October 2012 at 15 centres that provide haemodialysis and/or peritoneal dialysis. Apart from socio-demographic profile data collection, WHOQOL-BREF and DASS21 questionnaires were administered to study subjects. All three psychological symptoms had significant impact on quality of life domains of physical health, psychological health, social impact, perceived environment and overall quality of life. These findings suggest that subjects with symptoms of depression, anxiety and stress had poorer quality of life than those without, highlighting the negative impact of psychological symptoms. Copyright © 2015 Elsevier B.V. All rights reserved.

Higher mortality of patients on haemodialysis with pancreatic diabetes compared to type 2-diabetes

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Bodlaj Gert

2012-03-01

Full Text Available Abstract In rare cases (1-8% diabetic patients with end-stage renal disease (ESRD suffer from diabetic nephropathy (dNP due to pancreatic diabetes mellitus (PDM. Aim of this study was to investigate differences in the outcome of patients with PDM and those with type 2 diabetes. In a retrospective study we evaluated 96 diabetic patients, who started hemodialysis (HD in our dialysis centre (1997-2005. In 12 patients PMD was diagnosed, and 84 patients had type 2 diabetes. In both groups we compared vascular risk factors and prevalence of vascular diseases at the start of dialysis. We also evaluated incidence of malnutrition, and 5-year survival in both patient groups. The vascular risk factors were similar in both patient groups, also the prevalence of vascular diseases at the initiation of HD was similar in both groups. In the patients with PDM the mean BMI (kg/m2 was lower (22 + 3 versus 25 + 3, and also their serum albumin was lower (2.7 + 0.3 versus 3.4 + 0.3 g/dl, p Conclusions in HD-treated patients with type 2 diabetes or PDM the prevalence of vascular diseases was not significantly different. The lower survival of PDM patients can be related to poor nutrition status.

Evaluation of the waters of supply in the 30 haemodialysis room of the country

International Nuclear Information System (INIS)

Alberro, N.; Montero, A.; Valcarcel, L.; Pupo, I.; Frias, D.; Perez Oliva, F.

2004-01-01

The behavior of the quality of the drinking and purified for hemodialysis waters used in the National Institute of Nephrology was evaluated since 2002 up to now. A total of 20 chemical components was determined. The analytical results were compared with the Admissible Maximum Concentrations according to the Cuban Norm NC 92-02:85 for drinking water and with the Norm UNE 111-301-90 related to the water for hemodialysis. In general the quality in both type of waters complies with the Norms requirements

Pha-induced T-cell cytotoxity. Mechanism and application in haemodialysis and renal transplant patients.

NARCIS (Netherlands)

Huges-Wirawan, Gladys Ratna Widhi Indrati

1978-01-01

This thesis describes a method to measure PHA-incluced cytotoxicity of human lymphocytes (nonspecific T-cell cytotoxicity), using 3H-thymidine prelabelled target cells (HeLa cells). The method has some advantages over the widely used 51Cr-release assay. Its application in two clinical conditions is

Clinical profile of haemodialysis patients with diabetic nephropathy leading to end stage renal disease

International Nuclear Information System (INIS)

Gazzaz, Z.J.; Dhafar, K.O.; Tashkandi, M.A.; Farooq, M.U.

2010-01-01

To know the characteristics of the diabetic patients on regular dialysis at Al-noor Specialist Hospital, Makkah, Saudi Arabia. The data had been collected retrospectively from 13-11-2005 to 12-12-2005 from the diabetic patients directly those were on dialysis due to end stage renal disease (ESRD) and from their files. The total study subjects were 51 with mean age of Diabetics was (55.2 years +-7.9) showing male predominance 31(60.8%). All were Saudies. The mean duration of Diabetes mellitus and dialysis were (16.8years) and (22 months), respectively. The mean age of start of Diabetes mellitus and dialysis was (37.4 years) and (53.5 years). The mean duration of onset of diabetes to dialysis was (16.1 years). Out of the total, 29(56.9%) were non-smoker. Patients with family history of diabetes with other associated illnesses were 23(45%) followed by 15(29.4%) had family history of only diabetes. Type II diabetics were 40(78.4%). Regarding metabolic profile, patients with high blood glucose level were 10(19.6%) while 3(5.9%), 50(98%) and 18(35.3%) patients had high cholesterol, low density lipoprotein and triglyceride levels, respectively. Maximum number of patients were in sixth decade of life. Up to three fourth patients had family history of diabetes. Most of the subjects had only diabetic nephropathy. Maximum patients had high low density lipoprotein level. (author)

Color coded duplex sonography. Interdisciplinary vascular ultrasonography; Farbkodierte Duplexsonographie. Interdisziplinaerer vaskulaerer Ultraschall

Energy Technology Data Exchange (ETDEWEB)

Kubale, R. [Institut fuer Radiologie, Sonographie und Nuklearmedizin, Pirmasens (Germany); Stiegler, H. [Staedtisches Krankenhaus Schwabing, Muenchen (Germany). 7. Medizinische Abt.

2002-07-01

An interdisciplinary team of experts impart the state of the art in color coded duplex sonography applied for examination of all anatomic areas. Detailed information is given for every vascular area, describing the examination procedure, possible origins of mistakes or faults, and means to avoid them. In addition to the classical applications, eg. for examination of the extra- and intracranial vessels, vessels of the limbs, visceral vessels and the vessels of liver and kidney, there are chapters devoted to: haemodialysis shunts, arteriovenous malformations, duplex sonography of the penis, tumor vascularisation. (orig./CB) [German] Ein interdisziplinaeres Autorenteam vermittelt Ihnen den State of the Art der FKDS fuer alle anatomischen Regionen. Fuer jede der Gefaessregionen werden detaillierte Angaben zum Untersuchungsablauf, zu moeglichen Fehlerquellen und zu deren Vermeidung geboten. Neben den klassischen Anwendungen bei der Untersuchung - der extra- und intrakraniellen Gefaesse, - der Extremitaetengefaesse, - der viszeralen Gefaesse sowie der Gefaesse von Niere und Leber finden Sie Kapitel zu den Themen: Haemodialyseshunt, arteriovenoese Malformationen, Duplexsonographie des Penis und Tumorvaskularisation. (orig./AJ)

Clinical use of minoxidil (Loniten)1

Science.gov (United States)

Joekes, A M; Thompson, F D; O'Regan, P F B

1981-01-01

The powerful peripheral vasodilator minoxidil, in a dose of 5–40 mg daily, controlled the previously refractory blood pressure in 45 out of 47 patients for periods up to fifty-seven months. The majority of the previous polypharmacy was withdrawn, leaving most of the patients taking a beta-blocking drug, minoxidil and a diuretic. Severe sodium retention leading to congestive cardiac failure necessitated the withdrawal of the drug in 3 patients. In one patient the drug was discontinued because of postural hypotension, and it was withdrawn in 2 female patients because of hirsutism. Five patients were removed from the trial as they were started on chronic maintenance haemodialysis or received a renal transplant. Significant glucose intolerance developed in one patient, requiring the addition of an oral hypoglycaemic agent. The 4 deaths that occurred were not directly related to treatment. Following the oral administration of 5 mg minoxidil, an obvious reduction in both the systolic and diastolic pressure was seen in two hours. PMID:7230242

Suppressing unsteady flow in arterio-venous fistulae

Science.gov (United States)

Grechy, L.; Iori, F.; Corbett, R. W.; Shurey, S.; Gedroyc, W.; Duncan, N.; Caro, C. G.; Vincent, P. E.

2017-10-01

Arterio-Venous Fistulae (AVF) are regarded as the "gold standard" method of vascular access for patients with end-stage renal disease who require haemodialysis. However, a large proportion of AVF do not mature, and hence fail, as a result of various pathologies such as Intimal Hyperplasia (IH). Unphysiological flow patterns, including high-frequency flow unsteadiness, associated with the unnatural and often complex geometries of AVF are believed to be implicated in the development of IH. In the present study, we employ a Mesh Adaptive Direct Search optimisation framework, computational fluid dynamics simulations, and a new cost function to design a novel non-planar AVF configuration that can suppress high-frequency unsteady flow. A prototype device for holding an AVF in the optimal configuration is then fabricated, and proof-of-concept is demonstrated in a porcine model. Results constitute the first use of numerical optimisation to design a device for suppressing potentially pathological high-frequency flow unsteadiness in AVF.

Near death by milk of magnesia.

Science.gov (United States)

Alaini, Ahmed; Roldan, Carlos A; Servilla, Karen; Colombo, Elizabeth Sage

2017-03-21

We report a case of hypermagnesemia associated with the use of milk of magnesia in a male patient with end-stage renal disease. After experiencing nausea and vomiting, he developed severe bradycardia and then asystole. Resuscitation efforts were successful; however, he developed atrial fibrillation with severe widening of the QRS and diffuse ST elevation, hypothermia, hypotension and apnoea requiring intubation. Initial diagnoses included ST-elevation myocardial infarction, cardiogenic and/or septic shock and hyperkalaemia. However, serum magnesium was later found to be >4.1 mmol/L (equivalent to >10 mg/dL). He underwent haemodialysis (HD) to remove serum magnesium with remarkable overall improvement. Severe hypermagnesemia can manifest with severe bradycardia and asystole, shock, hypothermia and respiratory failure and can mimic acute coronary syndromes complicated with cardiogenic shock or septic shock. Therefore, clinicians should be aware of this life-threatening condition in patients with significant renal dysfunction. Timely treatment with HD is highly effective and lifesaving. 2017 BMJ Publishing Group Ltd.

Suicidal intoxication with potassium chlorate successfully treated with renal replacement therapy and extracorporeal liver support.

Science.gov (United States)

Sein Anand, Jacek; Barwina, Małgorzata; Zajac, Maciej; Kaletha, Krystian

2012-01-01

We present a case of a 22-year-old male who, in a suicide attempt, ingested approximately 200 g of potassium chlorate. Upon admission to the hospital, he presented in full respiratory failure with cyanosis. Methylene blue antidote was given but found to be ineffective. The patient was intubated and mechanical ventilation was initiated. Because of renal failure with anuria, intermittent haemodialysis (iHD) followed by continuous venovenous hemodiafiltration (CVVHDF) was performed. His hospital stay was also complicated by hemolysis, disseminated intravascular coagulation, and atrial fibrillation. Transfusions of packed red blood cells, platelets, and fresh frozen plasma were necessary to correct the deficits. He also developed liver failure and required two sessions of molecular adsorbent recirculating system (MARS) therapy. On day 14 of his hospitalization, he regained consciousness, as well as full respiratory and circulatory function. There are no controlled studies addressing management of potassium chlorate poisoning. We suggest that early renal replacement therapy should be strongly considered.

Ethylene and ammonia traces measurements from the patients' breath with renal failure via LPAS method

Science.gov (United States)

Popa, C.; Dutu, D. C. A.; Cernat, R.; Matei, C.; Bratu, A. M.; Banita, S.; Dumitras, D. C.

2011-11-01

The application of laser photoacoustic spectroscopy (LPAS) for fast and precise measurements of breath biomarkers has opened up new promises for monitoring and diagnostics in recent years, especially because breath test is a non-invasive method, safe, rapid and acceptable to patients. Our study involved assessment of breath ethylene and breath ammonia levels in patients with renal failure receiving haemodialysis (HD) treatment. Breath samples from healthy subjects and from patients with renal failure were collected using chemically inert aluminized bags and were subsequently analyzed using the LPAS technique. We have found out that the composition of exhaled breath in patients with renal failure contains not only ethylene, but also ammonia and gives valuable information for determining efficacy and endpoint of HD. Analysis of ethylene and ammonia traces from the human breath may provide insight into severity of oxidative stress and metabolic disturbances and may ensure optimal therapy and prevention of pathology at patients on continuous HD.

Infective endocarditis in Turkey: aetiology, clinical features, and analysis of risk factors for mortality in 325 cases

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Serap Şimşek-Yavuz

2015-01-01

Conclusions: In Turkey, IE occurs in relatively young patients and Brucella spp should always be taken into consideration as a cause of this infection. We should first consider streptococci as the causative agents of IE in young patients, those with CRHD or congenital heart valve disease, and cases of community-acquired IE. Staphylococci should be considered first in the case of pacemaker lead IE, when there are high levels of creatinine, and in cases of healthcare-associated IE. Enterococci could be the most probable causative agent of IE particularly in patients aged >50 years, those on dialysis, those with late prosthetic valve IE, and those with a perivalvular abscess. The early diagnosis and treatment of IE before complications develop is crucial because the mortality rate is high among cases with serious complications. The prevention of bacteraemia with the measures available among chronic haemodialysis patients should be a priority because of the higher mortality rate of subsequent IE among this group of patients.

Biocompatible Peritoneal Dialysis Fluids: Clinical Outcomes

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Yeoungjee Cho

2012-01-01

Full Text Available Peritoneal dialysis (PD is a preferred home dialysis modality and has a number of added advantages including improved initial patient survival and cost effectiveness over haemodialysis. Despite these benefits, uptake of PD remains relatively low, especially in developed countries. Wider implementation of PD is compromised by higher technique failure from infections (e.g., PD peritonitis and ultrafiltration failure. These are inevitable consequences of peritoneal injury, which is thought to result primarily from continuous exposure to PD fluids that are characterised by their “unphysiologic” composition. In order to overcome these barriers, a number of more biocompatible PD fluids, with neutral pH, low glucose degradation product content, and bicarbonate buffer have been manufactured over the past two decades. Several preclinical studies have demonstrated their benefit in terms of improvement in host cell defence, peritoneal membrane integrity, and cytokine profile. This paper aims to review randomised controlled trials assessing the use of biocompatible PD fluids and their effect on clinical outcomes.

Effect of water deionisers on 'fracturing osteodystrophy' and dialysis encephalopathy in Plymouth.

Science.gov (United States)

Leather, H M; Lewin, I G; Calder, E; Braybrooke, J; Cox, R R

1981-01-01

In the Plymouth area, 95 patients with end-stage renal failure have undergone haemodialysis for 6 months or longer. Of the 47 patients beginning dialysis between 1967 and 1973, when water deionisers were not used routinely, a bone disease with multiple fractures, 'fracturing osteodystrophy', occurred in 18 patients and dialysis encephalopathy in 10. Of the 48 patients first dialysing between 1974 and 1979, when water deionisers used commonly, fracturing osteodystrophy occurred in only one and dialysis encephalopathy also in only one. Duration of dialysis without a water deioniser appeared to be the most important factor in the development of these two conditions. The use of water deionisers usually led to healing of fractures in patients with fracturing osteodystrophy and also led to improvement in 4 of the 11 patients with dialysis encephalopathy. Neither condition has occurred in any patient using a water deioniser from the first dialysis. Water deionisers, therefore, appeared to be effective in both the treatment and prevention of fracturing osteodystrophy and dialysis encephalopathy.

Cerebral metabolic changes in neurologically presymptomatic patients undergoing haemodialysis: in vivo proton MR spectroscopic findings

International Nuclear Information System (INIS)

Chiu, Ming-Lun; Chiang, I. Chan; Li, Chun-Wei; Chang, Jer-Ming; Ko, Chih-Hung; Chuang, Hung-Yi; Sheu, Reu-Sheng; Lee, Chen-Chang; Hsieh, Tsyh-Jyi

2010-01-01

To prospectively investigate and detect early cerebral metabolic changes in patients with end-stage renal disease (ESRD) by using in vivo proton MR spectroscopy (MRS). We enrolled 32 patients with ESRD and 32 healthy controls between the ages of 26 and 50 years. Short echo time single-voxel proton MRS was acquired from volumes of interest (VOIs) located in the frontal grey and white matter, temporal white matter and basal ganglia. The choline/phospatidylcholine (Cho), myo-inositol (mI), N-acetylaspartate (NAA) and total creatine (tCr) peaks were measured and the metabolic ratios with respect to tCr were calculated. In the ESRD group, significant elevations of the Cho/tCr and mI/tCr ratios were observed for the frontal grey matter, frontal white matter, temporal white matter and basal ganglia as compared with controls. There was no significant difference in the NAA/tCr ratios at all VOIs between the ESRD patients and the healthy controls. Proton MRS is a useful and non-invasive imaging tool for the detection of early cerebral metabolic changes in neurologically presymptomatic ESRD patients. (orig.)

Reduced Mortality in Maintenance Haemodialysis Patients on High versus Low Dialysate Magnesium: A Pilot Study

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Christoph Schmaderer

2017-08-01

Full Text Available Background: Although low magnesium levels have been associated with an increased mortality in dialysis patients, they are kept low by routinely-used dialysates containing 0.50 mmol/L magnesium. Thus, we investigated the impact of a higher dialysate magnesium concentration on mortality. Methods: 25 patients on high dialysate magnesium (HDM of 0.75 mmol/L were 1:2 matched to 50 patients on low dialysate magnesium (LDM of 0.50 mmol/L and followed up for 3 years with regards to all-cause and cardiovascular mortality. Patients were matched according to age, gender, a modified version of the Charlson Comorbidity Index (CCI, and smoking status. Results: During the follow-up period, five patients died in the HDM and 18 patients in the LDM group. Patients in the HDM group had significantly higher ionized serum magnesium levels than matched controls (0.64 ± 0.12 mmol/L vs. 0.57 ± 0.10 mmol/L, p = 0.034. Log rank test showed no difference between treatment groups for all-cause mortality. After adjustment for age and CCI, Cox proportional hazards regression showed that HDM independently predicted a 65% risk reduction for all-cause mortality (hazard ratio 0.35, 95% confidence interval [CI]: 0.13, 0.97. Estimated 3-year probability of death from a cardiovascular event was 14.5% (95% CI: 7.9, 25.8 in the LDM group vs. 0% in the HDM group. Log rank test found a significant group difference for cardiovascular mortality (χ2 = 4.15, p = 0.042. Conclusions: Our data suggests that there might be a beneficial effect of an increased dialysate magnesium on cardiovascular mortality in chronic dialysis patients.

Treatment of secondary hyperparathyroidism in haemodialysis patients: a randomised clinical trial comparing paricalcitol and alfacalcidol

DEFF Research Database (Denmark)

Hansen, Ditte; Brandi, Lisbet; Rasmussen, Knud

2009-01-01

BACKGROUND: Secondary hyperparathyroidism is a common feature in patients with chronic kidney disease. Its serious clinical consequences include renal osteodystrophy, calcific uremic arteriolopathy, and vascular calcifications that increase morbidity and mortality.Reduced synthesis of active vita...... in the risk of cardiovascular mortality depending on which vitamin D analog that are used. This has potential major importance for this group of patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT00469599....... vitamin D contributes to secondary hyperparathyroidism. Therefore, this condition is managed with activated vitamin D. However, hypercalcemia and hyperphosphatemia limit the use of activated vitamin D.In Denmark alfacalcidol is the primary choice of vitamin D analog.A new vitamin D analog, paricalcitol...... and hyperphosphatemia are associated with increased cardiovascular mortality in patients with chronic kidney disease.If there is any difference in the ability of these two vitamin D analogs to decrease the secondary hyperparathyroidism without causing hypercalcemia and hyperphosphatemia, there may also be a difference...

Cerebral metabolic changes in neurologically presymptomatic patients undergoing haemodialysis: in vivo proton MR spectroscopic findings

Energy Technology Data Exchange (ETDEWEB)

Chiu, Ming-Lun; Chiang, I. Chan [Kaohsiung Medical University Hospital, Department of Medical Imaging (China); Li, Chun-Wei [Kaohsiung Medical University, Department of Medical Imaging and Radiological Sciences, College of Health Science (China); Chang, Jer-Ming [Kaohsiung Medical University, Department of Internal Medicine, Kaohsiung Hsiao-Kang Municipal Hospital (China); Kaohsiung Medical University, Department of Nephrology, School of Medicine, College of Medicine (China); Ko, Chih-Hung [Kaohsiung Medical University, Department of Psychiatry, School of Medicine, College of Medicine (China); Kaohsiung Medical University Hospital, Department of Psychiatry (China); Chuang, Hung-Yi [Kaohsiung Medical University, Faculty of Public Health, College of Health Science (China); Kaohsiung Medical University Hospital, Department of Environmental and Occupational Medicine (China); Sheu, Reu-Sheng [Kaohsiung Medical University, Department of Radiology, Kaohsiung Municipal Hsiao-Kang Hospital (China); Kaohsiung Medical University, Department of Radiology, Faculty of Medicine, College of Medicine (China); Lee, Chen-Chang [Kaohsiung Medical University, Department of Medical Imaging and Radiological Sciences, College of Health Science (China); Kaohsiung Medical Centre, Department of Radiology, Chang Gung Memorial Hospital (China); Hsieh, Tsyh-Jyi [Kaohsiung Medical University Hospital, Department of Medical Imaging (China); Kaohsiung Medical University, Department of Radiology, Faculty of Medicine, College of Medicine (China); Kaohsiung Municipal Ta-Tung Hospital, Department of Medical Imaging (China)

2010-06-15

To prospectively investigate and detect early cerebral metabolic changes in patients with end-stage renal disease (ESRD) by using in vivo proton MR spectroscopy (MRS). We enrolled 32 patients with ESRD and 32 healthy controls between the ages of 26 and 50 years. Short echo time single-voxel proton MRS was acquired from volumes of interest (VOIs) located in the frontal grey and white matter, temporal white matter and basal ganglia. The choline/phospatidylcholine (Cho), myo-inositol (mI), N-acetylaspartate (NAA) and total creatine (tCr) peaks were measured and the metabolic ratios with respect to tCr were calculated. In the ESRD group, significant elevations of the Cho/tCr and mI/tCr ratios were observed for the frontal grey matter, frontal white matter, temporal white matter and basal ganglia as compared with controls. There was no significant difference in the NAA/tCr ratios at all VOIs between the ESRD patients and the healthy controls. Proton MRS is a useful and non-invasive imaging tool for the detection of early cerebral metabolic changes in neurologically presymptomatic ESRD patients. (orig.)

Efficacy and its predictor in microwave ablation for severe secondary hyperparathyroidism in patients undergoing haemodialysis.

Science.gov (United States)

Diao, Zongli; Liu, Xu; Qian, Linxue; Liu, Jing; Liu, Sha; Liu, Wenhu

2016-09-01

Microwave ablation (MWA) can be used to treat severe secondary hyperparathyroidism; however, its efficacy and the predictor of its efficacy are unclear. In this retrospective study we determined the predictor of efficacy of MWA and compared the efficacy of MWA and parathyroidectomy. Patients with severe secondary hyperparathyroidism who had received MWA or parathyroidectomy were enrolled in the study. Participants with MWA were divided into response and no response groups based on efficacy. Possible predictors were analysed using logistic regression to determine efficacy predictors. The participants were divided into MWA and parathyroidectomy groups, and the efficacy (including rates of achieving recommended goals for intact parathyroid hormone (iPTH), calcium, and phosphorus levels) were compared between the two groups. Thirty-one participants were enrolled for predictor analysis. Only baseline iPTH level predicted efficacy (OR 0.997, P = 0.018). The optimal threshold value of iPTH for predicting efficacy was 1493.5 pg/mL. To compare efficacy, 30 patients were enrolled in MWA (18/30) and parathyroidectomy (12/30) groups. The rates of achieving recommended goals for iPTH levels varied between 0 and 60%; a significant difference was found between the groups at 5 months (P = 0.01). However, in the parathyroidectomy group, the iPTH level and rate of iPTH secondary hyperparathyroidism; parathyroidectomy is more effective for severe secondary hyperparathyroidism than MWA.

Bayesian pharmacokinetics of lithium after an acute self-intoxication and subsequent haemodialysis: a case report

NARCIS (Netherlands)

Kerbusch, Thomas; Mathôt, Ron A. A.; Otten, Hans M. M. B.; Meesters, Eelco W.; van Kan, Hendrikus J. M.; Schellens, Jan H. M.; Beijnen, Jos H.

2002-01-01

We report a case of a 39-year-old male with bipolar affective disorder who was admitted to hospital with an intentional acute lithium intoxication resulting in renal insufficiency. The patient had previously been treated with lithium, risperidone, fluoxetine and lorazepam, and successfully titrated

Chronic kidney disease: information on southern brazilian patients with kidney disease - 10.4025/actascihealthsci.v34ispec.16048 Chronic kidney disease: information on southern brazilian patients with kidney disease - 10.4025/actascihealthsci.v34ispec.16048

Directory of Open Access Journals (Sweden)

Maria Dalva de Barros Carvalho

2012-12-01

Full Text Available The profile of patients undergoing haemodialysis in the dialysis unit of Hospital Santa Casa de Maringá, Maringá PR Brazil, is provided. A questionnaire on social and economic data and underlying diseases prior to the Chronic Kidney Disease (CKD identified the patients’ profile. The project was approved by the Ethics Committee of the institution. Eighty-three patients, with 54.21% males, were interviewed. Age bracket ranged between 20 and 59 years in 65.06% of patients. Only 27.71% maintained jobs after the diagnosis and the start of treatment; 63.86% had an average personal income between 1 and 3 minimum wages; 63.85% did not practice any physical activity. Moreover, 53.01% belonged to the European-Brazilian white group; 20.48% to the Afro-Brazilian brown group; 19.28% to the Afro-Brazilian Negro group; 6.02% to other ethnic groups. Further, 85.54% patients reported having an underlying disease prior to the CKD, namely, 61.45% were hypertensive; 31.33% were diabetics and 20.48% had other diseases. Results show the need of a greater attention to these patients’ health care to reduce the negative impacts related to the chronic disease focused.The profile of patients undergoing haemodialysis in the dialysis unit of Hospital Santa Casa de Maringá, Maringá PR Brazil, is provided. A questionnaire on social and economic data and underlying diseases prior to the Chronic Kidney Disease (CKD identified the patients’ profile. The project was approved by the Ethics Committee of the institution. Eighty-three patients, with 54.21% males, were interviewed. Age bracket ranged between 20 and 59 years in 65.06% of patients. Only 27.71% maintained jobs after the diagnosis and the start of treatment; 63.86% had an average personal income between 1 and 3 minimum wages; 63.85% did not practice any physical activity. Moreover, 53.01% belonged to the European-Brazilian white group; 20.48% to the Afro-Brazilian brown group; 19.28% to the Afro-Brazilian Negro

Improving arteriovenous fistula patency: Transdermal delivery of diclofenac reduces cannulation-dependent neointimal hyperplasia via AMPK activation

Science.gov (United States)

MacAskill, Mark G.; Watson, David G.; Ewart, Marie-Ann; Wadsworth, Roger; Jackson, Andrew; Aitken, Emma; MacKenzie, Graeme; Kingsmore, David; Currie, Susan; Coats, Paul

2015-01-01

Creation of an autologous arteriovenous fistula (AVF) for vascular access in haemodialysis is the modality of choice. However neointimal hyperplasia and loss of the luminal compartment result in AVF patency rates of ~ 60% at 12 months. The exact cause of neointimal hyperplasia in the AVF is poorly understood. Vascular trauma has long been associated with hyperplasia. With this in mind in our rabbit model of AVF we simulated cannulation autologous to that undertaken in vascular access procedures and observed significant neointimal hyperplasia as a direct consequence of cannulation. The neointimal hyperplasia was completely inhibited by topical transdermal delivery of the non-steroidal anti-inflammatory (NSAID) diclofenac. In addition to the well documented anti-inflammatory properties we have identified novel anti-proliferative mechanisms demonstrating diclofenac increases AMPK-dependent signalling and reduced expression of the cell cycle protein cyclin D1. In summary prophylactic transdermal delivery of diclofenac to the sight of AVF cannulation prevents adverse neointimal hyperplasic remodelling and potentially offers a novel treatment option that may help prolong AVF patency and flow rates. PMID:25866325

Cemento-ossifying fibroma in a patient with end-stage renal disease.

Science.gov (United States)

Gopinath, Divya; Beena, V T; Sugirtharaj, G; Vidhyadharan, K; Salmanul Faris, K; Kumar, Sajai J

2013-01-01

The presence of chronic renal disease (CRD) is a predisposing factor for the occurrence of soft and hard tissue lesions in the oral cavity. The cemento-ossifying fibroma (COF) is an uncommon benign fibroosseous lesion composed of fibrocellular component and calcified materials like cementum and woven bone. A 37-year-old female patient undergoing chronic haemodialysis reported to our institution with a complaint of slow growing, nontender swelling of mandible of 6-month duration. Computed tomography disclosed an ill-defined lesion showing thinning and expansion of buccal as well as lingual cortical plate with flecks of radiopacity in centre. Incision biopsy revealed histological characteristics consistent with cemento-ossifying fibroma. The lesion was excised under local anesthesia. The histopathological examination revealed irregularly shaped bone and cementum-like hard tissue calcifications contained within hypercellular fibrous tissue stroma, leading to a confirmation of the diagnosis of cemento-ossifying fibroma. This paper aims to provide light to the fact that the soft and hard tissues of the oral region may become susceptible to the development of pathological growths in case of some particular systemic conditions.

Sustainability of the Peritoneal Dialysis-First Policy in Hong Kong.

Science.gov (United States)

Choy, Agnes Shin-Man; Li, Philip Kam-Tao

2015-01-01

In Hong Kong, the average annual cost of haemodialysis (HD) per patient is more than double of that of peritoneal dialysis (PD). As the number of patients with end-stage renal disease (ESRD) has surged, it has posed a great financial burden to the government and society. A PD-first policy has been implemented in Hong Kong for three decades based on its cost-effectiveness, and has achieved successful outcomes throughout the years. A successful PD-first policy requires medical expertise in PD, the support of dedicated staff and a well-designed patient training programme. Addressing patients' PD problems is the key to sustainability of the PD-first policy. In this article, we highlight three important groups of patients: those with frequent peritonitis, ultrafiltration failure or inadequate dialysis. Potential strategies to improve the outcomes of these groups will be discussed. Moreover, enhancing HD as back-up support and promoting organ transplantation are needed in order to maintain sustainability of the PD-first policy. © 2015 S. Karger AG, Basel.

Cardiac failure due to arteriovenous fistula with brachiocephalic stenosis: a gated heart case study

International Nuclear Information System (INIS)

Abel, G.; Irish, A.; Henderson, A.; Lenzo, N.

2003-01-01

Full text: There are numerous causes of cardiac failure of which the commonest in our community include ischaemic cardiomyopathy, post-viral cardiomyopathy, alcohol-induced cardiomyopathy and drug-induced cardiomyopathy. All these entities cause low output cardiac failure however high output cardiac failure is also well recognised. This includes heart failure related to such conditions as hyperthyroidism, anaemia, pregnancy, beri-beri, and Paget's disease. A rare cause of high output cardiac failure is an arteriovenous fistula. We present an unusual case of a patient with end-stage renal failure on haemodialysis who developed extensive dilatation of their left arm arteriovenous fistula secondary to bachiocephalic vein stenosis. The labelled red blood cell gated heart blood pool study demonstrated decreased left ventricular function and extensive pooling of blood within the tortuous dilated left arm vessels. A follow-up study post-ligation of the arteriovenous fistula showed improvement of the left ventricular ejection fraction. The associated contrast venography findings are also demonstrated. Copyright (2003) The Australian and New Zealand Society of Nuclear Medicine Inc

Hepatitis C Virus in Arab World: A State of Concern

Directory of Open Access Journals (Sweden)

Mohamed A. Daw

2012-01-01

Full Text Available Hepatitis C virus has been considered to be one of the most important devastating causes of chronic hepatitis, cirrhosis, and hepatic cellular carcinoma. The prevalence of such virus varies greatly over the world. Arab world has a unique geography and consists over nineteen countries who share the same heritage and customs and do speak the same language. In this area, the epidemiology of hepatitis C is not well understandable. Hepatitis C virus was found to be endemic in Arabia. The serostatus of such virus was found to be variable among these countries with uniform patterns of genotypes. Such prevalence varies tremendously according to the risk factors involved. Blood and blood products, haemodialysis, intravenous, and percutaneous drug users, and occupational, habitual, and social behavior were found to be the important factors involved. Hepatitis C will have major social, economic, and even political burdens on such young and dynamic societies. Thus, strategies and clear policy of intervention are urgently needed to combat the consequences of HCV both regionally and at state level of each country.

Acute renal failure requiring dialysis--a 5 year series.

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Hooi, L S

1997-09-01

A retrospective review of 246 patients with established acute renal failure (ARF) needing dialysis from 1990-1994 is reported from Hospital Sultanah Aminah, Johor Bahru. Peritoneal dialysis was more commonly used than haemodialysis or haemofiltration. Patients on mechanical ventilation in Intensive Care Unit (ICU) who were hypercatabolic and fluid overloaded were treated with haemofiltration. Males outnumbered females by a ratio of 1.5:1. The majority were Malays (61.4%). Most patients were from the district of Johor Bahru, but 41.5% were from other districts in the Johor state. The mean age was 47.1 years (SD 18.2). The ARF was caused by acute tubular necrosis in 55.3%, post-renal obstruction in 22.8%, nephrotoxins in 5.7% and other causes in 16.2%. The proportions of patients referred from the medical, surgical and obstetric and gynaecology units were 50.8%, 45.5% and 3.7% respectively. The mortality rate was 48%. Patients with established ARF should be dialysed early as they tolerate uraemia poorly. Prevention is by prompt treatment of patients with sepsis, avoidance of hypovolaemia and nephrotoxic drugs.

Persistent bacteraemia caused by Staphylococcus aureus in the gall bladder.

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Yu, Alexander Tin Han; Cun, Tony; Benamu, Esther; Renault, Cybele

2017-11-08

Staphylococcus aureus bacteraemia (SAB) remains a complex disease with a high associated morbidity and mortality, especially when it is able to establish an occult nidus safe from antimicrobial eradication. Without rapid identification and intervention, the nidus can cause persistent relapse of disease, morbidity and mortality. Having a high clinical suspicion for the foci of occult S. aureus is important, and awareness of potential sites of infection is critical and can be life-saving.We present a unique case of a 65-year-old man with end-stage renal disease receiving haemodialysis who developed septic shock from SAB. Despite 18 days of appropriate antibiotics, the patient had persistent high-grade bacteraemia until his gall bladder was ultimately percutaneously drained. The day after drainage, he cleared his blood cultures, although he ultimately passed away as he decided to transition his care to focus on comfort measures. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Polyomavirus BK replication in renal transplant recipients: combined monitoring of viremia and VP1 mRNA in urine

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Sara Astegiano

2010-06-01

Full Text Available Introduction. Human polyomavirus BK (BKV is worldwide distributed, with a seroprevalence rate of 70–90% in the adults. Following primary infection, BK remains latent in the renourinary tract as the epidemiologically most relevant latency site, and in B cell, brain, spleen and probably other tissues. Reactivation may occur in both immunocompetent subjects and immunocompromised patients. In renal transplantation, in the context of intense immunosuppression, viral replication may determine BKV-associated nephropathy (BKVAN with interstitial nephritis and/or ureteral stenosis in 1–10% of the patients and leading to graft failure and return to haemodialysis in 30 to 80% of the cases (5. Screening of BKV replication represents the basic strategy to predict early the onset of BKVAN and may allow for earlier intervention with reduced allograft loss (3, 4. Nowadays, replication of BKV is monitored by quantification of BKV-DNA in serum and urine (2. The aim of this study was to evaluated the role of BKV VP1 mRNA in urine as a marker of viral replication in renal transplant recipients.

Research Update: Facile synthesis of CoFe2O4 nano-hollow spheres for efficient bilirubin adsorption

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Rakshit, Rupali; Pal, Monalisa; Chaudhuri, Arka; Mandal, Madhuri; Mandal, Kalyan

2015-11-01

Herein, we report an unprecedented bilirubin (BR) adsorption efficiency of CoFe2O4 (CFO) nanostructures in contrast to the commercially available activated carbon and resin which are generally used for haemoperfusion and haemodialysis. We have synthesized CFO nanoparticles of diameter 100 nm and a series of nano-hollow spheres of diameter 100, 160, 250, and 350 nm using a simple template free solvothermal technique through proper variation of reaction time and capping agent, oleylamine (OLA), respectively, and carried out SiO2 coating by employing Stöber method. The comparative BR adsorption study of CFO and SiO2 coated CFO nanostructures indicates that apart from porosity and hollow configuration of nanostructures, the electrostatic affinity between anionic carboxyl group of BR and cationic amine group of OLA plays a significant role in adsorbing BR. Finally, we demonstrate that the BR adsorption capacity of the nanostructures can be tailored by varying the morphology as well as size of the nanostructures. We believe that our developed magnetic nanostructures could be considered as a potential material towards therapeutic applications against hyperbilirubinemia.

Cognitive function and advanced kidney disease: longitudinal trends and impact on decision-making.

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Iyasere, Osasuyi; Okai, David; Brown, Edwina

2017-02-01

Background: Cognitive impairment commonly affects renal patients. But little is known about the influence of dialysis modality on cognitive trends or the influence of cognitive impairment on decision-making in renal patients. This study evaluated cognitive trends amongst chronic kidney disease (CKD), haemodialysis (HD) and peritoneal dialysis (PD) patients. The relationship between cognitive impairment and decision-making capacity (DMC) was also assessed. Methods: Patients were recruited from three outpatient clinics. Cognitive function was assessed 4-monthly for up to 2 years, using the Montreal Cognitive Assessment (MoCA) tool. Cognitive trends were assessed using mixed model analysis. DMC was assessed using the Macarthur Competency Assessment tool (MacCAT-T). MacCAT-T scores were compared between patients with cognitive impairment (MoCA cognitive impairment had lower MacCAT-T compared with those without [median (interquartile range) 19 (17.9-19.6) versus 17.4 (16.3-18.4); P = 0.049]. Conclusions: Cognition declines faster in dialysis patients compared with CKD patients and in HD patients compared with PD patients. Cognitive impairment affects DMC in patients with advanced kidney disease.

Clearing of toxic substances: are there differences between the available liver support devices?

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Krisper, Peter; Stadlbauer, Vanessa; Stauber, Rudolf E

2011-09-01

Toxins accumulating in liver failure split into water solved (e.g. ammonia) and albumin bound substances (e.g. bilirubin). Because the latter cannot be removed by conventional haemodialysis, special liver support systems have been developed. The majority of data concerning elimination efficiency exist for the cell-free devices Molecular Adsorbent Recirculating System (MARS) and Prometheus, as they have been commercially available in Europe since many years. Overall, Prometheus provides higher clearances for most liver toxins, especially if they are tightly albumin bound. However, for bile acids and cytokines no such differences could be found. Single pass albumin dialysis (SPAD) can be assumed to be equally effective as MARS. None of the bioartificial liver support systems being developed is on the market today and published clearance data are scarce. In general, clearance efficiency for albumin bound substances is relatively low in all systems currently available. Besides optimizing biocompatibility and selectivity, future technologies should also focus on improved detoxification efficiency of liver support devices. © 2011 John Wiley & Sons A/S.

Acute Renal Failure Induced by Chinese Herbal Medication in Nigeria

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Effiong Ekong Akpan

2015-01-01

Full Text Available Traditional herbal medicine is a global phenomenon especially in the resource poor economy where only the very rich can access orthodox care. These herbal products are associated with complications such as acute renal failure and liver damage with a high incidence of mortalities and morbidities. Acute renal failure from the use of herbal remedies is said to account for about 30–35% of all cases of acute renal failure in Africa. Most of the herbal medications are not usually identified, but some common preparation often used in Nigeria includes “holy water” green water leaves, bark of Mangifera indica (mango, shoot of Anacardium occidentale (cashew, Carica papaya (paw-paw leaves, lime water, Solanum erianthum (Potato tree, and Azadirachta indica (Neem trees. We report a rare case of a young man who developed acute renal failure two days after ingestion of Chinese herb for “body cleansing” and general wellbeing. He had 4 sessions of haemodialysis and recovered kidney function fully after 18 days of admission.

Citrate dialysate does not induce oxidative stress or inflammation in vitro as compared to acetate dialysate

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Rafael Pérez-García

2017-11-01

Full Text Available Increased acetataemia during haemodialysis sessions has been associated with a number of abnormalities, including increased oxidative stress, pro-inflammatory cytokines and nitric oxide synthesis. Citric acid may play an alternative role to acetate as a dialysate stabilizer given that the effect of citrate on complement and leukocyte activation is different to that of acetate. The purpose of this study was to compare the inflammatory effect in immunocompetent blood cells of acetate dialysate and citrate dialysate. Materials and methods: The effect of acetate and/or citrate was investigated in the whole blood of uremic patients and in healthy in vitro samples. Four types of dialysate were tested: dialysate 1, acetate-free with 1 mmol/L of citrate; dialysate 2, with 0.8 mmol/L of citrate and 0.3 mmol/L of acetate; dialysate 3, citrate-free with 3 mmol/L of acetate; and dialysate 4, citrate-free with 4 mmol/L of acetate. The cell types used were: human monocyte culture (THP-1; and peripheral blood mononuclear cells (PBMCs from healthy subjects and uremic patients on haemodialysis. ICAM-1 was determined and levels of reactive oxygen species and total microvesicles were quantified. Results: Unlike the citrate dialysates, the dialysates with acetate (dialysate 3 and dialysate 4 induced increased ICAM-1 expression density in THP-1 cells; an increase in ICAM-1 expression was observed in the immunocompetent cells of healthy subjects with acetate dialysate (dialysate 3 and dialysate 4 but not with citrate dialysate (dialysate 1 and dialysate 2. No significant ICAM-1 differences were found between the different dialysates in the cells of haemodialysed patients. Reactive oxygen species expression and the number of microvesicles increased significantly with acetate dialysate but not with citrate dialysate in the cells of both healthy subjects and haemodialysed patients. Conclusion: At the concentrations in which it is generally used in clinical practice

Effective flow performances and dialysis doses delivered with permanent catheters: a 24-month comparative study of permanent catheters versus arterio-venous vascular accesses.

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Canaud, Bernard; Leray-Moragues, Hélène; Kerkeni, Nadia; Bosc, Jean-Yves; Martin, Katja

2002-07-01

Permanent venous catheters have emerged as a long-term vascular access option for renal replacement therapy in end-stage renal disease patients. The design and venous location of catheter devices bear intrinsic flow limitations that may negatively affect the adequacy of dialysis and the patient outcome. There is limited data comparing the long-term dialysis adequacy delivered with permanent catheters vs arterio-venous vascular accesses (AVA). To explore this problem, we conducted a prospective 24-month trial comparing the flow performances and dialysis dose (Kt/Vdp) deliveries of both access options in a group of 42 haemodialysis patients during two study phases. During the first 12 months the patients completed a treatment period by means of permanent dual silicone catheters (DualKT). Then they were transferred to an AVA (40 native arterio-venous fistulas and two PTFE grafts) and monitored for an additional 12-month period. Assessments of flow adequacy and dialysis quantification were performed monthly. Dialysis adequacy was achieved in all cases. No patient had to be transferred prematurely to the AVA because of catheter failure. Three catheters had to be replaced due to bacteraemia in three patients. The mean effective blood flow rates achieved were 316+/-3.5 ml/min and 340+/-3.3 ml/min with DualKT and AVA, respectively, for a pre-set machine blood flow of 348+/-2.2 ml/min. Recirculation rates evaluated with the 'slow blood flow' method were 8.6+/-0.6 and 12.1+/-0.8% for DualKT and AVA using mean values of the solute markers urea and creatinine. Due to the possibility of a comparison veno-venous vs arterio-venous blood circulation, a corrected arterio-venous access recirculation could be derived from the difference between the two, which was around 3%. The blood flow resistance of the DualKT was slightly higher than with AVA as indicated by venous pressure differences. Kt/Vdp delivered was 1.37+/-0.02 and 1.45+/-0.02 with DualKT and AVA access respectively. The

The effect of neuromuscular electrical stimulation on muscle strength, functional capacity and body composition in haemodialysis patients

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Vicent Esteve

2017-01-01

Conclusions: (1 NMES improved muscle strength, functional capacity and quadriceps muscle composition in our patients. (2 Based on the results obtained, NMES could be a new therapeutic alternative to prevent muscle atrophy and progressive physical deterioration. (3 However, future studies are necessary to establish the potential beneficial effects of NMES in HD patients.

The Effectiveness of Cognitive Behavioral Therapy versus Psychoeducation in the Management of Depression among Patients Undergoing Haemodialysis.

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Al Saraireh, Faris A; Aloush, Sami M; Al Azzam, Manar; Al Bashtawy, Mohammed

2018-01-25

The aim of this randomized controlled trial was to compare the effectiveness of psychoeducation versus cognitive behavioral therapy (CBT) in the management of depression among renal dialysis patients. A sample of 130 dialysis patients participated in the study and they were assigned at random to one of two therapies: psychoeducation (N = 65) or CBT (N = 65). Hamilton depression rating scale was completed by the participants in both groups prior to the therapies and after completion. Both therapies were effective in the management of depression, although psychoeducation was superior. Psychoeducation is recommended over CBT in the management of depression among renal dialysis patients.

NT-proBNP and troponin T levels differ after haemodialysis with a low versus high flux membrane

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Laveborn, Emilie; Lindmark, Krister; Skagerlind, Malin; Stegmayr, Bernd

2015-01-01

BACKGROUND: Brain natriuretic peptide (BNP), N-terminal-proBNP (NT-proBNP), and high sensitive cardiac troponin T (TnT) are markers that are elevated in chronic kidney disease and correlate with increased risk of mortality. Data are conflicting on the effect of biomarker levels by hemodialysis (HD).Our aim was to clarify to what extent HD with low-flux (LF) versus high-flux (HF) membranes affects the plasma levels of BNP, NT-proBNP, and TnT. METHODS AND MATERIALS: 31 HD patients were included...

CIRCULATING ANTIBODIES TO ERYTHROPOIETIN ARE ASSOCIATED WITH LOWER EFFICACY OF RECOMBINANT EPOETIN TREATMENT IN PATIENTS UNDERGOING HAEMODIALYSIS

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V. D. Nazarov

2018-01-01

Full Text Available Biological preparations (BP obtained by gene engineering possess a special characteristic called immunogenicity, i.e. propensity of biological drugs to induce an undesired immune response associated with arising anti-drug antibodies. These antibodies can change BP pharmacokinetics and pharmacodynamics, and therapeutical efficacy. A significant proportion of hemodialysis patients with end-stage renal disease treated by recombinant erythropoietin (rEPO have clinical features of resistance to such therapy. The aim of the study was to investigate whether anti-rEPO antibodies are associated with hemoglobin concentrations (Hb and red blood cells counts (RBC in hemodialysis patients, receiving long-term rEPO therapy. This research was performed at the Research Institute of Nephrology at the First St. Petersburg I.Pavlov State Medical University. Thirty-seven hemodialysis patients (pts with end-stage renal disease and anemia treated with different rEPO formulations were included into the study. The patients were further divided into two groups: those with diminished and normal clinical response to rEPO therapy (DCR, n = 21 vs NCR group, n = 16, respectively. To determine threshold levels of antibodies to rEPO-beta (Roche, Switzerland we tested blood serum samples of 35 healthy blood donors who never received rEPO in the past. Concentration of antibodies was measured by means of dot-blot method. The threshold antibody concentrations were defined by measurement of anti-rEPO concentrations in 2-fold stepwise dilutions (1:10 to 1:200 of blood sera from 35 healthy donors .The threshold value for rEPO-binding antibodies was 20.27 µg/ml (95 CI%±0.43. Antibodies to rEPO were found in 54 % of serum samples in the patients. Anti-rEPO antibodies concentrations correlated with mean values of hemoglobin and erythrocyte counts over a period of 12-months for the entire group of hemodialysis patients (r = -0.368, p = 0.025 and r = -0.336, p = 0.042 respectively. Concentration of anti-rEPO antibodies, and the mean weekly rEPO dose were significantly higher in DCR group, compared to NCR group (p = 0.0019. In conclusion, higher levels of anti-rEPO binding antibodies seem to be associated with decreased therapeutic response to the clinically applied rEPO formulations. 

Post-Dilution on Line Haemodiafiltration with Citrate Dialysate: First Clinical Experience in Chronic Dialysis Patients

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Vincenzo Panichi

2013-01-01

Full Text Available Background. Citrate has anticoagulative properties and favorable effects on inflammation, but it has the potential hazards of inducing hypocalcemia. Bicarbonate dialysate (BHD replacing citrate for acetate is now used in chronic haemodialysis but has never been tested in postdilution online haemodiafiltration (OL-HDF. Methods. Thirteen chronic stable dialysis patients were enrolled in a pilot, short-term study. Patients underwent one week (3 dialysis sessions of BHD with 0.8 mmol/L citrate dialysate, followed by one week of postdilution high volume OL-HDF with standard bicarbonate dialysate, and one week of high volume OL-HDF with 0.8 mmol/L citrate dialysate. Results. In citrate OL-HDF pretreatment plasma levels of C-reactive protein and β2-microglobulin were significantly reduced; intra-treatment plasma acetate levels increased in the former technique and decreased in the latter. During both citrate techniques (OL-HDF and HD ionized calcium levels remained stable within the normal range. Conclusions. Should our promising results be confirmed in a long-term study on a wider population, then OL-HDF with citrate dialysate may represent a further step in improving dialysis biocompatibility.

Improving arteriovenous fistula patency: Transdermal delivery of diclofenac reduces cannulation-dependent neointimal hyperplasia via AMPK activation.

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MacAskill, Mark G; Watson, David G; Ewart, Marie-Ann; Wadsworth, Roger; Jackson, Andrew; Aitken, Emma; MacKenzie, Graeme; Kingsmore, David; Currie, Susan; Coats, Paul

2015-08-01

Creation of an autologous arteriovenous fistula (AVF) for vascular access in haemodialysis is the modality of choice. However neointimal hyperplasia and loss of the luminal compartment result in AVF patency rates of ~60% at 12months. The exact cause of neointimal hyperplasia in the AVF is poorly understood. Vascular trauma has long been associated with hyperplasia. With this in mind in our rabbit model of AVF we simulated cannulation autologous to that undertaken in vascular access procedures and observed significant neointimal hyperplasia as a direct consequence of cannulation. The neointimal hyperplasia was completely inhibited by topical transdermal delivery of the non-steroidal anti-inflammatory (NSAID) diclofenac. In addition to the well documented anti-inflammatory properties we have identified novel anti-proliferative mechanisms demonstrating diclofenac increases AMPK-dependent signalling and reduced expression of the cell cycle protein cyclin D1. In summary prophylactic transdermal delivery of diclofenac to the sight of AVF cannulation prevents adverse neointimal hyperplasic remodelling and potentially offers a novel treatment option that may help prolong AVF patency and flow rates. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Measurement of human serum parathyroid hormone in disorders of calcium metabolism and during administration of certain gut hormones

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Coetzee, J.; Klaff, L.J.; Epstein, S.

1980-01-01

A sensitive radio-immunoassay for parathyroid hormone (PTH) using the commercially available antisera AS 211/32 and AS 211/41 has been established. The lower limit of sensitivity of the assay is 0,25 ng/ml. Seventy-nine per cent of normal subjects have PTH levels in the measurable range, with a mean of 0,49 ng/ml (SD more or less 0,26 ng/ml). Only 1 of 9 patients with proven primary hyperparathyroidism had a normal serum PTH value. The mean serum PTH value in this group was 3,0 more or less 0,26 ng/ml, which differed significantly from that in the normal group (P<0,001). The serum PTH level of 33 patients on chronic haemodialysis was uniformly raised, while in 8 patients with hypoparathyroidism PTH levels were undetectable. Patients with malignant disease presented a mixed picture, with raised, normal or undetectable PTH levels. We investigated a possible relationship between the gut hormones, gastrin, secretin and cholecystokininpancreozymin (CCK-PZ) and PTH secretion in human volunteers. No effect was found, although the investigations were conducted over relatively short time periods

Eight-Year Experience with Nocturnal, Every-Other-Day, Online Haemodiafiltration.

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Maduell, Francisco; Ojeda, Raquel; Arias-Guillen, Marta; Rossi, Florencia; Fontseré, Néstor; Vera, Manel; Rico, Nayra; Gonzalez, Leonardo Nicolás; Piñeiro, Gastón; Jiménez-Hernández, Mario; Rodas, Lida; Bedini, José Luis

2016-01-01

New haemodialysis therapeutic regimens are required to improve patient survival. Longer and more frequent dialysis sessions have produced excellent survival and clinical advantages, while online haemodiafiltration (OL-HDF) provides the most efficient form of dialysis treatment. In this single-centre observational study, 57 patients on 4-5-hour thrice-weekly OL-HDF were switched to nocturnal every-other-day OL-HDF. Inclusion criteria consisted of stable patients with good prospects for improved occupational, psychological and social rehabilitation. The aim of this study was to report our 8-year experience with this schedule and to evaluate analytical and clinical outcomes. Nocturnal, every-other-day OL-HDF was well tolerated and 56% of patients were working. The convective volume increased from 26.7 ± 2 litres at baseline to 46.6 ± 6.5 litres at 24 months (p every-other-day OL-HDF could be an excellent therapeutic alternative since it is well tolerated and leads to clinical and social-occupational rehabilitation with satisfactory morbidity and mortality. These encouraging results strengthen us to continue and invite other clinicians to join this initiative. © 2016 S. Karger AG, Basel.

Observational study on markers of cardiovascular risk in renal patient: conventional hemodialysis vs. haemofiltration online.

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Melero-Rubio, Esperanza; Párraga-Díaz, Mateo; Gómez-Sánchez, M Paz; Pellicer-Villaescusa, Silvia; Merchán-Mayado, Esteban

2009-12-01

Homocysteine is considered as independent predictor of cardiovascular risk. Patients treated with haemodialysis (HD) exhibit elevated homocysteine levels, even four times higher than the general population does. This study focuses on the determination of the vascular risk in patients treated with conventional HD and haemodiafiltration on-line (HDF). It was also considered important to determine whether there was a relationship between homocysteine and the variables given to the patient such as dialysis dose, obesity and treatment with folic acid, vitamin B6 and vitamin B12. A one-year cross-sectional observational study was conducted on patients initially treated with renal replacement therapy such as HDF on-line and conventional HD. Data collected included patient's age, sex, aetiology, duration of dialysis treatment and association with dialysis session, including data on body mass index, waist circumference, treatment with vitamin B6, B12 and folic acid. The results obtained conclusively indicate that patients treated with renal replacement therapy such as HDF on-line exhibit lower homocysteine levels than those treated with conventional HD. Therefore we can conclude that: homocysteine markers indicate that patients treated with HDF on-line are exposed to lower average vascular risk.

Impact of Vitamin D on the Cardiovascular System in Advanced Chronic Kidney Disease (CKD) and Dialysis Patients.

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Gluba-Brzózka, Anna; Franczyk, Beata; Ciałkowska-Rysz, Aleksandra; Olszewski, Robert; Rysz, Jacek

2018-06-01

In patients suffering from chronic kidney disease (CKD), the prevalence of cardiovascular disease is much more common than in the general population. The role of vitamin D deficiency had been underestimated until a significant association was found between vitamin D therapy and survival benefit in haemodialysis patients. Vitamin D deficiency is present even in the early stages of chronic kidney disease. The results of experimental studies have revealed the relationship between vitamin D deficiency and impairment of cardiac contractile function, higher cardiac mass and increased myocardial collagen content. Experimental models propose that intermediate end points for the relationship between vitamin D deficiency and higher risk of cardiovascular disease comprise diminished left ventricular hypertrophy (LVH), enhanced left ventricular diastolic function, and decreased frequency of heart failure. Multiple observational studies have demonstrated an association between the use of active vitamin D therapy in patients on dialysis and with CKD and improved survival. However, there are also many studies indicating important adverse effects of such treatment. Therefore, large randomized trials are required to analyze whether supplementation of vitamin D may affect outcomes and whether it is safe to be used in CKD patients.

Cemento-Ossifying Fibroma in a Patient with End-Stage Renal Disease

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Divya Gopinath

2013-01-01

Full Text Available The presence of chronic renal disease (CRD is a predisposing factor for the occurrence of soft and hard tissue lesions in the oral cavity. The cemento-ossifying fibroma (COF is an uncommon benign fibroosseous lesion composed of fibrocellular component and calcified materials like cementum and woven bone. A 37-year-old female patient undergoing chronic haemodialysis reported to our institution with a complaint of slow growing, nontender swelling of mandible of 6-month duration. Computed tomography disclosed an ill-defined lesion showing thinning and expansion of buccal as well as lingual cortical plate with flecks of radiopacity in centre. Incision biopsy revealed histological characteristics consistent with cemento-ossifying fibroma. The lesion was excised under local anesthesia. The histopathological examination revealed irregularly shaped bone and cementum-like hard tissue calcifications contained within hypercellular fibrous tissue stroma, leading to a confirmation of the diagnosis of cemento-ossifying fibroma. This paper aims to provide light to the fact that the soft and hard tissues of the oral region may become susceptible to the development of pathological growths in case of some particular systemic conditions.

Paracetamol (acetaminophen) poisoning.

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Park, B Kevin; Dear, James W; Antoine, Daniel J

2015-10-19

Paracetamol directly causes around 150 deaths per year in UK. We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of treatments for acute paracetamol poisoning? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). At this update, searching of electronic databases retrieved 127 studies. After deduplication and removal of conference abstracts, 64 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 46 studies and the further review of 18 full publications. Of the 18 full articles evaluated, one systematic review was updated and one RCT was added at this update. In addition, two systematic reviews and three RCTs not meeting our inclusion criteria were added to the Comment sections. We performed a GRADE evaluation for three PICO combinations. In this systematic overview we categorised the efficacy for six interventions, based on information about the effectiveness and safety of activated charcoal (single or multiple dose), gastric lavage, haemodialysis, liver transplant, methionine, and acetylcysteine.

Ischaemic memory imaging using metabolic radiopharmaceuticals: overview of clinical settings and ongoing investigations.

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Yoshinaga, Keiichiro; Naya, Masanao; Shiga, Tohru; Suzuki, Eriko; Tamaki, Nagara

2014-02-01

"Ischaemic memory" is defined as a prolonged functional and/or biochemical alteration remaining after a particular episode of severe myocardial ischaemia. The biochemical alteration has been reported as metabolic stunning. Metabolic imaging has been used to detect the footprint left by previous ischaemic episodes evident due to delayed recovery of myocardial metabolism (persistent dominant glucose utilization with suppression of fatty acid oxidation). β-Methyl-p-[(123)I]iodophenylpentadecanoic acid (BMIPP) is a single-photon emission computed tomography (SPECT) radiotracer widely used for metabolic imaging in clinical settings in Japan. In patients with suspected coronary artery disease but no previous myocardial infarction, BMIPP has shown acceptable diagnostic accuracy. In particular, BMIPP plays an important role in the identification of prior ischaemic insult in patients arriving at emergency departments with acute chest pain syndrome. Recent data also show the usefulness of (123)I-BMIPP SPECT for predicting cardiovascular events in patients undergoing haemodialysis. Similarly, SPECT or PET imaging with (18)F-FDG injected during peak exercise or after exercise under fasting conditions shows an increase in FDG uptake in postischaemic areas. This article will overview the roles of ischaemic memory imaging both under established indications and in ongoing investigations.

Successful resuscitation of hypermagnesaemic asystolic cardiac arrest with the use of early transvenous cardiac pacemaker: a case report.

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Miller, M A; Crystal, C S; Helphenstine, J; Young, S E

2006-03-01

A 63 year old woman presented to the emergency department (ED) with 1 week of progressive dyspnoea, constipation, and generalized weakness. She had undergone spinal fustion surgery 10 days previously, and had a history of chronic renal insufficiency. The patient had been using milk of magnesia and magnesium citrate in unknown amounts to alleviate her constipation over this time frame. During her ED stay she became progressively hypotensive and bradycardic, and despite aggressive resuscitative measures she suffered an asystolic arrest 1 hour into her ED course. She was resuscitated with conventional therapy, but her haemodynamic profile did not improve significantly until transvenous cardiac pacing was employed. Her magnesium level was 10.4 mmol/l. Treatment of magnesium overload has focused upon haemodialysis, forced diuresis, and the use of intravenous calcium salts. Case reports have previously documented survival of moderately to severely ill patients when these modalities have been used. Likewise, failure of resuscitation despite use of these methods has been previously noted. To our knowledge, this is the first reported case clearly demonstrating the efficacy of transvenous cardiac pacing to successfully resuscitate a patient upon whom multiple vasopressors, fluids, and calcium previously had no clear effect.

Metformin-associated lactic acidosis mimicking ischaemic bowel.

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Ali, Sajjad; Labuschagne, Heloise; Azarov, Nickolay; Hindi, Zakaria; Oud, Lavi

2018-02-01

Metformin-associated lactic acidosis (MALA) is a rare complication among patients who are diabetic, commonly presenting with non-specific findings, and developing mostly among those with other risk factors for lactic acidosis. We report the development of MALA in a 67-year-old man with diabetes who presented with progressive abdominal pain and bloody diarrhoea. On presentation the patient was in shock, with signs suggestive of peritonitis, and with severe lactic acidosis, renal failure and non-specific findings on abdominal CT. Neither the patient nor family could provide details of his home pharmaceuticals. Circulatory resuscitation with intravenous crystalloids and vasopressors was commenced, along with empiric broad-spectrum antibiotics. Emergent laparotomy did not show pathological findings. Emergent haemodialysis, initiated postoperatively, resulted in rapid resolution of shock and lactic acidosis. A list of patient's medications, provided afterwards by the family, included metformin. Microbiological studies remained negative and renal function normalised by the time of patient's hospital discharge after 9 days. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Ischaemic memory imaging using metabolic radiopharmaceuticals: overview of clinical settings and ongoing investigations

International Nuclear Information System (INIS)

Yoshinaga, Keiichiro; Naya, Masanao; Shiga, Tohru; Suzuki, Eriko; Tamaki, Nagara

2014-01-01

''Ischaemic memory'' is defined as a prolonged functional and/or biochemical alteration remaining after a particular episode of severe myocardial ischaemia. The biochemical alteration has been reported as metabolic stunning. Metabolic imaging has been used to detect the footprint left by previous ischaemic episodes evident due to delayed recovery of myocardial metabolism (persistent dominant glucose utilization with suppression of fatty acid oxidation). β-Methyl-p-[ 123 I]iodophenylpentadecanoic acid (BMIPP) is a single-photon emission computed tomography (SPECT) radiotracer widely used for metabolic imaging in clinical settings in Japan. In patients with suspected coronary artery disease but no previous myocardial infarction, BMIPP has shown acceptable diagnostic accuracy. In particular, BMIPP plays an important role in the identification of prior ischaemic insult in patients arriving at emergency departments with acute chest pain syndrome. Recent data also show the usefulness of 123 I-BMIPP SPECT for predicting cardiovascular events in patients undergoing haemodialysis. Similarly, SPECT or PET imaging with 18 F-FDG injected during peak exercise or after exercise under fasting conditions shows an increase in FDG uptake in postischaemic areas. This article will overview the roles of ischaemic memory imaging both under established indications and in ongoing investigations. (orig.)

Challenging convention: symbolic interactionism and grounded theory.

Science.gov (United States)

Newman, Barbara

2008-01-01

Not very much is written in the literature about decisions made by researchers and the justifications on method as a result of a particular clinical problem, together with an appropriate and congruent theoretical perspective, particularly for Glaserian grounded theory. I contend the utilisation of symbolic interactionism as a theoretical perspective to inform and guide the evolving research process and analysis of data when using classic or Glaserian grounded theory (GT) method, is not always appropriate. Within this article I offer an analysis of the key issues to be addressed when contemplating the use of Glaserian GT and the utilisation of an appropriate theoretical perspective, rather than accepting convention of symbolic interactionism (SI). The analysis became imperative in a study I conducted that sought to explore the concerns, adaptive behaviours, psychosocial processes and relevant interactions over a 12-month period, among newly diagnosed persons with end stage renal disease, dependent on haemodialysis in the home environment for survival. The reality of perception was central to the end product in the study. Human ethics approval was granted by six committees within New South Wales Health Department and one from a university.

Automated measurement of 25-OH Vitamin D on the LUMIPULSE® G1200: analytical verification and method comparison.

Science.gov (United States)

Parra, Marina; Foj, Laura; Filella, Xavier

2016-07-01

Because of its potential value in several pathologies, clinical interest in 25-hydroxy Vitamin D (25OH-D) is increasing. However, the standardisation of assays remains a significant problem. Our aim was to evaluate the performance of the novel Lumipulse G 25-OH Vitamin D assay (Fujirebio), comparing results with the Liaison (Diasorin) method. Analytical verification of the Lumipulse G 25-OH Vitamin D assay was performed. Both methods were compared using sera from 226 patients, including 111 patients with chronic renal failure (39 on haemodialysis) and 115 patients without renal failure. In addition, clinical concordance between assays was assessed. For Lumipulse G 25-OH Vitamin D assay, the limit of detection was 0.3 ng/mL, and the limit of quantification was 2.5 ng/mL with a 9.7% of coefficient of variation. Intra-and inter-assay coefficients of variation were Lumipulse G. Clinical concordance assessed by Kappa Index was 0.66. Lumipulse G 25-OH Vitamin D showed a good clinical concordance with the Liaison assay, although overall results measured in Lumipulse were higher by an average of 6.5%.

Pleuroperitoneal leak complicating peritoneal dialysis: a case series.

LENUS (Irish Health Repository)

Kennedy, C

2012-02-01

Pressure related complications such as abdominal wall hernias occur with relative frequency in patients on peritoneal dialysis. Less frequently, a transudative pleural effusion containing dialysate can develop. This phenomenon appears to be due to increased intra-abdominal pressure in the setting of congenital or acquired diaphragmatic defects. We report three cases of pleuroperitoneal leak that occurred within a nine-month period at our institution. We review the literature on this topic, and discuss management options. The pleural effusion resolved in one patient following drainage of the peritoneum and a switch to haemodialysis. One patient required emergency thoracocentesis. The third patient developed a complex effusion requiring surgical intervention. The three cases highlight the variability of this condition in terms of timing, symptoms and management. The diagnosis of a pleuroperitoneal leak is an important one as it is managed very differently to most transudative pleural effusions seen in this patient population. Surgical repair may be necessary in those patients who wish to resume peritoneal dialysis, or in those patients with complex effusions. Pleuroperitoneal leak should be considered in the differential diagnosis of a pleural effusion, particularly a right-sided effusion, in a patient on peritoneal dialysis.

Central venous catheter placement by an interventional radiology unit: an australian experience

International Nuclear Information System (INIS)

Lee, M. K. S.; Mossop, P. J.; Vrazas, J. I.

2007-01-01

The aim of this retrospective study was to analyse the outcomes of central venous catheter (CVC) placement carried out by an interventional radiology unit. A review of our hospital records identified 331 consecutive patients who underwent insertion of a tunnelled or non-tunnelled CVC between January 2000 and December 2004. Key outcome measures included the technical success rate of CVC insertion and the percentage of immediate ( 30 days) complications. A total of 462 CVCs were placed under radiological guidance, with an overall success rate of 98.9%. Immediate complications included one pneumothorax, which was diagnosed 7 days after subclavian CVC insertion, and eight episodes of significant haematoma or bleeding within 24 h of CVC insertion. No cases were complicated by arterial puncture or air embolus. Catheter-related sepsis occurred in 2% of non-tunnelled CVC and 8.9% of tunnelled CVC. The overall incidence of catheter-related sepsis was 0.17 per 100 catheter days. As the demand for chemotherapy and haemodialysis grows with our ageing population, interventional radiology suites are well placed to provide a safe and reliable service for the placement of central venous access devices

Myosin heavy-chain isoform distribution, fibre-type composition and fibre size in skeletal muscle of patients on haemodialysis

DEFF Research Database (Denmark)

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

2007-01-01

of age-, gender- and BMI-matched untrained control subjects. The aerobic work capacity of the patients was also determined. Results. The MHC composition for I, IIA and IIX isoforms was found to be 35.3%±18.2%, 35.9%±7.1% and 28.9%±15.6%, respectively, findings supported by the ATPase histochemically...... determined fibre-type composition of the vastus lateralis muscle. The mean fibre area of type 1 and 2 fibres was 3283±873 and 3594±1483 µm2, respectively. The MHC composition and the size of the type 1 fibres of the patients on HD were significantly different from those of the control subjects. Conclusions....... The data demonstrate relatively fewer type 1 and consequently more type 2x fibres, with a corresponding change in MHC isoforms (MHC I and MHC IIX) in the skeletal muscle of patiens on HD. Several patients on HD were found to have type 1 (or relative percentage of MHC I) fibres. Such a low percentage...

Application of model of incremental haemodialysis, based on residual renal function, at the initiation of renal replacement therapy

Directory of Open Access Journals (Sweden)

José L. Merino

2017-01-01

Conclusions: Incremental HD treatment, with twice-weekly HD, may be an alternative in selected patients. This approach can largely preserve residual renal function at least for the first year. Although this pattern probably is not applicable to all patients starting RRT, it can and should be an initial alternative to consider.

A non-invasive, on-line deuterium dilution technique for the measurement of total body water in haemodialysis patients

Czech Academy of Sciences Publication Activity Database

Chan, C.; Smith, D.; Španěl, Patrik; McIntyre, Ch. W.; Davies, S. J.

2008-01-01

Roč. 23, č. 6 (2008), s. 2064-2070 ISSN 0931-0509 Institutional research plan: CEZ:AV0Z40400503 Keywords : flowing after-glow mass spectrometer (FA-MS) * body composition * deuterium dilution Subject RIV: CF - Physical ; Theoretical Chemistry Impact factor: 3.568, year: 2008

Porphyria Cutanea Tarda in a Patient with End-Stage Renal Disease: A Case of Successful Treatment with Deferoxamine and Ferric Carboxymaltose

Directory of Open Access Journals (Sweden)

Natacha Rodrigues

2017-01-01

Full Text Available Porphyria cutanea tarda (PCT is a rare disease, with a strong association with hepatitis C virus. PCT is particularly problematic in end-stage renal disease patients as they have no renal excretion of porphyrins and these are poorly dialyzed. Also, conventional treatment of PCT is compromised in these patients as hydroxychloroquine is contraindicated, phlebotomies with the stipulated frequency are poorly tolerated in already anaemia-prone patients, and iron-chelating agents are less efficient in removing iron and contribute to worsening anaemia. The authors report a patient on haemodialysis, with hepatitis C infection, that is diagnosed with PCT. Despite the good clinical results with deferoxamine, she became dependent on blood transfusions because of her ferropenic state. Every time oxide iron was started, the patient developed clinical features of the disease, resolving after the suspension of the drug. A decision was made to start the patient on ferric carboxymaltose, which was well tolerated without disease symptoms and need of further blood transfusions. This case suggests that deferoxamine is efficient in treatment of porphyria cutanea tarda. Also, ferric carboxymaltose may be a valuable option for refractory anaemia in patients with this disease and end-stage renal disease, as it seems to provide iron without clinical relapse of the disease.

Pronounced reversible hyperammonemic encephalopathy associated with combined valproate-topiramate therapy in a 7-year-old girl.

Science.gov (United States)

Weise, Sebastian; Syrbe, Steffen; Preuss, Matthias; Bertsche, Astrid; Merkenschlager, Andreas; Bernhard, Matthias K

2015-01-01

Valproate is one of the most frequently used anticonvulsive drugs in children and adults. Valproate is a generally well tolerated medication. However, encephalopathy with or without hyperammonemia is one of its rare adverse events. We present a 7-year-old girl who suffered from epilepsy with generalized tonic-clonic seizures and absence epilepsy. She was initially treated with topiramate. Methylprednisolone pulse therapy and long-term therapy with valproate were initiated due to an increase of seizure frequency. At day 5 of therapy, a further increase of seizure frequency was observed followed by lethargy and somnolence. Liver enzymes remained within normal range, but ammonia serum levels increased to a maximum of 544 mmol/l. Discontinuing valproate and starting potassium-benzoate and sodium-phenylbutyrate improved the clinical condition and ammonia serum levels. Haemodialysis was not required. Cranial magnetic resonance imaging ruled out brain edema. The patient was further on successfully treated with a combination of both, topiramate and levetiracetam. Seizures did not recur and development was normal until now (3 years later). To the best of our knowledge, we observed the highest ammonia serum levels ever reported in valproate-induced hyperammonemia with a complete remission of the subsequent encephalopathy. Topiramate might increase the risk of valproate-induced encephalopathy by carbonic anhydrase inhibition.

Ischaemic memory imaging using metabolic radiopharmaceuticals: overview of clinical settings and ongoing investigations

Energy Technology Data Exchange (ETDEWEB)

Yoshinaga, Keiichiro [Hokkaido University Graduate School of Medicine, Department of Molecular Imaging, Sapporo (Japan); Naya, Masanao [Hokkaido University Graduate School of Medicine, Department of Cardiology, Sapporo (Japan); Shiga, Tohru; Suzuki, Eriko; Tamaki, Nagara [Hokkaido University Graduate School of Medicine, Department of Nuclear Medicine, Sapporo (Japan)

2014-02-15

''Ischaemic memory'' is defined as a prolonged functional and/or biochemical alteration remaining after a particular episode of severe myocardial ischaemia. The biochemical alteration has been reported as metabolic stunning. Metabolic imaging has been used to detect the footprint left by previous ischaemic episodes evident due to delayed recovery of myocardial metabolism (persistent dominant glucose utilization with suppression of fatty acid oxidation). β-Methyl-p-[{sup 123}I]iodophenylpentadecanoic acid (BMIPP) is a single-photon emission computed tomography (SPECT) radiotracer widely used for metabolic imaging in clinical settings in Japan. In patients with suspected coronary artery disease but no previous myocardial infarction, BMIPP has shown acceptable diagnostic accuracy. In particular, BMIPP plays an important role in the identification of prior ischaemic insult in patients arriving at emergency departments with acute chest pain syndrome. Recent data also show the usefulness of {sup 123}I-BMIPP SPECT for predicting cardiovascular events in patients undergoing haemodialysis. Similarly, SPECT or PET imaging with {sup 18}F-FDG injected during peak exercise or after exercise under fasting conditions shows an increase in FDG uptake in postischaemic areas. This article will overview the roles of ischaemic memory imaging both under established indications and in ongoing investigations. (orig.)

The Experience of Older People in the Shared Decision-Making Process in Advanced Kidney Care

Science.gov (United States)

Jenkins, Karen; McManus, Breeda; Gracey, Brian

2016-01-01

Introduction. This qualitative descriptive study was designed to understand the experiences of older people (>70 years) when making a decision about renal replacement therapy. This was a coproduced study, whereby patients and carers were involved in all aspects of the research process. Methods. A Patient and Carer Group undertook volunteer and research training. The group developed the interview questions and interviewed 29 people who had commenced dialysis or made a decision not to have dialysis. Interview data were transcribed and analysed, and common themes were identified. Results. 22 men and 7 women (mean age 77.4 yrs) from two hospitals were interviewed. 18 had chosen haemodialysis, 6 peritoneal dialysis, and 5 supportive care. The majority of patients were involved in the dialysis decision. Most were satisfied with the amount of information that they received, although some identified that the quality of the information could be improved, especially how daily living can be affected by dialysis. Conclusion. Our findings show that overall older patients were involved in the dialysis decision along with their families. Our approach is innovative because it is the first time that patients and carers have been involved in a coproduced study about shared decision-making. PMID:27990438

Dialysis Malnutrition and Malnutrition Inflammation Scores: screening tools for prediction of dialysis-related protein-energy wasting in Malaysia.

Science.gov (United States)

Harvinder, Gilcharan Singh; Swee, Winnie Chee Siew; Karupaiah, Tilakavati; Sahathevan, Sharmela; Chinna, Karuthan; Ahmad, Ghazali; Bavanandan, Sunita; Goh, Bak Leong

2016-01-01

Malnutrition is highly prevalent in Malaysian dialysis patients and there is a need for a valid screening tool for early identification and management. This cross-sectional study aims to examine the sensitivity of the Dialysis Malnutrition Score (DMS) and Malnutrition Inflammation Score (MIS) tools in predicting protein-energy wasting (PEW) among Malaysian dialysis patients. A total of 155 haemodialysis (HD) and 90 peritoneal dialysis (PD) patients were screened for risk of malnutrition using DMS and MIS and comparisons were made with established guidelines by International Society of Renal Nutrition and Metabolism (ISRNM) for PEW. MIS cut-off score of >=5 indicated presence of malnutrition in all patients. A total of 59% of HD and 83% of PD patients had PEW by ISRNM criteria. Based on DMS, 73% of HD and 71% of PD patients exhibited moderate malnutrition, whilst using MIS, 88% and 90%, respectively were malnourished. DMS and MIS correlated significantly in HD (r2=0.552, pmalnutrition classification were established (score >=5) for use amongst Malaysian dialysis patients. Both DMS and MIS are valid tools to be used for nutrition screening of dialysis patients especially those undergoing peritoneal dialysis. The DMS may be a more practical and simpler tool to be utilized in the Malaysian dialysis settings as it does not require laboratory markers.

The role of economies of scale in the cost of dialysis across the world: a macroeconomic perspective.

Science.gov (United States)

Karopadi, Akash Nayak; Mason, Giacomo; Rettore, Enrico; Ronco, Claudio

2014-04-01

The treatment of chronic kidney disease through dialysis is a considerable expense in most health systems. The two chief methods of providing dialysis, haemodialysis (HD) and peritoneal dialysis (PD) have significant differences in cost composition and factors of production. The aim of this article is to identify and quantify the macroeconomic variables that influence the relative cost of such modalities across different countries. From previously published literature, we extracted the estimates of HD/PD cost ratios in a total of 46 countries. We conducted a multivariate regression analysis using the estimated HD/PD cost ratio in each country, with several country level indicators as explanatory variables. We found a strong statistical effect of the following variables on the HD/PD cost ratio: country's level of development, economies of scale and percentage of private health-care expenditure. The statistical effects on HD/PD ratio by local manufacturing and relaxed import regulation of PD equipment were calculated and were found to be very significant. it is possible for a country to still reap the benefits of economies of scale in provision of PD, even in the absence of a large enough market to make local production of PD equipment feasible in that country.