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Sample records for hemodialysis blood stream

  1. Recharging Red Blood Cell Surface by Hemodialysis

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    Katrin Kliche

    2015-02-01

    Full Text Available Background: Similar as in vascular endothelium the negatively charged glycocalyx of erythrocytes selectively buffers sodium. Loss of glycocalyx (i.e. loss of negative charges leads to increased erythrocyte sodium sensitivity (ESS quantified by a recently developed salt-blood-test (SBT. The hypothesis was tested whether a regular 4-hour hemodialysis (4h-HD alters ESS. Methods: In 38 patients with end stage renal disease (ESRD ESS was measured before and after 4h-HD, together with standard laboratory and clinical parameters (electrolytes, acid-base status, urea, creatinine, hemoglobin, c-reactive protein and blood pressure. Results: Before 4h-HD, 20 patients (out of 38 were classified as “salt sensitive” by SBT. After 4h-HD, this number decreased to 11. Erythrocyte sodium buffering power remained virtually constant in patients with already low ESS before dialysis, whereas in patients with high ESS, 4h-HD improved the initially poor sodium buffering power by about 20%. No significant correlations could be detected between standard blood parameters and the respective ESS values except for plasma sodium concentration which was found increased by 3.1 mM in patients with high salt sensitivity. Conclusions: 4h-HD apparently recharges “run-down” erythrocytes and thus restores erythrocyte sodium buffering capacity. Besides the advantage of efficient sodium buffering in blood, erythrocytes with sufficient amounts of free negative charges at the erythrocyte surface will cause less (mechanical injury to the negatively charged endothelial surface due to efficient repulsive forces between blood and vessel wall. Hemodialysis improves erythrocyte surface properties and thus may prevent early vascular damage in patients suffering from ESRD.

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

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    Garevani H

    2007-11-01

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

  3. Small bowel enteroclysis using a hemodialysis blood pump

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    Lee, Soon Jin; Lim, Hyo Keun; Lee, Won Jae; Kim, Kyeong Ah; Lee, Yeon Ok; Hwang, Jung Hwa; Choi, Sang Hee; Lim, Jae Hoon [Samsung Medical Center, Seoul (Korea, Republic of)

    1998-04-01

    The purpose of this study is to describe the usefulness of small bowel enteroclysis using a hemodialysis blood pump. Over 1 16 month period, 135 double contrast small bowel enteroclysis examinations were performed in 132 patients using a hemodialysis blood pump. Following incubation of the proximal jejunum, barium at a dilution of 50 % and 0.5 %-methylcellulose were infused at a constant rate using a hemodialysis blood pump and multiple spot films of the small intestine were obtained. Success rate, quality of radiographs, positive findings, fluoroscopic time and complications were evaluated. It spite of the long fluoroscopic time and invasiveness, double contrast small bowel enteroclysis is useful for the evaluation of small bowel disease. The infusion of barium and methylcellulose using a hemodialysis blood pump give radiographs of good quality. (author). 18 refs., 2 tabs., 10 figs.

  4. Critical Evaluation of Blood Volume Measurements during Hemodialysis

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    Dasselaar, Judith J.; van der Sande, Frank M.; Franssen, Casper F. M.

    2012-01-01

    Devices that continuously measure relative blood volume (RBV) changes during hemodialysis (HD) are increasingly used for the prevention of dialysis hypotension and fine-tuning of dry weight. However, RBV measurements are subject to various limitations. First, RBV devices provide information on relat

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

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

    2012-09-01

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

  6. [Blood detoxification using superparamagnetic nanoparticles (magnetic hemodialysis)].

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    Ciochină, Al D; Untu, Alina; Iacob, Gh

    2010-01-01

    The authors present an experimental study realized in order to simulate blood detoxification with the help of supermagnetic nanoparticles. The particles used are red oxide nanoparticles which are considered to be equivalent from a magnetic susceptibility and dynamic diameter point of view to the complex structures of magnetite nanoparticles. Two types of custom HGMS matrices have been used--a threaded one and a micro-spheres one. For testing red oxide particles have been purposefully created to have a lower magnetic susceptibility than magnetite or iron-carbon particles used in other experimental studies. Different concentrations of iron oxide, glycerine and water have been prepared, creating a 3.5 cP viscosity (equivalent to the one of the blood); the concentrations of the prepared solutions varied between 0.16 mg/mL and 2 mg/mL, with the background magnetic field value ranging from 0.25 T to 0.9 T, in order to observer the effectiveness of filtering at different intensities. The efficiency of HGMS filtering in experimental conditions was almost completely successful (99.99%) in all experimental conditions, both with the threaded and micro-spheres matrices. The high gradient magnetic separation system of nanoparticles has maximum efficiency and has the potential of being implemented in a medical blood detoxification device.

  7. The relationship between symptoms and blood pressure during maintenance hemodialysis.

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    Meredith, David J; Pugh, Christopher W; Sutherland, Sheera; Tarassenko, Lionel; Birks, Jacqueline

    2015-10-01

    Intradialytic hypotension (IDH) is a detrimental complication of maintenance hemodialysis, but how it is defined and reported varies widely in the literature. European Best Practice Guideline and Kidney Disease Outcomes Quality Initiative guidelines require symptoms and a mitigating intervention to fulfill the diagnosis, but morbidity and mortality outcomes are largely based on blood pressure alone. Furthermore, little is known about the incidence of asymptomatic hypotension, which may be an important cause of hypoperfusion injury and impaired outcome. Seventy-seven patients were studied over 456 dialysis sessions. Blood pressure was measured at 15-minute intervals throughout the session and compared with post-dialysis symptom questionnaire results using mixed modeling to adjust for repeated measures in the same patient. The frequency of asymptomatic hypotension was estimated by logistic regression using a variety of commonly cited blood pressure metrics that describe IDH. In 113 sessions (25%) where symptoms were recorded on the questionnaire, these appear not to have been reported to dialysis staff. When symptoms were reported (293 sessions [64%]), an intervention invariably followed. Dizziness and cramp were strongly associated with changes in systolic blood pressure (SBP), but not diastolic blood pressure. Nausea occurred more frequently in younger patients but was not associated with falls in blood pressure. Thresholds that maximized the probability of an intervention rather than a session remaining asymptomatic were SBP hemodialysis, which leads to an underestimation of IDH if symptom-based definitions are used. A revised definition of IDH excluding patient-reported symptoms would be in line with literature reporting morbidity and mortality outcomes and include sessions in which potentially detrimental asymptomatic hypotension occurs.

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

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    Santos B.C.

    2003-01-01

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

  9. Predictors of nonadherence with blood pressure regimens in hemodialysis

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    Kauric-Klein Z

    2013-09-01

    Full Text Available Zorica Kauric-KleinCollege of Nursing, Wayne State University, Detroit, MI, USABackground: Hypertension is very poorly controlled in patients on hemodialysis (HD. Demographic and psychosocial predictors of nonadherence with blood pressure (BP regimens in HD have not been investigated. A study of 118 HD patients from six outpatient HD units was conducted to determine the relationship between demographic/psychosocial factors and adherence with BP-related regimens, ie, fluid restriction, BP medication adherence, and HD treatment adherence.Methods: Descriptive statistics, Pearson correlations, and multiple regressions were conducted to analyze and determine the relationships between variables.Results: Younger age was related to increased fluid gains (r = -0.37, P < 0.01, decreased medication adherence (r = -0.19, P = 0.04, increased missed HD treatments (r = -0.37, P < 0.01, and diastolic BP (r = -0.60, P < 0.01. Female sex was significantly related to decreased fluid gains (r = -0.28, P < 0.01. Race was related to increased missed HD treatments (r = 0.22, P = 0.02. Increased social support was related to decreased missed HD treatments (r = -0.22, P = 0.02. Depression scores were inversely related to decreased medication adherence scores (r = 0.24, P = 0.01.Conclusion: By identifying risk factors for nonadherence with BP-related regimens (young age, male sex, decreased social support, and depression, health care providers can plan early clinical intervention to minimize the risk of nonadherence.Keywords: nonadherence, hemodialysis, blood pressure, demographic predictors, psychosocial predictors

  10. Effects of the Intermittent Pneumatic Circulator on Blood Pressure during Hemodialysis

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    Miao-Ju Hsu

    2010-11-01

    Full Text Available Hypotension is frequently reported during hemodialysis. This study aimed to examine the effect of the intermittent pneumatic circulator on blood pressure during hemodialysis. Sixteen subjects with chronic hemodialysis were recruited. Each subject randomly received two test conditions on separate days, hemodialysis with and without the circulator. The circulator was applied to the subject on lower extremities during 0.5–1 hr, 1.5–2 hr, 2.5–3 hr, and 3.5–4 hr of hemodialysis. Systolic and diastolic blood pressures (SBP and DBP and heart rate (HR were analyzed at pre-dialysis, 1 hr, 2 hr, and 3 hr of hemodialysis. Stroke volume (SV and cardiac output (CO were evaluated between 2.5 and 3.0 hr of hemodialysis. Blood chemicals (sodium, calcium, potassium, and phosphorous and Kt/V before and after each hemodialysis session were analyzed. The number of episodes of hypotension was also recorded. The circulator intervention significantly improved SBP and DBP across all time points (P = 0.002 for SBP; P = 0.002 for DBP. The frequency of hypotension was significantly decreased (P = 0.028. SV and CO were significantly improved with the circulator intervention (P = 0.017 for SV; P = 0.026 for CO and no statistical significances were found on blood chemicals or Kt/V analyses. The results suggested that the circulator intervention helps stabilize blood pressure and appears to be a practical treatment. Future studies are suggested to develop new circulator innovations with sensor feedback systems to enhance safety and maximize treatment efficiency.

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

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    蔡宏

    2014-01-01

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

  12. Home Hemodialysis

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    ... pressure, which can cause a headache or stroke low blood pressure, which can make a person feel nauseous, faint, ... of the same risks as standard hemodialysis, including low blood pressure and infection. Low blood pressure is much less ...

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

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    谷立杰

    2013-01-01

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

  14. Blood pressure recordings during hemodialysis access interventions: implications for acute management.

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    Asif, Arif; Castro, Hector; Waheed, Ahmed Ameen; Kumar, Vishesh; Haqqie, Syed S; Siskin, Gary; Mathew, Roy O; Mason, Darius; Vachharajani, Tushar; Nayer, Ali; Merrill, Donna; Akmal, Muhammad U T; Salman, Loay

    2013-01-01

    A retrospective study evaluating the pattern of blood pressure and its related complications before, during, and after percutaneous hemodialysis interventions was performed in patients presenting with asymptomatic hypertension. Hemodialysis patients undergoing percutaneous interventions including tunneled hemodialysis catheter insertion, percutaneous balloon angioplasty and thrombectomy procedure, and stage II hypertension (systolic blood pressure ≥160 mmHg) were included in this analysis. Blood pressure medications were not used while midazolam and fentanyl were routinely administered. Patients were followed for up to 4 weeks to monitor any complications. The mean blood pressure before, during, and after the procedures were 185 ± 18/96 ± 14, 172 ± 22/92 ± 15, and 153 ± 25/87 ± 14, respectively. There was a statistically significant difference between the blood pressure readings before and after the procedure (before = 185 ± 18/96 ± 14, after = 153 ± 25/87 ± 14; p = 0.001). None of the patients had a stroke, myocardial infarction, or acute pulmonary edema before, during, or after the procedure or during the 4-week follow-up period. A significant reduction in blood pressure was observed after the procedure without the administration of any antihypertensive medication. These results suggest that the reduction in blood pressure observed after percutaneous dialysis access interventions (particularly in the presence of midazolam and fentanyl) may make it unnecessary to treat asymptomatic hypertension prior to these procedures. © 2013 Wiley Periodicals, Inc.

  15. Effect of hemodialysis combined blood perfusion on micro inflammation and nutrition status of diabetic nephropathy patients

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    Jin-Lin Xie; Qin-Qi Nie; Xia-Fei Li

    2015-01-01

    Objective:To study the effect of hemodialysis combined blood perfusion on micro inflammation and nutrition status of diabetic nephropathy patients.Methods: 118 cases of diabetic nephropathy patients received treatment in our hospital from December 2012 to December 2014 were chose for study and randomly divided into two groups. Observation group received hemodialysis combined blood perfusion, while control group received pure hemodialysis therapy. Then nutrition status indexes, biochemical indexes and inflammation response degrees were compared.Results:(1) nutrition status indexes: compared with control group, serum Hb and Alb levels of observation group showed increasing trend, MAC and MAMC showed ncreasing trend; (2) biochemical indexes: compared with control group, serum mRNA levels of IGF-1β,PA, TRF, RBP of observation group showed increasing trend; (3) inflammation response degrees: compared with control group, serum IL-17, IL-22, IL-1β, TGF-β1, SAA levels of observation group showed decreased trend.Conclusion: hemodialysis combined blood perfusion treatment can effectively reduce inflammation in patients with diabetic nephropathy and improve general nutritional status.

  16. Blood flow measurements during hemodialysis vascular access interventions - Catheter-based thermodilution or Doppler ultrasound?

    DEFF Research Database (Denmark)

    Heerwagen, Søren T; Hansen, Marc A; Schroeder, Torben V

    2012-01-01

    Purpose: To test the clinical performance of catheter-based thermodilution and Doppler ultrasound of the feeding brachial artery for blood flow measurements during hemodialysis vascular access interventions.Methods: Thirty patients with arteriovenous fistulas who underwent 46 interventions had...... access blood flow measured before and after every procedure. Two methods, catheter-based thermodilution and Doppler ultrasound, were compared to the reference method of ultrasound dilution. Catheter-based thermodilution and Doppler ultrasound were performed during the endovascular procedures while flow...

  17. 78 FR 38994 - Implanted Blood Access Devices for Hemodialysis; Draft Guidance for Industry and Food and Drug...

    Science.gov (United States)

    2013-06-28

    ... HUMAN SERVICES Food and Drug Administration Implanted Blood Access Devices for Hemodialysis; Draft Guidance for Industry and Food and Drug Administration Staff; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and Drug Administration (FDA) is announcing...

  18. Estimation of indocyanine green concentration in blood from fluorescence emission: application to hemodynamic assessment during hemodialysis

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    Maarek, Jean-Michel I.; Holschneider, Daniel P.

    2009-09-01

    There is considerable interest in assessing cardiovascular function noninvasively in patients receiving hemodialysis. A possible approach is to measure the blood concentration of bolus-injected indocyanine green dye and to apply the dye-dilution method for estimating cardiac output and blood volume. Blood ICG concentration can be derived from a measurement of the ICG fluorescence through the dialysis tubing if a simple and unique calibration relationship can be established between transmural fluorescence intensity and blood ICG concentration. We investigated this relationship using Monte Carlo simulations of light transport in blood with varying hematocrit and ICG concentrations and performed empiric measurements of optical absorption and ICG fluorescence emission to confirm our findings. The ICG fluorescence intensity measured at the blood surface, as well as the light intensity remitted by the blood, varied as hematocrit changes modified the absorption and scattering characteristics of the blood. Calibration relationships were developed between fluorescence intensity and ICG concentration that accounted for hematocrit changes. Combining the backreflected fluorescence and the reflected light measured near the point of illumination provided optimal signal intensity, linearity, and robustness to hematocrit changes. These results provide a basis for developing a noninvasive approach to derive optically circulating blood ICG concentration in hemodialysis circuits.

  19. Design and construct an optical device to determine relative blood volume in patients undergoing hemodialysis.

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    Dormanesh, Banafshe; Tofangchiha, Shahnaz; Abouei, Vahid; Sharifian, Hani

    2014-04-01

    Occurrence of hypotension during hemodialysis in nearly 20-30% of patients, shows is the necessity of continuous monitoring the patients' blood pressure during hemodialysis. Since directly and non-invasively continuous blood pressure monitoring, is not easy, finding a parameter related to blood pressure, for indirect monitoring is of great value. Related blood volume (RBV) is one of the parameters, related to blood pressure and have a good potential to reflect the patient's hemodynamic condition. The main objective of this study was to design and construct an optical device to determine the RBV in patients undergoing hemodialysis, during the process. After initial studies in order to select a proper sensor, using the ORCAD software, an analog circuit was designed. The implementation and modification of the circuit was done by the clinical tests, using expired blood. Afterwards, for calculation the RBV, controlling the display, data storage and sending it to the computer, an ATmega16 microcontroller was used. For programing the microcontroller, CodeVision software and then Altium Designer software were used for the circuit compression, in order to design the printed circuit board. Finally, all parts of the analog and digital circuit, AC to DC converter and the LCD were embedded in a box. After finalization of the device and before testing it in a real situation, expired blood was used for final evaluation. The evaluation was done by changing the blood concentration, at the start point by adding water to it. In fact, the device can track the changes in blood concentration and display the RBV. After this evaluation, the device was tested in a clinical situation. The results showed there are no interactions between this device and the other devices used in the dialysis section and it can work properly in order to measure the RBV. Considering the hypotension and its consequences in a patient on hemodialysis, solving this problem seems necessary. One method for

  20. Effects of Unsaturated Fat Dietary Supplements on Blood Lipids, and on Markers of Malnutrition and Inflammation in Hemodialysis Patients

    DEFF Research Database (Denmark)

    Ewers, Bettina; Riserus, Ulf; Marckmann, Peter

    2009-01-01

    OBJECTIVE: We examined the effects of commercially available unsaturated fat dietary supplements on blood lipids, and on markers of malnutrition and inflammation, in an adult population of hemodialysis (HD) patients. DESIGN: This was a restricted, randomized (equal blocks), investigator-blinded 2x6...... as assessed according to C-reactive protein serum concentrations. Adding unsaturated fat to the diet seems to be a safe and effective way to prevent and treat malnutrition in hemodialysis patients....

  1. [Evaluation of serum iron in hemodialysis patients and its variation due to the difference of blood sampling time].

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    Matsumoto, Yasutoshi; Ozawa, Yasuaki; Imafuku, Yuji; Yoshida, Hiroshi

    2011-11-01

    Diurnal variations in serum iron concentration were examined to investigate the influence of sampling time in hemodialysis (HD) patients and healthy subjects. The serum iron concentration and TIBC of HD patients decreased significantly (pserum ferritin concentration of HD patients increased significantly (piron transport system: under such condition intracellural iron transition out into peripheral blood stream is low in HD patients. Serum iron concentration in samples collected in the evening decreased significantly both in HD patients (pserum iron concentration reveal almost similar decrement in both groups. In HD patients, serum iron concentration of the blood samples collected on the third day morning after HD and second day morning after HD was examined to see the influence from changes of circulating plasma volume. The serum iron concentration and Hct value in the second day sampling increased significantly compared to the third day sampling (pserum iron concentration corrected by Hct in the second day sampling increased significantly (pserum iron concentration vary in sampling time in HD patients as well as in healthy subjects. We also deduct that there may be other factors concerning changes in circulating plasma volume.

  2. Association between routine and standardized blood pressure measurements and left ventricular hypertrophy among patients on hemodialysis

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    Walsh Michael

    2010-06-01

    Full Text Available Abstract Background Left ventricular (LV hypertrophy is common among patients on hemodialysis. While a relationship between blood pressure (BP and LV hypertrophy has been established, it is unclear which BP measurement method is the strongest correlate of LV hypertrophy. We sought to determine agreement between various blood pressure measurement methods, as well as identify which method was the strongest correlate of LV hypertrophy among patients on hemodialysis. Methods This was a post-hoc analysis of data from a randomized controlled trial. We evaluated the agreement between seven BP measurement methods: standardized measurement at baseline; single pre- and post-dialysis, as well as mean intra-dialytic measurement at baseline; and cumulative pre-, intra- and post-dialysis readings (an average of 12 monthly readings based on a single day per month. Agreement was assessed using Lin's concordance correlation coefficient (CCC and the Bland Altman method. Association between BP measurement method and LV hypertrophy on baseline cardiac MRI was determined using receiver operating characteristic curves and area under the curve (AUC. Results Agreement between BP measurement methods in the 39 patients on hemodialysis varied considerably, from a CCC of 0.35 to 0.94, with overlapping 95% confidence intervals. Pre-dialysis measurements were the weakest predictors of LV hypertrophy while standardized, post- and inter-dialytic measurements had similar and strong (AUC 0.79 to 0.80 predictive power for LV hypertrophy. Conclusions A single standardized BP has strong predictive power for LV hypertrophy and performs just as well as more resource intensive cumulative measurements, whereas pre-dialysis blood pressure measurements have the weakest predictive power for LV hypertrophy. Current guidelines, which recommend using pre-dialysis measurements, should be revisited to confirm these results.

  3. Blood flow measurements during hemodialysis vascular access interventions - Catheter-based thermodilution or Doppler ultrasound?

    DEFF Research Database (Denmark)

    Heerwagen, Søren T; Hansen, Marc A; Schroeder, Torben V

    2012-01-01

    Purpose: To test the clinical performance of catheter-based thermodilution and Doppler ultrasound of the feeding brachial artery for blood flow measurements during hemodialysis vascular access interventions.Methods: Thirty patients with arteriovenous fistulas who underwent 46 interventions had...... by ultrasound dilution was determined within three days of the procedure. The methods were compared using regression analysis and tested for systematic bias. Results: Failure to position the thermodilutional catheter correctly was observed in 8 out of 46 (17%) pre-intervention measurements. Post...

  4. Chronobiology of arterial hypertension in hemodialysis patients: implications for home blood pressure monitoring.

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    Agarwal, Rajiv; Light, Robert P

    2009-10-01

    Hemodialysis patients have a steady increase in blood pressure (BP) during the 44-hour interdialytic interval when ambulatory BP monitoring is used. Home BP recording allows for a longer period of monitoring between dialysis treatments and may better define the chronobiological characteristics of arterial hypertension. This study sought to determine the optimal time to perform home BP monitoring in hemodialysis patients to improve the strength of prediction of 44-hour interdialytic ambulatory BP. Diagnostic test study. This is an ancillary analysis of patients participating in the Dry-weight Reduction in Hypertensive Hemodialysis Patients (DRIP) trial. Home BP measured 3 times daily for 1 week by using a validated oscillometric monitor on 3 occasions at 4-week intervals after randomization. Home BP measured during the first third, second third, and last third of time elapsed after the dialysis treatment, as well as each third of the dialysis treatment, was compared with the overall ambulatory BP. Interdialytic ambulatory BP measured on 3 occasions at 4-week intervals after randomization. During the interdialytic interval, we found an increase in systolic ambulatory BP of 0.30 +/- 0.36 mm Hg/h and an increase in systolic home BP of 0.40 +/- 0.25 mm Hg/h. This relationship in home BP reached a plateau after approximately 48 hours. A similar pattern was seen for diastolic home BP. Probing dry weight steepened the slope of ambulatory BP, but did not alter the time-dependent relationship of home BP. Home BP was on average higher (bias) by 14.1 (95% confidence interval, 12.0 to 16.2)/5.7 mm Hg (95% confidence interval, 4.6 to 6.9). The SD of differences between methods (precision) was 4.6/2.8 mm Hg. Measurement of BP during each third of the interdialytic interval gave the best precision, measured by using model fit compared with ambulatory BP measurements. Our cohort was overrepresented by African American hemodialysis patients. Whether African American participants

  5. Does antibiotic lock therapy prevent catheter-associated bacteremia in hemodialysis?

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    Macarena Jiménez

    2015-01-01

    Full Text Available Central venous catheter-related blood stream infection is a major cause of morbidity and mortality in patients with renal disease treated with hemodialysis. Antibiotic lock solutions can be effective in preventing this complication in patients with hemodialysis. Searching in Epistemonikos database, which is maintained by screening more than twenty databases, we identified eight systematic reviews including seventeen randomized trials. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded that antibiotic lock solutions probably decrease catheter-related blood stream infection in hemodialysis patients.

  6. Postprandial blood glucose level in maintenance hemodialysis patients predicts post-transplant-diabetes-mellitus.

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    Haider, D G; Mittermayer, F; Friedl, A; Batrice, A; Auinger, M; Wolzt, M; Hörl, W H

    2010-03-01

    Post-transplant-diabetes-mellitus (PTDM) is a frequent complication after kidney transplantation. One-hundred-and-seven patients with kidney transplantation were screened for the occurrence of PTDM. Of these, full data sets from 49 subjects were available with documented glucose concentrations during maintenance hemodialysis (MHD) and regular clinical follow-up of 7-34 months. For assessment of glucose metabolism the response to a standard meal during MHD was used in normoglycemic patients based on fasting blood glucose. Abnormal postprandial blood glucose concentration was defined as >140 mg/dl 2 h after food intake.Twelve end stage renal disease patients had abnormal postprandial blood glucose on MHD. All 12 subjects but also four MHD patients with normal postprandial and fasting blood glucose values developed PTDM. Multivariate Cox-regression analysis revealed that abnormal postprandial blood glucose is a strong predictor for PTDM (Hazard ratio: 42.3 (IQR: 7.9-227.2); p<0.001). Fasting blood glucose (94 vs. 100 mg/dl) was not different between MHD patients who did (n=16) or did not (n=33) develop PTDM.This study suggests that measurement of postprandial blood glucose during MHD identifies patients who develop PTDM after kidney transplantation. It should be used for screening of patients at risk.

  7. Optimal blood pressure level and best measurement procedure in hemodialysis patients

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    Annie Saint-Remy

    2005-10-01

    Full Text Available Annie Saint-Remy, Jean-Marie KrzesinskiNephrology-Hypertension/Dialysis Unit, University Hospital of Liège, Liège, BelgiumAbstract: Hypertension occurs frequently among hemodialysis (HD patients and can be due to many factors, such as salt intake, elevated sympathetic tone, and uremic toxins. It is responsible for the high cardiovascular risk associated with renal disease. Generally, in HD patients, while there is an elevation of systolic blood pressure (BP, diastolic BP seems to decrease, and the resultant effect is high pulse pressure, which can have a deleterious effect on the cardiovascular system. Although controversial, in the HD population the relationship between BP and risk of death seems to be U shaped, probably because of pre-existing cardiac disease in patients with the lowest BP. In chronic kidney disease, BP lower than 130/80 mmHg is recommended, but an appropriate target for BP in the HD population remains to be established. Moreover, there is no consensus regarding which routine peridialysis BP (pre- or post-dialysis BP, or both can ensure the diagnosis of hypertension in this population. Ambulatory BP monitoring remains the gold standard to quantify the integrated BP load applied to the cardiovascular system. As well, home BP assessment could contribute to improve the definition of an optimal BP in the HD population. An ideal goal for post-dialysis systolic BP seems to be a value higher than 110 mmHg and lower than 150 mmHg. However, HD patients are generally old and often have cardiac complications, so a reasonable pre-dialysis target systolic BP could be 150 mmHg. It is prudent to suggest that an improvement in BP control is necessary in the HD population, first by slow and smooth removal of extracellular volume (dry weight and thereafter by the use of appropriate antihypertensive medication.Keywords: hemodialysis, hypertension, blood pressure measurement, peridialysis blood pressure, blood pressure control

  8. Blood pressure elevation in hemodialysis patients after the Great East Japan Earthquake.

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    Tani, Yoshihiro; Nakayama, Masaaki; Tanaka, Kenichi; Hayashi, Yoshimitsu; Asahi, Koichi; Kamata, Tatsuhiko; Ogihara, Masahiko; Sato, Keiji; Matsushima, Masato; Watanabe, Tsuyoshi

    2014-02-01

    A major earthquake measuring 9.0 on the Richter scale struck northeastern Japan at 2:46 pm on 11 March 2011. Several reports have described transient increases in blood pressure after major earthquakes, but the impact of such increases on hemodialysis patients has not been reported. We retrospectively investigated changes in blood pressure and influencing factors in 205 patients (mean age 66.6±13.0 years; male 51.7%; median dialysis vintage 6.0 (2.0-11.0) years) on chronic dialysis at three dialysis centers in the affected area (Fukushima City) for 8 weeks after the earthquake. Pre-dialysis blood pressure was significantly elevated at 1 week after the earthquake compared with baseline (systolic vs. diastolic blood pressure: 153.1±20.2/80.1±13.5 vs. 148.6±20.0/77.5±12.8 mm Hg, Pearthquake comprised baseline blood pressure and α-blockers. The earthquake induced a significant elevation in blood pressure among patients on chronic dialysis, and activation of the sympathetic nervous system might at least in part be associated with the mechanism underlying this increase.

  9. Home blood pressure control after the great East Japan earthquake in patients on chronic hemodialysis.

    Science.gov (United States)

    Tanaka, Kenichi; Nakayama, Masaaki; Kanno, Makoto; Kimura, Hiroshi; Watanabe, Kimio; Tani, Yoshihiro; Hayashi, Yoshimitsu; Asahi, Koichi; Suzuki, Kazuhiro; Watanabe, Tsuyoshi

    2014-04-01

    At 14:46 on 11 March 2011, northeastern Japan was struck by a major earthquake measuring 9.0 on the Richter scale (the Great East Japan Earthquake). Several reports have suggested a transient blood pressure (BP) increase after a major earthquake, but its impact on BP in chronic dialysis patients has not been reported. In a retrospective review of 25 hemodialysis patients who were residents of Koriyama City, changes in the morning home BP after the earthquake were investigated. Home systolic and diastolic BPs were significantly elevated 1 week after the earthquake (158 ± 16 mm Hg vs. 151 ± 13 mm Hg, P earthquake was unchanged from baseline in patients treated with sympatholytics and/or renin-angiotensin system (RAS) inhibitors. BP values returned to baseline by 4 weeks after the earthquake, but percent changes in mean BP were significantly greater even 2 weeks, 4 weeks, and 6 weeks after the earthquake in patients not treated with RAS inhibitors than in those treated with RAS inhibitors (2 weeks 7.0% ± 4.5% vs. 0.2% ± 5.0%, P earthquake. Home BP was significantly increased after a major earthquake in patients on chronic hemodialysis. Prolonged deterioration of BP control after the earthquake was associated with non-use of RAS inhibitors. © 2013 The Authors. Therapeutic Apheresis and Dialysis © 2013 International Society for Apheresis.

  10. Novel Wearable Device for Blood Leakage Detection during Hemodialysis Using an Array Sensing Patch

    Directory of Open Access Journals (Sweden)

    Yi-Chun Du

    2016-06-01

    Full Text Available Hemodialysis (HD is a clinical treatment that requires the puncturing of the body surface. However, needle dislodgement can cause a high risk of blood leakage and can be fatal to patients. Previous studies proposed several devices for blood leakage detection using optical or electrical techniques. Nonetheless, these methods used single-point detection and the design was not suitable for multi-bed monitoring. This study proposed a novel wearable device for blood leakage monitoring during HD using an array sensing patch. The array sensing patch combined with a mapping circuit and a wireless module could measure and transmit risk levels. The different risk levels could improve the working process of healthcare workers, and enhance their work efficiency and reduce inconvenience due to false alarms. Experimental results showed that each point of the sensing array could detect up to 0.1 mL of blood leakage and the array sensing patch supports a risk level monitoring system up to 8 h to alert healthcare personnel of pertinent danger to the patients.

  11. Correlation Analysis between Complex Relative Permittivity and Biochemical Components for Blood of Dialysis Patients before and after Hemodialysis

    Science.gov (United States)

    Takeda, Akira; Takata, Kazuyuki; Nagao, Hirotomo; Wang, Jianqing; Fujiwara, Osamu

    We previously measured for healthy subjects and patients who require hemodialysis the complex relative permittivity (εr´-jεr´´) of whole blood, and found that εr´-axis intercept εrt´ of straight line approximation to the Cole-Cole plots at frequencies from 200 MHz to 1GHz is significantly different with a level of less than 1% among its averaged values for healthy subjects and patients before and after dialysis, though any correlations between εrt´ and blood urea nitrogen (BUN) and creatinine being used as main indices for hemodialysis evaluation have not so far been clarified. In this study, to make correlation analyses between the intercept εrt´ and blood biochemical components for nine patients before and after hemodialysis, we measured six kinds of their blood components including BUN and creatinine, and calculated their Pearson product-moment correlation coefficients for εrt´ along with significant probability P based on a t-test. It should be noted that P is a reference probability to determine whether or not a null hypothesis can be rejected, and that the P value of 0.05 is commonly used as a significance level for statistical test. As a result, we found that a strong correlation with P 0.05 between εrt´ and other blood components including BUN and creatinine. Although albumin is not used as an index for hemodialysis efficiency, it can reflect water amount in blood vessels and liver operation. This finding implies that εrt´ could be used as an index for evaluating blood viscosity and liver function.

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

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    Hecking Manfred

    2012-06-01

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

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

    Science.gov (United States)

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

    2015-09-01

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

  14. Catheter-related blood stream infection caused by Raoultella ornithinolytica

    OpenAIRE

    2015-01-01

    Raoultella spp. representatives are Gram-negative capsulated, nonmotile rods. These bacteria are found in the natural environment: plants, water, soil and insects. R. ornithinolytica is one of the three species of Raoultella. R. ornithinolytica is the only species within the genus which has the ability to produce ornithine decarboxylase. Human infections related to R. ornithinolytica are exceedingly rare. The present case report describes catheter-related blood stream infection caused by R. o...

  15. Catheter-related blood stream infection caused by Raoultella ornithinolytica.

    Science.gov (United States)

    Sękowska, Alicja; Dylewska, Katarzyna; Gospodarek, Eugenia; Bogiel, Tomasz

    2015-11-01

    Raoultella spp. representatives are Gram-negative capsulated, nonmotile rods. These bacteria are found in the natural environment: plants, water, soil and insects. R. ornithinolytica is one of the three species of Raoultella. R. ornithinolytica is the only species within the genus which has the ability to produce ornithine decarboxylase. Human infections related to R. ornithinolytica are exceedingly rare. The present case report describes catheter-related blood stream infection caused by R. ornithinolytica and successfully treated with antibiotic therapy.

  16. Infections in hemodialysis: a concise review. Part II: blood transmitted viral infections

    Science.gov (United States)

    Eleftheriadis, T; Liakopoulos, V; Leivaditis, K; Antoniadi, G; Stefanidis, I

    2011-01-01

    Hemodialysis (HD) patients are particularly predisposed to infections. It seems that the HD procedure per se as well as disturbances in both innate and adaptive immunity significantly contribute to this susceptibility. Infections are the major cause of morbidity and the second cause of death following cardiovascular events in HD patients. Episodes of bacteremia and pneumonia account for the majority of severe infections in this population. In addition to these bacterial infections another common problem in HD units is the blood transmitted viral infections, particularly infections caused by hepatitis B virus, hepatitis C virus and Human immunodeficiency virus. A number of safety concerns exist for limiting the spread of these viral infections among HD patients and the staff of the unit. The aim of the present review is to present in a concise albeit practical form the difficult aspect of infections in HD. For practical reasons the review is separated in two parts. The previous first part covered bacteremia and respiratory infections, while the present second part covers blood transmitted viral infections. PMID:22110292

  17. Integrating Flexible Sensor and Virtual Self-Organizing DC Grid Model With Cloud Computing for Blood Leakage Detection During Hemodialysis.

    Science.gov (United States)

    Huang, Ping-Tzan; Jong, Tai-Lang; Li, Chien-Ming; Chen, Wei-Ling; Lin, Chia-Hung

    2017-08-01

    Blood leakage and blood loss are serious complications during hemodialysis. From the hemodialysis survey reports, these life-threatening events occur to attract nephrology nurses and patients themselves. When the venous needle and blood line are disconnected, it takes only a few minutes for an adult patient to lose over 40% of his / her blood, which is a sufficient amount of blood loss to cause the patient to die. Therefore, we propose integrating a flexible sensor and self-organizing algorithm to design a cloud computing-based warning device for blood leakage detection. The flexible sensor is fabricated via a screen-printing technique using metallic materials on a soft substrate in an array configuration. The self-organizing algorithm constructs a virtual direct current grid-based alarm unit in an embedded system. This warning device is employed to identify blood leakage levels via a wireless network and cloud computing. It has been validated experimentally, and the experimental results suggest specifications for its commercial designs. The proposed model can also be implemented in an embedded system.

  18. The Effect of Orem's Self-care Education on Interdialytic Weight and Blood Pressure Changes in Hemodialysis Patients

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    Parinaz Jahanpeyma

    2016-07-01

    Full Text Available Chronic renal disease is known as progressive and irreversible loss of renal function. These diseases cover a wide range from proteinuria to increase in serum creatinine which is a clear sign of weak glomerular filtration rate and complete failure of kidney in final stages of kidney disease. Sodium retention in kidney patients accumulate liquids in their body, followed by the overweight and hypertension. The present study aimed to investigate the effect of Orem’s self-care education on overweight between two dialysis sessions and blood pressure in patients suffering chronic kidney failure under treatment in Ayatollah Taleghani Hospital at Urmia. The present study is a quasiexperimental one conducted in a group with pretest and posttest in the hemodialysis ward of Ayatollah Taleghani Hospital of Urmia. 50 patients suffering chronic kidney failure were selected according to the purpose of the study and characteristics of the units under study. The data for the study were collected through interviews and the questionnaire for identifying needs, demographic information and the checklist. İn the pretest, the patients were asked to fill out the questionnaire for needs, demographic information and checklist and their average overweight between two dialysis sessions were recorded along with their blood pressure. Then, an educational plan was commenced based on problems identified and Orem’s self-care theory and was taught to the patients in three thirtyminute sessions in five groups of ten subjects. Supplementary resources like videos, booklets etc. were also utilized. Two months later, average overweight and blood pressure for two months after training were measured. The data collected were analyzed through SPSS (version 18 computer application and coupled T test. The study revealed that the patients overweight decreased significantly between two dialysis sessions (P0.05. Conducting self-care teaching programs on patients under hemodialysis

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

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    Rahimi A

    2008-06-01

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

  20. Blood pressure measurement in hemodialysis: The importance of the measurement technique.

    Science.gov (United States)

    Kubrusly, M; de Oliveira, Claudia Maria Costa; Silva, R P; Pinheiro, M A; Rocha, M B C; Magalhães, R M

    2016-03-01

    Systemic arterial hypertension contributes to the high cardiovascular morbidity in hemodialysis (HD) patients, but the accuracy of blood pressure (BP) measurement in this population has not been well studied. To evaluate the agreement between BP measurement using the routine measurement technique (usual method) and the technique recommended by the VII Joint (standard method). This cross-sectional study enrolled 124 patients in a single center who had undergone dialysis for more than three months and were 18 years of age or older. The BP was verified at the start of dialysis by the nursing team (usual method) and by the researchers (standard method). The agreement between the systolic and diastolic BP (SBP and DBP) measurements was tested by the Bland-Altman analysis. A difference in BP measurement higher than ±5 mm Hg was considered clinically significant. The studied group had a mean age of 53.2 years. The average difference between routine and standard BP measurement was -6 mm Hg for SBP (limits of agreement: -40.1-28 mm Hg; P measured by both methods was observed in 69.4% of the patients for SBP and in 61.3% for DBP. The disagreement between the results of different BP measurement methods in HD patients was significant and the BP was underestimated using the usual BP method. BP measurement standardization should be encouraged to avoid errors in diagnosis and therapy.

  1. Arterial line pressure control enhanced extracorporeal blood flow prescription in hemodialysis patients

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    Rosales Laura

    2008-11-01

    Full Text Available Abstract Background In hemodialysis, extracorporeal blood flow (Qb recommendation is 300–500 mL/min. To achieve the best Qb, we based our prescription on dynamic arterial line pressure (DALP. Methods This prospective study included 72 patients with catheter Group 1 (G1, 1877 treatments and 35 arterio-venous (AV fistulae Group 2 (G2, 1868 treatments. The dialysis staff was trained to prescribe Qb sufficient to obtain DALP between -200 to -250 mmHg. We measured ionic clearance (IK: mL/min, access recirculation, DALP (mmHg and Qb (mL/min. Six prescription zones were identified: from an optimal A zone (Qb > 400, DALP -200 to -250 to zones with lower Qb E (Qb -199. Results Treatments distribution in A was 695 (37% in G1 vs. 704 (37.7% in G2 (P = 0.7. In B 150 (8% in G1 vs. 458 (24.5% in G2 (P P = 0.62. IK in A was 214 ± 34 (G1 vs. 213 ± 35 (G2 (P = 0.65. IK Anova between G2 zones was: A vs. C and D (P P = 0.02. Conclusion In conclusion, an optimal Qb can de prescribed with DALP of -200 mmHg. Staff adherence to DLAP treatment prescription could be reached up to 81.3% in catheters and 84.1% in AV fistulae.

  2. Development of a telecare system based on ZigBee mesh network for monitoring blood pressure of patients with hemodialysis in health care centers.

    Science.gov (United States)

    Du, Yi-Chun; Lee, You-Yun; Lu, Yun-Yuan; Lin, Chia-Hung; Wu, Ming-Jei; Chen, Chung-Lin; Chen, Tainsong

    2011-10-01

    In Taiwan, the number of the patients needing dialysis increases rapidly in recent years. Because there is risk in every hemodialysis session, monitoring physiological status, such as blood pressure measurement every 30 min to 1 h is needed during about 4 h hemodialysis process. Therefore, an assisted measurement on blood pressure is needful in dialysis care centers. Telecare system (TCS) is regarded as one of important technique in the medical care. In this study, we utilized ZigBee wireless technique to establish a mesh network for monitoring blood pressure automatically and data storage in medical record system for display and further analysis. Moreover, while the blood pressure exceeds the normal range, the system could send a warning signal to remind, or inform the relatives and clinicians in health care center through the personal handy-phone system (PHS) immediately. The proposed system provides an assisted device for monitoring patients' blood pressure during hemodialysis process and saving medical manpower.

  3. RELATIONSHIP BETWEEN BLOOD-PRESSURE DURING HEMODIALYSIS AND AMBULATORY BLOOD-PRESSURE IN BETWEEN DIALYSES

    NARCIS (Netherlands)

    HUISMAN, RM; DEBRUIN, C; KLONT, D; SMIT, AJ

    1995-01-01

    Background. Ambulatory blood pressure measurements in haemodialysis patients are relevant in view of the high cardiovascular morbidity and mortality in chronic haemodialysis patients. Methods. Twelve normotensive patients were studied from the beginning of one dialysis until the end of the next (mea

  4. RELATIONSHIP BETWEEN BLOOD-PRESSURE DURING HEMODIALYSIS AND AMBULATORY BLOOD-PRESSURE IN BETWEEN DIALYSES

    NARCIS (Netherlands)

    HUISMAN, RM; DEBRUIN, C; KLONT, D; SMIT, AJ

    1995-01-01

    Background. Ambulatory blood pressure measurements in haemodialysis patients are relevant in view of the high cardiovascular morbidity and mortality in chronic haemodialysis patients. Methods. Twelve normotensive patients were studied from the beginning of one dialysis until the end of the next (mea

  5. RELATIONSHIP BETWEEN BLOOD-PRESSURE DURING HEMODIALYSIS AND AMBULATORY BLOOD-PRESSURE IN BETWEEN DIALYSES

    NARCIS (Netherlands)

    HUISMAN, RM; DEBRUIN, C; KLONT, D; SMIT, AJ

    1995-01-01

    Background. Ambulatory blood pressure measurements in haemodialysis patients are relevant in view of the high cardiovascular morbidity and mortality in chronic haemodialysis patients. Methods. Twelve normotensive patients were studied from the beginning of one dialysis until the end of the next

  6. The effect of allopurinol on lowering blood pressure in hemodialysis patients with hyperuricemia

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    Mojgan Jalalzadeh

    2012-01-01

    Full Text Available Background: Hyperuricemia has been associated with the development of high blood pressure (BP. We studied the effects of allopurinol therapy in hyperuricemic hemodialysis (HD patients with high BP. Materials and Methods: This single-blind, randomized cross-over clinical study involved 55 HD patients with serum uric acid level > 6.5 (men and > 5.5 mg/dL (women. They were randomly divided in two groups, each of which went through two phases. Group-1 in phase-1 received 100 mg/day orally of allopurinol for three months; while Group-2 was given whatever medication they received prior to the study. After two months of washing period, the groups were crossed-over. The BP levels were measured before and after HD during the eight months study period. Results: Fifty-three patients completed the study (33 men and 20 women, with mean age of 55.8 years. Uric acid levels decreased significantly during the12 weeks of allopurinol therapy (7.71 ± 1.53 to 5.2 ± 1.2 P < 0.005. Overall, after the 12 weeks of allopurinol therapy, systolic and diastolic BP also significantly decreased in allopurinol group, 15.8% (139 to 117, P < 0.0005 and 8.6% (81 to 74, P < .0005, respectively. There were not significant changes in body mass index, blood urea nitrogen, creatinine, albumin, cholesterol, triglyceride, hemoglobin, liver enzymes and serum electrolytes level after treatment. Patients treated with allopurinol had a significant increase in the quality of dialysis (KT/V (P: 0.043. Conclusions: In HD patients, allopurinol treatment reduced BP. The results indicate a new potential therapeutic approach for controlling BP in HD patients.

  7. Correlation analysis of high precision blood flow imaging in secondary parathyroid function in maintenance hemodialysis patients

    Institute of Scientific and Technical Information of China (English)

    Wen-Ze Du; Le Chen; Xiao-Yun Wu

    2016-01-01

    Objective:To investigate the value of high precision blood flow imaging (Fine-Flow) in secondary parathyroid function (SHPT) in patients with maintenance hemodialysis (MHD). Methods: A total of 95 MHD patients with SHPT in our hospital from January 2015 to June 2016 were selected as the research object. According to the Fine-Flow examination of parathyroid gland, 73 cases were divided into display group, 22 cases were not shown; Display group according to the hyperplasia of parathyroid diameter were divided into 1.5 cm group of 17 cases; display group according to the blood flow into the rich group of 41 cases, not rich group of 32 cases; according to whether calcification were divided into calcification group of 43 cases, non calcified group of 30 cases. CDFI was used for the anterior region of neck transverse and longitudinal scanning, check the thyroid and around the dorsal lobes.The size, echo, lesion number and blood flow were measured, parathyroid hormone (PTH), serum calcium (Ca), phosphorus (P), and calculate the Ca and P product (Ca×P) were measured.Results: PTH and Ca of the display group were significantly higher than that of the non display group, and differences in P and Ca×P were not statistically significant; Parathyroid diameter >1.5 cm PTH levels were significantly higher than the other three groups, diameter 1-1.5 cm group and >1.5 cm group Ca, diameter Ca×P was higher than that in group <5 cm and 0.5-1.0 cm group, difference in P of four groups was not statistical significant; group PTH, P, abundant blood flow Ca×P were not significantly higher than the rich group, difference in P of two groups was no statistical significance; group Ca was significantly higher than that of calcification calcification group, differences in PTH, P, Ca×P of the two groups were not statistically significant.Conclusions:MHD patients with SHPT, parathyroid Fine-Flow display rate is high, and has the characteristic performance. Its operation is simple, non

  8. Debate from the 2012 ASH Annual Scientific Sessions: should blood pressure be reduced in hemodialysis patients? Pro position.

    Science.gov (United States)

    Agarwal, Rajiv L

    2012-01-01

    Among chronic hemodialysis patients with hypertension, blood pressure should be lowered. Blood pressure reduction with antihypertensive drugs does not increase mortality; in contrast, meta-analysis of randomized trials suggests that treatment of hypertension in this high-risk population may, in fact, improve cardiovascular outcomes. The association of low blood pressure with increased mortality in longitudinal studies should not be considered as evidence against lowering blood pressure. Lowering blood pressure among hypertensive patients should primarily be done by sodium restriction and dry-weight reduction. Treatment is perhaps better directed to home blood pressure than pre- or post-dialysis blood pressure recordings. Although no firm data are available, it appears that treating home blood pressure to blood pressure recordings during dialysis are important to ensure patient safety. Adequately designed and powered randomized trials are needed to examine the notion that blood pressure lowering and, if so, to what level of blood pressure will improve clinically meaningful outcomes among chronic dialysis patients. Published by Elsevier Inc.

  9. Study on the Inlfuencing Factors of Blood Pressure Variability in Patients Undergoing Maintenance Hemodialysis

    Institute of Scientific and Technical Information of China (English)

    BAI Xiao-hui; PAN Rong-hua; ZHAO Yan-mei; WU Yue-lu; RUI Guo-hua

    2016-01-01

    Objective: To investigate the inlfuencing factors of blood pressure variability (BPV) in patients with maintenance hemodialysis (MHD), so as to improve the patients’ prognosis. Methods:The clinical data of 107 MHD patients were retrospectively analyzed. According to intradialytic systolic pressure (SBP)-BPV, the patients were assigned into high SBP-BPV group (n=52) and low SBP-BPV group (n=55). According to intradialytic diastolic pressure (DBP)-BPV, they were divided into high DBP-BPV group (n=49) and low DBP-BPV group (n=58). The basic characteristics of patients in high and low SBP-BPV groups and DBP-BPV groups were compared, and the inlfuencing factors of both SBP-BPV and DBP-BPV were also analyzed. Results: The differences were statistically significant between high and low SBP-BPV groups by comparison to the age, dry weight, body mass index (BMI), dialysis age, interdialysis weight gain (IDWG) rate, pre-dialysis SBP, albumin (ALB), hemoglobin (Hb), total cholesterol (TC) and calcium-phosphorus product (P<0.05 orP<0.01). The differences were also statistically signiifcant between high and low DBP-BPV groups by comparison to the age, dry weight, BMI, IDWG rate, pre-dialysis SBP and DBP, Hb and calcium-phosphorus product (P<0.05 orP<0.01). Multiple linear regression analysis revealed that SBP-BPV was positively correlated with the age, IDWG rate and pre-dialysis SBP (P=0.002,P=0.001,P=0.006), while negatively with Hb (P=0.021). They were all regarded as independent inlfuencing factors of SBP-BPV. Both IDWG rate and pre-dialysis DBP were positively correlated with DBP-BPV (P=0.019,P=0.004), and could be considered as independent inlfuencing factors of DBP-BPV. Conclusion:Advanced age, increased IDWG%, pre-dialysis high SBP and decreased Hb are independent risk factors of SBP-BPV, and both increased IDWG rate and pre-dialysis high DBP are independent risk factors of DBP-BPV in intradialytic MHD patients. Pre-dialysis patients should positively control the weight

  10. Study on the Influencing Factors of Blood Pressure Variability in Patients Undergoing Maintenance Hemodialysis

    Directory of Open Access Journals (Sweden)

    Xiao-hui BAI

    2016-09-01

    Full Text Available Objective: To investigate the influencing factors of blood pressure variability (BPV in patients with maintenance hemodialysis (MHD, so as to improve the patients’ prognosis.Methods: The clinical data of 107 MHD patients were retrospectively analyzed. According to intradialytic systolic pressure (SBP-BPV, the patients were assigned into high SBP-BPV group (n=52 and low SBP-BPV group (n=55. According to intradialytic diastolic pressure (DBP-BPV, they were divided into high DBP-BPV group (n=49 and low DBP-BPV group (n=58. The basic characteristics of patients in high and low SBP-BPV groups and DBP-BPV groups were compared, and the influencing factors of both SBP-BPV and DBP-BPV were also analyzed.Results: The differences were statistically significant between high and low SBP-BPV groups by comparison to the age, dry weight, body mass index (BMI, dialysis age, interdialysis weight gain (IDWG rate, pre-dialysis SBP, albumin (ALB, hemoglobin (Hb, total cholesterol (TC and calcium-phosphorus product (P<0.05 or P<0.01. The differences were also statistically significant between high and low DBP-BPV groups by comparison to the age, dry weight, BMI, IDWG rate, pre-dialysis SBP and DBP, Hb and calcium-phosphorus product (P<0.05 or P<0.01. Multiple linear regression analysis revealed that SBP-BPV was positively correlated with the age, IDWG rate and pre-dialysis SBP (P=0.002, P=0.001, P=0.006, while negatively with Hb (P=0.021. They were all regarded as independent influencing factors of SBP-BPV. Both IDWG rate and pre-dialysis DBP were positively correlated with DBP-BPV (P=0.019, P=0.004, and could be considered as independent influencing factors of DBP-BPV.Conclusion: Advanced age, increased IDWG%, pre-dialysis high SBP and decreased Hb are independent risk factors of SBP-BPV, and both increased IDWG rate and pre-dialysis high DBP are independent risk factors of DBP-BPV in intradialytic MHD patients. Pre-dialysis patients should positively control the

  11. Relationship between Interdialytic Weight Gain and Blood Pressure in Pediatric Patients on Chronic Hemodialysis

    Directory of Open Access Journals (Sweden)

    Olivera Marsenic

    2016-01-01

    Full Text Available Overhydration is reported to be the main cause of hypertension (HTN as well as to have no association with HTN in hemodialysis (HD population. This is the first report of the relationship between interdialytic weight gain (IDWG and pre-HD blood pressure (BP in pediatric patients in relation to residual urine output (RUO. We studied 170 HD sessions and interdialytic periods performed during a 12-week period in 5 patients [age 4–17 years, weight 20.8–66 kg, 3 anuric (102 HD sessions, and 2 nonanuric (68 HD sessions]. BP is presented as systolic BP index (SBPI and diastolic BP index (DBPI, calculated as systolic or diastolic BP/95th percentile for age, height, and gender. IDWG did not differ (P>0.05 between anuric and nonanuric pts. There was a positive but not significant correlation between IDWG and both pre-HD SBPI (r=0.833, P=0.080 and pre-HD DBPI (r=0.841, P=0.074. Pre-HD SBPI (1.01±0.12 versus 1.13±0.18 and DBPI (0.92±0.16 versus 1.01±0.24 were higher in nonanuric patents (P<0.001 and P<0.01, resp.. Pre-HD HTN may not be solely related to IDWG and therapies beyond fluid removal may be needed. Individualized approach to HTN management is necessary in pediatric dialysis population.

  12. Measurement and Hemodialysis Effect of Complex Relative Permittivity for Blood of Kidney Patients Using Open-Ended Coaxial Measurement Probe

    Science.gov (United States)

    Takeda, Akira; Takata, Kazuyuki; Nagao, Hirotomo; Wang, Jianqing; Fujiwara, Osamu

    Before evaluating the quality of hemodialysis from the limited volume of human blood using a commercially available open-ended coaxial probe, we previously measured the complex relative permittivity of pure water from 200 MHz to 6 GHz with respect to its measured liquid volume, and revealed that 1.9 ml water in a beaker with a diameter of 24 mm and a depth of 2 mm gives a variation within ±0.5 % for the real part and ±7 % for the imaginary part. Based on the above finding, we measured the dielectric properties of 2.5 ml whole blood at 25°C for 10 normal healthy subjects and 9 hemodialysis patients. The measured results on healthy subjects show good agreement with the data reported by Gabriel for human blood at 37°C, while they provide different dispersion characteristics of straight lines for their Cole-Cole plots. The measured results on the patients give further different dispersion characteristics in comparison with the healthy subjects. In order to investigate the above differences statistically, the student t-test was conducted to reveal that permittivity at infinite frequency for the Cole-Cole plots is significantly different with a level of 1 % among its averaged values for normal healthy subjects and patients before dialysis.

  13. Exsanguination of a home hemodialysis patient as a result of misconnected blood-lines during the wash back procedure: A case report

    Directory of Open Access Journals (Sweden)

    Allcock Kerryanne

    2012-05-01

    Full Text Available Abstract Background Home hemodialysis is common in New Zealand and associated with lower cost, improved survival and better patient experience. We present the case of a fully trained home hemodialysis patient who exsanguinated at home as a result of an incorrect wash back procedure. Case presentation The case involves a 67 year old male with a history of well controlled hypertension and impaired glucose tolerance. He commenced on peritoneal dialysis in 2006 following the development of end stage kidney failure secondary to focal segmental glomerulosclerosis. He transferred to hemodialysis due to peritoneal membrane failure in 2010, and successfully trained for home hemodialysis over a 20 week period. Following one month of uncomplicated dialysis at home, he was found deceased on his machine at home in the midst of dialysis. His death occurred during the wash back procedure performed using the “open circuit” method, and resulted from misconnection of the saline bag to the venous end of the extracorporeal blood circuit instead of the arterial end. This led to approximately 2.3L of his blood being pumped into the saline bag resulting in hypovolaemic shock and death from exsanguination. Conclusions Despite successful training, critical procedural errors can still be made by patients on home hemodialysis. In this case, the error involved misconnection of the saline bag for wash back. This case should prompt providers of home hemodialysis to review their training protocols and manuals. Manufacturers of dialysis machinery should be encouraged to design machines specifically for home hemodialysis, and consider distinguishing the arterial and venous ends of the extracorporeal blood circuit with colour coding or incompatible connectivity, to prevent occurrences such as these in the future.

  14. A numerical study of the effect of catheter angle on the blood flow characteristics in a graft during hemodialysis

    Science.gov (United States)

    Ryou, Hong Sun; Kim, Soyoon; Ro, Kyoungchul

    2013-02-01

    For patients with renal failure, renal replacement therapies are needed. Hemodialysis is a widely used renal replacement method to remove waste products. It is important to improve the patency rate of the vascular access for efficient dialysis. Since some complications such as an intimal hyperplasia are associated with the flow pattern, the hemodynamics in the vascular access must be considered to achieve a high patency rate. In addition, the blood flow from an artificial kidney affects the flow in the vascular access. Generally, the clinical techniques of hemodialysis such as the catheter angle or dialysis dose have been set up empirically. In this study, a numerical analysis is performed on the effect of the catheter angle on the flow in the graft. Blood is assumed to be a non-Newtonian fluid. According to the high average wall shear stress value, the leucocytes and platelets can be activated not only at the arterial anastomosis, but also at the bottom of the venous graft, when the catheter angle is not zero. For a catheter angle less than five degrees, there is a low shear and high oscillatory shear index region that appears at the venous graft and the venous anastomosis. Thus, a catheter angle less than five degrees should be avoided to prevent graft failure.

  15. Infections in hemodialysis: a concise review. Part II: blood transmitted viral infections

    OpenAIRE

    2011-01-01

    Hemodialysis (HD) patients are particularly predisposed to infections. It seems that the HD procedure per se as well as disturbances in both innate and adaptive immunity significantly contribute to this susceptibility. Infections are the major cause of morbidity and the second cause of death following cardiovascular events in HD patients. Episodes of bacteremia and pneumonia account for the majority of severe infections in this population. In addition to these bacterial infections another com...

  16. Pseudomonas aeruginosa blood stream infection isolates from patients with recurrent blood stream infection: Is it the same genotype?

    Science.gov (United States)

    McCARTHY, K L; Kidd, T J; Paterson, D L

    2017-08-22

    The type identity of strains of Pseudomonas aeruginosa from primary and recurrent blood stream infection (BSI) has not been widely studied. Twenty-eight patients were identified retrospectively from 2008 to 2013 from five different laboratories; available epidemiological, clinical and microbiological data were obtained for each patient. Isolates were genotyped by iPLEX MassARRAY MALDI-TOF MS and rep-PCR. This showed that recurrent P. aeruginosa BSI was more commonly due to the same genotypically related strain as that from the primary episode. Relapse due to a genotypically related strain occurred earlier in time than a relapsing infection from an unrelated strain (median time: 26 vs. 91 days, respectively). Line related infections were the most common source of suspected BSI and almost half of all BSI episodes were associated with neutropenia, possibly indicating translocation of the organism from the patient's gut in this setting. Development of meropenem resistance occurred in two relapse isolates, which may suggest that prior antibiotic therapy for the primary BSI was a driver for the subsequent development of resistance in the recurrent isolate.

  17. Hemodialysis access - self care

    Science.gov (United States)

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

  18. Bacillus cereus from blood cultures: virulence genes, antimicrobial susceptibility and risk factors for blood stream infection.

    Science.gov (United States)

    Horii, Toshinobu; Notake, Shigeyuki; Tamai, Kiyoko; Yanagisawa, Hideji

    2011-11-01

    We characterized the profiles of virulence genes and antimicrobial susceptibility of Bacillus cereus isolates from blood cultures as well as the risk factors for blood stream infections (BSIs). The diversity of virulence gene patterns was found to be wide among 15 B. cereus isolates from BSIs and also among 11 isolates from contaminated blood cultures. The MicroScan broth microdilution method yielded results corresponding with those of the agar dilution (reference) method for levofloxacin, linezolid, and vancomycin, while the Etest results were consistent with the reference results for clindamycin, gentamicin, imipenem, levofloxacin, and linezolid. Compared with the reference values, however, some isolates showed marked differences of the minimum inhibitory concentrations (MICs) for ampicillin and clindamycin when determined using the MicroScan method, or the MICs for ampicillin, meropenem, and vancomycin when determined using the Etest method. Significantly more patients were treated with antimicrobials for more than 3 days during the 3-month period before isolation in the BSI group. Prior antimicrobial therapy may be a risk factor for BSIs due to B. cereus.

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

    Science.gov (United States)

    2014-10-09

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

  20. Dose adjustment of carboplatin in patients on hemodialysis.

    Science.gov (United States)

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

    2014-03-01

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

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

    Science.gov (United States)

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

    1989-06-01

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

  2. Bare and protein-conjugated Fe3O4 ferromagnetic nanoparticles for utilization in magnetically assisted hemodialysis: biocompatibility with human blood cells

    Science.gov (United States)

    Stamopoulos, D.; Manios, E.; Gogola, V.; Benaki, D.; Bouziotis, P.; Niarchos, D.; Pissas, M.

    2008-12-01

    Magnetically assisted hemodialysis is a development of conventional hemodialysis and is based on the circulation of ferromagnetic nanoparticle-targeted binding substance conjugates (FN-TBS Cs) in the bloodstream of the patient and their eventual removal by means of a 'magnetic dialyzer'. Presented here is an in vitro investigation on the biocompatibility of bare Fe3O4 FNs and Fe3O4-bovine serum albumin Cs with blood cells, namely red blood cells (RBCs), white blood cells (WBCs) and platelets (Plts). Atomic force microscopy (AFM) and optical microscopy (OM) enabled the examination of blood cells at the nanometer and micrometer level, respectively. The observations made on FN- and C-maturated blood samples are contrasted to those obtained on FN- and C-free reference blood samples subjected to exactly the same maturation procedure. Qualitatively, both AFM and OM revealed no changes in the overall shape of RBCs, WBCs and Plts. Incidents where bare FNs or Cs were bound onto the surface of RBCs or internalized by WBCs were very rare. Detailed examination by means of OM proved that impaired coagulation of Plts is not initiated/promoted either by FNs or Cs. Quantitatively, the statistical analysis of the obtained AFM images from RBC surfaces clearly revealed that the mean surface roughness of RBCs maturated with bare FNs or Cs was identical to the one of reference RBCs.

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

    Institute of Scientific and Technical Information of China (English)

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

    2011-01-01

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

  4. Blood compatibility and permeability of heparin-modified polysulfone as potential membrane for simultaneous hemodialysis and LDL removal.

    Science.gov (United States)

    Huang, Xiao-Jun; Guduru, Deepak; Xu, Zhi-Kang; Vienken, Jörg; Groth, Thomas

    2011-01-10

    Heparin was covalently immobilized on PSf membranes to obtain a dialysis membrane with high affinity for LDL. WCA and streaming potential measurements were performed to investigate wettability and surface charge of the membranes. The morphology of the membranes was investigated by SEM. An ELISA was used to measure the adsorption and desorption of LDL on plain and modified PSf. Blood compatibility was studied by measurement of thrombin time, partial thromboplastin time, kallikrein activity and platelet adhesion. It was found that the blood compatibility of the membrane was improved by covalent immobilization of heparin at its surface. However, PSf-Hep membrane showed higher flux recovery after BSA solution filtration, which revealed antifouling property of PSf-Hep membranes.

  5. Blood stream in the art: thoughts on music and hemorheology.

    Science.gov (United States)

    Nemeth, N

    2009-01-01

    People of medical vocation have felt a strong attraction to arts for centuries, sometimes even developing into strong bonds. The subject of present essay is to enumerate - at times, analyzing the possible interactions of - correlations of the relationship between blood circulation and musical arts. The love of arts, consumption of arts and the creation of art can in some way contribute to a more balanced, wholesome life, to spiritual and intellectual harmony. These factors in turn can aid medical activity - not only the curing of the patients, but also the doctor-patient relationship, education and scientific research.

  6. Protocol of randomized control trial for effectiveness of angiotensin receptor blockers on blood pressure control among euvolemic hypertensive hemodialysis patients.

    Science.gov (United States)

    Aftab, Raja Ahsan; Khan, Amer Hayat; Syed Sulaiman, Syed Azhar; Khan, Tahir Mehmood; Adnan, Azreen Syazril

    2017-04-01

    Volume overload and the renin-aldosterone-angiotensin system (RAAS) are 2 major factors contributing to hypertension (HTN) among hemodialysis (HD) patients. Although volume-dependent components of HTN can be corrected by appropriate volume removal, a proportion of HD patients experience elevated blood pressure (BP) despite achieving euvolemic and ideal dry weight. A single center, prospective, randomized, parallel design, single-blind trial will be conducted in the Malaysian state of Kelantan among postdialysis euvolemic hypertensive patients that are on regular dialysis at least 3 times a week. The primary outcome of the trial will be to note the effectiveness of losartan (RAAS inhibitor) in reducing systolic BP look at all causes of mortality. A body composition monitor (BCM) will be used to assess postdialysis volume and dry weight. Postdialysis euvolemic patients that have systolic BP > 140 mm Hg will be randomized using Covariate Adaptive Randomization to standard or treatment arm. Participants in the treatment arm will be given 50 mg of losartan once daily except on dialysis days, whereas the standard arm patients will be prescribed non-RAAS antihypertensive agents. The study participants will be followed for a period of 12 months. A Wilcoxon statistical test will be performed to note the difference in BP from baseline up to 12 months using Statistical Package for the Social Sciences (SPSS) 20. The study protocols are approved from the Ethical and Research Committee of the Universiti Sains Malaysia (USM/JEPeM/15050173). The trial is registered under the Australia New Zealand Clinical Trial Registry (ACTRN12615001322527). The trial was registered on 2/12/2015 and the 1st patient was enrolled on 10/12/2015. The trial was formally initiated on 16/02/2016. Management of HTN among HD patients requires understanding the primary cause of HTN and treating accordingly. The current trial is an attempt to reduce BP among postdialysis euvolemic but

  7. Extracorporeal gas exchange with the DeltaStream rotary blood pump in experimental lung injury.

    Science.gov (United States)

    Dembinski, Rolf; Kopp, Rüdger; Henzler, Dietrich; Hochhausen, Nadine; Oslender, Nicole; Max, Martin; Rossaint, Rolf; Kuhlen, Ralf

    2003-06-01

    In most severe cases of the acute respiratory distress syndrome, veno-venous extracorporeal membrane oxygenation (ECMO) can be used to facilitate gas exchange. However, the clinical use is limited due to the size and the concomitant risk of severe adverse events of conventionally-used centrifugal blood pumps with high extracorporeal blood volumes. The DeltaStream blood pump is a small-sized rotary blood pump that may reduce extracorporeal blood volume, foreign surfaces, contact activation of the coagulation system, and blood trauma. The aim of the present study was to test the safety and efficacy of the DeltaStream pump for ECMO in animals with normal lung function and experimental acute lung injury (ALI). Therefore, veno-venous ECMO was performed for 6 hours in mechanically ventilated pigs with normal lung function (n=6) and with ALI induced by repeated lung lavage (n=6) with a blood flow of 30% of the cardiac output. Gas flow with a FiO2 of 1.0 was set to equal blood flow. With a mean activated clotting time of 121 +/- 22 s, no circulatory impairment or thrombus formation was revealed during ECMO. Furthermore, free plasma Hb did not increase. In controls, hemodynamics and gas exchange remained unchanged. In animals with ALI, hemodynamics remained stable and gas transfer across the extracorporeal oxygenators was optimal, but only in 2 animals was a marked increase in PaO2 observed. CO2 removal was efficacious in all animals. We concluded that the DeltaStream blood pump may be used for veno-venous ECMO without major blood damage or hemodynamic impairment.

  8. Hemodialysis removal of norfloxacin.

    Science.gov (United States)

    Lau, A H; Tang, I; Fitzloff, J; Jain, R

    1994-01-01

    The effect of hemodialysis on norfloxacin removal was evaluated in 7 patients. Single 800-mg doses of the drug were given to the subjects prior to dialysis using cuprophan hollow fiber dialyzers. Arterial and venous sample pairs were obtained at hourly intervals during treatment. Norfloxacin plasma concentrations were determined by HPLC. The mean hemodialysis clearance and extraction ratio were 38.84 +/- 10.92 ml/min and 0.19 +/- 0.06, respectively. Small differences in these parameters were observed between dialyzers with different surface areas (p > 0.05) and also between treatments using different blood flow rates (p > 0.05). Since a relatively small amount of norfloxacin is removed by hemodialysis, dosage adjustment is not necessary to compensate for the extracorporeal removal.

  9. Noninvasive quantification of blood potassium concentration from ECG in hemodialysis patients

    Science.gov (United States)

    Corsi, Cristiana; Cortesi, Marilisa; Callisesi, Giulia; De Bie, Johan; Napolitano, Carlo; Santoro, Antonio; Mortara, David; Severi, Stefano

    2017-01-01

    Blood potassium concentration ([K+]) influences the electrocardiogram (ECG), particularly T-wave morphology. We developed a new method to quantify [K+] from T-wave analysis and tested its clinical applicability on data from dialysis patients, in whom [K+] varies significantly during the therapy. To elucidate the mechanism linking [K+] and T-wave, we also analysed data from long QT syndrome type 2 (LQT2) patients, testing the hypothesis that our method would have underestimated [K+] in these patients. Moreover, a computational model was used to explore the physiological processes underlying our estimator at the cellular level. We analysed 12-lead ECGs from 45 haemodialysis and 12 LQT2 patients. T-wave amplitude and downslope were calculated from the first two eigenleads. The T-wave slope-to-amplitude ratio (TS/A) was used as starting point for an ECG-based [K+] estimate (KECG). Leave-one-out cross-validation was performed. Agreement between KECG and reference [K+] from blood samples was promising (error: −0.09 ± 0.59 mM, absolute error: 0.46 ± 0.39 mM). The analysis on LQT2 patients, also supported by the outcome of computational analysis, reinforces our interpretation that, at the cellular level, delayed-rectifier potassium current is a main contributor of KECG correlation to blood [K+]. Following a comprehensive validation, this method could be effectively applied to monitor patients at risk for hyper/hypokalemia. PMID:28198403

  10. Blood flow measurement using digital subtraction angiography for assessing hemodialysis access function

    Science.gov (United States)

    Koirala, Nischal; Setser, Randolph M.; Bullen, Jennifer; McLennan, Gordon

    2017-03-01

    Blood flow rate is a critical parameter for diagnosing dialysis access function during fistulography where a flow rate of 600 ml/min in arteriovenous graft or 400-500 ml/min in arteriovenous fistula is considered the clinical threshold for fully functioning access. In this study, a flow rate computational model for calculating intra-access flow to evaluate dialysis access patency was developed and validated in an in vitro set up using digital subtraction angiography. Flow rates were computed by tracking the bolus through two regions of interest using cross correlation (XCOR) and mean arrival time (MAT) algorithms, and correlated versus an in-line transonic flow meter measurement. The mean difference (mean +/- standard deviation) between XCOR and in-line flow measurements for in vitro setup at 3, 6, 7.5 and 10 frames/s was 118+/-63 37+/-59 31+/-31 and 46+/-57 ml/min respectively while for MAT method it was 86+/-56 57+/-72 35+/-85 and 19+/-129 ml/min respectively. The result of this investigation will be helpful for selecting candidate algorithms while blood flow computational tool is developed for clinical application.

  11. 血液透析低血压的常见原因及回顾性分析%Retrospective analysis and common causes of low blood pressure in hemodialysis

    Institute of Scientific and Technical Information of China (English)

    杨静; 刘国锋; 程琳

    2014-01-01

    目的:分析透析低血压产生的原因及防治方法。方法:2012年血透病例96例及2013年血透病例120例,每周透析2~3次,共行血透19200次,低通量透析和高通量透析交替使用。对比两组低血压的发生率。结果:2012年血透病例96例低血压发生率16%,2013年血透病例120例低血压发生率7%。结论:透析低血压是尿毒症维持性血液透析的常见并发症之一,避免透析低血压关键是预防。%Objective:To analyze the causes and prevention methods of low blood pressure in hemodialysis.Methods:96 cases of hemodialysis in 2012 and 120 cases of hemodialysis in 2013 were enrolled, 2~3 times a week dialysis,and the total times of hemodialysis was 19 200,and the low flux dialysis and high flux dialysis used interchangeably.The incidence of low blood pressure was compared in the two groups.Results:The incidence of low blood pressure in 96 cases was 16% in 2012 and the incidence of low blood pressure in 120 cases was 7% in 2013.Conclusion:The low blood pressure is one of the most common complications of the persistent hemodialysis in uremia,and the prevention is the key to avoid low blood pressure in hemodialysis.

  12. Measurement of streaming potentials of mammalian blood vessels, aorta and vena cava, in vivo.

    Science.gov (United States)

    Sawyer, P N; Himmelfarb, E; Lustrin, I; Ziskind, H

    1966-09-01

    Attempts to measure streaming potentials in large rabbit blood vessels in vivo have been carried out. Streaming potentials, V(89), were measured by the introduction of microelectrodes through the wall of the blood vessel at separations greater than 1 cm. The outputs from these electrodes fed through calomel cells were amplified and recorded directly by using an Electronics for Medicine photorecorder (White Plains, N. Y.). "Effective streaming currents" were determined by running the output through a low impedence galvanometer while simultaneously measuring the resistance of the circuit V(8) were, therefore, calculated from two measurements and compared. Flow through vessels studied was measured using two different electromagnetic flowmeters. The results indicate that V(8) present in both aorta and vena cava are of the order of 5 to 10 mv. By using the Helmholtz-Smoluchowski equation into which flow was reintegrated, the numbers yield zeta potentials approximating 0.1 to 0.4 v in both aorta and vena cava. This number approaches the apparent upper limit for zeta (actually "interfacial potentials") potentials in biological systems. The measured "i.f." potential is considered as the interreaction of several physical and metabolic factors operating at the blood intimal interface. The polarity of the potential suggests that the interface is negative with respect to the blood flowing through the vessel. Interfacial potential and related V(8) are discussed in terms of their possible importance as a mechanism for maintaining vascular homeostasis in the living animal.

  13. Dialysis - hemodialysis

    Science.gov (United States)

    ... doctor. Together, you can decide what type of hemodialysis is right for you. ... F (38.0°C) The arm where your catheter is placed swells and the ... and vomiting Drowsiness, confusion, or problems concentrating

  14. Home hemodialysis

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  15. Streaming flow from ultrasound contrast agents by acoustic waves in a blood vessel model.

    Science.gov (United States)

    Cho, Eunjin; Chung, Sang Kug; Rhee, Kyehan

    2015-09-01

    To elucidate the effects of streaming flow on ultrasound contrast agent (UCA)-assisted drug delivery, streaming velocity fields from sonicated UCA microbubbles were measured using particle image velocimetry (PIV) in a blood vessel model. At the beginning of ultrasound sonication, the UCA bubbles formed clusters and translated in the direction of the ultrasound field. Bubble cluster formation and translation were faster with 2.25MHz sonication, a frequency close to the resonance frequency of the UCA. Translation of bubble clusters induced streaming jet flow that impinged on the vessel wall, forming symmetric vortices. The maximum streaming velocity was about 60mm/s at 2.25MHz and decreased to 15mm/s at 1.0MHz for the same acoustic pressure amplitude. The effect of the ultrasound frequency on wall shear stress was more noticeable. Maximum wall shear stress decreased from 0.84 to 0.1Pa as the ultrasound frequency decreased from 2.25 to 1.0MHz. The maximum spatial gradient of the wall shear stress also decreased from 1.0 to 0.1Pa/mm. This study showed that streaming flow was induced by bubble cluster formation and translation and was stronger upon sonication by an acoustic wave with a frequency near the UCA resonance frequency. Therefore, the secondary radiant force, which is much stronger at the resonance frequency, should play an important role in UCA-assisted drug delivery.

  16. STREAM

    DEFF Research Database (Denmark)

    Godsk, Mikkel

    This paper presents a flexible model, ‘STREAM’, for transforming higher science education into blended and online learning. The model is inspired by ideas of active and collaborative learning and builds on feedback strategies well-known from Just-in-Time Teaching, Flipped Classroom, and Peer...... Instruction. The aim of the model is to provide both a concrete and comprehensible design toolkit for adopting and implementing educational technologies in higher science teaching practice and at the same time comply with diverse ambitions. As opposed to the above-mentioned feedback strategies, the STREAM...

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

    Institute of Scientific and Technical Information of China (English)

    门雯瑾; 丁致民

    2011-01-01

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

  18. A retrospective study of palindrome symmetrical-tip catheters for chronic hemodialysis access in China.

    Science.gov (United States)

    Ye, Chaoyang; Mao, Zhiguo; Zhang, Pan; Zhang, Yuqiang; Rong, Shu; Chen, Jing; Mei, Changlin

    2015-07-01

    Hemodialysis catheters remain necessary for long-term vascular access in patients for whom arteriovenous access may be problematic or impossible. Developments in catheter design have improved long-term catheter functionality, and reduced the rate of infection and complications associated with their use. This retrospective study of 284 cases of chronic catheterization in 271 patients treated between 2009 and 2011 using Tal Palindrome™ symmetrical-tip (N = 118) or Quinton™ Permcath™ step-tip (N = 166) hemodialysis catheters evaluates the efficacy and the safety of symmetrical-tip dialysis catheters for chronic hemodialysis, compared with a step-tip catheter. Measurements of catheter performance included mean catheter dwell time, incidence of low blood flow, and rates of infection and catheter-related blood stream infection (CRBSI). The symmetrical-tip catheter had a significantly longer mean dwell time compared with the step-tip catheter; 329.4 ± 38.1 versus 273.1 ± 25.4 d (p catheter days was lower for the symmetrical-tip compared with the step-tip catheter; 1.13 versus 6.86 (p catheter was also associated with a lower incidence of complications; the rates of infection (0.28 vs. 0.78; p catheters, and catheter removal occurred less often for the symmetrical-tip catheter (8% vs. 16%; p hemodialysis catheter was associated with a longer mean dwell time, lower incidence of low blood flow, and lower infection rate compared with the step-tip catheter.

  19. In vitro and in vivo study of hazardous effects of Ag nanoparticles and Arginine-treated multi walled carbon nanotubes on blood cells: application in hemodialysis membranes.

    Science.gov (United States)

    Zare-Zardini, Hadi; Amiri, Ahmad; Shanbedi, Mehdi; Taheri-Kafrani, Asghar; Kazi, S N; Chew, B T; Razmjou, Amir

    2015-09-01

    One of the novel applications of the nanostructures is the modification and development of membranes for hemocompatibility of hemodialysis. The toxicity and hemocompatibility of Ag nanoparticles and arginine-treated multiwalled carbon nanotubes (MWNT-Arg) and possibility of their application in membrane technology are investigated here. MWNT-Arg is prepared by amidation reactions, followed by characterization by FTIR spectroscopy, Raman spectroscopy, and thermogravimetric analysis. The results showed a good hemocompatibility and the hemolytic rates in the presence of both MWNT-Arg and Ag nanoparticles. The hemolytic rate of Ag nanoparticles was lower than that of MWNT-Arg. In vivo study revealed that Ag nanoparticle and MWNT-Arg decreased Hematocrit and mean number of red blood cells (RBC) statistically at concentration of 100 µg mL(-1) . The mean decrease of RBC and Hematocrit for Ag nanoparticles (18% for Hematocrit and 5.8 × 1,000,000/µL) was more than MWNT-Arg (20% for Hematocrit and 6 × 1000000/µL). In addition, MWNT-Arg and Ag nanoparticles had a direct influence on the White Blood Cell (WBC) drop. Regarding both nanostructures, although the number of WBC increased in initial concentration, it decreased significantly at the concentration of 100 µg mL(-1) . It is worth mentioning that the toxicity of Ag nanoparticle on WBC was higher than that of MWNT-Arg. Because of potent antimicrobial activity and relative hemocompatibility, MWNT-Arg could be considered as a new candidate for biomedical applications in the future especially for hemodialysis membranes.

  20. Dry-Weight: A Concept Revisited in an Effort to Avoid Medication-Directed Approaches for Blood Pressure Control in Hemodialysis Patients

    Science.gov (United States)

    Weir, Matthew R.

    2010-01-01

    Background and objectives: Achieving and maintaining dry-weight appears to be an effective but forgotten strategy in controlling and maintaining normotension among hypertensive patients on hemodialysis. Methods: Qualitative review of literature to define dry-weight and its utility in achieving blood pressure control. Results: The concept of dry-weight has evolved over time and its definition has changed. One such definition defines dry-weight as the lowest tolerated postdialysis weight achieved via gradual change in postdialysis weight at which there are minimal signs or symptoms of hypovolemia or hypervolemia. Although clinical examination does not perform well in detecting latent increase in dry-weight, several technologies such as relative plasma volume monitoring and body impedance analysis are emerging that may help in assessing dry-weight in the future. Sodium restriction is a modifiable risk factor that can lead to better blood pressure (BP) control. However, dietary sodium restriction requires lifestyle modifications that are difficult to implement and even harder to sustain over the long term. Restricting dialysate sodium is a simpler but underexplored strategy that can reduce thirst, limit interdialytic weight gain, and assist the achievement of dry-weight. Achievement of dry-weight can improve interdialytic BP, reduce pulse pressure, and limit hospitalizations. Conclusions: Avoiding medication-directed control of BP may enhance the opportunity to probe dry-weight, facilitate removal of volume, and limit the risk for pressure-volume overload, which may be a significant concern leading to myocardial remodeling in the hemodialysis patient. Probing dry-weight among patients with ESRD has the potential to improve dismal cardiovascular outcomes. PMID:20507951

  1. Effect of high--flux hemodialysis on blood biochemical indices in maintenance hemodialysis patients%高通量透析对维持性血液透析患者血液生化指标的影响

    Institute of Scientific and Technical Information of China (English)

    谢鸣部; 潘淼(通讯作者); 黄智敏

    2013-01-01

    目的观察高通量透析对维持性血液透析( maintenance hemodialysis,MHD)患者血脂、钙磷代谢、炎症、营养等指标的影响。方法将30例维持性透析患者随机分为高通量透析组和低通量透析组,比较2组治疗前及6个月后患者的总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、钙(Ca)、磷(P)、超敏C-反应蛋白(hs-CRP)、血清白蛋白(ALB)水平。结果与治疗前及低通量透析组比较,高通量透析组TG、TC、LDL、hs-CRP、P水平下降, Ca、ALB、HDL升高,其差异有统计学意义(均P<0.05)。结论高通量透析可改善维持性血液透析患者血脂、钙磷代谢、炎症及营养状态。%Objective: To study the impact of high--flux hemodialysis on microinflammatory lipid profile and malnutrition in maintenance hemodialysis (MHD) patients. Methods: 30 patients on MHD were randomly divided into high--flux hemodialysis group and low--flux hemodialysis group. Total cholesterol, triglyceride, high density lipoprotein, low density lipoprotein, serum calcium,serum phosphorus, high sensitivity C-reactive protein ,serum albumin, were measured before treatment and after six months in two groups. Results: Total cholesterol, triglyceride, low density lipoprotein, serum phosphorus, high sensitivity C-reactive protein were reduced in high--flux hemodialysis group compared with low--flux hemodialysis group (P <0.05). serum calcium, high density lipoprotein, ,serum albumin, were increased in high--flux hemodialysis group compared with low--flux hemodialysis group ( P < 0. 05). Conclusions: high--flux hemodialysis can improve Calcium and phosphorus metabolism lipid profile and microinflammatory malnutrition status function in hemodialysis patients.

  2. Effect of low versus high dialysate sodium concentration on blood pressure and endothelial-derived vasoregulators during hemodialysis: a randomized crossover study.

    Science.gov (United States)

    Inrig, Jula K; Molina, Christopher; D'Silva, Kristin; Kim, Catherine; Van Buren, Peter; Allen, Jason D; Toto, Robert

    2015-03-01

    Intradialytic hypertension affects ∼15% of hemodialysis patients and is associated with increased morbidity and mortality. While intradialytic hypertension is associated with increases in endothelin 1 relative to nitric oxide (NO), the cause of these imbalances is unknown. In vitro evidence suggests that altering plasma sodium levels could affect endothelial-derived vasoregulators and blood pressure (BP). Thus, we hypothesized that compared to high dialysate sodium, low dialysate sodium concentration would lower endothelin 1 levels, increase NO release, and reduce BP. 3-week, 2-arm, randomized, crossover study. 16 patients with intradialytic hypertension. Low (5 mEq/L below serum sodium) versus high (5 mEq/L above serum sodium) dialysate sodium concentration. Endothelin 1, nitrite (NO2(-)), and BP. Mixed linear regression was used to compare the effect of dialysate sodium (low vs high) and randomization arm (low-then-high vs high-then-low) on intradialytic changes in endothelin 1, NO2(-), and BP values. The average systolic BP throughout all hemodialysis treatments in a given week was lower with low dialysate sodium concentrations compared with treatments with high dialysate sodium concentrations (parameter estimate, -9.9 [95% CI, -13.3 to -6.4] mm Hg; P low vs high dialysate sodium concentrations (parameter estimate, -6.1 [95% CI, -9.0 to -3.2] mm Hg; P low vs high dialysate sodium concentrations. Carryover effects limited the power to detect significant changes in endothelial-derived vasoregulators, and future studies will require parallel trial designs. Low dialysate sodium concentrations significantly decreased systolic BP and ameliorated intradialytic hypertension. Longer studies are needed to determine the long-term effects of low dialysate sodium concentrations on BP and clinical outcomes. Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2009-01-01

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

  4. Headache associated with hemodialysis

    Directory of Open Access Journals (Sweden)

    Nikić Petar M.

    2008-01-01

    Full Text Available INTRODUCTION Hemodialysis (HD is one of the most accessible methods for the treatment of the growing number of patients suffering from terminal-stage renal insufficiency. Although headache is the most frequently encountered neurological symptom during HD, there are few studies reporting its prevalence and clinical features. OBJECTIVE The objective of this study was to examine the frequency, demographic and clinical features of headache during HD, and to compare these parameters among patients with and without headache. METHOD The study involved 126 patients (48 female and 78 male with chronic renal failure on regular HD for at least six months, at the Dialysis Unit of Nephrology Department, Kruševac. All patients were inquired about their possible problems with headache using the standardized questionnaire designed according to the diagnostic criteria of the International Headache Classification of Headache Disorders, second edition, published in 2004 (ICHD-II. Subsequently, the patients were clinically evaluated and patients with headaches were further sub classified by a neurologist with special interest in headache disorders. Patients with headache were compared to the patients without headache regarding age, sex, duration of HD, causes of end-stage renal disease, arterial diastolic and systolic blood pressure, and serum values of the most important blood parameters such as sodium, potassium, urea and creatinine. In the group of patients with headache we analyzed the characteristics of specific headache type according to ICHD-II classification. We also analyzed the most important clinical features of hemodialysis headache (HDH. RESULTS In the group of 126 evaluated patients, 41 (32.5% patients had headaches. There were no statistically significant differences between the patients with headaches and those without headaches regarding sex, age, BMI, duration of HD, causes of end-stage renal disease, arterial blood pressure, red blood cell count

  5. Influence of hemodialysis with difference transfusion speed on blood pressure and heart rate of elderly patients%血液透析不同的回血速度对老年人血压及心率的影响

    Institute of Scientific and Technical Information of China (English)

    安惠旒

    2012-01-01

    [Objective]To study the influence of difference transfusion speed on blood pressure and heart rate of elderly patients with hemodialysis. [Methods]30 elderly patients in Xingtai Third Hospital were treated by hemodialysis with difference transfusion speed, the blood pressure and heart rate before and after transfusion were observed. [Results]The transfusion speed of 100 ml/min and 80 ml /min would increase the blood pressure and heart rate of patients, and 50 ml/min was safe, which had less effect on blood pressure and heart rate. [Conclusion]The proper transfusion speed can reduce the incidence rate of hypertensive complications in elderly patients with hemodialysis , and improve the quality of hemodialysis.%目的 探讨不同的回血速度对透析老年人血压及心率的影响.方法 采用不同回血速度对邢台市第三医院30例老年透析患者进行血液透析治疗,观察回血前后患者血压及心率的情况.结果 100 ml/min、80 ml/min回血速度会引起患者血压升高,心率加快;50 ml/min回血速度较安全,对血压及心率影响不大(P<0.05).结论 适当的回血速度可以减少老年透析患者高血压并发症的发生,可提高患者的透析质量.

  6. Does the extracorporeal circulation worsen anemia in hemodialysis patients? Investigation with advanced microscopes of red blood cells drawn at the beginning and end of dialysis

    Directory of Open Access Journals (Sweden)

    Stamopoulos D

    2013-10-01

    Full Text Available Dimosthenis Stamopoulos,1 Nerantzoula Bakirtzi,2,3 Efthymios Manios,1 Eirini Grapsa41Institute of Advanced Materials, Physicochemical Processes, Nanotechnology and Microsystems, National Center for Scientific Research 'Demokritos,' Athens, Greece; 2Department of Nephrology, Hospital 'G. Gennimatas,' Athens, Greece; 3Renal Unit, Hospital 'Alexandra,' Athens, Greece; 4Renal Unit, Hospital 'Aretaieion,' Athens, GreeceBackground: In hemodialysis (HD patients, anemia relates to three main factors: insufficient production of erythropoietin; impaired management of iron; and decreased lifespan of red blood cells (RBCs. The third factor can relate to structural deterioration of RBCs due to extrinsic (extracorporeal circuit; biochemical activation and/or mechanical stress during dialysis and intrinsic (uremic milieu; biochemical interference of the RBC membrane constituents with toxins mechanisms. Herein, we evaluate information accessed with advanced imaging techniques at the cellular level.Methods: Atomic force and scanning electron microscopes were employed to survey intact RBCs (iRBCs of seven HD patients in comparison to seven healthy donors. The extrinsic factor was investigated by contrasting pre- and post-HD samples. The intrinsic environment was investigated by comparing the microscopy data with the clinical ones.Results: The iRBC membranes of the enrolled HD patients were overpopulated with orifice-like (high incidence; typical size within 100–1,000 nm and crevice-like (low incidence; typical size within 500–4,000 nm defects that exhibited a statistically significant (P < 0.05 relative increase (+55% and +350%, respectively in respect to healthy donors. The relative variation of the orifice and crevice indices (mean population of orifices and crevices per top membrane surface between pre- and post-HD was not statistically significant (−3.3% and +4.5%, respectively. The orifice index correlates with the concentrations of urea, calcium, and

  7. 人造血管在维持血液透析患者中的应用和护理方法%Application and nursing method of artificial blood vessel in maintenance hemodialysis patients

    Institute of Scientific and Technical Information of China (English)

    杨波; 刘晓玲

    2016-01-01

    Objective:To explore the application and nursing methods of artificial blood vessel in maintenance hemodialysis patients.Methods:2 cases of hemodialysis patients who were treated with artificial blood vessels were selected.We observed the internal fistula situation of the artificial blood vessels,and to explore the corresponding nursing methods.Results:2 cases of internal fistula in artificial blood vessels were unobstructed;the blood flow remained at 200~280 mL/min;there were no postoperative complications occurred.Conclusion:The application of artificial blood vessels in maintenance hemodialysis patients has significant effect.It can protect the normal circulation of blood effectively,and it has less complications.%目的:探讨人造血管在维持血液透析患者中的应用和护理方法。方法:收治使用人造血管进行透析患者2例,观察患者人造血管的内瘘情况,并探讨相应的护理方法。结果:2例患者的人造血管内瘘全部通畅,血流量保持在200~280 mL/min,术后无并发症发生。结论:人造血管在维持血液透析患者中的应用效果显著,能有效保障血液的正常流转,并发症少。

  8. Proteomic Investigations into Hemodialysis Therapy

    Directory of Open Access Journals (Sweden)

    Mario Bonomini

    2015-12-01

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

  9. Influence of blood purification for calcium and phosphorus metabolism of maintenance hemodialysis patients%血液净化方式对维持性血液透析患者钙磷代谢的影响

    Institute of Scientific and Technical Information of China (English)

    刘怀瓒; 徐琴; 孙世泽

    2014-01-01

    目的:前瞻性研究血液透析、血液透析+血液灌流、血液透析+血液透析滤过3种不同血液净化方式对维持性血液透析患者血清PTH、钙、磷的临床疗效的影响。方法:46例维持性血液透析患者随机分为血液透析组15例,血液灌流组15例和血液透析滤过组16例。观察3组试验前(0个月)、治疗6个月后血清钙、磷、PTH 水平变化。结果:血液透析组试验前(0个月)与治疗6个月后钙、磷、PTH水平无明显变化(P>0.05);血液透析滤过组、血液灌流组试验前(0个月)与治疗6个月后钙、磷、PTH测定水平比较,磷及PTH水平下降,钙水平升高(P<0.05)。结论:血液透析滤过和血液灌流两种血液净化方式比血液透析能较好改善维持性血液透析患者矿物质及钙磷代谢紊乱,提高患者生活质量。%Objective:To prospective study of hemodialysis,hemoperfusion and hemodialysis,hemodialysis and hemodiafiltration about 3 different ways of blood purification on clinical curative effect of maintenance hemodialysis patients with serum PTH,calci-um,phosphorus.Methods:We selected 46 cases of maintenance hemodialysis patients.These patients were randomly divided into hemodialysis group with 15 cases,the blood perfusion group with 15 cases,and hemodiafiltration group with 16 cases.Before the experiment(0 months),6 months after treatment the changes of serum calcium,phosphorus,PTH levels were compared.The changes of serum calcium,phosphorus,PTH levels before the experiment(0 months)and 6 months after treatment were compared.Results:In hemodialysis group,there were no significant changes of calcium,phosphorus,PTH levels before the experiment(0 months)and 6 months after treatment(P>0.05);In Hemodiafiltration group and hemoperfusion group,calcium,phosphorus,PTH levels before the test(0 months)were compared with 6 months after treatment,phosphorus and PTH levels were reduced,calcium levels were elevat-ed(P<0

  10. Blood vessel endothelium-directed tumor cell streaming in breast tumors requires the HGF/C-Met signaling pathway.

    Science.gov (United States)

    Leung, E; Xue, A; Wang, Y; Rougerie, P; Sharma, V P; Eddy, R; Cox, D; Condeelis, J

    2016-11-28

    During metastasis to distant sites, tumor cells migrate to blood vessels. In vivo, breast tumor cells utilize a specialized mode of migration known as streaming, where a linear assembly of tumor cells migrate directionally towards blood vessels on fibronectin-collagen I-containing extracellular matrix (ECM) fibers in response to chemotactic signals. We have successfully reconstructed tumor cell streaming in vitro by co-plating tumors cells, macrophages and endothelial cells on 2.5 μm thick ECM-coated micro-patterned substrates. We found that tumor cells and macrophages, when plated together on the micro-patterned substrates, do not demonstrate sustained directional migration in only one direction (sustained directionality) but show random bi-directional walking. Sustained directionality of tumor cells as seen in vivo was established in vitro when beads coated with human umbilical vein endothelial cells were placed at one end of the micro-patterned 'ECM fibers' within the assay. We demonstrated that these endothelial cells supply the hepatocyte growth factor (HGF) required for the chemotactic gradient responsible for sustained directionality. Using this in vitro reconstituted streaming system, we found that directional streaming is dependent on, and most effectively blocked, by inhibiting the HGF/C-Met signaling pathway between endothelial cells and tumor cells. Key observations made with the in vitro reconstituted system implicating C-Met signaling were confirmed in vivo in mammary tumors using the in vivo invasion assay and intravital multiphoton imaging of tumor cell streaming. These results establish HGF/C-Met as a central organizing signal in blood vessel-directed tumor cell migration in vivo and highlight a promising role for C-Met inhibitors in blocking tumor cell streaming and metastasis in vivo, and for use in human trials.Oncogene advance online publication, 28 November 2016; doi:10.1038/onc.2016.421.

  11. High Mortality from Blood Stream Infection in Addis Ababa, Ethiopia, Is Due to Antimicrobial Resistance

    Science.gov (United States)

    Seboxa, Teshale; Amogne, Wondwossen; Abebe, Workeabeba; Tsegaye, Tewodros; Azazh, Aklilu; Hailu, Workagegnehu; Fufa, Kebede; Grude, Nils; Henriksen, Thor-Henrik

    2015-01-01

    Background Managing blood stream infection in Africa is hampered by lack of bacteriological support needed for antimicrobial stewardship, and background data needed for empirical treatment. A combined pro- and retrospective approach was used to overcome thresholds in clinical research in Africa. Methods Outcome and characteristics including age, HIV infection, pancytopenia and bacteriological results were studied in 292 adult patients with two or more SIRS criteria using univariate and confirming multivariate logistic regression models. Expected randomly distributed resistance covariation was compared with observed co-resistance among gram-negative enteric bacteria in 92 paediatric blood culture isolates that had been harvested in the same hospital during the same period of time. Results Mortality was fivefold increased among patients with positive blood culture results [50.0% vs. 9.8%; OR 11.24 (4.38–25.88), p < 0.0001], and for this group of patients mortality was significantly associated with antimicrobial resistance [OR 23.28 (3.3–164.4), p = 0.002]. All 11 patients with Enterobacteriaceae resistant to 3rd. generation cephalosporins died. Eighty-nine patients had pancytopenia grade 3–4. Among patients with negative blood culture results, mortality was significantly associated with pancytopenia [OR 3.12 (1.32–7.39), p = 0.01]. HIV positivity was not associated with increased mortality. Antimicrobial resistance that concerned gram-negative enteric bacteria, regardless of species, was characterized by co-resistance between third generation cephalosporins, gentamicin, chloramphenicol, and co-trimoxazole. Conclusion Mortality was strongly associated with growth of bacteria resistant to empirical treatment, and these patients were dead or dying when bacteriological reports arrived. Because of co-resistance, alternative efficient antibiotics would not have been available in Ethiopia for 8/11 Enterobacteriaceae-infected patients with isolates resistant to third

  12. Blood stream infections caused by Acinetobacter baumannii group in Japan - Epidemiological and clinical investigation.

    Science.gov (United States)

    Fujikura, Yuji; Yuki, Atsushi; Hamamoto, Takaaki; Kawana, Akihiko; Ohkusu, Kiyofumi; Matsumoto, Tetsuya

    2016-06-01

    Acinetobacter calcoaceticus-Acinetobacter baumannii complex, especially A. baumannii, Acinetobacter pittii and Acinetobacter nosocomialis, constitutes an important group of nosocomial pathogens; however, epidemiological or clinical characteristics and prognosis is limited in Japan. From 2009 to 2013, 47 blood stream infection cases resulting from A. baumannii group were reviewed at the National Defense Medical College, an 800-bed tertiary hospital. To determine the genospecies, further comparative nucleotide sequence analyses of the RNA polymerase b-subunit (rpoB) gene were performed. Sequence analysis of rpoB gene showed that 25 (49.0%), 17 (33.3%) and 5 (9.8%) cases were caused by A. baumannii, A. pittii and A. nosocomialis, respectively. The 30-day and in-hospital mortality rates of A. baumannii were 8.5% and 25.5%, respectively, and there were no significant differences between Acinetobacter species. Clinical characteristics were statistically insignificant. Multidrug-resistant Acinetobacter species were detected in 3 cases (5.9%) with same pulsed-field gel electrophoresis (PFGE) pattern and A. baumannii was less susceptible to amikacin and levofloxacin. In this study, the mortality and clinical characteristics were similar among A. baumannii group isolate cases despite some showing drug resistance. However, identification of Acinetobacter species helps to initiate appropriate antibiotic therapy in earlier treatment phase, because A. baumannii shows some drug resistance.

  13. Risk factors and characteristics of blood stream infections in patients with newly diagnosed multiple myeloma.

    Science.gov (United States)

    Huang, Chun-Teng; Liu, Chia-Jen; Ko, Po-Shen; Liu, Han-Tsung; Yu, Yuan-Bin; Hsiao, Liang-Tsai; Gau, Jyh-Pyng; Tzeng, Cheng-Hwai; Chiou, Tzeon-Jye; Liu, Jin-Hwang; Yang, Muh-Hwa; Huang, Ling-Ju; Liu, Chun-Yu

    2017-01-06

    Patients with multiple myeloma are generally immune-compromised either due to pronounced depression in primary antibody responses or because of anti-myeloma therapy. Infection is a major risk factor for early deaths among these patients. The impact of blood stream infections (BSI) on newly diagnosed myeloma patients has been less studied. We aimed to study the incidence and risk factors of BSI within 3 months after diagnosis of multiple myeloma in a tertiary referral center. Between November 2002 and December 2008, consecutive patients with multiple myeloma in Taipei Veterans General Hospital were retrospectively enrolled. Characteristics of patients with or without BSI were collected. Possible factors associated with development of BSI were analyzed by Cox regression. There were a total of 222 patients. The incidence of BSI within 3 months after diagnosis is 11.7%. The patients with BSI had poorer survival outcomes than those without (mortality rate: 50% vs. 20.9%, p  2 vs. ≤ 2: OR 3.58, p = 0.005) were the independent risk factors of BSI, whereas immunoglobulin deficiency and low absolute lymphocyte count were not associated with risk of BSI development. Our study highlights the characteristic of myeloma patients with BSI and the importance of disease and host factors on risk of BSI. Myeloma patients with risks of BSI should be properly managed to reduce early mortality.

  14. [Hemodialysis with biological object].

    Science.gov (United States)

    Eventov, V L; Maksimenko, V A; Zhidkov, I L; Andrianova, M Iu

    2005-01-01

    The essence of the method of biodialysis (hemodialysis with biological object) developed and suggested by the authors for clinical use consists in that the healthy organism exerts, through a system of mass transfer, a therapeutic action on the sick organism. Blood from the affected and healthy organisms is perfused through individual mass exchangers (dialyzers, hemodiafilters and hemofilters), which are hydraulically connected by a circulating transport medium. Metabolites that accumulate in blood of the affected organism diffuse into the transport medium and, from there, into blood of the healthy organism, which metabolizes them. The reverse process occurs simultaneously: substances, whose concentration in blood of the sick organism is less versus the healthy organism, diffuse from blood of the healthy organism to blood of patient. The method suggested by us can be used in clinical practice for normalizing a variety of parameters in patients with hepatic and renal insufficiency. Besides, a number of substances can be transferred from the healthy donor to patient in the process of biodialysis, which opens promising potentialities for the treatment of many diseases.

  15. Central venous catheter-related blood stream infections in patients receiving intravenous iloprost for pulmonary hypertension.

    Science.gov (United States)

    Sammut, D; Elliot, C A; Kiely, D G; Armstrong, I J; Martin, L; Wilkinson, J; Sephton, P; Jones, J; Hamilton, N; Hurdman, J; McLellan, E; Sabroe, I; Condliffe, R

    2013-07-01

    Catheter-related blood stream infection (CR-BSI) in patients with pulmonary hypertension (PH) receiving intravenous iloprost via an indwelling central line has previously not been fully described. Recent studies have suggested a link between the pH of prostanoid infusions and the rate and nature of CR-BSI. We have investigated CR-BSI in patients receiving intravenous iloprost at our unit. Databases and hospital records were interrogated for all patients receiving intravenous iloprost between September 2007 and June 2012. Fifty-nine patients received intravenous iloprost via an indwelling central catheter with a total of 23,072 treatment days. There were 15 episodes of CR-BSI, identified using a systematic screening protocol, involving 11 patients giving an overall CR-BSI rate of 0.65/1,000 treatment days. CR-BSI rate for Gram-positive organisms was 0.26/1,000 treatment-days and for Gram-negative organisms was 0.39/1,000 treatment-days. The pH of iloprost in typical dosing regimens was comparable to the pH used in standard-diluent treprostinil and dissimilar to alkaline epoprostenol infusions. The proportion of Gram-negative CR-BSI was similar to that reported for standard-diluent treprostinil. CRP was normal on admission in 33 % of cases of confirmed CR-BSI and remained normal in 13 % of cases. CR-BSI rates with intravenous iloprost are comparable to those observed for other prostanoids. The high proportion of Gram-negative organisms observed and the neutral pH of iloprost infusions support the previously hypothesised link between pH and antimicrobial activity. Although usually elevated during a CR-BSI, CRP may be normal in early infection and a normal result cannot completely exclude infection.

  16. Understanding Gram-negative Central Line-Associated Blood Stream Infection in a Surgical Trauma ICU.

    Science.gov (United States)

    Duane, Therese M; Kikhia, Rashid M; Wolfe, Luke G; Ober, Janis; Tessier, Jeffrey M

    2015-08-01

    The purpose of this study was to review central line-associated blood stream infection (CLABSI) data from a surgical trauma intensive care unit to better understand patient risk factors, pathogens, and treatment interventions. We performed a retrospective review of all surgical ICU patients who met the Centers for Disease Control definition for Gram-negative CLABSI from 2006 through 2013. Demographics, pathogens, interventions, and outcomes were evaluated. A total of 40 patients were included with an average age of 49.9 ± 19 years and 72.5 per cent male. The average length of central venous line (CVL) was 11 ± 5.9 days with average time from line placement to positive culture 9.4 ± 6.8 days. Most common organisms were Enterobacter species (37.5%) with 17.8 per cent of all cultured organisms considered multidrug resistant. Piperacillin-tazobactam (67.5%) was the most commonly used antibiotic. Overall mortality rate was 22.5 per cent. A total of 11 patients who developed a recurrence did so at 10.7 ± 8 days and were similar to those without recurrence. Predominant pathogens associated with surgical trauma intensive care unit CLABSI in this study are different from those Gram-negative bacteria associated with published studies in the general hospital population. Further investigation into risk factors for infection and relapse is important to minimize such consequences. Understanding appropriate line placement and use as well as clarifying optimal duration of therapy is integral in improving outcomes.

  17. Effect of different blood purification treatment on the complications in hemodialysis patients%不同血液净化方式对血液透析患者并发症的影响

    Institute of Scientific and Technical Information of China (English)

    常淑莹; 程巧玲

    2012-01-01

    目的 研究不同血液净化方式对维持性血液透析患者并发症的影响.方法 选择维持性血液透析≥6个月的患者98例,并将其随机分为4组,常规血液透析(HD)组24例、血液透析滤过(HDF)组24例、血液透析+血液灌流(炭肾HP+ HD)组25例,血液透析+血液灌流(树脂HP+ HD)组25例.治疗6个月后观察4组患者血红蛋白(Hb)、血清β2-微球蛋白(β2-MG)、全段甲状旁腺素(iPTH)、血磷(P)以及血压、皮肤瘙痒程度和肤色等指标.结果 树脂HP+ HD组治疗后各指标变化显著,皮肤瘙痒缓解,肤色变白,血压稳定,治疗前后比较差异有统计学意义(P<0.05);炭肾HP+ HD组和HDF组患者β2-MG、iPTH和皮肤瘙痒明显缓解,治疗前后比较差异有统计学意义(P<0.05),其余指标变化不明显;HD组患者肌酐、尿素氮治疗前后变化明显,其余各观察指标治疗前后比较差异均无统计学意义.结论 维持性血液透析患者应用树脂HP+ HD治疗可有效减少并发症的发生.%Objective To investigate the effect of different blood purification treatment on the complications in patients with maintenance hemodialysis. Methods 98 patients with maintenance hemodialysis were recruited,and were randomly divided into four groups:hemodialysis( HD) group(24 cases) , hemodiafiltration( HDF) group(24 cases) .hemodialysis incombination with hemoperfusion( carbon kidney HP + HD) group(25 cases) ,and hemodialysis incombination with hemoperfusion(resin HP + HD) group (25 cases). All of these patients received similar treatment including use of iron,calcium,erythropoietin and so on, besides different blood purification. Before and after 6 months treatment, the levels of serum Hb,β2-MG,iPTH, P and the blood pressure, itching of the skin, complexion and other indicators were compared. Results The The indicators of the patients in resin HP + HD group improved significantly, including relief of pruritus, improvement of complexion and

  18. 鲑鱼降钙素对维持性血液透析患者血压的影响%The Effect of Salmon Calcitonin on Blood Pressure in Patients with Maintenance Hemodialysis

    Institute of Scientific and Technical Information of China (English)

    刘春秋; 李良志; 刘雷; 汤跃武; 史继红; 王军; 吴泽成; 何先红

    2013-01-01

    Objective:To observe the effect of salmon calcitonin on blood pressure in patients with maintenance hemodialysis. Methods:120 patients having long-term maintenance hemodialysis along with chronic renal failure were selected, and they were randomly divided into a control group (n=60) and a treatment group (n=60) by sortition. Patients in control group were treated according to conventional treatment drug. Based on the treatment in control group, salmon calcitonin injections were applied in the patients of treatment group.The changes of blood pressure and iPTH levels were observed before and after treatment.Results:Compared with the control group, diastolic blood pressure, systolic blood pressure and iPTH levels were significantly decreased in the treatment group (P<0.05), the rate of reaching the standard in blood pressure was significantly increased (x2=4.48,P=0.034).Conclusion:The application of salmon calcitonin in maintenance hemodialysis patients can lower iPTH levels in blood and help to control blood pressure.%  目的:观察鲑鱼降钙素对维持性血液透析患者血压的影响。方法:选择长期维持血液透析慢性肾衰患者120例,按抽签方式随机分为对照组和治疗组,各60例,对照组按常规给予治疗药物,治疗组在对照组治疗基础上应用鲑鱼降钙素注射液,观察治疗前后血压、血iPTH水平的变化。结果:与对照组比较,治疗组舒张压、收缩压、血iPTH水平均显著下降(P<0.05),血压达标率显著提高(x2=4.48,P=0.034)。结论:维持性血液透析患者应用鲑鱼降钙素能降低血iPTH水平,有助于血压的控制。

  19. Hemodialysis-related headaches

    Directory of Open Access Journals (Sweden)

    Đurić Marija

    2007-01-01

    Full Text Available Background/Aim. Hemodialysis (HD is a therapeutic procedure used to partially correct homeostatic disorders and prevent complications of uremia to appear in the terminal stage of renal insufficiency. The aim of this study was to evaluate and analyze the incidence and features of headaches in patients undergoing hemodialysis. Methods. A total of 143 patients, 50 women and 93 men, undergoing hemodialysis, were questioned about their problems with headache using a questionnaire designed according to the diagnostic criteria of the International Headache Classification of Headache Disorders from 2004. The patients were separated into two groups: the patients without headache and the patients with repeated headaches. Afterwards, the patients with headaches were further divided into subgroups: the patients who had the headaches before the beginning of HD and patients who experienced repeated headaches with the beginning of HD headache (HDH. In the group of patients with headaches we analyzed characteristics of headache according to which diagnoses of headaches were made, as well as the effects of HD on headaches. We also analyzed features of HDH. The patients with headache were compared to the patients without headache regarding sex, age, duration of HD, causes of end-stage renal disease, arterial diastolic and systolic blood pressure and serum concentration of hemoglobin, urea nitrogen, creatinine, sodium and potassium. The results were statistically compared. Results. In the group of 143 patients examined, 27 (18.9% patients had headaches. There were no statistically significant differences between the group of patients with headaches and those without headache regarding to sex, age, duration of HD, causes of end-stage renal disease, serum concentration of hemoglobin, urea nitrogen, creatinine, sodium and potassium. The patients with headaches showed significantly higher mean values of systolic blood pressure during HD in comparison to the patients

  20. The level of endotoxins in hemodialysis water and dialysate in Lithuanian hemodialysis centers.

    Science.gov (United States)

    Skarupskienė, Inga; Bumblytė, Inga Arūnė; Tamošaitis, Donatas; Venterienė, Jūratė; Kuzminskis, Vytautas

    2010-01-01

    The composition and quality of the dialysis fluid play an important role in the modulation of dialysis-related complications. During hemodialysis, patient's blood has a contact with dialysate through a semipermeable membrane. Bacterial endotoxins can pass through the membrane pores into the patient's blood and cause a silent chronic microinflammation. The aim of this study was to determine the level of endotoxins in hemodialysis water and dialysate in Lithuanian hemodialysis centers. Dialysis water (n=50) and dialysate (n=50) were collected from 91% (n=50) of all hemodialysis centers. The presence of bacterial endotoxins was evaluated using a sensitive Limulus amebocyte lysate test, which detects intact lipopolysaccharides. The level of endotoxins was lower than 0.25 EU/mL in 43 (86%) dialysis water samples and in 46 (92%) dialysate samples, and complied with the recommendations of the European Pharmacopoeia and the European Best Practice Guidelines for pure dialysis fluid. The dialysate of 39 (78%) Lithuanian hemodialysis centers complied with the definition of an ultrapure dialysis fluid. The water and dialysate were of insufficient quality in 14% and in 8% of Lithuanian hemodialysis centers, respectively, and this could be improved by the establishment of routine investigation of endotoxins.

  1. 21 CFR 876.5540 - Blood access device and accessories.

    Science.gov (United States)

    2010-04-01

    ... provide access to a patient's blood for hemodialysis or other chronic uses. When used in hemodialysis, it... conditions and provides access to a patient's blood for hemodialysis. The device includes implanted blood..., such as catheters, cannulae or hollow needles, which are inserted into appropriate blood vessels or a...

  2. Occult Hepatitis C Virus Infection among Hemodialysis Patients

    OpenAIRE

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

    2008-01-01

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

  3. Hospital acquired blood stream infection as an adverse outcome for patients admitted to hospital with other principle diagnosis

    Directory of Open Access Journals (Sweden)

    Hamdan H Al-Hazmi

    2014-01-01

    Full Text Available Background: Hospital acquired infections (HAI have emerged as an important public health problem and are a leading cause of morbidity and mortality worldwide. They affect both developed and resource-poor countries and constitute a significant burden both for the patient and for the health care system. Specific objectives in this study are assessment of HAI rate among patients admitted with other principle diagnosis, to identifying the causative agents of hospital acquired infections and to identify some possible risk factors associated with each type of infection, both health related and non-health related. Patients and Methods: The study was done on selected diagnosis groups during year 2010. The infections were found among 250 patients (43.6% males have been exposed to episodes of infections. Median age of patients was 56. Data were abstracted from the archived patients′ files in medical record department using the annually infection control log-book prepared by the infection control department. The Data collected were demographic information about the patients (age and sex, clinical condition (diagnosis and the length of hospital stay and possible risk factors for infection as smoking, diabetes mellitus, hypertension and exposure to invasive devices or exposure to surgical procedures. Results: Liver diseases 22.8%, cardiac diseases 22.8%, Gastro-Intestinal System diseases 20%, urinary system diseases 13.6%, and endocrinal disorder 13.6% Prostate gland diseases 7.2%. Episodes of infections caused by 9 types of organisms divided into 47.2% for blood stream infection and 52.8% for other types. 66% acquired blood stream infection were exposed to central venous line. Conclusion: Most common type of HAIs was blood stream infections. Liver, cardiac diseases and gastro-intestinal diseased patients show more proportion of HAIs while urinary system and prostate disease patients show less proportion of HAIs. Gram negative bacilli were the most common

  4. Evaluation of blood stream infections by Candida in three tertiary hospitals in Salvador, Brazil: a case-control study

    Directory of Open Access Journals (Sweden)

    Maria Goreth Barberino

    Full Text Available Invasive infections caused by Candida spp. are an important problem in immunocompromised patients. There is scarce data on the epidemiology of blood stream candidiasis in Salvador, Brazil. This study evaluates the risk factors associated with candidemia, among patients admitted to three tertiary, private hospitals, in Salvador, Brazil. We conducted a case-control, retrospective study to compare patients with diagnosis of candidemia in three different tertiary hospitals in Salvador, Brazil. Patients were matched for nosocomial, acquired infections, according to the causal agent: cases were defined by positive blood cultures for Candida species. Controls were those patients who had a diagnosis of systemic bacterial infection, with a positive blood culture to any bacteria, within the same time period (± 30 days of case identification. The groups were compared for the main known risk factors for candidemia and for mortality rates. A hundred thirty-eight patients were identified. Among the 69 cases, only 14 were diagnosed as infected by Candida albicans. Candida species were defined in only eight cultures: C. tropicalis (4 cases, C. glabrata, C. parapsilosis, C. guillermondi, C. formata (1 case each. The main risk factors, identified in a univariate analysis, were: presence of a central venous catheter (CVC, use of parenteral nutrition support (PNS, previous exposure to antibiotics, and chronic renal failure (CRF. No association was detected with surgical procedures, diabetes mellitus, neutropenia or malignancies. Patients were more likely to die during the hospitalization period, but the rates of death caused by the infections were similar for cases and controls. The length of hospitalization was similar for both groups, as well as the time for a positive blood culture. Blood stream infection by Candida spp. is associated with CVC, PNS, previous use of antibiotics, and CRF. The higher mortality rate for cases probably better reflects the severity

  5. Evaluation of blood stream infections by Candida in three tertiary hospitals in Salvador, Brazil: a case-control study

    Directory of Open Access Journals (Sweden)

    Maria Goreth Barberino

    2006-02-01

    Full Text Available Invasive infections caused by Candida spp. are an important problem in immunocompromised patients. There is scarce data on the epidemiology of blood stream candidiasis in Salvador, Brazil. This study evaluates the risk factors associated with candidemia, among patients admitted to three tertiary, private hospitals, in Salvador, Brazil. We conducted a case-control, retrospective study to compare patients with diagnosis of candidemia in three different tertiary hospitals in Salvador, Brazil. Patients were matched for nosocomial, acquired infections, according to the causal agent: cases were defined by positive blood cultures for Candida species. Controls were those patients who had a diagnosis of systemic bacterial infection, with a positive blood culture to any bacteria, within the same time period (± 30 days of case identification. The groups were compared for the main known risk factors for candidemia and for mortality rates. A hundred thirty-eight patients were identified. Among the 69 cases, only 14 were diagnosed as infected by Candida albicans. Candida species were defined in only eight cultures: C. tropicalis (4 cases, C. glabrata, C. parapsilosis, C. guillermondi, C. formata (1 case each. The main risk factors, identified in a univariate analysis, were: presence of a central venous catheter (CVC, use of parenteral nutrition support (PNS, previous exposure to antibiotics, and chronic renal failure (CRF. No association was detected with surgical procedures, diabetes mellitus, neutropenia or malignancies. Patients were more likely to die during the hospitalization period, but the rates of death caused by the infections were similar for cases and controls. The length of hospitalization was similar for both groups, as well as the time for a positive blood culture. Blood stream infection by Candida spp. is associated with CVC, PNS, previous use of antibiotics, and CRF. The higher mortality rate for cases probably better reflects the severity

  6. ORIGINAL ARTICLE: Antifungal Activity of Some Natural Essential Oils against Candida Species Isolated from Blood Stream Infection

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    Amit Kumar

    2012-01-01

    Full Text Available Background: Candida is a part of normal microflora of human body and exists as an opportunistic pathogen as it attacks immunocompromised patients. Aims and Objectives: Candida is the most commonly isolated organism from blood stream infections. Fluconazole is the major antifungal drug used for treatment of Candida. Resistance to fluconazole has been increasing in recent years so there should be search of some other alternative. To find out these alternatives, anti candidial activity of some natural essential oils was studied. Materials and Methods: In the present study nine Candida strains isolated from blood stream infections were collected from National Culture Collection of Pathogenic Fungi (N.C.C.P.F. P.G.I.M.E.R Chandigarh India and the antifungal activity of some natural essential oils such as lemongrass oil, coconut oil, almond oil and clove oil was checked by using agar diffusion method. Result: All oils have shown a significantly anti-candidal activity. However, the antifungal activity was maximum in lemongrass oil. Conclusion: Our study may help to design new chemotherapeutic strategies against Candidal infections.

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

    Directory of Open Access Journals (Sweden)

    Esmée M Ettema

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

  8. Daily hemodialysis 2006. State of the art.

    Science.gov (United States)

    Pierratos, A; McFarlane, P; Chan, C T; Kwok, S; Nesrallah, G

    2006-06-01

    The need to improve the dialysis outcomes, the negative results from the HEMO and ADEMEX studies as well reports of clinical benefits have rekindled the interest in daily hemodialysis. Although no randomized controlled studies have been published, a large number of manuscripts have described significant benefits from both the short or nocturnal forms of daily (quotidian) dialysis or hemo(dia)filtration. They include improved quality of life, hemodynamic stability, blood pressure control with minimal number of medications, anemia control, regression of cardiac hypertrophy and improved nutrition. Furthermore, quotidian nocturnal hemodialysis provides higher dialysis dose, and has been described to improve endothelial as well as endothelial progenitor cell function, heart rate variability, sleep and phosphate control while it offers unrestricted diet. Several studies have pointed to a lower overall cost and improved cost utility when treating patients using quotidian hemodialysis at home. The obstacles to widespread use are the reimbursement structure in most countries, the willingness and ability of the patients to do home hemodialysis and the availability of user-friendly machines. A prospective randomized controlled study sponsored by the National Institutes of Health (NIH) and US Centers for Medicare and Medicaid services (CMS) currently underway will be pivotal in confirming these benefits and convincing the stakeholders to promote the use of daily hemodialysis.

  9. Sodium and volume balance and control of blood pressurein traditional hemodialysis patients%传统维持性血液透析患者钠水平衡与高血压

    Institute of Scientific and Technical Information of China (English)

    王康; 李德萍; 邱晶

    2010-01-01

    Objectives To investigate the relationship between hypertension and removal of sodium,extracellular volume in patients treated with traditional hemodialysis modality. Methods Hemodialysis group: all the patients in our hemodiaysis unit treated with traditional hemodialysis modality(3 times per week)for at least 3months were selected(n =98) , the values of blood pressure, serum sodium, proportion of weight loss to the weight before hemodialysis and the dry weight were registered. No dialysis group: all the in patients with CKD4 or CKDS who never received any modality of renal replacement therapy were selected (n = 118) , the values of blood pressure, serum sodium on the admission day were also registered. All the acquired data from each group were analysised and statistics with SPSS. Results Blood pressure was better controlled in hemodailysis patients compared with the patients in no dialysis group(X2 = 10.767, p =0.001). Serum sodium correlate with hypertension in all the cases in 2 groups(re = 0.151, p =0.027) , but no relationship between them in each group. Blood pressure was lower in patients who have attained dry weight compared with patients who have not attained dry weight (X2 = 16.450, p < 0.01). Conclusions Lower salt intake, convection depended on the prescribed ultrafiltration together with diffusion occurred across the dialyzer membrane based on the dialysate sodium and serum sodium consist the best protocol to attain the balance of systemic sodium and control the blood pressure in patients with traditional hemodalysis.%目的 探讨传统维持性血液透析模式下透析患者钠水清除和高血压之间的关系.方法 血液透析组:3次/周,透析3个月及以上的维持性血液透析患者98例,收集人选病例最近1个月透析前的血压、血钠水平、脱水量占透析前体重的比例以及是否达到干体重等数据;未透析组:同期未进行过任何肾脏替代治疗的CKD4期、CKD5期所有住院患者118例,收集

  10. Influence of Sodium Ion Concentration in Dialysate on Blood Pressure of Hemodialysis Patients%透析液钠离子浓度对血液透析患者血压的影响

    Institute of Scientific and Technical Information of China (English)

    赵茜芸; 郝丽

    2012-01-01

    Objective To discuss the influence of changing sodium ion concentration in dialysate on the blood pressure of maintenance hemodialysis patients. Methods All 30 maintenance hemodialysis patients with hypertension, who received hemodialysis from 2009 July to 2012 February in our blood purification center,were selected with administration of 3 months of dialysis treat-ment:140 mmol/L sodium ion concentration in dialysate( dialysis mode A) and 135 mmol/L respectively (dialysis mode B). A-dopting self-comparison method, the blood pressure of patients 3 months before and after the treatment was observed. Results Compared with the values before dialysis, the blood pressure of patients with dialysis mode B was improved significantly after the dialysis,and the difference was statistically significant(( = 10. 037,18. 139.P 0. 05). Conclusion The dialysis mode B was obviously superior to dialysis mode A. The lowering sodium ion concentration in dialysate can reduce the occurrence of hypertension in maintenance hemodialysis patients.%目的 探讨透析液钠离子浓度的改变对维持性血液透析患者血压的影响.方法 选择2009年7月-2012年2月在我院血液净化中心进行血液透析的30例维持性血液透析的高血压患者,分别给予透析液钠离子浓度为140mmoL/L(透析模式A)和透析液钠离子浓度为135 mmol/L(透析模式B)的透析模式各透析3个月,采用自身对照,观察患者前3个月和后3个月血压的变化.结果 通过6个月的观察发现,透析模式B的患者透析后与透析前比较,血压显著改善,差异有统计学意义(t=10.037、18.139,P<0.01);透析模式A的患者透析后与透析前比较,差异无统计学意义(t=-0.218、0.264,P>0.05).结论 透析模式B的血压控制显著优于透析模式A,降低透析液钠离子的浓度可以降低维持性血液透析高血压患者高血压的发生.

  11. Correlation of serum leptin with levels of hemoglobin in hemodialysis

    Directory of Open Access Journals (Sweden)

    Rafieian-Kopaei Mahmoud

    2012-04-01

    Full Text Available To examine the association of serum leptin level with anemia in hemodialysis, we investigated 36 patients (males: 21, diabetics: 11 under regular hemodialysis. For patients, complete blood counts, iron profile, serum leptin, and adequacy of hemodialysis were assessed. In this study a significant correlation of serum leptin with level of hemoglobin and body mass index was detected. An association between serum leptin and total iron binding capacity was observed. No correlation of serum ferritin with leptin level was seen. Our findings attest previous findings showing that greater serum leptin levels are associated with greater hemoglobin levels.

  12. Clinical Performance of a Salivary Amylase Activity Monitor During Hemodialysis Treatment

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    Masaru Shimazaki

    2008-01-01

    Full Text Available The hemodialysis procedure is thought to be a physical stressor in the majority of hemodialyzed patients. Previous studies suggest that elevated salivary amylase level may correlate with increased plasma norepinephrine level under psychological and physical stress conditions. In this study, we investigated biological stress reactivity during hemodialysis treatment using salivary amylase activity as a biomarker. Seven patients (male/female = 5/2, age:67.7+ /− 5.9 years who had been receiving regular 4 h hemodialysis were recruited. Salivary amylase activity was measured using a portable analyzer every hour during the hemodialysis session. Salivary amylase activity was shown to be relatively stable and constant throughout hemodialysis, whereas there were significant changes in systolic blood pressure and pulse rate associated with blood volume reduction. Our results show that hemodialysis treatment per se dose not affect salivary amylase activity.

  13. Effect of hemodialysis combined with hemoperfusion on nutritional status and blood lipids in maintenance hemodialysis patients%血液透析联合血液灌流对维持性血液透析患者营养状况及血脂的影响

    Institute of Scientific and Technical Information of China (English)

    刘新君

    2013-01-01

    Objective To explore the effect of hemoperfusion (HP) on the nutritional status and blood lipids in maintenance hemodialysis (HD) patients. Methods Thirty patients of chronic maintenance hemodialysis in the blood purification center in our hospital were randomly divided into two groups: the conventional hemodialysis group (HD group) and regular hemodialysis combined with hemoperfusion group (HD+HP group), each with 15 cases. Blood samples were collected before treatment and six months after treatment. The changes in C-reactive protein (CRP), albumin (Alb), hemoglobin (Hb), total cholesterol (TC), triglyceride (TG)), low density lipoprotein (LDL), high density lipo-protein (HDL) were investigated. Results (1) Before treatment, the levels of blood CRP, TC, TG, Hb, Alb, LDL, and HDL showed no statistically significant difference between the two groups (P>0.05). The levels of CRP, TC, TG in HD group after treatment showed no statistically significant difference with those before treatment (P>0.05). The levels of blood CRP, TC, TG in the HD+HP group after treatment decreased significantly than those before treatment (P0.05). After treatment, in the HD+HP group the levels of Hb, Alb, HDL increased significantly (P<0.01). (3) The increase in Hb, HDL and Alb was significantly more profound in the HD+HP group than the HD group (P<0.01 or P<0.05). The decrease in the levels of CRP, TC, TG and LDL was significantly more profound in the HD+HP group than the HD group (P<0.01). Conclusion Hemoperfusion therapy can reduce the blood levels of C-reactive protein, total cholesterol, triglycerides and LDL, increase the levels of serum albumin, high density lipopro-tein and hemoglobin, which thus significantly improves the nutritional status and lipid profile in maintenance hemodialy-sis patients.%目的 探讨血液灌流(HP)治疗对维持性血液透析(HD)患者营养状况及血脂的影响.方法 选择我院血液净化中心慢性维持性血液透析患者30例,随机分为

  14. Dietary sodium and clinical outcome in hemodialysis: where do we stand and what is next?

    Science.gov (United States)

    Rambod, Mehdi; Tolouian, Ramin

    2012-07-01

    The association of dietary sodium and outcome is widely studied in the general population, but less is known in hemodialysis patients. The evidence supporting daily dietary sodium intake of 2 g on hemodialysis is not strong. Mc Causland et al. found that higher dietary sodium intake was marginally associated with a higher ultrafiltration requirement and mortality, but not with blood pressure. Well-designed clinical trials are needed to examine the association of dietary sodium modification and outcomes in hemodialysis patients.

  15. 无肝素血液透析中凝血的原因分析和护理对策%Analysis and nursing countermeasures on blood clotting in no-heparin hemodialysis

    Institute of Scientific and Technical Information of China (English)

    徐美

    2015-01-01

    Objective To explore the causes of coagulation in heparin free hemodialysis and nursing stragi‐ties .Methods We pre‐flushed dialyzer and blood clotting of pipelines by physiological saline .During hemodialysis , the pipeline of dialyzer was flushed by physiological saline ,Blood flow was 250 ~ 300 mL/min. Results A total of 35 patients were on dialysis for 175 times .There are three patients got early termination of dialysis because of de‐veloping grade Ⅲ clotting ,2 times of replacement for dialyzer because of grade clotting .Conclusion Health care workers have a high degree of responsibility .Those nursing measures ,such as ensuring the effective blood flow , controlling ultrafiltration ,timing saline flush dialyzers and piping ,avoiding air into the circulation line and avoiding transfusion of blood products can guarantee that non‐heparin dialysis is carried out smoothly.%目的:探讨无肝素血液透析发生凝血的原因和护理对策。方法用0.9%氯化钠注射液预冲透析器和血路管,并在透析时定时用0.9%氯化钠注射液冲洗管路和透析器,血流量250~300 mL /min 。结果35例患者共透析175次,有3次患者发生Ⅲ级凝血提前结束透析,2次发生Ⅲ级凝血更换透析器。结论医护人员有高度的责任心,保证有效的血流量,控制超滤量,定时0.9%氯化钠注射液冲洗透析器及管路,避免空气进入循环管路,避免在透析装置系统输注血制品等护理措施是无肝素透析顺利进行的保障。

  16. Current concepts in the diagnosis of blood stream infections. Are novel molecular methods useful in clinical practice?

    Science.gov (United States)

    Huttunen, Reetta; Syrjänen, Jaana; Vuento, Risto; Aittoniemi, Janne

    2013-11-01

    The decision on the right empirical treatment in bacteremia places particular demands on the clinician. As long as no microbiological diagnosis can be immediately drawn, the clinical diagnosis together with knowledge of local antimicrobial resistance must determine the antimicrobial choice. The use of several amplification, hybridization, and mass spectrometry methods has been studied in patient cohorts in comparison with blood culture-based conventional techniques. However, no clinical outcome trials have been conducted in which the use of these novel methods would guide antimicrobial therapy. Local differences in bacterial antimicrobial resistance cause differences in the regional need for molecular methods for the early detection of resistance mechanisms. The implementation of novel methods in clinical use requires active discussion between laboratory experts and clinicians. Providing rapid susceptibility results using conventional methods can lead to timely changes to appropriate antimicrobial therapy and the costs are lower than with the molecular methods. Gram-stain information in combination with clinical data is an underestimated, underused, rapid, and economical means of assessing the etiology of blood stream infection.

  17. Impact of arteriovenous fistula blood flow on serum il-6, cardiovascular events and death: An ambispective cohort analysis of 64 Chinese hemodialysis patients

    Science.gov (United States)

    Zhang, Nan; Zhang, Chunxiu; Pei, Guangchang; Wang, Pengge; Yang, Juan; Guo, Yujiao; Wang, Meng; Wang, Yuxi; Yang, Qian; Zhu, Han; Liao, Wenhui; Zhang, Zhiguo; Yao, Ying; Zeng, Rui; Xu, Gang

    2017-01-01

    Flows (Qa) of arteriovenous fistula (AVF) impact the dialysis adequacy in hemodialysis (HD) patients. However, data for different access flow levels on outcomes related to long-term dialysis patients, especially in Chinese patients, are limited. Herein, we performed an ambispective, mono-centric cohort study investigating the association between the AVF flows and inflammation, cardiovascular events and deaths in Chinese hemodialysis patients bearing a radio-cephalic fistula (AVF) from 2009 to 2015. Twenty-three patients (35.9%) developed at least one episode of cardiovascular disease (CVD) in two years after AVF creation. AVF Qa, IL-6 and hsCRP were significantly higher in patients with CVD than in patients without CVD. Multi-factorial binary logistic regression analysis found that the independent and strongest risk factor for CVD in HD patients was serum IL-6, which showed a positive association with AVF Qa levels in patients. Therefore, the linkage between AVF Qa tertiles and adverse clinical outcomes (cardiovascular events and mortality) was examined over a median follow-up of five years. IL-6 was significantly increased in the high AVF Qa (>1027.13 ml/min) group. Patients with median AVF Qa showed the lowest morbidity and mortality of CVD according to the AVF Qa tertiles, whereas higher Qa was associated with a higher risk of CVD, and lower AVF Qa (600 ml/min ≤AVF Qa <821.12 ml/min) had a higher risk of non-CVD death. Therefore, keeping the AVF Qa at an optimal level (821.12 to 1027.13 ml/min) would benefit HD patients, improve long-term clinical outcomes and lower AVF-induced inflammation. PMID:28267753

  18. Corynebacterium striatum Bacteremia Associated with a Catheter-Related Blood Stream Infection

    Directory of Open Access Journals (Sweden)

    Ueno Daisuke

    2017-01-01

    Full Text Available A 49-year-old woman visited our emergency department because of exertional dyspnea due to severe left ventricular functional failure. It progressed to disseminated intravascular coagulation and disturbance of consciousness on day 67 of admission. Gram-positive bacilli were detected from two different blood culture samples on day 67 of admission. An API-Coryne test and sequencing (1~615 bp of the 16S rRNA gene were performed, and the strain was identified as Corynebacterium striatum. The bacterium was detected from the removed central venous catheter tip too, and the patient was diagnosed with catheter-related bloodstream infection by C. striatum. However, treatment was not effective, and the patient died on day 73 of admission.

  19. Corynebacterium striatum Bacteremia Associated with a Catheter-Related Blood Stream Infection

    Science.gov (United States)

    Oishi, Tomohiro; Yamane, Kunikazu; Terada, Kihei

    2017-01-01

    A 49-year-old woman visited our emergency department because of exertional dyspnea due to severe left ventricular functional failure. It progressed to disseminated intravascular coagulation and disturbance of consciousness on day 67 of admission. Gram-positive bacilli were detected from two different blood culture samples on day 67 of admission. An API-Coryne test and sequencing (1~615 bp) of the 16S rRNA gene were performed, and the strain was identified as Corynebacterium striatum. The bacterium was detected from the removed central venous catheter tip too, and the patient was diagnosed with catheter-related bloodstream infection by C. striatum. However, treatment was not effective, and the patient died on day 73 of admission. PMID:28197349

  20. Whole genome sequence typing and microarray profiling of nasal and blood stream methicillin-resistant Staphylococcus aureus isolates: Clues to phylogeny and invasiveness.

    Science.gov (United States)

    Hamed, Mohamed; Nitsche-Schmitz, Daniel Patric; Ruffing, Ulla; Steglich, Matthias; Dordel, Janina; Nguyen, Duy; Brink, Jan-Hendrik; Chhatwal, Gursharan Singh; Herrmann, Mathias; Nübel, Ulrich; Helms, Volkhard; von Müller, Lutz

    2015-12-01

    Hospital-associated methicillin-resistant Staphylococcus aureus (MRSA) infections are frequently caused by predominant clusters of closely related isolates that cannot be discriminated by conventional diagnostic typing methods. Whole genome sequencing (WGS) and DNA microarray (MA) now allow for better discrimination within a prevalent clonal complex (CC). This single center exploratory study aims to distinguish invasive (blood stream infection) and non-invasive (nasal colonization) MRSA isolates of the same CC5 into phylogenetic- and virulence-associated genotypic subgroups by WGS and MA. A cohort of twelve blood stream and fifteen nasal MRSA isolates of CC5 (spa-types t003 and t504) was selected. Isolates were propagated at the same period of time from unrelated patients treated at the University of Saarland Medical Center, Germany. Rooted phylotyping based on WGS with core-genome single nucleotide polymorphism (SNP) analysis revealed two local clusters of closely related CC5 subgroups (t504 and Clade1 t003) which were separated from other local t003 isolates and from unrelated CC5 MRSA reference isolates of German origin. Phylogenetic subtyping was not associated with invasiveness when comparing blood stream and nasal isolates. Clustering based on MA profiles was not concordant with WGS phylotyping, but MA profiles may identify subgroups of isolates with nasal and blood stream origin. Among the new putative virulence associated genes identified by WGS, the strongest association with blood stream infections was shown for ebhB mutants. Analysis of the core-genome together with the accessory genome enables subtyping of closely related MRSA isolates according to phylogeny and presumably also to the potential virulence capacity of isolates.

  1. Doppler measurements of feto-placental blood stream in pregnant smokers

    Directory of Open Access Journals (Sweden)

    Gordana Bogdanović

    2011-12-01

    Full Text Available Introduction: Doppler analysis of the feto-placental and fetal circulation give dynamic information on the condition of the bloodstream during pregnancy, and early detection of fetal hypoxia. The objectives of the study were: testing whether there is influence of smoking on feto-placental circulation; determining whether there is a link to a number of smoked cigarettes during the day; assessing the benefits of Doppler ultrasonographic screening in detection of fetal hypoxia in pregnant women who smoke during pregnancy.Methods: 300 pregnancies were included in the prospective research. With regard to a number of smoked cigarettes the pregnant women were divided into three groups: I. the first group (moderate smokers consisted of 100 pregnant women who smoked up to 15 cigarettes a day during pregnancy; II. the second group (heavy smokers 100 pregnant women who smoked more than 15 cigarettes a day during pregnancy and III. the third group (control group 100 pregnant women who did not smoke during pregnancy. All pregnant women underwent Doppler measurements of blood circulation (determination of resistance index – RI in the umbilical artery, fetal aorta and middle cerebral artery.Results: The intensity of smoking has influence to circulation because RI in the umbilical artery and fetal aorta is increased and RI is decreased in the middle cerebral artery in pregnant women heavy smokers in comparison to pregnant women moderate smokers.Conclusion: Doppler sonography of the blood vessels could have an important role in detection of hypoxia and monitoring of the condition of the fetus of pregnant women who smoked during pregnancy.

  2. Portable calibration instrument of hemodialysis unit

    Science.gov (United States)

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

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Francisca Monsalve-Castillo

    2012-02-01

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

  4. Anterior chamber depth during hemodialysis

    Directory of Open Access Journals (Sweden)

    Gracitelli CPB

    2013-08-01

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

  5. Hepatitis C in hemodialysis patients

    Institute of Scientific and Technical Information of China (English)

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

    2015-01-01

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

  6. Correlation of compliance with central line associated blood stream infection guidelines and outcomes: a review of the evidence

    Directory of Open Access Journals (Sweden)

    Gerkin R

    2012-05-01

    Full Text Available Background Clinical practice guidelines are developed to assist in patient care but the evidence basis for many guidelines has been called into question. Methods We conducted a literature review using PubMed and analyzed the overall quality of evidence and made strength of recommendation behind 8 Institute of Health Care (IHI guidelines for prevention of central line associated blood stream infection (CLABSI. Quality of evidence was assessed by the American Thoracic Society (ATS levels of evidence (levels I through III. We also examined data from our intensive care units (ICUs for evidence of a correlation between guideline compliance and the development of VAP.Results None of the guidelines was graded at level I. Two of the guidelines were graded at level II and the remaining 6 at level III. Despite the lack of evidence, 2 of the guidelines (hand hygiene, sterile gloves were given a strong recommendation. Chlorhexidine and use of nonfemoral sites were given a moderate recommendation. In our ICUs compliance with the use of chlorhexidine correlated with a reduction in CLABSI (p<0.02 but the remainder did not.Conclusions The IHI CLABSI guidelines are based on level II or III evidence. Data from our ICUs supported the use of chlorhexidine in reducing CLABSI. Until more data from well-designed controlled clinical trials become available, physicians should remain cautious when using current IHI guidelines to direct patient care decisions or as an assessment of the quality of care.

  7. Blood Serum Levels of IL-2, IL-6, IL-8, TNF-α and IL-1β in Patients on Maintenance Hemodialysis

    Institute of Scientific and Technical Information of China (English)

    Jacek Rysz; Maciej Banach; Aleksandra Cialkowska-Rysz; Robert Stolarek; Marcin Barylski; Jaroslaw Drozdz; Piotr Okonski

    2006-01-01

    Cytokines are essential mediators of immune response and inflammatory reactions. Patients with chronic renal failure (CRF) commonly present with abnormalities of immune function related with impaired kidney function and the accumulation of uremic toxins in addition to bioincompatibility of dialyzer membranes. During a hemodialysis (HD) session, cytokines are released mainly by monocytes activated by endotoxin-type compounds in dialyzer fluid,complement factors and direct contact with dialyzer membrane. The study included 15 CRF patients, aged 36.4 ± 2.9 years, on regular HD maintenance therapy for mean 68 ± 10 months and 15 healthy controls. It was designed to assess serum levels of a panel of inflammatory cytokines: IL-1β, IL-2, IL-6, IL-8 and TNF-α in CRF patients on regular maintenance HD before, 20, 60 and 240 minutes of a single HD session in parallel with C-reactive protein (CRP) as an additional parameter. CRP concentration was increased in HD patients when compared with healthy controls. The concentrations of IL-1, IL-6, IL-8 and TNF-α were increased, whereas the serum level of IL-2 was not altered during a single HD session.

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

    Directory of Open Access Journals (Sweden)

    Rose Anne Kulik

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

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

    Directory of Open Access Journals (Sweden)

    Rose Anne Kulik

    2008-08-01

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

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

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    Reza Hekmat

    2009-03-01

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

  11. Far-infrared therapy: a novel treatment to improve access blood flow and unassisted patency of arteriovenous fistula in hemodialysis patients.

    Science.gov (United States)

    Lin, Chih-Ching; Chang, Chao-Fu; Lai, Ming-Yu; Chen, Tzen-Wen; Lee, Pui-Ching; Yang, Wu-Chang

    2007-03-01

    Vascular access malfunction, usually presenting with an inadequate access flow (Qa), is the leading cause of morbidity and hospitalization in hemodialysis (HD) patients. Many methods of thermal therapy have been tried for improving Qa but with limited effects. This randomized trial was designed to evaluate the effect of far-infrared (FIR) therapy on access flow and patency of the native arteriovenous fistula (AVF). A total of 145 HD patients were enrolled with 73 in the control group and 72 in the FIR group. A WS TY101 FIR emitter was used for 40 min, and hemodynamic parameters were measured by the Transonic HD(02) monitor during HD. The Qa(1)/Qa(2) and Qa(3)/Qa(4) were defined as the Qa measured at the beginning/at 40 min later in the HD session before the initiation and at the end of the study, respectively. The incremental change of Qa in the single HD session with FIR therapy was significantly higher than that without FIR therapy (13.2 +/- 114.7 versus -33.4 +/- 132.3 ml/min; P = 0.021). In comparison with control subjects, patients who received FIR therapy for 1 yr had (1) a lower incidence (12.5 versus 30.1%; P unassisted patency of AVF (85.9 versus 67.6%; P < 0.01). In conclusion, FIR therapy, a noninvasive and convenient therapeutic modality, can improve Qa and survival of the AVF in HD patients through both its thermal and its nonthermal effects.

  12. Central venous catheter-related blood stream infection rate in critical care units in a tertiary care, teaching hospital in Mumbai

    Directory of Open Access Journals (Sweden)

    K Chopdekar

    2011-01-01

    Full Text Available Blood stream infections related to central venous catheterization are one of the major device-associated infections reported. Patients admitted in critical care units requiring central venous catheterization and presenting with signs of septicemia during catheterization period were investigated for catheter-related blood stream infections (CRBSI. The CRBSI rate was 9.26 per 1000 catheter days in general with highest rate in neonatal intensive care unit (27.02/1000 days. Site of insertion of catheter and duration of catheterization did not show the influence on the CRBSI rate. Coagulase-negative Staphylococci were the predominant cause. Mortality of 33% was observed in patients with CRBSI. Since central venous catheters are increasingly being used in the critical care, regular surveillance for infection associated them are essential.

  13. Association Between Antimicrobial Resistance in Escherichia coli Isolates from Food Animals and Blood Stream Isolates from Humans in Europe: An Ecological Study

    DEFF Research Database (Denmark)

    Vieira, Antonio; Collignon, Peter; Aarestrup, Frank Møller

    2011-01-01

    Background: In addition to medical antimicrobial usage, the use of antimicrobials in food animals contributes to the occurrence of resistance among some bacterial species isolated from infections in humans. Recently, several studies have indicated that a large proportion of Escherichia coli causing...... infections in humans, especially those resistant to antimicrobials, have an animal origin.Methods: We analyzed the correlation between the prevalence of antimicrobial resistance in E. coli isolates from blood stream infections in humans and in E. coli isolates from poultry, pigs, and cattle between 2005...... and 2008 for 11 countries, using available surveillance data. We also assessed the correlation between human antimicrobial usage and the occurrence of resistance in E. coli isolates from blood stream infections.Results: Strong and significant correlations between prevalences of resistance to ampicillin (r...

  14. Hemodialysis access procedures

    Science.gov (United States)

    ... 3 to 6 weeks to heal. Central venous catheter: If you need hemodialysis right away and you do not have time ... in the neck, chest, or upper leg. This catheter is temporary. It can be used for dialysis while you wait for a fistula or graft ...

  15. Epidemiology of Blood Stream Infection due to Candida Species in a Tertiary Care Hospital in Japan over 12 Years: Importance of Peripheral Line-Associated Candidemia

    OpenAIRE

    Ishikane, Masahiro; Hayakawa, Kayoko; Kutsuna, Satoshi; Takeshita, Nozomi; Ohmagari, Norio

    2016-01-01

    Background Candidemia is an important cause of mortality in healthcare settings. Peripheral lines are a source of candidemia, yet few studies have reported on the clinico-epidemiological features of candidemia due to peripheral-line associated blood stream infection (PLABSI). Methods We conducted a single-centre retrospective cohort study of all patients with candidemia between 2002 and 2013. PLABSI was defined as the presence of at least one of the following: the presence of phlebitis or the...

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

    Science.gov (United States)

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

    2011-07-01

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

  17. 腹膜透析和血液透析对尿毒症患者血钾的影响%Effects of peritoneal dialysis and hemodialysis on blood potassium concentrations in patients with uremia

    Institute of Scientific and Technical Information of China (English)

    林明增; 范佳妮; 陈霄峰; 陈文芬

    2014-01-01

    目的:探讨血液透析与腹膜透析对尿毒症患者血钾的影响。方法对97例血液透析及45例腹膜透析均治疗3个月以上的患者进行血钾、血钠、血氯测定和比较,并调查当月患者的尿量及住院情况。结果腹膜透析组的低钾、低钠、低氯血症发生率分别为20.0%、15.6%、37.8%,而血液透析组分别为2.1%、4.1%、16.5%,两组差异有统计学意义(P<0.05)。血液透析组的高钾血症发生率为28.9%,而腹膜透析组为11.1%,两组差异有统计学意义(P<0.05)。血液透析组患者的血钾、血氯分别为(5.076±1.093)、(99.660±3.889)mmol/L ,腹膜透析组分别为(4.435±0.99)、(96.910±3.646)mmol/L ,两组差异均有统计学意义(均P<0.05)。尿量>500ml者腹膜透析组占55.6%,血液透析组占6.2%,两组差异有统计学意义(P<0.05)。两组患者住院率的差异无统计学意义(P>0.05)。结论腹膜透析组低钾血症发生率高,血液透析组的高钾血症发生率高,需要对不同透析方式的患者饮食状况进行相应的指导,不能忽视患者在使用一些药物时对血钾异常可能产生的影响。%Objective To investigate the effects of peritoneal dialysis and hemodialysis on blood potassium concentration in patients with uremia. Methods The levels of serum potassium, sodium and chloride were measured in 45 uremic patients un-dergoing peritoneal dialysis and 97 patients undergoing hemodialysis for more than three months. In addition, the urine output and hospitalization of patients were also documented. Results The incidence rate of hypokalemia, hyponatremia and low chlo-rine in peritoneal dialysis group was 20.0%, 15.6%and 37.8%;and in peritoneal dialysis group was 2.1%, 4.1%, 16.5%respec-tively (P500ml in peritoneal dialysis and hemodialysis groups accounted for 55.6% and 6.2%, respectively (P<0.05). These was no difference in hospitalization between two

  18. Coagulase-negative staphylococci causing blood stream infection at an Indian tertiary care hospital: Prevalence, antimicrobial resistance and molecular characterisation

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    S Singh

    2016-01-01

    Full Text Available Introduction: Recent years have seen a rise of coagulase-negative staphylococci (CoNS from common contaminants to agents of nosocomial blood stream infections (BSI's. Molecular typing and establishing a correlation with antibiotic resistance is essential particularly in countries like India where genotyping studies for drug-resistant CoNS are sparse. Methods: A prospective study was done over 18 months, wherein 42,693 blood samples were received, and 59 patients with BSI due to CoNS were evaluated. The isolates recovered were identified by a biochemical test panel and matrix-assisted laser desorption ionization – time of flight mass spectrometry followed by antimicrobial susceptibility testing by Kirby–Baur disc diffusion method and E-test strips. Staphylococcal chromosomal cassette mec (SCCmec element was characterised by multiplex polymerase chain reaction for all methicillin-resistant (MR isolates. Results: The majority of CoNS isolated were constituted by Staphylococcus haemolyticus (47.5% followed by Staphylococcus epidermidis (33.9%, Staphylococcus hominis (11.86%, Staphylococcus cohnii (5.08% and Staphylococcus warneri (1.69%. Among all isolates 57.6% were MR with statistically significant higher resistance versus methicillin sensitive-CoNS. This difference was significant for erythromycin (76% vs. 44%, P = 0.011, rifampicin (50% vs. 12%,P= 0.002 and amikacin (26.5% vs. 4%, P = 0.023, ciprofloxacin (64.7% vs. 20%, P = 0.001 and cotrimoxazole (55.9% vs. 20%, P = 0.006. SCCmec type I was predominant (61.8%, P = 0.028 and exhibited multidrug resistance (76.2%. Coexistence of SCCmec type I and III was seen in 8.82% MR isolates. Conclusion: CoNS exhibit high antimicrobial resistance thereby limiting treatment options. The presence of new variants of SCCmec type in hospital-acquired CoNS may predict the antibiotic resistance pattern. This is the first evaluation of the molecular epidemiology of CoNS causing BSI from India and can serve as a

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

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    Hamid Kalantari

    2014-01-01

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

  20. Exploration of a reasonable dialysate temperature setting in hemodialysis for patients with hypertension

    Institute of Scientific and Technical Information of China (English)

    Lin-Fang Xu; Chun-Lei Wu; Hong-Mei Sun; Tong-Qiang Liu

    2016-01-01

    Objective: This study aims to investigate the effect of 4 different dialysate temperatures on blood pressure during hemodialysis for patients with hypertension. Methods: Using a self-controlled method, the patients' body temperature was set as T. Accordingly, the dialysate temperature was set as 37 ℃, Tþ0.5 ℃, T, and T-0.5 ℃. The changes in blood pressure, heart rate, mean arterial pressure and dialysis-induced adverse reactions at the 4 different dialysate temper-atures were consistently monitored. Results: Patients who received hemodialysis with 37 ℃ and Tþ0.5 ℃ dialysate demonstrated an un-stable blood pressure and a higher incidence of adverse reactions. Patients who received hemodialysis with T and T-0.5 ℃ dialysate showed a relatively stable blood pressure, heart rate, and mean arterial pressure during dialysis. In particular, dialysate at T-0.5 ℃ resulted in the most stable blood pressure, the fewest adverse reactions and the best self-assessed comfort scores (P Conclusions: The dialysate temperature during hemodialysis for patients with hypertension should be set to a temperature based on patients' preoperative body temperate T or 0.5 ℃ below T. This practice is suggested to enhance the stability of patients' blood pressure and heart rate during hemodialysis, reduce complications and improve patients' tolerance of hemodialysis.

  1. 低分子肝素与肝素钠在维持性血液透析患者对血脂影响的比较%THE COMPARISON OF THE INFLUENCE OF LOW MOLECULAR WEIGHT HEPARIN AND HEPARIN SODIUM FOR THE BLOOD LIPID OF MAINTENANCE HEMODIALYSIS PATIENTS

    Institute of Scientific and Technical Information of China (English)

    刘凌汐

    2011-01-01

    [目的]探讨低分子肝素与肝素钠在维持性血液透析患者治疗中血脂变化情况的比较.[方法]选取某院2008年7月~2010年6月透析患者60例作为研究对象,全部患者随机分为对照组(肝素组)30例和观察组30例(低分子肝素组),观察比较两组透析前后血脂变化,包括血清总胆固醉(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C )、低密度脂蛋白胆固醇(LDL-C).[结果]两组患者透析后血脂水平较透析前均有所改善,且观察组患者透析后血清总胆固醇(TG)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、改善较对照组更明显(P<0.05).两组患者在透析器及管路方面凝血、透析后出血倾向方面有明显差异(P<0.05).B组复用次数明显增多.[结论]低分子肝素在维持性血液透析患者中血脂变化较肝素明显.%[Objective] To study the comparison of the influence of low molecular weight heparin and heparin sodium for the blood lipid of maintenance hemodialysis patients. [Methods] 60 patients treated with hemodialysis in our hospital from July 2008 to June 2010 were selected as research subjects, and all the patients were randomly divided into control group (heparin group) 30 cases and observation group (low molecular weight heparin group) 30 cases, then the blood lipid including serum total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) of the two groups were observed and compared. [Results] The levels of blood lipid in the two groups after the hemodialysis were better than those before the hemodialysis, and the levels of serum total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) of observation group after the hemodialysis were more improved than those of control group (P < 0.05). And there were obvious differences

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

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    Iman Taghizade Firoozjayi

    2016-03-01

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

  3. Chlorine dioxide and hemodialysis

    Energy Technology Data Exchange (ETDEWEB)

    Smith, R.P. (Dartmouth Coll., Hanover, NH (USA). Dept. of Pharmacology and Toxicology)

    1989-05-01

    Because it has little or no tendency to generate carcinogenic trihalomethanes such as chloroform, chlorine dioxide is an attractive alternative to chlorine for drinking water disinfection. There are, however, concerns about its acute toxicity, and the toxic effects of its by-products, chlorite and chlorate. The human experience with chlorine dioxide in both controlled, prospective studies and in actual use situations in community water supplies have as yet failed to reveal adverse health effects. The EPA has recommended standards of 0.06 mg/L for chlorine dioxide and standards of 0.007 mg/L for chlorite and chlorate in drinking water. Among groups who may be at special risk from oxychlorines in drinking water are patients who must undergro chronic extracorporeal hemodialysis. Although even units for home hemodialysis are supposed to be equipped with devices which effectively remove oxychlorines, there is a always a possibility of operator error or equipment failure. When the equipment is adequately maintained, it is likely that dialysis patients will have more intensive exposures from drinking water than from dialysis fluids despite the much larger volumes of water that are involved in dialysis. This paper discusses a hemodialysis and the standards and effects of oxychlorines. 90 refs., 2 tabs.

  4. 改良式血液透析联合血液灌流治疗尿毒症患者的护理观察%Improved hemodialysis union blood perfusion nursing observation for the Treatment Of patients with uremia

    Institute of Scientific and Technical Information of China (English)

    张晓莉; 谢萍

    2016-01-01

    目的:观察改良式血液透析联合血液灌流(HD+HP)治疗尿毒症的临床效果,并总结其护理方法。方法:将20例尿毒症患者行改良式HD+HP治疗,观察治疗前后对患者的食欲、睡眠状况、皮肤瘙痒以及β2-微球蛋白(β2-MG)水平改善情况。结果:改良式HD+HP治疗后,β2-微球蛋白清除效果显著,患者尿毒症相关症状(食欲、睡眠、皮肤瘙痒)明显改善。结论:改良后的HD+HP疗法,清除毒素更彻底,效果显著,且操作更为便捷,患者依从性高。%Objective:To observe the improvement of hemodialysis union blood perfusion (HD+HP) for treatment of uremia,and summarize the nursing methods.Methods:20 cases of uremic patients improved HD+HP treatment,observation of patients before and after the treatment of appetite,sleep patterns,itchy skin,and beta 2-microglobulin (beta2-MG) level to improve the situation.Results:improved HD+HP after treatment,the beta 2-microglobulin removal effect is remarkable,in patients with uremia symptoms (appetite,sleep,itchy skin) improved significantly.Conclusion:modified HD+HP therapy,more thoroughly remove toxin,the effect is remarkable,and more convenient operation,high patient compliance.

  5. Comparison of the clinical effects between catheter exchange methods in geriatric patients with tunneled cuffed hemodialysis catheters

    Institute of Scientific and Technical Information of China (English)

    周参新

    2012-01-01

    Objective To compare the infection-free and overall survival between first and subsequent tunneled cuffed hemodialysis catheters in geriatric patients. Methods The study involved 57 geriatric patients [32 male,25 female; mean age(72.4±6.7) years]undergoing maintenance hemodialysis in our blood

  6. Nutritional status in nocturnal hemodialysis

    NARCIS (Netherlands)

    Ipema, Jacoba Regina

    2016-01-01

    Malnutrition is extremely prevalent in hemodialysis patients and may result in loss of muscle mass and poor physical functioning. Malnutrition is also a major predictor of increased morbidity and mortality. The central theme of this thesis is how the transition from conventional hemodialysis to noct

  7. The Effects of Hemodialysis on Tear Osmolarity

    Science.gov (United States)

    Taskapili, Muhittin; Serefoglu Cabuk, Kubra; Aydin, Rukiye; Atalay, Kursat; Kirgiz, Ahmet; Sit, Dede; Kayabasi, Hasan

    2015-01-01

    Aim. To determine the effects of hemodialysis (HD) on tear osmolarity and to define the blood biochemical tests correlating with tear osmolarity among patients with end stage renal disease (ESRD). Material-Method. Tear osmolarity of ESRD patients before and after the hemodialysis program was determined as well as the blood biochemical data including glucose, sodium, potassium, calcium, urea, and creatinine levels. Results. Totally 43 eyes of 43 patients (20 females and 23 males) with a mean age of 53.98 ± 18.06 years were included in the study. Tear osmolarity of patients was statistically significantly decreased after hemodialysis (314.06 ± 17.77 versus 301.88 ± 15.22 mOsm/L, p = 0.0001). In correlation analysis, pre-HD tear osmolarity was negatively correlated with pre-HD blood creatinine level (r = −0.366,  p = 0.016). Post-HD tear osmolarity was statistically significantly correlated with the post-HD glucose levels (r = 0.305  p = 0.047). Tear osmolarity alteration by HD was negatively correlated with creatinine alteration, body weight alteration, and ultrafiltration (r = −0.426,  p = 0.004; r = −0.365,  p = 0.016; and r = −0.320, p = 0.036, resp.). There was no correlation between tear osmolarity and Kt/V and URR values. Conclusion. HD effectively decreases tear osmolarity to normal values and corrects the volume and composition of the ocular fluid transiently. Tear osmolarity alteration induced by HD is correlated with body weight changes, creatinine alterations, and ultrafiltration. PMID:26640702

  8. The Effects of Hemodialysis on Tear Osmolarity

    Directory of Open Access Journals (Sweden)

    Muhittin Taskapili

    2015-01-01

    Full Text Available Aim. To determine the effects of hemodialysis (HD on tear osmolarity and to define the blood biochemical tests correlating with tear osmolarity among patients with end stage renal disease (ESRD. Material-Method. Tear osmolarity of ESRD patients before and after the hemodialysis program was determined as well as the blood biochemical data including glucose, sodium, potassium, calcium, urea, and creatinine levels. Results. Totally 43 eyes of 43 patients (20 females and 23 males with a mean age of 53.98±18.06 years were included in the study. Tear osmolarity of patients was statistically significantly decreased after hemodialysis (314.06±17.77 versus 301.88±15.22 mOsm/L, p=0.0001. In correlation analysis, pre-HD tear osmolarity was negatively correlated with pre-HD blood creatinine level (r=-0.366,  p=0.016. Post-HD tear osmolarity was statistically significantly correlated with the post-HD glucose levels (r=0.305  p=0.047. Tear osmolarity alteration by HD was negatively correlated with creatinine alteration, body weight alteration, and ultrafiltration (r=-0.426,  p=0.004; r=-0.365,  p=0.016; and r=-0.320, p=0.036, resp.. There was no correlation between tear osmolarity and Kt/V and URR values. Conclusion. HD effectively decreases tear osmolarity to normal values and corrects the volume and composition of the ocular fluid transiently. Tear osmolarity alteration induced by HD is correlated with body weight changes, creatinine alterations, and ultrafiltration.

  9. Biofeedback systems and adaptive control hemodialysis treatment

    Directory of Open Access Journals (Sweden)

    Azar Ahmad

    2008-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Hisham Ismail

    2010-08-01

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

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

    Science.gov (United States)

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

    2012-06-01

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

  12. After injection into the striatum, in vitro-differentiated microglia- and bone marrow-derived dendritic cells can leave the central nervous system via the blood stream.

    Science.gov (United States)

    Hochmeister, Sonja; Zeitelhofer, Manuel; Bauer, Jan; Nicolussi, Eva-Maria; Fischer, Marie-Therese; Heinke, Bernhard; Selzer, Edgar; Lassmann, Hans; Bradl, Monika

    2008-12-01

    The prototypic migratory trail of tissue-resident dendritic cells (DCs) is via lymphatic drainage. Since the central nervous system (CNS) lacks classical lymphatic vessels, and antigens and cells injected into both the CNS and cerebrospinal fluid have been found in deep cervical lymph nodes, it was thought that CNS-derived DCs exclusively used the cerebrospinal fluid pathway to exit from tissues. It has become evident, however, that DCs found in peripheral organs can also leave tissues via the blood stream. To study whether DCs derived from microglia and bone marrow can also use this route of emigration from the CNS, we performed a series of experiments in which we injected genetically labeled DCs into the striata of rats. We show here that these cells migrated from the injection site to the perivascular space, integrated into the endothelial lining of the CNS vasculature, and were then present in the lumen of CNS blood vessels days after the injection. Moreover, we also found these cells in both mesenteric lymph nodes and spleens. Hence, microglia- and bone marrow-derived DCs can leave the CNS via the blood stream.

  13. Antiangiogenic factors and maternal hemodynamics during intensive hemodialysis in pregnancy.

    Science.gov (United States)

    Cornelis, Tom; Spaanderman, Marc; Beerenhout, Charles; Perschel, Frank H; Verlohren, Stefan; Schalkwijk, Casper G; van der Sande, Frank M; Kooman, Jeroen P; Hladunewich, Michelle

    2013-10-01

    We report on a 21-year-old pregnant patient with IgA nephropathy who was initiated on intensive hemodialysis (8 hours of hemodialysis 3 times a week) at a gestational age of 26 weeks on the basis of worsening kidney function resulting in rapidly progressive fatigue and difficulties in metabolic control. Throughout the pregnancy, and while on intensive hemodialysis, 24-hour ambulatory blood pressure control was within the target, and results of weekly 24-hour measurement of central hemodynamics and pulse wave velocity, and of serial levels of circulating (anti-)angiogenic factors were comparable to normal pregnancies. Estimated fetal growth evolved along the 50th percentile, and no polyhydramnios was detected. After induction for a sudden, unexplained increase in blood pressure, she delivered a healthy boy of 2480 g at a gestational age of 36 weeks. This case adds to the expanding literature that supports the use of intensive hemodialysis in pregnant patients with end-stage renal disease and illustrates, for the first time, the potential use of serial (anti-) angiogenic factors and 24-hour measurements of blood pressure and hemodynamic indices in order to facilitate monitoring of these complicated patients.

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

    Institute of Scientific and Technical Information of China (English)

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

    2010-01-01

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

  15. Removal of Dolutegravir by Hemodialysis in HIV-Infected Patients with End-Stage Renal Disease.

    Science.gov (United States)

    Moltó, José; Graterol, Fredzzia; Miranda, Cristina; Khoo, Saye; Bancu, Ioana; Amara, Alieu; Bonjoch, Anna; Clotet, Bonaventura

    2016-04-01

    Data on dolutegravir removal by hemodialysis are lacking. To study this, we measured dolutegravir plasma concentrations in samples of blood entering and leaving the dialyzer and of the resulting dialysate from 5 HIV-infected patients with end-stage renal disease. The median dolutegravir hemodialysis extraction ratio was 7%. The dolutegravir concentrations after the dialysis session remained far above the protein-binding-adjusted inhibitory concentration. Our results show minimal dolutegravir removal by hemodialysis, with no specific dolutegravir dosage adjustments required in this setting. (This study is registered at ClinicalTrials.gov under registration number NCT02487706.).

  16. Thallium Intoxication Treated with Long-Term Hemodialysis, Forced Diuresis and Prussian Blue

    DEFF Research Database (Denmark)

    Larsen, Elfinn; Solgaard, Per Bent; Freund, L. Gade

    1978-01-01

    A 56 yr old woman, who ingested 2 g of thallium sulfate, was successfully treated with long-term hemodialysis for 200 h during 10 days, combined with forced diuresis and Prussian blue. The effect of the artificial kidney dialysis was determined by repeated analysis of the Tl concentration...... in the dialysis bath and in blood samples. During the 1st 120 h of hemodialysis, 143 mg of Tl was eliminated via the artificial kidney and 110 mg via the urinary tract. The present case of acute Tl intoxication is the 1st in which long-term hemodialysis has been used in the acute phase...

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

    OpenAIRE

    Vinay Rao; Prasannalakshmi Rao

    2014-01-01

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

  18. No significant effect of angiotensin II receptor blockade on intermediate cardiovascular end points in hemodialysis patients

    DEFF Research Database (Denmark)

    Peters, Christian D; Kjaergaard, Krista D; Jensen, Jens D;

    2014-01-01

    Agents blocking the renin-angiotensin-aldosterone system are frequently used in patients with end-stage renal disease, but whether they exert beneficial cardiovascular effects is unclear. Here the long-term effects of the angiotensin II receptor blocker, irbesartan, were studied in hemodialysis...... the study period significantly correlated with changes in both left ventricular mass and arterial stiffness. Thus, significant effects of irbesartan on intermediate cardiovascular end points beyond blood pressure reduction were absent in hemodialysis patients....

  19. Occult hepatitis C virus infection among hemodialysis patients.

    Science.gov (United States)

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

    2008-12-01

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

  20. Effects of Different Blood Purification Treatment on Renal Function in Patients with Maintenance Hemodialysis%不同血液净化方式对维持性血液透析患者肾功能的影响

    Institute of Scientific and Technical Information of China (English)

    王方利

    2016-01-01

    Objective To discuss the impacts of low flux hemodialysis method and high flux hemodialysis method on residual renal function (RRF) in maintenance hemodialysis (MHD) patients.Methods 33 cases of uremia patients using high-flux hemodialysis dialyzers were set as observation group, 30 cases of uremia patients using low-flux hemodialysis dialyzers were set as control group. RRF, serum phosphorus, triglycerides ester, and cholesterol levels in two groups before and after treatment were compared.Results After treatment RRF results in observation group was significantly better than control group, and serum phosphorus, triglyceride, and cholesterol levels improved more significantly than control group (P<0.05).Conclusion The high flux hemodialysis method has less impact on RRF in MHD patients, the protective effect of which is better than low flux hemodialysis method.%目的:探讨低通量血液透析法、高通量血液透析法对维持性血液透析(MHD)患者残余肾功能(RRF)的影响。方法33例尿毒症患者接受高通量血液透析器治疗,设为观察组,30例尿毒症患者接受低通量血液透析器治疗,设为对照组,比较治疗前后两组RRF、血清磷、三酰甘油、胆固醇等水平。结果治疗后RRF观察组明显好于对照组,且血清磷、三酰甘油、胆固醇水平改善幅度明显优于对照组(P<0.05)。结论高通量血液透析法对MHD患者RRF影响小,保护作用优于低通量血液透析法。

  1. Music for Hemodialysis patients

    DEFF Research Database (Denmark)

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

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

  2. Music for Hemodialysis patients

    DEFF Research Database (Denmark)

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

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

  3. Ultrapure Water System for Hemodialysis Therapy

    Science.gov (United States)

    2011-07-21

    The Change of Biomarkers CRP, CBC With the Use of Ultra Pure Water System for; Hemodialysis.; The Rate of Adverse Events Such as Hypotension During Hemodialysis Therapy With Ultra Pure Water; System as Compared to Conventional Water System.

  4. Short daily and nocturnal hemodialysis: New therapies for a new century?

    Directory of Open Access Journals (Sweden)

    Rocco Micheal

    2009-01-01

    Full Text Available The National Institutes of Health (NIH sponsored HEMO Study did not demonstrate that an increase in dialysis dose was associated with an improvement in patient mortality rates. Despite this negative result, there is ongoing interest in determining if still higher doses of dialysis may be of benefit to patients receiving chronic hemodialysis therapy. Testing this hypothesis requires the use of more fre-quent hemodialysis and/or a much longer duration for each dialysis session. "Short daily hemodialysis", actually six times per week hemodialysis for 1.5 to 3 hours per session, provides a significant increase in small molecule clearance as measured by urea kinetics. "Long nocturnal daily hemodialysis", actually six times per week hemodialysis for 6-8 hours per session, provides a significant increase in both small and large molecular weight clearance and often alleviates the need to take phosphate binders. Both forms of more frequent dialysis have been shown to improve control of blood pressure. One small randomized trial of nocturnal versus conventional home dialysis showed a decrease in left ventricular (LV mass at 6 months in the nocturnal arm only. Most clinical trials conducted in these dialysis modalities have been observational trials and have enrolled small numbers of patients. The National Institutes of Health is sponsoring two clinical trials via the Frequent Hemodialysis Network to determine the effect of these two more frequent dialysis modalities on intermediate outcomes. In the short daily study, 250 patients will be randomized to receive either six times per week HD, with a session length of 1.5 to 2.75 hours, or conventional in-center hemodialysis. In the nocturnal study, 150 patients will be randomized to receive either six times per week overnight dialysis, with a session length of at least 6 hours, or conventional home hemodialysis.

  5. Short daily and nocturnal hemodialysis: new therapies for a new century?

    Science.gov (United States)

    Rocco, Micheal V

    2009-01-01

    The National Institutes of Health (NIH) sponsored HEMO Study did not demonstrate that an increase in dialysis dose was associated with an improvement in patient mortality rates. Despite this negative result, there is ongoing interest in determining if still higher doses of dialysis may be of benefit to patients receiving chronic hemodialysis therapy. Testing this hypothesis requires the use of more fre-quent hemodialysis and/or a much longer duration for each dialysis session. "Short daily hemodialysis", actually six times per week hemodialysis for 1.5 to 3 hours per session, provides a significant increase in small molecule clearance as measured by urea kinetics. "Long nocturnal daily hemodialysis", actually six times per week hemodialysis for 6-8 hours per session, provides a significant increase in both small and large molecular weight clearance and often alleviates the need to take phosphate binders. Both forms of more frequent dialysis have been shown to improve control of blood pressure. One small randomized trial of nocturnal versus conventional home dialysis showed a decrease in left ventricular (LV) mass at 6 months in the nocturnal arm only. Most clinical trials conducted in these dialysis modalities have been observational trials and have enrolled small numbers of patients. The National Institutes of Health is sponsoring two clinical trials via the Frequent Hemodialysis Network to determine the effect of these two more frequent dialysis modalities on intermediate outcomes. In the short daily study, 250 patients will be randomized to receive either six times per week HD, with a session length of 1.5 to 2.75 hours, or conventional in-center hemodialysis. In the nocturnal study, 150 patients will be randomized to receive either six times per week overnight dialysis, with a session length of at least 6 hours, or conventional home hemodialysis.

  6. Taurolidine locks significantly reduce the incidence of catheter-related blood stream infections in high-risk patients on home parenteral nutrition.

    Science.gov (United States)

    Saunders, J; Naghibi, M; Leach, Z; Parsons, C; King, A; Smith, T; Stroud, M

    2015-02-01

    Emerging evidence suggests taurolidine reduces the risk of repeated episodes of catheter related blood stream infections (CRBSI) in a subgroup of patients receiving home parenteral nutrition (HPN). We defined 3 indications where taurolidine could be considered and retrospectively analysed data from patients who were treated over a 10 year period to examine the validity of these criteria. Twenty-two patients were identified from a total HPN population of 81, representing 33.2 years of experience. The overall CRBSI rate pre- and post-taurolidine usage was reduced from 5.71 to 0.99 infections per 1000 patient parenteral nutrition days (P-value taurolidine is used as secondary prophylaxis and providing initial data suggesting the benefit of its use as primary prophylaxis.

  7. Analysis on blood stream infections in patients in surgical intensive care unit%SICU 患者血流感染危险因素分析

    Institute of Scientific and Technical Information of China (English)

    李楠; 任军红; 李双玲; 王东信

    2015-01-01

    OBJECTIVE To investigate the risk factors and prognosis of blood stream infections in surgical critically ill patients and simultaneously analyze the sources ,distribution and characteristics of drug resistance of the patho‐gens so as to guide clinical practice in anti‐infection therapy , especially in empirical anti‐infection therapy . METHODS The clinical data of 59 patients confirmed to have infections in surgical intensive care unit between 2007 and 2013 were collected .The risk factors of blood stream infections ,source ,distribution and characteristics of drug resistance of the pathogens ,and prognosis of the patients were analyzeds .The software Windows SPSS17 .0 was used for statistical analysis .RESULTS A total of 96 strains of pathogens were isolated from the 59 patients with blood stream infections .Gram‐positive bacteria ,gram‐negative bacteria and fungi accounted for 30 .20% (29 strains) ,47 .92% (46 strains) ,21 .88% (21 strains) respectively .Multidrug‐resistant bacteria accounted for 45 .83% (44 strains) of all bacteria .Staphylococcus aureus had 100 .00% resistance to linezolid ,K lebsiella pneu‐moniae and Pseudomonas aeruginosa had 100 .00% resistance to ampicillin .CONCLUSION Patients with blood stream infections in surgical intensive care unit had various risk factors with a variety of pathogens from different sources .Their prognosis was very poor .Enhanced monitoring and effective anti‐infection strategy should be a‐dopted .%目的:了解外科重症监护病房(S IC U )患者血流感染的危险因素、病原菌来源及分布、耐药特点、患者预后,为临床抗感染治疗尤其是经验性抗感染治疗提供指导。方法收集2007-2013年SICU确诊为血流感染的59例患者临床资料,对其感染的危险因素、病原菌来源及分布、耐药性及预后进行描述性研究,采用 Window s SPSS17.0进行统计分析。结果59例血流感染患者共检出病原菌96

  8. Hypertension and hemodialysis: pathophysiology and outcomes in adult and pediatric populations.

    Science.gov (United States)

    Van Buren, Peter N; Inrig, Jula K

    2012-03-01

    Hypertension is prevalent in adult and pediatric end-stage renal disease patients on hemodialysis. Volume overload is a primary factor contributing to hypertension, and attaining true dry weight remains a priority for nephrologists. Other contributing factors to hypertension include activation of the sympathetic and renin-angiotensin-aldosterone systems, endothelial cell dysfunction, arterial stiffness, exposure to hypertensinogenic drugs, and electrolyte imbalances during hemodialysis. Epidemiologic studies in adults show that uncontrolled hypertension results in cardiovascular morbidity, but reveal increased mortality risk at low blood pressure, so that it remains unclear what the target blood pressure should be. Despite the lack of a definitive BP target, gradual dry weight reduction should be the first intervention for BP control. Renin-angiotensin-aldosterone system inhibitors have been shown to improve cardiovascular morbidity and mortality and are recommended as the initial pharmacologic therapy for hypertensive hemodialysis patients. Short-daily or nocturnal hemodialysis are also good therapeutic options for these patients. It is already established that hypertension in pediatric hemodialysis patients is associated with adverse cardiovascular outcomes, and there is emerging evidence that the mechanisms causing hypertension are similar to adults. Hypertension in adult and pediatric hemodialysis patients warrants aggressive management, although clinical trial evidence of a target BP that improves mortality does not currently exist.

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

    Science.gov (United States)

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

    2010-08-01

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

  10. Epidemiology of Blood Stream Infection due to Candida Species in a Tertiary Care Hospital in Japan over 12 Years: Importance of Peripheral Line-Associated Candidemia.

    Science.gov (United States)

    Ishikane, Masahiro; Hayakawa, Kayoko; Kutsuna, Satoshi; Takeshita, Nozomi; Ohmagari, Norio

    2016-01-01

    Candidemia is an important cause of mortality in healthcare settings. Peripheral lines are a source of candidemia, yet few studies have reported on the clinico-epidemiological features of candidemia due to peripheral-line associated blood stream infection (PLABSI). We conducted a single-centre retrospective cohort study of all patients with candidemia between 2002 and 2013. PLABSI was defined as the presence of at least one of the following: the presence of phlebitis or the resolution of clinical symptoms after peripheral-line withdrawal, with careful exclusion of an alternative explanation for bacteraemia. We described the epidemiology of candidemia and assessed predictive factors of PLABSI due to Candida spp., peripheral line-associated candidemia (PLAC), compared with non-PLAC. A total of 301 episodes of candidemia, including 37 of PLAC, were diagnosed during the study period. Central-line associated blood stream infection, intra-abdominal infection, and infection of unknown source accounted for the remaining 233, 14, and 17 cases, respectively. The overall incidence rate of candidemia was 0.11/1000 patient-days. In multivariate analysis, cephalosporin exposure (odds ratio [OR] = 2.22, 95% CI 1.04-4.77), polymicrobial bacteraemia/fungaemia (OR = 2.87, 95% CI 1.02-8.10), and ID specialist consultation (OR = 2.40, 95% CI 1.13-5.13) were identified as independent predictors of PLAC. Although non-PLAC had a higher mortality, the length of hospital stay after candidemia was similar between the two groups and candidemia duration was longer in the PLAC group. PLACs are an important cause of candidemia in hospitalized patients. Appropriate identification and management of PLAC are crucial.

  11. Prescribing dialysate bicarbonate concentrations for hemodialysis patients.

    Science.gov (United States)

    Heineken, F G; Brady-Smith, M; Haynie, J; Van Stone, J C

    1988-01-01

    A rearranged equation of Sargent and Gotch (1) was used to determine dialysate bicarbonate concentrations for hemodialysis patients. Parameters in this equation include an estimate of the acid generated by each patient between treatments, an estimate for the dialyzer dialysance for bicarbonate, ultrafiltration rate, blood flow rate and a targeted mid-dialysis plasma bicarbonate concentration of 25 mEq/L. Nine patients were studied over a 35 week period to verify this method of determining each patient's dialysate bicarbonate concentration. Prescribed dialysate bicarbonate concentrations for the nine patients varied from 29 to 38 mEq/L with five patients having a prescribed value of 35 mEq/L. After a baseline period of five weeks, five patients switched from a 37 mEq/L acetate dialysate to their prescribed dialysate bicarbonate concentration. Four patients who had already been on bicarbonate dialysis at a concentration of 35 mEq/L were dialyzed with their prescribed dialysate bicarbonate concentrations. Patients were then followed for a study period of 30 weeks. The prescribed dialysate bicarbonate concentration resulted in more normal acid/base chemistries for both groups of patients. The results also demonstrate that chronic hemodialysis patients require individualization of dialysate bicarbonate concentrations.

  12. Clinical value study of low molecular heparin sodium for calcium-phosphorus metabolism and blood lipid of hemodialysis patients%探究低分子肝素钠对血液透析患者钙磷代谢及血脂影响的临床价值

    Institute of Scientific and Technical Information of China (English)

    王聪

    2016-01-01

    Objective To explore clinical value of low molecular heparin sodium for calcium-phosphorus metabolism and blood lipid of hemodialysis patients.MethodsChoose 60 cases hemodialysis patients in our hospital from August 2014 to August 2015, and randomly divide them into two groups, 30 cases in control group, 30 in study group, which was treated with common heparin sodium and low molecular heparin sodium injection. Analyze and compare two groups with changes of triglyceride (TG), total cholesterol (TC), calcium and phosphorus before treatment, 6 months and one year after treatment.results Before treatment, TG, TC, calcium, phosphorus indexes of two groups patients showed no significant difference (P> 0.05). 6 months after treatment, the above indexes improvement of study group was significantly better than control group, difference between groups showed statistical significant (P0.05)),治疗6个月后,研究组在上述各项质改善情况显著优于对照组,组间数据对比差异明显,(P<0.05)具有统计学意义。结论对血液透析患者采用低分子肝素注射,可有效改善他们钙磷代谢、血脂紊乱的情况,效果安全,值得推广。

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

    Institute of Scientific and Technical Information of China (English)

    Seyed-Moayed Alavian

    2009-01-01

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

  14. 血液透析联合血液灌流治疗慢性肾衰竭16例临床分析%Clinical analysis of 16 cases with chronic renal failure treated by hemodialysis combined with blood perfusion

    Institute of Scientific and Technical Information of China (English)

    诺敏

    2015-01-01

    Objective:To study the clinical effect of hemodialysis combined with blood perfusion in the treatment of chronic renal failure patients.. Methods: randomly selected in our hospital in February 2011 to 2014 may treated hemodialysis union blood irrigation lfow regimen in the treatment of patients with chronic renal failure in 16 cases, as the observation group, another randomly selected in our hospital during this period were the application of blood dialysis treatment in patients with chronic renal failure (CRF) in 20 cases, set as the control group. To compare the clinical symptoms and the clinical symptoms of the 2 groups. Results: observation group were significantly better than the contrast group, the difference is statistically value (P 0.05),治疗后2组患者各项指标均有明显改善,观察组患者改善程度优于对照组,差异有统计学价值(P<0.05);对比患者食欲、睡眠以及皮肤瘙痒症状等改善情况,观察组患者好转率显著优于对照组,差异有统计学价值(P<0.05)。结论:相对于单纯应用血液透析的传统治疗,联合血液灌流治疗方案对患者临床指标改善情况更为突出且明显提升患者生活质量,值得临床普及推广。

  15. Streams with Strahler Stream Order

    Data.gov (United States)

    Minnesota Department of Natural Resources — Stream segments with Strahler stream order values assigned. As of 01/08/08 the linework is from the DNR24K stream coverages and will not match the updated...

  16. Ecology of blood stream infection and antibiotic resistance in intensive care unit at a tertiary care hospital in North India

    Directory of Open Access Journals (Sweden)

    Chand Wattal

    2014-06-01

    Full Text Available OBJECTIVE: To analyse the prevalent microorganisms and their antimicrobial resistance among intensive care unit patients in a tertiary care centre in New Delhi. METHODS: A retrospective study of all consecutive blood cultures from various intensive care unit patients in the hospital during four years (January 2008 to December 2011. Antibiotic consumption data in the intensive care units were also analysed during the same period. RESULTS: Out of the total 22,491 blood cultures processed, 2846 samples were positive and 3771 microorganisms were isolated. The blood culture positivity was estimated as 12.7% of which 67.5% were monomicrobial and 32.5% polymicrobial infections. Gram negative bacilli, Gram positive cocci, and fungi were isolated in 49%, 33%, and 18% cases, respectively. Coagulase negative staphylococcus was the commonest single isolate followed by Candida spp. A drastic shift in the distribution of Candida spp. towards nonalbicans along with high resistance to azole group of antifungals suggest echinocandins for the empiric therapy of candidemia. High penicillin resistance in Gram positive isolates suggest vancomycin, linezolid and tigecycline as the options for empiric therapy, whereas tigecycline and colistin are the only options remaining for highly resistant Gram negative isolates. Aminoglycosides were observed to have better sensitivity and reduced usage when compared with cephalosporins and ß-lactam + ß-lactam inhibitor combinations. CONCLUSIONS: High frequencies of multidrug resistant organisms were observed in intensive care units which is a warning as to use the only few effective antimicrobials wisely to reduce selective pressure on sensitive strains.

  17. 应用多频生物电阻抗法调节血液透析患者干体重对血压的影响%Effect of adjusting dry weight by bio-impedance spectrum analysis on blood pressure control in hemodialysis patients

    Institute of Scientific and Technical Information of China (English)

    孙芳; 刘婧; 马丽洁; 沈洋; 崔太根; 周亦伦

    2011-01-01

    Objective To evaluate fluid distribution in patients on maintenance hemodialysis by whole-body bioimpedance spectroscopy and to evaluate the effect of adjusting dry body weight (DBW)on blood pressure control and complications in hemodialysis patients. Methods One hundred and nineteen stable hemodialysis patients were enrolled. Post-dialysis extracellular water(ECW)were measured by whole-body multi-frequency bioimpedance spectroscopy (Bodystat, UK) and standardized using body weight (ECW%). Eighty-two cases of sex, age and body weight matched normal individuals were selected as controls. DBW was adjusted according to the ECW%, and the effect of adjusting DBW on blood pressure control and complications was evaluated. Results Systolic blood pressure was significantly reduced after decreasing DBW in the group with high ECW% [from (165±15)mmHg to (142±10)mmHg in males,P < 0.01; from (160±7)mmHg to (138±6)mmHg in females, P < 0.01)], whereas dialysis-related complications didn't increase. DBW was increased in five symptomatic normotensive patients with low ECW%. The ECW% and blood pressure remained unchanged, while intradialytic symptoms improved. Conclusions Bio-impedance spectrum analysis is helpful for estimation of volume status and blood pressure control in hemodialysis patients.%目的 观察在多频生物电阻抗法指导下调节干体重(DBW)对血液透析患者血压及透析相关并发症的影响.方法 应用多频生物电阻抗分析仪测量细胞外液(ECW).根据同性别正常对照组的ECW值确定正常参考范围.对ECW增高(提示容量过负荷)者,逐步降低DBW,观察ECW和血压的变化.对ECW降低(提示容量不足)者,逐步升高DBW,观察ECW、血压及透析相关并发症的影响.结果 ECW增高者降低DBW后,透析间期男性收缩压从(165±15)mmHg下降至(142±10)mmHg(P<0.01);女性收缩压从(160±7)mmHg下降至(138±6)mmHg(P<0.01),且未增加透析相关并发症.ECW降低者升高DBW后,透

  18. Blood

    Science.gov (United States)

    ... Also, blood is either Rh-positive or Rh-negative. So if you have type A blood, it's either A positive or A negative. Which type you are is important if you need a blood transfusion. And your Rh factor could be important ...

  19. Hemodialysis and water quality.

    Science.gov (United States)

    Coulliette, Angela D; Arduino, Matthew J

    2013-01-01

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

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

    Science.gov (United States)

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

    2016-04-01

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

  1. Endovascular treatment of hemodialysis arteriovenous fistulas

    DEFF Research Database (Denmark)

    Heerwagen, Søren T; Hansen, Marc A; Schroeder, Torben V

    2012-01-01

    Purpose: The purpose of this study was to investigate if the immediate hemodynamic outcome of an endovascular intervention on a dysfunctional hemodialysis arteriovenous fistula is a prognostic factor for primary patency. Methods: This was a prospective observational study including 61 consecutive...... patients with dysfunctional arteriovenous fistulas referred to our endovascular unit. Patients were treated in accordance with institutional standard protocol including immediate pre- and post-interventional blood flow measurements using an intravascular catheter system. The primary endpoint was primary...... potential predictor variables. Results: Post interventional flow did not significantly influence primary patency (p = 0.76). Primary patency was found to be affected by having a history of previous intervention(s) (p = 0.008, hazard ratio 2.9) or low fistula age (P=.038, hazard ratio 0.97 [one...

  2. Genistein Modified Polymer Blends for Hemodialysis Membranes

    Science.gov (United States)

    Chang, Teng; Kyu, Thein; Define, Linda; Alexander, Thomas

    2012-02-01

    A soybean-derived phytochemical called genistein was used as a modifying agent to polyether sulfone/polyvinyl pyrrolidone (PES/PVP) blends to produce multi-functional hemodialysis membranes. With the aid of phase diagrams of PES/PVP/genistein blends, asymmetric porous membranes were fabricated by coagulating in non-solvent. Both unmodified and genistein modified PES/PVP membranes were shown to be non-cytotoxic to the blood cells. Unmodified PES/PVP membranes were found to reduce reactive oxygen species (ROS) levels, whereas the genistein modified membranes exhibited suppression for ˜60% of the ROS levels. Also, the genistein modified membranes revealed significant suppression of pro-inflammatory cytokines: IL-1β, IL-6, and TNF-α. Moreover, addition of PVP to PES showed the reduced trend of platelet adhesion and then leveled off. However, the modified membranes exhibited suppression of platelet adhesion at low genistein loading, but beyond 15 wt%, the platelet adhesion level rised up.

  3. Persistent blood stream infection in patients supported with a continuous-flow left ventricular assist device is associated with an increased risk of cerebrovascular accidents.

    Science.gov (United States)

    Trachtenberg, Barry H; Cordero-Reyes, Andrea M; Aldeiri, Molham; Alvarez, Paulino; Bhimaraj, Arvind; Ashrith, Guha; Elias, Barbara; Suarez, Erik E; Bruckner, Brian; Loebe, Matthias; Harris, Richard L; Zhang, J Yi; Torre-Amione, Guillermo; Estep, Jerry D

    2015-02-01

    Common adverse events in patients supported with Continuous-flow left ventricular assist devices (CF-LVAD) include infections and cerebrovascular accidents (CVA). Some studies have suggested a possible association between blood stream infection (BSI) and CVA. Medical records of patients who received Heartmate II (HMII) CF-LVADs in 2008-2012 at a single center were reviewed. CVA was categorized as either hemorrhagic (HCVA) or ischemic (ICVA). BSI was divided into persistent (pBSI) and nonpersistent (non-pBSI). pBSI was defined as BSI with the same organism on repeated blood culture >72 hours from initial blood culture despite antibiotics. Univariate and multivariate analyses were performed to determine predictors. A total of 149 patients had HMII implanted; 76% were male, and the overall mean age was 55.4 ± 13 years. There were a total of 19 (13%) patients who had CVA (7 HCVA and 12 ICVA) at a median of 295 days (range 5-1,096 days) after implantation. There were a total of 28 (19%) patients with pBSI and 17 (11%) patients with non-pBSI. Patients with pBSI had a trend toward greater BMI (31 kg/m(2) vs 27 kg/m(2); P = .09), and longer duration of support (1,019 d vs 371 d; P CVA on multivariate analysis (odds ratio [OR] 5.97; P = .003) as well as persistent Pseudomonas aeruginosa infection (OR 4.54; P = .048). Persistent BSI is not uncommon in patients supported by CF-LVAD and is highly associated with all-cause CVA and increased all-cause mortality. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Analysis of urea distribution volume in hemodialysis.

    Science.gov (United States)

    Maduell, F; Sigüenza, F; Caridad, A; Miralles, F; Serrato, F

    1994-01-01

    According to the urea kinetic model it is considered that the urea distribution volume (V) is that of body water, and that it is distributed in only one compartment. Since the V value is different to measure, it is normal to use 58% of body weight, in spite of the fact that it may range from 35 to 75%. In this study, we have calculated the value of V by using an accurate method based on the total elimination of urea from the dialysate. We have studied the V, and also whether the different dialysis characteristics modify it. Thirty-five patients were included in this study, 19 men and 16 women, under a chronic hemodialysis programme. The dialysate was collected in a graduated tank, and the concentration of urea in plasma and in dialysate were determined every hour. Every patient received six dialysis sessions, changing the blood flow (250 or 350 ml/min), the ultrafiltration (0.5 or 1.5 l/h), membrane (cuprophane or polyacrylonitrile) and/or buffer (bicarbonate or acetate). At the end of the hemodialysis session, the V value ranged from 43 to 72% of body weight; nevertheless, this value was practically constant in every patient. The V value gradually increased throughout the dialysis session, 42.1 +/- 6.9% of body weight in the first hour, 50.7 +/- 7.5% in the second hour and 55.7 +/- 7.9% at the end of the dialysis session. The change of blood flow, ultrafiltration, membrane or buffer did not alter the results. The V value was significantly higher in men in comparison with women, 60.0 +/- 6.6% vs. 50.5 +/- 5.9% of body weight (p < 0.001).

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

    Directory of Open Access Journals (Sweden)

    Kei Nagai

    2014-01-01

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

  6. Prevalence of occult HBV among hemodialysis patients in two districts in the northern part of the West Bank, Palestine.

    Science.gov (United States)

    Dumaidi, Kamal; Al-Jawabreh, Amer

    2014-10-01

    Occult hepatitis B infection is the case with undetectable HBsAg, but positive for HBV DNA in liver tissue and/or serum. Occult hepatitis B infection among hemodialysis patients in Palestine has been understudied. In this study, 148 hemodialysis patients from 2 northern districts in Palestine, Jenin (89) and Tulkarem (59), were investigated for occult hepatitis B, HBV, HCV infections with related risk factors. ELISA and PCR were used for the detection of anti-HBc and viral DNA, respectively. The overall prevalence of occult hepatitis B infection among the study group was 12.5% (16/128). Occult hepatitis B infection is more prevalent among males with most cases (15/16) from Jenin District. About one-third (42/132) of the hemodialysis patients were anti-HBc positive. Approximately 27% of the hemodialysis patients were infected with HCV. Around 20% (28/140) were positive for HBV DNA, but only 8.2% (12/146) of the hemodialysis patients were positive for HBsAg. The comparison between hemodialysis patients with occult hepatitis B infection and those without occult hepatitis B infection for selected risk factors and parameters as liver Enzyme, age, sex, HCV infection, blood transfusion, kidney transplant, anti-HBc, and vaccination showed no statistical significance between both categories. Duration of hemodialysis significantly affected the rate of HCV infection. HCV is significantly higher in hemodialysis patients with both Diabetes mellitus and hypertension. The prevalence of occult hepatitis B infection among hemodialysis patients is high; requiring stringent control policies. HBsAg assay is insufficient test for accurate diagnosis of HBV infection among hemodialysis patients.

  7. Neurotoxicity caused by valacyclovir in a patient on hemodialysis

    NARCIS (Netherlands)

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

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

  8. Neurotoxicity caused by valacyclovir in a patient on hemodialysis

    NARCIS (Netherlands)

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

    1998-01-01

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

  9. Life Quality of Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Noorallah Tahery

    2013-05-01

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

  10. Transhepatic venous catheters for hemodialysis

    Directory of Open Access Journals (Sweden)

    Mohamed El Gharib

    2014-06-01

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

  11. Hemodialysis Tunneled Catheter Noninfectious Complications

    Science.gov (United States)

    Miller, Lisa M.; MacRae, Jennifer M.; Kiaii, Mercedeh; Clark, Edward; Dipchand, Christine; Kappel, Joanne; Lok, Charmaine; Luscombe, Rick; Moist, Louise; Oliver, Matthew; Pike, Pamela; Hiremath, Swapnil

    2016-01-01

    Noninfectious hemodialysis catheter complications include catheter dysfunction, catheter-related thrombus, and central vein stenosis. The definitions, causes, and treatment strategies for catheter dysfunction are reviewed below. Catheter-related thrombus is a less common but serious complication of catheters, requiring catheter removal and systemic anticoagulation. In addition, the risk factors, clinical manifestation, and treatment options for central vein stenosis are outlined.

  12. Rosuvastatin in diabetic hemodialysis patients

    DEFF Research Database (Denmark)

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

    2011-01-01

    A randomized, placebo-controlled trial in diabetic patients receiving hemodialysis showed no effect of atorvastatin on a composite cardiovascular endpoint, but analysis of the component cardiac endpoints suggested that atorvastatin may significantly reduce risk. Because the AURORA (A Study to Eva...

  13. Is there a future for electrochemically assisted hemodialysis? Focus on the application of polypyrrole-nanocellulose composites.

    Science.gov (United States)

    Ferraz, Natalia; Mihranyan, Albert

    2014-05-01

    This work summarizes the various aspects of using electrochemically assisted solute removal techniques in hemodialysis with a focus on blood electrodialysis and electrochemically controlled uremic retention solute removal using polypyrrole. In particular, the feasibility of using highly porous conductive polypyrrole-Cladophora cellulose membranes for hemodialysis are overviewed as a part of our dedicated research efforts during the past 4 years. The potential benefits and the current limitations associated with using the electrochemically controlled uremic retention solute removal techniques are discussed in detail.

  14. Development and Assessment of a Single Tube Internally ControlledMultiplex PCR Assay to Detect Different Pathogenic Bacteria Involved inBlood Stream Infections

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Arabestani

    2013-01-01

    Full Text Available Background: Bloodstream infections are associated with high morbidity and mortality. Delayed etiological diagnosis and inadequate antimicrobial therapy are associated with treatment failures. Objectives: This study describes the development and assessment of a new multiplex PCR that includes an Internal Control (IC for the assurance of the whole workflow from the extraction of the DNA until the revelation of the amplicons. Materials and Methods: A unique sequence was chosen for each pathogen and used for primer design. Primers for amplification of Enterobacteriaceae, Enterococcus spp, Staphylococcus spp, Acinetobacterbaumanii and IC were designed and tested for sensitivity and specificity on the basis of their standard strains. Results: The multiplex PCR showed a sensitivity ranging from 1 to 100 target copies per reaction or 50 to 100 colony forming unit (CFU per ml to the whole blood depending on the bacterial species. The specificity of this method was elevated and no false positive amplification was identified for 17 different species other than the target microorganisms. Moreover, the detection of the IC was observed in the concentration as low as 1 copy per reaction. The correct co-amplification of IC for each single bacterial species showed a correct whole workflow procedure starting from the extraction step. Conclusion: This new assay permits a rapid and accurate detection of some pathogenic microorganisms, that are among the most commonly detected ones in blood stream infections in Iran, with a simple and cost-effective method which includes the use of an internal control to validate the whole procedure thus avoiding false negative results.

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

    NARCIS (Netherlands)

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

    2003-01-01

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

  16. A role for peripherally inserted central venous catheters in the prevention of catheter-related blood stream infections in patients with hematological malignancies.

    Science.gov (United States)

    Sakai, Toshiro; Kohda, Kyuhei; Konuma, Yuichi; Hiraoka, Yasuko; Ichikawa, Yukari; Ono, Kaoru; Horiguchi, Hiroto; Tatekoshi, Ayumi; Takada, Kouichi; Iyama, Satoshi; Kato, Junji

    2014-12-01

    Central venous catheter-related blood stream infections (CR-BSIs) are a serious complication in patients with hematological malignancies. However, it remains unclear whether there is a difference in the rate of CR-BSI associated with the conventional type of central venous catheters (cCVCs) and peripherally inserted CVCs (PICCs) in such patients. To address this question, we retrospectively investigated the incidence of CR-BSIs associated with PICCs versus cCVCs in patients with hematological malignancies. We used PICCs in all consecutive patients requiring CVC placement between February 2009 and February 2013. We compared the CR-BSI rate in patients with PICCs with that in patients with cCVCs treated between September 2006 and January 2009 (control group). Eighty-four patients received PICCs and 85 received cCVCs. The most common reason for removal due to catheter-related complications was CR-BSI. The CR-BSI rate in the PICC group was significantly lower than that in the cCVC group (PICCs: 1.23/1000 catheter days; cCVCs: 5.30/1000 catheter days; P Catheter-related complications other than CR-BSIs occurred at an extremely low rate in the PICC group. The median catheter-related complication-free survival duration was significantly longer in the PICC group than in the cCVC group. Our study shows that PICCs are useful in patients with hematological malignancies.

  17. Antifungal Susceptibility Patterns, In Vitro Production of Virulence Factors, and Evaluation of Diagnostic Modalities for the Speciation of Pathogenic Candida from Blood Stream Infections and Vulvovaginal Candidiasis

    Directory of Open Access Journals (Sweden)

    Chaitanya Tellapragada

    2014-01-01

    Full Text Available Candida spp. have emerged as successful pathogens in both invasive and mucosal infections. Varied virulence factors and growing resistance to antifungal agents have contributed to their pathogenicity. We studied diagnostic accuracy of HiCrome Candida Differential Agar and Vitek 2 Compact system for identification of Candida spp. in comparison with species-specific PCR on 110 clinical isolates of Candida from blood stream infections (54, 49% and vulvovaginal candidiasis (56, 51%. C. albicans (61% was the leading pathogen in VVC, while C. tropicalis (46% was prominent among BSIs. HiCrome Agar and Vitek 2 Compact had good measures of agreement (κ 0.826 and 0.895, respectively, in comparison with PCR. We also tested these isolates for in vitro production of proteinase, esterase, phospholipases, and biofilms. Proteinase production was more among invasive isolates (P=0.017, while phospholipase production was more among noninvasive isolates (P=0.001. There was an overall increase in the production of virulence factors among non-albicans Candida. Identification of clinical isolates of Candida up to species level either by chromogenic agar or by Vitek 2 Compact system should be routinely done to choose appropriate therapy.

  18. Malnutrition-Inflammation Score in Hemodialysis Patients

    OpenAIRE

    Behrooz Ebrahimzadehkor; Atamohammad Dorri; Abdolhamed Yapan-Gharavi

    2014-01-01

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

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

    Science.gov (United States)

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

    2016-05-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2011-01-01

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

  1. Analysis of Blood Stream Infections in Intensive Care Unit%重症医学科患者血流感染细菌谱分析

    Institute of Scientific and Technical Information of China (English)

    汪海源; 洪涛; 吴兴茂; 臧彬

    2016-01-01

    Objective To analyze blood stream infections(BSI)in ICU patients,to explore the bacterial spectrum characteristics and time distribu⁃tion,so as to provide a reference for the clinical use of antibiotics. Methods A retrospective analysis was carried out. A total of 1 330 patients admit⁃ted in our hospital intensive care unit(ICU)from January 2012 to March 2013(15 months)were selected for the study,the occurrence rate of blood stream infections,the bacteria spectrum of it and the bacteria spectrum distribution in different period of time(admitted in ICU for the first week,sec⁃ond week and later)were analyzed. The subjects were divided into 2 groups(CVC cases and non⁃CVC cases)depended on CVC indwelling or not. Results There were 971 cases with central venous catheter(CVC),the occurrence of bloodstream infection were 96 cases,the infection rate was 9.89%,including 359 non⁃CVC cases and 12 blood stream infection cases. The infection rate was 3.34%,and the total blood infection rate was 8.12%. A total of 157 strains of pathogen were isolated,among which 16 strains were isolated from non⁃CVC cases. Infection of gram⁃negative bacilli, gram⁃positive cocci and fungi were 56.7%,32.5%and 10.8%,respectively. Staphylococcus(16.6%),Bauman acinetobacter(15.9%),Enterococ⁃cus(14.6%),Pseudomonasaeruginosa(10.2%)and Klebsiella(10.2%)were the most common bacteria. For the distribution of time,in non⁃CVC cases gram⁃negative bacilli were more than other bacilli in the first and second week(3 vs 1,4 vs 1)in ICU,more gram⁃positive cocci( 5 vs 2) were isolated after two weeks,no fungi were detected;in CVC cases,gram negative bacilli were in a dominant position all the time(the number of gram negative bacilli,gram positive bacteria and fungi were 31 cases,24 cases and 3 cases in the first week respectively,23 cases,12 cases,11 cas⁃es in the second week,26 cases,8 cases and 3 cases after the second week),the proportion of each species in the first week were 53

  2. Optimizing lithium dosing in hemodialysis

    DEFF Research Database (Denmark)

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

    2006-01-01

    We studied a 62-year-old female hemodialysis patient during initiation and maintenance of lithium carbonate therapy. Three different methods were applied to estimate the regimen: a scenario based on volume of distribution (V(d)), a scenario based on glomerular filtration rate (GFR), and a scenario...... estimates. Furthermore, the maintenance dose estimated from the central compartment (V1) led to plasma concentrations within the therapeutic range. Thus, a regimen where 12.2 mmol lithium was given after each hemodialysis session resulted in stable between-dialysis plasma lithium concentrations...... in this patient with no residual kidney function. We did not observe adverse effects related to this regimen, which was monitored from 18 days to 8 months of therapy, and the patient experienced relief from her severe depressive disorder. In conclusion, dialysis patients may be treated with lithium administrated...

  3. Prevalence of Secondary Hyper Parathyroidism in Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    F Behzad

    2007-04-01

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

  4. Hemodialysis Catheter Heat Transfer for Biofilm Prevention and Treatment.

    Science.gov (United States)

    Richardson, Ian P; Sturtevant, Rachael; Heung, Michael; Solomon, Michael J; Younger, John G; VanEpps, J Scott

    2016-01-01

    Central line-associated bloodstream infections (CLABSIs) are not easily treated, and many catheters (e.g., hemodialysis catheters) are not easily replaced. Biofilms (the source of infection) on catheter surfaces are notoriously difficult to eradicate. We have recently demonstrated that modest elevations of temperature lead to increased staphylococcal susceptibility to vancomycin and significantly soften the biofilm matrix. In this study, using a combination of microbiological, computational, and experimental studies, we demonstrate the efficacy, feasibility, and safety of using heat as an adjuvant treatment for infected hemodialysis catheters. Specifically, we show that treating with heat in the presence of antibiotics led to additive killing of Staphylococcus epidermidis with similar trends seen for Staphylococcus aureus and Klebsiella pneumoniae. The magnitude of temperature elevation required is relatively modest (45-50°C) and similar to that used as an adjuvant to traditional cancer therapy. Using a custom-designed benchtop model of a hemodialysis catheter, positioned with tip in the human vena cava as well as computational fluid dynamic simulations, we demonstrate that these temperature elevations are likely achievable in situ with minimal increased in overall blood temperature.

  5. Spontaneous retroperitoneal hemorrhage after hemodialysis involving anticoagulant agents

    Institute of Scientific and Technical Information of China (English)

    Wen-xing FAN; Song-min HUANG; Ping FU; Zheng-xu DENG; Fang LIU; Rong-bo LIU; Ling HE; Bogati AMRIT; Li ZANG; Jing-wen LI; Xian-rong LIU

    2012-01-01

    In this paper,we described the symptoms and treatment of a patient with diabetic nephropathy accompanied by spontaneous retroperitoneal hemorrhage after hemodialysis.An elderly female patient with diabetic nephropathy presented with severe pain,numbness,and an increasing swelling in the left hip and left thigh after six sessions of hemodialysis involving the use of an antiplatelet drug and an anticoagulant agent.Her hemoglobin decreased to 46 g/L.An abdominal ultrasound showed a hematoma in the left retroperitoneal space,and computed tomography (CT) findings revealed a 6 cm×8 cm×10 cm hematoma in the left psoas muscle.After aggressive supportive therapy [the administration of packed red blood cell transfusion,carbazochrome sodium sulfonate injection,and continuous venovenous hemofiltration (CWH)],the patient's vital signs stabilized and her hemoglobin increased to 86 g/L.Repeat CT showed that the hematoma had been partially absorbed after two weeks.Eventually,the patient was discharged with stable vital signs.Physicians should be aware of the possibility of spontaneous retroperitoneal hemorrhage,particularly in patients with diabetic nephropathy undergoing hemodialysis involving the use of anticoagulant agents.

  6. 从血透并发症谈血透设备的维护思路%Talk about the Idea of Hemodialysis Equipment Maintenance from the Hemodialysis Complications

    Institute of Scientific and Technical Information of China (English)

    彭旭

    2014-01-01

    血液透析可以有效治疗肾功能衰竭,延长患者生命,提高患者的生活质量。随着血液净化中心的建设和发展,血液透析患者得到了有效的治疗,但血透并发症却越来越多。对此,从血透并发症来探讨血透设备的维护思路。%Hemodialysis can effectively treat renal failure, prolong life and improve the quality of life of patients. With the construction and development of blood purification center hemodialysis patients receive effective treatment, but complications are more and more dialysis. In this regard, explore the ideas from complications of hemodialysis equipment maintenance hemodialysis.

  7. Volume-independent mechanisms of hypertension in hemodialysis patients : Clinical implications

    NARCIS (Netherlands)

    Blankestijn, PJ; Ligtenberg, G

    2004-01-01

    The renin-angiotensin and sympathetic nervous systems are often activated in hemodialysis (HD) patients; the pathogenesis of this condition is discussed. Medications aimed at reducing renin and sympathetic activity may improve the cardiovascular prognosis, independent of its effect on blood pressure

  8. Presence and significance of TT virus in Danish patients on maintenance hemodialysis

    DEFF Research Database (Denmark)

    Boysen, T.; Christensen, J. K.; Madsen, C. D.

    2003-01-01

    on maintenance hemodialysis at a single center were invited to participate. Demographic and clinical data were registered. Blood samples for virological and routine biochemical tests were drawn simultaneously. TTV DNA was detected using polymerase chain reaction (PCR). TTV viral load was estimated by means...

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

    Science.gov (United States)

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

    1987-01-01

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

  10. Fluctuation of Ultrafiltration Coefficient of Hemodialysis Membrane During Reuse

    Science.gov (United States)

    Arif, Idam; Christin

    2010-12-01

    Hemodialysis treatment for patient with kidney failure is to regulate body fluid and to excrete waste products of metabolism. The patient blood and the dialyzing solution (dialysate) are flowed counter currently in a dialyzer to allow volume flux of fluid and diffusion of solutes from the blood to the dialysate through a semipermiable membrane. The volume flux of fluid depends on the hydrostatic and the osmotic pressure difference between the blood and the dialysate. It also depends on the membrane parameter that represents how the membrane allows the fluid and the solutes to move across as a result of the pressure difference, known as the ultrafiltration coefficient Kuf. The coefficient depends on the number and the radius of membrane pores for the movement of the fluids and the solutes across the membrane. The measured membrane ultrafiltration coefficient of reused dialyzer shows fluctuation between one uses to another without any significant trend of change. This indicates that the cleaning process carried out before reuse does not cause perfect removal of clots that happen in the previous use. Therefore the unblocked pores are forced to work hardly to obtain targeted volume flux in a certain time of treatment. This may increase the unblocked pore radius. Reuse is stopped when there is indication of blood leakage during the hemodialysis treatment.

  11. Inadequate doses of hemodialysis. Predisposing factors, causes and prevention

    Directory of Open Access Journals (Sweden)

    Pehuén Fernández

    2017-04-01

    Full Text Available Patients receiving sub-optimal dose of hemodialysis have increased morbidity and mortality. The objectives of this study were to identify predisposing factors and causes of inadequate dialysis, and to design a practical algorithm for the management of these patients. A cross-sectional study was conducted. Ninety patients in chronic hemodialysis at Hospital Privado Universitario de Córdoba were included, during September 2015. Twenty two received sub-optimal dose of hemodialysis. Those with urea distribution volume (V greater than 40 l (72 kg body weight approximately are 11 times more likely (OR = 11.6; CI 95% = 3.2 to 51.7, p < 0.0001 to receive an inadequate dose of hemodialysis, than those with a smaller V. This situation is more frequent in men (OR = 3.5; 95% CI 1.01-15.8; p = 0.0292. V greater than 40 l was the only independent predictor of sub-dialysis in the multivariate analysis (OR = 10.3; 95% CI 2.8-37; p < 0.0004. The main cause of suboptimal dialysis was receiving a lower blood flow (Qb than the prescribed (336.4 ± 45.8 ml/min vs. 402.3 ± 28.8 ml/min respectively, p < 0.0001 (n = 18. Other causes were identified: shorter duration of the session (n = 2, vascular access recirculation (n = 1, and error in the samples (n = 1. In conclusion, the only independent predisposing factor found in this study for sub-optimal dialysis is V greater than 40 l. The main cause was receiving a slower Qb than prescribed. From these findings, an algorithm for the management of these patients was developed

  12. Multisite external validation of a risk prediction model for the diagnosis of blood stream infections in febrile pediatric oncology patients without severe neutropenia.

    Science.gov (United States)

    Esbenshade, Adam J; Zhao, Zhiguo; Aftandilian, Catherine; Saab, Raya; Wattier, Rachel L; Beauchemin, Melissa; Miller, Tamara P; Wilkes, Jennifer J; Kelly, Michael J; Fernbach, Alison; Jeng, Michael; Schwartz, Cindy L; Dvorak, Christopher C; Shyr, Yu; Moons, Karl G M; Sulis, Maria-Luisa; Friedman, Debra L

    2017-10-01

    Pediatric oncology patients are at an increased risk of invasive bacterial infection due to immunosuppression. The risk of such infection in the absence of severe neutropenia (absolute neutrophil count ≥ 500/μL) is not well established and a validated prediction model for blood stream infection (BSI) risk offers clinical usefulness. A 6-site retrospective external validation was conducted using a previously published risk prediction model for BSI in febrile pediatric oncology patients without severe neutropenia: the Esbenshade/Vanderbilt (EsVan) model. A reduced model (EsVan2) excluding 2 less clinically reliable variables also was created using the initial EsVan model derivative cohort, and was validated using all 5 external validation cohorts. One data set was used only in sensitivity analyses due to missing some variables. From the 5 primary data sets, there were a total of 1197 febrile episodes and 76 episodes of bacteremia. The overall C statistic for predicting bacteremia was 0.695, with a calibration slope of 0.50 for the original model and a calibration slope of 1.0 when recalibration was applied to the model. The model performed better in predicting high-risk bacteremia (gram-negative or Staphylococcus aureus infection) versus BSI alone, with a C statistic of 0.801 and a calibration slope of 0.65. The EsVan2 model outperformed the EsVan model across data sets with a C statistic of 0.733 for predicting BSI and a C statistic of 0.841 for high-risk BSI. The results of this external validation demonstrated that the EsVan and EsVan2 models are able to predict BSI across multiple performance sites and, once validated and implemented prospectively, could assist in decision making in clinical practice. Cancer 2017;123:3781-3790. © 2017 American Cancer Society. © 2017 American Cancer Society.

  13. Hemodialysis improves endothelial venous function in end-stage renal disease

    Directory of Open Access Journals (Sweden)

    A.M.V. Silva

    2008-06-01

    Full Text Available The objective of the present study was to determine the acute effect of hemodialysis on endothelial venous function and oxidative stress. We studied 9 patients with end-stage renal disease (ESRD, 36.8 ± 3.0 years old, arterial pressure 133.8 ± 6.8/80.0 ± 5.0 mmHg, time on dialysis 55.0 ± 16.6 months, immediately before and after a hemodialysis session, and 10 healthy controls matched for age and gender. Endothelial function was assessed by the dorsal hand vein technique using graded local infusion of acetylcholine (endothelium-dependent venodilation, EDV and sodium nitroprusside (endothelium-independent venodilation. Oxidative stress was evaluated by measuring protein oxidative damage (carbonyls and antioxidant defense (total radical trapping antioxidant potential - TRAP in blood samples. All patients were receiving recombinant human erythropoietin for at least 3 months and were not taking nitrates or a-receptor antagonists. EDV was significantly lower in ESRD patients before hemodialysis (65.6 ± 10.5 vs controls (109.6 ± 10.8; P = 0.010 and after hemodialysis (106.6 ± 15.7; P = 0.045. Endothelium-independent venodilation was similar in all comparisons performed. The hemodialysis session significantly decreased TRAP (402.0 ± 53.5 vs 157.1 ± 28.3 U Trolox/µL plasma; P = 0.001. There was no difference in protein damage comparing ESRD patients before and after hemodialysis. The magnitude of change in the EDV was correlated negatively with the magnitude of change in TRAP (r = -0.70; P = 0.037. These results suggest that a hemodialysis session improves endothelial venous function, in association with an antioxidant effect.

  14. Defining incidence, risk factors, and impact on survival of central line-associated blood stream infections following hematopoietic cell transplantation in acute myeloid leukemia and myelodysplastic syndrome.

    Science.gov (United States)

    Lukenbill, Joshua; Rybicki, Lisa; Sekeres, Mikkael A; Zaman, Muhammad Omer; Copelan, Alexander; Haddad, Housam; Fraser, Thomas; DiGiorgio, Megan J; Hanna, Rabi; Duong, Hien; Hill, Brian; Kalaycio, Matt; Sobecks, Ronald; Bolwell, Brian; Copelan, Edward

    2013-05-01

    Central line-associated blood stream infections (CLABSI) commonly complicate the care of patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) after allogeneic stem cell transplantation (HCT). We developed a modified CLABSI (MCLABSI) definition that attempts to exclude pathogens usually acquired because of disruption of mucosal barriers during the vulnerable neutropenic period following HCT that are generally included under the original definition (OCLABSI). We conducted a retrospective study of all AML and MDS patients undergoing HCT between August 2009 and December 2011 at the Cleveland Clinic (N = 73), identifying both OCLABSI and MCLABSI incidence. The median age at transplantation was 52 years (range, 16 to 70); 34 had a high (≥3) HCT comorbidity index (HCT-CI); 34 received bone marrow (BM), 24 received peripheral stem cells (PSC), and 15 received umbilical cord blood cells (UCB). Among these 73 patients, 23 (31.5%) developed OCLABSI, of whom 16 (69.6%) died, and 8 (11%) developed MCLABSI, of whom 7 (87.5%) died. OCLABSI was diagnosed a median of 9 days from HCT: 5 days (range, 2 to 12) for UCB and 78 days (range, 7 to 211) for BM/PSC (P < .001). MCLABSI occurred a median of 12 days from HCT, with similar earlier UCB and later BM/PSC diagnosis (P = .030). Risk factors for OCLABSI in univariate analysis included CBC (P < .001), human leukocyte antigen (HLA)-mismatch (P = .005), low CD34(+) count (P = .007), low total nucleated cell dose (P = .016), and non-Caucasian race (P = .017). Risk factors for OCLABSI in multivariable analysis were UCB (P < .001) and high HCT-CI (P = .002). There was a significant increase in mortality for both OCLABSI (hazard ratio, 7.14; CI, 3.31 to 15.37; P < .001) and MCLABSI (hazard ratio, 6.44; CI, 2.28 to 18.18; P < .001). CLABSI is common and associated with high mortality in AML and MDS patients undergoing HCT, especially in UCB recipients and those with high HCT-CI. We propose

  15. Successful treatment of malaria tropica with acute renal failure and cerebral involvement by plasmapheresis and hemodialysis.

    Science.gov (United States)

    Stuby, U; Kaiser, W; Biesenbach, G; Zazgornik, J

    1988-01-01

    A non-immune, 31-year-old woman developed an acute infection with Plasmodium falciparum after travelling to Kenia. The parasites proved resistant to chloroquine and sulfadoxine/pyrimethamine. The course of the disease was complicated by acute renal failure, hepatocellular damage, disorders of blood coagulation, thrombocytopenia, hemolysis and cerebral involvement. Despite a very high level of parasitemia (50% parasitized erythrocytes) a rapid clinical improvement was achieved by plasmapheresis and hemodialysis. Our experience shows that plasmapheresis and hemodialysis are excellent additive methods which rapidly improve clinical symptoms and may reduce morbidity and mortality in severe malaria tropica.

  16. 21 CFR 876.5860 - High permeability hemodialysis system.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false High permeability hemodialysis system. 876.5860... hemodialysis system. (a) Identification. A high permeability hemodialysis system is a device intended for use... toxemic conditions by performing such therapies as hemodialysis, hemofiltration, hemoconcentration,...

  17. Nosocomial blood stream infection in intensive care units at Assiut University Hospitals (Upper Egypt with special reference to extended spectrum β-lactamase producing organisms

    Directory of Open Access Journals (Sweden)

    Mahmoud Mohammed A

    2009-05-01

    Full Text Available Abstract Aim This study investigated the nosocomial blood stream infection (BSI in the adult ICUs in Assiut university hospitals to evaluate the rate of infection in different ICUs, causative microorganisms, antimicrobial resistance, outcome of infection, risk factors, prevalence of extended spectrum B-lactamase producing organisms and molecular typing of Klebsiella pneumoniae strains to highlight the role of environment as a potential source of nosocomial BSI. Methods This study was conducted over a period of 12 months from January 2006 to December 2006. All Patients admitted to the different adult ICUs were monitored daily by attending physicians for subsequent development of nosocomial BSI. Blood cultures were collected from suspected patients to detect the causative organisms. After antimicrobial susceptibility testing, detection of ESBLs was conducted among gram negative isolates. Klebsiella pneumoniae isolates were tested by PCR to determine the most common group of B-lactamase genes responsible for resistance. Klebsiella pneumoniae isolates from infected patients and those isolated from the environment were typed by RAPD technique to investigate the role of environment in transmission of infection. Results The study included 2095 patients who were admitted to different ICUs at Assiut University Hospitals from January 2006 to December 2006. Blood samples were collected from infected patients for blood cultures. The colonies were identified and antibiotic sensitivities were performed. This study showed that the rate of nosocomial BSI was 75 per 1000 ICU admissions with the highest percentages in Trauma ICU (17%. Out of 159 patients with primary bloodstream infection, 61 patients died representing a crude mortality rate of 38%. Analysis of the organisms causing BSI showed that Gram positive organisms were reported in 69.1% (n = 121; MRSA was the most prevalent (18.9%, followed by methicillin resistant coagulase negative Staphylococci (16

  18. Costs and Outcomes in Hemodialysis and Hemodiafiltration

    NARCIS (Netherlands)

    Mazairac, A.H.A.

    2011-01-01

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

  19. Costs and Outcomes in Hemodialysis and Hemodiafiltration

    NARCIS (Netherlands)

    Mazairac, A.H.A.

    2011-01-01

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

  20. 糖尿病肾病患者血液透析中血压变化特点及护理措施探析%Changes in blood pressure of patients with diabetic nephropathy in the process of hemodialysis and related care measures

    Institute of Scientific and Technical Information of China (English)

    王应; 刘从国; 程蓉; 张潇

    2015-01-01

    目的:分析糖尿病肾病患者血液透析中血压变化特点并探讨应采取的护理措施。方法统计分析我院肾内科2013年1月至2014年9月收治的40例糖尿病肾病患者的临床资料。结果研究组患者血液透析中低血压的发生率32.5%(13/40),高于对照组的12.5%(5/40),差异有统计学意义(P <0.05);透析开始时、透析1、2、3 h 的收缩压平均下降值均高于对照组(P <0.05);恶心呕吐、意识突然丧失、打哈欠、鼾声、表情淡漠、嗜睡、无特殊症状发生率均显著高于对照组,差异有统计学意义(P <0.05)。结论糖尿病肾病患者血液透析中极易发生低血压,且血压具有较大的下降幅度、较快的下降速度及复杂多样的临床表现,临床应采取有效的护理措施加强对该类患者的护理。%Objective To analyze changes in blood pressure of patients with diabetic nephropathy in the process of hemodial-ysis and related care measures.Methods The clinical data of 40 cases of diabetic nephropathy admitted into the Nephrology Depart-ment of our hospital from January 2013 to September 2014 were analyzed statistically.Results The incidence of hypotension in the process of hemodialysis for the study group was 32.5% (13 /40),which was significantly higher than that of the control group 12.5%(5 /40)(P <0.05).At the start of dialysis,average decline in systolic blood pressure at hours 1,2 and 3 were significantly higher than those of the control group (P <0.05).Incidence of nausea and vomiting,sudden loss of consciousness,yawning,snoring,apa-thy,lethargy and symptomlessness were all significantly higher than those of the control group (P <0.05).Conclusion Diabetic ne-phropathy patients were prone to have hypotension in the process of hemodialysis,with a higher rate of pressure decline,and complex and diverse clinical manifestations in blood pressure.Effective measures should be taken to

  1. Presence and significance of TT virus in Danish patients on maintenance hemodialysis

    DEFF Research Database (Denmark)

    Boysen, Trine; Christensen, Jens K; Madsen, Chris D;

    2003-01-01

    OBJECTIVES: To determine the prevalence of TT virus (TTV) in a population of Danish hemodialysis patients and evaluate possible relations between TTV infection and elevated levels of C-reactive protein (CRP) and hypo-response to treatment with erythropoietin (EPO). MATERIAL AND METHODS: Patients...... on maintenance hemodialysis at a single center were invited to participate. Demographic and clinical data were registered. Blood samples for virological and routine biochemical tests were drawn simultaneously. TTV DNA was detected using polymerase chain reaction (PCR). TTV viral load was estimated by means....... CONCLUSIONS: TTV is common in patients on maintenance hemodialysis. The presence of TTV is associated with increasing age. Patients with a high TTV viral load had lower levels of hemoglobin than the others. TTV infection is not related to elevated levels of ALT or CRP or to hypo-response to EPO treatment....

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

    Directory of Open Access Journals (Sweden)

    Eduardo O. Chielle

    2015-06-01

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

  3. Occult hepatitis C virus infection in Iranian hemodialysis patients

    OpenAIRE

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

    2015-01-01

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

  4. 不同血液净化方式对维持性血透患者尿毒素清除效果的观察%Effects of Different Blood Purification Techniques on Eliminating Uremic Toxins in Maintenance Hemodialysis Patients

    Institute of Scientific and Technical Information of China (English)

    王宏儒; 鲍晓荣

    2013-01-01

    Objective: To determine the effects of different blood purification techniques on eliminating uremic toxins in maintenance hemodialysis( MHD ) patients. Methods: sixty MHD patients, selected from our blood purification center, were divided into three groups randomly: hemoperfusion combined with hemodialysis ( HP + HD ) group( n = 20 ), hemodiafiltration ( HDF ) group( n = 20 ), hemodialysis ( HD ) group( n = 20 ). Before and after single treatment, serum blood urea nitrogen ( BUN ), beta 2 - microglobulin ( β2 - MG ), parathyroid hormone ( PTH ), homocysteine ( Hcy ), high sensitivity C - reactive protein ( hs - CRP ) were measured. Single dialysis adequency ( KT/V ) was calculated by the formula Daugirdas. The adverse reactions associated with the therapy were observed. Results:( 1 )After single treatment, the levels of serum BUN decreased significantly in all the three groups ( P 0. 05).(3 )The levels of PTH decreased significantly in both HP + HD and HDF groups( P 0. 05 ). The level of PTH was no significant change in HD group. ( 4 )The Hcy concentration decreased significantly in all the three groups( P 0.05 ), and the increase rate of hs - CRP were no significant difference among the three groups, too. ( 6 )No obvious adverse reaction was observed, and there were no significant changes in the count of WBC and Plt before and after treatment in all the three groups. Conclusion: The hemoperfusion using activated carbon as absorbing material combined with hemodialysis has definite effect on eliminating small,middle molecule toxins( BUN,PTH ) and protein binding toxins( Hcy ). The effect on eliminating β2 - MG is superior to HD but inferior to HDF. It has well single dialysis adequency and no obvious adverse reaction.%目的:观察不同血液净化方式对维持性血透(maintenance hemodialysis,MHD)患者尿毒素清除的效果.方法:选择我院血液净化中心符合入选标准的60例MHD患者,随机分为血液灌流联合血液透析(HP+HD)组,血液

  5. Decline of hepatitis C infection in hemodialysis patients in Central Brazil: a ten years of surveillance

    Directory of Open Access Journals (Sweden)

    Megmar AS Carneiro

    2005-07-01

    Full Text Available Hepatitis C virus (HCV has been a significant problem for hemodialysis patients. However this infection has declined in regions where the screening for anti-HCV in blood banks and hemodialysis-specific infection control measures were adopted. In Brazil, these measures were implemented in 1993 and 1996, respectively. In addition, all studied units have implemented isolation of anti-HCV positive patients since 2000. In order to evaluate the impact of these policies in the HCV infection prevalence, accumulated incidence, and risk factors in hemodialysis population of Goiânia City, Central Brazil, all patients were interviewed and serum samples tested for HCV antibodies in 1993, 1996, 1999, and 2002. In the first six years (1993-1999, anti-HCV prevalence increased from 28.2 to 37.2%, however a b decrease in positivity was detected between 1999 and 2002 (37.8 vs 16.5% when the measures were fully implemented. Also, a decrease of the anti-HCV accumulated incidence in cohorts of susceptible individuals during 1993-2002 (71%, 1996-2002 (34.2%, and 1999-2002 (11.7% was found. Analysis of risk factors showed that length of time on hemodialysis, blood transfusion before screening for anti-HCV and treatment in multiple units were statistically associated with anti-HCV (p < 0.05. Our study showed a significant decline of hepatitis C infection in hemodialysis patients of Central Brazil, ratifying the importance of public health strategies for control and prevention of hepatitis C in the hemodialysis units.

  6. Hepatitis B viral infection in maintenance hemodialysis patients: A three year follow-up

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To observe the prevalence of hepatitis B virus (HBV)infection in maintenance hemodialysis patients.METHODS: Eighty-eight hemodialysis patients who had been receiving hemodialysis regularly for an average of 39.45 ± 7.57 (range from 36 to 49) mo were enrolled in this study. HBV markers were measured in these patients before hemodialysis and in 100 healthy controls by the chemiluminescent microparticle immunoassay(CMI) method in order to compare the incidence of HBV infection in hemodialysis patients versus normal healthy people. All patients were then divided into two groups:patients positive for HBV markers (I.e. Those positive for HBsAg, anti-HBc, HBeAg, anti-Hbe, with or without positive anti-HBs) (n = 33), and patients negative for HBV markers (including those only positive anti-HBs)(n = 55). The following information was obtained for all patients: socio-demographic data, number of blood transfusions and some laboratory investigations. After 39.45± 7.57 mo follow-up, HBV markers were measured in these patients by CMI.RESULTS: The incidence of HBV infection in maintenance hemodialysis patients was 37.5%, which was higher than in controls (9%). In the patients positive for HBV markers, there were 13 patients (39.4%) who had a history of blood transfusion, which was more than the number [12 (21.8%), P = 0.04] of patients negative for HBV markers. Eight of the 88 patients negative for HBV markers turned out to be positive, while three of the 33 patients positive for HBV markers turned out to be negative. There was no cirrhosis of the liver or hepatoma occurring in these patients.CONCLUSION: Maintenance hemodialysis patients have a higher risk of HBV infection than the average population. The number of blood transfusions is associated with an increased prevalence of HBV. While it is hard for hemodialysis patients to eliminate HBV, the prognosis of patients with positive HBV markers is good.

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

    Directory of Open Access Journals (Sweden)

    Pei-Yu Wu

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

  8. 血液透析联合血液灌流对尿毒症患者β2-微球蛋白和超敏C反应蛋白的影响%Effect of Hemodialysis Combined with Blood Perfusion on the Expression ofβ2-Microglobulin and High-Sensitivity C-Reac-tive Protein in Patients with Uremia

    Institute of Scientific and Technical Information of China (English)

    朱君; 邱炽昌; 钟春梅

    2016-01-01

    目的 观察血液透析联合血液灌流对尿毒症患者β2-微球蛋白 (β2-MG) 和超敏C反应蛋白 (hs-CRP) 水平的影响.方法 将我院行维持性血液透析的60例尿毒症患者随机分为两组各30例, 分别采用单纯血液透析治疗 (HD组), HA130树脂灌流器串联血液透析器 (HP+HD组) 治疗, 首次透析前后和3个月后检查患者β2-微球蛋白和超敏C反应蛋白. 结果 HP+HD组首次透析后、 透析3个月后β2-MG、 hs-CRP水平较透析前明显降低 (P <0.05), 首次透析后、 透析3个月后β2-MG、 hs-CRP水平与HD组比较差异有统计学意义 (P<0.05). 结论 血液透析联合血液灌流可降低尿毒症患者β2-微球蛋白和超敏C反应蛋白浓度, 改善患者微炎症状态, 对减少透析相关性淀粉样变等并发症和心血管事件发生具有积极的作用.%Objective To observe the effect of hemodialysis combined with blood perfusion on the expression ofβ2-microglobulin (β2-MG) and high-sensitivity C-reactive protein (hs-CRP) in patients with uremia. Methods Sixty patients with uremia in our hospital were randomly divided into the HD group (single maintenance hemodialysis) and HP + HD group (series connection with HA130-type resin hemoperfusion apparatus and hemodialyzer), with 30 cases in each group. Before and after first dialysis, and 3 months after dialysis, the levels ofβ2-MG and hs-CRP of two groups were detected and compared. Results After first dialysis, and 3 months after dialysis, the levels ofβ2-MG and hs-CRP of HP+HD group were significantly lower than those before dialysis, and significantly lower than those of HD group at the same time points;all the differences were statistically significant (P<0.05). Conclusions Hemodialysis combined with blood perfusion can reduce the levels ofβ2-MG and hs-CRP of patients with uremia, which has positive significance for reducing the incidences of dialysis related amyloidosis and cardiovascular events.

  9. Telemedicine technology and applications for home hemodialysis.

    Science.gov (United States)

    Agroyannis, B; Fourtounas, C; Romagnoli, G; Skiadas, M; Tsavdaris, C; Chassomeris, C; Tzanatos, H; Kopelias, I; Lymberopoulos, D; Psarras, J

    1999-10-01

    Home hemodialysis (HD) for the treatment of patients with end-stage renal disease (ESRD) was first put into practice about 30 years ago. In this paper we describe the application of telematics monitoring services (TMS) for supporting patients who need home or satellite HD (SHD). For the clinical trials two modified HD machines were located in the renal unit and a central control station (UNIX workstation with multimedia PC-terminal) was located in another room of the hospital. Bi-directional communication between modified HD machines and central control station was managed via ISDN (Integrated Services Digital Network) links. Using these HD-machines 150 HD sessions were performed in nine patients over a period of five months. This system enabled on-line remote supervision of the HD machine-related functions (air in the blood, leak of blood, low conductivity etc.) and the clinical condition of patients through measurement of blood pressure (BP), pulse rate, PO2 (pulse oxymetry) and electrocardiogram (ECG) from the central control station (CCS). The user checked the type of alarm/warning, its appearance on HD machines and multimedia terminal units (MTU), the action of the protective system and the appearance of consultative messages from CCS on the remote terminal unit RTU. According to the data collected, the disturbances of HD machine function were visible and audible in the CCS and the user messages were always observed on the RTU. No unusual dialysis-associated complications were observed, all data and alarms/warnings were transmitted correctly and patients had adequate HD treatment.

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

    DEFF Research Database (Denmark)

    Reinhard, Mark; Frystyk, Jan; Jespersen, Bente

    2011-01-01

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

  11. Optimizing lithium dosing in hemodialysis

    DEFF Research Database (Denmark)

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

    2006-01-01

    We studied a 62-year-old female hemodialysis patient during initiation and maintenance of lithium carbonate therapy. Three different methods were applied to estimate the regimen: a scenario based on volume of distribution (V(d)), a scenario based on glomerular filtration rate (GFR), and a scenario...... in this patient with no residual kidney function. We did not observe adverse effects related to this regimen, which was monitored from 18 days to 8 months of therapy, and the patient experienced relief from her severe depressive disorder. In conclusion, dialysis patients may be treated with lithium administrated...

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

    Directory of Open Access Journals (Sweden)

    Mitra Mahdavimazdeh

    2009-09-01

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

  13. Assessment of adequacy of hemodialysis dose at a Palestinian hospital

    Directory of Open Access Journals (Sweden)

    Heba Adas

    2014-01-01

    Full Text Available Adequacy of hemodialysis improves patient survival, quality of life and biochemical outcomes and minimizes disease complications and hospitalizations. This study was an observational cross-sectional study that was conducted in July 2012. Blood tests, weight and blood pressure were measured before and after hemodialysis. Single-pool Kt/V and urea reduction ratio (URR were calculated. The targets based on the National Kidney Foundation Disease Outcomes Quality Initiative (KDOQI Clinical Practice Guidelines were Kt/V ≥ 1.2 and URR ≥ 65%. Of the 64 patients, 41 (64.1% were males. The mean age of the patients was 58.13 ± 17.2 years. The mean body mass index (BMI was 25.04 ± 5.01 kg/m 2 . The mean Kt/V and URR were 1.06 ± 0.05 and 54.4 ± 19.3, respectively. There was no significant difference between men and women (1.06 ± 0.47 versus 1.04 ± 0.55, P = 0.863 and (54.7 ± 19.59 versus 53.81 ± 19.17, P = 0.296. Only 25 (39.1% patients achieved the Kt/V goal and only 22 (34.4% had target URR, and there was no significant association between hemodialysis adequacy and any of the variables such as sex, age, presence of chronic diseases or BMI. Serum potassium levels post-dialysis were significantly lower in patients who reached the target Kt/V (mean = 3.44 ± 0.48 versus 3.88 ± 0.48, P = 0.001. Most patients were inadequately dialyzed and a large percentage of the patients did not attain the targets. Attempts to achieve the desired goals are necessary. It is important to calculate Kt/V or URR and individualize the dialysis doses for each patient.

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

    Institute of Scientific and Technical Information of China (English)

    Ru Lei

    2016-01-01

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

  15. Flow Structure Associated with Hemodialysis Catheters

    Science.gov (United States)

    Foust, Jason

    2005-11-01

    Insertion of a hemodialysis catheter into the superior vena cava (SVC) gives rise to complex flow patterns, which arise from the simultaneous injection and extraction of blood through different holes (ports) of the catheter. Techniques of high-image-density particle image velocimetry are employed in a scaled-up water facility. This approach allows characterization of both the instantaneous and time-averaged flow structure due to generic classes of side hole geometries. The trajectory of the injection jet is related to the ratio of the initial jet velocity to the mainstream velocity through the SVC, and to the type of distortion of the jet cross-section. Furthermore, the mean and fluctuating velocity and vorticity fields are determined. Significant turbulent stresses develop rapidly in the injection jet, which can impinge upon the wall of the simulated SVC. Immediately downstream of the injection hole, a recirculation cell of low velocity exists adjacent to the catheter surface. These and other representations of the flow structure are first evaluated for a steady throughflow, then for the case of a pulsatile waveform in the SVC, which matches that of a normal adult.

  16. Hemodialysis machine technology: a global overview.

    Science.gov (United States)

    Polaschegg, Hans-Dietrich

    2010-11-01

    The market for hemodialysis machines, the background, the current products of manufacturers and the features of hemodialysis machines are described in this article. In addition to the established companies and their products, Chinese manufacturers, and new developments for home hemodialysis, are outlined based on publications available on the internet and patent applications. Here, a critical review of the state of the art questions the medical usefulness of high-tech developments, compared with the benefits of more frequent and/or longer dialysis treatment with comparable simple machines.

  17. Stream Evaluation

    Data.gov (United States)

    Kansas Data Access and Support Center — Digital representation of the map accompanying the "Kansas stream and river fishery resource evaluation" (R.E. Moss and K. Brunson, 1981.U.S. Fish and Wildlife...

  18. Analytical Solution of Multicompartment Solute Kinetics for Hemodialysis

    Directory of Open Access Journals (Sweden)

    Przemysław Korohoda

    2013-01-01

    Full Text Available Objective. To provide an exact solution for variable-volume multicompartment kinetic models with linear volume change, and to apply this solution to a 4-compartment diffusion-adjusted regional blood flow model for both urea and creatinine kinetics in hemodialysis. Methods. A matrix-based approach applicable to linear models encompassing any number of compartments is presented. The procedure requires the inversion of a square matrix and the computation of its eigenvalues λ, assuming they are all distinct. This novel approach bypasses the evaluation of the definite integral to solve the inhomogeneous ordinary differential equation. Results. For urea two out of four eigenvalues describing the changes of concentrations in time are about 105 times larger than the other eigenvalues indicating that the 4-compartment model essentially reduces to the 2-compartment regional blood flow model. In case of creatinine, however, the distribution of eigenvalues is more balanced (a factor of 102 between the largest and the smallest eigenvalue indicating that all four compartments contribute to creatinine kinetics in hemodialysis. Interpretation. Apart from providing an exact analytic solution for practical applications such as the identification of relevant model and treatment parameters, the matrix-based approach reveals characteristic details on model symmetry and complexity for different solutes.

  19. [Control of HCV, HBV and HIV Infections in Hemodialysis].

    Science.gov (United States)

    Fabrizi, Fabrizio; Martin, Paul; Messa, Piergiorgio

    2013-01-01

    Infections with blood-borne pathogens are still common among patients on maintenance dialysis all over the world. The control of infection due to blood-borne viruses (particularly HBV) within dialysis units has been a major goal in the management of patients with chronic kidney disease in the industrialized world. Standard precautions and specific procedures have been recommended to prevent infections with HBV, HCV and HIV within dialysis units. Isolation of HBsAg positive patients by dialysis rooms, staff and machines continues to be an important step to control HBV infection within dialysis units, according to the CDC and other regulatory agencies. Some prospective observational studies have reported the complete prevention of HCV transmission to hemodialysis patients in the absence of any isolation policy, and the use of dedicated dialysis machines for HCV-infected patients is not recommended by clinical guidelines. Isolation of HCV-infected patients should be considered in special circumstances only. Vaccination is an important tool against transmission of HBV among patients on long-term dialysis even if the immune response towards the hepatitis B vaccine remains unsatisfactory. Hemodialysis is considered a low risk setting for the transmission of human immunodeficiency virus (HIV) infection, providing that standard and specific procedures are carefully observed. HIV-infected patients do not have to be isolated from other patients or dialyzed separately on dedicated machines.

  20. Stream Lab

    OpenAIRE

    Kummel, Miro; Bruder, Andrea; Powell, Jim; Kohler, Brynja; Lewis, Matt

    2016-01-01

    Dead leaves, ping-pong balls or plastic golf balls are floated down a small stream. The number of leaves/balls passing recording stations along the stream are tallied. Students are then challenged to develop a transport model for the resulting data. From this exercise students gain greater understanding of PDE modeling, conservation laws, parameter estimation as well as mass and momentum transport processes.

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Azar BARADARAN

    2011-12-01

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

  3. Sleep Disorders in ESRD Patients Undergoing Hemodialysis

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Abassi

    2016-04-01

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

  4. Hemodialysis as a rite of transition

    Directory of Open Access Journals (Sweden)

    Esperanza Vélez Vélez

    2006-03-01

    Full Text Available This article intends to explore the conceptual and practical application of the rites of transition model in the care of renal patients on hemodialysis treatment in our cultural environment. An ethnographic approach and narrative qualitative methodology were used, with an interpretation grounded in the constructivist paradigm. By convenient sampling, twelve patients on hemodialysis treatment were selected The immersion in hemodialysis culture and the observation process were done in the hemodialysis unit and also at patients’ home , where the in-depth interviews were carried out. The analysis of patients’ narratives shows the three stages of the rites of transition: separation, transition and reincorporation. The metaphoric usefulness of this model’s application and its possible influence on the quality of care offered to these patients is argued.

  5. Dissecting aortic aneurysm in maintenance hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Ounissi M

    2009-01-01

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

  6. Treatment Methods for Kidney Failure: Hemodialysis

    Science.gov (United States)

    ... hemodialysis treatments by avoiding high-potassium foods, including bananas, oranges, potatoes, and tomatoes. Read more in the NKDEP fact sheet Potassium: Tips for People with Chronic Kidney Disease . ...

  7. Self-Care Ability in Hemodialysis Patients

    OpenAIRE

    Atashpeikar, Soulmaz; Jalilazar, Tahereh; Heidarzadeh, Mehdi

    2012-01-01

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

  8. Cutaneous oxalosis after long-term hemodialysis.

    Science.gov (United States)

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

    1992-07-01

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

  9. Hemodialysis patients' perceptions of home hemodialysis and self-care.

    Science.gov (United States)

    Visaya, Marie Angela

    2010-01-01

    Home hemodialysis (HHD) is an optimal option for patients requiring renal replacement therapy. It has been noted through research that this type of therapy is more cost-effective than in-centre therapies, and the benefits to patients are well documented (Harwood & Leitch, 2006). As stated by the Ministry of Health and Long-Term Care (MoHLTC), a total of 40% of renal failure patients are expected to do home dialysis (either peritoneal dialysis or HHD) by the year 2010 (Kashani & Motiwala, 2007). Even though the literature indicates that the numbers of those doing home dialysis are declining every year, there is no evidence to demonstrate why the numbers are declining. A quantitative cross-sectional descriptive study was conducted using the Patient Perception Survey and the Jo Pre-Training Assessment Tool (JPAT) to assess in-centre hemodialysis patients' perceptions regarding home dialysis, as well as their self-care ability. The two frameworks utilized were the Theory of Planned Behavior and Orem's Theory of Self-Care. According to the Theory of Planned Behavior, the 26 patients out of 49 who had positive perceptions regarding home dialysis would be expected to participate in home dialysis. However, according to the patients' responses to the domains within the JPAT, only eight out of the 26 would be considered suitable to participate in home dialysis. Only two of the domains, communication and social support, were found to be significantly related to patients'perceptions regarding home dialysis. Health care professionals need to implement interventions that incorporate assessment of communication and social support when addressing home dialysis therapy with a patient with end-stage renal disease (ESRD).

  10. Evaluation of Stream Mining Classifiers for Real-Time Clinical Decision Support System: A Case Study of Blood Glucose Prediction in Diabetes Therapy

    Directory of Open Access Journals (Sweden)

    Simon Fong

    2013-01-01

    Full Text Available Earlier on, a conceptual design on the real-time clinical decision support system (rt-CDSS with data stream mining was proposed and published. The new system is introduced that can analyze medical data streams and can make real-time prediction. This system is based on a stream mining algorithm called VFDT. The VFDT is extended with the capability of using pointers to allow the decision tree to remember the mapping relationship between leaf nodes and the history records. In this paper, which is a sequel to the rt-CDSS design, several popular machine learning algorithms are investigated for their suitability to be a candidate in the implementation of classifier at the rt-CDSS. A classifier essentially needs to accurately map the events inputted to the system into one of the several predefined classes of assessments, such that the rt-CDSS can follow up with the prescribed remedies being recommended to the clinicians. For a real-time system like rt-CDSS, the major technological challenges lie in the capability of the classifier to process, analyze and classify the dynamic input data, quickly and upmost reliably. An experimental comparison is conducted. This paper contributes to the insight of choosing and embedding a stream mining classifier into rt-CDSS with a case study of diabetes therapy.

  11. Incremental short daily home hemodialysis: a case series.

    Science.gov (United States)

    Toth-Manikowski, Stephanie M; Mullangi, Surekha; Hwang, Seungyoung; Shafi, Tariq

    2017-07-05

    Patients starting dialysis often have substantial residual kidney function. Incremental hemodialysis provides a hemodialysis prescription that supplements patients' residual kidney function while maintaining total (residual + dialysis) urea clearance (standard Kt/Vurea) targets. We describe our experience with incremental hemodialysis in patients using NxStage System One for home hemodialysis. From 2011 to 2015, we initiated 5 incident hemodialysis patients on an incremental home hemodialysis regimen. The biochemical parameters of all patients remained stable on the incremental hemodialysis regimen and they consistently achieved standard Kt/Vurea targets. Of the two patients with follow-up >6 months, residual kidney function was preserved for ≥2 years. Importantly, the patients were able to transition to home hemodialysis without automatically requiring 5 sessions per week at the outset and gradually increased the number of treatments and/or dialysate volume as the residual kidney function declined. An incremental home hemodialysis regimen can be safely prescribed and may improve acceptability of home hemodialysis. Reducing hemodialysis frequency by even one treatment per week can reduce the number of fistula or graft cannulations or catheter connections by >100 per year, an important consideration for patient well-being, access longevity, and access-related infections. The incremental hemodialysis approach, supported by national guidelines, can be considered for all home hemodialysis patients with residual kidney function.

  12. Effect of herb paste formulas by principle of strengthening the spleen, tonifying the kidney and activating blood circulation on malnutrition in maintenance hemodialysis patients%健脾补肾活血膏方对维持性血液透析患者营养不良状态的影响

    Institute of Scientific and Technical Information of China (English)

    林启展; 周敏; 宋智智; 吴秀清

    2012-01-01

    Objective: To observe the influences of nourishing spleen and kidney and blood-activating paste on malnutrition in maintenance hemodialysis(MHD) patients, and to investigate the healing effect and safety of the paste, in order to provide the reference for traditional Chinese medicine(TCM) on undernourished MHD patients. Methods: According to the inclusion and exclusion standard, 36 patients were selected. According to whether taking the paste, the patients were divided into two groups: treatment group and control group. All the patients were given maintenance hemodialysis, basis of conventional medicine, and dietary guidance. In addition, the treatment group take the paste, 3 months for a period of treatment. Observe and record the situation before and after treatment, including anthropometric arameters (BMI, TSF, MAC, MAMC), laboratory examinationlHb. Alb, PA, PCR), SGA score, clinic sign change, safety observation index(hepatic function, plasma lipids, ion etc.). Analysis and evaluate the clinical efficacy and safety of the paste. Results: The nourishing spleen and kidney and blood-activating paste can improve the malnutrition in MHD patients to some extent. Conclusion: The nourishing spleen and kidney and blood-activating paste has greatly raised the level of Alb, Hb, PCR; and it has greatly improved SGA score and clinical symptoms.%目的:观察健脾补肾活血中药膏方对维持性血液透析(简称“血透”)患者营养不良状态的影响,初步探讨中药膏方的疗效和安全性,为临床应用中医药干预维持性血透患者营养不良提供参考.方法:36例血透患者,按患者接受膏方治疗的意愿分为膏方治疗组和对照组,治疗组在规律血透、对症治疗以及饮食指导等基础上服用中药膏方3个月.观察、记录两组患者治疗前后在人体测量指标(身体质量指数、肱三头肌皮褶厚度、上臂围、上臂肌围)、实验窒指标(血清白蛋白、前白蛋白、血红蛋白、蛋白

  13. 老年维持性血液透析患者透析间期血压节律的影响因素分析%Investigation of factors of circadian rhythm of interdialytic ambulatory blood pressure in elderly maintenance hemodialysis patients

    Institute of Scientific and Technical Information of China (English)

    王莹; 牛建英; 范伟锋; 罗丽红; 钱英俊; 张绮; 顾勇

    2011-01-01

    目的 探讨老年维持性血液透析(MHD)患者透析间期动态血压节律的影响因素.方法 选择28例老年MHD患者,均丁透析间期进行24 h动态血压监测,同时完善血液生化指标和心脏超声检查,根据动态血压监测中夜间收缩压下降率情况将患者分为2组:血压节律正常组和血压节律异常组.采用独立样本t检验或Fisher确切概率法比较两组患者一般情况、血液生化指标、动态血压参数、心脏结构及功能的差异;采用多因素Logistic回归分析老年MHD患者透析间期血压节律的影响因素,结果(1)血压节律异常组甲状旁腺激素水平、动态动脉硬化指数、对称性动态动脉硬化指数、左室质量指数高于血压节律正常组(P<0.05),差异有统计学意义.(2)多因素Logistic回归分析结果显示,甲状旁腺激素、对称性动念动脉硬化指数、左室肥大是动态血压节律异常的独立危险因素,结论继发性甲状腺机能亢进、动脉硬化、左室肥大是老年MHD患者透析间期动念血压节律异常的独市危险因素.%Objective To investigate factors that influence circadian rhythm of interdialytic ambulatory blood pressure in elderly patients with maintenance hemodialysis (MHD). Methods Ambulatory blood pressure monitoring (ABPM) was conducted in twenty-eight elderly MHD patients between two dialysis sessions. The data of ABPM as well as echocardio-graphy and serum biochemical indicators were examined. Two groups were identified with different ranges of decline rate of nocturnal systolic blood pressure: normal and abnormal blood pressure rhythm groups. Clinical records on epidemiologic, hematological, ABPM and cardiac ultrasonic aspects of the two groups were compared by independent-samples T test or Fisher exact method. Logistic regression model was used to analysis the risk factors influencing circadian rhythm of interdialytic ambulatory blood pressure in elderly MHD patients. Results (1) The

  14. 高通量血液透析在治疗尿毒症患者中的应用%Application of high - flux hemodialysis therapy uremia

    Institute of Scientific and Technical Information of China (English)

    叶爱玲; 刘君; 陈惠琳

    2015-01-01

    Objective:To observe the clinical effects of uremic patients by the high - flux hemodialysis. Methods:120 cases of uremic patients admitted in nephrology of our hospital were randomly divided into the high - flux hemodialysis group and the low - flux hemodialysis group. Compared the serum creati-nine,the blood urea nitrogen,and serum potassium,β2 - microglobulin and serum parathyroid hormone before and after hemodialysis. Compared the change of hemoglobin and infection before and after hemodialysis. Results:The serum creatinine,the blood urea nitrogen and serum potassium of the high - flux he-modialysis group were not significantly different,compared with those of the low - flux hemodialysis group before hemodialysis,(P 〉 0. 05). The β2 - micro-globulin levels and IPTH in the high - flux hemodialysis group were significantly lower than those in the low - flux hemodialysis group after hemodialysis(P〈 0. 05). The hemoglobin levels in the high - flux hemodialysis group was significantly higher than those in the low - flux hemodialysis group after hemodi-alysis(P 〈 0. 05). The hypotension,the infection and other adverse reactions in the high - flux hemodialysis group were not significantly different,compared with those in the low - flux hemodialysis group after hemodialysis(P 〉 0. 05). There was low incidence rate of adverse reactions in the two groups. Conclu-sion:The high - flux hemodialysis treatment can effectively remove macromolecular uremic toxins such as β2 - microglobulin,IPTH,can effectively reduce chronic complications of hemodialysis and can effectively improve quality of life for patients.%目的:探讨高通量血液透析在治疗尿毒症患者中的应用效果。方法:将120例尿毒症患者随机等分为高通量组和低通量组,高通量组应用高通量血液透析,低通量组应用低通量血液透析。比较两组患者血液透析治疗前后血清肌酐(Scr)、尿素氮(BUN)、血钾(K +)、β2

  15. Influence of Frequent Nocturnal Home Hemodialysis on Food Preference

    NARCIS (Netherlands)

    Ipema, Karin; Franssen, Casper; van der Schans, Cees; Smit, Lianne; Noordman, Sabine; Haisma, Hinke

    Objective: Dialysis patients frequently report a change of taste that is reversible after renal transplantation, suggesting that uremic toxins may negatively influence taste. Currently, frequent nocturnal home hemodialysis (NHHD) is the most effective method of hemodialysis, and is associated with

  16. stream-stream: Stellar and dark-matter streams interactions

    Science.gov (United States)

    Bovy, Jo

    2017-02-01

    Stream-stream analyzes the interaction between a stellar stream and a disrupting dark-matter halo. It requires galpy (ascl:1411.008), NEMO (ascl:1010.051), and the usual common scientific Python packages.

  17. Decreased percentage of peripheral naïve T cells is independently associated with ischemic stroke in patients on hemodialysis.

    Science.gov (United States)

    Chen, Rongyi; Hu, Jiachang; Xiang, Fangfang; Tan, Xiao; Shen, Bo; Liu, Zhonghua; Lv, Wenlv; Ding, Xiaoqiang; Cao, Xuesen; Zou, Jianzhou

    2017-09-15

    Cerebrovascular complications, including ischemic stroke, account for poor outcomes in patients on hemodialysis. T cell responses may be involved in the pathogenesis of ischemic stroke. We aimed to evaluate the role of naïve T cells in development of ischemic stroke in patients on hemodialysis. In this cross-sectional study, 156 patients on hemodialysis in our blood purification center were included. These patients were divided into the ischemic stroke (IS) group (61 cases) and non-ischemic stroke (non-IS) group (95 cases) according to a new diagnosis after initiation of hemodialysis. After being lysed with red blood cell lysis solution, peripheral blood was tested by flow cytometry to detect the expression of CD45RO and CCR7 in CD4 T and CD8 T cells. Correlation analysis and logistic regression analysis were conducted to identify potential independent risk factors for ischemic stroke. The percentage of peripheral naïve T cells was lower in the IS group [median (interquartile range (IQR)) 13.9% (8.6-22.9%)] compared with the non-IS group [median (IQR) 22.7% (15.9-32.2%), P T cells were negatively associated with ischemic stroke (r = -0.308, P T cells had an independent negative association with ischemic stroke in patients on hemodialysis (odds ratio 0.933, 95% CI 0.883, 0.986; P = 0.013). A decrease in percentage of peripheral CD4 naïve T cells is a risk factor for ischemic stroke in patients on hemodialysis.

  18. 21 CFR 876.5665 - Water purification system for hemodialysis.

    Science.gov (United States)

    2010-04-01

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

  19. Is incremental hemodialysis ready to return on the scene? From empiricism to kinetic modelling.

    Science.gov (United States)

    Basile, Carlo; Casino, Francesco Gaetano; Kalantar-Zadeh, Kamyar

    2017-08-01

    Most people who make the transition to maintenance dialysis therapy are treated with a fixed dose thrice-weekly hemodialysis regimen without considering their residual kidney function (RKF). The RKF provides 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, although these effects may be confounded by patient comorbidities. Preservation of the RKF requires a careful approach, including regular monitoring, avoidance of nephrotoxins, gentle control of blood pressure to avoid intradialytic hypotension, and an individualized dialysis prescription including the consideration of incremental hemodialysis. There is currently no standardized method for applying incremental hemodialysis in practice. Infrequent (once- to twice-weekly) hemodialysis regimens are often used arbitrarily, without knowing which patients would benefit the most from them or how to escalate the dialysis dose as RKF declines over time. The recently heightened interest in incremental hemodialysis has been hindered by the current limitations of the urea kinetic models (UKM) which tend to overestimate the dialysis dose required in the presence of substantial RKF. This is due to an erroneous extrapolation of the equivalence between renal urea clearance (Kru) and dialyser urea clearance (Kd), correctly assumed by the UKM, to the clinical domain. In this context, each ml/min of Kd clears the urea from the blood just as 1 ml/min of Kru does. By no means should such kinetic equivalence imply that 1 ml/min of Kd is clinically equivalent to 1 ml/min of urea clearance provided by the native kidneys. A recent paper by Casino and Basile suggested a variable target model (VTM) as opposed to the fixed model, because the VTM gives more clinical weight to the RKF and allows

  20. Spontaneous Hemocholecyst in an End-Stage Renal Failure Patient on Low Molecular Weight Heparin Hemodialysis

    Directory of Open Access Journals (Sweden)

    Konstantinos Blouhos

    2012-01-01

    Full Text Available The present paper describes a case of spontaneous hemocholecyst in a patient with end-stage renal failure on low molecular weight heparin hemodialysis. The patient presented with acute right upper quadrant pain. An initial ultrasound scan demonstrated a distended gallbladder containing echogenic bile without stones. During hospitalization the patient became febrile, and jaundiced, developed leukocytosis, and had an elevation in serum bilirubin, transaminases, and alkaline phosphatase. A new ultrasound demonstrated a thick-walled gallbladder containing echogenic bile and pericholecystic fluid. MRI depicted a distended gallbladder containing material of mixed signal intensity and a normal biliary tract. Open cholecystectomy revealed a gallbladder filled with blood and clots, and transcystic common bile duct exploration flushed blood clots out of the bile duct. To our knowledge this is the second case of spontaneous hemocholecyst reported in the literature as a consequence of uremic bleeding and LMWH hemodialysis in the absence of other pathology.

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

    Science.gov (United States)

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

    2015-01-01

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

  2. Intracellular Phosphate Dynamics in Muscle Measured by Magnetic Resonance Spectroscopy during Hemodialysis.

    Science.gov (United States)

    Lemoine, Sandrine; Fournier, Thomas; Kocevar, Gabriel; Belloi, Amélie; Normand, Gabrielle; Ibarrola, Danielle; Sappey-Marinier, Dominique; Juillard, Laurent

    2016-07-01

    Of the 600-700 mg inorganic phosphate (Pi) removed during a 4-hour hemodialysis session, a maximum of 10% may be extracted from the extracellular space. The origin of the other 90% of removed phosphate is unknown. This study tested the hypothesis that the main source of phosphate removed during hemodialysis is the intracellular compartment. Six binephrectomized pigs each underwent one 3-hour hemodialysis session, during which the extracorporeal circulation blood flow was maintained between 100 and 150 ml/min. To determine in vivo phosphate metabolism, we performed phosphorous ((31)P) magnetic resonance spectroscopy using a 1.5-Tesla system and a surface coil placed over the gluteal muscle region. (31)P magnetic resonance spectra (repetition time =10 s; echo time =0.35 ms) were acquired every 160 seconds before, during, and after dialysis. During the dialysis sessions, plasma phosphate concentrations decreased rapidly (-30.4 %; P=0.003) and then, plateaued before increasing approximately 30 minutes before the end of the sessions; 16 mmol phosphate was removed in each session. When extracellular phosphate levels plateaued, intracellular Pi content increased significantly (11%; P<0.001). Moreover, βATP decreased significantly (P<0.001); however, calcium levels remained balanced. Results of this study show that intracellular Pi is the source of Pi removed during dialysis. The intracellular Pi increase may reflect cellular stress induced by hemodialysis and/or strong intracellular phosphate regulation.

  3. Increased Intracranial Pressure during Hemodialysis in a Patient with Anoxic Brain Injury

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    Anton Lund

    2017-01-01

    Full Text Available Dialysis disequilibrium syndrome (DDS is a serious neurological complication of hemodialysis, and patients with acute brain injury are at increased risk. We report a case of DDS leading to intracranial hypertension in a patient with anoxic brain injury and discuss the subsequent dialysis strategy. A 13-year-old girl was admitted after prolonged resuscitation from cardiac arrest. Computed tomography (CT revealed an inferior vena cava aneurysm and multiple pulmonary emboli as the likely cause. An intracranial pressure (ICP monitor was inserted, and, on day 3, continuous renal replacement therapy (CRRT was initiated due to acute kidney injury, during which the patient developed severe intracranial hypertension. CT of the brain showed diffuse cerebral edema. CRRT was discontinued, sedation was increased, and hypertonic saline was administered, upon which ICP normalized. Due to persistent hyperkalemia and overhydration, ultrafiltration and intermittent hemodialysis were performed separately on day 4 with a small dialyzer, low blood and dialysate flow, and high dialysate sodium content. During subsequent treatments, isolated ultrafiltration was well tolerated, whereas hemodialysis was associated with increased ICP necessitating frequent pauses or early cessation of dialysis. In patients at risk of DDS, hemodialysis should be performed with utmost care and continuous monitoring of ICP should be considered.

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

    Science.gov (United States)

    Coelho, Silvia

    2016-01-01

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

  5. QT Interval and QT Dispersion in Patients Undergoing Hemodialysis: Revisiting the Old Theory

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    Mohamed A. Alabd

    2011-07-01

    Full Text Available Aims: We sought to explore the response of the corrected QT (QTc interval duration and QT dispersion (QTD to hemodialysis. Methods: We enrolled 50 patients with end-stage renal disease undergoing regular hemodialysis. Blood samples were drawn for measurement of serum electrolytes, and a 12-lead ECG was performed to measure the QTc interval duration and QTD, immediately before and just after dialysis sessions. Results: The mean age of the cohort was 42.8 ± 12.2 years (58% males. Both the QTc duration and QTD showed marked variability after hemodialysis. A significant correlation was found between the decrease of both serum potassium and magnesium levels after dialysis and the post-dialysis QTc interval duration, with Pearson’s correlation coefficients r = –0.43 and r = –0.34, p = 0.002 and p = 0.01, respectively. Patients with a post-dialysis increase of QTc interval duration had a significantly higher percentage of reduction of serum potassium (p = 0.029, whereas patients with a post-dialysis increase of QTD had a significantly higher percentage of reduction of serum magnesium (p = 0.03. Conclusion: Our findings suggest a highly variable response of the QTc interval duration and QTD to hemodialysis. The post-dialysis QTc interval duration inversely correlated with the decrease of both serum potassium and magnesium levels after dialysis.

  6. QT Interval and QT Dispersion in Patients Undergoing Hemodialysis: Revisiting the Old Theory

    Science.gov (United States)

    Alabd, Mohamed A.; El-Hammady, Walid; Shawky, Ahmed; Nammas, Wail; El-Tayeb, Mohamed

    2011-01-01

    Aims We sought to explore the response of the corrected QT (QTc) interval duration and QT dispersion (QTD) to hemodialysis. Methods We enrolled 50 patients with end-stage renal disease undergoing regular hemodialysis. Blood samples were drawn for measurement of serum electrolytes, and a 12-lead ECG was performed to measure the QTc interval duration and QTD, immediately before and just after dialysis sessions. Results The mean age of the cohort was 42.8 ± 12.2 years (58% males). Both the QTc duration and QTD showed marked variability after hemodialysis. A significant correlation was found between the decrease of both serum potassium and magnesium levels after dialysis and the post-dialysis QTc interval duration, with Pearson's correlation coefficients r = −0.43 and r = −0.34, p = 0.002 and p = 0.01, respectively. Patients with a post-dialysis increase of QTc interval duration had a significantly higher percentage of reduction of serum potassium (p = 0.029), whereas patients with a post-dialysis increase of QTD had a significantly higher percentage of reduction of serum magnesium (p = 0.03). Conclusion Our findings suggest a highly variable response of the QTc interval duration and QTD to hemodialysis. The post-dialysis QTc interval duration inversely correlated with the decrease of both serum potassium and magnesium levels after dialysis. PMID:22470374

  7. Therapeutic efficacy of different Hemodialysis prescriptions in canine azotemia

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    Ekta Atul Thakkar

    2014-12-01

    Full Text Available Aim: The aim was to determine therapeutic efficacy of different Hemodialysis prescriptions in canine azotemia. Materials and Methods: Patients (n=9 with acute onset of renal dysfunction or chronic patients with superimposed acute factor (component or patients with known chronic nature of the disease were dialyzed with Fresenius 4008S hemodialysis machine after jugular catheterization. Patients were randomly divided into two groups, one group (n=3 was dialyzed every day and second (n=4 was dialyzed on alternate days. The patients were evaluated for following parameters to compare the efficacy of the dialysis prescription: Urea reduction ratio (URR, creatinine reduction ratio (CRR, Kt/V, time averaged concentration of urea (TAC urea. Result and Discussion: Increasing both dialysis frequency and duration is the superior dialysis schedule. Patient dialyzed every day with total processed blood volume 1.79 L/Kg for 4 h 26 min/session had the lowest TAC of 36.82 mg/dl, thereby was considered it as a better prescription.

  8. Hepatitis B and C virus infection among hemodialysis patients in Yogyakarta, Indonesia: Prevalence and molecular evidence for nosocomial transmission.

    Science.gov (United States)

    Rinonce, Hanggoro Tri; Yano, Yoshihiko; Utsumi, Takako; Heriyanto, Didik Setyo; Anggorowati, Nungki; Widasari, Dewiyani Indah; Lusida, Maria Inge; Soetjipto; Prasanto, Heru; Hotta, Hak; Hayashi, Yoshitake

    2013-08-01

    Hemodialysis patients are at an increased risk of acquiring hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. However, the prevalence of hepatitis viral infection and its genotype distribution among hemodialysis patients in Indonesia are unclear. In order to investigate these issues and the possibility of nosocomial transmission, 161 hemodialysis patients and 35 staff members at one of the hemodialysis unit in Yogyakarta, Indonesia, were tested for serological and virological markers of both viruses. HBV surface antigen (HBsAg) was detected in 18 patients (11.2%) and in two staff members (5.7%). Anti-HCV was detected in 130 patients (80.7%) but not in any staff members. Occult HBV and HCV infection were detected in 21 (14.7%) and 4 (12.9%) patients, respectively. The overall prevalence rates of HBV and HCV infection among patients were 24.2% and 83.2%, respectively. HCV infection was independently associated with hemodialysis duration and the number of blood transfusions. Phylogenetic analysis revealed that 23 of 39 tested HBV strains (59%) were genotype B, 11 (28.2%) were genotype C, and 5 (12.8%) were genotype A. HCV genotype 1a was dominant (95%) among 100 tested HCV strains. Nosocomial transmission was suspected because the genotype distribution differed from that of the general population in Indonesia, and because the viral genomes of several strains were identical. These findings suggest that HBV and HCV infection is common among hemodialysis patients in Yogyakarta, and probably occurs through nosocomial infection. Implementation of strict infection-control programs is necessary in hemodialysis units in Indonesia.

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

    Institute of Scientific and Technical Information of China (English)

    袁静

    2013-01-01

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

  10. Concentrations of cadmium, Cobalt, Lead, Nickel, and Zinc in Blood and Fillets of Northern Hog Sucker (Hypentelium nigricans) from streams contaminated by lead-Zinc mining: Implications for monitoring

    Science.gov (United States)

    Schmitt, C.J.; Brumbaugh, W.G.; May, T.W.

    2009-01-01

    Lead (Pb) and other metals can accumulate in northern hog sucker (Hypentelium nigricans) and other suckers (Catostomidae), which are harvested in large numbers from Ozark streams by recreational fishers. Suckers are also important in the diets of piscivorous wildlife and fishes. Suckers from streams contaminated by historic Pb-zinc (Zn) mining in southeastern Missouri are presently identified in a consumption advisory because of Pb concentrations. We evaluated blood sampling as a potentially nonlethal alternative to fillet sampling for Pb and other metals in northern hog sucker. Scaled, skin-on, bone-in "fillet" and blood samples were obtained from northern hog suckers (n = 75) collected at nine sites representing a wide range of conditions relative to Pb-Zn mining in southeastern Missouri. All samples were analyzed for cadmium (Cd), cobalt (Co), Pb, nickel (Ni), and Zn. Fillets were also analyzed for calcium as an indicator of the amount of bone, skin, and mucus included in the samples. Pb, Cd, Co, and Ni concentrations were typically higher in blood than in fillets, but Zn concentrations were similar in both sample types. Concentrations of all metals except Zn were typically higher at sites located downstream from active and historic Pb-Zn mines and related facilities than at nonmining sites. Blood concentrations of Pb, Cd, and Co were highly correlated with corresponding fillet concentrations; log-log linear regressions between concentrations in the two sample types explained 94% of the variation for Pb, 73-83% of the variation for Co, and 61% of the variation for Cd. In contrast, relations for Ni and Zn explained <12% of the total variation. Fillet Pb and calcium concentrations were correlated (r = 0.83), but only in the 12 fish from the most contaminated site; concentrations were not significantly correlated across all sites. Conversely, fillet Cd and calcium were correlated across the range of sites (r = 0.78), and the inclusion of calcium in the fillet-to-blood

  11. Epidemiology of hemodialysis patients in Aleppo city

    Directory of Open Access Journals (Sweden)

    Moukeh Ghamez

    2009-01-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

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

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    Ansgar Reising

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

  14. Clinical importance of color doppler ultrasonography in preoperative assessment of hemodialysis vascular access creation

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    Petrović Dejan

    2012-03-01

    Full Text Available Chronic kidney failure is characterized with progressive and ireversible diminishing of glomerular filtration rate. Arterio-venous fistula (AVF for hemodialysis should be created in patients with endogenous creatinine clearance ≤ 20 mL/min/1,73m2. Inner diameter of a. radialis ≥ 2.0 mm, inner diameter of v.cephalica ≥ 2.5 mm, flow velocity through the a.radialis - VmaxS ≥ 50 cm/s and flow through the a. radialis - Qa.radialis ≥ 40 mL/m intenable adequate maturing of distal radio-cephalic AVF. Diameter of v.cephalica ≥ 4.0 mmand blood flow Q AV ≥ 500 mL/min, four weeks after the AVF creation, indicate adequately matured AVF and possibility of puncturing it. Maximal blood flow velocity through AVF of 100-350 cm/s and blood flow of 500-1000 mL/min, are signs of good function of AVF and adequate hemodialysis. Color Doppler ultrasonography enables preoperative planning of AVF, early complication detection, choice of appropriate therapeutical procedure for complication treatment, estimation of maturation, prime time for puncture and AVF function, which all contribute to a significant morbidity decrease and better life quality in hemodialysis patients.

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

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    Munna Lal Patel

    2015-01-01

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

  16. Near-Death Experience in Patients on Hemodialysis.

    Science.gov (United States)

    Johnson, Sharona

    2015-01-01

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

  17. ACUTE SYMPTOMS AND COMPLICATIONS OF HEMODIALYSIS

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    Bárbara Paula Magalhães de Deus

    2015-07-01

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

  18. [Vascular access guidelines for hemodialysis].

    Science.gov (United States)

    Rodríguez Hernández, J A; González Parra, E; Julián Gutiérrez, J M; Segarra Medrano, A; Almirante, B; Martínez, M T; Arrieta, J; Fernández Rivera, C; Galera, A; Gallego Beuter, J; Górriz, J L; Herrero, J A; López Menchero, R; Ochando, A; Pérez Bañasco, V; Polo, J R; Pueyo, J; Ruiz, Camps I; Segura Iglesias, R

    2005-01-01

    Quality of vascular access (VA) has a remarkable influence in hemodialysis patients outcomes. Dysfunction of VA represents a capital cause of morbi-mortality of these patients as well an increase in economical. Spanish Society of Neprhology, aware of the problem, has decided to carry out a revision of the issue with the aim of providing help in comprehensión and treatment related with VA problems, and achieving an homogenization of practices in three mayor aspects: to increase arteriovenous fistula utilization as first vascular access, to increment vascular access monitoring practice and rationalise central catheters use. We present a consensus document elaborated by a multidisciplinar group composed by nephrologists, vascular surgeons, interventional radiologysts, infectious diseases specialists and nephrological nurses. Along six chapters that cover patient education, creation of VA, care, monitoring, complications and central catheters, we present the state of the art and propose guidelines for the best practice, according different evidence based degrees, with the intention to provide help at the professionals in order to make aproppiate decissions. Several quality standars are also included.

  19. Erectile dysfunction in hemodialysis patients

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    Imen Gorsane

    2016-01-01

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

  20. Inflammatory Response to Sorbent Hemodialysis.

    Science.gov (United States)

    Rosales, Laura; Thijssen, Stephan; Kruse, Anja; Sipahioglu, Murat Hairy; Hirachan, Padam; Raimann, Jochen G; Kuntsevich, Viktoriya; Carter, Mary; Levin, Nathan W; Kotanko, Peter

    2015-01-01

    Inflammation is common and associated with morbidity and mortality in hemodialysis (HD) patients. Exposure to endotoxin contained in the dialysate may trigger inflammation. Dialysate volume is substantially reduced in sorbent HD compared with standard single-pass dialysis. In this prospective study (Clinicaltrials.gov, number: NCT00788905), we compared the inflammatory response to single-pass and sorbent HD. Patients receiving single-pass HD were studied during 1 week of sorbent HD (Allient system; Renal Solutions, Warrendale, PA) and 1 week of single-pass HD. Patients were dialyzed using high-flux polysulfone dialyzers. Midweek pre- and post-HD serum levels of high-sensitivity C-reactive protein, interleukin (IL)-1β, IL-6, IL-10, interferon gamma, tumor necrosis factor alpha (TNF-α), and eotaxin were determined and their intradialytic change corrected for hemoconcentration during single-pass HD and sorbent HD compared by paired t-test. We enrolled 18 patients, nine completed the study. Although TNF-α decreased during both single-pass and sorbent HD (p < 0.001), none of the other biomarkers changed significantly during HD. We observed no difference between single-pass and sorbent HD. For the markers investigated in this study, there was no difference in the acute intradialytic inflammatory response to single-pass or sorbent HD.

  1. Falls in elderly hemodialysis patients.

    Science.gov (United States)

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

    2011-10-01

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

  2. Relationship between fibroblast growth factor-23 in peripheral blood and cardiovascular events in maintenance hemodialysis patients%维持性血液透析患者外周血成纤维细胞生长因子23水平与心血管事件关系的研究

    Institute of Scientific and Technical Information of China (English)

    李开龙; 陈菁; 张莹; 王燕; 李开斌; 何娅妮

    2011-01-01

    目的 探讨维持性血液透析(maintenance hemodialysis,MHD)患者外周血成纤维细胞生长因子23(fibroblast growth factor-23,FGF-23)水平与心血管事件的关系.方法选择2008年10至2010年2月在第三军医大学血液净化中心接受MHD的慢性肾脏病(chronic kidney disease,CKD)5期患者155例,研究周期6个月,按6个月内有无发生心血管事件分成心血管事件组和非心血管事件组.对2组患者在性别、年龄、CKD基础病、血压控制、血红蛋白水平、营养状况、透析模式和药物使用等方面进行可比性分析.同时检测2组患者研究前后血清磷、钙、全段甲状旁腺激素(intact parathyroid hormone,iPTH)、FGF-23和血浆1,25(OH)2D3的水平,并进行比较分析.结果心血管事件组患者外周血FGF-23水平显著高于非心血管事件组FGF-23水平(P<0.001);相关分析发现,MHD患者外周血FGF-23水平与心血管事件的发生显著性正相关(r=0.77,P<0.001);非心血管事件组血液滤过(hemofiltration,HF)时间显著多于心血管事件组(P<0.001),非心血管事件组研究结束和研究开始时比较,血磷、iPTH和FGF-23水平均显著性降低(P<0.001).研究结束后,非心血管事件组和心血管事件组比较,血磷、iPTH和FGF-23也显著降低(P<0.001).结论 CKD 5期MHD患者外周血FGF-23水平可望作为心血管事件发生的预警指标之一;HF对血磷、iPTH和FGF-23有良好的清除作用,血液透析联合HF治疗可以有效减少MHD患者心血管事件的发生.%Objective To study the relationship between fibroblast growth factor-23 (FGF-23) in peripheral blood and cardiovascular complications in patients on maintenance hernodialysis (MHD). Methods A total of 155 patients with chronic kidney disease (CKD) at stage 5 treated in this hemodialysis center from Oct. 2006 to Feb. 2010 were enrolled in the study, and the study was lasted for 6 months. Patients were divided into cardiovascular event group or non

  3. Evaluation of Ulnar neuropathy on hemodialysis patients

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    Babak Vahdatpour

    2012-01-01

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

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

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    A Abbaszadeh

    2010-12-01

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

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

    Science.gov (United States)

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

    2015-10-01

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

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

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

    2013-01-01

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

  7. 国产JH-2000血透机与进口透析机临床疗效比较%Clinical Curative Effect of JH- 2000 Hemodialysis Units

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    尹良红; 蔡启德; 陈湛华; 郑绮宜

    2003-01-01

    Objective The project of researching and manufacturing JH- 2000 Hemodialysis Units is supported by National Education Department, the science & technical Department of Guangzhou. The working principle of JH - 2000 Hemodialysis units is quite different with the imported machines. This experiments is to compare the clinic curative effect of foreig JH - 2000 Hemodialysis Units and those of imported ones. Methods Select sixty chronic renal failure patients, separate them into two groups. Thirty patients to be observation group, the other thirty patients to be the control group. Results During the clinic using of both kinds of machines,JH- 2000 Hemodialysis Units works on well,the blood pump of it runs stable;the whole monitor system is quite precise,the filtration volume is accurate. The data of experiments show that Cr and BUN in the blood of patients drop down apparently (P < 0.01 ). Water and Electrolyte disturbance have been controlled and corrected.Patients have no adverse reactions. Conclusion Curative effect of JH - 2000 Hemodialysis Units is significant, there are no obvious distinctions with the control group, so it can be used to maintain hemodialysis therapy, and the beside hemodialysis therapy as well.

  8. Management of Patient Care in Hemodialysis While Focusing on Cardiovascular Disease Events and the Atypical Role of Hyper- and/or Hypotension: A Systematic Review

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    Amjad Khan

    2016-01-01

    Full Text Available Background. Hemodialysis related hemodynamic instability is a major but an underestimated issue. Moreover, cardiovascular events are the leading cause of morbidity and mortality associated with blood pressure in hemodialysis patients. However, there have been many controversies regarding the role and management of hyper- and/or hypotension during hemodialysis that needs to be addressed. Objective. To critically review the available published data on the atypical role of hyper- and/or hypotension in cardiovascular associated morbidity and mortality in patients on hemodialysis and to understand the discrepancies in this context. Methods. A comprehensive search of literature employing electronic as well as manual sources and screening 2783 papers published between Jan 1980 and Oct 2015 was conducted to collect, identify, and analyze relevant information through peer-reviewed research articles, systematic reviews, and other published works. The cardiovascular events, including accelerated atherosclerotic cardiovascular disease (ASCVD, stroke, heart failure, myocardial infarction, myocardial ischemia, and stress induced myocardial dysfunction, leading to death were considered relevant. Results. A total of 23 published articles met the inclusion criteria and were included for in-depth review and analysis to finalize a comprehensive systematic review article. All the studies showed a significant association between the blood pressure and cardiovascular disease events in hemodialysis patients. Conclusions. Both intradialytic hypertension/hypotension episodes are major risk factors for cardiovascular mortality with a high percentage of probable causality; however, clinicians are faced with a dilemma on how to evaluate blood pressure and treat this condition.

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

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    Klarenbach Scott

    2006-02-01

    Full Text Available Abstract Background Nocturnal hemodialysis (NHD is an alternative to conventional three times per week hemodialysis (CvHD and has been reported to improve several health outcomes. To date, no randomized controlled trial (RCT has compared NHD and CvHD. We have undertaken a multi-center RCT in hemodialysis patients comparing the effect of NHD to CvHD on left ventricular (LV mass, as measured by cardiac magnetic resonance imaging (cMR. Methodology/design All patients in Alberta, Canada, expressing an interest in performing NHD are eligible for the study. Patients enrolled in the study will be randomized to either NHD or CvHD for a six month period. All patients will have a full clinical assessment, including collection of biochemical and cMR data at baseline and at 6 months. Both groups of patients will be monitored biweekly to optimize blood pressure (BP to a goal of Discussion To our knowledge, this study will be the first RCT evaluating health outcomes in NHD. The impact of NHD on LV mass represents a clinically important outcome which will further elucidate the potential benefits of NHD and guide future clinical endpoint studies.

  10. 妇幼保健院新生儿早发型血流感染分析%Analysis of neonatal early-onset blood stream infections in maternal and children's hospital

    Institute of Scientific and Technical Information of China (English)

    黄小艺; 刘志伟

    2012-01-01

    目的 探讨妇幼保健院新生儿早发型血流感染的病原菌、药敏率以及临床特点,为临床诊疗提供指导帮助.方法 回顾性分析1999年12月-2009年5月医院65例新生儿早发型血流感染病例血培养病原菌分布及药敏率;根据有无临床症状分为新生儿败血症组和菌血症组,比较两组新生儿胎龄、出生体重、性别、分娩方式、窒息史、母亲产前抗菌药物应用情况及预后.结果 医院新生儿早发型血流感染发病率为0.88%;新生儿早发型血流感染革兰阳性菌占73.85%,病原菌前5位依次为无乳链球菌、大肠埃希菌、李斯特菌属、肠球菌属及凝固酶阴性葡萄球菌,分别占26.15%、24.61%、16.93%、15.38%、9.23%;单核李斯特菌及大肠埃希菌是引起新生儿早发型败血症死亡的主要病原菌;青霉素G、万古霉素对革兰阳性菌耐药率为0;败血症组早产儿、低出生体重儿、窒息率及死亡率均高于菌血症组(P<0.05),母体宫内感染确诊率、新生儿生后抗菌药物预防性使用率低于菌血症组(P<0.05).结论 妇幼保健院新生儿早发型血流感染以革兰阳性菌为主,青霉素类抗菌药物可作为新生儿早发型感染预防及治疗首选经验性药物,各医院应根据该院菌群分布特点及耐药性合理选择抗菌药物;对母亲具有宫内感染高危因素的新生儿尤其是早产儿,低出生体重儿预防性应用抗菌药物可缓解新生儿早发型血流感染临床症状及降低其死亡率.%OBJECTIVE To investigate the distribution, antibiotic resistance of positive results and clinical characteristics of neonatal early-onset blood stream infections in maternal &. children's hospital so as to provide evidence for prophylactic and therapeutic use of antibiotics. METHODS A retrospective analysis was conducted on 65 neonates with neonatal early-onset blood stream infections, which were confirmed by hemoculture and

  11. Technical aspects of home hemodialysis

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    Alhomayeed B

    2009-01-01

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

  12. Sleep disorders in hemodialysis patients

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    Sabry Alaa

    2010-01-01

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

  13. Technical aspects of home hemodialysis.

    Science.gov (United States)

    Alhomayeed, B; Lindsay, R M

    2009-03-01

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

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

    Science.gov (United States)

    Zakharov, Sergey; Pelclova, Daniela; Navratil, Tomas; Belacek, Jaromir; Kurcova, Ivana; Komzak, Ondrej; Salek, Tomas; Latta, Jiri; Turek, Radovan; Bocek, Robert; Kucera, Cyril; Hubacek, Jaroslav A; Fenclova, Zdenka; Petrik, Vit; Cermak, Martin; Hovda, Knut Erik

    2014-07-01

    During an outbreak of methanol poisonings in the Czech Republic in 2012, we were able to study methanol and formate elimination half-lives during intermittent hemodialysis (IHD) and continuous veno-venous hemodialysis/hemodiafiltration (CVVHD/HDF) and the relative impact of dialysate and blood flow rates on elimination. Data were obtained from 11 IHD and 13 CVVHD/HDF patients. Serum methanol and formate concentrations were measured by gas chromatography and an enzymatic method. The groups were relatively comparable, but the CVVHD/HDF group was significantly more acidotic (mean pH 6.9 vs. 7.1 IHD). The mean elimination half-life of methanol was 3.7 and formate 1.6 h with IHD, versus 8.1 and 3.6 h, respectively, with CVVHD/HDF (both significant). The 54% greater reduction in methanol and 56% reduction in formate elimination half-life during IHD resulted from the higher blood and dialysate flow rates. Increased blood and dialysate flow on the CVVHD/HDF also increased elimination significantly. Thus, IHD is superior to CVVHD/HDF for more rapid methanol and formate elimination, and if CVVHD/HDF is the only treatment available then elimination is greater with greater blood and dialysate flow rates.

  15. Whole body protein metabolism in chronic hemodialysis

    NARCIS (Netherlands)

    Veeneman, Jorden Marcus

    2004-01-01

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

  16. On pressure: volume relations in hemodialysis

    NARCIS (Netherlands)

    E.H.Y. Ie (Eric)

    2005-01-01

    textabstractChapter 1 is a brief introduction to several aspects of cardiovascular pressure-volume relations in dialysis patients. The aims of the thesis are presented. In Chapter 2, an overview is presented of circulatory physiology in hemodialysis (HD) patients. Volume withdrawal by ultrafiltrati

  17. Subjective sleep efficiency of hemodialysis patients

    NARCIS (Netherlands)

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

    2008-01-01

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

  18. Subjective sleep efficiency of hemodialysis patients

    NARCIS (Netherlands)

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

    2008-01-01

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

  19. Sterilization of heparinized cuprophan hemodialysis membranes

    NARCIS (Netherlands)

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

    1996-01-01

    The effects of sterilization of dry heparinized Cuprophan hemodialysis membranes by means of ethylene oxide (EtO) exposure, gamma irradiation, or steam on the anticoagulant activity and chemical characteristics of immobilized heparin and the permeability of the membrane were investigated.

  20. Prevention and treatment of hemodialysis access thrombosis

    NARCIS (Netherlands)

    Smits, Johannes Henricus Maria

    2001-01-01

    Thrombosis of the vascular access is the main problem in hemodialysis therapy for end-stage renal disease. In most cases, thrombosis is associated with the presence of one or more stenoses in the access. These stenoses are due to progressive neointimal hyperplasia. In this thesis, methods are descri

  1. Diffusive Silicon Nanopore Membranes for Hemodialysis Applications.

    Directory of Open Access Journals (Sweden)

    Steven Kim

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

  2. Intravenous iron supplementation in children on hemodialysis.

    NARCIS (Netherlands)

    Leijn, E.; Monnens, L.A.H.; Cornelissen, E.A.M.

    2004-01-01

    BACKGROUND: Children with end-stage renal disease (ESRD) on hemodialysis (HD) are often absolute or functional iron deficient. There is little experience in treating these children with intravenous (i.v.) iron-sucrose. In this prospective study, different i.v. iron-sucrose doses were tested in child

  3. Intravenous iron supplementation in children on hemodialysis.

    NARCIS (Netherlands)

    Leijn, E.; Monnens, L.A.H.; Cornelissen, E.A.M.

    2004-01-01

    BACKGROUND: Children with end-stage renal disease (ESRD) on hemodialysis (HD) are often absolute or functional iron deficient. There is little experience in treating these children with intravenous (i.v.) iron-sucrose. In this prospective study, different i.v. iron-sucrose doses were tested in

  4. Subjective sleep efficiency of hemodialysis patients

    NARCIS (Netherlands)

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

    2008-01-01

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

  5. Whole body protein metabolism in chronic hemodialysis

    NARCIS (Netherlands)

    Veeneman, Jorden Marcus

    2004-01-01

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

  6. Hemodialysis Tunneled Catheter-Related Infections

    Science.gov (United States)

    Miller, Lisa M.; Clark, Edward; Dipchand, Christine; Hiremath, Swapnil; Kappel, Joanne; Kiaii, Mercedeh; Lok, Charmaine; Luscombe, Rick; Moist, Louise; Oliver, Matthew; MacRae, Jennifer

    2016-01-01

    Catheter-related bloodstream infections, exit-site infections, and tunnel infections are common complications related to hemodialysis central venous catheter use. The various definitions of catheter-related infections are reviewed, and various preventive strategies are discussed. Treatment options, for both empiric and definitive infections, including antibiotic locks and systemic antibiotics, are reviewed.

  7. Endovascular treatment of hemodialysis arteriovenous fistulas

    DEFF Research Database (Denmark)

    Heerwagen, Søren T; Hansen, Marc A; Schroeder, Torben V;

    2012-01-01

    Purpose: The purpose of this study was to investigate if the immediate hemodynamic outcome of an endovascular intervention on a dysfunctional hemodialysis arteriovenous fistula is a prognostic factor for primary patency. Methods: This was a prospective observational study including 61 consecutive...

  8. Necrotizing fasciitis and infective endocarditis caused by Escherichia coli in a hemodialysis patient.

    Science.gov (United States)

    Tsai, Ming-Hsien; Leu, Jyh-Gang; Fang, Yu-Wei; Hsieh, Shih-Chung

    2015-10-01

    Patients with uremia are often immunocompromised and uremia patients undergoing maintenance dialysis are often vulnerable to uncommon infections. We report a 40-year-old man who was undergoing maintenance hemodialysis and was initially diagnosed with monomicrobal necrotizing fasciitis of the lower limbs, based on blood and pus cultures that yielded Escherichia coli. His condition improved after surgical debridement and antibiotic therapy. However, he eventually died of intracranial hemorrhage related to septic emboli. Concurrent infective endocarditis was diagnosed based on an echocardiogram that indicated vegetation in the left ventricular region. Escherichia coli-related necrotizing fasciitis and infective endocarditis is rarely seen in clinical practice. There should be a high index of suspicion for multiple infections when a hemodialysis patient presents with an uncommon infection.

  9. Observational study of need for thrombolytic therapy and incidence of bacteremia using taurolidine-citrate-heparin, taurolidine-citrate and heparin catheter locks in patients treated with hemodialysis.

    Science.gov (United States)

    Solomon, Laurie R; Cheesbrough, John S; Bhargava, Ramya; Mitsides, Nicos; Heap, Michael; Green, Gerwyn; Diggle, Peter

    2012-01-01

    Catheter-related blood stream infections may be reduced by interdialytic locking with Taurolidine, a nontoxic antimicrobial agent. A formulation of 1.35% Taurolidine in 4% citrate (TC) is associated with a greater need for thrombolysis to maintain catheter patency than 5000 U/ml heparin. Our aim was to determine whether addition of 500 Units/ml of heparin to TC reduces the need for thrombolysis. TCH (1.35% taurolidine, 4% citrate and 500 U/ml heparin) was compared to TC and Heparin 5000 U/ml using retrospective data. Hundred and six adult hemodialysis patients with internal jugular tunnelled intravascular catheters using TCH were compared with 34 patients using TC and 34 patients using heparin 5000 U/ml respectively. Outcomes were time to first use of thrombolysis and bacteremia rates.TCH reduced the need for thrombolysis compared to TC (hazard ratio, 0.2; 95%CI: 0.06, 0.5; p < 0.001) and was not significantly different from heparin 5000 U/ml (hazard ratio, 1.4; 95%CI: 0.5, 3.9; p = 0.5). The bacteremia rates from all causes were 1.33, 1.22 and 3.25 per 1000 catheter- days (p < 0.001) in the TCH, TC and heparin groups respectively. Addition of 500 U/ml heparin to TC reduces the need for thrombolysis without increasing bacteremia and may achieve patency comparable to heparin 5000 U/ml.

  10. [Simulation in medicine: first experiences under hemodialysis].

    Science.gov (United States)

    Duranti, Ennio; Calzeroni, Gino; Venneri, Francesco; Marziali, Mauro

    2013-01-01

    Education and practical training in medicine is neglected and pass directly from theory to do on the field, while also each task requires the acquisition of health behaviors that are aware and accountable to the outreach. In hemodialysis is necessary to create synergies and partnerships between different cooperating figures. Addressing organizational and legal protection of the professionals (Clinical Risk). Acquiring operational capabilities of team work. Managing the team roles and functions.It is necessary then to acquire a modern methodology where the simulation represents the main tool, "the mistake" need to "learn" and the acquisition of "awareness" about event handling (in this case on Hemodialysis), in the context of clinical scenarios absolutely realistic.The methodology is based on simulated tasks using past experience as a business tool and innovative research. Debriefing and discussion with those involved and finally debrief collegiate looking for active/latent errors and use of international guidelines. Use of indicators to measure and review of performance during the various events and proactively promoting the reduction of the error.Among the types of participants was clear the minor presence of doctors of hemodialysis, probably for the wrong feeling of being checked and then judged in carrying out of actions made complex by urgency. In addition participating physicians have all stressed the usefulness of simulations of unusual events within the Hemodialysis treatment, but that if not solved can lead to death of the patient.Simulation under hemodialysis, although its first steps, appears to be an effective methodology able to stimulate self-criticism of the operators, but still with hesitations and fears above all by the nephrologists timorous of being judged more on technical skills than on organizational skills and leadership.

  11. The economic burden of hemodialysis in Jordan

    Directory of Open Access Journals (Sweden)

    Emad Adel Al-Shdaifat

    2013-01-01

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

  12. Thyroid hormone concentrations in dialysate during hemodialysis in children

    Energy Technology Data Exchange (ETDEWEB)

    Waters, W.; Bulla, M.; Buschsieweke, U.; Kutzim, H.

    1981-12-01

    Thyroxine (T4) concentration in dialysate in the course of hemodialysis was determined in 15 children. Concentrations were measured by a modified radioimmunoassay. During hemodialysis there was a slight increase in T4 concentration. At the end of hemodialysis T4 concentration was about 50% higher than soon after the onset of hemodialysis. The loss of T4 into dialysate during hemodialysis was 19.2 ..mu..g; the loss of T3 was less than 75 ng. The amount of the daily loss of thyroid hormones into dialysate was found to be in the range of normal urinary excretion. The lowering of serum thyroid hormone concentrations in children on hemodialysis cannot be explained by the loss of these hormones into dialysate.

  13. Zeolitic ammonium ion exchange for portable hemodialysis dialysate regeneration.

    Science.gov (United States)

    Patzer, J F; Yao, S J; Wolfson, S K

    1995-01-01

    Ammonia removal from a recirculating dialysate stream is a major challenge in developing a truly portable, regenerable hemodialysis system. Three zeolites, type F, type W, and clinoptilolite, were found to have good ammonia ion exchange capacity with linear equilibrium ion exchange coefficients of 0.908, 0.488, and 0.075 L/g, respectively. The linear equilibrium ion exchange coefficient relates dialysate ammonia concentration (mumol/L) to the amount of ammonia absorbed by zeolite (mumol/g) at equilibrium. Ammonia uptake by zeolite powders was fast, with equilibrium reached within 15 sec. Zeolite ammonia ion exchange and regeneration through multiple cycles was studied using an ion exchange column containing clinoptilolite pellets. Zeolite ion exchange capability was regenerated by flushing the column with 2 mol/L sodium chloride after an ion exchange run. The column maintained ammonia ion exchange capacity through six ion exchange/regeneration cycles, demonstrating multiple dialysis use possibilities. Atomic absorption spectroscopy of the column effluent showed no detectible (< 1 part per million) Si or Al leached from the zeolite.

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

    Directory of Open Access Journals (Sweden)

    Seifi S, Mokhtari A

    2008-07-01

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

  15. Dietary intakes and some biochemical markers in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Emine Yassibas

    2016-03-01

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

  16. Infrequent dialysis: a new paradigm for hemodialysis initiation.

    Science.gov (United States)

    Rhee, Connie M; Unruh, Mark; Chen, Jing; Kovesdy, Csaba P; Zager, Phillip; Kalantar-Zadeh, Kamyar

    2013-01-01

    Nearly a half-century ago, the thrice-weekly hemodialysis schedule was empirically established as a means to provide an adequate dialysis dose while also treating the greatest number of end-stage renal disease (ESRD) patients using limited resources. Landmark trials of hemodialysis adequacy have historically been anchored to thrice-weekly regimens, but a recent randomized controlled trial demonstrated that frequent hemodialysis (six times per week) confers cardiovascular and survival benefits. Based on these collective data and experience, clinical practice guidelines advise against a less than thrice-weekly treatment schedule in patients without residual renal function, yet provide limited guidance on the optimal treatment frequency when substantial native kidney function is present. Thus, during the transition from Stage 5 chronic kidney disease to ESRD, the current paradigm is to initiate hemodialysis on a "full-dose" thrice-weekly regimen even among patients with substantial residual renal function. However, emerging data suggest that frequent hemodialysis accelerates residual renal function decline, and infrequent regimens may provide better preservation of native kidney function. Given the high mortality rates during the first 6 months of hemodialysis and the survival benefits of preserved native kidney function, initiation with twice-weekly treatment schedules ("infrequent hemodialysis") with an incremental increase in frequency over time may provide an opportunity to optimize patient survival. This review outlines the clinical benefits of post-hemodialysis residual renal function, studies of twice-weekly treatment regimens, and the potential risks and benefits of infrequent hemodialysis.

  17. Clinical outcomes of end stage renal disease and adequacy of adult maintenance hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Ismail Mahmud Ali, Amirthalingam R

    2014-07-01

    Full Text Available Background & Aim: End stage renal disease (ESRD is an irreversible loss of kidney function caused by various risk factors and affected persons of lives mainly depending on the technology of renal replacement therapy (RRT or renal transplantation (RT to sustain the life. Aim of this study is to overview the clinical outcomes of ESRD and adequacy of maintenance hemodialysis among the patients. Materials & Methods: Currently, there are sixty two end stage renal disease patient’s clinical data’s were collected and included in the study. For all patients, pre and post hemodialysis samples were collected and processed through biochemical and hematology auto analyzer. The hemodialysis modalities 4008 H/S and high-flux & low flux ultra filter dialyzers had utilized to three dialysis sessions per week, 4 hrs per session for each individuals. Blood flow rates differed from 150 to 350ml min-1 dependingon conditions and standard dialysate flow was 500ml/ min-1. Results: Of total sixty two patients, 51.62% females and 48.38% males with mean age of 47.76 (18-72 years; gradually increased at the ages of 55 to 72 years then adult age. Concerning overall risk factors in ESRD, 61.30% of hypertension as a leading risk factor followed by 21% NIDDM, 11.30% other kidney diseases and 6.40% cardiac related diseases. Although, there are others clinical signs such as hypothyroidisms; extra-pulmonary infection, retinitis pigmentosa and infertility have been diagnosed. In addition, nearly 33.87%% of HCV, 6.45% HBV and 3.22% of co-infection have been prevalence in ESRD hemodialysis population. Relating to hepatitis C, B and co-infection during dialysis exposure were 29.41%, 2.94% and 2.94% in that order. In relation to overall adequacy of maintenance hemodialysis in this study nearly 75.80% (≥ 1.3 to 2.5 Kt/V and 24.20% (1.05 to 1.3 Kt/V were been analyzed through Kt/V formula for wastage clearance. Conclusion: The present study highlighted that the co morbidity of

  18. Stent tunnel technique to save thrombosed native hemodialysis fistula with extensive venous aneurysm

    Directory of Open Access Journals (Sweden)

    Rabellino M

    2017-07-01

    Full Text Available Martin Rabellino,1 Guillermo J Rosa-Diez,2 Sergio A Shinzato,1 Pablo Rodriguez,1 Oscar A Peralta,1 Maria S Crucelegui,2 Rosario Luxardo,2 Agustina Heredia-Martinez,2 Mariela I Bedini-Rocca,2 Ricardo D García-Mónaco1 1Department of Angiography and Endovascular Therapy, 2Department of Nephrology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina Introduction and purpose: The increasing number of patients undergoing hemodialysis and the limited number of access sites have resulted in an increasing number of techniques to maintain vascular access for hemodialysis. Thrombosed arteriovenous (AV fistulas with large venous aneurysms have poor treatment results, with both endovascular and surgical techniques, leading to a high rate of definitive AV access loss. The purpose of this study was to review the feasibility and initial results of this novel endovascular treatment of thrombosed AV fistulas with large venous aneurysms.Materials and methods: A novel endovascular treatment technique of inserting nitinol auto-expandable uncovered stents stretching through the whole puncture site area, thus creating a tunnel inside the thrombus, was retrospectively analyzed and described.Results: A total of 17 stents were placed in 10 hemodialysis fistulas, with a mean venous coverage length of 17.8 cm. In all the cases, 100% technical success was achieved, with complete restoration of blood flow in all patients. There were no procedure-related complications. The mean follow-up was 167 days (range 60–420 days, with a primary and assisted patency of 80% and 100%, respectively. No multiple trans-stent struts-related complications were observed. Three stent fractures were diagnosed with plain films at the site of puncture without consequence in the venous access permeability.Conclusion: The “stent tunnel technique” is a feasible, safe and effective alternative to salvage native hemodialysis access, thus extending the function of the venous access with

  19. ICU中革兰阴性菌血流感染的危险因素分析%Analysis on risk factors of Gram-negative bacterial blood-stream infection in ICU

    Institute of Scientific and Technical Information of China (English)

    韩静静; 邓艳萍; 高鑫; 吕丽琼; 徐亚青; 成于珈

    2016-01-01

    ,including 93 case‐times of Gram‐negative bacterial infection .The Gram‐negative pathogenic bacteria were Acinetobacter baumanii ,Klebsiella pneumoniae ,Acinetobacter calcoaceticus baumanii ,E .coli ,pseudomonas aeruginosa ,etc .Except E .coli was mainly originated from community acquired infection ,other bacteria were mainly originated from nosocomial infection .In order to differing from other pathogenic bacterial blood stream infection ,the Logistic regression analysis results showed that the independent risk factors of G‐negative bacterial blood‐stream infection in ICU had serum PCT levels over 10 .0 ng/mL (OR= 60 .52 ,P= 0 .001) ,receiving the therapy of carbapenem and third generation cephalosporins (OR=16 .09 ,P=0 .03) ,hospitalization duration less than 2 weeks be‐fore suffering from disease (OR=13 .79 ,P=0 .03) and digestive system basic disease(OR=12 .94 ,P=0 .01) .Conclusion Gram‐negative bacterial blood‐stream infection in ICU of the Renmin Hospital of Wuhan University is mainly caused by multi‐drug resist‐ant bacteria .Serum PCT level over 10 .0 ng/mL ,hospitalization duration less than 2 weeks before infection ,receiving the therapy of carbapenem and third generation cephalosporin and basic diseases of digestive system are the independent risk factors influencing the occurrence and diagnosis of blood‐stream infection .

  20. Using Medical-Device Wearable to Improve Hemodialysis Patient’s Live and Access the Holistic Health

    Science.gov (United States)

    Chen, W. L.; Wu, C.-C.; Kan, C. D.

    2017-06-01

    The increasing incidence of end-stage renal disease (ESRD) is the major burden to health budgets and a threat to public health worldwide. For many years, Taiwan has been ranked the first in the world for the number of hemodialysis patients. For solving the above-mentioned circumstance, we demonstrate the project, here, which goal is to construct the holistic health for hemodialysis patient. The project is to design a wearable medicine-device which can simultaneously measure and monitor the vital sign, including heart rate (HR), pulse oximetry (SPO2), continuous non-invasive blood pressure (c-NIBP), and total body water (TBW), of hemodialysis patient. By aid of the device we design, hemodialysis patients will get better health care than before. This device comprises three techniques. The first is named “Using phonoangiography technique to early detect the dysfunction of arteriovenous access by arteriovenous access (AVA) stenosis detector”. The stenosis detector based on autoregressive model was employed to simultaneously estimate the status of AVA life cycle and to tract changes in frequency spectra. It helps hemodialysis patients to early detect the dysfunction of AVA and alarms them to make a return visit. The second technique is named “Physiological detecting device for wearable medical device and encoding algorithm development”. The feature of the second technique is to optimize the prognosis by analyzing physiological signals, including water content index, pulse oximetry, and blood pressure in the meanwhile. The third technique is named “Intelligent and smart tourniquet”. This technique aims to preclude AVA dysfunction caused by inappropriate hemostasis.

  1. Complex central venous catheter insertion for hemodialysis.

    Science.gov (United States)

    Powell, Steven; Belfield, Jane

    2014-01-01

    Despite the introduction of payment by results in the UK, there has been no decrease in central venous catheter (CVC) use. In part, this may relate to a requirement to dialyse through a CVC while autogenous access matures. Mortality data have improved in parallel and patients on hemodialysis live longer, which may lead to an increased exposure to CVCs.Exposure to CVCs carries a significant risk of infection and occlusion requiring their repositioning or exchange. The mid to long-term sequelae of CVC use is central venous occlusion leaving clinical teams with an ever increasing challenge to find adequate venous access.In this article, we will discuss the challenges faced by operators inserting CVCs into the hemodialysis-dependent patient who has exhausted more tradition insertion sites. These include translumbar caval catheters, transocclusion and transcollateral catheters, transjugular Inferior Vena Cava catheter positioning, and transhepatic catheters. We will demonstrate the techniques employed, complications, and anticipated longevity of function.

  2. [Hemodialysis on a cruise ship: our logbook].

    Science.gov (United States)

    Valiño Pazos, Cristina; Sáez Rodríguez, Loreto; Meizoso Ameneiro, Ana

    2013-05-01

    After a diet and hydric restriction, travelling is one of the most limiting and worrying activities for patients under chronic renal replacement therapy. The vital dependency on the hemodialysis machine makes travelling an extremely difficult experience. In order to prove the legitimacy of our patients' fears, we embarked on to a cruise-liner with them. This confirmed their limitations when travelling thanks to the reliable data input. This study describes our personal and professional experience as nurses, specialized in hemodialysis, embarking onto a cruise-liner with twelve patients suffering from ESRD. Our goal is to share that experience with professional nurses as well as patients who seek information in regards to this type of trip with a specialized nurse. A summary of this work was presented as a communication oral in the XXXVI Congress of the Spanish Society of Nephrology Nursing.

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

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    Randon R.B.

    2005-01-01

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

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

    Science.gov (United States)

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

    2014-12-01

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

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

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    Marcel Jaqueto

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

  6. Hepatitis B virus infection profile in hemodialysis patients in Central Brazil: prevalence, risk factors, and genotypes

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    Renata C Ferreira

    2006-09-01

    Full Text Available Hemodialysis patients are at high risk for hepatitis B virus (HBV infection. A survey was conducted in the hemodialysis population of the state of Goiás, Central Brazil, aiming to assess the prevalence of HBV infection, to analyse associated risk factors, and also to investigate HBV genotypes distribution. A total of 1095 patients were interviewed in 15 dialysis units. Serum samples were screened for HBV serological markers by enzyme-linked immunosorbent assay. Hepatitis B surface antigen (HBsAg positive samples were tested for HBV DNA by polymerase chain reaction and genotyped by restriction fragment length polymorphism. Global HBV infection prevalence was 29.8% (95% CI: 27.1-32.5. Multivariate analysis of risk factors showed that male gender, length of time on hemodialysis, and blood transfusion before 1993 were associated with HBV positivity. HBV DNA was detected in 65.4% (17/26 of the HBsAg-positive samples. Thirteen of 17 HBV DNA positive samples were genotyped. Genotype D (61.5% was predominant, followed by A (30.8%, while genotype F was detected in only one (7.7% sample.

  7. Uric acid is associated with nutritional status in maintenance hemodialysis patients

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    Ji Eun Lee

    2012-06-01

    Full Text Available Purines, mainly contained in meats, are metabolized finally to uric acid in humans. Although digestion of meat is impaired in end-stage renal disease patients on hemodialysis owing to anorexia and decreased taste, hyperuricemia is common in these patients. In this cross-sectional study, we analyzed demographic characteristics, normalized protein nitrogen appearance (nPNA, serum albumin concentration, and serum uric acid levels and other laboratory parameters in sixty patients on maintenance hemodialysis. There were 33 (55% males and 27 (45% females. The mean age was 62.9±14.3 years and the mean body mass index was 22.7±3.8 kg/m2. The mean serum uric acid level was 7.2±1.2 mg/dL, with the range of 5.1–10.8 mg/dL. There was a statistically significant correlation between serum uric level and nPNA (p < 0.05. The serum uric acid level was also positively correlated with blood urea nitrogen level (p < 0.01 and serum phosphorus level (p < 0.05. Our results suggest that serum uric acid level is associated with nutritional status, and might be a possible marker for protein nutrition in maintenance hemodialysis patients.

  8. [Short-term single-needle hemodialysis on native fistulae: a general review].

    Science.gov (United States)

    Rostoker, Guy

    2010-12-01

    In the 1980s, Belgian researchers showed that dialysis with a specific double-lumen cannula and a twin pump-head single-needle system was at least as efficient as conventional double-needle dialysis, based on Kt/V, the hematocrit, nerve conduction and survival. For more than 15 years, single-needle hemodialysis has been used worldwide for specific situations, such as temporary and reversible problems of vascular access or, more recently, at the beginning of hemodialysis with the twin aims of allowing native fistulae to mature and of reducing cannulation complications. Careful monitoring of the dialysis dose is mandatory when single-needle dialysis is used for more than a week, given the risk of under-dialysis (especially by ionic dialysance and dialysis monitor-recorded Kt/V) and the use of ultrapure dialysate, because of the high frequency of backfiltration. The efficiency of single-needle hemodialysis can be improved by increasing the effective blood flow rate to 250 ml/min, using a short 15-gauge stainless-steel needle, and employing a larger dialysis membrane. Detection of abnormal coagulation in hollow fibers necessitates an increase in anticoagulation or the use of a citrate dialysate or dialysers with anticoagulation properties such as filters coated with heparin or vitamin E. Biological hemolysis related to shear stresses between red cells and the needle should be monitored by measuring plasma haptoglobin and lactic deshydrogenase before and after the dialysis session. Copyright © 2010. Published by Elsevier SAS.

  9. Sleep Disorders in ESRD Patients Undergoing Hemodialysis

    OpenAIRE

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

    2016-01-01

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

  10. Ultrasound Evaluation Before and After Hemodialysis Access

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    Daryoush Saedi

    2009-01-01

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

  11. Evaluation of Ulnar neuropathy on hemodialysis patients

    OpenAIRE

    2012-01-01

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

  12. Increased cerebral water content in hemodialysis patients.

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    Kathrin Reetz

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

  13. Diagnosis, Treatment, and Prevention of Hemodialysis Emergencies.

    Science.gov (United States)

    Saha, Manish; Allon, Michael

    2017-02-07

    Given the high comorbidity in patients on hemodialysis and the complexity of the dialysis treatment, it is remarkable how rarely a life-threatening complication occurs during dialysis. The low rate of dialysis emergencies can be attributed to numerous safety features in modern dialysis machines; meticulous treatment and testing of the dialysate solution to prevent exposure to trace elements, toxins, and pathogens; adherence to detailed treatment protocols; and extensive training of dialysis staff to handle medical emergencies. Most hemodialysis emergencies can be attributed to human error. A smaller number are due to rare idiosyncratic reactions. In this review, we highlight major emergencies that may occur during hemodialysis treatments, describe their pathogenesis, offer measures to minimize them, and provide specific interventions to prevent catastrophic consequences on the rare occasions when such emergencies arise. These emergencies include dialysis disequilibrium syndrome, venous air embolism, hemolysis, venous needle dislodgement, vascular access hemorrhage, major allergic reactions to the dialyzer or treatment medications, and disruption or contamination of the dialysis water system. Finally, we describe root cause analysis after a dialysis emergency has occurred to prevent a future recurrence.

  14. The relationships between exogenous and endogenous antioxidants with the lipid profile and oxidative damage in hemodialysis patients

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    Brucker Natália

    2011-10-01

    Full Text Available Abstract Background We sought to investigate the relationships among the plasma levels of carotenoids, tocopherols, endogenous antioxidants, oxidative damage and lipid profiles and their possible effects on the cardiovascular risk associated with hemodialysis (HD patients. Methods The study groups were divided into HD and healthy subjects. Plasma carotenoid, tocopherol and malondialdehyde (MDA levels, as well as erythrocyte reduced glutathione (GSH, were measured by HPLC. Blood antioxidant enzymes, kidney function biomarkers and the lipid profiles were analyzed by spectrophotometric methods. Results Plasma lycopene levels and blood glutathione peroxidase (GPx activity were significantly decreased in HD patients compared with healthy subjects. Total cholesterol, low-density lipoprotein cholesterol (LDL-c, creatinine, urea, MDA, GSH, superoxide dismutase (SOD and catalase (CAT were significantly increased in HD (p Conclusions Lycopene may represent an additional factor that contributes to reduced lipid peroxidation and atherogenesis in hemodialysis patients.

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

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    Vasantha Janardhan

    2011-01-01

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

  16. Comparison of risk factors for cardiovascular disease in hemodialysis and peritoneal dialysis patients

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    Ozlem Harmankaya

    2015-09-01

    Full Text Available OBJECTIVE: In this study, we aimed to compare the cardiovascular risk factors that might be associated with inflammation, atherosclerosis and metabolic syndrome between hemodialysis and peritoneal dialysis patients. METHODS: Fifty hemodialysis and 50 peritoneal dialysis patients who had been receiving dialysis therapy for at least one year were included in the study. Venous blood samples were taken after 12 hours of fasting, and serum glucose, triglyceride, low-density lipoprotein (LDL-cholesterol, high-density lipoprotein (HDL-cholesterol, C-reactive protein, fibrinogen and homocysteine levels were measured. The presence of atherosclerotic plaques in the carotid artery was evaluated by carotid Doppler ultrasound. These data were analyzed by Student’s t test, the chi-square test and the Mann-Whitney U test, as appropriate. RESULTS: No difference was found between the hemodialysis (n=50 and peritoneal dialysis (n=50 patient groups regarding mean age, gender distribution, body mass index or dialysis duration (p=0.269, 0.683, 0.426, and 0.052, respectively. LDL-cholesterol, fibrinogen and homocysteine levels were significantly higher in peritoneal dialysis patients (p=0.006, 0.001, and 0.002, respectively. In patients with diabetes mellitus (n=17 who were undergoing renal replacement therapy, LDL-cholesterol and fibrinogen levels were significantly higher than in patients without diabetes mellitus who were undergoing renal replacement therapy (p=0.001 and 0.004, respectively. CONCLUSION: In our study, cardiovascular risk factors (especially LDL-cholesterol were more frequent in peritoneal dialysis patients than in hemodialysis patients.

  17. Assessing of Dialysis Adequacy in Patients under Hemodialysis in Dialysis Department of Ekbatan Hospital in Hamadan

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    E. Nadi

    2003-10-01

    Full Text Available Determining reduction proportion of blood urea in patients under hemodialysis in dialysis department of Ekbatan hospital and comparison between obtained results and standard scales. This study was descriptive, cross - Sectional. In this study the number of 100 patient under dialysis in were evaluated and their blood samples were accumitated before and after dialysis and were transferred to the laboratory. Results were calculated by BUN formula, meanwhile the other parameters as, the time of dialysis, speed of blood circulation, percentage of filter clearance, patient weight before and after dialysis, blood pressure before and after dialysis, also evaluated and registered. To consider the obtained results from BUN calculations we found out that 10% of individuals have URR 65%. In that the results are in accord with standard scales, and revealed adequate dialysis. About 34% were near accepted range (55%-64%. The rest of individuals about 56% were lower than accepted URR.

  18. Effect of different kinds of blood purification with implosive therapy of calcitriol for renal osteopathy in patients with maintenance hemodialysis%不同血液净化方式联合骨化三醇冲击治疗对维持性血液透析患者肾性骨病的治疗效果

    Institute of Scientific and Technical Information of China (English)

    孙培荣; 马列清; 刘静; 张军; 李德新; 王凡

    2015-01-01

    目的 观察不同血液净化方式联合骨化三醇冲击治疗对维持性血液透析患者肾性骨病的疗效,探讨治疗肾性骨病的最佳方案.方法 将45例符合标准的患者按数字表法随机分为3组,每组15例.普通透析组接受血液透析治疗;血液透析滤过组接受血液透析滤过治疗,每2周1次;血液透析灌流组接受血液透析联合血液灌流治疗,每2周1次.所有患者均使用骨化三醇冲击治疗.检测治疗0、1、3个月血清钙、磷、甲状旁腺素水平.结果 治疗前3组患者血清钙、磷、甲状旁腺素水平差异无统计学意义(P>0.05).治疗1个月及3个月后,血液透析组患者血钙、血磷下降水平,三组间两两比较差异无统计学意义(P>0.05).血液透析组甲状旁腺素水平治疗1个月及3个月与治疗前比较差异无统计学意义(P>0.05);治疗3个月与治疗前及治疗1个月比较差异有统计学意义(P<0.05).血液透析滤过组和血液透析灌流组甲状旁腺素水平治疗1个月、3个月与治疗前比较明显下降,差异有统计学意义(P<0.05),治疗3个月与治疗1个月比较,差异有统计学意义(P<0.05).血液透析灌流组甲状旁腺素水平治疗3个月和治疗1个月比较,差异无统计学意义(P>0.05).治疗3个月时,甲状旁腺素水平血液透析滤过组与血液透析灌流组比较差异有统计学意义(P<0.05).结论 对维持性血液透析肾性骨病的患者而言,血液透析滤过及血液透析灌流联合骨化三醇冲击治疗可以有效控制肾性骨病.%Objective To observe the effect of different kinds of blood purification with implosive therapy of calcitriol for renal osteopathy in patients with maintenance hemodialysis(MDH).Methods Fortyfive patients of MDH with renal osteopathy who received implosive therapy of calcitriol were randomly individed into three groups,with 15 patients in each group.The A group received conventional hemodialysis (HD).The B group

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

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    Amel Harzallah

    2015-01-01

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

  20. Hemodialysis catheter related rhodococcus bacteremia in immunocompetent host

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    Pranav Dalal

    2011-01-01

    Full Text Available Rhodococcus equi (R. equi is an uncommon cause of infection in immunocompetent individuals. We describe a case of R. equi bacteremia associated with hemodialysis (HD catheter in an immunocompetent patient. A 38-year-old female with end-stage renal disease (ESRD of uncertain etiology, on HD for the past 15 months who was previously healthy otherwise, was admitted with the complaints of intermittent fever, mild nausea and occasional vomiting for two weeks. Last HD was performed four days earlier through a tunneled right internal jugular permacath. Clinically the patient was afebrile and in no acute distress. She was hemodynamically stable with no peripheral stigmata of an endovascular infection. Physical examination was essentially normal. Initially, the patient was treated with intravenous vancomycin with each HD, retaining the catheter. However, due to persistently positive blood cultures, HD catheter had to be removed. The patient became afebrile and nausea and vomiting resolved. She improved clinically, and repeated surveillance blood cultures done after the removal of catheter were reported negative. Subsequently, a new HD catheter was inserted for her. Although R. equi is an uncommon cause of infection in immunocompetent individuals, it does occur with considerable mortality and morbidity, and a high index of clinical suspicion is required to recognize this infection in immunocompetent individuals.

  1. 血培养和血清降钙素原检测对血流感染者早期诊治的临床价值%Clinical value of procalcitonin detection and blood culture in early diagnosis of blood stream infection

    Institute of Scientific and Technical Information of China (English)

    李明友; 林茂锐; 黄基伟; 刘桂治; 杨华文; 钟丽梅

    2015-01-01

    目的:探讨血培养和血清降钙素原(PC T )联合检测对血流感染患者早期诊治的临床价值。方法对625例患者血标本用酶联荧光分析法(ELFA)测定血清PCT ,同时进行血培养,并对23例血培养阳性的重症患者血清PCT 进行多次检测和结果分析。结果血培养结果为阴性的患者(阴性组)PC T阳性率为41.01%(0.05~2.58μg/L ),血培养结果为阳性的患者(阳性组)PC T阳性率为80.77%(0.05~200.00μg/L )。阳性组 PC T 阳性率高于阴性组,差异有统计学意义(χ2=65.12,P<0.01)。假丝酵母菌、多种细菌、革兰阴性杆菌和革兰阳性球菌感染患者的PC T阳性率分别为100.00%、100.00%、92.11%和56.81%。对23例血培养阳性的重症患者进行了多次PC T检测,治疗过程中PC T水平逐渐降低者预后较好,PC T>10μg/L且持续维持高水平者,其预后较差。结论同时进行血培养和PC T检测对血流感染患者的早期诊治有着重要的临床价值。%Objective To explore the clinical value of procalcitonin (PCT ) and blood culture in the united diagnosis of early blood stream infection .Methods The blood specimens of 625 patients were collected ,the serum level of PCT was detected by EL‐FA ,and the blood culture was accessed at the same time .23 cases of blood culture positive samples were received continuous detec‐tion of PCT ,and the results were analyzed .Results Positive rate of PCT was 41 .01% (0 .05 -2 .58 μg/L)in patients with blood culture negative results (negative group) ,and that in patients with blood culture positive results (positive group) was 80 .77%(0 .05-200 .00 μg/L) .The positive rate of PCT in positive group was significantly higher than negative group (χ2 =65 .12 ,P<0 .01) .Positive rates of PCT in patients with infection of Candida tropicalis ,kinds of bacteria ,Gram‐negative bacilli and Gram‐posi‐tive cocci

  2. 2004 Japanese Society for Dialysis Therapy guidelines for renal anemia in chronic hemodialysis patients.

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

    2004-12-01

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

  3. Vitamin D deficiency in hemodialysis patients

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    Beena Bansal

    2012-01-01

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

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

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    Lorraine S Dias

    2011-01-01

    Full Text Available The treatment of baclofen overdose is primarily supportive. There have been case reports of hemodialysis being used in patients with chronic kidney disease with baclofen overdose. A case report of hemodialysis in a baclofen-overdose patient with normal renal function is presented. Review of literature has also been provided.

  5. Strategies to Reduce Hemodialysis Catheter-related Complications

    NARCIS (Netherlands)

    Weijmer, M.C.

    2007-01-01

    The objective of the studies presented in this thesis was to reduce hemodialysis catheter-related complications by studying the influence of the following issues. In Chapter 3 we address the best cannulation site once the time period a hemodialysis catheter is needed has been estimated. We showed t

  6. Complication of hemodialysis access (pseudoaneurysm: a case report.

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    Mahmood Hosseinzadeh Maleki

    2014-02-01

    Full Text Available The number of patients with end-stage renal disease has steadily increased and improvements in hemodialysis techniques have lead to extended life expectancy. Pseudoaneurysm is a relatively rare complication of autogenous vascular access. We have reported a case in which an anastomotic pseudoaneurysm developed in a patient on hemodialysis treatment.

  7. Hepatitis C viral infection in a Chinese hemodialysis unit

    Institute of Scientific and Technical Information of China (English)

    LI Han; WANG Shi-xiang

    2010-01-01

    Background The prevalence of hepatitis C virus (HCV) infection among maintenance hemodialysis (MHD) patients varies among countries and among dialysis units within a single country. The present study aimed to investigate the prevalence and characteristics of HCV infection in MHD patients in a Chinese hemodialysis unit.Methods One hundred and ninety-two patients on MHD for an average of (86.1±30.0) months (range 6-181 months) were enrolled in this cross-sectional study. HCV antibody and HCV-RNA were measured in these MHD patients before hemodialysis by enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR) methods.According to the result, all the patients were then divided into two groups: GroupⅠwas positive for HCV antibody and/or HCV-RNA (n=32), and Group Ⅱ was negative for HCV antibody and HCV-RNA (n=160). The following information was obtained for all the patients: socio-demographic data, history of blood transfusions and kidney transplantation, and some laboratory values. The MHD patients who were positive for HCV antibody and/or HCV-RNA were followed for more than three years. The disease activities were graded into "asymptomatic" if alanine aminotransferase (ALT) was less than 40 U/L,"low activities" if ALT was 40-79 U/L, and "high activities" if ALT was equal to or above 80 U/L.Results The prevalence of HCV infection in MHD patients in our dialysis unit in May 2009 was 16.7, which was significantly higher than in general population (3.2%). Among the 32 MHD patients with HCV positive, 20 patients were positive for HCV antibody but negative for HCV-RNA, eight patients were positive both for HCV antibody and HCV-RNA,four patients were negative for HCV antibody but positive for HCV-RNA. Eleven patients had a history of kidney transplantation and 12 had a history of blood transfusion, which were significantly more than among the MHD patients without HCV. Thirty of the 32 MHD patients were asymptomatic. There were no significant

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

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    Vikas

    2014-10-01

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

  9. Korean Red Ginseng Improves Blood Pressure Stability in Patients with Intradialytic Hypotension

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    I-Ju Chen

    2012-01-01

    Full Text Available Introduction. Intradialytic hypotension (IDH is a common complication during hemodialysis which may increase mortality risks. Low dose of Korean red ginseng (KRG has been reported to increase blood pressure. Whether KRG can improve hemodynamic stability during hemodialysis has not been examined. Methods. The 8-week study consisted of two phases: observation phase and active treatment phase. According to prehemodialysis blood pressure (BP, 38 patients with IDH were divided into group A (BP ≥ 140/90 mmHg, n = 18 and group B (BP < 140/90 mmHg, n = 20. Patients were instructed to chew 3.5 gm KRG slices at each hemodialysis session during the 4-week treatment phase. Blood pressure changes, number of sessions disturbed by symptomatic IDH, plasma levels of vasoconstrictors, blood biochemistry, and adverse effects were recorded. Results. KRG significantly reduced the degree of blood pressure drop during hemodialysis (P<0.05 and the frequency of symptomatic IDH (P<0.05. More activation of vasoconstrictors (endothelin-1 and angiotensin II during hemodialysis was found. The postdialytic levels of endothelin-1 and angiotensin II increased significantly (P<0.01. Conclusion. Chewing KRG renders IDH patients better resistance to acute BP reduction during hemodialysis via activation of vasoconstrictors. Our results suggest that KRG could be an adjuvant treatment for IDH.

  10. Designing a model to minimize inequities in hemodialysis facilities distribution

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    Teresa M. Salgado

    2011-11-01

    Full Text Available Portugal has an uneven, city-centered bias in the distribution of hemodialysis centers found to contribute to health care inequities. A model has been developed with the aim of minimizing access inequity through the identification of the best possible localization of new hemodialysis facilities. The model was designed under the assumption that individuals from different geographic areas, ceteris paribus, present the same likelihood of requiring hemodialysis in the future. Distances to reach the closest hemodialysis facility were calculated for every municipality lacking one. Regions were scored by aggregating weights of the “individual burden”, defined as the burden for an individual living in a region lacking a hemodialysis center to reach one as often as needed, and the “population burden”, defined as the burden for the total population living in such a region. The model revealed that the average travelling distance for inhabitants in municipalities without a hemodialysis center is 32 km and that 145,551 inhabitants (1.5% live more than 60 min away from a hemodialysis center, while 1,393,770 (13.8% live 30-60 min away. Multivariate analysis showed that the current localization of hemodialysis facilities is associated with major urban areas. The model developed recommends 12 locations for establishing hemodialysis centers that would result in drastically reduced travel for 34 other municipalities, leaving only six (34,800 people with over 60 min of travel. The application of this model should facilitate the planning of future hemodialysis services as it takes into consideration the potential impact of travel time for individuals in need of dialysis, as well as the logistic arrangements required to transport all patients with end-stage renal disease. The model is applicable in any country and health care planners can opt to weigh these two elements differently in the model according to their priorities.

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

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    Savaş SİPAHİ

    2012-01-01

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

  12. Why does three times per week hemodialysis provide inadequate dialysis for children?

    Science.gov (United States)

    Fischbach, Michel; Zaloszyc, Ariane; Laetitia, Higel; Menouer, Soraya; Terzic, Joelle

    2014-10-01

    The duration of chronic conventional dialysis is a risk factor in children, both in terms of growth retardation and cardiovascular morbidity and mortality. Therefore, we need to develop alternative strategies, such as preemptive kidney transplantation and/or more intensive dialysis prescription. Indeed, conventional hemodialysis could be improved in all children by the use of high permeable membrane and ultrapure dialysis fluids (having very low endotoxin levels); by the addition of a convective dialysis dose to the urea diffusion dialysis dose (Kt/Vurea), i.e., hemodiafiltration; moreover, by the preservation of cardiovascular morphology and function (optimized blood pressure control); and also by the prescription of more frequent/longer dialysis sessions.

  13. Subphrenic Abscess as a Complication of Hemodialysis Catheter-Related Infection

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    Fernando Caravaca

    2014-01-01

    Full Text Available We describe an unusual case of subphrenic abscess complicating a central venous catheter infection caused by Pseudomonas aeruginosa in a 59-year-old woman undergoing hemodialysis. The diagnosis was made through computed tomography, and Pseudomonas aeruginosa was isolated from the purulent drainage of the subphrenic abscess, the catheter tip and exit site, and the blood culture samples. A transesophageal echocardiography showed a large tubular thrombus in superior vena cava, extending to the right atrium, but no evidence of endocarditis or other metastatic infectious foci. Catheter removal, percutaneous abscess drainage, anticoagulation, and antibiotics resulted in a favourable outcome.

  14. Clinical analysis of Acinetobacter baumannii blood stream infections in 25 patients%25例鲍氏不动杆菌血流感染临床分析

    Institute of Scientific and Technical Information of China (English)

    陈柱; 张丽; 李媛媛; 韩娜; 张民伟

    2013-01-01

    susceptibility rate to tigecycline was the highest (100. 0%), amikacin more than 90. 0%, and other antibiotics less than 40. 0%. There were totally 14 (56. 0%) strains of pandrug-resistant isolates. As compared with the pandrug-resistant strains and non-pandrug-resistant strains, the differences in the use of carbapenems antibiotics two weeks before the blood cultured positive and the invasive operation were statistically significant (P<0. 05). CONCLUSION The pandrug-resistant strains take a large proportion of the A. baumannii isolates causing bloodstream infections, the mortality of the patients is high. The old age, invasive operation, and more than 2 weeks of hospital stay are the common predisposing factors. The use of carbapenems antibiotics and invasive operation may be high-risk factors for the pan-drug resistant cases.

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

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    Selm Salem

    2010-01-01

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

  16. Correlation between intraocular pressure and the biometric structure of the anterior chamber in patients of chronic renal failure with hemodialysis

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    Zhi-Ying Yu

    2017-02-01

    Full Text Available AIM: To investigate the correlation between intraocular pressure(IOPchanges pre- and post-hemodialysis(HDand the biometric structure of the anterior chamber in patients of chronic renal failure. METHODS: Fifty-two patients(take right eye as study onewith hemodialysis that were diagnosed with chronic renal failure by nephrology in our hospital from January 2015 to December 2015 were collected. Fifty-two eyes were divided into four groups based on Shaffer classification combined with ultrasound biomicroscopy(UBMand gonioscopy manifestations: wide angle group, narrow angle group, extremely narrow group and close angle group. Venous blood was collected to get plasma colloid osmotic pressure before HD and within 60s after HD. IOP was measured with rebound intraocular pressure gauge in a supine positon approximately 30min before starting HD, 2h after HD begin and approximately 30min after HD ending. Approximately 30min before and after HD, central corneal thickness was measured with corneal endothelial cell counter, central anterior chamber depth and lens thickness were taken by A scan, angle opening distance, trabecular iris angle, iris thickness and ciliary body thickness were measured by UBM. RESULTS: Plasma osmotic pressure reduced after HD, the difference was statistically significant(t=3.04, PF=41.69, PPPF=6.44, PPt=2.61, PCONCLUSION: The influence of hemodialysis on IOP is related to the biometric structure of the anterior chamber. And extremely narrow angle is risk factor of elevated IOP during hemodialysis, narrow angle may be a risk factor. While patients with wide angle is relatively safe. We suggest to take ocular examination as early as possible for patients with hemodialysis, and focus on patients with narrow angle.

  17. 血液透析面临的问题与挑战%The problem and challenge faced by hemodialysis

    Institute of Scientific and Technical Information of China (English)

    孙雪峰

    2015-01-01

    虽然血液透析应用于临床治疗已经90余年,成为急、慢性肾衰竭的最主要治疗手段,但仍然存在许多问题与挑战。在我国,伴随血液透析患者的快速增加,将给我国医疗保障体系带来严重挑战,亟待加快社会资金参入和培养合格的血液透析医护人员。从血液透析的基本技术层面看,血液透析开始的最佳时机?血管通路是否一定要优先选择血管内瘘?血液透析患者的适宜透析液钙浓度?目前尚存争议。从血液透析并发症防治层面看,透析患者血压控制靶目标?甲状旁腺激素控制的靶目标?目前也无定论。本文将结合现有文献证据进行评述,为临床医生的临床实践提供借鉴。%Although hemodialysis has been applied to clinical treatment for more than 90 years and become the main treatment for patients with acute and chronic renal failures,nephrologists are still faced with many problems and challenges.The rapid increase of hemodialysis patients in our country will bring serious challenges to China′s health care,which is in urgent need of being supported by more social capital participation and cultivation of qualified hemodialysis medical workers.There are still controversies.From the basic technical level of hemodialysis:when is the best time for hemodialysis initiation?Is intravascular fistula definitely the first choice of vascular access?What is the suitable calcium concentration of dialysate for hemodialysis patients?Besides,from the aspect of prevention and treatment of hemodialysis complications in dialysis patients:what is the target of blood pressure control?How about the target for parathyroid hormone control?In this article,the existing literature evidence was reviewed in order to provide reference for clinical doctors in clinical practice.

  18. Hepatitis C prevalence and risk factors in hemodialysis patients in Central Brazil: a survey by polymerase chain reaction and serological methods

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    Carneiro Megmar AS

    2001-01-01

    Full Text Available An hemodialysis population in Central Brazil was screened by polymerase chain reaction (PCR and serological methods to assess the prevalence of hepatitis C virus (HCV infection and to investigate associated risk factors. All hemodialysis patients (n=428 were interviewed in eight dialysis units in Goiânia city. Blood samples were collected and serum samples screened for anti-HCV antibodies by an enzyme-linked immunosorbent assay (ELISA. Positive samples were retested for confirmation with a line immunoassay (LIA. All samples were also tested for HCV RNA by the PCR. An overall prevalence of 46.7% (CI 95%: 42-51.5 was found, ranging from 20.7% (CI 95%: 8.8-38.1 to 90.4% (CI 95%: 79.9-96.4 depending on the dialysis unit. Of the 428 patients, 185 were found to be seropositive by ELISA, and 167 were confirmed positive by LIA, resulting in an anti-HCV prevalence of 39%. A total of 131 patients were HCV RNA-positive. HCV viremia was present in 63.5% of the anti-HCV-positive patients and in 10.3% of the anti-HCV-negative patients. Univariate analysis of risk factors showed that the number of previous blood transfusions, transfusion of blood before mandatory screening for anti-HCV, length of time on hemodialysis, and treatment in multiple units were associated with HCV positivity. However, multivariate analysis revealed that blood transfusion before screening for anti-HCV and length of time on hemodialysis were significantly associated with HCV infection in this population. These data suggest that nosocomial transmission may play a role in the spread of HCV in the dialysis units studied. In addition to anti-HCV screening, HCV RNA detection is necessary for the diagnosis of HCV infection in hemodialysis patients.

  19. Different kinds of blood purification with implosive therapy of calcitriol for influence of renal osteopathy index of maintenance hemodialysis patients%不同血液净化方式联合骨化三醇冲击治疗对维持性血液透析患者肾性骨病指标的影响及意义

    Institute of Scientific and Technical Information of China (English)

    童昌军

    2011-01-01

    目的 通过观察不同血液净化方式联合骨化三醇冲击治疗对维持性血液透析患者肾性骨病指标的影响,探讨肾性骨病合适的治疗方案.方法 将60例符合标准的患者按随机数字表法分为3组,每组20例.所有患者采用骨化三醇冲击治疗,使用低钙透析液.普通透析组患者采用常规透析,血液透析滤过组患者采用血液透析滤过治疗,每周透析3次,其中血液透析滤过治疗每周1次.血液透析灌流组患者采用血液透析联合血液灌流治疗,每周透析3次,其中血液透析联合血液灌流治疗每周1次.结果 3组患者使用不同透析方式联合药物治疗3个月后发现,治疗前3组患者血钙、血磷、血甲状旁腺激素水平比较差异无统计学意义(P>0.05),治疗后1个月血液透析灌流组患者血磷与普通透析组患者比较差异有统计学意义(P<0.05),而血液透析滤过组患者的血磷与普通透析组比较差异无统计学意义(P>0.05);治疗后3个月血液透析滤过组和血液透析组患者的血甲状旁腺激素、血磷、血钙水平与普通透析组比较差异也有统计学意义(P<0.05),而血液透析滤过组和血液透析灌流组间血甲状旁腺激素、血磷、血钙水平比较差异无统计学意义(P>0.05).结论 对于维持性血液透析的患者存在高磷血症以及继发性甲状旁腺激素的升高等肾性骨病的指标异常,可以应用血液透析滤过以及血液透析联合血液灌流治疗,且安全可行.%Objective TO observe different kinds of blood purification with implosive therapy of calcitriol for influence of Renal Osteopathy index of Maintenance hemodialysis (MHD) patients,discuss the appropriate treatment for Renal Osteopathy.Methods 60 patients who were according with the standard divided into three groups randomly,20 patients each group,implosive therapy of calcitriol,using low calcium dialysate,the A group using conventional dialysis,the B group

  20. 干体重控制及低钠透析对血透患者高血压控制的作用%Effect of reducing dry body weight and decreasing dialysate sodium concentration on blood pressure control in maintenance hemodialysis patients

    Institute of Scientific and Technical Information of China (English)

    刘婧; 刘冬雪; 周亦伦; 孙芳; 马丽洁; 沈洋; 黄静; 崔太根

    2012-01-01

    Objective To explore the possible effect of individualized therapeutic interventions on blood pressure control in maintenance hemodialysis patients. Methods Home blood pressure monitoring was carried out in stable maintenance HD patients in our center, systolic blood pressure (Home-SBP) 3> 150 mmHg was defined as uncontrolled hypertension. Those with uncontrolled hypertension were subject to bioimpendance analysis, serum sodium measurement, and antihypertensive agents evaluation. Individualized interventions including reducing dry body weight, negative sodium gradient dialysis and re-adjusting antihypertensive agents were applied accordingly. The patients were followed for 2 months, and home -BP was monitored. Results 105 HD patients in total had their home-BP monitored, sixty patients were determined as uncontrolled hypertension (57.1%). Thirty over-hydrated patients had their dry body weight reduced under guidance of bioimpedance technique, which resulted in significant decrease in Home-SBP (12 mmHg, P< 0.001), Home-DBP (5 mmHg, P = 0.002) and dose of antihypertensive agents (P= 0.030). Twelve patients with their serum sodium level lower than dialysate sodium were subject to negative sodium gradient dialysis, significant decrease in Home-SBP (14.0 mmHg, P = 0.003), Home-DBP (8.1 mmHg, P = 0.014) were discovered. The other 18 patients had their Home-SBP and Home-DBP significantly reduced (11.6 mmHg, P < 0.001; 4.2 mmHg, P = 0.021) by re-adjusting antihypertensive drugs. The overall percentage of uncontrolled hypertension was decreased to 31.4% (P < 0.001) at the end of study. Conclusion Application of individualized therapeutic interventions in hypertensive HD patients is helpful in improving overall BP control.%目的 探索基于不同病因的个体化治疗模式对改善血液透析(HD)患者高血压控制率的影响.方法 选取我院部分稳定维持性HD患者进行家庭血压(Home-BP)监测,以家庭血压的收缩压(Home-SBP)≥150 mmHg为未控

  1. Cardioprotective medication use in hemodialysis patients

    Science.gov (United States)

    Miller, Lisa M; Hopman, Wilma M; Garland, Jocelyn S; Yeates, Karen E; Pilkey, Rachel M

    2006-01-01

    BACKGROUND Cardiovascular disease is the leading cause of mortality in patients with renal failure, accounting for more than 50% of deaths in end-stage renal disease. Risk factor modification with the use of cardioprotective medications such as angiotensin-converting enzyme inhibitors (ACEIs), beta-adrenergic antagonists (beta-blockers), acetylsalisylic acid (ASA) and 3-hydroxy-3-methyl-glutaryl coenzyme A reductase inhibitors (statins) has been shown to reduce mortality in the general population. OBJECTIVE To determine the extent of use of these medications in a hemodialysis population. METHODS This was a cross-sectional study of a cohort of 185 prevalent hemodialysis patients. The inclusion criterion was dialysis dependence and there were no exclusion criteria. Data collection was by chart review. Contraindications to individual medication classes were not obtained. RESULTS There were 185 patients enrolled, the mean age was 63.42±15.1 years and 126 (68.1%) were male. Sixty-six (35.7%) patients had diabetes and 89 (48.1%) patients had established coronary artery disease (CAD). Forty-six (24.9%) patients were on ACEIs or angiotensin II receptor blockers, 59 (31.9%) were on beta-blockers, 70 (37.8%) were on ASA and 84 (45.4%) were on statins. Although these medications were used in fewer than 60% of patients, those with CAD were more likely to be prescribed an ACEI or an angiotensin II receptor blocker (P=0.026), a beta-blocker (P<0.001), ASA (P<0.001) or a statin (P=0.001) than those without CAD. There were no differences in the use of these medications between diabetic and nondiabetic patients. CONCLUSIONS Many hemodialysis patients are not prescribed cardioprotective medications. Given the high cardiovascular mortality in this high-risk population, more attention to reducing cardiovascular risk is warranted. PMID:16835669

  2. Functional Status of Patients on Maintenance Hemodialysis

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    Akash Nabil

    1999-01-01

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

  3. Endovascular treatment of hemodialysis access pseudoaneurysms.

    Science.gov (United States)

    Shah, Aamir S; Valdes, Jaime; Charlton-Ouw, Kristofer M; Chen, Zhongxue; Coogan, Sheila M; Amer, Hammad M; Estrera, Anthony L; Safi, Hazim J; Azizzadeh, Ali

    2012-04-01

    Pseudoaneurysm (PSA) formation is a complication of hemodialysis access. Open repair requires PSA resection, interposition graft placement, and insertion of a catheter as a bridge. Endovascular stent graft repair is an alternative that permits immediate use of the access site. The objective of this study was to determine the efficacy of stent grafts for repair of arteriovenous fistula and arteriovenous graft PSA. A retrospective review of medical records from October 2007 to March 2011 revealed 24 patients with a PSA who underwent endovascular repair using a stent graft. Indications for repair included PSA with symptoms (n = 11), PSA with skin erosion (n = 8), PSA with failed hemodialysis (n = 3), and PSA after balloon angioplasty of a stenosis (n = 2). Outcome measures were technical success, 30-day and 180-day patency, secondary interventions, and complications. All the statistical analyses were conducted by using software SAS 9.1 (SAS, SAS Institute, Gary, NC). Twenty-seven self-expanding stent grafts (Viabahn, W. L. Gore, n = 25; Fluency, Bard, n = 2) were used to treat hemodialysis access (arteriovenous graft, n = 13; arteriovenous fistula, n = 11) PSA in 24 patients (16 females; mean age, 55.7 years; mean body mass index, 28.4; mean PSA diameter, 19.5 mm). Comorbidities included hypertension (n = 22; 91.7%), diabetes mellitus (n = 8; 33.3%), and coronary artery disease (n = 4; 16.67%). The median time from access creation to repair was 455 days. The technical success rate was 100%. Balloon angioplasty of an outflow stenosis was performed in 56% of stent grafts. The 30- and 180-day patency rate was 100% and 69.2%, respectively. Three secondary interventions were performed for treatment of unrelated stenosis. Treatment failure occurred in five (18.5%) stent grafts due to infection (n = 3) and thrombosis (n = 2). Treatment of PSA with skin erosion was associated with failure due to infection (odds ratio, 5.0; 95% confidence interval, .38, 66.01). The remaining

  4. Incremental Hemodialysis: The University of California Irvine Experience.

    Science.gov (United States)

    Ghahremani-Ghajar, Mehrdad; Rojas-Bautista, Vanessa; Lau, Wei-Ling; Pahl, Madeleine; Hernandez, Miguel; Jin, Anna; Reddy, Uttam; Chou, Jason; Obi, Yoshitsugu; Kalantar-Zadeh, Kamyar; Rhee, Connie M

    2017-05-01

    Incremental hemodialysis has been examined as a viable hemodialysis regimen for selected end-stage renal disease (ESRD) patients. Preservation of residual kidney function (RKF) has been the driving impetus for this approach given its benefits upon the survival and quality of life of dialysis patients. While clinical practice guidelines recommend an incremental start of dialysis in peritoneal dialysis patients with substantial RKF, there remains little guidance with respect to incremental hemodialysis as an initial renal replacement therapy regimen. Indeed, several large population-based studies suggest that incremental twice-weekly vs. conventional thrice-weekly hemodialysis has favorable impact upon RKF trajectory and survival among patients with adequate renal urea clearance and/or urine output. In this report, we describe a case series of 13 ambulatory incident ESRD patients enrolled in a university-based center's Incremental Hemodialysis Program over the period of January 2015 to August 2016 and followed through December 2016. Among five patients who maintained a twice-weekly hemodialysis schedule vs. eight patients who transitioned to thrice-weekly hemodialysis, we describe and compare patients' longitudinal case-mix, laboratory, and dialysis treatment characteristics over time. The University of California Irvine Experience is the first systemically examined twice-weekly hemodialysis practice in North America. While future studies are needed to refine the optimal approaches and the ideal patient population for implementation of incremental hemodialysis, our case-series serves as a first report of this innovative management strategy among incident ESRD patients with substantial RKF, and a template for implementation of this regimen. © 2017 Wiley Periodicals, Inc.

  5. Benefits and implementation of home hemodialysis: A narrative review

    Directory of Open Access Journals (Sweden)

    Ayman Karkar

    2015-01-01

    Full Text Available Home hemodialysis (HD is a modality of renal replacement therapy that can be safely and independently performed at home by end-stage renal disease (ESRD patients. Home HD can be performed at the convenience of the patients on a daily basis, every other day and overnight (nocturnal. Despite the great and many perceived benefits of home HD, including the significant improvements in health outcomes and resource utilization, the adoption of home HD has been limited; lack or inadequate pre-dialysis education and training constitute a major barrier. The lack of self-confidence and/or self-efficacy to manage own therapy, lack of family and/or social support, fear of machine and cannulation of blood access and worries of possible catastrophic events represent other barriers for the implementation of home HD besides inadequate competence and/or expertise in caring for home HD patients among renal care providers (nephrologists, dialysis nurses, educators. A well-studied, planned and prepared and carefully implemented central country program supported by adequate budget can play a positive role in overcoming the challenges to home HD. Healthcare authorities, with the increasingly financial and logistic demands and the relatively higher mortality and morbidity rates of the conventional in-center HD, should tackle home HD as an attractive and cost-effective modality with more freedom, quality of life and improvement of clinical outcomes for the ESRD patients.

  6. New Options for Iron Supplementation in Maintenance Hemodialysis Patients.

    Science.gov (United States)

    Vaziri, Nosratola D; Kalantar-Zadeh, Kamyar; Wish, Jay B

    2016-03-01

    End-stage renal disease results in anemia caused by shortened erythrocyte survival, erythropoietin deficiency, hepcidin-mediated impairment of intestinal absorption and iron release, recurrent blood loss, and impaired responsiveness to erythropoiesis-stimulating agents (ESAs). Iron malabsorption renders oral iron products generally ineffective, and intravenous (IV) iron supplementation is required in most patients receiving maintenance hemodialysis (HD). IV iron is administered at doses far exceeding normal intestinal iron absorption. Moreover, by bypassing physiologic safeguards, indiscriminate use of IV iron overwhelms transferrin, imposing stress on the reticuloendothelial system that can have long-term adverse consequences. Unlike conventional oral iron preparations, ferric citrate has recently been shown to be effective in increasing serum ferritin, hemoglobin, and transferrin saturation values while significantly reducing IV iron and ESA requirements in patients treated with HD. Ferric pyrophosphate citrate is a novel iron salt delivered by dialysate; by directly reaching transferrin, its obviates the need for storing administered iron and increases transferrin saturation without increasing serum ferritin levels. Ferric pyrophosphate citrate trials have demonstrated effective iron delivery and stable hemoglobin levels with significant reductions in ESA and IV iron requirements. To date, the long-term safety of using these routes of iron administration in patients receiving HD has not been compared to IV iron and therefore awaits future investigations.

  7. Innovative strategy with potential to increase hemodialysis efficiency and safety

    Science.gov (United States)

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

    2014-03-01

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

  8. Benefits and implementation of home hemodialysis: A narrative review.

    Science.gov (United States)

    Karkar, Ayman; Hegbrant, Jörgen; Strippoli, Giovanni F M

    2015-11-01

    Home hemodialysis (HD) is a modality of renal replacement therapy that can be safely and independently performed at home by end-stage renal disease (ESRD) patients. Home HD can be performed at the convenience of the patients on a daily basis, every other day and overnight (nocturnal). Despite the great and many perceived benefits of home HD, including the significant improvements in health outcomes and resource utilization, the adoption of home HD has been limited; lack or inadequate pre-dialysis education and training constitute a major barrier. The lack of self-confidence and/or self-efficacy to manage own therapy, lack of family and/or social support, fear of machine and cannulation of blood access and worries of possible catastrophic events represent other barriers for the implementation of home HD besides inadequate competence and/or expertise in caring for home HD patients among renal care providers (nephrologists, dialysis nurses, educators). A well-studied, planned and prepared and carefully implemented central country program supported by adequate budget can play a positive role in overcoming the challenges to home HD. Healthcare authorities, with the increasingly financial and logistic demands and the relatively higher mortality and morbidity rates of the conventional in-center HD, should tackle home HD as an attractive and cost-effective modality with more freedom, quality of life and improvement of clinical outcomes for the ESRD patients.

  9. Development of a novel catheter preventing the outflow of debris and thrombus on percutaneous transluminal angioplasty for hemodialysis access fistulas.

    Science.gov (United States)

    Horita, Yuki; Namura, Masanobu; Matsumura, Masami

    2006-06-01

    If a large amount of debris or thrombus dislodges from a lesion because of dilation of the stenotic or occluded lesion in the hemodialysis access fistula when angioplasty is performed, it may move into the pulmonary artery via the central vein, resulting in pulmonary embolism. A novel sheath has been developed to prevent the outflow of debris or thrombus to the central vein. The catheter consists of a 5 F sheath introducer and a silicone balloon attached at the tip of the sheath. The silicon balloon is inflated via small inflation lumen on the shaft wall of the sheath. In the case of percutaneous transluminal angioplasty (PTA), the silicone balloon is inflated to block the blood flow by a mixture of contrast medium and physiological saline, and then dilate a stenotic or occluded lesion by PTA balloon. Next, the debris and thrombus are aspirated using the flush-lumen of this device. Finally, the silicone balloon is deflated and the dilation of the lesion is confirmed. A case of hemodialysis access fistula graft with massive thrombotic occlusion was presented. This device enabled Fogarty procedure using PTA balloon and the blood flow of the graft was completely improved and a large amount of thrombus was removed. This novel device is useful to prevent the embolic complication of the intervention for hemodialysis access fistula. Copyright 2006 Wiley-Liss., Inc.

  10. Prioritized Contact Transport Stream

    Science.gov (United States)

    Hunt, Walter Lee, Jr. (Inventor)

    2015-01-01

    A detection process, contact recognition process, classification process, and identification process are applied to raw sensor data to produce an identified contact record set containing one or more identified contact records. A prioritization process is applied to the identified contact record set to assign a contact priority to each contact record in the identified contact record set. Data are removed from the contact records in the identified contact record set based on the contact priorities assigned to those contact records. A first contact stream is produced from the resulting contact records. The first contact stream is streamed in a contact transport stream. The contact transport stream may include and stream additional contact streams. The contact transport stream may be varied dynamically over time based on parameters such as available bandwidth, contact priority, presence/absence of contacts, system state, and configuration parameters.

  11. StreamCat

    Data.gov (United States)

    U.S. Environmental Protection Agency — The StreamCat Dataset provides summaries of natural and anthropogenic landscape features for ~2.65 million streams, and their associated catchments, within the...

  12. In vitro utilization of ferromagnetic nanoparticles in hemodialysis therapy

    Science.gov (United States)

    Stamopoulos, D.; Benaki, D.; Bouziotis, P.; Zirogiannis, P. N.

    2007-12-01

    The in vitro utilization of biocompatible ferromagnetic nanoparticles (BFNs) in hemodialysis (HD), routinely used today for the treatment of end stage renal disease (ESRD), is introduced in this work. The proposed strategy is termed magnetically assisted hemodialysis (MAHD) and it aims to become a more efficient development of conventional HD. The method is based on the production of biocompatible ferromagnetic nanoparticles-targeted binding substances conjugates (BFNs-TBSs Cs) constructed of BFNs and specifically designed TBSs that should have high affinity and binding capacity for target toxic substances (TTSs) which must be removed from the ESRD patient subjected to HD. Antibodies or even specific proteins could serve as the TBS of the desired BFNs-TBSs Cs. The BFNs-TBSs Cs should be administered to the patient timely prior to the MAHD session so as to bind with the desired TTSs during their free circulation in the vascular network. Eventually, the complete BFNs-TBSs-TTSs structure can be selectively removed during the MAHD session by means of an external inhomogeneous magnetic field that is applied either at the dialyzer or at other collection point(s) along the blood circulation line of the dialysis machine. The advantages of MAHD over conventional HD regarding the patient's comfort and overall health status are discussed in detail among practical issues. To examine this proposition we employed Fe3O4 and bovine serum albumin (BSA) as the BFN and the TBS constituents respectively, since they are both highly biocompatible. By means of x-ray diffraction, atomic force microscopy, circular dichroism spectropolarimetry, UV-vis spectrophotometry, SQUID magnetometry, and nuclear magnetic resonance we evaluated (i) the structural/morphological characteristics, (ii) the magnetic retraction efficiency, and most importantly (iii) the toxin binding affinity and capacity of both bare Fe3O4 BFNs and Fe3O4-BSA Cs by performing in vitro experiments on specific TTSs

  13. In vitro utilization of ferromagnetic nanoparticles in hemodialysis therapy

    Energy Technology Data Exchange (ETDEWEB)

    Stamopoulos, D [Institute of Materials Science, NCSR ' Demokritos' , 153-10, Aghia Paraskevi, Athens (Greece); Benaki, D [Institute of Biology, NCSR ' Demokritos' , 153-10, Aghia Paraskevi, Athens (Greece); Bouziotis, P [Institute of Radioisotopes-Radiodiagnostic Products, NCSR ' Demokritos' , 153-10, Aghia Paraskevi, Athens (Greece); Zirogiannis, P N [Department of Nephrology, General Hospital ' G Gennimatas' , National Health System, 115-27, Athens (Greece)

    2007-12-12

    The in vitro utilization of biocompatible ferromagnetic nanoparticles (BFNs) in hemodialysis (HD), routinely used today for the treatment of end stage renal disease (ESRD), is introduced in this work. The proposed strategy is termed magnetically assisted hemodialysis (MAHD) and it aims to become a more efficient development of conventional HD. The method is based on the production of biocompatible ferromagnetic nanoparticles-targeted binding substances conjugates (BFNs-TBSs Cs) constructed of BFNs and specifically designed TBSs that should have high affinity and binding capacity for target toxic substances (TTSs) which must be removed from the ESRD patient subjected to HD. Antibodies or even specific proteins could serve as the TBS of the desired BFNs-TBSs Cs. The BFNs-TBSs Cs should be administered to the patient timely prior to the MAHD session so as to bind with the desired TTSs during their free circulation in the vascular network. Eventually, the complete BFNs-TBSs-TTSs structure can be selectively removed during the MAHD session by means of an external inhomogeneous magnetic field that is applied either at the dialyzer or at other collection point(s) along the blood circulation line of the dialysis machine. The advantages of MAHD over conventional HD regarding the patient's comfort and overall health status are discussed in detail among practical issues. To examine this proposition we employed Fe{sub 3}O{sub 4} and bovine serum albumin (BSA) as the BFN and the TBS constituents respectively, since they are both highly biocompatible. By means of x-ray diffraction, atomic force microscopy, circular dichroism spectropolarimetry, UV-vis spectrophotometry, SQUID magnetometry, and nuclear magnetic resonance we evaluated (i) the structural/morphological characteristics, (ii) the magnetic retraction efficiency, and most importantly (iii) the toxin binding affinity and capacity of both bare Fe{sub 3}O{sub 4} BFNs and Fe{sub 3}O{sub 4}-BSA Cs by performing in vitro

  14. On-line near-infrared spectrometer to monitor urea removal in real time during hemodialysis.

    Science.gov (United States)

    Cho, David S; Olesberg, Jonathon T; Flanigan, Michael J; Arnold, Mark A

    2008-08-01

    The ex vivo removal of urea during hemodialysis treatments is monitored in real time with a noninvasive near-infrared spectrometer. The spectrometer uses a temperature-controlled acousto optical tunable filter (AOFT) in conjunction with a thermoelectrically cooled extended wavelength InGaAs detector to provide spectra with a 20 cm(-1) resolution over the combination region (4000-5000 cm(-1)) of the near-infrared spectrum. Spectra are signal averaged over 15 seconds to provide root mean square noise levels of 24 micro-absorbance units for 100% lines generated over the 4600-4500 cm(-1) spectral range. Combination spectra of the spent dialysate stream are collected in real-time as a portion of this stream passes through a sample holder constructed from a 1.1 mm inner diameter tube of Teflon. Real-time spectra are collected during 17 individual dialysis sessions over a period of 10 days. Reference samples were extracted periodically during each session to generate 87 unique samples with corresponding reference concentrations for urea, glucose, lactate, and creatinine. A series of calibration models are generated for urea by using the partial least squares (PLS) algorithm and each model is optimized in terms of number of factors and spectral range. The best calibration model gives a standard error of prediction (SEP) of 0.30 mM based on a random splitting of spectra generated from all 87 reference samples collected across the 17 dialysis sessions. PLS models were also developed by using spectra collected in early sessions to predict urea concentrations from spectra collected in subsequent sessions. SEP values for these prospective models range from 0.37 mM to 0.52 mM. Although higher than when spectra are pooled from all 17 sessions, these prospective SEP values are acceptable for monitoring the hemodialysis process. Selectivity for urea is demonstrated and the selectivity properties of the PLS calibration models are characterized with a pure component selectivity

  15. Restless legs syndrome in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Shahram Rafie

    2016-01-01

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

  16. Pregnancy during Hemodialysis: A Single Center Experience

    Directory of Open Access Journals (Sweden)

    Bahadi Abdelali

    2010-01-01

    Full Text Available Successful pregnancy outcome is an uncommon occurrence in women requiring chronic dialysis treatment. We reviewed the course and outcome of 9 pregnancies occurred in women on chronic hemodialysis in our center from 1999-2007; 5 of them ended with delivery of alive newborns, 2 with fetal deaths in-utero, and 2 with abortions. The average age of patients was 34 years. The etiology of the original kidney disease was unknown in 44.4% of the cases, and only 22.2% of the patients maintained diuresis. Dialysis started in 8 cases before the diagnosis of pregnancy. The average gestational age at diagnosis was 14 weeks. We modified the prescription of dialysis in 4 patients by increasing the frequency of the dialysis sessions to 6 per week and in 3 by increasing the duration of each session to 6 hours. Anemia was present in all the cases; 3 patients received erythropoietin and 4 patients required transfusion. The pregnancy was com-plicated in 44% of the cases by a polyhydramnios. The average time at delivery was 33 weeks and it was achieved in 80% of pregnancies through vaginal route. The average weight of newborns was to 2380 g. We conclude that pregnancy in women on hemodialysis is possible. The success of pregnancy may be influenced by the residual diuresis and early diagnosis to improve the quality of dialysis by increasing the dialysis dose.

  17. Serum Protein Profile Alterations in Hemodialysis Patients

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-11-18

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

  18. Restless legs syndrome in hemodialysis patients.

    Science.gov (United States)

    Rafie, Shahram; Jafari, Majid; Azizi, Mostafa; Bahadoram, Mohammad; Jafari, Shima

    2016-03-01

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

  19. Querying JSON Streams

    OpenAIRE

    Bo, Yang

    2010-01-01

    A data stream management system (DSMS) is similar to a database management system (DBMS) but can search data directly in on-line streams. Using its mediator-wrapper approach, the extensible database system, Amos II, allows different kinds of distributed data resource to be queried. It has been extended with a stream datatype to query possibly infinite streams, which provides DSMS functionality. Nowadays, more and more web applications start to offer their services in JSON format which is a te...

  20. Effect of compoundα-keto acid tablets on nutritional status, calcium-phosphorus metabolism and inflammatory factors in patients with maintenance hemodialysis

    Institute of Scientific and Technical Information of China (English)

    Min-Hui Xi; Pei-Ju Mao; Dan-Huan Zhang; Ling-Yun Chen

    2015-01-01

    Objective:To investigate the effect of compoundα-keto acid tablets on nutritional status, calcium-phosphorus metabolism and inflammatory factors in patients with maintenance hemodialysis.Methods: 84 cases with maintenance hemodialysis were collected, according to the order of treatment were randomly divided into the observation group and control group, each of 42 cases. The control group was treated with maintenance hemodialysis, on the basis of this; the observation group was treated with compound-1α-keto acid tablets. The serum total protein(TP), serum albumin(ALB), hemoglobin (HB), transferrin (TRF), calcium (Ca), phosphorus (P), calcium phosphorus product (Ca×P), serum intact parathyroid hormone (iPTH), interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-alpha) and high sensitive C reactive protein (hs-CRP) of two groups were tested before and after treatment.Results:After treatment, the TP, ALB, HB, TRF of observation group were significantly higher than those in the control group (P<0.05), and blood P, blood Ca×P, serum iPTH were significantly lower than the control group (P<0.05), serum IL-6, TNF-alpha and hs-CRP levels were significantly lower than those of the control group (P<0.05).Conclusion:Compoundα-keto acid tablets can effectively improve the nutritional status of hemodialysis patients, maintain the metabolism of calcium and phosphorus balance, and can reduce the inflammatory reaction, is worth the clinical promotion and application.

  1. Productivity of Stream Definitions

    NARCIS (Netherlands)

    Endrullis, Jörg; Grabmayer, Clemens; Hendriks, Dimitri; Isihara, Ariya; Klop, Jan

    2007-01-01

    We give an algorithm for deciding productivity of a large and natural class of recursive stream definitions. A stream definition is called ‘productive’ if it can be evaluated continuously in such a way that a uniquely determined stream is obtained as the limit. Whereas productivity is undecidable

  2. Productivity of stream definitions

    NARCIS (Netherlands)

    Endrullis, J.; Grabmayer, C.A.; Hendriks, D.; Isihara, A.; Klop, J.W.

    2008-01-01

    We give an algorithm for deciding productivity of a large and natural class of recursive stream definitions. A stream definition is called ‘productive’ if it can be evaluated continually in such a way that a uniquely determined stream in constructor normal form is obtained as the limit. Whereas prod

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1979-03-01

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

  4. Impact of Oxidative Stress in Premature Aging and Iron Overload in Hemodialysis Patients

    Science.gov (United States)

    Hernández Vázquez, Wendy Ivett; Solorio-Meza, Sergio; Albarrán-Tamayo, Froylán; Ramos-Rodríguez, Edna; Benítez- Bribiesca, Luis

    2016-01-01

    Background. Increased oxidative stress is a well described feature of patients in hemodialysis. Their need for multiple blood transfusions and supplemental iron causes a significant iron overload that has recently been associated with increased oxidation of polyunsaturated lipids and accelerated aging due to DNA damage caused by telomere shortening. Methods. A total of 70 patients were evaluated concomitantly, 35 volunteers with ferritin levels below 500 ng/mL (Group A) and 35 volunteers with ferritin levels higher than 500 ng/mL (Group B). A sample of venous blood was taken to extract DNA from leukocytes and to measure relative telomere length by real-time PCR. Results. Patients in Group B had significantly higher plasma TBARS (p = 0.008), carbonyls (p = 0.0004), and urea (p = 0.02) compared with those in Group A. Telomeres were significantly shorter in Group B, 0.66 (SD, 0.051), compared with 0.75 (SD, 0.155) in Group A (p = 0.0017). We observed a statistically significant association between relative telomere length and ferritin levels (r = −0.37, p = 0.001). Relative telomere length was inversely related to time on hemodialysis (r = −0.27, p = 0.02). Conclusions. Our findings demonstrate that iron overload was associated with increased levels of oxidative stress and shorter relative telomere length. PMID:27800120

  5. Effects of 12 weeks nutrition education on nutritional status in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Harin Rhee

    2012-06-01

    Full Text Available Protein-energy malnutrition is present in a large proportion of patients with end stage renal disease and, is a strong risk factor for mortality in these patients. This study was aimed to evaluate the effectiveness of 12-weeks nutrition education during the hemodialysis session for the improvement of nutritional status. From the June 2011 to the September 2011, patients who were on regular hemodialysis in Pusan National University Hospital were enrolled in this study. In education group, intensive nutrition education was performed by the hemodialysis nurse, for fifty to sixty minutes during the hemodialysis session, once a week. Curriculum for renal nutrition includes regular taking of their medication, intake of moderate amount of protein and sufficient calories, reduction of water, salt, potassium and phosphate intake. Otherwise, any education program was not performed in patients of control group. Nutrition status was assessed by the subjective global assessment (SGA,body mass index (BMI, triceps skinfold thickness (TSF, arm muscle area(AMC and laboratory markers such as serum albumin, serum blood urea nitrogen(BUN and hemoglobin(Hb level before and after the education. Effect of nutrition education was analyzed using ANCOVA test. A total of 49 patients were enrolled in this study and nutrition education was provided to 25 hemodialysis patients. Their mean age was 57.20±15.49 in education group and 55.13±14.42 in control groupand male was 56.0% in education group and 50.0% in control group and, other baseline characteristics were not significantly different between two groups. After the 12-week education, significant improvement was found in SGA, serum albumin, BUN and Hb level. SGA score was improved from 6.36±0.99 to 6.72±0.61 in education group, compared to control group(6.38±0.88 to 6.42±0.88, p=0.029 . Improvement of serum albumin level, BUN and Hb was as follows: serum albumin(4.23±0.28 to 4.30±0.25 in education group, 4.28±0

  6. Analysis of resistance to antibiotics of Gram-negative bacilli isolated from 149 children with blood stream infections%149例革兰阴性杆菌血流感染患儿病原菌耐药分析

    Institute of Scientific and Technical Information of China (English)

    樊卫红; 周晓英; 刘杰; 周海峰

    2012-01-01

    Objective:To investigate the pathogens and drug resistance of Gram-negative bacilli in children with blood stream infections, and to provide a reference for clinical medication. Methods: According to National Committee for Clinical Laboratary Standards (2010), Gram-negative bacilli isolates from blood specimens of 149 children admitted in 2011 were identified, and their antimicrobial susceptibility was tested by VITEK-2 automatic identification microbiological analysis system. Results: Sixty-nine strains of Klebsiella pneumoniae were isolated from blood samples of 149 children, in which 59 (85.51%) were extended-spectrum β-actamases producing strains (ESBLs), 10 (14. 49%) were non-ESBLs-producing strains. In 30 strains of intestine Escherichia coli bacteria, 12 (40. 00%) were ESBLs-producing strains and 18 (60. 00%) were non-ESBLs-producing strains. Twenty-six Acinetobacter baumannii strains and 24 other bacteria strains were identified All the ESBLs-producing Klebsiella pneumoniae strains were susceptible to imipenem, cefoxitin, Levofloxacin, and Cipfofloxacin, and their drug resistance to β-lactam was significantly higher than non-ESBLs-producing strains, and the resistance rates to piperacillin and ampicillin was as high as 100. 00%. Tazobactam inhibited ESBLs-producing Klebsiella pneumoniae significantly. The inhibitory effect of piperacillin/tazobactam on ESBLs-producing Klebsiella pneumoniae was stronger than ampicillin / sulbactam(resistance rates was 18. 64% and 89. 83% respectively). Carbapenems (imi-penem, meropenem) were good choice for ESBLs-producing Klebsiella pneumoniae infection. The resistance rate of Escherichia coli was lower than that of Klebsiella pneumoniae. Conclusions; Klebsiella pneumoniae is a major pathogen of pediatric blood stream infections due to Gram-negative bacilli, in which the incidence of ESBLs-producing Klebsiella pneumoniae infection is very high. Imipenem and meropenem are good choice for treatment of infections caused by

  7. Activity of nuclear factor-kappa B in peripheral blood mononuclear cells of diabetes patients at different levels of blood glucose control with maintenance hemodialysis%不同血糖控制水平糖尿病血液透析患者外周血单个核细胞核因子κB的活性

    Institute of Scientific and Technical Information of China (English)

    王景福; 邢恩鸿; 段书众; 张昆; 郭风玲; 赵亚娟; 胡桂才

    2011-01-01

    BACKGROUND: Abnormal activation of nuclear factor-kappa 8 (NF-7B) and protein kinase C signal transduction pathway ethecentral link of occurrence and development of diabetes mellitus and related complications.OBJECTIVE: To investigate the NF-7B actwrh/ in peripheral blood mononuclear cells(PBMC) in diabetes patient of differentlevel; of blood glucose control with maintenance hemodiah/sis and investigate the relationship of NF-?B activity with gh/cosylatedhemoglobin (HbAlc) and high sensitwe C reactive protein (hs-CRP) levels and malnutrition.METHOOS: The indices of 71 chronic renal failure uremia patients with maintenance he modi a lysis we re anah/zed throughcross-sectional study. Twenty-tuvo diabetic nephropattiy patient with maintenance hemodiah/siswere drwided into good control ofblood glucose group (J7=12) and poor control of blood glucose group f/r= 10). The o1her43 norvdiabeticnephropathy patient withmaintenance nemo dialysis were taken as control group.RESULTS AND CONCLUSION: The serum albumin and serum prealbumin level; of patients in the poor control of blood glucosegroup were significantly lower than those in the good control of blood glucose group and non-diabetic nephropathy group.Theserum hs-CRP level and NF-?B activity of patients in poor control of blood glucose group were signrficantr/ higher than those inthe good control of blood glucose group and n on-diabetic nephropathy group. HbAlc was posrtn/er/ correlated with serum hs-CRPlevel and NF-?B actwity and was negatively correlated with serum albumin and serum pre album in. NF-'PB actwtywa; posrfve^correlated with hs-C RP levels and was negativer/ correlated with serum albumin and serum prealbumin. The results suggest thatpoorer control of blood glucose in diabetic nephropathy patientswrth maintenance hemodialysisleadstostrcngerNF-TBacS/t/.more obvious inflammatory reaction and more severe malnutrition. Abnormal activation of NF-7B induced by poor control of bloodglucose is one of the main reasons

  8. Serum ferritin is associated with arterial stiffness in hemodialysis patients: results of a 3-year follow-up study.

    Science.gov (United States)

    Lin, Kao-Chang; Tsai, Meng-Yi; Chi, Chun-Ling; Yu, Lai-King; Huang, Li-Hsueh; Chen, Chien-An

    2015-11-01

    Iron may contribute to vascular injury through reactive oxygen species. Hemodialysis patients frequently receive iron supply for correction of anemia and are at a high risk of cardiovascular disease. We tested the relationship between iron status and change in arterial stiffness in hemodialysis patients. We measured iron status in 53 hemodialysis patients and studied the association with clinical, biochemical, and arterial stiffness measured by brachial-ankle pulse wave velocity (baPWV) over 3 years. The blood pressure was controlled to below 140/90 mmHg by anti-hypertensive drugs. Median and interquartile range of baseline baPWV, baPWV at 3 years, and ΔbaPWV (difference between 3-year baPWV and baseline baPWV) were following: 17.6 (14.8-18.9), 16.9 (15.3-19.9), and 0.2 (-1.2 to 2.7) m/s. At baseline, baPWV was positively correlated with age, serum ferritin, and systolic blood pressure in univariate analysis. However, in multivariate analysis, only age and serum ferritin remained the significant determinants of baseline baPWV. After 3 years, ΔbaPWV was negatively correlated with age and positively with 3-year averaged serum ferritin in univariate analysis. Then, in multivariate analysis, only 3-year averaged serum ferritin was the important determinant of ΔbaPWV. ΔbaPWV was significantly increased in patients with 3-year averaged serum ferritin >500 ng/mL compared to patients with 3-year averaged serum ferritin ≤500 ng/mL. In hemodialysis patients, serum ferritin associates with the progressive arterial stiffness, especially when serum ferritin >500 ng/mL.

  9. Epidemiology of Occult Hepatitis B Infection Among Thalassemic, Hemophilia, and Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Mohammad Kazemi Arababadi

    2012-05-01

    Full Text Available Context: Hepatitis B virus (HBV is the most common disease commuted through blood transfusion. Occult hepatitis B infection (OBI is a form of the disease which does not present Hepatitis B surface antigens (HBsAg in the serum of patients; however, HBVDNA is detectable in the serum and hepatocytes of patients. OBI is an important risk factor to induce post transfusion hepatitis (PTH, cirrhosis, hepatocellular carcinoma (HCC and reactivation of the HBV. Recently, several reports from various regions of the world have been published regarding PTH among blood recipients as well as HCC, and cirrhosis among patients who require permanent blood transfusion, including diseases such as hemophilia, hemodialysis and thalassemia. This form of the hepatitis also creates problems for individuals that are co-infected with other viruses such as HCV and HIV. To determine the prevalence of OBI among hemophilia, hemodialysis and thalassemia patients is important because it is a high risk factor for PTH, HCC and cirrhosis therefore, its detection is a critical strategy for most health care services. This review addresses recent information regarding prevalence of OBI in relation to the mentioned diseases.Evidence Acquisition: The data presented here was collected by searching the key words in Pubmed and Scopous databases.Results: Our searching in the published papers revealed that OBI prevalence is frequent in patients receiving frequent blood transfusions.Conclusions: it seems that one of the main mechanisms for OBI transmission is most likely through infected blood and its component and evaluation of the prevalence of OBI in donors and patients, especially those with hemophilia and thalassemia should be foul considered.

  10. Safety and functionality of transhepatic hemodialysis catheters in chronic hemodialysis patients.

    Science.gov (United States)

    Şanal, Bekir; Nas, Ömer Fatih; Doğan, Nurullah; Korkmaz, Mehmet; Hacıkurt, Kadir; Yıldız, Abdulmecid; Kan Aytaç, İrem İris; Hakyemez, Bahattin; Erdoğan, Cüneyt

    2016-01-01

    We aimed to investigate the safety and functionality of tunneled transhepatic hemodialysis catheters in chronic hemodialysis patients. Thirty-eight patients (20 women aged 56±10 years and 18 men aged 61±11 years) with transhepatic tunneled hemodialysis catheters were evaluated. The date of the first transhepatic catheterization, indications, procedure details, functional time periods of catheters, reasons for the removal or revision of catheters, catheter-related complications, and current conditions of patients were retrospectively analyzed. A total of 69 catheters were properly placed in all patients (100% technical success) under imaging guidance during the 91-month follow-up period. The functionality of 35 catheters could not be evaluated: five catheters were removed because of noncomplication related reasons (surgical fistulas were opened in two cases [2/35, 5.7%], transplantation was performed in three cases [3/35, 8.6%]), 18 patients died while their catheters were functional (18/35, 51.4%), and 12 catheters were still functional at the time of the study (12/35, 34.3%). The functionality of catheters was evaluated the remaining 34 catheters that necessitated revision because of complications. Furthermore, only half of the catheters were functional on day 136 when evaluated using Kaplan-Meier analysis. The four main complications were thrombosis (16/34, 47%; complication rate of 0.37 days in 100 catheters), infection (8/34, 23.5%; 0.18 days in 100 catheters), migration (8/34, 23.5%; 0.18 days in 100 catheters), and kinking (2/34, 6%; 0.04 days in 100 catheters). Transhepatic venous catheterization is a safe and functional alternative route in chronic hemodialysis patients without an accessible central venou route. The procedure can be performed with high technical success and low complication rates under imaging guidance.

  11. Hemodialysis for methyl alcohol poisoning: A single-center experience

    Directory of Open Access Journals (Sweden)

    Vivek B Kute

    2012-01-01

    Full Text Available Methanol is a cheap and potent adulterant of illicit liquors. Hemodialysis (HD is the best method to rapidly remove both toxic acid metabolites and parent alcohols, and it plays a fundamental role in treating severely poisoned patients. This retrospective study was carried out on 91 patients with detectable serum methanol levels who underwent HD. Because toxic alcohol levels were not immediately available, the initial diagnosis and treatment was based on clinical history with evidence of toxic alcohol intake, presence of high anion metabolic acidosis and/or end organ damage. Patients received bicarbonate, ethanol, according to clinical features and blood gases. Patients underwent HD in the setting of known methanol ingestion with high anion gap metabolic acidosis, or evidence of end-organ damage, regardless of methanol level. HD prescription included large surface area dialyzer (≥1.5 m2, blood flow rate of 250-350 mL/min and dialysate flow rate of 500 mL/min for 4-6 h. Between 9 and 11 July 2009, 91 males with mean age 40 ± 8.5 years underwent HD, and 13 patients required a second HD session. Patients consumed 100-500 mL illicit liquors, and symptoms appeared six and 60 h later. Clinical features were gastro-intestinal symptoms (83.5%, visual disturbances (60.4%, central nervous system symptoms (59.3% and dyspnea (43.9%. Before HD, mean pH was 7.11 ± 0.04 (range 6.70- 7.33 and mean bicarbonate levels were 8.5 ± 4.9 mmol/L (range 2-18. Three patients died due to methanol intoxication. Mortality was associated with severe metabolic acidosis (pH ≤ 6.90, ventilator requirement and coma/seizure on admission (P < 0.001. Timely HD, bicarbonate, ethanol and supportive therapy can be life-saving in methanol intoxication.

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

    OpenAIRE

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

    2010-01-01

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

  13. Treatment of refractory hemodialysis ascites with maintenance peritoneal dialysis.

    Science.gov (United States)

    Ing, T S; Daugirdas, J T; Popli, S; Kheirbek, A O; Humayun, H M; Gandhi, V C; Chapa, S M

    1981-04-01

    In 5 patients who were receiving maintenance hemodialysis, ascites developed that was refractory to treatment by ultrafiltration during hemodialysis. Use of sequential isolated ultrafiltration and hemodialysis therapy either precipitated side effects or else required prolongation of total treatment time which the patients declined to accept. In 4 of the patients, ascites was believed to be primarily responsible for severe, progressive cachexia. Maintenance peritoneal dialysis was instituted in all patients, and abdominal fluid was removed gradually, over a period of 2 to 3 days. Ascites resolved promptly in each case. Three patients noted a dramatic improvement in appetite after relief of abdominal distension. Follow-up periods ranged from 6 to 4 1/2 years. Our results suggest that maintenance peritoneal dialysis can successfully control hemodialysis ascites.

  14. Recurrent Ochrobactrum anthropi and Shewanella putrefaciens bloodstream infection complicating hemodialysis.

    Science.gov (United States)

    Shrishrimal, Kumarpal

    2012-01-01

    Bloodstream infections (BSIs) are common in hemodialysis, especially when the access is a catheter. These infections are more commonly gram-positive bacteria or gram-negative bacilli and on some occasions, fungi. Ochrobactrum anthropi and Shewanella putrefaciens are ubiquitous hydrophilic gram-negative bacilli. There have been three cases of O. anthropi BSI reported in hemodialysis patients (one from the United States and two from Vienna) and two cases of S. putrefaciens BSI in hemodialysis patients (one from the United States and the other from Japan). There have been few more cases reported of infections with these bacteria in peritoneal dialysis, especially outside the United States. We present a novel case of a patient with both recurrent O. anthropi and S. putrefaciens BSI complicating hemodialysis. There have been no reports in the literature of such a case. We also discuss the microbiology, clinical features, and the challenging aspects of treatment of such infections.

  15. In vitro evaluation of heparinized cuprophan hemodialysis membranes

    NARCIS (Netherlands)

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

    1997-01-01

    Cuprophan hemodialysis membranes can be heparinized using N,N-carbonyldiimidazole (CDI) as a coupling agent. In this study, the characteristics of heparinized Cuprophan membranes have been evaluated. After immobilization, heparin partially retained its biologic activity. An anticoagulant activity of

  16. Sublethal microcystin exposure and biochemical outcomes among hemodialysis patients

    Science.gov (United States)

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

  17. In vitro evaluation of heparinized Cuprophan hemodialysis membranes

    NARCIS (Netherlands)

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

    1996-01-01

    Cuprophan hemodialysis membranes can be heparinized using N,N-carbonyldiimidazole (CDI) as a coupling agent. In this study, the characteristics of heparinized Cuprophan membranes have been evaluated. After immobilization, heparin partially retained its biologic activity. An anticoagulant activity of

  18. Incidencia de bacteriemia asociada a catéter en niños hospitalizados que reciben nutrición parenteral Blood-stream catheter related infection in inpatient children receiving parenteral nutrition

    Directory of Open Access Journals (Sweden)

    E. Vaquero Sosa

    2011-02-01

    Full Text Available Las infecciones relacionadas con el catéter son la complicación más grave en los pacientes portadores de un catéter venoso central. Se considera que la nutrición parenteral (NP constituye un factor de riesgo de desarrollar una infección relacionada con el catéter (IRCat. Material y métodos: para conocer la tasa de infección y poder establecer estrategias de prevención de la infección nosocomial, se revisaron todas las historias de los 120 pacientes que recibieron NP a lo largo de 2008. Todas las historias de los pacientes con un episodio fiebre y hemocultivo positivo fueron consideradas. La tasa de infección se definió como número de episodios por cada 1000 días de NP. Resultados: Se obtuvieron 48 hemocultivos positivos. La tasa global de bacteriemia asociada a catéter fue de 37,8/1000 días de NP. La incidencia fue significativamente mayor en lactantes menores de 2 años de edad. Los gérmenes que se encontraron con mayor frecuencia fueron Estafilococo coagulasa negativo (56,8%, seguidos de bacilos Gram (20,8%, Staph aureus (12,5% y los hongos (12,5%. No encontramos diferencias en la tasa de infección cuando ajustamos por la enfermedad de base o la duración de la NP. Conclusiones: La tasa de infección en niños con NP en el hospital es considerablemente elevada. La NP parece constituir un factor de riesgo de desarrollar IRCat. Es necesario establecer políticas adecuadas y continuadas para conseguir disminuir la tasa de infección nosocomial.Blood-stream catheter related infection is the most severe complication in patients carrying a central venous catheter. Parenteral nutrition (PN use seems to be a risk factor for developing a catheter-related infection (CRI. Material & methods: In order to know the incidence of CRI in children to further implement policies to reduce nosocomial infection, we review all charts of children (1 month to 17 years who received parenteral nutrition while in hospital. All episodes of fever

  19. A Taurolidine-Citrate-Heparin Lock Solution Effectively Eradicates Pathogens From the Catheter Biofilm in Hemodialysis Patients.

    Science.gov (United States)

    Zwiech, Rafał; Adelt, Maria; Chrul, Sławomir

    2016-01-01

    Catheter-related bacteremia (CRB) is a typical complication of hemodialysis catheter use. Catheter lumen colonization by pathogens is regarded as a direct cause of CRB. Once settled, the catheter biofilm increases the risk of developing infection, thus necessitating insertion replacement and antibiotic treatment. The study assessed the self-sufficient efficacy of taurolidine-citrate-heparin lock solution in eradicating catheter biofilm bacteria and keeping it sterile in patients on hemodialysis. Twenty-nine chronic patients on hemodialysis with tunneled and nontunneled catheters locked with a heparin filling (the mean time of heparin lock use -30.1 ± 2.0 days) and subsequently converted to a taurolidine-citrate-heparin filling were included. Peripheral vein and catheter lumen blood cultures were obtained before the filling change and after taurolidine-citrate-heparin lock use (mean time 33.8 ± 7.6 days). Twenty-four participants with tunneled and nontunneled catheters locked with taurolidine-citrate-heparin filling served as the control group. During the heparin-locking period, CRB was diagnosed in 3 cases (only nontunneled catheters). The catheter blood cultures findings were positive in 23 patients (10 temporary and 13 permanent catheters), whereas both the catheter and peripheral vein blood cultures were sterile in 3 of 29 subjects (only permanent catheters). Irrespective of catheter type (tunneled or nontunneled), repeated culture revealed no pathogens in any of the 23 patients with initial positive catheter blood culture, after the use of taurolidine-citrate-heparin filling. No positive blood culture was noted in the control group. The taurolidine-citrate-heparin lock solution effectively eradicated pathogens from nontunneled and tunneled catheter biofilms and helped to maintain catheter lumen sterility.

  20. Inert gas analysis of ventilation-perfusion matching during hemodialysis.

    OpenAIRE

    1984-01-01

    The mechanism of hypoxemia during hemodialysis was investigated by the multiple inert gas elimination technique in anesthetized, paralyzed, mechanically ventilated dogs. Profound leukopenia occurred in the first hour of a 2-h hemodialysis with a cuprophan membrane and dialysate that contained acetate. Arterial partial pressure of O2 and CO2 and oxygen consumption remained unchanged during dialysis. Pulmonary carbon dioxide elimination and lung respiratory exchange ratio decreased with the ini...

  1. Antierythropoietin Antibodies in Hemodialysis Patients Treated with Recombinant Erythropoietin

    OpenAIRE

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

    2014-01-01

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

  2. The home hemodialysis hub: physical infrastructure and integrated governance structure.

    Science.gov (United States)

    Marshall, Mark R; Young, Bessie A; Fox, Sally J; Cleland, Calli J; Walker, Robert J; Masakane, Ikuto; Herold, Aaron M

    2015-04-01

    An effective home hemodialysis program critically depends on adequate hub facilities and support functions and on transparent and accountable organizational processes. The likelihood of optimal service delivery and patient care will be enhanced by fit-for-purpose facilities and implementation of a well-considered governance structure. In this article, we describe the required accommodation and infrastructure for a home hemodialysis program and a generic organizational structure that will support both patient-facing clinical activities and business processes.

  3. Persistent Temporal Streams

    Science.gov (United States)

    Hilley, David; Ramachandran, Umakishore

    Distributed continuous live stream analysis applications are increasingly common. Video-based surveillance, emergency response, disaster recovery, and critical infrastructure protection are all examples of such applications. They are characterized by a variety of high- and low-bandwidth streams as well as a need for analyzing both live and archived streams. We present a system called Persistent Temporal Streams (PTS) that supports a higher-level, domain-targeted programming abstraction for such applications. PTS provides a simple but expressive stream abstraction encompassing transport, manipulation and storage of streaming data. In this paper, we present a system architecture for implementing PTS. We provide an experimental evaluation which shows the system-level primitives can be implemented in a lightweight and high-performance manner, and an application-based evaluation designed to show that a representative high-bandwidth stream analysis application can be implemented relatively simply and with good performance.

  4. [The Experience of Fluid Management in Hemodialysis Patients].

    Science.gov (United States)

    Kim, Yoonsoo; Kim, Miyoung

    2015-10-01

    The purpose of this study was to explore the experience of fluid management in hemodialysis patients by describing how they manage fluid intake and what affects fluid management. Purposive sampling yielded 11 patients who have received hemodialysis for one year or longer in one general hospital. Data were collected through in-depth interviews and analysed using Giorgi's phenomenological method. Data collection and analysis were performed concurrently. The findings regarding how hemodialysis patients manage fluid intake were classified into four constituents: 'recognizing the need for fluid control', 'observing the status of fluid accumulation', 'controlling fluid intake and output', 'getting used to fluid management'. The factors that affect fluid management of hemodialysis patients were revealed as 'willpower', 'change in the mindset', 'support system', and 'emotional state'. The study results show that hemodialysis patients manage fluid intake through food and exercise as well as interpersonal relationships. These findings suggest that strategies in the development of nursing interventions for hemodialysis patients should be directed at assisting them in familiarization with fluid management based on an understanding of their sociocultural contexts.

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

    Science.gov (United States)

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

    2015-03-01

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

  6. Correlates of decade-long technique survival on home hemodialysis.

    Science.gov (United States)

    Delano, B G; Friedman, E A

    1990-01-01

    Since initiating home hemodialysis 20 years ago, the authors have successfully trained 192 selected patients who began self dialysis at home. Of these, 36 patients (19%) have continued uninterrupted home hemodialysis for 10 or more years (mean 14 years). To ascertain which factors might predict long duration on home hemodialysis these 36 long-term patients (LT) were compared to the entire group (all). Mean age at initiation of dialysis was 36 years in LT and 40 years in all. There was no significant difference in gender between LT and all. A significantly greater (p less than 0.01) proportion of LT (72%) were white compared with the whole group (53%). Seventy-eight percent of LT were middle class while 67% of the entire group were middle class (p less than 0.05). Renal diagnosis in LT were glomerulonephritis in ten (28%) polycystic kidney disease in eight (22%) congenital and/or infectious renal disease in eight (22%), miscellaneous or unknown in the rest. Hereditary disease thus accounted for 36% of all LT. Twenty-four LT remain on home hemodialysis, four returned to center dialysis and nine died. The authors conclude that 1) Home hemodialysis for a decade or longer is not rare in selected patients. 2) White, middle class men remain on home hemodialysis the longest. Although declining in popularity, this treatment modality proffers survival advantage for appropriately chosen individuals.

  7. The many streams of the Magellanic Stream

    CERN Document Server

    Stanimirovic, Snezana; Heiles, Carl; Douglas, Kevin A; Putman, Mary; Peek, Joshua E G

    2008-01-01

    We present results from neutral hydrogen (HI) observations of the tip of the Magellanic Stream (MS), obtained with the Arecibo telescope as a part of the on-going survey by the Consortium for Galactic studies with the Arecibo L-band Feed Array. We find four large-scale, coherent HI streams, extending continously over a length of 20 degrees, each stream possessing different morphology and velocity gradients. The newly discovered streams provide strong support for the tidal model of the MS formation by Connors et al. (2006), which suggested a spatial and kinematic bifurcation of the MS. The observed morphology and kinematics suggest that three of these streams could be interpreted as a 3-way splitting of the main MS filament, while the fourth stream appears much younger and may have originated from the Magellanic Bridge. We find an extensive population of HI clouds at the tip of the MS. Two thirds of clouds have an angular size in the range 3.5'--10'. We interpret this as being due to thermal instability, which...

  8. Clinical effects of a polyethylene glycol grafted cellulose membrane on thrombogenicity and biocompatibility during hemodialysis.

    Science.gov (United States)

    Akizawa, T; Kino, K; Kinugasa, E; Koshikawa, S; Ikada, Y; Kishida, A; Hatanaka, Y; Imamura, K

    1990-01-01

    The biocompatibility and thrombogenicity of polyethylene-glycol (PEG)-grafted cellulose hemodialysis (HD) membranes (PEGC) were investigated in cross-over HD of five HD patients with ordinary cellulose (OC). The PEGC significantly suppressed transient leukocyte and thrombocytopenia, and release of C3a, beta-thromboglobulin and platelet factor 4, in corresponding with the quantity of grafted PEG. HD with PEGC resulted in lower granulocyte elastase production, protein and blood cells adsorption on the membrane surface than those with OC. Minimum heparin in HD with PEGC was three times lower than that with OC, with the thrombin-antithrombin III complex elevation lower than that in HD with OC. The results indicate that the grafted PEG effectively suppresses blood and membrane interaction, thus improving biocompatibility and reducing thrombogenicity in clinical HD.

  9. Application and effect of FOCUS-PDCA methodology on the control of catheter-related blood stream infection%FOCUS-PDCA 方法学在控制 CRBSI 过程中的应用及效果

    Institute of Scientific and Technical Information of China (English)

    封卫征; 朱金京

    2014-01-01

    Objective To evaluate the effect of FOCUS-PDCA program(find,organize,clarify,understand,se-lect,plan,do,check,act )on the prevention and control of catheter-related blood stream infection (CRBSI)in an intensive care unit(ICU).Methods Process of central venous catheterization and nursing care were analyzed by u-sing FOCUS-PDCA program,and the causes for CRBSI were found out ;a continuous quality improvement (CQI) team was established to provide training for ICU nurses,and the process was improved and supervised,virtuous cir-cle was created.Results Incidence of CRBSI decreased from 8.29‰ before FOCUS-PDCA intervention(January-December,2010)to 3.20‰ after FOCUS-PDCA intervention(January 2011 -December 2012),the difference was significant (χ2 =14.6,P <0.001).Conclusion FOCUS-PDCA program is effective for controlling the incidence of CRBSI.%目的:探讨运用 FOCUS-PDCA 程序预防控制重症监护室(ICU)导管相关血流感染(CRBSI)的效果。方法运用 FOCUS-PDCA 程序分析中心静脉置管以及护理操作流程中的各个环节,明确 CRBSI 发生的具体原因;成立持续质量控制(CQI)小组并对 ICU 护士进行培训,对操作流程进行改进和监督,形成良性循环。结果运用 FOCUS-PDCA 程序干预前(2010年1-12月),ICU 的 CRBSI 发病率为8.29‰;经干预后(2011年1月-2012年12月),CRBSI 的发病率降至3.20‰,差异具有统计学意义(χ2=14.6,P <0.001)。结论运用 FOCUS-PDCA程序控制 CRBSI 的发病率是有效的。

  10. Profile of low molecular weight tinzaparin sodium for anticoagulation during hemodialysis

    Directory of Open Access Journals (Sweden)

    Al-Saran Khalid

    2010-01-01

    Full Text Available Low-molecular-weight heparin (LMWH has been suggested as providing safe, effi-cient, convenient, and possibly more cost-effective anticoagulation for hemodialysis (HD than un-fractionated heparin (UFH with a single bolus dose at the start of hemodialysis effectively pre-vents clot formation in the dialyzer and bubble trap with fewer side-effects and possible benefits on uremic dyslipidemia. In this study, we compared the safety, clinical efficacy, and cost effectiveness of Tinzaparin sodium (Innohep with unfractionated heparin (UFH in 23 chronic HD patients; their extracorporeal anticoagulant protocol-consisted of UFH was switched to Tinzaparin for a period of 6 months. Clinical clotting (grade 1-4 was evaluated by visual inspection after blood draining of the air trap every hour and the dialyzer after each session. Anticoagulation with Tinzaparin sodium re-sulted in less frequent dialyzer and air-trap clotting compared to UFH (P= 001 and 0.04 respec-tively. Over 24 weeks, we observed no alteration in the serum lipid profile of the patients. There was a statistically significant improvement in the dialysis single pool Kt/V after 6 months of Tinza-parin use (1.40 ± 0.28 for Tinzaparin versus 1.23 ± 0.28 for heparin without any modification in the hemodialysis prescription. The total cost for 24 weeks use of Tinzaparin sodium was 23% more expensive compared to that for UFH. We conclude that a single bolus of Tinzaparin sodium injec-tion at the start of the dialysis session was more effective and convenient in our patients than UFH, but at a higher total cost. Furthermore, at least on the short term, there was no observed benefit on the lipid profile.

  11. Daily home hemodialysis at a health maintenance organization: three-year experience.

    Science.gov (United States)

    Kumar, Victoria A; Ledezma, Mateo L; Rasgon, Scott A

    2007-04-01

    Daily home hemodialysis (DHD), 5 to 7 short-duration hemodialysis treatments per week, promotes self-care and has beneficial effects on a number of clinical outcomes including blood pressure and volume control, electrolyte balance, uremic symptoms and sequelae, and quality of life. We sought to demonstrate that DHD is feasible and confers clinical benefits that permit savings in overall healthcare costs despite expenditures on program infrastructure and supplies. We examined the following outcomes monthly for all patients: laboratory values, dialysis adequacy, hospital admission records, surgical and interventional radiology records, and prescription medication usage. Twelve patients completed training in our home hemodialysis unit between April 2003 and April 2006. The mean age at the time of training was 58 years and mean vintage was 62 months. The mean treatment time was 147 min, and the mean number of treatments performed was 5.3 per week. When 1 patient with morbid obesity was excluded due to intentional weight loss, the mean dry weight at initiation of training was 71.9+/-12.4 kg and increased to 74.3+/-12.4 kg by the end of the study (p=0.66). The mean albumin increased from a baseline of 3.9+/-0.3 to 4.3+/-1.1 gm/dL during DHD (p=0.0015). The mean serum phosphorus levels were 5.4+/-1.4 mg/dL. Phosphate binder usage increased from a mean baseline of 2.6+/-1.4 to 4.2+/-2.6 tablets per meal during DHD (p=0.08). The mean delivered single pool Kt/V was 0.87 per treatment. During the 234 months studied, there were 11 hospital admissions (0.56 admissions per patient per year), with a mean length of stay of 3.7 days. Our results demonstrate that DHD improves nutritional status and decreases hospital admissions for dialysis-dependent patients.

  12. Sensitive troponins--which suits better for hemodialysis patients? Associated factors and prediction of mortality.

    Directory of Open Access Journals (Sweden)

    Ferruh Artunc

    Full Text Available BACKGROUND: In hemodialysis patients, elevated plasma troponin concentrations are a common finding that has even increased with the advent of newly developed sensitive assays. However, the interpretation and relevance of this is still under debate. METHODS: In this cross-sectional study, we analyzed plasma concentrations of sensitive troponin I (TnI and troponin T (TnT in stable ambulatory hemodialysis patients (n = 239 and investigated their associations with clinical factors and mortality. RESULTS: In all of the enrolled patients, plasma TnI or TnT was detectable at a median concentration of 14 pg/ml (interquartile range: 7-29 using the Siemens TnI ultra assay and 49 pg/ml (31-74 using the Roche Elecsys high sensitive TnT assay. Markedly more patients exceeded the 99th percentile for TnT than for TnI (95% vs. 14%, p<0.0001. In a multivariate linear regression model, TnT was independently associated with age, gender, systolic dysfunction, time on dialysis, residual diuresis and systolic blood pressure, whereas TnI was independently associated with age, systolic dysfunction, pulse pressure, time on dialysis and duration of a HD session. During a follow-up period of nearly two years, TnT concentration above 38 pg/mL was associated with a 5-fold risk of death, whereas elevation of TnI had a gradual association to mortality. CONCLUSION: In hemodialysis patients, elevations of plasma troponin concentrations are explained by cardiac function and dialysis-related parameters, which contribute to cardiac strain. Both are highly predictive of increased risk of death.

  13. [Hepatitis C virus infection in hemodialysis].

    Science.gov (United States)

    Simon, N

    1995-10-01

    The surveillance of HCV infections is now a must in the clinical management of hemodialysis patients. The natural history of HCV has shown acute hepatitis to be a constant feature although rarely symptomatic. Progression to chronicity occurs in 90% of the cases with detectable viremia in 80% of the cases. The long-term impact of the liver disease in chronic hemodialyzed patients remains to be defined. HCV is responsible for more than 90% of the non-A, non-B hepatitis case diagnosed among hemodialyzed patients. The transmission is either transfusional or nosocomial. Following recent transfusion safety regulations, the nosocomial risk became the predominant residual risk. Thus, all efforts should target HCV eradication. In the absence of specific prophylaxis, this can only be achieved by enforcement of very stringent precautions.

  14. Urgent peritoneal dialysis or hemodialysis catheter dialysis.

    Science.gov (United States)

    Lok, Charmaine E

    2016-03-01

    Worldwide, there is a steady incident rate of patients with end-stage kidney disease (ESKD) who require renal replacement therapy. Of these patients, approximately one-third have an "unplanned" or "urgent" start to dialysis. This can be a very challenging situation where patients have either not had adequate time for education and decision making regarding dialysis modality and appropriate dialysis access, or a decision was made and plans were altered due to unforeseen circumstances. Despite such unplanned starts, clinicians must still consider the patient's ESKD "life-plan", which includes the best initial dialysis modality and access to suit the patient's individual goals and their medical, social, logistic, and facility circumstances. This paper will discuss the considerations of peritoneal dialysis and a peritoneal dialysis catheter access and hemodialysis and central venous catheter access in patients who require an urgent start to dialysis.

  15. Vascular access for hemodialysis: arteriovenous fistula.

    Science.gov (United States)

    Malovrh, Marko

    2005-06-01

    The long-term survival and quality of life of patients on hemodialysis (HD) is dependant on the adequacy of dialysis via an appropriately placed vascular access. The optimal vascular access is unquestionably the autologous arteriovenous fistula (AVF), with the most common method being the conventional radio-cephalic fistula at the wrist. Recent clinical practice guidelines recommend the creation of native fistula or synthetic graft before the start of chronic HD therapy to prevent the need for complication-prone dialysis catheters. This could also have a beneficial effect on the rapidity of worsening kidney failure. A multidisciplinary approach (nephrologists, surgeons, radiologists and nurses) should improve the HD outcome by promoting the use of AVF. An important additional component of this program is the Doppler ultrasound for preoperative vascular mapping. Such an approach may be realized without unsuccessful surgical explorations, with a minimal early failure rate and a high maturation, even in patients with diabetes mellitus.

  16. Intradialytic Exercise is Medicine for Hemodialysis Patients.

    Science.gov (United States)

    Parker, Kristen

    2016-01-01

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

  17. [Impact of a quality program in hemodialysis].

    Science.gov (United States)

    Arenas, M D; Alvarez-Ude, F; Egea, J J; Gill, M T; Amoedo, M L; Millán, I; Soriano, A; Sirvent, A E

    2004-01-01

    One of the requirements of a health care quality management system is to be able to established clinical performance measures (CPM) for its key organisation processes. We described some of the performance measurement that has been used in our hemodialysis unit, since the implementation in the year 2001, of a Quality Management System (QMS). We analyze and compare the effect that the introduction of a ISO 9002 based QMS had in our CPM during the period 2001-2002 (post QMS) vs. the two previous years -1999-2000- (pre QMS). We defined several CPM for assessment of hemodialysis adequacy and medical management that covered : Anemia, iron status renal osteodystrophy, hemodialysis prescription and nutritional status , follow up of the established guidelines for vascular access care and prevention of nosocomial infections water quality and general performance outcome like annual crude mortality rate and hospitalization (express as hospital days/patient year). No significant difference was found between both periods regarding annual crude mortality( pre QMS 8.37% vs post QMS 8.95%) or the hospitalization rate ( pre 0.47 patient-days vs. post 0.52 patient-days) . There was a significant difference after implementation of the quality system in the average hemoglobin levels (pre 11.3 +/- 1.5 vs. post 11.9+ +/- .5 p 1.2 (pre 1.41 +/- 0.26 vs. post 1.50 +/- 0.33 pTSI) was unchanged (pre 27.98 +/- 14.39 vs.. post 29.4 +/- 16.66 p=0.11). There was a significant decrease in the average PTH levels (pre 234.9 +/- 285 vs. post 174 +/- 174 p300 pg/ml (pre 23.7% vs. post 16.4% p1.55 vs. post 5.01 +/- 1.47 p11 mg/dl (pre 14.6% vs. post 11% p6 g/dl (pre 34% post 21.5% p1.5% vs. post 10. 1%). The number of native A-V vascular access was similar in both periods and above the current DOQI Recommendations. Nevertheless, there was a gradual decrease in native A-V fistula, associated with an increase on the use of permanent catheters. The number of incident patients with a permanent catheter as

  18. Left ventricular myocardial function in hemodialysis and nondialysis uremia patients: a three-dimensional speckle-tracking echocardiography study.

    Directory of Open Access Journals (Sweden)

    Ran Chen

    Full Text Available BACKGROUND: Several studies have demonstrated that uremic patients who have preserved left ventricular ejection fraction (LVEF could still have the potential for systolic dysfunction. The aim of this study was to assess the differences between the left ventricular (LV myocardial function in hemodialysis and nondialysis uremic patients based on three-dimensional speckle-tracking echocardiography. METHODS: The study population consisted of 35 maintenance hemodialysis patients (the hemodialysis group, 30 uremic patients who were hospitalized for the creation of a primary arteriovenous fistula (the nondialysis group, and 32 healthy volunteers. All of the patients had normal left ventricular ejection fractions (i.e., 55% or greater. Three-dimensional speckle tracking echocardiography was performed to assess the left ventricle's global three-dimensional strain, regional longitudinal strain, circumferential strain, and radial strain. RESULTS: The left ventricular regional longitudinal strain, radial strain, circumferential strain, and global three-dimensional strain were significantly decreased in the nondialysis patients compared with the other two groups (all, P<0.001. However, the three-dimensional strain and the regional longitudinal strain were lower in the hemodialysis patients than in the controls (P<0.01. In the hemodialysis patients and the control group, the longitudinal strain, circumferential strain, and radial strain were higher at the apical level than they were at the basal level and midlevels. A multivariate linear regression analysis showed that the blood urea nitrogen and creatinine levels were independently associated with the values of the global three-dimensional strain (β = -0.217, P = 0.000; β = -0.243, P = 0.011, respectively and the longitudinal strain (β = -0.154, P = 0.032; β = -0.188, P = 0.029, respectively. CONCLUSIONS: Three-dimensional speckle-tracking echocardiography may detect

  19. Current international status of home hemodialysis.

    Science.gov (United States)

    Saito, Akira; Ohta, Yoriko; Sato, Kazuhiro; Ichinose, Mayuri; Arii, Tatsuro; Toyama, Katsuhide

    2012-01-01

    Three times weekly home hemodialysis (HHD) was introduced shortly after the initiation of chronic hemodialysis (HD) treatment in 1960. HHD eliminates the need of transportation to and from the dialysis unit and by allowing patients to set their own dialysis schedule, decreases the burden of treatment on their personal and professional lives. HHD has been found more economical and more highly associated with better patient survival than in-center dialysis. Nevertheless, the global prevalence of HHD decreased between 1980 and 2000 due to the increased availability of dialysis units and continuous ambulatory peritoneal dialysis, advances in cadaveric kidney transplantation, and several other factors. However, the availability of HHD at a frequency of more than 3 times/week, the typical frequency of conventional HD (CHD), in such forms as brief HD sessions of 2-3 h 5-6 days/week and nocturnal HD (NHD) has led to reversals in this trend. Frequent HHD, such as short daily HD (SDHD) and NHD instead of 3 times/week CHD, has been found to significantly improve hypertension, left ventricular mass, renal anemia, quality of life and mortality. On the other hand, NHD has been found to significantly improve hypertension, left ventricular mass, renal anemia, quality of life, malnutrition, mortality and phosphate clearance. Many observational clinical studies and one randomized controlled trial of SDHD and/or NHD have been conducted, and compact and convenient dialysis machines have been developed and used for HHD. The most recent data reported in the national and local registries of selected countries indicate that the prevalence of HHD among all dialysis patients from 2008 to 2010 varied from 0 to 3.3% except in New Zealand and Australia, where it was 16.3 and 9.3%, respectively. As HHD appears to be a more effective and economical dialysis modality than in-center CHD, its prevalence is likely to increase in the future.

  20. Pre to post-dialysis plasma sodium change better predicts clinical outcomes than dialysate to plasma sodium gradient in quotidian hemodialysis.

    Science.gov (United States)

    Thomson, Benjamin K A; Huang, Shih-Han S; Leitch, Rosemary E; Dixon, Stephanie; Heidenheim, Paul; Suri, Rita S; Chan, Christopher T; Lindsay, Robert M

    2013-10-01

    Sodium balance across a hemodialysis treatment influences interdialytic weight gain (IDWG), pre-dialysis blood pressure, and the occurrence of intradialytic hypotension, which associate with patient morbidity and mortality. In thrice weekly conventional hemodialysis patients, the dialysate sodium minus pre-dialysis plasma sodium concentration (δDPNa+) and the post-dialysis minus pre-dialysis plasma sodium (δPNa+) are surrogates of sodium balance, and are associated with both cardiovascular and all-cause mortality. However, whether δDPNa+ or δPNa+ better predicts clinical outcomes in quotidian dialysis is unknown. We performed a retrospective analysis of clinical and demographic data from the Southwestern Ontario Regional Home Hemodialysis program, of all patients since 1985. In frequent nocturnal hemodialysis, δPNa+ was superior to δDPNa+ in predicting IDWG (R(2)=0.223 vs. 0.020, P=0.002 vs. 0.76), intradialytic change in systolic (R(2)=0.100 vs. 0.002, P=0.02 vs. 0.16) and diastolic (R(2)=0.066 vs. 0.019, P=0.02 vs. 0.06) blood pressure, and ultrafiltration rate (R(2)=0.296 vs. 0.036, P=0.001 vs. 0.52). In short hours daily hemodialysis, δDPNa+ was better than δPNa+ in predicting intradialytic change in diastolic blood pressure (R(2)=0.101 vs. 0.003, P=0.02 vs. 0.13). However, δPNa+ was better than δDPNa+ in predicting IDWG (R(2)=0.105 vs. 0.019, P=0.04 vs. 0.68) and pre-dialysis systolic blood pressure (R(2)=0.103 vs. 0.007, P=0.02 vs. 0.82). We also found that the intradialytic blood pressure fall was greater in frequent nocturnal hemodialysis patients than in short hours daily patients, when exposed to a dialysate to plasma sodium gradient. These results provide a basis for design of prospective trials in quotidian dialysis modalities, to determine the effect of sodium balance on cardiovascular outcome.

  1. Body Composition Monitor Assessing Malnutrition in the Hemodialysis Population Independently Predicts Mortality

    NARCIS (Netherlands)

    Rosenberger, Jaroslav; Kissova, Viera; Majernikova, Maria; Straussova, Zuzana; Boldizsar, Jan

    Objective: Malnutrition is a known predictor of mortality in the general and hemodialysis populations. However, diagnosing malnutrition in dialysis patients remains problematic. Body composition monitoring (BCM) is currently used mainly for assessing overhydratation in hemodialysis patients, but it

  2. Body Composition Monitor Assessing Malnutrition in the Hemodialysis Population Independently Predicts Mortality

    NARCIS (Netherlands)

    Rosenberger, Jaroslav; Kissova, Viera; Majernikova, Maria; Straussova, Zuzana; Boldizsar, Jan

    2014-01-01

    Objective: Malnutrition is a known predictor of mortality in the general and hemodialysis populations. However, diagnosing malnutrition in dialysis patients remains problematic. Body composition monitoring (BCM) is currently used mainly for assessing overhydratation in hemodialysis patients, but it

  3. The Puzzling Ophiuchus Stream

    Science.gov (United States)

    Kohler, Susanna

    2016-01-01

    Dwarf galaxies or globular clusters orbiting the Milky Way can be pulled apart by tidal forces, leaving behind a trail of stars known as a stellar stream. One such trail, the Ophiuchus stream, has posed a serious dynamical puzzle since its discovery. But a recent study has identified four stars that might help resolve this streams mystery.Conflicting TimescalesThe stellar stream Ophiuchus was discovered around our galaxy in 2014. Based on its length, which appears to be 1.6 kpc, we can calculate the time that has passed since its progenitor was disrupted and the stream was created: ~250 Myr. But the stars within it are ~12 Gyr old, and the stream orbits the galaxy with a period of ~350 Myr.Given these numbers, we can assume that Ophiuchuss progenitor completed many orbits of the Milky Way in its lifetime. So why would it only have been disrupted 250 million years ago?Fanning StreamLed by Branimir Sesar (Max Planck Institute for Astronomy), a team of scientists has proposed an idea that might help solve this puzzle. If the Ophiuchus stellar stream is on a chaotic orbit common in triaxial potentials, which the Milky Ways may be then the stream ends can fan out, with stars spreading in position and velocity.The fanned part of the stream, however, would be difficult to detect because of its low surface brightness. As a result, the Ophiuchus stellar stream could actually be longer than originally measured, implying that it was disrupted longer ago than was believed.Search for Fan StarsTo test this idea, Sesar and collaborators performed a search around the ends of the stream, looking for stars thatare of the right type to match the stream,are at the predicted distance of the stream,are located near the stream ends, andhave velocities that match the stream and dont match the background halo stars.Histogram of the heliocentric velocities of the 43 target stars. Six stars have velocities matching the stream velocity. Two of these are located in the main stream; the other

  4. Homology analysis of Serratia marcescens strains causing blood stream infection in an intensive care unit%引发重症监护室内血流感染的粘质沙雷菌同源性分析

    Institute of Scientific and Technical Information of China (English)

    陈炜; 甄国东; 赵琼; 邓梅; 毕晟; 盛吉芳

    2015-01-01

    目的:分析从绍兴市中心医院重症监护室( ICU)内血流感染患者中分离的粘质沙雷菌株的同源性和耐药情况,为临床合理用药及感染控制提供依据。方法收集ICU病房2013年6月至2013年9月血流感染中分离培养出来的粘质沙雷菌株,并从ICU医务人员手上采集细菌,进行分离培养。对培养出的17株粘质沙雷菌进行药敏检测,用PCR技术扩增常见耐药基因,使用脉冲场凝胶电泳( PFGE)技术进行同源性分析。收集患者的临床资料,用Spearman相关法进行统计学分析。结果17株粘质沙雷菌对第一代、二代头孢霉素、庆大霉素、环丙沙星耐药率100%,对阿米卡星及头孢他啶敏感,对碳青酶烯类的耐药率为11.76%~35.29%,PCR扩增结果显示1(5.88%)株粘质沙雷菌携带TEM基因,17株粘质沙雷菌PFGE分型一致。结论粘质沙雷菌是重要的致病菌,存在着院内传播现象,具有多重耐药性。临床应根据药敏试验合理选用抗菌药物,加强感染控制,防止耐药菌株在院内交叉传播和暴发流行。%Objective To provide the guidance for the control and treatment of blood stream infec-tion caused by Serratia marcescens strains through analyzing the homology and drug resistant genes of the iso-lates collected from the Intensive Care Unit ( ICU) of Shaoxing County Central Hospital.Methods Serratia marcescens strains were isolated from ICU patients with blood stream infection and also from the hands of health care providers in the ICU from June 1st to September 30th, 2013.The antibiotic susceptibilities of the Serratia marcescens isolates were tested.PCR was performed to amplify the common drug resistant genes. Pulse-field gel electrophoresis ( PFGE) was carried out for analyzing the homology of all isolates.The com-plete clinical data of the patients were collected and statistically analyzed with Spearman′s rank correlation coefficient

  5. Effectiveness of disinfectants used in hemodialysis against both Candida orthopsilosis and C. parapsilosis sensu stricto biofilms.

    Science.gov (United States)

    Pires, Regina Helena; da Silva, Julhiany de Fátima; Gomes Martins, Carlos Henrique; Fusco Almeida, Ana Marisa; Pienna Soares, Christiane; Soares Mendes-Giannini, Maria José

    2013-05-01

    Biofilms have been observed in the fluid pathways of hemodialysis machines. The impacts of four biocides used for the disinfection of hemodialysis systems were tested against Candida parapsilosis sensu stricto and Candida orthopsilosis biofilms generated by isolates obtained from a hydraulic circuit that were collected in a hemodialysis unit. Acetic acid was shown to be the most effective agent against Candida biofilms. Strategies for effective disinfection procedures used for hemodialysis systems should also seek to kill and inhibit biofilms.

  6. Survival after acute hemodialysis in Pennsylvania, 2005-2007: a retrospective cohort study.

    Directory of Open Access Journals (Sweden)

    Sarah J Ramer

    Full Text Available BACKGROUND: Little is known about acute hemodialysis in the US. Here we describe predictors of receipt of acute hemodialysis in one state and estimate the marginal impact of acute hemodialysis on survival after accounting for confounding due to illness severity. MATERIALS AND METHODS: This is a retrospective cohort study of acute-care hospitalizations in Pennsylvania from October 2005 to December 2007 using data from the Pennsylvania Health Care Cost Containment Council. Exposure variable is acute hemodialysis; dependent variable is survival following acute hemodialysis. We used multivariable logistic regression to determine propensity to receive acute hemodialysis and then, for a Cox proportional hazards model, matched acute hemodialysis and non-acute hemodialysis patients 1∶5 on this propensity. RESULTS: In 2,131,248 admissions of adults without end-stage renal disease, there were 6,657 instances of acute hemodialysis. In analyses adjusted for predicted probability of death upon admission plus other covariates and stratified on age, being male, black, and insured were independent predictors of receipt of acute hemodialysis. One-year post-admission mortality was 43% for those receiving acute hemodialysis, compared to 13% among those not receiving acute hemodialysis. After matching on propensity to receive acute hemodialysis and adjusting for predicted probability of death upon admission, patients who received acute hemodialysis had a higher risk of death than patients who did not over at least 1 year of follow-up (hazard ratio 1·82, 95% confidence interval 1·68-1·97. CONCLUSIONS: In a populous US state, receipt of acute hemodialysis varied by age, sex, race, and insurance status even after adjustment for illness severity. In a comparison of patients with similar propensity to receive acute hemodialysis, those who did receive it were less likely to survive than those who did not. These findings raise questions about reasons for lack of

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

    OpenAIRE

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

    2008-01-01

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

  8. Hepatitis C and hepatitis B virus infection in different hemodialysis units in Belo Horizonte, Minas Gerais, Brazil

    Directory of Open Access Journals (Sweden)

    Busek Solange U

    2002-01-01

    Full Text Available The prevalence, virological and epidemilogical aspects of the hepatitis C virus (HCV and the hepatitis B virus (HBV infections vary among hemodialysis patients in different countries. Aiming at analyzing these aspects of HCV and HBV infections in hemodialysis patients in Belo Horizonte, MG, Brazil, we studied three hemodialysis units including 434 patients. Serology was used to detect anti-HCV and HBsAg. Reverse trancriptase nested polymerase chain reaction (RT-nested-PCR of the 5'-noncoding region was used to detect circulating HCV RNA and restriction fragment length polymorphism analysis for genotyping. Seroprevalence varied from 26.5% to 11.1% for hepatitis C and from 5.9% to 0% for hepatitis B. Risk factors observed for HBV and/or HCV infections were the number of patients per dialysis unit, duration of treatment, number of clinics attended, number of blood units transfused, and lower level scholarity. Alanine aminotransferase levels were altered with a higher frequency in HBV or HCV seropositive patients. Half of ten patients, negative for anti-HCV, had detectable viremia by RT-nested-PCR, indicating that this technique should be used to confirm infections in this group of patients. The HCV genotype 1 was the most frequently observed, followed by the genotype 2, but no correlation was detected between genotype and clinical or epidemiological data.

  9. Orally administrated Juzen-taiho-to/TJ-48 ameliorates erythropoietin (rHuEPO)-resistant anemia in patients on hemodialysis.

    Science.gov (United States)

    Nakamoto, Hidetomo; Mimura, Taku; Honda, Nobuko

    2008-10-01

    Maintenance of the red blood cell volume is a fundamental aspect of ensuring oxygen supply to the tissue. Recombinant human erythropoietin (rHuEPO) was approved for marketing in Japan in 1990 for the treatment of anemia in patients on dialysis. Recombinant human erythropoietin caused a significant increase in hemoglobin (Hb) levels in patients on dialysis. However, not all have a good response to rHuEPO therapy; the causes of rHuEPO failure include iron deficiency, infection, uremia, and interaction of some drugs. Juzen-taiho-to (TJ-48), a mixture of extracts from 10 medicinal herbs, has been used traditionally to treat patients with anemia, anorexia, or fatigue. To clarify the effect of TJ-48 on erythropoietin-resistant anemia, we studied the effect of TJ-48 in patients on hemodialysis with erythropoietin-resistant anemia. We divided 42 end-stage renal disease patients on hemodialysis with erythropoietin-resistant anemia (Hbrenal disease patients. This effect was, at least in part, due to the anti-inflammatory effect of TJ-48 in patients on hemodialysis.

  10. Measures of blood pressure and cognition in dialysis patients

    Science.gov (United States)

    There are few reports on the relationship of blood pressure with cognitive function in maintenance dialysis patients. The Cognition and Dialysis Study is an ongoing investigation of cognitive function and its risk factors in six Boston area hemodialysis units. In this analysis, we evaluated the rela...

  11. The prevalence of transfusion transmitted virus infection in blood donors

    Institute of Scientific and Technical Information of China (English)

    Cheng Hui Huang; Ru Guang Chen; Yu Sen Zhou; Hai Tao Wang; Chun Ying Xie

    2000-01-01

    @@INTRODUCTION A newly discovered DNA virus,transfusion transmitted virus (TTV), was reported as a cause of post-transfusion hepatitis of unknown etiology in Japan[1]. In order to investigate TTV prevalence in southern China, a study was carried out among blood donors, patients with liver diseases and hemodialysis to determine the epidemiological charateristics.

  12. Longitudinal study of serum zinc and copper levels in hemodialysis patients and their relation to biochemical markers.

    Science.gov (United States)

    Navarro-Alarcon, M; Reyes-Pérez, A; Lopez-Garcia, H; Palomares-Bayo, M; Olalla-Herrera, M; Lopez-Martinez, M C

    2006-12-01

    A 6-mo longitudinal study of 48 hemodialysis patients (HPs) with chronic renal failure was performed. Three blood samplings were done. Samples of whole blood from each patient were collected during hemodialysis sessions after passing through the artificial kidney. Zinc and copper levels were measured by atomic absorption spectrometry. Additionally, 36 biochemical indexes were evaluated during the study. Fifty-two healthy matched controls were also considered. Mean serum zinc and copper concentrations in HPs were significantly decreased (Zn) and increased (Cu), when compared with healthy controls (p < 0.01). Zinc concentrations found in the first and second blood samplings from patients were significantly lower than those measured for the third sampling (p < 0.01). The etiology of chronic renal failure influenced the statistically serum Zn levels of patients (p < 0.05). Serum copper levels of HPs were significantly diminished by the existence of secondary associated diseases (p < 0.01). Uric acid and parathyroid hormone, and total-cholesterol and glutamic-pyruvic-transaminase levels were significantly (p < 0.05) and linearly related with serum zinc and copper concentrations, respectively. From all of indexes, creatinine, direct bilirubin, magnesium, calcium, parathyroid hormone, transferrin, and albumin were statistically modified along the longitudinal study (p < 0.05). Transferrin serum levels were significantly diminished in the third blood sampling, indicating the tendency toward anemia in the patients. This result is reinforced by low levels of biochemical and hematological indexes related with iron body staus.

  13. Characterization of Hemodialysis Reverse Osmosis Wastewater From Yazd Educational Hospitals

    Directory of Open Access Journals (Sweden)

    Mohammad Saleh Ali-Taleshi

    2016-05-01

    Full Text Available This paper evaluates the technical feasibility of reusing hemodialysis reverse osmosis wastewater from educational hospitals in Yazd, Iran, as an alternative water source. For this study, from October to December 2013, hemodialysis reverse osmosis wastewater samples were obtained from two dialysis facilities and analyzed for biochemical oxygen demand (BOD, chemical oxygen demand (COD, pH, and electrical conductivity (EC using standard methods. Furthermore, concentrations of heavy metals such as Ag, Ba, Cd, Cu, Pb, Se, and Zn were calculated. Results were analyzed using the one sample t-test and independent t-test in SPSS 16 software. Mean concentrations of Ag, Ba, Cd, Cu, Fe, Pb, Se, and Zn in the hemodialysis reverse osmosis wastewater were 0.0960, 0.0611, 0.0186, 0.3381, 0.2153, 0.2212, 0.4196, and 0.0667 mg/L at S. Dr. Rahnamoon hospital, and 0.0963, 0.0849, 0.0177, 0.2942, 0.2160, 0.1827, 0.3420, and 0.0867 mg/L at S. Sadoughi hospital, respectively. The results also showed that the important challenges for reusing hemodialysis wastewater were its high EC and the presence of some elements, such as Se and Pb. Unlike Se and Pb, the concentrations of the other parameters were below discharge emission standards. Because of the large volumes of water used in hemodialysis, it is important to study the potential for reusing or recycling it. Through evaluation of the technical feasibility of hemodialysis wastewater reuse, this study draws attention to this neglected issue, especially in hemodialysis therapy.

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

    DEFF Research Database (Denmark)

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

    2016-01-01

    The objectives of this study were to assess the prevalence of chronic obstructive pulmonary disease (COPD) in hemodialysis patients with spirometry and to examine the effects of fluid removal by hemodialysis on lung volumes. Patients ≥18 years at two Danish hemodialysis centers were included...

  15. 21 CFR 876.5600 - Sorbent regenerated dialysate delivery system for hemodialysis.

    Science.gov (United States)

    2010-04-01

    ... hemodialysis. 876.5600 Section 876.5600 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND....5600 Sorbent regenerated dialysate delivery system for hemodialysis. (a) Identification. A sorbent regenerated dialysate delivery system for hemodialysis is a device that is part of an artificial kidney...

  16. The Andromeda Stream

    CERN Document Server

    Lewis, G F; Ferguson, A M N; Ibata, R A; Irwin, M J; McConnachie, A W; Tanvir, N

    2004-01-01

    The existence of a stream of tidally stripped stars from the Sagittarius Dwarf galaxy demonstrates that the Milky Way is still in the process of accreting mass. More recently, an extensive stream of stars has been uncovered in the halo of the Andromeda galaxy (M31), revealing that it too is cannibalizing a small companion. This paper reports the recent observations of this stream, determining it spatial and kinematic properties, and tracing its three-dimensional structure, as well as describing future observations and what we may learn about the Andromeda galaxy from this giant tidal stream.

  17. Hydrography - Streams and Shorelines

    Data.gov (United States)

    California Department of Resources — The hydrography layer consists of flowing waters (rivers and streams), standing waters (lakes and ponds), and wetlands -- both natural and manmade. Two separate...

  18. The case against streaming

    National Research Council Canada - National Science Library

    Natalia Mironova

    2014-01-01

    .... Cassidy, the safety coordinator at the Airline Pilots Association, says Levine and others advocating for live data streaming are oversimplifying the issue and overlooking the logistical concerns...

  19. Inventory of miscellaneous streams

    Energy Technology Data Exchange (ETDEWEB)

    Lueck, K.J.

    1995-09-01

    On December 23, 1991, the US Department of Energy, Richland Operations Office (RL) and the Washington State Department of Ecology (Ecology) agreed to adhere to the provisions of the Department of Ecology Consent Order. The Consent Order lists the regulatory milestones for liquid effluent streams at the Hanford Site to comply with the permitting requirements of Washington Administrative Code. The RL provided the US Congress a Plan and Schedule to discontinue disposal of contaminated liquid effluent into the soil column on the Hanford Site. The plan and schedule document contained a strategy for the implementation of alternative treatment and disposal systems. This strategy included prioritizing the streams into two phases. The Phase 1 streams were considered to be higher priority than the Phase 2 streams. The actions recommended for the Phase 1 and 2 streams in the two reports were incorporated in the Hanford Federal Facility Agreement and Consent Order. Miscellaneous Streams are those liquid effluents streams identified within the Consent Order that are discharged to the ground but are not categorized as Phase 1 or Phase 2 Streams. This document consists of an inventory of the liquid effluent streams being discharged into the Hanford soil column.

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

    Directory of Open Access Journals (Sweden)

    Dimković Nada

    2006-01-01

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

  1. Relationship between serum leptin level and cardiovascular, nutrtional risk factors in non-diabetic hemodialysis.

    Directory of Open Access Journals (Sweden)

    Hyung-Jong Kim

    2012-06-01

    Full Text Available Many studies showed that obesity was associated with high level of serum leptin, hyperhomocysteinemia, and insulin resistance in general population. Obesity is associated with various cardiovascular and metabolic complications. However, in end stage renal failure, it has been reported that obesity is associated with a favorable survival of patients. The purpose of this observational study was to investigate the relationship between serum leptin level increased at obesity and cardiovascular, nutritional traditional markers, and the comparison of patient’s survival for 5 years according to obesity in non-diabetic hemodialysis. A cross-sectional study was performed in obese and non-obese subjects according to body mass index. Fifteen obese patients (BMI≥25 kg/m2 and 29 non-obese patients (BMI<25 kg/m2 were studied. For each subject, blood was sampled for measurement of serum leptin, insulin resistance, C-reactive protein (CRP and nutritional parameters before hemodialysis. Insulin resistance was calculated by HOMA-IR. Linear regression analysis was performed to determine the relationship among insulin resistance, serum leptin level and nutritional parameters. In results, serum leptin level was significant positive correlated with BMI, nPCR, pre-albumin and HOMA-IR (p<0.05. Serum leptin level was significant negative correlated with tCO2 and CRP (p<0.05. Five years survival by Kaplan-Meier analysis was more favorable in obese group but did not show statistical significance (p=0.053. In conclusion, serum leptin level was associated with obesity and good nutrition status. But in view of positive correlation of HOMA-IR, serum leptin level may be associated with cardiovascular complication in non-diabetic hemodialysis patients. Therefore, we thought that serum leptin level may be a good nutritional marker and a cardiovascular risk factor. We thought that the further study for the proper leptin level will be needed and help the improvement of

  2. Efficacy of losartan for improving insulin resistance and vascular remodeling in hemodialysis patients.

    Science.gov (United States)

    Sun, Fang; Song, Yan; Liu, Jing; Ma, Li-Jie; Shen, Yang; Huang, Jing; Zhou, Yi-Lun

    2016-01-01

    Insulin resistance and vascular remodeling are prevalent and predict cardiovascular mortality in hemodialysis patients. Angiotensin II (Ang II) may be involved in both pathogenesis. In the present study, we investigated the effects of the Ang II receptor blocker losartan on insulin resistance, arterial stiffness, and carotid artery structure in hemodialysis patients. Seventy-two hemodialysis patients were randomly assigned to receive either losartan 50 mg qd (n = 36) or β-blocker bisoprolol 5 mg qd (n = 36). At the start and at month 12, ambulatory blood pressure (BP) monitoring, aortic pulse wave velocity (PWV) measurements, and carotid artery ultrasound were performed, and homeostasis model assessment index of insulin resistance (HOMA-IR) was determined. During the study period, bioimpedance method was used to evaluate volume status every 3 months. Home-monitored BPs were measured at least monthly. Ambulatory BP decreased significantly and similarly by either losartan or bisoprolol. Decreases in PWVs in losartan group at the end of month 12 were significantly greater than changes in PWV in bisoprolol group (0.9 ± 0.3 vs. 0.4 ± 0.5 m/s, P = 0.021). Common carotid artery intima-media cross-sectional area decreased significantly only in patients treated with losartan (20.3 ± 4.9 vs. 19.1 ± 5.1 mm(2) , P = 0.001), and HOMA-IR was also reduced in losartan group only (1.9 ± 1.0 vs. 1.7 ± 0.8, P = 0.003). Multiple regression analysis showed significant correlations between changes in PWV and changes in HOMA-IR. With comparable BP-lowering efficacy, losartan achieved better improvement in insulin sensitivity, arterial stiffness, and carotid artery hypertrophy in hemodialysis patients. The regression of arterial stiffness may be in part through attenuation in insulin resistance.

  3. Seroprevalence of Hepatitis Viruses B, C, D and HIV Infection Among Hemodialysis Patients in Kerman Province, South-East Iran

    Directory of Open Access Journals (Sweden)

    Mohammad Javad Zahedi

    2012-05-01

    Full Text Available Background: The prevalence of hepatitis viruses in hemodialysis patients has been reported to be much greater than in the general population. Attention to local data, effectively guides health planners so that they can control infections and prevent nosocomial transmissions.Objectives: This cross sectional study was carried out to determine the prevalence of hepatitis B (HBV, hepatitis C (HCV, and hepatitis D (HDV viruses, as well as the human immunodeficiency virus (HIV in dialysis centers in the Kerman Province, in the southeast of Iran.Patients and Methods: All hemodialysis patients (n = 228 in 7 centers were enrolled in the study. Hepatitis B surface antigens (HBsAg, HCV antibodies (Ab, HDV Ab and HIV Ab were measured using specific enzyme linked immunoassay kits (ULTRA kit, bioMérieux, France and confirmed by a qualitative PCR assay.Results: The studied group was comprised of 92 (40.4% females and 136 (59.6% males. The mean age of the patients was 51 ± 9.5 years and the duration of hemodialysis was 39.7 ± 7.9 months. Positive HBsAg was found in 7% of cases, HCV Ab in 7%, and patients with both viruses were detected in 1.7% cases. HIV Ab and HDV Ab were negative in all cases. Out of the other risk factors, frequency of blood transfusions was significantly correlated with positive HCV Ab (P < 0.008.Conclusions: Prevalence of HBV and HCV in hemodialysis patients was moderate to low in the Kerman Province, as in other parts of the country. Strict adherence to protective measures could lead to even lower rates.

  4. Association of CKD-MBD Markers with All-Cause Mortality in Prevalent Hemodialysis Patients: A Cohort Study in Beijing

    Science.gov (United States)

    Li, Duo; Zhang, Ling; Zuo, Li; Jin, Cheng Gang; Li, Wen Ge; Chen, Jin-Bor

    2017-01-01

    The relationships between all-cause mortality and serum intact parathyroid hormone (iPTH), calcium, and phosphate are fairly diverse in patients on maintenance hemodialysis according to prior studies. This study evaluated the association of chronic kidney disease-mineral and bone disorder (CKD-MBD) markers with all-cause mortality in prevalent hemodialysis patients from 2007 to 2012 in Beijing, China. A cohort, involving 8530 prevalent hemodialysis patients who had undergone a 6–70 months follow-up program (with median as 40 months) was formed. Related data was recorded from the database in 120 hemodialysis centers of Beijing Health Bureau (2007 to 2012). Information regarding baseline demographics, blood CKD-MBD markers and all-cause mortality was retrospectively reviewed. By using multivariate Cox regression model analysis, patients with a low iPTH level at baseline were found to have greater risk of mortality (<75pg/ml, HR = 1.36, 95% confidence interval (CI) 1.16–1.60) than those with a baseline iPTH level within 150–300 pg/ml. Similarly, death risk showed an increase when the baseline serum calcium presented a low level (<2.1mmol/L, HR = 1.54; 95% CI 1.37–1.74). Levels of baseline serum phosphorus were not associated with the risk of death. Similar results appeared through the baseline competing risks regression analysis. Patients with a lower level of serum iPTH or calcium are at a higher risk of all-cause mortality compared with those within the range recommended by Kidney Disease Outcome Quality Initiative (KDOQI) guidelines. PMID:28045985

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

    Directory of Open Access Journals (Sweden)

    Bruno Guéry

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

  6. Increased Hepato-Splanchnic Vasoconstriction in Diabetics during Regular Hemodialysis.

    Directory of Open Access Journals (Sweden)

    Werner Ribitsch

    Full Text Available Ultrafiltration (UF of excess fluid activates numerous compensatory mechanisms during hemodialysis (HD. The increase of both total peripheral and splanchnic vascular resistance is considered essential in maintaining hemodynamic stability. The aim of this study was to evaluate the extent of UF-induced changes in hepato-splanchnic blood flow and resistance in a group of maintenance HD patients during regular dialysis.Hepato-splanchnic flow resistance index (RI and hepato-splanchnic perfusion index (QI were measured in 12 chronic HD patients using a modified, non-invasive Indocyaningreen (ICG dilution method. During a midweek dialysis session we determined RI, QI, ICG disappearance rate (kICG, plasma volume (Vp, hematocrit (Hct, mean arterial blood pressure (MAP and heart rate (HR at four times in hourly intervals (t1 to t4. Dialysis settings were standardized and all patient studies were done in duplicate.In the whole study group mean UF volume was 1.86 ± 0.46 L, Vp dropped from 3.65 ± 0.77L at t1 to 3.40 ± 0.78L at t4, and all patients remained hemodynamically stable. In all patients RI significantly increased from 12.40 ± 4.21 mmHg∙s∙m2/mL at t1 to 14.94 ± 6.36 mmHg∙s∙m2/mL at t4 while QI significantly decreased from 0.61 ± 0.22 at t1 to 0.52 ± 0.20 L/min/m2 at t4, indicating active vasoconstriction. In diabetic subjects, however, RI was significantly larger than in non-diabetics at all time points. QI was lower in diabetic subjects.In chronic HD-patients hepato-splanchnic blood flow substantially decreases during moderate UF as a result of an active splanchnic vasoconstriction. Our data indicate that diabetic HD-patients are particularly prone to splanchnic ischemia and might therefore have an increased risk for bacterial translocation, endotoxemia and systemic inflammation.

  7. A maintenance hemodialysis diabetic patient with unexplained pulmonary and gastrointestinal involvement.

    Science.gov (United States)

    Yuvaraj, Anand; Abraham, Georgi; Kurien, Abraham; Koshy, Priyanka; Nair, Sanjeev; Ghosh, Sudhakshina

    2016-01-01

    A 50-year-old man with diabetes mellitus with diabetic retinopathy, peripheral neuropathy, hypertension, and end-stage renal disease on maintenance hemodialysis, presented with persistent cough and hiccups, continued to be unwell with weight loss, poor appetite, and recurrent respiratory symptoms such as wheezing and cough. Whole body positron emission tomography-computed tomography scan showed metabolically active lesions in liver, stomach/lesser sac, pancreas, and left sixth rib. As he had repeated bilateral transudative pleural effusion, left mini thoracotomy with pleural biopsy showed no evidence of granuloma or malignancy. Upper gastroscopy showed tiny gastric polyp; biopsy revealed benign lesion. Left posterior rib biopsy from the lesion and iliac crest biopsy showed no evidence of malignancy or granuloma. Further evaluation showed plasma chromogranin A -5737 μg/L (pain on conservative measures, penectomy with perineal urethrostomy was performed. Biopsy of the lesion showed blood vessels with intimal calcifications and thrombosis suggesting penile necrosis. © 2015 International Society for Hemodialysis.

  8. Impacts of parathyroidectomy on renal anemia and nutritional status of hemodialysis patients with secondary hyperparathyroidism.

    Science.gov (United States)

    Chen, Chen; Wu, Hua; Zhong, Lin; Wang, Xin; Xing, Zhuang-Jie; Gao, Bi-Hu

    2015-01-01

    The aim of this study was to investigate the impacts of parathyroidectomy (PTX) towards the renal anemia and nutritional status of hemodialysis patients with secondary hyperparathyroidism (SHPT). 32 patients, enrolled into the blood purification center of our hospital for the hemodialysis treatment, were collected and divided into the PTX group and the non-PTX group, with 16 patients in each group. The changes of relevant indicators such as immunoreactive parathyroid hormone (iPTH), anemia and nutrition were observed before, 1-, 3-, 6-month after the treatment. The contents of iPTH, Ca, P and Ca × P of the PTX group decreased rapidly 1 month after the surgery; while Hb and Hct increased significantly from the 1st postoperative month; the dosage of EPO was significantly reduced 3-month after the surgery; the content of Alb gradually increased from the 3(rd) postoperative month; the content of TG decreased significantly from the 6(th) postoperative month; while the contents of BMI and TSF increased significantly from the 6(th) postoperative month, which exhibited the statistically significant differences when compared with the preoperative and the non-PTX group (P anemia and nutritional status; SHPT was the important factor that would affect the renal anemia and malnutrition; PTX could reduce the amount of EPO, and reduce the economic burden of patients.

  9. Hepatitis E virus infection in hemodialysis patients: A seroepidemiological survey in Iran

    Directory of Open Access Journals (Sweden)

    EhsaniArdakani MohammadJavad

    2005-05-01

    Full Text Available Abstract Background The hepatitis E virus (HEV has a global distribution and is known to have caused large waterborne epidemics of icteric hepatitis. Transmission is generally via the fecal-oral route. Some reports have suggested parenteral transmission of HEV. Anti-HEV prevalence data among chronic hemodialysis (HD patients are few and give conflicting results. Methods This cross-sectional study was conducted in August of 2004. We tested 324 chronic HD patients attending three different units in the city of Tabriz, northwestern part of Iran, for anti-HEV antibody. A specific solid- phase enzyme-linked immunoassay (Diapro, Italy was used. Results The overall seroprevalence of hepatitis E was 7.4 %(95% CI: 4.6%–10.6%. The prevalence rate of HBV and HCV infection were 4.6% (95% CI: 2.3%–6.9% and 20.4% (95% CI: 16%–24.8%, respectively. No significant association was found between anti-HEV positivity and age, sex, duration of hemodialysis, positivity for hepatitis B or C virus infection markers and history of transfusion. Conclusion We observed high anti-HEV antibody prevalence; there was no association between HEV and blood borne infections (HBV, HCV, and HIV in our HD patients. This is the first report concerning seroepidemiology of HEV infection in a large group of chronic HD individuals in Iran.

  10. Endocarditis and spondylodiscitis associated with tunneled cuffed hemodialysis catheters: hospitalizations with poor outcomes.

    Science.gov (United States)

    Rocha, Ana; Castro, Rui; Santos, Josefina

    2015-04-01

    Patients undergoing chronic hemodialysis using tunneled cuffed catheters (TCCs) are at increased risk of metastatic infections, namely endocarditis and spondydodiscitis, and mortality is high in this group. The aim of this study was to determine the clinical features, causative organisms, its susceptibility and outcomes in patients hospitalized with these infections from a single center. All consecutive patients with TCC and endocarditis and/or spondylodiscitis treated at the authors' institution between 2005 and 2011 were selected retrospectively. A total of 7 cases of endocarditis and 7 cases of spondylodiscitis were diagnosed. Concurrent infection was present in 1 patient. The mean age was 63.4 years, 53.8% were male, 23% had diabetes and 31% had previous immunosuppression. The average time on hemodialysis was 24 months. Those patients with endocarditis presented with fever, and 43% had previous valvular disease; mitral valve involvement was the most common. Early surgery was performed in 2 patients.Concerning spondylodiscitis, the median time from first symptom to diagnosis was 48 days. The first manifestation was back pain in 86% percent of patients, and 71% had an epidural or paraspinous abscess demonstrated by neuroimaging. One patient underwent surgical drainage of the abscess. Regarding both infections, staphylococcus aureus was the most common causative agent with a lower rate of negative blood cultures. All patients received intravenous antibiotics for a mean duration of six weeks. The mortality rate was 46%. A high index of suspicion is critical in the early recognition and management of both of these infections.

  11. Decoration of heparin and bovine serum albumin on polysulfone membrane assisted via polydopamine strategy for hemodialysis.

    Science.gov (United States)

    Xie, Bingwu; Zhang, Ranran; Zhang, Huan; Xu, Anxiu; Deng, Yi; Lv, Yalin; Deng, Feng; Wei, Shicheng

    2016-06-01

    Renal failure brings about abnormality of waste and toxins and deposition in the body. In clinic, the waste and toxins in vitro are eliminated by hemodialysis device with polysulfone (PSF) porous membranes. In the work, decoration of heparin (Hep) and bovine serum albumin (BSA) on PSF membranes would be beneficial to improve the hemocompatibility and reduce the anaphylatoxin formation during hemodialysis. The PSF porous membranes are surface-modified by simply dipping them into dopamine aqueous solution for 8 h. Then, Hep and BSA are immobilized covalently onto the resultant membrane. Attenuated total reflectance Fourier transform infrared spectra (ATR-FTIR) confirms that Hep and BSA are successfully introduced onto the surface of PSF membranes. Scanning electronic microscopy (SEM) and atomic force microscopy (AFM) display the changes of surface morphologies after modification. The result of water contact angle measurement shows that the hydrophilicity of PSF membranes is remarkably improved after coating polydopamine (pDA) and binding Hep and BSA. The experiments of hemocompatibility indicate that Hep and BSA grafted onto membranes suppress the adhesion of platelet and enhance the anticoagulation ability of PSF membranes. Furthermore, the protein adsorption tests reveal that Hep and BSA immobilized onto membranes depress the protein absorption and develop antifouling-protein ability of pristine membrane. This study proves a convenient and simple approach to graft two functional organic polymers which, respectively, play a vital role and then improve the hemocompatibility and biocompatibility of PSF membranes for their biomedical and blood-contacting applications.

  12. A field guide to iron needs in the patient on hemodialysis.

    Science.gov (United States)

    Wick, Gail

    2009-01-01

    It is essential for nephrology nurses to understand the basics of iron function and the importance of maintaining iron balance in their patients. Iron forms the cornerstone of oxygen delivery in the body and is the most essential nutrient for the building of healthy erythrocytes. Given the vital importance of iron, the body has devised elaborate and tightly controlled mechanisms to transport iron to the bone marrow for hemoglobin production, recycle iron from dying erythrocytes, and prevent iron loss. In the healthy individual, daily iron intake needs are very small, and sufficient iron is easily absorbed from the duodenum. In patients on hemodialysis, this iron balance is dramatically altered due to blood loss, inflammation, and the use of erythropoiesis-stimulating agents. This article discusses the basics of iron physiology and the mechanisms by which iron is moved throughout the body and made available for developing erythrocytes. The ways in which iron balance is altered in the patient on hemodialysis and the most effective strategies to replete iron stores and maintain iron balance through the use of intravenous iron are also reviewed.

  13. Parameters of hemodialysis adequacy and patients’ survival depending on treatment modalities

    Directory of Open Access Journals (Sweden)

    Đurić Petar S.

    2015-01-01

    Full Text Available Introduction. Retrospective studies showed that hemodiafiltration was associated with a reduced risk of mortality compared with standard hemodialysis in the patients with end-stage renal disease. Recently, a few prospective randomized clinical trials found no advantage in survival with hemodiafiltration as compared with high-flux hemodialysis and low-flux hemodialysis. The aim of this study was to compare the parameters of hemodialysis adequacy and two-year survival of patients depending on the modality of hemodialysis. Material and Methods. A total of 159 hemodialysis patients were divided into 3 groups according to the type of hemodialysis treatment: group A - lowflux hemodialysis, group B - high-flux hemodialysis, and group C - hemodiafiltration. All patients had the same duration of hemodialysis sessions. The analysis included average one-year biochemical parameters, and two-year survival of patients. Results. The patients on hemodiafiltration were significantly younger, they had longer dialysis vintage and higher index of dialysis adequancy as compared with the patients on low-flux hemodialysis and high-flux hemodialysis, but without a difference between the two latter groups. Compared to the patients on low-flux hemodialysis, the patients on hemodiafiltration and high-flux hemodialysis had significantly higher hemoglobin value with less frequent erythropoietin stimulating agent use. According to Kaplan-Meier survival analysis, the patients on hemodiafiltration and high-flux hemodialysis had significantly better two-year survival than the patients on low-flux hemodialysis. Cox proportional hazards model confirmed that high-flux hemodialysis caused a significantly lower relative risk of mortality (56% reduction compared to low-flux hemodialysis (hazard ratio 0.44; P=0.026, and hemodiafiltration caused a 58% reduction in the relative risk of mortality compared to low-flux dialysis (hazard ratio 0.42; P=0.105, but without a statistical

  14. Hemodialysis-induced acute myocardial dyssynchronous impairment in children.

    Science.gov (United States)

    Hothi, Daljit K; Rees, Lesley; McIntyre, Christopher W; Marek, Jan

    2013-01-01

    In adults, recurrent hemodialysis (HD)-induced cardiac injury results in ischemic myocardial dysfunction. Uremic children, like adults, share the full complement of uremia-related cardiovascular abnormalities but without significant atheromatous coronary artery disease. The aim of this study was, to assess the impact of HD on left ventricular (LV) myocardial function in children. We assessed all single-center chronic HD patients (n = 15, range 1-17 years) excluding those with overt cardiac disease. Regional LV function and mechanical synchronicity was measured echographically by two-dimensional segmental longitudinal, circumferential and radial myocardial strain. All patients were assessed pre-dialysis and at the end of dialysis. In addition, we scanned age-matched controls at rest. The peak longitudinal strain was lower in uremic patients compared with controls with a significant fall during HD (mean peak strain -19.9 controls, -17.9 pre-HD, -15.3 end of HD, p < 0.05). Radial strain was lower in uremic patients and increased during HD. Circumferential strain was preserved in uremic patients and fell during HD. Intrasegmental deformation synchronicity was progressively worse pre-dialysis and end of dialysis compared with controls. Intradialytic peak longitudinal strain reduction was significantly associated with systolic blood pressure and ultrafiltrate volume (p < 0.05). Uremic children have impaired regional LV function, with a predisposition to longitudinal axis dysfunction and LV mechanical dyssynchrony, both of which are established markers of ischemic injury. This is further evidence for a characteristic cardiovascular phenotype in uremic patients that predisposes them to subclinical demand ischemia during dialysis. Copyright © 2013 S. Karger AG, Basel.

  15. Venous rupture complicating hemodialysis access angioplasty: percutaneous treatments and outcomes

    Energy Technology Data Exchange (ETDEWEB)

    La, Young Jong; Goo, Dong Erk; Kim, Dae Ho; Lee, Hae Kyoung; Hong, Hyun Suk; Kwon, Gui Hyang; Choi, Duk Lin; Ynag, Sung Boo [College of Medicine, Soonchunhyang Univ., Seoul (Korea, Republic of)

    2002-03-01

    To evaluate the usefulness of percutaneous management and prognosis in venous rupture during angioplasty of hemodialytic arteriovenous fistulas. Among 814 patients who underwent angioplasty on account of inadequate hemodialysis, 63(39 women and 24 men aged 20-78 (mean, 55.8) years) were included in this study. All 63 had peripheral venous stenosis. Venous rupture was diagnosed when contrast leakage was seen at venography after percutaneous angioplasty (PTA). In order to manage venous rupture, the sites at which this occurred were compressed manually for 3-5 minutes or blood flow was blocked with a balloon catheter for the same period. In one case, a stent was inserted at the rupture site. Using the Kaplan-Meier method, we investigated the patency rate of arteriovenous fistula (AVF) in cases of successful PTA. We also compared PTA patency rates in cases with and without peripheral venous rupture. Venous rupture occurred in 38 cephalic, 16 brachial, and 9 basilic veins. In 63 patients, bleeding stopped and in 54 (85.7 %) of thee, PTA was successful. Among the nine failed cases, dilatation was incomplete in five, though bleeding had stopped. In patients with brachial and cephalic vein rupture the venous tract at the rupture site was not located. Two patients underwent surgery: one of these experienced brachial venous rupture, with incontrollable bleeding, and the other had nerve compression symptoms due to hematoma. Among 54 patients in whom PTA was successful, the primary and secondary six-months rates for angioaccess were 47.9% and 81.2%, and the mean patency period was 6.1 and 15.8 months, respectively. In cases of non-venous rupture, the mean patency period was 9.6 months, significantly longer than in cases involving venous rupture (p=0.02). Venous rupture occurring during the PTA of hemodialytic AVF can be managed percutaneously.

  16. Intraoperative hemodialysis during liver transplantation: a decade of experience.

    Science.gov (United States)

    Nadim, Mitra K; Annanthapanyasut, Wanwarat; Matsuoka, Lea; Appachu, Kari; Boyajian, Mark; Ji, Lingyun; Sedra, Ashraf; Genyk, Yuri S

    2014-07-01

    Liver transplantation (LT) for patients with renal dysfunction is frequently complicated by major fluid shifts, acidosis, and electrolyte and coagulation abnormalities. Continuous renal replacement therapy (CRRT) has been previously shown to ameliorate these problems. We describe the safety and clinical outcomes of intraoperative hemodialysis (IOHD) during LT for a group of patients with high Model for End-Stage Liver Disease (MELD) scores. We performed a retrospective study at our institution of patients who underwent IOHD from 2002 to 2012. Seven hundred thirty-seven patients underwent transplantation, and 32% received IOHD. The mean calculated MELD score was 37, with 38% having a MELD score ≥ 40. Preoperatively, 61% were in the intensive care unit, 19% were mechanically ventilated, 43% required vasopressor support, and 80% were on some form of renal replacement therapy at the time of transplantation, the majority being on CRRT. Patients on average received 35 U of blood products and 4.8 L of crystalloids without significant changes in hemodynamics or electrolytes. The average urine output was 450 ml, and the average amount of fluid removal with dialysis was 1.8 L. The 90-day patient and dialysis-free survival rates were 90% and 99%, respectively. One-year patient survival rates based on the pretransplant renal replacement status and the MELD status were not statistically different. This is the first large study to demonstrate the safety and feasibility of IOHD in a cohort of critically ill patients with high MELD scores undergoing LT with good patient and renal outcomes.

  17. Human herpesvirus 6 infection in hemodialysis and peritoneal dialysis patients.

    Science.gov (United States)

    Altay, Mustafa; Akay, Hatice; Ünverdi, Selman; Altay, Filiz; Ceri, Mevlüt; Altay, F Aybala; Cesur, Salih; Duranay, Murat; Demiroz, Ali Pekcan

    2011-01-01

    Human herpesvirus 6 (HHV-6) infection occurs worldwide and can be reactivated from latency during periods of immunosuppression, especially after organ transplantation. No previous study has evaluated the influence of dialysis type on HHV-6 infection. The aim of the present study was to determine the prevalence of HHV-6 antibodies in hemodialysis (HD) and peritoneal dialysis (PD) patients. We studied 36 PD patients, 35 HD patients, and 20 healthy subjects, all with no history of organ transplantation. After systematic inquiries and a physical examination, blood was drawn for determination of biochemical parameters, cytomegalovirus immunoglobulin M (IgM) and immunoglobulin G (IgG), hepatitis B surface antigen, and the hepatitis C and human immunodeficiency virus antibodies. Titers of HHV-6 IgM and IgG antibodies were determined by ELISA. Titers for HHV-6 IgM antibody were positive in 9 HD patients (25.7%), 8 PD patients (22.2%), and 2 control subjects (10.0%, p > 0.05). More HD patients (20.0%) than PD patients (5.6%, p = 0.07) or control subjects (0.0%, p = 0.03) were positive for HHV-6 IgG antibody. In HD patients, HHV-6 IgG seropositivity and duration of dialysis were positively correlated (R = 0.33, p = 0.05). Infection with HHV-6 is not rare in PD and HD patients. In addition, HHV-6 IgG seropositivity was significantly higher in HD patients than in control subjects and approached significance when compared with seropositivity in PD patients. Moreover, in HD patients, HHV-6 IgG seropositivity correlated with duration on HD. These preliminary findings provide insight into the pre-transplantation period for patients and may aid our understanding of how to best protect patients against HHV-6 after transplantation.

  18. Left and right ventricular diastolic function in hemodialysis patients

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    Rudhani Ibrahim

    2010-01-01

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

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

    Science.gov (United States)

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

    2010-11-01

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

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

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    Dina Montasser

    2011-01-01

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

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

    Science.gov (United States)

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

    2006-01-01

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

  2. Correlation of serum 25-hydroxyvitamin D level with vascular calcification in hemodialysis patients

    Science.gov (United States)

    Wang, Fang; Wu, Shukun; Ruan, Yizhe; Wang, Li

    2015-01-01

    Objective: The aim of this study was to analyze the correlation of serum 25-hydroxyvitamin D level with vascular calcification in patients treated with hemodialysis. Methods: As a cross-sectional study, 126 patients receiving maintenance hemodialysis (MHD) in our hospital were enrolled in this study. According to the serum 25-hydroxyvitamin D level, the patients were divided into 25-hydroxyvitamin D deficiency group (30 ηg/ml or less than 30 ηg/ml) and 25-hydroxyvitamin D normal level group (>30 ηg/ml). All of the subjects underwent lateral lumbar, pelvis and hands X-ray examination to score the degree of calcification (Kauppila score). Results: Among the 126 patients treated with MHD, there were 110 patients with 25-hydroxyvitamin D deficiency and 16 patients with normal 25-hydroxyvitamin D level. There was no significant difference found in gender, age, age of dialysis, active vitamin D treatment, blood calcium, blood phosphorus, blood parathyroid hormone (PTH) and other related indicators between the two groups. The incidence of vascular calcification in patients with 25-hydroxyvitamin D deficiency was significantly higher than that in patients with normal 25-hydroxyvitamin D level (P = 0.001). Serum 25-hydroxyvitamin D level had a negative correlation with the calcification score (r = 0.193, P = 0.193). Logistic regression showed that 25-hydroxyvitamin D was not a risk factor for vascular calcification in MHD patients. Serum 25-hydroxyvitamin D level is generally low in patients with MHD. Conclusions: Patients with 25-hydroxyvitamin D deficiency have a higher incidence of vascular calcification with a markedly negative correlation. Thus, for the patients treated with MHD, vitamin D deficiency should be actively treated. PMID:26629071

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1994-02-01

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

  4. Longitudinal study of leptin levels in chronic hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Averbukh Zhan

    2011-06-01

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

  5. Pneumatic tourniquet for surgical procedures of hemodialysis vascular access.

    Science.gov (United States)

    Wang, Shouwen

    2015-01-01

    Pneumatic tourniquet has been frequently utilized in various surgical specialties to facilitate surgical procedures on the extremities. However, its use for surgical procedures of hemodialysis access has been limited to some surgeons in the United States and often confined to the hospital settings under general anesthesia or regional nerve block. We have successfully employed a pneumatic tourniquet system for surgical procedures of hemodialysis access under conscious sedation and local anesthesia in an outpatient setting. Because prolonged tourniquet inflation is associated with ischemic pain and other potential complications, we have limited the continuous inflation time to pneumatic tourniquet use is well tolerated under conscious sedation and not associated with significant adverse events. These and other reported data suggest that pneumatic tourniquet can reduce procedure time, minimize required dissection, reduce vascular trauma by eliminating vascular clamps and potentially improve the outcomes of surgical procedures of hemodialysis access. These advantages may be translated into cost savings for hemodialysis access care. This review discusses practical issues of pneumatic tourniquet use and its applications in surgical procedures of hemodialysis access. © 2014 Wiley Periodicals, Inc.

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

    Science.gov (United States)

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

    2010-09-01

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

  7. High Prevalence of Cardiovascular Disease in End-Stage Kidney Disease Patients Ongoing Hemodialysis in Peru: Why Should We Care About It?

    Directory of Open Access Journals (Sweden)

    Katia Bravo-Jaimes

    2015-01-01

    Full Text Available Purpose. To determine clinical, biochemical, and pharmacological characteristics as well as cardiovascular disease prevalence and its associated factors among end-stage kidney disease patients receiving hemodialysis in the main hemodialysis center in Lima, Peru. Methods. This cross-sectional study included 103 patients. Clinical charts were reviewed and an echocardiogram was performed to determine prevalence of cardiovascular disease, defined as the presence of systolic/diastolic dysfunction, coronary heart disease, ventricular dysrhythmias, cerebrovascular disease, and/or peripheral vascular disease. Associations between cardiovascular disease and clinical, biochemical, and dialysis factors were sought using prevalence ratio. A robust Poisson regression model was used to quantify possible associations. Results. Cardiovascular disease prevalence was 81.6%, mainly due to diastolic dysfunction. It was significantly associated with age older than 50 years, metabolic syndrome, C-reactive protein levels, effective blood flow ≤ 300 mL/min, severe anemia, and absence of mild anemia. However, in the regression analysis only age older than 50 years, effective blood flow ≤ 300 mL/min, and absence of mild anemia were associated. Conclusions. Cardiovascular disease prevalence is high in patients receiving hemodialysis in the main center in Lima. Diastolic dysfunction, age, specific hemoglobin levels, and effective blood flow may play an important role.

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

    Science.gov (United States)

    Rafieian-Kopaei, Mahmoud; Nasri, Hamid

    2013-01-01

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

  9. 血液透析相关性低血压的临床观察与处理%Clinical Observation and Treatment of Hemodialysis-Associated Hypotension

    Institute of Scientific and Technical Information of China (English)

    陶玲玲; 李敏

    2014-01-01

    Objective To observe the clinical symptoms in patients with hypotension during he-modialysis,and to analyze the causes and put forward the corresponding nursing countermeas-ures.Methods Data of 170 hemodialysis patients were investigated and analyzed to compare the physiological indicators between patients with hemodialysis-associated hypotension and patients without hemodialysis-associated hypotension.In addition,the causes of hemodialysis-associated hypotension were analyzed and the countermeasures were put forward.Results Hemodialysis was performed 10 200 times in the 170 patients,including 918 times in the 66 patients with hemo-dialysis-associated hypotension.The causes of hemodialysis-associated hypotension mainly in-cluded the deficiency of circulating blood volume,cardiogenic hypotension,and eating during dial-ysis.Compared with patients with hemodialysis-associated hypotension,the heart rate,mean arte-rial blood pressure and body weight gain significantly increased in patients without hemodialysis-associated hypotension.Conclusion The incidence of hemodialysis-associated hypotension is high and its clinical symptoms and causes vary among different patients.Foresight nursing should be strengthened and scientific and reasonable measures should be taken to improve the clinical effica-cy of hemodialysis.%目的:观察血液透析相关性低血压患者的临床症状,分析原因并提出相应的护理对策。方法调查和分析170例血透患者的治疗情况,对比分析血液透析相关性低血压发生患者和未发生患者的生理指标统计结果,分析其原因,提出对策措施。结果170例患者行血液透析10200例次,66例患者发生血透相关性低血压918例次;低血压发生原因主要包括有效循环血容量不足、心源性低血压、透析中进食等;血液透析相关性低血压发生患者的心率、平均动脉压和体质量增长量均高于未发生低血压的患者。结论血液透析相

  10. The blockade of renin-angiotensin-aldosterone system in hemodialysis patients to control hypertension and prevent cardiovascular disease: optimal pharmacotherapy.

    Science.gov (United States)

    Morishita, Yoshiyuki; Kusano, Eiji

    2011-10-01

    Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in hemodialysis (HD) patients. Hypertension (HT) is a major risk factor for CVD. The renin-angiotensin-aldosterone system (RAAS) plays pivotal roles in the pathogenesis of HT in HD patients. Previous studies suggested that the blockade of RAAS may be effective to control blood pressure (BP) and to prevent CVD in HD patients. A certain level of preventive effects against CVD by RAAS blockade in HD patients has been reported independently from a BP lowering effect. This review focuses on the effect of blocking RAAS in HD patients for the control of HT and the prevention of CVD.

  11. An approximate analytical solution to the ultra-filtration profile in a hemodialysis process between parallel porous plates

    Institute of Scientific and Technical Information of China (English)

    LU JunFeng; LU WenQiang

    2008-01-01

    In a hemodialysis process, the blood that runs through straight channels exchanges substances with the dialysate through a semi-permeable membrane. The waste products, such as urea and creatinine, are therefore removed from the plasma by the membrane. In the analysis of this process, determination of the ultra-filtration profile along the porous membrane surface remains a difficult problem. In this work, an analytical solution to the derivation of such a profile was detailed, and the feasibility of this solution was discussed. The ultra-filtration profile was found to be in a cosine shape.

  12. Antimicrobial susceptibility pattern and epidemiology of blood stream infections in China, 2012%2012年度全国血标本来源细菌分布及耐药状况

    Institute of Scientific and Technical Information of China (English)

    田磊; 朱旭慧; 孙自镛

    2015-01-01

    ,应根据药敏结果合理选用抗菌药物。%Objective To investigate the distribution and changing pa-ttern of susceptibility in bloodstream infection.Methods The blood cul-ture isolates from 557 tertiary hospitals and 232 second class hospitals were routinely isolated and identified.Antimicrobial susceptibility of these isolates were tested routinely.Results A total of 76483 strains were isolated from blood specimens in the tertiary hospitals during 2012.Gram-positive cocci and gram-negative bacilli accounted for 44.35%and 55.65%, respectively.A total of 6261 strains were isolated from blood specimens in the second-class hospitals during 2012.Gram-po-sitive cocci and gram -negative bacilli accounted for 48.89% and 51.11%, respectively.The most frequent gram-negative bacteria from the tertiary hospitals and the second -class hospitals were Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii and Enterobacter cloacae, the most fre-quent gram-positive bacteria were Coagulase-negative Staphylococus, Staphylococus aureus, Enterococcus faecium and Enterococcus faecalis.700 strains of Streptococcus pneumoniae ( 0.8%) , 28 strains of Hemophilus influenza (80.0%).The sensitivity rates of Enterococcus faecalis to Pencillin and Ampicillin were high (>80.0%).Escherichia coli was sensitive to not only Ampicillin/Sulbactam and Piperacillin/tazobactam (>90.0%) , but also Amikacin and Cefoxitin ( about 80.0%).Pseudomonas aeruginosa was sensitive to all of the common antibiotics almost.But it was just the opposite to Acinetobacter baumannii.Polymyxin B and Cefoperazone/Sulbactam were sensitive to Acinetobacter baumannii in the tertiary hospitals and the second-class hospitals, respec-tively(97.6%and 76.7%).Conclusion The datas of 2012 indicated that gram-negative bacilli, especially Esche-richia coli, played an important role in blood stream infections.A large number of Coagulase-negative Staphylococus, Staphylococus aureus were isolated

  13. Establishing Core Outcome Domains in Hemodialysis: Report of the Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) Consensus Workshop.

    Science.gov (United States)

    Tong, Allison; Manns, Braden; Hemmelgarn, Brenda; Wheeler, David C; Evangelidis, Nicole; Tugwell, Peter; Crowe, Sally; Van Biesen, Wim; Winkelmayer, Wolfgang C; O'Donoghue, Donal; Tam-Tham, Helen; Shen, Jenny I; Pinter, Jule; Larkins, Nicholas; Youssouf, Sajeda; Mandayam, Sreedhar; Ju, Angela; Craig, Jonathan C

    2017-01-01

    Evidence-informed decision making in clinical care and policy in nephrology is undermined by trials that selectively report a large number of heterogeneous outcomes, many of which are not patient centered. The Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) Initiative convened an international consensus workshop on November 7, 2015, to discuss the identification and implementation of a potential core outcome set for all trials in hemodialysis. The purpose of this article is to report qualitative analyses of the workshop discussions, describing the key aspects to consider when establishing core outcomes in trials involving patients on hemodialysis therapy. Key stakeholders including 8 patients/caregivers and 47 health professionals (nephrologists, policymakers, industry, and researchers) attended the workshop. Attendees suggested that identifying core outcomes required equitable stakeholder engagement to ensure relevance across patient populations, flexibility to consider evolving priorities over time, deconstruction of language and meaning for conceptual consistency and clarity, understanding of potential overlap and associations between outcomes, and an assessment of applicability to the range of interventions in hemodialysis. For implementation, they proposed that core outcomes must have simple, inexpensive, and validated outcome measures that could be used in clinical care (quality indicators) and trials (including pragmatic trials) and endorsement by regulatory agencies. Integrating these recommendations may foster acceptance and optimize the uptake and translation of core outcomes in hemodialysis, leading to more informative research, for better treatment and improved patient outcomes.

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

    Science.gov (United States)

    Honarmand, Marieh; Nakhaee, Alireza; Sargolzaie, Fahimeh

    2017-01-01

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

  15. HEARING ASSESSMENT IN CHRONIC RENAL FAILURE PATIENTS UNDERGOING HEMODIALYSIS

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    Arjun Singh

    2014-01-01

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

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

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    Qinglei Zhang

    2014-02-01

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