Kurita, Shigeaki; Moriwaki, Katsuyuki; Shiroyama, Kazuhisa; Sanuki, Mikako; Toyota, Yukari; Takebayashi, Minoru
Background Recently, rocuronium with subsequent use of sugammadex was proposed for electroconvulsive therapy (ECT) as an alternative to succinylcholine. Because sugammadex is cleared via the kidney with no metabolism, it is unknown that rocuronium-sugammadex use is safe in hemodialysis patients who received ECT. Case presentation In this case report, we used rocuronium with subsequent administration of sugammadex in a 69-year-old female, hemodialysis patient, scheduled for ten ECT sessions fo...
Kurita, Shigeaki; Moriwaki, Katsuyuki; Shiroyama, Kazuhisa; Sanuki, Mikako; Toyota, Yukari; Takebayashi, Minoru
Recently, rocuronium with subsequent use of sugammadex was proposed for electroconvulsive therapy (ECT) as an alternative to succinylcholine. Because sugammadex is cleared via the kidney with no metabolism, it is unknown that rocuronium-sugammadex use is safe in hemodialysis patients who received ECT. In this case report, we used rocuronium with subsequent administration of sugammadex in a 69-year-old female, hemodialysis patient, scheduled for ten ECT sessions for severe major depression. In the initial eight sessions, we tested the feasibility of rocuronium-sugammadex use for ECT. During the series of four ECT sessions, we measured plasma concentrations for the sum of sugammadex and sugammadex-rocuronium complex and observed whether possible residual sugammadex affected muscle relaxation during subsequent sessions of ECT. The results showed the feasibility of rocuronium-sugammadex use as muscle relaxants for ECT in patients undergoing hemodialysis. However, an accumulation of sugammadex did occur even after two sessions of hemodialysis, and residual sugammadex decreased the effect of the rocuronium given in the subsequent ECT sessions. Rocuronium-sugammadex was successfully utilized as muscle relaxants for ECT in this patient. Our experience in this case may indicate that if succinylcholine is contraindicated, rocuronium-sugammadex can be an alternative method for muscle relaxation during ECT in patients undergoing hemodialysis. When this rocuronium-sugammadex procedure is used, the effect of residual sugammadex after hemodialysis on the subsequently administered rocuronium should be considered.
Toth-Manikowski, Stephanie M.; Mullangi, Surekha; Hwang, Seungyoung; Shafi, Tariq
Background 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. Case presentation From 2011 to 2015, we initiated 5 incident hemodialysis patients on an ...
Yang, Ching-Ping; Kuo, Mei-Chuan; Guh, Jinn-Yuh; Chen, Hung-Chun
Methotrexate (MTX) is widely used in the treatment of rheumatoid arthritis (RA) with a side effect of pancytopenia. However, only a few cases of severe pancytopenia caused by low-dose MTX therapy have been reported, and the condition is rarely reported in uremic patients on dialysis therapy. We thereby report a hemodialysis patient who developed severe pancytopenia after oral treatment with low-dose MTX for RA. A 55-year-old woman who had been on regular hemodialysis treatment for 7 yr suffered from RA for 10 yr. She was regularly treated with celecoxib, prednisolone, and sulfasalazine in the past year. Because of the increasing arthralgia, 7.5 mg per week MTX was prescribed 3 months before admission. Stomatitis, fever, general fatigue, multiple skin carbuncles, and easy bruising developed after a cumulative dose of 90 mg. Pancytopenia was found at admission and the nadir of white blood cell count was 250/microL with 28% neutrophils, hematocrit was 22%, and platelet count was 6000/microL. Eosinophil counts increased from 11.5% initially to 26.1% on the sixth admission day. Transfusion with red blood cells and platelets, and appropriate antibiotics and folic acid were prescribed. She continued receiving regular hemodialysis and eventually recovered within 3 weeks.
Kim, Jung Min; Kim, Heung Cheol [Dept. of Radiology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon (Korea, Republic of)
Dialysis disequilibrium syndrome is a metabolic complication that can be caused by rapid removal of plasma urea during hemodialysis. Dialysis disequilibrium syndrome can lead to osmotic demyelinating syndrome. This case report describes one case of encephalopathy accompanied by dialysis disequilibrium syndrome with imaging findings acquired immediately after hemodialysis in a 55-year-old woman with chronic renal failure. The patient was observed to present repetitive seizures and sudden deterioration of consciousness immediately after hemodialysis. Shortly after the onset of symptoms, the patient underwent a CT scan. The imaging findings of the CT scan reveal symmetrical diffuse white matter edema of bilateral cerebral hemispheres that extends to the pons along the internal capsule. A follow-up MRI taken two years later shows that reversible changes without damage have occurred in the lesions. The patient can thus be seen to present symptoms characteristically associated with dialysis disequilibrium syndrome, while brain imaging reveals dif-fuse reversible brain edema.
Anees, M.; Barki, H.; Masood, M.
To measure the frequency of depression and its risk factors in patients under going hemodialysis. It is a cross-sectional prospective study conducted at Hemodialysis unit of Shalamar Hospital and Shaikh Zayed Hospital, Lahore from 1/sup st/ January 2006 to 30/sup th/ April 2006. All patients getting regular hemodialysis for more than three months were included. Beck's Depression Inventory- II (BDI-II; adapted in Urdu) was administered on all the patients who were able to read or understand it. Blood sample were drawn at the same time for routine hematological, biochemical parameters and viral markers (Anti HCV and HbsAg). Diagnosis was made as per Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM IV) for correlation of psychological variables with clinical, hematological and biochemical parameters. Eighty nine patients were enrolled which included fifty two (58.4%) were male and seventy seven (86.5%) were married. Major causes of renal failure were diabetes, hypertension and chronic glomerulonephrotis. Duration of dialysis was from 03 to 49 months with mean of 19.64 +- 11.7 months. Severity of depression was categorized in to mild, moderate and severe on the basis of BDI score. Majority of the patients fifty (56.1%) were moderately to severely depressed and there was no gender difference in the prevalence of depression. Majority of patients undergoing hemodialysis were depressed. Major risk factors for depression were marital status, illiteracy, number of children, socioeconomic factors, gender, hypertension and hypoalbuminemia. Patients with anemia, hyponatremia and hyperkalemia had suicidal tendency. Patients with hepatitis C and disturbed liver function have strong correlation with psychological parameters. (author)
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.
Orzincolo, C.; Ghedini, M.; Cardona, P.; Bedani, P.L.; Scutellari, P. N.
Destructive spondyloarthropathy (DSA) has been observed in patients undergoing long-term hemodialysis. The pathophysiology of this condition is still unknown, but there is evidence that amyloid depositions play an important role in its development. Despite several reports, the radiological evolution of these lesions is poorly known. The authors report the results of the radiographic follow-up (12-18 months) of 9 cases (7 female and 2 male patients; age 63±6 years) hemodilized for over 60 months (mean: 126±33). In 7 cases. radiographic patterns of destructive arthropathy were seen in peripheral joints as well. X-ray pictures demonstrated: 1) increased erosion of vertebral end plates (in all cases); 2) increased narrowing of invertebral spaces (in 5 cases); 3) increased collapse of vertebral bodies (in 5 cases); 4) increased malalignment of the involved segments (in 4 cases). In 3 autopsied cases β 2 -microglobulin amyloid depositions were found in disc and ligamentous paravertebral tissue. These results confirm that: 1) DSA is progressive in longterm hemodialysis patients; 2) radiographic evolution is often very quick; 3) the cervical spine is the most frequently involved location and the one where lesions are quickest to develop; 4) severe malalignament of the involved spine may be present, with subsequent neurological complications
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...
Milani, Rodrigo; Brofman, Paulo Roberto Slud; Souza, José Augusto Moutinho de; Barboza, Laura; Guimarães, Maximiliano Ricardo; Barbosa, Alexandre; Varela, Alexandre Manoel; Ravagnelli, Marcel Rogers; Silva, Francisco Maia da
To analyze the hospital outcomes of patients, with chronic renal insufficiency in the hemodialysis, submitted to OPCAB. Fifty-one patients with chronic renal insufficiency were submitted to OPCAB. Hemodialysis was performed on the day before and the day after the operation. Myocardial revascularization was performed using LIMA's suture and suction stabilization. Fifty-one patients, with an average of 61.28+/-11.09 years, were analyzed. Thirty patients (58.8%) were female. The predominant functional class was IV in 21 (41.1%) of the patients. The left ventricle ejection fraction was dire in 21 (41.1%) patients. The mean EUROSCORE of this series was 7.65+/-3.83 and the mean number of distal anastomosis was 3.1+/-0.78 per patient. The average time of mechanical ventilation was 3.78+/-4.35 hours and the mean ICU stay was 41.9+/-13.8 hours, while the average hospitalization was 6.5+/-1.31 days. In respect to complications, nine (17.6%) of the patients developed atrial fibrilation, and one (1.9%) patient presented with a case of ischemic stroke but had a good recovery during hospitalization. There were no deaths in this series. Chronic renal patients submitted to hemodialysis were always a high risk population for myocardial revascularization. In this series, the absence of extracorporeal circulation appeared to be safe and efficient in this special subgroup of patients. The operations were performed with low indices of complications, absence of deaths and relatively low stays in the ICU and in hospital.
Hashemi, Mohammad; Mehrabifar, Hamid; Homayooni, Fatemeh; Naderi, Mohammad; Montazerifar, Farzaneh; Ghavami, Saeid
It has been established that overproduction of reactive oxygen species (ROS) occurs during hemodialysis causing oxidation of proteins. Alpha-1-antitrypsin is the major circulating anti-protease which contains methionine in the active site. The aim of the present study was to measure the level of serum trypsin inhibitory capacity (sTIC) in hemodialysis patients. This case-control study was performed in 52 hemodialysis patients and 49 healthy controls. sTIC was measured by enzymatic assay. The sTIC was significantly (P< 0.001) lower in hemodialysis patients (1.87 + - 0.67 micron mol/min/mL) than healthy controls (2.83 + - 0.44 micron mol/min/L). Reduction of sTIC may be due to the oxidation of methionine residue in the reactive site of alpha-1 antitrypsin. (author)
Full Text Available Hidehiro Sugisawa,1 Toshio Shinoda,2 Yumiko Shimizu,3 Tamaki Kumagai,4 Hiroaki Sugisaki,5 Seiji Ohira6,† 1Department of Gerontology, Graduate School of Gerontology, J. F. Oberlin University, Tokyo, 2Department of Medical Care Technology, Faculty of Medical and Health Science, Tsukuba International University, Tsuchiura, 3Department of Community Health Nursing, The Jikei University School of Nursing, Chofu, 4Department of Fundamental Nursing, Graduate School of Nursing, Osaka City University, Osaka, 5Hachioji Azumacho Clinic, Hachioji, Tokyo, 6Sapporo Kita Clinic, Sapporo, Hokkai-do, Japan †Professor Dr. Seiji Ohira passed away on September 5, 2017 Background: This study aimed to investigate the levels of unmet needs for home and community-based services (HCBS evaluated by case managers (CMs among disabled patients on hemodialysis (DPHD and to examine factors related to unmet needs. Unmet needs for HCBS were defined as situations in which patients do not use or underuse HCBS despite needing them. Candidates for the factors relating to unmet needs for HCBS included three dimensions: predisposing, enabling, and need factors.Methods: Self-administrated questionnaires were collected from 391 CMs of DPHD certified with long-term care insurance. These were introduced by the dialysis facilities that a member of the Japanese Association of Dialysis Physicians belonged to. CMs were asked questions about their management of each individual case. HCBS included home help, visiting nursing, daycare, and short stay.Results: The prevalence of unmet needs for each HCBS ranged from 32% for home help to 48% for short stay. Barriers to service usage in the patients were associated with unmet needs for all four services. The patients with more severe cognitive malfunction were more likely to have unmet needs for visiting nursing and short stay. Heavier burden with caregiving was associated with more likelihood of unmet needs for home help and short stay
Sjolund, Jessica; Garcia Anton, Desiree; Bayes, Liz Y; Hoekstra, Tiny; Dekker, Friedo W; Munoz Mendoza, Jair
The effect of diuretics on residual renal function expressed as residual GFR (rGFR) and urine volume (rUV) using 24-hour urine collections has not been well examined in hemodialysis (HD) patients. We present a small (seven patient) but provocative case series describing a strikingly low rate of decline in rUV and rGFR (average of creatinine and urea clearances, 24-hour urine collections) in patients treated with increasing doses of furosemide (up to 360 mg/day) during the first 2 years after initiation of HD. Between 6 and 12 months, the mean rUV fell by 1 ml/month, whereas rGFR declined by 0.03 ml/min/1.73 m(2) /month. The mean rate of decline from 12 to 24 months for rUV (33 ml/month) and rGFR (0.02 ml/min/1.73 m(2) /month) were also low. While data are clearly limited and the observation retrospective, they are consistent with the better documented benefit of diuretics observed in end-stage renal disease patients treated with peritoneal dialysis. © 2016 Wiley Periodicals, Inc.
Full Text Available Abstract Introduction In the treatment of secondary hyperparathyroidism of chronic kidney disease, calcimimetics - allosteric modulators of the calcium-sensing receptor - inhibit glandular hyperplasia and significantly reduce circulating parathyroid hormone levels. They have a major impact on the management of secondary hyperparathyroidism. Case presentation We present the clinical case of a 41-year-old Caucasian man undergoing chronic hemodialysis, who had a parathyroidectomy to treat severe secondary hyperparathyroidism resistant to cinacalcet treatment. Preoperatively, 24 months after high-dose cinacalcet hydrochloride, we observed a persistently elevated intact parathyroid hormone serum level, and detected clear parathyroid gland hyperplasia regression on ultrasound. We performed a three-gland parathyroidectomy, which was assumed to be total, associated with a hemithyroidectomy. Our patient then entered a hypoparathyroid state. A histopathological examination showed that the removed parathyroid glands were of small size, with a total weight of 1g, associated with a multifocal small papillary thyroid cancer. Conclusion In the management of secondary hyperparathyroidism, cinacalcet hydrochloride effectively reduces total parathyroid gland hyperplasia. However, a persisting elevated intact parathyroid hormone serum level may be observed, demonstrating that reduced parathyroid hyperplastic tissue may still be associated with severe secondary hyperparathyroidism. Even if calcimimetics are very effective in secondary hyperparathyroidism treatment, further studies are necessary for a better understanding of their actions.
Holdaas, Hallvard; Holme, Ingar; Schmieder, Roland E
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...
Saitoh, Tomoya; Tanaka, Yoshiaki; Kuno, Tsutomu; Nagura, Yuji; Hayasaka, Kazumasa
The aim of this study was to evaluate the contrast enhancement, pharmacokinetics, dialyzability, and safety of gadodiamide in patients on hemodialysis. Thirteen hemodialysis patients with abdominal disease were examined after receiving intravenous gadodiamide (0.1 mmol/kg body weight) by magnetic resonance imaging (MRI) and were dialyzed at 1, 3, 5, and 8 days. Blood samples were obtained immediately before, during, and at the end of the first hemodialysis session and immediately before and at the end of the next three sessions. The complete blood count, blood biochemistry, β 2 -microglobulin, and gadolinium were measured. Dialysis of urea, creatinine, and gadolinium during the first hemodialysis session was assessed. Precontrast and postcontrast MRI and Gd-enhanced MR angiography (MRA) images were reviewed and visually evaluated by two radiologists; their evaluation was based on consensus. Gadodiamide did not cause any changes in renal function. An average of 73.8%, 92.4%, and 98.9% of the gadodiamide dose was eliminated by the end of the first, second, and third hemodialysis sessions, respectively. The average half-time of gadodiamide was 1.93 h (SD 0.55). The mean clearance of gadodiamide during hemodialysis was 63.5 ml/min (SD 21.9). There were no side effects related to the injection of gadodiamide. In all cases, diagnosable MRI and MRA images were obtained after gadodiamide injection in the hemodialysis patients. In hemodialysis patients, gadodiamide achieves diagnosable images. It is dialyzable and can be used safely without measures to increase excretion. (author)
DoorenbosBot, ACC; Geerlings, W; Houtman, IA
Four patients are discussed who underwent hemodialysis and developed anterior ischemic optic neuropathy (AION). Three patients had been treated by hemodialysis for several years. One patient developed bilateral optic neuropathy after the first hemodialysis session, So far, only four hemodialysis
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.
Kim, Yoo Kyung; Shim, Sung Shine; Shin, Jung Hee; Choi, Gyu Bock; Lee, Kyung Soo; Yi, Chin A; Oh, Yu Whan
A wide variety of pulmonary disorders related to hemodialysis or pre-existing renal disease occurs in hemodialysis patients. The disorders may be classified as 1) pulmonary abnormalities associated with chronic renal failures; 2) pulmonary complications arising during hemodialysis; 3) pulmonary infection; or 4) pulmonary-renal syndrome. An awareness of the various possible pulmonary disorders arising in hemodialysis patients may be helpful for the proper and timely management of such patients. We describe and illustrate various radiographic and CT findings of variable pulmonary disorders in hemodialysis patients
Butani, Lavjay; Calogiuri, Gianfranco
To describe hypersensitivity reactions in patients receiving maintenance hemodialysis. PubMed search of articles published during the past 30 years with an emphasis on publications in the past decade. Case reports and review articles describing hypersensitivity reactions in the context of hemodialysis. Pharmacologic agents are the most common identifiable cause of hypersensitivity reactions in patients receiving hemodialysis. These include iron, erythropoietin, and heparin, which can cause anaphylactic or pseudoallergic reactions, and topical antibiotics and anesthetics, which lead to delayed-type hypersensitivity reactions. Many hypersensitivity reactions are triggered by complement activation and increased bradykinin resulting from contact system activation, especially in the context of angiotensin-converting enzyme inhibitor use. Several alternative pharmacologic preparations and dialyzer membranes are available, such that once an etiology for the reaction is established, recurrences can be prevented without affecting the quality of care provided to patients. Although hypersensitivity reactions are uncommon in patients receiving hemodialysis, they can be life-threatening. Moreover, considering the large prevalence of the end-stage renal disease population, the implications of such reactions are enormous. Most reactions are pseudoallergic and not mediated by immunoglobulin E. The multiplicity of potential exposures and the complexity of the environment to which patients on dialysis are exposed make it challenging to identify the precise cause of these reactions. Great diligence is needed to investigate hypersensitivity reactions to avoid recurrence in this high-risk population. Copyright © 2017 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
Wang, Yu-Chieh; Huang, Shih-Yu; Lin, Ho-Tien; Hu, Jenkin-S; Chan, Kwok-Hon; Tsou, Mei-Yung
We present a case of post-operative iatrogenic quadriplegia, which occurred after subtotal parathyroidectomy. This patient was on long-term hemodialysis for 7 years. The need of prolonged neck extension for this procedure was probably the main risk factor for the spinal cord injury. Systemic hypotension which contributed to the injury in this case, should be anticipated and promptly treated to prevent further damage. Spinal deformities associated with end-stage renal disease may make such patients more susceptible. Since appropriate precautions against potential neurologic damage can be undertaken, we suggest that evaluating carefully for the pre-existing spinal stenosis before a procedure requiring prominent and prolonged hyper-extension of the neck, especially in long-term hemodialysis patients is of paramount importance. Copyright © 2011. Published by Elsevier B.V.
Sylvie Dusilová Sulková
Full Text Available Denosumab is a human monoclonal antibody representing a novel therapy of osteoporosis. Contrary to always other antiosteoporotic drugs, it is not contraindicated in advanced chronic kidney disease, as its pharmacokinetic does not differ from patients with normal kidney function. However, published case reports in chronic kidney disease (CKD patients stopped the therapy after single dose because of hypocalcemia. We present a case of successful treatment of osteoporosis in a young hemodialysis patient with repeated denosumab doses.
Reetz, Kathrin; Abbas, Zaheer; Eitner, Frank; Gross, Theresa; Schulz, Jörg Bernhard; Floege, Jürgen; Shah, N. J.; Costa, Ana Sofia; Gras, Vincent; Tiffin-Richards, Frances; Mirzazade, Shahram; Holschbach, Bernhard; Frank, Rolf Dario; Vassiliadou, Athina; Krüger, Thilo
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. Neuro...
metastatic the prognosis of EMPD is poor and treatment options are limited. We report a case of a complete response to single agent trastuzumab in a hemodialysis patient with metastatic Her2/neu overexpressed EMPD of the scrotum. Molecular profiling of his case as well as 12 other EMPD and 8 mammary Paget disease (MPD cases was completed and revealed multiple biomarker aberrations. Overexpression of Her2 was frequently noted (30%–40% in both EMPD and MPD patients and when present can be effectively treated with Her2 targeted agents. Trastuzumab therapy can be safely utilized in a hemodialysis patient. In addition, multiple protein overexpression and loss were seen in EMPD including PD-1, PD-L1, PTEN, and AR as well as PIK3CA mutation. These findings may lead to possible therapeutic interventions targeting these pathways in a disease with few effective treatment options.
Trevizoli, Jose Eduardo; de Paula Menezes, Raissa; Ribeiro Velasco, Lara Franciele; Amorim, Regina; de Carvalho, Mauro Birche; Mendes, Liliana Sampaio; Neto, Columbano Junqueira; de Deus Macedo, José Roberto; de Assis, Francisco; Neves, Rocha
Background and objectives: The severity of liver disease among hepatitis C patients on hemodialysis is controversial. The aim of this study was to compare the clinical, biochemical, and liver histologic characteristics of hepatitis C virus (HCV) in hemodialysis patients and in those with normal renal function. Design, setting, participants, & measurements: A case-control study was carried out with 36 HCV patients on hemodialysis and 37 HCV patients with normal renal function matched for gender, age at infection, and estimated time of infection. Results: HCV patients on hemodialysis had lower levels of alanina aminotransferase and lower viral load. Hepatic fibrosis was significantly higher in the patients with normal renal function (73%) than in hemodialysis patients (47.2%, P < 0.025); the same was observed for inflammatory activity (control group 59.5% versus hemodialysis patients 27.7%, P = 0.003). In addition, the risk of tissue inflammation was four times lower in hemodialysis patients (odds ratio = 0.23, P < 0.004), and severe inflammatory activity on biopsy was the only independent risk factor for fibrosis (P < 0.001). Conclusions: The lower biochemical and inflammatory activities observed in hemodialysis patients suggest that hemodialysis and uremia may have a protective role against progression of the disease caused by HCV. PMID:18650408
Ettema, Esmee M.; Kuipers, Johanna; Assa, Solmaz; Bakker, Stephan J. L.; Groen, Henk; Westerhuis, Ralf; Gaillard, Carlo A. J. M.; Gansevoort, Ron T.; Franssen, Casper F. M.
Objectives Plasma levels of copeptin, a surrogate marker for the vasoconstrictor hormone arginine vasopressin (AVP), are increased in hemodialysis patients. Presently, it is unknown what drives copeptin levels in hemodialysis patients. We investigated whether the established physiological stimuli
Full Text Available Depression is the most frequent psychological complication of haemodialysis (HD patients (pts and has been associated with impaired Quality of Life (QoL. The aim of our study was to investigate the prevalence of depression in HD pts in relation to sociodemographic factors and the relationship between depression and QoL.200 pts from Clinic for haemodialysis in Sarajevo, B&H were participating in the study. Mean age was S7,26±13,78 years and mean HD duration was 64’26±58,18 months. From the test material we applied BDI and SF-36.51% of our pts have shown depression (BDI>11 in various degrees (30%-mild depression, 8,5%-moderate depression and 12,5%-severe depression. As we could expect, the most emphasized symptoms of depression were somatic symptoms. 55,5% of pts have shown QoL lower then average. Sociodemographic data such as gender, marital status and HD duration did not influence significantly on pt’s QoL and occurrence of depression (p>0,05. As the age of the pts increased, level of depression increased too and QoL significantly decreased (p<0,05. Employed pts have shown significantly better QoL and lower level of depression in relation to unemployed pts (p<0,05. As the educational level of pts increased, QoL increased too and level of depression significantly decreased (p<0,05. Pts in 1st HD shift were significantly more depressed and have significantly worse mental health in compare to pts in 3rd HD shift (p<0,05. Our results showed a high prevalence of depressive symptoms among the study group that was linked to trend of poor QoL.
Vázquez-Rodríguez, Juan Gustavo; del Angel-García, Guadalupe
Pregnant patients with chronic renal insufficiency treated with hemodialysis experience adverse perinatal results. To compare perinatal complications of patients with chronic renal insufficiency undergoing hemodialysis who become pregnant vs. the complications of women with chronic renal insufficiency not undergoing dialysis but who then require dialysis during gestation. Transversal and retrospective study that included three patients with chronic renal insufficiency on chronic hemodialysis who became pregnant (group A) and three patients with chronic renal insufficiency without hemodialysis at the time of conception but who required dialysis during gestation (group B). Perinatal results were compared. Statistical analysis was performed with measures of central tendency and dispersion and Student t-test. Group A had 25 sessions vs. group B with 29 hemodialysis sessions (p = 0.88). Maternal complications were anemia 100% (six cases), Cesarean delivery 83.3% (group A 2 cases vs. group B 2 cases), preeclampsia 50% (group A 2 cases vs. group B 1 case), uncontrolled hypertension 50% (group A 2 cases vs. group B 1 case), preterm delivery 50% (group A 2 cases vs. group B 1 case), transfusion 33.3% (group A 2 cases), polyhydramnios 33.3% (group A 1 case vs. group B 1 case) and abortion 16.6% (group A 1 case). Fetal complications included fetal loss 16.6% (group A 1 case), neonatal mortality 33.3% (group A 1 cases vs. group B 1 case), prematurity 50% (group A2 cases vs. group B 1 case), fetal distress 50% (group A 1 case vs. group B 2 cases), respiratory failure 33.3% (group A 2 cases) and fetal growth restriction 16.6% (group A 1 case). Frequency of perinatal complications is elevated in both groups.
Full Text Available Renal failure caused by scrub typhus is known to be reversible. In most cases, renal function is almost fully restored after appropriate antibiotic treatment. A 71-year-old man was diagnosed with scrub typhus complicated by renal failure. A renal biopsy revealed histopathologic findings consistent with acute tubulointerstitial nephritis. Renal function did not improve 18 months after discharge and the patient required continuous hemodialysis. Although severe renal failure requiring dialysis is a rare complication of scrub typhus, we describe a case of scrub typhus requiring maintenance hemodialysis. To the best of our knowledge, this is the first such report.
Toth-Manikowski, Stephanie M; Mullangi, Surekha; Hwang, Seungyoung; Shafi, Tariq
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.
Full Text Available Audience: This classic team based learning (cTBL didactic is aimed for emergency medicine residents and fourth year medical students entering emergency medicine. Introduction: Over one million visits per year to United States (US emergency departments (ED are related to poisonings.1 Extracorporeal treatment (ECTR, specifically hemodialysis (HD, is one potential method to enhance elimination of certain drugs and their toxic metabolites.2-12 While HD may be life-saving in certain poisonings, it may have no effect on others and it carries associated risks and costs. It is essential that emergency physicians know the indications for HD in the poisoned patient. This cTBL reviews many poisonings which may be managed by HD. Objectives: By the end of this cTBL, the learner will: 1 recognize laboratory abnormalities related to toxic alcohol ingestion; 2 calculate an anion gap and osmolal gap; 3 know the characteristics of drugs that are good candidates for HD; 4 discuss the management of patients with toxic alcohol ingestions; 5 discuss the management of patients with salicylate overdose; 6 know the indications for HD in patients with overdoses of antiepileptic drugs; 7 discuss the management of patients with lithium toxicity. Method: This didactic session is a cTBL (classic team based learning.
Ye, Muyao; Liu, Yinghong; Zhou, Letian; Wang, Chang; Fu, Xiao; Peng, Youming; Liu, Hong
For maintenance hemodialysis (MHD) patients, the blood is in low hypercoagulable state due to the use of heparin or low molecular weight heparin during dialysis. It is not rare to see hematoma in the puncture site. In recent years, several cases have been reported of spontaneous kidney rupture, but no hip hematoma, let alone both occurred in succession. There was one MHD patient with spontaneous kidney bleeding and hip hematoma in our hospital in 2014, and we provided effective treatment and follow-up. © 2016 S. Karger AG, Basel.
Successful adalimumab treatment of a psoriasis vulgaris patient with hemodialysis for renal failure: A case report and a review of the previous reports on biologic treatments for psoriasis patients with hemodialysis for renal failure.
Kusakari, Yoshiyuki; Yamasaki, Kenshi; Takahashi, Toshiya; Tsuchiyama, Kenichiro; Shimada-Omori, Ryoko; Nasu-Tamabuchi, Mei; Aiba, Setsuya
The efficacy and safety of biologic treatments have been established in patients with moderate to severe psoriasis, but there are few reports on biologic therapy for patients with psoriasis complicated by end-stage renal failure on hemodialysis (HD). In this report, we demonstrated the efficacy and safety of adalimumab for patients with severe psoriasis on HD. A 46-year-old Japanese man with a 14-year history of psoriasis was referred to our clinic in September 2009. He had developed hypertension and renal failure during a 7-year history of cyclosporin treatment. With the infliximab treatment, he achieved 75% improvement of the Psoriasis Area and Severity Index (PASI) score within 3 months from the PASI of 42.3 before the treatment. However, his renal failure gradually deteriorated, and HD was initiated at 1 year after the introduction of infliximab. Because of hydration during the i.v. injection of infliximab, he developed pulmonary edema with every infliximab treatment after starting HD. We switched to ustekinumab treatment, but his psoriasis was not improved. Then, we switched to adalimumab and achieved a PASI-100 response within 2 months. The patient received adalimumab treatment for more than a year without any adverse effects. In addition to our case, five articles reported cases of psoriasis patients with renal failure on HD who were treated with biologics. The psoriatic lesions were improved by biologics in these cases, and no severe adverse effects on the renal function were reported. Thus, biologics are a reasonable treatment option for patients with severe psoriasis with renal failure on HD. © 2015 Japanese Dermatological Association.
Miki, Yusuke; Fujita, Yoshiro; Kawai, Ryosuke; Danbara, Atsushi; Ueno, Yukio; Ito, Yasuhiko
A 78-year-old man who was undergoing hemodialysis therapy was admitted to our hospital because of sore throat, remittent cervical lymphadenopathy, and polyarthritis over the preceding 4 weeks. On admission, he had bilateral cervical lymphadenopathy. He complained of arthralgia associated with tenderness, warmth and swelling of both elbows, left side wrist and left shoulder joint. The C-reactive protein level on admission was 15.3 mg/dl. Rheumatoid factor, antinuclear antibodies, tuberculin skin test and blood culture were negative. Joint fluid was not aspirated. Radiographs of the joints did not reveal any abnormalities. Acid-fast bacilli were demonstrated in the smear of the cervical lymph node with a fluorochrome rhodamine-auramine stain. Mycobacterium tuberculosis DNA was identified by polymerase chain reaction. We found the presence of caseating granuloma on the biopsy specimens and M.tuberculosis was detected from culture. At that point, we diagnosed this patient as having tuberculous lymphadenitis. His general symptoms resolved rapidly after starting with a three-drug regimen consisting of isoniazid, rifampin and pyrazinamide. His polyarthritis also improved dramatically. Finally we considered that his polyarthritis was tuberculous rheumatism, also called Poncet's disease. Poncet's disease is characterized by sterile polyarthritis during active tuberculosis infection. It is considered a reactive arthritis, which is a different entity from tuberculous arthritis. Although this is a rare disease, we should be aware of it in hemodialysis patient clinics, because the incidence of tuberculosis infection has been reported to be increasing in patients with end-stage renal failure.
Ramos-Martínez, Antonio; Roque, Fernado; Fariñas, Maria Carmen; Muñoz, Patricia; Verde, Eduardo; Cuerpo, Gregorio Pablo; de Alarcón, Arístides; Lepe, José Antonio; Miró, José María; Plata, Antonio; Goenaga, Miguel Ángel; García-Rosado, Dácil; Martínez-Monzonis, Amparo; de la Torre, Javier; García-Pavía, Pablo
Infective endocarditis (IE) is a severe complication associated with high mortality. To examine the clinical characteristics of IE in hemodialysis (HD) patients and to determine prognostic factors related to HD. From January 2008 to April 2015, 2488 consecutive patients with definite IE were included. Clinical characteristics of IE patients on HD were compared with those of IE patients who were not on HD. A total of 126 patients (63% male, median age: 66years; IQR: 54-74years) with IE (5.1%) were on HD. Fifty-two patients died during hospitalization (41%) and 17 additional patients (14%) died during the first year. The rate of patients who underwent surgery during hospitalization was lower in HD patients (38 patients, 30%) than in non-HD patients (1177 patients, 50%; p70years (OR: 4.1, 95% CI: 1.7-10), heart failure (OR: 3.3, 95% CI: 1.4-7-6), central nervous system (CNS) vascular events (OR: 6.7, 95% CI: 2.1-22) and septic shock (OR: 4.1, 95% CI: 1.4-12.1) were independently associated with fatal outcome in HD patients. Of the 38 patients who underwent surgery, 15 (39.5%) died during hospitalization. HD patients with IE present a high mortality. Advanced age and complications, such as heart failure, CNS stroke or septic shock, are associated with mortality. Copyright © 2017 Elsevier B.V. All rights reserved.
Chang, Chih-Hao; Huang, Myo-Ming; Yeih, Dong-Feng; Lu, Kuo-Cheng; Hou, Yi-Chou
Isolated pulmonary valve infective endocarditis caused by Candida is rare in chronic hemodialysis patients. The 2009 Infectious Diseases Society of America guidelines suggest the combined use of surgery and antibiotics to treat candidiasis; however, successful nonsurgical treatment of Candida endocarditis has been reported. A 63-year-old woman with end-stage kidney disease was admitted to our hospital after experiencing disorientation for 5 days. The patient was permanently bedridden because of depression, and denied active intravenous drug use. She received maintenance hemodialysis through a tunneled-cuffed catheter. An initial blood culture grew Candida guilliermondii without other bacteria. Subsequent blood cultures and tip culture of tunneled-cuffed catheter also grew C. guilliermondii, even after caspofungin replaced fluconazole. A 1.2-cm mobile mass was observed on the pulmonary valve. Surgical intervention was suggested, but the family of the patient declined because of her multiple comorbidities. The patient was discharged with a prescription of fluconazole, but she died soon after. Our patient is the first case with isolated pulmonary valve endocarditis caused by C. guilliermondii in patients with uremia. Hematologic disorders, in addition to long-term central venous catheter use, prolonged antibiotic intravenous injection, and congenital cardiac anomaly, predispose to the condition. The diagnosis "isolated" pulmonary IE is difficult, and combing surgery with antifungal antibiotics is the appropriate therapeutic management for Candida related pulmonary IE.
Full Text Available Abstract Background The relationship between intraocular pressure (IOP changes and hemodialysis has been evaluated for several decades. However, no report on an IOP rise in uveitis patients during hemodialysis has been previously documented. This report describes the case of an uveitis patient with repetitive IOP spikes associated with severe ocular pain during hemodialysis sessions, which resolved after glaucoma filtering surgery. Case presentation A 47-year-old male with diabetes and hypertension had complained of recurrent ocular pain in the left eye during hemodialysis sessions. A slit-lamp examination showed diffuse corneal epithelial edema with several white keratic precipitates and inflammatory cells (Grade 3+ in the anterior chamber of the left eye. No visible neovascularization or synechiae were visible on the iris or angle. Topical glaucoma eye-drops and intravenous mannitol before hemodialysis did not prevent subsequent painful IOP spikes in the left eye. At the end of hemodialysis, IOP averaged ~40 mmHg. After trabeculectomy with mitomycin C in the left eye, his IOP stabilized in the low-teens (range, 10–14 mmHg and no painful IOP spikes occurred during hemodialysis over the first postoperative year. Conclusion We present a case of recurrent painful IOP spikes during hemodialysis in a patient with unilateral anterior uveitis unresponsive to conventional medical treatment prior to hemodialysis. To our knowledge, this is the first case report of repetitive symptomatic IOP rise during hemodialysis in an uveitic glaucoma patient. This case highlights the importance of the awareness of the possibility that IOP may rise intolerably during hemodialysis in uveitis patients with a compromised outflow facility.
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.
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
Iman Taghizade Firoozjayi
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.
Full Text Available We present the first case of small cell lung cancer with Lambert-Eaton myasthenic syndrome during hemodialysis (HD. A 72-year-old male patient receiving HD experienced progressive muscle weakness. He was diagnosed with small cell lung cancer with Lambert-Eaton myasthenic syndrome due to an increased serum level of anti-voltage-gated calcium channel antibody and aspiration cytology on endobronchial ultrasonography for the swelling of a subcarinal lymph node. He received chemotherapy consisting of carboplatin (300 mg/m2 and etoposide (50 mg/m2, to which he had a partial response. However, the second therapy course could not be administered because of the unexpected development of severe hematological adverse events, which also prevented him from undergoing further HD. This case indicates that caution should be taken when using chemotherapy for such patients because of hypotension due to chemotherapy, with which it is impossible to undergo HD.
Full Text Available Vascular access for dialysis is essential for these patients with end-stage renal disease, improvements in hemodialysis managment have lead to extended life expectancy. The creation and maintenance of hemoaccess occupies a significant portion of most vascular and general surgery practices.Venous hypertension due to arteriovenous fistula is usually secondary to venous outlet obstruction. Side to side proximal artery arteriovenous fistula serves as a certain cause of hemodialysis, but it is rarely reported as a peripheral venous hypertension cause. We are reporting a case with developed venous hypertension having dermal injuries in the arm. The patient underwent successful side-to-side radio cephalic fistula creation in the snuffbox a year ago.
Anson, Heather M.; Byrd, Michelle R.; Koch, Ellen I.
This case report describes outpatient psychological treatment targeting adherence to fluid restrictions in a hemodialysis patient. The consequences of nonadherence to fluid restrictions in hemodialysis patients range from minor discomfort to increased hospitalizations and mortality rates. In addition, when patients chronically fail to adhere, they may no longer be candidates for kidney transplant. The interventions focused on polydipsia, characterized by excessive fluid intake. The methods in...
Full Text Available There are various etiologies for hypoglycemia in patients with chronic renal failure, and its pathogenesis is complex. Concomitant use of medications is the most common cause. We report a rare case of an 82-year-old woman with type 2 diabetes mellitus in end-stage renal disease undergoing maintenance hemodialysis, who experienced recurrent symptomatic hypoglycemia during treatment with propoxyphene for pain relief. Hypoglycemia occurred simultaneously with elevated levels of serum immunoreactive insulin and C-peptide. After discontinuing propoxyphene, hypoglycemia mitigated and the level of insulin returned to normal range. Our case reminds us that propoxyphene-induced hypoglycemia should not be ignored, especially in hemodialysis patients with cold sweats, agitation and depressed consciousness.
Akiyama, Yuji; Fujimaki, Toshihisa; Sakurai, Yusei
The patient was a 62-year-old female. Total gastrectomy was performed due to gastric ulcer in 1969. She was diagnosed as rheumatoid arthritis (RA) in 1985 and was developed to amyloidosis in 1991. She was started on hemodialysis (HD) for chronic renal failure in 1996. In 1998, her arthralgia was aggravated, and 100 mg/day of bucillamine was administered on the day of HD. Her arthralgia persisted, and switching to salazosulfapyridine (SASP) was considered. As there were no standards and no reports for the use of SASP in HD patients, we examined the pharmacokinetics of SASP and its metabolites, and compared our patient with the results of phase one study in normal subjects in Japan. In this case, the blood concentration of SASP was similar to that in healthy controls after single administration of 500 mg of SASP on the day of non-HD, while the concentration of sulfapyridine (SP) was higher than that in healthy donors. However, the blood concentrations of SASP, SP, and N4-acetyl-SP (AcSP) at 24 hours after administration were similar to those obtained in healthy men. SASP was not dialyzed, while about half of SP and AcSP, were dialyzed. In a five-day consecutive administration study also, the blood concentrations of these compounds on Day 5 were similar to those of phase one study, suggesting no accumulation. No adverse drug reaction was observed. As this case had the past history of total gastrectomy and amyloidosis, it is possible that this result is influenced by the factors. Therefore it is necessary to examine pharmacokinetics of SASP and its metabolites beforehand when administering this agent to other HD/RA patients.
Impact of parathyroidectomy on cardiovascular outcomes and survival in chronic hemodialysis patients with secondary hyperparathyroidism. A retrospective study of 50 cases prior to the calcimimetics era.
Conzo, Giovanni; Perna, Alessandra F; Savica, Vincenzo; Palazzo, Antonietta; Della Pietra, Cristina; Ingrosso, Diego; Satta, Ersilia; Capasso, Giovambattista; Santini, Luigi; Docimo, Giovanni
In chronic hemodialysis patients with secondary hyperparathyroidism, pathological modifications of bone and mineral metabolism increase the risk of cardiovascular morbidity and mortality. Parathyroidectomy, reducing the incidence of cardiovascular events, may improve outcomes; however, its effects on long-term survival are still subject of active research. From January 2004 to December 2006, 30 hemodialysis patients, affected by severe and unresponsive secondary hyperparathyroidism, underwent parathyroidectomy - 15 total parathyroidectomy and 15 total parathyroidectomy + subcutaneous autoimplantation. During a 5-year follow-up, patients did not receive a renal transplantation and were evaluated for biochemical modifications and major cardiovascular events - death, cardiovascular accidents, myocardial infarction and peripheral vascular disease. Results were compared with those obtained in a control group of 20 hemodialysis patients, affected by secondary hyperparathyroidism, and refusing surgical treatment, and following medical treatment only. The groups were comparable in terms of age, gender, dialysis vintage, and comorbidities. Postoperative cardiovascular events were observed in 18/30 - 54% - surgical patients and in 4/20 - 20%- medical patients, with a mortality rate respectively of 23.3% in the surgical group vs. 15% in the control group. Parathyroidectomy was not associated with a reduced risk of cardiovascular morbidity and survival rate was unaffected by surgical treatment. In secondary hyperparathyroidism hemodialysis patients affected by severe cardiovascular disease, surgery did not modify cardiovascular morbidity and mortality rates. Therefore, in secondary hyperparathyroidism hemodialysis patients, resistant to medical treatment, only an early indication to calcimimetics, or surgery, in the initial stage of chronic kidney disease - mineral bone disorders, may offer a higher long-term survival. Further studies will be useful to clarify the role of
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.
Reetz, Kathrin; Abbas, Zaheer; Costa, Ana Sofia; Gras, Vincent; Tiffin-Richards, Frances; Mirzazade, Shahram; Holschbach, Bernhard; Frank, Rolf Dario; Vassiliadou, Athina; Krüger, Thilo; Eitner, Frank; Gross, Theresa; Schulz, Jörg Bernhard; Floege, Jürgen; Shah, Nadim Jon
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.
Yamashita, Misuzu; Natsumeda, Masamitsu; Takasugi, Koji; Ueno, Akiko; Ezawa, Kayo; Ezawa, Kazuhiko
Rheumatoid arthritis (RA) is an autoimmune disorder characterized by progressive joint destruction that requires aggressive treatment using appropriate disease-modifying antirheumatic drugs (DMARDs). RA patients with renal failure, however, are intolerant to most DMARDs due to the potential toxicity. In Japan, tacrolimus was approved for the treatment of RA in 2005. Based on its pharmacokinetics, tacrolimus may be administered to the patients undergoing hemodialysis. We report two cases of RA patients on hemodialysis treated effectively and safely with tacrolimus.
Kato, Hideo; Hamada, Yukihiro; Hagihara, Mao; Hirai, Jun; Yamagishi, Yuka; Matsuura, Katsuhiko; Mikamo, Hiroshige
One of the major adverse events associated with linezolid treatment is pancytopenia. However, there are few reports about the tolerability of linezolid among patients undergoing hemodialysis. This study retrospectively investigated the frequency of bicytopenia (thrombocytopenia and erythropenia) secondary to linezolid treatment in patients undergoing and not-undergoing hemodialysis. In total, 181 patients treated with linezolid from January 2010 to July 2012 at Aichi Medical University Hospital were divided into three groups; patients undergoing hemodialysis (HD group), those with creatinine clearance (CLCR) of linezolid therapy were compared among three groups. Thrombocytopenia (linezolid therapy. In particular, the PLT nadir in HD group occurred earlier than that in non-HD groups (HD, 11.5 days [4-31 days]; CLCR linezolid treatment in patients undergoing hemodialysis. Copyright © 2015 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Full Text Available The risk of premature and progressive occlusive vascular disease is high in chronic uremic patients, and it accounts for more than 40% of the mortality in dialysis patients. End stage renal failure (ESRF patients exhibit elevated plasma homocystein levels, about four fold as much as those in the controls, and it is now considered as a causative factor for increased risk of cardiovascular death among these patients. The aim of this study was to evaluate the relationship of total plasma homocysteine level and echocardiographic abnormalities as a surrogate of cardiac disease outcome in hemodialysis patients. 123 adult patients on maintenance hemodialysis and having echocardiography done during January till November 2006 were enrolled in this cross-sectional study. Plasma homocysteine level was directly related to the presence of aortic regur-gitation r= 0.27 P= 0.009. There were negative correlations between ejection fraction (EF, left ventricular systolic dimension (LV.S (r= - 0.71, P= 0.0001, left ventricular diastolic dimension (LV.D (r= -0.23 p= 0.01 and age (r= - 0.021 P= 0.02. In conclusion we did not find the para-doxical reverse epidemiology in our patients and plasma total homocysteine level was in direct correlation with cardiac risk factors such as left ventricular mass index and aortic regurgitation.
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.
Full Text Available Malnutrition is a common problem among hemodialysis patients. This factor leads to increased morbidity and mortality. This study evaluates the nutritional status of patients on dialysis and analyses the various parameters used for assessing malnutrition. It is a cross-sectional study of 35 patients aged 18 years and up who have undergone dialysis three days a week for more than a year. The following were analysed: overall subjective assessment technique, Body Mass Index, anthropometric data and biological parameters (serum albumin, serum cholesterol, rate of alkaline reserves and C-reactive protein levels with a dietary three-day survey. Analysis of food survey data was performed using the software Bilnut. The patients’ average age was 46.7 years with a sex ratio of 1.18. Average waist size was 92.7±16.68 cm. Average arm circumference was 27.2±5.6 cm and average calf circumference was 32.03±5.87 cm. Malnutrition was found in 48% of cases according to SGA. Average BMI was 24.4 kg/m2. It was less than 23 Kg/m2 in 48% of cases. Average serum albumin concentration was 33.6 g/l and average CRP level was 6.16 mg/l. The average energy intake (Kcal/Kg/day was 30.87±11.92 the day of dialysis, 27.98±9.31 on a resting day and 29.93±9.42 on another day and the average protein intake (g/kg/day was 1.02±0.44 the day of dialysis, 0.94±0.36 a resting day and 1.04±0.36 on the other day. Malnutrition was frequent among our patients. The assessment of nutritional status in patients on dialysis requires simultaneous combination of several clinical, biologic and dietetic markers. Dietary management is mainly based on food survey regularly established.
Tiberio M. Siqueira Jr
Full Text Available The incidence of transitional cell carcinoma (TCC in patients submitted to hemodialysis is low. The presence of TCC with sarcomatoid features in this cohort is even scarcer. Herein, we describe a very rare case of synchronous multicentric muscle invasive bladder carcinoma with prostate invasion in a hemodialysis patient, submitted to complete en bloc urinary exenteration.
Anees, M.; Mumtaz, A.; Nazir, M.; Ibrahim, M.; Kausar, T.
To determine the referral pattern of dialysis patients to nephrologists and the effects of late referral on clinical, hematological and biochemical parameters in patients presenting for the first-time to dialysis center. This study was conducted on all patients of end stage renal diseases presenting for the first-time for undergoing hemodialysis at our center. Patients with acute renal failure were excluded from the study. At presentation, a history was taken from all the patients regarding seeking of nephrology services and referral pattern. Early and late referral was defined as the time of first referral or admission to a nephrologists greater or less than six months respectively before initiation of hemodialysis. All the patients were examined and their blood sample was drawn at the same time for routine hematological, biochemical parameters (urea, creatinine, serum potassium, calcium, phosphate and albumin) and viral markers (Anti HCV and HbsAg). In this study, 248 patients were enrolled, amongst them, 131 (52.8%) were male and 117 (47.2%) were female. Major causes of renal failure were diabetes mellitus, chronic glomerulonephritis and hypertension. Most of the patients were euvolemic and hypertensive. Sixty percent of patients were having very high urea (>200 mg/dl) and creatinine (>8.0 mg/dl). Most of the patients, 226 (91.1%), were anemic (Hemoglobin <11gm/dl) and 224 (90%) were hypoalbuminemic (serum albumin < 4gm/dl) on first presentation. Majority of patients were hyperkalemic, 139 (56.0%), hypocalcemic, 168 (67.7%) and serum phosphate level was high in only 117 (47%) patients. All the patients presented in emergency room to nephrologists at very late stage (100% late referral), when disease was very much advanced. All of them did not have permanent vascular access for hemodialysis on first presentation to dialysis center. Reasons for late referral were non-availability of nephrologists and nephrology services, non-renal doctors biased, unawareness and
Canaud, Bernard; Leray-Moragués, Hélène; Chenine-Koualef, Leila; Patrier, Laure
Hemodialysis is the most advanced form of artificial renal support. It ensures the survival of almost 2 million patients wordwide. Considerable progress has been made in recent years thanks to a better understanding of uremia, optimization of treatment modalities and more personalized treatment schedules. Increase of uremic toxins removal, improvement of hemodynamic tolerance of the sessions, reduction of proinflammatory reactions due to the bioincompatibility system are major advances that may explain the reduction of morbidity and mortality in dialysis patients. New technologies (nanotechnology, biotechnology, microelectronics) are now expected to introduce further progresses by miniaturizing devices and providing them with an "artificial intelligence" capable of interacting with the patient. The main obstacle remains ageing of uremic patients, increasing prevalence of comorbidities and shortage of social resources that are not conducive to innovation. By promoting a more physiological, longer and more effective hemodialysis performed at home with help of teledialysis monitoring that would probably be an interesting option to evaluate on a medico-economical point of view.
Heather M. Anson
Full Text Available This case report describes outpatient psychological treatment targeting adherence to fluid restrictions in a hemodialysis patient. The consequences of nonadherence to fluid restrictions in hemodialysis patients range from minor discomfort to increased hospitalizations and mortality rates. In addition, when patients chronically fail to adhere, they may no longer be candidates for kidney transplant. The interventions focused on polydipsia, characterized by excessive fluid intake. The methods involved 11-sessions of individual psychotherapy incorporating strategies including increasing awareness, decreasing motivation, increasing effort, engaging in competing events, conducting thought stopping, breaking repetitive routines, eliciting social support, and receiving reinforcement. Results demonstrated that the patient successfully restricted his fluid intake at or below recommended levels 83% of days after fading of treatment began. This case report demonstrates the success of cognitive behavioral treatment strategies with a nonpsychiatric hemodialysis patient.
Full Text Available The objective of the study was to determine the level of β2-microglobulin (β2-m in hemodialysis (HD patients and the factors affecting it. This cross sectional, hospital based study was conducted between September and December 2008 at the Hemodialysis unit of Shalamar Hospital, Lahore. All patients with end-stage renal disease (ESRD who were on main-tenance HD for more than three months were included in the study. Patients with acute renal failure and on dialysis for less than three months were excluded. Demographic data were collec-ted and details of dialysis (type of dialyzers, dialysate bath, membrane used were recorded. Blood samples of the patients were drawn for hematological (hemoglobin, hematocrit, bioche-mical (urea, creatinine, uric acid, albumin and β2-m level measurement. The total number of patients studied was 50. The major causes of ESRD included diabetes mellitus and hypertension seen in 37 (74% and 10 patients (20%, respectively. The β2-m levels were significantly elevated in the study patients; 92.6 ± 17.1 mg/L with a range of 54 to 130 mg/L as compared to 2.0 ± 1.29 mg/L in the control group. The patients′ age had a statistically significant relationship with the β2-m level. The major reason for increased β2-m level was use of low-flux dialyzers. Synthetic polysulphone membrane, bicarbonate, ultra pure dialysate and duration on HD were not asso-ciated with high β2-m levels. Also, we found an inverse relationship between β2-m levels and serum albumin of the study patients. Our study suggests that the β2-m levels are significantly high in dialysis patients. Use of low-flux dialyzer seems to be the major reason for the high β2-m levels. Age and albumin have statistically significant relationship with β2-m levels.
Maeshima, Keisuke; Torigoe, Masataka; Iwakura, Mikako; Yamanaka, Kunitoshi; Ishii, Koji
We report the case of a 44-year-old female undergoing maintenance hemodialysis in whom early-phase rheumatoid arthritis (RA) was successfully treated by leukocytapheresis (LCAP). The effects of prednisone, tacrolimus, and etanercept were limited, but LCAP was highly effective and its efficacy continued even after cessation of LCAP. Moreover, remission was maintained for 2 years after discontinuation of medication. LCAP may be an important treatment option for RA patients with end-stage renal failure who are on hemodialysis.
Ahmadvand A.; Saie R.; Sepehrmanesh Z.; Ghanbari A.R.
Background and Objectives: Hemodialysis as a treatment manner in chronic renal failure is a stressful process and has several various psycho-cognitive and social complications. The present study evaluated effect of cognitive-behavioral group therapy on anxiety and depression in hemodialysis patients. Methods: This research was a clinical trial study. Samples were young adults who were 18-45 years old. The Participants were divided into two groups (case & control). The Beck depression & anxiet...
Full Text Available Secondary hyperparathyroidism (SHPT is a common problem in patients with end-stage renal disease. In cases with severe and resistant SHPT, surgical parathyroidectomy (PTX is recommended. Hungry bone syndrome (HBS following surgical PTX is most often associated with hypocalcemia and hypophosphatemia. The mechanisms for the HBS are not clear, and a method for its prevention has not been established. We present three hemodialysis patients with persistant hypophosphatemia after PTX. In our parathyroidectomized patients, hypocalcemia could be corrected with calcium and vitamin D treatment, but hypophosphatemia continued for eight months in one patient and in two other patients until the last visit (10 and 2 months, respectively. Predisposing factors such as old age, diabetes mellitus and parathyroid adenoma were not found in our patients. All three patients were younger (<35 years old and anuric. Hemodialysis durations were seven, three and two years. In summary, HBS presented with hypocalcemia, and especially hypophosphatemia cannot be developed uncommonly and may persist for a long time following PTX in HD patients.
Maier, Alexandra; Stocks, Franziska; Pommer, Wolfgang
It is still controversial whether the mode of dialysis or preexisting comorbidities may influence the prognosis of patients with chronic kidney disease stage 5. Therefore, we performed a prospective case control study to evaluate whether the mode of dialysis may influence outcome. We found 25 cas...
Matsuo, H.; Nakamura, K.; Hayashi, J.; Nakura, T.; Saruki, K.; Andoh, Y.; Shibazaki, T.; Kubo, K.
To our knowledge, this is the first report ever on the implementation and results of gamma knife radiosurgery in a regularly dialysed patient. The case presented is that of a 59 year-old female patient with a meningioma. Her initial clinical presentation was with sustained headache. Diagnosis was made by using a brain CT scan and MR imaging. Treatment was performed literally without opening the skull. There was only one complication, namely that of postirradiation brain edema, which developed 19 weeks after the operation, and responded dramatically to steroid administration. This is one of the rare side effects of gamma knife therapy, but does not seem to be related to the fact that the patient was uremic. Gamma knife therapy was successful in this patient and her safety was no more compromised than that of a nonuremic patient undergoing radiosurgery. (authors)
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.
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
Kulik, Rose Anne; Falavigna, Dina Lúcia Morais; Nishi, Letícia; Araujo, Silvana Marques
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.
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.
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...
Weinhandl, Eric D; Nieman, Kimberly M; Gilbertson, David T; Collins, Allan J
Cardiovascular disease is a common cause of hospitalization in dialysis patients. Daily hemodialysis improves some parameters of cardiovascular function, but whether it associates with lower hospitalization risk is unclear. Observational cohort study using US Renal Data System data. Medicare-enrolled daily (5 or 6 sessions weekly) home hemodialysis (HHD) patients initiating NxStage System One use from January 1, 2006, through December 31, 2009, and contemporary thrice-weekly in-center hemodialysis patients, matched 5 to 1. Daily HHD or thrice-weekly in-center hemodialysis. All-cause and cause-specific hospital admissions, hospital readmissions, and hospital days assessed from Medicare Part A claims. For 3,480 daily HHD and 17,400 thrice-weekly in-center hemodialysis patients in intention-to-treat analysis, the HR of all-cause admission for daily HHD versus in-center hemodialysis was 1.01 (95%CI, 0.98-1.03). Cause-specific admission HRs were 0.89 (95%CI, 0.86-0.93) for cardiovascular disease, 1.18 (95%CI, 1.13-1.23) for infection, 1.01 (95%CI, 0.93-1.09) for vascular access dysfunction, and 1.02 (95%CI, 0.99-1.06) for other morbidity. Regarding cardiovascular disease, first admission and readmission HRs for daily HHD versus in-center hemodialysis were 0.91 and 0.87, respectively. Regarding infection, first admission and readmission HRs were 1.35 and 1.03, respectively. Protective associations of daily HHD with heart failure and hypertensive disease were most pronounced, as were adverse associations of daily HHD with bacteremia/sepsis, cardiac infection, osteomyelitis, and vascular access infection. Results may be confounded by unmeasured factors, including vascular access type; information about dialysis frequency, duration, and dose was lacking; causes of admission may be misclassified; results may not apply to patients without Medicare coverage. All-cause hospitalization risk was similar in daily HHD and thrice-weekly in-center hemodialysis patients. However
Jahromi, Soodeh Razeghi; Hosseini, Saeed; Razeghi, Effat; Meysamie, Ali pasha; Sadrzadeh, Haleh
Malnutrition is a predictor of increased mortality in chronic hemodialysis (HD) patients. Various factors may contribute to malnutrition in these patients including energy and protein intake, inflammation, and comorbidity. To determine the importance of these factors in malnutrition of chronic HD patients, we studied 112 chronic HD patients in two centers was evaluated with the Dialysis Malnutrition Score (DMS) and anthropometric and biochemical indices. Seventy six (67.8%) patients were classified as malnourished. According to DMS score, poor protein intake (r= -0.34, Penergy intake (r= - 0.18, Pmalnutrition in descending order of importance. Multiple regression analysis showed that only poor protein intake was the explanatory variable of anthropometric measurements decline including body mass index, triceps skin fold thick-ness, mid arm circumference, mid arm muscle circumference, fat free mass, fat mass, albumin, creatinine and transferrine. None of the mentioned factors predicted the decrease of biochemical markers. We conclude that the frequency of malnutrition is high in our population and poor protein intake is the primary contributing factor for this condition. Therefore, providing enough protein may be a simple and effective way in preventing malnutrition in these patients.
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.
Eslami, Ahmad Ali; Rabiei, Leili; Khayri, Freidoon; Rashidi Nooshabadi, Mohammad Reza; Masoudi, Reza
Sleep disorders are considered as one of the most important problems in hemodialysis patients, making their everyday life a serious hazard. Sleep quality of hemodialysis patients and consequences of sleep disorders on other aspects of health such as spiritual well-being are important issues. This study examined the relationship between spiritual well-being and quality of sleep in hemodialysis patients in Isfahan, Iran. This study was a correlation research, carried out on 190 hemodialysis patients. Data collection Questionnaires included demographic forms, Pittsburgh sleep quality index (PSQI), and Ellison and Paloutzian spiritual well-being scale. Data were analyzed using descriptive and inferential statistics (Pearson correlation and linear regression analysis) at P spiritual health conditions. Pearson correlation test showed significant relationship between the sleep quality items of Pittsburg and spiritual well-being (P spiritual health, family, education, financial status, marital status, occupation, and use of sleep medication, the predictive power of these variables was found 0.417% and prediction of spiritual well-being was more than others (ß = 0.209). Considering bed as one of the most vital physical, mental, and emotional needs, it is very important in mental and spiritual well-being of hemodialysis patients as an influencing factor in mental relaxation and reducing disease tensions. Paying attention to sleep quality and spiritual well-being components of hemodialysis patients in formulating and promoting healthcare programs is recommended.
Full Text Available Peripheral arterial disease (PAD is common in hemodialysis patients and predicts a poor prognosis. We conducted a prospective cohort study to identify risk factors for PAD including skin perfusion pressure (SPP in hemodialysis patients. The cohort included 373 hemodialysis patients among 548 patients who received hemodialysis at Oyokyo Kidney Research Institute, Hirosaki, Japan from August 2008 to December 2010. The endpoints were lower limb survival (peripheral angioplasty or amputation events and overall survival of 2 years. Our results showed that <70 mmHg SPP was a poor prognosis for the lower limb survival and overall survival. We also identified age, history of cardiovascular disease, presence of diabetes mellitus, smoking history, and SPP < 70 mmHg as independent risk factors for lower limb survival and overall survival. Then, we constructed risk criteria using the significantly independent risk factors. We can clearly stratify lower limb survival and overall survival of the hemodialysis patients into 3 groups. Although the observation period is short, we conclude that SPP value has the potential to be a risk factor that predicts both lower limb survival and the prognosis of hemodialysis patients.
Full Text Available This study was performed to evaluate whether any electrocardiogram (ECG para-meter can predict the presence of hyperkalemia in patients on maintenance hemodialysis (HD. In January 2006, we conducted a cross-sectional study of 80 stable patients with end-stage renal disease from four university-based HD units of Tehran, Iran, receiving conventional thrice-weekly HD. Pre-HD serum electrolyte values and conventional 12-lead ECG were obtained from each pa-tient. Bivariate linear regression was used for assessing relationship of the study variables with hyperkalemia (K + > 5.2 mg/dL. Multivariable logistic regression was used for evaluating inde-pendent relationship between decreased T wave duration (≤ 170 ms and other variables. Bivariate correlation analysis showed a significant inverse correlation between serum potassium concentration and T wave duration (P < 0.05. None of the patients with serum potassium of ≥ 5.6 mg/dL had T wave duration > 200 ms. Multivariate logistic analysis, after adjustment for other factors, also showed a significant relationship between decreased T wave duration (≤ 170 ms and hyper-kalemia. We conclude that although hyperkalemia does not induce the usual ECG changes in HD patients, decreased T wave duration was found to be a good indicator of this lethal condition.
Cohen, Scott D; Cukor, Daniel; Kimmel, Paul L
Anxiety is a common yet frequently overlooked psychiatric symptom in patients with ESRD treated with hemodialysis (HD). Anxiety is characterized by disruptive feelings of uncertainty, dread, and fearfulness. A variety of common medical complaints may be manifestations of an anxiety disorder, including palpitations, tremors, indigestion, numbness/tingling, nervousness, shortness of breath, diaphoresis, and fear. It is essential for the clinician to rule out specific medical conditions, including cardiovascular, pulmonary, and neurologic diseases, before ascribing these symptoms to an anxiety disorder. In addition, there is considerable overlap between the symptoms of anxiety and those of depression and uremia. This psychiatric condition has a significant adverse impact on patients' perception of quality of life. Little is known regarding the prevalence and impact of anxiety disorders in patients with ESRD treated with HD; however, many of the seemingly irrational behaviors of patients, or behaviors which place them in conflict with staff and physicians, such as behavioral noncompliance, may be the expression of an underlying anxiety disorder. In this review, we present three clinical vignettes, highlighting the impact of anxiety disorders in patients with ESRD treated with HD. Copyright © 2016 by the American Society of Nephrology.
Shu, Ying; Yu, Shaobin; Zha, Ling; Fu, Ping; Cui, Tianlei
Fungal endocarditis (FE) is commonly regarded as a rare but fatal disease. The incidence of infective endocarditis (IE) in hemodialysis (HD) patients is thought to be obviously higher than that in the general population. Moreover, IE occurs more likely in HD patients with catheters. With the increase of HD population and extensive use of catheters in HD patients, FE, as a special form of IE, may increase and bring new challenges to clinicians. We reported a case of FE associated with catheter infection in a 44-year-old woman on HD. The risk factors and treatment strategies of FE in HD patients were discussed. © 2017 International Society for Hemodialysis.
Emmons Gregory S
Full Text Available Abstract Introduction In the relapsed setting, arsenic trioxide remains the backbone of treatment. Scant literature exists regarding treatment of relapsed acute promyelocytic leukemia in patients with renal failure. To the best of our knowledge we are the first to report a safe and effective means of treatment for relapsed acute promyelocytic leukemia in the setting of advanced renal failure, employing titration of arsenic trioxide based on clinical parameters rather than arsenic trioxide levels. Case presentation A 33-year-old Caucasian man with a history of acute promyelocytic leukemia in remission for 3 years, as well as dialysis-dependent chronic renal failure secondary to a solitary kidney and focal segmental glomerulosclerosis and human immunodeficiency virus infection, receiving highly active antiretroviral therapy presented to our hospital with bone marrow biopsy-confirmed relapsed acute promyelocytic leukemia. Arsenic trioxide was begun at a low dose with dose escalation based only on side effect profile monitoring and not laboratory testing for induction as well as maintenance without undue toxicity. Our patient achieved and remains in complete hematologic and molecular remission as of this writing. Conclusion Arsenic trioxide can be used safely and effectively to treat acute promyelocytic leukemia in patients with advanced renal failure using careful monitoring of side effects rather than blood levels of arsenic to guide therapeutic dosing.
Ishibashi, Kazunari; Miyamae, Tatsuya
Bone scintigrams from a total of 75 hemodialysis patients using sup(99m)Tc-methylene-diphosphonate (MDP) were classified into two groups; Group I (56 patients) in which the uptake of the radioactivity appeared to be relatively high in the soft tissue and low in the bone, and Group II (19 patients) in which high uptake in the bone and low uptake in the soft tissue were observed. Patients in Group I were further classified into two subgroups; Group I sub(A) (articular type, 21 patients) which was characterized by relatively high uptake into the joint, and Group I sub(B) (reduction type, 35 patients) where uptake was faint in the whole region of the bone. The classification of patients in Group II was also performed; Group II sub(A) (spinal type, 14 patients) where high spinal uptake was observed, and Group II sub(B) (cranio-facial type, 5 patients) where high uptake into the cranio-facial region was observed. The results were compared with 146 subjects with normal bone scintigram in terms of the ratio of bone to soft tissue uptake (B/S ratio) for the cranial bone, jaw bone, lumbar vertebra and femoral bone, and the ratio of epiphysis to diaphysis uptake (E/D ratio) for the femoral bone. The B/S ratio was low in Group I and high in Group II for the bone studied, and the E/D ratio was markedly high in Group I sub(A). Histobiochemical examination indicated that patients in Group I sub(A) and Group II may have osteomalacia and secondary hyperparathyroidism, respectively. It was considered that the visual classification and semiquantitative study as described here were useful for evaluating the pathological condition of renal osteodystrophy. (author)
Ishibashi, Kazunari; Miyamae, Tatsuya
Bone scintigrams from a total of 75 hemodialysis patients using /sup 99m/Tc-methylene-diphosphonate (MDP) were classified into two groups; Group I (56 patients) in which the uptake of the radioactivity appeared to be relatively high in the soft tissue and low in the bone, and Group II (19 patients) in which high uptake in the bone and low uptake in the soft tissue were observed. Patients in Group I were further classified into two subgroups; Group I sub(A) (articular type, 21 patients) which was characterized by relatively high uptake into the joint, and Group I sub(B) (reduction type, 35 patients) where uptake was faint in the whole region of the bone. The classification of patients in Group II was also performed; Group II sub(A) (spinal type, 14 patients) where high spinal uptake was observed, and Group II sub(B) (cranio-facial type, 5 patients) where high uptake into the cranio-facial region was observed. The results were compared with 146 subjects with normal bone scintigram in terms of the ratio of bone to soft tissue uptake (B/S ratio) for the cranial bone, jaw bone, lumbar vertebra and femoral bone, and the ratio of epiphysis to diaphysis uptake (E/D ratio) for the femoral bone. The B/S ratio was low in Group I and high in Group II for the bone studied, and the E/D ratio was markedly high in Group I sub(A). Histobiochemical examination indicated that patients in Group I sub(A) and Group II may have osteomalacia and secondary hyperparathyroidism, respectively. It was considered that the visual classification and semiquantitative study as described here were useful for evaluating the pathological condition of renal osteodystrophy.
Krishna, Vinay Narasimha; Eason, Joseph B; Allon, Michael
Central venous stenosis (CVS) is encountered frequently among hemodialysis patients. Prior ipsilateral central venous catheterization and cardiac rhythm device insertions are common risk factors, but CVS can also occur in the absence of this history. Chronic CVS can cause thrombosis with partial or complete occlusion of the central vein at the site of stenosis. CVS is frequently asymptomatic and identified as an incidental finding during imaging studies. Symptomatic CVS presents most commonly as an upper- or lower-extremity edema ipsilateral to the CVS. Previously unsuspected CVS may become symptomatic after placement of an ipsilateral vascular access. The likelihood of symptomatic CVS may be affected by the central venous catheter (CVC) location; CVC side; duration of CVC dependence; type, location, and blood flow of the ipsilateral access; and extent of collateral veins. Venous angiography is the gold standard for diagnosis. Percutaneous transluminal angioplasty and stent placement can improve the stenosis and alleviate symptoms, but CVS typically recurs frequently, requiring repeated interventions. Refractory symptomatic CVS may require ligation of the ipsilateral vascular access. Because no available treatment option is curative, the goal should be to prevent CVS by minimizing catheters and central vein instrumentation in patients with chronic kidney disease and dialysis patients. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
Saleh Mohammad Yaser Salman
Full Text Available Restless legs syndrome (RLS is common among dialysis patients, with a reported prevalence of 6-60%. The prevalence of RLS in Syrian patients on hemodialysis (HD is not known. The purpose of this study is to determine the prevalence of RLS in patients on regular HD, and to find the possible correlation between the presence of RLS and demographic, clinical, and biochemical factors. One hundred and twenty-three patients (male/female = 70/53, mean age = 41.95 ± 15.11 years on HD therapy at the Aleppo University Hospital were enrolled into the study. RLS was diagnosed based on criteria established by the International Restless Legs Syn-drome Study Group (IRLSSG. Data procured were compared between patients with and without RLS. Applying the IRLSSG criteria for the diagnosis, RLS was seen in 20.3% of the study pa-tients. No significant difference in age, gender, and intake of nicotine and caffeine was found between patients with and without the RLS. Similarly, there was no difference between the two groups in the duration of end-stage renal disease (ESRD, the period of dialysis dependence, dialysis adequacy, urea and creatinine levels, and the presence of anemia. The co-morbidities and the use of drugs also did not differ in the two groups. Our study suggests that the high prevalence of RLS among patients on HD requires careful attention and correct diagnosis can lead to better therapy and better quality of life. The pathogenesis of RLS is not clear and further studies are required to identify any possible cause as well as to discover the impact of this syndrome on sleep, quality of life, and possibly other complications such as cardiovasculare disease.
Lund, Anton; Damholt, Mette B; Strange, Ditte G
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 strateg...
Bapat, Usha; Kedlaya, Prashanth G; Gokulnath
Dialysis therapy is extremely stressful as it interferes with all spheres of daily activities of the patients. This study is aimed at understanding the perceived illness intrusion among patients on hemodialysis (HD) and to find the association between illness intrusion and patient demo-graphics as well as duration of dialysis. A cross sectional study involving 90 patients with chronic kidney disease (CKD) stage V, on HD was performed during the period from 2005 to 2006. The subjects included were above 18 years of age, willing, stable and on dialysis for at least two months. Patients with psychiatric co-morbidity were excluded. A semi-structured interview schedule covering sociodemographics and a 13 item illness intrusion checklist covering the various aspects of life was carried out. The study patients were asked to rate the illness intrusion and the extent. The data were analyzed statistically. The mean age of the subjects was 50.28 + - 13.69 years, males were predominant (85%), 73% were married, 50% belonged to Hindu religion, 25% had pre-degree education, 25% were employed and 22% were housewives. About 40% and 38% of the study patients belonged to middle and upper socio-economic strata respectively; 86% had urban background and lived in nuclear families. The mean duration on dialysis was 24 + - 29.6 months. All the subjects reported illness intrusion to a lesser or greater extent in various areas including: health (44%), work (70%) finance (55%), diet (50%) sexual life (38%) and psychological status (25%). Illness had not intruded in areas of relationship with spouse (67%), friends (76%), family (79%), social (40%) and religious functions (72%). Statistically significant association was noted between illness intrusion and occupation (P= 0.02). (author)
Full Text Available Dialysis therapy is extremely stressful as it interferes with all spheres of daily acti-vities of the patients. This study is aimed at understanding the perceived illness intrusion among pa-tients on hemodialysis (HD and to find the association between illness intrusion and patient demo-graphics as well as duration of dialysis. A cross sectional study involving 90 patients with chronic kidney disease (CKD stage V, on HD was performed during the period from 2005 to 2006. The subjects included were above 18 years of age, willing, stable and on dialysis for at least two months. Patients with psychiatric co-morbidity were excluded. A semi-structured interview schedule covering socio-demographics and a 13 item illness intrusion checklist covering the various aspects of life was ca-rried out. The study patients were asked to rate the illness intrusion and the extent. The data were ana-lyzed statistically. The mean age of the subjects was 50.28 ± 13.69 years, males were predominant (85%, 73% were married, 50% belonged to Hindu religion, 25% had pre-degree education, 25% were employed and 22% were housewives. About 40% and 38% of the study patients belonged to middle and upper socio-economic strata respectively; 86% had urban background and lived in nuclear fami-lies. The mean duration on dialysis was 24 ± 29.6 months. All the subjects reported illness intrusion to a lesser or greater extent in various areas including: health (44%, work (70% finance (55%, diet (50% sexual life (38% and psychological status (25%. Illness had not intruded in areas of rela-tionship with spouse (67%, friends (76%, family (79%, social (40% and religious functions (72%. Statistically significant association was noted between illness intrusion and occupation (P= 0.02.
Abdulmalik M Alkatheri
Full Text Available Medication adherence was assessed in 89 patients on hemodialysis (HD at the King Abdul Aziz Medical City using an Arabic version of the Morisky Medication Adherence Scale (MASS-8. The results of the study revealed that 31.46% and 40.45% of the participants showed low and medium adherence, respectively, while 28.09% showed high medication adherence. Accordingly, 71.91% of the patients visiting the dialysis unit were considered medication non-adherent. While being of older age (P = 0.012, being married (P = 0.012 increased the level of adherence, being of medium level of education (P = 0.024 decreased adherence levels. On the other hand, gender, presence of a care-giver, number of members in the household and employment status seems to have no effect on the level of medication adherence. These results call upon the practitioners in HD units to develop intervention programs that can increase the level of medication adherence.
Sanai, T; Inoue, T; Okamura, K; Sato, K; Yamamoto, K; Abe, T; Node, K; Tsuruya, K; Iida, M
The presence or absence of hypothyroidism was assessed in 152 consecutive Japanese patients with end-stage renal disease on hemodialysis. Eight patients who had undergone treatment for thyroid disease before starting hemodialysis therapy, and 3 patients with amyloidosis due to rheumatoid arthritis were excluded. Of the remaining 141 hemodialysis patients, 14 (9.9%) (9 males and 5 females, aged 69.1 A+/- 8.8 years with a mean duration of hemodialysis of 69 A+/- 51 months) were in a hypothyroid state, defined as a thyroid-stimulating hormone (TSH) level > 5 mU/l. Antithyroid peroxidase antibodies were positive in only 1 of the 14 patients, while antithyroglobulin antibodies were negative in all of these patients. After iodide restriction, the serum TSH level decreased in all the patients from a mean of 16.49 A+/- 22.80 to 4.44 A+/- 3.35 mU/l after 1 month, 4.25 A+/- 2.24 mU/l after 2 months and 3.97 A+/- 2.22 mU/l after 3 months. The 3 months of iodide restriction were also associated with decreases in systolic blood pressure (142 A+/- 19 to 125 A+/- 16 mmHg, p patients on hemodialysis. Retention of excess iodide may be the mechanism responsible for reversible hypothyroidism rather than immunological perturbations. It is, therefore, recommended to attempt iodide restriction before starting l-thyroxine replacement therapy.
Tzamaloukas, Antonios H; Onime, Aideloje; Agaba, Emmanuel I; Vanderjagt, Dorothy J; Ma, Irene; Lopez, Andrea; Tzamaloukas, Rolinda A; Glew, Robert H
The state of hydration affects the outcomes of chronic dialysis. Bioelectrical impedance analysis (BIA) provides estimates of body water (V), extracellular volume (ECFV), and fat-free mass (FFM) that allow characterization of hydration. We compared single-frequency BIA measurements before and after 14 hemodialysis sessions in 10 Nigerian patients (6 men, 4 women; 44+/-7 years old) with clinical evaluation (weight removed during dialysis, presence of edema) and with estimates of body water obtained by the Watson, Chertow, and Chumlea anthropometric formulas. Predialysis and postdialysis values of body water did not differ between BIA and anthropometric estimates. However, only the BIA estimate of the change in body water during dialysis (-0.8+/-2.9 L) did not differ from the corresponding change in body weight (-1.3+/-3.0 kg), while anthropometric estimates of the change in body water were significantly lower, approximately one-third of the change in weight. Bioelectrical impedance analysis correctly detected the intradialytic change in body water content (the ratio V/Weight) in 79% of the cases, while anthropometric formula estimates of the same change were erroneous in each case. Compared with patients with clinical postdialysis euvolemia (n=7), those with postdialysis edema (n=5) had higher values of postdialysis BIA ratios V/FFM (0.77+/-0.01 vs. 0.72+/-0.03, phydration in patients on chronic hemodialysis. In contrast, BIA provides estimates of hydration agreeing with clinical estimates in the same patients, although it tends to underestimate body water and extracellular volume in patients with large collections of fluid in central body cavities.
Ipema, Karin J. R.; Struijk, Simone; van der Velden, Annet; Westerhuis, Ralf; van der Schans, Cees P.; Gaillard, Carlo A. J. M.; Krijnen, Wim P.; Franssen, Casper F. M.
Background Hemodialysis patients experience an elevated risk of malnutrition associated with increased morbidity and mortality. Nocturnal hemodialysis (NHD) results in more effective removal of waste products and fluids. Therefore, diet and fluid restrictions are less restricted in NHD patients.
Larkin, John W; Wingard, Rebecca L; Jiao, Yue; Rosen, Sophia; Ma, Lin; Usvyat, Len A; Maddux, Franklin W
Abstract Background The prevalence of depressive affect is not well defined in the incident hemodialysis (HD) population. We investigated the prevalence of and associated risk factors and hospitalization rates for depressive affect in incident HD patients. Methods We performed a prospective investigation using the Patient Health Questionnaire 2 (PHQ2) depressive affect assessment. From January to July of 2013 at 108 in-center clinics randomly selected across tertiles of baseline quality measures, we contacted 577 and 543 patients by telephone for depressive affect screening. PHQ2 test scores range from 0 to 6 (scores ≥3 suggest the presence of depressive affect). The prevalence of depressive affect was measured at 1–30 and 121–150 days after initiating HD; depressive affect risk factors and hospitalization rates by depressive affect status at 1–30 days after starting HD were computed. Results Of 1120 contacted patients, 340 completed the PHQ2. In patients screened at 1–30 or 121–150 days after starting HD, depressive affect prevalence was 20.2% and 18.5%, respectively (unpaired t-test, P = 0.7). In 35 patients screened at both time points, there were trends for lower prevalence of depressive affect at the end of incident HD, with 20.0% and 5.7% of patients positive for depressive affect at 1–30 and 121–150 days, respectively (paired t-test, P = 0.1). Hospitalization rates were higher in patients with depressive affect during the first 30 days, exhibiting 1.5 more admissions (P < 0.001) and 10.5 additional hospital days (P = 0.008) per patient-year. Females were at higher risk for depressive affect at 1–30 days (P = 0.01). Conclusions The prevalence of depressive affect in HD patients is high throughout the incident period. Rates of hospital admissions and hospital days are increased in incident HD patients with depressive affect. PMID:29423211
Schupp, Nicole; Dette, Eva Maria; Schmid, Ursula; Bahner, Udo; Winkler, Michaela; Heidland, August; Stopper, Helga
Hemodialysis patients have an elevated genomic damage in peripheral blood lymphocytes (PBLs) and an increased cancer incidence, possibly due to accumulation of uremic toxins like advanced glycation end products (AGEs). Because the vitamin B1 prodrug benfotiamine reduces AGE levels in experimental diabetes, and dialysis patients often suffer from vitamin B1 deficiency, we conducted two consecutive studies supplementing hemodialysis patients with benfotiamine. In both studies, genomic damage was measured as micronucleus frequency of PBLs before and at three time-points after initiation of benfotiamine supplementation. AGE-associated fluorescence in plasma, and in the second study additionally, the antioxidative capacity of plasma was analyzed. Benfotiamine significantly lowered the genomic damage of PBLs in hemodialysis patients of both studies independent of changes in plasma AGE levels. The second study gave a hint to the mechanism, as the antioxidative capacity of the plasma of the treated patients clearly increased, which might ameliorate the DNA damage.
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.
Hagiwara, Satoshi; Aratani, Hideyui; Miki, Takami; Nishizawa, Yoshiki; Okamura, Terue; Koizumi, Yoshiko; Ochi, Hironobu; Morii, Hirotoshi
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 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 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)
Patel, Priti R; Kallen, Alexander J; Arduino, Matthew J
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.
Inaiana Marques Filizola Vaz
Full Text Available Objective: To evaluate the intake of energy and nutrients by individuals on hemodialysis, following especific recommendations for this population and according to Food Guide for the Brazilian Population. Methods: A cross-sectional study, 118 adult patients, considered stable from, ten dialysis centers in Goiânia, Goiás. Dietary intake was estimated by six 24-hour recalls, and classified as adequate or inadequate, according to specific recommendations for individuals undergoing dialysis and that recommended for a healthy diet. A descriptive analysis was performed. Results: Average dietary intake of 2022.40 ± 283.70 kcal/day; 31.18 kcal/kg/day; 55.03 ± 4.20% carbohydrate; 30.23 ± 3.71% lipid, 1.18 ± 0.23 g protein/kg/day. Important prevalences of inadequacy were observed for the intake of calories (39.0%, protein (39.0% and other nutrients such as retinol (94.9%, saturated fat (87.3%, cholesterol (61,9%, iron (61.0%, potassium (60.2% and zinc (45.0%. Patients had a low intake of fruit food group (1.22 ± 0.89 servings and vegetables (1.76 ± 1.01 servings, dairy products (0.57 ± 0.43 servings and high intake of food group of oils and fats (3.45 ± 0.95 servings, sugars and sweets (1.55 ± 0.77 servings. Conclusion: Observed food consumption imbalance, characterized by excess of oils and fats, especially saturated oils and cholesterol, sugars and sweets, parallel to low intake of fruits and vegetables and dairy products. A considerable percentage of patients did not intake the minimum recommended of calories, protein, retinol, iron, zinc and potassium.
Zahra Abbas Ali Madadi; Jalil Azimian; Farzaneh Falahatpishe; Mahmoud Alipour Heidari
Background: Pain and stress of hemodialysis are experienced by more than 50% of patients who are suffering from renal disease; hence decreasing a part of these adverse effects can be effective on individual’s long term coping with hemodialysis. The current study was done to determine the effect of warm footbath with vibration on arteriovenous fistula puncture-related pain in hemodialysis patients. Methods: This clinical trial was conducted on 31 hemodialysis patients in 2014. The patients ...
Sathe, Kiran P; Yeo, Wee-Song; Liu, Isaac Desheng; Ekambaram, Sudha; Azar, Mohammed; Yap, Hui-Kim; Ng, Kar-Hui
While the appearance of red clots in the dialyzer is a common phenomenon in every hemodialysis unit, the occurrence of white thrombi in the tubing is relatively rare. We describe an adolescent male with recurrent white thrombi formation in the hemodialysis tubing. This patient had chronic renal failure from focal segmental glomerulosclerosis, but was no longer nephrotic at the time of the thrombi formation. He had a history of recurrent thrombosis of his vascular access. However, no pro-thrombotic risk factors could be identified. White particulate matter, measuring 1 to 3mm in size, and adherent to the arterial and venous blood tubing lines was found during the rinse back of a hemodialysis session. This was associated with a 60% decrease in his platelet count. Light microscopic examination of the deposits revealed the presence of platelet aggregates. He subsequently developed thrombosis of his arteriovenous graft six hours later. The white thrombi recurred at the next dialysis session, as well as six months later. These episodes occurred regardless of the type of dialysis machine or tubing, and appeared to resolve with an increase in heparin dose. Recurrent white thrombi formation can occur in the hemodialysis tubing of a patient with no identifiable pro-thrombotic factors. The white thrombi may be a harbinger of arteriovenous graft thrombosis and may be prevented by an increase in heparin dose.
Permatasari, T. D.; Thamrin, A.; Hanum, H.
Patients with chronic kidney disease, have a higher risk for psychological distress such as anxiety, depression and cognitive decline. Combination of Hemodialysis (HD)/hemoperfusion (HP) regularly able to eliminate uremic toxin with mild-to-large molecular weight better. HD/HP can remove metabolites, toxin, and pathogenic factors and regulate the water, electrolyte and acid-base balance to improve the quality of patient’s sleep and appetite also reduces itching of the skin, which in turn improve the quality and life expectancy. This research was a cross sectional research with a pre-experimental design conducted from July to September 2015 with 17 regular hemodialysis patients as samples. Inclusion criteria were regular hemodialysis patients and willingly participated in the research. The assessmentwas conducted using BDI to assess depression. To obtained the results, data were analyzed using T-Test and showed that that the average BDI score before the combination of HD/HP 18.59±9 to 8.18±2.83 after the combination (p<0.001). In conclusion, combination HD/HP can lower depression scores in patients with regular HD.
Full Text Available "nBackground: Anemia is a common complication accompanied by high morbidity and mortality in hemodialysis patients. Considering the fact that the reduction of erythropoietin (EPO synthesis is the main cause of uremic anemia, receiving recombinant human erythropoietin (rHuEPO can improve the condition in these patients. Some of these hemodialysis patients, however, have acceptable hemoglobin levels without any need to EPO. Higher BMI, higher albumin and leptin plasma levels and longer durations of hemodialysis are possible factors contributing to the reduced need for rHuEPO in these patients. The present study is designed to asses the relationship between the plasma levels of leptin and the reduced EPO need. "nMethods: Fifty eligible hemodialysis patients with hemoglobin levels higher than 11 mg/dl were enrolled in the cross-sectional study. The information on age, sex, hemodialysis duration and the cause of renal dysfunction were extracted from the files. The baseline plasma levels of Leptin and albumin were measured. The patients BMI and the weekly need for rHuEPO were also calculated. "nResults: There was no correlation between the weekly need for rHuEPO and sex, BMI, the cause of renal dysfunction and the plasma levels of albumin and leptin; it, however, was related with age and the duration of dialysis. While age negatively influences the weekly need, the duration of dialysis has a positive effect on the need. "nConclusion: The plasma levels of leptin are not directly correlated with the required amounts of rHuEPO, indicating that leptin is not an effective factor in erythropoiesis. Conversely, older age and shorter hemodialysis durations are accompanied by reduced need for rHuEPO.
Kalantar-Zadeh, Kamyar; Miller, Loren G; Daar, Eric S
Hepatitis C virus (HCV) infection is associated with an increase in proinflammatory cytokine levels. Similar changes are seen in maintenance hemodialysis patients with malnutrition-inflammation-cachexia syndrome (MICS), which is associated with poor clinical outcomes in this population. We hypothesized that HCV transcription-mediated amplification (TMA), a sensitive qualitative molecular test for HCV RNA, may identify maintenance hemodialysis patients with HCV infection not detected by means of antibody enzyme immunoassay (EIA), particularly in those with MICS. We evaluated HCV status in 314 maintenance hemodialysis patients by using HCV antibody EIA (version 2.0; Abbott Laboratories, Abbott Park, IL) and HCV TMA (Bayer Diagnostics Laboratories, Berkeley, CA). Twenty-five patients (8%) were EIA positive (EIA+)/TMA+; 4 patients (1%), EIA+/TMA negative (TMA-), and 22 patients (7%), EIA-/TMA+. In the 47 TMA+ patients, the sensitivity of EIA for HCV infection was only 53%. TMA+ patients had lower albumin levels and higher tumor necrosis factor alpha and serum glutamic oxaloacetic transaminase levels than TMA- patients. EIA+/TMA+ patients were more likely than EIA-/TMA+ or EIA-/TMA- patients to have hypoalbuminemia and higher iron and transaminase levels. Of all TMA+ patients, EIA- patients were more likely to have diabetes, be on dialysis therapy longer, and have lower liver enzyme levels and higher proinflammatory cytokine levels, including tumor necrosis factor alpha and interleukin 6. Maintenance hemodialysis patients infected with HCV according to TMA have clinical features suggestive of MICS. In this population, HCV EIA appears to have a low sensitivity for the identification of HCV infection, which may be caused by the confounding effect of MICS or other demographic or clinical factors. These apparently false-negative HCV antibody test results are seen in persons with a longer time on hemodialysis therapy, mirroring observations in other populations with serious
Inass Mahmood Abid Kamal
Full Text Available Background: Patients with chronic renal failure (CRF were on maintenance invasive hemodialysis (HD procedure. This procedure by itself affects immunity of the patients and became more susceptible to viral infections. Aim of the study: to investigate the occurrence of HBV, HCV and HIV infections in patients with hemodialysis. Patients and methods: A retrospective study of 430 end-stage renal failure patients, referred to hemodialysis department at XXXX Teaching Hospital, Baghdad-Iraq from January-2015 to January-2017. Patients were investigated for HBs-Ag using enzyme-labeled antigen test (Foresight-EIA-USA, HCV- Abs (IgG specific immunoglobulin using an HCV enzyme-labeled antigen test (Foresight-EIA-USAand anti - HIV Abs (IgG using enzyme-labeled antigen test (Foresight-EIA-USA. Results: The frequency of HBV infection in the first year was not significant between males (1.11% and females (0.00% (P = 0.295. About HCV also there are no significant differences between males (12.63% and females (9.31% (P = 0.347. After one year of follow up the frequencies of HBV and HCV were not significant between two sexes. Additionally, no any one of the patients had HIV infection. Conclusions: This study brings a light on that HBV and HCV were having the same frequencies in both genders and lower occurrence with time. Furthermore, HIV was not detected in those patients. Keywords: Virus, Hemodialysis, Infection
Hurtado, Claudia; Báez, María Soledad; Bate, Anabel; Opazo, Claudio; Troncoso, Mauricio
Although radioiodine (131-I) can be used as treatment of hyperthyroidism for patients in hemodialysis, its use is limited and the experience is mainly related to differentiated thyroid carcinoma. We report a 58 years old female on hemodialysis with recurrent hyperthyroidism after propylthiouracil treatment. She was successfully treated with 131-I and four months after the intervention her euthyroid state was confirmed. We measured 131-I activity in blood, dialysate liquid and other waste products, as well as patient radiation exposure rates. We found that 131-I elimination was prolonged through time with no major dependence on hemodialysis, as opposed to the elimination of 131-I in patients with thyroid carcinoma. This was probably due to high radiotracer uptake in hyper functioning thyroid tissue. Conversely, radiation content in dialysate wastes or equipment was minimal. Furthermore, the rate of both environmental exposure and exposure of nursing staff in charge of hemodialysis sessions, was minimal and met international security standards. In conclusion, I-131 therapy showed both appropriate effectiveness and safety in this case and may be considered as a suitable treatment alternative to thyroidectomy when antithyroid drugs are unsuccessful.
Fuertes, Jairo N; Rubinstein, Sofia; Reyes, Mariela; Iampornpipopchai, Pichet; Mujeeb, Shanza; Smith, Carroll R; Toporovsky, Arielle
Over the past 20 years, the role of psychological and social factors, including the physician-patient working alliance, have emerged as integral components of medical care for patients with a myriad of health conditions. The current study examines a model comprised of psychological-interpersonal factors and the extent to which it explains patient satisfaction with and adherence to hemodialysis treatment. One hundred and seven adults with end-stage renal disease who were receiving regular outpatient hemodialysis participated in the study. Path analyses show that the physician-patient working alliance indirectly predicts patient adherence through patient satisfaction and patients' outcome expectations. The working alliance directly predicts patients' quality of life. It is concluded that consistent with previous research, the physician-patient working alliance is a significant factor in predicting key patient behaviors in medical care.
Bridoux, Frank; Carron, Pierre-Louis; Pegourie, Brigitte; Alamartine, Eric; Augeul-Meunier, Karine; Karras, Alexandre; Joly, Bertrand; Peraldi, Marie-Noëlle; Arnulf, Bertrand; Vigneau, Cécile; Lamy, Thierry; Wynckel, Alain; Kolb, Brigitte; Royer, Bruno; Rabot, Nolwenn; Benboubker, Lotfi; Combe, Christian; Jaccard, Arnaud; Moulin, Bruno; Knebelmann, Bertrand; Chevret, Sylvie; Fermand, Jean-Paul
Cast nephropathy is the main cause of acute kidney injury in multiple myeloma and persistent reduction in kidney function strongly affects prognosis. Strategies to rapidly remove nephrotoxic serum-free light chains combined with novel antimyeloma agents have not been evaluated prospectively. To compare the hemodialysis independence rate among patients newly diagnosed with myeloma cast nephropathy treated with hemodialysis using a high-cutoff dialyzer (with very large membrane pores and high permeability to immunoglobulin light chains) or a conventional high-flux dialyzer (with small pores and lower permeability). Randomized clinical trial involving 98 patients with biopsy-proven myeloma cast nephropathy requiring hemodialysis treated at 48 French centers between July 2011 and June 2016; the final date of follow-up was June 29, 2016. Intensive hemodialysis (eight 5-hour sessions over 10 days) with either a high-cutoff dialyzer (46 patients) or a conventional high-flux dialyzer (48 patients). All patients received the same chemotherapy regimen of bortezomib and dexamethasone. Primary end point was hemodialysis independence at 3 months; secondary end points: hemodialysis independence rates at 6 and 12 months, hemodialysis- and chemotherapy-related adverse events, and death. Among 98 randomized patients, 94 (96%) (median age, 68.8 years [interquartile range, 61.2-75.3 years]; 45% women) were included in the modified intent-to-treat analysis. The hemodialysis independence rate at 3 months was 41.3% (n = 19) in the high-cutoff hemodialysis group vs 33.3% (n = 16) in the conventional hemodialysis group (between-group difference, 8.0% [95% CI, -12.0% to 27.9%], P = .42); at 6 months, the rate was 56.5% (n = 26) vs 35.4% (n = 17), respectively (between-group difference, 21.1% [95% CI, 0.9% to 41.3%], P = .04); and at 12 months, the rate was 60.9% (n = 28) vs 37.5% (n = 18) (between-group difference, 23.4% [95% CI, 3.2% to 43.5%], P = .02
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.
Al-Hasani, Hasanein; Roussou, Euthalia
Methotrexate (MTX) can be toxic to patients suffering from end stage renal disease (ESRD) on hemodialysis even at low doses. This increase in toxicity is more notable in terms of bone marrow suppression in the form of pancytopenia. Many methods of elimination including dialysis itself have been proven ineffective, and alternate treatments with anti-TNF alpha blockers can be considered.
de Guzman, Allan B.; Chy, Mark Anthony S.; Concepcion, April Faye P.; Conferido, Alvin John C.; Coretico, Kristine I.
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…
Tomanoski Vasilije; Gjorgjievska Gordana; Zvezdakovska Jasminka; Krecova Vasiliki; Andonoski Aleksandar; Nakovska Margarita; Muharemi Serjat; Kliseski Tode; Janakievska Pavlina; Ristoska Katerina; Veliu Ramazan; Vasileva Liljana; Jovanov Toni; Mehmedi-Veseli Kaltrina; Ferati Beane
Introduction. Factors that have been reported to affect erythropoietin (EPO) responsiveness in hemodialysis (HD) patients include iron deficiency, chronic inflammation, secondary hyperparathyroidism, malnutrition and inadequate HD dose. The aim of the study was to analyze the deteminants of hemoglobin variability in HD patients. Methods. The study encompassed 526 patients (197 F and 329 M). According to HD vintage at the beginning of the study the patients were divided into two groups: group-...
Małgorzewicz, S; Aleksandrowicz-Wrona, E; Owczarzak, A; Debska-Slizień, A; Rutkowski, B; Łysiak-Szydłowska, W
The aim of this study was to investigate the serum concentration of adipokines, such as leptin, adiponectin, and resistin, and assess its relation to nutritional and inflammatory parameters in both overweight and normal weight patients on maintenance hemodialysis. A total of 36 hemodialysis patients (27 M, 9 F; mean age 55.3 +/- 12 yr.) were examined and 23 additional healthy volunteers were recruited as the control group. The concentrations of leptin, leptin receptor, adiponectin, resistin, IL-6, TNFa and CRP were measured by ELISA. Assessment of nutritional status was determined by the levels of albumin, BMI, percentage of body fat (%F), lean body mass (LBM), and Subjective Global Assessment Score (SGA). According to the SGA 7-points score and the albumin level, 20 patients were of good nutritional status (6-7 points), while 16 patients were mildly malnourished (4-5 points). The concentrations of CRP, resistin, adiponectin, and TNFa were statistically higher in hemodialysis patients than in the control group (p pound 0.05). The adiponectin level was inversely correlated with %F (R Spearman=-0.3; p pound 0.05). The level of leptin was positively correlated with %F as well as with BMI and SGA scores (R Spearman=0.4; p pound 0.05). Although there was no significant difference in the nutritional status between the nonoverweight (BMI 18.5-24.99) and overweight (BMI (3)25.0) groups of patients, in the nonoverweight group there were 12 patients (54.5%) with signs of mild malnutrition compared to 4 malnourished patients (28.5%) in the overweight group. Nonoverweight patients presented significantly lower leptin concentration (12.7 vs 27.8 ug/l) and higher adiponectin level (38.9 vs 32.5 ng/ml) when compared to overweight patients. The levels of IL-6 and TNFa were higher in the nonoverweight group of patients. Overweight patients also had shorter durations of stay in the hemodialysis program (30.5 vs. 87.6 months). The results of our study indicate that lean hemodialysis
Alvarez, A.; Petraglia, A.; Caorsi, H.; Mazzuchi, N.; Olaizola, I.; Acuna, G.; Fajardo, L.; Ambrosoni, P.; Morelli, R.
A retrospective study was performed in 41 patients, in chronic hemodialysis with severe hyperparathyroidism (HPT), who underwent surgery during time period from 1985 to 1997. 22 females, 19 males, aged 50 and 14 years, with PTHI 1345 and 604 pg/ml were followed up 32 and 22 months. Three surgical methods we evaluated: group I) total para thyroidectomy(PTX) with Implants(n=24); group II) subtotal PTX(n=14) and group III) total PTX(n=3). It considered recurrence of HPT when PTH levels were higher than upper range of normal, after 6 months post surgery. persistence was defined when there was no standardization of PTH levels. In group I, 9 patients had normal parathyroid function, 7 had persistent hypoparathyroidism and had hyperparathyroidism (7 recurrences). Group II patients had parathyroid over function in 5 cases (4 persistence s), 5 were normal and 4 hypoparathyroidism. All patients of the third group had hypoparathyroidism. Long term normalization of parathyroid gland activity was achieved in one third of troduccion patients (34,1%) whereas 34,1% permanent hypoparathyroidism and 31,8% hyperparathyroidism. It found no differences in recurrence and histological subtype of parathyroid gland in the different groups. In conclusion, similar long term clinical results were obtained with the different groups. The surgical ideal treatment is controversial. We think that in the long run, the evolution of parathyroid status is mostly influenced by the persistence of uremic state rather than the type of surgery performed [es
Park, Christina; Obi, Yoshitsugu; Streja, Elani; Rhee, Connie M; Catabay, Christina J; Vaziri, Nosratola D; Kovesdy, Csaba P; Kalantar-Zadeh, Kamyar
The association between serum uric acid (SUA) and mortality has been conflicting among studies using hemodialysis (HD) patients. Given the close link between purine and protein in foods, we hypothesized that normalized protein catabolic rate (nPCR), a dietary protein intake surrogate, modifies the SUA-mortality association in the HD population. We identified 4298 patients who initiated HD and had one or more SUA measurement in a contemporary cohort of HD patients over 5 years (1 January 2007-31 December 2011), and examined survival probability according to the first uric acid measurement, adjusting for dialysis vintage, case-mix and malnutrition-inflammation complex-related variables. Mean SUA concentration was 6.6 ± 1.8 mg/dL. There was a consistent association of higher SUA with better nutritional status and lower all-cause mortality irrespective of adjusted models (Ptrend 6.0-7.0 mg/dL) showed no significant mortality risk [hazard ratio (HR) 0.90, 95% confidence interval (CI) 0.72-1.13], while the lowest category (HD patients. Contrary to the general population, low but not high SUA is associated with higher all-cause mortality in HD patients, especially in those with low protein intake. Nutritional features of SUA warrant additional studies. © The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
Salah Omar Bashir
Full Text Available Calcific uremic arteriolopathy (CUA, also known as calciphylaxis, is a rare condition most frequently seen in patients with advanced chronic kidney disease. The clinical picture is characterized by painful skin lesions and ulcerations. The underlying pathology is medial calcification and intimal proliferation with microthrombi of small arteries. CUA is commonly associated with secondary hyperparathyroidism and high serum calcium and phosphate products. This article reports an atypical case where CUA developed after parathyroidectomy and in the course of treatment of hungry bone syndrome. The patient was on hemodialysis for 14 years. He had developed secondary hyperparathyroidism and severe osteodystrophy. Calcium, Vitamin-D supplements, and calcimimetics failed to control his condition. He underwent parathyroidectomy but developed hungry bone syndrome postoperatively. He was managed with large doses of calcium and active Vitamin-D analogs to maintain his serum calcium. Two weeks later, he developed a painful single lesion on the tip of the penis which was diagnosed as CUA on clinical and radiographic evidence. The patient refused surgical intervention and opted for traditional treatment with honey and herbs with an excellent outcome. The case highlights the risk of CUA complicating the aggressive management of post-parathyroidectomy hungry bone syndrome.
Full Text Available The aim of this study was to ascertain the nutritional status of patients with Balkan (Endemic Nephropathy (BEN on maintenance hemodialysis (HD. The specimen of examines included 14 patients with BEN and 178 patients with another diagnosis on hemodialysis in Institute of Nephrology and Hemodialysis, Clinical Center Nis in 2002. Body mass index (BMI of male patients with BEN was 25.7±5.0 kg/m2; normal body weight was present in 66.7% of cases and obese in 33.3% of cases. BMI of female patients with BEN was 24.5±4.3 kg/m2; malnutrition was present in 12.5% of cases, normal body weight in 50.0% and obese in 37.5% of cases. Anthropometric indexes (BMI, lean body mass, body height, relative body weight, biceps, triceps, sub-scapular and iliac skinfold thickness, as well as, percent of body fat, mid-arm circumference and mid-arm muscle circumference of another HD patients was slight lower then HD patients with BEN, but differences was not statistically significant.
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.
Lund, Anton; Damholt, Mette B; Strange, Ditte G; Kelsen, Jesper; Møller-Sørensen, Hasse; Møller, Kirsten
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.
Souza, Cláudia Régia Dias de; Libério, Silvana Amado; Guerra, Rosane Nassar Meireles; Monteiro, Silvio; Silveira, Ericka Janine Dantas da; Pereira, Antonio Luiz Amaral
Thirty patients undergoing hemodialysis were evaluated for their periodontal condition through plaque, calculus and gingival indexes; PSR and IgA present in the saliva were also appraised in order to determine the periodontal condition of patients presenting chronic kidney disease. Results obtained demonstrated that in the studied group the plaque, calculus and gingival indexes were high. With regard to these patients' requirement to undergo periodontal treatment, most patients submitted to hemodialysis needed better oral hygiene, in addition to supra and sub gingival scraping and topic application of fluor (code 2). As to the IgA amount present in the saliva, only three patients showed a low density. Patients presenting chronic kidney disease disclosed a tendency for greater bacterial plaque concentration, high formation of dental calculus suggesting the need for periodontal treatment comprising supra and sub gingival scraping.
Scholze, Alexandra; Thies, Christina; Cheikhalfraj, Mohamed
We determined whether attainment of classical clinical performance measures for hemodialysis care improves survival in hemodialysis patients with increased arterial stiffness.......We determined whether attainment of classical clinical performance measures for hemodialysis care improves survival in hemodialysis patients with increased arterial stiffness....
Da, J J; Peng, H Y; Lin, X; Shen, Y; Zhao, J Q; He, S; Zha, Y
Objective: To explore the level of resting energy expenditure (REE) estimated by bioelectrical impedance analysis and the association of resting metabolic rate (RMR) with clinical related factors, and provide new ideas for improving protein energy wasting (PEW) in maintenance hemodialysis (MHD) patients. Methods: Seven hundred and sixty-five subjects receiving MHD between July 2015 and September 2016 in 11 hemodialysis centers in Guizhou province were enrolled in this cross-sectional study. Bioelectrical impedance analysis was used to measure RMR and body composition, such as lean body mass, fat mass and body cell mass (BCM). Baseline characteristics, routine blood test indexes and biochemical data of hemodialysis patients were collected. The level of RMR and body composition in hemodialysis patients was compared by gender grouping. Then the patients were divided into four groups according to the cutoff value of RMR quartile. Spearman correlation analysis and multiple linear regression analysis were used to analyze the relationships between RMR and clinical related factors. Results: The average age of MHD patients was (54.96±15.78) years and the duriation of dialysis was (42.3±9.0) months. The level of RMR in male patients (474 cases, 61.96%) was significantly higher than that in female patients [1 591(1 444, 1 764) kcal/d vs 1 226 (1 104, 1 354) kcal/d, P lean body mass ( P =0.193). Multiple linear regression analysis showed that RMR was positively correlated with body surface area (β=0.817) and lactate dehydrogenase (LDH) (β=0.198), and negatively correlated with age (β=-0.141), all P maintenance hemodialysis are associated with lactate dehydrogenase level, which may become a new index to evaluate energy consumption.
Bianco, G; Carlesimo, S C; Mazzarrino, R; Palestini, M
A case of Laurence-Moon-Biedl-Bardet syndrome in a patient undergoing hemodialysis is reported. The principal characteristics of this congenital syndrome are described. A possible pathogenetic mechanism of the atypical form of retinitis pigmentosa (sine pigmento) is discussed.
Huml, Anne M.; Sullivan, Catherine M.; Leon, Janeen B.; Sehgal, Ashwini R.
Because hemodialysis treatment has a limited ability to remove phosphorus, dialysis patients must restrict dietary phosphorus intake and use phosphorus binding medication. Among patients with restricted dietary phosphorus intake (1000 mg/d), phosphorus binders must bind about 250 mg of excess phosphorus per day and among patients with more typical phosphorus intake (1500 mg/d), binders must bind about 750 mg per day. To determine the phosphorus binding capacity of binder prescriptions among American hemodialysis patients, we undertook a cross-sectional study of a random sample of in-center chronic hemodialysis patients. We obtained data for one randomly selected patient from 244 facilities nationwide. About one-third of patients had hyperphosphatemia (serum phosphorus level > 5.5 mg/dL). Among the 224 patients prescribed binders, the mean phosphorus binding capacity was 256 mg/d (SD 143). 59% of prescriptions had insufficient binding capacity for restricted dietary phosphorus intake, and 100% had insufficient binding capacity for typical dietary phosphorus intake. Patients using two binders had a higher binding capacity than patients using one binder (451 vs. 236 mg/d, p phosphorus balance. Use of two binders results in higher binder capacity. Further work is needed to understand the impact of binder prescriptions on mineral balance and metabolism and to determine the value of substantially increasing binder prescriptions. PMID:23013171
Ahmed Farouk Donia; Mohamed Ahmed Elhadedy; Hanzada Mohamed El-Maghrabi; Mohamed Hamed Abbas; Mohamed Ashraf Foda
Hemodialysis (HD) patients are subjected to a number of physical and mental stresses. Physicians might be unaware of some of these problems. We assessed our patients′ opinion about the service provided at the dialysis unit. Our unit has 89 patients on HD. A questionnaire exploring our patients′ opinion relative to the service provided was prepared. The patients were asked to fill-in the questionnaire in a confidential manner. Questionnaires were then collected and examined while unaware of pa...
Sugioka, Yuko; Inui, Kentaro; Koike, Tatsuya
Disease-modifying anti-rheumatic drugs (DMARDs) are typically used for the therapy of rheumatoid arthritis (RA), but most have some nephrotoxicity. In several clinical studies, etanercept had fewer adverse effects on renal function than other DMARDs. We report the case of a 64-year-old woman with RA and renal insufficiency on hemodialysis treated using etanercept therapy. This case suggests that etanercept therapy might be effective in the short term for such patients.
Winther, Simon; Christensen, Jeppe Hagstrup; Flyvbjerg, Allan
Abstract BACKGROUND: Patients treated with hemodialysis (HD) have an increased mortality, mainly caused by cardiovascular disease (CVD). Osteoprotegerin (OPG) is a glycoprotein involved in the regulation of the vascular calcification process. Previous studies have demonstrated that OPG.......08; in the adjusted analyses, the p-value for trend was 0.03. CONCLUSIONS: In a high-risk population of hemodialysis patients with previously documented cardiovascular disease, a high level of OPG was an independent risk marker of all-cause mortality....... is a prognostic marker of mortality. The aim of this study was to investigate if OPG was a prognostic marker of all-cause mortality in high-risk patients with end-stage renal disease and CVD. METHODS: We prospectively followed 206 HD patients with CVD. OPG was measured at baseline and the patients were followed...
Fellström, Bengt C; Jardine, Alan G; Schmieder, Roland E
. Secondary end points included death from all causes and individual cardiac and vascular events. RESULTS: After 3 months, the mean reduction in low-density lipoprotein (LDL) cholesterol levels was 43% in patients receiving rosuvastatin, from a mean baseline level of 100 mg per deciliter (2.6 mmol per liter......BACKGROUND: Statins reduce the incidence of cardiovascular events in patients at high cardiovascular risk. However, a benefit of statins in such patients who are undergoing hemodialysis has not been proved. METHODS: We conducted an international, multicenter, randomized, double-blind, prospective...... trial involving 2776 patients, 50 to 80 years of age, who were undergoing maintenance hemodialysis. We randomly assigned patients to receive rosuvastatin, 10 mg daily, or placebo. The combined primary end point was death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke...
Brener, Zachary Z.; Bergman, Michael
Pica refers to the persistent, compulsive craving for and ingestion of nonfood items and certain food items. Pica is quite common among dialysis patients. The nutrient composition of some of the substances ingested may contribute to severe metabolic and mineral disturbances and other serious medical complications. We report the first case of a hemodialysis patient with chalk pica associated hypercalcemia who developed acute necrotizing pancreatitis. Hydration, nutritional support and hemodial...
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.
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.
Kinsella, Sinead M
Hemodialysis is associated with an increased risk of neoplasms which may result, at least in part, from exposure to ionizing radiation associated with frequent radiographic procedures. In order to estimate the average radiation exposure of those on hemodialysis, we conducted a retrospective study of 100 patients in a university-based dialysis unit followed for a median of 3.4 years. The number and type of radiological procedures were obtained from a central radiology database, and the cumulative effective radiation dose was calculated using standardized, procedure-specific radiation levels. The median annual radiation dose was 6.9 millisieverts (mSv) per patient-year. However, 14 patients had an annual cumulative effective radiation dose over 20 mSv, the upper averaged annual limit for occupational exposure. The median total cumulative effective radiation dose per patient over the study period was 21.7 mSv, in which 13 patients had a total cumulative effective radiation dose over 75 mSv, a value reported to be associated with a 7% increased risk of cancer-related mortality. Two-thirds of the total cumulative effective radiation dose was due to CT scanning. The average radiation exposure was significantly associated with the cause of end-stage renal disease, history of ischemic heart disease, transplant waitlist status, number of in-patient hospital days over follow-up, and death during the study period. These results highlight the substantial exposure to ionizing radiation in hemodialysis patients.
Kamal, Inass Mahmood Abid; Mahdi, Batool Mutar
Patients with chronic renal failure (CRF) were on maintenance invasive hemodialysis (HD) procedure. This procedure by itself affects immunity of the patients and became more susceptible to viral infections. to investigate the occurrence of HBV, HCV and HIV infections in patients with hemodialysis. A retrospective study of 430 end-stage renal failure patients, referred to hemodialysis department at XXXX Teaching Hospital, Baghdad-Iraq from January-2015 to January-2017. Patients were investigated for HBs-Ag using enzyme-labeled antigen test (Foresight-EIA-USA), HCV- Abs (IgG) specific immunoglobulin using an HCV enzyme-labeled antigen test (Foresight-EIA-USA)and anti - HIV Abs (IgG) using enzyme-labeled antigen test (Foresight-EIA-USA). The frequency of HBV infection in the first year was not significant between males (1.11%) and females (0.00%) (P = 0.295). About HCV also there are no significant differences between males (12.63%) and females (9.31%) (P = 0.347). After one year of follow up the frequencies of HBV and HCV were not significant between two sexes. Additionally, no any one of the patients had HIV infection. This study brings a light on that HBV and HCV were having the same frequencies in both genders and lower occurrence with time. Furthermore, HIV was not detected in those patients.
Isabella Ramos de Oliveira Liberato
Full Text Available OBJECTIVE: The present study was designed to analyze the serum levels of aspartate and alanine aminotransferases, gamma-glutamyl transferase, and the hematocrit in patients with chronic kidney disease who were undergoing peritoneal dialysis or hemodialysis. PATIENTS AND METHODS: Twenty patients on peritoneal dialysis and 40 on hemodialysis were assessed, and the patients were matched according to the length of time that they had been on dialysis. Blood samples were collected (both before and after the session for those on hemodialysis to measure the enzymes and the hematocrit. RESULTS: In the samples from the patients who were undergoing peritoneal dialysis, the aspartate and alanine aminotransferase levels were slightly higher compared with the samples collected from the patients before the hemodialysis session and slightly lower compared with the samples collected after the hemodialysis session. The levels of gamma-glutamyl transferase in the hemodialysis patients were slightly higher than the levels in the patients who were undergoing peritoneal dialysis. In addition, the levels of aminotransferases and gamma-glutamyl transferase that were collected before the hemodialysis session were significantly lower than the values collected after the session. The hematocrit levels were significantly lower in the patients who were on peritoneal dialysis compared with the patients on hemodialysis (both before and after the hemodialysis session, and the levels were also significantly lower before hemodialysis compared with after hemodialysis. CONCLUSION: The aminotransferase levels in the patients who were undergoing peritoneal dialysis were slightly higher compared with the samples collected before the hemodialysis session, whereas the aminotransferase levels were slightly lower compared with the samples collected after the session. The hematocrits and the aminotransferase and gamma-glutamyl transferase levels of the samples collected after the
Drew, David A; Lok, Charmaine E; Cohen, Joshua T; Wagner, Martin; Tangri, Navdeep; Weiner, Daniel E
Hemodialysis vascular access recommendations promote arteriovenous (AV) fistulas first; however, it may not be the best approach for all hemodialysis patients, because likelihood of successful fistula placement, procedure-related and subsequent costs, and patient survival modify the optimal access choice. We performed a decision analysis evaluating AV fistula, AV graft, and central venous catheter (CVC) strategies for patients initiating hemodialysis with a CVC, a scenario occurring in over 70% of United States dialysis patients. A decision tree model was constructed to reflect progression from hemodialysis initiation. Patients were classified into one of three vascular access choices: maintain CVC, attempt fistula, or attempt graft. We explicitly modeled probabilities of primary and secondary patency for each access type, with success modified by age, sex, and diabetes. Access-specific mortality was incorporated using preexisting cohort data, including terms for age, sex, and diabetes. Costs were ascertained from the 2010 USRDS report and Medicare for procedure costs. An AV fistula attempt strategy was found to be superior to AV grafts and CVCs in regard to mortality and cost for the majority of patient characteristic combinations, especially younger men without diabetes. Women with diabetes and elderly men with diabetes had similar outcomes, regardless of access type. Overall, the advantages of an AV fistula attempt strategy lessened considerably among older patients, particularly women with diabetes, reflecting the effect of lower AV fistula success rates and lower life expectancy. These results suggest that vascular access-related outcomes may be optimized by considering individual patient characteristics. Copyright © 2015 by the American Society of Nephrology.
Gaweda, Adam E.; Aronoff, George R.; Jacobs, Alfred A.; Rai, Shesh N.; Brier, Michael E.
One-size-fits-all protocol-based approaches to anemia management with erythropoiesis-stimulating agents (ESAs) may result in undesired patterns of hemoglobin variability. In this single-center, double-blind, randomized controlled trial, we tested the hypothesis that individualized dosing of ESA improves hemoglobin variability over a standard population-based approach. We enrolled 62 hemodialysis patients and followed them over a 12-month period. Patients were randomly assigned to receive ESA ...
Vogt, Barbara Perez; Ponce, Daniela; Caramori, Jacqueline Costa Teixeira
Obesity has been considered the key in metabolic syndrome (MetS) development, and fat accumulation may be responsible for the occurrence of metabolic abnormalities in hemodialysis patients. The use of gold-standard methods to evaluate obesity is limited, and anthropometric measures may be the simplest methods. However, no study has investigated the association between anthropometric indexes and MetS in these patients. Therefore, the aim was to determine which anthropometric indexes had the best association and prediction for MetS in patients undergoing hemodialysis. Cross-sectional study that included patients older than 18 years, undergoing hemodialysis for at least 3 months. Patients with liver disease and cancer or those receiving corticosteroids or antiretroviral therapy were excluded. Diagnostic criteria from Harmonizing Metabolic Syndrome were used for the diagnosis of MetS. Anthropometric indexes evaluated were body mass index (BMI); percent standard of triceps skinfold thickness and of middle arm muscle circumference; waist circumference (WC); sagittal abdominal diameter; neck circumference; waist-to-hip, waist-to-thigh, and waist-to-height ratios; sagittal index; conicity index; and body fat percentage. Ninety-eight patients were included, 54.1% male, and mean age was 57.8 ± 12.9 years. The prevalence of MetS was 74.5%. Individuals with MetS had increased accumulation of abdominal fat and general obesity. Waist-to-height ratio was the variable independently associated with MetS diagnosis (odds ratio, 1.21; 95% confidence interval, 1.09-1.34; P < .01) and that better predicts MetS, followed by WC and BMI (area under the curve of 0.840, 0.836, and 0.798, respectively, P < .01). Waist-to-height ratio was the best anthropometric predictor of MetS in maintenance hemodialysis patients. © 2015 American Society for Parenteral and Enteral Nutrition.
Obialo, Chamberlain I; John, Smitha; Bashir, Khalid
Hyponatremia is common in chronic kidney disease and in end stage kidney disease (ESKD) but hypernatremia is infrequent in ESKD. The incidence of hypernatremia is higher in ambulatory peritoneal dialysis (PD) than in hemodialysis (HD) patients. In PD patients it is often a result of excessive ultrafiltration but in HD it is often a result of dialysate composition errors. Dialysate composition errors can inadvertently cause either hyponatremia or hypernatremia. We present two cases of symptomatic hypernatremia which manifested as increased thirst, excessive weight gain and worsening hypertension in HD patients. The hypernatremia was caused by a combination of errors in online conductivity reading and a faulty hand held conductivity meter. Symptoms were relieved in both patients after replacement of the dialysis machine. © 2017 International Society for Hemodialysis.
Full Text Available Chadi Saifan, Elie El-Charabaty, Morton Kleiner, Suzanne El-SayeghDepartment of Medicine, Division of Nephrology, Staten Island University Hospital, Staten Island, NY, USABackground: Erythropoietin is a hormone that regulates erythropoiesis and is mainly produced by the kidneys. Several animal studies as well as a few case reports and case series have demonstrated that regenerating hepatic tissue can produce more erythropoietin than normal hepatic tissue. The purpose of the study was to examine the difference in hemoglobin and hematocrit levels as well as epoetin dosage in patients on hemodialysis with and without hepatitis C (HCV.Methods: A retrospective chart review was performed. Seventy-six patients were included in the study (19 with HCV and 57 without HCV at a ratio of 1:3. Exclusion criteria were a history of gastrointestinal bleeding or blood transfusion over the previous six months, polycystic kidney disease, and pregnancy. Variables examined included gender, age, duration of hemodialysis, hemoglobin, hematocrit, epoetin dose, aspartate transaminase, and ferritin levels over a three-month period.Results: The patients were divided into two groups. The first consisted of patients with HCV on hemodialysis and the second of patients on hemodialysis without HCV. Mean hemoglobin was 12.6 ± 1.2 g/dL for the HCV-positive group and 11.9 ± 1.1 g/dL for the HCV-negative group. The difference was statistically significant (P = 0.03. Mean hematocrit was higher in the HCV-positive group, but was not significantly different at 39.08% ± 4.06% versus 37.43% ± 3.4% in the HCV-negative group (t-test, P = 0.11. Further, the HCV-positive group required less epoetin, but this was not significantly different from that required in the HCV-negative group at 6258 ± 5208 IU versus 7596 ± 7056 IU, respectively (t-test, P = 0.38.Conclusion: In our study, patients with HCV infection were found to have higher hemoglobin and hematocrit levels and lower epoetin
... need to eat a special diet? Yes. Generally speaking, patients on dialysis are advised to increase their ... on our websites is information developed solely from internal experts on the subject matter, including medical advisory ...
Vaiciuniene, Ruta; Kuzminskis, Vytautas; Ziginskiene, Edita; Skarupskiene, Inga; Bumblyte, Inga A
The aim of this study was to evaluate whether adherence to treatment is associated with hospitalization risk in hemodialysis patients. We completed a cohort analysis of risk factors during 1 census month (November) and 1 year of follow-up during 5 consecutive years (2002-2006) in all end-stage renal disease patients hemodialyzed in the Kaunas region. During the census month, we collected data on noncompliance defined as (i) skipping of a hemodialysis (HD) session, (ii) shortening of 1 or more HD sessions, (iii) presence of hyperkalemia, (iv) presence of hyperphosphatemia, or (v) interdialytic weight gain (IDWG). In addition, data on age, sex, disability status, comorbidities, anemia control, malnutrition and inflammation, calcium-phosphorus metabolism and hospitalization rate were collected. Relative risk of hospitalization was estimated using Cox regression evaluating time to first hospitalization. We analyzed 559 patients for a total of 1,163 patient-years during the 5 years of the study. On multivariate analysis, adjusting for ischemic heart disease, diabetes mellitus, higher number of comorbid conditions, higher systolic blood pressure before dialysis, worse disability status, lower hemoglobin, albumin and urea before dialysis, the relative risk for hospitalization increased by 1.1 for every additional percentage point of IDWG and by 1.19 with each 1 mmol/L rise of serum phosphorus level. Skipping or shortening of hemodialysis sessions and serum potassium level were not associated with hospitalization. Higher IDWG and higher serum levels of phosphorus independently increased the relative risk of hospitalizations in hemodialysis patients. With skipped and shortened dialysis sessions, higher serum potassium level was not associated with hospitalization risk.
Kaya, M.; Cermik, T.F.; Uestuen, F.; Sen, S.; Berkarda, S.
The aim of this study was to evaluate the changes in salivary gland function in patients with chronic renal failure (CRF) undergoing hemodialysis. The group consisted of 23 patients with CRF (13 female, 10 male; mean age: 40±13 yr) and 14 healthy control subjects (mean age: 40±13 yr). All underwent dynamic salivary gland scintigraphy with gustatory stimulation. After intravenous administration of 99m Tc pertechnetate, first, perfusion images at 2 seconds per frame were acquired for 1 minute, then dynamic images at 1 minute per frame were acquired for 45 minutes. At 30 minutes after injection , 10 ml lemon juice was given for 15 minutes as a gustatory stimulus. We obtained time-activity curves derived from regions of interest centered over the four major salivary glands. The following functional indices were calculated for each gland: the time of maximum radioactivity (T max ) for the prestimulated period, the time of minimum radioactivity (T min ), as an indicator of velocity of secretion after stimulation, and the Lem E 5 % value as an indicator of the secretion function. When the patients with CRF undergoing hemodialysis were compared to the controls, there were statistically significant differences in T max , T min and Lem E 5 % values for bilateral parotid glands, and T min values for bilateral submandibular glands (p max and Lem E 5 % values for bilateral submandibular glands. There were also significant differences in T max and Lem E 5 % values for bilateral parotid glands between mild oral problems and severe oral problems in patients with CRF (undergoing hemodialysis). In this study, prolonged T max and T min values, and decreased Lem E 5 % values for parotid glands and prolonged T min values for submandibular glands on salivary scintigraphy pointed out decreased parenchymatous and excretory function in patients with CRF undergoing hemodialysis. (author)
Hung, Szu-Chun; Lin, Yao-Ping; Huang, Hsin-Lei; Pu, Hsiao-Fung; Tarng, Der-Cherng
Elevated aldosterone is associated with increased mortality in the general population. In patients on dialysis, however, the association is reversed. This paradox may be explained by volume overload, which is associated with lower aldosterone and higher mortality. We evaluated the relationship between aldosterone and outcomes in a prospective cohort of 328 hemodialysis patients stratified by the presence or absence of volume overload (defined as extracellular water/total body water >48%, as measured with bioimpedance). Baseline plasma aldosterone was measured before dialysis and categorized as low (280 pg/mL). Overall, 36% (n = 119) of the hemodialysis patients had evidence of volume overload. Baseline aldosterone was significantly lower in the presence of volume overload than in its absence. During a median follow-up of 54 months, 83 deaths and 70 cardiovascular events occurred. Cox multivariate analysis showed that by using the low aldosterone as the reference, high aldosterone was inversely associated with decreased hazard ratios for mortality (0.49; 95% confidence interval, 0.25-0.76) and first cardiovascular event (0.70; 95% confidence interval, 0.33-0.78) in the presence of volume overload. In contrast, high aldosterone was associated with an increased risk for mortality (1.97; 95% confidence interval, 1.69-3.75) and first cardiovascular event (2.01; 95% confidence interval, 1.28-4.15) in the absence of volume overload. The inverse association of aldosterone with adverse outcomes in hemodialysis patients is due to the confounding effect of volume overload. These findings support treatment of hyperaldosteronemia in hemodialysis patients who have achieved strict volume control.
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.
Harp, Richard J.; Stavropoulos, S. William; Wasserstein, Alan G.; Clark, Timothy W.I.
Purpose: Percutaneous hemodialysis thrombectomy causes subclinical pulmonary emboli without short-term clinical consequence; the long-term effects on the pulmonary arterial vasculature are unknown. We compared the prevalence of pulmonary hypertension between patients who underwent one or more hemodialysis access thrombectomy procedures with controls without prior thrombectomy.Methods: A retrospective case-control study was performed. Cases (n = 88) had undergone one or more hemodialysis graft thrombectomy procedures, with subsequent echocardiography during routine investigation of comorbid cardiovascular disease. Cases were compared with controls without end-stage renal disease (ESRD) (n = 100, group 1), and controls with ESRD but no prior thrombectomy procedures (n = 117, group 2). The presence and velocity of tricuspid regurgitation on echocardiography was used to determine the prevalence and grade of pulmonary hypertension; these were compared between cases and controls using the chi-square test and logistic regression.Results: The prevalence of pulmonary hypertension among cases was 52% (46/88), consisting of mild, moderate and severe in 26% (n = 23), 10% (n = 9) and 16% (n = 14), respectively. Prevalence of pulmonary hypertension among group 1 controls was 26% (26/100), consisting of mild, moderate and severe pulmonary hypertension in 14%, 5% and 7%, respectively. Cases had 2.7 times greater odds of having pulmonary hypertension than group 1 controls (p = 0.002). The prevalence of pulmonary hypertension among group 2 controls was 42% (49/117), consisting of mild, moderate and severe pulmonary arterial hypertension in 25% (n = 49), 10% (n = 12) and 4% (n = 5), respectively. Cases were slightly more likely to have pulmonary hypertension than group 2 controls (OR = 1.5), although this failed to reach statistical significance (p = 0.14).Conclusion: Prior hemodialysis access thrombectomy does not appear to be a risk factor for pulmonary arterial hypertension
Zabel, Rachel; Ash, Susan; King, Neil; Juffs, Philip; Bauer, Judith
The aim of this paper was to investigate the association between appetite and kidney-disease specific quality of life in maintenance hemodialysis patients. Quality of life (QoL) was measured using the kidney disease quality of life survey. Appetite was measured using self-reported categories and a visual analog scale. Other nutritional parameters included Patient-Generated Subjective Global Assessment (PGSGA), dietary intake, body mass index and biochemical markers C-reactive protein and albumin. Even in this well nourished sample (n=62) of hemodialysis patients, PGSGA score (r=-0.629), subjective hunger sensations (r=0.420) and body mass index (r=-0.409) were all significantly associated with the physical health domain of QoL. As self-reported appetite declined, QoL was significantly lower in nine domains which were mostly in the SF36 component and covered social functioning and physical domains. Appetite and other nutritional parameters were not as strongly associated with the Mental Health domain and Kidney Disease Component Summary Domains. Nutritional parameters, especially PGSGA score and appetite, appear to be important components of the physical health domain of QoL. As even small reductions in nutritional status were associated with significantly lower QoL scores, monitoring appetite and nutritional status is an important component of care for hemodialysis patients. Copyright © 2012 Elsevier Ltd. All rights reserved.
Full Text Available Introduction. Chronic renal failure and dialysis are complicated situations that affect on somatic and mental status of patients. In this study, relation between stress, renal diseas, dialysis and mental disorders was determined. Methods. In a case control study in Noor hospital"s dialysis ward (affiliated to Isfahan University of Medical Sciences and Health Services the mental status of 30 end stage renal disease (ESRD patients were compaired with well matched control group by MMPI. Results. Hypochondriasis (Hs, depression (D, hysteria (Hy psychastenia (Pt and schizophrenia (Sc were observed in ESRD patients more than controls (P < 0.05. Means of sociopathy (Pd, paranoia (Pa and hypomania (Ma had no difference between groups (P > 0.05. Realy sadness and dysphoria, rumintion with illness, obsession, anxiety, compulsion, impaired process of thinking, isolation tendency and odd sensation in patients were more than control group (P < 0.05. Discussion. Chronic diseases have psychological complication and as a stress must cope and adjust with it. So, these patients and their families must be educated about coping mechanism. When the patients and their families have good coping mechanism, they would be able tolerate these streses.
Younes, Nidal A.; Al-Mansour, M.; Sroujieh, Ahmad S.; Wahbeh, A.; Ailabouni, W.; Hamzah, Y.; Mahafzah, W.
To evaluate the spectrum of mineral abnormalities and bone disease (BD) in hemodialysis patients at Jordan University Hospital (JUH), Amman, Jordan. A cross-sectional study was conducted among 63 patients (38 males and 25 females), mean age 44.19 years (range 17-76 years), with chronic kidney disease (CKD) on regular hemodialysis at JUH between November 2004 and April 2005. All patients have undergone complete blood count, chemistry profile, alkaline phosphatase, serum albumin, intact parathyroid hormone (iPTH) and plain x-rays. Bone disorders were identified in 45 patients on x-rays (70%). Osteopenia was found in 43 patients (68.3%), subperiosteal resorption in 24 patients (38.3%) and metastatic calcification in 22 patients (35%). Hypocalcemia was found in 28.6% and hypercalcemia in 7.9%. All patients were taking calcium carbonate, and 55.5% of patients were on vitamin D supplements. The calcium levels in 63.5% and the phosphorus levels in 50.8% of patients were within the recommended guidelines of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI). Serum i-PTH level was above 300 pg/ml high turnover bone disease in 24.6% of patients, 21.3% had iPTH of 150-300 pg/ml target, and 44.3% had i-PTH levels below 100 pg/mL suggesting a dynamic bone disease. Patients with severe bone disease had a statistically significant higher iPTH levels (p<0.005). Bone disease and mineral abnormalities are common in hemodialysis patients at JUH. Earlier detection of bone disease and better overall management strategy may reduce the frequency and severity of bone disease in CKD patients in Jordan. (author)
Palmiane de Rezende Ramim Borges
Full Text Available This study aimed to determine the prevalence of infection related to the provisional catheter for hemodialysis in a teaching hospital and evaluate the risk factors associated with these infections. A cross-sectional study analyzed by descriptive statistics and parametric tests. It was found that out of 129 patients, 48.8 % had catheter-related infection in hemodialysis, 65 % were male, 33.3 % were 60 years old and over, and 88 % of patients were admitted to intensive care unit. The prevalence of infection in this group was high, and the vast majority of diagnoses of infection were empirical. Given this, it is suggested to establish the routine culture of the catheter tip in all cases of suspected catheter infection to improve the quality of patient care, and the relentless pursuit of the causes that trigger the infection process in line with good practice from across the healthcare team.
Nam Ho Kim
Full Text Available Bioimpedance analysis is a reliable technique for determining post dialysis target weight. Using this technique, we can understand body fluid status easier and conveniently. Moreover this technique can be used for check nutrition status and nutritional status of dialysis patients. We compared the body fluid status and nutrition status between hemodialysis (HD patients and peritoneal dialysis (PD patients by BCM (Body composition monitor technique. We studied 48 (30 males and 18 females PD patients, 21 (10 males and 11 females HD patients. Body composition monitoring (BCM, Fesenitus Medical Care, Germany was used as a tool for the analysis of bioimpedance. Extracellular water, Total body water, Intracellular water, Overhydration, E/I, Lean tissue mass, Fat Tissue mass was measured and those results were compared between two groups. HD patients were more hydrated than PD patients (61.9% vs. 35.4% and nutritional status such as LTI was poorer than peritoneal dialysis patients (11.7±1.7 vs. 15.3±2.6. Although total body water is more abundant in peritoneal patients (29.4±5.5L vs. 35.9±6.2L, Extracellular water and intracellular water ratio was relatively higher in Hemodialysis patients (E/I 0.98±0.13 vs. 0.87±0.12. The nutrition status was better in PD patients by comparing the percent of lean tissue mass (LTM% between two groups (LTM% 52.1±10.6% vs. 66.8±11.3. In conclusions, Hemodialysis patients were more hydrated with poorer nutrition status than peritoneal dialysis patients, but, due to the significant difference of age between two groups, further study should be required.
Full Text Available Introduction. A bone marrow biopsy is a useful procedure for the diagnosis and staging of various hematologic and systemic diseases. The objective of this study was to investigate whether the findings of bone marrow studies can predict mortality in chronic hemodialysis patients. Methods. Seventy-eight end-stage renal disease patients on maintenance hemodialysis underwent bone marrow biopsies between 2000 and 2011, with the most common indication being unexplained anemia followed by unexplained leukocytosis and leukopenia. Results. The survivors had a higher incidence of abnormal megakaryocyte distribution P=0.001, band and segmented cells P=0.021, and lymphoid cells P=0.029 than the nonsurvivors. The overall mortality rate was 38.5% (30/78, and the most common cause of mortality was sepsis (83.3% followed by respiratory failure (10%. In multivariate Cox regression analysis, both decreased (OR 3.714, 95% CI 1.671–8.253, P=0.001 and absent (OR 9.751, 95% CI 2.030–45.115, P=0.004 megakaryocyte distribution (normal megakaryocyte distribution as the reference group, as well as myeloid/erythroid ratio (OR 1.054, CI 1.012–1.098, P=0.011, were predictive of mortality. Conclusion. The results of a bone marrow biopsy can be used to assess the pathology, and, in addition, myeloid/erythroid ratio and abnormal megakaryocyte distribution can predict mortality in chronic hemodialysis patients.
Sabi, K A; Noto-Kadou-Kaza, B; Amekoudi, Y E; Tsevi, M C; Sylla, F; Kossidze, K; Gnionsahe, D A
The aim of this study was to assess adherence in people on hemodialysis and determine the factors of poor adherence. This cross-sectional study took place throughout the month of September, 2012, in the hemodialysis center of the Sylvanus Olympio University Hospital, the only such center in Togo. The study included 65 patients, with a mean age of 49.5 years (range: 22 to 77 years), more often men (sex ratio: 1.82) and married (74 %). More than half (58%) had completed secondary education, while 73% belonged to the least advantaged socioeconomic class; 61 (94%) had health insurance, and 57% had been on dialysis for 1 to 4 years. The compliance rate was 11%. The main factors associated with good adherence were marital status (p = 0.0339) and the patient's general health status (p = 0.001). Treatment fatigue (p = 0.0347), forgetfulness (p = 0.0001), dosage forms and drug characteristics (p = 0.0198) were all factors of noncompliance. Therapeutic non-compliance was proportional to the number of drugs prescribed (p = 0.4263). Adherence in hemodialysis patients in Togo is very poor.
Full Text Available Obstruction of blood flow in the superior vena cava (SVC results in symptoms and signs of SVC syndrome. SVC obstruction can be caused either by invasion or external compression of the SVC by contagious pathologic processes involving the right lung, lymph nodes, and other mediastinal structures, or by thrombosis of blood within the SVC. Occasionally, both mechanisms co-exist. We hereby report a case of a 28-year-old male, Saudi patient who was diagnosed with end-stage renal disease and was maintained on regular hemodiaysis via right jugular vein dual lumen catheter for ten months. Three years later, the patient presented with signs and symptoms suggestive of SVC obstruction that was successfully managed with SVC stenting.
Upadhyay, Chandani; Cameron, Karen; Murphy, Laura; Battistella, Marisa
Background Patients undergoing hemodialysis frequently report pain with multifactorial causes, not limited to that experienced directly from hemodialysis treatment. Their pain may be nociceptive, neuropathic, somatic or visceral in nature. Despite this, pain in this population remains under-recognized and under-treated. Although several tools have been used to measure pain in patients undergoing hemodialysis as reported in the literature, none of them have been validated specifically in this ...
Background and Objectives: Spiritual well-being has been recognized as an important resource to cope with illness and life stresses. The aim of this study is to determine the Spiritual well-being status as well as stress coping strategies in hemodialysis patients. Methods: This descriptive-analysis study included 95 randomly selected patients undergoing treatments with hemodialysis in hemodialysis centers of Qom hospitals. Data collection instruments were the Spiritual Well-Being Scale an...
Full Text Available Background : Studies have shown, about 20 to 80 percent of hemodialysis patients have sleep problems that can lead to reduction of their quality of life. With regard to high number of hemodialysis patients in the present age, promoting the level of their health issues are deemed important. In this regared, the purpose of this research was to determine the effect of foot massage on night sleeping in hemodialysis patients. Materials and Methods: This experimental clinical trial design, was conducted on 80 hemodialysis patients, admitted to the hemodialysis wards of Shahid Rahimi and Shohada hospitals of Khorramabad city in 2014. Data gathering was done by Pittsburg questionnaire and Sleep Log, by which the sleep condition of the subjects was assessed before and after the night of massage therapy. The treatment was Stroke Foot Massage, carried out during dialysis for 10 minutes, three times a week, for four consecutive weeks. Results: Changes in the Pittsburg questionnaire score indicated that, using foot massage can improve sleep quality of hemodialysis patients and sleep hours increased and generally sleep condition was progressively improving each week than the week before (p<0/001. Conclusion: According to the results of this study, foot massage has a favorable impact on sleep quality in hemodialysis patients undergoing hemodialysis and can be applied and trained as a useful method to improve sleep quality of patients in hemodialysis wards.
Cerebrovascular diseases are important causes of death in patients on maintenance hemodialysis. Recently, it has become clear that the presence of cerebral microbleeds (MBs) on T2 * -weighted magnetic resonance imaging (MRI) is closely related to intracerebral hemorrhages. This study investigated the incidence of MBs in chronic dialysis patients and prospective hemorrhagic complications of chronic dialysis patients with old intracerebral hemorrhages. Eighty patients (34 males, 46 females) with chronic renal failure, whose mean age was 62.9±11.4 years, were examined by MRI. The mean duration of hemodialysis was 7.8±6.3 years. MBs were found in 28 patients (35%) by T2 * -weighted MRI. Old intracerebral hemorrhages were seen in seven of the patients, and MBs were found in five (71%) of these seven patients. The frequency of old intracerebral hemorrhages was significantly higher in patients with MBs than in those without (p=0.048), and the numbers of MBs were significantly larger in patients with old intracerebral hemorrhages than in those without (p=0.0065). Three of the seven patients with old intracerebral hemorrhages had new hemorrhagic complications (two intracerebral hemorrhages and one cerebral microbleed) within a year. These intracerebral hemorrhages occurred in areas without MBs on the first T2 * -weighted MRI. T2 * -weighted MRI is useful for the detection of MBs, which may be a predictor of intracerebral hemorrhage. When a patient has a large number of MBs and old intracerebral hemorrhages, the risk of intracerebral hemorrhage undoubtedly increases. (author)
Lin, Yu-Feng; Wu, Vin-Cent; Ko, Wen-Je; Chen, Yih-Sharng; Chen, Yung-Ming; Li, Wen-Yi; Chou, Nai-Kuan; Chao, Anne; Huang, Tao-Min; Chang, Fan-Chi; Chen, Shih-I; Shiao, Chih-Chung; Wang, Wei-Jie; Tsai, Hung-Bin; Tsai, Pi-Ru; Hu, Fu-Chang; Wu, Kwan-Dun
The relationship between residual urine output and postoperative survival in maintenance hemodialysis patients is unknown. To explore the relationship between amount of urine before surgery and postoperative mortality and differences between postoperative nonanuria and anuria in maintenance hemodialysis patients. A total of 109 maintenance hemodialysis patients underwent major operations. Anuria was defined as urine output <30 mL in the 8 hours before the first session of postoperative dialysis. Propensity scores for postoperative anuria were developed. Postoperative residual urine output was 159.2 mL/8 h (SD, 115.1) in 33 patients; 76 patients were anuric. Preoperative residual urine output and adequate perioperative blood transfusion were positively related to postoperative urine output. Propensity-adjusted 30-day mortality was associated with postoperative anuria (odds ratio [OR], 4.56; 95% confidence interval [CI], 1.16-17.96; P = .03), prior stroke (OR, 4.46; 95% CI, 1.43-13.89; P = .01) and higher disease severity (OR, 1.10; 95% CI, 1.00-1.21; P = .049) at the first postoperative dialysis. OR of 30-day mortality was 5.38 for nonanuria to anuria vs nonanuria to nonanuria (P = .03) and 5.13 for preoperative anuria vs nonanuria to nonanuria (P = .01). By Kaplan-Meier analysis, 30-day mortality differed significantly among patients for nonanuria to nonanuria, anuria, and nonanuria to anuria (log rank, P = .045). Patients with preoperative nonanuria and postoperative anuria had higher mortality than did patients with no anuria before and after surgery and patients with anuria before surgery. Postoperative residual urine output is an important surrogate marker for disease severity.
Bahner, M.L.; Kaick, G. van; Bommer, J.; Sommerer, C.
The kidneys of patients with chronic renal failure undergoing maintenance hemodialysis may show different variances or complications. Most common are secondarily acquired renal cysts, which my be found in as many as 92% of patients after 8 years of hemodialysis. Single (in 12.5% of patients) or multiple (8.3%) cysts with bleeding are common; additionally, hematuria or ruptured cysts may be found. Bleeding into cysts is more common in patients with autosomal dominant polycystic kidney disease. Due to the decreasing urinary production development of kidney stones is very uncommon, but calcification in or around cysts can be found in 71% of patients. Kidney tumors occur 41 times more often in patients with chronic renal failure than in patients without kidney disease. We detected tumors in 4.2% of our patients on long-term dialysis. Diagnostic differentiation of the relatively slow growing and fairly late metastasizing malignant tumors from adenomas is not possible. Nevertheless, we screen our patients every 3-4 years. Computed tomography is superior to ultrasonography for this purpose, because ultrasonography lacks the necessary sensitivity in this group of patients. (orig.) [de
Dong Hyun Lee
Full Text Available A 78-year-old man on hemodialysis presented to our hospital with erythrocytosis. He had started hemodialysis 4 years previously, with a hemoglobin level of 9.8 g/dL, and was administered erythropoiesis stimulating agents and ferrous sulfate. Two years previously, his hemoglobin level increased to 14.5 g/dL and the treatment for anemia was discontinued. He continued hemodialysis thrice weekly; however, the hemoglobin level had increased to 17.0 g/dL at the time of presenting to our hospital. His serum erythropoietin level was 31.4 mIU/mL (range, 3.7–31.5 mIU/mL, carboxyhemoglobin level was 0.6% (range, 0–1.5%, and oxygen saturation in ambient air was 95.4%. The JAK2 V617F mutation was not observed and other bone marrow abnormalities were not identified. The patient was diagnosed with bladder cancer and a transurethral resection was performed. Eight months after the treatment of bladder cancer, his hemoglobin level was 15.1 g/dL, and he was diagnosed with idiopathic erythrocytosis.
Kamal, Inass Mahmood; Mutar Mahdi, Batool
Background: Patients with chronic renal failure (CRF) were on maintenance invasive haemodialysis (HD) procedure. This procedure by itself affects immunity of the patients and became more susceptible to viral infections. Aim of the study: to investigate the occurrence of HBV, HCV and HIV infections in patients with hemodialysis. Patients and methods: A retrospective study of 430 end-stage renal failure patients, referred to hemodialysis department at Al-Kindy Teaching Hospital, Baghdad-Iraq from Junuary-2015 to Junuary-2017. Patients were investigated for HBs-Ag using enzyme-labeled antigen test (Foresight-EIA-USA ), HCV- Abs (IgG) specific immunoglobulin using a HCV enzyme-labeled antigen test (Foresight-EIA-USA) and anti HIV Abs (IgG) using enzyme-labeled antigen test (Foresight-EIA-USA). Results: The frequency of HBV infection in the first year was not significant between males (1.11%) and females (0.00%)(P = 0.295). About HCV also there are no significant differences between males (12.63%) and females (9.31%)(P = 0.347). After one year of follow up the frequencies of HBV and HCV were not significant between two sexes. Additionally, no any one of the patients had HIV infection. Conclusions: This study brings a light on that HBV and HCV were having the same frequencies in both genders and lower occurrence with time. Furthermore, HIV was not detected in those patients.
Full Text Available Introduction: The prevalence of CKD patients in advanced stages with dialysis requirement continues to grow. A goal for the medical team, the patient and their caregivers is to provide a treatment that offers an impact on the prognosis and quality of life (QOL. Methods: In 100 patients with CKD on hemodialysis, randomized assigned, the quality of life by SF-36 was assessed, it was evaluated the functional capacity using the Karnofsky, ability to perform basic tasks of daily life through the index Barthel, presence of depression using the Beck test, family functioning through family APGAR, cognitive state through Minimental and presence of comorbidities using the Charlson index correlated with the sum of physical components (PCS and mental components (MCS of the SF-36 in patients in two renal units in Medellín and Bogotá, Colombia. Results: A decrease in QOL in the physical components (PCS Mental components (MCS regarding the general population. A significant correlation between low PCS and diabetes mellitus (-16 p=0.008 95% CI 2.49 was found. Low MCS showed relation with PTH (p=0.046 95% CI 0.000-0.014, Karnofsky index (p=0.034 95% CI 0.244 to 5.984 and Beck depression test (p=0.000 95% CI -13.606 to 6.253. Conclusions: The QOL of hemodialysis patients is affected with more impact on PCS, there is significant relationship between MCS with functional status and depression. To improve QOL in hemodialysis patients, non traditionally-measured variables should be measured and monitored and the therapeutic focus should be optimized addressed to physical rehabilitation, nutritional, functional and psychological state.
Full Text Available Methylenetetrahydrofolate Reductase (MTHFR is key enzyme in metabolism of homocysteine. Homozygotes for mutation (TT genotype have hyperhomocysteinemia, risk factor for atherosclerosis development. The aim of the study was to find out distribution of genotype frequencies of C677T MTHFR among patients on maintenance hemodialysis. Possible association of alleles and genotypes of C677T polymorphism of the MTHFR gene with age of onset, duration of dialysis and cause of kidney failure was studied also. Cross-sectional study includes 80 patients from Clinic of Hemodialysis KUCS in Sarajevo. In order to perform genotyping, isolated DNA was analyzed by RFLP-PCR and gel-electrophoresis. From total of 80 patients, 42.5% (n=24 were female, 57.5% (n=46 were male, mean age 54.59±1.78 years and duration of dialysis 79.92±6.32 months. Genotype distribution was: CC 51.2% (n=41, CT 37.5% (n=30 and TT 11.2% (n=9. Patients with wild-type genotype have longer duration of dialysis in month (87.1 ± 63.93 comparing to TT genotype patients (67.06 ± 39.3, with no statistical significance. T allele frequency was significantly higher in group of vascular and congenital cause of kidney failure (Pearson X2 =6.049, P<0.05 comparing to inflammation etiology group. Genotype distribution results are within the results other studies in Europe. Obtained results indicate that C677T polymorphism is not associated with onset, duration and cause of kidney failure in our hemodialysis population. There is an association of T allele of the MTHFR gene and vascular and congenital cause kidney failure.
Goldstein, Stuart L; Silverstein, Douglas M; Leung, Jocelyn C; Feig, Daniel I; Soletsky, Beth; Knight, Cathy; Warady, Bradley A
Recent evidence from adult hemodialysis (HD) patient studies reveal improved biochemical control and reported health-related quality of life after transition from conventional thrice weekly to daily home maintenance HD treatment. Published pediatric frequent dialysis experiences demonstrate similar improvement but all used conventional HD machines, which employ a treated municipal water supply, thereby frequently exposing patients to proinflammatory components. We report our pediatric experience with six-times-weekly HD using the NxStage system, which uses sterile dialysis fluid to provide dialysis in the home or center setting. Four patients (weight range 38-61.4 kg) completed the 16-week study. Patients exhibited progressive reductions in casual pretreatment systolic and diastolic blood pressures, discontinuation of antihypertensive medications, and decreased blood pressure load by ambulatory blood pressure monitoring. Mean serum phosphorus improved without change in phosphorus binder medication, and all three patients with a normalized protein catabolic rate 1.1 g/kg per day. Patients reported no adverse effects. Variable changes in proinflammatory cytokine levels were observed. We suggest that frequent HD with the NxStage system be considered for children who would benefit from home-based maintenance dialysis.
Reque, Javier; Quiroga, Borja; Ruiz, Caridad; Villaverde, Maria Teresa; Vega, Almudena; Abad, Soraya; Panizo, Nayara; López-Gómez, J Manuel
Pulmonary hypertension (PH) is a progressive disorder that can be caused by several underlying conditions or an intrinsic alteration of the pulmonary vasculature. Chronic increased pressure in the pulmonary vasculature leads to changes in the architecture of the vessels that can perpetuate PH and produce right ventricular dysfunction. These structural and functional alterations can decrease survival and quality of life of patients on hemodialysis; however, there is a lack of evidence about this problem in this population. The aim of this study is to establish the prevalence of PH in patients on hemodialysis and its association with specific factors related to this patient population. We included 202 prevalent patients on hemodialysis for at least 6 months and who were clinically stable. We collected demographic data, routine laboratory parameters and data of 2D Doppler-echocardiography. PH was defined as a systolic pulmonary artery pressure (SPAP) estimated by Doppler ultrasound above 35mmHg. Hydration status was assessed by determining the plasma concentration of N-terminal pro brain natriuretic peptide (Nt-proBNP). PH prevalence was 37.1% (75 patients). The average SPAP in the entire study population was 32±12mmHg and in the group with PH it was 45±11mmHg. We found a direct and statistically significant correlation between the presence of PH and age (P=.001), time on renal replacement therapy (P=.04), the presence of systolic dysfunction (P=.007), diastolic dysfunction (P= 01), mitral valve disease (P=.01) and double mitral and aortic disease (P=.007). Volume overload was closely associated with PH, as demonstrated by the correlation between the SPAP and Nt-proBNP levels (P=.001). We conclude that prevalence of PH in hemodialysis patients is high. And one of the most important associated factors is volume overload. More studies are needed to establish the impact of PH on morbidity and mortality of patients and to assess whether a better volume control improves
Zhang Yong; You Yuping; Chen Weizhen; Mo Congjian
To study serum leptin level in chronic renal failure (CRF) hemodialysis patients and the relationship between serum leptin level and residue renal function, body composition, and indices of malnutrition, 31 end-stage CRF hemodialysis patients and 38 healthy people were enrolled. Serum leptin levels were detected by radioimmunoassay. BMI, %Fat and LBM were measured by bioelectrical impedance analysis device. Alb, Chol, Hgb, BUN, SCr and Ccr of the patients were also examined. Results showed that Serum leptin level in end-stage CRF hemodialysis patients was markedly higher than that in healthy controls (P 0.05). Conclusion: Hyperleptinemia existed in end-stage CRF hemodialysis patients and might cause the loss of LBM. The leptin level was not correlated with residue renal function, but it could reflect the fat content. However, serum leptin did not play a significant role in protein malnutrition in end-stage CRF hemodialysis patients
Duranton, Flore; Kramer, Anneke; Szwarc, Ilan; Bieber, Brian; Gayrard, Nathalie; Jover, Bernard; Vetromile, Fernando; Massy, Ziad A.; Combe, Christian; Tentori, Francesca; Jager, Kitty J.; Servel, Marie-Françoise; Argilés, Àngel
Seasons and climate influence the regulation of blood pressure (BP) in the general population and in hemodialysis patients. It is unknown whether this phenomenon varies across the world. Our objective was to estimate BP seasonality in hemodialysis patients from different geographical locations.
Oka, Fumitoshi; Sagawa, Hitoshi; Yabe, Kinji
The patients receiving maintenance hemodialysis were divided into two groups in the absence and the presence of bone pain and investigated the markers of bone pain in these patients. These results suggested that the duration of receiving hemodialysis, serum contrations of alkaline phosphatase, osteocalcin and parathyroid hormone became to be the markers of bone pain. (author)
Van Camp, Yoleen P M; Vrijens, Bernard; Abraham, Ivo; Van Rompaey, Bart; Elseviers, Monique M
Phosphate control is a crucial treatment goal in end-stage renal disease, but poor patient adherence to phosphate binder therapy remains a challenge. This study aimed to estimate the extent of phosphate binder adherence in hemodialysis patients and to identify potential determinants. Phosphate binder adherence was measured blindly in 135 hemodialysis patients for 2 months using the medication event monitoring system. Patient data, gathered at inclusion through medical records, ad hoc questionnaires and the short form (SF)-36 health survey, included: (1) demographics, (2) perceived side-effects, belief in benefit, self-reported adherence to the therapy, (3) knowledge about phosphate binder therapy, (4) social support, and (5) quality of life (SF-36). Phosphatemia data was collected from charts. 'Being adherent' was defined as missing adherent' as missing adherent. Over the entire 8-week period, 22 % of patients were totally adherent. Mean phosphatemia levels were 0.55 mg/dl lower in adherent than nonadherent patients (4.76 vs. 5.31 mg/dl). Determinants for being totally adherent were living with a partner, higher social support (both were interrelated) and higher physical quality of life. Experiencing intake-related inconvenience negatively affected adherence. The social support and quality of life physical score explained 26 % of the variance in adherence. Phosphate binder nonadherence remains a major problem. Interventions should aim, at least, to improve social support. With few associated factors found and yet low adherence, an individualized approach seems indicated.
Edimar Pedrosa Gomes
Full Text Available Different factors can contribute to a sedentary lifestyle among hemodialysis (HD patients, including the period they spend on dialysis. The aim of this study was to evaluate characteristics of physical activities in daily life in this population by using an accurate triaxial accelerometer and to correlate these characteristics with physiological variables. Nineteen HD patients were evaluated using the DynaPort accelerometer and compared to nineteen control individuals, regarding the time spent in different activities and positions of daily life and the number of steps taken. HD patients were more sedentary than control individuals, spending less time walking or standing and spending more time lying down. The sedentary behavior was more pronounced on dialysis days. According to the number of steps taken per day, 47.4% of hemodialysis patients were classified as sedentary against 10.5% in control group. Hemoglobin level, lower extremity muscle strength, and physical functioning of SF-36 questionnaire correlated significantly with the walking time and active time. Looking accurately at the patterns of activity in daily life, HDs patients are more sedentary, especially on dialysis days. These patients should be motivated to enhance the physical activity.
Livia de Almeida Alvarenga
Full Text Available Abstract Introduction: The mortality of the population with chronic kidney disease (CKD on hemodialysis (HD is very high and the protein-energy malnutrition stands out as one of the most common consequences in relation to this condition. Objective: To evaluate the association between time of hemodialysis and nutritional parameters of patients. Methods: It is a cross-sectional study with secondary data, developed of the University Hospital of the Federal University of Juiz de Fora (HU/UFJF. This study was approved by the Research Ethics Committee (Nº 1.233.142, a total of 36 patients. The medical records and collected data were analyzed for anthropometric markers, biochemical and diet, considering two groups: HD time less than three and greater than or equal to three years. Results: There was reduction of mass of somatic protein with increased duration of HD. In relation to food intake was observed that in patients with increased duration of dialysis, an increase in average consumption of protein / kg of weight, calories, phosphorus and potassium, with a significant difference from the mean protein intake / kg (p = 0.04 and phosphorus (p = 0.045. Increasing HD time has altered body composition of patients, indicating a decline in the nutritional status of these individuals. Conclusion: HD patients are a risk group for protein-energy malnutrition, where HD time interferes with the nutritional status and food profile of the patient. The group HD time greater than or equal to 3 years presented worsening nutritional status.
Lassemillante, Annie-Claude M; Oliver, Veronica; Hickman, Ingrid; Murray, Eryn; Campbell, Katrina L
Introduction There is currently limited evidence on the use or safety of meal replacements as part of a low- or very-low-calorie diet in patients with renal insufficiency; however, these are occasionally used under dietetic supervision in clinical practice to achieve the desired weight loss for kidney transplant. This case series reports on the safety and efficacy of a weight loss practice utilizing meal replacements among hemodialysis patients, who needed to lose weight for kidney transplant. Methods Five hemodialysis patients were prescribed a modified low-calorie diet (950 kcal and 100 g protein per day) comprising three meal replacements (Optifast ® ), one main meal, and two low-potassium fruits per day. Dietary requirements and restrictions were met for all participants. Dialysis prescriptions, weight (predialysis and postdialysis), interdialytic weight gain, biochemistry, and medications were monitored during the study period for up to 12 months. Findings Participants were aged between 46 and 61 years, and the median time on the low-calorie diet was 364 days. Phosphate binders were temporarily ceased for one participant for reasons unrelated to this program and no other safety concerns were recorded. The low-calorie diet resulted in energy deficits ranging from 1170 kcal to 2160 kcal, and all participants lost weight (median 7% [range 5.2%-11.4%]). The most dramatic weight change appeared to occur by week 12, and declining adherence led to erratic weight change thereafter. Discussion This modified low-calorie diet was safe and effective to use in this population. Meal replacements are a useful weight loss strategy in hemodialysis patients, therefore, offering an alternative to usual weight loss protocols. © 2016 International Society for Hemodialysis.
Arias-Guillén, Marta; Wabel, Peter; Fontseré, Néstor; Carrera, Montserrat; Campistol, José Maria; Maduell, Francisco
Summary Background and objectives Achieving and maintaining optimal fluid status remains a major challenge in hemodialysis therapy. The aim of this interventional study was to assess the feasibility and clinical consequences of active fluid management guided by bioimpedance spectroscopy in chronic hemodialysis patients. Design, setting, participants, & measurements Fluid status was optimized prospectively in 55 chronic hemodialysis patients over 3 months (November 2011 to February 2012). Predialysis fluid overload was measured weekly using the Fresenius Body Composition Monitor. Time-averaged fluid overload was calculated as the average between pre- and postdialysis fluid overload. The study aimed to bring the time-averaged fluid overload of all patients into a target range of 0.5±0.75 L within the first month and maintain optimal fluid status until study end. Postweight was adjusted weekly according to a predefined protocol. Results Time-averaged fluid overload in the complete study cohort was 0.9±1.6 L at baseline and 0.6±1.1 L at study end. Time-averaged fluid overload decreased by −1.20±1.32 L (P<0.01) in the fluid-overloaded group (n=17), remained unchanged in the normovolemic group (n=26, P=0.59), and increased by 0.59±0.76 L (P=0.02) in the dehydrated group (n=12). Every 1 L change in fluid overload was accompanied by a 9.9 mmHg/L change in predialysis systolic BP (r=0.55, P<0.001). At study end, 76% of all patients were either on time-averaged fluid overload target or at least closer to target than at study start. The number of intradialytic symptoms did not change significantly in any of the subgroups. Conclusions Active fluid management guided by bioimpedance spectroscopy was associated with an improvement in overall fluid status and BP. PMID:23949235
Full Text Available Purpose: This descriptive study was carried out to reveal the level of physical activity in patients who receive hemodialysis due to chronic kidney failure and to identify its relationship with the prevalence of metabolic syndrome (MetS. Material and method: The study was conducted with 55 patients at the hemodialysis units of Alanya State Hospital and Private Alanya Anadolu Hospital between 10 and 30 June 2013. The study data were collected using the National Cholesterol Education Program, the Adult Treatment Panel III (NCEP-ATP III, a data collection form containing Metabolic Syndrome Diagnosis Criteria, and the International Physical Activity Questionnaire (IPAQ. The data were analyzed using arithmetic mean +/- standard deviation (SD, number and percentage distributions, independent sample t test, crosstabs, One Way Anova, and Pearson and #8217;s Correlation Analysis. Conclusion and suggestions: It was found that 41.8% of the patients were between 50 and 65 years of age, the majority of them were male (58.2%, hemodialysis had been administered to 69.1% of them for at least 36 months, and 50.9% of them met three and more of the MetS criteria. There was no statistically significant relationship between MetS and physical activity levels, but the length of physical activity was longer in those who did not meet the MetS diagnosis criteria (p>0.05. An increase in sedentary time raised the MetS criteria (p<0.05. Conclusion: Nearly 1/2 of the patients were at risk of MetS. Physical activity level being statistically ineffective on MetS can be associated with low physical activity level and longer sedentary time. It can be said that being completely sedentary increases BMI and therefore MetS. The study can be repeated on different samples and the results can be compared. [J Contemp Med 2014; 4(2.000: 69-75
Full Text Available Background: Chronic renal failure (CRF presents with an array of cutaneous manifestations. Newer changes are being described since the advent of hemodialysis, which prolongs the life expectancy, giving time for these changes to manifest. Aim: The aim of this study was to evaluate the prevalence of dermatologic problems among patients with chronic renal failure (CRF undergoing hemodialysis. Methods: One hundred patients with CRF on hemodialysis were examined for cutaneous changes. Results: Eighty-two per cent patients complained of some skin problem. However, on examination, all patients had at least one skin lesion attributable to CRF. The most prevalent finding was xerosis (79%, followed by pallor (60%, pruritus (53% and cutaneous pigmentation (43%. Other cutaneous manifestations included Kyrle′s disease (21%; fungal (30%, bacterial (13% and viral (12% infections; uremic frost (3%; purpura (9%; gynecomastia (1%; and dermatitis (2%. The nail changes included half and half nail (21%, koilonychia (18%, onychomycosis (19%, subungual hyperkeratosis (12%, onycholysis (10%, splinter hemorrhages (5%, Mees′ lines (7%, Muehrcke′s lines (5% and Beau′s lines (2%. Hair changes included sparse body hair (30%, sparse scalp hair (11% and brittle and lusterless hair (16%. Oral changes included macroglossia with teeth markings (35%, xerostomia (31%, ulcerative stomatitis (29%, angular cheilitis (12% and uremic breath (8%. Some rare manifestations of CRF like uremic frost, gynecomastia and pseudo-Kaposi′s sarcoma were also observed. Conclusions: CRF is associated with a complex array of cutaneous manifestations caused either by the disease or by treatment. The commonest are xerosis and pruritus and the early recognition of cutaneous signs can relieve suffering and decrease morbidity.
Morioka, Yuta; Arashi, Hiroyuki; Otsuki, Hisao; Yamaguchi, Junichi; Hagiwara, Nobuhisa
Instantaneous wave-free ratio (iFR) is a vasodilator-free index and is reported to have a good correlation with fractional flow reserve (FFR). Hemodialysis patients exhibit left ventricular hypertrophy, reduced arterial compliance, and impaired microcirculation. Such a coronary flow condition in these patients may influence the relationship between iFR and FFR. This study assessed the impact of hemodialysis on the relationship between iFR and FFR. The study enrolled 196 patients with 265 stenoses who underwent assessment via iFR, FFR assessment, and right heart catheterization. A good correlation between iFR and FFR was observed in hemodialysis patients. iFR in the hemodialysis group was significantly lower than in the non-hemodialysis group (0.81 ± 0.13 vs. 0.86 ± 0.13, p = 0.005), although no significant difference was found in FFR and percentage diameter stenosis. An iFR value of 0.84 was found to be equivalent to an FFR value of 0.8 in hemodialysis patients, which was lower than the standard predictive iFR range for ischemia. Vasodilator-free assessment by iFR could be beneficial in evaluating intermediate coronary stenosis in patients receiving hemodialysis. However, the threshold for iFR abnormality needs adjustment in hemodialysis patients, and larger clinical trials are required to confirm the results in this specific subset.
Deniz Cemgil Arıkan
Full Text Available Objective: To investigate the etiology of menstrual disorders among patients undergoing hemodialysis due to chronic renal failure by assessing menstrual history, serum hormone levels, and other biochemical factors. Material and methods: Thirty patients undergoing hemodialysis and 30 healthy women at reproductive age were enrolled in our study. Demographic characteristics, hormonal and biochemical data, and sonographically measured endometrial thickness values of the subjects were compared. In addition, the present and the pre-hemodialysis menstrual pattern of the patients undergoing hemodialysis were recorded. The hormonal, hematological, and biochemical data of the patients were compared according to their menstrual patterns. Results: No statistical significance was seen between age, BMI, gravida, parity, abortion, and curettage among groups (p>0.05. Hemoglobin and hematocrit levels were significantly lower in the hemodialysis group than in the control (p0.05. Mean serum LH and prolactin levels were significantly higher in the hemodialysis group compared to the control (p0.05. Serum LH and prolactin levels were higher, and serum FSH, estradiol and TSH levels were lower in patients who developed amenorrhea after hemodialysis treatment when compared to non-amenorrheic subjects. However, these differences were not statistically significant (p>0.05. Discussion: The most important factor in the etiology of menstrual disorders seen in chronic renal failure patients was high serum LH and prolactin levels. Hemodialysis is a successful treatment that extends life expectancy and ameliorates the hypothalamo-pituitary-ovarian axis in chronic renal failure patients.
María Elena Bruzzone
Full Text Available Introduction: Vascular and valvular calcifications are a frequent complication in dialyzed patients and are connected to an increased morbi-mortality. Many radiological methods (TAC multiple slices and with electrons emission have been used to investigate the presence of vascular calcifications in this population, but only few works have been focused on simple radiology. Objectives: The objectives of this work are to evaluate vascular calcifications by means of Kauppila index in hemodialysis prevalent patients, identify linked risk factors and determine their association with heart valves calcification. Methods: 95 stable patients under hemodialysis were surveyed during a period of 6 months longer. Abdominal Rx simple profile were performed on all patients to evaluate calcification of abdominal aorta by Kauppila index and twodimensional echocardiogram to detect valvular calcifications. Data were collected about sex, age, diabetes, Hypertension, tabaquism, dislipemia and bone-mineral metabolism. Results: 64.5% of the patients showed vascular calcifications. Average Kauppila index was 6.25. Age and time on dialysis correlated with vascular calcifications. In 31.6 % of individuals valvular calcifications were found, which presented significant association with diabetes and Kauppila Index. Conclusions: Vascular and valvular calcifications were frequent in the surveyed population. Kauppila index correlated with age, time on dialysis and valvular calcifications. Heart valves calcification was associated with diabetes.
Sgnaolin, Vanessa; Figueiredo, Ana Elizabeth Prado Lima
Adherence to treatment in patients on hemodialysis is not a simple process. Strategies to promote adherence will meet the need for improvements in the process of orientation concerning the disease and its pharmacological treatment. To identify compliance with pharmacological treatment of patients on hemodialysis and the main factors related to it we used the Adherence Scale. Observational, descriptive and cross-sectional study. Interviews were conducted to collect socioeconomic, pharmacological data, as well as those regarding self-reported adherence to drug. Out of the 65 participants, 55.4% showed non-compliance. The mean number of drugs used was 4.1 ± 2.5 (self-report) and 6.2 ± 3.0 (prescription). Statistical analysis showed significant differences concerning compliance at different ages (> 60 years are more adherent). A significant proportion of patients have difficulty to comply with treatment and the main factor was forgetfulness. Regarding age, elderly patients are more adherent to treatment. The low level of knowledge about the used drugs may be one of the reasons for the lack of adherence, and the patient's orientation process by a team of multiprofessionals involved in assisting is a strategy to promote adherence.
Taheri, Shahram; Mortazavi, Mojhgan; Shahidi Shahrzad; Seirafian, Shiva; Pourmoghadas, Ali; Garakyaraghi, Mohammad; Eshaghian, Afrooz; Ghassami, Maryam
We performed this study to assess whether low dose spironolactone could be administered in hemodialysis (HD) patients with moderate to severe heart failure to improve cardiovascular function and reduce hospitalization without inducing hyperkalemia. We enrolled 16 chronic HD patients with moderate to severe heart failure and left ventricle ejection fraction :5 45%. In a double blinded randomized placebo controlled study, one group of 8 patients received 25 mg of spironolactone after each dialysis session within six months, and the rest received a placebo. Echocardiography was performed on all the patients to assess ejection fraction and left ventricular mass during 12 hours after completion of hemodialysis at the beginning and the end of study. Serum potassium was measured predialysis every 4 weeks. The mean ejection fraction increased significantly more in spironolactone group during the study period than in the placebo group (6.2 + - 1.64 vs. 0.83 + - 4.9, P0.046). The mean left ventricular mass decreased in the spironolactone group, but increased significantly in the placebo group during the period (-8.4 + - 4.72 vs. 3 + -7.97. 95%, P= 0.021). The incidence of hyperkalemia was not significantly increased in the study or controlled groups. In conclusion, we found in this study that administration of spironolactone in chronic HD patients with moderate to severe heart failure substantially improved their cardiac function and decreases left ventricular mass without development of significant hyperkalemia. (author)
Chenitz, Kara B; Fernando, Michael; Shea, Judy A
Missed hemodialysis treatments lead to increased morbidity and mortality in the end-stage renal disease population. Little is known about why patients have difficulty attending their scheduled in-center dialysis treatments. Semistructured interviews with 15 adherent and 15 nonadherent hemodialysis patients were conducted to determine patients' attitudes about dialysis, health beliefs and risk perception regarding missed treatments, barriers and facilitators to hemodialysis attendance, and recommendations to improve the system to facilitate dialysis attendance. Average time on dialysis was 2.5 years for the nonadherent group and 7.3 years in the adherent group. In both groups, patients felt that dialysis is life-saving and a necessity. A substantial number of patients in both groups understood that missing hemodialysis treatments is dangerous and several patients could clearly communicate the risk of skipping. The most common barriers to hemodialysis were inadequate or unreliable transportation (mentioned in both groups) and a lack of motivation to get to dialysis or that dialysis is not a priority (typically mentioned by the nonadherent group). Facilitators to hemodialysis attendance included explanations from the health care team regarding the risk of skipping and relationships with other dialysis patients. Patient recommendations to improve dialysis attendance included continued education about the risk of poor attendance and more accessible transportation. Patients did not feel that home dialysis would improve adherence. Hemodialysis patients must adhere to a complex and burdensome regimen. Through the elucidation of barriers and facilitators to hemodialysis attendance and through specific patient recommendations, at least three interventions may be further investigated to improve hemodialysis attendance: Improvement of the transportation system, education and supportive encouragement from the health care team, and peer support mentorship. © 2014 International
Kotsikoris, Ioannis; Zygomalas, Apollon; Papas, Theofanis; Maras, Dimitris; Pavlidis, Polyvios; Andrikopoulou, Maria; Tsanis, Antonis; Alivizatos, Vasileios; Bessias, Nikolaos
Introduction: Central venous catheter placement is an effective alternative vascular access for dialysis in patients with chronic renal failure. The purpose of this study was to evaluate the insertion of central venous catheters for hemodialysis using angiographic techniques in patients with previous multiple catheterizations in terms of efficacy of the procedure and early complications. Materials and methods: Between 2008 and 2010, the vascular access team of our hospital placed 409 central venous catheters in patients with chronic renal failure. The procedure was performed using the Seldinger blind technique. In 18 (4.4%) cases it was impossible to advance the guidewire, and so the patients were transported to the angiography suite. Results: Using the angiographic technique, the guidewire was advanced in order to position the central venous catheter. The latter was inserted into the subclavian vein in 12 (66.6%) cases, into the internal jugular vein in 4 (22.2%) and into the femoral vein in 2 (11.1%) cases. There was only one complicated case with severe arrhythmia in 1 (5.5%) patient. Conclusion: Our results suggest that insertion of central venous catheters using angiographic techniques in hemodialysis patients with previous multiple catheterizations is a safe and effective procedure with few complications and high success rates
Kotsikoris, Ioannis, E-mail: email@example.com [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Zygomalas, Apollon, E-mail: firstname.lastname@example.org [Department of General Surgery, University Hospital of Patras (Greece); Papas, Theofanis, E-mail: email@example.com [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Maras, Dimitris, E-mail: firstname.lastname@example.org [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Pavlidis, Polyvios, E-mail: email@example.com [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Andrikopoulou, Maria, E-mail: firstname.lastname@example.org [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Tsanis, Antonis, E-mail: email@example.com [Department of Interventional Radiology, “Erythros Stauros” General Hospital (Greece); Alivizatos, Vasileios, E-mail: firstname.lastname@example.org [Department of General Surgery and Artificial Nutrition Unit, “Agios Andreas” General Hospital of Patras (Greece); Bessias, Nikolaos, E-mail: email@example.com [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece)
Introduction: Central venous catheter placement is an effective alternative vascular access for dialysis in patients with chronic renal failure. The purpose of this study was to evaluate the insertion of central venous catheters for hemodialysis using angiographic techniques in patients with previous multiple catheterizations in terms of efficacy of the procedure and early complications. Materials and methods: Between 2008 and 2010, the vascular access team of our hospital placed 409 central venous catheters in patients with chronic renal failure. The procedure was performed using the Seldinger blind technique. In 18 (4.4%) cases it was impossible to advance the guidewire, and so the patients were transported to the angiography suite. Results: Using the angiographic technique, the guidewire was advanced in order to position the central venous catheter. The latter was inserted into the subclavian vein in 12 (66.6%) cases, into the internal jugular vein in 4 (22.2%) and into the femoral vein in 2 (11.1%) cases. There was only one complicated case with severe arrhythmia in 1 (5.5%) patient. Conclusion: Our results suggest that insertion of central venous catheters using angiographic techniques in hemodialysis patients with previous multiple catheterizations is a safe and effective procedure with few complications and high success rates.
Modabber, Milad, E-mail: firstname.lastname@example.org [McMaster University, Michael G. DeGroote School of Medicine (Canada); Kundu, Sanjoy [Scarborough Hospital and Scarborough Vascular Ultrasound, The Vein Institute of Toronto (Canada)
Central venous occlusive disease (CVD) is a common concern among the hemodialysis patient population, with the potential to cause significant morbidity. Endovascular management of CVD, comprising percutaneous balloon angioplasty and bare-metal stenting, has been established as a safe alternative to open surgical treatment. However, these available treatments have poor long-term patency, requiring close surveillance and multiple repeat interventions. Recently, covered stents have been proposed and their efficacy assessed for the treatment of recalcitrant central venous stenosis and obstruction. Moreover, newly proposed algorithms for the surgical management of CVD warrant consideration. Here, we seek to provide an updated review of the current literature on the various treatment modalities for CVD.
Singh, Ranju; Cuchacovich, Raquel; Huang, Wenqun; Espinoza, Luis R
We describe a 60-year-old woman with active rheumatoid arthritis (RA) and endstage renal disease secondary to hypertensive nephrosclerosis undergoing hemodialysis. She had tried multiple antirheumatic medications; however, their usefulness was limited due to toxic side effects or lack of efficacy. She was then treated with chimeric antitumor necrosis factor monoclonal antibody (infliximab), which resulted in immediate improvement in clinical and laboratory measures. After about 2 years of therapy, no side effects have been observed. This report expands the spectrum of infliximab to include RA patients with renal insufficiency.
Hauber, Brett; Caloyeras, John; Posner, Joshua; Brommage, Deborah; Belozeroff, Vasily; Cooper, Kerry
Patient engagement and patient-centered care are critical in optimally managing patients with end-stage renal disease (ESRD). Understanding patient preferences is a key element of patient-centered care and shared decision making. The objective of this study was to elicit patients' preferences for the treatment of secondary hyperparathyroidism (SHPT) associated with ESRD using a discrete-choice experiment survey. Clinical literature, nephrologist input, patient-education resources, and a patient focus group informed development of the survey instrument, which was qualitatively pretested before its administration to a broader sample of patients. The National Kidney Foundation invited individuals in the United States with ESRD who were undergoing hemodialysis to participate in the survey. Respondents chose among three hypothetical SHPT treatment alternatives (two medical alternatives and surgery) in each of a series of questions, which were defined by attributes of efficacy (effect on laboratory values and symptoms), safety, tolerability, mode of administration, and cost. The survey instrument included a best-worst scaling exercise to quantify the relative bother of the individual attributes of surgery. Random-parameters logit models were used to evaluate the conditional relative importance of the attributes. A total of 200 patients with ESRD completed the survey. The treatment attributes that were most important to the respondents were whether a treatment was a medication or surgery and out-of-pocket cost. Patients had statistically significant preferences for efficacy attributes related to symptom management and laboratory values, but placed less importance on the attributes related to mode of administration and side effects. The most bothersome attribute of surgery was the risk of surgical mortality. Patients with ESRD and SHPT who are undergoing hemodialysis understand SHPT and have clear and measurable treatment preferences. These results may help inform
The progressive loss of residual renal function in peritoneal dialysis patients is associated with increased mortality. It has been suggested that incremental dialysis may help preserve residual renal function and improve patient survival. Residual renal function depends upon both patient related and dialysis associated factors. Maintaining patients in an over-hydrated state may be associated with better preservation of residual renal function but any benefit comes with a significant risk of cardiovascular consequences. Notably, it is only observational studies that have reported an association between dialysis patient survival and residual renal function; causality has not been established for dialysis patient survival. The tenuous connections between residual renal function and outcomes and between incremental hemodialysis and residual renal function should temper our enthusiasm for interventions in this area. PMID:25385441
Nikić, Petar M; Andrić, Branislav R; Stojimirović, Biljana B; Trbojevic-Stanković, Jasna; Bukumirić, Zoran
Coffee drinking is the main source of caffeine intake among adult population in the western world. It has been reported that low to moderate caffeine intake has beneficial effect on alertness and cognitive functions in healthy subjects. The aim of this study is to evaluate the impact of habitual coffee consumption on cognitive function in hemodialysis patients. In a cross-sectional study, 86 patients from a single-dialysis centre underwent assessment by the Montreal Cognitive Assessment tool and evaluation for symptoms of fatigue, mood, and sleep disorders by well-validated questionnaires. The habitual coffee use and the average daily caffeine intake were estimated by participants' response to a dietary questionnaire. Sixty-seven subjects (78%) consumed black coffee daily, mostly in low to moderate dose. Cognitive impairment was found in three-quarters of tested patients. Normal mental performance was more often in habitual coffee users (25% versus 16%). Regular coffee drinkers achieved higher mean scores on all tested cognitive domains, but a significant positive correlation was found only for items that measure attention and concentration (P = 0.024). Moderate caffeine intake by habitual coffee consumption could have beneficial impact on cognitive function in hemodialysis patients due to selective enhancement of attention and vigilance.
Sanhueza, María Eugenia; Cotera, Alejandro; Elgueta, Leticia; López S, Gloria; Loncon, Patricia; Macan, Fernando; Pérez, Francisco; Cavada, Gabriel; Alvo, Miriam
Despite a better management of the variables that influence the development of diabetic nephropathy there is a progressive increase in the prevalence of terminal renal failure among diabetics, whose cause is not clear. To study in a group of patients in hemodialysis, the quality of diabetes control previous to the entry to dialysis, their physical condition and their evolution. Diabetic patients with at least three months of hemodialysis answered a questionnaire about diabetes control quality previous to dialysis and had physical and laboratory assessment. They were followed for at least four years thereafter. Fifty seven patients aged 62+/-11 years were studied. Eighty four percent had some degree of disability. Eighty seven percent had high blood pressure and 73% had to enter dialysis as an emergency. Mean glycosilated hemoglobin was 7.7% and 58% had a dialysis dose with a Kt/Vofless than 1.2. Fifty eight percent died during follow up. No relationship between mortality and age, blood pressure, glycosilated hemoglobin of Kt/V, was observed. There is an inadequate management of blood glucose and blood pressure of diabetic patients before entry to dialysis. They are referred inverted exclamation markate to the nephrologist, the dialysis dose is insufficient and they have a high mortality.
Petar M. Nikić
Full Text Available Objective. Coffee drinking is the main source of caffeine intake among adult population in the western world. It has been reported that low to moderate caffeine intake has beneficial effect on alertness and cognitive functions in healthy subjects. The aim of this study is to evaluate the impact of habitual coffee consumption on cognitive function in hemodialysis patients. Methods. In a cross-sectional study, 86 patients from a single-dialysis centre underwent assessment by the Montreal Cognitive Assessment tool and evaluation for symptoms of fatigue, mood, and sleep disorders by well-validated questionnaires. The habitual coffee use and the average daily caffeine intake were estimated by participants’ response to a dietary questionnaire. Results. Sixty-seven subjects (78% consumed black coffee daily, mostly in low to moderate dose. Cognitive impairment was found in three-quarters of tested patients. Normal mental performance was more often in habitual coffee users (25% versus 16%. Regular coffee drinkers achieved higher mean scores on all tested cognitive domains, but a significant positive correlation was found only for items that measure attention and concentration (P=0.024. Conclusions. Moderate caffeine intake by habitual coffee consumption could have beneficial impact on cognitive function in hemodialysis patients due to selective enhancement of attention and vigilance.
Chirakarnjanakorn, Srisakul; Navaneethan, Sankar D; Francis, Gary S; Tang, W H Wilson
Patients undergoing maintenance hemodialysis develop both structural and functional cardiovascular abnormalities. Despite improvement of dialysis technology, cardiovascular mortality of this population remains high. The pathophysiological mechanisms of these changes are complex and not well understood. It has been postulated that several non-traditional, uremic-related risk factors, especially the long-term uremic state, which may affect the cardiovascular system. There are many cardiovascular changes that occur in chronic kidney disease including left ventricular hypertrophy, myocardial fibrosis, microvascular disease, accelerated atherosclerosis and arteriosclerosis. These structural and functional changes in patients receiving chronic dialysis make them more susceptible to myocardial ischemia. Hemodialysis itself may adversely affect the cardiovascular system due to non-physiologic fluid removal, leading to hemodynamic instability and initiation of systemic inflammation. In the past decade there has been growing awareness that pathophysiological mechanisms cause cardiovascular dysfunction in patients on chronic dialysis, and there are now pharmacological and non-pharmacological therapies that may improve the poor quality of life and high mortality rate that these patients experience. Copyright Â© 2017 Elsevier B.V. All rights reserved.
Tepel, Martin; Armbruster, Franz Paul; Grön, Hans Jürgen
Background: It was shown that nonoxidized PTH (n-oxPTH) is bioactive, whereas the oxidation of PTH results in a loss of biological activity. Methods: In this study we analyzed the association of n-oxPTH on mortality in hemodialysis patients using a recently developed assay system. Results......: Hemodialysis patients (224 men, 116 women) had a median age of 66 years. One hundred seventy patients (50%) died during the follow-up period of 5 years. Median n-oxPTH levels were higher in survivors (7.2 ng/L) compared with deceased patients (5.0 ng/L; P = .002). Survival analysis showed an increased survival...... in the highest n-oxPTH tertile compared with the lowest n-oxPTH tertile (χ(2), 14.3; P = .0008). Median survival was 1702 days in the highest n-oxPTH tertile, whereas it was only 453 days in the lowest n-oxPTH tertile. Multivariable-adjusted Cox regression showed that higher age increased odds for death, whereas...
Ahmad Ramadan Ali
Full Text Available Wegener′s granulomatosis is a serious autoimmune disorder characterized by necrotizing small-vessel vasculitis. It is a multisystem disease that primarily affects the lung and kidneys. Previous studies indicated few relapses of vasculitis after hemodialysis due to uremic immunosuppression. Our case report describes an end-stage renal failure patient who had developed non-caseating lung granulomata with giant cell formation and fibrinoid necrosis of arterial media that is consistent with Wegner′s granulomatosis for the first time and eight years after initiation of maintenance hemodialysis. We believe that such a phenomenon has rarely been reported.
Gillene Santos Ferreira
Full Text Available The objective was to identify the average total cost (ATC for installing and turning off hemodialysis on patients with central venous catheters. This quantitative, exploratory, and descriptive research, in the mode of a single-case study, was conducted in a public university hospital. The non-probabilistic sample corresponded to the observation of 100 installations and 100 terminations of hemodialysis on 42 patients during 23 days of collection. The ATC was calculated by multiplying the time spent by nurses by the unit cost of direct labor, and adding the cost of materials, solutions, and medications. The Brazilian currency (R$ was used for the calculations. The ATC for installation was R$ 80.10 and for shutting off was R$ 13.04, totaling R$ 93.14 per hemodialysis session. The results obtained will facilitate a better planning of the allocation of human, material, and financial resources enabling the increase of managerial strategies aimed at economic efficiency. doi: 10.5216/ree.v16i4.23044.
We propose in this work to assess the prevalence of cardiovascular risk factors in the chronic hemodialysis as well as diagnostic and prognostic performance of myocardial SPECT. We conducted a prospective study over a period of 5 years (1999-2004) assemble 52 chronic hemodialysis patients, 73 pour cent were treated at the hemodialysis unit of the principal Hospital Military - Tunis and 27 pour cent the hemodialysis unit of the polyclinic CNSS El Khadhra. The conventional periodic hemodialysis bicarbonate was the dialysis technique used in all our patients.
de Medina, M; Ashby, M; Diego, J; Pennell, J P; Hill, M; Schiff, E R; Perez, G O
Serum hyaluronan levels are increased in dialysis patients. We evaluated several factors that influence serum hyaluronan levels in 184 patients on chronic hemodialysis (duration 2.3 +/- 2.3 [SD] years). The levels were higher than normal in the whole group and in a subgroup of 133 patients without chronic infection, liver disease, or rheumatoid arthritis (215 +/- 19 and 205 +/- 22 microg/L, respectively). There was a tendency for the levels to be higher in a subgroup of patients with hepatitis c virus (HCV) infection. There was no correlation between hyaluronan levels, alanine aminotransferase (ALT), and duration or dose of dialysis. A weak but highly significant negative correlation between serum albumin levels and serum hyaluronan and ferritin levels was seen. The data suggest that chronic inflammation may explain, at least in part, the increased hyaluronan levels found in chronic dialysis patients.
Christensen, Alan J.; And Others
Examines the relation of coping to adherence among 57 hemodialysis patients. As predicted, coping efforts involving planful problem solving were associated with more favorable adherence when used in response to stressors involving a relatively controllable aspect of the hemodialysis context. For less controllable stressors, coping efforts…
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
Arshi, S.; Butt, G.U.D.; Mian, F.A.
Objective: The objective of this study was to see echocardiographic findings of cardiac dysfunction in patients of chronic kidney disease (CKD) on hemodialysis. Study Design: Comparative cross sectional study. Place and Duration of Study: Department of nephrology, Pakistan Institute of Medical Sciences. Islamabad from September 2014 to February 2015. Patients and Methods: One hundred patients of either gender were included in this study. Fifty patients of chronic kidney disease stage V on hemodialysis were taken for echocardiography and fifty were normal. Echocardiography was done for cardiac dysfunction. Systolic function was measured by ejection fraction (EF) and fractional shortening (FS). Diastolic function was measured by E/A ratio. Results: Out of 100 patients included in the study, 50 patients were on hemodialysis and 50 were control. Left ventricular end systolic and end diastolic volumes were higher in patients on hemodialysis than controls as well as left atrial enlargement and inter ventricular septum which was statistically significant. Ejection fraction, although normal and fractional shortening decreased in patients on hemodialysis (p<0.05). Diastolic dysfunction was present in 36 patients on hemodialysis, while absent in the control group. Conclusion: Patients with chronic kidney disease on hemodialysis have higher prevalence of cardiac dysfunction. (author)
Gil, Frederico F; Barros, Maxlene J; Macedo, Nazaré A; Júnior, Carmelino G E; Redoan, Roseli; Busatti, Haendel; Gomes, Maria A; Santos, Joseph F G
Intestinal parasites are an important cause of morbidity and mortality. Immunocompromised individuals may develop more severe forms of these infections. Taking into account the immunity impairment in patients suffering from chronic renal failure (CRF), we will determine the prevalence and associated symptoms of intestinal parasites in these patients. Controls without CRF were used for comparison. Stool samples were collected and processed for microscopic identification of parasites using the Formalin-ether concentration method. For Cryptosporidium diagnosis, the ELISA technique was used. One hundred and ten fecal samples from hemodialysis patients were analyzed, as well as 86 from a community group used as control group. A result of 51.6% of intestinal parasites was observed in hemodialysis patients and 61.6% in the control group. Cryptosporidium and Blastocystis were the most common infections in patients with CRF (26.4% and 24.5%, respectively). Blastocystis was the most common infection in the control group (41.9%), however no individual was found positive for Cryptosporidium. Among the CRF patients, 73.6% were symptomatic, 54.3% of these tested positive for at least one parasite, in contrast to 44.8% in asymptomatic patients (p = 0.38). The most common symptoms in this group were flatulence (36.4%), asthenia (30.0%) and weight loss (30.0%). In the control group, 91.9% were symptomatic, 60.8% of these tested positive for at least one parasite, in contrast to 71.4% in asymptomatic patients (p = 0.703). A significant difference between the two groups was observed with regard to symptoms, with bloating, postprandial fullness, and abdominal pain being more frequent in the control group than in the hemodialysis group (all p failure are frequent targets for renal transplantation, which as well as the inherent immunological impairment of the disease itself, results in immunosuppression by medication. For this reason, carriers of intestinal parasites with pathogenic
Kondo, Masahiro; Kuroda, Junko; Ikai, Yoshitomo; Hayashi, Rumiko; Uegaki, Shiori; Yoshida, Tatsuya; Yoshida, Atsuhiro; Komatsu, Hirokazu; Kimura, Kazunori
Here we report a case of successful treatment with combination chemotherapy of carboplatin(CBDCA)and paclitaxel for a patient undergoing hemodialysis(HD)with cancer of unknown primary, conducted by monitoring the observed AUC of ultrafilterable CBDCA. CBDCA was administered at a dose of 125 mg on day 1 in each course, an amount which had been calculated by the Calvert formula(GFR: 0, target AUC: 5). HD was started at a point in time one hour after the completion of each CBDCA administration, and performed for 5 hours in each course. Blood samples were collected during the first 3 courses of chemotherapy to measure the plasma concentration of free-platinum. The observed AUCs(o-AUC)of CBDCA in the first, second and third courses were 3. 03, 3. 44 and 3. 50mg·min/mL, respectively. The o-AUC in the first course was lower than that in the second course. The o-AUC in the second course was nearly equal to that in the third course, while each o-AUC was below the target AUC(t-AUC). Partial response was achieved after two courses of the CBDCA and paclitaxel combination chemotherapy, with adverse events of Grade 3 neutropenia and Grade 3 peripheral neuropathy observed in each course after the second course of chemotherapy. o-AUC of CBDCA administered to HD patients can not only be below t-AUC, as in this case, but also oppositely above t-AUC in cases with different doses of CBDCA or HD settings. Our results suggest that the monitoring of o-AUC of CBDCA is useful when practicing CBDCA-based chemotherapy safely and effectively in cancer patients undergoing HD.
Moncef El M′Barki Kadiri
Full Text Available Signs of protein-energy malnutrition are common in maintenance hemodialyis (HD patients and are associated with increased morbidity and mortality. To evaluate the nutritional status and relationship between various parameters used for assessing malnutrition, we performed a cross-sectional study in 37 HD patients treated with thrice weekly sessions for at least two weeks. Global nutritional status was evaluated by the dual-energy X-ray absorptiometry (DEXA scan. Body weight and several laboratory values, including serum albumin (Salb, serum prealbumin, bicarbonate, cholesterol, serum C-reactive protein (SCRP, and hemoglobin, were recorded. Dose of dialysis was evaluated by urea kinetic modeling. The patients were subdivided into two groups based on body mass index: group I, normal nutritional status (71% and group II, malnutrition (29%. The clinical factors associated with malnutrition included advanced age and cardio-vascular diseases (CVD, decreased fat mass (FM measured by DEXA, low Salb and prealbumin, and severe anemia. The Salb level was not only a predictor of nutritional status, but also was independently influenced by age and SCRP, which was more common in malnourished patients than in patients with normal nutritional status. Both low Kt/V and less weekly dialysis time were associated with malnutrition. The FM and lean body mass (LBM calculated by DEXA correlated with CVD and other markers of malnutrition (Salb, total cholesterol.
Molsted, Stig; Eidemak, Inge; Sorensen, Helle Tauby
BACKGROUND: The number of chronic renal failure patients treated by hemodialysis (HD) is continuously increasing. Most patients have reduced physical capacity and have a high risk of cardiac and vascular diseases. The aim of this study was to determine the effects of 5 months physical exercise...... limitations, severe peripheral polyneuropathy, inability to speak Danish or English, dementia or other mental disorders. The patients were randomly assigned to an exercise group (EG, n = 22) or a control group (CG, n = 11). Prior to randomization, baseline testing was performed. The effects were measured...... by aerobic capacity, '2-min stair climbing', 'squat test', self-rated health (SF36), blood pressure and lipids. All tests were carried out by blinded testers. The intervention consisted of 1 h of physical exercise twice a week for 5 months. RESULTS: 20 patients completed the intervention. Attendance was 74...
Molfino, Alessio; Kaysen, George A.; Chertow, Glenn M.; Doyle, Julie; Delgado, Cynthia; Dwyer, Tjien; Laviano, Alessandro; Fanelli, Filippo Rossi; Johansen, Kirsten L.
Objective To test the performance of appetite assessment tools among patients receiving hemodialysis. Design Cross-sectional. Setting Seven dialysis facilities in Northern California. Subjects 221 patients receiving hemodialysis. Intervention We assessed five appetite assessment tools [self-assessment of appetite, subjective assessment of appetite, visual analogue scale (VAS), Functional Assessment of Anorexia/Cachexia Therapy (FAACT) score and the Anorexia Questionnaire (AQ)]. Main outcome measures Reported food intake, normalized protein catabolic rate (nPCR), and change in body weight were used as criterion measures, and we assessed associations among the appetite tools and biomarkers associated with nutrition and inflammation. Patients were asked to report their appetite and the percentage of food eaten (from 0% to 100%) during the last meal compared to usual intake. Results Fifty-eight (26%) patients reported food intake ≤50% (defined as poor appetite). The prevalence of anorexia was 12% by self-assessment of appetite, 6% by subjective assessment of appetite, 24% by VAS, 17% by FAACT score, and 12% by AQ. All tools were significantly associated with food intake ≤50% (pappetite. The FAACT score and the VAS had the strongest association with food intake ≤50% (c-statistic 0.80 and 0.76). Patients with food intake ≤50% reported weight loss more frequently than patients without low intake (36% vs 22%) and weight gain less frequently (19% vs 35%; p=0.03). nPCR was lower among anorexic patients based on the VAS (1.1 ± 0.3 vs 1.2 ± 0.3, p=0.03). Ln IL-6 correlated inversely with food intake (p=0.03), but neither IL-6 nor CRP correlated with any of the appetite tools. Furthermore, only the self-assessment of appetite was significantly associated with serum albumin (p=0.02), prealbumin (p=0.02) and adiponectin concentrations (p=0.03). Conclusions Alternative appetite assessment tools yielded widely different estimates of the prevalence of anorexia in
Seifi S, Mokhtari A
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
Muzasti, R. A.; Lubis, H. R.
Mortality and morbidity rate, especially from cardiovascular disease in hemodialysis patients in Indonesia is still quite high. One of indicator to assess the predictive value of mortality is the phase angle (PhA) of bioimpedance analysis (BIA) scan examination. Determining the comparison of BMI and laboratory data as cardiovascular risk factors in hemodialysis patients based on PhA.A cross-sectional analytical study was done on 155 outpatientsin RasyidaRenal Hospital, Medan in 2016. Patients were two groups, namely PhAcardiovascular risk factors of hemodialysis patients were determined by age, BMI, and hemoglobin.
Bruce, Lisa; Li, Nien-Chen; Mooney, Ann; Maddux, Franklin W.
Background and objectives Recent studies demonstrated an association between depressive affect and higher mortality risk in incident hemodialysis patients. This study sought to determine whether an association also exists with hospitalization risk. Design, setting, participants, & measurements All 8776 adult incident hemodialysis patients with Medical Outcomes Study Short Form 36 survey results treated in Fresenius Medical Care North America facilities in 2006 were followed for 1 year from the date of survey, and all hospitalization events lasting >24 hours were tracked. A depressive affect score was derived from responses to two Medical Outcomes Study Short Form 36 questions (“down in the dumps” and “downhearted and blue”). A high depressive affect score corresponded with an average response of “some of the time” or more frequent occurrence. Cox and Poisson models were constructed to determine associations of depressive affect scores with risk for time to first hospitalization and risk for hospitalization events, as well as total days spent in the hospital, respectively. Results Incident patients with high depressive affect score made up 41% of the cohort and had a median (interquartile range) hospitalization event rate of one (0, 3) and 4 (0, 15) total hospital days; the values for patients with low depressive affect scores were one (0, 2) event and 2 (0, 11) days, respectively. For high-scoring patients, the adjusted hazard ratio for first hospitalization was 1.12 (1.04, 1.20). When multiple hospital events were considered, the adjusted risk ratio was 1.13 (1.02, 1.25) and the corresponding risk ratio for total hospital days was 1.20 (1.07, 1.35). High depressive affect score was generally associated with lower physical and mental component scores, but these covariates were adjusted for in the models. Conclusions Depressive affect in incident hemodialysis patients was associated with higher risk of hospitalization and more hospital days. Future
Mohamed E. Abdalla
Conclusion: There is impairment of lung function in patients with CRF undergoing hemodialysis. The main changes are small airway obstruction, reduction in carbon monoxide transfer and diminished 6MWT that were not completely improved in the kidney transplant patients.
Depression and quality of life in patients on long term hemodialysis at a national ... Quality of Life instrument were used to assess depression and quality of life. ... Haemodialysis patients who obtained low scores on quality of life measures ...
Yeyin, Nami; Cavdar, Iffet; Uslu, Lebriz; Abuqbeitah, Mohammad; Demir, Mustafa
Radioiodine therapy could be challenging in chronic renal failure patients requiring hemodialysis. The aim of this study was to establish the effects of hemodialysis on elimination of radioiodine from the body in thyroid carcinoma patients with end-stage chronic renal failure and to determine its effects on environmental radiation dose. Three end-stage chronic renal failure patients (four cases) diagnosed with differentiated thyroid carcinoma requiring radioiodine therapy were included in our study. Each patient was given 50-75 mCi (1850-2775 MBq) iodine-131 with 50% dose reduction. Dose rate measurement was performed at the 2nd, 24th, and 48th hour (immediately before and after hemodialysis) after radioiodine administration. The Geiger-Müller probe was held at 1 m distance at the level of the midpoint of the thorax for the dose rate measurement. The effective half-life of iodine-131 for three patients was found to be 44 h. In conclusion, the amount of radioiodine excreted per hemodialysis session was calculated to be 51.25%.
Habuka, Masato; Ito, Toru; Yoshizawa, Yuta; Matsuo, Koji; Murakami, Shuichi; Kondo, Daisuke; Kanazawa, Hiroshi; Narita, Ichiei
Refractory pleural effusion can be a life-threatening complication in patients receiving maintenance hemodialysis. We report successful treatment of refractory pleural effusion using a Denver® pleuroperitoneal shunt in one such patient. A 54-year-old Japanese man, who had previously undergone left nephrectomy, was admitted urgently to our department because of a high C-reactive protein (CRP) level, right pleural effusion, and right renal abscess. Because antibiotics proved ineffective and his general state was deteriorating, he underwent emergency insertion of a thoracic drainage tube and nephrectomy, and hemodialysis was started. Although his general state improved slowly thereafter, the pleural effusion, which was unilateral and transudative, remained refractory and therefore he needed to be on oxygenation. To control the massive pleural effusion, a pleuroperitoneal shunt was inserted. Thereafter, his respiratory condition became stable without oxygenation and he was discharged. His general condition has since been well. Although pleural effusion is a common complication of maintenance hemodialysis, few reports have documented the use of pleuroperitoneal shunt to control refractory pleural effusion. Pleuroperitoneal shunt has been advocated as an effective and low-morbidity treatment for refractory pleural effusion, and its use for some patients with recurrent pleural effusion has also been reported, without any severe complications. In the present case, pleuroperitoneal shunt improved the patient's quality of life sufficiently to allow him to be discharged home without oxygenation. Pleuroperitoneal shunt should be considered a useful treatment option for hemodialysis patients with refractory pleural effusion.
Full Text Available Insomnia and limb pain are common problems in dialysis patients. In addition, restless leg syndrome (RLS as a specific cause of insomnia and limb pain has been reported in many studies. The purpose of this study was to estimate incidence of insomnia and RLS as a cause of insomnia in these patients. Twenty-six patients undergoing hemodialysis were investigated for insomnia, limb pain and RLS as per the defined criteria. They were evaluated for dialysis quality, dialysis duration, hemoglobin, serum phosphorous, ionized calcium, iron and ferritin levels. These variables between patients with insomnia and those with normal sleep were evaluated by independent "t" test. Without considering the etiology or pathogenesis of insomnia, we evaluated the occurrence of insomnia and limb pain in these patients, and specifically, restless leg syndrome. Insomnia and limb pain were common in dialytic patients. 46% of patients had insomnia. 91% of sleepless group had limb pain as a persistent, annoying complaint. Limb pain was not seen in groups with a normal sleep pattern. Restless leg syndrome was found in 8% of total cases (2 out of 26 and 17% among the insomnia group (2 out of 12. In spite of high incidence of insomnia among patients undergoing regular hemodialysis, role of RLS is trivial. There is a strong relationship between hemoglobin levels and duration of renal replacement therapy to insomnia occurrence.
Malaki, Majid; Mortazavi, Fakhr Sadat; Moazemi, Sussan; Shoaran, Maryam
Insomnia and limb pain are common problems in dialysis patients. In addition, restless leg syndrome (RLS) as a specific cause of insomnia and limb pain has been reported in many studies. The purpose of this study was to estimate incidence of insomnia and RLS as a cause of insomnia in these patients. Twenty-six patients undergoing hemodialysis were investigated for insomnia, limb pain and RLS as per the defined criteria. They were evaluated for dialysis quality, dialysis duration, hemoglobin, serum phosphorous, ionized calcium, iron and ferritin levels. These variables between patients with insomnia and those with normal sleep were evaluated by independent "t" test. Without considering the etiology or pathogenesis of insomnia, we evaluated the occurrence of insomnia and limb pain in these patients, and specifically, restless leg syndrome. Insomnia and limb pain were common in dialytic patients. 46% of patients had insomnia. 91% of sleepless group had limb pain as a persistent, annoying complaint. Limb pain was not seen in groups with a normal sleep pattern. Restless leg syndrome was found in 8% of total cases (2 out of 26) and 17% among the insomnia group (2 out of 12). In spite of high incidence of insomnia among patients undergoing regular hemodialysis, role of RLS is trivial. There is a strong relationship between hemoglobin levels and duration of renal replacement therapy to insomnia occurrence.
Full Text Available Objective: To analyze the effect of high flux hemodialysis on plasma toxin molecule contents and body’s microinflammatory state in patients with uremia. Methods: A total of 96 cases of patients with uremia receiving inpatient dialysis in our hospital from June 2011 to March 2015 were selected as research subjects and randomly divided into observation group and control group, each group with 48 cases. Control group received low flux hemodialysis (LF-HD, observation group received high flux hemodialysis (HF-HD, and then levels of plasma renal function-related toxins, oxidative stress-related toxins, leptin, intact parathyroid hormone and asymmetric dimethylarginine as well as levels of microinflammatory state-related factors of two groups were compared. Results: Plasma BUN, Scr, UA and β2-MG levels of observation group after dialysis were significantly lower than those of control group; plasma MDA and Cor levels of observation group after dialysis were lower than those of control group, and levels of GSH and SOD were higher than those of control group; plasma Leptin, iPTH and ADMA levels of observation group after 1 time and 5 times of dialysis were significantly lower than those of control group; plasma hs-CRP, IL-6, TNF-α and ASAA levels of observation group after dialysis were significantly lower than those of control group. Conclusion: High flux hemodialysis for patients with uremia can effectively eliminate related toxins in the body and reduce systemic microinflammatory state, and it has active clinical significance.
Donia, Ahmed Farouk; Elhadedy, Mohamed Ahmed; El-Maghrabi, Hanzada Mohamed; Abbas, Mohamed Hamed; Foda, Mohamed Ashraf
Hemodialysis (HD) patients are subjected to a number of physical and mental stresses. Physicians might be unaware of some of these problems. We assessed our patients' opinion about the service provided at the dialysis unit. Our unit has 89 patients on HD. A questionnaire exploring our patients' opinion relative to the service provided was prepared. The patients were asked to fill-in the questionnaire in a confidential manner. Questionnaires were then collected and examined while unaware of patient identities. Sixty-nine patients (77.5%) responded to the questionnaire. Eight patients (11.6%) revealed their names on the questionnaire. According to the questionnaire, the patients were asked to assess the service of each service by choosing one of the following grades: "excellent," "mediocre" or "bad." For the whole group of contributing patients, there were 563 "excellent," 85 "mediocre" and five "bad" choices in addition to 37 blank "no comment" choices. Food service had the least percentage (68%) of evaluation as "excellent," while doctor' performance got the highest excellent evaluation (85.5%). Thirty-five patients (50.7%) added further comment(s). An audit meeting was conducted to discuss these results. Exploring the opinion of patients on HD might uncover some areas of dissatisfaction and help in improving the provided service. We recommend widespread usage of questionnaires to assess patient satisfaction as well as to assess other health-care aspects.
Arabi, Mohammad, E-mail: email@example.com; Ahmed, Ishtiaq; Mat’hami, Abdulaziz [Prince Sultan Military Medical City (PSMMC), Division of Endovascular Interventional Radiology, Department of Medical Imaging (Saudi Arabia); Ahmed, Dildar; Aslam, Naveed [Prince Sultan Military Medical City (PSMMC), Department of Nephrology (Saudi Arabia)
PurposeWe report our institutional experience with sharp central venous recanalization in chronic hemodialysis patients who failed standard techniques.Materials and MethodsSince January 2014, a series of seven consecutive patients (four males and three females), mean age 35 years (18–65 years), underwent sharp central venous recanalization. Indications included obtaining hemodialysis access (n = 6) and restoration of superior vena cava (SVC) patency to alleviate occlusion symptoms and restore fistula function (n = 1). The transseptal needle was used for sharp recanalization in six patients, while it could not be introduced in one patient due to total occlusion of the inferior vena cava. Instead, transmediastinal SVC access using Chiba needle was obtained.ResultsTechnical success was achieved in all cases. SVC recanalization achieved symptoms’ relief and restored fistula function in the symptomatic patient. One patient underwent arteriovenous fistula creation on the recanalized side 3 months after the procedure. The remaining catheters were functional at median follow-up time of 9 months (1–14 months). Two major complications occurred including a right hemothorax and a small hemopericardium, which were managed by covered stent placement across the perforated SVC.ConclusionSharp central venous recanalization using the transseptal needle is feasible technique in patients who failed standard recanalization procedures. The potential high risk of complications necessitates thorough awareness of anatomy and proper technical preparedness.
Arabi, Mohammad; Ahmed, Ishtiaq; Mat’hami, Abdulaziz; Ahmed, Dildar; Aslam, Naveed
PurposeWe report our institutional experience with sharp central venous recanalization in chronic hemodialysis patients who failed standard techniques.Materials and MethodsSince January 2014, a series of seven consecutive patients (four males and three females), mean age 35 years (18–65 years), underwent sharp central venous recanalization. Indications included obtaining hemodialysis access (n = 6) and restoration of superior vena cava (SVC) patency to alleviate occlusion symptoms and restore fistula function (n = 1). The transseptal needle was used for sharp recanalization in six patients, while it could not be introduced in one patient due to total occlusion of the inferior vena cava. Instead, transmediastinal SVC access using Chiba needle was obtained.ResultsTechnical success was achieved in all cases. SVC recanalization achieved symptoms’ relief and restored fistula function in the symptomatic patient. One patient underwent arteriovenous fistula creation on the recanalized side 3 months after the procedure. The remaining catheters were functional at median follow-up time of 9 months (1–14 months). Two major complications occurred including a right hemothorax and a small hemopericardium, which were managed by covered stent placement across the perforated SVC.ConclusionSharp central venous recanalization using the transseptal needle is feasible technique in patients who failed standard recanalization procedures. The potential high risk of complications necessitates thorough awareness of anatomy and proper technical preparedness.
Full Text Available Full training according to the information needs of patients reduces health care costs and increases the quality of care. The present study was conducted aims to prioritize the preferences of hemodialysis patients in acquisition of health information to be able to provide training according to these preferences and their prioritization after achieving them. This study was a descriptive cross-sectional one which was conducted on all hemodialysis patients who visited Kowsar Hospital in Semnan within the year 2014-2015. Data collecting tool was researcher-made questionnaire which assessed physical information needs of patients in four areas of nutrition, energy, pain and discomfort, sleep and rest. Data were analyzed by SPSS software version 16 using the descriptive statistics.71 hemodialysis patients participated in this study. 68.6%, 50.7%, 42.6% and 46.7% of patients expressed acquisition information regarding hematopoietic foods, how to increase mobility, how to relieve itching during dialysis and mental activities before sleep as their first priorities, respectively. The results of this study showed that hemodialysis patients need to know what kinds of information in the field of physical problems. To facilitate adaptation and selfcare of patients, providing information and training based on the real needs of patients will be helpful.
Ahmed Farouk Donia
Full Text Available Hemodialysis (HD patients are subjected to a number of physical and mental stresses. Physicians might be unaware of some of these problems. We assessed our patients′ opinion about the service provided at the dialysis unit. Our unit has 89 patients on HD. A questionnaire exploring our patients′ opinion relative to the service provided was prepared. The patients were asked to fill-in the questionnaire in a confidential manner. Questionnaires were then collected and examined while unaware of patient identities. Sixty-nine patients (77.5% responded to the questionnaire. Eight patients (11.6% revealed their names on the questionnaire. According to the questionnaire, the patients were asked to assess the service of each service by choosing one of the following grades: "excellent," "mediocre" or "bad." For the whole group of contributing patients, there were 563 "excellent," 85 "mediocre" and five "bad" choices in addition to 37 blank "no comment" choices. Food service had the least percentage (68% of evaluation as "excellent," while doctor′ performance got the highest excellent evaluation (85.5%. Thirty-five patients (50.7% added further comment(s. An audit meeting was conducted to discuss these results. Exploring the opinion of patients on HD might uncover some areas of dissatisfaction and help in improving the provided service. We recommend widespread usage of questionnaires to assess patient satisfaction as well as to assess other health-care aspects.
Gaweda, Adam E; Aronoff, George R; Jacobs, Alfred A; Rai, Shesh N; Brier, Michael E
One-size-fits-all protocol-based approaches to anemia management with erythropoiesis-stimulating agents (ESAs) may result in undesired patterns of hemoglobin variability. In this single-center, double-blind, randomized controlled trial, we tested the hypothesis that individualized dosing of ESA improves hemoglobin variability over a standard population-based approach. We enrolled 62 hemodialysis patients and followed them over a 12-month period. Patients were randomly assigned to receive ESA doses guided by the Smart Anemia Manager algorithm (treatment) or by a standard protocol (control). Dose recommendations, performed on a monthly basis, were validated by an expert physician anemia manager. The primary outcome was the percentage of hemoglobin concentrations between 10 and 12 g/dl over the follow-up period. A total of 258 of 356 (72.5%) hemoglobin concentrations were between 10 and 12 g/dl in the treatment group, compared with 208 of 336 (61.9%) in the control group; 42 (11.8%) hemoglobin concentrations were hemoglobin concentrations were >12 g/dl in the treatment group compared with 46 (13.4%) in the control group. The median ESA dosage per patient was 2000 IU/wk in both groups. Five participants received 6 transfusions (21 U) in the treatment group, compared with 8 participants and 13 transfusions (31 U) in the control group. These results suggest that individualized ESA dosing decreases total hemoglobin variability compared with a population protocol-based approach. As hemoglobin levels are declining in hemodialysis patients, decreasing hemoglobin variability may help reduce the risk of transfusions in this population.
Facincani, Tila; Guimarães, Maia Nogueira Crown; De Sousa Dos Santos, Sigrid
The adverse effects of yellow fever (YF) vaccine in dialysis patients are not well known. There is concern about the risks and benefits of the vaccine in immunocompromised patients living in endemic areas, particularly given the risk of resurgence of urban YF with the spread of Aedes aegypti mosquitoes. The purpose of this study was to assess the coverage and safety of YF vaccine in chronic dialysis patients. A cross-sectional study of 130 chronic dialysis patients was performed. Data were collected on clinical characteristics and YF vaccine status. Patients not vaccinated against YF or without a booster vaccination within the last 10 years were referred to receive the vaccine, and adverse effects were monitored. Previous vaccination was verified in 44 patients within the last 10 years and in 26 patients at more than 10 years ago, with no mention of adverse effects. Thirty-six patients had never been vaccinated and 24 had an unknown vaccination status. Of the total 86 patients referred for immunization, 45 actually received the YF vaccine, with 24.4% experiencing mild local adverse effects and 4.4% experiencing fever. No serious adverse effects attributable to YF vaccine were observed (anaphylaxis, neurological or viscerotropic disease). YF vaccine coverage among hemodialysis patients is low, and the vaccine appeared to be safe in this population with a small sample size. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.
Full Text Available Most unilateral pedicle stress fractures occur on the contralateral side of patients with unilateral spondylolysis. However, there are few reports of unilateral pedicle stress fractures in patients with bilateral spondylolysis and spondylolisthesis. We report a unique case of unilateral pedicle stress fracture in a long-term hemodialysis patient with isthmic spondylolisthesis. A 65-year-old man who had undergone hemodialysis presented with lower back pain that had persisted for several years. The patient experienced severe right lower extremity pain with no history of trauma. Computed tomography revealed unilateral pedicle fracture with bilateral L5 spondylolysis and spondylolisthesis with progression of scoliosis. The patient underwent Gill laminectomy of L5 with pedicle screw fixation at L4-S1 and interbody fusion at L5-S1. The patient’s leg pain ceased immediately, and he began walking without leg pain. In our present patient, development of scoliosis caused by destructive spondyloarthropathy may have contributed to a unilateral pedicle fracture.
Orzincolo, C.; Ghedini, M.; Cardona, P.; Bedani, P.L.; Storari, A.; Scutellari, P.N.; Cavallari, L.
Osteoarticular complications, which are characterized by osseous pain, pathologic fractures, and decreased articular mobility, represent one of the mayor problems affecting long-term (over 15 years) hemodialysis patients. These changes seem to have a multifactorial etiology; they include osteomalacia, secondary hyperparathyroidism, and dialysis-related amyloidosis. Ten patients (5 males and 5 females, mean age 55± 7 years) on long-term (over 15 years) hemodialysis were submitted to X-ray examinations of the skull, spine, shoulders, wrists, pelvis, and knees. Serum calcium, phosphorous, parathyroid hormone, alkaline phosphatase, and basal aluminium levels were also calculated. Osteopenia was demonstrated in all patients. Seven of them had alterations due to hyperparathyroidism. Six patients exhibited signs related to dialysis spondyloarthropathy; in 9 cases amyloid lesions, geodes, and erosions were present in wrists, humeral heads, or hips. One patients exhibited osteomalacic changes. Most long-terms dialysis patients presented multifactorial osteoarticular changes due to hyperparathyroidism, osteomalacia and dialysis-related amyloidosis. Clinical sympoms and decreased articular mobility appeared to be due mainly to amyloid osteoarthropathy
Mandic, Ante; Tomic, Monika; Petrov, Bozo; Romic, Zeljko
Atrial fibrillation is one of the most frequent arrhythmias diagnosed in clinical practice and it is also relatively common in dialysis patients. Atrioventricular and intraventricular conduction disturbances are less investigated in hemodialysis patients and data about their prevalence are insufficient. The objective of this study was to determine the prevalence of atrial fibrillation, atrioventricular blocks and bundle branch blocks in hemodialysis patients and to analyze different clinical ...
Full Text Available Background: Nowadays, chronic kidney disease (CKD is known as an epidemic disease all around the world. Chronic kidney disease considered as a serious health problem with numerous side effects, including complications progressive in reducing glomerular filtration rate (GFR, imbalances in the homeostasis of the body and decreased quality of life and finally an increase in mortality due to cardiovascular problems. End-stage renal disease leads to hypocalcemia and hyperphosphatemia, that as a result of, parathyroid hormone (PTH will increased that secondary hyperparathyroidism will occurred eventually. So it is essential to routine examination of electrolytes in these patients. The current study have been done to determine the electrolytes in saliva as a non-invasive sample in hemodialysis patients in order to the saliva to be presented as an appropriate samples for clinical laboratories. Methods: In the present case-control study that has been performed at Imam Ali Hospital, Bojnord, North Khorasan Province, Iran, in the summer of 2016, 44 hemodialysis patients and 44 aged, gender and body mass index (BMI matched healthy controls were selected and then their cell count, Hb, HCT, iron, ferritin, total iron binding capacity (TIBC, glucose, CRP, triglycerides, cholesterol, urea, creatinine, calcium, phosphorus, potassium and PTH were measured. Results: Calcium and phosphorus were higher in hemodialysis patients in comparison to the control group. Furthermore, there are not any significant relationship between levels of calcium, phosphorus and potassium in both serum and saliva samples. In addition, we observed the positive relationship between PTH in serum as well as phosphorus and potassium in the saliva. Conclusion: The findings of current study have been shown that salivary levels of calcium and phosphorus in hemodialysis patients is higher than healthy people, therefor could be a non- invasive suitable marker for diagnosis. In addition, blood PTH
Shimizu, Minako; Doi, Shigehiro; Nakashima, Ayumu; Naito, Takayuki; Masaki, Takao
This study examined the clinical significance of N-terminal pro brain natriuretic peptide level as a cardiac marker in Japanese hemodialysis patients. This was a multicenter cross-sectional study involving 1428 Japanese hemodialysis patients. Ultrasonic cardiography data at post-hemodialysis were obtained from 395 patients. We examined whether serum N-terminal pro brain natriuretic peptide levels were associated with cardiac parameters and assessed cut-off values and investigated factors associated with a reduced ratio of N-terminal pro brain natriuretic peptide levels pre- and post-hemodialysis. Multivariate logistic regression analysis showed that pre- and post-hemodialysis N-terminal pro brain natriuretic peptide levels were associated with left ventricular hypertrophy on electrocardiogram (odds ratio: 3.10; p N-terminal pro brain natriuretic peptide levels were also significantly associated with ejection fraction on urine chorionic gonadotrophin (ultrasonic cardiography; odds ratio: 35.83; p N-terminal pro brain natriuretic peptide reduction ratio during a hemodialysis session correlated with Kt/V, membrane area, membrane type, modality, body weight gain ratio, treatment time, and ultrafiltration rate with multiple linear regression ( R: 0.53; p N-terminal pro brain natriuretic peptide are associated with the presence of left ventricular hypertrophy in this population. The post-hemodialysis N-terminal pro brain natriuretic peptide level is a useful marker for systolic dysfunction.
Huang, Shih-Han S; Filler, Guido; Lindsay, Robert; McIntyre, Chris W
Dialysis patients have high mortality rate and the leading cause of death is cardiovascular disease. Uremic cardiomyopathy differs from that due to conventional atherosclerosis, where cardiovascular changes result in ineffective circulation and lead to tissue ischemia. Modern dialysis has significant limitations with fluid management probably the most challenging. Current evidence suggests that both volume overload and aggressive fluid removal can induce circulatory stress and multi-organ injury. Furthermore, we do not have accurate volume assessment tools. As a result, targeting euvolemia might result in more harm than benefit with conventional hemodialysis therapy. Therefore, it might be time to consider a degree of permissive over-hydration until we have better tools to both determine ideal weight and improve current renal replacement therapy so that the process of achieving it is not so fraught with the current dangers. © 2014 Wiley Periodicals, Inc.
Vogt, Barbara Perez; Souza, Priscilla L; Minicucci, Marcos Ferreira; Martin, Luis Cuadrado; Barretti, Pasqual; Caramori, Jacqueline Teixeira
Abstract Background: Chronic kidney disease (CKD) and metabolic syndrome are characterized by overlapping disorders, including glucose intolerance, hypertension, dyslipidemia, and, in some cases, obesity. However, there are no specific criteria for the diagnosis of metabolic syndrome in CKD. Metabolic syndrome can also be associated with increased risk of mortality. Some traditional risk factors may protect dialysis patients from mortality, known as "reverse epidemiology." Metabolic syndrome might undergo reverse epidemiology. The objectives were to detect differences in frequency and metabolic characteristics associated with three sets of diagnostic criteria for metabolic syndrome, to evaluate the accuracy of insulin resistance (IR) and inflammation to identify patients with metabolic syndrome, and to investigate the effects of metabolic syndrome by three sets of diagnostic criteria on mortality in chronic hemodialysis patients. An observational study was conducted. Diagnostic criteria for metabolic syndrome proposed by National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), International Diabetes Federation (IDF), and Harmonizing the Metabolic Syndrome (HMetS) statement were applied to 98 hemodialysis patients. The prevalence of metabolic syndrome was 51%, 66.3%, and 75.3% according to NCEP ATP III, IDF, and HMetS criteria, respectively. Diagnosis of metabolic syndrome by HMetS was simultaneously capable of revealing both inflammation and IR, whereas NCEP ATP III and IDF criteria were only able to identify IR. Mortality risk increased in the presence of metabolic syndrome regardless of the criteria used. The prevalence of metabolic syndrome in hemodialysis varies according to the diagnostic criteria used. IR and inflammation predict metabolic syndrome only when diagnosed by HMetS criteria. HMetS was the diagnostic criteria that can predict the highest risk of mortality.
Elizabeth D Hilborn
Full Text Available 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. Serum microcystin concentrations were quantified with enzyme-linked immunosorbent assay which measures free serum microcystin LR equivalents (ME. We describe serum ME concentrations and biochemical outcomes among a subset of patients during 8 weeks following exposure. Thirteen patients were included; 6 were males, patients' median age was 45 years (range 16-80, one was seropositive for hepatitis B surface antigen. The median serum ME concentration was 0.33 ng/mL (range: <0.16-0.96. One hundred thirty nine blood samples were collected following exposure. Patients' biochemical outcomes varied, but overall indicated a mixed liver injury. Linear regression evaluated each patient's weekly mean biochemical outcome with their maximum serum ME concentration; a measure of the extrinsic pathway of clotting function, prothrombin time, was negatively and significantly associated with serum ME concentrations. This group of exposed patients' biochemical outcomes display evidence of a mixed liver injury temporally associated with microcystin exposure. Interpretation of biochemical outcomes are complicated by the study population's underlying chronic disease status. It is clear that dialysis patients are a distinct 'at risk' group for cyanotoxin exposures due to direct intravenous exposure to dialysate prepared from surface drinking water supplies. Careful monitoring and treatment of water supplies used to prepare dialysate is required to prevent future cyanotoxin exposure events.
Al-Ezzy, Yahya A.; Al-Hamaty, Nabil A.; Haza'a, Kamel; Thania, Salim Y.; Al-Barraq, Abulmoghni O.
To study the characteristics of hemodialized patients included in the study and demonstrate patterns of cardiovascular manifestations (CM) in patients as well as the impact of the duration of dialysis on these manifestations. Study was carried out on 50 patients in the Dialysis Unit ,Al-Thawra General Hospital,Sana'a, Yemen, between September 2000 and December 2000. Study was carried out on patients who were on regular hemodialysis ; male to female ratio was1.3:1 with mean age of 39.8+ 1 2.6 years and mean dialysis duration of 61.3+-7.57 months. Study revealed the following results: 70% of patients have hypertension with mean systolic blood pressure (BP) of 151+-32mm Hg and mean diastolic BP of 94+-19mm Hg valvular was in the dysfunctions were found in 70%, heart failure in 50%, ischemic changes in 34% and finally 26% of patients have pericardial effusion where only one of the patient (2%) had pericardial rub. We concluded that CM were found higher than other centres worldwide. We recommend to re-evaluate the practice in this department particularly the efficiency of dialysis and followup of the patients. Statistically there was no significant correlation between the duration of dialysis and CM. (author)
Full Text Available Peritonitis has been independently associated with increased morbidity and mortality in peritoneal dialysis patients. However, there are few reports on peritonitis in hemodialysis patients. We aim at investigating both the risk profiles and prognostic impact of peritonitis in hemodialysis patients.This nation-wide longitudinal study uses claims data obtained from the Taiwan National Health Insurance Research Database. A total of 80,733 incident hemodialysis patients of age ≥ 20 years without a history of peritonitis were identified between January 1, 1998 and December 31, 2009. Predictors of peritonitis events were estimated using Cox proportional hazard models. Time-dependent Cox proportional hazard models were used to estimate hazard ratio for mortality attributed to peritonitis exposure.Of 80,733 incident hemodialysis patients over a 13-year study period, peritonitis was diagnosed in 935 (1.16%, yielding an incidence rate of 2.91 per 1000 person-years. Female gender, liver cirrhosis and polycystic kidney disease were three of the most significant factors for peritonitis in both non-diabetic and diabetic hemodialysis patients. The cumulative survival rate of patients with peritonitis was 38.8% at 1 year and 10.1% at 5 years. A time-dependent Cox multivariate analysis showed that peritonitis had significantly increased hazard ratio for all cause mortality. Additionally, the risk of mortality remained significantly higher for non-diabetic hemodialysis patients that experienced peritonitis.The risk of peritonitis in hemodialysis patients is higher in female gender, liver cirrhosis and polycystic kidney disease. Although peritonitis is a rare condition, it is associated with significantly poorer outcome in hemodialysis patients.
Lu, Yueh-An; Tu, Kun-Hua; Lee, Cheng-Chia; Wu, Patricia W; Chang, Chee-Jen; Tian, Ya-Chung; Yang, Chih-Wei; Chu, Pao-Hsien
Peritonitis has been independently associated with increased morbidity and mortality in peritoneal dialysis patients. However, there are few reports on peritonitis in hemodialysis patients. We aim at investigating both the risk profiles and prognostic impact of peritonitis in hemodialysis patients. This nation-wide longitudinal study uses claims data obtained from the Taiwan National Health Insurance Research Database. A total of 80,733 incident hemodialysis patients of age ≥ 20 years without a history of peritonitis were identified between January 1, 1998 and December 31, 2009. Predictors of peritonitis events were estimated using Cox proportional hazard models. Time-dependent Cox proportional hazard models were used to estimate hazard ratio for mortality attributed to peritonitis exposure. Of 80,733 incident hemodialysis patients over a 13-year study period, peritonitis was diagnosed in 935 (1.16%), yielding an incidence rate of 2.91 per 1000 person-years. Female gender, liver cirrhosis and polycystic kidney disease were three of the most significant factors for peritonitis in both non-diabetic and diabetic hemodialysis patients. The cumulative survival rate of patients with peritonitis was 38.8% at 1 year and 10.1% at 5 years. A time-dependent Cox multivariate analysis showed that peritonitis had significantly increased hazard ratio for all cause mortality. Additionally, the risk of mortality remained significantly higher for non-diabetic hemodialysis patients that experienced peritonitis. The risk of peritonitis in hemodialysis patients is higher in female gender, liver cirrhosis and polycystic kidney disease. Although peritonitis is a rare condition, it is associated with significantly poorer outcome in hemodialysis patients.
Full Text Available ABSTRACT: The Chronic Renal Failure (CRF is characterized by irreversible loss of renal function. The treatment for these patients is the realization of dialysis therapy, which significantly affects the life quality. The present study aimed to identify the effect caused by hemodialysis in life activities of patients treated. It opted for the interviews as a methodological reference, the universe investigated corresponded to 56 patients. Results showed that the underlying diagnosis was the most frequent Hypertension in 44.65% of cases, those who reported constant vertigo was 76.78%, 87.50% patients did not perform because of the occupational therapy and 96.42% voice changes in diet and fluid intake. Complications from treatment affect the functional abilities, imposing limitations on daily activities which disrupt the individuals life. Therefore, it is extremely important that the nursing staff is able to intervene before these events, providing treatment for patients in the proper orientation, as well as an emotional preparation, so that the same is skilled to live with restriction imposed in the face of CRF.Keywords: Hemodialysis, life activities, nursing.
Zhang Yijing; Tian Jinsheng; Feng Xiaoyan
Objective: To study the effects of low-flux hemodialysis (LFHD), high-flux hemodialysis (HFHD) and hemodiafiltration (HDF) on the serum inflammatory cytokine in maintenance hemodialysis (MHD) patients. Methods: Sixty MHD patients were randomly divided into LFHD group, HFHD group and HDF group. Results: The levels of serum CRP, IL-6, IL-8 and TNF-α were detected in three groups and control group. The results showed that levels of CRP, IL-6, IL-8 and TNF-α in patients with MHD before treatment were much higher than these in control group (P 0.05). The levels of CRP, IL-6, IL-8 and TNF-α did not significantly decrease in patients with HFHD after the first hemodialysis (P>0.05). The levels of CRP, IL-6, IL-8 and TNF-α decreased markedly in patients with HFHD after 6 months hemodialysis (P<0.05). The levels of CRP, IL-6, IL-8 and TNF-α decreased significantly in patients with HDF after the first hemodialysis and after 6 months (P<0.05). The levels of CRP, IL-6, IL-8 and TNF-α in HDF group were significantly lower than those in HFHD group after 6 months (P<0.05). Conclusion: There was microinflammatory state in MHD patients. The lowering of patients' serum CRP, IL-6, IL-8 and TNF-α levels and thus the recovery from microinflammatory state may be achieved by HDF, HFHD, and HFHD preferably by HDF. (authors)
Pakpour, Amir H.; Saffari, Mohsen; Yekaninejad, Mir Saeed
were included using a convenience sampling approach in a cross-sectional study. Data collection was performed using a Persian translation of the Short Form-36 questionnaire in combination with demographic and clinically related questions. The collected data were analyzed using a logistic regression......INTRODUCTION: This study evaluated the health-related quality of life (HRQOL) in a sample of Iranian patients undergoing maintenance hemodialysis. The data were compared with the HRQOL for the Iranian general population. MATERIALS AND METHODS: Two-hundred and fifty patients undergoing hemodialysis...... the fact that patients undergoing hemodialysis suffer from poor HRQOL. In comparison with data from other studies from Asian and European countries, this sample of Iranian patients on hemodialysis had a lower HRQOL, a discrepancy that might be due to differences in life style, socioeconomic status...
Plesner, Louis L; Warming, Peder E; Nielsen, Ture L
The objectives of this study were to assess the prevalence of chronic obstructive pulmonary disease (COPD) in hemodialysis patients with spirometry and to examine the effects of fluid removal by hemodialysis on lung volumes. Patients ≥18 years at two Danish hemodialysis centers were included....... Forced expiratory volume in one second (FEV1 ), forced vital capacity (FVC), and FEV1 /FVC ratio were measured with spirometry before and after hemodialysis. The diagnosis of COPD was based on both the GOLD criteria and the lower limit of normal criteria. There were 372 patients in treatment at the two...... centers, 255 patients (69%) completed spirometry before dialysis and 242 of these (65%) repeated the test after. In the initial test, 117 subjects (46%) had airflow limitation indicative of COPD with GOLD criteria and 103 subjects (40.4%) with lower limit of normal criteria; COPD was previously diagnosed...
M. Al Eissa
Full Text Available Aim. To assess the degree of satisfaction among hemodialysis patients and the factors influencing this satisfaction. Methods. Patients were recruited from 3 Saudi dialysis centers. Demographic data was collected. Using 1 to 10 Likert scale, the patients were asked to rate the overall satisfaction with, and the overall impact of, their dialysis therapy on their lives and to rate the effect of the dialysis therapy on 15 qualities of life domains. Results. 322 patients were recruited (72.6% of the total eligible patients. The mean age was 51.7 years (±15.4; 58% have been on dialysis for >3 years. The mean Charlson Comorbidity Index was 3.2 (±2, and Kt/V was 1.3 (±0.44. The mean satisfaction score was (7.41 ± 2.75 and the mean score of the impact of the dialysis on the patients' lives was 5.32 ± 2.55. Male patients reported worse effect of dialysis on family life, social life, energy, and appetite. Longer period since the commencement of dialysis was associated with adverse effect on finances and energy. Lower level of education was associated with worse dialysis effect on stress, overall health, sexual life, hobbies, and exercise ability. Conclusion. The level of satisfaction is affected by gender, duration on dialysis, educational level, and standard of care given.
Arababadi, Mohammad Kazemi; Hassanshahi, Gholamhossein; Yousefi, Hassan
End-stage renal disease patients on chronic hemodialysis (HD) patients are at risk for both hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, and they may coexist. To determine the prevalence and clinical impact of HBV and HCV infection, we studied poly chain reaction (PCR) and reverse transcription (RT)-PCR on the blood samples of 90 HD patients in Kerman, Iran. ELISA test was used to detect anti-HBc, anti-HBs and HBs Ag. We found that 30 out of 90 (33.3%) patients were PCR-RT-PCR positive for HCV-RNA. No HBV-DNA (0%) was detected through the PCR study in both positive and negative HCV-RNA patient groups. Though none of the samples was HBsAg positive, 10 (33.3%) HCV-RNA positive patients were anti-HBc positive, and 12 (40.7%) were anti-HBs positive. We conclude that prevalence of hepatitis C infection is high in HD patients in our region, but not associated with active HBV infection. (author)
Rhee, Jinnie J; Zheng, Yuanchao; Montez-Rath, Maria E; Chang, Tara I; Winkelmayer, Wolfgang C
There is a lack of data on the relationship between glycemic control and cardiovascular end points in hemodialysis patients with diabetes mellitus. We included adult Medicare-insured patients with diabetes mellitus who initiated in-center hemodialysis treatment from 2006 to 2008 and survived for >90 days. Quarterly mean time-averaged glycated hemoglobin (HbA 1c ) values were categorized into diabetes mellitus. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
Yildiz A; Tufan F
Abdulmecit Yildiz,1 Fatih Tufan2 1Department of Nephrology, Uludag University School of Medicine, Bursa, 2Department of Geriatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, TurkeyWe read the recently published and well-designed study of Lee et al that suggests that bioimpedance analysis (BIA) gives relevant information about hydration status and malnutrition in hemodialysis patients. The authors recommend that utilization of BIA routinely in hemodialysis patients would be...
Spry, Leslie A; Burkart, John M; Holcroft, Christina; Mortier, Leigh; Glickman, Joel D
Vascular access infections are of concern to hemodialysis patients and nurses. Best demonstrated practices (BDPs) have not been developed for home hemodialysis (HHD) access use, but there have been generally accepted practices (GAPs) endorsed by dialysis professionals. We developed a survey to gather information about training provided and actual practices of HHD patients using the NxStage System One HHD machine. We used GAP to assess training used by nurses to teach HHD access care and then ...
Infectious endocarditis (IE), a complication that is both cardiac and infectious, occurs frequently and is associated with a heavy burden of morbidity and mortality in chronic hemodialysis patients (CHD). About 2-6% of chronic hemodialysis patients develop IE and the incidence is 50-60 times higher among CHD patients than in the general population. The left heart is the most frequent location of IE in CHD and the different published series report a prevalence of left valve involvement varying from 80% to 100%. Valvular and perivalvular abnormalities, alteration of the immune system, and bacteremia associated with repeated manipulation of the vascular access, particularly central venous catheters, comprise the main factors explaining the left heart IE in CHD patients. While left-sided IE develops in altered valves in a high-pressure system, right-sided IE on the contrary, generally develops in healthy valves in a low-pressure system. Right-sided IE is rare, with its incidence varying from 0% to 26% depending on the study, and the tricuspid valve is the main location. Might the massive influx of pathogenic and virulent germs via the central venous catheter to the right heart, with the tricuspid being the first contact valve, have a role in the physiopathology of IE in CHD, thus facilitating bacterial adhesion? While the physiopathology of left-sided IE entails multiple and convincing mechanisms, it is not the case for right-sided IE, for which the physiopathological mechanism is only partially understood and remains shrouded in mystery.
Seyed Reza Borzou
Full Text Available Today improve lifestyle and health promotion is a basic requirement for human society and the need for more tangible factor in the increase in chronic diseases such as chronic kidney disease and hemodialysis process is followed. As life expectancy increases, due to the importance of promoting behavior change. The aim of this study was to evaluate the effect of health promoting behaviors was on the lifestyle of patients undergoing hemodialysis. In this study, 70 patients undergoing hemodialysis training centers - medical Hamadan were selected. That is because Hamedan only two dialysis centers, randomly one of them was selected as a test group and a control group. Of the patients referred to the center for sampling in each group 35 patients were studied. For groups of six 30-minute sessions on an individual basis during hemodialysis, held over three weeks in a row. Data analysis using descriptive statistics and statistical tests of Kolmogorov - Smirnov, T and T were analyzed with SPSS version 16. In the experimental group, health-promoting lifestyle scores before and after intervention showed significant statistical differences (001 / 0 < p. The mean scores of health-promoting lifestyle intervention and control groups after the intervention, there was a significant difference (p<0.05. Teaching with an emphasis on health-promoting behaviors, hemodialysis patients was improved lifestyle. Develop and implement training programs to improve lifestyle behaviors and health promoting effective step is hemodialysis patients.
Dzhavad-Zade, M D; Agaev, M M; Agabalaeva, L I; Karaev, M Eh; Movla-Zade, N G; Orudzheva, A K; Shepeleva, A A; Shindyan, M A
The task of the study was to investigate the effect of systematic hemodialysis on lipid and hormonal metabolic indices in patients with chronic renal insufficiency (CRI) by means of radioimmunoassay. In 83.3%, patients with CRI at the terminal stage demostrated lipid disorders noted against a background of noticeable hormonal imbalance and characterized by high levels of insulin, parathormone, cortisol, somatropin in the blood serum and a low level of triiodothyronine in the blood. Systematic hemodialysis did not result in significant changes in lipid metabolism. Lipid metabolic disorders in patients with CRI at the terminal stage were detected in 91.7% of cases. Changes in the level of hormones under study were characterized by a decrease in thyroxine concentration thus weakening thyroid function in CRI patients.
Shi, Ya-xue; Ye, Meng; Liang, Wei; Zhang, Hao; Zhao, Yi-ping; Zhang, Ji-wei
Central venous stenosis and obstruction (CVD) is a serious and prevalent challenge to both resolve the venous hypertension symptoms and maintain the pantency of the ipsilateral hemodialysis access in hemodialysis patients. This study aimed to summarize our experience of the endovascular management of the central venous stenosis or obstruction in hemodialysis patients. Twenty-four haemodialysis cases of central vein stenosis or obstruction with ipsilateral functional vascular access in our hospital between July 2006 and February 2012 were treated by interventional therapy and the data were analyzed retrospectively. Eighteen males and six females with mean age of (66.4 ± 13.8) years and manifesting with arm swelling and venous hypertension were enrolled; 62.5% of them had a history of catheterization. Venography showed stenotic lesion in 10 cases including eight cases of brachiocephalic vein stenosis and two cases of subclavian vein stenosis and 14 cases of obstruction lesions including seven cases of short brachiocephalic obstruction and seven cases of long segment obstruction. Interventional therapy was performed and the technique success rate was 83.3%. Percutaneous transluminal angioplasty (PTA) was performed in nine cases and stent was performed in 11 cases firstly. The symptoms of venous hypertension were resolved after intervention in all the cases. There was no major complication and death perioperatively. During follow-up, reintervention was done, the primary patency rates were (88.9 ± 10.5)%, (64.8 ± 10.5)% and (48.6 ± 18.7)% at 3 months, 6 months and 1 year after treatment in the PTA group; (90.0 ± 9.5)% and (77.1 ± 14.4)% at 6 months and 1 year after treatment in the stent group, respectively. The secondary patency rates were (48.6 ± 18.7)% in the PTA group and (83.3 ± 15.2)% in the stent group 1 year after treatment, respectively. There was no significant difference between the two groups (primary patency, P = 0.20; secondary patency, P = 0
Marcio Rodrigues Costa
Full Text Available Purpose: The proposal of this study was to determine the prevalence and the associated factors of erectile dysfunction (ED among hemodialysis (HD patients. Materials and Methods: This was a cross-sectional study based on data collected from HD male patients. Clinical, demographic and laboratory data of all patients were collected in three HD clinics from December 2010 to June 2011. Patients answered questions of erectile function domain from International Index of Erectile Function. Data were evaluated by descriptive analysis and by univariate (ULRA and multivariate logistic regression analysis (MLRA. Results: Three hundred and five patients participated of the study. The prevalence of ED was 68.19%. ED was associated with diabetes (DM, benign prostatic hyperplasia, glomerulonephritis as cause of chronic renal failure (CRF, smoking habits, lower creatinine levels (ULRA, use of calcium channel blocker (MLRA, aging, lower education level, alcohol consumption, DM (as cause of CRF and coronary insufficiency (ULRA and MLRA. Conclusions: ED was highly prevalent in the HD men. It was independently associated with aging, current use of alcohol, long alcohol use (even for those who do not drink more, lower education level, diabetes as cause of CRF, coronary insufficiency and use of channel blockers calcium.
Background The prevalence, determinants and prognosis of pulmonary hypertension among long-term hemodialysis patients in the USA are poorly understood. Methods A cross-sectional survey of prevalence and determinants of pulmonary hypertension was performed, followed by longitudinal follow-up for all-cause mortality. Pulmonary hypertension was defined as an estimated systolic pulmonary artery pressure of >35 mmHg using echocardiograms performed within an hour after the end of dialysis. Results Prevalent in 110/288 patients (38%), the independent determinants of pulmonary hypertension were the following: left atrial diameter (odds ratio 10.1 per cm/m2, P pulmonary hypertension (53%, CMR 168.9/1000 patient-years) and 39 among 178 without pulmonary hypertension (22%, CMR 52.5/1000 patient-years) [unadjusted hazard ratio (HR) for death 2.12 (95% confidence interval 1.41–3.19), P pulmonary hypertension remained an independent predictor for all-cause mortality [HR 2.17 (95% confidence interval 1.31–3.61), P pulmonary hypertension is common and is strongly associated with an enlarged left atrium and poor long-term survival. Reducing left atrial size such as through volume control may be an attractive target to improve pulmonary hypertension. Improving pulmonary hypertension in this group of patients may improve the dismal outcomes. PMID:22290987
Full Text Available Background/Aim. Chronic renal disease is one of the growing problems all over the world. Health-related quality of life (HRQoL is an important indicator for those with a chronic disease, such as chronic renal disease, because it may serve as predictor of mortality and hospitalization. The aim of this study was to assess HRQoL in patients on chronic maintenance hemodialysis (HD, and compare it with patients suffering from hypertension (HTA, and normal controls of the same age and gender (C. Methods. The study enrolled 224 males and females older than 18 years: 67 in the HD group, 78 in the HTA group, and 79 in the C group. HRQoL was assessed in all groups using 15-D questionnaire. Results. Significantly higher level of education was recorded in the HD group compared to other two groups. In the HD group there were significantly less employed persons (9% and significantly more retired (67.2%. All groups were similar regarding an average monthly income and marital status. We found significantly lower total HRQoL score in patients in the HD group, compared to normal controls (0.78 ± 0.16 vs. 0.89 ± 0.10 in the HTA and 0.95 ± 0.06 in the C group as well as specific scores in almost all investigated domains, except in speech, eating and mental functions. Patients in the HD and HTA groups had similar self-reported quality of life in additional 3 domains: hearing, elimination and distress, while the HD group reported significantly lower scores in remaining 9 domains: mobility, vision, breathing, sleeping, usual activities, discomfort and symptoms, depression, vitality and sexual activity. Patients in the HTA group had significantly lower scores than normal controls in 8 domains (hearing, sleeping, elimination, usual activities, discomfort and symptoms, depression, distress and vitality as well as in total quality of life, while in remaining 4 domains there was no significant difference (mobility, vision, breathing, sexual activity. Conclusion. Both
Di Micco, Lucia; Torraca, Serena; Sirico, Maria Luisa; Tartaglia, Domenico; Di Iorio, Biagio
Pulse wave velocity (PWV) is a predictor of morbidity and mortality in patients with end-stage renal disease (ESRD). Dialysis patients show cyclic changes in PWV related to their hydration status and blood pressure. Our aim is to assess the impact of daily dialysis on PWV. We performed a randomized crossover study of 60 patients who underwent standard hemodialysis (HD) three times per week for at least 6 months. Patients were classified into three groups according to their PWV values before (pre-) and after (post-) HD, with a cutoff value of 12 m s(-1), as follows: the low-low (LL) group had normal pre-HD and post-HD PWV; the high-low (HL) group had high pre-HD PWV and normal post-HD PWV; and the high-high (HH) group had high pre- and post-HD PWV. All patients continued standard HD for 2 weeks. A total of 10 patients from each group were randomly assigned to continue standard HD for 1 week and then underwent daily dialysis for 1 week. The remaining 10 patients underwent daily dialysis for 1 week and then underwent standard HD for 1 week. PWV values were measured before and 1 h after each dialysis session. With daily dialysis treatment, 2 of 20 patients (10%) moved from the PWV-HH group to the PWV-HL group, whereas 18 of 20 patients (90%) moved from the PWV-HL group to the PWV-LL group (P = 0.030). Daily dialysis reduces PWV in the ESRD patients. As PWV is a strong predictor of mortality in ESRD and has cyclic variations in patients who are on standard HD, we believe that daily dialysis may be used in patients with high PWV levels to reduce their mortality risk.
Suzuki, Hitoe; Shibuya, Asuka; Ando, Minoru; Akiba, Takashi; Nitta, Kosaku
We report a female with amyloid arthropathy of the hip joints. She was a 67-year-old woman who had been treated by hemodialysis for 22 years. She had demonstrated a 5-month history of continuous low-grade fever and pain in her left hip and she was finally unable to walk by herself. Findings on X-ray films and MRI of the hip joints suggested avascular necrosis in both femur heads. To palliate symptoms, bipolar surgery on the left hip joint was performed. Pathological examination of bone tissue specimen demonstrated that there was some , β 2 -microglobulin (β 2 -MG)-related amyloid accumulation in the femur head. Based on this clinical experience, we performed MRI screening for amyloid lesions of the hip joints in another 11 asymptomatic female patients undergoing hemodialysis for 20 years or more. Cystic lesions of the hip joints were observed in 8 patients, amyloid arthropathy in 2 patients, and fluid trapped in the joint in 1 patient. Patients with amyloidosis had significantly lower serum β 2 -MG levels than patients without amyloidosis (28.6 mg/L versus 41.4 mg/L; p=0.0339). Our findings show that dialysis-related amyloidosis of the hip joints is one of the potential and significant problems in female patients on long-term hemodialysis therapy. It may be important to screen for this pathological condition in long-term hemodialysis patients. (author)
Caetano, Cristina; Valente, Ana; Oliveira, Telma; Garagarza, Cristina
To evaluate how different compartments of body composition can affect survival in hemodialysis (HD) patients. Multicenter longitudinal observational study of a cohort of patients in HD with 12 months of follow-up. Patients from 34 Nephrocare dialysis units in Portugal were included. A total of 697 patients on maintenance HD during 4 hours 3 days per week were enrolled. Dry weight, presence of diabetes, body mass index (BMI), lean tissue index (LTI), fat tissue index (FTI), body cell mass index (BCMI), albumin and hydration status were recorded at baseline. In all patients, the assessment of body composition was carried out using the Body Composition Monitor (BCM; Fresenius Medical Care a Deutschland GmbH, Germany). Survival during a 12-month period of follow-up. Patient's mean (±standard deviation) age was 65.4 ± 14.3 years, and median (interquartile range) HD vintage was 41 (19-81) months. Patients who died during the study period, had higher age (P < .001), lower dry weight (P = .001), BMI (P < .001), albumin (P < .001), LTI (P = .015), and also lower BCMI (P = .046). Patients with diabetes (P = .045), BMI < 18.5 kg/m(2) (P < .001), albumin < 4.0 g/dL (P < .001), relative overhydration ≥ 15% (P = .001), low FTI (P = .019), and also those in the lowest tertile of BCMI (P = .022) displayed a significantly worse survival. In the Cox regression analysis, the overall mortality of patient was related to low FTI, relative overhydration, BMI < 18.5 kg/m(2), BCMI ≤ 5.2 kg/m(2), and albumin < 4.0 g/dL. Several body composition parameters demonstrated to have an important role in predicting 1-year mortality in HD patients. Albumin, FTI, and BMI were useful predictors of mortality in these patients. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
Zhai, Hongxia; Li, Liang; Yin, Yaxin; Zhang, Jinjin; Chen, Haiwei; Liu, Runmei; Xia, Yun-feng
The aim of this study was to explore the efficacy and safety of hemodialysis in interventional therapy for patients with coronary artery disease combined with chronic renal insufficiency. With the aging and social development, the number of coronary artery disease patients with chronic renal insufficiency gradually increased. Total 58 coronary heart disease patients with chronic renal dysfunction were selected. These patients were characterized with typical angina symptoms and typical electrocardiogram (ECG) changes of onset angina. Continuous oral administration of sodium bicarbonate tablets 1 g 3/day × 3 days and slow intravenous input sodium chloride 1000 ∼1500 mL 3-12 h before operation were given. By this way, all patients were treated by hydration and alkalization. After percutaneous coronary intervention (PCI) treatment, patients were immediately transferred to undergo 4 h of dialysis treatment without removing indwelling of femoral artery puncture sheath tube to protect renal function. Changes in renal function including serum creatinine, glomerular filtration rate, and urine were observed and recorded. All patients were successfully underwent PCI treatment. Within one month after PCI, there were no obvious complication and no stent thrombosis occurred. Among of 58 patients, 56 cases showed no significant increase in serum creatinine levels compared with those before operation. However, serum creatinine level of one patient increased to 251 umol/L and one patient still required permanent dialysis. Using hemodialysis in interventional therapy in coronary artery disease patients with chronic renal insufficiency could significantly improve the prognosis of the patients.
Kim, Cheol Young; Goo, Dong Erk; Kim, Dae Ho; Hong, Hyun Suk; Lee, Hae Kyoung; Choi, Duk Lin; Yang, Sung Boo; Moon, Chul
To analyse the effectiveness of percutaneous treatment of central venous obstruction in patients undergoing hemodialysis. In 100 patients, 107 central venous strictures (56 subclavian (occlusion:21, stenosis:35) and 51 innominate (occlusion:23,stenosis:28)) were assessed, and 170 percutaneous angioplasty procedures were performed. Balloon dilation of the venous lumen was the preferred mode, but if dilation was incomplete we inserted a stent at the site of the stricture. Technical success, procedural complications and the long-term patency rate were evaluated, and the patency difference according to location and degree of stricture, the existence of DM, and any history of central catheter insertion was also determined. We inserted 52 stents in 170 procedures, in 157 (92.4%) of which initial technical success was achieved. Stent migration occurred in two cases and balloon rupture in three. The 6- and 12-month primary patency rates were 46.2% and 24.1%, respectively, and the mean patency rate was 8.5 months. The 1-, 2-and 3-year accumulative patency rates were 59.8%, 47.5% and 35.7%, respectively, and the mean patency rate was 23.5 months. Other than in the history of central catheter insertion, there were no statistically significant differences in patency rates (p=0.0128). In hemodialysis patients with a central venous stricture, percutaneous angioplasty is a safe and useful procedure, but to maintain long-term central venous patency, repeated interventions are required
Full Text Available Vascular access stenosis is a major complication in hemodialysis patients. We prospectively observed 50 patients in whom 50 nitinol shape-memory alloy-recoverable technology (SMART stents were used as salvage therapy for recurrent peripheral venous stenosis. Twenty-five stents each were deployed in native arteriovenous fistula (AVF and synthetic arteriovenous polyurethane graft (AVG cases. Vascular access patency rates were calculated by Kaplan-Meier analysis. The primary patency rates in AVF versus AVG at 3, 6, and 12 months were 80.3% versus 75.6%, 64.9% versus 28.3%, and 32.3% versus 18.9%, respectively. The secondary patency rates in AVF versus AVG at 3, 6, and 12 months were 88.5% versus 75.5%, 82.6% versus 61.8%, and 74.4% versus 61.8%, respectively. Although there were no statistically significant difference in patency between AVF and AVG, AVG showed poor tendency in primary and secondary patency. The usefulness of SMART stents was limited in a short period of time in hemodialysis patients with recurrent vascular access stenosis.
Full Text Available Hemodialysis treatment methods in patients with chronic kidney failure increase the life span of these patients, but hemodialysis affects all life aspects of patients and diminishes the quality of life patients. The aim of the study was to examine the relationship between emotional intelligence and quality of life for hemodialysis patients . This study was a descriptive – correlational research conducted in 2014 on 98 hemodialysis patients Referred to Hospitals of University Medical Sciences in Iran Iranshahr . The tools used in this study included demographic questionnaire, Cyberia Shrink Emotional Intelligence Questionnaire, and the Kidney Disease Quality of Life-Short Form Questionnaire. After obtaining informed consent, patient completed the questionnaire. Finally, raw data were collected through questionnaires and were analyzed using SPSS16 Software. To investigate the relationships between predictor and criterion variables, Pearson correlation and linear regression analysis were used . The mean age of patients was 33/36 and the majority of participants were male (58.1 percent. In terms of variable of education level, majority of participants had elementary education, and 54.54% of the mean weight of the patients was 41.06 kg. Mean score of life quality was 41.06 ± 15.95 and the mean score of emotional intelligenc e was 43.99 ± 10.50. Pearson correlation coefficient with 99% p robability confidence showed significant positive correlation between the components of emotional intelligence and quality of life in hemodialysis patients (p<0.001 and emotional intelligence with regression coefficient 0.412 predicts 30% of the variance of quality of life in hemodialysis patients . It is recommended for nurses and nursing directors to improve the quality of life hemodialysis patients by training emotional intelligence skills.
Full Text Available Cardiovascular diseases are a major cause of morbidity and mortality in patients with end-stage renal disease (ESRD. The aim of our investigation was the evaluation of an extensive cardiovascular profile in hemodialysis (HD and peritoneal dialysis (PD patients. We studied 74 patients with ESRD (38 males, 36 females, maintained either on chronic HD (n= 50 or chronic PD (n= 24 and age and sex matched 20 healthy subjects as controls. The lipid profile, homo-cysteine (Hcy and C reactive protein (CRP were measured. When compared to a healthy popu-lation, HD patients displayed a marked atherogenic profile, as attested by increased levels of total cholesterol (TC, triglycerides (TG, low-density lipoprotein-cholesterol (LDL-C, apolipoprotein A (Apo A, CRP, Hcy and lower concentrations of high-density lipoprotein-cholesterol (HDL-C, Apo B, albumin (ALB. A significant difference was noted concerning the rates of Apo B, HDL-C, TC, ALB and Hcy. Same biological disorders that those found at HD patients were noted in these PD patients. One also noted lower concentration in Apo A. there were a significant diffe-rence with the reference group concerning the rates of albumin, Apo A, HDL-Cl and Hcy. When compared to PD patients, HD patients had significantly decreased concentration of LDL-C. The peculiar metabolic changes observed in the present study confirm the marked tendency of patients with impaired renal function for developing cardiovascular diseases, irrespectively of the type of dialysis. We suggest including uremia-related risk factors in the panel for evaluation of cardio-vascular risk in dialysis patients.
Full Text Available To investigate nutritional status and body composition in different ages of maintaining hemodialysis (HD patients. 129 patients (male 62, female 67 with the mean age 56.33±14.14 years on HD were divided into four groups with age under 40, 40-69, 60-69 and over 70 years. Body composition was evaluated with Multi-frequency bioelectric impedance analysis (BIA and 83 healthy subjects, matched for age and sex, were as the control. In all patients, about 6.2% were underweight with body mass index (BMI less than 18.5 Kg/m2. The incidence of underweight were 0%, 6.2%, 4.8% and 11.1% in groups under 40, 40-59, 60-69 and over 70 years respectively. Serum Creatinine, ALB, pre-ALB and normalized protein catabolic rate (nPCR were significantly decreased in patients over 70 years. The young patients under 40 years also displayed lower nPCR and CHO value compared with that of group 40-59 years. Body cell mass, lean tissue mass, lean tissue index and relative lean tissue mass in HD patients were significantly lower than that in age and sex matched control group. Meanwhile, fat mass, fat tissue index and relative fat were increase 20% than the control. They were less different between HD patients and controls in age of 40-59 years, however, difference significantly increased in other three groups and changes were most obvious in patients over 70 years. In conclusion, our study showed that nutritional status was significantly associated with the age in HD patients. Patients under 40 years and over 70 years old displayed much severer protein wasting and more fat tissue storage.
Mohamed Amine Hamzi
Full Text Available Previous studies have shown that insomnia is a common sleep disorder in patients with end-stage renal disease. This study aims to determine the prevalence and risk factors of insomnia in our chronic hemodialysis (HD patients. This is a cross-sectional study conducted in three HD units in Morocco. To assess the prevalence of insomnia, we used a specific questionnaire. Patients complaining of difficulty in falling asleep and/or nocturnal awakenings occurring seven nights a week during the last month were included in the group “insomnia;” the other patients were used as controls. Clinical, biological, and dialysis data were recorded for each patient. Sleep disorders and their subjective causes were also identified. Eighty-nine percent of questioned patients admitted to having sleep disturbances of different degrees. Insomnia was significantly associated with female gender and time of dialysis. Age, body mass index, inter-dialytic weight gain, and blood pressure were similar between the two groups, as well as dialytic parameters and drug use. There was no significant difference in the values of plasma creatinine, urea, hemoglobin, parathyroid hormone, calcium, phosphorus, C-reactive protein, and albumin between the groups. Disorders most frequently encountered in patients with insomnia were waking up at night (90%, difficulty falling asleep (60%, and daytime sleepiness (60%. The restless legs syndrome was seen in half of these patients. The main reported causes of insomnia were anxiety and/or depression (70% and bone pain (67%. Insomnia is common in HD patients and is frequently associated with other disorders of sleep. Female sex and duration on dialysis are the two risk factors found in our study. Insomnia does not appear related to any biochemical or dialysis parameters. Increased attention should be given to the management of dialysis patients regarding the diagnosis and management of insomnia and associated sleep disorders.
Full Text Available Introduction. One of the characteristic signs of uremic syndrome is anemia. One of major factors that affects on severity of anemia in ESRD is underlying diseas. The porpuse of this study is to compaire anemia between diabetic and non diabetic ESRD patients. Methods. In a case control study we compared the mean valuse of Hb, Het, MCV, MCH, MCHC, BUN, Cr and duration of dialysis between diabetic and nondiabetic patients on chronic hemodialyis. some variables (such as age, sex, use of erythropoietin, nonderolone decaonats, folic acid, ferrous sulfate, transfusion and blood loss in recent three months and acquired kidney cysts were matched between cases and controls. Results. Means of Hb were 9±1.3 and 8 ± 1.7 in diabetic and non diabetic patients (P<0.05. Mean corposcular volume in diabetic patients (91±3.1 fl was more higher than non diabetic ones (87.1 ± 8.9 (P < 0.05. Other indices had no differences between two groups (P > 0.05. Discussion. Severity of anemia in patients with diabetic nephropathy is milder that other patients with ESRD. So, Anemia as an indicator of chronocity of renal disease in diabetics is missleading.
Yoshioka, Masami; Shirayama, Yasuhiko; Imoto, Issei; Hinode, Daisuke; Yanagisawa, Shizuko; Takeuchi, Yuko; Bando, Takashi; Yokota, Narushi
AIM To investigate awareness and attitudes about preventive dental visits among dialysis patients; to clarify the barriers to visiting the dentist. METHODS Subjects included 141 dentate outpatients receiving hemodialysis treatment at two facilities, one with a dental department and the other without a dental department. We used a structured questionnaire to interview participants about their awareness of oral health management issues for dialysis patients, perceived oral symptoms and attitudes about dental visits. Bivariate analysis using the χ2 test was conducted to determine associations between study variables and regular dental check-ups. Binominal logistic regression analysis was used to determine factors associated with regular dental check-ups. RESULTS There were no significant differences in patient demographics between the two participating facilities, including attitudes about dental visits. Therefore, we included all patients in the following analyses. Few patients (4.3%) had been referred to a dentist by a medical doctor or nurse. Although 80.9% of subjects had a primary dentist, only 34.0% of subjects received regular dental check-ups. The most common reasons cited for not seeking dental care were that visits are burdensome and a lack of perceived need. Patients with gum swelling or bleeding were much more likely to be in the group of those not receiving routine dental check-ups (χ2 test, P < 0.01). Logistic regression analysis demonstrated that receiving dental check-ups was associated with awareness that oral health management is more important for dialysis patients than for others and with having a primary dentist (P < 0.05). CONCLUSION Dialysis patients should be educated about the importance of preventive dental care. Medical providers are expected to participate in promoting dental visits among dialysis patients. PMID:27648409
Phelan, P J
Background: There is a paucity of data concerning the risks associated with warfarin in hemodialysis (HD) patients. We compared major bleeding episodes in this group with HD patients not receiving warfarin and with a cohort of non-HD patients receiving warfarin. Methods: A retrospective review of 141 HD patients on warfarin (HDW), 704 HD patients not on warfarin (HDNW) and 3,266 non-dialysis warfarin patients (NDW) was performed. Hospital admissions for hemorrhagic events and ischemic strokes were examined as was hospital length of stay and blood product use. INR variability was also assessed. Results: The incidence rates for major hemorrhage per 100 patient years was 10.8 in the HDW group as compared to 8.0 in the HDNW (p = 0.593) and 2.1 in the NDW (p < 0.001) groups. Mean units of red blood cell transfusions required was higher in patients on dialysis with no significant difference between HDW and HDNW groups. The risk of ischemic stroke per 100 patient years was 1.7 in the HDW group as compared to 0.7 in the HDNW groups (p = 0.636) and 0.4 in the NDW (p = 0.003). The HDW group had higher inter-measurement INR variability compared to the NDW group (p = 0.034). In patients with atrial fibrillation, HDW group had a higher incidence of ischemic stroke than the NDW group (2.2 versus 0.4 events per 100 patient years; p = 0.024). Conclusions: This study confirms the higher bleeding risk associated with HD\\/ESRD but suggests that warfarin use in these patients may not add significantly to this risk. We also demonstrated high rates of ischemic stroke in HD patients despite warfarin use. Summary: Our study compares the frequency of major hemorrhage and secondarily, ischemic stroke in HD patients receiving or not receiving warfarin, with non-HD patients receiving warfarin. The major finding was that frequency of hemorrhage was higher in HD patients receiving warfarin than in non-HD patients receiving warfarin, but not different in HD patients with or without warfarin. A
Phelan, P J
BACKGROUND: There is a paucity of data concerning the risks associated with warfarin in hemodialysis (HD) patients. We compared major bleeding episodes in this group with HD patients not receiving warfarin and with a cohort of non-HD patients receiving warfarin. METHODS: A retrospective review of 141 HD patients on warfarin (HDW), 704 HD patients not on warfarin (HDNW) and 3,266 non-dialysis warfarin patients (NDW) was performed. Hospital admissions for hemorrhagic events and ischemic strokes were examined as was hospital length of stay and blood product use. INR variability was also assessed. RESULTS: The incidence rates for major hemorrhage per 100 patient years was 10.8 in the HDW group as compared to 8.0 in the HDNW (p = 0.593) and 2.1 in the NDW (p < 0.001) groups. Mean units of red blood cell transfusions required was higher in patients on dialysis with no significant difference between HDW and HDNW groups. The risk of ischemic stroke per 100 patient years was 1.7 in the HDW group as compared to 0.7 in the HDNW groups (p = 0.636) and 0.4 in the NDW (p = 0.003). The HDW group had higher inter-measurement INR variability compared to the NDW group (p = 0.034). In patients with atrial fibrillation, HDW group had a higher incidence of ischemic stroke than the NDW group (2.2 versus 0.4 events per 100 patient years; p = 0.024). CONCLUSIONS: This study confirms the higher bleeding risk associated with HD\\/ESRD but suggests that warfarin use in these patients may not add significantly to this risk. We also demonstrated high rates of ischemic stroke in HD patients despite warfarin use. SUMMARY: Our study compares the frequency of major hemorrhage and secondarily, ischemic stroke in HD patients receiving or not receiving warfarin, with non-HD patients receiving warfarin. The major finding was that frequency of hemorrhage was higher in HD patients receiving warfarin than in non-HD patients receiving warfarin, but not different in HD patients with or without warfarin. A
Full Text Available Introduction. Factors that have been reported to affect erythropoietin (EPO responsiveness in hemodialysis (HD patients include iron deficiency, chronic inflammation, secondary hyperparathyroidism, malnutrition and inadequate HD dose. The aim of the study was to analyze the deteminants of hemoglobin variability in HD patients. Methods. The study encompassed 526 patients (197 F and 329 M. According to HD vintage at the beginning of the study the patients were divided into two groups: group-1 encompassed 153 patients with HD vintage bellow 24 months, and group-2 encompassed 329 patients with HD vintage over 24 months. Over a period of 21 months after admission the following parameters were analyzed: hemoglobin (Hb, EPO dose, iron dose, HD dose (eKT/V, transferrin saturation (TSAT, C-reactive protein (CRP, ferritin and serum albumin at 3 months and parathyroid hormone (PTH at 6 months. Results. The percentage of patients with Hb>=105g/L significantly improved, and the average Hb level significantly increased in both groups over a period of 21 months. The average EPO and iron dose significantly decreased, but TSAT and ferritin levels significantly increased over a period of 21 months. The average eKT/V and s-albumin values significantly increased, but the average CRP and PTH levels significantly decresead over a period of 21 months. In group-1 EPO dose and CRP, but in group-2 EPO dose, ferritin, HD vintage, and iron dose were statistically significant predictors of the Hb level 9 months after admission. Conclusions. Insufficient EPO therapy, iron deficiency and chronic inflammation were the main factors of inadequate correction of anemia in HD patients before admission.
Full Text Available OBJECTIVE: Depression is the most important neuropsychiatric complication in chronic kidney disease because it reduces quality of life and increases mortality. Evidence demonstrating the association between dialysis shift and depression is lacking; thus, obtaining such evidence was the main objective of this study. METHOD: This cross-sectional study included patients attending a hemodialysis program. Depression was diagnosed using Beck's Depression Inventory. Excessive daytime sleepiness was evaluated using the Epworth Sleepiness Scale. RESULTS: A total of 96 patients were enrolled (55 males, age 48±14 years. Depression and excessive daytime sleepiness were observed in 42.7% and 49% of the patients, respectively. When comparing variables among the three dialysis shifts, there were no differences in age, dialysis vintage, employment status, excessive daytime sleepiness, hemoglobin, phosphorus levels, or albumin levels. Patients in the morning shift were more likely to live in rural areas (p<0.0001, although patients in rural areas did not have a higher prevalence of depression (p= 0.30. Patients with depression were more likely to be dialyzed during the morning shift (p= 0.008. Independent risk factors for depression were age (p<0.03, lower levels of hemoglobin (p<0.01 and phosphorus (p<0.01, and dialysis during the morning shift (p= 0.0009. The hospitalization risk of depressive patients was 4.5 times higher than that of nondepressive patients (p<0.008. CONCLUSION: These data suggest that depression is associated with dialysis shift, higher levels of phosphorus, and lower levels of hemoglobin. The results highlight the need for randomized trials to determine whether this association occurs by chance or whether circadian rhythm disorders may play a role.
Full Text Available Patients with chronic renal insufficiency (CRI have reduced hemoglobin levels, mostly as a result of decreased kidney production of erythropoietin, but the relation between renal insufficiency and the magnitude of hemoglobin reduction has not been well defined. Hereditary hemochromatosis is an inherited disorder of iron metabolism. The importance of the association of hemochromatosis with treatment for anemia among patients with CRI has not been well described. We analyzed the frequency of the C282Y and H63D mutations in the HFE gene in 201 Brazilian individuals with CRI undergoing hemodialysis. The analysis of the effects of HFE mutations on iron metabolism and anemia with biochemical parameters was possible in 118 patients of this study (hemoglobin, hematocrit, ferritin levels, transferrin saturation, and serum iron. A C282Y heterozygous mutation was found in 7/201 (3.4% and H63D homozygous and heterozygous mutation were found in 2/201 (1.0% and 46/201 (22.9%, respectively. The allelic frequencies of the HFE mutations (0.017 for C282Y mutation and 0.124 for H63D mutation did not differ between patients with CRI and healthy controls. Regarding the biochemical parameters, no differences were observed between HFE heterozygous and mutation-negative patients, although ferritin levels were not higher among patients with the H63D mutation (P = 0.08. From what we observed in our study, C282Y/H63D HFE gene mutations are not related to degrees of anemia or iron stores in CRI patients receiving intravenous iron supplementation (P > 0.10. Nevertheless, the present data suggest that the H63D mutation may have an important function as a modulating factor of iron overload in these patients.
Azar, Ahmad Taher
Cooling the dialysate below 36.5 degree C is an important factor that contributes to hemody-namic stability in patients during hemodialysis (HD). In this study, the effect of dialysate tempe-rature on hemodynamic stability, patients' perception of dialysis discomfort and post dialysis fatigue were assessed in a group of patients on HD. A total of 50 patients, all of whom were on 3-times-perweek dialysis regimen, were studied. Patients were assessed during six dialysis sessions; in three sessions, the dialysate temperature was normal (37 degree C) and in three other sessions, the dialysate temperature was low (35 degree C). Specific scale questionnaires were used in each dialysis session, to evaluate the symptoms during the dialysis procedure as well as post-dialysis fatigue, and respective scores were noted. The results showed that usage of low dialysate temperature was associated with the following: higher post dialysis systolic blood pressure (P< 0.05) and lower post dialysis heart rate (P<0.01), with similar ultrafiltration rates, better intra-dialysis symptoms score and post-dialysis fatigue scores (P< 0.001, and P<0.001, respectively), shorter post-dialysis fatigue period (P<0.001) as well as higher urea removal (P< 00001) and Kt/V (P< 0.0001). Patients' perceptions were measured by a questionnaire, which showed that 76% of them felt more energetic after dialysis with cool dialysate and requested to be always dialyzed with cool dialysate. Low temperature dialysate is particularly beneficial for highly symptomatic patients, improves tolerance to dialysis in hypotensive patients and helps increase ultrafiltration while maintaining hemodynamic stability during and after dialysis. (author)
Mancini, Andrea; Castriotta, Giuseppe; Angelini, Pernina; Bozzi, Michele; Giancaspro, Vincenzo; La Raia, Elvira; Nisi, Maria Teresa; Proscia, Anna Rita; Tarantino, Giuseppe; Vitale, Ottavia; Cuzzola, Cristoforo
A pseudoaneurysm or false aneurysm of the brachial artery is an uncommon occurrence in patients receiving hemodialysis with arteriovenous fistula (AVF). We describe the case of a 76-year-old woman presenting with a large, tender, pulsatile mass in the right antecubital region 10 cm from the AVF. B-mode ultrasound examination revealed a saccular hematoma. Color doppler showed a recirculation movement of blood, creating a two colors image called "Korean flag". The patient was transferred to the surgical unit where she first underwent ultrasound-guided compression and then surgical repair of the pseudoaneurysm. Two weeks after surgery the AVF was used again as an access for hemodialysis. Differentiating between a false and a true aneurysm based on ultrasound is not always straightforward. Doppler ultrasound findings can be decisive for the early diagnosis of a pseudoaneurysm to ensure proper treatment planning given the dangerous complications of ruptures. Treatment options include: compression, percutaneous thrombin injection, endovascular exclusion with covered stents, aneurysmectomy and surgical repair. Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.
Full Text Available Heparin, a commonly used anticoagulant agent, is frequently used in patients undergoing hemodialysis. As with most medications, heparin has a significant side effect profile. Two of its most important side effects, major bleeding and hyperkalemia, may be devastating without immediate diagnosis and treatment. Major bleeding such as gastrointestinal, genitourinary or intracranial bleeding is occasionally encountered and rarely neglected. However, heparin-induced cardiac tamponade is rarely encountered and may be easily overlooked. Another side effect, heparin-induced hyperkalemia, an unusual but well-described side effect, is frequently forgotten until life-threatening arrhythmia has occurred. We report a case involving a 40-year-old male patient with uremia, who had received heparin for 10 days for deep vein thrombosis in the left lower extremity. Hemopericardium with cardiac tamponade and life-threatening hyperkalemia were both noted in this patient.
Full Text Available Introduction. Sleep disorders and psychological disturbances are common in end-stage renal disease (ESRD patients. However, despite their frequency and importance, such conditions often go unnoticed, since all patients do not clearly manifest fully expressed symptoms. Objective. This study aimed to determine the prevalence of depression and poor sleep quality and to examine the association between these disorders and demographic, clinical and treatment-related characteristics of ESRD patients on hemodialysis (HD. Methods. The study included 222 patients (132 men and 90 women, mean age 57.3±11.9 years, from 3 HD centers in Central Serbia, which provided us with biochemical parameters and demographic data. Sleep quality and depression were assessed using the Pittsburgh Sleep Quality Index (PSQI and Beck Depression Inventory (BDI, respectively. Results. The average BDI was 16.1±11.3. Depressed patients were significantly older (p=0.041, had a significantly lower dialysis adequacy (p=0.027 and a significantly worse quality of sleep (p<0.001, while they did not show significant difference as regarding sex, employment, marital status, comorbidities, dialysis type, dialysis vintage, shift and laboratory parameters. The average PSQI was 7.8±4.5 and 64.2% of patients were poor sleepers. Poor sleepers were significantly older (p=0.002, they were more often females (p=0.027 and had a significantly higher BDI (p<0.001, while other investigated variables were not correlated with sleep quality. A statistically significant positive correlation was found between BDI and PSQI (r=0.604; p<0.001. Conclusion. Depression and poor sleep quality are frequent and interrelated among HD patients.
treatment could reduce their problems especially in case of overweight between two hemodialysis sessions. Therefore, the use of this model in hemodialysis patients is recommended.
Seo, I.S.; Sy, W.M.; Heneghan, W.; Manoli, A.; Gozum, M.
Prosthetic graft A-V fistulae (AVf) (10 adults) and internal AVf (14 adults) as avenues of hemodialysis were created surgically in the limbs of 24 renal failure patients. AVf can malfunction or become obstructed and to date only contrast fistulography (CnF) is used to document such problems. Thirty-three RnF's were performed in 24 patients and CnF's in seven patients. Eleven had clinical features of AVf malfunction and 13 were asymptomatic. 99mTc compounds, TcO/sup -//sub 4/ or MDP (20 mCi) were injected into the AVf through a 19-gauge butterfly. 2 sec. dynamic images (qualitative data) and simultaneous computer acquisition in 64 x 64 byte mode with 0.5 sec/frame for 120 frames (quantitative data) were obtained. Normal qualitative and quantitative criteria were established. 10/11 symptomatic and 2/13 asymptomatic patients showed abnormal scintigraphic features and time activity curves indicating AVf malfunction. All 12 patients demonstrated abnormal collateral formation; 8/12 had stenosis, 3/12 showed equivocal stenosis and in 1/12 no stenosis was shown. In these 12 patients the S/sub 2/ (second circulation)/S/sub 1/ (initial circulation) ratio was below 10%. In 5/12 whose S/sub 2//S/sub 1/ ratio was less than 1%, the CnF and surgical repair confirmed the presence of stenosis. RnF appears to be a simple, benign, and accurate imaging procedure in the evaluation of AVf malfunction.
Luís Henrique Bezerra Cavalcanti Sette
Full Text Available We reviewed the literature regarding the serum levels of the enzymes aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyl transferase in patients with chronic kidney disease on hemodialysis with and without viral hepatitis. Original articles published up to January 2013 on adult patients with chronic kidney disease on hemodialysis were selected. These articles contained the words “transaminases” “aspartate aminotransferase” “alanine aminotransferase” “gamma glutamyl transferase,” “liver enzymes”, AND “dialysis” OR “hemodialysis”. A total of 823 articles were retrieved. After applying the inclusion and exclusion criteria, 49 articles were selected. The patients with chronic kidney disease on hemodialysis had reduced serum levels of aminotransferases due to hemodilution, lower pyridoxine levels, or elevated homocysteine levels. The chronic kidney disease patients on hemodialysis infected with the hepatitis C virus also had lower aminotransferase levels compared with the infected patients without chronic kidney disease. This reduction is in part due to decreased viremia caused by the dialysis method, the production of a hepatocyte growth factor and endogenous interferon-α, and lymphocyte activation, which decreases viral action on hepatocytes. Few studies were retrieved on gamma-glutamyl transferase serum levels; those found reported that there were no differences between the patients with or without chronic kidney disease. The serum aminotransferase levels were lower in the patients with chronic kidney disease on hemodialysis (with or without viral hepatitis than in the patients with normal renal function; this reduction has a multifactorial origin.
Full Text Available Background and Objectives: Hemodialysis as a treatment manner in chronic renal failure is a stressful process and has several various psycho-cognitive and social complications. The present study evaluated effect of cognitive-behavioral group therapy on anxiety and depression in hemodialysis patients. Methods: This research was a clinical trial study. Samples were young adults who were 18-45 years old. The Participants were divided into two groups (case & control. The Beck depression & anxiety inventories were used as a measure of psychological symptoms at pretest and posttest and Cognitive-behavioral group therapy as intervention was done at week12. Data Were analyzed with SPSS-16 and t-test, chi square. A p<0.05 was considered significant. Results: In this study, there was not a significant difference in the demographic characteristics between the two groups. Before of intervention, mean Anxiety score of the experimental group was 25.72±5.87, and in the case group it was 25.22±7.56 as well as mean Depression score in the two groups was 35.44±14.97, 33.11±9.2 respectively. The difference of the two groups in anxiety and depression scores was not significant. After the intervention, the mean anxiety score of experimental group was 15.94±6.23, and in the case group it was 28.05±10.04 (p<0.05. Mean of depression score in the experimental group was 22.27±13.32, and in the case group it was 33.94±9.46 (p<0.01.Conclusion: This research showed that group therapy (cognitive-behavioral decreased depression and anxiety remarkably in dialysis patients. Therefore, it is suggested that in addition to the prescription of medication, psychological interventions be done for such patients.
The CT findings of 19 hemodialyzed patients with brain hemorrhage (BH) were evaluated. The 30-day mortality rate was 78.9%. The lesion locations in the 19 cases with BH were putaminal hemorrhage in 8 patients, putaminothalamic (mixed) hemorrhage in 7, thalamic hemorrhage in one, subcortical hemorrhage in one, and cerebellar hemorrhage in one. In the remaining patient, the bleeding was confined to the ventricular system. One remarkable CT finding was the formation of a massive hematoma in most cases. In some cases, the hematoma occupied the greater part of one cerebral hemisphere. Oral anticoagulants and/or antiplatelet drugs, and intravenous heparinization could produce massive accumulations of blood in the brain parenchyma. The second major finding was the low CT absorption values of the hematoma at the acute stage, as compared to that of hypertensive BH. This decreased absorption density resulted from a low hemoglobin concentration in the hematoma itself due to the severe anemia occurring in patients on long-term maintenance hemodialysis. (author)
Otake, S.; Yamana, D.; Tsuruta, Y.; Mizutani, H.; Ohba, S.
The aim of this study was to determine the spectrum of MR findings of presumed amyloid arthropathy of the hip joints in patients on long-term hemodialysis. We prospectively performed T1- and T2-weighted spin-echo imaging on 152 consecutive patients on hemodialysis. The duration of hemodialysis ranged from 5 months to 24 years, 2 months (mean: 8 years, 8 months). The frequency, location, and signal intensity of bone lesions were assessed. In 12 cases with contrast-enhanced MR examination, enhancement pattern of bone lesions, synovial lesions, and intra-articular lesions were characterized. Bone lesions presumed to be amyloid deposits were identified in 60 patients (39 %). Magnetic resonance imaging revealed that amyloid lesions were more extensive than anticipated by plain radiographs. All bone lesions showed decreased signal intensity on T1-weighted images. On T2-weighted images, bone lesions showed increased signal intensity in 32 patients (54 %), decreased signal intensity in 11 patients (18 %), and both increased and decreased signal intensity in 17 patients (28 %). Following intravenous injection of gadolinium-based contrast, all bone lesions showed moderate enhancement. Synovial thickening could not be identified on T1- and T2-weighted images. However, contrast-enhanced images showed thickened synovial membrane, which could be differentiated from joint fluid. Intra-articular nodules showed decreased or intermediate signal intensity on T1-weighted images and decreased signal intensity on T2-weighted images; the intra-articular nodules were contiguous with subchondral bone lesions. Magnetic resonance imaging is useful for evaluating the distribution and extent of amyloidosis of the hip joints in patients undergoing long-term hemodialysis. (orig.) (orig.)
Ohkawa, Sakae; Kaizu, Yukiko; Odamaki, Mari; Ikegaya, Naoki; Hibi, Ikuo; Miyaji, Kunihiko; Kumagai, Hiromichi
There is controversy about whether the dietary protein requirement of 1.2 g/kg/d for hemodialysis (HD) patients, in the nutritional guidelines recommended by the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-KDOQI), is reasonable. A cross-sectional study was conducted in 129 stable HD patients without diabetes (84 men, 45 women) to investigate the association between the protein equivalent of nitrogen appearance normalized by ideal body weight (nPNAibw), an index of protein intake, and skeletal muscle mass or other metabolic consequences. Patients were divided into 5 groups according to nPNAibw index. Midthigh muscle area (TMA), midthigh subcutaneous fat area (TSFA), abdominal muscle area (AMA), abdominal subcutaneous fat area (ASFA), and visceral fat area (AVFA) were measured using computed tomography, and various nutritional parameters were compared among these groups. TMA and AMA values increased with increasing dietary protein intake from less than 0.7 g/kg/d to 0.9-1.1 g/kg/d and showed a plateau at greater than 0.9 to 1.1 g/kg/d of dietary protein intake. Conversely, fat mass, including TSFA, ASFA, and AVFA, and serum potassium concentration increased with graded protein intake, and no plateau was formed. Patients with nPNAibw greater than 1.3 g/kg/d satisfied the criterion of visceral obesity. Although serum prealbumin levels showed a trend similar to that of muscle mass, there was no significant difference in serum albumin levels among the study groups. Optimal dietary protein requirement for patients undergoing maintenance HD in a stable condition appears to be less than the level recommended by the NKF-KDOQI nutritional guidelines.
Kogirima, Miho; Sakaguchi, Katsuhiko; Nishino, Kohsuke; Ichikawa, Yoko; Hiramatsu, Fumie; Yamamoto, Shigeru
Due to high resting energy expenditure (REE) in maintenance hemodialysis patients, an increase in energy intake is usually recommended to improve their nutritional status. However, some patients appear to have poor appetite and low energy intake. In such patients low energy metabolism is expected. We hypothesized that in maintenance hemodialysis patients there are two types of the energy metabolism, high and low. This study was aimed at finding the energy metabolism in maintenance hemodialysis patients, especially in those with poor nutritional status. Subjects were hemodialysis out-patients (34 males and 20 females, mean age 59.1+/-10.7 y). REE was measured by an indirect calorimeter. Protein intake was obtained from normalized protein catabolic rate (nPCR), and physical activity level (PAL) was obtained by time study. Nutritional status assessed by serum albumin concentration was poor (3.7+/-0.2 g/dL) in spite of the adequate protein intake (1.1+/-0.3 g/kg per day). Only 11% of the subjects had appropriate serum albumin concentration. Mean REE was 24.6 kcal/kg per day which was lower than that of healthy Japanese (26.5 kcal/kg per day). REE and PAL positively correlated with serum albumin concentration (p<0.01). The results suggest that maintenance hemodialysis patients with poor nutritional status may have low REE.
Raul Carlos Wahle
Full Text Available In coinfected HBV/HCV patients, HBV replication is usually suppressed by HCV over the time. No study to date has evaluated the HBV viremia in long-term follow-up after HCV treatment in hemodialysis patients with HBV/HCV coinfection. This study aimed to assess the evolution of HBV viremia after HCV treatment in this special population. Ten hemodialysis patients with HBV/HCV coinfection with dominant HCV infection (HBV lower than 2000 IU/mL and significant fibrosis were treated with interferon-alpha 3 MU 3×/week for 12 months and could be followed for at least 36 months after HCV treatment. Six cases of HBV reactivation (60% during follow-up were observed and 5/6 had been successfully treated for HCV. Patients with HBV reactivation received anti-HBV therapy. Our preliminary findings indicate that treatment of hepatitis C in HBV/HCV coinfected hemodialysis patients may favor HBV reactivation. Thus, continued monitoring of HBV viremia must be recommended and prompt anti-HBV therapy should be implemented.
Poorgholami, Farzad; Abdollahifard, Sareh; Zamani, Marzieh; Kargar Jahromi, Marzieh; Badiyepeyma Jahromi, Zohreh
Chronic renal failure exposes patients to the risk of several complications, which will affect every aspect of patient's life, and eventually his hope. This study aims to determine the effect of stress management group training on hope in hemodialysis patients. In this quasi-experimental single-blind study, 50 patients with renal failure undergoing hemodialysis at Motahari Hospital in Jahrom were randomly divided into stress management training and control groups. Sampling was purposive, and patients in stress management training group received 60-minute in-person training by the researcher (in groups of 5 to 8 patients) before dialysis, over 5 sessions, lasting 8 weeks, and a researcher-made training booklet was made available to them in the first session. Patients in the control group received routine training given to all patients in hemodialysis department. Patients' hope was recorded before and after intervention. Data collection tools included demographic details form, checklist of problems of hemodialysis patients and Miller hope scale (MHS). Data were analyzed in SPSS-18, using Chi-square, one-way analysis of variance, and paired t-test. Fifty patients were studied in two groups of 25 each. No significant difference was observed between the two groups in terms of age, gender, or hope before intervention. After 8 weeks of training, hope reduced from 95.92±12.63 to 91.16±11.06 (P=0.404) in the control group, and increased from 97.24±11.16 to 170.96±7.99 (P=0.001) in the stress management training group. Significant differences were observed between the two groups in hope scores after the intervention. Stress management training by nurses significantly increased hope in hemodialysis patients. This low cost intervention can be used to improve hope in hemodialysis patients.
Rokni Yazdi, Hadi; Faraji, Safoura; Ahmadi, Farokhlegha; Shahmirzae, Reza
Endothelial injury is a well-known complication in chronic kidney disease (CKD) and hemodialysis. One of the sites in which early vascular changes may be detected is the retina. Of course, these flow changes may not be detected in ophthalmologic exams, but it seems that color Doppler sonography of retinal arteries may be helpful in these cases. In previous studies on CKD patients who underwent chronic hemodialysis,hemodynamic changes were noted in retinal arteries, but no study has been performed to determine which of the two processes (CKD or chronic hemodialysis) can produce these changes. In this study, we tried to answer this question. Doppler ultrasonography of the orbital vasculature including the ophthalmic artery and the central retinal artery was carried out in 17 patients (34 eyes) with chronic renal failure (CRF) who underwent hemodialysis, 17 patients (34 eyes)with CRF without a history of hemodialysis and 17 normal patients (34 eyes). The peak systolic velocity (PSV), end diastolic velocity (EDV) and resistance index were measured excluding hypertensive, diabetic patients and patients with cardiovascular disease. The mean PSV and EDV were lower only in the ophthalmic artery of CRF patients irrespective of the history of hemodialysis (PSV was 35.2 in hemodialysis, 38.8 in CRF and 51.6 in normal patients, P value = 0.001 and EDV was 7.4, 9.4, 11.8, respectively, P value =0.001) with no significant difference in the resistance index of the ophthalmic artery and other parameters [EDV, PSV, Resistance Index (RI)] in the central retinal artery. The mean PSV and DSV in the ophthalmic artery were lower only in the ophthalmic artery of CRF patients regardless of the history of hemodialysis. No significant difference in the resistance index of the ophthalmic artery and other parameters (EDV, PSV) of the central retinal artery were noted between different groups. These findings suggest that microvascular disease and endothelial cell dysfunction of the orbital
Full Text Available Sudden cardiac death is one of the primary causes of mortality in chronic hemodialysis (HD patients. Prolonged QTc interval is associated with increased rate of sudden cardiac death. The aim of this article is to assess the abnormalities found in electrocardiograms (ECGs, and to explore factors that can influence the QTc interval.A total of 141 conventional HD patients were enrolled in this study. ECG tests were conducted on each patient before a single dialysis session and 15 minutes before the end of dialysis session (at peak stress. Echocardiography tests were conducted before dialysis session began. Blood samples were drawn by phlebotomy immediately before and after the dialysis session.Before dialysis, 93.62% of the patients were in sinus rhythm, and approximately 65% of the patients showed a prolonged QTc interval (i.e., a QTc interval above 440 ms in males and above 460ms in females. A comparison of ECG parameters before dialysis and at peak stress showed increases in heart rate (77.45±11.92 vs. 80.38±14.65 bpm, p = 0.001 and QTc interval (460.05±24.53 ms vs. 470.93±24.92 ms, p<0.001. After dividing patients into two groups according to the QTc interval, lower pre-dialysis serum concentrations of potassium (K+, calcium (Ca2+, phosphorus, calcium* phosphorus (Ca*P, and higher concentrations of plasma brain natriuretic peptide (BNP were found in the group with prolonged QTc intervals. Patients in this group also had a larger left atrial diameter (LAD and a thicker interventricular septum, and they tended to be older than patients in the other group. Then patients were divided into two groups according to ΔQTc (ΔQTc = QTc peak-stress- QTc pre-HD. When analyzing the patients whose QTc intervals were longer at peak stress than before HD, we found that they had higher concentrations of Ca2+ and P5+ and lower concentrations of K+, ferritin, UA, and BNP. They were also more likely to be female. In addition, more cardiac construction
Full Text Available Non-adherence to the therapeutic regimen is an increasingly growing problem especially among patients undergoing hemodialysis. The aim of this study was to modify the Greek version of Simplified Medication Adherence Questionnaire (GR-SMAQ for patients undergoing hemodialysis (GR-SMAQ-HD and explore its validity and reliability. Between June 2016 and November 2016 a group of patients undergoing hemodialysis (N=107 completed the Greek version of SMAQ. The study was carried out in three Dialysis Units of Hospitals of Athens and Peloponnese region, Greece. The form of GR-SMAQ was modified specifically for renal patients while four additional items were added so as the tool study all aspects of adherence to hemodialysis regimen. Construct validity was checked through exploratory factor analysis with principal Component Analysis with the Equamax method. Test-retest reliability and internal consistency were tested. Statistical analysis was performed using the IBM SPSS Statistics version 21. The significance level was set up at 5%. The Greek version of SMAQ for patients undergoing hemodialysis includes eight questions. Three factors emerged from factor analysis. Cronbach’s α coefficient was 0.742 for the whole scale and for each subscale was for Medication Adherence 0.75, for Attendance at hemodialysis session 0.856 and for Diet/Fluid restriction was 0.717. The total mean score was 6.29 (±1.82. GR-SMAQ-HD is a reliable and valuable tool that can be used by hemodialysis nurses and students of nursing for detection of adherence levels in clinical practice.
Wong, Kevin; Marks, Barry A; Qureshi, Anwer; Stemm, Joseph J
Central venous catheterization is widely used in patients on hemodialysis. A rare complication associated with the clinical use of central venous catheters is perforation of the heart or major vessels. We report a case of inadvertent perforation of the left atrium and thrombosis after the placement of a hemodialysis catheter in the right internal jugular vein. In such cases, surgical removal of the central venous catheter from perforation sites in the heart and vessel walls poses anesthetic challenges because of the high risk of pneumothorax, hemorrhage, arrhythmias, thrombosis, and death.
Green, Darren; Roberts, Paul R; New, David I; Kalra, Philip A
Sudden cardiac death (SCD) is the leading cause of death in hemodialysis patients, accounting for death in up to one-quarter of this population. Unlike in the general population, coronary artery disease and heart failure often are not the underlying pathologic processes for SCD; accordingly, current risk stratification tools are inadequate when assessing these patients. Factors assuming greater importance in hemodialysis patients may include left ventricular hypertrophy, electrolyte shift, and vascular calcification. Knowledge regarding SCD in hemodialysis patients is insufficient, in part reflecting the lack of an agreed-on definition of SCD in this population, although epidemiologic studies suggest the most common times for SCD to occur are toward the end of the long 72-hour weekend interval between dialysis sessions and in the 12 hours immediately after hemodialysis. Accordingly, it is hypothesized that the dialysis procedure itself may have important implications for SCD. Supporting this is recognition that hemodialysis is associated with both ventricular arrhythmias and dynamic electrocardiographic changes. Importantly, echocardiography and electrocardiography may show changes that are modifiable by alterations to dialysis prescription. The most effective preventative strategy in the general population, implanted cardioverter-defibrillator devices, are less effective in the presence of chronic kidney disease and have not been studied adequately in dialysis patients. Last, many dialysis patients experience SCD despite not fulfilling current criteria for implantation, making appropriate allocation of defibrillators uncertain. Copyright © 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
Unal, Kevser Sevgi; Balci Akpinar, Reva
The aim of this study is to examine the effectiveness of foot reflexology and back massage on optimizing the sleep quality and reducing the fatigue of hemodialysis patients. The study includes 105 volunteer patients who were registered at a private dialysis clinic and were receiving hemodialysis treatment. Foot reflexology and back massage were administered to the patients two times a week for four weeks. The Visual Analogue Scale for Fatigue and the Pittsburg Sleep Quality Index were used to collect data. The differences between the pretest and posttest score averages of the patients on the Visual Analogue Scale for Fatigue and the Pittsburg Sleep Quality Index were statistically significant (p Foot reflexology and back massage were shown to improve the sleep quality and reduce the fatigue of hemodialysis patients. Compared to back massage, foot reflexology was determined to be more effective. Copyright © 2016 Elsevier Ltd. All rights reserved.
Yu, Junhong; Ng, Hui J; Nandakumar, Mooppil; Griva, Konstadina
This study set out to explore the experience of food cravings and thirst, and their management strategies in patients on hemodialysis. Semi-structured interviews with N = 32 hemodialysis patients were analyzed thematically. Findings indicated that food cravings and thirst were common in everyday life of patients and resulted in different emotional responses. A combination of cognitive and behavioral strategies was employed, including avoidance, controlled consumption, and substitution. Self-monitoring and compensatory strategies were also used to prevent or compensate for lapses. These findings lay the groundwork for future work aimed to improve adherence in end-stage renal disease patients. © The Author(s) 2014.
Full Text Available Brain natriuretic peptide (BNP levels increase in patients with congestive heart failure. Theoretically, BNP levels can be helpful in the determination of the "dry weight" of hemodialysis patients. To evaluate the effect of hemodialysis on the plasma concentration of BNP and to determine the factors that affect BNP levels during hemodialysis in patients with chronic renal failure, we studied five stable patients with chronic renal failure. A total of 15 blood samples were obtained for BNP levels at 24, 48 and 72 hours after the last hemodialysis session. The plasma BNP levels did not change significantly either with ultrafiltration volume or with time since last dialysis. However, the BNP levels correlated positively with the erythropoietin (EPO dose (r=0.98, P< 0.001 and negatively with the serum albumin levels (r = 0.94, P=0.02. Univariate analysis showed that the EPO dose (P=0.001 and the albumin level (P=0.02 were significant predictors of BNP level. Adjusted multivariate analysis showed significant interaction between the EPO dose and the albumin level (P=0.01, P=0.03 respectively. In conclusion: the plasma BNP levels were not significantly influenced by ultrafiltration volume or time since last dialysis. However, the BNP levels may be a useful prognostic parameter for assessing the risk of cardiovascular morbidity and mortality in hemodialysis patients.
Full Text Available Vitamin D deficiency is fequently observed in chronic kidney disease. We conducted this study to determine the concentration of the above-mentioned parameters and the correlation between them in order to optimize therapy with vitamin D in patients with end-stage renal disease (ESRD on hemodialysis. In 53 patients on hemodialysis due to ESRD, vitamin D [Calcidiol (25(OHD], parathyroid hormone (PTH, calcium, phosphorus, albuminuria, albumin:creatinine ratio (ACR and other parameters have been followed up. Analysis of the levels of vitamin D has been carried out by High Performance Liquid Chromatography (HPLC, the PTH is determined by the system Centaur XP, Siemens Diagnostic, Electro-chemiluminescence immunoassay (ECLIA, and for albumin in urine we used immunological method [Miltigent microalbumin assay (Abbott Laboratories Diagnostics. We found out deficiency and insufficiency of vitamin D in 56.6% and 37.7%, as well as average 4.5 times increase in the PTH, hyperphosphatemia, hypocalcemia, albuminuria (A2 or A3, over 10 times increase in the ACR, secondary hyperparathyroidism. We registered a negative correlation between vitamin D and PTH. We confirmed the increase in creatinine and cystatin C in the patients on hemodialysis. There are few literature data for patients on hemodialysis, however, regarding the extent of the vitamin deficiency and its relationship with PTH, albuminuria, calcium, phosphorus, etc. Our data have indicated that patients on hemodialysis due to ESRD are associated with high incidence of vitamin D insufficiency or deficiency.
Wong, S W; Chan, Y M; Lim, T S
There is mounting evidence demonstrating the importance of adequate physical activity to promote better well-being among hemodialysis patients. Available data pertaining to the levels of physical activity and its determinants among hemodialysis patients is, however, scarce in Malaysia. The objectives of this study are hence to determine the levels of physical activity and it associated factors among hemodialysis patients. A total of 70 subjects were recruited from three dialysis centres in Selangor. A face-to-face interview was conducted to obtain socio-demographic data and subjects' knowledge on dietary sources. Medical history, biochemical parameters and weight status were obtained from medical records. Physical activity level (PAL) was assessed using the Global Physical Activity Questionnaire (GPAQ). A total of 81.4% and 18.6% of the respondents had low and moderate PALs, respectively. Thus, none of the respondents had high PAL. Serum creatinine, education level, personal income and knowledge score on potassium-related medical complications were factors found to correlate significantly with PAL. Multiple linear regression analysis showed that higher PAL was predicted by a lower knowledge score on dietary sodium source, higher education and higher serum creatinine. Despite consistent documentation of the potential positive impact of physical exercise on hemodialysis outcomes, the level of physical activity remains low among these patients. It is hoped that these findings can add to the existing body of knowledge and serve as a supporting document for the formulation of appropriate interventions to improve the status of physical activity among hemodialysis patients in Malaysia.
Full Text Available Background: Whey protein can improve quality of life and vitamin E can reduce oxidative stress. Due to the reduced quality of life in hemodialysis patients, this study was conducted to evaluate the effect of whey beverage fortified with vitamin E on quality of life in hemodialysis patients. Methods: Ninety two 17 to 65 years old patients who were on hemodialysis were randomly assigned to four groups of (i 1 receiving whey beverage fortified with vitamin E, (ii 2 receiving whey beverage, (iii 3 receiving vitamin E, and (iv 4 as the control group receiving no intervention. SF- 12 questionnaire was used for assessing quality of life in the participants. Results: Bodily pain score improved significantly in group 3 while, a significant decline was seen for bodily pain in control group. An improvement was seen in groups 1 and 2. Physical health showed a significant improvement in group 1. Considering social functioning scores, improvement in whey beverage and vitamin E groups was seen. An improvement of quality of life in whey beverage fortified with vitamin E was noticed. Conclusion: Whey protein and vitamin E were shown to reduce oxidative stress and their effect on neurotransmitters in brain such as serotonin and dopamine leads to improvement in quality of life in hemodialysis patients. Doing longer studies with questionnaires such as SF-36, may help precise investigation of whey protein and vitamin E effects on quality of life of hemodialysis patients.
Parvan, Kobra; lakdizaji, Sima; Roshangar, Fariborz; Mostofi, Mahtab
Introduction: Despite many advances in the treatment of chronic renal failure, the quality of sleep in patients who suffer from this disease is at the risk. The high prevalence of sleep disorders in hemodialysis patients, which is concomitant with physical, behavioral, and psychological problems, has always affected these patients' quality of life (QOL). This study aimed to determine the relationship between quality of sleep and quality of life in hemodialysis patients. Methods: By using a descriptive and correlational design, this study was conducted on 245 hemodialysis patients in 2012. Patients were selected by convenience sampling from the hemodialysis ward of four training hospitals of Tabriz and Maragheh. Quality of sleep was measured by the Pittsburgh Sleep Quality Index (PSQI), and the quality of life for patients was measured by the Kidney Disease Quality Of Life questionnaire (KDQOL-SF). Results: 83.3% of hemodialysis patients had poor quality of sleep. Poor quality of life was significantly associated with poor quality of sleep. There was a significant negative correlation between global PSQI and important aspects of quality of life including physical health, symptoms and problems, the impact of kidney disease on daily life, burden of kidney disease, mental health, social support, and sexual function. Conclusion: The low quality of sleep in hemodialysis patients has an effect on the deterioration of their quality of life. Therefore, training, counseling, and advocacy programs should be developed to improve the patients' quality of sleep and quality of life, especially those with lower education level and income, and older people. PMID:25276738
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.
Full Text Available Quality of Life (QoL is a consistent and powerful predictor that affects the out-come in end-stage renal disease (ESRD patients on dialysis. This study was undertaken to identify the factors that might predict QoL scores among ESRD patients on hemodialysis (HD. The study was conducted at three HD units in Saudi Arabia from January 2007 to January 2008. We studied 100 HD patients (53 males and 47 females and used the SF-36 and KDQoL-SF forms covering six domains of QoL, namely physical, emotional, social, illness impact, medical and financial satisfaction, and overall general health. The mean age of the study patients was 47.5 ± 13.8 years and the mean duration of dialysis was 77.2 ± 75.5 months. The QoL scores were 45.8 ± 17.1 for general health, 53.1 ± 32.0 for physical QoL, 50.5 ± 14.8 for emotional QoL, 54.9 ± 18.1 for social QoL, 46.5 ± 13.7 for illness impact, and 45.9 ± 12.2 for the medical and financial domain. The total QoL score was 49.5 ± 13.7. The male patients had statistically significantly reduced QoL and younger patients had better QoL scores. The QoL scores revealed a decreasing trend with decreasing level of education; they were elevated among employed patients. Multiple linear regression analysis demonstrated that age, dialysis duration, and male sex were negative predictors of QoL score. We conclude from our study that QoL is reduced in all the health domains of HD patients. Older age, male gender, unemployment, and duration of dialysis adversely affected the QoL scores. Adequate management of some of these factors could influence patient outcomes.
Hung, Szu-Chun; Tarng, Der-Cherng
The role of aldosterone has expanded from its genomic effects that involve renal sodium transport to nongenomic effects such as cardiac and renal fibrosis. Elevated aldosterone levels are associated with increased mortality in the general population. However, the association is reversed in patients with end-stage renal disease on maintenance hemodialysis. We have shown that the inverse association between aldosterone and mortality in hemodialysis patients is due to the confounding effect of volume overload. Volume overload, which is prevalent in patients with chronic kidney disease, is associated with both lower aldosterone concentrations and higher mortality. Our findings support salt and water restriction and treatment of hyperaldosteronemia in hemodialysis patients who have achieved strict volume control. Copyright © 2016 Elsevier Inc. All rights reserved.
Gao Peizhu; Ding Wenbin; Ming Zhibing; Sun Juyun
Objective: To summarize the experience of the nursing care of indwelling catheter thrombolysis for acute thrombosis in the arteriovenous fistula in eight hemodialysis patients. Methods: After breaking thrombus through indwelling catheter, both bolus injection and micro-pump continuous infusion of urokinase was employed in eight hemodialysis patients with acute thrombosis in the arteriovenous fistula. The necessary nursing measures were carried out to assist the whole therapeutic procedure. Results: All the patients could well cooperate with the procedure of indwelling catheter thrombolysis and urokinase infusion. The reopening rate of the obstructed fistula was 100%. Conclusion: Indwelling catheter thrombolysis with urokinase infusion is a simple, effective and safe treatment for acute thrombosis in the arteriovenous fistula in hemodialysis patients. In order to obtain optimal results, necessary nursing measures must be carried out. (authors)
Hemodialysis patients are at greater risk of cardiovascular disease. Higher than expected cardiovascular morbidity and mortality in this population has been attributed to dislipidemia as well as inflammation. The causes of inflammation in hemodialysis patients are multifactorial. Several markers were used for the detection of inflammatory reaction in patients with chronic renal disease. These markers can be used for the prediction of future cardiovascular events. Among the several parameters of inflammatory markers, serum, CRP is well known and its advantages for the detection of inflammation and its predictor ability has been evaluated in several studies. This review addressed the associated factors and markers of inflammation in hemodialysis patients. In addition, their ability in predicting future atherosclerosis and effect of treatment has been reviewed. However, this context particularly in using CRP as a prediction marker of inflammation and morbidity requires further studies. PMID:24009946
Hemodialysis patients are at greater risk of cardiovascular disease. Higher than expected cardiovascular morbidity and mortality in this population has been attributed to dislipidemia as well as inflammation. The causes of inflammation in hemodialysis patients are multifactorial. Several markers were used for the detection of inflammatory reaction in patients with chronic renal disease. These markers can be used for the prediction of future cardiovascular events. Among the several parameters of inflammatory markers, serum, CRP is well known and its advantages for the detection of inflammation and its predictor ability has been evaluated in several studies. This review addressed the associated factors and markers of inflammation in hemodialysis patients. In addition, their ability in predicting future atherosclerosis and effect of treatment has been reviewed. However, this context particularly in using CRP as a prediction marker of inflammation and morbidity requires further studies.
Jang, Hyung Suk; Lee, Chang Suk; Yang, Young Hee
This study was done to examine the relation of uncertainty, uncertainty appraisal, and self-management in patients undergoing hemodialysis, and to identify factors influencing self-management. A convenience sample of 92 patients receiving hemodialysis was selected. Data were collected using a structured questionnaire and medical records. The collected data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlations and multiple regression analysis with the SPSS/WIN 20.0 program. The participants showed a moderate level of uncertainty with the highest score being for ambiguity among the four uncertainty subdomains. Scores for uncertainty danger or opportunity appraisals were under the mid points. The participants were found to perform a high level of self-management such as diet control, management of arteriovenous fistula, exercise, medication, physical management, measurements of body weight and blood pressure, and social activity. The self-management of participants undergoing hemodialysis showed a significant relationship with uncertainty and uncertainty appraisal. The significant factors influencing self-management were uncertainty, uncertainty opportunity appraisal, hemodialysis duration, and having a spouse. These variables explained 32.8% of the variance in self-management. The results suggest that intervention programs to reduce the level of uncertainty and to increase the level of uncertainty opportunity appraisal among patients would improve the self-management of hemodialysis patients.
Full Text Available The kinetics of protein transport to and from the vascular compartment play a major role in the determination of fluid balance and plasma refilling during hemodialysis (HD sessions. In this study we propose a whole-body mathematical model describing water and protein shifts across the capillary membrane during HD and compare its output to clinical data while evaluating the impact of choosing specific values for selected parameters.The model follows a two-compartment structure (vascular and interstitial space and is based on balance equations of protein mass and water volume in each compartment. The capillary membrane was described according to the three-pore theory. Two transport parameters, the fractional contribution of large pores (αLP and the total hydraulic conductivity (LpS of the capillary membrane, were estimated from patient data. Changes in the intensity and direction of individual fluid and solute flows through each part of the transport system were analyzed in relation to the choice of different values of small pores radius and fractional conductivity, lymphatic sensitivity to hydraulic pressure, and steady-state interstitial-to-plasma protein concentration ratio.The estimated values of LpS and αLP were respectively 10.0 ± 8.4 mL/min/mmHg (mean ± standard deviation and 0.062 ± 0.041. The model was able to predict with good accuracy the profiles of plasma volume and serum total protein concentration in most of the patients (average root-mean-square deviation < 2% of the measured value.The applied model provides a mechanistic interpretation of fluid transport processes induced by ultrafiltration during HD, using a minimum of tuned parameters and assumptions. The simulated values of individual flows through each kind of pore and lymphatic absorption rate yielded by the model may suggest answers to unsolved questions on the relative impact of these not-measurable quantities on total vascular refilling and fluid balance.
Conclusion: The results of this study provided evidence that there is a strong relationship between the health locus of control and self-management behaviors in hemodialysis patients. This study provides important information for medical professionals as they design strategies to educate hemodialysis patients on their health locus of control and self-management behaviors.
Silva, Bruno Caldin da; Sanjuan, Adriano; Costa-Hong, Valéria; Reis, Luciene Dos; Graciolli, Fabiana; Consolim-Colombo, Fernanda; Bortolotto, Luiz Aparecido; Moyses, Rosa Maria Affonso; Elias, Rosilene Motta
Bone metabolism disorder (BMD) and vascular dysfunction contribute to excess cardiovascular mortality observed in hemodialysis patients. Vascular dysfunction, a new marker of atherosclerosis, can play a role in this risk. Even though associated with higher mortality in the general population, such vascular evaluation in patients on hemodialysis has not been extensively studied. In this cross-sectional study, hemodialysis patients were submitted to flow-mediated dilation, subendocardial viability ratio (SEVR) and ejection duration index assessment, in order to estimate the impact of BMD markers on vascular dysfunction. A matched cohort of patients with (n = 16) and without (n = 11) severe secondary hyperparathyroidism (SHPT) was studied. Additionally, time spent under severe SHPT was also evaluated. Patients with severe SHPT had lower SEVR and higher ejection duration index, indicating higher cardiovascular risk. Lower SEVR was also associated to diastolic blood pressure (r = 0.435, p = 0.049), serum 25-Vitamin-D levels (r = 0.479, p = 0.028) and to more time spent under severe secondary hyperparathyroidism (SHPT), defined as time from PTH > 500pg/ml until parathyroidectomy surgery or end of the study (r = -0.642, p = 0.027). In stepwise multiple regression analysis between SEVR and independent variables, lower SEVR was independently associated to lower serum 25-Vitamin-D levels (p = 0.005), female sex (p = 0.012) and more time spent under severe SHPT (p = 0.001) in a model adjusted for age, serum cholesterol, and blood pressure (adjusted r² = 0.545, p = 0.001). Subendocardial perfusion was lower in patients with BMD, reflecting higher cardiovascular risk in this population. Whether early parathyroidectomy in the course of kidney disease could modify such results still deserves further investigation. Distúrbios do metabolismo ósseo (DMO) e alterações da função vascular contribuem para a elevada mortalidade de pacientes em hemodiálise. A disfunção vascular
Chai, Chao; Liu, Saifeng; Fan, Linlin; Liu, Lei; Li, Jinping; Zuo, Chao; Qian, Tianyi; Haacke, E Mark; Shen, Wen; Xia, Shuang
Cerebral venous oxygen saturation (SvO 2 ) is an important indicator of brain function. There was debate about lower cerebral oxygen metabolism in hemodialysis patients and there were no reports about the changes of deep regional cerebral SvO 2 in hemodialysis patients. In this study, we aim to explore the deep regional cerebral SvO 2 from straight sinus using quantitative susceptibility mapping (QSM) and the correlation with clinical risk factors and neuropsychiatric testing . 52 hemodialysis patients and 54 age-and gender-matched healthy controls were enrolled. QSM reconstructed from original phase data of 3.0 T susceptibility-weighted imaging was used to measure the susceptibility of straight sinus. The susceptibility was used to calculate the deep regional cerebral SvO 2 and compare with healthy individuals. Correlation analysis was performed to investigate the correlation between deep regional cerebral SvO 2 , clinical risk factors and neuropsychiatric testing. The deep regional cerebral SvO 2 of hemodialysis patients (72.5 ± 3.7%) was significantly lower than healthy controls (76.0 ± 2.1%) (P deep regional cerebral SvO 2 in patients. The Mini-Mental State Examination (MMSE) scores of hemodialysis patients were significantly lower than healthy controls (P deep regional cerebral SvO 2 did not correlate with MMSE scores (P = 0.630). In summary, the decreased deep regional cerebral SvO 2 occurred in hemodialysis patients and dialysis duration, parathyroid hormone, hematocrit, hemoglobin and red blood cell may be clinical risk factors.
Gopalakrishnan, Natarajan; Usha, Thiruvengadam; Thopalan, Balasubramaniyan; Dhanapriya, Jeyachandran; Dineshkumar, Thanigachalam; Thirumalvalavan, Kaliaperumal; Sakthirajan, Ramanathan
Hemophilia A is a hereditary X-linked recessive disease caused by mutations in the gene encoding factor VIII (FVIII), occurring in 1 out of 10,000 persons. Life expectancy and quality of life have dramatically improved recently in patients with hemophilia. Chronic kidney disease and need for renal replacement therapy in these patients are rare. The development of inhibitors to FVIII is the most serious complication of hemophilia and makes treatment of bleeds very challenging. We describe here a 28-year-old male patient with severe hemophilia A with presence of factor VIII inhibitor, who had end stage renal disease. Central venous access device was inserted along with infusion of factor eight inhibitor bypass activity before and after the procedure. He is currently on thrice weekly hemodialysis and doing well for 6 months without bleeding episodes. To our knowledge, hemophilia A with factor VIII inhibitor managed with hemodialysis has not been reported so far. © 2016 International Society for Hemodialysis.
Hassanzadeh, Mohammadali; Kiani, Fatemeh; Bouya, Salehoddin; Zarei, Mohammad
This study aimed to compare the effects of relaxation techniques on fatigue in hemodialysis patients. This clinical trial study was conducted on 105 hemodialysis patients. The subjects were categorized into three groups as: relaxation, aromatherapy and control. In the relaxation group, Benson muscle relaxation techniques were employed; in the aromatherapy group, the inhalation of two drops of 5% lavender essential oil used and the control group only received regular healthcare actions. Data collected by using brief fatigue inventory, before and after the intervention. Results of the current study indicated significant differences in the mean of changes in fatigue scores before and after the intervention between the relaxation and aromatherapy groups, but the difference was insignificant in the control group. Aromatherapy with lavender essential oil can decrease the level of fatigue in the patients undergoing hemodialysis compared to Benson relaxation techniques. Copyright © 2018 Elsevier Ltd. All rights reserved.
de Francisco, Angel L M; Kim, Joseph; Anker, Stefan D; Belozeroff, Vasily; Canaud, Bernard; Chazot, Charles; Drüeke, Tilman B; Eckardt, Kai-Uwe; Floege, Jürgen; Kronenberg, Florian; Macdougall, Iain C; Marcelli, Daniele; Molemans, Bart; Passlick-Deetjen, Jutta; Schernthaner, Guntram; Stenvinkel, Peter; Wheeler, David C; Fouqueray, Bruno; Aljama, Pedro
ARO, an observational study of hemodialysis (HD) patients in Europe, aims to enhance our understanding of patient characteristics and practice patterns to improve patient outcome. HD patients (n = 8,963) from 134 Fresenius Medical Care facilities treated between 2005 and 2006 were randomly selected from 9 European countries (Czech Republic, France, Hungary, Italy, Poland, Portugal, Spain, Slovak Republic and Slovenia) and Turkey. Information was captured on demographics, comorbidities, medications, laboratory and dialysis parameters, and outcome. Patients were followed for 1.4 ± 0.7 years. Wide variation by country was observed for age, sex and diabetes as a cause of chronic kidney disease. Cardiovascular disease was present in 73% of patients. Dialysis parameters were homogeneous across countries. Arteriovenous fistulas were frequently used (73%). More incident patients had hemoglobin <11 g/dl than prevalent patients (50 vs. 33%, respectively). Phosphatemia and intact parathyroid hormone were similar between incident and prevalent patients (4.7 ± 1.2 mg/dl and 190 vs. 213 ng/l, respectively). Medication use varied widely by country. In total, 5% of patients underwent renal transplantation. Overall death rate was 124/1,000 patient-years. ARO revealed differences in HD practice patterns and patient characteristics in the 10 participating countries. Future ARO studies will fill gaps in the knowledge about the care of European HD patients. Copyright © 2010 S. Karger AG, Basel.
Luis, Desiree; Zlatkis, Karyn; Comenge, Beatriz; García, Zoraida; Navarro, Juan F; Lorenzo, Victor; Carrero, Juan Jesús
The multiple dietary restrictions recommended to hemodialysis patients may be difficult to achieve and, at the same time, may result in nutritional deficiencies rendering a poor dietary quality. We here assess the dietary quality and adherence to renal-specific guideline recommendations among hemodialysis patients from a single center in Canary Islands, Spain. Cross-sectional study, including 91 patients undergoing maintenance hemodialysis. Clinical data and 3-day dietary records were collected. We compared patient's reported nutrients intake with guideline recommendations. We also evaluated their alignment with current American Heart Association dietary guidelines for cardiovascular prevention. Seventy-seven percent and 50% of patients consumed less than the recommended daily energy and protein, respectively. Although half of the patients met the recommendations for dietary fat intake, this was accounted by an excess of saturated fat in 92% of them. Only 22% consumed sufficient fiber. A very small proportion of patients (less than 50%) met the requirements for vitamins and other micronutrients. Insufficient dietary intake was observed in most patients for all vitamins except for cobalamin. Similarly, inadequate dietary intake was observed for many minerals, by both excess (phosphorus, calcium, sodium, and potassium) and defect (magnesium). Most patients met the recommendations for iron and zinc in their diets. A large proportion of hemodialysis patients at our center did not meet current renal-specific dietary recommendations. The quality of the diet was considered poor and proatherogenic according to American Heart Association guidelines. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
Full Text Available BACKGROUNDS: This study was conducted to determine the prevalence and severity of anemia in children and adolescents on chronic hemodialysis, and to identify independent predictors of anemia in children on hemodialysis. METHODS: This cross-sectional study was performed between September 2005 and January 2006. The study population consisted of 25 patients aged 7−20 years on chronic hemodialysis from pediatric hemodialysis centers in Isfahan. RESULTS: A total of 22 (88% patients had hemoglobin levels of <11 g/dL (anemic and 12 patients (48% had hemoglobin levels of <8 g/dL (severe anemia. The mean age of these patients was 15.5 ± 3.7 years. Mean time on chronic dialysis was 20.44 ± 15.25 months. Anemia was more common and more severe among children who were on dialysis for less than 6 months. There was an inverse relationship between the severity of anemia and duration of hemodialysis (P = 0.019, r = – 0.465. Nearly all patients were treated with erythropoietin, Children with more severe anemia received slightly higher dose of erythropoietin (P = 0.09, r = 0.202. There was a significant difference between serum albumin values in anemic patients and patients without anemia (P = 0.023. There was a correlation between serum albumin and hemoglobin level (r = 0.511, P = 0.01. Intact PTH levels were >200 pg/ml in 16 patients (66% and >400 pg/ml in 9 patients (37. 5%. There was a reverse correlation between intact PTH level >200 pg/ml and hemoglobin level (r = -0.505, P = 0.046. CONCLUSIONS: The prevalence of anemia in hemodialysis children in Isfahan appears to be higher than that reported in the other studies in spite of extensive use of rHuEPO and iron supplementation. We found this to be especially true for patients new on hemodialysis (less than 6 months and in those with low albumin and severe hyperparathyroidism. KEY WORDS: Hemodialysis, anemia, children.
Onofriescu, Mihai; Siriopol, Dimitrie; Voroneanu, Luminita; Hogas, Simona; Nistor, Ionut; Apetrii, Mugurel; Florea, Laura; Veisa, Gabriel; Mititiuc, Irina; Kanbay, Mehmet; Sascau, Radu; Covic, Adrian
Chronic subclinical volume overload occurs very frequently and may be ubiquitous in hemodialysis (HD) patients receiving the standard thrice-weekly treatment. It is directly associated with hypertension, increased arterial stiffness, left ventricular hipertrophy, heart failure, and eventually, higher mortality and morbidity. We aimed to assess for the first time if the relationship between bioimpedance assessed overhydration and survival is maintained when adjustments for echocardiographic parameters are considered. A prospective cohort trial was conducted to investigate the impact of overhydration on all cause mortality and cardiovascular events (CVE), by using a previously reported cut-off value for overhydration and also investigating a new cut-off value derived from our analysis of this specific cohort. The body composition of 221 HD patients from a single center was assessed at baseline using bioimpedance. In 157 patients supplemental echocardiography was performed (echocardiography subgroup). Comparative survival analysis was performed using two cut-off points for relative fluid overload (RFO): 15% and 17.4% (a value determined by statistical analysis to have the best predictive value for mortality in our cohort). In the entire study population, patients considered overhydrated (using both cut-offs) had a significant increased risk for all-cause mortality in both univariate (HR = 2.12, 95%CI = 1.30-3.47 for RFO>15% and HR = 2.86, 95%CI = 1.72-4.78 for RFO>17.4%, respectively) and multivariate (HR = 1.87, 95%CI = 1.12-3.13 for RFO>15% and HR = 2.72, 95%CI = 1.60-4.63 for RFO>17.4%, respectively) Cox survival analysis. In the echocardiography subgroup, only the 17.4% cut-off remained associated with the outcome after adjustment for different echocardiographic parameters in the multivariate survival analysis. The number of CVE was significantly higher in overhydrated patients in both univariate (HR = 2.46, 95%CI = 1.56-3.87 for RFO >15% and HR = 3.67, 95%CI = 2
Full Text Available Chronic subclinical volume overload occurs very frequently and may be ubiquitous in hemodialysis (HD patients receiving the standard thrice-weekly treatment. It is directly associated with hypertension, increased arterial stiffness, left ventricular hipertrophy, heart failure, and eventually, higher mortality and morbidity. We aimed to assess for the first time if the relationship between bioimpedance assessed overhydration and survival is maintained when adjustments for echocardiographic parameters are considered.A prospective cohort trial was conducted to investigate the impact of overhydration on all cause mortality and cardiovascular events (CVE, by using a previously reported cut-off value for overhydration and also investigating a new cut-off value derived from our analysis of this specific cohort. The body composition of 221 HD patients from a single center was assessed at baseline using bioimpedance. In 157 patients supplemental echocardiography was performed (echocardiography subgroup. Comparative survival analysis was performed using two cut-off points for relative fluid overload (RFO: 15% and 17.4% (a value determined by statistical analysis to have the best predictive value for mortality in our cohort.In the entire study population, patients considered overhydrated (using both cut-offs had a significant increased risk for all-cause mortality in both univariate (HR = 2.12, 95%CI = 1.30-3.47 for RFO>15% and HR = 2.86, 95%CI = 1.72-4.78 for RFO>17.4%, respectively and multivariate (HR = 1.87, 95%CI = 1.12-3.13 for RFO>15% and HR = 2.72, 95%CI = 1.60-4.63 for RFO>17.4%, respectively Cox survival analysis. In the echocardiography subgroup, only the 17.4% cut-off remained associated with the outcome after adjustment for different echocardiographic parameters in the multivariate survival analysis. The number of CVE was significantly higher in overhydrated patients in both univariate (HR = 2.46, 95%CI = 1.56-3.87 for RFO >15% and HR = 3
Kwan, Bonnie Ching-Ha; Chow, Kai-Ming; Ma, Terry King-Wing; Cheng, Phyllis Mei-Shan; Leung, Chi-Bon; Li, Philip Kam-Tao; Szeto, Cheuk-Chun
Cardiovascular disease is the major cause of mortality and morbidity in dialysis patients. Recently, circulating endotoxin is found to associate with the systemic inflammatory state and cardiovascular disease of dialysis patients. Previous studies showed that the use of ultrapure dialysate for hemodialysis could reduce the exposure to exogenous endotoxin. We studied the effect of using ultrapure dialysate for hemodialysis on circulating endotoxin and bacterial DNA fragment levels and vascular stiffness. This is an open-labeled prospective study of 25 patients (14 male). Circulating endotoxin and bacterial DNA level, vascular stiffness as represented by arterial pulse wave velocity (PWV), nutrition and hydration status were monitored before and repeatedly throughout 12 months after the use of ultrapure dialysate for hemodialysis. The average age was 58.9 ± 10.2 years; 21 patients completed the study. Within 4 weeks of conversion to ultrapure dialysate for hemodialysis, the plasma endotoxin level fell from 0.302 ± 0.083 to 0.209 ± 0.044 EU/ml (p hemodialysis patients, circulating endotoxin level is associated with vascular stiffness and systemic inflammation. Using ultrapure dialysate for hemodialysis effectively reduces circulating endotoxin level in hemodialysis patients. The long-term benefit of using ultrapure dialysate for hemodialysis requires further study. © 2013 S. Karger AG, Basel.
Danyelle Romana Alves Rios
Full Text Available Hemodialysis is a modality of blood filtration in which accumulated toxins and water are removed from the body. This treatment is indicated for patients at the end stage of renal disease. Vascular access complications are responsible for 20–25% of all hospitalizations in dialyzed patients. The occurrence of thrombosis in the vascular access is a serious problem that may severely compromise or even make the hemodialysis impossible, which is vital for the patient. The aim of this study was to investigate inflammatory profile in patients undergoing hemodialysis as well as the association between these alterations and vascular access thrombosis. A total of 195 patients undergoing hemodialysis have been evaluated; of which, 149 patients had not experienced vascular access thrombosis (group I and 46 patients had previously presented this complication (group II. Plasma levels of cytokines including interleukin (IL- 2, IL-4, IL-5, IL-10, TNF-α, and IFN-γ were measured by cytometric bead array. Our results showed that patients with previous thrombotic events (group II had higher levels of the IL-2, IL-4, IL-5, and IFN-γ when compared to those in group I. Furthermore, a different cytokine signature was detected in dialyzed patients according to previous occurrences or not of thrombotic events, suggesting that elevated levels of T-helper 1 and T-helper 2 cytokines might, at least in part, contribute to this complication.
Kotoda, Atsushi; Akimoto, Tetsu; Kato, Maki; Kanazawa, Hidenori; Nakata, Manabu; Sugase, Taro; Ogura, Manabu; Ito, Chiharu; Sugimoto, Hideharu; Muto, Shigeaki; Kusano, Eiji
It is widely assumed that central venous stenosis (CVS) is most commonly associated with previous central venous catheterization among the chronic hemodialysis (HD) patients. We evaluated the validity of this assumption in this retrospective study. The clinical records from 2,856 consecutive HD patients with vascular access failure during a 5-year period were reviewed, and a total of 26 patients with symptomatic CVS were identified. Combined with radiological findings, their clinical characteristics were examined. Only seven patients had a history of internal jugular dialysis catheterization. Diagnostic multidetector row computed tomography angiography showed that 7 of the 19 patients with no history of catheterization had left innominate vein stenosis due to extrinsic compression between the sternum and arch vessels. These patients had a shorter period from the time of creation of the vascular access to the initial referral (9.2 ± 7.6 months) than the rest of the patients (35.5 ± 18.6 months, p = 0.0017). Our findings suggest that cases without a history of central venous catheterization may not be rare among the HD patients with symptomatic CVS. However, those still need to be confirm by larger prospective studies of overall chronic HD patients with symptomatic CVS.
Riedel, E; Nündel, M; Hampl, H
In hemodialysis patients, free amino acids and alpha-ketoacids in plasma were determined by fluorescence HPLC to assess the effect of alpha-ketoglutarate administration in combination with the phosphate binder calcium carbonate on the amino acid metabolism. During 1 year of therapy in parallel to inorganic phosphate, urea in plasma decreased significantly, histidine, arginine and proline as well as branched chain alpha-ketoacids, in particular alpha-ketoisocaproate, a regulator of protein metabolism, increased. Thus, administration of alpha-ketoglutarate with calcium carbonate effectively improves amino acid metabolism in hemodialysis patients as it decreases hyperphosphatemia.
Full Text Available Abdulmecit Yildiz,1 Fatih Tufan2 1Department of Nephrology, Uludag University School of Medicine, Bursa, 2Department of Geriatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, TurkeyWe read the recently published and well-designed study of Lee et al that suggests that bioimpedance analysis (BIA gives relevant information about hydration status and malnutrition in hemodialysis patients. The authors recommend that utilization of BIA routinely in hemodialysis patients would be rational. We would like to make a few comments about their study.View original paper by Lee et al.
Kakey, Musher Ismail Salih; Abdoulrahman, Kamaran Kaiani
The present study aims to evaluate iron related parameters in chronic renal failure (CRF) patients on hemodialysis (HD). The study was carried out in Kidney Dialysis Center of Hawler Teaching Hospital in Erbil governorate. This study comprised (76) patients with chronic renal failure on hemodialysis and 41 healthy subjects as a control group of same ages. All hemodialysis patients were taking erythropoietin. The blood samples were taken from the patients before and after the process of hemodialysis for liver parameters and oxidative stress estimations. The results of this study showed lower levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin, total bilirubin, total protein and total antioxidant capacity (TAC), while higher levels of alkaline phosphatase (ALP), direct bilirubin and malondialdeyhde (MDA) before analysis was seen. Hemodialysis causes increasing in AST, ALT, albumin, total bilirubin, total protein and decreasing in ALP, direct bilirubin MDA and TAC.
Golan, Eliezer; Haggiag, Isabelle; Os, Pnina; Bernheim, Jacques
Background and objectives: Pain is a frequent complaint of hemodialysis (HD) patients, yet information regarding its causes and frequency is relatively scarce. The aim of this study was to evaluate the frequency and possible causes of chronic pain in patients who are on long-term HD.
Christensen, Alan J.; And Others
Examined the joint effects of private body consciousness (PBC) and degree of illness-related physical impairment on treatment regimen adherence in a sample of 52 hemodialysis patients. Predicted the effect of PBC on adherence would vary as a function of patients' level of illness-related physical impairment. Results are discussed in terms of…
Pezeshgi, Aiyoub; Moharrami, Bahareh; Kolifarhood, Goodarz; Sadeghi, Alireza; Asadi-Khiavi, Masoud
Introduction: Cardiovascular events are the major cause of death in patients with chronic renal failure. About half of dialysis patients because of reduced phosphorus clearance have hyperphosphatemia. Hyperphosphatemia and following secondary hyperparathyroidism lead to some cardiovascular changes. Hemodialysis (HD) partly removes phosphorus during each dialysis session. Objectives: Presented study was designed to evaluate dialyzer variation effect on phosphorus level as a prognostic factor a...
Full Text Available Aim: comparative investigation of cardos (antibodies to angiotensin II receptor subtype 1 (AT., C-terminal fragment, diovan (Valsartan or both drug combination effects (changing of clinical picture, physical exertion tolerance and quality of life for treatment chronic heart failure (CHF patients. Methods. 12-month open-label randomized research was performed. CHF patients (NYHA Class l-ll, n=30 with concomitant chronic kidney disease (stage V, conventional hemodialysis were randomized (10 patients in each group for 6-month treatment by cardos (group I, average dose 1,8g/day, diovan (group II, average dose 80mg/dayorboth drug combination (group III, cardos 1,8g/day and diovan 80mg/day. CHD basic treatment was prescribed for all patients. In a 6-month drug crossover between groups I and I was performed, group III was divided into 2 subgroups (subgroup IIIA— cardos, subgroup NIB — diovan followed by next 6-month treatment. Results. Long-term treatment by cardos has improved functional class (NYHA of CHF patients with concomitant chronic kidney disease (stage V, conventional hemodialysis. cardos, diovan and both drug combination have demonstrated improvement of physical exertion tolerance, quality of life and patient clinical status during 6-min walking test. Conclusion. Cardos and diovan have shown the same efficacy. Cardos can be used as real alternative in case of ARA administration necessity
Kugler, Christiane; Maeding, Ilona; Russell, Cynthia L
Adherence to diet and fluid restrictions by adults on hemodialysis treatment is challenging. This study compared non-adherence (NA) to diet and fluid restrictions between adult US and German hemodialysis patients, and assessed potential predictors for NA. A cross-sectional multicenter comparative study of 456 adult hemodialysis patients was conducted in 12 outpatient-based hemodialysis centers in the United States and Germany. NA was based on self-report using the Dialysis Diet and Fluid Non-adherence Questionnaire (DDFQ). Laboratory marker, interdialytic weight gain (IDWG) and dialysis adequacy (Kt/V) information were obtained from medical records. Mean time on dialysis was 50 months (range 3-336); mean age was 62 years (range 19-91), with the majority of patients (89.7%) being white. Self-reported frequency of NA to diet was 80.4% and to fluid 75.3% in the total sample. The degree of NA to diet and fluid differed significantly, with the US patients (68.1% vs. 61.1%) reporting less NA when compared with German (81.6% vs. 79.0%) patients (phemodialysis patients. Our findings suggest that patient, condition-related, socioeconomic and health care system-related factors may contribute to NA to diet and fluid restrictions.
Chen, Hung-Yuan; Cheng, I-Chih; Pan, Yi-Ju; Chiu, Yen-Ling; Hsu, Shih-Ping; Pai, Mei-Fen; Yang, Ju-Yeh; Peng, Yu-Sen; Tsai, Tun-Jun; Wu, Kwan-Dun
Sleep disturbance is common in dialysis patients and is associated with the development of enhanced inflammatory responses. Cognitive-behavioral therapy is effective for sleep disturbance and reduces inflammation experienced by peritoneal dialysis patients; however, this has not been studied in hemodialysis patients. To determine whether alleviation of sleep disturbance in hemodialysis patients also leads to less inflammation, we conducted a randomized controlled interventional study of 72 sleep-disturbed hemodialysis patients. Within this patient cohort, 37 received tri-weekly cognitive-behavioral therapy lasting 6 weeks and the remaining 35, who received sleep hygiene education, served as controls. The adjusted post-trial primary outcome scores of the Pittsburgh Sleep Quality Index, the Fatigue Severity Scale, the Beck Depression Inventory, and the Beck Anxiety Inventory were all significantly improved from baseline by therapy compared with the control group. The post-trial secondary outcomes of high-sensitive C-reactive protein, IL-18, and oxidized low-density lipoprotein levels significantly declined with cognitive-behavioral therapy in comparison with the control group. Thus, our results suggest that cognitive-behavioral therapy is effective for correcting disorganized sleep patterns, and for reducing inflammation and oxidative stress in hemodialysis patients.
Full Text Available A 66-year-old man with severe renal insufficiency presented with mild confusion associated with uremia. Cranial magnetic resonance imaging (MRI showed no remarkable changes. The patient was placed on short-duration hemodialysis (2 hours with smaller surface area and low blood flow (100 mL/min to avoid dialysis disequilibrium syndrome (DDS. His consciousness gradually improved and he did not develop apparent DDS symptoms. However, T2-weighted FLAIR MRI showed increased signal intensities bilaterally in the cortical and subcortical areas of the occipital lobe on day 15. In other words, cranial MRI showed cerebral edema, indicating asymptomatic DDS. On day 29, cranial MRI showed a return to findings on admission. In this case, because the patient did not have apparent DDS symptoms despite MRI changes, we diagnosed asymptomatic cerebral edema. The patient was discharged on regular intermittent HD without any neurological deficits. No further neurological disturbances were noted during 1-year follow-up. MRI findings in ESKD patients without DDS symptoms help to clarify the diagnosis of cerebral edema. In this case, the patient did not have apparent DDS symptoms and was therefore diagnosed with asymptomatic cerebral edema.
Winkelmayer, Wolfgang C.; Wheeler, David C.; van Biesen, Wim; Tugwell, Peter; Manns, Braden; Hemmelgarn, Brenda; Harris, Tess; Crowe, Sally; Ju, Angela; O’Lone, Emma; Evangelidis, Nicole; Craig, Jonathan C.
Background and objectives Patient centeredness is widely advocated as a cornerstone of health care, but it is yet to be fully realized, including in nephrology. Our study aims to describe nephrologists’ perspectives on defining and implementing patient-centered outcomes in hemodialysis. Design, setting, participants, & measurements Face-to-face, semistructured interviews were conducted with 58 nephrologists from 27 dialysis units across nine countries, including the United States, the United Kingdom, Australia, Austria, Belgium, Canada, Germany, Singapore, and New Zealand. Transcripts were thematically analyzed. Results We identified five themes on defining and implementing patient-centered outcomes in hemodialysis: explicitly prioritized by patients (articulated preferences and goals, ascertaining treatment burden, defining hemodialysis success, distinguishing a physician-patient dichotomy, and supporting shared decision making), optimizing wellbeing (respecting patient choice, focusing on symptomology, perceptible and tangible, and judging relevance and consequence), comprehending extensive heterogeneity of clinical and quality of life outcomes (distilling diverse priorities, highly individualized, attempting to specify outcomes, and broadening context), clinically hamstrung (professional deficiency, uncertainty and complexity in measurement, beyond medical purview, specificity of care, mechanistic mindset [focused on biochemical targets and comorbidities], avoiding alarm, and paradoxical dilemma), and undermined by system pressures (adhering to overarching policies, misalignment with mandates, and resource constraints). Conclusions Improving patient-centered outcomes is regarded by nephrologists to encompass strategies that address patient goals and improve wellbeing and treatment burden in patients on hemodialysis. However, efforts are hampered by ambiguities about how to prioritize, measure, and manage the plethora of critical comorbidities and broader
Full Text Available This paper is a report of a study of The Relationship between Self-Esteem and Coping Styles in patients undergoing hemodialysis in Iran. Hemodialysis patients face with multiple physical and psychological stressful factors; they use coping styles in order to cope with the challenges. A descriptive-correlation study was conducted based on the data collected from patients undergoing hemodialysis by census method in the city of Kerman using the Endler and Parker coping style, Self-esteem and demographic information questionnaires. The mean age of patients was 56.21 ± 1.45 years and 58.5% were male. The statistically positive relationship between self-esteem and problem-oriented coping style (p=0.05 and inverse relationship between self-esteem and emotion-oriented style (p<0.001. The patients with higher and lower self-esteem used problem-oriented and emotion-oriented styles, respectively. According to the results, it is necessary for nurses to enhance their role in promoting self-esteem and help patients undergoing hemodialysis while using problem-oriented style.
Rafiee Vardanjani, Leila; Parvin, Neda; Mahmoodi Shan, Gholamreza
The present study was conducted to investigate the effect of individual, multistep intervention on adherence to treatment in hemodialysis patients referred to a hemodialysis center in Shahrekord, Iran. In this interventional study, hemodialysis patients referring the center of the study were randomly assigned into two control and intervention groups (each 33). The control group received routine treatment, recommended dietary and fluid restrictions. The intervention group participated in eight individual interventional sessions accompanied routine treatment. At the beginning and the end of the study, routine laboratory tests and end-stage renal disease-adherence questionnaire were filled out for patients in both groups. The data were analyzed using Mann-Whitney and Wilcoxon tests. At the end of the study, the two groups showed a significant difference in all domains of adherence except adherence to diet and adherence was better in the intervention group (p adherence to dialysis program (p = 0.04, r = 0.254). After intervention, serum phosphorus decreased significantly in the intervention group (p Adherence to treatment is one of the major problems in hemodialysis patients; however, comprehensive interventions are required in view of individual condition. Implications for Rehabilitation Adherence to treatment means that all patients' behaviors (diet, fluids and drugs intake) should be in line with the recommendations given by healthcare professionals. There is evidence on the association between adherence to treatment and decreased risk of hospitalization in dialysis patients. Individual structured programs are most likely to be successful in encouraging adherence to treatment.
Butler, Philip J.; Sood, Shreya; Mojibian, Hamid; Tal, Michael G.
Background: Catheter-related infections (CRIs) are a significant source of morbidity and mortality in hemodialysis patients. The identification of novel, modifiable risk factors for CRIs may lead to improved outcomes in this population. Peripherally inserted central catheters (PICCs) have been hypothesized to compromise vascular access due to vascular damage and venous thrombosis, whereas venous thrombosis has been linked to the development of CRIs. Here we examine the association between PICC placement and CRIs. Methods: A retrospective review was performed of all chronic hemodialysis catheter placements and exchanges performed at a large university hospital from September 2003 to September 2008. History of PICC line use was determined by examining hospital radiologic records from December 1993 to September 2008. Catheter-related complications were assessed and correlated with PICC line history. Results: One hundred eighty-five patients with 713 chronic tunneled hemodialysis catheter placements were identified. Thirty-eight of those patients (20.5%) had a history of PICC placement; these patients were more likely to have CRIs (odds ratio = 2.46, 95% confidence interval = 1.71–3.53, p < .001) compared with patients without a history of PICC placement. There was no difference between the two groups in age or number of catheters placed. Conclusion: Previous PICC placement may be associated with catheter-related infections in hemodialysis patients.
Siregar, R. H.; Muzasti, R. A.
Cardiovascular disease is the most inducer of morbidity and mortality of chronic kidney disease (CKD) patients who have undergone dialysis. Today, neutrophil to lymphocyte ratio (NLR) is considered an indicator of the severity and extent of systemic inflammation and atherosclerosis in patients with renal and cardiovascular disorders. To examine the relationship between NLR with PAD in regular hemodialysis patients, a cross-sectional study, Ankle- Brachial Index (ABI) measurement and peripheral blood examination was on 72 regular hemodialysis patients ≥6 months. The ABI value ≤0.9 is considered PAD. NLR≥ 3.5 is considered abnormal based on some pre-existing research. Prevalence of PAD is 29.16%. Chi- square test showed significant correlation between NLR with PAD (p = 0.0001), multiplication of Calcium and Phosphorus (p = 0.0001), and type 2 Diabetes Mellitus (T2DM) (p = 0.039), multivariate analysis showed that NLR was an independent predictor for PAD in regular hemodialysis patients (RR = 2.271 p = 0.027). In conclusion, NLR, a new inflammatory marker of peripheral blood examination may serve as a marker of PAD in a regular hemodialysis patient, in addition to the multiplication of Calcium and Phosphorus as well as T2DM.
Full Text Available Abstract Dyslipidemia is common in chronic hemodialysis patients and its underlying mechanism is complex. Hemodialysis causes an imbalance between antioxidants and production of reactive oxygen species, which induces the oxidative stress and thereby may lead to accelerated atherosclerosis. Statins have been found to be little effective in end-stage kidney disease and other lipid-lowering therapies have been only scarcely studied. The study aimed to assess the effect of low-dose fenofibrate therapy on plasma lipids and redox status in long-term hemodialysis patients with mild hypertriglyceridemia. Twenty seven chronic hemodialysis patients without any lipid-lowering therapy were included in a double-blind crossover, placebo-controlled study. The patients were randomized into two groups and were given a sequence of either 100 mg of fenofibrate per each hemodialysis day for 4 weeks or placebo with a week-long wash-out period between treatment periods. Plasma lipids, high sensitive C-reactive protein (CRP, urea, creatinine, electrolytes, phosphocreatine kinase (CK, GOT, GPT and plasma thiols (total and free glutathione, homocysteine, cysteine and cysteinylglycine were measured at baseline and after each of the study periods. Plasma aminothiols were measured by reversed phase HPLC with thiol derivatization with 2-chloro-1-methylquinolinium tetrafluoroborate. Fenofibrate therapy caused a significant decrease of total serum cholesterol, LDL cholesterol and triglycerides and an increase of HDL cholesterol. The treatment was well tolerated with no side-effects but there was a small but significant increase of CK not exceeding the upper limit of normal range. There were no changes of serum CRP, potassium, urea, and creatinine and liver enzymes during the treatment. Neither total nor total free cysteinylglycine and cysteine changed during the study but both total and free glutathione increased during the therapy with fenofibrate and the same was observed
Turkmen, Ercan; Yildirim, Tolga; Yilmaz, Rahmi; Hazirolan, Tuncay; Eldem, Gonca; Yilmaz, Engin; Aybal Kutlugun, Aysun; Altindal, Mahmut; Altun, Bulent
HFE gene mutations are responsible from iron overload in general population. Studies in hemodialysis patients investigated the effect of presence of HFE gene mutations on serum ferritin and transferrin saturation (TSAT) with conflicting results. However effect of HFE mutations on iron overload in hemodialysis patients was not previously extensively studied. 36 hemodialysis patients (age 51.3 ± 15.6, (18/18) male/female) and 44 healthy control subjects included in this cross sectional study. Hemoglobin, ferritin, TSAT in the preceding 2 years were recorded. Iron and erythropoietin (EPO) administered during this period were calculated. Iron accumulation in heart and liver was detected by MRI. Relationship between HFE gene mutation, hemoglobin, iron parameters and EPO doses, and tissue iron accumulation were determined. Iron overload was detected in nine (25%) patients. Hemoglobin, iron parameters, weekly EPO doses, and monthly iron doses of patients with and without iron overload were similar. There was no difference between control group and hemodialysis patients with respect to the prevalence of HFE gene mutations. Iron overload was detected in five of eight patients who had HFE gene mutations, but iron overload was present in 4 of 28 patients who had no mutations (P = 0.01). Hemoglobin, iron parameters, erythropoietin, and iron doses were similar in patients with and without gene mutations. HFE gene mutations remained the main determinant of iron overload after multivariate logistic regression analysis (P = 0.02; OR, 11.6). Serum iron parameters were not adequate to detect iron overload and HFE gene mutation was found to be an important risk factor for iron accumulation. © 2017 International Society for Hemodialysis.
Bagheri-Nesami, Masoumeh; Espahbodi, Fatemeh; Nikkhah, Attieh; Shorofi, Seyed Afshin; Charati, Jamshid Yazdani
This study sought to determine the effects of lavender aromatherapy on pain following needle insertion into a fistula in patients undergoing hemodialysis. This is a randomized controlled clinical trial in which 92 patients undergoing hemodialysis with arteriovenous fistulas were randomly divided into two groups. The experimental-group patients inhaled lavender essence with a concentration of 10% for 5 min during 3 hemodialysis sessions, while the control-group patients received aromatherapy free of lavender essence. The mean VAS pain intensity score in the experimental and control groups before the intervention was 3.78 ± 0.24 and 4.16 ± 0.32, respectively (p = 0.35). The mean VAS pain intensity score in the experimental and control groups after three aromatherapy sessions was 2.36 ± 0.25 and 3.43 ± 0.31, respectively (p = 0.009). Lavender aromatherapy may be an effective technique to reduce pain following needle insertion into a fistula in hemodialysis patients. Copyright © 2013 Elsevier Ltd. All rights reserved.
Angermann, Susanne; Baumann, Marcus; Wassertheurer, Siegfried; Mayer, Christopher Clemens; Steubl, Dominik; Hauser, Christine; Suttmann, Yana; Reichelt, Anna-Lena; Satanovskij, Robin; Lorenz, Georg; Lukas, Moritz; Haller, Bernhard; Heemann, Uwe; Grimmer, Timo; Schmaderer, Christoph
Cognitive impairment in hemodialysis patients is common and associated with adverse outcomes. So far, the underlying pathogenesis remains unclear. Therefore, we examined the potential relationship between cognitive impairment and three different categories of risk factors with particular focus on arterial stiffness measured by pulse wave velocity (PWV). A total of 201 chronic hemodialysis patients underwent cognitive testing under standardized conditions using the Montreal Cognitive Assessment (MoCA). Demographic data including cardiovascular risk factors, dialysis-associated factors as well as factors related to chronic kidney disease (CKD) were analyzed. To account for arterial stiffness, PWV was measured by ambulatory blood pressure monitoried with an oscillometric device that records brachial blood pressure along with pulse waves. In our cohort, 60.2% of patients showed pathological MoCA test results indicating cognitive impairment. PWV was significantly associated with cognitive impairment apart from age, educational level, diabetes, and hypercholesterolemia. High prevalence of cognitive impairment in hemodialysis patients was confirmed. For the first time, an association between cognitive impairment and arterial stiffness was detected in a larger cohort of hemodialysis patients. Concerning the underlying pathogenesis of cognitive impairment, current results revealed a potential involvement of arterial stiffness, which has to be further evaluated in future studies. © 2017 The Author(s). Published by Portland Press Limited on behalf of the Biochemical Society.
Topçiu–Shufta, Valdete; Miftari, Ramë; Haxhibeqiri, Valdete; Haxhibeqiri, Shpend
Background: Higher than expected cardiovascular mortality in hemodialysis patients, has been attributed to dyslipidemia as well as inflammation. Beta2-Microglobulin (β2M) is an independent predictor of outcome for hemodialysis patients and a representative substance of middle molecules. Results: In 40 patients in high-flux membrane hemodialysis, we found negative correlation of β2M with high density lipoprotein (r=-0.73, p<0.001) and albumin (r= -0.53, p<0.001) and positive correlation with triglycerides (r=0.69, p<0.001), parathyroid hormone (r=0.58, p < 0.05) and phosphorus (r= 0.53, p<0.001). There was no correlation of β2M with C- reactive protein (CRP) and interleukin-6 (IL-6). During the follow-up period of three years, 6 out of 40 patients have died from cardiovascular events. Conclusion: In high-flux membrane hemodialysis patients, we observed a significant relationship of β2M with dyslipidemia and mineral bone disorders, but there was no correlation with inflammation. PMID:27994294
Topçiu-Shufta, Valdete; Miftari, Ramë; Haxhibeqiri, Valdete; Haxhibeqiri, Shpend
Higher than expected cardiovascular mortality in hemodialysis patients, has been attributed to dyslipidemia as well as inflammation. Beta2-Microglobulin (β2M) is an independent predictor of outcome for hemodialysis patients and a representative substance of middle molecules. In 40 patients in high-flux membrane hemodialysis, we found negative correlation of β2M with high density lipoprotein (r=-0.73, p<0.001) and albumin (r= -0.53, p<0.001) and positive correlation with triglycerides (r=0.69, p<0.001), parathyroid hormone (r=0.58, p < 0.05) and phosphorus (r= 0.53, p<0.001). There was no correlation of β2M with C- reactive protein (CRP) and interleukin-6 (IL-6). During the follow-up period of three years, 6 out of 40 patients have died from cardiovascular events. In high-flux membrane hemodialysis patients, we observed a significant relationship of β2M with dyslipidemia and mineral bone disorders, but there was no correlation with inflammation.
Fukuma, Shingo; Shimizu, Sayaka; Shintani, Ayumi; Kamitani, Tsukasa; Akizawa, Tadao; Fukuhara, Shunichi
Among aging hemodialysis patients, loss of physical function has become a major issue. We developed and validated a model of predicting loss of physical function among elderly hemodialysis patients. We conducted a cohort study involving maintenance hemodialysis patients ≥65 years of age from the Dialysis Outcomes and Practice Pattern Study in Japan. The derivation cohort included 593 early phase (1996-2004) patients and the temporal validation cohort included 447 late-phase (2005-12) patients. The main outcome was the incidence of loss of physical function, defined as the 12-item Short Form Health Survey physical function score decreasing to 0 within a year. Using backward stepwise logistic regression by Akaike's Information Criteria, six predictors (age, gender, dementia, mental health, moderate activity and ascending stairs) were selected for the final model. Points were assigned based on the regression coefficients and the total score was calculated by summing the points for each predictor. In total, 65 (11.0%) and 53 (11.9%) hemodialysis patients lost their physical function within 1 year in the derivation and validation cohorts, respectively. This model has good predictive performance quantified by both discrimination and calibration. The proportion of the loss of physical function increased sequentially through low-, middle-, and high-score categories based on the model (2.5%, 11.7% and 22.3% in the validation cohort, respectively). The loss of physical function was strongly associated with 1-year mortality [adjusted odds ratio 2.48 (95% confidence interval 1.26-4.91)]. We developed and validated a risk prediction model with good predictive performance for loss of physical function in elderly hemodialysis patients. Our simple prediction model may help physicians and patients make more informed decisions for healthy longevity. © The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA.
Full Text Available In the patients with end-stage renal disease (ESRD with hepatitis B virus (HBV infection who underwent hemodialysis, the viral load of HBV DNA is relatively low and stable. For this phenomenon, some studies suggest that hemodialysis can reduce the HBV DNA load. The mechanism, which remains unclear, may be as follows: when HBV DNA enters the dialysate through the dialysis membrane, it was adsorbed onto the dialysis membrane; some virus particles were destroyed, and antiviral substances were produced in the course of hemodialysis. At present, there is no consensus on the mechanism responsible for the influence of maintained hemodialysis on the viral load of HBV DNA. This article reviews the factors involved in the influence of maintained hemodialysis on the viral load in ESRD patients with HBV infection and the recent progress.
Hokama, Sanehiro; Oda, Masami; Kadekawa, Katsumi
Acute renal failure induced by contrast media is an important problem in renal insufficiency patients. Prophylactic hemodialysis is usually undertaken after the administration of radiocontrast media. However, we decided to cease giving prophylactic hemodialysis from February, 2002 in line with the guidelines regarding dialysis and contrast media administration provided by the European Society of Urogenital Radiology. We reported our policy at the doctor's meeting of hemodialysis therapy and at the meeting of clinical engineering technologists which were held in Okinawa. After the presentation, a questionnaire survey in 28 hospitals was undertaken by telephone. In all the hospitals, prophylactic hemodialysis after the administration of radiocontrast media was still being continued, with the exception of one hospital. We need to enlighten medical staff that the strategy of performing hemodialysis immediately after the administration of contrast media in patients with reduced renal function does not diminish the rate of radiocontrast media-induced nephropathy. (author)
Michael J. Raphael
Full Text Available Background: Patients with end-stage renal disease (ESRD have a high rate of hospitalization and are prone to care gaps that may occur during the transition from hospital to home. The virtual ward (VW is an innovative model that provides short-term transitional care to patients upon hospital discharge. The VW may be an effective intervention to address care gaps. Objectives: The primary objective of the pilot study was to assess the feasibility and practicality of implementing the Home Dialysis VW (HDVW on a broader scale. Design: The HDVW Pilot Study enrolled home hemodialysis patients following one of four inclusion criteria: 1. Discharge from hospital, 2. Completion of an in-hospital medical procedure, 3. Prescription of an antibiotic, 4. Completion of home hemodialysis training. Patients were followed in the HDVW for 14 days and during this time were assessed serially with a clinician-led telephone interview for one of three transitional care gaps: 1. Requirement for change in hemodialysis prescription, 2. Requirement for coordination of follow-up care, 3. Requirement for medication change. Setting: The study was conducted in Toronto, Ontario, Canada at a quaternary care academic teaching hospital from 2012–2013. Patients: This study included 52 HDVW admissions among 35 patients selected from the existing home hemodialysis program. Measurements: The primary outcome was the identification of the number of care gaps at each HDVW admission. Secondary outcomes included the identification of potential predictors of care gaps and description of clinical adverse events following HDVW admission (readmissions, emergency department visits, unplanned visits to the home hemodialysis in-center. Results: The implementation and execution of the HDVW Pilot Study proved to be technically feasible and practical. A care gap was identified in 35 (67 % of the HDVW admissions. In total, the cohort experienced 85 care gaps. There were no baseline demographic
Yeh, Shih-Chun; Yeh, Hui-Fang
Hemodialysis patients usually have a sense of hopelessness. This can affect their physical, mental and spiritual health, and can even be life- threatening. This article discusses a nursing experience involving a dialysis patient who also suffered from cancer had and a sense of hopelessness due to the distress caused by the two severe illnesses. The author assessed the patient by means of Roy's theory during the nursing period (5/7/2005-6/18/2005). Data were collected through physical assessments, interviews, observation of interaction with family members and a medical history review. The patient had characteristics of hopelessness, such as pessimism, moodiness, frequent sighing, frowning, eye-closing and negative thinking. The author applied a safe, easy, and non-invasive complementary therapy program including music therapy, aromatherapy and massage with essential oil to improve the patient's physical and mental states. Through these approaches, the patient learned to release stress, and to express his feelings, so that he could adapt to his current life, changed as it was by the illnesses, and face the impact of those illnesses with a positive attitude. The author would like to share this case report to provide nursing professionals with a source of reference for healthcare quality improvement.
Khalatbari Soltani, Saman; Jamaluddin, Rosita; Tabibi, Hadi; Mohd Yusof, Barakatun Nisak; Atabak, Shahnaz; Loh, Su-Peng; Rahmani, Leila
Inflammation and lipid abnormalities are two important risk factors for cardiovascular disease in hemodialysis (HD) patients. The present study was designed to investigate the effects of flaxseed consumption on systemic inflammation and serum lipid profile in HD patients with lipid abnormalities. This was an unblinded, randomized clinical trial. Thirty HD patients with dyslipidemia (triglyceride >200 mg/dL and/or high-density lipoprotein-cholesterol (HDL-C) consumption improves lipid abnormalities and reduces systemic inflammation in HD patients with lipid abnormalities. © 2012 The Authors. Hemodialysis International © 2012 International Society for Hemodialysis.
Huang, Bihong; Lai, Bihong; Xu, Ling; Wang, Ying; Cao, Yanpei; Yan, Ping; Chen, Jing
Returning to society plays an important role in improving the quality of life in maintenance hemodialysis (MHD) patients, and retention of employment is one of the core enablers. The study is to assess the employment status and to determine the variables for unemployment in Chinese MHD patients. Prevalent MHD patients from four dialysis centers in Shanghai China were enrolled. We assessed patients' employment status, current social functioning, hemodialysis modality, annual income and general health condition. Among current unemployed working-age patients, the reasons of quitting jobs and willingness of being reemployed were evaluated. A total of 231 patients were studied, among which 114 patients were unemployed 1 year before hemodialysis. Among 117 employed patients, 16 patients quitted jobs before dialysis inception, while 49 patients quitted jobs at the initiation of HD, and 26 patients followed after a few months' HD. The main reasons for ceasing employment were physical insufficiency, conflict between dialysis and work schedules, lack of support from employers and resistance from family members. Among the 166 patients who were in their working age, 26 patients were employed. The unemployed patients had the characters of elder age, lower education level, higher annual family income, higher female ratio, lower blood flow, lower physical functioning, and social functioning and lower frequency of weekend hemodialysis and HDF/HF. Among the 140 unemployed patients, only 47 patients had the willingness of being reemployed. Their unemployment status was positively associated with elder age ((OR) 3.13, 95% CI, 1.08-9.1), lower education level ((OR) 1.97, 95% CI, 1.05-5.92), and higher family income ((OR) 7.75, 95% CI, 2.49-24.14). Ratio of employment and willingness of being reemployed was low in MHD working-age patients. Lack of social and family's support also hampered patient's returning to society except for the HD treatment quality.
Wang, Jialin; Streja, Elani; Soohoo, Melissa; Chen, Joline L.T.; Rhee, Connie M.; Kim, Taehee; Molnar, Miklos Z.; Kovesdy, Csaba P.; Mehrotra, Rajnish; Kalantar-Zadeh, Kamyar
Objective Markers of better nutritional status including both higher levels of serum albumin (as a measure of visceral proteins) and creatinine (as a measure of the muscle mass) are associated with lower mortality in conventional (thrice-weekly) hemodialysis patients. However, data for these associations in twice-weekly hemodialysis patients, in whom less frequent hemodialysis may confound nutritional predictors, are lacking. Design, Settings and Subjects We identified 1,113 twice-weekly and matched 4,448 thrice-weekly hemodialysis patients from a large national dialysis cohort of incident hemodialysis patients over 5 years (2007-2011). Mortality risk, adjusted for potential confounders, was examined across two-by-two combinations of serum creatinine (creatinine≥6mg/dl and albumin≥3.5g/dl as reference, patients with creatininecreatinine mortality associations between twice-weekly and thrice-weekly hemodialysis patients (p-for-interaction 0.7667). Conclusions Surrogate markers of higher visceral protein and muscle mass combined may confer greatest survival in both twice-weekly and thrice-weekly hemodialysis patients. PMID:27528412
Borzou Seyed Reza
Full Text Available Background and Objective: Today more than ever, the importance of health promoting behaviors is considered. Maintaining the function, independence and increasing the quality of life of chronic patients such as hemodialysis patients is influenced by health promoting behaviors. The current study was conducted to determine the effect of education of health promoting behaviors on the quality of life in hemodialysis patients. Materials and Method: In the current quasi-experimental study, 70 hospitalized patients were selected through convenient sampling in hemodialysis wards of two Therapeutic-Educational Centers in Hamadan in 2014. Then, the subjects were randomly allocated into two intervention and control groups of 35 persons. In intervention group, 6 educational sessions were held during the hemodialysis. Quality of life of patients in two groups was measured through Ferrans and Powers Quality of Life Index-dialysis version before and three months after the intervention. Data were analyzed in SPSS 16, and using chi-square test, independent T-test and paired-T test . Results: In intervention group, the mean score of quality of life after intervention was changed from 18.85 ± 5.4 to 20.11 ± 5.46 (p < 0.001 and in control group from 19.41 ± 4.67 to 18.39 ± 4.10 (p = 0.08. After intervention, quality of life of patients in intervention group was increased in health and functioning domain (18.6 ± 5.7 (p < 0.001 and was increased in psychological/spiritual domain to 19.3 ± 7.02 (p=0.041 Conclusion: Education of health-promoting behaviors improved the quality of life of hemodialysis patients. Therefore, according to chronic nature of disease, the education of these behaviors can be effective in improving the quality of life.
B S Lakshmi
Full Text Available The long-term dialysis therapy for end-stage renal disease takes a heavy toll of quality of life of the patient. Several factors such as fatigue and decreased physical capability, impaired social and mental functioning, contribute to this forlorn state. To meld maintenance dialysis treatment with a regular employment can be a serious test. A cross-sectional study of employment of patients on hemodialysis and peritoneal dialysis in a state government tertiary institute in South India was performed between June 2015 and December 2015. Patients who completed 3 months of regular dialysis were only included in the study. The number of patients on hemodialysis was 157 and on peritoneal dialysis was 69. The employment status before the initiation of dialysis was 60% (93 out of 155 and 63.7% (44 out of 69 in hemodialysis and peritoneal dialysis, respectively. After initiation, the loss of employment was observed in 44% (41 out of 93 in hemodialysis and 51.2% (26 out of 44 in peritoneal dialysis (P = 0.2604. Even though there was fall of absolute number of job holders in both the blue and white collar jobs, the proportion of jobholders in the white collar job holders improved. On univariate analysis, the factors which influenced the loss of employment were males, age between 50 and 60 years, number of comorbidities >2, illiteracy and blue collar versus white collar job before the initiation of dialysis. The majority of patients had the scores above 80 on Karnofsky performance scale and the majority belonged upper and middle classes than lower classes on modified Kuppuswamy's socioeconomic status scale; however, the loss of employment was also disproportionately high. There appeared a substantial difference in the attitude of the patients toward the employment. There was no difference between hemodialysis and peritoneal dialysis in the loss of employment of our patients.
Kai, Brandon; Bogorad, Yuliya; Nguyen, Leigh-Anh N; Yang, Su-Jau; Chen, Wansu; Spencer, Hillard T; Shen, Albert Y-J; Lee, Ming-Sum
The optimal management of stroke prophylaxis in hemodialysis patients with atrial fibrillation is controversial. The purpose of this study was to determine the risk of mortality, stroke, and bleeding associated with the use of warfarin in hemodialysis patients with atrial fibrillation. This was a retrospective, population-based study of hemodialysis patients with atrial fibrillation between January 1, 2006, and September 30, 2015. Association of warfarin use with mortality, stroke, and bleeding was determined by propensity score-matched, Cox proportional hazard models. Among the 4286 patients with atrial fibrillation on hemodialysis, 989 (23%) were prescribed warfarin. Propensity score matching was used to identify 888 matched pairs with similar baseline characteristics. Warfarin use was associated with lower risk of all-cause death (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.69-0.84) and lower risk of ischemic stroke (HR 0.68, 95% CI 0.52-0.91). Warfarin use was not associated with a higher risk of hemorrhagic stroke (HR 1.2, 95% CI 0.6-2.2) or gastrointestinal bleeding (HR 0.97, 95% CI 0.77-1.2). The treatment effect was largest in the group with the best international normalized ratio control as measured by time in therapeutic range. Subgroup analyses showed warfarin use was associated with survival benefit in most subgroups. The 2 subgroups that did not benefit were patients with a history of hemorrhagic stroke and patients with concurrent aspirin use. Warfarin use is associated with lower all-cause mortality and ischemic stroke, without significantly increasing the risk of bleeding in hemodialysis patients with atrial fibrillation. Copyright © 2017 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
Burmeister, Jayme Eduardo; Mosmann, Camila Borges; Costa, Veridiana Borges; Saraiva, Ramiro Tubino; Grandi, Renata Rech; Bastos, Juliano Peixoto; Gonçalves, Luiz Felipe; Rosito, Guido Aranha
There are scarce epidemiological data on cardiovascular risk profile of chronic hemodialysis patients in Brazil. The CORDIAL study was designed to evaluate cardiovascular risk factors and follow up a hemodialysis population in a Brazilian metropolitan city. All patients undergoing regular hemodialysis for chronic renal failure in all fifteen nephrology centers of Porto Alegre were considered for inclusion in the baseline phase of the CORDIAL study. Clinical, laboratory and demographic data were obtained in medical records and in structured individual interviews performed in all patients by trained researchers. A total of 1215 patients were included (97.3% of all hemodialysis patients in the city of Porto Alegre). Their average age was 58.3 years old, 59.5% were male and 62.8% were white. The prevalence of cardiovascular risk factors observed was 87.5% for hypertension, 84.7% for dyslipidemia, 73.1% for sedentary lifestyle, 53.7% for tobacco use, and 35.8% for diabetes. In a multivariate adjusted analysis, we found that sedentary lifestyle (p = 0.032, PR 1.08 - 95%CI: 1.01-1.15), dyslipidemia (p = 0.019, PR 1.08 - 95%CI: 1.01-1.14), and obesity (p < 0.001, PR 1.96 - 95%CI: 1.45-2.63) were more frequent in women; and hypertension (p = 0.018, PR 1.06 - 95%CI: 1.01-1.11) and tobacco use (p = 0.006, PR 2.7 - 95%CI: 1.79-4.17) were more often found among patients under 65 years old. Sedentary lifestyle was independently associated with time in dialysis less than 12 months (p < 0.001, PR 1.23 - 95% CI: 1.14-1.33). Hemodialysis patients in this southern metropolitan Brazilian city have a high prevalence of cardiovascular risk factors resembling many northern countries
Burmeister, Jayme Eduardo, E-mail: firstname.lastname@example.org [Universidade Federal de Ciências da Saúde de Porto Alegre - Programa de Pós-graduação em Ciências da Saúde, Porto Alegre, RS (Brazil); Universidade Luterana do Brasil - Curso de Medicina, Porto Alegre, RS (Brazil); Mosmann, Camila Borges [Universidade Luterana do Brasil - Curso de Medicina, Porto Alegre, RS (Brazil); Costa, Veridiana Borges [Universidade Federal de Ciências da Saúde de Porto Alegre - Faculdade de Medicina, Porto Alegre, RS (Brazil); Saraiva, Ramiro Tubino; Grandi, Renata Rech; Bastos, Juliano Peixoto [Universidade Luterana do Brasil - Curso de Medicina, Porto Alegre, RS (Brazil); Gonçalves, Luiz Felipe [Universidade Federal do Rio Grande do Sul - Faculdade de Medicina, Porto Alegre, RS (Brazil); Hospital Mãe de Deus - Departamento de Nefrologia, Porto Alegre, RS (Brazil); Rosito, Guido Aranha [Universidade Federal de Ciências da Saúde de Porto Alegre - Programa de Pós-graduação em Ciências da Saúde, Porto Alegre, RS (Brazil); Universidade Luterana do Brasil - Curso de Medicina, Porto Alegre, RS (Brazil)
There are scarce epidemiological data on cardiovascular risk profile of chronic hemodialysis patients in Brazil. The CORDIAL study was designed to evaluate cardiovascular risk factors and follow up a hemodialysis population in a Brazilian metropolitan city. All patients undergoing regular hemodialysis for chronic renal failure in all fifteen nephrology centers of Porto Alegre were considered for inclusion in the baseline phase of the CORDIAL study. Clinical, laboratory and demographic data were obtained in medical records and in structured individual interviews performed in all patients by trained researchers. A total of 1215 patients were included (97.3% of all hemodialysis patients in the city of Porto Alegre). Their average age was 58.3 years old, 59.5% were male and 62.8% were white. The prevalence of cardiovascular risk factors observed was 87.5% for hypertension, 84.7% for dyslipidemia, 73.1% for sedentary lifestyle, 53.7% for tobacco use, and 35.8% for diabetes. In a multivariate adjusted analysis, we found that sedentary lifestyle (p = 0.032, PR 1.08 - 95%CI: 1.01-1.15), dyslipidemia (p = 0.019, PR 1.08 - 95%CI: 1.01-1.14), and obesity (p < 0.001, PR 1.96 - 95%CI: 1.45-2.63) were more frequent in women; and hypertension (p = 0.018, PR 1.06 - 95%CI: 1.01-1.11) and tobacco use (p = 0.006, PR 2.7 - 95%CI: 1.79-4.17) were more often found among patients under 65 years old. Sedentary lifestyle was independently associated with time in dialysis less than 12 months (p < 0.001, PR 1.23 - 95% CI: 1.14-1.33). Hemodialysis patients in this southern metropolitan Brazilian city have a high prevalence of cardiovascular risk factors resembling many northern countries.
Riedel, E; Hampl, H; Steudle, V; Nündel, M
Calcium alpha-ketoglutarate administration to 24 malnourished hemodialysis patients for 1 year leads to a significant increase in plasma concentrations of L-arginine from 53.6 +/- 18.3 (compared to a healthy control group: 87.5 +/- 27.3) to 71.1 +/- 15.9 mumol/l (p calcium alpha-ketoglutarate administration.
Trudeke (G I. Struijk-Wielinga
Conclusion: Protein and energy intake of hemodialysis patients is lower than their daily needs. On non dialysis days intake is even lower than on dialysis days. The meals consumed during dialysis treatment contain enough energy but not enough protein to meet requirements.
Discussion: Hemodialysis patients treated with paricalcitol presented significantly decreased ADMA levels compared with those who did not receive this treatment. Possible beneficial effects in terms of cardiovascular morbidity and mortality by paricalcitol and its association with ADMA and nitric oxide synthesis are unknown. Studies to confirm this effect and determine the underlying pathophysiological mechanism are necessary.
These data indicate that walking impairments in hemodialysis patients are not due exclusively to declines in physical function, but that cognitive-motor interference also plays a significant role. This has significant clinical importance, as therapies designed to improve walking performance and physical function, such as nutritional and exercise interventions, may need to be augmented with cognitive training in order to have maximum benefits.
Full Text Available Background and Objectives Chronic renal disease is a threatening condition for the health, economic, and social status of the affected person and his/her family. Patients undergoing hemodialysis encounter mental and health problems; the current study aimed at predicting resilience via social support and illness perceptions among patients undergoing hemodialysis. Methods The current descriptive-correlational study had a statistical population including 308 patients undergoing hemodialysis in Kerman, Iran, in 2017. Based on the Krejcie-Morgan table, the minimum required sample size was 169. The sample was selected using a convenience sampling method. Data collection tools were the Connor-Davidson resilience scale, the medical outcome study (MOS social support survey developed by Sherbourne and Stewart, and the brief illness perception questionnaire developed by Broadbent et al. Data were analyzed using a Pearson correlation coefficient and a stepwise regression analysis via SPSS version 19. Results Results indicated that resilience was significantly and positively related to social support (r = 0.318, P < 0.05 and illness perceptions (r = 0.165, P < 0.05. Among the subscales of social support, emotional support, tangible support, and social interaction could predict resilience, and among the subscales of illness perceptions, only cognitive representation could predict resilience. Conclusions The obtained results demonstrated that resilience was significantly and positively related to social support and illness perceptions. Additionally, the subscales of social support and illness perceptions could predict resilience among the patients undergoing hemodialysis.
Henning, Bernhard F; Holzhausen, Helge; Tepel, Martin
Plasma paraoxonase (PON) is an enzyme that hydrolyzes organic phosphate and aromatic carboxylic acid esters. Reduced activity is associated with early events of atherogenesis. The relevance of PON phenotypes is not well characterized in hemodialysis patients. In a cross-sectional study we measure...
Depreter, B.; Heijboer, A.C.; Langlois, M.R.
Introduction: We evaluated the accuracy of three automated assays for 25(OH)D measurement in comparison to ID-XLC-MS/MS in hemodialysis patients, considering the importance of their vitamin D status and reported discrepant results obtained with automated assays. Methods: All three assays were
Mazairac, A.H.A.; de Wit, G.A.; Penne, E.L.; van der Weerd, N.C.; Grooteman, M.P.C.; van den Dorpel, M.A.; Nube, M.J.; Buskens, E.; Levesque, R.; ter Wee, P.M.; Bots, M.L.; Blankestijn, P.J.
Objective: Health-related quality of life (HRQOL) is an important outcome in dialysis care. Previous research has related protein-energy nutritional status to generic HRQOL domains, but it is still not clear as to how it relates to HRQOL domains that are unique to hemodialysis patients. Therefore,
Toriihara, Akira; Kitazume, Yoshio; Nishida, Hidenori; Kubota, Kazunori; Nakadate, Masashi; Tateishi, Ukihide
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.
Toriihara, Akira; Kitazume, Yoshio; Nishida, Hidenori; Kubota, Kazunori; Nakadate, Masashi; Tateishi, Ukihide
The whole-body 2-deoxy-2-[18F]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. PMID:25973341
Dr. Aijaz Ahmed, Dr. Muhammad Nadeem Ahsan, Dr. Pooran Mal*, Dr. Hamid Nawaz Ali Memon, Dr. Samreen and Dr. Sajjad Ali
Objective: To determine the frequency of ischemic heart disease in patients of chronic kidney disease on maintenance hemodialysis Patients and Methods: A total of 160 patients with diagnosis of CKD in department of Nephrology, Liaquat National Hospital Karachi were recruited in this six months cross sectional study. Demographic information was recorded. Then patients were underwent ECG. Reports were assessed and ischemic heart disease was labeled while all the data was collected using the pro...
Lu, Yueh-An; Lee, Shen-Yang; Lin, Hui-Yi; Liu, Yen-Chun; Kao, Huang-Kai; Chen, Yung-Chang; Tian, Ya-Chung; Hung, Cheng-Chieh; Yang, Chih-Wei; Hsu, Hsiang-Hao
Reconsidering when to initiate renal replacement therapy (RRT) in patients with chronic kidney disease (CKD) has been emphasized recently. With evolving modern aged and diabetes-prone populations, conventional markers of uremia are not sufficient for determining the optimal timing for dialysis initiation. This retrospective cohort study examined the association between hyperphosphatemia and uremic patients who need RRT registration. All patients from the department of nephrology in one tertiary medical center in northern Taiwan who had advanced CKD and estimated glomerular filtration rates regression models were used to identify factors associated with hemodialysis initiation decision making. During the study period, 209 of 292 patients with advanced CKD were enrolled in hemodialysis program and 83 patients (controls) were not. Univariable analysis indicated that male sex, current smoking, diabetes mellitus, hypertension, coronary artery disease, high serum creatinine level, and high serum phosphate level were associated with initiation of hemodialysis. Multivariable analysis indicated that those with higher serum phosphate level (odds ratio [OR] = 2.4, 95% confidence interval [CI] = 1.6-3.5, p = 1.4 × 10(-5)) and being in nephrology care for <12 months (OR = 0.4, 95% CI = 0.2-0.8, p = 0.016) tended to be significant markers for hemodialysis initiation. Hyperphosphatemia, in addition to conventional laboratory markers and uremic symptoms, may be a useful marker to determine timing of hemodialysis initiation in patients with advanced CKD. Copyright © 2016 Chang Gung University. Published by Elsevier B.V. All rights reserved.
Full Text Available Little is known about actual dietary patterns and their associations with clinical outcomes in hemodialysis patients. We identified dietary patterns in hemodialysis patients in Japan and examined associations between dietary patterns and clinical outcomes.We used data from 3,080 general-population participants in the Hisayama study (year 2007, and data from 1,355 hemodialysis patients in the Japan Dialysis Outcomes and Practice Patterns Study (JDOPPS: years 2005-2007. Food intake was measured using a brief self-administered diet-history questionnaire (BDHQ. To identify food groups with the Hisayama population data, we used principal components analysis with Promax rotation. We adjusted the resulting food groups for total daily energy intake, and then we used those adjusted food-group scores to identify dietary patterns in the JDOPPS patients by cluster analysis (Ward's method. We then used Cox regression to examine the association between dietary patterns and a composite of adverse clinical outcomes: hospitalization due to cardiovascular disease or death due to any cause.We identified three food groups: meat, fish, and vegetables. Using those groups we then identified three dietary patterns: well-balanced, unbalanced, and other. After adjusting for potential confounders, we found an association between an unbalanced diet and important clinical events (hazard ratio 1.90, 95% C.I. 1.19-3.04.Hemodialysis patients whose diet was unbalanced were more likely to have adverse clinical outcomes. Thus hemodialysis patients might benefit not only from portion control, but also from a diet that is well-balanced diet with regard to the food groups identified here as meat, fish, and vegetables.
Tonelli, Marcello; Lloyd, Anita; Pannu, Neesh; Klarenbach, Scott; Ravani, Pietro; Jindal, Kailash; MacRae, Jennifer; Unsworth, Larry; Manns, Braden; Hemmelgarn, Brenda
Rural-dwelling hemodialysis patients have less frequent contact with nephrologists than urban-dwelling patients, and are known to have higher mortality. We hypothesized that rural-dwelling hemodialysis patients would have more evidence of poorly controlled extracellular fluid volume (ECVF) than otherwise similar urban-dwellers. We studied prevalent hemodialysis patients within a single renal program in Alberta, Canada and assessed ECFV using bioimpedance spectroscopy (BIS). Our primary outcome was impedance vector length (ohm/m) as assessed by BIS using the Xitron Hydra 4200 device, where shorter vector length indicated poorer ECFV control. Because poor ECFV control can lead to hypertension, we also assessed pre- and post-dialysis blood pressure. We measured outcomes at baseline. We studied 228 hemodialysis patients, of whom 115 (50.4 %) and 113 (49.6 %) were urban- and rural-dwelling, respectively. There were no differences in volume control in urban versus rural participants; odds ratio (OR) for vector length in the lowest sex-specific quartile of vector length was 0.93 (95 % CI 0.54, 1.59) after adjusting for age, sex, diabetic status, years since dialysis initiation and phase angle. The odds of very poor blood pressure control (pre-dialysis blood pressure ≥180/100) did not differ between urban and rural participants [fully adjusted OR 0.96 (0.36, 2.60)]. Differences in ECFV control do not appear to explain higher mortality among remote- and rural- dwelling hemodialysis patients, compared to urban-dwellers.
A D Sajgure
Full Text Available The progressive loss of kidney function is accompanied by metabolic acidosis. The relationship between metabolic acidosis, nutritional status, and oral bicarbonate supplementation has not been assessed in the Indian chronic kidney disease (CKD population who are on maintenance hemodialysis (MHD. This is a single-center prospective study conducted in the Western part of India. Thirty-five patients, who were receiving MHD were assessed for metabolic acidosis along with various nutritional parameters at the baseline and at the follow-up after 3 months, postcorrection of acidosis with oral sodium bicarbonate supplements. The relationship between the correction of metabolic acidosis with oral bicarbonate supplements and changes in dietary and various nutritional parameters were evaluated. Metabolic acidosis at the baseline evaluation was found in 62.86% cases of the cohort with a mean serum bicarbonate value of 20.18 ± 4.93 mmol/L. The correction of acidosis with increment in the mean dosage of oral sodium bicarbonate supplements from 0.69 ± 0.410 mmol/kg/day at baseline to 1.04 ± 0.612 mmol/kg/day, significantly reduced the prevalence of metabolic acidosis to 23.33% cases at the follow-up. Improvement in serum bicarbonate level showed significant dietary, anthropometric, and nutritional improvements in these patients. Hence, we conclude that correction of metabolic acidosis with optimal oral bicarbonate supplementation plays a pivotal role in the treatment of malnourished CKD patients on MHD.
Orfila, C; Goffinet, F; Goudable, C; Eche, J P; Ton That, H; Manuel, Y; Suc, J M
Abdominal fat tissue aspiration was used in 22 long-term hemodialysis patients (5-17 years). Fourteen of these patients had carpal tunnel syndrome and amyloid deposits of beta 2-microglobulin in the synovium. One patient had a spontaneous rupture of the spleen with amyloid deposits in spleen vessels. Seven other patients presented carpal tunnel syndrome and/or articular pains, and radiological lytic lesions in bone, strongly suggesting an amyloid origin. As a control group, in 22 patients with biopsy-proven amyloidosis, abdominal fat tissue aspirates were performed and were studied under the same conditions: by light microscopy these tissues were stained with Congo red and examined with a polarizing microscope; these specimens were also studied by electron microscopy. In all hemodialyzed patients, no amyloid deposit was present in fat tissue with Congo red staining and by electron microscopy. On the contrary, amyloid was observed in 17 of 22 cases in other types of amyloidosis. It seems that this method which has been proved to be simple and sensitive for the diagnosis of systemic amyloidosis is not a good marker for the presence of amyloid in long-term hemodialysis patients.
Full Text Available Inger Miriam Janssen,1 Ansgar Gerhardus,2,3 Gero D von Gersdorff,4 Conrad August Baldamus,4 Mathias Schaller,4 Claudia Barth,5 Fueloep Scheibler6 1Department of Epidemiology and International Public Health, Bielefeld University, Bielefeld, Germany; 2Department for Health Services Research, University of Bremen, Bremen, Germany; 3Health Sciences Bremen, University of Bremen, Bremen, Germany; 4Department of Internal Medicine II, University Hospital of Cologne, Cologne, Germany; 5KfH Kuratorium fuer Dialyse und Nierentransplantation e.V., Neu-Isenburg, Germany; 6Department of Non-Drug Interventions, Institute for Quality and Efficiency in Health Care, Cologne, Germany Background: Chronic kidney disease is an increasing health problem worldwide and in its final stage (stage V can only be treated by renal replacement therapy, mostly hemodialysis. Hemodialysis has a major influence on the everyday life of patients and many patients report dissatisfaction with treatment. Little is known about which aspects of treatment are considered important by hemodialysis patients. The objective of this study was to rate the relative importance of different outcomes for hemodialysis patients and to analyze whether the relative importance differed among subgroups of patients.Patients and methods: Within the framework of a yearly questionnaire which is distributed among patients receiving hemodialysis by the largest hemodialysis provider in Germany, we assessed the relative importance of 23 outcomes as rated on a discrete visual analog scale. Descriptive statistics were used to rank the outcomes. Subgroup analyses were performed using Mann–Whitney U or Kruskal–Wallis tests.Results: Questionnaires of 4,518 hemodialysis patients were included in the analysis. The three most important outcomes were safety of treatment, health-related quality of life, and satisfaction with care. Further important outcomes were hospital stays, accompanying symptoms, hemodialysis
Nor Baizura Md Yusop
Full Text Available Although hemodialysis treatment has greatly increased the life expectancy of end stage renal disease patients, low quality of life among hemodialysis patients is frequently reported. This cross-sectional study aimed to determine the relationship between medical history, hemodialysis treatment and nutritional status with the mental and physical components of quality of life in hemodialysis patients. Respondents (n=90 were recruited from Hospital Kuala Lumpur and dialysis centres of the National Kidney Foundation of Malaysia. Data obtained included socio-demography, medical history, hemodialysis treatment and nutritional status. Mental and physical quality of life were measured using the Mental Composite Summary (MCS and Physical Composite Summary (PCS of the Short-Form Health Survey 36-items, a generic core of the Kidney Disease Quality of Life Short Form. Two summary measures and total SF-36 was scored as 0-100, with a higher score indicating better quality of life. Approximately 26 (30% of respondents achieved the body mass index (24 kg/m(2 and more than 80% (n=77 achieved serum albumin level (>35.0 mg/dL recommended for hemodialysis patients. The majority of respondents did not meet the energy (n=72, 80% and protein (n=68,75% recommendations. The total score of SF-36 was 54.1 ± 19.2, while the score for the mental and physical components were 45.0 ± 8.6 and 39.6 ± 8.6, respectively. Factors associated with a higher MCS score were absence of diabetes mellitus (p=0.000 and lower serum calcium (p=0.004, while higher blood flow (p=0.000, higher serum creatinine (p=0.000 and lower protein intake (p=0.006 were associated with a higher PCS score. To improve the overall quality of life of hemodialysis patients, a multidisciplinary intervention that includes medical, dietetic and psychosocial strategies that address factors associated with mental and physical quality of life are warranted to reduce further health complications and to improve quality
Md Yusop, Nor Baizura; Yoke Mun, Chan; Shariff, Zalilah Mohd; Beng Huat, Choo
Although hemodialysis treatment has greatly increased the life expectancy of end stage renal disease patients, low quality of life among hemodialysis patients is frequently reported. This cross-sectional study aimed to determine the relationship between medical history, hemodialysis treatment and nutritional status with the mental and physical components of quality of life in hemodialysis patients. Respondents (n=90) were recruited from Hospital Kuala Lumpur and dialysis centres of the National Kidney Foundation of Malaysia. Data obtained included socio-demography, medical history, hemodialysis treatment and nutritional status. Mental and physical quality of life were measured using the Mental Composite Summary (MCS) and Physical Composite Summary (PCS) of the Short-Form Health Survey 36-items, a generic core of the Kidney Disease Quality of Life Short Form. Two summary measures and total SF-36 was scored as 0-100, with a higher score indicating better quality of life. Approximately 26 (30%) of respondents achieved the body mass index (24 kg/m(2)) and more than 80% (n=77) achieved serum albumin level (>35.0 mg/dL) recommended for hemodialysis patients. The majority of respondents did not meet the energy (n=72, 80%) and protein (n=68,75%) recommendations. The total score of SF-36 was 54.1 ± 19.2, while the score for the mental and physical components were 45.0 ± 8.6 and 39.6 ± 8.6, respectively. Factors associated with a higher MCS score were absence of diabetes mellitus (p=0.000) and lower serum calcium (p=0.004), while higher blood flow (p=0.000), higher serum creatinine (p=0.000) and lower protein intake (p=0.006) were associated with a higher PCS score. To improve the overall quality of life of hemodialysis patients, a multidisciplinary intervention that includes medical, dietetic and psychosocial strategies that address factors associated with mental and physical quality of life are warranted to reduce further health complications and to improve quality of
Martínez, Beatriz Bertolaccini; Custódio, Rodrigo Pereira
The stress of living with a terminal disease has a negative impact on the mental health of hemodialysis (HD) patients. Spirituality is a potential coping mechanism for stressful experiences. Studies on the relationship between spirituality and mental health among HD patients are scarce. The purpose of this study was to evaluate the relationship between mental health and spiritual well-being among HD patients. Cross-sectional observational study on hemodialysis patients at a single center in Brazil, between January and December 2011. Mental health was assessed using the General Health Questionnaire and spiritual wellbeing was assessed using the Spiritual Wellbeing Scale; 150 HD patients participated in the study. A significant correlation was found between mental health and spiritual wellbeing (P = 0.001). Spiritual wellbeing was the strongest predictor of mental health, psychological distress, sleep disturbance and psychosomatic complaints. Poor mental health was associated with lower spiritual wellbeing. This has important implications for delivery of palliative care to HD patients.
Hemodialysis (HD) patients have been increasing recently. Some rheumatoid arthritis (RA) patients need hemodialysis (HD), though the proportion is not high. At present, such patients are almost treated with corticosteroids and/or nonsteroidal anti-inflammatory drugs alone, even if they have a high disease activity that would require disease-modifying anti-rheumatic drug (DMARD) therapy, partly because the safety of DMARDs in RA patients with end-stage renal disease has not been confirmed. Their joint destruction would be inevitable and lead to impaired activities of daily living. As there are no guidelines for the use of DMARDs in HD patients, here I reviewed the previous reports about the treatment of DMARDs including biologics for patients with RA undergoing HD.
Sav, Murat Yusuf; Sav, Tansu; Senocak, Elif; Sav, Nadide Melike
Headache is one of the most frequently encountered neurological symptoms during hemodialysis. According to International Classification of Headache criteria dialysis-related headache was defined as the headache occurring during hemodialysis with no specific characteristic. It resolves spontaneously within 72 hours after the hemodialysis session ends. There are few studies in the literature investigating the clinical features of dialysis headache. The pathophysiology of hemodialysis-related headache is not known, but various triggering factors have been identified, including changes in blood pressure, serum sodium and magnesium levels during hemodialysis sessions, caffeine deprivation and stress. The aim of this article is to evaluate and analyze features of headache in patients undergoing hemodialysis. © 2014 International Society for Hemodialysis.
Mansoureh Ashghali Farahani
Full Text Available Background: Studies suggest that family caregivers of hemodialysis patients experience a high level of burden, which could lead to numerous physical and psychological problems. Despite the need for adequate training and support, these caregivers are mostly neglected, and few studies have been performed in this regard. Aim: to evaluate the effect of educational programs on the home care of hemodialysis patients and burden of their family caregivers. Method: This randomized controlled clinical trial was conducted on 76 caregivers of hemodialysis patients referred to Shahid Hasheminejad Hemodialysis Center of Tehran, Iran in 2015. Subjects were divided into two groups of intervention and control (n=38. The intervention group received four training sessions on the home care of hemodialysis patients for two weeks, and the control group received routine care. Data were collected using the Caregiver Burden Inventory (CBI at the beginning and six weeks after the intervention. Data analysis was performed in SPSS V.21 using Chi-square, Fisher’s exact test, independent and paired T-test, and Mann-Whitney U test. Results: In this study, no significant difference was observed between the two groups in terms of demographic characteristics. At the baseline, mean score of caregiver burden in the intervention and control groups was 88.5±11.7 and 84.9±15.1, respectively, and no significant difference was observed between the groups in this regard (P=0.30. Six weeks after the intervention, the results of independent T-test revealed a significant difference between the mean scores of caregiver burden in the intervention (58.7±6.6 and control groups (87.8±11.7 (P
Sharif, Alireza; Aghakhani, Arezoo; Velayati, Ali Akbar; Banifazl, Mohammad; Sharif, Mohammad Reza; Razeghi, Effat; Kheirkhah, Davood; Kazemimanesh, Monireh; Bavand, Anahita; Ramezani, Amitis
The aim of this study was to evaluate the frequency and genotype of human parvovirus B19 and its relation with anemia among Iranian patients under dialysis. Fifty hemodialysis (HD) and 33 peritoneal dialysis (PD) patients were enrolled. B19 IgG and IgM antibodies were assessed by ELISA, and the presence of B19 DNA was evaluated by nested PCR. PCR products were sequenced directly and phylogenetic analysis was performed. In the HD group, the prevalence of B19 antibodies was 54% for IgG and 4% for IgM. B19 DNA was detected in 10% of the cases, and 10% showed B19 IgG and viremia simultaneously. In the PD group, the prevalence of B19 IgG and IgM was 57.6 and 0% respectively, whereas B19 DNA was found in 12.1% of the group. A total of 9.1% showed B19 IgG and viremia concurrently. There was no significant difference regarding anemia and B19 infection in either group. All B19 isolates were clustered in genotype 1A. Our findings indicate that B19 infection plays no role in leading chronic anemia in dialysis patients. However, persistent B19 viremia and the circulation of the same strains in dialysis patients may indicate a potential risk for the contamination of dialysis equipment and nosocomial spread of B19 infection within dialysis units. © 2017 S. Karger AG, Basel.
Sasaki, Yohei; Shimizu, Yoshio; Nakata, Junichiro; Kameda, Toshiaki; Muto, Masahiro; Ohsawa, Isao; Io, Hiroaki; Hamada, Chieko; Horikoshi, Satoshi; Tomino, Yasuhiko
Thyroid function test values are generally at low levels in patients with end-stage kidney disease. Life-threatening thyrotoxicosis or thyroid storm is rare, especially in hemodialysis (HD) patients, and is characterized by multisystem involvement and a high mortality rate if not immediately recognized and treated. Here, we report a female patient with severe symptomatic thyroid storm, receiving long-term HD and glucocorticoid therapy. Methimazole at a dose of 15 mg per day, β-adrenergic bloc...
Kuroda, Takeshi; Tanabe, Naohito; Nozawa, Yukiko; Sato, Hiroe; Nakatsue, Takeshi; Kobayashi, Daisuke; Wada, Yoko; Saeki, Takako; Nakano, Masaaki; Narita, Ichiei
Objective Our objective was to examine the safety and effects of therapy with biologics on the prognosis of rheumatoid arthritis (RA) patients with reactive amyloid A (AA) amyloidosis on hemodialysis (HD). Methods Twenty-eight patients with an established diagnosis of reactive AA amyloidosis participated in the study. The survival was calculated from the date of HD initiation until the time of death, or up to end of June 2015 for the patients who were still alive. HD initiation was according ...
Majid Malaki; Fakhr Sadat Mortazavi; Sussan Moazemi; Maryam Shoaran
Insomnia and limb pain are common problems in dialysis patients. In addition, restless leg syndrome (RLS) as a specific cause of insomnia and limb pain has been reported in many studies. The purpose of this study was to estimate incidence of insomnia and RLS as a cause of insomnia in these patients. Twenty-six patients undergoing hemodialysis were investigated for insomnia, limb pain and RLS as per the defined criteria. They were evaluated for dialysis quality, dialysis duration, hemoglobin, ...
Duarte, Priscila Silveira; Miyazaki, Maria Cristina; Blay, Sergio Luís; Sesso, Ricardo
Depression is an important target of psychological assessment in patients with end-stage renal disease because it predicts their morbidity, mortality, and quality of life. We assessed the effectiveness of cognitive-behavioral therapy in chronic hemodialysis patients diagnosed with major depression by the Mini International Neuropsychiatric Interview (MINI). in a randomized trial conducted in Brazil, an intervention group of 41 patients was given 12 weekly sessions of cognitive-behavioral grou...
Bo Kyung Sohn; Yun Kyu Oh; Jung-Seok Choi; Jiyoun Song; Ahyoung Lim; Jung Pyo Lee; Jung Nam An; Hee-Jeong Choi; Jae Yeon Hwang; Hee-Yeon Jung; Jun-Young Lee; Chun Soo Lim
Background : Many patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD) experience depression. Depression influences patient quality of life (QOL), dialysis compliance, and medical comorbidity. We developed and applied a group cognitive behavioral therapy (CBT) program including mindfulness meditation for ESRD patients undergoing HD, and measured changes in QOL, mood, anxiety, perceived stress, and biochemical markers. Methods : We conducted group CBT over a 12-week period...
Chang, Chung-Hsin; Yang, Cheng-Ming; Yang, An-Hang
Transitional cell carcinoma (TCC) is the most common malignancy in dialysis patients of Taiwan. The reason for such a high incidence of TCC is undetermined. The correlation between the underlying renal disease and the development of TCC was investigated. The authors retrospectively reviewed the clinical data and outcome of 1537 chronic hemodialysis (HD) patients from 1993 to 2002. The incidence of TCC was computed. The Cox regression method was used to analyze the role of potential risk factors. After a mean dialysis duration of 46.5 months, 26 (1.69%) patients with TCC were diagnosed. The standardized incidence ratio (SIR) of TCC was 48.2 as compared with the general population and the SIR of TCC seemed higher in women (65.1) and in the age group 50 to 54 years (173.6). Of them, most cases showed no definite etiology. All these cases showed bilateral contracted kidneys. Nonnephrotic proteinuria was found in all cases and trace glucosuria was found in 17 (65%). Painless gross hematuria was the cardinal symptom and distant metastasis was rare. Also, TCC in upper urinary tracts were common and found in 14 (54%) of patients. Age at the time of dialysis, female sex, compound analgesic use, and Chinese herb use had statistical significance as risk factors (P Taiwan, especially in female and middle-aged patients. The study indicated that chronic tubulointerstitial nephritis (CTIN) is the most likely underlying renal disease in HD patients with TCC, a high percentage of the CTIN related to the usage of Chinese herbs or compound analgesics may contribute to the development of TCC, whereas diabetes or chronic glomerulonephritis play only a minor role.
Yazdi, Farin Kiany; Karimi, Noozhan; Rasouli, Manoochehr; Roozbeh, Jamshid
C-reactive protein (CRP) has been implicated as a possible mediator of the association between periodontitis and several systemic diseases. This study evaluated the impact of nonsurgical periodontal treatment on the serum levels of CRP in chronic kidney disease (CKD) patients on hemodialysis. A total of 77 CKD patients on hemodialysis were included in this study. At baseline, periodontal examination was assessed for all the patients, and chronic periodontitis was defined through clinical attachment level and probing pocket depth, according to the American Association of Periodontology. Nonsurgical periodontal treatment was performed and serum levels of CRP were evaluated at baseline and 8 weeks after periodontal treatment. Periodontal treatment resulted in significant reductions in CRP levels (p periodontitis. Periodontitis is an important source of systemic inflammation in CKD patients. Nonsurgical periodontal treatment can effectively reduce the serum level of CRP in these patients.
Klarić, Miro; Letica, Ivona; Petrov, Bozo; Tomić, Monika; Klarić, Branka; Letica, Ludvig; Francisković, Tanja
Depression and anxiety are prevailing mental problem in patients on chronic hemodialysis and they have great influence on outcome of illness. Additionally, these disorders are rarely identified in that population of patients and they are insufficiently treated. The aim of this study was to assess the prevalence of depression and anxiety in patients on chronic hemodialysis in University Clinical Hospital Mostar and to examine the correlation between the demographic variables and the time spent on dialysis with depression and anxiety levels. The experimental group consisted of 56 patients on chronic hemodialysis in Mostar Clinical Hospital. The control group 1 consisted of 53 patients diagnosed with a chronic illness and treated for at least a year, while the control group 2 consisted of 51 persons who were not diagnosed with any chronic somatic or mental illness. Demographic data were collected using the constructed questionnaire. The Beck Depression Inventory-BDI was used to determine depression, while the Spielberger State-Trait Anxiety Inventory-STAI was used to determine anxiety. We recorded significantly higher prevalence of depression in patients on chronic dialysis (51.8%) than in patients with a chronic illness (41.5%) and persons without chronic illnesses (9.8%; p < 0.001). Trait anxiety level was significantly higher in hemodialysed patients compared to the other two groups (p = 0.006) but there were no significant differences in state anxiety level. The study has not shown any significant difference in the prevalence of depression and anxiety level regarding the differences in sex, gender and education level, apart from a higher level of state anxiety in patients with a lower education level (p = 0.032). These results indicate that patients on hemodialysis have a significantly higher level of depression and a higher level of trait anxiety compared to patients with chronic illnesses and especially compared to general population.
Tang, Xiaojing; Hu, Xiaohong; Mei, Changlin; Yu, Shengqiang
Resistant hypertension is a common and refractory complication of hemodialysis (HD) patients and is associated with a higher risk of cardiovascular morbidity and mortality. Here we present a case of resistant hypertension treated successfully by nocturnal HD. A 63-year-old female with end-stage kidney disease was hospitalized for severe headache, objective vertigo and persistent vomiting for 1 month on February 6, 2012. She had been on intermittent HD for 3 months, and her blood pressure maintained 200-240/100-130 mm Hg even after using 7 kinds of antihypertensive drugs including olmesartan, benazepril, nitrendipine, arotinolol, terazosin, clonidine and torasemide. A CT of the abdomen revealed a mild hyperplasia of the left adrenal gland (fig. 1). However, plasma renin, angiotensin and aldosterone were all within the normal range. Nocturnal extended HD was initiated with a blood flow rate of 150 ml/min and a dialysis time of 7 h. After 3 months of nocturnal HD, all symptoms were relieved and her systolic blood pressure started to decrease by 10-20 mm Hg. Six months later, the predialysis blood pressure was decreased to 140-160/90-100 mm Hg and the antihypertensive drugs were reduced to 4 kinds. Meanwhile, the blood biochemical parameters including hemoglobin, serum calcium, phosphate and parathyroid hormone were all controlled well during 2 years of treatment. This case indicates that nocturnal extended HD is probably a promising and effective choice for resistant hypertension in HD patients.
Imtiaz, S.; Nasir, K.; Dhrolia, M.F.; Abbas, H. N.; Ahmad, A.; Hussain, M.
Objective: The effect of month of Ramadan on the mortality in hemodialysis patients, and to compare it with that in all other Islamic months. Study Design: A descriptive study. Place and Duration of Study: Hemodialysis Unit, The Kidney Center, Karachi, from January 1989 to December 2012. Methodology: All those patients who were diagnosed to have end stage kidney disease and on maintenance hemodialysis for more than 3 months, regardless of underlying cause of kidney failure were included. Patients with acute kidney injury were excluded. Status of the patients was recorded at the end of the study period. The fasting status of the patients was not mentioned. The deaths of the patients were further evaluated and frequencies of death in all twelve Islamic months were calculated. Results: A total of 1,841 patients were registered, out of whom 897 (48.7%) died, and 269 (14.6%) survived till the end of the study. One thousand and fifty six (57.3%) were males, 651 (35.4%) were diabetic. Total number of 143 (7.76%) events occurred in Ramadan, out of which 94 patients died which make nearly 11% of the total deaths distributed in 12 Islamic months. Frequency of death was higher in Ramadan when compared with other months. Conclusion: Ramadan reflected a higher frequency of death. Therefore, there is a need to evaluate the risk factors in a prospective study so that the dialysis patients can be better managed during this period. (author)
Okazaki, Hisanori; Ishimura, Eiji; Okuno, Senji; Norimine, Kyoko; Yamakawa, Kenjiro; Yamakawa, Tomoyuki; Shoji, Shigeichi; Nishizawa, Yoshiki; Inaba, Masaaki
Serum magnesium (Mg) levels have been associated with muscle performance in the general population. We hypothesized that serum Mg would be associated with muscle quality in hemodialysis patients. A total of 310 patients were examined (age: 58 ± 12 years, hemodialysis duration: 6.4 ± 6.0 years, 60.6% men, and 36.1% diabetics). Arm lean mass was measured by dual energy X-ray absorptiometry (DXA) on the dominant side. Arm muscle quality was defined as the ratio of the handgrip strength to the arm lean mass of the same side (kg/kg). Serum Mg was 1.15 ± 0.16 mmol/L (2.8 ± 0.4 mg/dL), being higher than the reference range of normal subjects. There was a significant negative correlation between muscle quality and age (r = -0.326, p<0.0001) and duration of hemodialysis (r = -0.253, p<0.0001). The muscle quality of the diabetics was significantly lower than that of the non-diabetics (p<0.001). There was a significant, positive correlation between muscle quality and serum Mg (r = 0.118, p<0.05), but not serum calcium or phosphate. In multiple regression analysis, age, gender, hemodialysis duration, diabetes, and serum Mg (β = 0.129, p<0.05) were significantly and independently associated with muscle quality (R(2) = 0.298, p<0.0001). These results demonstrated that a lower serum Mg concentration was significantly associated with poor muscle quality in hemodialysis patients. Further studies are needed to explore the mechanism by which lower serum Mg affects muscle quality.
Garcia, R.; Jimenez Feltstrom, D.; Luis dimon, F. J.; Sanchez Carmona, G.; Herrador Cordoba, M.
This work aims to define a biokinetic model for the I-131, and solve it for different conditions of the patient or person affected (normal, with cancer of the thyroid or hyperthyroid). Solve the model in the case of a patient treated with I-131 for ablation of thyroid remnants with undergoing renal insufficiency and hemodialysis . Get the parameters Biokinetic this model for different situations. (Author)
Poorgholami, Farzad; Javadpour, Shohreh; Saadatmand, Vahid; Jahromi, Marzieh Kargar
The assessment of self-esteem in hemodialysis people is becoming increasingly important and necessary. Low self-esteem as a problem in patients undergoing hemodialysis decreases adherence to treatment. The researcher intends to carry out a study in order to investigate the effect of self-care education on enhancement of the self-esteem of patients undergoing hemodialysis in Iran. This is a quasi-experimental study. The subjects of the study who were selected based on purposive sampling method consisted of 50 patients with advanced chronic renal disease treated with hemodialysis. Before the intervention, two questionnaires were completed by patients. There was no intervention in the control group and the patients received only routine care in the hospital. In the experimental group, the hemodialysis patients received 5 consecutive one-hour training sessions by the researcher. Then the Rosenberg scale was filled out by the patients 2 month later. According to the results, Paired t-test showed a significant difference between the mean self-esteem score in both groups before and after intervention. Increasing the knowledge and awareness of hemodialysis patients must constitute a cornerstone of therapy and an integral part of nursing responsibilities. Nurses should educate the patients about self-care behaviors and remind them of the dangerous complications of abandoning these.
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.
Pakpour, Amir H.; Nourozi, Saeedeh; Mølsted, Stig
INTRODUCTION: The aim of the study was to assess the validity and reliability of the SF-12 questionnaire in a sample of Iranian patients undergoing hemodialysis. MATERIALS AND METHODS: One hundred and forty-four hemodialysis patients were included from dialysis centers in Zanjan, Iran, and were...... asked to complete the SF-12 and SF-36 questionnaires. An initial test-retest reliability evaluation was performed on a sample of 70 patients from the total group, with a retest interval of 14 days. Reliability was estimated by internal consistency and validity was assessed using known-group comparisons...... and construct validity on the patient group as a whole. A linear regression analysis was used to assess any variation in the physical component summary and mental component summary scores of the SF-36 with the respective component summary scores of the SF-12. In addition, the factor structure...
Thilo, Florian; Caspari, Christina; Scholze, Alexandra
Background/Aims: Impaired immune function is common in patients with chronic renal failure. Now, we determined whether serum levels of free immunoglobulin light chains predict mortality in patients with chronic kidney disease stage 5 on hemodialysis. Methods: We performed a prospective cohort study...... of 160 hemodialysis patients with a median follow-up of 15 months (interquartile range, 3-44 months). Serum levels of free κ and λ immunoglobulin light chains were measured at the start of the study. The primary end point was mortality from any cause. Results: In survivors, median serum levels of free κ...... plus λ immunoglobulin light chains were significantly higher compared with nonsurvivors (p light chains above the median compared with patients with serum levels below the median of 210 mg...
Esther D. Kim
Discussion: Higher AIx and cPP, which are indicative of abnormal wave reflections in distal vessels, are associated with, and might contribute to, declining cognitive function in patients starting hemodialysis.
Hamadah, Abdurrahman M; Beaulieu, Lynn M; Wilson, John W; Aksamit, Timothy R; Gregoire, James R; Williams, Amy W; Dillon, John J; Albright, Robert C; Onuigbo, Macaulay; Iyer, Venkateshwaran K; Hickson, LaTonya J
The incidence of tuberculosis (TB) in end-stage renal disease is significantly higher than that in the general population. Among those with kidney dysfunction, anti-TB treatment is associated with increased side effects, but the effect on healthcare utilization is unknown. Methods/Aim: To assess patient-reported symptoms, adverse effects and describe changes in healthcare utilization patterns during treatment for TB, we conducted a case series (n = 12) of patients receiving maintenance hemodialysis (HD) from Mayo Clinic Dialysis Services and concurrent drug therapy for TB from January 2002 through May 2014. Healthcare utilization (hospitalizations and emergency department (ED) visits independent of hospital admission) was compared before and during treatment. Patients were treated for latent (n = 7) or active (n = 5) TB. The majority of patients with latent disease were treated with isoniazid (n = 5, 71%), while active-disease patients received a 4-drug regimen. Adverse effects were reported in 83% of patients. Compared to measurements prior to drug initiation, serum albumin and dialysis weights were similar at 3 months. Commonly reported anti-TB drug toxicities were described. More than half (58%) of the patients were hospitalized at least once. No ED or hospital admissions occurred in the period prior to drug therapy, but healthcare utilization increased during treatment in the latent disease group (hospitalization rate per person-month: pre 0 vs. post 1). Among HD patients, anti-TB therapy is associated with frequently reported symptoms and increased healthcare utilization. Among this subset, patients receiving treatment for latent disease may be those with greatest increase in healthcare use. Careful monitoring and early complication detection may help optimize medication adherence and minimize hospitalizations. © 2016 S. Karger AG, Basel.
Full Text Available Osama Sawalmeh,1 Shaheed Moala,1 Zakaria Hamdan,2 Huda Masri,3 Khubaib Ayoub,4 Emad Khazneh,2 Mujahed Shraim5 1Medicine Department, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine; 2Nephrology Department, 3Pharmacy Department, 4Internal Medicine Department, An-Najah National University Hospital, Nablus, Palestine; 5Public Health Department, College of Health Sciences, Qatar University, Doha, Qatar Background: Secondary hyperparathyroidism is a common complication of chronic kidney disease and is managed using vitamin D replacement therapy. Very few studies have examined the effectiveness of pulse alfacalcidol therapy in comparison to daily oral alfacalcidol therapy in suppressing serum parathyroid hormone (PTH levels in hemodialysis patients. The aim of this randomized controlled trial was to replicate the findings of prior studies comparing effectiveness of pulse oral alfacalcidol therapy versus daily oral alfacalcidol therapy in suppressing PTH after 13 weeks of therapy using a Palestinian sample of hemodialysis patients, and to identify demographic and biomedical characteristics of patients that are independently associated with PTH levels.Methods: One hundred and sixty-seven patients completed the study, 88 in the daily group and 79 in the pulse group. The pulse group had more clinically significant reduction in mean PTH level by 75 pg/dL at 13 weeks than the daily group, but this was not statistically significant.Results: The effect of alfacalcidol therapy on metabolism of phosphate and corrected calcium levels was comparable in both groups, and pulse therapy was not associated with increased risk of hypercalcemia and hyperphosphatemia. Serum PTH levels were independently and inversely associated with older age and diabetes.Conclusion: Switching daily alfacalcidol therapy to thrice-weekly alfacalcidol pulse therapy seems safe and convenient, especially for hemodialysis patients with poor compliance
Gilbertson David T
Full Text Available Abstract Background Some hemodialysis patients require large doses of erythropoiesis-stimulating agents (ESAs to manage anemia. These patients, termed “ESA hyporesponsive,” have been characterized using various definitions. We applied three definitions of hyporesponsiveness to a large, national cohort of hemodialysis patients to assess the impact of definition on counts and on characteristics associated with hyporesponsiveness. Methods We studied point-prevalent hemodialysis patients on May 1, 2008, with Medicare as primary payer, who survived through December 31, 2008. Included patients received recombinant human erythropoietin (EPO in each month, August-December. Hyporesponsiveness definitions were: above the ninetieth percentile of total monthly EPO dose; above the ninetieth percentile of total monthly EPO dose divided by weight in kg; above the ninetieth percentile of total monthly EPO dose divided by hemoglobin level. Hyporesponsiveness was further classified as chronic, acute, or other. Comorbid conditions were assessed before and concurrent with the hyporesponsive period. Results Women, African Americans, and patients aged Conclusions As associations were similar between patient characteristics and three methods of characterizing EPO hyporesponsiveness, the simplest definition using EPO dose can be used.
Luz María Tejada-Tayabas
Full Text Available OBJECTIVE: To examine, from the nursing perspective, the needs and challenges of coordinated hospital-home care for renal patients on hemodialysis. METHODS: A qualitative analysis was conducted with an ethnographic approach in a hemodialysis unit in San Luis Potosi, Mexico. Semistructured interviews were conducted with nine nurses, selected by purposeful sampling. Structured content analysis was used. RESULTS: Nurses recounted the needs and challenges involved in caring for renal patients. They also identified barriers that limit coordinated patient care in the hospital and the home, mainly the work overload at the hemodialysis unit and the lack of a systematic strategy for education and lifelong guidance to patients, their families and caregivers. CONCLUSIONS: This study shows the importance and necessity of establishing a strategy that goes beyond conventional guidance provided to caregivers of renal patients, integrating them into the multidisciplinary group of health professionals that provide care for these patients in the hospital to establish coordinated hospital-home care that increases therapeutic adherence, treatment substitution effectiveness and patient quality of life.
Kopple, Joel D; Cheung, Alfred K; Christiansen, Jens Sandahl
Adult maintenance hemodialysis (MHD) patients experience high mortality and morbidity and poor quality of life (QoL). Markers of protein-energy wasting are associated with these poor outcomes. The OPPORTUNITY™ Trial examined whether recombinant human growth hormone (hGH) reduces mortality in hypo...... in hypoalbuminemic MHD patients. Secondary end points were effects on number of hospitalizations, cardiovascular events, lean body mass (LBM), serum proteins, exercise capacity, QoL and adverse events....
Kopple, Joel D; Cheung, Alfred K; Christiansen, Jens Sandahl
Adult maintenance hemodialysis (MHD) patients experience high mortality and morbidity and poor quality of life (QoL). Markers of protein-energy wasting are associated with these poor outcomes. The OPPORTUNITY™ Trial examined whether recombinant human growth hormone (hGH) reduces mortality in hypo...... in hypoalbuminemic MHD patients. Secondary end points were effects on number of hospitalizations, cardiovascular events, lean body mass (LBM), serum proteins, exercise capacity, QoL and adverse events....
Alessandro Capitanini; Sara Lange; Claudia D'Alessandro; Emilio Salotti; Alba Tavolaro; Maria E. Baronti; Domenico Giannese; Adamasco Cupisti
Patients affected by end-stage renal disease (ESRD) show quite lower physical activity and exercise capacity when compared to healthy individuals. In addition, a sedentary lifestyle is favoured by lack of a specific counseling on exercise implementation in the nephrology care setting. Increasing physical activity level should represent a goal for every dialysis patient care management. Three crucial elements of clinical care may contribute to sustain a hemodialysis exercise program: a) involv...
Ximena Atilano; José Luis.Miguel; Jorge Martínez; Rafael Sánchez; Rafael Selgas
The hemodialysis (HD) patient is fluid overloaded, even when there is no apparent edema. Due to this, is vital to know the dry weight. No clinical or laboratory parameters are reliable, simple and accessible for this purpose. The bioelectrical impedance has been applied to estimate body fluids and dry weight. The purpose was to use the bioelectrical vector analysis (BIVA) as a tool to adjust the intensity of ultrafiltration and achievement of dry weight in HD patients. We performed monthly me...
Kim, Youngmee; Evangelista, Lorraine S.
Previous data indicate that negative perception of disease and non-adherence to recommended treatment may lead to unfavorable clinical outcomes in patients on maintenance hemodialysis (HD). However, a paucity of research addresses clinical outcomes in the end stage renal disease (ESRD) population as a function of patients’ illness perceptions and their degree of adherence to recommended treatment. The study was conducted to examine illness perceptions and treatment adherence rates in patients...
Naalweh, Karam Sh.; Barakat, Mohammad A.; Sweileh, Moutaz W.; Al-Jabi, Samah W.; Sweileh, Waleed M.; Zyoud, Sa?ed H.
Background Adherence to diet recommendations, fluid restriction, prescribed medications, and attendance at hemodialysis (HD) sessions are essential for optimal and effective treatment of patients with end-stage renal disease. No data regarding this issue are available from Palestine. Therefore, this study was carried out to assess adherence to diet, fluid restriction, medications, and HD sessions. Methods A cross-sectional study of HD patients at An-Najah National University Hospital was carr...
Ottaviani, Ana Carolina; Souza, Érica Nestor; Drago, Natália de Camargo; Mendiondo, Marisa Silvana Zazzetta de; Pavarini, Sofia Cristina Iost; Orlandi, Fabiana de Souza
OBJECTIVE: to analyze the relationship between the hope and spirituality of patients with chronic kidney disease undergoing hemodialysis.METHOD: this is a cross-sectional, correlational study. The sample was composed of 127 patients of a Renal Replacement Unit. Data were collected through individual interviews guided by the following instruments: participant characterization, Herth Hope Index (HHI), and Pinto Pais-Ribeiro Spirituality Scale (PP-RSS).RESULTS: the average HHI score was 38.06 (±...
Spry, Leslie A; Burkart, John M; Holcroft, Christina; Mortier, Leigh; Glickman, Joel D
Vascular access infections are of concern to hemodialysis patients and nurses. Best demonstrated practices (BDPs) have not been developed for home hemodialysis (HHD) access use, but there have been generally accepted practices (GAPs) endorsed by dialysis professionals. We developed a survey to gather information about training provided and actual practices of HHD patients using the NxStage System One HHD machine. We used GAP to assess training used by nurses to teach HHD access care and then assess actual practice (adherence) by HHD patients. We also assessed training and adherence where GAPs do not exist. We received a 43% response rate from patients and 76% response from nurses representing 19 randomly selected HHD training centers. We found that nurses were not uniformly instructing HHD patients according to GAP, patients were not performing access cannulation according to GAP, nor were they adherent to their training procedures. Identification of signs and symptoms of infection was commonly trained appropriately, but we observed a reluctance to report some signs and symptoms of infection by patients. Of particular concern, when aggregating all steps surveyed, not a single nurse or patient reported training or performing all steps in accordance with GAP. We also identified practices for which there are no GAPs that require further study and may or may not impact outcomes such as infection. Further research is needed to develop strategies to implement and expand GAP, measure outcomes, and ultimately develop BDP for HHD to improve infectious complications. © 2014 The Authors. Hemodialysis International published by Wiley Periodicals, Inc. on behalf of International Society for Hemodialysis.
Lu Yun; Xue Jun; Lin Xiangtong; Deng Shouzhen; Li Ding
Objective: To investigate the effect of different membrane on the clearance of serum β 2 -MG in maintenance hemodialysis patients. Method: 106 maintenance hemodialysis patients randomized divided into group A and group B. Group A used cellulose triacetate membrane (N-130E), Group B used polysulfone membrane (F6). The levels of serum β 2 -MG before and after hemodialysis were compared in Group A and B, respectively. Results: Before hemodialysis, the level of serum β 2 -MG was not significant different between Group A and B (46.74 ± 19.46 mg/L vs 47.49 ± 16.71 mg/L, P>0.05). In Group A, compared with that before hemodialysis, the level of serum β 2 -MG after hemodialysis decreased significantly. (46.74±19.46 mg/L vs 39.76 ±17.66 mg/L, before HD vs after HD, P 2 -MG between before and after hemodialysis (47.49±16.71 mg/L vs 50.19±22.76 mg/L, P>0.05). Conclusion: N-130E dialyzer is better than F6 dialyzer as the effect of clearance serum β 2 -MG is concerned
Shiota, E; Maekawa, M; Kono, T
Abstract We analyzed the levels of endotoxin and β-d-glucan, which possibly induce cytokine production, in the synovial fluid of patients on long-term hemodialysis and compared the results to those in patients with osteoarthritis and rheumatoid arthritis. We studied 42 knees in 42 hemodialysis patients, 21 in 21 osteoarthritis patients, and 26 in 26 rheumatoid arthritis patients. The mean ages were 60.7, 63.2, and 59.7 years, respectively. The duration of hemodialysis in the long-term hemodialysis group averaged 14.0 years. The concentrations of endotoxin and β-d-glucan in the synovial fluid of these three groups were measured. The concentration of endotoxin was the same in the three groups. However, the concentration of β-d-glucan was significantly higher in long-term hemodialysis patients. This finding suggests that β-d-glucan may have some relation to the pathogenesis of the synovitis which exists in the hydrarthrosis of long-term hemodialysis patients.
Ewers, Bettina; Riserus, Ulf; Marckmann, Peter
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....
Nakagawa, Chie; Inaba, Masaaki; Ishimura, Eiji; Yamakawa, Tomoyuki; Shoji, Shigeichi; Okuno, Senji
We reported previously that muscle quality and muscle strength provide clinically relevant predictors for better survival in hemodialysis patients. Iron overload might impair muscle function by its accumulation in muscle in such patients. Serum ferritin, a marker for body iron store, was examined for its association with handgrip strength (HGS) and muscle quality which was defined as the ratio of HGS to arm lean mass measured with dual-energy X-ray absorptiometry. In 300 Japanese hemodialysis patients, age, hemodialysis duration, body mass index, and serum albumin were 58.0 ±12.0 (mean ± standard deviation) years, 4.2 (1.8-10.4) (median [25th-75th percentile]) years, 20.4 ± 2.8 kg/m(2), 4.0 ± 0.3 g/dL, respectively. Hemoglobin and hematocrit were 8.9 ± 1.2 g/dL, and 28.8 ± 3.9%, respectively, whereas transferrin saturation and serum ferritin were 29.8 ± 11.0% and 100 (54-172) ng/mL, respectively. Serum ferritin significantly correlated in a positive manner with the total dose of iron orally administered during the previous 6 months (r = 0.185, P = .0013). HGS and muscle quality were 23.1 ± 10.4 kg and 11.6 ± 3.8 kg/kg, respectively. In multivariate analysis to elucidate the factors associated with HGS and muscle quality in 300 hemodialysis patients, which included transferrin saturation and log serum ferritin, in addition to age, gender, hemodialysis duration, the presence/absence of diabetes, body mass index as independent variables, log serum ferritin emerged as a significant and independent factor which associated in a negative fashion with HGS (β = -0.091, P = .0395) and tendency toward negative association with muscle quality (β = -0.100, P = .0754). In summary, the present study demonstrated the significant association of serum ferritin with HGS and muscle quality in hemodialysis patients and thus suggested that we should be careful of iron overload to avoid its possible harmful effect on muscle in such patients. Copyright © 2016 National Kidney
Full Text Available Background: Prevalence of End Stage Renal Disease (ESRD is increasing in the world. Because of clinical importance of ESRD and absence of significant data, we studied the epidemiology of end stage renal failure in patients under hemodialysis in Lorestan province. Material and methods: This descriptive cross sectional study was carried out between January 2012 and January 2013 in dialysis centers of Lorestan university of medical sciences .Subject were selected by census method and data galhered using a questionnaire. At the end, collected data were analyzed by SPSS software, descriptive statistics and Chi-square test. Results: All the patients under hemodialysis were 318 cases, 182 out of them (57.2% and 136(42.8% were male and female respectively. The mean age of the subjects was 53.2± 16.4 years. The cause of renal failure in 38.1% of the patients were hypertension, diabetes (19.2% and unknown factors (27.4%. As well as 5.97% of the patients infected by HCV, HBV or HIV . A significant statistical difference was observed between causes of chronic renal failure and different ages of the subjects (p=0.002. Conclusion: Augmentation of screening programs and especially, early referral of high risk subjects to nephrologists is recommended for prevention of end stage renal disease.
Karavetian, Mirey; de Vries, Nanne; Elzein, Hafez; Rizk, Rana; Bechwaty, Fida
Assess the effect of intensive nutrition education by trained dedicated dietitians on osteodystrophy management among hemodialysis patients. Randomized controlled trial in 12 hospital-based hemodialysis units equally distributed over clusters 1 and 2. Cluster 1 patients were either assigned to usual care (n=96) or to individualized intensive staged-based nutrition education by a dedicated renal dietitian (n=88). Cluster 2 patients (n=210) received nutrition education from general hospital dietitians, educating their patients at their spare time from hospital duties. Main outcomes were: (1) dietary knowledge(%), (2) behavioral change, (3) serum phosphorus (mmol/L), each measured at T0 (baseline), T1 (post 6 month intervention) and T2 (post 6 month follow up). Significant improvement was found only among patients receiving intensive education from a dedicated dietitian at T1; the change regressed at T2 without statistical significance: knowledge (T0: 40.3; T1: 64; T2: 63) and serum phosphorus (T0: 1.79; T1: 1.65; T2: 1.70); behavioral stages changed significantly throughout the study (T0: Preparation, T1: Action, T2: Preparation). The intensive protocol showed to be the most effective. Integrating dedicated dietitians and stage-based education in hemodialysis units may improve the nutritional management of patients in Lebanon and countries with similar health care systems. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Full Text Available Objective: To study the correlation of erythropoietin (EPO resistance with oxidative stress response and inflammatory response in patients with maintenance hemodialysis. Methods: A total of 184 patients with end-stage renal disease who received maintenance hemodialysis in Shaanxi Provincial People’s Hospital between March 2015 and October 2016 were selected as dialysis group, 102 volunteers who received physical examination in Shaanxi Provincial People’s Hospital during the same period were selected as control group, the EPO resistance index was assessed, the median was calculated, and serum oxidative stress and inflammatory response indexes were detected. Results: Serum T-AOC, SOD and CAT levels in dialysis group were significantly lower than those in control group while MDA, AOPP, IFN-γ, HMGB-1, ICAM-1, IL-4 and IL-10 levels were significantly higher than those in control group; serum T-AOC, SOD and CAT levels in patients with high ERI were significantly lower than those in patients with low ERI while MDA, AOPP, IFN-γ, HMGB-1, ICAM-1, IL-4 and IL-10 levels were significantly higher than those in patients with low ERI. Conclusion: The degree of EPO resistance in patients with maintenance hemodialysis is closely related to the activation of oxidative stress response and inflammatory response.
Full Text Available Prevalence of cognitive disorders is high in maintenance hemodialysis patients. Montreal cognitive assessment (MoCA is used for detecting and evaluation of cognitive disorder degree in this patient population. In examined patient population, only 5 (12.5% of them had normal cognitive function (MoCA ≥26. Mild cognitive impairment (MoCA 18-26 was found in 65.9% (29 patients, while moderate cognitive disorder (MoCA 10-17 was detected in 6 (21.6% patients. Major cognitive disorder wasn’t detected in examined population. Statistically significant correlation was not established between laboratory parameters and overall MoCA score. Statistically significant correlation, however, was established between MoCA item that evaluates space and time orientation and intermediate secondary hyperparathyroidism and space and time orientation and severe secondary hyperparathyroidism. Hemodynamic instability during hemodialysis and silent ischemia of the brain are increasing risk of appearance of cognitive disorders in maintenance hemodialysis patients.
Rymarz, Aleksandra; Gibińska, Julia; Zajbt, Maria; Piechota, Wiesław; Niemczyk, Stanisław
Nutritional status has a significant impact on the outcomes in the dialysis population. The aim of this study was to evaluate the association between body composition and a one-year survival of hemodialysis patients. Forty-eight patients with chronic kidney disease stage V treated with hemodialysis for more than three months were included. Body composition was assessed by bioimpedance spectroscopy (Body Composition Monitor, Fresenius Medical Care). Blood samples for serum creatinine, serum albumin, serum prealbumin, high sensitivity C-reactive protein (hsCRP), interleukin 6 (IL-6), insulin-like growth factor 1(IGF-1) concentrations were taken before the midweek dialysis session. Over the course of a one-year observation, seven patients died. We observed a significantly lower lean tissue index (LTI) (p = .013) and higher IL-6 (p = .032) and hsCRP levels (p = .011) among the patients who died. The remaining biochemical markers did not differ between these two groups. Kapplan-Meier analysis revealed a worse survival rate in patients with sarcopenia (lower than the 10th percentile for their age and gender) in comparison with those with normal LTI. However, it was not of statistical significance (p = .055). LTI inversely correlated with age and IL-6 and positively with IGF-1. Sarcopenia defined as decreased LTI, is a relatively common condition among patients undergoing maintenance hemodialysis, it can also be associated with a lower one-year survival rate. Decreased lean tissue mass can be associated with old age, lower IGF-1 levels and higher IL-6 levels. Body composition assessment may provide prognostic data for hemodialysis patients.
Introduction: patients undergoing hemodialysis repetitively experience pain and anxiety related to arterivenous fistula (AVF) punctures. Using of appropriate methods of pain relief in these patients is very important. The purpose of this study was to compare the effect of lidocaine gel and inhalation of lavender aromatherapy on pain intensity of arterivenous fistula puncture in hemodialysis patients. Methods: In this before and after clinical trial study, 40 hemodialysis patients were sele...
Full Text Available Abstract Malnutrition, anemia and increased atherosclerosis are the main causes of mortality in hemodialysis patients. Therapies designed to improve the disorders might therefore be expected to improve outcome. The effects of Nandrolone Decanoate (ND, in 64 stable hemodialysis patients, were studied with respect to the following parameters: nutritional status, hematological indexes, lipid profiles including serum levels of lipoprotein(a [Lp(a] in terms of differences in apolipoprotein(a [apo(a]. The patients were treated with ND at dose of 100 mg/I.M./week for 4 months. After 2 and 4 months of treatment the elevations in the serum levels of albumin (p 30 mg/dl than those of with low Lp(a (
Hegbrant, J.; Thysell, H.; Ekmann, R.
The fasting plasma levels of nine gastrointestinal regulatory peptides were measured by radioimmunoassay in 13 stable patients with chronic renal failure, receiving hemodialysis treatment regularly and compared with those of ten healthy controls. The plasma concentrations of gastrin-releasing peptide, motilin, neurotensin, pancreatic polypeptide, peptide YY, somatostatin, substance P, and vasoactive intestinal peptide were increased. The plasma level of gastrin was not statistically different from that of the control (p=0.077). It is concluded that patients with chronic renal failure, receiving hemodialysis treatment regularly, have increased concentrations of eight of nine measured gastrointestinal regulatory peptides. The elevated levels of gastrointestinal peptides in patients with chronic renal failure may contribute to uremic gastrointestinal symptoms and dysfunctions. It is necessary to make a renal function evaluation before interpreting measured plasma levels of gastrointestinal regulatory peptides. 62 refs., 2 tabs
Full Text Available Background and Objectives: Spiritual well-being has been recognized as an important resource to cope with illness and life stresses. The aim of this study is to determine the Spiritual well-being status as well as stress coping strategies in hemodialysis patients. Methods: This descriptive-analysis study included 95 randomly selected patients undergoing treatments with hemodialysis in hemodialysis centers of Qom hospitals. Data collection instruments were the Spiritual Well-Being Scale and Jalowiec Coping Scale Data were analyzed via SPSS 16 software, by using descriptive statistics, Pearson correlation coefficient and independent t-test. Results: The mean and standard deviation score of spiritual well-being of patients were 91.98±15.09 while the mean and standard deviation of existential and religious well-being were 50.76±8.06 and 41.22±8.91, respectively. 52.6% got scores higher than the average score in spiritual well-being. The most common coping strategies in patients were Evasive and Supportant copings. Spiritual well-being and problem-oriented coping strategies had a significant positive correlation (r = 0.41, p = 0.008. But there was no significant relationship between spiritual well-being and emotion-focused coping strategies. Conclusion: Results showed that hemodialysis patients mostly use emotion-oriented strategies when facing disease and treatment’s challenges. There was a positive relation between spiritual well-being and problem-oriented coping strategies; therefore, in order to increase levels of coping with the disease, the care plan should be written with an emphasis on patients' spiritual needs.
Full Text Available Anemia is a common complication in chronic kidney disease (CKD patients receiving hemodialysis. The effect of high-flux dialysis (HFD on anemia remains unclear. This prospective study aimed to evaluate the effect of HFD on anemia, and the potential of soluble transferrin receptor (sTfR as a marker of iron status and erythropoiesis in CKD patients on hemodialysis. Forty patients, who switched from conventional low-flux dialysis to HFD for 12 months, were enrolled in this study. The levels of sTfR, hemoglobin (Hb, iron, and nutritional markers, as well as the dose of recombinant human erythropoietin (rhEPO and use of chalybeate were determined at 0, 2, 6, and 12 months after starting HFD. HFD significantly increased the hemoglobin level and reduced sTfR level in CKD patients (p < 0.05. In addition, significant decreasing linear trends were observed for rhEPO dosage and chalybeate use (p < 0.05. The level of sTfR was positively correlated with the percentage of reticulocytes (RET%, rhEPO dose, and chalybeate use, while it was negatively correlated with Hb levels and total iron-binding capacity results (all p < 0.05. A univariate generalized estimating equation (GEE model showed that the Hb level, RET%, rhEPO dose, and chalybeate use were the variables associated with sTfR levels. A multivariate GEE model showed that the time points when hemodialysis was performed were the variables associated significantly with sTfR levels. Overall, our findings suggest that HFD can effectively improve renal anemia in hemodialysis patients, and sTfR could be used as a marker of erythropoiesis in HFD patients.
Widjaja, J. A.; Simadibrata, C.; Srilestari, A.; Marbun, M. B. H.
Insomnia is a problem often experienced by patients on chronic dialysiswhich reduces their quality of life. Current management of insomnia with this specific group of patients has yet to produce optimum results. In this study, we explored the roleof acupuncture as a treatment for symptoms of insomnia in patients on chronic dialysis. Twenty-eight hemodialysis patients suffering from insomnia were divided randomly into two groups, an acupuncture group (n = 15) who received acupuncture treatment at the points HT7 Shenmen, PC6 Neiguan, GV20 Baihui, and EX-HN1 Sishenchong, anda control group (n = 13) who underwenta sham procedure in which a needle was inserted into an elastic bandage at the same points. The acupuncture treatment was done during hemodialysis twice a week for five weeks. PSQI scores and the WHOQOL-BREF were assessed before treatment, after the fifth treatment, and at the end of the treatment. Significant differences were found in the PSQI score ((4.20±2.27 vs. 11.23±3.37) p = 0.000) and in the WHOQOL-BREF ((94.53±10.08 vs. 82.69±11.90) p = 0.008) between the acupuncture group and the control group by the end of the period of treatment. Acupuncture treatment effectively improved the quality of sleep and the quality of life for these chronic hemodialysis patients.
Matlabi, Hossein; Ahmadzadeh, Sharareh
Quality of life (QoL) has become an important issue for patients with chronic renal failure diseases who are permanently undergoing hemodialysis. In this study, an adapted schedule for the evaluation of individual quality of life (SEIQoL-adapted) was used to evaluate QoL among hemodialysis patients, to explore their views about the most important aspects of life satisfaction. A multiple approach design and convenience sampling were applied to recruit 53 patients from a hemodialysis unit in Iran. Data were collected through structured interviews and then analyzed using conventional content analysis. A total score for QoL was calculated using scale guideline. The most important aspects of life were health, family, financial status, living conditions, leisure activities, relationships and socializing, religious and spiritual issues, medical knowledge, and therapies or treatments. The calculated mean QoL score was 66.2, indicating a relatively high life satisfaction. Males had higher QoL scores than females in both married and single groups. Moreover, the relationships between the QoL scores and education, job and marital status were not statistically significant. The SEIQoL-adapted revealed reasonable lay definitions of QoL in a group of patients following chronic renal failure. The patients' views of the aspects of life could be used by health policy makers, clinicians, and caregivers as a reliable guide to the most important priorities for treatment and medical interventions.
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.
Noori, Nazanin; Kovesdy, Csaba P; Bross, Rachelle; Lee, Martin; Oreopoulos, Antigone; Benner, Deborah; Mehrotra, Rajnish; Kopple, Joel D; Kalantar-Zadeh, Kamyar
Lean body mass (LBM) is an important nutritional measure representing muscle mass and somatic protein in hemodialysis patients, for whom we developed and tested equations to estimate LBM. A study of diagnostic test accuracy. The development cohort included 118 hemodialysis patients with LBM measured using dual-energy x-ray absorptiometry (DEXA) and near-infrared (NIR) interactance. The validation cohort included 612 additional hemodialysis patients with LBM measured using a portable NIR interactance technique during hemodialysis. 3-month averaged serum concentrations of creatinine, albumin, and prealbumin; normalized protein nitrogen appearance; midarm muscle circumference (MAMC); handgrip strength; and subjective global assessment of nutrition. LBM measured using DEXA in the development cohort and NIR interactance in validation cohorts. In the development cohort, DEXA and NIR interactance correlated strongly (r = 0.94, P < 0.001). DEXA-measured LBM correlated with serum creatinine level, MAMC, and handgrip strength, but not with other nutritional markers. Three regression equations to estimate DEXA-measured LBM were developed based on each of these 3 surrogates and sex, height, weight, and age (and urea reduction ratio for the serum creatinine regression). In the validation cohort, the validity of the equations was tested against the NIR interactance-measured LBM. The equation estimates correlated well with NIR interactance-measured LBM (R² ≥ 0.88), although in higher LBM ranges, they tended to underestimate it. Median (95% confidence interval) differences and interquartile range for differences between equation estimates and NIR interactance-measured LBM were 3.4 (-3.2 to 12.0) and 3.0 (1.1-5.1) kg for serum creatinine and 4.0 (-2.6 to 13.6) and 3.7 (1.3-6.0) kg for MAMC, respectively. DEXA measurements were obtained on a nondialysis day, whereas NIR interactance was performed during hemodialysis treatment, with the likelihood of confounding by volume status
Kooshki, A; Samadipour, E; Akbarzadeh, R
Background: Despite the high levels of inflammation in hemodialysis patients and the effects of diet on systemic inflammation, such as the development of atherosclerosis and cardiovascular disease, few studies have evaluated the relationship of macronutrients and antioxidants intake with serum C-reactive protein (CRP). Therefore, this study assessed the relationship between serum high sensitivity CRP (hs-CRP) with macronutrients and antioxidants intake and serum albumin. Methods: This cross-sectional study used census sampling to select 75 hemodialysis patients (35 men and 40 women) who attended the hemodialysis department of Vaseie Hospital of Sabzevar, Iran. After obtaining the written consent, all the patients were interviewed and dietary data was collected by using a semi-quantitative food frequency questionnaire including 160 food items. Diet analysis was performed with Nutritionist IV. Before being connected to the dialysis machine, 5 cc fasting blood samples were obtained from all participants and serum hs-CRP and albumin levels were measured. All the statistical analyses were conducted with SPSS -for Windows, version 16.0. Results: The patients' mean body mass index was 20.09 ± 3.27 kg/ m2. The participants' intake of antioxidants and all macronutrients, except for carbohydrates and proteins, was less than the standard levels. Moreover, the hs-CRP had significant inverse relationships with serum albumin (P=0.0001) and vitamin E and C intakes but was not significant. Also, a significant relationship was observed between hs-CRP levels and the intake of energy (P=0.002) and protein (P=0.0001). Conclusion: Our findings indicated hs-CRP levels of hemodialysis patients to have significant inverse relationships with serum albumin and vitamin E and C intakes but was not significant. Also, a significant relationship was observed between hs-CRP levels and the intake of energy and protein.
Lara, Kelly A; Chua, Rochelle Anne; Vo, Trung D
Autogenous arteriovenous fistula (AVF) is the primary recommended access for hemodialysis. Long-term use will not uncommonly result in AVF aneurysmal degeneration. Aneurysm-associated complications encompass pain, skin ulceration, infection, thrombosis, cannulation difficulties, and life-threatening bleeding. Various methods to repair aneurysmal AVFs have been described. However, there may be circumstances when this is not possible and require insertion of a temporary hemodialysis catheter (HDC) until a new arteriovenous access is created. We describe a case series of creating a new simultaneous AVF while continuing to use the primary failing aneurysmal AVF to avoid placement of an HDC. Once the new AVF becomes operational, the primary aneurysmal AVF can be abandoned. Six patients underwent simultaneous new AVF creation, 4 ipsilateral, and 2 contralateral. None of the patients developed symptomatic steal syndrome or congestive heart failure. Five of 6 patients had successful usage of the new AVF, and subsequently underwent ligation and excision of the aneurysmal AVF, thus avoiding a temporary HDC. Close monitoring for skin compromise and bleeding in the aneurysmal AVF is recommended while the new AVF matures. Copyright © 2018 Elsevier Inc. All rights reserved.
Ji Eun Lee
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.
Maryam Frad Tabatabaei
Full Text Available Happiness is one of the most important human psychological needs that plays a key role in the formation of a person's character and mental health. This quasi-experimental study aimed to determine the effect of happiness training in reducing depression and anxiety and improving quality of life among hemodialysis patients. The participants consisted of 30 female dialysis patients that referred to hemodialysis ward in Zahedan city. The participants were placed in two groups, experimental and control, each included 15 members. Afterwards, the Fordyce happiness training was implemented on the experimental group in 8 sessions (a 90-minute session per week. Pretest and posttest were conducted on both groups. In the current study, for gathering data in the pretest and posttest, the Beck Depression Inventory, Katel Anxiety Questionnaire, and 36-Item Short Form (SF-36 Health Survey were employed. The results of the data analysis showed significant differences between the mean scores of the hemodialysis patients placed in the experimental and control groups on depression, anxiety, and quality of life. Accordingly, it can be concluded that the happiness training was effective in reducing the patients' depression and anxiety and enhancing their quality of life.
Abreo, Adrian P; Dalrymple, Lorien S; Chertow, Glenn M; Kaysen, George A; Herzog, Charles A; Johansen, Kirsten L
Previous studies of patients with end-stage renal disease have examined the role of fluid shifts on apnea-hypopnea episodes, but the association between volume overload and patient-reported sleep quality or duration has not been well-established. We studied the association between predialysis bioimpedance spectroscopy-derived volume estimates and self-reported sleep quality and duration in 638 patients in the United States Renal Data System ACTIVE/ADIPOSE study receiving hemodialysis from 2009 to 2011. We used questionnaires to assess self-reported sleep duration and quality. We used relative hydration status (fluid overload/extracellular water; FO/ECW) as the primary predictor and examined associations with hours of sleep duration using linear regression. We used multivariable ordinal logistic regression to determine the association between categories of relative hydration status (normal hydration [FO/ECW 15%]) and four levels of difficulty with falling asleep, waking, and returning to sleep. Higher relative hydration status was associated with fewer hours of sleep (-0.31 hours per 10%, 95% confidence interval (CI) -0.49 to -0.13). Compared to the normal hydration group, there was a statistically significant association between higher relative hydration status category and more frequent nighttime waking (OR: mild overhydration 1.92 [95% CI 1.23-2.99], hyperhydration 1.87 [95% CI 1.16-2.99]), a trend toward more difficulty returning to sleep (OR: mild overhydration 1.46 [95% CI 0.94-2.27], hyperhydration 1.52 [95% CI 0.95-2.43]), and no association between relative hydration category and difficulty falling asleep. Hydration status was associated with self-reported sleep duration in patients on dialysis. Future studies should prospectively examine the effects of optimizing fluid status on sleep duration and quality. © 2016 International Society for Hemodialysis.
Abe, Masanori; Hamano, Takayuki; Wada, Atsushi; Nakai, Shigeru; Masakane, Ikuto
Background Little information is available regarding which type of dialyzer membrane results in good prognosis in patients on chronic hemodialysis. Therefore, we conducted a cohort study from a nationwide registry of hemodialysis patients in Japan to establish the association between different dialyzer membranes and mortality rates. Methods We followed 142,412 patients on maintenance hemodialysis (female, 39.1%; mean age, 64.8 ? 12.3 years; median dialysis duration, 7 [4?12] years) for a year...
Full Text Available Introduction: Uremic pruritus (UP is a common and distressing complication of end-stage renal disease (ESRD. Aglobal cross-sectional study of 18,000 hemodialysis patientsreported a 42% prevalence of moderate or extreme UP, which was strongly associated with sleep disturbance, depression, impaired quality of life, and mortality. Pruritus is commonly encountered in individuals with end-stage renal disease (ESRD on hemodialysis (HD. Materials and Methods: This cross-sectional study was performed in order to find out the prevalence of pruritus in patients on regular maintenance hemodialysis (HD as well as to analyze its relationship to age, sex of the patient, duration of hemodialysis in months per patient, serum levels of phosphate, PTH, KT/V (index of dialysis dose, parameters in the beggining of the study and six months after. The data were analyzed by descriptive statistics- Wilcoxon Signed Rank Test and Chi-square test with Yates correction factor. Results: Sixty and two patients with ESRD (age ranging from 31 to 87years free from systemic, skin or psychiatric disorders and other secondary causes attributable to pruritis, undergoing maintenance HD (duration on HD 4-348months; mean 86.97 and median 79,5months at Fresenius dialysis center, Banja Luka, Bosnia and Herzegovina were evaluated for pruritus. Pruritus has been discovered in 21 out of 34males (54,8% and 6 out of 28females (22,2%. Our study as many others showed that pruritus is very common (45.2% in HD patients. Applying c2 test with Yates correction factor is highly statistically significant (c2 = 8.003, p = 0.005 by gender. Research of the gender revealed that pruritus appeared more in men analysis. There were no significant differences between other measured markers: to age, duration of hemodialysis in months per patient, serum levels of phosphate, PTH, KT/V (index of dialysis dose in patients with pruritus and in patients without pruritus. Conclusions:This first cross-sectional study
Kumar, S.; Trivedi, H. L.; Smith, E. K.
Symptoms of compression of the median nerve in the carpal tunnel developed in two patients in whom an arteriovenous fistula was created to alleviate chronic renal failure through hemodialysis. Anatomic changes in the wrist area due to the fistula are probably important in the development of this syndrome, and pre-existing uremic peripheral polyneuropathy may also be important in the early development of local symptoms of nerve damage. Images FIG. 1 PMID:1201544
Roxo, Renata Spósito; Xavier, Vivian Bertoni; Miorin, Luiz Antônio; Magalhães, Andrea Olivares; Sens, Yvoty Alves Dos Santos; Alves, Vera Lúcia Dos Santos
Literature shows that patients undergoing hemodialysis present poor physical conditioning and low tolerance to exercise. They may also suffer from respiratory dysfunctions. The purpose of this study was to evaluate the effects of neuromuscular electrical stimulation on pulmonary function and functional capacity of patients with chronic kidney disease on hemodialysis. Forty adult patients with chronic kidney disease on hemodialysis were prospectively studied and randomized into two groups (control n = 20 and treatment n = 20). The treatment group underwent bilateral femoral quadriceps muscles electrical stimulation for 30 minutes during hemodialysis, three times per week, for two months. The patients were evaluated by pulmonary function test, maximum respiratory pressures, maximum one-repetition test, and six-minute walk test (6MWT), before and after the treatment protocol. The treatment group presented increased maximum inspiratory (MIP) (p = 0.02) and expiratory pressures (MEP) (p grupos (controle n = 20 e tratamento n = 20). O grupo tratamento realizou protocolo com estimulação elétrica neuromuscular em quadríceps femoral por 30 minutos durante a hemodiálise, três vezes por semana, durante dois meses. Todos pacientes realizaram espirometria, pressões respiratórias máximas, teste de uma repetição máxima e teste da caminhada dos seis minutos (TC6), antes e após o período de acompanhamento. O grupo tratamento apresentou aumento da pressão inspiratória máxima com p = 0,02 na comparação entre grupos e p grupo de tratamento com p grupo controle. A estimulação elétrica neuromuscular teve impacto positivo sobre a função pulmonar e a capacidade funcional levando ao melhor desempenho físico em pacientes em hemodiálise.
Nasri, Hamid; Asl, Mohammad Kazem Hosseini
The purpose of this prospective study is to determine the prevalence of Helicobacter pylori (H. pylori) infection among stable chronic hemodialysis (HD) patients having non ulcer dyspepsia. The study was carried out on 80 patients consisting of 40 patients with dyspepsia and 40 consecutive control subjects without renal disease and dyspepsic symptoms. Mean age of patients were 56 +- 14 and 47 +- 15 respectively. This study showed no significant difference of H. pylori infection between the two groups. Tissue examination of gastric antrum showed higher localization of H. pylori in HD patients in contrast to controls. This finding has not been reported before and needs further confirmation and evaluation for its significance. (author)
Liu, Na; Kim, Jinman; Jung, Younhyun; Arisy, Adani; Nicdao, Mary Ann; Mikaheal, Mary; Baldacchino, Tanya; Khadra, Mohamed; Sud, Kamal
Patients undertaking long-term and chronic home hemodialysis (HHD) are subject to feelings of isolation and anxiety due to the absence of physical contact with their health care professionals and lack of feedback in regards to their dialysis treatments. Therefore, it is important for these patients to feel the "presence" of the health care professionals remotely while on hemodialysis at home for better compliance with the dialysis regime and to feel connected with health care professionals. This study presents an HHD system design for hemodialysis patients with features to enhance patient's perceived "copresence" with their health care professionals. Various mechanisms to enhance this perception were designed and implemented, including digital logbooks, emotion sharing, and feedback tools. The mechanism in our HHD system aims to address the limitations associated with existing self-monitoring tools for HHD patients. A field trial involving 3 nurses and 74 patients was conducted to test the pilot implementation of the copresence design in our HHD system. Mixed method research was conducted to evaluate the system, including surveys, interviews, and analysis of system data. Patients created 2757 entries of dialysis cases during the period of study. Altogether there were 492 entries submitted with "Very Happy" as the emotional status, 2167 entries with a "Happy" status, 56 entries with a "Neutral" status, 18 entries with an "Unhappy" status, and 24 entries with a "Very unhappy" status. Patients felt assured to share their emotions with health care professionals. Health care professionals were able to prioritize the review of the entries based on the emotional status and also felt assured to see patients' change in mood. There were 989 entries sent with short notes. Entries with negative emotions had a higher percentage of supplementary notes entered compared to the entries with positive and neutral emotions. The qualitative data further showed that the HHD system was
Kraus, Michael; Burkart, John; Hegeman, Rebecca; Solomon, Richard; Coplon, Norman; Moran, John
Home hemodialysis has been a therapeutic option for almost 4 decades. The complexity of dialysis equipment has been a factor-limiting adoption of this modality. We performed a feasibility study to demonstrate the safety of center-based vs. home-based daily hemodialysis with the NxStage System One portable hemodialysis device. We also performed a retrospective analysis to determine if clinical effects previously associated with short-daily dialysis were also seen using this novel device. We conducted a prospective, 2-treatment, 2-period, open-label, crossover study of in-center hemodialysis vs. home hemodialysis in 32 patients treated at 6 U.S. centers. The 8-week In-Center Phase (6 days/week) was followed by a 2-week transition period and then followed by the 8-week Home Phase (6 days/week). We retrospectively collected data on hemodialysis treatment parameters immediately preceding the study in a subset of patients. Twenty-six out of 32 patients (81%) successfully completed the study. Successful delivery of at least 90% of prescribed fluid volume (primary endpoint) was achieved in 98.5% of treatments in-center and 97.3% at home. Total effluent volume as a percentage of prescribed volume was between 94% and 100% for all study weeks. The composite rate of intradialytic and interdialytic adverse events per 100 treatments was significantly higher for the In-Center Phase (5.30) compared with the Home Phase (2.10; p=0.007). Compared with the period immediately preceding the study, there were reductions in blood pressure, antihypertensive medications, and interdialytic weight gain. Daily home hemodialysis with a small, easy-to-use hemodialysis device is a viable dialysis option for end-stage renal disease patients capable of self/partner-administered dialysis.
Freire de Medeiros, Camila Maroni Marques; Arantes, Eder Pinheiro; Tajra, Rafael Dib de Paulo; Santiago, Hendrio Reginaldo; Carvalho, André Ferrer; Libório, Alexandre Braga
Resilience and religiosity have received attention as an important process in the experience and management of chronic comorbidities; however, there is no study evaluating resilience in hemodialysis patients and its association with other psychological dimensions or with treatment adherence. This observational prospective study assessed resilience (25 item Wagnild and Young Resilience Scale), religiosity under three dimensions (organizational, non-organizational and intrinsic) using DUREL scale, depressive symptoms (Patient Health Questionnaire-9) and health-related quality of life (Short Form-36 questionnaire). The main outcomes were medication adherence using the Morisky Medication Adherence Scale-8 (MMAR-8) and the missing/shortened dialysis sessions in the following six months. Of 208 patients approached, 202 (97.1%) agreed to participate. One hundred twenty-three patients (60.9%) were males and mean age was 52.8 ± 14.8 years-old. The median time on hemodialysis was 36 months (IQR, 12, 84). 82 (40.6%) patients obtained a MMAS-8 score adherence'. Overall, the mean score of medication adherence was low (5.7 ± 2.1). About adherence to hemodialysis sessions, patients missed a total of 234 (1.6%) hemodialysis sessions. Forty-eight patients (23.7%) missed an average of at least three sessions in six months. Regarding adherence to medication, there was no association in the uni- or multivariate analysis between religiosity dimensions and MMAS-8 score. After adjustment, resilience was positively associated with MMAS-8 score (standardized β coefficient .239, p = .016). Organized and intrinsic religiosity were associated with adherence to dialysis sessions (standardized β coefficient .258, p = .004 and .231, p = .026, respectively). Interestingly, opposite to medication adherence, more resilient patients were associated with less adherence to hemodialysis sessions (standardized β coefficient -.296, p = .001). Religiosity was associated with dialysis
Full Text Available Nutritional status in patients on hemodialysis is always of concern as malnutrition predisposes to excess morbidity and mortality. Most of the nutritional supplements available in the market are expensive. We explored the possibility of improving nutrition of the patients on maintenance hemodialysis by supplementation of calories and proteins that can be given in the form of a palatable and economical gruel in this prospectively designed, open labeled study. Patients who were on maintenance hemodialysis (twice a week for a period of at least 6 months were divided into two groups. The study group was given the gruel supplement and the control group was not given the gruel supplement. Nutritional status was assessed in the study group and controls at 0 and 3 months by the following parameters: percentage body fat, mid arm muscle circumference and serum albumin. Analysis of results revealed that there was a significant decline in the protein intake at the end of the 3 rd month in the control group (P = 0.01. Other parameters did not show significant change at the end of the study period in both groups. The nutritional supplement can be assumed to have helped at least in the maintenance of protein intake over this short period and could possibly in the long run contribute to improvement of nutritional parameters.
Takaki, Jiro; Yano, Eiji
The goal of this study was to assess the relationship between emotion- and task-oriented coping (EOC/TOC) with stress and employment in patients undergoing maintenance hemodialysis. Individuals aged 18 to 64 yr who had uremia and had been undergoing hemodialysis regularly for at least three months were evaluated according to sociodemographic and clinical factors. Work status was defined using the most recent International Labour Organization definitions. Patients were requested to complete the following questionnaires: the Japanese version of the Coping Inventory for Stressful Situations, the Short Form-36 Health Survey, an item on itchiness, the Self-Efficacy on Health-Related Behavior Scale, the Japanese version of the Health Locus of Control Scale, the Social Support Scale, and the Japanese version of the Hospital Anxiety and Depression Scale. A total of 317 individuals participated in this study. Among men, age, physical functioning, EOC, and depression differed significantly (pTOC was not significantly associated with employment in either sex. Multiple logistic regression analyses, including possible confounders, indicated that when EOC increased by 10 points, the associated adjusted odds ratio of an unemployed or economically inactive status changed by 1.48 (95% confidence interval, 1.04-2.11; p=0.030) in men and by 1.88 (95% confidence interval, 1.02-3.46; p=0.042) in women. These results suggest that EOC is associated with employment in patients receiving maintenance hemodialysis.
Full Text Available Objective: The aim of this study was to explore the burden of care for patients undergoing hemodialysis from the experiences of family caregivers. Methods: In this qualitative study, a content analysis approach was used for data collection and analysis. Participants were 16 family caregivers selected through purposive sampling from four medical education centers affiliated with Ahvaz Jundishapur University of Medical Sciences, Iran. Semi-structured interviews were held to collect data. Results: Four categories were developed as follows: ‘care challenges’, ‘psychological vulnerabilities’, ‘the chronic nature of care ’and “care in the shade”. The categories led to the development of the main theme of ‘progressive exhaustion’ experienced by the family caregivers during the provision of care to patients undergoing hemodialysis. Conclusion: Family caregivers have a significant role in the process of patient care, and this role leads them to progressive exhaustion; therefore, the overall health of the caregivers should be taken into account and more attention should be paid to their quality of life, social welfare, and satisfaction level. Keywords: Family caregivers, Hemodialysis, Progressive exhaustion, Qualitative study
Ghasemi, A.; Shafiee, M.; Rowghani, K.
To investigate the effect of cool dialysis on hemodynamic parameters and serum nitric oxide levels in diabetic patients, we studied 20 old (mean age 63.3+-7.5) chronic hemodialysis diabetics who were dialyzed twice, once using cool and once using standard (37 C) temperature dialysis solution. During the study, all the dialysis conditions were maintained the same except cooling the dailysate from 37C to 35C. Hemodynamic parameters including SBP, DBP and HR were measured hourly. Oral temperature was measured before and after dialysis. Serum urea and nitric oxide metabolites were determined before and after hemodialysis. Systolic, diastolic and mean arterial pressure decreased significantly during standard compared to cool dialysis. Maximum decrease of systolic, diastolic and mean arterial pressure was observed during the third hour of dialysis and magnitude of decrease was 18, 17 and 14 percent for standard temperature and 6, 1, and 4 percent for cool dialysis, respectively. Heart rate did not differ significantly between the two study groups. Compared to the pre dialysis levels of serum nitric oxide metabolites, the post dialysis levels decreased significantly with cool and standard temperature dialysate (59+-5 vs. 37+-4, and 63+-7 vs. 41+-5, umol/L respectively, P<0.01). Cool dialysis could decrease episodes of hypotension and stabilized hemodynamic parameters in diabetic patients. Probably other mechanisms than increased serum nitric oxide levels may be involved in hemodialysis hypotension in this group of patients. (author)
Shavit, L; Lifschitz, M; Plaksin, J; Grenader, T; Slotki, I
Catheter thrombosis is common and results in inadequate dialysis treatment and, frequently, in catheter loss. Since dialysis treatment runs on a strict schedule, occluded catheters need to be restored in a timely and cost effective manner. We present a new shortened protocol of urokinase infusion that allows hemodialysis to be performed within 90 minutes. To chronic hemodialysis patients, who developed complete catheter occlusion, urokinase was infused simultaneously through both lumens of the catheter (125,000 units to each lumen) over 90 minutes. Technical success was defined as restoring blood pump speed to at least 250 ml/min. We determined the average time from catheter placement to first clot event (primary patency PP), recurrent clot event after urokinase treatment (secondary patency SP), catheter salvage rate and cause for removal. 37 catheters developed total thrombosis and urokinase was used to restore patency one or more times (total 47 treatments). Catheter salvage rate was 97 %. The average time of PP was 152 ± 56 days (7 - 784 days). Nine patients (30%) developed recurrent occlusion and the average time of SP was 64 ± 34 days (2 - 364 days). One catheter was removed because of dysfunction due to thrombosis. Other catheters were removed due to infection, fistula maturation or fell out spontaneously. Hemodialysis was performed immediately after treatment with blood speed of 250 ml/min in all patients. Our protocol is highly effective, short, and allows to restore patency of totally occluded central venous catheters with minimal disruption of the dialysis session.
Cornelia DY Nekada
Full Text Available Background and Objective: Data from Indonesia Basic Health Research (2013 states that the chronic renal failure in Indonesia is increasing, especially in Yogyakarta with the prevalence of chronic renal failure of 0,3%. If the patients of chronic renal failure are in End Stage Renal Disease (ESRD, the kidney needs replacement therapy to help its function. This therapy is called Continuous Renal Replacement Therapy (CRRT or Hemodialysis (HD. Hemodialysis therapy may influence to the imbalance of oxyhemoglobin in the blood. Patients undergoing hemodialysis may experience intradialytic nausea and vomiting. The objective of this study is to identify whether there is a relationship between pre-dialysis oxygenation status through oxygen saturation (SpO2 and respiratory rate (RR examination and the intradialytic nausea-vomiting occurrence. Method: This research is a comparative research with analytical cross sectional design. This research was conducted in hemodialysis room in Public Hospital of Panembahan Senopati Bantul. The subject of the research was taken using total sampling, by paying attention to research ethics. The total research subjects are 183 respondents. The researchers measured the oxygen saturation and patients’ respiratory rate and examined the intradialytic nausea and vomiting complaints. Result: The analysis result of Fisher’s exact in this research shows p value of 0,000 both in bivariate analysis of oxygen saturation to the nausea and vomiting occurrence and in bivariate analysis of the respiratory rate to the nausea and vomiting occurrence. The multivariate analysis employing regression logistic shows that the OR of oxygen saturation is 73,57, this means that the measurement of the abnormal oxygen saturation has the chance of seventy three times more to the nausea and vomiting occurrence, if compared to the patients with normal oxygen saturation. Conclusion and Suggestion: Intradialytic nausea and vomiting is one of the causes
Timothy S. Laux
Full Text Available ABSTRACT Objective To document the prevalence of patients on hemodialysis in southwestern Guatemala who have chronic kidney disease (CKD of non-traditional causes (CKDnt. Methods This cross-sectional descriptive study interviewed patients on hemodialysis at the Instituto Guatemalteco de Seguridad Social on their health and occupational history. Laboratory serum, urine and vital sign data at the initiation of hemodialysis were obtained from chart reviews. Patients were classified according to whether they had hypertension or obesity or neither. The proportion of patients with and without these traditional CKD risk factors was recorded and the association between demographic and occupational factors and a lack of traditional CKD risk factors analyzed using multivariate logistic regression. Results Of 242 total patients (including 171 non-diabetics enrolled in hemodialysis in southwestern Guatemala, 45 (18.6% of total patients and 26.3% of non-diabetics lacked traditional CKD risk factors. While agricultural work history was common, only travel time greater than 30 minutes and age less than 50 years old were significantly associated with CKD in the absence of traditional risk factors. Individuals without such risk factors lived throughout southwestern Guatemala’s five departments. Conclusions The prevalence of CKDnT appears to be much lower in this sample of patients receiving hemodialysis in Southwestern Guatemala than in hospitalized patients in El Salvador. It has yet to be determined whether the prevalence is higher in the general population and in patients on peritoneal dialysis.
Laux, Timothy S; Barnoya, Joaquin; Cipriano, Ever; Herrera, Erick; Lopez, Noemi; Polo, Vicente Sanchez; Rothstein, Marcos
Objective To document the prevalence of patients on hemodialysis in southwestern Guatemala who have chronic kidney disease (CKD) of non-traditional causes (CKDnt). Methods This cross-sectional descriptive study interviewed patients on hemodialysis at the Instituto Guatemalteco de Seguridad Social on their health and occupational history. Laboratory serum, urine and vital sign data at the initiation of hemodialysis were obtained from chart reviews. Patients were classified according to whether they had hypertension or obesity or neither. The proportion of patients with and without these traditional CKD risk factors was recorded and the association between demographic and occupational factors and a lack of traditional CKD risk factors analyzed using multivariate logistic regression. Results Of 242 total patients (including 171 non-diabetics) enrolled in hemodialysis in southwestern Guatemala, 45 (18.6% of total patients and 26.3% of non-diabetics) lacked traditional CKD risk factors. While agricultural work history was common, only travel time greater than 30 minutes and age less than 50 years old were significantly associated with CKD in the absence of traditional risk factors. Individuals without such risk factors lived throughout southwestern Guatemala's five departments. Conclusions The prevalence of CKDnT appears to be much lower in this sample of patients receiving hemodialysis in Southwestern Guatemala than in hospitalized patients in El Salvador. It has yet to be determined whether the prevalence is higher in the general population and in patients on peritoneal dialysis.
Tran, Cao Thach; Bundgaard, Henning; Ladefoged, Søren Daustrand
Disturbances in plasma potassium concentration (pK) are well known risk factors for the development of cardiac arrhythmia. The aims of the present study were to evaluate the effect of hemodialysis on exercise pK dynamics and QT hysteresis, and whether QT hysteresis is associated with the p......K decrease following exercise. Twenty-two end-stage renal disease patients exercised on a cycle ergometer with incremental work load before and after hemodialysis. ECG was recorded and pK was measured during exercise and recovery. During exercise, pK increased from 5.1 ± 0.2 to 6.1 ± 0.2 mM (mean ± SE; P...
Full Text Available A long non-coding RNA called ANRIL located on chromosome 9p21.3 has been identified as a novel genetic factor associated with cardiovascular disease. Investigation of several single nucleotide polymorphisms (SNPs of Noncoding Antisense RNA in the INK4 Locus (ANRIL gene are of particular interest. This article reports data related to the research article entitled: “Association of ANRIL gene polymorphisms with major adverse cardiovascular events in hemodialysis patients” (Arbiol-Roca et al. . Data presented show the genotypic distribution of four selected ANRIL SNPs: rs10757278, rs4977574, rs10757274 and rs6475606 in a cohort constituted by 284 hemodialysis patients. This article analyzes the Hardy-Weinberg disequilibrium of each studied SNP, and the linkage disequilibrium between them.
of the protein transthyretin (TTR) in plasma from hemodialysis patients in a randomized, placebo-controlled study in vivo and after administration to plasma in vitro. TTR was selected due to its low molecular weight and the free cysteine residue in the polypeptide chain, which is known to be extensively modified...... by formation of mixed disulfides. METHODS: Plasma levels of TTR were determined by a non-commercial enzyme-linked immunosorbent assay (ELISA) using polyclonal rabbit anti-human TTR antibodies. Spectra of immunoprecipitated TTR were obtained using an AutoflexSpeed matrix assisted laser desorption ionization-time......Analysis. TTR variants were expressed as relative amounts of the summed intensity of all observed TTR variants. RESULTS: The administration of NAC during a hemodialysis session resulted in a substantial increase of native TTR from median 15% (range 8.8-30%) to median 40% (37-50) and a reduction of S...
Full Text Available Purpose: Elderly patients who undergo hemodialysis are more fragile than older persons not on dialysis. However, it is not clear if this frailty exists before hemodialysis or if it becomes evident or more acute at the time of beginning a dialysis therapy program. The purpose of this study is to analyze if changes at both the motor and cognitive levels go hand in hand with the beginning of dialysis, and, if this is the case, to identify possible risk factors associated with the functional decline in these patients. Methods: A multicentric prospective pilot observational study was conducted in an ambulatory population with the primary objective to represent the evolution of functional gait capacity in patients before and during hemodialysis treatment, to show gait insecurity during treatment follow-up, if it is present. The secondary objectives are to identify risk factors in the development of gait insecurity, and to measure the prevalence of falls during the follow-up period. Results: The enrolment of patients began in January 2015 and the duration of the data collection will be at least 36 months. In the first 24 months, 19 patients have been included in the study. Preliminary data analysis is not expected before July 2018. Conclusions: The identification of frailty predictors is of major importance in order to identify and target patients at the highest risk of frailty who may be likely to benefit from preventive intervention.
Sabaghian, Tahereh; Hajibaratali, Bahareh; Samavat, Shiva
Bio-impedance analysis (BIA) is a preferred method for estimating the volume status. However, it cannot be utilized in daily practice. Since the assessment of the volume status is important and challenging for hemodialysis (HD) patients, the aim of study was to determine the volume status in chronic HD patients using echocardiographic parameters and assess its correlation with BIA. In this cross-sectional analysis, echocardiography and BIA were performed on 30 chronic HD patients 30 min before and 30 min after dialysis. All the cases of dialysis were performed in the middle of the week. This study also assessed the correlation between echocardiographic parameters and BIA parameters. There were significant differences between ECW, TBW, and TBW% (TBW/W) before and after HD. Significant differences were observed between echocardiographic parameters of IVCD, IVCDi min , IVCDi max before and after the HD. LVEDD, LVESD, LA area, mitral valve inflow, E/E', and IVRT, were improved after dialysis, too. There was a significant correlation between IVCDi min as an index of volume status, ECW% and TBW% before HD and IVCDi min change after dialysis had a significant correlation with %ECW change after dialysis. Comparison between hypertensive and non-hypertensive groups indicated IVCDi min was significantly lower in non-hypertensive group after dialysis. Our results showed a correlation between IVCDi min and BIA parameters before HD. So, it seems that IVCDi min can be a good parameter for determining the volume status of HD patients. However, further studies, with larger sample size and with a prospective study design, are required to confirm these results.
Full Text Available Abstract Background Poor adherence to treatment is common in patients on hemodialysis which may increase risk for poor clinical outcomes and mortality. Self management interventions have been shown to be effective in improving compliance in other chronic populations. The aim of this trial is to evaluate the effectiveness of a recently developed group based self management intervention for hemodialysis patients compared to standard care. Methods/Design This is a multicentre parallel arm block randomized controlled trial (RCT of a four session group self management intervention for hemodialysis patients delivered by health care professionals compared to standard care. A total of 176 consenting adults maintained on hemodialysis for a minimum of 6 months will be randomized to receive the self management intervention or standard care. Primary outcomes are biochemical markers of clinical status and adherence. Secondary outcomes include general health related quality of life, disease-specific quality of life, mood, self efficacy and self-reported adherence. Outcomes will be measured at baseline, immediately post-intervention and at 3 and 9 months post-intervention by an independent assessor and analysed on intention to treat principles with linear mixed-effects models across all time points. A qualitative component will examine which aspects of program participants found particularly useful and any barriers to change. Discussion The NKF-NUS intervention builds upon previous research emphasizing the importance of empowering patients in taking control of their treatment management. The trial design addresses weaknesses of previous research by use of an adequate sample size to detect clinically significant changes in biochemical markers, recruitment of a sufficiently large representative sample, a theory based intervention and careful assessment of both clinical and psychological endpoints at various follow up points. Inclusion of multiple dependent
Full Text Available Chronic inflammation is highly prevalent in maintenance hemodialysis (MHD patients, and it has been shown to be a strong predictor of morbidity and mortality. Mitochondrial DNA (mtDNA released into circulation after cell damage can promote inflammation in patients and animal models. However, the role and mechanisms of circulatory mtDNA in chronic inflammation in MHD patients remain unknown. Sixty MHD patients and 20 health controls were enrolled in this study. The circulatory mtDNA was detected by quantitative real-time PCR assay. Plasma interleukin 6 (IL-6 and tumor necrosis factor α (TNF-α were quantitated by ELISA assay. Dialysis systems in MHD patients and in vitro were used to evaluate the effect of different dialysis patterns on circulatory mtDNA. Circulatory mtDNA was elevated in MHD patients comparing to that of health control. Regression analysis demonstrated that plasma mtDNA was positively associated with TNF-α and the product of serum calcium and phosphorus, while negatively associated with hemoglobin and serum albumin in MHD patients. MtDNA induced the secretion of IL-6 and TNF-α in the THP-1 cells. Single high-flux hemodialysis (HF-HD and on line hemodiafiltration (OL-HDF but not low-flux hemodialysis (LF-HD could partially reduce plasma mtDNA in MHD patients. In vitro, both HD and hemofiltration (HF could fractional remove mtDNA. Collectively, circulatory mtDNA is elevated and its level is closely correlated with chronic inflammation in MHD patients. HF-HD and HDF can partially reduce circulatory mtDNA in MHD patients.
Full Text Available Background: Hemodialysis (HD patients are on multiple medications, see many prescribers and have many hospitalizations which put them at risk for medication record discrepancies and medication related problems (MRP. Being able to effectively identify and reconcile these medication issues is crucial in reducing hospitalizations, morbidities, and mortalities. The care of the hemodialysis patients can be enhanced by incorporating a pharmacist into the interprofessional team. There is little data in the literature on medication record discrepancies and MRP’s in dialysis patients. Objective: The objectives of this research were to determine the types of medication discrepancies and MRPs in dialysis patients and if recommendations for changes based on these findings were accepted by providers. Methods: Patients were asked to bring medications to the dialysis unit for review. Discrepancy and MRP recommendations were communicated to the unit staff via written progress notes. A follow-up was performed an average of 33 days later to determine if the recommendations were accepted. Results: Overall, in 93 unique patients, 376 discrepancies (3.1 per patient and 64 MRPs (0.5 per patient were identified. The most common type of discrepancy and MRP was drug omission and indication without drug, respectively. Of the total 440 interventions, 77% were ultimately accepted. Discrepancies were more likely to be accepted as compared to MRPs (85% vs. 27%, respectively. Conclusion: Medication record discrepancies and MRPs are common in dialysis patients. Recommendations related to discrepancies were more likely to be accepted by the providers as compared to MRPs. Medication records became inaccurate within 12 months. A pharmacy-based medication reconciliation and review program may have an important impact on the care of hemodialysis patients.
Scott, Meri Kay; Shah, Niyati A; Vilay, A Mary; Thomas, Joseph; Kraus, Michael A; Mueller, Bruce A
Our objective was to determine the effects of peridialytic oral supplements on nutritional markers and quality of life (QOL) in patients receiving maintenance hemodialysis. This trial was open, prospective, nonrandomized, and comparative. This study was performed at an outpatient hemodialysis unit in a teaching hospital. This study included 88 adults with chronic kidney disease at stage 5. This study involved directly observed nutrition therapy with >or=1 can of enteral nutrition (Nepro) with each hemodialysis session thrice weekly for 3 months, or standard care. Changes in biochemical markers of nutritional status and QOL, as measured by the Kidney Disease Quality of Life-Short Form, were determined. Peridialytic oral nutrition resulted in a significant difference between the nutrition and comparison groups in serum albumin change over time (P = .03; repeated-measures analysis of variance with covariates). Mean (+/-SD) serum albumin concentration did not differ between baseline and month 3 in the nutrition group (3.68 +/- 0.33 g/dL vs. 3.75 +/- 0.40 g/dL; P = .12), but in the comparison group, serum albumin levels declined significantly (3.93 +/- 0.34 g/dL at baseline versus 3.81 +/- 0.37 g/dL at month 3; P = .04). The "role-physical" domain score of the Kidney Disease Quality of Life-Short Form significantly changed over time in the nutrition group versus the comparison group (P = .02; repeated-measures analysis of variance with covariates). Nepro was well-tolerated, and greater than 80% of the prescribed therapy was consumed. Oral nutrition, as part of structured, directly observed peridialytic therapy in chronic hemodialysis patients, was well-accepted, and resulted in the maintenance of serum albumin levels and QOL with respect to impact of physical health on daily activities. These findings need to be confirmed in a randomized, controlled trial.
Shih, Chiung-Yu; Huang, Chiu-Ya; Huang, Mei-Lun; Chen, Chyong-Mei; Tang, Fu-In
To explore the association between the sociodemographic factors and the needs of patients undergoing hemodialysis in Taiwan. Concomitant discomfort, including physical and mental aspects, affects the patients' quality of life and their willingness to undergo hemodialysis. Maslow's hierarchy of needs is a well-known tool to assess different levels of human needs. We conducted a small-scale cross-sectional observational study using a structured needs assessment questionnaire on 159 patients from the Taipei Veterans General Hospital hemodialysis unit. The overall mean scores of physical, mental, spiritual, other needs, and needs in relation to medical staff care were 4.0±0.8, 3.2±0.8, 2.7±1.0, 3.1±0.9, and 4.1±0.7, respectively. The results showed that the patients' highest need was in relation to medical staff care, followed by physical needs. Further analysis showed that patients who are still employed during the treatment process have higher mental, spiritual, and other needs. Patient who are financially supported by their family have higher physical needs. Patients taken cared of by paid caregivers have lower spiritual needs and other needs. This is also the same with patients who are religious as opposed to those who are non-religious. Patients who have attained tertiary education have higher other needs compared to patients who have only achieved up to primary or secondary education. The study is the first in Taiwan to identify and quantify the needs of patients undergoing hemodialysis. When the needs of the patients are identified in relation to their sociodemographic factors, the medical staff can give the appropriate treatment in order to meet the needs and improve the patients' well-being. Healthcare providers should not only focus on the patients' physiological needs, but should determine and address their other needs in various aspects in order to improve the quality and efficacy of the dialysis care process. This article is protected by copyright
Shiota, E; Maekawa, M; Ohtani, M
The synovial fluid components in long-term hemodialysis patients (HD; 43 knees in 43 patients) were investigated and compared with those in patients with osteoarthritis (OA; 21 knees in 21 patients) and rheumatoid arthritis (RA; 26 knees in 26 patients). The average ages in the three groups were, respectively, 60.7 years (range, 34-79 years), 63.2 years (range, 48-88 years), and 59.7 years (range, 37-76 years). The duration of hemodialysis in the HD group averaged 14.0 years (range, 4-24 years). The concentrations of hyaluronic acid, protein, and isomers of chondroitin sulfate (chondroitin 6-sulfate [C6S] and chondroitin 4-sulfate [C4S]) in the synovial fluid, and its viscosity were measured. Differences in each of the parameters were investigated according to disease clinical stage, roentgenological grade, and periods of dialysis in the HD group. The viscosity of the synovial fluid and the concentration of hyaluronic acid in HD patients were similar to those in OA patients; however, the C6S/C4S ratio in the synovial fluid of HD patients was similar to that in RA patients. The latter finding suggests that synovitis may be present in the hydrarthrosis of HD patients. The cause of this synovitis in HD patients remains to be elucidated.
Maskova, Jana; Komarkova, Jana; Kivanek, Jiri; Danes, Jan; Slavikova, Marcela
Purpose: To report our experience and results with the endovascular treatment of central vein stenoses and occlusions in hemodialysis patients. Methods: Between October 1999 and August 2001 (22 months) we performed 22 interventional procedures in 14 hemodialysis patients (8 women, 6 men) ranging in age from 38 to 87 years (mean 76 years). The indication for intervention was stenosis (n = 10) or occlusion (n =4) of a central vein in the upper arm used for dialysis inpatients with arm swelling and/or shunt malfunction. All patients had a previous history of subclavian vein cannulation. There were six percutaneous transluminal angioplasties (PTAs) and eight primary stentplacements and eight repeat interventions. Seven were for restenoses and one for early occlusion, with two secondary stent placements and six PTA of in-stent stenoses. In two patients a second stent was implanted. The mean follow-up was 8.5 months (range 1-19 months). All stents were self-expandable with diameters ranging from 9 to 16 mm. Results: All but one of the procedures was technically successful (95%, n = 21). The patient with an unsuccessful procedure died 1 month after the procedure, but the death was not procedure-related. During follow-up three patients died with a patent shunt and central vein, none of them in connection with the procedure. No complication occurred during the interventional procedures. One patient was lost to follow-up. The primary patency rate at 12 months was 43%, with a primary assisted patency rate of 83% and a secondary patency rate of 100% (n 6). Conclusion: Central vein stenoses and occlusions are associated with previous subclavian vein cannulation. They are a serious problem in hemodialysis patients with a shunt on the same arm.Endovascular treatment is a suitable option for these patients
Kido, Ryo; Akizawa, Tadao; Fukagawa, Masafumi; Onishi, Yoshihiro; Yamaguchi, Takuhiro; Fukuhara, Shunichi
Background Does the use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers individually or as a combination confer a survival benefit in hemodialysis patients? The answer to this question is yet unclear. Methods We performed a case-cohort study using data from the Mineral and Bone Disorder Outcomes Study for Japanese CKD stage 5D patients (MBD-5D), a 3-year multicenter prospective case-cohort study, including 8,229 hemodialysis patients registered from 86 facilities in Japan. All patients had secondary hyperparathyroidism, a condition defined as a parathyroid hormone level ≥180 pg/mL and/or receiving vitamin D receptor activators. We compared all-cause mortality rates between those receiving ACEI, ARB, and their combination and non-users with interaction testing. We used marginal structural Poisson regression (causal model) to estimate the causal effect and interaction adjusted for possible time-dependent confounding. Cardiovascular mortality was also evaluated. Results Among 3,762 randomly sampled subcohort patients, those taking ACEI, ARB, and their combination at baseline accounted for 4.0, 31.6, and 3.8%, respectively. Over 3 years, 1,226 all-cause and 462 cardiovascular deaths occurred. Compared to non-users, ARB-alone users had a lower all-cause mortality rate (adjusted incident rate ratio [aIRR] 0.62, 95% CI 0.50–0.76), whereas ACEI-alone users showed a statistically similar rate (aIRR 1.01, 95% CI 0.57–1.77). On the contrary, combination users had a greater mortality rate (aIRR 2.56, 95% CI 1.22–5.37), showing significant interaction (p = 0.03). Analysis for cardiovascular mortality showed similar results. Conclusion Among hemodialysis patients with secondary hyperparathyroidism, unlike ACEI use, ARB use was associated with greater survival than non-use. Conversely, combination use was associated with greater mortality. Controlled trials are warranted to verify the causality factors of these associations. PMID:29161689
Mateti, Uday Venkat; Nagappa, Anantha Naik; Attur, Ravindra Prabhu; Bairy, Manohar; Nagaraju, Shankar Prasad; Mallayasamy, Surulivelrajan; Vilakkathala, Rajesh; Guddattu, Vasudev; Balkrishnan, Rajesh
Patient information leaflets are universally-accepted resources to educate the patients/users about their medications, disease and lifestyle modification. The obje