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Sample records for korean hemodialysis patients

  1. Elderly Peritoneal Dialysis Compared with Elderly Hemodialysis Patients and Younger Peritoneal Dialysis Patients: Competing Risk Analysis of a Korean Prospective Cohort Study

    PubMed Central

    Kim, Hyunsuk; An, Jung Nam; Kim, Dong Ki; Kim, Myoung-Hee; Kim, Ho; Kim, Yong-Lim; Park, Ki Soo; Oh, Yun Kyu; Lim, Chun Soo; Kim, Yon Su; Lee, Jung Pyo

    2015-01-01

    The outcomes of peritoneal dialysis (PD) in elderly patients have not been thoroughly investigated. We aimed to investigate the clinical outcomes and risk factors associated with PD in elderly patients. We conducted a prospective observational nationwide adult end-stage renal disease (ESRD) cohort study in Korea from August 2008 to March 2013. Among incident patients (n = 830), patient and technical survival rate, quality of life, and Beck’s Depression Inventory (BDI) scores of elderly PD patients (≥65 years, n = 95) were compared with those of PD patients aged ≤49 years (n = 205) and 50~64 years (n = 192); and elderly hemodialysis (HD) patients (n = 315). The patient death and technical failure were analyzed by cumulative incidence function. Competing risk regressions were used to assess the risk factors for survival. The patient survival rate of elderly PD patients was inferior to that of younger PD patients (P<0.001). However, the technical survival rate was similar (P = 0.097). Compared with elderly HD patients, the patient survival rate did not differ according to dialysis modality (P = 0.987). Elderly PD patients showed significant improvement in the BDI scores, as compared with the PD patients aged ≤49 years (P = 0.003). Low albumin, diabetes and low residual renal function were significant risk factors for the PD patient survival; and peritonitis was a significant risk factor for technical survival. Furthermore, low albumin and hospitalization were significant risk factors of patient survival among the elderly. The overall outcomes were similar between elderly PD and HD patients. PD showed the benefit in BDI and quality of life in the elderly. Additionally, the technical survival rate of elderly PD patients was similar to that of younger PD patients. Taken together, PD may be a comparable modality for elderly ESRD patients. PMID:26121574

  2. Elderly Peritoneal Dialysis Compared with Elderly Hemodialysis Patients and Younger Peritoneal Dialysis Patients: Competing Risk Analysis of a Korean Prospective Cohort Study.

    PubMed

    Kim, Hyunsuk; An, Jung Nam; Kim, Dong Ki; Kim, Myoung-Hee; Kim, Ho; Kim, Yong-Lim; Park, Ki Soo; Oh, Yun Kyu; Lim, Chun Soo; Kim, Yon Su; Lee, Jung Pyo

    2015-01-01

    The outcomes of peritoneal dialysis (PD) in elderly patients have not been thoroughly investigated. We aimed to investigate the clinical outcomes and risk factors associated with PD in elderly patients. We conducted a prospective observational nationwide adult end-stage renal disease (ESRD) cohort study in Korea from August 2008 to March 2013. Among incident patients (n = 830), patient and technical survival rate, quality of life, and Beck's Depression Inventory (BDI) scores of elderly PD patients (≥65 years, n = 95) were compared with those of PD patients aged ≤49 years (n = 205) and 50~64 years (n = 192); and elderly hemodialysis (HD) patients (n = 315). The patient death and technical failure were analyzed by cumulative incidence function. Competing risk regressions were used to assess the risk factors for survival. The patient survival rate of elderly PD patients was inferior to that of younger PD patients (P<0.001). However, the technical survival rate was similar (P = 0.097). Compared with elderly HD patients, the patient survival rate did not differ according to dialysis modality (P = 0.987). Elderly PD patients showed significant improvement in the BDI scores, as compared with the PD patients aged ≤49 years (P = 0.003). Low albumin, diabetes and low residual renal function were significant risk factors for the PD patient survival; and peritonitis was a significant risk factor for technical survival. Furthermore, low albumin and hospitalization were significant risk factors of patient survival among the elderly. The overall outcomes were similar between elderly PD and HD patients. PD showed the benefit in BDI and quality of life in the elderly. Additionally, the technical survival rate of elderly PD patients was similar to that of younger PD patients. Taken together, PD may be a comparable modality for elderly ESRD patients. PMID:26121574

  3. Sleep Issues with Patients Receiving Hemodialysis.

    PubMed

    Tocco, Kathleen; Rowder, Cheryl; VanNoord, Mary

    2015-01-01

    Poor sleep among the general population is understudied, unrecognized, and often not assessed This is especially true for patients receiving hemodialysis. This study used a case study design to examine the impact of hemodialysis treatments on the sleep of two patients as measured by actigraphy and self-reported sleep logs. Patient 1 experienced an average sleep efficiency of 82.3% on non-hemodialysis days compared to 75.0% on dialysis days, which resulted in a 7.3 percentage point change and 9.7% better sleep efficiency on non-hemodialysis days. Patient 2 reported sleep efficiency 76.6% on non-hemodialysis days compared to 70.5% dialysis on days, resulting in a 6.1 percentage point change and 8.7% better sleep efficiency on non-hemodialysis days. Actigraphy sleep patterns provided an initial move toward best practice for sleep evaluation in this population. PMID:26875228

  4. Hepatitis C in hemodialysis patients

    PubMed Central

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

    2015-01-01

    Despite reduction of hepatitis C prevalence after recognition of the virus and testing of blood products, hemodialysis (HD) patients still comprise a high risk group. The natural history of hepatitis C virus (HCV) infection in dialysis is not fully understood while the clinical outcome differs from that of the general population. HD patients show a milder liver disease with lower aminotransferase and viral levels depicted by milder histological features on liver biopsy. Furthermore, the “silent” clinical course is consistent with a slower disease progression and a lower frequency of cirrhosis and hepatocellular carcinoma. Potential explanations for the “beneficial” impact of uremia and hemodialysis on chronic HCV infection are impaired immunosurveillance leading to a less aggressive host response to the virus and intradialytic release of “hepatoprotective” cytokines such as interferon (IFN)-α and hepatocyte growth factor. However, chronic hepatitis C is associated with a higher liver disease related cardiovascular and all-cause mortality of HD patients. Therapy is indicated in selected patients groups including younger patients with low comorbidity burden and especially renal transplant candidates, preferably after performance of a liver biopsy. According to current recommendations, choice of treatment is IFN or pegylated interferon with a reported sustained viral response at 30%-40% and a withdrawal rate ranging from 17% to 30%. New data regarding combination therapy with low doses of ribavirin which provide higher standard variable rates and good safety results, offer another therapeutic option. The new protease inhibitors may be the future for HCV infected HD patients, though data are still lacking. PMID:25848478

  5. Sleep disorders in hemodialysis patients.

    PubMed

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

    2010-03-01

    The prevalence of sleep disorders is higher in patients with kidney failure than the general population. We studied the prevalence of sleep disorders in 88 (mean age; 41.59 +/- 16.3 years) chronic hemodialysis (HD) patients at the Urology and Nephrology Center, Mansoura University, Egypt over 4-month period. The investigated sleep disorders included insomnia, restless leg syndrome (RLS), obstructive sleep apnea syndrome (OSAS), excessive daytime sleepiness (EDS), narcolepsy and sleep walking, and we used a questionnaire in accordance with those of the International Restless Legs Syndrome Study Group, the Berlin questionnaire, Italian version of Epworth Sleepiness Scale, International Classification of Sleep Disorders, and the specific questions of Hatoum's sleep questionnaire. The prevalence of sleep disorders was 79.5% in our patients, and the most common sleep abnormality was insomnia (65.9%), followed by RLS (42%), OSAS (31.8%), snoring (27.3%), EDS (27.3%), narcolepsy (15.9%), and sleep walking (3.4%). Insomnia correlated with anemia (r=0.31, P= 0.003), anxiety (r=0.279, P= 0.042), depression (r=0.298, P= 0.24) and RLS (r=0.327, P= 0.002). Also, RLS correlated with hypoalbuminemia (r=0.41, P= < 0.0001), anemia (r=0.301 and P= 0.046), hyperphosphatemia (r=0.343 and P= 0.001). EDS correlated with OSAS (r=0.5, P= < 0.0001), snoring (r=0.341, P= 0.001), and social worry (r=0.27, P= 0.011). Sleep disorders are quite common in the HD patients, especially those who are anemic and hypoalbuminemic. Assessment of sleep quality, preferably with polysomnography, is necessary to confirm our results. Interventional studies for management of sleep disorders in HD patients are warranted. PMID:20228517

  6. Reduced plasma pyrophosphate levels in hemodialysis patients.

    PubMed

    Lomashvili, Koba A; Khawandi, Wassim; O'Neill, W Charles

    2005-08-01

    Pyrophosphate (PPi) is a known inhibitor of hydroxyapatite formation and has been shown to inhibit medial vascular calcification in vitamin D-toxic rats. It was demonstrated recently that endogenous production of PPi prevents calcification of rat aorta that are cultured in high concentrations of calcium and phosphate. For determining whether PPi metabolism is altered in hemodialysis patients, plasma levels and dialytic clearance of PPi were measured in stable hemodialysis patients. Predialysis plasma [PPi] was 2.26 +/- 0.19 microM in 38 clinically stable hemodialysis patients compared with 3.26 +/- 0.17 in 36 normal subjects (P < 0.01). Approximately 30% of plasma PPi was protein bound, and this was not altered in dialysis patients. There was a weak inverse correlation with age in normal individuals but not in dialysis patients. Plasma [PPi] in dialysis patients was correlated with plasma [PO4(3-)] (r = 0.56) but not with [Ca2+], parathyroid hormone, or the dose of dialysis, and levels did not vary between interdialytic periods of 2 and 3 d. Plasma [PPi] decreased 32 +/- 5% after standard hemodialysis in 17 patients. In vitro clearance of PPi by a 2.1-m2 cellulose acetate dialyzer was 36%, and the mean PPi removal in five patients was 43 +/- 5 micromol, consistent with a similar in vivo clearance. Cleared PPi was greater than the plasma pool but less than the estimated extracellular fluid pool. Erythrocyte PPi content decreased 24 +/- 4%, indicating that intracellular PPi is removed as well. It is concluded that plasma [PPi] is reduced in hemodialysis patients and that PPi is cleared by dialysis. Plasma levels in some patients were below those that have previously been shown to prevent calcification of vessels in culture, suggesting that altered PPi metabolism could contribute to vascular calcification in hemodialysis patients. PMID:15958726

  7. Staphylococcus aureus bacteremia in hemodialysis patients.

    PubMed

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

    1977-01-01

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

  8. [Work capacity in patients on hemodialysis].

    PubMed

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

    2004-01-01

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

  9. Catheter associated infections in hemodialysis patients.

    PubMed

    Sanavi, Suzan; Ghods, Ahad; Afshar, Reza

    2007-03-01

    Hemodialysis catheter related infections (HCRI) are one of the major causes of increasing mortality, morbidity and cost of therapy in hemodialysis patients. Prevention of HCRI requires the identification of predisposing risk factors. To determine the frequency of HCRI risk factors, we studied 116 patients (54% male, mean age of 49.5+/-16 years) patients with HCRI between 2003-2004. Forty one percent of the patients were diabetic. There was a history of previous catheter placement and infection in 41% and 32% of patients, respectively. Pathogenic organisms isolated from blood cultures included Staphylococcus-aureus 42%, Coagulase-negative Staphylococci 20%, E. Coli 19%, Enterococci 7%, Streptococcus D 7%, Pseudomonas aeruginosa 4%, and Klebsiella 1%. Bacterial resistance to vancomycin and amikacin was present in 7% and 4% of the cases, respectively. Hemodialysis catheter related blood borne infections comprised 67% of the total blood-borne infections in our hospital. No significant statistical association was found between HCRI and age, gender, diabetes mellitus, serum albumin level <30 g/L, leukocyte count, erythrocyte sedimentation rate, anatomical location of catheter, mean duration of antibiotic therapy, mean catheter duration, frequency of hemodialysis sessions, pathogenic organisms, and history of previous catheter infection. We conclude that the prevalence of pathogenic organisms of HCRI were similar to previous studies. However, bacterial resistance to antibiotics was low. The mean duration of catheter usage was longer than previously reported. PMID:17237890

  10. Survival analysis of patients on maintenance hemodialysis.

    PubMed

    Chandrashekar, A; Ramakrishnan, S; Rangarajan, D

    2014-07-01

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

  11. Survival analysis of patients on maintenance hemodialysis

    PubMed Central

    Chandrashekar, A.; Ramakrishnan, S.; Rangarajan, D.

    2014-01-01

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

  12. Oral Tori in Chronic Hemodialysis Patients

    PubMed Central

    Chao, Pei-Jung; Yang, Huang-Yu; Huang, Wen-Hung; Weng, Cheng-Hao; Wang, I-Kuan; Tsai, Aileen I.; Yen, Tzung-Hai

    2015-01-01

    Background. This study investigated the epidemiology of torus palatinus (TP) and torus mandibularis (TM) in hemodialysis patients and analyzed the influences of hyperparathyroidism on the formation of oral tori. Method. During 2013, 119 hemodialysis patients were recruited for dental examinations for this study. Results. The prevalence of oral tori in our sample group was high at 33.6% (40 of 119). The most common location of tori was TP (70.0%), followed by TM (20.0%), and then both TP and TM (10.0%). Of the 40 tori cases, most (67.5%) were <2 cm in size; moreover, the majority (52.5%) were flat in shape. In symmetry, most (70.0%) occurred in the midline, followed by bilateral sides (20.0%). Notably, the levels of intact parathyroid hormone did not differ in patients with or without tori (P = 0.611). Furthermore, patients with tori did not differ from patients without tori in inflammatory variables such as log high-sensitivity C-reactive protein (P = 1.000) or nutritional variables such as albumin (P = 0.247). Finally, there were no differences between patients with and without tori in adequacy of dialysis (P = 0.577). Conclusions. Neither hyperparathyroidism nor inflammation malnutrition syndrome was found to contribute to the formation of oral tori in chronic hemodialysis patients. Further studies are warranted. PMID:25918724

  13. The employment potential of hemodialysis patients.

    PubMed

    Ferrans, C E; Powers, M J

    1985-01-01

    This study examined variables that may influence the employment potential of hemodialysis patients. The study group consisted of currently employed (n = 20) and currently unemployed (n = 20) hemodialysis patients. All subjects had been employed before starting dialysis and were currently judged physically able to work by their physicians. No significant differences were found in job satisfaction or job importance before starting dialysis. The groups did not differ on biophysiological status or perception of health. However, a greater number of the unemployed had held jobs requiring heavier physical labor and reported that uremic symptoms prevented them from working. They also encountered more job discrimination due to illness and had a greater loss of career and life goals. No significant differences were found between the two groups in life satisfaction or dependence. In both groups the more independent subjects reported greater satisfaction with life. PMID:3850487

  14. Increased Cerebral Water Content in Hemodialysis Patients

    PubMed Central

    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

    2015-01-01

    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. PMID:25826269

  15. Serum Protein Profile Alterations in Hemodialysis Patients

    SciTech Connect

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

    2003-11-18

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

  16. General Surgery in Patients on Maintenance Hemodialysis

    PubMed Central

    Haimov, M.; Glabman, S.; Schupak, E.; Neff, M.; Burrows, L.

    1974-01-01

    A review of the experience with 66 patients on chronic hemodialysis who underwent 67 major surgical procedures is presented. There were 58 general surgical procedures, and nine major cardiovascular procedures including four emergency cardiac valve replacements. The preoperative, intraoperative and postoperative management of these patients is discussed as well as the morbidity and mortality encountered. It is concluded that patients on well-managed chronic dialysis will tolerate minor and major surgery well and renal failure should no longer be regarded as a relative contraindication for appropriate elective or emergency surgery. PMID:4275820

  17. Hyperhomocysteinemia and cardiovascular risks in hemodialysis patients.

    PubMed

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

    2010-09-01

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

  18. Restless legs syndrome in hemodialysis patients.

    PubMed

    Rafie, Shahram; Jafari, Majid; Azizi, Mostafa; Bahadoram, Mohammad; Jafari, Shima

    2016-03-01

    Restless legs syndrome (RLS) is a neurological disorder characterized by uncomfortable sensation of paresthesia in legs that subsequently causes involuntary and continuous movement of the lower limbs, especially at rest. Its prevalence in hemodialysis is more than that in the general population. Different risk factors have been suggested for RLS. We studied the prevalence and risk factors of RLS in 137 hemodialysis patients followed up at our center. The patients completed at least three months on dialysis and fulfilled four criteria for the diagnosis of RLS. We compared the patients with and without RLS, and the odds ratios (ORs) were estimated by the logistic regression models. The prevalence of RLS was 36.5% in the study patients. Among the variables, diabetes was the only predicting factor for the development of RLS. The diabetic patients may be afflicted with RLS 2.25 times more than the non-diabetics. Women developed severe RLS 5.23 times more than men. Neurodegeneration, decrease in dopamine level, higher total oxidant status, and neuropathy in diabetic patients may explain the RLS symptoms. PMID:26997386

  19. Time-Limited Group Counseling for Chronic Home Hemodialysis Patients

    ERIC Educational Resources Information Center

    Wilson, Charles J.; And Others

    1974-01-01

    Compared effects of six sessions of group counseling of nine chronic home hemodialysis patients with a comparable no treatment control group. Comparisons revealed no significant differences between groups. Subsequent testing a year later suggested that hemodialysis patients use the defensive mechanism of denial in adapting to their condition.…

  20. Caregiver burden among nocturnal home hemodialysis patients.

    PubMed

    Rioux, Jean-Philippe; Narayanan, Ranjit; Chan, Christopher T

    2012-04-01

    Recent studies have suggested improvements in quality of life (QOL) in patients on quotidian dialysis compared with conventional hemodialysis. Few studies have focused on the burden and QOL in caregivers of patients with end-stage renal disease (ESRD) on nocturnal home hemodialysis (NHD). We aim to assess the caregivers' burden, QOL, and depressive symptoms and to compare these parameters with their patients' counterparts. Cross-sectional surveys were sent to 61 prevalent NHD patients and their caregivers. Surveys assessed demographics, general self-perceived health using the 12-Item Short Form Health Survey (SF-12) and the presence of depression using the Beck Depression Inventory. Subjective burden on caregivers was assessed by the Caregiver Burden scale and was compared with perceived burden by the patients. Thirty-six patients and 31 caregivers completed the survey. The majority of caregivers were female (66%), spouse (81%) with no comorbid illness (72%). Their mean age was 51 ± 11 years. Patients were mostly male (64%) with a median ESRD vintage of 60 months (interquartile range [IQR], 18-136 months) and a mean age of 52 ± 10 years. Compared to caregivers, patients had lower perceived physical health score but had similar mental health score. Depression criteria were present in 47% of patients and 25% of caregivers. Total global burden perceived by either caregivers or patients is relatively low. Although there is a relatively low global burden perceived by caregivers and patients undergoing NHD, a significant proportion of both groups fulfilled criteria for depression. Further innovative approaches are needed to support caregivers and patients performing NHD to reduce the intrusion of caring for a chronic illness and the risk of developing depression. PMID:22304491

  1. Oxycodone accumulation in a hemodialysis patient.

    PubMed

    Foral, Pamela A; Ineck, Joseph R; Nystrom, Kelly K

    2007-02-01

    Oxycodone and oxycodone-containing analgesics are often used for the relief of pain. In the presence of renal dysfunction, the half-life of oxycodone and metabolites can be prolonged. We describe the case of a 41-year-old chronic hemodialysis patient who received multiple doses of oxycodone/acetaminophen resulting in accumulation of the medication and consequent lethargy, hypotension and respiratory depression. These adverse effects were reversed with multiple bolus doses of naloxone, followed by a continuous infusion administered for 45 hours. Utilizing the Naranjo probability scale, the patient had a "probable" adverse drug reaction to the oxycodone. Oxycodone should be used with caution in patients with chronic renal failure. PMID:17330696

  2. Lifestyle of Hemodialysis Patients in Comparison with Outpatients

    PubMed Central

    Moghadasian, Sima; Sahebi Hagh, Mohammad Hasan; Aghaallah Hokmabadi, Leila

    2012-01-01

    Introduction: Nowadays, the chronic diseases are known to be associated with lifestyle risk factors. Hemodialysis patients encounter considerable amount of physical, mental and social pressure. Lifestyle is important because it affects quality of life and has important role in prevention. This study aimed to compare the lifestyle of hemodialysis patients and outpatients in health clinics of Tabriz. Methods: This was a case-control study on 155 hemodialysis patients and 155 outpatients referring to five dialysis centers and clinics, who met the inclusion criteria. Demographic data and some questions about lifestyle in nutrition, stress, physical activity and smoking were asked. Results: The history of hypertension among hemodialysis patients was 34.6% greater than outpatients. High daily salt consumption (more than two tablespoons a day) was 40.5% higher among hemodialysis patients than outpatients. In terms of saturated oil intake, it was 30.8%higher among hemodialysis patients. Problem in communicating with family members was 69.8% higher in hemodialysis patients. In terms of physical activity, 46.4% of outpatients had higher physical activity like walking. Conclusion: Lifestyle in different dimensions was associated with chronic kidney disease (CKD); therefore, the officials of health system are recommended to develop a program to combat chronic diseases and integrate it with providing the first-level health services. It seems that public education can have a major role in life-style modification and in chronic kidney diseases prevention. PMID:25276683

  3. Intradialytic Exercise is Medicine for Hemodialysis Patients.

    PubMed

    Parker, Kristen

    2016-01-01

    When a person's kidneys fail, hemodialysis (HD) is the most common treatment modality. With a growing number of patients requiring this life-sustaining treatment, and with evidence illustrating the significant physical dysfunction of this population, encouraging exercise is essential. The use of intradialytic exercise, as a novel and efficient use of time during HD, is well established in Australia and some European nations; however, it is slower to start in North America. While a large number of small studies have demonstrated numerous benefits and safe delivery of intradialytic exercise training for patients with end-stage kidney disease, intradialytic exercise is rarely delivered as standard of care. It is of utmost importance for health care staff to overcome barriers and bring theory into practice. Included in this report are current recommendations from governing bodies, expert opinion, as well as established policies and procedures from a successful intradialytic exercise program in Canada. PMID:27399824

  4. New-onset psoriasis in a maintenance hemodialysis patient.

    PubMed

    Triga, Konstantina; Dousdampanis, Periklis; Aggelakou-Vaitis, Stamatina; Gellner, Karen

    2012-01-01

    New-onset psoriasis is extremely rare in hemodialysis (HD) patients, and several trials of dialysis therapies (HD and peritoneal dialysis) in psoriasis have indicated remarkable improvement in skin lesions and well-being even in patients without renal impairment. We describe a patient who developed severe psoriasis despite undergoing chronic maintenance hemodialysis for 5 years and was treated successfully with oral cyclosporin A. PMID:22098821

  5. Cognitive function among hemodialysis patients in Japan

    PubMed Central

    2011-01-01

    Background Over 290,000 patients are undergoing hemodialysis (HD) in Japan. With old age, the odds of undergoing HD treatment sharply increase, as does the prevalence of cognitive impairment. The aim of the present work was to assess cognitive impairment in HD patients and its relation to clinical characteristics. Methods Using a cross-sectional design, we administered the Mini-Mental State Examination (MMSE) to 154 HD outpatients and 852 participants from the Iwaki Health Promotion Project 2010, representing the general population. Results The prevalence of cognitive impairment based on the MMSE was 18.8% in HD patients. HD patients showed a higher prevalence of cognitive impairment in older groups (50 years and older). In a logistic regression model with age, gender and amount of education as covariates, undergoing HD was a significant independent factor (OR = 2.28, 95% CI 1.33 to 3.94) associated with a lower MMSE score. Among HD patients, we found that level of education was associated with MMSE score. Conclusions There is a high prevalence of cognitive impairment among HD patients that has adverse implications for hospitalization and shortens their life expectancy. HD treatment was an independent risk factor for cognitive impairment. Clinicians should carefully monitor and treat cognitive impairment in HD patients. Further studies are required to determine the reasons for cognitive impairment in HD patients. PMID:21867512

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

    PubMed Central

    Assa, Solmaz; Bakker, Stephan J. L.; Groen, Henk; Westerhuis, Ralf; Gaillard, Carlo A. J. M.; Gansevoort, Ron T.

    2015-01-01

    Objectives Plasma levels of copeptin, a surrogate marker for the vasoconstrictor hormone arginine vasopressin (AVP), are increased in hemodialysis patients. Presently, it is unknown what drives copeptin levels in hemodialysis patients. We investigated whether the established physiological stimuli for copeptin release, i.e. plasma osmolality, blood volume and mean arterial pressure (MAP), are operational in hemodialysis patients. Methods 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. Results 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. Conclusions Plasma copeptin levels are elevated predialysis and increase further during hemodialysis. Volume stimuli, i.e. decreases in MAP and blood

  7. Sublethal microcystin exposure and biochemical outcomes among hemodialysis patients

    EPA Science Inventory

    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...

  8. Uremic pleuritis in chronic hemodialysis patients.

    PubMed

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

    2013-01-01

    Chronic hemodialysis (HD) patients are predisposed to several complications associated with pleural effusion. In addition, uremia can directly cause pleuritis. However, there are inadequate data about pathogenesis and natural course of uremic pleuritis. In this study, 76 chronic HD patients with pleural effusion admitted to the Respiratory Center of Masih Daneshvari Hospital, in Tehran, Iran between June 2005 and May 2011 were evaluated to figure out the etiology of their pleural disease. Among these patients, patients with uremic pleuritis were identified and studied. The rate of uremic pleuritis was 23.7%. Other frequent etiologies of pleural effusion were parapneumonic effusion (23.7%), cardiac failure (19.7%), tuberculosis (6.6%), volume overload, malignancy, and unknown. In patients with uremic pleuritis, dyspnea was the most common symptom, followed by cough, weight loss, anorexia, chest pain, and fever. Compared to patients with parapneumonic effusion, patients with uremic effusion had a significantly higher rate of dyspnea and lower rate of cough and fever. Pleural fluid analysis showed that these patients had a significantly lower pleural to serum lactic dehydrogenase ratio, total pleural leukocytes, and polymorphonuclear count compared to patients with parapneumonic effusion. Improvement was achieved in 94.1% of patients with uremic pleuritis by continuation of HD, chest tube insertion or pleural decortication; an outcome better than the previous reports. Despite the association with an exudative effusion, inflammatory pleural reactions in patients with uremic pleuritis may not be as severe as infection-induced effusions. Owing to the advancement in HD technology and other interventions, outcome of uremic pleuritis may be improved. PMID:22716271

  9. Intradialytic Hypoxemia in Chronic Hemodialysis Patients.

    PubMed

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

    2016-01-01

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

  10. Pulmonary Hypertension in Hemodialysis Patients Following Repeated Endovascular Thrombectomy

    PubMed Central

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

    2016-01-01

    Background The prevalence of pulmonary hypertension is unusually high in Taiwanese patients with end-stage renal disease. Thrombosis of hemodialysis grafts is common and pulmonary embolism has been reported after endovascular thrombectomy. The aim of this study was to evaluate the relationship between pulmonary hypertension and endovascular thrombectomy of hemodialysis grafts. Methods One hundred and ten patients on hemodialysis via arteriovenous grafts were enrolled in our study. The mean pulmonary artery pressure (PAP) was measured by right heart catheterization. Clinical information was collected by review of medical records. Comorbid cardiopulmonary disease was evaluated by echocardiography and chest X-ray. The history of patient vascular access thrombosis was reviewed from database, hemodialysis records, and interviews with staff at hemodialysis centers. Results Fifty-two participants (47%) had pulmonary hypertension diagnosed by right heart catheterization. There was no difference in the number of thrombectomy procedures between patients with and without pulmonary hypertension. Based on multivariate analysis, the number of prior endovascular thrombectomy procedures did not correlate with mean PAP (F-value = 1.10, p = 0.30) nor was it associated with pulmonary hypertension (odds ratio = 0.92, p = 0.17). Conclusions Prior endovascular arteriovenous graft thrombectomies were not associated with pulmonary hypertension or increased mean PAP in end-stage renal disease patients on maintenance hemodialysis. PMID:27274170

  11. Serum nickel concentrations in hemodialysis patients with environmental exposure

    SciTech Connect

    Hopfer, S.M.; Fay, W.P.; Sunderman, F.W. Jr.

    1989-05-01

    Nickel was analyzed by electrothermal atomic absorption spectrophotometry in serum specimens from 22 healthy hospital workers and 30 patients with end-stage renal disease treated by extracorporeal hemodialysis, who resided in Sudbury, Ontario, Canada, a city with extensive nickel mines and smelters. Samples of tap water from Sudbury contained 109 +/- 46 micrograms Ni per L (P less than 0.01 vs 0.4 +/- 0.2 micrograms Ni per L in corresponding water samples from Hartford, Connecticut). Serum nickel concentrations averaged 0.6 +/- 0.3 micrograms Ni per L in Sudbury hospital workers (P less than 0.05 vs 0.2 +/- 0.2 micrograms Ni per L in corresponding serums from 43 healthy hospital workers in Hartford). In serums collected post-treatment from Sudbury hemodialysis patients, nickel concentrations averaged 8.5 +/- 2.8 micrograms Ni per L, (i.e., 14-times the corresponding mean in Sudbury hospital workers, P less than 0.01), but were not significantly higher than the nickel concentrations in serums from 42 Hartford hemodialysis patients (7.2 +/- 2.2 micrograms Ni per L). This study confirms the presence of hypernickelemia in hemodialysis patients, but does not suggest that hemodialysis patients have significantly increased risk of nickel toxicity in Sudbury, compared to Hartford, despite the high nickel concentrations in Sudbury tap water. This favorable outcome attests to the efficient deionization of water used to prepare hemodialysis solutions in Sudbury.

  12. Malondialdehyde can predict survival in hemodialysis patients

    PubMed Central

    RUSU, CRINA CLAUDIA; RACASAN, SIMONA; KACSO, INA MARIA; MOLDOVAN, DIANA; POTRA, ALINA; PATIU, IOAN MIHAI; VLADUTIU, DAN; CAPRIOARA, MIRELA GHERMAN

    2016-01-01

    Background and aims Cardiovascular (CV) disease is the leading cause of morbidity and mortality in hemodialysis (HD) patients. Kidney disease is associated with increased oxidative stress (OS), a nontraditional CV risk factor. Few studies evaluate the effect of OS markers on CV events (CVE) and survival in HD patients. The aim of this study is to examine potential determinants of OS markers and their predictive role on survival and CV morbidity and mortality in HD patients during a long-term follow-up (108 months). Methods We conducted an analytical cross-sectional prospective observational study, carried on a cohort of randomly selected HD patients. We registered in 44 HD patients baseline characteristics, OS markers, mortality and CVE over a period of 108 months and we used statistical analysis (descriptive, Kaplan-Meier, univariate and multivariate Cox model) for interpretation. Results Bound malondialdehyde (bMDA) was positively correlated with serum calcium, protein carbonyls (PC) were inversely correlated with diastolic blood pressure (DBP) and directly correlated with ferritin, NOx was directly correlated with ceruloplasmin) and serum albumin. Of the measured OS markers only bMDA was related to survival (HR=3.29 95% CI (1.28–8.44), p=0.01), and approached statistical significance in the effect on CV mortality (HR=2.85 95% CI (0.88–9.22), p=0.07). None of the measured OS markers was associated with CVE. Conclusions bMDA has a strong predictive value on survival in HD patients in a long-term follow-up (9 years). Its value is correlated with CV mortality but is not a predictor of CV events. Regular assessment of MDA in HD patients and the development of strategies aimed at reducing oxidative stress in these patients might be beneficial. PMID:27152077

  13. Restless legs syndrome in patients on hemodialysis.

    PubMed

    Salman, Saleh Mohammad Yaser

    2011-03-01

    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. PMID:21422649

  14. Sleep Disorders in ESRD Patients Undergoing Hemodialysis.

    PubMed

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

    2016-03-01

    Kidney failure affects different aspects of normal life. Among different manifestations, sleep problem can be considered as a common complaint of ESRD (End Stage Renal Disease) patients. In this study, we aimed to investigate the interrelationship between sleep disorders in ESRD patients and their characteristics. Through a cross-sectional study (2010-2011), 88 ESRD patients undergoing maintenance hemodialysis thrice weekly were recruited to enter the study. We used a self-administered questionnaire into which the data were reflected. The patients selected their specific sleep disorders using a nine-item scale while the Epworth Sleepiness Scale (ESS) determined both the presence and severity of sleep disorders. The data was finally analyzed with their baseline characteristics, dialysis characteristics, medication/stimulants use, and clinical and biochemical parameters. Over 95% of the patients had, at least, one specific sleep disorder while the ESS revealed 36.36% of patients as normal, 59.09% as having mild sleep disorders, and 4.54% as having moderate to severe sleep disorders. Sleep disorders were significantly correlated with older ages (P=0.035), dialysis dose (P=0.001), blood creatinine levels (P=0.037), upper airways obstruction (P=0.035), hepatomegaly (P=0.006), hepatic failure (P=0.001), higher blood TSH levels (P=0.039), history of hypothyroidism (P=0.005), and the use of levodopa (P=0.004), anti-hypertensive medications (P=0.006), benzodiazepines (P=0.006), Eprex (Erythropoietin) (P=0.001), Venofer (Iron Sucrose Injection) (P=0.013), and phosphate-binders agents (P=0.018). Sleep disorders are common findings among ESRD patients and seem to be a more complicated issue than a simple accumulation of the wastes products in the body. Whatever the causes of sleep disorders are, disorder-specific treatments should be considered. PMID:27107522

  15. Medication adherence among adult patients on hemodialysis.

    PubMed

    Alkatheri, Abdulmalik M; Alyousif, Sarah M; Alshabanah, Najla; Albekairy, Abdulkareem M; Alharbi, Shemylan; Alhejaili, Fayze F; Alsayyari, Abdullah A; Qandil, Abeer Ma; Qandil, Amjad M

    2014-07-01

    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. PMID:24969185

  16. Satisfaction with Care of Patients on Hemodialysis

    PubMed Central

    Paine, Susan S.; Grobert, Megan E.; Stidley, Christine A.; Gabbay, Ezra; Harford, Antonia M.; Zager, Philip G.; Miskulin, Dana C.; Meyer, Klemens B.

    2015-01-01

    Background and objectives Little is known about patients receiving dialysis who respond to satisfaction and experience of care surveys and those who do not respond, nor is much known about the corollaries of satisfaction. This study examined factors predicting response to Dialysis Clinic, Inc. (DCI)’s patient satisfaction survey and factors associated with higher satisfaction among responders. Design, setting, participants, & measurement A total of 10,628 patients receiving in-center hemodialysis care at 201 DCI facilities between January 1, 2011, and December 31, 2011, aged ≥18 years, treated during the survey administration window, and at the facility for ≥3 months before survey administration. Primary outcome was response to at least one of the nine survey questions; secondary outcome was overall satisfaction with care. Results Response rate was 77.3%. In adjusted logistic regression (odds ratios with 95% confidence intervals), race other than black (white race, 1.23 [1.10 to 1.37]), missed treatments (1.16 [1.02 to 1.32]) or shortened treatments (≥5 treatments, 1.40 [1.22 to 1.60]), more hospital days (>3 days in the last 3 months, 1.89 [1.66 to 2.15]), and lower serum albumin (albumin level <3.5 g/dl, 1.4 [1.28 to 1.73]) all independently predicted nonresponse. In adjusted linear regression, the following were more satisfied with care: older patients (age ≥63 years, 1.84 [1.78 to 1.90]; age <63 years, 1.91 [1.86 to 1.97]; P<0.001), white patients (1.76 [1.71 to 1.81]) versus black patients (1.93 [1.88 to 1.99]) or those of other race (1.93 [1.83 to 2.03]) (P<0.001), patients with shorter duration of dialysis (≤2.5 years, 1.79 [1.73 to 1.84]; >2.5 years, 1.96 [1.91 to 2.02]; P<0.001), patients who had missed one or fewer treatments (1.83 [1.78 to 1.88]) versus those who had missed more than one treatment (1.92 [1.85 to 1.98]; P=0.002) and those who had shortened treatment (for one treatment or less, 1.84 [1.77 to 1.90]; for two to four treatments, 1

  17. Cloxacillin-induced seizure in a hemodialysis patient.

    PubMed

    El Nekidy, Wasim; Dziamarski, Nicole; Soong, Derrick; Donaldson, Christine; Ibrahim, Muhieldean; Kadri, Albert

    2015-10-01

    We are reporting a cloxacillin-induced seizure in a patient with stage 5 chronic kidney disease requiring hemodialysis. To our knowledge, there are no published case reports of seizures induced by parenteral cloxacillin in hemodialysis patients. A young hemodialysis female was admitted to the hospital with decreased level of consciousness. Blood cultures revealed methicillin-sensitive Staphylococcus aureus where cloxacillin 2 g intravenously every 4 hours was initiated. Head computed tomography (CT) was not significant. After 14 hours of cloxacillin therapy (4 doses), the patient demonstrated tonic/clonic seizure activity, where phenytoin and lorazepam were initiated. The anti-seizure medications partially reduced seizure activity. Once the cloxacillin was discontinued, the seizures stopped. Two weeks later, all anti-seizure medications were stopped with no further seizure activity. Cloxacillin elimination in hemodialysis patients is similar to patients with normal kidney function. Although cloxacillin does not significantly cross the blood-brain barrier, the correlation between the start of seizures and cloxacillin initiation was confirmed by the negative CT and blood chemistry laboratory results. Moreover, seizure activity was terminated upon discontinuation of cloxacillin. Although further investigation for the cause of such seizures is warranted, clinicians should use caution when giving high doses of cloxacillin in hemodialysis patients. PMID:25582344

  18. Effect of Regular Exercise Program on Depression in Hemodialysis Patients

    PubMed Central

    Rezaei, Jahangir; Abdi, Alireza; Rezaei, Mansour; Heydarnezhadian, Jafar; Jalali, Rostam

    2015-01-01

    Background and Aim. Depression is the most common psychological disorder in hemodialysis patients which decreases their quality of life and increases the mortality. This study was conducted to assess the effect of regular exercise on depression in hemodialysis patients. Methods. In a randomized clinical trial, 51 hemodialysis patients were allocated in two groups. Beck Depression Inventory (BDI) scale was used to assessing depression rate in participants. Designed program was educated using poster and face-to-face methods for case group. Intervention was carried out three times a week for ten weeks. At the beginning and the end of the study, depression rate of the subjects was assessed. Data was analyzed by SPSS16 software and descriptive and inferential statistics. Findings. According to the results of this study, there were no differences between case and control groups in depression rate at the beginning of the study, but there was significant difference after intervention (P = 0.016). In the beginning of the study, the mean and SD of depression in case group were 23.8 ± 9.29 and reduced to 11.07 ± 12.64 at the end (P < 0.001). Conclusion. The regular exercise program could reduce the depression in hemodialysis patients; therefore it is suggested for training this program for hemodialysis patients. This trial is registered with Iranian Registry of Clinical Trial (IRCT) number IRCT201205159763N1. PMID:27347502

  19. Auditory brainstem responses in patients under treatment of hemodialysis.

    PubMed

    Aspris, Andreas K; Thodi, Chryssoula D; Balatsouras, Dimitrios G; Thodis, Elias D; Vargemezis, Vassilis; Danielides, Vassilis

    2008-01-01

    This study evaluated the effects of end stage chronic renal failure (CRF) on auditory function and changes in auditory function following a single session of hemodialysis. The experimental group included 31 patients with end-stage renal failure on chronic hemodialysis. The control group consisted of 31 healthy volunteers. The patients were examined prior to and following a session of hemodialysis. Measurements included pure tone audiometry, tympanometry and acoustic reflex measurements, auditory brainstem responses (ABR), and blood now chemistry parameters. Controls underwent the same test battery, with the exception of biochemical and hematological assessment. Prior to hemodialysis sessions, all ABR latencies except interpeak latency I-III were significantly prolonged in the experimental group. A comparison between controls and the experimental group following hemodialysis indicated that wave V absolute latency and interpeak latencies III-V and I-V were significantly prolonged in the slow repetition rate paradigm. In the fast repetition rate, absolute latencies of waves I and V and III-V interpeak latencies were prolonged in the experimental group. Comparison of ABR recordings prior to and following hemodialysis showed overall significant difference between the measures. Post hoc analysis showed a significant improvement in wave I and V latencies in the slow repetition rate and wave V latency in the fast repetition rate. This study showed that neural conduction along the auditory pathway is delayed in patients with end stage CRF as compared to healthy subjects. Dialysis sessions improve overall neural auditory function. However, patients with end stage CRF show delayed conduction even after a session of hemodialysis. PMID:18569911

  20. Predictive factors of restless leg syndrome in hemodialysis patients

    PubMed Central

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

    2016-01-01

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

  1. Results of cataract surgery in renal transplantation and hemodialysis patients

    PubMed Central

    Luo, Li-Hua; Xiong, Shi-Hong; Wang, Yan-Ling

    2015-01-01

    AIM To compare the effect of cataract surgery in renal transplantation and hemodialysis patients. METHODS We evaluated 51 eyes of 31 renal transplantation patients, 41 eyes of 29 hemodialysis patients and 45 eyes of 32 normal control patients who received phacoemulsification and intraocular lens (IOL) implantation from January, 2000 to August, 2014 in the Beijing Friendship Hospital. Each individual underwent a blood routine and a kidney function examination. Routine ophthalmologic examination included best-corrected visual acuity (BCVA), a slit-lamp examination to detect cataract type, determination of intraocular pressure, a corneal endothelial count, and fundus examination. All patients received phacoemulsification and an IOL implantation. RESULTS For the types of cataract in the three groups, transplantation group was significantly different from normal control group (P=0.04), the most kind is posterior subcapsular cataract (PSC) in transplantation group 33 (64.7%), hemodialysis group had no significantly difference from normal control group (P=0.43), and the difference between transplantation group and hemodialysis group also had significantly difference (P=0.02). For postoperative BCVA in the three groups, transplantation group had significantly difference from normal control group (P=0.03), hemodialysis group was significantly different from normal control group (P=0.00), and the difference between transplantation group and hemodialysis group also had significantly difference (P=0.00). The multiple linear regression equation is Y=0.007 hemoglobin (Hb)-0.000233 serum creatinine (Cr), R2=0.898. Postoperative fundus examination showed that hemorrhage, exudation, and macular degeneration were greater in the hemodialysis group. CONCLUSION This study showed that the PSC was more in the renal transplantation patients. BCVA was better and fundus lesions were less frequent in the renal transplantation group than in the hemodialysis group after cataract surgery. The

  2. Dental considerations for the patient with renal disease receiving hemodialysis.

    PubMed

    De Rossi, S S; Glick, M

    1996-02-01

    An increasing number of Americans are living with end-stage renal disease. This disease has many implications for dentistry, in terms of oral manifestations and management of afflicted patients. The authors present pertinent information to help dentists treat patients who exhibit the oral and systemic manifestations of renal disease, from the onset of renal impairment through hemodialysis. PMID:8682990

  3. Mortality in Hemodialysis Patients Over 65 Years of Age

    PubMed Central

    Coric, Aida; Resic, Halima; Celik, Damir; Masnic, Fahrudin; Ajanovic, Selma; Prohic, Nejra; Beciragic, Amela; Grosa, Emir; Smajlovic, Ajdin; Mujakovic, Aida

    2015-01-01

    Introduction: Based on the statistics the population in Bosnia and Herzegovina is getting older. In 2013 the average life span for women was 73.6 years and 68.1 for men. The chronic hemodialysis program is mainly reserved for elderly patients with high mortality risk. The most common cause of hemodialysis mortality relates to cardiovascular diseases (60.2%), regardless of frequent innovations and improvement of hemodialysis procedures. The aim of the study: was to determine the mortality rate by age groups with comments on the presence of non-traditional predictors (anemia, hypoalbuminemia, CRP, vascular access and PTH) in dialysis patients in the follow-up period of 36 months. Methods: The study included all patients undergoing chronic hemodialysis treatment at the Clinic of Hemodialysis of the Clinical Center University of Sarajevo (CCUS). Results: Out of a total number of hemodialysis patients (n=232), the specific mortality rate in patients under 65 years of age was 16.8%, and 50.5% in patients over 65 years of age. According to the age groups the mortality rate in elderly patients is as follows: from 65 to 74 years (45.1%), from 75 to 84 years (55.0%), over ≥85 years (75.0%). The most frequent vascular access in patients under and above 65 is arteriovenous fistula (79.6% and 62.1 %), temporary hemodialysis catheter (11.7% and 43.8 %) and long-term hemodialysis catheter (8.8% and 4.2 %). In the age group under 65 years of age the temporary hemodialysis catheter is significantly and more frequently used in diseased patients in respect to survivors (34.8% vs. 7.0%) [χ2(2)=15.769, p=0.001]. Diseased patients from the age group over 65 had a significantly lower mean value of haemoglobin in blood (M=100.9±17.5 g/L) in respect to survivors (M=109.2±17.1)[t(93)=2.339; p=0.021], lower mean value of albumin in blood (Me=32.0; IQR=29.0 do 35.0) in respect to survivors (Me=34.0; IQR=32.0 to 38.0) [U=762.5; p=0.006], and higher mean value of CRP in blood (Me=19.3 mg

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

    PubMed Central

    Sabri, Mohammad Reza; Fahimi, Farnaz; Hajialiasgar, Soheila; Etminan, Abbas; Nazemi, Sarir; Salehi, Farzaneh

    2012-01-01

    Background: Atherosclerosis is the leading cause of death in hemodialysis patients. These patients are also very prone to L-carnitine deficiency due to kidney disease. In this clinical trial, we investigated the effect of oral L-carnitine on endothelial function of these patients. Materials ans Methods: We studied 31 adult chronic hemodialysis patients in our center and divided them into two groups. The first group (n = 20) received 1500 mg/dialysis interval (every other day) oral L-carnitine. The control group (n = 11) received placebo for one month. Ultrasonographic measurements of flow mediated dilation and carotid intima-media thickness were performed before and after one month of L-carnitine and placebo therapy. Results: This study showed that after one month of L-carnitine or placebo therapy there was no significant improvement in flow mediated dilation (p = 0.80 and p = 0.59, respectively) or decrease in carotid intima-media thickness (p = 0.12 and p = 0.50, respectively). Conclusions: Our study revealed that one month of oral L-carnitine therapy did not improve endothelial function in hemodialysis patients. Long-term studies with large sample size using intravenous form and higher doses of the drug are required to clarify the questionable role of L-carnitine in hemodialysis patients. PMID:23626603

  5. An investigation of coping styles of hemodialysis patients

    PubMed Central

    Dehkordi, Leila Mardanian; Shahgholian, Nahid

    2013-01-01

    Background: Hemodialysis patients are exposed to different stressful factors and have to use coping strategies as supportive processes. The goal of the present study is to investigate coping styles of hemodialysis patients. Materials and Methods: This is a descriptive analytical study conducted on 96 patients referring to hemodialysis centers affiliated to Isfahan University of Medical Sciences in 2011. The data, collected by a questionnaire including two sections of demographic characteristics and patients’ coping with the disease, were analyzed by parametric and non- parametric statistical tests. Results: Patients used emotion focused coping strategies more (mean = 20.07, SD = 4.39) to adapt with the disease compared to problem focused coping strategies (mean = 14.65, SD = 5.08). There was a significant association in coping (P = 0.027) and emotion focused dimension (P = 0.008) in various ages, but there was no significant association in problem focused dimension (P = 0.134). Conclusion: Since most of the hemodialysis patients use emotion focused coping styles, it is suggested to consider educational programs on application of problem focused coping styles for these patients in order to decrease the pressures of the disease and treatment, and to promote their mental health, quality of life and efficiency. PMID:23983727

  6. Sodium Thiosulfate Pharmacokinetics in Hemodialysis Patients and Healthy Volunteers

    PubMed Central

    Stauffer, Emilie; Kalicki, Robert; Hildebrandt, Tatjana; Frey, Brigitte M.; Frey, Felix J.; Uehlinger, Dominik E.; Pasch, Andreas

    2011-01-01

    Summary Background and objectives Vascular calcification is a major cause of morbidity and mortality in dialysis patients. Human and animal studies indicate that sodium thiosulfate (STS) may prevent the progression of vascular calcifications. The pharmacokinetics of STS in hemodialysis patients has not been investigated yet. Design, setting, participants, & measurements STS was given intravenously to 10 hemodialysis patients on- and off-hemodialysis. Additionally, STS was applied to 9 healthy volunteers once intravenously and once orally. Thiosulfate concentrations were measured by using a specific and sensitive HPLC method. Results In volunteers and patients, mean endogenous thiosulfate baseline concentrations were 5.5 ± 1.82 versus 7.1 ± 2.7 μmol/L. Renal clearance was high in volunteers (1.86 ± 0.45 ml/min per kg) and reflected GFR. Nonrenal clearance was slightly, but not significantly, higher in volunteers (2.25 ± 0.32 ml/min per kg) than in anuric patients (2.04 ± 0.72 ml/min per kg). Hemodialysis clearance of STS was 2.62 ± 1.01 ml/min per kg. On the basis of the nonrenal clearance and the thiosulfate steady-state serum concentrations, a mean endogenous thiosulfate generation rate of 14.6 nmol/min per kg was calculated in patients. After oral application, only 4% of STS was recovered in urine of volunteers, reflecting a low bioavailability of 7.6% (0.8% to 26%). Conclusions Given the low and variable bioavailability of oral STS, only intravenous STS should be prescribed today. The biologic relevance of the high hemodialysis clearance for the optimal time point of STS dosing awaits clarification of the mechanisms of action of STS. PMID:21566113

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  8. The Adequacy of Phosphorus Binder Prescriptions Among American Hemodialysis Patients

    PubMed Central

    Huml, Anne M.; Sullivan, Catherine M.; Leon, Janeen B.; Sehgal, Ashwini R.

    2013-01-01

    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 <0.001). A majority of binder prescriptions have insufficient binding capacity to maintain 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

  9. THE ASSESSMENT OF CAREGIVER BURDEN IN CAREGIVERS OF HEMODIALYSIS PATIENTS

    PubMed Central

    Mashayekhi, Fatemeh; Pilevarzadeh, Motahareh; Rafati, Foozieh

    2015-01-01

    Background: Chronic renal failure is among the chronic disease which due to persistence of the disease and long treatment process has various effects on the physiological, psychological, functional ability, lifestyle changes, and independence status of the patient and his family. This may result in the burden feeling in caregivers. According to the importance of the subject, this study is to assess the level of caregiver burden in caregivers of hemodialysis patients. Methods: This is a cross-sectional analytical descriptive study that was conducted in 2014 on the caregivers of hemodialysis patients. Research instruments were consisted of two parts: demographic data check list and caregiver burden questionnaire. Data were analyzed by SPSS statistical software and Pearson correlation coefficient tests. A p value of less than 0.05 was considered statistically significant. Results: In this study, 72.5% of caregivers reported moderate to severe levels of caregiver burden. A significant relationship was observed between gender of the patient with caregiver burden score of (p=0.031) and type of the income with caregiver burden score of (p=0.000). Caregivers of male patients and patients with inadequate income had a higher caregiver burden score. Conclusions: Our results showed that more than half of the caregivers of hemodialysis patients had moderate to severe levels of caregiver burden, therefore it is worthy that health officials and nurses pay special attention to this issue by communicating with these patients and their caregivers. PMID:26622201

  10. Use of herbal remedies among patients undergoing hemodialysis.

    PubMed

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

    2013-11-01

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

  11. Segregation, income disparities, and survival in hemodialysis patients.

    PubMed

    Kimmel, Paul L; Fwu, Chyng-Wen; Eggers, Paul W

    2013-02-01

    Social and ecologic factors, such as residential segregation, are determinants of health in the general population, but how these factors associate with outcomes among patients with ESRD is not well understood. Here, we examined associations of income inequality and residence, as social determinants of health, with survival among black and white patients with ESRD. We merged U.S. Renal Data System data from 589,036 patients who started hemodialysis from 2000 through 2008 with race-specific median household income data from the Census Bureau. We used Gini Index coefficients to assess income distributional inequality and the Dissimilarity Index to determine residential segregation. Black patients lived in areas of lower median household income compared with white patients ($26,742 versus $41,922; P<0.001). Residence in areas with higher median household income was associated with improved survival. Among whites, income inequality was associated with mortality. Among blacks exclusively, residence in highly segregated areas was associated with increased mortality. In conclusion, black hemodialysis patients in the United States are particularly susceptible to gradients in income and residential segregation. Interventions directed at highly segregated black neighborhoods might favorably affect hemodialysis patient outcomes. PMID:23334394

  12. Prevention of sudden cardiac death in hemodialysis patients.

    PubMed

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

    2014-01-01

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

  13. Chryseobacterium meningosepticum bacteremia in diabetic nephropathy patient on hemodialysis

    PubMed Central

    Dias, M.; Prashant, K.; Pai, R.; Scaria, B.

    2010-01-01

    The Chryseobacterium species are inhabitants of soil and water. In the hospital environment, they exist in water systems and wet surfaces. We report here a case of Chryseobacterium meningosepticum bacteremia in a diabetic nephropathy patient on hemodialysis. He was successfully treated with Vancomycin and ceftazidime for three weeks with good clinical outcome. This is the first case reported in dialysis patients from India. PMID:21206682

  14. Cardiac veins: collateral venous drainage pathways in chronic hemodialysis patients.

    PubMed

    Ozmen, Evrim; Algin, Oktay

    2016-01-01

    Venous anomalies are diagnostic and therapeutic challenges. Subclavian or superior vena cava stenosis can be developed and venous return can be achieved via cardiac veins and coronary sinus in patients with central venous catheter for long-term hemodialysis. These types of abnormalities are not extremely rare especially in patients with a history of central venous catheter placement. Detection of these anomalies and subclavian vein stenosis before the surgical creation of hemodialysis fistulae or tunneled central venous catheter placement may prevent unnecessary interventions in those patients. Multidetector computed tomography (MDCT) technique can give further information when compared with fluoroscopy or digital subtraction angiography in the management of these patients. This case report describes interesting aspects of central vein complications in hemodialysis patients. As a conclusion, there are limited data about thoracic venous return, and further prospective studies with large patient number are required. MDCT with 3D reconstruction is particularly useful for the accurate evaluation of venous patency, variations, and collateral circulation. Also it is an excellent tool for choosing and planning treatment. PMID:27056032

  15. Predictors of Provider-Patient Visit Frequency During Hemodialysis

    PubMed Central

    Slinin, Yelena; Guo, Haifeng; Li, Suying; Liu, Jiannong; Morgan, Benjamin; Ensrud, Kristine; Gilbertson, David T.; Collins, Allan J.; Ishani, Areef

    2013-01-01

    Background/Aims In 2004, the Centers for Medicare & Medicaid Services tied reimbursement for outpatient hemodialysis services to number of times per month providers see their dialysis patients, resulting in increased provider-patient visit frequency. Greater provider-patient visit frequency is associated with lower hospitalization risk for hemodialysis patients. Determinants of visit frequency are uncertain. We aimed to identify patient, provider, and dialysis facility characteristics associated with provider visit frequency. Methods This retrospective cohort study used United States Renal Data System (USRDS) data for point-prevalent patients receiving in-center hemodialysis on January 1, 2006 (n = 144,860). Patient characteristics were defined January 1-June 30, 2006, and provider-patient visit frequency (< 4 vs. ≥ 4 visits/month) July 1-December 31, 2006. Patient characteristics were obtained from the USRDS. Provider data were obtained from the American Medical Association Physician Master File. We determined longitudinal associations between patient, provider, and facility characteristics and provider-patient visit frequency using logistic regression. Results Patient characteristics independently associated with greater provider-patient visit frequency included older age, African American race, longer dialysis duration, higher comorbidity score, Medicaid eligibility, urban residence, better compliance with dialysis, and more hospital days during run-in. Provider characteristics associated with greater provider-patient visit frequency included more years in practice, graduation from a foreign medical school, shorter distance between provider office and dialysis unit, and caring for more dialysis patients; facility characteristics included free-standing, independent status. Conclusion After the Medicare reimbursement policy change, several patient, provider, and facility characteristics were independently associated with greater dialysis provider-patient visit

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

    PubMed

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

    2012-03-01

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

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

    PubMed

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

    2016-08-01

    Occult hepatitis C virus (HCV) infection (OCI) was reported in an apparently disease-free state in the absence of liver disease, anti-HCV and HCV-RNA in the serum. The existing data examining the clinical significance of OCI and its potential as a source of HCV infection among hemodialysis patients are very limited. We examined the presence of OCI among patients on maintenance hemodialysis at Minia Governorate, Egypt; an HCV endemic country. A total of 81 subjects with negative markers for HCV were enrolled. HCV-RNA was tested in PBMCs by real-time PCR. For the 81 subjects, the average dialysis duration was 32.7 ± 21.7 months and the average ALT level (±SD) was 26 ± 12 U/L while that of AST was 29 ± 16 U/L. Out of the 81 subjects, three (3.7%) were HCV-RNA positive in PBMCs in the absence of serum anti-HCV and HCV-RNA indicating OCI. The viral load of the OCI subjects ranged from 172 to 4150 IU/ml. History of liver disease was positive in one of the three positive patients. These results highlight the potential risk of HCV transmission from patients within hemodialysis units in Egypt. J. Med. Virol. 88:1388-1393, 2016. © 2016 Wiley Periodicals, Inc. PMID:26743014

  18. Depression and Cognitive Function in Maintenance Hemodialysis Patients

    PubMed Central

    Agganis, Brian T.; Weiner, Daniel E.; Giang, Lena M.; Scott, Tammy; Tighiouart, Hocine; Griffith, John L.; Sarnak, Mark J.

    2010-01-01

    Background Both depression and cognitive impairment are common in hemodialysis patients, are associated with adverse clinical outcomes, and place an increased burden on health care resources. Study Design Cross-sectional cohort Setting & Participants 241 maintenance hemodialysis patients in the Boston area Predictor Depressive symptomatology, defined by a Center for Epidemiological Studies Depression Scale (CES-D) score of 16 or higher Outcome Performance on a detailed neurocognitive battery Results Mean age was 63.8 years, 49.0% were female, 21.6% were African American, and median dialysis duration was 13.8 months. There were 57 (23.7%) participants with significant depressive symptoms. In multivariable analysis adjusting for age, sex, education and other comorbid conditions, participants with and without depressive symptoms performed similarly on the Mini-Mental State Examination (p=0.4) and tests of memory. However, participants with greater depressive symptoms performed significantly worse on tests assessing processing speed, attention, and executive function, including Trails Making Test B (p=0.02) and Digit-Symbol Coding (p=0.01). Defining depression using a CES-D score ≥18 did not substantially change results. Limitations Cross-sectional design, absence of brain imaging Conclusions Hemodialysis patients with a greater burden of depressive symptoms perform worse on tests of cognition related to processing speed and executive function. Further research is needed to assess the effects of treating depressive symptoms on cognitive performance in dialysis patients. PMID:20673602

  19. Restless legs syndrome in hemodialysis patients in Iran.

    PubMed

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

    2015-05-01

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

  20. Prospective study on prevalence of dermatological changes in patients under hemodialysis in hemodialysis units in Tanta University hospitals, Egypt

    PubMed Central

    Mourad, Basma; Hegab, Doaa; Okasha, Kamal; Rizk, Sarah

    2014-01-01

    Introduction Chronic hemodialysis patients experience frequent and varied mucocutaneous manifestations in addition to hair and nail disorders. The aim of this study was to evaluate the prevalence of dermatological changes among patients with end-stage renal disease under hemodialysis in a hemodialysis unit in Tanta University hospitals over a period of 6 months, and to evaluate the relations of these dermatological disorders with the duration of hemodialysis as well as with different laboratory parameters in these patients. Patients and methods Ninety-three patients with end-stage renal disease on regular hemodialysis (56 males and 37 females) were selected and included in this cross-sectional, descriptive, analytic study. Their ages ranged from 18–80 years. All patients underwent thorough general and dermatological examinations. Laboratory investigations (complete blood counts, renal and liver function tests, serum parathormone levels, serum electrolytes, alkaline phosphatase, random blood sugar, and Hepatitis C virus (HCV) antibodies) were evaluated. Results This study revealed that most patients had nonspecific skin changes, including xerosis, pruritus, pallor, ecchymosis, hyperpigmentation, and follicular hyperkeratosis. Nail and hair changes were commonly found, especially half and half nail, koilonychia, subungal hyperkeratosis, melanonychia, onychomycosis, and brittle and lusterless hair. Mucous membrane changes detected were pallor, xerostomia, macroglossia, bleeding gums, aphthous stomatitis, and yellow sclera. There was a significant positive correlation between the presence of pruritus and serum parathormone level. There was a significant negative correlation between the presence of mucous membrane changes and hemoglobin level. Conclusion Nonspecific mucocutaneous manifestations are common in patients on hemodialysis, particularly xerosis, dyspigmentation, and pruritus. Early and prompt recognition and treatment of dermatological conditions in patients

  1. Pharmacokinetics and dialysability of naltrexone in patients undergoing hemodialysis.

    PubMed

    Kambia, Nicolas K; Dine, Thierry; Odou, Pascal; Bah, Salmane; Azar, Raymond; Gressier, Bernard; Dupin-Spriet, Thérèse; Luyckx, Michel; Brunet, Claude

    2004-01-01

    The disposition of naltrexone (NLT) (REVIA), an opioid antagonist intended for patients with impaired renal function and with severe intractable itching refractory to regular antipruritic therapy, was characterized. Hemodialysis effects on both efficacy and elimination of NLT also were assessed. We developed a simple, sensitive and selective reverse-phase high-performance liquid chromatographic (HPLC) method for measuring NLT plasma concentration in hemodialysis patients treated to relieve pruritus. NLT and the internal standard, naloxone (NLX) were extracted from plasma using a solid-phase extraction method with sep-pack C18 cartridge. The method was employed to determine both naltrexone pharmacokinetics and dialysability parameters during 4-h in dialyzed patients with chronic renal impairment. Thus, seven patients (2 men, 5 women) with end-stage renal disease and pruritus on regular hemodialysis were included. They received one tablet of NLT (Revia, 50 mg) orally prior dialysis session. The Cmax at the inlet and at the outlet the dialyzer were higher (255+/-117 ng/mL and 206+/-137 ng/ml respectively) in comparison with healthy subjects (9 - 44 ng/mL). The decrease hepatic first-pass metabolism of NLT consecutive to end-stage renal disease and the renal impairment could explain the increased levels of the drug in plasma. Tmax before and after dialysis plates remain unchanged as healthy subjects (approximately 1h). With regard to dialysability, a high dialyzer extraction ratio averating 30 % was found with a low dialysis clearance of 58.70+/-17 mL/min. The amount removed by dialysis is only 1.27 mg. We concluded that hemodialysis has little effect on NLT blood levels, and consequently on drug pharmacokinetics, when the drug is delivered to dialyzed patients following oral route. Thus, dosage adjustement is not required in the presence of advanced dialysis-dependant renal failure. In patients with end-stage renal disease, hemodialysis does not result in clinically

  2. Dialysis - hemodialysis

    MedlinePlus

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

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

    PubMed

    Belasco, Angelica G; Sesso, Ricardo

    2002-04-01

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

  4. Effect of Membrane Permeability on Survival of Hemodialysis Patients

    PubMed Central

    Locatelli, Francesco; Martin-Malo, Alejandro; Hannedouche, Thierry; Loureiro, Alfredo; Papadimitriou, Menelaos; Wizemann, Volker; Jacobson, Stefan H.; Czekalski, Stanislaw; Ronco, Claudio; Vanholder, Raymond

    2009-01-01

    The effect of high-flux hemodialysis membranes on patient survival has not been unequivocally determined. In this prospective, randomized clinical trial, we enrolled 738 incident hemodialysis patients, stratified them by serum albumin ≤4 and >4 g/dl, and assigned them to either low-flux or high-flux membranes. We followed patients for 3 to 7.5 yr. Kaplan-Meier survival analysis showed no significant difference between high-flux and low-flux membranes, and a Cox proportional hazards model concurred. Patients with serum albumin ≤4 g/dl had significantly higher survival rates in the high-flux group compared with the low-flux group (P = 0.032). In addition, a secondary analysis revealed that high-flux membranes may significantly improve survival of patients with diabetes. Among those with serum albumin ≤4 g/dl, slightly different effects among patients with and without diabetes suggested a potential interaction between diabetes status and low serum albumin in the reduction of risk conferred by high-flux membranes. In summary, we did not detect a significant survival benefit with either high-flux or low-flux membranes in the population overall, but the use of high-flux membranes conferred a significant survival benefit among patients with serum albumin ≤4 g/dl. The apparent survival benefit among patients who have diabetes and are treated with high-flux membranes requires confirmation given the post hoc nature of our analysis. PMID:19092122

  5. Malnutrition Markers and Serum Ghrelin Levels in Hemodialysis Patients

    PubMed Central

    Montazerifar, Farzaneh; Karajibani, Mansour; Gorgij, Farnia; Akbari, Ommolbanin

    2014-01-01

    Objective. The aim of study was to investigate the changes levels of serum ghrelin in HD patients and its relationship to some malnutrition markers compared with healthy controls. Methods. Forty-five patients on hemodialysis and forty healthy controls were studied. Biochemical parameters and serum ghrelin levels were measured. Both daily dietary intakes and body mass index (BMI) assessments were performed for evaluation of nutritional status. Results. Ghrelin concentrations were significantly reduced in patients undergoing hemodialysis when compared to healthy controls (5 ± 0.68 (1.1–18.5) pg/mL versus 7.8 ± 0.84 (2.4–18.3) pg/mL; P = 0.004). BMI and serum albumin in HD patients were markedly reduced compared to controls. The patients with an insufficient intake of energy and protein demonstrated slightly lower levels of serum ghrelin. A negative correlation between serum ghrelin concentration with age (r = −0.34, P = 0.02), BUN (r = −0.26, P < 0.01), and serum creatinine (r = −0.27, P < 0.01) was observed in HD patients. Conclusions. The findings suggest that decreased ghrelin levels in HD patients might be associated with anorexia. Further studies are needed to determine changes in serum ghrelin levels during dialysis and to clarify whether the decrease in ghrelin levels contributes to the malnutrition that is common in these patients.

  6. [Some aspects of homocysteine metabolism in hemodialysis patients].

    PubMed

    Bednarek-Skublewska, Anna; Buraczyńska, Monika; Wawrzycki, Sławomir; Baranowicz-Gaszczyk, Iwona; Ksiazek, Andrzej

    2002-11-01

    Homocysteine (Hcy) is a non-protein forming sulfur amino acid, synthesised from methionine (Met), whose metabolism is at the junction of two metabolic pathways: remethylation and transsulfuration. Increased Hcy serum concentration is a well established independent risk factor of cardiovascular diseases and a known feature of end stage renal disease. Hcy plasma level is influenced by folate, vitamin B6 and genetic factors. Mutation C677T in gene encoding methylenetetrahydrofolate reductase (MTHFR), an enzyme involved in Hcy remethylation has been associated with elevated Hcy in homozygous carriers (TT genotype). Several amino acids take part in metabolism of Hcy. There are abnormalities of concentration of the non essential and essential of amino acids in serum of patients treated with hemodialysis (HD). It is possible that these abnormalities of amino acids can change the Hcy metabolism. The aim of this study was the evaluation of some aspects of Hcy metabolism. We examined the MTHFR gene polymorphism and its relationship with plasma Hcy concentration. The plasma levels of total amino acids and amino acids connected with Hcy metabolism: methionine (Met), seryne (Ser), cysteine (Cyst) and tauryne (Tau) were evaluated in hemodialysis patients. The study was conducted in 71 (35 male, 36 female) patients, mean age 56.2 +/- 12.4 years. They were dialysed for a mean duration of 87.7 +/- 84.7 months (range 2-302). The control group (CG) in which Hcy and amino acids levels were examined consisted of 12 healthy subjects. Serum (EDTA) Hcy levels were measured by EIA-Hcy ELISA kit. The MTHFR gene polymorphism was evaluated by means of the polymerase chain reaction (PCR). The amino acids were measured by chromatography in amino acid analyser AAA 400. Mean concentration of Hcy was significantly higher in patients than in CG (31.1 +/- 9.1 vs 11.9 +/- 2.9 mumol/L; p < 0.01). Genotype frequencies in patients were: 42.8% for CC, 48.5% for CT and 8.7% for TT. Mean concentration of

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

    PubMed

    Shiota, Kotomi; Hashimoto, Toshihiko

    2016-04-01

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

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

    PubMed Central

    Shiota, Kotomi; Hashimoto, Toshihiko

    2016-01-01

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

  9. Depression in patients on hemodialysis and their caregivers.

    PubMed

    Saeed, Zeb; Ahmad, Aizaz M; Shakoor, Abdul; Ghafoor, Farkhanda; Kanwal, Shumaela

    2012-09-01

    Depression is recognized as the most common psychiatric problem in patients with end-stage renal disease. Stress negatively affects the quality of life of not only the patients on hemodialysis but also their caregivers. The objective of this study was to measure and compare the frequency of depression in these patients and their attendants, and to assess the associated risk factors in both groups. A cross-sectional study was conducted at our hemodialysis unit from June to September 2009. A total of 180 patients and 180 caregivers were enrolled and the Beck's Depression Inventory (BDI-II) questionnaire was administered. Of the 360 respondents, 201 (55.8%) were males and 264 (73.3) were married. According to the BDI scoring, 135 (75%) of the patients and 60 (33.4%) of the attendants were found to be moderately to severely depressed. Marriage (OR 1.817), low income status (OR 1.757) and unemployment (OR 4.176) correlated with increased depression grade, while gender and education level did not. Anemia was the only co-morbidity showing positive association with depression scores in the patients' group (P = 0.023). We conclude that the majority of the patients undergoing dialysis were depressed and were twice more likely to be depressed than their caregivers. In both groups, marriage and unemployment were associated with increased depressive symptoms, while household income showed negative association with depression. Gender and education level were not related to the depression scores. PMID:22982905

  10. Predicting erythropoietin resistance in hemodialysis patients with type 2 diabetes

    PubMed Central

    2013-01-01

    Background Resistance to ESAs (erythropoietin stimulating agents) is highly prevalent in hemodialysis patients with diabetes and associated with an increased mortality. The aim of this study was to identify predictors for ESA resistance and to develop a prediction model for the risk stratification in these patients. Methods A post-hoc analysis was conducted of the 4D study, including 1015 patients with type 2 diabetes undergoing hemodialysis. Determinants of ESA resistance were identified by univariate logistic regression analyses. Subsequently, multivariate models were performed with stepwise inclusion of significant predictors from clinical parameters, routine laboratory and specific biomarkers. Results In the model restricted to clinical parameters, male sex, shorter dialysis vintage, lower BMI, history of CHF, use of ACE-inhibitors and a higher heart rate were identified as independent predictors of ESA resistance. In regard to routine laboratory markers, lower albumin, lower iron saturation, higher creatinine and higher potassium levels were independently associated with ESA resistance. With respect to specific biomarkers, higher ADMA and CRP levels as well as lower Osteocalcin levels were predictors of ESA resistance. Conclusions Easily obtainable clinical parameters and routine laboratory parameters can predict ESA resistance in diabetic hemodialysis patients with good discrimination. Specific biomarkers did not meaningfully further improve the risk prediction of ESA resistance. Routinely assessed data can be used in clinical practice to stratify patients according to the risk of ESA resistance, which may help to assign appropriate treatment strategies. Clinical trial registration The study was registered at the German medical authority (BfArM; registration number 401 3206). The sponsor protocol ID and clinical trial unique identified number was CT-981-423-239. The results of the study are published and available at http

  11. Dialysis disequilibrium syndrome induced by neoplastic meningitis in a patient receiving maintenance hemodialysis

    PubMed Central

    2013-01-01

    Background Dialysis disequilibrium syndrome is characterized by neurological symptoms resulting from cerebral edema, which occurs as a consequence of hemodialysis. Dialysis disequilibrium syndrome most often occurs in patients who have just started hemodialysis, during hemodialysis, or soon after hemodialysis; although it may also occur in patients who are under maintenance hemodialysis with pre-existing neurological disease. Case presentation A 70-year-old woman, who had been receiving maintenance hemodialysis for one year, was diagnosed with ovarian cancer by ascites cytological examination. Two years later, she reported severe headache and nausea during hemodialysis and was diagnosed with dialysis disequilibrium syndrome. Although brain images revealed mild hydrocephalus without any mass lesions, poorly differentiated adenocarcinoma cells were detected in her cerebrospinal fluid. These findings indicated that DDS was induced by neoplastic meningitis due to ovarian cancer metastasis. Conclusion Neoplastic meningitis should be considered and excluded in hemodialysis patients with dialysis disequilibrium syndrome and malignancy by cytological examination of the cerebrospinal fluid even if cerebral imaging shows no obvious lesions. This is the first reported case of dialysis disequilibrium syndrome induced by neoplastic meningitis in a patient receiving maintenance hemodialysis. PMID:24238645

  12. Physical Activity in Hemodialysis Patients Measured by Triaxial Accelerometer

    PubMed Central

    Gomes, Edimar Pedrosa; Reboredo, Maycon Moura; Carvalho, Erich Vidal; Teixeira, Daniel Rodrigues; Carvalho, Laís Fernanda Caldi d'Ornellas; Filho, Gilberto Francisco Ferreira; de Oliveira, Julio César Abreu; Sanders-Pinheiro, Helady; Chebli, Júlio Maria Fonseca; de Paula, Rogério Baumgratz; Pinheiro, Bruno do Valle

    2015-01-01

    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. PMID:26090432

  13. Physical Activity in Hemodialysis Patients Measured by Triaxial Accelerometer.

    PubMed

    Gomes, Edimar Pedrosa; Reboredo, Maycon Moura; Carvalho, Erich Vidal; Teixeira, Daniel Rodrigues; Carvalho, Laís Fernanda Caldi d'Ornellas; Filho, Gilberto Francisco Ferreira; de Oliveira, Julio César Abreu; Sanders-Pinheiro, Helady; Chebli, Júlio Maria Fonseca; de Paula, Rogério Baumgratz; Pinheiro, Bruno do Valle

    2015-01-01

    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. PMID:26090432

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

    PubMed

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

    2016-01-01

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

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

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

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

    PubMed Central

    Nobahar, Monir; Tamadon, Mohammad Reza

    2016-01-01

    Introduction: Patients undergoing hemodialysis require direct and continuous care. Identifying the barriers to and factors facilitating hemodialysis care can improve care quality. Objectives: The aim of this study was to assess the barriers and facilitators of care for hemodialysis patients. Patients and Methods: This study was conducted as a qualitative study and it utilized content analysis approach. The study was performed in hemodialysis ward of Kowsar hospital in Semnan, in 2014. We used purposive sampling method with maximum diversity. Semi-structured interviews with open questions were used to collect data from a total of 20 participants. Results: The main topic of health care challenges was divided into two main categories, including the facilitators and barriers of hemodialysis care. The facilitators of hemodialysis care had four subcategories, including "intimate relationship", "basic knowledge", "hemodialysis skills", and "experience". The category of barriers had eight subcategories, including "shortage of nurses and heavy workload", "weak authority of the head nurse", "ignorant director of nursing", "shortage of nephrologists", "lack of vascular surgery expert", "lack of nurse’s aide and nursing assistant ", "unskilled staffs", and "interference by patients’ caregivers". Conclusion: The findings of this study showed that access to human resources and their abilities were among the factors facilitating care. However, lack of qualified medical staff at each level of care delivery was one of the barriers to hemodialysis care. Hence, it is of great importance for policy makers, managers, and program designers to recruit human resources who have the characteristics and competencies required for providing hemodialysis care. PMID:27069967

  17. Ultrasonographic detection of thyroid nodules in hemodialysis patients in Japan.

    PubMed

    Sanai, Toru; Okamura, Ken; Inoue, Teruo; Abe, Tetsuya; Tsuruya, Kazuhiko; Node, Koichi

    2010-06-01

    The study of thyroid nodules in hemodialyzed patients using ultrasonography has been described in a limited number of reports. The thyroid glands of 143 patients with end-stage renal disease on hemodialysis were examined by ultrasonography using frequency probes. Although a goiter (thyroid volume > 20 mL) was observed in only 20 patients (14%), nodular lesions of the thyroid gland were more frequent and found in 85 patients (59.4%), especially in female patients (42 patients, 72.4%). The etiology of thyroid nodular lesions was as follows: cyst in 43 (30.0%), adenomatous goiter in 14 (9.8%), adenoma in 11 (7.7%), hypoechoic lesion in 17 (11.9%), and intrathyroid calcification in 8 (5.6%). Ultrasound-guided fine-needle aspiration cytology was performed in 5 patients, but no abnormal cells were found. Compared to patients without nodules, the age was higher in patients with cysts (54 +/- 15 vs. 63 +/- 13 years; P < 0.05) and hypoechoic lesions (70 +/- 13 years; P < 0.05). The serum thyroglobulin level was higher in patients with adenomatous goiters (26 +/- 28 vs. 148 +/- 166 ng/mL; P < 0.05). The thyroid volume was greater in patients with adenomatous goiters (14.2 +/- 5.7 vs. 19.0 +/- 7.3 mL; P < 0.05) and adenomas (18.2 +/- 6.7 mL; P < 0.05). In conclusion, patients undergoing hemodialysis frequently develop thyroid abnormalities and ultrasonography is a useful imaging modality to identify these lesions. PMID:20609186

  18. Survival Benefit of Statins in Hemodialysis Patients Awaiting Renal Transplantation.

    PubMed

    Aftab, Waqas; Gazallo, Juliana; Motabar, Ali; Varadrajan, Padmini; Deedwania, Prakash C; Pai, Ramdas G

    2015-06-01

    End-stage renal disease (ESRD) patients have extraordinarily high cardiovascular risk and mortality, yet the benefit of statins in this population remains unclear based on the randomized trials. We investigated the prognostic value of statins in a large, pure cohort of prospectively recruited patients with ESRD awaiting renal transplantation, and being followed up in a dedicated cardiac clinic. We prospectively collected demographic, clinical, laboratory, and pharmacological data on 423 consecutive ESRD patients on hemodialysis awaiting renal transplantation. Survival analysis was performed as a function of statin therapy. The baseline characteristics were as follows: age 57 ± 11 years, males 64%, diabetes mellitus in 68%, known coronary artery disease in 30%, left ventricular (LV) ejection fraction 61 ± 11%. Over a mean follow-up of 2 years, there were 43 deaths. Adjusted for age, gender, hypertension, body mass index, diabetes mellitus, coronary artery disease, smoking, and treatment with angiotensin converting enzyme inhibitor, β blocker, and antiplatelet medications, statin use was a predictor of lower mortality (hazard ratio 0.30, 95% confidence interval 0.11-0.79, p = 0.01). This beneficial effect of statin was supported by propensity score analysis (p = 0.02) and was consistent across all clinical subgroups. The benefit of statins seemed to be greater in those with LV hypertrophy and smoking. Statin therapy in hemodialysis patients awaiting renal transplant is independently associated with better survival supporting its use in this high-risk population. PMID:26060381

  19. Central Venous Disease in Hemodialysis Patients: An Update

    SciTech Connect

    Modabber, Milad; Kundu, Sanjoy

    2013-08-01

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

  20. Cardiac calcified amorphous tumor in a hemodialysis patient.

    PubMed

    Seo, Hiroyuki; Fujii, Hiromichi; Aoyama, Takanobu; Sasako, Yoshikado

    2016-06-01

    We present a case of cardiac calcified amorphous tumor, a rare intracardiac non-neoplastic tumor, in a hemodialysis patient. A 72-year-old woman with no history of thromboembolic, malignant, or inflammatory disease presented with dyspnea. Echocardiography revealed a highly echoic, slightly mobile mass with an acoustic shadow originating from the mitral subvalvular apparatus, extending to the left ventricular outflow tract. She underwent surgical resection of the mass through the aortic valve, which was easily excised from the papillary muscle and chordae tendineae. Histopathologic examination revealed nodular calcium deposits on a background of amorphous degenerated fibrin material, consistent with calcified amorphous tumor. PMID:25742783

  1. [Hemodialysis, sociological analysis of caregivers and patients].

    PubMed

    Loubert, Christine

    2016-01-01

    The trajectory of elderly patients undergoing haemodialysis is different from that of younger patients. A detailed description of these trajectories has resulted in the identification of certain characteristics inherent to the elderly. A study suggests moving beyond the perceptual knowledge of the professional in order to objectify the factors influencing these interpersonal relationships. PMID:26805643

  2. Population pharmacokinetics of levofloxacin in Korean patients.

    PubMed

    Kiem, Sungmin; Ryu, Sung-Mun; Lee, Yun-Mi; Schentag, Jerome J; Kim, Yang-Wook; Kim, Hyeon-Kuk; Jang, Hang-Jae; Joo, Yong-Don; Jin, Kyubok; Shin, Jae-Gook; Ghim, Jong-Lyul

    2016-08-01

    Levofloxacin (LVFX) has different effects depending on the area under the concentration-time curve (AUC)/minimum inhibitory concentration (MIC) ratio. While AUC can be expressed as dose/clearance (CL), we measured serial concentrations of LVFX in Koreans and tried to set a Korean-specific equation, estimating the CL of the antibiotic. In total, 38 patients, aged 18-87 years, received once daily intravenous LVFX doses of 500 mg or 250 mg, depending on their renal function. Four plasma samples were obtained according to a D optimal sampling design. The population pharmacokinetic (PK) parameters of LVFX were estimated using non-linear mixed-effect modeling (NONMEM, ver. 7.2). The CL of LVFX was dependent on creatinine clearance (CLCR) as a covariate. The mean population PK parameters of LVFX in Koreans were as follows: CL (l/hour) = 6.19 ×  (CLCR/75)(1.32). The CL of LVFX in Koreans is expected to be lower than that in Western people. PMID:25976699

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

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

  4. Coping with Treatment-Related Stress: Effects on Patient Adherence in Hemodialysis.

    ERIC Educational Resources Information Center

    Christensen, Alan J.; And Others

    1995-01-01

    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…

  5. Parathyroidectomy Improves Restless Leg Syndrome in Patients on Hemodialysis

    PubMed Central

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

    2016-01-01

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

  6. Evaluation of parathyroid autograft growth and function in hemodialysis patients

    SciTech Connect

    Karsenty, G.; Petraglia, A.; Bourdeau, A.; Gambini, D.J.; Moreau, J.F.; Lecharpentier, Y.; Zingraff, J.; Bournerias, F.; Buisson, C.; Dubost, C.

    1986-07-01

    The aim of our study was to evaluate the function and growth of parathyroid tissue autografted into the forearm of hemodialysis patients using several presently available methods. In a dynamic study, the secretory function of autografted tissue was evaluated in seven patients using either zero calcium dialysate or calcium infusion. In an additional prospective study, seven patients had repeated determinations of plasma immunoreactive parathyroid hormone (iPTH) concentration on samples from both forearms, a radionuclide evaluation of autograft function using thallium-201 chloride, and real time ultrasonography. Light microscopy analysis was performed in two patients. The dynamic study demonstrated that induction of hypocalcemia was followed by an increase, and induction of hypercalcemia by a decrease in circulating iPTH in both forearms using three different radioimmunoassays similar to what has been reported for normal parathyroid tissue. A significant gradient (ie, greater than 2.0) of plasma iPTH concentration in samples from both forearms was observed in only three out of the seven patients of the prospective study. Two of these patients disclosed an increased uptake of /sup 201/TI chloride at the site of autografted tissue and had an echographically detectable mass. In both, hyperplastic parathyroid tissue was removed. At present, the remaining third patient does not have other features of recurrent hyperparathyroidism. In conclusion, autotransplanted parathyroid tissue of hemodialysis patients shows an adequate response to physiologic stimuli such as hypo- and hypercalcemia. Dynamic tests, therefore, appear to be a useful tool in the assessment of its function. In addition, radionuclide and echographic studies may be reliable adjuncts in the detection of marked parathyroid autograft hyperplasia.

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

    PubMed

    Aoyagi, Teiichiro; Tachibana, Masaaki; Naganuma, Shinji

    2013-01-01

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

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

    PubMed

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

    2015-01-01

    Hemodialysis (HD) patients are subjected to a number of physical and mental stresses. Physicians might be unaware of some of these problems. We assessed our patients' opinion about the service provided at the dialysis unit. Our unit has 89 patients on HD. A questionnaire exploring our patients' opinion relative to the service provided was prepared. The patients were asked to fill-in the questionnaire in a confidential manner. Questionnaires were then collected and examined while unaware of patient identities. Sixty-nine patients (77.5%) responded to the questionnaire. Eight patients (11.6%) revealed their names on the questionnaire. According to the questionnaire, the patients were asked to assess the service of each service by choosing one of the following grades: "excellent," "mediocre" or "bad." For the whole group of contributing patients, there were 563 "excellent," 85 "mediocre" and five "bad" choices in addition to 37 blank "no comment" choices. Food service had the least percentage (68%) of evaluation as "excellent," while doctor' performance got the highest excellent evaluation (85.5%). Thirty-five patients (50.7%) added further comment(s). An audit meeting was conducted to discuss these results. Exploring the opinion of patients on HD might uncover some areas of dissatisfaction and help in improving the provided service. We recommend widespread usage of questionnaires to assess patient satisfaction as well as to assess other health-care aspects. PMID:25579719

  9. Increased arterial stiffness predicts cognitive impairment in hemodialysis patients.

    PubMed

    Tasmoc, Alexandra; Donciu, Mihaela-Dora; Veisa, Gabriel; Nistor, Ionut; Covic, Adrian

    2016-07-01

    Introduction Cognitive impairment is a major, but underdiagnosed, risk factor for negative outcomes in patients with chronic kidney disease (CKD). The main goal of this study was to evaluate, for the first time, the relationship between arterial stiffness and cognitive impairment in a cohort of hemodialysis patients. Methods We prospectively analyzed the cognitive function and pulse wave velocity (PWV) of 72 hemodialysis patients, mean age 56.54 ± 13.96 y, from two Romanian dialysis centers. We administered to all patients the Mini Mental State Examination (MMSE), Trail Making Test Part-A (TMTA) and Part-B (TMTB), and Mini-Cog Test. Radial arterial waveforms during 40 cardiac cycles were recorded in each patient. Findings Mean MMSE score was 25.13 ± 3.47, mean MiniCog score was 3.51 ± 1.18, mean TMTA (sec) was 103.77 ± 53.13 and mean TMTB (sec) was 214.93 ± 112.25. In linear unadjusted regression, PWV values were associated with worse MMSE scores (β = -0.36, P = 0.001, 95% CI: -0.68 to -0.17), and MiniCog scores (β = -0.26, P = 0.02, 95% CI: -0.19 to -0.01). Also, PWV value was significant associated with TMTA test, but not with TMTB. After further adjustments, PWV remained a strong predictor for cognitive impairment measured by MMSE, TMTA, MiniCog, but not for TMTB. Discussion Cognitive impairment was associated with higher PWV values in our cohort. Further evidence is needed in order to support arterial stiffness as a long-term predictor for cognitive decline in ESRD patients. PMID:26861856

  10. Link between Peripheral Artery Disease and Heart Rate Variability in Hemodialysis Patients

    PubMed Central

    Chen, Szu-Chia; Chen, Chien-Fu; Huang, Jiun-Chi; Lee, Mei-Yueh; Chen, Jui-Hsin; Chang, Jer-Ming; Hwang, Shang-Jyh; Chen, Hung-Chun

    2015-01-01

    Peripheral artery disease (PAD) and low heart rate variability (HRV) are highly prevalent in hemodialysis patients, and both are associated with increased cardiovascular morbidity and mortality. This study aims to examine the suggested relationship between PAD and HRV, and the relationship of parameters before and after hemodialysis. This study enrolled 161 maintenance hemodialysis patients. PAD was defined as ABI < 0.9 in either leg. HRV was performed to assess changes before and after hemodialysis. The change in HRV (△HRV) was defined as post-hemodialysis HRV minus pre-hemodialysis HRV. Patients’ clinical parameters were collected from the dialysis records. All HRV parameters except high frequency (HF) % were lower in patients with PAD than patients without PAD, though not achieving significant level. In patients without PAD, HF (P = 0.013), low frequency (LF) % (P = 0.028) and LF/HF (P = 0.034) were significantly elevated after hemodialysis, whereas no significant HRV parameters change was noted in patients with PAD. Serum intact parathyroid hormone was independently associated with △HF (β = -0.970, P = 0.032) and △LF% (β = -12.609, P = 0.049). Uric acid level (β = -0.154, P = 0.027) was negatively associated with △LF/HF in patients without PAD. Our results demonstrated that some of the HRV parameters were significantly increased after hemodialysis in patients without PAD, but not in patients with PAD, reflecting a state of impaired sympatho-vagal equilibrium. Severity of secondary hyperparathyroidism and hyperuricemia contributed to lesser HRV parameters increase after hemodialysis in patients without PAD. PMID:26237669

  11. A Comparison of Temporal Patterns of Fatigue in Patients on Hemodialysis

    PubMed Central

    Horigan, Ann E.; Barroso, Julie V.

    2016-01-01

    This qualitative study describes the temporal patterns of fatigue found as part of a larger study designed to elicit a description of the experience and self-management of fatigue for patients on hemodialysis. Two patterns of fatigue were identified. The first pattern, continuous fatigue, was characterized by participants who experienced fatigue at all times, which was their normal, baseline feeling. Within this group, two subgroups were identified. The second pattern of fatigue, post-dialysis fatigue only, was characterized by participants who experienced fatigue only after their hemodialysis session. This study is unique because it expands our knowledge about hemodialysis and fatigue by describing the patterns that fatigue follows over time from one hemodialysis session to the next. Insight into these phenomena could help ameliorate fatigue and allow nurses to tailor interventions for patients on hemodialysis. PMID:27254968

  12. A Comparison of Temporal Patterns of Fatigue in Patients on Hemodialysis.

    PubMed

    Horigan, Ann E; Barroso, Julie V

    2016-01-01

    This qualitative study describes the temporal patterns of fatigue found as part of a larger study designed to elicit a description of the experience and self-management of fatigue for patients on hemodialysis. Two patterns of fatigue were identified. The first pattern, continuous fatigue, was characterized by participants who experienced fatigue at all times, which was their normal, baseline feeling. Within this group, two subgroups were identified. The second pattern of fatigue, post-dialysis fatigue only, was characterized by participants who experienced fatigue only after their hemodialysis session. This study is unique because it expands our knowledge about hemodialysis and fatigue by describing the patterns that fatigue follows over time from one hemodialysis session to the next. Insight into these phenomena could help ameliorate fatigue and allow nurses to tailor interventions for patients on hemodialysis. PMID:27254968

  13. [Patient who developed heparin-induced thrombocytopenia type II after 24 years on hemodialysis].

    PubMed

    Gavranić, Bruna Brunetta; Basić-Jukić, Nikolina; Kes, Petar

    2012-10-01

    Heparin-induced thrombocytopenia type II (HIT) is a clinicopathologic syndrome in which one or more clinical events are temporally related to heparin administration and caused by HIT antibodies. There are at least five different types of clinical events that are associated with HIT: thrombocytopenia; thrombosis; skin necrosis at heparin injection site, venous limb gangrene; and an acute systemic reaction that occurs 5-30 min after intravenous bolus of heparin. HIT typically presents 5-14 days after initiation of heparin therapy, later onset is unusual. Heparin is a routine anticoagulant in hemodialysis but administration is different than in surgical and other medical population. Doses are lower and administered every other day, yet hemodialysis patients receive heparin for years. Relationship between dialysis vintage and HIT-antibody positivity has been analyzed in two studies. In national survey of HIT in hemodialysis population of the United Kingdom mean time between starting hemodialysis and development of HIT was 61 days (5-390 days). Japanese authors also found greatest incidence of HIT antibody positivity in patients who were on hemodialysis for less than 1 year, none of patients on hemodialysis for more than 10 years was HIT-antibody positive. We present a case of 70-years old female who developed HIT after 24 years of hemodialysis and exposure to heparin. First 22 years she was receiving unfractionated heparin for anticoagulation during hemodialysis sessions. Afterwards her therapy was changed to low molecular weight heparin. Last 12 years she has tunneled cuffed catheter which was also filled with unfractionated heparin. She had a history of severe renal osteodistrophy and severe aortal valve stenosis, hypothyreosis, thrombosis of both subclavian veins and partial colon resection due to mesenterial artery thrombosis. Her thrombocyte count was low, but despite extensive work-up which included HIT antibody detection, no cause could be identified. She

  14. Non catheter-related bacteremia caused by Pseudomonas oryzihabitans in a patient undergoing hemodialysis.

    PubMed

    Hellou, Elias; Artul, Suheil; Omari, Sohaib; Taha, Mohamad; Armaly, Zaher; Nseir, William

    2014-07-01

    Pseudomonas oryzihabitans (P. orizyhabitans) has already been reported both as a human and a zoonotic pathogen. A few cases of P. orizyhabitans bacteremia have been reported among patients who underwent peritoneal dialysis. P. orizyhabitans bacteremia has never been reported among patients on hemodialysis. We report the first case of P. orizyhabitans bacteremia in a chronic hemodialysis patient; this patient did not have a central venous catheter angioaccess as a potential portal of entry. PMID:24612459

  15. [Hepatitis C incidence in hemodialysis patients in Brazil from 2000 to 2003].

    PubMed

    Cherchiglia, Mariangela Leal; Giordano, Luiz Flávio Couto; Machado, Elaine Leandro; Gomes, Isabel Cristina; Carmo, Ricardo Andrade; Acúrcio, Francisco de Assis; Andrade, Eli Iola Gurgel; Queiroz, Odilon Viana; Ferreira, Carolina Souza

    2016-08-01

    The study aimed to estimate the incidence of HCV seroconversion in hemodialysis patients in the Brazilian Unified National Health System (SUS). This was a prospective, non-concurrent study using patients' data identified by deterministic and probabilistic record linkage in the SUS information system. The study included 47,079 patients started on hemodialysis between January 1, 2000, and December 31, 2003, followed until seroconversion or conclusion of the study in 2004. Three percent of hemodialysis patients HCV-seroconverted (1.7 per 100 patient-years). Increased risk of HCV seroconversion was associated with age, glomerulonephritis, geographic region, HIV-positivity, and dialysis service. The observed HCV seroconversion rate was similar to that in developed countries, highlighting evidence of transmission among hemodialysis patients. PMID:27509552

  16. An unusual case of cocoon abdomen in a patient on hemodialysis

    PubMed Central

    Jaryal, A.; Rathi, M.; Bal, A.; Goyal, A.; Ramachandran, R.; Kumar, V.; Kohli, H. S.; Gupta, K. L.

    2016-01-01

    “Cocoon abdomen” or sclerosing encapsulating peritonitis is a rare cause of intestinal obstruction. It has been described in patients on continuous ambulatory peritoneal dialysis. The exact etiology is unknown, but pathogenesis rests on chronic peritoneal inflammation. No case has been reported so far in patients on hemodialysis. We hereby report a case of cocoon abdomen presenting as refractory ascites with intestinal obstruction in a patient on maintenance hemodialysis. PMID:26937080

  17. Nocturnal hemodialysis

    PubMed Central

    Ranganathan, D.; John, G. T.

    2012-01-01

    Patients receiving conventional hemodialysis have high hospitalisation rates, poor quality of life and survival compared to the general population. Many centres around the world are providing longer hours of hemodialysis - short daily hemodialysis and nocturnal hemodialysis - with a view to improving patient survival and quality of life. Studies have shown that nocturnal haemodiaysis is more effective than conventional hemodialysis in clearing most small, middle and larger molecule toxins and suggest nocturnal dialysis enhances patient survival and quality of life. Concerns include patient acceptance, vascular access related complications and increased cost. The purpose of this review is to examine the advantages and drawbacks of nocturnal dialysis, with a focus on applicability to India where the renal physician has to face cultural and economic barriers, erratic power supply and poor water quality. PMID:23326041

  18. Prevalence of Depressive Symptoms among Hemodialysis and Peritoneal Dialysis Patients

    PubMed Central

    AlDukhayel, AbdulRhman

    2015-01-01

    Introduction End stage renal disease (ESRD) affects patient’s physical and psychological health. Depression is the most common psychiatric illness among patients with ESRD. This study aimed to identify the prevalence of depressive symptoms among patients undergoing peritoneal (PD) and hemodialysis (HD), also to correlate these symptoms with the demographic data. Methods this is a cross-sectional study that includes 133 PD patients and 133 HD patients attending the King Fahad Dialysis Center at King Saud Medical Complex (KSMC), Riyadh, Saudi Arabia. Socio-demographic data were documented. Depression was evaluated by using the zung self- rating depression scale (Zung SDS). Results using the Zung SDS; the prevalence of depression was significantly higher among PD patients (98.5%) in compare with HD patients (83.5%). Conclusion the study reveals that there is a high prevalence of depressive symptoms among PD and HD patients. This will lead us to think of adding a system for screening, diagnosis and treatment of depression for all dialysis patients to improve their life. PMID:25901128

  19. Diabetes therapies in hemodialysis patients: Dipeptidase-4 inhibitors.

    PubMed

    Nakamura, Yuya; Hasegawa, Hitomi; Tsuji, Mayumi; Udaka, Yuko; Mihara, Masatomo; Shimizu, Tatsuo; Inoue, Michiyasu; Goto, Yoshikazu; Gotoh, Hiromichi; Inagaki, Masahiro; Oguchi, Katsuji

    2015-06-25

    Although several previous studies have been published on the effects of dipeptidase-4 (DPP-4) inhibitors in diabetic hemodialysis (HD) patients, the findings have yet to be reviewed comprehensively. Eyesight failure caused by diabetic retinopathy and aging-related dementia make multiple daily insulin injections difficult for HD patients. Therefore, we reviewed the effects of DPP-4 inhibitors with a focus on oral antidiabetic drugs as a new treatment strategy in HD patients with diabetes. The following 7 DPP-4 inhibitors are available worldwide: sitagliptin, vildagliptin, alogliptin, linagliptin, teneligliptin, anagliptin, and saxagliptin. All of these are administered once daily with dose adjustments in HD patients. Four types of oral antidiabetic drugs can be administered for combination oral therapy with DPP-4 inhibitors, including sulfonylureas, meglitinide, thiazolidinediones, and alpha-glucosidase inhibitor. Nine studies examined the antidiabetic effects in HD patients. Treatments decreased hemoglobin A1c and glycated albumin levels by 0.3% to 1.3% and 1.7% to 4.9%, respectively. The efficacy of DPP-4 inhibitor treatment is high among HD patients, and no patients exhibited significant severe adverse effects such as hypoglycemia and liver dysfunction. DPP-4 inhibitors are key drugs in new treatment strategies for HD patients with diabetes and with limited choices for diabetes treatment. PMID:26131325

  20. Manganese-induced Parkinsonism in a patient undergoing maintenance hemodialysis.

    PubMed

    Ohtake, Takayasu; Negishi, Kousuke; Okamoto, Kouji; Oka, Machiko; Maesato, Kyoko; Moriya, Hidekazu; Kobayashi, Shuzo

    2005-10-01

    We report a rare case of manganese (Mn)-induced parkinsonism in a patient on maintenance hemodialysis therapy who complained of gait disturbance and dysarthria. His symptoms and abnormal magnetic resonance imaging (MRI) findings of the brain were thought to be caused, at least in part, by long-term ingestion of a health supplement (Chlorella extract) that contained 1.7 mg of Mn in the usual daily dose. Elevated serum and cerebrospinal fluid Mn levels were detected, and brain MRI showed areas of abnormal intensity in the bilateral basal ganglia (low intensity on T1-weighted images and high intensity on T2-weighted images). Edetic acid infusion therapy dramatically improved the MRI abnormalities, after which his symptoms gradually improved 4 months later. PMID:16183431

  1. Factors Affecting Hemodialysis Patients' Satisfaction with Their Dialysis Therapy

    PubMed Central

    Al Eissa, M.; Al Sulaiman, M.; Jondeby, M.; Karkar, A.; Barahmein, M.; Shaheen, F. A. M.; Al Sayyari, A.

    2010-01-01

    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. PMID:21152200

  2. Complication of diagnostic pleural aspiration: is it of value in hemodialysis patients?

    PubMed

    Corbett, Richard W; Ashby, Damien R

    2014-04-01

    Pleural effusions are common in hemodialysis patients and are associated with significant morbidity. Diagnostic pleural aspiration and subsequent biochemical analysis can be used to differentiate exudates and transudates. In particular, Light's criteria have been validated in the general population although their efficacy in hemodialysis patients is unclear. Furthermore, aspiration is not without risk; we report the case of a life-threatening thoracic bleed as a complication of diagnostic thoracocentesis in a hemodialysis patient, in whom a transudative effusion was misclassified according to Light's criteria. Retrospective examination of a further 22 aspirations in hemodialysis patients suggests that biochemical analysis of pleural fluid in this group is of limited value. Careful clinical and radiological assessment may be of greater value in determining individuals who may benefit from formal drainage, rather than diagnostic aspiration with its attendant risks. PMID:24393436

  3. Spallation and migration of silicone from blood-pump tubing in patients on hemodialysis

    SciTech Connect

    Leong, A.S.; Disney, A.P.; Gove, D.W.

    1982-01-21

    Spalled particles of silicone were observed in the livers of patients with chronic renal failure treated by hemodialysis. The refractile particles of silicone were associated with various degrees of hepatic inflammation and fibrosis, and granulomatous hepatitis was evident in nine cases. Retrospective examination revealed the material in 18 of 38 liver-biopsy samples from patients on hemodialysis who had clinical hepatic dysfunction. Of 31 autopsies of patients who had undergone hemodialysis, 22 revealed silicone in the liver, and silicone was also present in the spleen in all cases and in the marrow, lungs, and nodes in some. Giant cells containing silicone were also observed in these organs. Silicone was present in patients who had undergone hemodialysis for six weeks to 84 months (mean, 24 months). The identity of the material was confirmed by atomic absorption and by electron microprobe analysis. The silicone was traced to a segment of silicone tubing located in the roller pump of the dialysis machine.

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

    PubMed Central

    Koycheva, Reneta Yovcheva; Cholakov, Vasil; Andreev, Jivko; Penev, Margarit; Iliev, Rosen; Nancheva, Krasimira; Tsoneva, Vanya

    2016-01-01

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

  5. Increased oxidative stress in foam cells obtained from hemodialysis patients.

    PubMed

    Gonçalves, Marlene S B; Fabris, Bruno A; Brinholi, Francis F; Bortolasci, Chiara C; Watanabe, Maria A E; Oliveira, Karen B; Delfino, Vinícius D A; Lavado, Edson L; Barbosa, Décio S

    2013-04-01

    Premature atherosclerosis represents the main cause of mortality among end-stage renal disease patients (ESRD). Increased inflammation and oxidative stress are involved in initiation and progression of the atherosclerotic plaque. As foam cells are capable of producing significant amounts of inflammatory mediators and free radicals, we hypothesized that foam cells from uremic patients could produce more inflammation and oxidative stress than foam cells from normal people and be, somehow, involved in the accelerated atherosclerosis of uremia. To test this hypothesis, the levels of a few markers of inflammation and oxidative stress: Tumor necrosis factor-α, inducible nitric oxide synthase, malondialdehyde, nitric oxide by-products were measured in the supernatants of macrophage-derived foam cells cultures from 18 hemodialysis patients and 18 apparently healthy individuals controls. Malondialdehyde levels in the supernatant of cell cultures (macrophages stimulated or not with native and oxidized lipoprotein) were significantly increased in uremic patients; no statistically significant difference was found between the supernatant concentrations of nitric oxide by-products, inducible nitric oxide synthase activity, and tumor necrosis factor-α between patients and controls. Our results, obtained with human macrophages and macrophage-derived foam cells, are compatible with the theory that increased cellular oxidative stress and inflammatory activity in ESRD patients could accelerate the atherosclerotic process. The present culture protocol showed it is possible to use human mononuclear cells to evaluate the oxidative metabolism of foam cells, which are considered to be the initial step of atherosclerotic lesions. PMID:22928784

  6. Factors associated with risk of suicide in patients with hemodialysis.

    PubMed

    Martiny, Camila; de Oliveira e Silva, Adriana Cardoso; Neto, José Pedro Simões; Nardi, Antonio Egidio

    2011-01-01

    Suicide risk (SR) has been associated to several factors; one of them is the presence of psychiatric disorders. This study has the objective of investigating the relationship between the risk factors for suicidal behavior in patient bearers of chronic renal illness who are undertaking hemodialysis treatment. Sixty-nine undertook a short, structured diagnostic interview. The prevalence of some psychiatric disorders showed itself greater in the sample than that in the population in general. A significant positive correlation was found between SR, major depressive episode, and agoraphobia without panic disorder. The religiosity of the patient was also evaluated as an influencing factor of SR. Nonreligious patients had 8 times more chance to have SR compared to religious patients. However, the referred effect only occurred in nondepressed religious patients. The latter indicated that religiosity had its effect annulled in depressed patients. This study shows the importance of measures of intervention in mental health, mainly in relation to prevention and treatment of major depressive episode with a view to reducing SR. PMID:21193182

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

    PubMed

    Kinjo, K; Satake, S; Ohama, T

    2009-09-01

    A 64-year-old male on regular hemodialysis who was a human T lymphotrophic virus Type I (HTLV-I) carrier developed cryptococcal pleuritis. The initial manifestations of the present case were a persistent cough and the accumulation of unilateral pleural effusion. A culture of the pleural fluid of the patient grew cryptococcus neoformans and a test for antigens against cryptococcus neoformans in the pleural fluid was also positive, therefore, cryptococcal pleuritis was diagnosed. Pleural cryptococcosis per se is rare and it is extremely rare for a dialysis patient to develop pleural cryptococcosis. To our knowledge, only a few cases of cryptococcal pleuritis have so far been reported in patients on dialysis. Furthermore, an isolated occurrence of cryptococcal pleuritis with no cryptococcal pulmonary parenchymal lesions, as was seen in the present case, is rare because cryptococcal pleuritis is usually associated with underlying cryptococcal pulmonary parenchymal lesions. Patients on chronic dialysis are susceptible to developing pleural effusion from many etiologies such as congestive heart failure, infection (tuberculosis, bacterial, viral, parasitic, fungal), collagen vascular disease, drug reaction, metastasis, or uremia itself. Cryptococcal pleuritis developing in a dialysis patient is extremely rare, but physicians should consider cryptococcal infection as a possible cause when pleural effusion develops in a dialysis patient and no other cause is identified, as occurred in the present case. PMID:19761731

  8. Holistic health assessment tool for patients on maintenance hemodialysis.

    PubMed

    Singhania, P R; Mandalika, S

    2012-07-01

    The recent emphasis on assessment of the psychological status, availability of newer and better methods of interpreting the anthropometric measurements of renal patients on dialysis therapy prompted the authors to develop the "Holistic Health Assessment Tool for dialysis patients (HHAT-D)." A total of 30 subjects (25-65 years), enrolled from dialysis centers in Mumbai were administered the HHAT-D tool to assess anthropometric, biochemical, functional, and psychological status (knowledge, needs, that coping strategies) along with dietary intake. The results showed that majority of the patients (73.3%) were mild to moderately malnourished. A highly significant negative correlation of anthropometric measurements (BMI, lean body mass, mid arm circumference, arm muscle area, bicep skin fold thickness, % usual body weight, and % standard body weight) with the HHAT-D scores (P<0.01) confirmed the validity of the tool in assessing the degree of malnutrition. The poor health status of the patients was further confirmed by the average (40%) to poor (36.6%) flexibility status and poor dietary nutrient intake. Moderate (36.6%) to high (60%) coping effectiveness was recorded in the patients as assessed using the "coping effectiveness inventory." A high degree of interitem correlation (Cronbach's coefficient alpha-test value 0.836) also proved the reliability of the HHAT-D tool. Thus, the HHAT-D was found to be a specific and reliable tool for assessment of holistic health status of patients on maintenance hemodialysis to improve quality of life and facilitate faster recovery. PMID:23162270

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

    PubMed

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

    2006-05-01

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

  10. Association of Coronary Artery Calcium Score and Vascular Dysfunction in Long-Term Hemodialysis Patients

    PubMed Central

    Zeb, Irfan; Ahmadi, Nasser; Molnar, Miklos Z; Li, Dong; Shantouf, Ronney; Hatamizadeh, Parta; Choi, Taeyoung; Kalantar-Zadeh, Kamyar; Budoff, Matthew J

    2015-01-01

    Background Long-term hemodialysis patients are prone to an exceptionally high burden of cardiovascular disease and mortality. The novel temperature based technology of Digital Thermal Monitoring (DTM) of vascular reactivity appears associated with the severity of coronary artery disease in asymptomatic population. We hypothesized that in hemodialysis patients the DTM and coronary artery calcium (CAC) score have a gradient association that follows that of subjects without kidney disease. Methods We examined the cross-sectional DTM-CAC associations in a group of long-term hemodialysis patients and their 1:1 matched normal counterparts, Area under the curve for temperature (TMP-AUC), the surrogate of the DTM index of vascular function, was assessed after a 5-minute arm-cuff reactive hyperemia test. Coronary calcium score was measured via EBCT or MDCT scan. Results We studied 105 randomly recruited hemodialysis patients (age:58±13 years, 47 % men) and 105 age- and gender-matched controls. In hemodialysis patients vs. controls TMP-AUC was significantly worse (114±72 vs. 143±80. p=0.001) and CAC score was higher (525±425 vs. 240±332, p<0.001). Hemodialysis patients were 14 times more likely to have CAC score >1000 as compared with controls. After adjustment for known confounders, the relative risk for case vs. control for each standard deviation decrease in TMP-AUC was 1.46 (95%CI: 1.12-1.93, p=0.007). Conclusions Vascular reactivity measured via the novel DTM technology is incrementally worse across CAC scores in hemodialysis patients, in whom both measures are even worse than their age- and gender matched controls. The DTM technology may offer a convenient and radiation-free approach to risk-stratify hemodialysis patients. PMID:22962941

  11. Spirituality, Social Support, and Survival in Hemodialysis Patients

    PubMed Central

    Spinale, Joann; Cohen, Scott D.; Khetpal, Prashant; Peterson, Rolf A.; Clougherty, Brenna; Puchalski, Christina M.; Patel, Samir S.; Kimmel, Paul L.

    2008-01-01

    Background and objectives: No studies have evaluated the relationship among spirituality, social support, and survival in patients with ESRD. This study assessed whether spirituality was an independent predictor of survival in dialysis patients with ESRD after controlling for age, diabetes, albumin, and social support. Design, setting, participants, & measurements: A total of 166 patients who had ESRD and were treated with hemodialysis completed questionnaires on psychosocial variables, quality of life, and religious and spiritual beliefs. The religious variables were categorized into three scores on a 0 to 20 scale (low to high levels): Spirituality, religious involvement, and religion as coping. Social support was assessed using the Multidimensional Scale for Perceived Social Support. Analyses were also performed including and excluding patients with HIV infection. Religious variables were categorized on the basis of means, medians, and tertiles. Results: In analyses that used religious variables, only the responses on the spirituality scale split at the mean were associated with survival. The association of other religious variables with survival did not reach significance. Social support correlated with spirituality, religion as coping, and religious involvement measures. Only social support and age were associated with survival when controlling for diabetes, albumin concentration, HIV infection, and spirituality. Conclusions: These data suggest that the effects of spirituality may be mediated by social support. Larger, multicenter, prospective studies that use well-validated tools to measure religiosity and spirituality are needed to determine whether there is an independent association of spirituality variables with survival in patients with ESRD. PMID:18922991

  12. Does Pomegranate intake attenuate cardiovascular risk factors in hemodialysis patients?

    PubMed Central

    2014-01-01

    Background Atherosclerotic cardiovascular disease (CVD) is the most common cause of morbidity and mortality among hemodialysis (HD) patients. It has been attributed, among other causes, to hypertension and dyslipidemia. The aim of the present study was to investigate the effect of a year-long consumption of Pomegranate juice (PJ), on two traditional cardiovascular (CV) risk factors: hypertension and lipid profile, as well as on cardiovascular events. Methods 101 HD patients were randomized to receive 100 cc of PJ (0.7 mM polyphenols) or matching placebo juice, three times a week for one year. The primary endpoints were traditional CV risk factors; blood pressure and lipid profile. Systolic, diastolic and pulse pressure, plasma levels of triglycerides (TG), high density lipoprotein (HDL), low density lipoprotein (LDL) and total cholesterol were monitored quarterly during the study year. Secondary endpoint was incidence of cardiovascular events. Results PJ consumption yielded a significant time response improvement in systolic blood pressure, pulse pressure, triglycerides and HDL level; an improvement that was not observed in the placebo intake group. These beneficial outcomes were more pronounced among patients with hypertension, high level of triglycerides and low levels of HDL. Conclusion Regular PJ consumption by HD patients reduced systolic blood pressure and improved lipid profile. These favorable changes may reduce the accelerated atherosclerosis and high incidence of CVD among HD patients. Trial registration ClinicalTrials.gov registry, Identifier number: NCT00727519 PMID:24593225

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

    PubMed

    Pop-Jordanova, Nada D; Polenakovic, Momir H

    2013-02-01

    Studies related to psychological aspects of dialysis patients show that depression and anxiety are the most common characteristics. The aim of our study was to analyze the personality profile in patients on chronic maintenance dialysis and to evaluate more specifically the level of depression. The total number of patients was 68 (30 females and 38 males), with mean age 62.3 and 56.5 for females and males respectively. Mean duration of dialysis was 6.73 years for females and 6.68 years for men (the period varied from 0.5 to 18 years). For the evaluation of psychological characteristics, we used two psychometric instruments: Minnesota Multiphase Personality Inventory (MMPI- 201) and Beck Depression Inventory. The obtained results confirmed the presence of depression in patients treated with hemodialysis. The level of depression is variable (minimal is present in 21.43%; mild in 35.71%; moderate in 17.85% and severe in 14.28% of patients). The depression is significantly positively correlated with age (p<0.05) as well as with educational level, and negatively with the duration of dialysis. Specific characteristics of personality obtained with MMPI are hypersensitivity, depressive mood, and withdrawal from friends and relatives. More specific emotional traits are the accentuated anxiety, low level of hostility, but very high passive aggression which destroys their social communications. Some response measures for depression such as relaxation training, psychological support, music therapy, or peripheral biofeedback are recommended. PMID:23335381

  14. HDL Cholesterol, Apolipoproteins, and Cardiovascular Risk in Hemodialysis Patients

    PubMed Central

    Genser, Bernd; Drechsler, Christiane; Scharnagl, Hubert; Grammer, Tanja B.; Stojakovic, Tatjana; Krane, Vera; Ritz, Eberhard; Wanner, Christoph; März, Winfried

    2015-01-01

    High concentrations of HDL cholesterol are considered to indicate efficient reverse cholesterol transport and to protect from atherosclerosis. However, HDL has been suggested to be dysfunctional in ESRD. Hence, our main objective was to investigate the effect of HDL cholesterol on outcomes in maintenance hemodialysis patients with diabetes. Moreover, we investigated the associations between the major protein components of HDL (apoA1, apoA2, and apoC3) and end points. We performed an exploratory, post hoc analysis with 1255 participants (677 men and 578 women) of the German Diabetes Dialysis study. The mean age was 66.3 years and the mean body mass index was 28.0 kg/m2. The primary end point was a composite of cardiac death, myocardial infarction, and stroke. The secondary end point included all-cause mortality. The mean duration of follow-up was 3.9 years. A total of 31.3% of the study participants reached the primary end point and 49.1% died from any cause. HDL cholesterol and apoA1 and apoC3 quartiles were not related to end points. However, there was a trend toward an inverse association between apoA2 and all-cause mortality. The hazard ratio for death from any cause in the fourth quartile compared with the first quartile of apoA2 was 0.63 (95% confidence interval, 0.40 to 0.89). The lack of an association between HDL cholesterol and cardiovascular risk may support the concept of dysfunctional HDL in hemodialysis. The possible beneficial effect of apoA2 on survival requires confirmation in future studies. PMID:25012163

  15. Intradialytic Hypoxemia and Clinical Outcomes in Patients on Hemodialysis

    PubMed Central

    Meyring-Wösten, Anna; Zhang, Hanjie; Ye, Xiaoling; Fuertinger, Doris H.; Chan, Lili; Kappel, Franz; Artemyev, Mikhail; Ginsberg, Nancy; Wang, Yuedong; Thijssen, Stephan

    2016-01-01

    Background and objectives Intradialytic hypoxemia has been recognized for decades, but its associations with outcomes have not yet been assessed in a large patient cohort. Design, setting, participants, & measurements Our retrospective cohort study was conducted between January of 2012 and January of 2015. We recorded blood oxygen saturation every minute during hemodialysis in patients with arteriovenous access. A 6-month baseline period with at least 10 treatments with oxygen saturation measurements preceded a 12-month follow-up. Patients were stratified by the presence or absence of prolonged intradialytic hypoxemia defined as oxygen saturation <90% for at least one third of the treatment time. Demographic, laboratory, and treatment data and hospitalization and mortality rates were compared between the groups. Multivariate Cox regression analysis was used to assess baseline predictors of all-cause mortality during follow-up. Results In total, 100 (10%) of 983 patients had prolonged intradialytic hypoxemia. These patients were older (+3.6 years; 95% confidence interval, 0.8 to 6.3), had longer dialysis vintage (+1.2 years; 95% confidence interval, 0.3 to 2.1), and had higher prevalence of congestive heart failure (+10.8%; 95% confidence interval, 1.6 to 20.7) and chronic obstructive pulmonary disease (+13%; 95% confidence interval, 5 to 21.2). They also resembled an inflammatory phenotype, with lower serum albumin levels (−0.1 g/dl; 95% confidence interval, −0.2 to 0) and higher neutrophil-to-lymphocyte ratios (+1; 95% confidence interval, 0.5 to 1.6). They had lower hemoglobin levels (−0.2 g/dl; 95% confidence interval, −0.4 to 0) and required more erythropoietin (+1374 U per hemodialysis treatment; 95% confidence interval, 343 to 2405). During follow-up, all-cause hospitalization (1113 hospitalizations; univariate hazard ratio, 1.46; 95% confidence interval, 1.22 to 1.73) and mortality (89 deaths; adjusted hazard ratio, 1.98; 95% confidence interval, 1

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

    PubMed Central

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

    2009-01-01

    Background Hemodialysis patients are at risk for deficiency of essential trace elements and excess of toxic trace elements, both of which can affect health. We conducted a systematic review to summarize existing literature on trace element status in hemodialysis patients. Methods All studies which reported relevant data for chronic hemodialysis patients and a healthy control population were eligible, regardless of language or publication status. We included studies which measured at least one of the following elements in whole blood, serum, or plasma: antimony, arsenic, boron, cadmium, chromium, cobalt, copper, fluorine, iodine, lead, manganese, mercury, molybdenum, nickel, selenium, tellurium, thallium, vanadium, and zinc. We calculated differences between hemodialysis patients and controls using the differences in mean trace element level, divided by the pooled standard deviation. Results We identified 128 eligible studies. Available data suggested that levels of cadmium, chromium, copper, lead, and vanadium were higher and that levels of selenium, zinc and manganese were lower in hemodialysis patients, compared with controls. Pooled standard mean differences exceeded 0.8 standard deviation units (a large difference) higher than controls for cadmium, chromium, vanadium, and lower than controls for selenium, zinc, and manganese. No studies reported data on antimony, iodine, tellurium, and thallium concentrations. Conclusion Average blood levels of biologically important trace elements were substantially different in hemodialysis patients, compared with healthy controls. Since both deficiency and excess of trace elements are potentially harmful yet amenable to therapy, the hypothesis that trace element status influences the risk of adverse clinical outcomes is worthy of investigation. PMID:19454005

  17. Restless Legs Syndrome: Associated Risk Factors in Hemodialysis Patients

    PubMed Central

    Beladi-Mousavi, Seyed Seifollah; Jafarizade, Mehrian; Shayanpour, Shokouh; Bahadoram, Mohammad; Moosavian, Seyed Mostafa; Houshmand, Gholamreza

    2015-01-01

    Background: Restless legs syndrome (RLS) may be associated with increased morbidity and mortality among end-stage renal disease (ESRD) patients; however, it is a disorder that is neglected in dialysis centers. Objectives: The goal of this study was to investigate the clinical factors associated with RLS among ESRD patients. Patients and Methods: This cross-sectional study was conducted on ESRD patients undergoing maintenance hemodialysis (HD) in three HD centers in Ahvaz city in Southwest Iran. Blood samples were obtained prior to a dialysis session to check the routine laboratory test results and assess the adequacy of dialysis. The presence of RLS was assessed by using the international RLS study group (IRLSSG) diagnostic criteria. The IRLSSG rating scale was also used to evaluate the severity of the RLS symptoms. Results: Of the 139 HD patients enrolled in this study, 60 were female (43.2%) and 79 were male (56.8%), with a mean age of 51.82 ± 13.31 years. The prevalence of RLS was 15.8% (22 patients), with 50% of them (11 patients) having severe or very severe symptoms. There was a significant relationship between RLS and longer durations of dialysis (P < 0.001). The mean level of serum ferritin was lower in patients without RLS, but it was not significant (P = 0.065). No significant differences were found according to age, gender, dialysis shifts, and hemoglobin (Hb) level among patients with and without RLS. Conclusions: We conclude that a significant percentage of ESRD patients undergoing maintenance HD have severe or very severe RLS symptoms. The presence of RLS is associated to longer durations of dialysis. PMID:26866010

  18. Isolated pleural effusion as a presentation of high cardiac output heart failure in a hemodialysis patient.

    PubMed

    Dhawan, Vibhu; Ariyamuthu, Venkatesh; Malhotra, Kunal; Dalal, Pranav; Bichu, Prasad; Dorairajan, Smrita

    2012-10-01

    Congestive heart failure is a well-recognized complication of hemodialysis arteriovenous fistula. Symptoms of dyspnea are usually associated with signs of congestive heart failure including pulmonary edema, pleural effusions, lower extremity edema, and liver enlargement, to name a few. We present a case of a gentleman with end-stage renal disease on chronic hemodialysis, which developed acute bilateral transudative pleural effusions in the absence of other signs of systemic venous congestion, associated with pulmonary venous congestion. We also discuss the pathogenesis and role of hemodialysis in management of this patient. PMID:23036038

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

    PubMed

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

    2016-04-01

    Data on dolutegravir removal by hemodialysis are lacking. To study this, we measured dolutegravir plasma concentrations in samples of blood entering and leaving the dialyzer and of the resulting dialysate from 5 HIV-infected patients with end-stage renal disease. The median dolutegravir hemodialysis extraction ratio was 7%. The dolutegravir concentrations after the dialysis session remained far above the protein-binding-adjusted inhibitory concentration. Our results show minimal dolutegravir removal by hemodialysis, with no specific dolutegravir dosage adjustments required in this setting. (This study is registered at ClinicalTrials.gov under registration number NCT02487706.). PMID:26856824

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

    PubMed

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

    2012-05-01

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

  1. Optimizing hemodialysis practices in Canada could improve patient survival.

    PubMed

    Yeates, Karen E; Mendelssohn, David C; Ethier, Jean; Trpeski, Lilyanna; Na, Jingbo; Bragg-Gresham, Jennifer L; Eichleay, Margaret A; Pisoni, Ronald L; Port, Fritz K

    2007-01-01

    Data from the Canadian Organ Replacement Registry (CORR) and the Dialysis Outcomes and Practice Patterns Study (DOPPS) were used to determine whether practice patterns have changed in Canada since the introduction of the Canadian Society of Nephrology (CSN) Guidelines in 1999. DOPPS data were then used to calculate the impact of not meeting the proposed guideline targets and to estimate the potential life years gained if all Canadian hemodialysis patients achieved guideline targets. For dialysis dose and hemoglobin targets, Canadian facility performance has significantly improved over time. The vascular access use patterns show trends toward a worse pattern with increased catheter use. A calculation of the percentage of attributable risk suggests that 49% of deaths could possibly be averted if all patients currently outside the guidelines achieved them over the next five years. This corresponds to a decrease in the annual death rate from 18 to 10.1 per hundred patient years. These data support the need for improved adherence to guidelines. If Canadian caregivers were to optimize practice patterns, patient outcomes could be improved. PMID:17691708

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

    PubMed

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

    2016-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  4. Proton Pump Inhibitor Use and Magnesium Concentrations in Hemodialysis Patients: A Cross-Sectional Study

    PubMed Central

    Nakashima, Akio; Ohkido, Ichiro; Yokoyama, Keitaro; Mafune, Aki; Urashima, Mitsuyoshi; Yokoo, Takashi

    2015-01-01

    Magnesium concentration is a proven predictor of mortality in hemodialysis patients. Recent reports have indicated that proton pump inhibitor (PPI) use affects serum magnesium levels, however few studies have investigated the relationship between PPI use and magnesium levels in hemodialysis patients. This study aimed to clarify the association between PPI use and serum magnesium levels in hemodialysis patients. We designed this cross sectional study and included 1189 hemodialysis patients in stable condition. Associations between PPI and magnesium-related factors, as well as other possible confounders, were evaluated using a multiple regression model. We defined hypomagnesemia as a value < 2.0 mg/dL, and created comparable logistic regression models to assess the association between PPI use and hypomagnesemia. PPI use is associated with a significantly lower mean serum magnesium level than histamine 2 (H2) receptor antagonists or no acid-suppressive medications (mean [SD] PPI: 2.52 [0.45] mg/dL; H2 receptor antagonist: 2.68 [0.41] mg/dL; no acid suppressive medications: 2.68 [0.46] mg/dL; P = 0.001). Hypomagnesemia remained significantly associated with PPI (adjusted OR, OR: 2.05; 95% CI: 1.14–3.69; P = 0.017). PPI use is associated with an increased risk of hypomagnesemia in hemodialysis patients. Future prospective studies are needed to explore magnesium replacement in PPI users on hemodialysis. PMID:26618538

  5. Obesity, Diabetes and Survival in Maintenance Hemodialysis Patients

    PubMed Central

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

    2016-01-01

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

  6. [Hyperhomocysteinemia as a vascular risk factor in chronic hemodialysis patients].

    PubMed

    Trimarchi, Hernán; Young, Pablo; Díaz, María L; Schropp, Juan; Forrester, Mariano; Freixas, Emilio

    2005-01-01

    Homocysteine is an independent risk factor for cardiovascular disease in the general population. In addition, it plays a main role in the development of atherogenesis and thrombosis, particularly in end-stage renal disease patients. Therefore, hemodialysis patients are under the burden of homocysteine toxic effects, present in nearly 90% of dialysis patients. Our group found that folic acid is an efficient therapeutic approach to decrease homocysteine levels, and the addition of intravenous methylcobalamin potentiates this effect; however, methylcobalamin alone was unsuccessful to normalize homocysteine levels. With time a group of patients required a higher dose of folic acid to reduce hyperhomocysteinemia. Patients homozygous and, to a lesser extent heterozygous, to the C677T thermolabile variant of methylenetetrahydrofolate reductase (MTHFR) presented a reduced catalytic activity and required a higher folic acid dose. Vascular-access thrombotic events were similar in all patients according to the variants of the enzyme, suggesting that treating hyperhomocysteinemia was the key to lower the risk of thromboses. Noteworthy, hypohomocysteinemia, generally acompanying malnourishment, is associated to higher mortality. Albeit hyper-homocysteinemia is considered a vascular risk factor in renal failure patients, it has not yet been established in this population if its correction is associated with a decrease in the rate of vascular disease and thrombosis. However, given the mentioned evidence about the low risk and good tolerance of vitamin therapy, we believe it useful to know folate, cobalamin and homocysteine blood levels in chronic renal patients and start a prompt treatment, which may proof adequate to maintain homocysteine levels of 10 +/- 5 micromol/l. PMID:16433478

  7. Antiplatelet Therapy in Hemodialysis Patients Undergoing Percutaneous Coronary Interventions

    PubMed Central

    Summaria, Francesco; Giannico, Maria B.; Talarico, Giovanni P.; Patrizi, Roberto

    2015-01-01

    Context: Coronary artery disease is highly prevalent among patients with end stage renal disease/hemodialysis (ESRD/HD) and coronary percutaneous interventions (PCI) has been increased by nearly 50% over the past decade. After PCI with stent placement, guidelines recommend dual antiplatelet therapy (DAPT), but no specifically tailored pharmacotherapy approach is outlined for this frail population, mostly excluded from large randomized clinical trials (RCTs). Evidence Acquisition: We reviewed current evidences on the use of antiplatelet therapy in patients with ESRD/HD undergoing PCI, focusing on the efficacy and safety of specific agents and their indications for detailed clinical settings. Results: Clinical setting in HD patients is the principal determinant of the type, onset, combination and duration of the DAPT. However, irrespective clinical setting, in addition to aspirin, clopidogrel is currently the most used antiplatelet agent even if no information derived from RCTs are available in ESRD. Due to the large experience acquired in routine clinical practice, the awareness of safety is higher for clopidogrel than newer antiplatelet agents. Because of lack of data, the use of prasugrel and ticagrelor is actually not recommended. However, in case of high ischemic and acceptable bleeding risk, they may be selectively used in ESRD/HD. Conclusions: This investigation might contribute to delineate the best treatment options for this high risk population. PMID:26528445

  8. Feasibility and Safety of Coronary Procedures via an Arteriovenous Graft Approach in Patients on Maintenance Hemodialysis

    PubMed Central

    Ko, Rye-Cheng; Liao, Min-Tsun; Lin, Lin; Hsieh, Mu-Yang; Lin, Pei-Shan; Tsai, Kuei-Chin; Chao, Chia-Lun; Wu, Chih-Cheng

    2015-01-01

    Background Traditionally, a radial or brachial arterial approach is unadvisable in hemodialysis patients. Consequently, coronary angiography or angioplasty is usually performed via a femoral artery approach in these patients, who carry a higher risk of vascular access complications. In hemodialysis patients, arteriovenous grafts (AVG) are created for repeated punctures; however, the feasibility and safety of a trans-AVG approach for coronary angiography or angioplasty remains unclear. Methods In our institution, cardiac catheterizations were attempted via AV grafts in hemodialysis patients with a U-shaped forearm AVG. We retrospectively identified coronary angiography or angioplasty procedures in hemodialysis patients from a computer-based database in our hospital. The procedure details and outcomes were obtained from review of the clinical, angiographic and hemodialysis records. Results From 2008 to 2013, 167 procedures in hemodialysis patients were identified from 2866 diagnostic or interventional coronary procedures in our institution. Out of these, 24 procedures in 17 patients were performed via a trans-AVG approach. In all AVG procedures, a 6F 16-cm or 7F 10-cm sheath was placed from the AVG into the brachial artery. All diagnostic procedures were successfully performed. In 14 procedures, the patients also underwent angioplasty and all of the angioplasty procedures were successful. There was no arterial spasm, arterial dissection, puncture site hematoma, or acute thrombosis of the AVG during or after the procedures. Conclusions A trans-AVG approach appears to be a feasible and safe route for coronary angiography or angioplasty in hemodialysis patients with a U-shaped forearm AVG. However, further studies with a larger patient number are necessary. PMID:27122921

  9. Development and validation of a theory-based multimedia application for educating Persian patients on hemodialysis.

    PubMed

    Feizalahzadeh, Hossein; Tafreshi, Mansoureh Zagheri; Moghaddasi, Hamid; Farahani, Mansoureh A; Khosrovshahi, Hamid Tayebi; Zareh, Zahra; Mortazavi, Fakhrsadat

    2014-05-01

    Although patients on hemodialysis require effective education for self-care, several issues associated with the process raise barriers that make learning difficult. Computer-based education can reduce these problems and improve the quality of education. This study aims to develop and validate a theory-based multimedia application to educate Persian patients on hemodialysis. The study consisted of five phases: (1) content development, (2) prototype development 1, (3) evaluation by users, (4) evaluation by a multidisciplinary group of experts, and (5) prototype development 2. Data were collected through interviews and literature review with open-ended questions and two survey forms that consisted of a five-level scale. In the Results section, patient needs on hemodialysis self-care and related content were categorized into seven sections, including kidney function and failure, hemodialysis, vascular access, nutrition, medication, physical activity, and living with hemodialysis. The application designed includes seven modules consisting of user-controlled small multimedia units. During navigation through this application, the users were provided step-by-step information on self-care. Favorable scores were obtained from evaluations by users and experts. The researchers concluded that this application can facilitate hemodialysis education and learning process for the patients by focusing on their self-care needs using the multimedia design principles. PMID:24642877

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

    PubMed Central

    Liu, Yan; Xiao, Xiao; Qin, Dan-Ping; Tan, Rong-Shao; Zhong, Xiao-Shi; Zhou, Dao-Yuan; Liu, Yun; Xiong, Xuan; Zheng, Yuan-Yuan

    2016-01-01

    Many long-term maintenance hemodialysis patients have symptoms of protein-energy wasting caused by malnutrition. Each session of hemodialysis removes about 10 to 12 g of amino acids and 200 to 480 kcal of energy. Patients receiving hemodialysis for chronic kidney disease may be undernourished for energy, protein consumption, or both. Non-diabetic hemodialysis patients were randomized to three treatment groups: oral supplementation, oral supplementation plus high-concentration glucose solution (250 mL containing 50% glucose) and these two interventions plus 8.5% amino acids solution. The post-treatment energy status of the glucose group was significantly higher than its baseline level, whereas the control group’s status was significantly lower. The glucose group had significantly higher concentrations of asparagine, glutamine, glycine, alanine, and lysine after treatment. All treatment groups had significantly increased hemoglobin levels but significantly decreased transferrin levels after treatment compared to baseline. After treatment, the amino acid group had significantly higher albumin level compared to the glucose group (p = 0.001) and significantly higher prealbumin level compared to the control group (p = 0.017). In conclusion, long-term intervention with high-concentration glucose solution at each hemodialysis session is a simple and cheap method that replenished energy stores lost during hemodialysis of non-diabetic patients. PMID:27271658

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

    PubMed

    Liu, Yan; Xiao, Xiao; Qin, Dan-Ping; Tan, Rong-Shao; Zhong, Xiao-Shi; Zhou, Dao-Yuan; Liu, Yun; Xiong, Xuan; Zheng, Yuan-Yuan

    2016-01-01

    Many long-term maintenance hemodialysis patients have symptoms of protein-energy wasting caused by malnutrition. Each session of hemodialysis removes about 10 to 12 g of amino acids and 200 to 480 kcal of energy. Patients receiving hemodialysis for chronic kidney disease may be undernourished for energy, protein consumption, or both. Non-diabetic hemodialysis patients were randomized to three treatment groups: oral supplementation, oral supplementation plus high-concentration glucose solution (250 mL containing 50% glucose) and these two interventions plus 8.5% amino acids solution. The post-treatment energy status of the glucose group was significantly higher than its baseline level, whereas the control group's status was significantly lower. The glucose group had significantly higher concentrations of asparagine, glutamine, glycine, alanine, and lysine after treatment. All treatment groups had significantly increased hemoglobin levels but significantly decreased transferrin levels after treatment compared to baseline. After treatment, the amino acid group had significantly higher albumin level compared to the glucose group (p = 0.001) and significantly higher prealbumin level compared to the control group (p = 0.017). In conclusion, long-term intervention with high-concentration glucose solution at each hemodialysis session is a simple and cheap method that replenished energy stores lost during hemodialysis of non-diabetic patients. PMID:27271658

  12. Asymmetric Dimethylarginine, Race, and Mortality in Hemodialysis Patients

    PubMed Central

    Drew, David A.; Tighiouart, Hocine; Scott, Tammy; Kantor, Amy; Fan, Li; Artusi, Carlo; Plebani, Mario; Weiner, Daniel E.

    2014-01-01

    Background and objectives Levels of asymmetric dimethylarginine, an inhibitor of nitric oxide synthase, are elevated in kidney disease and associated with mortality in white European hemodialysis populations. Nitric oxide production and degradation are partially genetically determined and differ by racial background. No studies have measured asymmetric dimethylarginine in African Americans on dialysis and assessed whether differences exist in its association with mortality by race. Design, setting, participants, & measurements Asymmetric dimethylarginine was measured in 259 patients on maintenance hemodialysis assembled from 2004 to 2012 in Boston area outpatient centers. Cox proportional hazards models were used to determine the association between asymmetric dimethylarginine and all-cause mortality, and an interaction with race was tested. Results Mean (SD) age was 63 (17) years, 46% were women, and 22% were African American. Mean asymmetric dimethylarginine in non–African Americans was 0.79 µmol/L (0.16) versus 0.70 µmol/L (0.11) in African Americans (P<0.001); 130 patients died over a median follow-up of 2.3 years. African Americans had lower mortality risk than non–African Americans (hazard ratio, 0.27; 95% confidence interval, 0.15 to 0.50) that was robust to adjustment for age, comorbidity, and asymmetric dimethylarginine (hazard ratio, 0.35; 95% confidence interval, 0.17 to 0.69). An interaction was noted between race and asymmetric dimethylarginine (P=0.03), such that asymmetric dimethylarginine was associated with higher mortality in non–African Americans (adjusted hazard ratio, 1.29; 95% confidence interval, 1.06 to 1.57 per 1 SD higher asymmetric dimethylarginine) but not in African Americans (adjusted hazard ratio, 0.57; 95% confidence interval, 0.28 to 1.18). Additional adjustment for fibroblast growth factor 23 partially attenuated the association for non–African Americans (adjusted hazard ratio, 1.22; 95% confidence interval, 0.98 to 1

  13. [Descriptive study of hemodialysis in the critical patient. Report of 198 cases].

    PubMed

    Ostabal Artigas, M I; Gota Angel, R; Suárez Pinilla, M A; Millastre Benito, A

    1994-12-01

    In the last five year, 198 critic patients developed acute renal failure, requiring hemodialysis in the hospital. We realized a descriptive study and analyzed the factors that were statistically associated with higher mortality: a surgical etiology, clinic criteria for the inicial of hemodialysis, respiratory failure, hemodynamic inestability, hepatic insufficciency, disseminated intravascular coagulacion and oliguric or anuria. The sepsis and the cardiorrespiratory complications were the cause of mortality most important. The 14% of the surviving requiring continue in the programs of hemodyalisis. PMID:7734664

  14. [Patient with acute renal injury presenting dabigatran overdose: Hemodialysis for surgery].

    PubMed

    Bachellerie, B; Ruiz, S; Conil, J-M; Crognier, L; Seguin, T; Georges, B; Fourcade, O

    2014-01-01

    Dabigatran is a direct thrombin inhibitor indicated for stroke and systemic embolism prevention in patients with non-valvular atrial fibrillation. No reversal agent exists, but hemodialysis has been proposed as dabigatran removal method. We report a case of an 80-year-old man presenting hemorrhage with dabigatran overdose caused by obstructive acute renal failure. Before nephrostomy, several hemodialysis sessions were necessary to remove dabigatran probably because of its large volume of distribution. PMID:24378048

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

    PubMed

    Kharlamova, U V; Il'icheva, O E

    2012-01-01

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

  16. Heterogeneous Characteristics of Korean Patients with Dysferlinopathy

    PubMed Central

    Park, Hyung Jun; Hong, Ji-Man; Suh, Gyoung Im; Shin, Ha Young; Kim, Seung Min; Sunwoo, Il Nam; Suh, Bum Chun

    2012-01-01

    Dysferlinopathy is caused by mutations in the DYSF gene. To characterize the clinical spectrum, we investigated the characteristics of 31 Korean dysferlinopathy patients confirmed by immunohistochemistry. The mean age of symptom onset was 22.23 ± 7.34 yr. The serum creatine kinase (CK) was highly increased (4- to 101-fold above normal). The pathological findings of muscle specimens showed nonspecific dystrophic features and frequent inflammatory cell infiltration. Muscle imaging studies showed fatty atrophic changes dominantly in the posterolateral muscles of the lower limb. The patients with dysferlinopathy were classified by initial muscle weakness: fifteen patients with Miyoshi myopathy phenotype (MM), thirteen patients with limb girdle muscular dystrophy 2B phenotype (LGMD2B), two patients with proximodistal phenotype, and one asymptomatic patient. There were no differences between LGMD2B and MM groups in terms of onset age, serum CK levels and pathological findings. Dysferlinopathy patients usually have young adult onset and high serum CK levels. However, heterogeneity of clinical presentations and pathologic findings upon routine staining makes it difficult to diagnose dysferlinopathy. These limitations make immunohistochemistry currently the most important method for the diagnosis of dysferlinopathy. PMID:22468107

  17. Infective endocarditis in chronic hemodialysis patients: experience from Morocco.

    PubMed

    Montasser, Dina; Bahadi, Abdelali; Zajjari, Yassir; Asserraji, Mohamed; Alayoude, Ahmed; Moujoud, Omar; Aattif, Toufik; Kadiri, Moncef; Zemraoui, Nadir; El Kabbaj, Driss; Hassani, Mohamed; Benyahia, Mohamed; El Allam, Mustapha; Oualim, Zouhir; Akhmouch, Ismail

    2011-01-01

    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 regular 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 Staphylococcus 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 Staphylococcus. 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. PMID:21196639

  18. Radionuclide fistulogram (RnF) in hemodialysis patients

    SciTech Connect

    Seo, I.S.; Sy, W.M.; Heneghan, W.; Manoli, A.; Gozum, M.

    1984-01-01

    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.

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

    PubMed

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

    2016-01-01

    The objectives of this study were to assess the prevalence of chronic obstructive pulmonary disease (COPD) in hemodialysis patients with spirometry and to examine the effects of fluid removal by hemodialysis on lung volumes. Patients ≥18 years at two Danish hemodialysis centers were included. Forced expiratory volume in one second (FEV1 ), forced vital capacity (FVC), and FEV1 /FVC ratio were measured with spirometry before and after hemodialysis. The diagnosis of COPD was based on both the GOLD criteria and the lower limit of normal criteria. There were 372 patients in treatment at the two centers, 255 patients (69%) completed spirometry before dialysis and 242 of these (65%) repeated the test after. In the initial test, 117 subjects (46%) had airflow limitation indicative of COPD with GOLD criteria and 103 subjects (40.4%) with lower limit of normal criteria; COPD was previously diagnosed in 24 patients (9%). Mean FVC and FEV1 decreased mildly after dialysis (FVC: 2.84 to 2.79 L, P < 0.01. FEV1 : 1.97 to 1.93 L, P < 0.01) Hemodialysis did not affect the FEV1 /FVC ratio or number of subjects with airflow limitation indicative of COPD (113 vs. 120, P = 0.324; n = 242). COPD is a frequent and underdiagnosed comorbidity in patients on chronic hemodialysis. Spirometry should be considered in all patients on dialysis in order to address dyspnea adequately. Hemodialysis induced a small fall in mean FEV1 and FVC, which was more pronounced in patients with little or no fluid removal, but the FEV1 /FVC ratio and the number of subjects with airflow limitation indicative of COPD were not affected by dialysis. PMID:26245152

  20. Genetic damage in patients moving from hemodialysis to online hemodiafiltration.

    PubMed

    Rodríguez-Ribera, Lara; Pastor, Susana; Corredor, Zuray; Silva, Irene; Diaz, Juan Manuel; Ballarin, José; Marcos, Ricardo; Coll, Elisabeth

    2016-03-01

    End-stage renal failure patients exhibit a high incidence of genetic damage and genomic instability. Part of this genetic damage is assumed to be caused by the hemodialysis (HD) procedure. To reduce these effects, different alternative HD procedures have been proposed, such as the use of high efficiency convective therapies to improve the reactive oxygen species/antioxidant ratio. To determine the efficiency of online hemodiafiltration (HDF) technique on the levels of DNA damage, we have measured the frequency of micronucleus in peripheral blood lymphocytes of 33 individuals moving from low-flux HD to post-dilution online HDF. In addition to basal levels of genetic damage, potential changes in radiosensitivity were measured as indicators of genomic instability. Plasma antioxidant capacity was also determined. Second samples were obtained after 6 months on the HDF protocol. Results indicate that moving to online HDF therapy produce a significant reduction of the basal levels of genetic damage, but does not affect the genomic instability status. In addition, a greater increase in plasma antioxidant capacity was observed. In spite of the lack of correlation between these parameters, our results confirm the usefulness of the online HDF technique as a way to reduce DNA damage in HD patients. PMID:26285921

  1. A Longitudinal Study of Uremic Pruritus in Hemodialysis Patients

    PubMed Central

    Mathur, Vandana S.; Lindberg, Jill; Germain, Michael; Block, Geoffrey; Tumlin, James; Smith, Mark; Grewal, Mandeep

    2010-01-01

    Background and objectives: Although uremic pruritus (UP) is a highly prevalent complication of chronic kidney disease, it remains poorly characterized. There have been no longitudinal studies of natural history, and no health-related quality of life (HR-QOL) instruments have been developed for UP. The objectives of this study were to describe the natural history of UP, to compare rating scales of itching intensity, and to assess usefulness and validity of HR-QOL instruments for UP. Design, setting, participants, & measurements: The intensity, severity, and effects of pathologic itching on HR-QOL were assessed prospectively in 103 patients with UP on chronic hemodialysis. Outcome measures were obtained at scheduled intervals over 3.5 months. Results: Itching daily or nearly daily was reported by 84% of patients and had been ongoing for >1 year in 59%. In 83%, pruritus involved large, nondermatomal areas with striking bilateral symmetry. Two thirds of the patients were using medications such as antihistamines, steroids, and various emollients without satisfactory relief of itching. Statistically significant associations were found among itching intensity, severity, and HR-QOL measures in domains such as mood, social relations, and sleep. Among patients with moderate-to-severe UP, changes in itching intensity of 20% or greater were associated with significant reductions in HR-QOL measures. Conclusions: This first longitudinal study of UP describes key features of UP and its effect on HR-QOL. The assessment instruments we have developed are easily used, are responsive to changes in UP intensity, and should facilitate clinical evaluation and research to meet the needs of afflicted patients. PMID:20558560

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

    PubMed Central

    Janssen, Inger Miriam; Gerhardus, Ansgar; von Gersdorff, Gero D; Baldamus, Conrad August; Schaller, Mathias; Barth, Claudia; Scheibler, Fueloep

    2015-01-01

    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 duration, and the improvement or preservation of a good emotional state. Age, profession, and education had the strongest influence on relevant differences of preferences for outcomes; no relevant influence of sex or comorbidity was observed. Conclusion Outcomes concerning the delivery or provision of care and aspects influencing quality of life are rated by patients to be at least as important as clinical outcomes. Many of the outcomes judged to be important by the patients are not regularly considered in research, evaluation studies, or quality programs. PMID:26170634

  3. Sleep Quality and Depression and Their Association with Other Factors in Hemodialysis Patients

    PubMed Central

    Firoz, Masomeh Norozi; Shafipour, Vida; Jafari, Hedayat; Hosseini, Seyed Hamzeh; Charati, Jamshid Yazdani

    2016-01-01

    Background: Sleep disorders and depression, accompanied by reduced quality of life and increased mortality are the most common psychological problems in dialysis patients. This study was conducted with the aim to investigate depression and sleep quality and their association with some demographic and clinical factors in hemodialysis patients. Method: This descriptive-correlative study was conducted on 310 patients undergoing hemodialysis in 8 centers in educational hospitals in Mazandaran University of Medical Sciences. Data collection tools included a demographic questionnaire, Beck Depression Inventory, and Pittsburg Sleep Quality Index (PSQI). Statistical analysis was conducted using Chi-Square test and regression model. Results: Results obtained showed 44.8% depression in patients. Significant relationships were found between depression and increased blood phosphorus (P=0.002) and urea (P=0.001). Poor sleep quality was observed in 73.5% of hemodialysis patients, which was found significantly related to aging (P=0.048), female (P=0.04), and reduced frequency of weekly hemodialysis (P=0.035). Conclusion: Depression and poor sleep quality are two common factors in hemodialysis patients, but patients do not overtly show symptoms of these disorders.

  4. Implementation of routine foot check in patients with diabetes on hemodialysis: associations with outcomes

    PubMed Central

    Marn Pernat, Andreja; Peršič, Vanja; Usvyat, Len; Saunders, Lynn; Rogus, John; Maddux, Franklin W; Lacson, Eduardo; Kotanko, Peter

    2016-01-01

    Objective Patients with diabetes are at increased risk of foot ulcers, which may result in limb amputations. While regular foot care prevents ulcerations and amputation in those patients with diabetes not on dialysis, evidence is limited in diabetic hemodialysis patients. We investigated the association between the implementation of a routine foot check program in diabetic incident hemodialysis patients, and major lower limb amputations. Methods In 1/2008, monthly intradialytic foot checks were implemented as part of standard clinic care in all Fresenius Medical Care North America hemodialysis facilities. Patients with diabetes who initiated hemodialysis between 1/2004 and 12/2007 constituted the preimplementation cohort, and patients starting hemodialysis between 1/2008 and 12/2011 comprised the postimplementation cohort. In addition, we conducted a sensitivity analysis where we excluded patients from the clinics with <10 patients in the postimplementation period and where percent difference in patient with diabetes number between postimplementation and preimplementation period was <20%. We compared lower limb amputation rates employing Poisson regression models with offset of exposure time in these two cohorts. Results We studied 35 513 patients in the preimplementation and 25 779 patients in the postimplementation cohort. In the postimplementation cohort, amputation rate decreased by 17% (p=0.0034). The major lower limb amputation rate was 1.30 per 100 patient years in preimplementation and 1.07 in postimplementation cohort. These beneficial results were corroborated in the multivariate analysis (p=0.0175) and were even more pronounced in the sensitivity analysis (p=0.0083). Conclusion Monthly foot checks are associated with reduction of major lower limb amputations in diabetic incident hemodialysis patients. PMID:26958348

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

    PubMed Central

    Hai, Xin; Landeras, Veeda; Dobre, Mirela A.; DeOreo, Peter; Meyer, Timothy W.; Hostetter, Thomas H.

    2015-01-01

    Large size, protein binding and intracellular sequestration are well known to limit dialytic removal of compounds. In studying the normal renal and dialytic handling of trimethylamine oxide (TMAO), a molecule associated with cardiovascular disease in the general population, we discovered two largely unrecognized additional limitations to sustained reduction of a solute by chronic hemodialysis. We measured solute levels and handling in subjects on chronic hemodialysis (ESRD, n = 7) and compared these with levels and clearance in normal controls (NLS, n = 6). The ESRD patients had much higher peak predialysis plasma levels of TMAO than NLS (77 ± 26 vs 2±1 μM, mean ± SD, p<0.05). For comparison, predialysis BUN levels in ESRD subjects were 45±11 mg/dl and 15±3 mg/dl in NLS. Thus TMAO levels in ESRD average about 40 fold those in NLS while BUN is 3 fold NLS. However, the fractional reduction of TMAO concentration during dialysis, was in fact greater than that of urea (86±3 vs 74±6%, TMAO vs urea, p < 0.05) and its dialytic clearance while somewhat lower than that of urea was comparable to creatinine’s. Also production rates were similar (533±272 vs 606 ± 220 μ moles/day, ESRD vs NLS, p>0.05). However, TMAO has a volume of distribution about one half that of urea. Also in NLS the urinary clearance of TMAO was high (219±78 ml/min) compared to the urinary urea and creatinine clearances (55±14 and 119±21 ml/min, respectively). Thus, TMAO levels achieve multiples of normal much greater than those of urea due mainly to 1) TMAO’s high clearance by the normal kidney relative to urea and 2) its smaller volume of distribution. Modelling suggests that only much more frequent dialysis would be required to lower levels Thus, additional strategies such as reducing production should be explored. Furthermore, using urea as the sole marker of dialysis adequacy may be misleading since a molecule, TMAO, that is dialyzed readily accumulates to much higher multiples of

  6. Electrocardiographic Abnormalities and QTc Interval in Patients Undergoing Hemodialysis

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2016-09-01

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

  8. Sublethal Microcystin Exposure and Biochemical Outcomes among Hemodialysis Patients

    PubMed Central

    Hilborn, Elizabeth D.; Soares, Raquel M.; Servaites, Jerome C.; Delgado, Alvima G.; Magalhães, Valéria F.; Carmichael, Wayne W.; Azevedo, Sandra M. F. O.

    2013-01-01

    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. PMID:23894497

  9. Nutritional Markers and Body Composition in Hemodialysis Patients

    PubMed Central

    Valtuille, Rodolfo; Casos, Maria Elisa; Fernandez, Elmer Andres; Guinsburg, Adrian; Marelli, Cristina

    2015-01-01

    The aims of this study were to analyse body composition, to detect the presence of undernutrition, and to establish a relationship between undernutrition and the biological markers routinely used as indicators of nutritional status in hemodialysis (HD) patients (pts). We used a body composition monitor (BCM) that expresses body weight in terms of lean tissue mass (LTM) and fat tissue mass (FTM) independent of hydration status. From nine HD units, 934 pts were included. Undernutrition was defined as having a lean tissue index (LTI = LTM/height2) below the 10th percentile of a reference population. Biochemical markers and parameters delivered by BCM were used to compare low LTI and normal LTI groups. Undernutrition prevalence was 58.8% of the population studied. Low LTI pts were older, were significantly more frequently overhydrated, and had been on HD for a longer period of time than the normal LTI group. FTI (FTI = FTM/ height2) was significantly higher in low LTI pts and increased according to BMI. LTI was not influenced by different BMI levels. Albumin and C-reactive protein correlated inversely (r = −0.28). However neither of them was statistically different when considering undernourished and normal LTI pts. Our BCM study was able to show a high prevalence of undernutrition, as expressed by low LTI. In our study, BMI and other common markers, such as albumin, failed to predict malnutrition as determined by BCM. PMID:27347538

  10. Physical methods for evaluating the nutrition status of hemodialysis patients.

    PubMed

    Marcelli, Daniele; Wabel, Peter; Wieskotten, Sebastian; Ciotola, Annalisa; Grassmann, Aileen; Di Benedetto, Attilio; Canaud, Bernard

    2015-10-01

    This article aims to provide an overview of the different nutritional markers and the available methodologies for the physical assessment of nutrition status in hemodialysis patients, with special emphasis on early detection of protein energy wasting (PEW). Nutrition status assessment is made on the basis of anamnesis, physical examination, evaluation of nutrient intake, and on a selection of various screening/diagnostic methodologies. These methodologies can be subjective, e.g. the Subjective Global Assessment score (SGA), or objective in nature (e.g. bioimpedance analysis). In addition, certain biochemical tests may be employed (e.g. albumin, pre-albumin). The various subjective-based and objective methodologies provide different insights for the assessment of PEW, particularly regarding their propensity to differentiate between the important body composition compartments-fluid overload, fat mass and muscle mass. This review of currently available methods showed that no single approach and no single marker is able to detect alterations in nutrition status in a timely fashion and to follow such changes over time. The most clinically relevant approach presently appears to be the combination of the SGA method with the bioimpedance spectroscopy technique with physiological model and, additionally, laboratory tests for the detection of micro-nutrient deficiency. PMID:25791209

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

    PubMed Central

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

    2016-01-01

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

  12. Evaluation of noninvasive tests for diagnosis of Helicobacter pylori infection in hemodialysis patients

    PubMed Central

    Tamadon, Mohamad Reza; Saberi Far, Morteza; Soleimani, Alireza; Ghorbani, Raheb; Semnani, Vahid; Malek, Farhad; Malek, Mojtaba

    2013-01-01

    Background: Hemodialysis is the most common method of renal replacement therapy for treatment of acute and chronic kidney failure. Helicobacter pylori (H. pylori) plays a major role in development of peptic ulcer, gastric neoplasms, and lymphoma as well as increased risk of cardiovascular disorders in hemodialysis patients. Objectives: In this study the diagnostic values of noninvasive tests [i.e. urea breath test (UBT), helicobacter pylori stool antigen test (HPSA) and serology] in diagnosis of H. pylori infection in hemodialysis patients have been studied. Patients and Methods: All patients undergoing hemodialysis in Fatemieh Hospital, Semnan, Iran, were enrolled in the study, and their H. pylori status were assessed by using non-invasive tests including UBT, HPSA and serology. Patients with at least two out of 3 positive tests were considered infected with H. pylori. Results: The sensitivity, specificity, and positive and negative predictive values of the tests used in diagnosing H. pylori infection were 62.5%, 65.4%, 62.5% and 65.4% for UBT, 100%, 72.2%, 58.3% and 100% for serology, and 100%, 75%, 60.9% and 100% for fecal antigen test, respectively. Conclusions: This study showed that H. pylori serology and stool antigen tests have higher diagnostic values than UBT, and they are more reliable than UBT in diagnosis of H. pylori infection in hemodialysis patients. PMID:24475457

  13. Endothelial Progenitor Cells Predict Long-Term Mortality in Hemodialysis Patients

    PubMed Central

    Lu, Chien-Lin; Leu, Jyh-Gang; Liu, Wen-Chih; Zheng, Cai-Mei; Lin, Yuh-Feng; Shyu, Jia-Fwu; Wu, Chia-Chao; Lu, Kuo-Cheng

    2016-01-01

    Background: The endothelial progenitor cells (EPCs) dysfunction is a critical event in the initiation of atherosclerotic plaque development and the level of circulating EPCs can be considered a biomarker of cardiovascular events. The level and functional change in EPCs has been investigated in hemodialysis patients, but the effect of absolute number of EPCs on risk of death has not yet been explored. We hypothesized that the number of EPCs predicted death from cardiovascular and all-cause mortality in hemodialysis patients. Methods: We evaluate the association between endothelial progenitor cells and clinical outcome in 154 patients on maintenance hemodialysis. The blood sample was drawn at the time of patient enrollment and EPCs were identified by flow cytometry using triple staining for CD34/CD133/KDR. Results: The median duration of follow-up was 4.19 years. There were 79 (51.3%) deaths during the follow-up period, 41 of whom died due to a confirmed cardiovascular cause. The cumulative survival was greater in the high-EPC group than the low-EPC group for all-cause and cardiovascular mortality. Decreased EPCs levels were associated with a significant increase in the risk of cardiovascular and all-cause mortality after adjusting for age, gender, current smokers, diabetes mellitus, and hypertension. Conclusions: The level of circulating EPCs independently predicts the clinical outcome in patients on maintenance hemodialysis. Thus, the EPCs levels may be a useful predictive tool for evaluating the risk of death in maintenance hemodialysis patients. PMID:26941585

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

    PubMed

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

    2016-08-01

    To explore detection and adequacy evaluation of erythrocyte glutathione S transferase (GST) on levels of circulating toxins in hemodialysis patients in Qinhuangdao region in China, this study divided 84 cases of long-term, end-stage hemodialysis patients into 2 groups: one group of 33 cases of adequate hemodialysis (spKt/V ≥ 1.3) and another group of 51 cases of inadequate hemodialysis (spKt/V < 1.3), according to the urea index value of the unit chamber model (spKt/V). Another 50 cases of subjects found healthy by a physical examination were taken as the control group, and the differences in the related clinical and biochemical indexes of the 3 groups were compared and analyzed. The levels of GST, creatinine, high sensitivity C-reactive protein (hs-CRP), transferrin saturation (TSAT), parathyroid hormone (PTH), interleukin-2,6,8 (IL-2,6,8) and tumor necrosis factor-a (TNF-a) in the hemodialysis group were significantly higher than those in the control group (P < 0.05), and GST, IL-2, 6, 8, and TNF-a levels in the inadequate hemodialysis group were significantly higher than in the adequate hemodialysis group (P < 0.05). Pearson's relevant analysis showed that the levels of GST and spKt/V, IL-2, IL-6, IL-8, and TNF-a have a positive correlation (P < 0.05), and they have no correlation with levels of creatinine, hs-CRP, TSAT, and PHT (P > 0.05). There were 23 patients with levels of spKt/V ≥ 1.3 after adjusting the dialysis solution for 51 cases of inadequate hemodialysis patients, and the GST level after the adjustment was significantly lower than that before the adjustment, but still higher than that in the adequate dialysis group. This concludes that the maintenance of hemodialysis in patients has certain relevance on spKt/V and associated inflammatory factors. Through the study, it can be determined that GST can effectively respond to adequate hemodialysis, which has a guiding significance on adjusting the blood dialysis solution in clinical practice. PMID

  15. The Effect of Stress Management Training on Hope in Hemodialysis Patients

    PubMed Central

    Poorgholami, Farzad; Abdollahifard, Sareh; Zamani, Marzieh; Jahromi, Marzieh Kargar; Jahromi, Zohreh Badiyepeymaie

    2016-01-01

    Introduction: 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. Method: 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. Results: 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. Conclusion: Stress management training by nurses significantly increased hope in hemodialysis patients. This low cost intervention can be used to improve hope in hemodialysis patients. PMID:26925895

  16. Use of Traditional Korean Medicine by Patients with Musculoskeletal Disorders

    PubMed Central

    Wang, Bo-Ram; Choi, In Young; Kim, Kwang-Jum; Kwon, Young Dae

    2013-01-01

    Background South Korea has maintained a dual healthcare delivery system that incorporates both traditional Korean and Western medicine. In this research, we identified the determinants of the frequency of using traditional Korean medicine among musculoskeletal patients, who are known to be the most frequent users of complementary and alternative medicine. Methods In this research, we reviewed 2 consecutive years of nationally representative survey data from the 2008 and 2009 Korea Health Panel Survey. We analyzed the utilization of outpatient services by musculoskeletal patients within 12 months of the 2009 survey date. A two-part model was used because some patients did not use traditional Korean medicine and skewness was present in the data on traditional Korean medicine use. In the first part, logistic regression analysis was performed to investigate the use of traditional Korean medicine. In the second part, multiple regression analysis was performed to analyze the frequency of traditional Korean medicine usage among the subjects who visited traditional Korean medical institutions. Results The frequency of traditional Korean medicine usage was positively associated with ages of 40–49 years and over 60, restrictions on daily life, a greater number of chronic diseases, not being hospitalized, and more frequent visits (more than five times) to conventional hospitals or clinics for musculoskeletal disorders. Conclusions The important determinants of the frequency of traditional Korean medicine usage were age, activity restrictions, the number of chronic diseases, hospitalization history, and the number of visits to conventional hospitals for musculoskeletal disorders. The results contribute to our understanding of the characteristics of traditional Korean medicine users and may be used as a basic resource for related policymaking by government officials and medical professionals. PMID:23658811

  17. Spontaneous nontraumatic subarachnoid hemorrhage without cerebrovascular malformations in a maintenance hemodialysis patient

    PubMed Central

    Jayasurya, R.; Murugesan, N.; Kumar, R.; Dubey, A. K.; Priyamvada, P. S.; Swaminathan, R. P.; Parameswaran, S.

    2015-01-01

    Nontraumatic subarachnoid hemorrhage (SAH) in a dialysis patient is an uncommon occurrence and is often associated with high mortality. We report for the first time in India, a case of spontaneous nontraumatic, nonaneurysmal SAH without any cerebrovascular malformation in a maintenance hemodialysis patient, following a session of hemodialysis. The dialysis prescription needs to be modified in these patients, in order to prevent worsening of cerebral edema and progression of hemorrhage. Where available, continuous forms of renal replacement therapies, with regional anticoagulation seem to be the best option for such patients, till neurologic stabilization is achieved. PMID:26628800

  18. The management of food cravings and thirst in hemodialysis patients: A qualitative study.

    PubMed

    Yu, Junhong; Ng, Hui J; Nandakumar, Mooppil; Griva, Konstadina

    2016-02-01

    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. PMID:24659512

  19. Predictors of quality of life in hemodialysis patients.

    PubMed

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

    2013-03-01

    Quality of Life (QoL) is a consistent and powerful predictor that affects the out-come in end-stage renal disease (ESRD) patients on dialysis. This study was undertaken to identify the factors that might predict QoL scores among ESRD patients on hemodialysis (HD). The study was conducted at three HD units in Saudi Arabia from January 2007 to January 2008. We studied 100 HD patients (53 males and 47 females) and used the SF-36 and KDQoL-SF forms covering six domains of QoL, namely physical, emotional, social, illness impact, medical and financial satisfaction, and overall general health. The mean age of the study patients was 47.5 ± 13.8 years and the mean duration of dialysis was 77.2 ± 75.5 months. The QoL scores were 45.8 ± 17.1 for general health, 53.1 ± 32.0 for physical QoL, 50.5 ± 14.8 for emotional QoL, 54.9 ± 18.1 for social QoL, 46.5 ± 13.7 for illness impact, and 45.9 ± 12.2 for the medical and financial domain. The total QoL score was 49.5 ± 13.7. The male patients had statistically significantly reduced QoL and younger patients had better QoL scores. The QoL scores revealed a decreasing trend with decreasing level of education; they were elevated among employed patients. Multiple linear regression analysis demonstrated that age, dialysis duration, and male sex were negative predictors of QoL score. We conclude from our study that QoL is reduced in all the health domains of HD patients. Older age, male gender, unemployment, and duration of dialysis adversely affected the QoL scores. Adequate management of some of these factors could influence patient outcomes. PMID:23538347

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

    PubMed

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

    2014-02-01

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

  1. Non-linear heart rate variability indices in the Frequent Hemodialysis Network trials of chronic hemodialysis patients

    PubMed Central

    Ferrario, Manuela; Raimann, Jochen G.; Larive, Brett; Pierratos, Andreas; Thijssen, Stephan; Rajagopalan, Sanjay; Greene, Tom; Cerutti, Sergio; Beck, Gerald; Chan, Christopher; Kotanko, Peter

    2015-01-01

    Background Non-linear heart rate variability (HRV) indices were hypothesized to correlate with cardiac function, fluid overload and physical performance in hemodialysis patients Methods 24-hour Holter electrocardiograms were recorded in patients enrolled in the Frequent Hemodialysis Network (FHN) Daily Dialysis Trial. Correlations between nonlinear HRV indices and left-ventricular ejection fraction (LVEF), left-ventricular end-diastolic volume (LVEDV), extracellular volume (ECV)/total-body water (TBW) ratio, the SF-36 Physical Health Composite (PHC) and Physical Functioning scores (PF) were tested. Results We studied 210 subjects [average age 49.8±13.5 years, 62% males, 42% diabetics]. In non-diabetic patients, MSE SampEn and MSE ApEn correlated positively with LVEF, PF, PH, and inversely with LVEDV and ECV/TBW. SPS correlated positively with ECV/TBW (r=0.27). Irregularity measures (MSE ApEn, MSE SampEn) correlated positively with LVEDV (r=0.19 and 0.20). Conclusion Nonlinear HRV indices indicated an association between a deteriorated heart rate regulatory system and impaired cardiac function, fluid accumulation and poor physical condition. PMID:26159747

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

    PubMed Central

    Parvan, Kobra; lakdizaji, Sima; Roshangar, Fariborz; Mostofi, Mahtab

    2013-01-01

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

  3. The Relation between Perceived Social Support and Anxiety in Patients under Hemodialysis

    PubMed Central

    Davaridolatabadi, Elham; Abdeyazdan, Gholamhossein

    2016-01-01

    Introduction The increase in the number of patients under hemodialysis treatment is a universal problem. With regard to the fact that there have been few social-psychological studies conducted on patients under hemodialysis treatment, the current study was conducted to investigate anxiety and perceived social support and the relation between them among these patients. Methods This cross-sectional study was conducted on 126 patients under hemodialysis treatment in Isfahan in 2012. After randomly selecting a hospital with a hemodialysis ward, purposive sampling was conducted. Data collection tools included state-trait anxiety and perceived social support inventory. The data were analyzed using the Spearman correlation coefficient. Results Among the participants, 68.3% received average perceived social support. In addition, perceiving the tangible dimension of support was lower compared to other dimensions (Mean 40.02). Level of trait and state anxiety (65 and 67.5%) of over half of the participants was average. There was in inverse relationship between state and trait anxiety and total perceived social support and emotional and information dimensions (r = −0.340, r = −0.229). State and trait anxiety had the highest relation with emotional and information dimension of social support, respectively. Conclusion Patients under hemodialysis treatment suffer from numerous psychological and social problems. Low awareness and emotional problems result in the increase of anxiety and reduction of perceived social support. Reduction of social support has negative effect on treatment outcomes. PMID:27148434

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  6. Comparison of Anthropometric Data between End-stage Renal Disease Patients Undergoing Hemodialysis and Healthy Adults in Korea

    PubMed Central

    Lee, Seoung Woo; Park, Geun Ho; Lee, Sun Young; Song, Joon Ho

    2005-01-01

    Protein-calorie malnutrition is prevalent in hemodialysis (HD) patients. The prevalence of obesity in healthy Korean adults has increased rapidly during the last 10 years. However, there are few large scale data collections available about the current weight status of Korean HD patients. The weight statuses of 10,304 HD patients (data from the Insan Memorial Dialysis Registry 2002, Korean Society of Nephrology) were compared to those of 12,436 control subjects (age > 18) by using body mass index (BMI). Weight status was assessed by WHO classification for Asian-Pacific region [underweight (UW): < 18.5; normal weight (NW): 18.5-22.9; overweight (OW): 23-24.9; obese (OB): 25-29.9; and extremely obese (EOB): > 30 kg/m2] in both the control and HD patients. HD patients had significantly lower body weight and BMI than the controls in all age groups and in both sexes. For the male controls, the proportions of OW and OB showed a reversed U-shape, peaking at the 5th and 6th decades. of the numbers of those classified as NW and UW were relatively small. For the female controls, the proportions of OW and OB progressively increased with age. On the contrary, in HD patients, the proportions of NW and UW were large, up to more than 70%, and those of OW and OB were small in both sexes. In each age group, UW was seen significantly more in the HD group than in the control group. The 6th decade age group showed the highest prevalence ratio for UW in the HD group for both sexes, compared to the controls (Male: 17.33, Female: 17.68). The percentages of UW were related to HD duration and age in both sexes. In conclusion, Korean HD patients seem to have small proportions of OW and OB, compared to the general population, and protein-calorie malnutrition may still be an important nutritional condition. PMID:16259064

  7. Patients' Responses to a Drawing Experience in a Hemodialysis Unit: A Step towards Healing.

    ERIC Educational Resources Information Center

    Weldt, Cristina

    2003-01-01

    Investigates patients' responses to drawing experiences while in a hemodialysis unit. It was postulated that patients would be stimulated to talk about issues and experiences and improve their confidence and self-esteem. Results indicate that all patients enjoyed the experience of drawing; they became focused on doing the drawings and the hours…

  8. Reversed association between aldosterone and mortality in hemodialysis patients: Role of volume overload.

    PubMed

    Hung, Szu-Chun; Tarng, Der-Cherng

    2016-07-01

    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. PMID:26826322

  9. Multiphasic effects of blood pressure on survival in hemodialysis patients.

    PubMed

    Hannedouche, Thierry; Roth, Hubert; Krummel, Thierry; London, Gérard M; Jean, Guillaume; Bouchet, Jean-Louis; Drüeke, Tilman B; Fouque, Denis

    2016-09-01

    Dialysis patients exhibit an inverse, L- or U-shaped association between blood pressure and mortality risk, in contrast to the linear association in the general population. We prospectively studied 9333 hemodialysis patients in France, aiming to analyze associations between predialysis systolic, diastolic, and pulse pressure with all-cause mortality, cardiovascular mortality, and nonfatal cardiovascular endpoints for a median follow-up of 548 days. Blood pressure components were tested against outcomes in time-varying covariate linear and fractional polynomial Cox models. Changes throughout follow-up were analyzed with a joint model including both the time-varying covariate of sequential blood pressure and its slope over time. A U-shaped association of systolic blood pressure was found with all-cause mortality and of both systolic and diastolic blood pressure with cardiovascular mortality. There was an L-shaped association of diastolic blood pressure with all-cause mortality. The lowest hazard ratio of all-cause mortality was observed for a systolic blood pressure of 165 mm Hg, and of cardiovascular mortality for systolic/diastolic pressures of 157/90 mm Hg, substantially higher than currently recommended values for the general population. The 95% lower confidence interval was approximately 135/70 mm Hg. We found no significant correlation for either systolic, diastolic, or pulse pressure with myocardial infarction or nontraumatic amputations, but there were significant positive associations between systolic and pulse pressure with stroke (per 10-mm Hg increase: hazard ratios 1.15, 95% confidence interval 1.07 and 1.23; and 1.20, 1.11 and 1.31, respectively). Thus, whereas high pre-dialysis blood pressure is associated with stroke risk, low pre-dialysis blood pressure may be both harmful and a proxy for comorbid conditions leading to premature death. PMID:27521114

  10. Modelling Transcapillary Transport of Fluid and Proteins in Hemodialysis Patients

    PubMed Central

    Pietribiasi, Mauro; Waniewski, Jacek; Załuska, Alicja; Załuska, Wojciech; Lindholm, Bengt

    2016-01-01

    Background 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. Methods 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. Results 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). Conclusions 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

  11. Renalase Gene rs2576178 Polymorphism in Hemodialysis Patients: Study in Bosnia and Herzegovina

    PubMed Central

    Kiseljakovic, Emina; Mackic-Djurovic, Mirela; Hasic, Sabaheta; Beciragic, Amela; Valjevac, Amina; Alic, Lejla; Resic, Halima

    2016-01-01

    Introduction: Renalase is a protein secreted in kidneys and considered as a blood pressure modulator. High rates of hypertension and its regulation in patients on hemodialysis demands search for potential cause and treatment. The aim of this study was to determine the genotype and allele frequencies of renalase gene rs2576178 polymorphism in population from Bosnia and Herzegovina. Also, the objective of present study was to find the possible association between renalase gene rs2576178 polymorphism and hypertension in patients on hemodialysis. Material and Methods: The genotype of renalase gene rs2576178 polymorphism was determined in 137 participants (100 patients on hemodialysis and 37 controls), using polymerase chain reaction (PCR) and subsequent cleavage with MspI restriction endonuclease. Genotype and allele frequencies were assessed for Hardy-Weinberg equilibrium using a Chi-squared test. The value of P<0.05 was considered as statistically significant. Results: Comparison of genotype distribution and allele frequency in participants on hemodialysis with and without hypertension, and healthy control showed no statistical difference. Conclusion: The results of the study suggest that renalase gene rs2576178 polymorphism is not a factor that influences blood pressure in patients on hemodialysis. PMID:26980928

  12. Clinical and Echocardiographic Factors Associated with Right Ventricular Systolic Dysfunction in Hemodialysis Patients

    PubMed Central

    López-Quijano, Juan Manuel; Gordillo-Moscoso, Antonio; Viana-Rojas, Jesús Antonio; Carrillo-Calvillo, Jorge; Mandeville, Peter B.; Chevaile-Ramos, Alejandro

    2016-01-01

    Background Chronic kidney disease is a disorder of epidemic proportions that impairs cardiac function. Cardiovascular diseases are the leading cause of death in hemodialysis patients, and the understanding of new nontraditional predictors of mortality could improve their outcomes. Right ventricular systolic dysfunction (RVSD) has recently been recognized as a predictor of cardiovascular death in heart failure and hemodialysis patients. However, the factors contributing to RVSD in hemodialysis patients remain unknown. The aim of this study was to evaluate the clinical and echocardiographic factors associated with RVSD in hemodialysis patients. Methods A cross-sectional study was conducted in which 100 outpatients with end-stage renal disease on chronic hemodialysis were evaluated. A transthoracic echocardiographic examination was performed at optimal dry weight. Right ventricular systolic function was evaluated using tricuspid annular plane systolic excursion (TAPSE). Clinical and echocardiographic data were recorded for each patient. A multivariate linear logistic regression was created using RVSD (TAPSE <14 mm) as the dependent variable. Results Fifteen patients with RVSD and 85 patients without RVSD were analyzed. TAPSE had a positive correlation with left ventricular ejection fraction (LVEF) and myocardial relaxation velocity. Independent contributors to RVSD were LVEF (OR 1.14, 95% CI 1.05-1.26), left ventricular mass index (OR 1.02, 95% CI 1.00-1.04), and myocardial relaxation velocity (OR 1.81, 95% CI 1.18-3.19). Conclusions Echocardiographic factors were significant contributors to RVSD. These measurements could be included as part of the routine workup in all end-stage renal disease patients on hemodialysis.

  13. Feasibility of a hemodialysis safety checklist for nurses and patients: a quality improvement study

    PubMed Central

    Thomas, Alison; Silver, Samuel A.; Rathe, Andrea; Robinson, Pamela; Wald, Ron; Bell, Chaim M.; Harel, Ziv

    2016-01-01

    Background Patients with end-stage renal disease are at high risk for medical errors given their comorbidities, polypharmacy and coordination of care with other hospital departments. We previously developed a hemodialysis safety checklist (Hemo Pause) to be jointly completed by nurses and patients. Our objective was to determine the feasibility of using this checklist during every hemodialysis session for 3 months. Methods We conducted a single-center, prospective time series study. A convenience sample of 14 nurses and 22 prevalent in-center hemodialysis patients volunteered to participate. All participants were trained in the administration of the Hemo Pause checklist. The primary outcome was completion of the Hemo Pause checklist, which was assessed at weekly intervals. We also measured the acceptability of the Hemo Pause checklist using a local patient safety survey. Results There were 799 hemodialysis treatments pre-intervention (13 January–5 April 2014) and 757 post-intervention (5 May–26 July 2014). The checklist was completed for 556 of the 757 (73%) treatments. Among the hemodialysis nurses, 93% (13/14) agreed that the checklist was easy to use and 79% (11/14) agreed it should be expanded to other patients. Among the hemodialysis patients, 73% (16/22) agreed that the checklist made them feel safer and should be expanded to other patients. Conclusions The Hemo Pause safety checklist was acceptable to both nurses and patients over 3 months. Our next step is to spread this checklist locally and conduct a mixed methods study to determine mechanisms by which its use may improve safety culture and reduce adverse events. PMID:27274816

  14. Association of Thyroid Functional Disease With Mortality in a National Cohort of Incident Hemodialysis Patients

    PubMed Central

    Kim, Steven; Gillen, Daniel L.; Oztan, Tolga; Wang, Jiaxi; Mehrotra, Rajnish; Kuttykrishnan, Sooraj; Nguyen, Danh V.; Brunelli, Steven M.; Kovesdy, Csaba P.; Brent, Gregory A.; Kalantar-Zadeh, Kamyar

    2015-01-01

    Context: Hypothyroidism is a common condition that disproportionately affects hemodialysis patients. In the general population, hypothyroidism is associated with higher mortality, particularly in populations with underlying cardiovascular risk. Despite their heightened cardiovascular mortality, the impact of hypothyroidism on the survival of hemodialysis patients remains uncertain. Objective: To examine whether hypothyroidism is independently associated with higher mortality in hemodialysis patients. Design, Setting, and Patients: Among 8840 incident hemodialysis patients receiving care from a large national dialysis provider from January 2007 to December 2011, we examined the association of hypothyroidism (TSH >5.0 mIU/L) with mortality. Main Outcome Measures: Associations between baseline and time-dependent hypothyroidism with all-cause mortality were determined using case-mix adjusted Cox models. In secondary analyses, we examined the impact of low-normal, upper-normal, subclinical range, and overt range TSH levels (TSH ≥0.5–3.0, >3.0–5.0, >5.0–10.0, and >10.0 mIU/L, respectively) on mortality risk. Results: The study population consisted of 1928 (22%) hypothyroid and 6912 (78%) euthyroid patients. Baseline and time-dependent hypothyroidism were associated with higher mortality: adjusted hazard ratios (95% confidence intervals) were 1.47 (1.34–1.61) and 1.62 (1.45–1.80), respectively. Compared to low-normal TSH, upper-normal, subclinical hypothyroid, and overt hypothyroid TSH levels were associated with incrementally higher adjusted death risk in baseline and time-dependent analyses. In time-dependent analyses, the hypothyroidism-mortality association was increasingly stronger across higher body mass index strata. Conclusions: Hypothyroidism as well as upper-normal TSH levels are associated with higher mortality in hemodialysis patients. Further studies are needed to determine whether restoration of TSH to low-normal levels with thyroid hormone

  15. Utilizing the health belief model to assess vaccine acceptance of patients on hemodialysis.

    PubMed

    Adams, Angela; Hall, Mellisa; Fulghum, Janis

    2014-01-01

    Vaccine rates in patients on hemodialysis are substantially lower than the Healthy People 2020 targets. The purpose of this study is to utilize the perceptions and cues for action constructs of the Health Belief Model (HBM) to assess the attitudes of patients receiving outpatient hemodialysis regarding acceptance of the seasonal influenza, pneumococcal, and hepatitis B virus vaccines. Vaccine acceptance is defined as receiving the vaccine. Study findings suggest age, perceived susceptibility, and perceived severity increase the odds of getting some vaccines. Findings have implications for the development of patient education materials, interdisciplinary team assessments, and plan of care strategies to increase vaccine acceptance. PMID:25244894

  16. Rupture of an infectious pseudoaneurysm of the aortic arch in an end-stage renal failure patient with chronic hemodialysis.

    PubMed

    Chung, Sarah; Choi, Dae Eun; Na, Ki Ryang; Lee, Kang Wook

    2015-07-01

    In hemodialysis patients, vascular access infection remains a significant cause of morbidity and mortality. It has various complications, including bacterial endocarditis, spinal epidural abscess, osteomyelitis, septic arthritis, and septic pulmonary emboli. However, aortitis with infected pseudoaneurysm formation is very rare. Here, we report a case of necrotizing aortitis in a hemodialysis patient with an arteriovenous graft infection. PMID:26042414

  17. Kinetics of parathyroid hormone after parathyroidectomy in chronic hemodialysis patients.

    PubMed

    Skalli, Z; Elouazzani, H; Alhamany, Z; Mattous, M; Benamar, L; Bayahia, R; Belkouchi, M; El Malki, HadjOmar; Ouzeddoun, N

    2015-11-01

    Secondary hyperparathyroidism is a common complication in chronic renal failure. The treatment in some cases requires parathyroidectomy. The kinetics of the parathyroid hormone (PTH) levels after surgery helps to evaluate the efficacy of parathyroidectomy. Prospective analysis was made of the kinetics of intact PTH (iPTH) after parathyroidectomy in 10 chronic hemodialysis (HD) patients who had secondary hyperparathyroidism. We determined the levels of iPTH before surgery and its evolution after parathyroidectomy at regular intervals: Day 0, D7, D15, D30 and D90. The mean age of our patients was 40 ± 13 years, with a sex ratio of 1. The mean duration on HD was 122 ± 63 months. The duration of secondary hyperparathyroidism varied from one year to 12 years. All patients had received medical treatment for hyperparathyroidism. The indications for parathyroidectomy included resistance to medical treatment in seven cases, development of brown tumors in two cases and soft tissue calcifications in one case. All patients had radiographic evidence of hyperparathyroidism. The parathyroidectomy was sub-total in all patients, 6/8 in four cases and 7/8 in six cases. The mean iPTH level was 2341 ± 1946 pg/mL before surgery. A sharp drop in this level was noticed on D0, with a median of 92 pg/mL and, thereafter, the levels were 79 pg/mL on D7, 25 pg/mL on D15 and 36 pg/mL after 1 month. At 3 months post-surgery, the mean iPTH level was 302 pg/mL. Histological examination of the resected gland showed parathyroid hyperplasia in all patients. In our series, the efficacy of sub-total parathyroidectomy was satisfactory with rapid normalization of PTH, which is consistent with the literature data. Sub-total parathyroidectomy still has a place in the treatment of secondary hyperparathyroidism in chronic renal failure. Its indications should be limited to cases resistant to medical treatment and, in particular, in cases with occurrence of complications. PMID:26586059

  18. Comparison of two educational methods (family-centered and patient-centered) on hemodialysis: Related complications

    PubMed Central

    Zolfaghari, Mitra; Asgari, Parvaneh; Bahramnezhad, Fatemeh; AhmadiRad, Sajad; Haghani, Hamid

    2015-01-01

    Background: Hypotension and muscular cramp are the common complications of hemodialysis. Effective control of hemodialysis complications increases the survival time and the quality of life of patients on hemodialysis. Considering that failure to follow a therapeutic plan is one of the most prevalent causes of hemodialysis complications, the present research was conducted to study the effect of two educational methods (family-centered and patient-centered) on some complications that occur during hemodialysis. Materials and Methods: This clinical trial was performed from June to November 2012 in the hemodialysis ward of Imam Khomeini Hospital and Tehran Amir Aalam Hospital. Research samples included 60 patients in the age range of 18-65 years who were randomly included in patient-centered education (30 people in even days) and family-centered education (30 people in odd days). Blood pressure and muscle cramp were checked using researcher-made checklist in three stages (before and at the second and fourth week after intervention). Hypotension (before the start of dialysis, at the first, second, and third hour, and at the end hours) and muscle cramp (in the middle of hemodialysis and the end half an hour) were also checked. Data were analyzed using SPSS software, version 16, with Chi-square test, Fisher test, and independent t-test. Results: Before intervention, the two groups did not show significant difference in terms of hypotension [with P = 0.91 and variations mean of 1.60 (1.30)] and muscle cramp [with P = 0.50 and variations mean of 1.06 (1.01)]. In the second and fourth week after intervention, there was significant difference between the two groups in terms of hypotension [with P = 0.016 and variations mean of 0.70 (0.70) and P = 0.02 and variations mean of 0.86 (0.62)] and muscle cramp [with P = 0.01 and variations mean of 0.46 (0.86) and P = 0.02 and variations mean of 1 (1.05)]. Conclusions: Considering that the study results showed that family

  19. Serum Magnesium and Sudden Death in European Hemodialysis Patients

    PubMed Central

    de Roij van Zuijdewijn, Camiel L. M.; Grooteman, Muriel P. C.; Bots, Michiel L.; Blankestijn, Peter J.; Steppan, Sonja; Büchel, Janine; Groenwold, Rolf H. H.; Brandenburg, Vincent; van den Dorpel, Marinus A.; ter Wee, Piet M.; Nubé, Menso J.; Vervloet, Marc G.

    2015-01-01

    Despite suggestions that higher serum magnesium (Mg) levels are associated with improved outcome, the association with mortality in European hemodialysis (HD) patients has only scarcely been investigated. Furthermore, data on the association between serum Mg and sudden death in this patient group is limited. Therefore, we evaluated Mg in a post-hoc analysis using pooled data from the CONvective TRAnsport STudy (CONTRAST, NCT00205556), a randomized controlled trial (RCT) evaluating the survival risk in dialysis patients on hemodiafiltration (HDF) compared to HD with a mean follow-up of 3.1 years. Serum Mg was measured at baseline and 6, 12, 24 and 36 months thereafter. Cox proportional hazards models, adjusted for confounders using inverse probability weighting, were used to estimate hazard ratios (HRs) of baseline serum Mg on all-cause mortality, cardiovascular mortality, non-cardiovascular mortality and sudden death. A generalized linear mixed model was used to investigate Mg levels over time. Out of 714 randomized patients, a representative subset of 365 (51%) were analyzed in the present study. For every increase in baseline serum Mg of 0.1 mmol/L, the HR for all-cause mortality was 0.85 (95% CI 0.77–94), the HR for cardiovascular mortality 0.73 (95% CI 0.62–0.85) and for sudden death 0.76 (95% CI 0.62–0.93). These findings did not alter after extensive correction for potential confounders, including treatment modality. Importantly, no interaction was found between serum phosphate and serum Mg. Baseline serum Mg was not related to non-cardiovascular mortality. Mg decreased slightly but statistically significant over time (Δ -0.011 mmol/L/year, 95% CI -0.017 to -0.009, p = 0.03). In short, serum Mg has a strong, independent association with all-cause mortality, cardiovascular mortality and sudden death in European HD patients. Serum Mg levels decrease slightly over time. PMID:26600017

  20. The Impact of Hemodialysis and Arteriovenous Access Flow on Extracranial Hemodynamic Changes in End-Stage Renal Disease Patients

    PubMed Central

    2016-01-01

    In this study, we characterized cerebral blood flow changes by assessment of blood flow parameters in neck arteries using carotid duplex ultrasonography and predictive factors for these hemodynamic changes. Hemodynamic variables were measured before and during hemodialysis in 81 patients with an arteriovenous access in their arm. Hemodialysis produced significant lowering in peak systolic velocity and flow volume of neck arteries and calculated total cerebral blood flow (1,221.9 ± 344.9 [before hemodialysis] vs. 1,085.8 ± 319.2 [during hemodialysis], P < 0.001). Effects were greater in vessels on the same side as the arteriovenous access and these changes were influenced by arteriovenous access flow during hemodialysis, both in the CCA (r = -0.277, P = 0.015) and the VA (r = -0.239, P = 0.034). The change of total cerebral blood flow during hemodialysis was independently related with age, presence of diabetes, and systemic blood pressure. PMID:27478334

  1. Temporal Trends in Health-Related Quality of Life among Hemodialysis Patients in the United States

    PubMed Central

    Meyer, Klemens B.; Griffith, John L.; Richardson, Michelle M.; Miskulin, Dana C.

    2010-01-01

    Background and objectives: Health-related quality of life (HRQOL) is a measure of the well being of hemodialysis patients and an independent prognostic predictor. Our aim was to determine whether HRQOL among hemodialysis patients has changed over time. Design, setting, participants, & measurements: We retrospectively analyzed data collected by Dialysis Clinic, Inc. from adult patients starting hemodialysis between January 1, 1997 and May 31, 2006. The primary outcome was HRQOL assessed by Short Form 36, 6 to 18 months after and closest to the 1-year anniversary of starting hemodialysis. Secular trends were analyzed by linear regression for continuous variables and logistic regression for categorical ones. Year of starting dialysis was the predictor. A five-point difference on a 0 to 100 scale was considered clinically significant. Results: Short Form 36 scores were available for 11,079 patients. Role Physical, General Health, Vitality, Social Functioning, and Physical Component Summary scores were unchanged among patients over the study period. Statistically significant (P < 0.05) but clinically insignificant changes were observed in Physical Functioning (−0.2 points/yr), Bodily Pain (+0.2 points/yr), Mental Health (+0.15 points/yr), and Mental Component Summary scores (+0.13 points/yr). Only Role Emotional showed clinically significant improvement. Trends were unchanged after adjusting for age, gender, race, diabetes, hemoglobin, phosphorous, Kt/V, and albumin. Conclusions: Most HRQOL domains showed either no statistically significant change or statistically but not clinically significant change over almost a decade. These results suggest that, despite important developments in hemodialysis care since 1997, little progress was made in improving HRQOL of hemodialysis patients. PMID:20019114

  2. Clearance and synthesis rates of beta 2-microglobulin in patients undergoing hemodialysis and in normal subjects

    SciTech Connect

    Floege, J.; Bartsch, A.; Schulze, M.; Shaldon, S.; Koch, K.M.; Smeby, L.C. )

    1991-08-01

    Retention of {beta} 2-microglobulin in patients undergoing hemodialysis is associated with a {beta} 2-microglobulin-derived amyloidosis. Removal of {beta} 2-microglobulin by renal replacement therapy has been proposed for the prevention of this amyloidosis. Currently, however, data on the {beta} 2-microglobulin synthesis rate in patients undergoing hemodialysis are scarce, and consequently it remains speculative how much removal would be necessary to counterbalance synthesis. The plasma kinetics of iodine 131-labeled {beta} 2-microglobulin were therefore examined in 11 patients with anuria who were undergoing long-term hemodialysis. Five healthy persons served as controls. Kinetic modeling of the plasma curves showed that the data fitted a two-pool model (r2 greater than 0.96) consisting of a rapid 2 to 4 hour distribution phase followed by a less steep curve, described by the plasma (metabolic) clearance (Clp). Synthetic rates were calculated from Clp and the {beta} 2-microglobulin steady state plasma concentration (plus {beta} 2-microglobulin removal during hemodialysis in the case of high flux hemodialysis). The results showed a significantly higher Clp in normal controls as compared with patients undergoing hemodialysis (65.5 {plus minus} 12.8 ml/min (mean {plus minus} SD) versus 3.4 {plus minus} 0.7 ml/min). In contrast, the {beta} 2-microglobulin synthesis rate in the patient group (3.10 {plus minus} 0.79 mg/kg/day) was not significantly different from that of normal controls (2.40 {plus minus} 0.67 mg/kg/day), which was due to markedly elevated {beta} 2-microglobulin plasma concentrations in the patients (37.6 {plus minus} 14.1 mg/L vs 1.92 {plus minus} 0.27 mg/L). These findings suggest that the presence of end-stage renal disease does not have a significant impact on the beta 2-microglobulin generation rate.

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

    PubMed

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

    1988-01-01

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

  4. Art Therapy with a Hemodialysis Patient: A Case Analysis. Brief Report

    ERIC Educational Resources Information Center

    Nishida, Miki; Strobino, Jane

    2005-01-01

    Art therapy has been used to support the coping skills of patients with various medical illnesses. The purpose of this case study was to examine the usefulness of art therapy in promoting communication and a positive sense of well-being in a hemodialysis patient. The participant was a 57-year-old Caucasian female who had been treated with…

  5. Body Consciousness, Illness-Related Impairment, and Patient Adherence in Hemodialysis.

    ERIC Educational Resources Information Center

    Christensen, Alan J.; And Others

    1996-01-01

    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…

  6. Reduction of left ventricular ejection fraction after 12-month follow-up in hemodialysis patients

    PubMed Central

    Momeni, Ali; Khaledi, Arsalan; Hasanzadeh, Katayoun

    2016-01-01

    Introduction: Cardiovascular disease is the most common cause of morbidity and mortality in hemodialysis patients. Objectives: The aim of this study was to detect echocardiographic abnormality in the beginning and after 12-month follow-up in the hemodialysis patients. Patients and Methods: In a cross-sectional study, 60 hemodialysis patients older than 18 years and the dialysis duration longer than three months were enrolled. At the beginning of the study, echocardiography was done and after 12 months was repeated in all of the patients by the same cardiologist. At the end of the study, data were analyzed using SPSS software (version 19). Results: From the total of cases 37 were male and 23 female. At the beginning of the study, mitral regurgitation, tricuspid regurgitation and aortic insufficiency were found in 54, 47 and 11 patients respectively. After 12 months left ventricular ejection fraction (LVEF) decreased significantly, however there was no significant difference between other echocardiographic findings at the beginning and after 12 months. Conclusion: Decrease in LVEF over time in hemodialysis patients may be due to negative effect of uremia on cardiac function, so it seems that periodical cardiac evaluation of these patients is essential and beneficial. PMID:27069961

  7. Aneurysm of the tibial-saphenous fistula in hemodialysis patient: the results of surgical treatment

    PubMed Central

    Günday, Murat

    2011-01-01

    Arteriovenous fistulas are widely used for hemodialysis patients with end-stage renal failure. Due to the lack of suitable veins because of the arteriovenous fistulas previously opened in the upper extremity, alternative access routes are being tested. Few complications of long-term alternative arteriovenous fistulas have been reported in the literature. We report the results of surgical repairs of aneurysms that occurred on anterior tibial-saphenous arteriovenous fistulas (along the vein) in patients with end-stage renal disease after 5 years on hemodialysis. PMID:22140315

  8. Prosthetic Arteriovenous Graft Contact Dermatitis Masquerading as an Arteriovenous Graft Infection in a Hemodialysis Patient

    PubMed Central

    Ramagiri-Vinod, Nagadarshini; Tahir, Hassan; Narukonda, Sandhya; Joshi, Medha

    2016-01-01

    Prosthetic arteriovenous (AV) graft is the second most common vascular access of choice in hemodialysis patients. Rare complications of such grafts are increasingly seen due to rising population of patients on hemodialysis. Infections and thrombosis are the most common complications. Though metallic implants are known to cause hypersensitivity skin reactions, prosthetic AV grafts are rarely known to cause such kind of reactions due to inert nature of materials used in their preparation. We present a case of 54-year-old male who developed contact dermatitis after AV graft creation which was mistreated initially as infection. PMID:27493977

  9. Takotsubo Cardiomyopathy in Two Patients without Any Cardiac Symptom on Maintenance Hemodialysis

    PubMed Central

    Ueda, Hiroyasu; Hiraoka, Hisatoyo

    2013-01-01

    Takotsubo cardiomyopathy is a disorder characterized by left ventricular apical ballooning and electrocardiographic changes in the absence of coronary artery disease. While reversible in many cases, the mechanism of this disorder remains unclear. The most frequent clinical symptoms of takotsubo cardiomyopathy on admission are chest pain and dyspnea, resembling acute myocardial infarction. Here, we describe two cases of takotsubo cardiomyopathy without chest pain or dyspnea in patients on maintenance hemodialysis. The asymptomatic nature of these two cases may be due to the patients being on hemodialysis. Periodic electrocardiograms (ECG) may be helpful in screening this population for asymptomatic takotsubo cardiomyopathy and in evaluating its incidence. PMID:24527248

  10. Determinants of Slow Walking Speed in Ambulatory Patients Undergoing Maintenance Hemodialysis

    PubMed Central

    Matsuzawa, Ryota; Kutsuna, Toshiki; Yamamoto, Shuhei; Yoneki, Kei; Harada, Manae; Ishikawa, Ryoma; Watanabe, Takaaki; Yoshida, Atsushi

    2016-01-01

    Walking ability is significantly lower in hemodialysis patients compared to healthy people. Decreased walking ability characterized by slow walking speed is associated with adverse clinical events, but determinants of decreased walking speed in hemodialysis patients are unknown. The purpose of this study was to identify factors associated with slow walking speed in ambulatory hemodialysis patients. Subjects were 122 outpatients (64 men, 58 women; mean age, 68 years) undergoing hemodialysis. Clinical characteristics including comorbidities, motor function (strength, flexibility, and balance), and maximum walking speed (MWS) were measured and compared across sex-specific tertiles of MWS. Univariate and multivariate logistic regression analyses were performed to examine whether clinical characteristics and motor function could discriminate between the lowest, middle, and highest tertiles of MWS. Significant and common factors that discriminated the lowest and highest tertiles of MWS from other categories were presence of cardiac disease (lowest: odds ratio [OR] = 3.33, 95% confidence interval [CI] = 1.26–8.83, P<0.05; highest: OR = 2.84, 95% CI = 1.18–6.84, P<0.05), leg strength (OR = 0.62, 95% CI = 0.40–0.95, P<0.05; OR = 0.57, 95% CI = 0.39–0.82, P<0.01), and standing balance (OR = 0.76, 95% CI = 0.63–0.92, P<0.01; OR = 0.81, 95% CI = 0.68–0.97, P<0.05). History of fracture (OR = 3.35, 95% CI = 1.08–10.38; P<0.05) was a significant factor only in the lowest tertile. Cardiac disease, history of fracture, decreased leg strength, and poor standing balance were independently associated with slow walking speed in ambulatory hemodialysis patients. These findings provide useful data for planning effective therapeutic regimens to prevent decreases in walking ability in ambulatory hemodialysis patients. PMID:27018891

  11. Vascular access and patient outcomes in hemodialysis: questions answered in recent literature.

    PubMed

    Añel, Ramon L; Yevzlin, Alexander S; Ivanovich, Peter

    2003-03-01

    Hemodialysis is not possible without access to the vascular system to provide an adequate and reliable source of blood flow through the hemodialyzer. Since maintenance hemodialysis therapy became a reality in the latter half of the twentieth century, no vascular access has exceeded the success and reliability of arteriovenous fistulae (AVF). They have the lowest infection and thrombosis rates, have the longest patency rates, and are associated with the best morbidity and mortality outcomes of any access modality. In the United States, the majority of patients starting hemodialysis do not have a primary AVF, which may explain why vascular access complications represent almost 20% of the total spending for hemodialysis. In addition, as much as 50% of hospitalization costs for end-stage renal disease are related to access issues. Every effort must be directed in the U.S. as well as elsewhere to promote the use of AVF whenever possible. In some European countries, more than 90% of patients have AVF as their hemodialysis access when nephrologists perform placement of vascular access. Already, some programs in the U.S. have recognized the need for trained nephrologists to provide these services. U.S. interventional nephrologists should be given the opportunity to learn AVF placement procedures to emulate their European counterparts, and thus improve U.S. dialysis outcomes. PMID:12662209

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

    PubMed

    Dumaidi, Kamal; Al-Jawabreh, Amer

    2014-10-01

    Occult hepatitis B infection is the case with undetectable HBsAg, but positive for HBV DNA in liver tissue and/or serum. Occult hepatitis B infection among hemodialysis patients in Palestine has been understudied. In this study, 148 hemodialysis patients from 2 northern districts in Palestine, Jenin (89) and Tulkarem (59), were investigated for occult hepatitis B, HBV, HCV infections with related risk factors. ELISA and PCR were used for the detection of anti-HBc and viral DNA, respectively. The overall prevalence of occult hepatitis B infection among the study group was 12.5% (16/128). Occult hepatitis B infection is more prevalent among males with most cases (15/16) from Jenin District. About one-third (42/132) of the hemodialysis patients were anti-HBc positive. Approximately 27% of the hemodialysis patients were infected with HCV. Around 20% (28/140) were positive for HBV DNA, but only 8.2% (12/146) of the hemodialysis patients were positive for HBsAg. The comparison between hemodialysis patients with occult hepatitis B infection and those without occult hepatitis B infection for selected risk factors and parameters as liver Enzyme, age, sex, HCV infection, blood transfusion, kidney transplant, anti-HBc, and vaccination showed no statistical significance between both categories. Duration of hemodialysis significantly affected the rate of HCV infection. HCV is significantly higher in hemodialysis patients with both Diabetes mellitus and hypertension. The prevalence of occult hepatitis B infection among hemodialysis patients is high; requiring stringent control policies. HBsAg assay is insufficient test for accurate diagnosis of HBV infection among hemodialysis patients. PMID:24992542

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

    PubMed Central

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

    2013-01-01

    Background: Hemodialysis patients usually experience high levels of psychological stress, anxiety, and depression. Reducing these matters in patients provides more psychological resources to cope with their physical situation. Aim: The present study aimed to explore the efficacy of Benson's relaxation technique for stress, anxiety, and depression of patients with hemodialysis. Materials and Methods: Eighty hemodialysis patients were selected from two hospitals as an intervention and control groups. Then Benson relaxation training was implemented in the intervention group for 15 min twice a day during 4 weeks. The patients were assessed by depression, anxiety, and stress scale; which was completed before and after the intervention. Results: There were significant differences between stress and anxiety levels in case group before and after intervention (P > 0.001) and there is no meaningful difference between the mean of depression value in case group before and after intervention (P > 0.22). Conclusion: Instructing Benson's relaxation technique is accompanied by reducing stress and anxiety level of hemodialysis patients. Reducing stress and anxiety levels can provide more calmness for the patients so that pursuing medical therapy would be accompanied with more tranquility. Authors have suggested to improve and prevent the patients’ psychological problems as well as other chronic disorders by applying this practice. PMID:24251271

  14. Glycated Albumin Predicts Long-term Survival in Patients Undergoing Hemodialysis

    PubMed Central

    Lu, Chien-Lin; Ma, Wen-Ya; Lin, Yuh-Feng; Shyu, Jia-Fwu; Wang, Yuan-Hung; Liu, Yueh-Min; Wu, Chia-Chao; Lu, Kuo-Cheng

    2016-01-01

    Background: In patients with advanced renal dysfunction undergoing maintenance hemodialysis, glycated albumin (GA) levels may be more representative of blood glucose levels than hemoglobin A1C levels. The aim of this study was to determine the predictive power of GA levels on long-term survival in hemodialysis patients. Methods: A total of 176 patients with a mean age of 68.2 years were enrolled. The median duration of follow-up was 51.0 months. Receiver-operating characteristic curve analysis was utilized to determine the optimal cutoff value. We examined the cumulative survival rate by Kaplan-Meier estimates and the influence of known survival factors with the multivariate Cox proportional-hazard regression model. Results: In the whole patient group, cumulative survival in the low GA group was better than in the high GA group (p=0.030), with more prominence in those aged <70 years (p=0.029). In subgroup analysis, both diabetic (DM) and non-DM patients with low GA had a better cumulative survival compared with those with high GA. The risk of mortality increased by 3.0% for each 1% increase in serum GA level in all patients undergoing hemodialysis. Conclusions: In addition to serving as a glycemic control marker, GA levels may be useful for evaluating the risk of death in both DM and non-DM patients on hemodialysis. PMID:27226780

  15. Study of Serum Levels of Leptin, C-Reactive Protein and Nutritional Status in Hemodialysis Patients

    PubMed Central

    Montazerifar, Farzaneh; Karajibani, Mansour; Hassanpour, Zahra; Pourmofatteh, Mahla

    2015-01-01

    Background: Leptin is secreted by adipose tissue and decreases appetite. However, the role of leptin in the pathogenesis of hemodialysis (HD)-related malnutrition has not been fully evaluated. Objectives: The aim of study was to investigate the association between the serum leptin levels, serum C-reactive protein (CRP) levels, and nutritional status in hemodialysis patients. Patients and Methods: This analytical descriptive study included 45 hemodialysis patients and 40 healthy subjects. Biochemical parameters and serum leptin levels were measured. The nutritional status was evaluated using a food frequency questionnaire (FFQ) and the calculation of the body mass index (BMI). Results: Serum leptin (P < 0.05) and albumin (P < 0.0001) levels and BMI (P < 0.001) of HD patients were significantly lower, while CRP levels were significantly higher than those of controls (P < 0.0001). HD patients consumed the lower daily servings of the food groups compared to the control subjects (P < 0.0001). A significant positive correlation between serum levels of leptin and albumin and BMI was demonstrated. No significant correlations were identified between leptin level, CRP level, and other variables. Conclusions: The findings suggest that low levels of leptin may be a contributory factor for malnutrition in HD patients. Further studies are required to ascertain the significance of leptin levels in relation to nutritional factors in hemodialysis patients. PMID:26430525

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

    SciTech Connect

    Butler, Philip J. Sood, Shreya; Mojibian, Hamid; Tal, Michael G.

    2011-02-15

    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.

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

    PubMed

    Coelho, Silvia

    2016-01-01

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

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

    PubMed

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

    2016-08-01

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

  19. Impact of Improving Quality of Dialysis Fluid on Oxidative Stress and Lipid Profile in Hemodialysis Patients

    PubMed Central

    Elkabbaj, Driss; Bahadi, Abdelali; Cherrah, Yahia; Errasfa, Mourad; Eljaoudi, Rachid

    2013-01-01

    The aim of this study was to evaluate the levels of malondialdehyde as an oxidative stress marker in the same hemodialysis patients after changing the quality of dialysate with ultrapure dialysis fluid. Methods. This prospective study concerns hemodialysis patients; all patients were in the first step treated with conventional dialysate, and in the second step (three months later) the same patients were treated with online produced ultrapure dialysis fluid. The malondialdehyde, C-reactive protein, total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, fibrinogen, and albumin were quantified before the two steps. Results. Thirty-seven patients completed the study. Ultrapure dialysis fluid reduced but not significantly the malondialdehyde concentrations. Both dialysis fluids were associated with improvement in the malondialdehyde level before and after the hemodialysis session. In lipid parameters, there was a significant decrease with conventional dialysis fluid versus ultrapure dialysis fluid of triglycerides, total cholesterol, and high-density lipoprotein in patients' blood. Instead, the level of low-density lipoprotein, fibrinogen, albumin, and C-reactive protein does not change significantly. Conclusion. The lipid parameters were improved for triglycerides and total cholesterol. Malondialdehyde increases following the hemodialysis session, and the conventional dialysate increased malondialdehyde levels more than the ultrapure dialysis but the differences were not statistically significant. PMID:24967229

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

    PubMed

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

    2016-04-01

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

  1. The Effect of Stretching Exercises on Severity of Restless Legs Syndrome in Patients on Hemodialysis

    PubMed Central

    Aliasgharpour, Mansooreh; Abbasi, Zahra; Pedram Razi, Shadan; Kazemnezhad, Anoshiravan

    2016-01-01

    Background The restless legs syndrome is a sensorimotor disorder that is very common in patients on hemodialysis. Due to pharmacological treatments which have their own side effects, nowadays, studies have turned to non-pharmacological treatments. Objectives The present study aims to assess the effect of stretching exercises on the severity of restless legs syndrome in patients on hemodialysis. Patients and Methods This clinical trial study was conducted on 33 patients who had been identified using diagnostic criteria from the hemodialysis ward of Hasheminejad Hospital in Tehran. Participants were randomly divided into the intervention group (n = 17) and control group (n = 16). Stretching exercises were performed on legs during the dialysis for half an hour, three times a week for 8 weeks in intervention group. Data were collected by using the international restless legs syndrome study group scale. Results The results showed that the majority of participants were suffering from moderate restless legs syndrome. The symptom severity of this syndrome meaningfully changed eight weeks after intervention in the intervention group compared to the control group (P < 0.001). Conclusions The results highlighted the significance of training and performing the stretching exercises during dialysis for the purpose of improving restless legs syndrome symptoms and the quality of care of hemodialysis patients. PMID:27625757

  2. Successful leukocytapheresis therapy in a patient with rheumatoid arthritis on maintenance hemodialysis.

    PubMed

    Maeshima, Keisuke; Torigoe, Masataka; Iwakura, Mikako; Yamanaka, Kunitoshi; Ishii, Koji

    2015-01-01

    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. PMID:24517518

  3. Benefits of the Nephros Dual Stage Ultrafilter in Chronic Hemodialysis Patients: Evidence for Improved ESA Responsiveness

    PubMed Central

    Valeri, Anthony; Lee, Bobby; Duffy, John; Ferrer, Robin; Vilotta, Ronald

    2016-01-01

    Installation of the Nephros Dual Stage Ultrafilter (DSU) added to a conventional hemodialysis unit to achieve ultrapure dialysate was tested in a group of 23 stable outpatients on chronic hemodialysis. Comparing the 6-month period prior to the installation of the filters (as baseline) to the 6-month period after the installation of the filters, we found a significant 40% reduction in the darbepoetin dose needed to maintain a stable hemoglobin level (p < 0.001). In addition, surrogate inflammatory markers, WBC count and serum albumin level, showed small but statistically significant improvements (p = 0.008 and p = 0.042, respectively). In conclusion, the use of the Nephros DSU to further reduce endotoxin exposure in chronic hemodialysis patients can result in improved erythropoiesis-stimulating agent (ESA) responsiveness and a lower ESA dose. PMID:26889475

  4. The Effect of Continuous Care Model on the Sleep Quality of Hemodialysis Patients

    PubMed Central

    Otaghi, Masoumeh; Bastami, Mohamadreza; Borji, Milad; Tayebi, Ali; Azami, Milad

    2016-01-01

    Background One of the most prevalent problems in hemodialysis patients is sleep disturbance. Poor sleep quality has unpleasant bio-psycho-social outcomes. The positive effects of implementing the continuous care model (CCM) were verified with different variables, including sleep quality. This study was done with different populations, using two groups. Objectives This study aims to identify the sleep quality of hemodialysis patients in the city of Ilam and determine the effects of CCM on sleep quality. Patients and Methods We performed a quasi-experimental research study with 56 hemodialysis patients at the Shahid Mostafa Hospital in Ilam during 2014 and 2015. Pretests and posttests were conducted with the study groups and the control groups. Pretests were conducted over a one-month period, then repeated immediately before the study. Posttests were conducted immediately after the study and then repeated one month later. Participants were selected by census method and randomly divided into two groups. Ethical considerations were observed. Based on the continuous care model, interventions were performed through educational sessions over a three-week period. Consultations for continuous sleep monitoring, controls, and evaluations were conducted with the study group over the next nine weeks. Data were gathered from patient demographics questionnaires and PQSI, then introduced in SPSS 22 and analyzed with descriptive and analytic statistics (t-paired, ANOVA with repeated measures, follow-up tests such as S-N-K, Duncan, Sheffe and Tukey). Results One month prior to the study, 94.6% of the participants suffered from poor sleep quality. Immediately before and after the study, 91% complained of poor sleep quality. And one month after intervention, the figure dropped to 82%. Applying the CCM positively affected the sleep quality of hemodialysis patients in Ilam, and was statistically meaningful one month after intervention (P = 0.001). Conclusions Hemodialysis patients need

  5. Polymorphism in methylenetetrahydrofolate reductase, plasminogen activator inhibitor-1, and apolipoprotein E in hemodialysis patients.

    PubMed

    Al-Muhanna, Fahad; Al-Mueilo, Samir; Al-Ali, Amein; Larbi, Emmanuel; Rubaish, Abdullah; Abdulmohsen, Mohammed Fakhry; Al-Zahrani, Alhussain; Al-Ateeq, Suad

    2008-11-01

    The methylenetetrahydrofolate reductase (MTHFR) gene polymorphism, apolipoprotein E (apo epsilon4) gene polymorphism and polymorphism of plasminogen activator inhibitor-1 (PAI-1) have been shown to be associated with end-stage renal disease (ESRD). To determine the prevalence of these mutations in Saudi patients with ESRD on hemodialysis, we studied the allelic frequency and genotype distribution in patients receiving hemodialysis and in a control group, all residing in the Eastern Province of Saudi Arabia. The genotypes were determined using allele specific hybridization procedures and were confirmed by restriction fragment length polymorphism. The T allele frequency and homozygous genotype of MTHFR in ESRD patients were 14% and 2.4%, respectively compared to 13.4% and 0%, respectively in the control group. The allele frequency and homozygous genotype of 4G/4G PAI-1 gene polymorphism were 46.4% and 4.8% respectively in ESRD patients compared to 57.1% and 32% respectively in the control group. The apo s4 allele frequency and homozygous genotype distribution in hemodialysis patients were 7% and 2.4%, respectively compared to 13% and 2% in the control group. Although allele frequency of C677T of MTHFR was statistically similar in the hemodialysis patients and in the control group, the homozygotes T allele genotype was over represented in the hemodialysis group compared to normal. The prevalence of PAI-1 4G/4G polymorphism in ESRD patients was lower when compared to the control group. The prevalence of apo s4 allele did not differ significantly between the two groups. The present results demonstrate that all three studied polymorphic mutations are present in our population and that they may contribute to the etiology of the disease in our area. PMID:18974580

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

    PubMed Central

    Burmeister, Jayme Eduardo; Mosmann, Camila Borges; Costa, Veridiana Borges; Saraiva, Ramiro Tubino; Grandi, Renata Rech; Bastos, Juliano Peixoto; Gonçalves, Luiz Felipe; Rosito, Guido Aranha

    2014-01-01

    Background There are scarce epidemiological data on cardiovascular risk profile of chronic hemodialysis patients in Brazil. Objective The CORDIAL study was designed to evaluate cardiovascular risk factors and follow up a hemodialysis population in a Brazilian metropolitan city. Methods 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. Results 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). Conclusion Hemodialysis patients in this southern metropolitan Brazilian city have a high prevalence of cardiovascular risk factors resembling many northern countries. PMID:24759948

  7. Febuxostat improves endothelial function in hemodialysis patients with hyperuricemia: A randomized controlled study.

    PubMed

    Tsuruta, Yuki; Kikuchi, Kan; Tsuruta, Yukio; Sasaki, Yuko; Moriyama, Takahito; Itabashi, Mitsuyo; Takei, Takashi; Uchida, Keiko; Akiba, Takashi; Tsuchiya, Ken; Nitta, Kosaku

    2015-10-01

    Endothelial dysfunction is often found in both hyperuricemia and hemodialysis patients. Recent studies have shown that treating hyperuricemia with allopurinol improves endothelial dysfunction. This study is performed to assess the effect of febuxostat on endothelial dysfunction in hemodialysis patients with hyperuricemia. We randomly assigned 53 hemodialysis patients with hyperuricemia to a febuxostat (10 mg daily) group and a control group and measured flow-mediated dilation, serum uric acid (UA) levels, systolic and diastolic blood pressure, malondialdehyde-modified low-density lipoprotein (MDA-LDL), and highly sensitive C-reactive protein (hsCRP) at baseline and at the end of a 4-week study period. Flow-mediated dilation increased from 5.3% ± 2.4% to 8.9% ± 3.6% in the febuxostat group but did not change significantly in the control group. Treatment with febuxostat resulted in a significant decrease in serum UA level and a significant decrease in MDA-LDL compared with baseline, but no significant difference was observed in hsCRP level or blood pressure. No significant differences were observed in the control group. Febuxostat improved endothelial dysfunction and reduced serum UA levels and oxidative stress in hemodialysis patients with hyperuricemia. PMID:25998500

  8. Low 25-hydroxyvitamin D levels and cognitive impairment in hemodialysis patients

    Technology Transfer Automated Retrieval System (TEKTRAN)

    25-hydroxyvitamin D (25[OH]D) deficiency and cognitive impairment are both prevalent in hemodialysis patients in the United States. This study tested the hypothesis that 25(OH)D deficiency may be associated with cognitive impairment because of its vasculoprotective, neuroprotective, and immune-modul...

  9. The Multidisciplinary Hemodialysis Patient Satisfaction Scale: Reliability, Validity, and Scale Development.

    ERIC Educational Resources Information Center

    Martin, Pamela Davis; Brantley, Philip J.; McKnight, G. Tipton; Jones, Glenn N.; Springer, Annette

    1997-01-01

    The development and preliminary reliability and validity studies are reported for the Multidisciplinary Hemodialysis Patient Satisfaction Scale, a 110-item Likert scale that assesses satisfaction with team health care services. The methods used to construct subscales may have implications for other psychometric studies of satisfaction and quality…

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

    PubMed

    Ekart, Robert; Hojs, Radovan

    2016-07-01

    Obesity is a chronic disease that is increasingly prevalent around the world and is a well-recognized risk factor for type 2 diabetes and hypertension, leading causes of end-stage renal disease (ESRD). The obese diabetic patient with ESRD is a challenge for the nephrologist with regard to the type of renal replacement therapy that should be suggested and offered to the patient. There is no evidence that either peritoneal dialysis or hemodialysis is contraindicated in obese ESRD patients. In the literature, we can find a discrepancy in the impact of obesity on mortality among hemodialysis vs. peritoneal dialysis patients. Several studies in hemodialysis patients suggest that a higher BMI confers a survival advantage - the so-called "reverse epidemiology". In contrast, the literature among obese peritoneal dialysis patients is inconsistent, with various studies reporting an increased risk of death, no difference, or a decreased risk of death. Many of these studies only spanned across a few years, and this is probably too short of a time frame for a realistic assessment of obesity's impact on mortality in ESRD patients. The decision for dialysis modality in an obese diabetic patient with ESRD should be individualized. According to the results of published studies, we cannot suggest PD or HD as a better solution for all obese diabetic patients. The obese patient should be educated about all their dialysis options, including home dialysis therapies. In this review, the available literature related to the dialysis modality in obese patients with diabetes and ESRD was reviewed. PMID:27067614

  11. Dialysis-related factors affecting quality of life in patients on hemodialysis.

    PubMed

    Anees, Muhammad; Hameed, Farooq; Mumtaz, Asim; Ibrahim, Muhammad; Saeed Khan, Muhammad Nasir

    2011-01-01

    INTRODUCTION. Treatment modalities for end-stage renal disease affect quality of life (QOL) of the patients. This study was conducted to assess the QOL of patients on hemodialysis and compare it with caregivers of these patients. Cause of ESRD and dialysis-related factors affecting QOL were also examined. MATERIALS AND METHODS. This cross-sectional study was conducted on patient on maintenance hemodialysis for more than 3 months at 3 dialysis centers of Lahore. Fifty healthy individuals were included as controls from among the patients' caregivers. The QOL index was measured using the World Health Organization QOL questionnaire, with higher scores corresponding to better QOL of patients. RESULTS. Eighty-nine patients (71.2%) were men, 99 (79.2%) were married, 75 (60.0%) were older than 45 years, and 77 (61.6%) were on dialysis for more than 8 months. Patients on hemodialysis had a poorer QOL as compared to their caregivers in all domains except for domain 4 (environment). There was no difference in the QOL between the three dialysis centers of the study, except for domain 3 (social relationship) of the patients at Mayo Hospital (a public hospital), which was significantly better. Nondiabetic patients had a better QOL in domain 1 (physical health) as compared to diabetic patients. Duration of dialysis had a reverse correlation with the overall QOL. CONCLUSIONS. We found that QOL of hemodialysis patients was poor as compared to caregivers of the patients, especially that of diabetics. Also, duration of dialysis had a reverse correlation with QOL. PMID:21189427

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

    PubMed

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

    2016-07-01

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

  13. Telomeric G-Tail Length and Hospitalization for Cardiovascular Events in Hemodialysis Patients

    PubMed Central

    Hirashio, Shuma; Nakashima, Ayumu; Doi, Shigehiro; Anno, Kumiko; Aoki, Eriko; Shimamoto, Akira; Yorioka, Noriaki; Kohno, Nobuoki; Masaki, Takao

    2014-01-01

    Background and objectives Telomeric G-tails play a pivotal role in maintaining the intramolecular loop structure of telomeres. Previous in vitro studies have suggested that the erosion of telomeric G-tails triggers cellular senescence, leading to organ dysfunction and atherosclerosis. The authors recently established a method to measure telomeric G-tail length using a hybridization protection assay. Using this method, this study investigated whether telomeric G-tail length could be used as a novel predictor for future cardiovascular events in hemodialysis patients. Design, setting, participants, & measurements A prospective observational study was performed involving a cohort of 203 Japanese hemodialysis patients to examine the lengths of telomeric G-tails and total telomeres and subsequent cardiovascular events during a median follow-up period of 48 months. The lengths of telomeric G-tails and total telomeres were also measured in 203 participants who did not have CKD and who were age- and sex-matched to hemodialysis patients. Results The lengths of telomeric G-tails and total telomeres were significantly shorter in hemodialysis patients than in control subjects. Telomeric G-tails, but not total telomeres, were independently and negatively associated with clinical history of cardiovascular disease. During follow-up, 80 cardiovascular events occurred. Total telomere length did not predict cardiovascular events. However, the length of telomeric G-tails was associated with new-onset cardiovascular events (hazard ratio per log luminescence signals, 0.12; 95% confidence interval, 0.12 to 0.50) that persisted after adjustment for age, sex, diabetes mellitus, clinical history of cardiovascular disease, inflammation, use of vitamin D, and serum levels of phosphate and intact parathyroid hormone. Conclusions Longer telomeric G-tail length is associated with a lower risk of future cardiovascular events in hemodialysis patients. PMID:25237070

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

    Md Yusop, Nor Baizura; Yoke Mun, Chan; Shariff, Zalilah Mohd; Beng Huat, Choo

    2013-01-01

    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

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

    PubMed

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

    2016-09-01

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

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

    PubMed

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

    2016-01-01

    When the kidney is seriously impaired, various uremic toxins (UTs) accumulate in the body, often exerting unfavorable effects on physiological functions and drug pharmacokinetics. To prevent this, it is important to determine plasma UT levels accurately in chronic kidney disease patients. Although attempts to predict plasma UT levels using biomarkers have been made, the correlation between UT levels and the markers is not yet fully understood. In this study, we assessed the correlations among plasma levels of indoxyl sulfate (IS), indoleacetic acid (IA), and 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid (CMPF) in 20 hemodialysis patients and evaluated the relationship between the plasma levels of UTs and clinical parameters, such as serum creatinine (Scr), blood urea nitrogen, and estimated glomerular filtration rate (eGFR), with special focus on IS. There were no correlations among the plasma levels of the three UTs before and immediately after hemodialysis. However, a significant correlation was observed between plasma IS levels and Scr before hemodialysis (r=0.643, p=0.002), with the correlation becoming much stronger when using the data obtained immediately after hemodialysis (r=0.744, p<0.001). Further, plasma IS levels showed a significant negative correlation with eGFR (r=-0.558, p=0.011). However, no correlations were observed for IA or CMPF. The results obtained from this study suggest that plasma IS levels can be predicted from Scr values, although the precise mechanism behind the correlation remains to be clarified. PMID:27477735

  18. Methemoglobinemia in critically ill patients during extended hemodialysis and simultaneous disinfection of the hospital water supply

    PubMed Central

    2009-01-01

    Introduction To evaluate the cause of methemoglobinemia in patients undergoing extended daily hemodialysis/hemodiafiltration we analyzed the relationship between methemoglobinemia and the water disinfection schedule of the hospital. Methods We reviewed all arterial blood gas analyses, obtained over a one-year period, in patients undergoing extended hemodialysis/hemodiafiltration, and compared the methemoglobin concentrations obtained on the days when the water supply was disinfected, using a hydrogen peroxide/silver ion preparation, with data measured on disinfection-free days. Results The evaluation of 706 measurements revealed a maximum methemoglobin fraction of 1.0 (0.8; 1.2) % (median and 25th; 75th percentiles) during hemodialysis/hemodiafiltration on the disinfection-free days. The methemoglobin fraction increased to 5.9 (1.3; 8.4) % with a maximal value of 12.2% on the days of water disinfection (P < 0.001 compared to disinfection-free days). Spot checks on hydrogen peroxide concentrations in the water supply, the permeate, and the dialysate, using a semi-quantitative test, demonstrated levels between 10 and 25 mg/l during water disinfection. Conclusions Our results demonstrate that even a regular hospital water disinfection technique can be associated with significant methemoglobinemia during extended hemodialysis. Clinicians should be aware of this potential hazard. PMID:19821985

  19. Efficacy and Safety of Roflumilast in Korean Patients with COPD

    PubMed Central

    Lee, Jae Seung; Hong, Yoon Ki; Park, Tae Sun; Lee, Sei Won; Oh, Yeon-Mok

    2016-01-01

    Purpose Roflumilast is the only oral phosphodiesterase 4 inhibitor approved to treat chronic obstructive pulmonary disease (COPD) patients [post-bronchodilator forced expiratory volume in 1 second (FEV1) <50% predicted] with chronic bronchitis and a history of frequent exacerbations. This study evaluated the efficacy and safety of roflumilast in Korean patients with COPD and compared the efficacy based on the severity of airflow limitation. Materials and Methods A post-hoc subgroup analysis was performed in Korean COPD patients participating in JADE, a 12-week, double-blinded, placebo-controlled, parallel-group, phase III trial in Asia. The primary efficacy endpoint was the mean [least-squares mean adjusted for covariates (LSMean)] change in post-bronchodilator FEV1 from baseline to each post-randomization visit. Safety endpoints included adverse events (AEs) and changes in laboratory values, vital signs, and electrocardiograms. Results A total of 260 Korean COPD patients were recruited, of which 207 were randomized to roflumilast (n=102) or placebo (n=105) treatment. After 12 weeks, LSMean post-bronchodilator FEV1 increased by 43 mL for patients receiving roflumilast and decreased by 60 mL for those taking placebo. Adverse events were more common in the roflumilast group than in the placebo group; however, the types and frequency of AEs were comparable to those reported in previous studies. Conclusion Roflumilast significantly improved lung function with a tolerable safety profile in Korean COPD patients irrespective of the severity of airflow limitation. PMID:27189287

  20. Zinc deficiency anemia and effects of zinc therapy in maintenance hemodialysis patients.

    PubMed

    Fukushima, Tatsuo; Horike, Hideyuki; Fujiki, Shigeatsu; Kitada, Shingo; Sasaki, Tamaki; Kashihara, Naoki

    2009-06-01

    Quantitative adjuvant zinc therapy using polaprezinc was performed to examine the correlation between zinc concentration and anemia in maintenance hemodialysis patients to propose appropriate treatment. Anemia and serum zinc concentration were measured in 117 patients with chronic renal failure receiving outpatient maintenance hemodialysis at Tsuyama Chuo Kinen Hospital. Two bags of polaprezinc (containing zinc 34 mg/day) were administered to 58 patients with lower than normal zinc levels (Zn < 80 mg/dl) as adjuvant zinc therapy to assess anemia improvement. Zinc concentration and all anemia parameters showed significant positive correlation, indicating that anemia improves in patients with high serum zinc levels. Regarding the effects of adjuvant zinc therapy for improving anemia, hemoglobin levels were found to increase significantly to the highest value at 3 weeks. During treatment, the dosage of erythropoietin was reduced significantly from baseline at all assessment points. No zinc poisoning from therapy was seen, but two patients had diarrhea (1.9%). Zinc-treated patients required iron therapy due to the development of iron deficiency. Most maintenance hemodialysis patients suffer from zinc deficiency anemia, and zinc-based polaprezinc has been confirmed to be an effective and safe adjuvant zinc treatment. Most patients diagnosed as refractory anemia with no response to erythropoietin also suffer from zinc deficiency anemia, many of whom are expected to benefit from zinc therapy to improve their anemia. Possible zinc deficiency anemia should be considered in the treatment of refractory anemia with no response to erythropoietin. PMID:19527468

  1. Risk Factors of HCV Seroconversion in Hemodialysis Patients in Tabriz, Iran

    PubMed Central

    Somi, Mohammad Hossein; Etemadi, Jalal; Ghojazadeh, Morteza; Farhang, Sara; Faramarzi, Mehrasa; Foroutan, Sanaz; Soleimanpour, Maryam

    2014-01-01

    Background: Hepatitis C virus (HCV) infection is a significant health concern in patients with end-stage renal disease under dialysis. Epidemiological studies have reported a prevalence rate of 5.5-55.9% for this condition in Iran. Objectives: We evaluated the risk factors for HCV infection and seroconversion in hemodialysis patients. Patients and Methods: A retrospective analysis was performed on 455 hemodialysis patients from each of the five dialysis units in Tabriz, northwest Iran. Possible risk factors for HCV infection and seroconversion were evaluated. Results: A total of 37 patients were HCV positive (8.1% of the study population) and seroconversion occurred in 18 of them during the dialysis treatment (3.95% of the study population). History of renal transplantation (44.4%, P < 0.0001), surgical intervention (except for renal transplantation and AV fistula placement) (94.4%, P = 0.03), and mean duration of dialysis (106.06 ± 55.519, P < 0.0001) had strong statistically significant associations with the seroconversion. Conclusions: The current study indicates increased risk for HCV infection in patients under dialysis and its relation with the mean duration of hemodialysis, history of renal transplantation and surgical intervention. Considering the immune deficiency in these patients, intense education to both patients and medical staff will be beneficial. PMID:24976839

  2. Effectiveness of Self-Care Education on the Enhancement of the Self-Esteem of Patients Undergoing Hemodialysis

    PubMed Central

    Poorgholami, Farzad; Javadpour, Shohreh; Saadatmand, Vahid; Jahromi, Marzieh Kargar

    2016-01-01

    Introduction and Aim: 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. Method and material: 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. Result: According to the results, Paired t-test showed a significant difference between the mean self-esteem score in both groups before and after intervention. Conclusion: 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. PMID:26383201

  3. Insomnia and Restless Leg Syndrome in Patients Undergoing Chronic Hemodialysis in Rafsanjan Ali Ibn Abitaleb Hospital

    PubMed Central

    Hasheminasab Zaware, Roshanak; Mahmoodi Meymand, Mohammad Hossein; Rezaeian, Mohsen; Mohammadi Kamalabadi, Niloofar; Mostafavi, Seyed-Ali; Abdolkarimi Dawarani, Mohammad Ali; Jome Yazdian, Reyhane; Bidaki, Reza

    2016-01-01

    Background: Sleep is one of the most fundamental human needs; without any doubt sleep is even more essential for sick patients, especially for patients with chronic illnesses. Sleep disturbance may lead to anxiety and reduced quality of life. Restless leg syndrome (RLS) is a sensory-motor disorder accompanied by a strong desire to move the legs or other parts of the body, which can cause sleep disturbance. Its etiology is unknown, but increased urea and creatinine levels before dialysis, iron deficiency due to kidney failure and end-stage renal disease (ESRD) are mentioned as causes. Objectives: This study is designed to examine the prevalence of insomnia and restless leg syndrome in patients undergoing chronic hemodialysis in Rafsanjan Ali Ibn Abitaleb Hospital. Patients and Methods: In this study we used two questionnaires to evaluate the presence of RLS and insomnia in ESRD patients who were undergoing hemodialysis treatment as kidney replacement therapy. Results: According to our results, 54.5% of patients were diagnosed with RLS, and of those 65.2% and 42.9% were women and men, respectively. RLS is seen more often among patients with blood group type A, but this result was not statistically significant. There was a statistically significant correlation between RLS and a positive family history of RLS, between RLS and the number of hemodialysis treatments per week and also between RLS and the Insomnia Severity Index. Unlike previous studies, in this study we did not find any statistically significant correlation between RLS and biochemical factors such as serum iron, TIBC, BUN, creatinine, potassium, calcium and phosphorous levels. Conclusions: The frequency of RLS among our patients was remarkable and we conclude that all patients who are undergoing hemodialysis should be screened for RLS, which can assist in providing proper attention and treatment. PMID:26981494

  4. Unexpected Abscess Localization of the Anterior Abdominal Wall in an ADPKD Patient Undergoing Hemodialysis.

    PubMed

    Sabanis, Nikos; Paschou, Eleni; Gavriilaki, Eleni; Mourounoglou, Maria; Vasileiou, Sotirios

    2015-01-01

    Autosomal Dominant Polycystic Kidney Disease (ADPKD) is one of the most common monogenic disorders and the leading inheritable cause of end-stage renal disease worldwide. Cystic and noncystic extrarenal manifestations are correlated with variable clinical presentations so that an inherited disorder is now considered a systemic disease. Kidney and liver cystic infections are the most common infectious complications in ADPKD patients. Furthermore, it is well known that ADPKD is commonly associated with colonic diverticular disease which recently has been reported to be linked to increased risk of infection on hemodialysis patients. Herein, we present a case of anterior abdominal wall abscess caused by Enterococcus faecalis in a patient with ADPKD undergoing hemodialysis. Although the precise pathway of infection remains uncertain, the previous medical history as well as the clinical course of our patient led us to hypothesize an alternative route of infection from the gastrointestinal tract through an aberrant intestinal barrier into the bloodstream and eventually to an atypical location. PMID:26301109

  5. Translumbar placement of paired hemodialysis catheters (Tesio Catheters) and follow-up in 10 patients

    SciTech Connect

    Biswal, Rajiv; Nosher, John L.; Siegel, Randall L.; Bodner, Leonard J.

    2000-01-15

    For lack of other suitable access, 10 consecutive patients received paired hemodialysis catheters for long-term hemodialysis using a translumbar approach to the inferior vena cava (IVC). All attempts were successful. Five paired catheters were placed using the single-puncture technique, and five using the dual-puncture technique. Catheters were in place for a total of 2252 catheter days. The average duration of catheter placement was 250 days (range 30-580 days). All catheters were functioning up to the time the study was completed or the patient died. The most common complication was partial dislodgment of the catheter in 3 of 23 catheters (13%), all occurring in obese patients. One episode of retroperitoneal hemorrhage was noted in a patient having the single-access technique. There were no episodes of infection or IVC thrombosis.

  6. Risk stratification for cardiac death in hemodialysis patients without obstructive coronary artery disease.

    PubMed

    Nishimura, Masato; Tsukamoto, Kazumasa; Tamaki, Nagara; Kikuchi, Kenjiro; Iwamoto, Noriyuki; Ono, Toshihiko

    2011-02-01

    The incidence of cardiac death is higher among patients receiving dialysis compared with the general population. Although obstructive coronary artery disease is involved in cardiac deaths in the general population, deaths in hemodialysis patients occur in the apparent absence of obstructive coronary artery disease. To study this further, we prospectively enrolled 155 patients receiving hemodialysis after angiography had confirmed the absence of obstructive coronary lesions. All patients were examined by single-photon emission computed tomography using the iodinated fatty acid analog, BMIPP, the uptake of which was graded in 17 standard myocardial segments and assessed as summed scores. Insulin resistance was determined using the homeostasis model assessment index of insulin resistance (HOMA-IR). During a mean follow-up of 5.1 years, 42 patients died of cardiac events. Stepwise Cox hazard analysis associated cardiac death with reduced BMIPP uptake and increased insulin resistance. Patients were assigned to subgroups based on BMIPP summed scores and HOMA-IR cutoff values for cardiac death of 12 and 5.1, respectively, determined by receiver operating characteristic analysis. Cardiac death-free survival rates at 5 years were the lowest (32.2%) in the subgroup with both a summed score and assessment equal to or above the cutoff values compared with any other combination (52.9-98.7%) above, equal to, or below the thresholds. Thus, impaired myocardial fatty acid metabolism and insulin resistance may be associated with cardiac death among hemodialysis patients without obstructive coronary artery disease. PMID:20944544

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

    PubMed

    Desseix, Aurélie; Merville, Pierre; Couzi, Lionel

    2010-04-01

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

  8. Successful Management of Recurrent Colon Ulcer in Hemodialysis Patient after Conversion to Peritoneal Dialysis.

    PubMed

    Lee, Ji Young; Moon, In Tae; Lee, Hye Young; Lee, Hang Lak; Han, Dong Soo

    2015-12-01

    Lower gastrointestinal complications often develop in end stage renal disease patients, and among the more problematic is recurrent colon ulcer. The exact pathogenesis of this condition is not known and there were no specific therapeutic modalities concerning this type of disease entity. We report, with a literature review, a case of recurrent colon ulcer with intermittent hematochezia in an end stage renal disease patient on long term hemodialysis that improved after conversion to peritoneal dialysis. PMID:26691193

  9. The adaptation problems of patients undergoing hemodialysis: socio-economic and clinical aspects1

    PubMed Central

    Frazão, Cecília Maria Farias de Queiroz; de Sá, Jéssica Dantas; Medeiros, Ana Beatriz de Almeida; Fernandes, Maria Isabel da Conceição Dias; Lira, Ana Luisa Brandão de Carvalho; Lopes, Marcos Venícios de Oliveira

    2014-01-01

    OBJECTIVES: to identify adaptation problems under Roy's Model in patients undergoing hemodialysis and to correlate them with the socioeconomic and clinical aspects. METHOD: a transversal study, undertaken using a questionnaire. The sample was made up of 178 individuals. The Chi-squared and Mann-Whitney U tests were undertaken. RESULTS: the adaptation problems and the socioeconomic and clinical aspects which presented statistical associations were: Hyperkalemia and age; Edema and income; Impairment of a primary sense: touch and income; Role failure and age; Sexual dysfunction and marital status and sex; Impairment of a primary sense: vision and years of education; Intolerance to activity and years of education; Chronic pain and sex and years of education; Impaired skin integrity and age: Hypocalcemia and access; Potential for injury and age and years of education; Nutrition below the organism's requirements and age; Impairment of a primary sense: hearing and sex and kinetic evaluation of urea; Mobility in gait and/or coordination restricted, and months of hemodialysis; and, Loss of ability for self-care, and months of hemodialysis and months of illness. CONCLUSION: adaptation problems in the clientele undergoing hemodialysis can be influenced by socioeconomic/clinical data. These findings contribute to the development of the profession, fostering the nurse's reflection regarding the care. PMID:25591091

  10. Prepare the patient for future challenges when facing hemodialysis: nurses' experiences

    PubMed Central

    Sturesson, Anna; Ziegert, Kristina

    2014-01-01

    Chronic kidney disease is a major health problem due to the significant financial burden for the healthcare system and likewise for the patient who needs the treatment. The patient's whole life situation is turned upside down with chronic kidney disease when they are confronted with the forced change to start treatment with hemodialysis. Patients with chronic kidney disease experience a lack of adequate emotional support from nurses during the transition to hemodialysis. The purpose of this study was to explore nurses’ experiences of giving support to patients during the transition to hospital-bound hemodialysis. The study had a qualitative descriptive design with a content analysis approach; eight nurses from four hospitals in the south of Sweden participated. The results showed that the nurses gave threshold support with an openness and awareness of the patient's individual needs during the transition, except that there seemed to be a lack of knowledge and ability to provide emotional support. Patient support during the transition could therefore be absent. Education, at local and national levels, is needed for the nurse to be able to give professional emotional support. Further research is also desired in order to provide nurses with the tools they need to give emotional support, which is of utmost importance. PMID:24717268

  11. Serum Soluble (Pro)Renin Receptor Levels in Maintenance Hemodialysis Patients

    PubMed Central

    Amari, Yoshifumi; Morimoto, Satoshi; Nakajima, Fumitaka; Ando, Takashi; Ichihara, Atsuhiro

    2016-01-01

    The (pro)renin receptor [(P)RR] is cleaved by furin to generate soluble (P)RR [s(P)RR], which reflects the status of the tissue renin-angiotensin system. Hemodialysis patients have advanced atherosclerosis. The aim of this study was to investigate the relationships between serum s(P)RR levels and background factors, including indices of atherosclerosis, in hemodialysis patients. Serum s(P)RR levels were measured in hemodialysis patients and clearance of s(P)RR through the membrane of the dialyzer was examined. Furthermore, relationships between serum s(P)RR levels and background factors were assessed. Serum s(P)RR levels were significantly higher in hemodialysis patients (30.4 ± 6.1 ng/ml, n = 258) than those in subjects with normal renal function (21.4 ± 6.2 ng/ml, n = 39, P < 0.0001). Clearance of s(P)RR and creatinine were 56.9 ± 33.5 and 147.6 ± 9.50 ml/min, respectively. Serum s(P)RR levels were significantly higher in those with ankle-brachial index (ABI) of < 0.9, an indicator of severe atherosclerosis, than those with ABI of ≥ 0.9 (32.2 ± 5.9 and 30.1 ± 6.2 ng/ml, respectively, P < 0.05). An association between low ABI and high serum s(P)RR levels was observed even after correction for age, history of smoking, HbA1c, and LDL-C. Serum s(P)RR levels were significantly higher in hemodialysis patients when compared with subjects with normal renal function, although s(P)RR is dialyzed to some extent, but to a lesser extent than creatinine. High serum s(P)RR levels may be associated with atherosclerosis independent of other risk factors, suggesting that serum s(P)RR could be used as a marker for atherosclerotic conditions in hemodialysis patients. PMID:27367528

  12. Diagnosis of pheochromocytoma in a hemodialysis patient through measurement of plasma catecholamines.

    PubMed

    Vantomme, Bram; Donck, Jan; van Hooland, Simon; Wauters, Anne; De Clippele, Marc; Neirynck, Valerie; Huysman, Frédérique

    2016-07-01

    We report the case of a patient on chronic hemodialysis treatment with paroxysms of severe arterial hypertension accompanied by tachycardia, pallor, sweating and tremor. Measurement of plasma catecholamines revealed norepinephrine level of 4625 pg/mL (reference range 191-225 pg/mL), epinephrine level of 1035 pg/mL (58-76 pg/mL) and dopamine level of 148 pg/mL (50-100 pg/mL). MRI showed a left adrenal mass of 2 cm. After the patient was started on an alpha-1 adrenergic receptor blocker, she underwent a left adrenalectomy. Anatomopathological examination confirmed the diagnosis of pheochromocytoma. Although urinary testing is not possible in anuric hemodialysis patients, diagnosis of pheochromocytoma can be made through measurement of plasma free metanephrines and/or plasma catecholamines. PMID:26749316

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

    PubMed

    McIntyre, Christopher W; Goldsmith, David J

    2015-06-01

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

  14. Use of arsenic trioxide in a hemodialysis-dependent patient with relapsed acute promyelocytic leukemia.

    PubMed

    Perreault, Sarah; Moeller, Julie; Patel, Kejal; Eyler, Rachel; Pham, Trinh; Russell, Kerry; Podoltsev, Nikolai

    2016-08-01

    Arsenic trioxide has been established for use in both relapsed and front-line treatment of acute promyelocytic leukemia. Dose adjustments are recommended to be considered in severe renal impairment although dosage reduction guidelines are not provided. In addition, toxicities of arsenic are significant. The use of arsenic trioxide has not been well studied in dialysis patients and there is a paucity of data in the literature to support the use in such a situation. We describe an 81-year-old relapsed acute promyelocytic leukemia hemodialysis-dependent patient with a pre-existing cardiac condition who was treated with 10 mg arsenic trioxide three times weekly after dialysis. These findings provide support along with the marginal amount of currently published data for an arsenic trioxide dosing regimen in hemodialysis patients. PMID:25972392

  15. Lack of seasonal variation in blood pressure in patients on hemodialysis in a North American center.

    PubMed

    Fine, A

    2000-09-01

    Seasonal variation in blood pressure in patients undergoing hemodialysis in Europe has recently been described. If confirmed, this has important therapeutic, research, and epidemiological implications. All normotensive patients not administered antihypertensive drugs in our unit were studied. Predialysis blood pressures were measured before each dialysis treatment over two 2-month periods, January through February and July through August, in Winnipeg, Canada, a city with one of the most extreme seasonal temperature variations in North America. No difference in blood pressures was found between summer and winter (141 +/- 5/75 +/- 2 versus 140 +/- 4/74 +/- 2 mm Hg; P = not significant). Average daily temperatures were -16 degrees C in winter and 23 degrees C in summer. Interdialytic weight gain was the same in both groups. In conclusion, season has no effect on blood pressure in hemodialysis patients in a North American center. Reported seasonal changes in blood pressure in Europe may be related to nonclimatic factors. PMID:10977788

  16. [Primary testicular malignant lymphoma in a hemodialysis patient : a case report].

    PubMed

    Nakatsuji, Hiroyoshi; Sakaki, Manabu; Hamao, Takumi

    2015-02-01

    We report a case of testicular malignant lymphoma in a hemodialysis patient. A 65-year-old man who had been undergoing hemodialysis for 8 years and 10 months consulted our hospital with right testicular enlargement in August 2012. Under a diagnosis of testicular cancer from manipulation test and ultrasonography, high orchiectomy was performed. Computed tomography showed swelling of the retroperitoneal lymph nodes. Histopathological examination revealed diffuse, non-Hodgkin B-cell lymphoma, CD20+. R-CHOP chemotherapy was initiated and retroperitoneal lymph node swelling completely disappeared after 1 cycle of chemotherapy. After completing 2 cycles of chemotherapy, the patient developed interstitial pneumonia, and thus radiotherapy to the retroperitoneal space including the left testis was performed. As of July 2014, the patient remains alive without recurrence. PMID:25812596

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

    PubMed Central

    Ferris, Maria; Gibson, Keisha; Plattner, Brett; Gipson, Debbie S.; Kotanko, Peter; Marcelli, Daniele; Marelli, Cristina; Etter, Michael; Carioni, Paola; von Gersdorff, Gero; Xu, Xiaoqi; Kooman, Jeroen P.; Xiao, Qingqing; van der Sande, Frank M.; Power, Albert; Picoits-Filho, Roberto; Sylvestre, Lucimary; Westreich, Katherine; Usvyat, Len

    2016-01-01

    Background The aim of this study was to describe the experience of pediatric and young adult hemodialysis (HD) patients from a global cohort. Methods The Pediatric Investigation and Close Collaborative Consortium for Ongoing Life Outcomes for MONitoring Dialysis Outcomes (PICCOLO MONDO) study provided de-identified electronic information of 3244 patients, ages 0–30 years from 2000 to 2012 in four regions: Asia, Europe, North America and South America. The study sample was categorized into pediatric (≤18 years old) and young adult (19–30 years old) groups based on the age at dialysis initiation. Results For those with known end-stage renal disease etiology, glomerular disease was the most common diagnosis in children and young adults. Using Europe as a reference group, North America [odds ratio (OR) 2.69; CI 1.29, 5.63] and South America (OR 4.21; CI 2.32, 7.63) had the greatest mortality among young adults. North America also had higher rates of overweight, obesity, hypertension, cardiovascular disease, hospitalizations and secondary diabetes compared with all other regions. Initial catheter use was greater for North American (86.4% in pediatric patients and 75.2% in young adults) and South America (80.6% in pediatric patients and 75.9% in young adults). Catheter use at 1-year follow-up was most common in North American children (77.3%) and young adults (62.9%). Asia had the lowest rate of catheter use. For both age groups, dialysis adequacy (equilibrated Kt/V) ranged between 1.4 and 1.5. In Asia, patients in both age groups had significantly longer treatment times than in any other region. Conclusions The PICCOLO MONDO study has provided unique baseline and 1-year follow-up information on children and young adults receiving HD around the globe. This cohort has brought to light aspects of care in these age groups that warrant further investigation. PMID:26985383

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

    PubMed

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

    2015-01-01

    Background. Uremic pruritus (UP) is a common symptom in patients undergoing maintenance hemodialysis for end-stage renal disease (ESRD). Objective. To determine the clinical efficacy of auricular acupressure therapy on pruritus in hemodialysis patients and to explore possible underlying mechanisms. Methods. Patients receiving maintenance hemodialysis at a referral medical center were recruited and assigned to intervention (n = 32) and control (n = 30) groups. The intervention group underwent auricular acupressure treatment three times a week for six weeks. Auricular acupressure was not applied to patients in the control group. However, tape without Vaccaria seeds was applied to the same six auricular acupoints as the intervention group. Pruritus scores were assessed using VAS scores, and enzyme-linked immunosorbent assays (ELISA) were used to measure levels of other possible contributory biochemical factors. Results. There was a significant difference in mean VAS scores between the postintervention and control groups during follow-up (3.844 ± 1.687 versus 5.567 ± 2.285, F = 22.32, P < 0.0001). Compared to the control group, serum histamine levels in the postintervention group at the six-week follow-up had decreased significantly (F = 5.01, P = 0.0290). Conclusion. Our findings suggest that auricular acupressure may be a useful treatment in the multidisciplinary management of UP in ESRD patients. PMID:26495017

  19. Production of proinflammatory and regulatory monokines in hemodialysis patients shown at a single-cell level.

    PubMed

    Girndt, M; Sester, U; Kaul, H; Köhler, H

    1998-09-01

    Immunologic complications of chronic renal failure are associated with the overproduction of proinflammatory cytokines by monocytes. This is partly due to renal failure itself but is further enhanced by hemodialysis treatment with frequent contact between blood and dialyzer membranes. Previous studies have shown an imbalance of proinflammatory and regulatory monokines in these patients. This study examines monokine production in hemodialysis patients using for the first time a very sensitive method of cytokine detection at a single-cell level by flow cytometry ("cytoflow technique"). Monocytes were stained intracellularly for the production of interleukin-6 (IL-6) and IL-10 after 20 h of culture with lipopolysaccharide. It was shown that high levels of proinflammatory IL-6 in hemodialysis patients are due to an increased number of monocytes producing this cytokine, while IL-6 synthesis per cell remains unchanged. In contrast, elevated levels of regulatory IL-10 are due to an increased synthesis per cell. This study demonstrates that in healthy subjects there is a population of monocytes producing exclusively IL-10 after 20 h of stimulation by lipopolysaccharide. This distinct population of regulatory monocytes is infrequent in dialysis patients, in whom most of the IL-10-positive monocytes also produce IL-6. These findings indicate that overproduction of proinflammatory factors in dialysis patients is at least in part due to a loss of cytokine-specific differentiation in monocytes. PMID:9727378

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

    PubMed Central

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

    2015-01-01

    Background. Uremic pruritus (UP) is a common symptom in patients undergoing maintenance hemodialysis for end-stage renal disease (ESRD). Objective. To determine the clinical efficacy of auricular acupressure therapy on pruritus in hemodialysis patients and to explore possible underlying mechanisms. Methods. Patients receiving maintenance hemodialysis at a referral medical center were recruited and assigned to intervention (n = 32) and control (n = 30) groups. The intervention group underwent auricular acupressure treatment three times a week for six weeks. Auricular acupressure was not applied to patients in the control group. However, tape without Vaccaria seeds was applied to the same six auricular acupoints as the intervention group. Pruritus scores were assessed using VAS scores, and enzyme-linked immunosorbent assays (ELISA) were used to measure levels of other possible contributory biochemical factors. Results. There was a significant difference in mean VAS scores between the postintervention and control groups during follow-up (3.844 ± 1.687 versus 5.567 ± 2.285, F = 22.32, P < 0.0001). Compared to the control group, serum histamine levels in the postintervention group at the six-week follow-up had decreased significantly (F = 5.01, P = 0.0290). Conclusion. Our findings suggest that auricular acupressure may be a useful treatment in the multidisciplinary management of UP in ESRD patients. PMID:26495017

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

    ClinicalTrials.gov

    2014-10-09

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

  2. Citrate Anticoagulation in Tandem Membrane Plasma-Exchange or Immunoadsorption and Hemodialysis in Patients With Immunological Diseases and Dialysis-Dependence.

    PubMed

    Ponikvar, Rafael; Gubenšek, Jakob; Ponikvar, Jadranka Buturović

    2016-06-01

    In 1996 we performed tandem membrane plasma exchange-hemodialysis in a 3-year-old girl and tandem immunoadsorption-hemodialysis with citrate as the only anticoagulant in a patient with Goodpasture's syndrome. In the present study, we evaluated the feasibility, efficacy and safety of 24 tandem plasma exchange/immunoadsorption hemodialysis procedures in four different circuit setups with citrate as the only anticoagulant. In two setups, the tandem procedures were connected in series (plasma exchange hemodialysis and immunoadsorption hemodialysis), while in the other two setups they were in parallel (plasma exchange hemodialysis with independent blood circuits and plasma exchange hemodialysis with independent arterial blood lines, but with a common return line). All tandem procedures were feasible, efficient and safe. No serious side-effects were recorded. The most elegant setup was the procedure with independent, parallel blood circuits. However, serial tandem procedures provided for the elimination of citrate and normalization of electrolytes before blood was returned to the patient. PMID:27312909

  3. The Impact of Hemodialysis on Sexual Function in Male Patients using the International Index of Erectile Function Questionnaire (IIEF)

    PubMed Central

    Savadi, Hossein; Khaki, Morteza; Javnbakht, Maryam; Pourrafiee, Hasan

    2016-01-01

    Introduction Routine hemodialysis is one of the preferred treatment methods in patients with chronic kidney disease. It seems that routine hemodialysis can be effective in improving sexual function in these patients. This study aimed to determine the effect of routine dialysis sessions over a six-month period on the status of sexual function in men with chronic renal failure using the International Index of Erectile Function (IIEF) questionnaire. Methods The cross-sectional study was conducted from November 2015 to November 2016 on patients with chronic renal failure who were first-time candidates for routine hemodialysis and who were referred to Imam Reza Hospital of Mashhad. All of the patients completed the IIEF questionnaire before their first hemodialysis. Afterwards, all of the patients underwent routine dialysis sessions over a six-month period and completed the IIEF questionnaire again at the end of the sixth month. The prevalence of sexual dysfunction was assessed before and after hemodialysis. The scores on the two IIEF questionnaires were compared according to five domains, i.e., erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction. The comparisons were done before and after hemodialysis using the paired-samples t-test. Statistical analyses were performed using SPSS version 19. Results The study included 30 men with a mean age of 40.2 ± 8.2. The prevalence of sexual dysfunctions in the order of their frequency was as follows: intercourse satisfaction (100%), overall satisfaction (100%), sexual desire (96.7%), orgasmic function (93.3%), and erectile function (90%). After six months of treatment with hemodialysis, the ratings of all areas of sexual dysfunction were improved significantly (p-value = 0.00 for all domains). Conclusion According to the results of this study, it seems that a six-month course of hemodialysis can improve erectile function, orgasmic function, sexual desire, intercourse

  4. Occult Hepatitis C Virus Infection in Hemodialysis Patients; Single Center Study

    PubMed Central

    El-shishtawy, Samya; Sherif, Nevine; Abdallh, Emad; Kamel, Laila; Shemis, Mohamed; Saleem, Abdel Aziz Ali; Abdalla, Haitham; el Din, Hesham Gamal

    2015-01-01

    Introduction A new form of hepatitis C virus infection, known as occult hepatitis C virus (HCV) infection, is characterized by the presence of HCV_RNA in the liver or peripheral blood mononuclear cells (PBMCs). However, no serological markers of infection occur and there is not as much damage to the liver damage as is produced by chronic hepatitis C. There is a high incidence of HCV infection among hemodialysis patients, there is significant concern about viral transmission. HCV infection is a major problem in hemodialysis (HD) units even though blood products are screened for anti-HCV antibodies and other precautions are taken. The aim of this study was to determine the prevalence of occult HCV infection in PBMC in chronic hemodialysis (CHD) patients in the dialysis unit at Theodor Bilharz Research Institute (TBRI) with HCV antibodies and HCV RNA negativity irrespective of their liver function tests. Methods Fifty-three patients who were repeatedly were anti-HCV negative and serum HCV-RNA negative and on regular hemodialysis for > six months were enrolled in the study, which was conducted in the dialysis unit of Nephrology Department at TBRI; there were 10 healthy matched controls. The patients were classified into two groups according to the result HCV RNA in their PBMCs. Serological markers of HCV infection, including anti-HCV antibody and serum HCV-RNA, were repeatedly negative for all patients included in the study. We collected serum and PBMC samples from the patients on the day they entered the study. The test of all serum samples for anti-HCV antibodies and HCV-RNA was repeated by RT-PCR to ensure that the patients did not have these HCV serologic markers, We also measured their ALT and GGT levels. Results Occult hepatitis C virus infection (OCI) was detected in 15.1% of our CHD patients without any evidence of chronic liver disease. Conclusion Occult HCV infection was present among the hemodialysis patients irrespective of whether they had persistent

  5. Factors Affecting Hemodialysis Adequacy in Cohort of Iranian Patient with End Stage Renal Disease

    PubMed Central

    Shahdadi, Hosein; Balouchi, Abbas; Sepehri, Zahra; Rafiemanesh, Hosein; Magbri, Awad; Keikhaie, Fereshteh; Shahakzehi, Ahmad; Sarjou, Azizullah Arbabi

    2016-01-01

    Background: There are many factors that can affect dialysis adequacy; such as the type of vascular access, filter type, device used, and the dose, and rout of erythropoietin stimulation agents (ESA) used. The aim of this study was investigating factors affecting Hemodialysis adequacy in cohort of Iranian patient with end stage renal disease (ESRD). Methods: This is a cross-sectional study conducted on 133 Hemodialysis patients referred to two dialysis units in Sistan-Baluchistan province in the cities of Zabol and Iranshahr, Iran. We have looked at, (the effects of the type of vascular access, the filter type, the device used, and the dose, route of delivery, and the type of ESA used) on Hemodialysis adequacy. Dialysis adequacy was calculated using kt/v formula, two-part information questionnaire including demographic data which also including access type, filter type, device used for hemodialysis (HD), type of Eprex injection, route of administration, blood groups and hemoglobin response to ESA were utilized. The data was analyzed using the SPSS v16 statistical software. Descriptive statistical methods, Mann-Whitney statistical test, and multiple regressions were used when applicable. Results: The range of calculated dialysis adequacy is 0.28 to 2.39 (units of adequacy of dialysis). 76.7% of patients are being dialyzed via AVF and 23.3% of patients used central venous catheters (CVC). There was no statistical significant difference between dialysis adequacy, vascular access type, device used for HD (Fresenius and B. Braun), and the filter used for HD (p> 0.05). However, a significant difference was observed between the adequacy of dialysis and Eprex injection and patients’ time of dialysis (p <0.05). Conclusion: Subcutaneous ESA (Eprex) injection and dialysis shift (being dialyzed in the morning) can have positive impact on dialysis adequacy. Patients should be educated on the facts that the type of device used for HD and the vascular access used has no

  6. β-Blocker Dialyzability and Mortality in Older Patients Receiving Hemodialysis

    PubMed Central

    Dixon, Stephanie N.; Fleet, Jamie L.; Roberts, Matthew A.; Hackam, Daniel G.; Oliver, Matthew J.; Suri, Rita S.; Quinn, Robert R.; Ozair, Sundus; Beyea, Michael M.; Kitchlu, Abhijat; Garg, Amit X.

    2015-01-01

    Some β-blockers are efficiently removed from the circulation by hemodialysis (“high dialyzability”) whereas others are not (“low dialyzability”). This characteristic may influence the effectiveness of the β-blockers among patients receiving long-term hemodialysis. To determine whether new use of a high-dialyzability β-blocker compared with a low-dialyzability β-blocker associates with a higher rate of mortality in patients older than age 66 years receiving long-term hemodialysis, we conducted a propensity-matched population-based retrospective cohort study using the linked healthcare databases of Ontario, Canada. The high-dialyzability group (n=3294) included patients initiating atenolol, acebutolol, or metoprolol. The low-dialyzability group (n=3294) included patients initiating bisoprolol or propranolol. Initiation of a high- versus low-dialyzability β-blocker was associated with a higher risk of death in the following 180 days (relative risk, 1.4; 95% confidence interval, 1.1 to 1.8; P<0.01). Supporting this finding, we repeated the primary analysis in a cohort of patients not receiving hemodialysis and found no significant association between dialyzability and the risk of death (relative risk, 1.0; 95% confidence interval, 0.9 to 1.3; P=0.71). β-Blocker exposure was not randomly allocated in this study, so a causal relationship between dialyzability and mortality cannot be determined. However, our findings should raise awareness of this potentially important drug characteristic and prompt further study. PMID:25359874

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

    PubMed Central

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

    2015-01-01

    In this cross-sectional study, we hypothesized that hemodialysis patients consuming greater processed meat is associated with hypertension risk, which can be partly explained by the high sodium content in processed meat. From September 2013 to May 2014, one hundred and four patients requiring chronic hemodialysis treatment were recruited from hemodialysis centers. Data on systolic blood pressure and diastolic blood pressure before receiving dialysis, and 3-day dietary records of the recruited patients were collected. HD patients with systolic and diastolic blood pressures greater than140 mmHg and higher than 90 mmHg, respectively, were considered hypertension risk. Protein foods were divided into 4 categories: red meat, white meat, soybeans, and processed meat (e.g., sausage and ham). In a model adjusted for energy intake and hypertension history, additional servings of processed meats was positively associated to systolic blood pressure >140 mmHg (odds ratio [95% confidence interval]: 2.1 [1.0–4.3]), and diastolic blood pressure > 90 mmHg (odds ratio: 2.5 [1.2–5.5]). After adjustment for dietary sodium contents or body mass index (BMI), most associations were substantially attenuated and were no longer significant. In systolic blood pressure greater than140 mmHg, one serving per day of red meats (β = -1.22, P < .05) and white meats (β = -0. 75, P = .05) was associated with a reduced risk compared with one serving per day of processed meats. Similarly, compared with one serving per day of processed meat, a reduced risk of diastolic blood pressure higher than 90 mmHg was associated with one serving per day of red meat (β = -1. 59, P < .05), white meat (β = -0. 62, P < .05). Thus, in these hemodialysis patients, intake of processed meat is significantly positively associated with higher blood pressure risk, and both sodium contents in processed meat and BMI significantly contributes to this association. PMID:26517837

  8. Uremic Pruritus, Dialysis Adequacy, and Metabolic Profiles in Hemodialysis Patients: A Prospective 5-Year Cohort Study

    PubMed Central

    Chen, Hung-Yuan; Chiu, Yen-Ling; Hsu, Shih-Ping; Pai, Mei-Fen; Ju-YehYang; Lai, Chun-Fu; Lu, Hui-Min; Huang, Shu-Chen; Yang, Shao-Yu; Wen, Su-Yin; Chiu, Hsien-Ching; Hu, Fu-Chang; Peng, Yu-Sen; Jee, Shiou-Hwa

    2013-01-01

    Background Uremic pruritus is a common and intractable symptom in patients on chronic hemodialysis, but factors associated with the severity of pruritus remain unclear. This study aimed to explore the associations of metabolic factors and dialysis adequacy with the aggravation of pruritus. Methods We conducted a 5-year prospective cohort study on patients with maintenance hemodialysis. A visual analogue scale (VAS) was used to assess the intensity of pruritus. Patient demographic and clinical characteristics, laboratory parameters, dialysis adequacy (assessed by Kt/V), and pruritus intensity were recorded at baseline and follow-up. Change score analysis of the difference score of VAS between baseline and follow-up was performed using multiple linear regression models. The optimal threshold of Kt/V, which is associated with the aggravation of uremic pruritus, was determined by generalized additive models and receiver operating characteristic analysis. Results A total of 111 patients completed the study. Linear regression analysis showed that lower Kt/V and use of low-flux dialyzer were significantly associated with the aggravation of pruritus after adjusting for the baseline pruritus intensity and a variety of confounding factors. The optimal threshold value of Kt/V for pruritus was 1.5 suggested by both generalized additive models and receiver operating characteristic analysis. Conclusions Hemodialysis with the target of Kt/V ≥1.5 and use of high-flux dialyzer may reduce the intensity of pruritus in patients on chronic hemodialysis. Further clinical trials are required to determine the optimal dialysis dose and regimen for uremic pruritus. PMID:23940749

  9. Lanthanum carbonate versus sevelamer hydrochloride: improvement of metabolic acidosis and hyperkalemia in hemodialysis patients.

    PubMed

    Filiopoulos, Vassilis; Koutis, Ioannis; Trompouki, Sofia; Hadjiyannakos, Dimitrios; Lazarou, Dimitrios; Vlassopoulos, Dimosthenis

    2011-02-01

    Sevelamer hydrochloride (SH) has been reported to aggravate metabolic acidosis and hyperkalemia. This study was performed to evaluate acid-base status and serum potassium changes after replacing SH with lanthanum carbonate (LC) in hemodialysis patients. SH was prescribed for 24 weeks in 14 stable hemodialysis patients and replaced by LC in a similar treatment schedule. Laboratory tests, including indices of acid-base status, nutrition, bone/mineral metabolism, and dialysis adequacy, were performed monthly during the study. Dialysate bicarbonate, potassium and calcium concentrations remained constant. Serum bicarbonate and pH rose, and serum potassium dropped significantly under LC. Alkaline phosphatase also decreased significantly under LC. No significant differences were observed in the other studied parameters between the two treatment periods. Control of serum phosphate was similar under both phosphate-binders and no differences were observed in calcium, Ca × P product, CRP, or lipid levels. Dialysis adequacy was constantly kept within K/DOQI target-range. Although full compliance to treatment was reported, three patients on LC complained of gastrointestinal upset and/or a metallic taste, and four had difficulty chewing the LC tablet. LC improves metabolic acidosis and hyperkalemia in hemodialysis patients previously under SH. Although both medications are well-tolerated, the gastrointestinal side-effects appear to occur more frequently with LC; a fact that, together with difficulties in chewing the tablet, may result in decreased compliance. PMID:21272248

  10. Experiences of Patients on Outpatient Hemodialysis Therapy Who Are Anticipating a Transplant.

    PubMed

    Moran, Aoife

    2016-01-01

    The person with kidney failure may experience many lifestyle disruptions that initiate distressing responses. This article reports on the results of a phenomenological study that explored the experiences of patients with kidney failure who were receiving outpatient hemodialysis therapy and who were either on the transplant list or in the process of being assessed to get on the transplant list. The participants described the existential distress they endured as a result of living with this disease and treatment; however, the participants' descriptions of distress were different than the psychological perspective of emotional distress depicted in the existing research. The information provided in this article can enhance nurses' ability to recognize and respond more appropriately to the distressing moods experienced by patients with kidney failure on outpatient hemodialysis. PMID:27501631

  11. Periodontitis and the end-stage renal disease patient receiving hemodialysis maintenance therapy.

    PubMed

    Craig, Ronald G; Kotanko, Peter

    2009-10-01

    Atherosclerotic complications, including myocardial infarction and stroke, are highly prevalent and associated with increased systemic inflammation in patients who have end-stage renal disease (ESRD) and are receiving renal hemodialysis maintenance therapy. In the general population, an increasing body of evidence suggests periodontitis can contribute to systemic inflammation and may contribute to atherosclerotic complications. In addition, results of recent interventional trials suggest effective periodontal therapy may decrease systemic inflammation as well as endothelial dysfunction, an early predictor of atherosclerotic complications. Because moderate-to-severe periodontitis appears to be highly prevalent in the renal hemodialysis population, effective periodontal therapy may reduce systemic inflammation and thereby become a treatment consideration for this population. This article will acquaint dental practitioners with ESRD and the association between systemic inflammation and mortality. Also discussed are the possible contributions of destructive periodontal diseases to systemic inflammation and the dental management of patients receiving renal replacement therapies. PMID:19824568

  12. Thrombophilia in Korean patients with arterial or venous thromboembolisms

    PubMed Central

    Kim, Sungbae; Song, Incheol; Huh, Seung

    2016-01-01

    Purpose To determine the prevalence of thrombophilia in Korean patients with an arterial thromboembolism (ATE) or a venous thromboembolism (VTE), and to evaluate the characteristic of VTE in patients with thrombophilia. Methods Hospital records of 294 patients (228 with VTE, 66 with ATE) including two foreign ones (mean age, 51.4 years) who underwent thrombophilia testing between August 2006 and March 2015 were reviewed retrospectively. In general, such screening was performed according to the guidelines of the international consensus statement for VTE. Thrombophilia testing included evaluations of the factor V Leiden and prothrombin G20210A mutations, levels of proteins C and S and antithrombin, and antiphospholipid antibody syndrome (APLS). Results A factor V Leiden mutation was not found in the 292 Korean patients. A prothrombin G21210A mutation was investigated in 33 patients but none was found. Among 226 Korean patients with VTE, 130 demonstrated no thrombophilia and 55 patients did after exclusion of 41 patients without confirmatory test. The most common form was protein S deficiency (31 of 55, 56%) followed by protein C deficiency, antithrombin deficiency, and APLS. When comparing patients with a VTE or deep vein thrombosis (DVT) according to the presence of thrombophilia, thrombophilia was associated with younger age (P = 0.001 for VTE; P < 0.001 for DVT) and a family history (P < 0.001 for VTE and DVT). Conclusion We did not find any factor V Leiden mutation in Korean subjects at high risk for thrombophilia. Therefore, this testing is not warranted. Thrombophilia was associated with VTE in younger age and a family history. PMID:27274510

  13. Managing hospitalized hemodialysis patients: A guide for the non-nephrologist.

    PubMed

    Saeed, Fahad; Wong, Leslie P

    2015-01-01

    In-hospital care of end-stage renal disease (ESRD) patients, on hemodialysis, is different from the general population in various aspects. Non-nephrologists do not typically receive specialized training to take care of these patients. However, in most circumstances, they serve as the primary attending for these patients in the hospital setting. There is paucity of the literature guiding non-nephrologists on this important issue. This article highlights the key management aspects of in-hospital care of these patients that all the non-nephrologists should know. PMID:26414595

  14. Circulatory mitochondrial DNA is a pro-inflammatory agent in maintenance hemodialysis patients.

    PubMed

    Cao, Hongdi; Ye, Hong; Sun, Zhiping; Shen, Xia; Song, Zongwei; Wu, Xiaochun; He, Weichun; Dai, Chunsun; Yang, Junwei

    2014-01-01

    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. PMID:25485699

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

    PubMed Central

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

    2016-01-01

    Background Studies have shown that family caregivers of hemodialysis patients experience high levels of burden. However, these caregivers are often neglected, and no studies are available on the effectiveness of coping strategies on the burden of care among these caregivers. Objectives This study aimed to examine the effectiveness of problem-focused coping strategies (communication skills, anger management, and deep breathing) on the burden on caregivers of hemodialysis patients. Patients and Methods A randomized controlled clinical trial was conducted on 76 family caregivers of hemodialysis patients referred to Shahid Hasheminejad hemodialysis center in Tehran, Iran. The subjects were equally allocated into two groups of 38. Through a coin-tossing method, caregivers of patients who referred on even or odd days of the week were randomly assigned into the intervention group or the control group, respectively. The intervention group received four training sessions on problem-focused coping strategies, but the control group did not receive any intervention. Both groups answered the caregiver’s burnout inventory at the start and six weeks after the last educational session. Descriptive statistics, chi-square, Fisher’s exact test, independent-samples t-test, and Mann-Whitney U test were used to analyze the data. Results The majority of caregivers (54%) were in the age range of 35 - 55 years, female (68.4%), and married (70%). No significant difference was found between the baseline mean caregivers’ burden scores of the intervention and control groups (88.56 ± 11.74 vs. 84.97 ± 15.13, P = 0.308). However, the mean caregivers’ burden in the intervention group decreased, and the two groups were significantly different at the end of the study (58.77 ± 6.64 vs. 87.84 ± 11.74, P < 0.001). Conclusions The current study showed the effectiveness of problem-focused coping strategies on reducing the burden on caregivers of hemodialysis patients. Authorities and

  16. Dynamic changes of carotid artery intima-media thickness and mortality in hemodialysis patients

    PubMed Central

    Stolic, R; Ilic, A; Jovanovic, A; Grbic, R; Odalovic, D; Smilic, Lj; Lazic, S; Krdzic, B; Nedovic, J

    2015-01-01

    Introduction Intima-media thickness (IMT) of the carotid artery is a widely accepted parameter for detection and quantification of atherosclerosis. The aim of the study was the evaluation of the impact of changes of IMT on the mortality of patients on hemodialysis. Methods The study was organized as a prospective and observational one. Intima-media thickness was determined by ultrasound in 194 patients who were evaluated every year during a three-year period. We analyzed the mortality rate of patients on hemodialysis in relation to their biochemical parameters, demographic and anthropometric characteristics, type of dialysis, smoking habits and statin therapy. Results Female gender and hemodiafiltration emerged as good predictors of long-term survival. Baseline IMT values were significantly lower than those at the end of the second (p <0.001) and third years of the study (p <0.001). The baseline values positively correlated with uric acid levels (p =0.027) and body mass index (p =0.024), while at the end of the second year, IMT positively correlated with LDL-cholesterol (p =0.037) and triglyceride levels (p =0.018) and body mass index (p =0.045). Patients on hemodiafiltration had significantly higher values for erythrocytes (p =0.047), hemoglobin (p =0.005), creatinine (p =0.048), Kt/V (p =0.026), albumin (p =0.012), LDL-cholesterol (p <0.001), body mass index (p <0.001),and lower IMT values at the end of the first year (p =0.039), compared to patients on bicarbonate hemodialysis. Predictors of death were the duration of hemodialysis (p <0.001), and IMT at the end of the first (p =0.008) and second years of the study (p =0.005). Conclusion Dynamic changes of IMT of the carotid arteries during the first two years were found in our study to be predictors of mortality in patients on hemodialysis. Hippokratia 2015; 19 (2):158-163. PMID:27418766

  17. Polymerization of intact beta 2-microglobulin in tissue causes amyloidosis in patients on chronic hemodialysis.

    PubMed Central

    Gorevic, P D; Munoz, P C; Casey, T T; DiRaimondo, C R; Stone, W J; Prelli, F C; Rodrigues, M M; Poulik, M D; Frangione, B

    1986-01-01

    Systemic amyloidosis with a predilection for bone and synovium may complicate the course of patients on long-term hemodialysis. This form of amyloidosis can be typed as distinct from other amyloid diseases by using small tissue samples obtained by bone biopsy and at postmortem. Immunoblot analysis of two-dimensional gels of partially solubilized amyloid fibrils established that tissue deposits are composed of monomers, dimers, and higher polymers of beta 2-microglobulin (beta 2m) and that amyloid P component was also present. Anti-beta 2m antiserum recognized fibrils, as shown by immunoelectron microscopy. Purified monomer isolated from dissociated fibrils yielded peptides corresponding to the entire known sequence of beta 2m. Virtually all serum beta 2m, as well as that present in tissue fluid bathing amyloid fibrils, was monomeric. Hemodialysis-related amyloidosis is an example of a deposition disease occurring in hemodialysis patients. We have shown conclusively that, in this amyloid disease, polymerization of an intact normal serum protein to a fibrillar configuration may occur without proteolysis. We propose the designation A beta 2m for this form of amyloid fibril subunit protein. Images PMID:3532124

  18. Endovascular Treatment of Central Vein Stenoses and/or Occlusions in Hemodialysis Patients

    SciTech Connect

    Maskova, Jana; Komarkova, Jana; Kivanek, Jiri; Danes, Jan; Slavikova, Marcela

    2003-02-15

    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.

  19. Pulmonary Hypertension Among End-Stage Renal Failure Patients Following Hemodialysis Access Thrombectomy

    SciTech Connect

    Harp, Richard J.; Stavropoulos, S. William; Wasserstein, Alan G.; Clark, Timothy W.I.

    2005-01-15

    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

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

    PubMed Central

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

    2016-01-01

    Abstract Skin changes are common in patients on dialysis. This study focused on putative associations of specific skin findings with comorbidities and mortality. We performed a retrospective analysis of data from 508 patients on maintenance hemodialysis therapy in 7 centers in the German State of North Rhine Westphalia. Data had been collected by interview, from patient files, and from targeted physical examination in an earlier prospective study screening hemodialysis patients for the presence of nephrogenic systemic fibrosis. While on dialysis, patients’ extremities had been examined for any of the following: edematous skin at the lower extremities, hyperpigmentation, induration, and xerosis cutis. Our present data analyses focused on associated mortality and comorbidities. Five hundred eight patients (median age 71 years, range 20.0–95.9; n = 292 men) had agreed to participate in the initial study: 48% (n = 243) were diabetics and 46% (n = 232) had been diagnosed with coronary heart disease. On examination, 86% of patients (n = 439) presented with at least 1 of the prespecified skin changes. Skin edema (n = 89; 18%), hyperpigmentation (n = 74; 15%), and induration (n = 9; 2%) were independently associated with increased mortality over 24 months (P < 0.002, P < 0.030, and P < 0.020, respectively). In our study, prespecified skin changes indicated an increased mortality risk in patients on chronic hemodialysis. Routinely assessing the skin of dialysis patients represents a simple, reliable, and cost effective means of identifying those at greatest risk. PMID:27015187

  1. Transthyretin Predicts Cardiovascular Outcome in Hemodialysis Patients With Type 2 Diabetes

    PubMed Central

    Henze, Andrea; Espe, Katharina M.; Wanner, Christoph; Krane, Vera; Raila, Jens; Hocher, Berthold; Schweigert, Florian J.; Drechsler, Christiane

    2012-01-01

    OBJECTIVE BMI and albumin are commonly accepted parameters to recognize wasting in dialysis patients and are powerful predictors of morbidity and mortality. However, both parameters reveal limitations and may not cover the entire range of patients with wasting. The visceral protein transthyretin (TTR) may be helpful in overcoming the diagnostic and prognostic gap. Therefore, the aim of this study was to assess the association of TTR with morbidity and mortality in hemodialysis patients. RESEARCH DESIGN AND METHODS The TTR concentration was determined in plasma samples of 1,177 hemodialysis patients with type 2 diabetes. Cox regression analyses were used to determine hazard ratios (HRs) for the risk of cardiovascular end points (CVEs) and mortality according to quartiles of TTR concentration for the total study cohort and the subgroups BMI ≥23 kg/m2, albumin concentration ≥3.8 g/dL, and a combination of both. RESULTS A low TTR concentration was associated with an increased risk for CVE for the total study cohort (HR 1.65 [95% CI 1.27–2.14]), patients with BMI ≥23 kg/m2 (1.70 [1.22–2.37]), albumin ≥3.8 g/dL (1.68 [1.17–2.42]), and the combination of both (1.69 [1.13–2.53]). Additionally, a low TTR concentration predicted mortality for the total study cohort (1.79 [1.43–2.24]) and patients with BMI ≥23 kg/m2 (1.46 [1.09–1.95]). CONCLUSIONS The current study demonstrated that TTR is a useful predictor for cardiovascular outcome and mortality in diabetic hemodialysis patients. TTR was particularly useful in patients who were not identified to be at risk by BMI or albumin status. PMID:22923667

  2. Family-Centered Education and Its Clinical Outcomes in Patients Undergoing Hemodialysis Short Running

    PubMed Central

    Bahramnezhad, Fatemeh; Asgari, Parvaneh; Zolfaghari, Mitra; Farokhnezhad Afshar, Pouya

    2015-01-01

    Background: Poor adherence to treatment in patients undergoing hemodialysis leads to many complications, including death of the patient. Objectives: This study was aimed to investigate the effect of family-based training on common side-effects during dialysis. Patients and Methods: The present randomized controlled trial study was conducted on 60 patients undergoing hemodialysis at hospitals of Tehran University of Medical Sciences, Iran, from May 2012 to October 2012. Samples were randomly divided into two groups of patient-education (n = 30) and education of patient associated with an active member of the family (n = 30). Blood pressure, chest pain, nausea, vomiting, headaches and muscle cramps were followed with a check list and a questionnaire. The frequencies of the abovementioned complications at the mentioned intervals were recorded in three stages (before the intervention as well as two and four weeks after the intervention). Data analysis was performed using SPSS software, version 16, with chi-square test, Fisher’s exact test and independent t-test. Results: The mean ages of the patients in patient-centered and the family-oriented groups were 47.41 ± 10.31 and 48.16 ± 9.21, respectively. The result showed that some of the variables such as chest pain (P = 0.50, P = 0.01), nausea (P = 0.50, P = 0.01), headache (P = 0.81, P = 0.016), and blood pressure (P = 0.91, P = 0.016) were statistically significant before and four weeks after the intervention. Conclusions: According to the result of this study, the presence of families in a treatment plan could be essential to follow the treatment plan and subsequently reduced the complications of hemodialysis. PMID:26290749

  3. Quality of Life Assessment in Korean Patients with Pemphigus

    PubMed Central

    Sung, Jae Yong; Roh, Mi Ryung

    2015-01-01

    Background Measuring the quality of life (QOL) is important in the evaluation of nonclinical aspects of diseases, for the discovery of functional and psychological limitations, and in choosing treatment in the initial phase of the disease. Pemphigus is a potentially fatal autoimmune bullous disease caused by autoantibodies against desmogleins (cadherin family proteins in desmosomes). Thus far, there has been no published study on QOL in Korean patients with pemphigus. Objective To study the impact of pemphigus on the QOL in a large number of Korean patients. Methods Sixty-six patients enrolled at the Gangnam Severance Hospital from March 2012 to March 2013 were assessed for QOL by using the Dermatology Life Quality Index (DLQI), and for anxiety and depression by using the General Health Questionnaire (GHQ). Spearman's rank-order correlation, t-test, and ANOVA were used to identify the relations between the DLQI score and other clinical variables. Results Pemphigus vulgaris and pemphigus foliaceus significantly reduced the QOL of patients. The average DLQI score for all patients was 10.18. The mean DLQI score was 13.45 in patients in the active state and 5.15 in the patients in the remission state. The DLQI score highly correlated with disease severity, titer of anti-desmoglein 1 in enzyme-linked immunosorbent assay, and the corticosteroid dose. However, the QOL was not affected by sex, age, subtype of pemphigus, duration of disease, or comorbidities. Forty-two percent of the patients showed a positive result in the GHQ, reflecting probable minor psychiatric nonpsychotic conditions, and the GHQ score positively correlated to the DLQI score. Conclusion Pemphigus significantly impairs the QOL of patients. The QOL of Korean pemphigus patients significantly correlates with clinical severity. Therefore, considerable attention should be paid to the patients' QOL and psychological states as well as clinical status. PMID:26512162

  4. The effect of use of dates on serum potassium in nondiabetic hemodialysis patients.

    PubMed

    Siddiqi, Nauman; El Shahat, Osama; Bokhari, Ebtisam; Roujouleh, Haytham; Hamid, M Hisham; Sheikh, Iftikhar; El-Sayed, Hassan; Saleh, Ayman; Seddik, Ayman

    2009-11-01

    Hyperkalemia is common in patients with ESRD and may contribute to mortality. Dates have been reported to be high in potassium content. One of the concerns on hemodialysis (HD) is convincing patients to give up ingestion of dates as a part of their diet. To determine the effect of dates on serum potassium on patients, we studied 9 (M: F, 6:3, mean age 47.6) non diabetic patients on chronic hemodialysis, without evidence of hyperkalemia on monthly labs. Nearly all the patients had been on dialysis for an average of four years. The average monthly potassium was 4.6 mmol/L. The patients ingested 100 gm of dates (Rothana and Sukari) on two separate dialysis sessions. Serum potassium was measured at two and four hours post ingestion along with ECG monitoring. The patients underwent their regular dialysis as scheduled. The patients acted as their own controls and underwent the same protocol with 20meq of KCl on a separate session. The potassium levels did not change significantly over the four hours with either variety of dates or with potassium solution. Combining the two types of dates resulted in a trend towards higher potassium levels than with KCl, but it did not reach statistical significance. We conclude that in selected HD patients without hyperkalemia, ingestion of a few dates does not cause significant hyperkalemia and could be allowed on days of dialysis prior to their dialysis sessions. PMID:19861864

  5. 5-year mortality in hemodialysis patients: a single center study in Tripoli.

    PubMed

    Buargub, Mahdia A

    2008-03-01

    To investigate the 5-year mortality of patients undergoing maintenance hemo-dialysis (HD) at Al-Shat center Tripoli, we reviewed during June 2007 the records of all the HD patients initiated on HD from Jun 2000 and Jan 2002. There were 124 patients in the study, 77 males (63.6%) and 47 (36.4%) females, with a mean age of 49 +/- 14 years. Diabetic nephropathy (DN) was the underlying kidney disease in 34 (27.4%) patients. After 5 years; 3 patients were transferred to other centers, 18 (14.9%) patients underwent kidney transplan-tation. Out of the 103 patients who continued on hemodialysis, 53 (51.4%) expired during the 5-year follow-up. Mortality was associated with older age (p 50 years) and DN (p< 0.002 and OR of 3.9). Mortality rate in diabetics was 74.1% and significantly associated with male sex (p< 0.0067 and OR of 2.4), older age (p< 0.004), presence of hypertension (p< 0.003 and OR of 3.9), type 1 diabetes (OR 1.6), and elevated mean body weight (p< 0.046). Mortality was also relatively higher in black patients (OR of 2.0) and smokers (OR of 1.39). In conclusion, the overall 5- year mortality for dialysis patients was elevated and higher in the diabetics. PMID:18310882

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

    PubMed

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

    2016-01-01

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

  7. Roy’s Adaptation Model-Based Patient Education for Promoting the Adaptation of Hemodialysis Patients

    PubMed Central

    Afrasiabifar, Ardashir; Karimi, Zohreh; Hassani, Parkhideh

    2013-01-01

    Background In addition to physical adaptation and psychosocial adjustment to chronic renal disease, hemodialysis (HD) patients must also adapt to dialysis therapy plan. Objectives The aim of the present study was to examine the effect of Roy’s adaptation model-based patient education on adaptation of HD patients. Patients and Methods This study is a semi-experimental research that was conducted with the participation of all patients with end-stage renal disease referred to the dialysis unit of Shahid Beheshti Hospital of Yasuj city, 2010. A total of 59 HD patients were randomly allocated to two groups of test and control. Data were collected by a questionnaire based on the Roy’s Adaptation Model (RAM). Validity and reliability of the questionnaire were approved. Patient education was determined by eight one-hour sessions over eight weeks. At the end of the education plan, the patients were given an educational booklet containing the main points of self-care for HD patients. The effectiveness of education plan was assessed two months after plan completion and data were compared with the pre-education scores. All analyses were conducted using the SPSS software (version 16) through descriptive and inferential statistics including correlation, t-test, ANOVA and ANCOVA tests. Results The results showed significant differences in the mean scores of physiological and self-concept models between the test and control groups (P = 0.01 and P = 0.03 respectively). Also a statistical difference (P = 0.04) was observed in the mean scores of the role function mode of both groups. There was no significant difference in the mean scores of interdependence modes between the two groups. Conclusions RAM based patient education could improve the patients’ adaptation in physiologic and self-concept modes. In addition to suggesting further research in this area, nurses are recommended to pay more attention in applying RAM in dialysis centers. PMID:24396575

  8. Low Plasma α-Tocopherol Concentrations and Adverse Clinical Outcomes in Diabetic Hemodialysis Patients

    PubMed Central

    Espe, Katharina M.; Raila, Jens; Henze, Andrea; Blouin, Katja; Schneider, Andreas; Schmiedeke, Daniel; Krane, Vera; Pilz, Stefan; Schweigert, Florian J.; Hocher, Berthold; Wanner, Christoph

    2013-01-01

    Summary Background and objectives Trials with the antioxidant vitamin E have failed to show benefit in the general population. Considering the different causes of death in ESRD, this study investigated the association between plasma concentrations of α-tocopherol and specific clinical outcomes in diabetic hemodialysis patients. Design, settings, participants, & measurements In 1046 diabetic hemodialysis patients (participants of the German Diabetes and Dialysis Study), α-tocopherol was measured in plasma by reversed-phase HPLC. By Cox regression analyses, hazard ratios were determined for prespecified end points according to baseline plasma α-tocopherol levels: sudden death (n=134), myocardial infarction (n=172), stroke (n=89), combined cardiovascular events (n=398), fatal infection (n=107), and all-cause mortality (n=508). Results Patients had a mean age of 66±8 years, and mean plasma α-tocopherol level was 22.8±9.6 µmol/L. Levels of α-tocopherol were highly correlated to triglycerides (r=0.63, P<0.001). Patients in the lowest α-tocopherol quartile had (in unadjusted analyses) a 79% higher risk of stroke and a 31% higher risk of all-cause mortality compared with patients in the highest quartile. The associations were attenuated after adjustment for confounders (hazard ratiostroke=1.56, 95% confidence interval=0.75–3.25; hazard ratiomortality=1.22, 95% confidence interval=0.89–1.69, respectively). There was no association between α-tocopherol and myocardial infarction, sudden death, or infectious death. Conclusions Plasma α-tocopherol concentrations were not independently associated with cardiovascular outcomes, infectious deaths, or all-cause mortality in diabetic hemodialysis patients. The lack of association can partly be explained by a confounding influence of malnutrition, which should be considered in the planning of trials to reduce cardiovascular risk in dialysis patients. PMID:23335039

  9. Effects of Cinacalcet on Fracture Events in Patients Receiving Hemodialysis: The EVOLVE Trial.

    PubMed

    Moe, Sharon M; Abdalla, Safa; Chertow, Glenn M; Parfrey, Patrick S; Block, Geoffrey A; Correa-Rotter, Ricardo; Floege, Jürgen; Herzog, Charles A; London, Gerard M; Mahaffey, Kenneth W; Wheeler, David C; Dehmel, Bastian; Goodman, William G; Drüeke, Tilman B

    2015-06-01

    Fractures are frequent in patients receiving hemodialysis. We tested the hypothesis that cinacalcet would reduce the rate of clinical fractures in patients receiving hemodialysis using data from the Evaluation of Cinacalcet HCl Therapy to Lower Cardiovascular Events trial, a placebo-controlled trial that randomized 3883 hemodialysis patients with secondary hyperparathyroidism to receive cinacalcet or placebo for ≤64 months. This study was a prespecified secondary analysis of the trial whose primary end point was all-cause mortality and non-fatal cardiovascular events, and one of the secondary end points was first clinical fracture event. Clinical fractures were observed in 255 of 1935 (13.2%) patients randomized to placebo and 238 of 1948 (12.2%) patients randomized to cinacalcet. In an unadjusted intention-to-treat analysis, the relative hazard for fracture (cinacalcet versus placebo) was 0.89 (95% confidence interval [95% CI], 0.75 to 1.07). After adjustment for baseline characteristics and multiple fractures, the relative hazard was 0.83 (95% CI, 0.72 to 0.98). Using a prespecified lag-censoring analysis (a measure of actual drug exposure), the relative hazard for fracture was 0.72 (95% CI, 0.58 to 0.90). When participants were censored at the time of cointerventions (parathyroidectomy, transplant, or provision of commercial cinacalcet), the relative hazard was 0.71 (95% CI, 0.58 to 0.87). Fracture rates were higher in older compared with younger patients and the effect of cinacalcet appeared more pronounced in older patients. In conclusion, using an unadjusted intention-to-treat analysis, cinacalcet did not reduce the rate of clinical fracture. However, when accounting for differences in baseline characteristics, multiple fractures, and/or events prompting discontinuation of study drug, cinacalcet reduced the rate of clinical fracture by 16%-29%. PMID:25505257

  10. Impact of Living Environment on 2-Year Mortality in Elderly Maintenance Hemodialysis Patients

    PubMed Central

    Huang, Wen-Hung; Lin, Ja-Liang; Lin-Tan, Dan-Tzu; Chen, Kuan-Hsing; Hsu, Ching-Wei; Yen, Tzung-Hai

    2013-01-01

    Background Studies on risk factors of mortality in elderly patients with hemodialysis usually focus on comorbidities, nutrition, and inflammation. Discussion on the correlation between living environment and mortality of these patients is limited. Methods A total of 256 elderly hemodialysis patients participated in this 2-year prospective observational study. The subjects were divided into 2 subgroups based on whether they were living in Taipei Basin (n = 63) or not (n = 193). Demographic, hematological, nutritional, inflammatory, biochemical, and dialysis-related data were obtained for cross-sectional analysis. Causes of death and mortality rates were also analyzed for each subgroup. Results Patients in the basin group had a higher incidence of combined protein-energy wasting and inflammation than those in the around basin group. At the end of the 2-year follow-up, 68 patients had died. Univariate binary logistic regression analysis revealed that a very advanced age, basin group, serum albumin levels, serum creatinine levels, non-anuria, and the complications of stroke and CAD were associated with 2-year mortality. Meanwhile, log high-sensitivity C-reactive protein (hs-CRP) levels were not associated with 2-year mortality. Multivariate Cox regression analysis revealed that basin group, serum albumin levels, and the complications of stroke and CAD were significant risk factors for 2-year mortality in these patients. Conclusion The results of this study indicate that factors such as living in the Taipei Basin with higher air pollutant levels in elderly hemodialysis patients is associated with protein-energy wasting and inflammation, as well as 2-year mortality. These findings suggest that among this population, living environment is as important as comorbidities and nutrition. Furthermore, air pollution should be getting more attention especially in the overcrowding Basin topography. PMID:24058552

  11. Scabies Among Elderly Korean Patients with Histories of Leprosy.

    PubMed

    Park, Hyungcheol; Lee, Chaeyoung; Park, Seungkyu; Kwon, Hyeon; Kweon, Sun-Seog

    2016-07-01

    A scabies epidemic, traced by the hospital-based surveillance system, was reported in a Korean leprosarium. A total of 200 symptomatic cases were found during 2012-2014 among 570 elderly former leprosy patients. Most of cases were classic type scabies (87%) and aged 75 years and older (72%). Surveillance system for early diagnosis and prompt intervention was applied and the scabies epidemic was controlled effectively in this long-term care facility. PMID:27114302

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

    PubMed

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

    2016-04-01

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

  13. Survey of home hemodialysis patients and nursing staff regarding vascular access use and care

    PubMed Central

    Spry, Leslie A; Burkart, John M; Holcroft, Christina; Mortier, Leigh; Glickman, Joel D

    2015-01-01

    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. PMID:25154423

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

    PubMed

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

    2013-04-01

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

  15. Increased dietary sodium is independently associated with greater mortality among prevalent hemodialysis patients

    PubMed Central

    Mc Causland, Finnian R.; Waikar, Sushrut S.; Brunelli, Steven M.

    2013-01-01

    Dietary sodium is thought to play a major role in the pathogenesis of hypertension, hypervolemia and mortality in hemodialysis patients. Thus, restriction is almost universally recommended. However, the evidence on which these assumptions are based is limited. We undertook a post-hoc analysis of the Hemodialysis Study with available dietary, clinical and laboratory information. Linear regression models were fit to estimate associations of dietary sodium with ultrafiltration requirement, blood pressure and nutritional indices. Cox regression models were fit to estimate the association of dietary sodium intake, sodium:calorie intake, sodium:potassium intake and prescribed sodium restriction with all-cause mortality. Complete data were available in 1770 subjects, of whom 44% were male, 63% were black and 44% were diabetic. Mean age was 58 (±14) years; median dietary sodium intake was 2080 (IQR: 1490-2850) mg/day. After case-mix adjustment, higher reported dietary sodium was associated with greater ultrafiltration requirement, caloric and protein intake; sodium:calorie intake ratio associated with greater UF requirement; sodium:potassium ratio associated with higher serum sodium. None were associated with pre-dialysis systolic blood pressure. Higher baseline reported dietary sodium, sodium:calorie ratio and sodium:potassium ratio were independently associated with greater all-cause mortality. No associations between prescribed dietary sodium restriction and mortality were observed. Higher reported dietary sodium intake is independently associated with greater mortality among prevalent hemodialysis subjects. Randomized trials are warranted to determine whether dietary sodium restriction improves survival. PMID:22418981

  16. [A case of sigmoid colon cancer in a patient undergoing hemodialysis treated by tegafur/uracil/folinate].

    PubMed

    Miyazawa, Tomonori; Chida, Tadasu; Hasegawa, Shigeru; Iwafuchi, Yo-Ichi; Kamimura, Akira; Watanabe, Gen

    2008-01-01

    The patient was a 59-year-old man who had undergone hemodialysis because of chronic renal failure. The patient was diagnosed as colonic perforation due to stricture of sigmoid colon cancer, and sigmoidectomy was performed. Since colonic perforation and imperfect lymphnode dissection might increase the risk of recurrence, the patient underwent 6 courses of tegafur/uracil/folinate(UFT/LV)chemotherapy. No adverse events occurred in the course of chemotherapy. UFT/LV chemotherapy may be administered safely with careful management even for a patient on hemodialysis. PMID:18195547

  17. Rehospitalizations and Emergency Department Visits after Hospital Discharge in Patients Receiving Maintenance Hemodialysis.

    PubMed

    Harel, Ziv; Wald, Ron; McArthur, Eric; Chertow, Glenn M; Harel, Shai; Gruneir, Andrea; Fischer, Hadas D; Garg, Amit X; Perl, Jeffrey; Nash, Danielle M; Silver, Samuel; Bell, Chaim M

    2015-12-01

    Clinical outcomes after a hospital discharge are poorly defined for patients receiving maintenance in-center (outpatient) hemodialysis. To describe the proportion and characteristics of these patients who are rehospitalized, visit an emergency department, or die within 30 days after discharge from an acute hospitalization, we conducted a population-based study of all adult patients receiving maintenance in-center hemodialysis who were discharged between January 1, 2003, and December 31, 2011, from 157 acute care hospitals in Ontario, Canada. For patients with more than one hospitalization, we randomly selected a single hospitalization as the index hospitalization. Of the 11,177 patients included in the final cohort, 1926 (17%) were rehospitalized, 2971 (27%) were treated in the emergency department, and 840 (7.5%) died within 30 days of discharge. Complications of type 2 diabetes mellitus were the most common reason for rehospitalization, whereas heart failure was the most common reason for an emergency department visit. In multivariable analysis using a cause-specific Cox proportional hazards model, the following characteristics were associated with 30-day rehospitalization: older age, the number of hospital admissions in the preceding 6 months, the number of emergency department visits in the preceding 6 months, higher Charlson comorbidity index score, and the receipt of mechanical ventilation during the index hospitalization. Thus, a large proportion of patients receiving maintenance in-center hemodialysis will be readmitted or visit an emergency room within 30 days of an acute hospitalization. A focus on improving care transitions from the inpatient setting to the outpatient dialysis unit may improve outcomes and reduce healthcare costs. PMID:25855772

  18. Impact of Carotid Intima-Media Thickness on Long-term Outcome in Hemodialysis Patients

    PubMed Central

    Patel, Munna Lal; Radheyshyam; Verma, Amita; Sachan, Rekha; Kamal, Ritul

    2015-01-01

    Background: Chronic kidney disease (CKD) patients on hemodialysis are highly prone to cardiovascular disease, which accounts for roughly half of the mortality in these patients. Atherosclerosis begins many years before the development of clinical manifestations. Measurement of carotid intima-media thickness (CIMT) is a noninvasive procedure to detect early atherosclerotic changes. Aims: The aim of the study was to evaluate the correlation between CIMT and cardiovascular risk factors and to investigate its prognostic significance in CKD patients on hemodialysis. Materials and Methods: This was a prospective study carried out over a period of 18 months. Total 88 patients on hemodialysis and 50 healthy controls were enrolled in the study. Biochemical assay and CIMT was assessed using the high resolution 7.5 MHz sonography technique in all subjects. Results: Significant positive correlation was found with age, blood urea, serum creatinine, serum triglyceride, low-density lipoprotein, serum phosphorus, serum calcium-phosphorus product, serum uric acid, 24 h urine protein, systolic blood pressure, diastolic blood pressure, and body mass index. Negative correlation was found with estimated glomerular filtration rate. Adjusted hazards ratios of all cause and cardiovascular mortality for an increase of 0.1 mm in CIMT was 1.16 (95% confidence interval 0.15-9.09). Patients with CIMT value <0.97 mm had a renal survival rate of 73.4% while patients with value >0.97 mm had a renal survival rate of 16.5%. Conclusion: Uremia is an additive risk factors in those subjects who have raised CIMT despite of traditional cardiovascular risk factors. PMID:26199926

  19. Reversible Ceftriaxone-Induced Pseudolithiasis in an Adult Patient with Maintenance Hemodialysis

    PubMed Central

    Shima, Aya; Suehiro, Takaichi; Takii, Misaki; Soeda, Hiroyasu; Hirakawa, Makoto

    2015-01-01

    Ceftriaxone (CTRX) is a third-generation cephalosporin widely used for the treatment of bacterial infections in patients with renal disease because of its excretion by both renal and hepatic mechanisms. Biliary pseudolithiasis is a known CTRX-associated complication; however, there have been no studies of this adverse event in adult patients receiving maintenance hemodialysis. Here we report the case of a 79-year-old Japanese woman with end-stage renal disease (ESRD) receiving maintenance hemodialysis who developed CTRX-induced pseudolithiasis. The patient received CTRX for bronchial pneumonia. Fifteen days following CTRX initiation, the patient presented with stomachache. Because of the presence of one gallstone and increased gallbladder wall thickness on computed tomography scans, not detected at the onset of pneumonia, the patient was diagnosed with CTRX-induced gallbladder pseudolithiasis. CTRX was discontinued immediately. At 48 days following CTRX withdrawal, the gallstone and thickening of the gallbladder wall had completely resolved. ESRD may be a risk factor for CTRX-induced pseudolithiasis as hepatic excretion of CTRX is the predominant clearance mechanism in patients with ESRD. More attention should be paid to CTRX-induced pseudolithiasis following the use of CTRX in ESRD patients. PMID:26558252

  20. Evaluation of oxidative stress and thyroid hormone status in hemodialysis patients in Gorgan

    PubMed Central

    Velayeti, Javad; Mansourian, Azad Reza; Mojerloo, Mohammad; Marjani, Abdoljalal

    2016-01-01

    Aims: The aim of this study focused on serum malondialdehyde (MDA) levels and erythrocyte superoxide dismutase (SOD) and catalase (CAT) activities in hemodialysis patients and compared with control groups. Materials and Methods: Forty-five hemodialyzed patients and 45 control groups recruited in this study. Serum creatinine and urea, thyroid hormones (THs) levels and erythrocyte antioxidant enzyme activities were determined. Results: Hemodialysis (HD) patients showed higher levels of MDA than control groups (P < 0.01), but the levels of thyroxin (T3), free triiodothyronine (fT3), and free thyroxin (fT4), SOD and CAT were low in HD patients (P < 0.01). Serum T3, fT3, and fT4 levels were significantly negative correlated with MDA (P < 0.01). Conclusion: It is concluded that serum lipid peroxidation is markedly increased in HD patients. This means that elevated reactive oxygen species may interact with the lipid molecules in HD patients. HD may cause significant changes in TH levels. Thyroid-stimulating hormone level in HD patients is slightly similar to that of control groups. This suggests that thyroid is able to resynthesize for hormonal urinary losses. PMID:27186552

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

    Castro, Carlos E Figueroa; Madariaga, Miguel G

    2008-12-01

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

  3. [Teriparatide:benefit and safety for bone disease in CKD patients undergoing hemodialysis].

    PubMed

    Yamamoto, Suguru; Ei, Isei; Narita, Ichiei

    2016-09-01

    Teriparatide, 1-34 parathyroid hormone, is one of effective treatments for osteoporosis. Teriparatide shows an anabolic effect for bone formation, as a result, increases bone mineral density as well as prevention of fractures in the general population. On the other hand, there are a few report about the effect of teriparatide on increase of bone mineral density in maintenance hemodialysis patients. In addition to CKD-MBD, osteoporosis is also an important pathological change in ESRD patients, therefore its safety and efficacy should be discussed in more detail. PMID:27561345

  4. Chryseobacterium meningosepticum in a parapneumonic effusion in a chronic kidney disease patient on hemodialysis.

    PubMed

    Gnanasoundran, Vanitha; Fernando, Edwin M; Kumar, Senthil; Kumar, Raj; Valavan, Thiruma; Mohan, Chandra; Mohammed, Noor; Prasad, Srinivasa

    2014-10-01

    Chryseobacterium meningosepticum is an uncommon human pathogen, which is an inhabitant of soil and water. It should be included in the list of suspected nosocomial infections, especially in patients with immunocompromised status. C. meningosepticum infections are not common but are clinically important because the organism is naturally resistant to multiple antibiotics. We report a case where the bacterium was isolated from the pleural fluid from a chronic kidney disease patient on hemodialysis, who developed pneumonia with complicated parapneumonic effusion. To the best of our knowedge, this is the first case where C. meningosepticum is isolated from the pleural effusion, from India. PMID:24698165

  5. Pleuritis caused by Campylobacter jejuni subspecies jejuni in a patient undergoing long-term hemodialysis.

    PubMed

    Nagai, Miho; Hirayama, Kouichi; Ohishi, Tsuyoshi; Shimohata, Homare; Ohkusu, Kiyofumi; Kobayashi, Masaki

    2010-01-01

    A 73-year-old female hemodialysis patient experienced fever, shortness of breath on effort, and chest discomfort. A decrease in breath sounds in the right lung field, leukocytosis, elevated CRP level, and a right massive pleural effusion were observed. The patient was diagnosed with bacterial pleuritis based on leukocyte-predominant exudative pleural effusion, and treated with ceftriaxone. Her symptoms, however, were not improved, so thoracic drainage was attempted. Campylobacter species were isolated from cultured pleural fluid samples, and Campylobacter jejuni subspecies jejuni was detected on the multiplex PCR assay. The antibiotic was therefore changed to minocycline following pazufloxacin, and her symptoms were improved. PMID:21088354

  6. Pharmacokinetic analyses of carboplatin in a patient with cancer of the fallopian tubes undergoing hemodialysis: A case report

    PubMed Central

    Wada, Takuma; Fukuda, Takeshi; Kawanishi, Masaru; Tasaka, Reiko; Imai, Kenji; Yamauchi, Makoto; Kasai, Mari; Hashiguchi, Yasunori; Ichimura, Tomoyuki; Yasui, Tomoyo; Sumi, Toshiyuki

    2016-01-01

    Opportunities for patients undergoing hemodialysis to receive chemotherapy are increasing. A combination of paclitaxel and carboplatin (TC) is first-line chemotherapy in patients with Müllerian cancer. However, the optimal dose and time interval between the end of carboplatin administration and initiation of hemodialysis remains to be elucidated. TC was administered to a patient with fallopian tube cancer undergoing hemodialysis. The paclitaxel regimen was determined to be 135 mg/m2 (total of 210 mg) over 3 h. After paclitaxel administration, 125 mg of carboplatin was administered over 1 h to achieve a target area under the concentration-time curve (AUC) of 5.0 mg•min/ml using the Calvert formula. The time interval between the end of carboplatin administration and hemodialysis initiation was 1 h at the first cycle, 16 h at the second cycle and 20 h at the third cycle, and the AUC obtained was 2.86, 4.16 and 6.0 mg•min/ml, respectively. The desired AUC of free platinum was demonstrated and only mild side effects were observed at the third cycle. Therefore, hemodialysis was initiated 20 h after completion of carboplatin infusion at cycles 4–6. The total chemotherapy planned was completed without severe adverse events. Measurement of the concentration of free platinum subsequent to administration is useful for determination of the optimal dose of carboplatin and time interval following administration to obtain an adequate AUC. The present study suggests that carboplatin can be administered to a patient undergoing hemodialysis, and that an adequate interval between the end of carboplatin administration and hemodialysis initiation may be ~20 h.

  7. The authority for certain clinical tasks performed by unlicensed patient care technicians and LPNs/LVNs in the hemodialysis setting: a review.

    PubMed

    O'Keefe, Cathleen

    2014-01-01

    The growing incidence of end stage renal disease (ESRD) has resulted in an ever-increasing demand for hemodialysis services throughout the country. Unlicensed assistive personnel (UAP), including dialysis technicians or patient care technicians (PCTs), and licensed practical nurses (LPNs) or licensed vocational nurses (LVNs) perform a vital role in the care of patients undergoing hemodialysis and are a critical staff component in hemodialysis facilities. This analysis provides a broad overview of the positions of states with respect to the administration of heparin and saline via peripheral and central lines by PCTs and LPNs/LVNs in the hemodialysis setting. PMID:25065058

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

    PubMed

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

    2000-01-01

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

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

    PubMed

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

    2016-07-01

    Uremia-associated anorexia may be related to altered levels of long chain n-6 and n-3 polyunsaturated fatty acid (PUFA) derived circulating endocannabinoids (EC) and EC-like compounds that are known to mediate appetite. Our study's hypothesis was that such molecules are associated with appetite in patients with end-stage renal disease. A cross-sectional observational study was performed in 20 chronic hemodialysis patients (9 females, 11 males) and 10 healthy female controls in whom appetite was assessed using the Simplified Nutritional Appetite Questionnaire (SNAQ) and blood drawn in the fasting (and when applicable) pre-dialysis state. Blood levels of PUFA and EC were also measured. Higher blood levels of the long chain n-6 fatty acid 20:4n6 (arachidonic acid) and lower levels of the long chain n-3 fatty acid 20:5n3 (eicosapentaenoic acid) were observed in female hemodialysis patients compared to controls. No differences were observed between male and female patients. In female study participants strong correlations between specific EC-like compounds and total SNAQ scores were noted, including with the n-6 PUFA derived linoleoyl ethanolamide (L-EA; ρ=-0.60, P<.01) and the n-3 PUFA derived docosahexaenoyl ethanolamide (DH-EA; ρ=0.63, P<.01). The L-EA:DH-EA ratio was most strongly associated with the SNAQ score (ρ=-0.74, P≤.001), and its questions associated with appetite (ρ=-0.69, P≤.01) and satiety (ρ=-0.81, P≤.001). These findings support a link between circulating EC and appetite in hemodialysis patients. PMID:27333956

  10. RISK OF DEMENTIA IN PERITONEAL DIALYSIS PATIENTS COMPARED WITH HEMODIALYSIS PATIENTS

    PubMed Central

    Wolfgram, Dawn F.; Szabo, Aniko; Murray, Anne M.; Whittle, Jeff

    2016-01-01

    Background Compared with similarly aged controls, patients with end-stage renal disease (ESRD) have a higher prevalence of cognitive impairment and more rapid cognitive decline, which is not explained by traditional risk factors alone. Since previous small studies suggest an association of cognitive impairment with dialysis modality, we compared incident dementia among patients initiating hemodialysis (HD) versus peritoneal dialysis (PD) in a large national cohort. Methods This is a retrospective cohort study of incident dialysis patients in the United States from 2006 to 2008 with no diagnosis of dementia prior to beginning dialysis. We evaluated the effect of initial dialysis modality on incidence of dementia, diagnosed by Medicare claims data, adjusted for baseline demographic and clinical data from USRDS registry. Results Our analysis included 121,623 patients, of whom 8,663 initiated dialysis on PD. The mean age of our cohort was 69.2 years. Patients who initiated on PD had a lower cumulative incidence of dementia than those who initiated HD (1.0% versus 2.7%, 2.5% versus 5.3%, and 3.9% versus 7.3% at 1, 2, and 3 years, respectively). The risk of dementia for patients who started on PD was lower compared with those who started on HD, with a hazard ratio (HR) = 0.46 [0.41, 0.53], in an unadjusted model and HR 0.74 [0.64, 0.86] in a matched model. Conclusions Dialysis modality is associated with incident dementia in a cohort of older ESRD patients. This finding warrants further investigation of the effect of dialysis modality on cognitive function and evaluation for possible mechanisms. PMID:25742686

  11. Right Ventricular Enlargement within Months of Arteriovenous Fistula Creation in 2 Hemodialysis Patients

    PubMed Central

    Ragupathi, Loheetha; Johnson, Drew

    2016-01-01

    Surgically created arteriovenous fistulae (AVF) for hemodialysis can contribute to hemodynamic changes. We describe the cases of 2 male patients in whom new right ventricular enlargement developed after an AVF was created for hemodialysis. Patient 1 sustained high-output heart failure solely attributable to the AVF. After AVF banding and subsequent ligation, his heart failure and right ventricular enlargement resolved. In Patient 2, the AVF contributed to new-onset right ventricular enlargement, heart failure, and ascites. His severe pulmonary hypertension was caused by diastolic heart failure, diabetes mellitus, and obstructive sleep apnea. His right ventricular enlargement and heart failure symptoms did not improve after AVF ligation. We think that our report is the first to specifically correlate the echocardiographic finding of right ventricular enlargement with AVF sequelae. Clinicians who treat end-stage renal disease patients should be aware of this potential sequela of AVF creation, particularly in the upper arm. We recommend obtaining preoperative echocardiograms in all patients who will undergo upper-arm AVF creation, so that comparisons can be made postoperatively. Alternative consideration should be given to creating the AVF in the radial artery, because of less shunting and therefore less potential for right-sided heart failure and pulmonary hypertension. A multidisciplinary approach is optimal when selecting patients for AVF banding or ligation. PMID:27547150

  12. Right Ventricular Enlargement within Months of Arteriovenous Fistula Creation in 2 Hemodialysis Patients.

    PubMed

    Ragupathi, Loheetha; Johnson, Drew; Marhefka, Gregary D

    2016-08-01

    Surgically created arteriovenous fistulae (AVF) for hemodialysis can contribute to hemodynamic changes. We describe the cases of 2 male patients in whom new right ventricular enlargement developed after an AVF was created for hemodialysis. Patient 1 sustained high-output heart failure solely attributable to the AVF. After AVF banding and subsequent ligation, his heart failure and right ventricular enlargement resolved. In Patient 2, the AVF contributed to new-onset right ventricular enlargement, heart failure, and ascites. His severe pulmonary hypertension was caused by diastolic heart failure, diabetes mellitus, and obstructive sleep apnea. His right ventricular enlargement and heart failure symptoms did not improve after AVF ligation. We think that our report is the first to specifically correlate the echocardiographic finding of right ventricular enlargement with AVF sequelae. Clinicians who treat end-stage renal disease patients should be aware of this potential sequela of AVF creation, particularly in the upper arm. We recommend obtaining preoperative echocardiograms in all patients who will undergo upper-arm AVF creation, so that comparisons can be made postoperatively. Alternative consideration should be given to creating the AVF in the radial artery, because of less shunting and therefore less potential for right-sided heart failure and pulmonary hypertension. A multidisciplinary approach is optimal when selecting patients for AVF banding or ligation. PMID:27547150

  13. Effect of zinc supplementation on body mass index and serum levels of zinc and leptin in pediatric hemodialysis patients

    PubMed Central

    El-Shazly, Ahmed Nabih; Ibrahim, Soha Abd El-Hady; El-Mashad, Ghada Mohamed; Sabry, Jehan H; Sherbini, Nashwa Said

    2015-01-01

    Introduction Zinc is an essential trace element for human nutrition, and its deficiency is associated with anorexia, poor food efficiency, growth retardation, and impaired neurological and immune systems. The zinc-deficiency rate is particularly high in many disease states, such as with end-stage renal disease patients undertaking hemodialysis. The aim of this study was to determine the effect of zinc supplementation on body mass index (BMI) and serum levels of zinc and leptin in pediatric hemodialysis patients. Patients and methods This was a prospective clinical trial study in which 60 hemodialysis patients were randomly divided into two groups: group I received 50–100 mg zinc sulfate (equivalent to 11–22 mg elemental zinc) according to age, sex, and nutritional status of the child; and group II received placebo (cornstarch) twice daily for 90 days. Anthropometric measurements were taken, and serum zinc and leptin levels were determined by colorimetric test with 5-Br-3′-phosphoadenosine-5′-phosphosulfate and enzyme-linked immunosorbent assay, respectively, at days 0 and 90 of the study. Results Zinc supplementation resulted in a significant increase in mean serum zinc level and BMI. Serum leptin decreased significantly after supplementation in children under hemodialysis. A significant negative correlation was observed between serum zinc and leptin levels as a result of zinc supplementation. Conclusion There was an increase in serum zinc level and BMI and decreased serum leptin after zinc supplementation in children under hemodialysis. PMID:26677341

  14. Percutaneous Cholecystostomy as a First-Line Therapy in Chronic Hemodialysis Patients with Acute Cholecystitis with Midterm Follow-up

    SciTech Connect

    Gumus, Burcak

    2011-04-15

    Purpose: The purpose of this article was to share midterm results of percutaneous cholecystostomy (PC) as a first-line therapy in chronic hemodialysis patients with acute cholecystitis. Methods: Fourteen chronic hemodialysis patients with acute cholecystitis underwent PC between March 2007 and May 2009 at our institute. On preoperative assessment, the patients were classified into the ASA score by the anesthesiology team. All patients were class IV because of severe underlying comorbidities. The patients were referred to interventional radiology unit for PC by consensus of the multidisciplinary team. Results: The PC was technically successful in all the patients without minor or major complications related to the procedure. Clinical symptoms in three patients who presented with sepsis and multiorgan failure did not resolve after PC, and these patients died following urgent surgery, including open cholecystectomy and common bile duct exploration. A new cholecystitis attack was detected in one patient in the acalculous group at the sixth month of the follow-up period. The mean catheterization time was 31.7 (range, 28-41) days. The mean follow-up time was 13.3 (range 4-21) months. Conclusions: The PC may come into consideration as a first-line treatment modality in the management of acute cholecystitis in poor surgical candidate chronic hemodialysis patients. This is the first report focusing on the midterm results of PC as a first-line therapy in hemodialysis patients with acute cholecystitis who could be operated on.

  15. Comparison of Regulatory T Cells in Hemodialysis Patients and Healthy Controls: Implications for Cell Therapy in Transplantation

    PubMed Central

    Afzali, Behdad; Edozie, Francis C.; Fazekasova, Henrieta; Scottà, Cristiano; Mitchell, Peter J.; Canavan, James B.; Kordasti, Shahram Y.; Chana, Prabhjoat S.; Ellis, Richard; Lord, Graham M.; John, Susan; Hilton, Rachel; Lechler, Robert I.

    2013-01-01

    Summary Background and objectives Cell-based therapy with natural (CD4+CD25hiCD127lo) regulatory T cells to induce transplant tolerance is now technically feasible. However, regulatory T cells from hemodialysis patients awaiting transplantation may be functionally/numerically defective. Human regulatory T cells are also heterogeneous, and some are able to convert to proinflammatory Th17 cells. This study addresses the suitability of regulatory T cells from hemodialysis patients for cell-based therapy in preparation for the first clinical trials in renal transplant recipients (the ONE Study). Design, setting, participants, & measurements Healthy controls and age- and sex-matched hemodialysis patients without recent illness/autoimmune disease on established, complication-free hemodialysis for a minimum of 6 months were recruited. Circulating regulatory T cells were studied by flow cytometry to compare the regulatory T cell subpopulations. Regulatory T cells from members of each group were compared for suppressive function and plasticity (IL-17–producing capacity) before and after in vitro expansion with and without Rapamycin, using standard assays. Results Both groups had similar total regulatory T cells and subpopulations I and III. In each subpopulation, regulatory T cells expressed similar levels of the function-associated markers CD27, CD39, HLA-DR, and FOXP3. Hemodialysis regulatory T cells were less suppressive, expanded poorly compared with healthy control regulatory T cells, and produced IL-17 in the absence of Rapamycin. However, Rapamycin efficiently expanded hemodialysis regulatory T cells to a functional and stable cell product. Conclusions Rapamycin-based expansion protocols should enable clinical trials of cell-based immunotherapy for the induction of tolerance to renal allografts using hemodialysis regulatory T cells. PMID:23580782

  16. Association Between Vascular Access Dysfunction and Subsequent Major Adverse Cardiovascular Events in Patients on Hemodialysis

    PubMed Central

    Kuo, Te-Hui; Tseng, Chien-Tzu; Lin, Wei-Hung; Chao, Jo-Yen; Wang, Wei-Ming; Li, Chung-Yi; Wang, Ming-Cheng

    2015-01-01

    Abstract The association between dialysis vascular access dysfunction and the risk of developing major adverse cardiovascular events (MACE) in hemodialysis patients is unclear and has not yet been investigated. We analyzed data from the National Health Insurance Research Database of Taiwan to quantify this association. Adopting a case–control design nested within a cohort of patients who received hemodialysis from 2001 to 2010, we identified 9711 incident cases of MACE during the stage of stable maintenance dialysis and 19,422 randomly selected controls matched to cases on age, gender, and duration of dialysis. Events of vascular access dysfunction in the 6-month period before the date of MACE onset (ie, index date) for cases and before index dates for controls were evaluated retrospectively. The presence of vascular access dysfunction was associated with a 1.385-fold higher odds of developing MACE as estimated from the logistic regression analysis. This represents a significantly increased adjusted odds ratio (OR) at 1.268 (95% confidence interval [CI] = 1.186–1.355) after adjustment for comorbidities and calendar years of initiating dialysis. We also noted a significant exposure–response trend (P < 0.001) between the frequency of vascular access dysfunction and MACE, with the greatest risk (adjusted OR = 1.840, 95% CI = 1.549–2.186) noted in patients with ≥3 vascular access events. We concluded that dialysis vascular access dysfunction was significantly associated with an increased risk of MACE. Hence, vascular access failure can be an early sign for MACE in patients receiving maintenance hemodialysis. Active monitoring and treatment of cardiovascular risk factors and related diseases, not merely managing vascular access dysfunction, would be required to reduce the risk of MACE. PMID:26131808

  17. Noninvasive assessment of skin iron content in hemodialysis patients. An index of parenchymal tissue iron content

    SciTech Connect

    Friedlaender, M.M.; Kaufman, B.; Rubinger, D.; Moreb, J.; Popovtzer, M.M.; Goredetsky, R.

    1988-07-01

    Iron overload has been described in patients undergoing chronic hemodialysis. The present study was undertaken to evaluate a rapid, noninvasive method for determination of skin iron by the technique of diagnostic x-ray spectrometry (DXS). Thirty-five patients receiving chronic hemodialysis treatment entered the study and were compared with 25 normal controls. Since pathological skin iron deposition occurs mainly at the dermal-epidermal junction in the basal cells of the epidermis, measurements were made in the thenar eminence representing mainly epidermal tissue (FeE), and in the forearm representative mainly of dermis (FeD). The mean +/- SD FeE iron concentrations were equivalent to 14.5 +/- 8.8 and 18.2 +/- 10.2 parts per million wet weight tissue (ppm) and both were significantly higher than in normal controls in which they averaged 9.2 +/- 2.5 ppm (P less than 0.005) and 10.2 +/- 3.2 ppm (P less than 0.001), respectively. There was significant positive correlation between individual skin iron determinations with the total number of blood transfusions received, the rate of blood transfusion, and with serum ferritin levels. Bone marrow hemosiderin was examined in six patients and showed a similar trend. Despite correlation only with indirect indices of tissue iron, our findings suggest that DXS may serve as a reliable quick method for noninvasive estimation of nonreticuloendothelial tissue iron deposition in hemodialysis patients suspected of having transfusional iron overload. The method may be valuable in monitoring the effects of chelation therapy.

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

    PubMed

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

    2016-06-01

    Valve surgery in hemodialysis-dependent patients is associated with postoperative complications and a high mortality rate, and such patients frequently suffer cachexia. This study aimed to determine pre- and intraoperative risk factors associated with in-hospital mortality and long-term survival in hemodialysis-dependent patients undergoing heart valve surgery from the viewpoint of nutrition status. Eighty-seven hemodialysis-dependent patients who underwent valve surgery between January 1998 and October 2015 were retrospectively reviewed. Thirty-seven potential perioperative risk factors were evaluated. The in-hospital mortality rate was 12.6 % (11 patients). Univariate analysis identified New York Heart Association Functional Classification III or IV, emaciation (body mass index <17.6 kg/m(2)), total cholesterol <120 mg/dl, serum albumin <3.0 mg/dl, emergent/urgent surgery, and intraoperative blood transfusion >3000 ml as predictors of in-hospital death. Multivariate logistic regression analysis confirmed low serum albumin <3.0 mg/dl (hazard ratio 7.22; p = 0.032) and emergent/urgent operation (hazard ratio 43.57; p = 0.035) as independent predictors of in-hospital death. The 1- and 3-year actuarial survival rates were 64.9 ± 5.4 and 51.8 ± 5.8 %, respectively. Long-term survival estimated by log-rank test was negatively impacted by anemia (hemoglobin <10 mg/dl), low serum albumin, emergent/urgent operation, and infective endocarditis. Multivariate analysis using Cox proportional hazards modeling indicated low serum albumin (hazard ratio 2.12; p = 0.047) and emergent/urgent operation (hazard ratio 8.97; p = 0.0002) as independent predictors of remote death. Hypoalbuminemia and emergent/urgent operation are strong predictors of in-hospital and remote death. Malnutrition before surgery should be considered for operative risk estimation, and adequate preoperative nutrition management may improve surgical outcomes for hemodialysis

  19. Functional assessment staging (FAST) in Korean patients with Alzheimer's disease.

    PubMed

    Na, Hae-Ri; Kim, Sang-Yun; Chang, Young-Hee; Park, Moon-Ho; Cho, Sung-Tae; Han, Il-Woo; Kim, Tae-You; Hwang, Sul-A

    2010-01-01

    Functional Assessment Staging (FAST) was devised to meet the need for a more brief patient-derived rating scale for evaluating changes in functional performance and activities of daily living skills in all the stages of Alzheimer's disease (AD). FAST was administered to 464 patients with probable AD according to the National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria. The patients were also evaluated using the Korean version of the Mini-Mental Status Examination (K-MMSE), the Clinical Dementia Rating (CDR), the Clinical Dementia Rating-Sum of Boxes (CDR-SB), the Global Deterioration Scale (GDS), the Barthel Activities of Daily Living (B-ADL), and the Seoul-Instrumental Activities of Daily Living (S-IADL). For patients with moderate to severe dementia, the Korean versions of the Severe Impairment Battery (SIB-Ko) and Baylor profound mental status examination (BPMSE-Ko) were also administered. There were significant correlations between the FAST and the K-MMSE scores (r= - 0.71, p< 0.001), between the FAST and the SIB-Ko scores (r= - 0.54, p< 0.001) and between the FAST and the BPMSE-Ko scores (r=- 0.46, p< 0.001). The FAST was also correlated with the CDR, the CDR-SB, the B-ADL, and the S-IADL (p< 0.001). Ultimately, FAST is a reliable and valid assessment technique for evaluating functional deterioration in AD patients throughout the disease course. Moreover, the findings of the present study suggest that the FAST elucidates a characteristic pattern of progressive, ordinal, and functional decline in AD in Korean AD patients with dementia. PMID:20847407

  20. Environmental NO2 and CO Exposure: Ignored Factors Associated with Uremic Pruritus in Patients Undergoing Hemodialysis

    NASA Astrophysics Data System (ADS)

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

    2016-08-01

    Uremic pruritus (UP), also known as chronic kidney disease–associated pruritus, is a common and disabling symptom in patients undergoing maintenance hemodialysis (MHD). The pathogenesis of UP is multifactorial and poorly understood. Outdoor air pollution has well-known effects on the health of patients with allergic diseases through an inflammatory process. Air pollution–induced inflammation could occur in the skin and aggravate skin symptoms such as pruritus or impair epidermal barrier function. To assess the role of air pollutants, and other clinical variables on uremic pruritus (UP) in HD patients, we recruited 866 patients on maintenance HD. We analyzed the following variables for association with UP: average previous 12-month and 24-month background concentrations for nitrogen dioxide (NO2) and carbon monoxide (CO), and suspended particulate matter of <2.5 μm (PM2.5). In a multivariate logistic regression, hemodialysis duration, serum ferritin levels, low-density lipoprotein levels, and environmental NO2/CO levels were positively associated with UP, and serum albumin levels were negatively associated with UP. This cross-sectional study showed that air pollutants such as NO2 and CO might be associated with UP in patients with MHD.

  1. Environmental NO2 and CO Exposure: Ignored Factors Associated with Uremic Pruritus in Patients Undergoing Hemodialysis.

    PubMed

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

    2016-01-01

    Uremic pruritus (UP), also known as chronic kidney disease-associated pruritus, is a common and disabling symptom in patients undergoing maintenance hemodialysis (MHD). The pathogenesis of UP is multifactorial and poorly understood. Outdoor air pollution has well-known effects on the health of patients with allergic diseases through an inflammatory process. Air pollution-induced inflammation could occur in the skin and aggravate skin symptoms such as pruritus or impair epidermal barrier function. To assess the role of air pollutants, and other clinical variables on uremic pruritus (UP) in HD patients, we recruited 866 patients on maintenance HD. We analyzed the following variables for association with UP: average previous 12-month and 24-month background concentrations for nitrogen dioxide (NO2) and carbon monoxide (CO), and suspended particulate matter of <2.5 μm (PM2.5). In a multivariate logistic regression, hemodialysis duration, serum ferritin levels, low-density lipoprotein levels, and environmental NO2/CO levels were positively associated with UP, and serum albumin levels were negatively associated with UP. This cross-sectional study showed that air pollutants such as NO2 and CO might be associated with UP in patients with MHD. PMID:27507591

  2. Environmental NO2 and CO Exposure: Ignored Factors Associated with Uremic Pruritus in Patients Undergoing Hemodialysis

    PubMed Central

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

    2016-01-01

    Uremic pruritus (UP), also known as chronic kidney disease–associated pruritus, is a common and disabling symptom in patients undergoing maintenance hemodialysis (MHD). The pathogenesis of UP is multifactorial and poorly understood. Outdoor air pollution has well-known effects on the health of patients with allergic diseases through an inflammatory process. Air pollution–induced inflammation could occur in the skin and aggravate skin symptoms such as pruritus or impair epidermal barrier function. To assess the role of air pollutants, and other clinical variables on uremic pruritus (UP) in HD patients, we recruited 866 patients on maintenance HD. We analyzed the following variables for association with UP: average previous 12-month and 24-month background concentrations for nitrogen dioxide (NO2) and carbon monoxide (CO), and suspended particulate matter of <2.5 μm (PM2.5). In a multivariate logistic regression, hemodialysis duration, serum ferritin levels, low-density lipoprotein levels, and environmental NO2/CO levels were positively associated with UP, and serum albumin levels were negatively associated with UP. This cross-sectional study showed that air pollutants such as NO2 and CO might be associated with UP in patients with MHD. PMID:27507591

  3. Prognostic effect of high-flux hemodialysis in patients with chronic kidney disease

    PubMed Central

    Li, X.; Xu, H.; Xiao, X.C.; Deng, S.L.; Wang, W.; Tang, R.

    2015-01-01

    We investigated the prognostic effects of high-flux hemodialysis (HFHD) and low-flux hemodialysis (LFHD) in patients with chronic kidney disease (CKD). Both an electronic and a manual search were performed based on our rigorous inclusion and exclusion criteria to retrieve high-quality, relevant clinical studies from various scientific literature databases. Comprehensive meta-analysis 2.0 (CMA 2.0) was used for the quantitative analysis. We initially retrieved 227 studies from the database search. Following a multi-step screening process, eight high-quality studies were selected for our meta-analysis. These eight studies included 4967 patients with CKD (2416 patients in the HFHD group, 2551 patients in the LFHD group). The results of our meta-analysis showed that the all-cause death rate in the HFHD group was significantly lower than that in the LFHD group (OR=0.704, 95%CI=0.533-0.929, P=0.013). Additionally, the cardiovascular death rate in the HFHD group was significantly lower than that in the LFHD group (OR=0.731, 95%CI=0.616-0.866, P<0.001). The results of this meta-analysis clearly showed that HFHD decreases all-cause death and cardiovascular death rates in patients with CKD and that HFHD can therefore be implemented as one of the first therapy choices for CKD. PMID:26628394

  4. Different Aspects of Fatigue Experienced by Patients Receiving Maintenance Dialysis in Hemodialysis Units

    PubMed Central

    Biniaz, Vajihe; Tayybi, Ali; Nemati, Eghlim; Sadeghi Shermeh, Mehdi; Ebadi, Abbas

    2013-01-01

    Background Fatigue, a common symptom reported by patients receiving dialysis, is a multidimensional and subjective experience which is readily understood by individuals but difficult to measure. Objectives This study was performed to identify the prevalence of differential aspects of fatigue among patients receiving maintenance dialysis. Patients and Methods The cross-sectional study was conducted in two hemodialysis wards in Tehran with a sample of 163 participants. In this study, the multidimensional fatigue inventory was used to determine the level of fatigue. Demographic data were also collected with self-report survey. To analyze data with SPSS statistical software, test Chi square, T-test, and ANOVA were used. P- Value less than 0.05 was considered significant. Results All the patients experienced degrees of fatigue and 50 (30.7%) of the participants experienced a high level of fatigue. Fatigue scores arrangement was founded for physical fatigue followed by reduced activity and general fatigue. Lower levels of fatigue were reported for mental fatigue and reduced motivation. There was no diversity in this study in the levels of fatigue in respects of gender and marital status and employment status. Participants with diabetic nephropathy were the most fatigued. Conclusions People with chronic kidney disease regardless of their age, gender, state of health, and duration of hemodialysis experience high levels of fatigue; it is particularly important for health providers to understand this level of fatigue which affects the daily life of patients. PMID:24350089

  5. Association between Serum Soluble Klotho Levels and Mortality in Chronic Hemodialysis Patients

    PubMed Central

    Otani-Takei, Naoko; Masuda, Takahiro; Akimoto, Tetsu; Honma, Sumiko; Watanabe, Yuko; Shiizaki, Kazuhiro; Miki, Takuya; Kusano, Eiji; Asano, Yasushi; Kuro-o, Makoto; Nagata, Daisuke

    2015-01-01

    Klotho is a single-pass transmembrane protein predominantly expressed in the kidney. The extracellular domain of Klotho is subject to ectodomain shedding and is released into the circulation as a soluble form. Soluble Klotho is also generated from alternative splicing of the Klotho gene. In mice, defects in Klotho expression lead to complex phenotypes resembling those observed in dialysis patients. However, the relationship between the level of serum soluble Klotho and overall survival in hemodialysis patients, who exhibit a state of Klotho deficiency, remains to be delineated. Here we prospectively followed a cohort of 63 patients with a mean duration of chronic hemodialysis of 6.7 ± 5.4 years for a median of 65 months. Serum soluble Klotho was detectable in all patients (median 371 pg/mL, interquartile range 309–449). Patients with serum soluble Klotho levels below the lower quartile (<309 pg/mL) had significantly higher cardiovascular and all-cause mortality rates. Furthermore, the higher all-cause mortality persisted even after adjustment for confounders (hazard ratio 4.14, confidence interval 1.29–13.48). We conclude that there may be a threshold for the serum soluble Klotho level associated with a higher risk of mortality. PMID:26604925

  6. The Survival of Roma Minority Patients on Chronic Hemodialysis Therapy - A Romanian Multicenter Survey

    PubMed Central

    Stoian, Dana; Schiller, Oana; Timar, Romulus; Timar, Bogdan; Bob, Flaviu; Donciu, Mihaela Dora; Munteanu, Mircea; Mihaescu, Adelina; Covic, Adrian; Schiller, Adalbert

    2016-01-01

    Objective The Roma minority represents the largest ethnic group in Central and South-East European countries. Data regarding the mortality in Roma hemodialysis subjects are limited. We evaluated the 3 year mortality of ESRD Roma patients treated with hemodialysis (HD). Study Design and Setting Our prospective cohort study included 600 ESRD patients on HD therapy recruited from 7 HD centers, from the main geographical regions of Romania. The median age of the patients was 56 (19) years, 332 (55.3%) being males, 51 (8.5%) having Roma ethnicity. Results Roma ESRD patients initiate dialysis at a younger age, 47.8 years vs. 52.3 years (P = 0.017), present higher serum albumin (P = 0.013) and higher serum phosphate levels (P = 0.021). In the Roma group, the overall 3 year mortality was higher when compared to Caucasians (33.3% vs. 24.8%). The multivariate survival analysis revealed that being of Roma ethnicity is an independent risk factor for mortality (HR = 1.74; 95% CI = 1.04–2.91; P = 0.035). Conclusions Roma patients with ESRD initiate HD therapy at a younger age as compared to Caucasians. They have a higher 3 year mortality rate and are dying at a younger age. Roma ethnicity represents an independent risk factor for mortality in our cohort. PMID:27196564

  7. Missed dialysis sessions and hospitalization in hemodialysis patients after Hurricane Katrina.

    PubMed

    Anderson, Amanda H; Cohen, Andrew J; Kutner, Nancy G; Kopp, Jeffrey B; Kimmel, Paul L; Muntner, Paul

    2009-06-01

    In order to evaluate the factors that contributed to missed dialysis sessions and increased hospitalizations of hemodialysis patients after Hurricane Katrina, we contacted 386 patients from 9 New Orleans hemodialysis units. Data were collected through structured telephone interviews on socio-demographics, dialysis factors, and evacuation characteristics. Overall, 44% of patients reported missing at least one and almost 17% reported missing 3 or more dialysis sessions. The likelihood of missing 3 or more sessions was greater for those whose dialysis vintage was less than 2 years compared to those for whom it was 5 or more years, who had 38 or fewer billed dialysis sessions compared to those who had 39 or more in the 3 months before the storm, who lived alone before the storm, who were unaware of their dialysis facility's emergency plans, who did not evacuate prior to hurricane landfall, and who were placed in a shelter. The adjusted odds ratio of hospitalization among patients who missed 3 or more compared to those who did not miss any dialysis sessions was 2.16 (95% CI: 1.05-4.43). These findings suggest that when preparing for future disasters more emphasis needs to be placed on patient awareness and early execution of emergency plans. PMID:19212421

  8. Erythropoietin Dose and Mortality in Hemodialysis Patients: Marginal Structural Model to Examine Causality.

    PubMed

    Streja, Elani; Park, Jongha; Chan, Ting-Yan; Lee, Janet; Soohoo, Melissa; Rhee, Connie M; Arah, Onyebuchi A; Kalantar-Zadeh, Kamyar

    2016-01-01

    It has been previously reported that a higher erythropoiesis stimulating agent (ESA) dose in hemodialysis patients is associated with adverse outcomes including mortality; however the causal relationship between ESA and mortality is still hotly debated. We hypothesize ESA dose indeed exhibits a direct linear relationship with mortality in models of association implementing the use of a marginal structural model (MSM), which controls for time-varying confounding and examines causality in the ESA dose-mortality relationship. We conducted a retrospective cohort study of 128 598 adult hemodialysis patients over a 5-year follow-up period to evaluate the association between weekly ESA (epoetin-α) dose and mortality risk. A MSM was used to account for baseline and time-varying covariates especially laboratory measures including hemoglobin level and markers of malnutrition-inflammation status. There was a dose-dependent positive association between weekly epoetin-α doses ≥18 000 U/week and mortality risk. Compared to ESA dose of <6 000 U/week, adjusted odds ratios (95% confidence interval) were 1.02 (0.94-1.10), 1.08 (1.00-1.18), 1.17 (1.06-1.28), 1.27 (1.15-1.41), and 1.52 (1.37-1.69) for ESA dose of 6 000 to <12 000, 12 000 to <18 000, 18 000 to <24 000, 24 000 to <30 000, and ≥30 000 U/week, respectively. High ESA dose may be causally associated with excessive mortality, which is supportive of guidelines which advocate for conservative management of ESA dosing regimen in hemodialysis patients. PMID:27298736

  9. Erythropoietin Dose and Mortality in Hemodialysis Patients: Marginal Structural Model to Examine Causality

    PubMed Central

    Streja, Elani; Park, Jongha; Chan, Ting-Yan; Lee, Janet; Soohoo, Melissa; Rhee, Connie M.; Arah, Onyebuchi A.; Kalantar-Zadeh, Kamyar

    2016-01-01

    It has been previously reported that a higher erythropoiesis stimulating agent (ESA) dose in hemodialysis patients is associated with adverse outcomes including mortality; however the causal relationship between ESA and mortality is still hotly debated. We hypothesize ESA dose indeed exhibits a direct linear relationship with mortality in models of association implementing the use of a marginal structural model (MSM), which controls for time-varying confounding and examines causality in the ESA dose-mortality relationship. We conducted a retrospective cohort study of 128 598 adult hemodialysis patients over a 5-year follow-up period to evaluate the association between weekly ESA (epoetin-α) dose and mortality risk. A MSM was used to account for baseline and time-varying covariates especially laboratory measures including hemoglobin level and markers of malnutrition-inflammation status. There was a dose-dependent positive association between weekly epoetin-α doses ≥18 000 U/week and mortality risk. Compared to ESA dose of <6 000 U/week, adjusted odds ratios (95% confidence interval) were 1.02 (0.94–1.10), 1.08 (1.00–1.18), 1.17 (1.06–1.28), 1.27 (1.15–1.41), and 1.52 (1.37–1.69) for ESA dose of 6 000 to <12 000, 12 000 to <18 000, 18 000 to <24 000, 24 000 to <30 000, and ≥30 000 U/week, respectively. High ESA dose may be causally associated with excessive mortality, which is supportive of guidelines which advocate for conservative management of ESA dosing regimen in hemodialysis patients. PMID:27298736

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

    PubMed Central

    Wang, Liang-Jen; Chen, Chih-Ken; Hsu, Heng-Jung; Wu, I-Wen; Sun, Chiao-Yin; Lee, Chin-Chan

    2014-01-01

    Objective Depression is the most prevalent comorbid psychiatric disease among hemodialysis patients with end-stage renal disease. This cross-sectional study investigated whether depression in hemodialysis patients is associated with the polymorphism of the 5′ flanking transcriptional region (5-HTTLPR) of the serotonin transporter gene, the valine (Val)-to-methionine (Met) substitution at codon 66 (Val66Met) polymorphism of the brain-derived neurotrophic factor (BDNF) gene, or plasma BDNF levels. Methods A total of 188 participants (mean age: 58.5±14.0 years; 89 men and 99 women) receiving hemodialysis at the Chang Gung Memorial Hospital were recruited. The diagnosis of major depressive disorder (MDD) was confirmed using the Chinese version of the Mini International Neuropsychiatric Interview. The genotypes of 5-HTTLPR and BDNF Val66Met were conducted using polymerase chain reactions plus restriction fragment length polymorphism analysis. The plasma BDNF levels were measured using an enzyme-linked immunosorbent assay kit. Results Forty-five (23.9%) patients fulfilled the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR) criteria for a MDD. There were no significant effects of the 5-HTTLPR or BDNF Val66Met gene polymorphism on MDD among the hemodialysis patients. The plasma BDNF levels correlated significantly with age (P=0.003) and sex (P=0.047) but not with depression, the genotypes of 5-HTTLPR and BDNF Val66Met, the current antidepressant treatment, or the duration under hemodialysis. Conclusion Our results did not support the hypothesis of an involvement of the 5HTTLPR and BDNF Val66Met genotypes, or plasma BDNF levels in the pathogenesis of depression, in patients receiving hemodialysis. A study with a large sample size and homogenous patient group is warranted to confirm these findings. PMID:25045267

  11. RETROSPECTIVE STUDY OF MICROORGANISMS ASSOCIATED WITH VASCULAR ACCESS INFECTIONS IN HEMODIALYSIS PATIENTS

    PubMed Central

    D’Amato-Palumbo, S; Kaplan, AA; Feinn, RS; Lalla, RV

    2013-01-01

    Objective To assess microorganisms associated with vascular access-associated infections (VAIs) in hemodialysis patients, with respect to possible origin from the mouth. Study Design A retrospective and comparative analysis of the microbes associated with VAI in hemodialysis patients treated during a 10-year period was performed using the Human Oral Microbiome Database (HOMD). Results Of 218 patient records identified, 65 patients collectively experienced 115 VAI episodes. The most common microorganisms involved were Staphylococcus aureus (49.6% of infections), Staphylococcus epidermidis (10.4%), Serratia marcescens (10.4%), Pseudomonas aeruginosa (9.6%), and Enterococcus faecalis / fecum (8.7%). None of these was found in 1% or more of HOMD clone libraries, indicating that they very rarely colonize the teeth or plaque. Conclusions Most VAIs were associated with microorganisms more likely to originate from other body sites than from the oral cavity. The risk of a VAI being caused by microorganisms originating from the oral cavity is very small. PMID:23217535

  12. Home Hemodialysis

    MedlinePlus

    ... Organizations​​ . (PDF, 345 KB)​​​​​ Alternate Language URL Home Hemodialysis Page Content On this page: What is home ... Points to Remember Clinical Trials What is home hemodialysis? Home hemodialysis is hemodialysis that a person can ...

  13. Febuxostat and Increased Dialysis as a Treatment for Severe Tophaceous Gout in a Hemodialysis Patient

    PubMed Central

    Frassetto, Lynda Ann; Gibson, Suzanne

    2016-01-01

    Uric acid accumulates in renal failure and is thought to be a uremic toxin—that is, higher levels of uric acid are more damaging to the kidneys. Urate crystals can precipitate in the kidney tubules, cause urate stones, and promote inflammatory changes in the renal interstitium and vascular endothelium. Uric acid is also a small non-protein-bound molecule and therefore easily dialyzable. Here, we present the case of an anuric hemodialysis patient with severe tophaceous gout who regained some renal function and whose gout burden significantly decreased resulting in marked improvement in functional status using a new gout medication, febuxostat, and increased frequency of dialysis. PMID:27200198

  14. The impact of short daily hemodialysis on anemia and the quality of life in Chinese patients

    PubMed Central

    Jiang, J.L.; Ren, W.; Song, J.; Sun, Q.L.; Xiao, X.Y.; Diao, X.Z.; Huang, Y.H.; Lan, L.; Wang, P.; Hu, Z.

    2013-01-01

    Anemia is a frequent complication in hemodialysis patients. Compared to conventional hemodialysis (CHD), short daily hemodialysis (sDHD) has been reported to be effective in many countries except China. The aim of the present study was to determine whether sDHD could improve anemia and quality of life (QOL) for Chinese outpatients with end-stage renal disease. Twenty-seven patients (16 males/11 females) were converted from CHD to sDHD. All laboratory values were measured before conversion (baseline), at 3 months after conversion (sDHD1), and at 6 months after conversion (sDHD2). The patient's QOL was evaluated at baseline and 6 months after conversion using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). Hemoglobin concentration increased significantly from 107.4±7.9 g/L at baseline to 114.4±6.8 g/L (P<0.05) at sDHD1, and 118.3±8.4 g/L (P<0.001) at sDHD2 (Student paired t-test). However, the dose requirement for erythropoietin decreased from 6847.8±1057.3 U/week at baseline to 5869.6±1094.6 U/week (P<0.05) at sDHD2. Weekly stdKt/V increased significantly from 2.05±0.13 at baseline to 2.73±0.20 (P<0.001) at sDHD1, and 2.84±0.26 (P<0.001) at sDHD2. C-reactive protein decreased from baseline to sDHD1 and sDHD2, but without statistically significant differences. Physical and mental health survey scores increased in the 6 months following conversion to sDHD. sDHD may increase hemoglobin levels, decrease exogenous erythropoietin dose requirements, and improve QOL in Chinese hemodialysis patients compared to CHD. A possible mechanism for improvement of clinical outcomes may be optimized management of uremia associated with the higher efficiency of sDHD. PMID:23970065

  15. Beta 2-microglobulin amyloidosis presenting as esophageal perforation in a hemodialysis patient.

    PubMed

    Khan, G A; Lewis, F I; Dasgupta, M

    1997-01-01

    A 45-year-old male with hypertensive end-stage renal disease and on maintenance hemodialysis for 13 years is reported. He presented with life-threatening hematemesis, secondary to esophageal rupture. Immunohistological staining and electron microscopy examination of the esophageal perforation showed depositions of beta 2-microglobulin (beta 2-M) amyoloid. The unique aspect presented here is the localized esophageal involvement with beta 2-M amyloidosis. This is the first reported patient with esophageal perforation, due to the deposition and infiltration of the lower esophagus with beta 2-M which predisposed to its rupture. PMID:9426849

  16. Febuxostat and Increased Dialysis as a Treatment for Severe Tophaceous Gout in a Hemodialysis Patient.

    PubMed

    Frassetto, Lynda Ann; Gibson, Suzanne

    2016-01-01

    Uric acid accumulates in renal failure and is thought to be a uremic toxin-that is, higher levels of uric acid are more damaging to the kidneys. Urate crystals can precipitate in the kidney tubules, cause urate stones, and promote inflammatory changes in the renal interstitium and vascular endothelium. Uric acid is also a small non-protein-bound molecule and therefore easily dialyzable. Here, we present the case of an anuric hemodialysis patient with severe tophaceous gout who regained some renal function and whose gout burden significantly decreased resulting in marked improvement in functional status using a new gout medication, febuxostat, and increased frequency of dialysis. PMID:27200198

  17. Use of Nitinol Stents Following Recanalization of Central Venous Occlusions in Hemodialysis Patients

    SciTech Connect

    Rajan, Dheeraj K. Saluja, Jasdeep S.

    2007-07-15

    Purpose. To retrospectively review the patency of endovascular interventions with nitinol stent placement for symptomatic central venous occlusions in hemodialysis patients. Methods. A retrospective review of all patients who underwent endovascular interventions for dysfunctional hemodialysis grafts and fistulas was performed from April 2004 to August 2006. A total of 6 patients presented with arm and/or neck and facial swelling and left brachiocephalic vein occlusion. The study group consisted of 3 men and 3 women with a mean age of 79.5 years (SD 11.2 years). Of these 6 patients, 1 had a graft and 5 had fistulas in the left arm. The primary indication for nitinol stent placement was technical failure of angioplasty following successful traversal of occluded central venous segments. Patency was assessed from repeat fistulograms and central venograms performed when patients redeveloped symptoms or were referred for access dysfunction determined by the ultrasound dilution technique. No patients were lost to follow-up. Results. Nitinol stent placement to obtain technically successful recanalization of occluded venous segments was initially successful in 5 of 6 patients (83%). In 1 patient, incorrect stent positioning resulted in partial migration to the superior vena cava requiring restenting to prevent further migration. Clinical success was observed in all patients (100%). Over the follow-up period, 2 patients underwent repeat intervention with angioplasty alone. Primary patency was 83.3% (95% CI 0.5-1.2) at 3 months, and 66.7% at 6 and 12 months (0.2-1.1, 0.1-1.2). Secondary patency was 100% at 12 months with 3 patients censored over that time period. Mean primary patency was 10.4 months with a mean follow-up of 12.4 months. No complications related to recanalization of the occluded central venous segments were observed. Conclusion. Our initial experience has demonstrated that use of nitinol stents for central venous occlusion in hemodialysis patients is

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

    PubMed

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

    2016-06-01

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

  19. Major Barriers Responsible for Malnutrition in Hemodialysis Patients: Challenges to Optimal Nutrition

    PubMed Central

    Ekramzadeh, Maryam; Mazloom, Zohreh; Jafari, Peyman; Ayatollahi, Maryam; Sagheb, Mohammad Mahdi

    2014-01-01

    Background: Nutritional barriers may contribute to malnutrition in hemodialysis (HD) patients. Higher rates of morbidity and mortality rates have been reported in malnourished HD patients. These patients are faced with different challenges affecting their nutritional status. Objectives: The aim of this cross-sectional study was to identify most important barriers responsible for malnutrition in HD patients. Patients and Methods: We randomly selected 255 of 800 stable HD patients from three HD centers with an age range of 18-85 years, who had been on hemodialysis for at least three months without any acute illness. Each patient was interviewed to evaluate malnutrition [subjective global assessment (SGA), malnutrition inflammation score (MIS)], and potential medical, behavioral and socioeconomic barriers. Body composition of patients was checked through bioelectrical impedance analysis (BIA). Routine clinical markers of malnutrition such as serum albumin and total protein were measured using standard automated techniques. Binary logistic regression model was used to find the association between nutritional markers and potential barriers. Results: Patients with higher SGA had lower knowledge about general nutrition [odds ratio (OR), 1.3], potassium (OR, 1.89), difficulty chewing (OR, 1.16), and shopping (OR, 1.16). Those with greater MIS scores had poor appetite (OR, 1.3), depression (OR, 1.21), and difficulty with cooking (OR, 1.15). Lower BCM (body cell mass) was associated with poor appetite (OR, 0.92) and needed help for cooking (OR, 0.88). Patients with higher BFMI (body fat mass index) had insufficient general nutrition (OR, 1.15), and protein (OR, 1.27) knowledge, and needed help for shopping (OR, 1.14). Moreover, patients with higher SGA scores were those with older age and longer duration of HD. Conclusions: Three medical barriers (poor appetite, depression and difficulty chewing), one behavioral barrier (poor total nutrition, protein, and potassium knowledge

  20. Enhanced elimination of dabigatran: Identifying the appropriate patient for the use of continuous venovenous hemodialysis instead of intermittent hemodialysis-A simulation analysis.

    PubMed

    Liesenfeld, Karl-Heinz; Gruenenfelder, Fredrik; Clemens, Andreas

    2016-05-01

    There are clinical situations where rapid elimination of dabigatran is beneficial. Intermittent hemodialysis (IHD) removes dabigatran effectively but is not always available and requires a hemodynamically stable patient. We therefore investigated the continuous venovenous hemodialysis (CVVHD) technique for its potency in the elimination of dabigatran. Based on pharmacometric characterization of dabigatran in IHD, we simulated a broad range of dialysis settings for CVVHD and then applied the model to specific clinical situations. Dialysis of 3 hours' duration with typical clinical settings (dialysate flow rate 50 mL/min; blood flow rate 150 mL/min) reduced dabigatran plasma concentration by 14-17% in addition to the patient body clearance. Extending dialysis duration to 8 or 16 hours for patients with severe renal dysfunction resulted in additional reductions from 26% up to 40%. When comparing with IHD for different endpoints (reaching 50% of initial dabigatran concentration, or nondetectability of dabigatran by the Hemoclot test), CVVHD did not reach comparable elimination rates. CVVHD is not fast enough to prepare for urgent interventions in patients with high bleeding risks. However, in situations where less hemodynamically stressful modalities seem indicated, CVVHD might be useful in moderately to severely renally impaired patients to accelerate dabigatran elimination. PMID:26272714

  1. The Prevalence of Metabolic Syndrome and Factors Associated with Quality of Dialysis among Hemodialysis Patients in Southern Taiwan

    PubMed Central

    Tu, Shu-Fen; Chou, Yu-Ching; Sun, Chien-An; Hsueh, Shu-Chun; Yang, Tsan

    2012-01-01

    Objectives: The purpose of this study was to evaluate the prevalence of metabolic syndrome (MetS) among hemodialysis patients and factors associated with quality of dialysis. Methods: Data were collected from 377 long-term hemodialysis patients who received hemodialysis treatment from clinics in Tainan and Kaohsiung between November 2009 and February 2010. MetS was defined using criteria set by the adult treatment panel III (ATP-III). But, the cutpoint of waist circumference has been modified to adjust for Asian populations. The measurement of Kt/V was used as an indicator of the quality of dialysis. A below 1.4 Kt/V was considered poor dialysis quality. Results: Results showed that the prevalence of MetS among the chronic hemodialysis patients in this sample was 61.0%. Logistic regression results identified that the quality of dialysis in females was better than that in males (odds ratio (OR)=7.98, 95% confidence interval (CI): 2.52-25.31). Better quality dialysis was associated with older age, longer treatment time, and increased blood flow rate (OR=1.49, 13.63, and 1.35, respectively). However, for every one kilogram increase in weight, the quality of dialysis decreased by 13 percents (OR=0.87, 95% CI: 0.83-0.92). Conclusions: MetS is common among hemodialysis patients. The prevalence of hypertension, hyperlipidemia, and hyperglycaemia were significantly higher among hemodialysis patients. Quality of dialysis related to gender, age, weight, and the dialysis prescription (treatment time and blood flow rate). PMID:22980378

  2. [Are disinfectant residues remained after cleaning hemodialysis machine procedure safe for patients?].

    PubMed

    Szewczyk, Małgorzata; Grzeszczuk, Karolina; Walski, Tomasz; Suder, Marek; Komorowska, Małgorzata

    2013-01-01

    The dialysis machine shall be cleaned and disinfected after each patient treatment or after every 72 hours break in working. An acceptable disinfectants such as Puristeril plus or Puristeril 340, Citrosteril, Diasteril and Sporotal are used for decontamination. Puristeril 340 is designed for cold disinfection and due to the low pH value, the necessary decalcification of hemodialysis machines is easily achieved. It can be used for all haemodialysis systems like hemodialysis machines, water treatment devices and circuit pipes. Diluted Puristeril decomposes in a non-toxic way. Degradation products of peracetic acid, which is main component of Puristeril are: hydrogen peroxide and acetic acid. Peracetic acid is widely used for disinfection due to its exceptionally broad spectrum of microbiocidal activity at low concentrations and short exposure times. After use Puristeril is easily removable by rinsing with water. This paper deals with the effect of the Puristeril toxicity on blood as a function of its concentration and incubation time. Concentration range of 3.5-70 ppm was used, with particular emphasis on concentrations close to 5 ppm, a value is the limit of sensitivity of strips of starch potassium iodide, the tests for detection of peracetic acid. There was a strong increase in autohaemolysis and malondialdehyde concentrations with increasing concentration of Puristeril. There were also changes in dependence on the parameters of the incubation time, with the greatest effects obtained after 2 hours incubation with Puristeril. The detection limit of peracetic acid used strips of starch potassium iodide does not guarantee the safety of a patient undergoing hemodialysis. Even the residual concentration of Puristeril plus cause increased lipid peroxidation of membrane, and therefore suggest the routine use of stripes on the lower limit of detection of peracetic acid or implement measurement of hydrogen peroxide residues performed with sensitivity 1 ppm. PMID:24003659

  3. Cross-sectional small intestinal surveillance of maintenance hemodialysis patients using video capsule endoscopy: SCHEMA study

    PubMed Central

    Hosoe, Naoki; Matsukawa, Shigeaki; Kanno, Yoshihiko; Naganuma, Makoto; Imaeda, Hiroyuki; Ida, Yosuke; Tsuchiya, Yoshitsugu; Hibi, Toshifumi; Ogata, Haruhiko; Kanai, Takanori

    2016-01-01

    Background and study aims: Small intestinal pathology in hemodialysis (HD) patients has been studied in only a small number of retrospective case series. One method for noninvasively surveying small intestinal disorders is video capsule endoscopy (VCE). The primary aim of this study was to investigate the prevalence of small intestinal abnormalities among asymptomatic maintenance HD outpatients using VCE. The secondary aim was to assess the clinical impact of these abnormalities. Patients and methods: This study consisted of two phases. In phase I, a cross-sectional study, a cohort of patients who received maintenance HD three times weekly at an outpatient hemodialysis clinic were studied using VCE. Phase II was a prospective cohort study with follow up for 1 year after VCE. Results: Fifty-six patients were enrolled in this study, and two were excluded from analysis due to capsule retention in the stomach. The prevalence of small bowel abnormalities in HD patients was 64.8 % (35/54) (95 % confidential interval 52.1 % – 77.6 %). Of 54 patients, 21 (38.9 %) had mucosal lesions, 10 (18.5 %) had vascular lesions, and 4 (7.4 %) had both lesion types. During the 1-year follow-up period, events occurred in four patients. A small bowel-associated event was observed in one patient, who underwent laparoscopy-assisted small intestinal partial resection 3 months after diagnosis by VCE. All patients in whom events were seen had small bowel abnormalities; no events were observed in the VCE-negative group. Conclusions: Although asymptomatic maintenance HD patients had a high prevalence of small bowel abnormalities (64.8 %), they did not have a high incidence of small bowel-associated events during the 1-year follow-up. PMID:27227120

  4. Effect of ethnicity on erythropoietin therapy response for hemodialysis patients: a retrospective study.

    PubMed

    Al-Khalaf, Bader; Al-Khalaf, Nour; Mustafa, Seham

    2013-10-01

    Anemia is a common feature in chronic kidney disease patients due to deficiency of erythropoietin (EPO). Diseased kidneys are unable to produce EPO, which enhances red blood cell production from the bone marrow. Recombinant human EPO in hemodialysis patients was introduced with perfect outcomes as a hormonal substitutive treatment. Some ethnic minority groups have high prevalence of anemia associated with chronic kidney diseases. The aim of this study is to evaluate the differences between African Caribbeans and Caucasians' EPO therapy response with regard to hemoglobin (Hb), some factors affecting it and some comorbid conditions. A retrospective study for 6 months of 100 patients on hemodialysis was conducted on two ethnic minorities groups; 46 patients were African Caribbean and 54 patients were Caucasian, who received EPO therapy at once or three times weekly dose at the Hanbury Dialysis Unit of Royal London Hospital. There were three types of EPO therapy used: Aranesp, Mircera and Neorecormon. Forty-six patients were African Caribbean and 54 patients were Caucasian. There were 63.4% of patients treated by Aranesp while 13% were given Mircera; 22.8% of the sample used Neorecorman. It was shown that the chosen comorbid conditions had higher percentage in the African Caribbeans than in Caucasians. Diabetic and/or hypertensive patients are almost double the patient numbers. In addition, sickle cell anemia is only present in African Caribbeans. There were 43.5% of African Caribbeans and 81.1% of Caucasians who met the standards of Hb level. There was no significant difference between African Caribbeans and Caucasians regarding parathyroid hormone, c-reactive protein, B12, mean corpuscular volume, ferritin, and folate. In this study, there was a significant difference in the Hb levels between African Caribbean and Caucasian groups. Sixty percent of African Caribbeans had mean Hb less than normal levels. However, they received lower EPO dose than Caucasians. As a

  5. Development and Evaluation of the CAHPS® Survey for In-center Hemodialysis Patients

    PubMed Central

    Weidmer, Beverly A.; Cleary, Paul D.; Keller, San; Evensen, Christian; Hurtado, Margarita P.; Kosiak, Beth; Gallagher, Patricia M.; Levine, Roger; Hays, Ron D.

    2015-01-01

    Background The U.S. Centers for Medicare & Medicaid Services (CMS) assesses patient experiences of care as part of the End Stage Renal Disease (ESRD) Prospective Payment System and Quality Incentive Program. This article describes the development and evaluation of the Consumer Assessment of Healthcare Providers and Systems In-Center Hemodialysis survey (CAHPS® ICH survey). Study Design We conducted formative research to generate survey questions and conducted statistical analyses of survey responses to evaluate the survey’s measurement properties. Setting and Participants Formative research included 5 focus groups (2 with hemodialysis patients, 2 with caregivers, 1 with nephrologists) and 56 cognitive interviews with dialysis patients. We collected field test responses to the survey from 1454 dialysis patients receiving care at 32 facilities. Measurements & Outcomes We assessed the CAHPS ICH Survey. Results Response rate was 46%. Analyses support 3 multi-item scales: Nephrologists’ Communication and Caring (7 items, Cronbach’s alpha = 0.89); Quality of Dialysis Center Care and Operations (22 items, alpha = 0.93); and, Providing Information to Patients (11 items, alpha = 0.75). The communication scale was the most strongly correlated with the global rating of the ‘kidney doctor’ (r = 0.78). The Dialysis Center Care and Operations scale was most strongly correlated with the global ratings of staff (r = 0.75) and of the center (r = 0.69). Providing Information to Patients was most strongly correlated with the global rating of the staff (r=0.41). Limitations Males and younger patients were over-represented in the field test compared to the general U.S. population of dialysis patients. A relatively small number of patients completed the survey in Spanish. Conclusions This study provides support for the reliability and validity of the CAHPS ICH survey for assessing ESRD patient experiences of care at dialysis facilities. The survey can be used to compare care

  6. [Non-pharmacologic treatment of arterial hypertension in hemodialysis patients].

    PubMed

    Chazot, C; Charra, B

    2007-10-01

    High blood pressure in dialysis patients is related to extracellular volume excess and the related increase of systemic vascular resistances. Scribner has early described the treatment of hypertension with ultrafiltration and low salt diet, without any drugs. The dry weight method relies on the progressive reduction of the postdialysis body weight until blood pressure is normalized. Additional measures are needed such as low salt diet, neutral sodium balance during dialysis treatment, stop of antihypertensive drugs, adequate length of the dialysis session, and patient education. It may exist a lag time between the normalization of the extracellular volume and blood pressure. It is related to the correction of the hemodynamic consequences of the extracellular volume overload. Moreover, the dry weight may potentially vary in patients undergoing catabolic intercurrent events. The complications of these changes (severe hypertension, pulmonary oedema) must be anticipated by the nephrologist and the staff to avoid additional morbidity to the patient. PMID:18340684

  7. Cardiovascular disease and cognitive function in maintenance hemodialysis patients

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Cardiovascular disease (CVD) and cognitive impairment are common in dialysis patients. Given the proposed role of microvascular disease on cognitive function, particularly cognitive domains that incorporate executive functions, we hypothesized that prevalent systemic CVD would be associated with wor...

  8. Diagnostic accuracy of the defining characteristics of the excessive fluid volume diagnosis in hemodialysis patients1

    PubMed Central

    Fernandes, Maria Isabel da Conceição Dias; Bispo, Miclécia de Melo; Leite, Érida Maria Diniz; Lopes, Marcos Venícios de Oliveira; da Silva, Viviane Martins; Lira, Ana Luisa Brandão de Carvalho

    2015-01-01

    Objective: to evaluate the accuracy of the defining characteristics of the excess fluid volume nursing diagnosis of NANDA International, in patients undergoing hemodialysis. Method: this was a study of diagnostic accuracy, with a cross-sectional design, performed in two stages. The first, involving 100 patients from a dialysis clinic and a university hospital in northeastern Brazil, investigated the presence and absence of the defining characteristics of excess fluid volume. In the second step, these characteristics were evaluated by diagnostic nurses, who judged the presence or absence of the diagnosis. To analyze the measures of accuracy, sensitivity, specificity, and positive and negative predictive values were calculated. Approval was given by the Research Ethics Committee under authorization No. 148.428. Results: the most sensitive indicator was edema and most specific were pulmonary congestion, adventitious breath sounds and restlessness. Conclusion: the more accurate defining characteristics, considered valid for the diagnostic inference of excess fluid volume in patients undergoing hemodialysis were edema, pulmonary congestion, adventitious breath sounds and restlessness. Thus, in the presence of these, the nurse may safely assume the presence of the diagnosis studied. PMID:26625996

  9. Blood Volume Changes Induced By Low-Intensity Intradialytic Exercise in Long-Term Hemodialysis Patients.

    PubMed

    Ookawara, Susumu; Miyazawa, Haruhisa; Ito, Kiyonori; Ueda, Yuichiro; Kaku, Yoshio; Hirai, Keiji; Hoshino, Taro; Mori, Honami; Yoshida, Izumi; Morishita, Yoshiyuki; Tabei, Kaoru

    2016-01-01

    Intradialytic exercise-induced blood volume (BV) reduction may cause intradialytic hypotension in hemodialysis (HD) patients. However, BV recovery time after intradialytic exercise remains unknown. Hemodialysis patients were recruited, and their relative BV change (%ΔBV) were measured with intradialytic exercise (n = 12). After confirming the linearity of %ΔBV for 30 min, patients exercised using a stationary cycle in the supine position. The target exercise intensity was a 10% increase in heart rate (HR), corresponding to relatively low-intensity exercise. Baseline %ΔBV (assumed baseline) were calculated for the 30 min before exercise using linear regression analysis. The mean intradialytic exercise start and end times after HD initiation were 93.0 ± 8.4 and 116.4 ± 8.3 min, respectively, a mean exercise duration of 23.5 ± 2.6 min. Percentage change in blood volume declined rapidly upon exercise initiation and gradually increased above the assumed baseline throughout HD. At the end of HD, %ΔBV in the exercise group was significantly higher than the assumed baseline (measured - assumed baseline %ΔBV: 2.17 ± 0.62%; p = 0.02). Intradialytic exercise with low intensity in the supine position attenuated ultrafiltration-induced BV reduction at the end of HD. Therefore, intradialytic exercise may prevent intradialytic hypotension during later HD, although its intensity was relatively low level. PMID:26720736

  10. Changes in QT intervals in patients with end-stage renal disease before and after hemodialysis.

    PubMed

    Malhis, Mahmoud; Al-Bitar, Sami; Farhood, Saleh; Zaiat, Khair Al-Deen

    2010-05-01

    Increased dispersion of QT intervals is known to predispose to ventricular arrhythmias and sudden cardiac death. To assess the effect of hemodialysis (HD) on QT and corrected QT (QTc) intervals and their dispersions in chronic hemodialyzed patients we studied 85 patients (male/female = 48/37; mean age 44 +/- 17 year) on chronic hemodialysis. Simultaneous 12-lead ECG was recorded before and after HD in a standard setting. The QT intervals for each lead were measured manually by one observer using calipers. Each QT interval was corrected for heart rate: QTc= QT/ mean square root of R-R (in milliseconds [ms]). ECG parameters, body weight, blood pressure, heart rate, electrolytes (Na+, K+, Ca++, phosphate), urea, and creatinine were measured before and after HD. The mean of pre and post dialysis cycle intervals was 828 +/- 132 ms and 798 +/- 122 ms respectively; the difference was not significant. The mean of QTmax intervals changed significantly from 446 +/- 47 to 465 +/- 72 ms (P < 0.05). The mean of corrected QTcmax intervals increased significantly from 472 +/- 38 to 492 +/- 58 ms (P < 0.05). The mean of QT dispersions and the corrected QT interval dispersions changed from 60 +/- 29 to 76 +/- 32 ms (P < 0.05) from 72 +/- 46 to 98 +/- 56 ms (P < 0.05), respectively. During HD, the serum potassium and phosphate levels decreased whereas the calcium levels increased. We conclude that QT and QTc interval and dispersion increase in HD patients. PMID:20427869

  11. Let them eat during dialysis: an overlooked opportunity to improve outcomes in maintenance hemodialysis patients.

    PubMed

    Kalantar-Zadeh, Kamyar; Ikizler, T Alp

    2013-05-01

    In individuals with chronic kidney disease, surrogates of protein-energy wasting, including a relatively low serum albumin and fat or muscle wasting, are by far the strongest death risk factor compared with any other condition. There are data to indicate that hypoalbuminemia responds to nutritional interventions, which may save lives in the long run. Monitored, in-center provision of high-protein meals and/or oral nutritional supplements during hemodialysis is a feasible, inexpensive, and patient-friendly strategy despite concerns such as postprandial hypotension, aspiration risk, infection control and hygiene, dialysis staff burden, diabetes and phosphorus control, and financial constraints. Adjunct pharmacologic therapies can be added, including appetite stimulators (megesterol, ghrelin, and mirtazapine), anabolic hormones (testosterone and growth factors), antimyostatin agents, and antioxidative and anti-inflammatory agents (pentoxiphylline and cytokine modulators), to increase efficiency of intradialytic food and oral supplementation, although adequate evidence is still lacking. If more severe hypoalbuminemia (<3.0 g/dL) not amenable to oral interventions prevails, or if a patient is not capable of enteral interventions (e.g., because of swallowing problems), then parenteral interventions such as intradialytic parenteral nutrition can be considered. Given the fact that meals and supplements during hemodialysis would require only a small fraction of the funds currently used for dialysis patients this is also an economically feasible strategy. PMID:23313434

  12. A field guide to iron needs in the patient on hemodialysis.

    PubMed

    Wick, Gail

    2009-01-01

    It is essential for nephrology nurses to understand the basics of iron function and the importance of maintaining iron balance in their patients. Iron forms the cornerstone of oxygen delivery in the body and is the most essential nutrient for the building of healthy erythrocytes. Given the vital importance of iron, the body has devised elaborate and tightly controlled mechanisms to transport iron to the bone marrow for hemoglobin production, recycle iron from dying erythrocytes, and prevent iron loss. In the healthy individual, daily iron intake needs are very small, and sufficient iron is easily absorbed from the duodenum. In patients on hemodialysis, this iron balance is dramatically altered due to blood loss, inflammation, and the use of erythropoiesis-stimulating agents. This article discusses the basics of iron physiology and the mechanisms by which iron is moved throughout the body and made available for developing erythrocytes. The ways in which iron balance is altered in the patient on hemodialysis and the most effective strategies to replete iron stores and maintain iron balance through the use of intravenous iron are also reviewed. PMID:19715107

  13. Efficacy of SMART Stent Placement for Salvage Angioplasty in Hemodialysis Patients with Recurrent Vascular Access Stenosis

    PubMed Central

    Hatakeyama, Shingo; Toikawa, Terumasa; Okamoto, Akiko; Yamamoto, Hayato; Imanishi, Kengo; Okamoto, Teppei; Tokui, Noriko; Suzuki, Yuichiro; Sugiyama, Naoki; Imai, Atsushi; Hashimoto, Yasuhiro; Kudo, Shigemasa; Yoneyama, Takahiro; Koie, Takuya; Kamimura, Noritaka; Saitoh, Hisao; Funyu, Tomihisa; Ohyama, Chikara

    2011-01-01

    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. PMID:22164331

  14. [Caroli's syndrome in a patient on hemodialysis: diagnostic and therapeutic difficulties].

    PubMed

    Duranti, Ennio; Gatti, Guido; Duranti, Diletta

    2010-01-01

    We present the case of a 65-year-old male patient without any family history of renal or hepatic disease. He had been on maintenance hemodialysis for 4 months because of autosomal recessive polycystic kidney disease. At the start of the hemodialysis session he reported general malaise, abdominal pain, fever and diarrhea occurring in the last two days. Laboratory workup showed neutrophilic leukocytosis and increased serum amylase and C-reactive protein. Abdominal contrast-enhanced CT scan and MRI cholangiography showed hepatic cysts with marked dilatation of the intra- and extrahepatic bile ducts. The patient underwent cholecystectomy with hepaticojejunal Rouxen- Y anastomosis and was discharged with oral ciprofloxacin. Histology confirmed marked cystic dilatation of the bile ducts. Because of persistent episodes of septic fever, administration of ciprofloxacin was continued. After 4 months retrograde endoscopic pancreatography was performed which led to a diagnosis of Caroli's syndrome associated with polycystic kidneys. Given the rarity of the disease and its difficult diagnosis, when patients with polycystic kidneys and liver cysts experience recurrent episodes of septic fever of unknown origin, Caroli's disease should be taken into account and the appropriate tests should be carried out to confirm the diagnosis. PMID:20922688

  15. Correlation of Inflammation and Lipoprotein (a) with Hypercoagulability in Hemodialysis Patients

    PubMed Central

    Topçiu-Shufta, Valdete; Haxhibeqiri, Valdete; Begolli, Luljeta; Baruti-Gafurri, Zana; Veseli, Shemsi; Haxhibeqiri, Shpend; Miftari, Ramë; Kurti, Leonard; Avdiu, Driton

    2015-01-01

    Background: Inflammatory and procoagulant markers are potential mediators for the cardiovascular risk in hemodialysis patients. Lipoprotein (a) [Lp(a)], is another important risk factor with inflammatory and procoagulant effects. Materials and methods: In 78 hemodialysis patients and 40 controls, C-reactive protein (CRP), Interleukin-6 (IL-6), lipoprotein (a) [Lp (a)], fibrinogen, D-dimer, von Wilebrand factor (vWF) and serum albumin were determined. Results: CRP, IL-6, Lp(a), fibrinogen, D-dimer and vWF, were significantly higher, and serum albumin was significantly lower in patients compared to controls (24.40 mg/L vs. 6.39 mg/L, p<0.001; 1.92 pg/ml vs. 0.35 pg/ml, 28.05 mg/dL vs.16.25 mg/dL, p<0.001; 3.44 g/L vs. 2.55 g/L, p<0.01; 1.81 µgFEU /ml vs. 0.50 µgFEU /ml, p<0.01; 152.9 % vs. 85.6 %, p<0.001; 32.1 g/L vs. 40.50 g/L, p<0.001). The patients were divided into two groups: 40 patients with CRP levels over than 10 mg/L and 38 with CRP levels in normal range. These parameters showed significant differences between patients with elevated CRP and patients with normal CRP levels. CRP and IL-6 correlated positively with Lp(a), (r = 0.62, p < 0.001; r=0.54, p<0.001), fibrinogen, (r = 0.63, p < 0.001; r = 0.49, p<0.01) D dimer (r = 0.72, p<0.001; r = 0.55, p<0.01), vWF (r = 0.76, p<0.01; r = 0.63, p<0.001) and negatively with serum albumin (r = -0.80, p<0.01; r = -0.60, p<0.001), in patients with elevated CRP, but not in patients with normal CRP levels and controls. Conclusion: According to the results hemodialysis patients with increased inflammatory markers, have the elevated Lp(a) and procoagulant markers and the greater risk for atherosclerotic cardiovascular disease. PMID:26543308

  16. Pharmacological and Non-pharmacological Treatment Options for Depression and Depressive Symptoms in Hemodialysis Patients

    PubMed Central

    Grigoriou, Stefania S.; Karatzaferi, Christina; Sakkas, Giorgos K.

    2015-01-01

    Depression is a mental disorder with a high prevalence among patients with end stage renal disease (ESRD). It is reported that depression afflicts approximately 20-30% of this patient population, being associated, amongst other, with high mortality rate, low adherence to medication and low perceived quality of life. There is a variety of medications known to be effective for the treatment of depression but due to poor adherence to treatment as well as due to the high need for medications addressing other ESRD comorbidities, depression often remains untreated. According to the literature, depression is under-diagnosed and undertreated in the majority of the patients with chronic kidney disease. In the current review the main pharmacological and non-pharmacological approaches and research outcomes for the management of depressive symptoms in hemodialysis patients are discussed. PMID:26973957

  17. The care and keeping of vascular access for home hemodialysis patients.

    PubMed

    Faratro, Rose; Jeffries, Janine; Nesrallah, Gihad E; MacRae, Jennifer M

    2015-04-01

    Creating and maintaining a healthy vascular access is a critical factor in successful home hemodialysis (HD). This article aims to serve as a "how-to manual" regarding vascular access issues for both patients and health-care providers in a home HD program. This document outlines cannulation options for patients with arteriovenous access and describes troubleshooting techniques for potential complications; strategies are suggested to help patients overcome fear of cannulation and address problems associated with difficult cannulation. Technical aspects of central venous catheter care, as well as a guide to troubleshooting catheter complications, are covered in detail. Monitoring for access-related complications of stenosis, infection, and thrombosis is a key part of every home HD program. Key performance and quality indicators are important mechanisms to ensure patient safety in home HD and should be used during routine clinic visits. PMID:25925828

  18. Relationship between Illness Perceptions, Treatment Adherence, And Clinical Outcomes in Patients On Maintenance Hemodialysis

    PubMed Central

    Kim, Youngmee; Evangelista, Lorraine S.

    2011-01-01

    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 on maintenance HD, and to determine if illness perceptions and adherence behaviors influence clinical outcomes. One hundred fifty-one patients completed the Revised Illness Perception Questionnaire and the ESRD-Adherence Questionnaire. Illness perceptions did not independently predict any clinical outcomes in patients on maintenance HD; however, specific adherence behaviors affected clinical outcomes. Therefore, strategies to enhance adherence should be rigorously pursued in this population to improve clinical outcomes. PMID:20629465

  19. [Management of hemodialysis patients using simple informatics program].

    PubMed

    Devcić, Bosiljka; Jelić, Ita; Racki, Sanjin

    2014-03-01

    Providing health care and good hospital organization are always based on a well-educated and competent nurse. Nurses can significantly affect the result of overall treatment, which has a professional and financial effect. Nursing Informatics is a specialty that integrates nursing, computer and information science applied to nursing management as well as transfer of data, information and knowledge in nursing practice. This facilitates nurses' integration in supporting decision-making and implementation of health care. Informatics emphasizes overall nursing practice and nurses should have basic computer skills. In this article, we show how the use of simple tables, designed by using Microsoft Office programs (Word and Excel), has been employed for over a decade in facilitating the organization of daily work, monitoring of patients and their prescribed therapy. A trained nurse-manager will be able to evaluate patient care and to organize health care administration using all human and technical resources. The vision of the national health care system is still not achievable due to the lack of infrastructure. Nurses and computer documentation of patients with chronic kidney disease can significantly improve the quality of patient care and treatment. PMID:24979896

  20. The Effect of Cinacalcet on Calcific Uremic Arteriolopathy Events in Patients Receiving Hemodialysis: The EVOLVE Trial

    PubMed Central

    Kubo, Yumi; Floege, Anna; Chertow, Glenn M.; Parfrey, Patrick S.

    2015-01-01

    Background and objectives Uncontrolled secondary hyperparathyroidism (sHPT) in patients with ESRD is a risk factor for calcific uremic arteriolopathy (CUA; calciphylaxis). Design, setting, participants, & measurements Adverse event reports collected during the Evaluation of Cinacalcet HCl Therapy to Lower Cardiovascular Events trial were used to determine the frequency of CUA in patients receiving hemodialysis who had moderate to severe sHPT, as well as the effects of cinacalcet versus placebo. CUA events were collected while patients were receiving the study drug. Results Among the 3861 trial patients who received at least one dose of the study drug, 18 patients randomly assigned to placebo and six assigned to cinacalcet developed CUA (unadjusted relative hazard, 0.31; 95% confidence interval [95% CI], 0.13 to 0.79; P=0.014). Corresponding cumulative event rates (95% CI) at year 4 were 0.011% (0.006% to 0.018%) and 0.005% (0.002% to 0.010%). By multivariable analysis, other factors associated with CUA included female sex, higher body mass index, higher diastolic BP, and history of dyslipidemia or parathyroidectomy. Median (10%, 90% percentile) plasma parathyroid hormone concentrations proximal to the report of CUA were 796 (225, 2093) pg/ml and 410 (71, 4957) pg/ml in patients randomly assigned to placebo and cinacalcet, respectively. Active use of vitamin K antagonists was recorded in 11 of 24 patients with CUA, nine randomly assigned to placebo, and two to cinacalcet, in contrast to 5%–7% at any one time point in patients in whom CUA was not reported. Conclusion Cinacalcet appeared to reduce the incidence of CUA in hemodialysis recipients who have moderate to severe sHPT. PMID:25887067

  1. The link between bone disease and cardiovascular complications in hemodialysis patients

    PubMed Central

    Elsheikh, Noha; Sherif, Nevine; Zeid, Sameh Abou; Eldamarawy, Mervat; Ali, Ahmed; Sabry, Amal Ismail

    2016-01-01

    Introduction The burden on the cardiovascular system is the main cause of mortality in chronic renal patients, and bone disease, which also may cause disability, is one of the most important complications in those patients. The aim of this study was to determine the link between cardiovascular and bone disease, which frequently occur together. Methods In this matched case-control study, 70 subjects were subjected for full laboratory assessment as well as estimation of parathyroid hormone (PTH) level, vitamin D level, complete echocardiography, and dual energy absorptiometry. Of the 70 patients, 50 were on regular hemodialysis, and there were 20 normal controls matched with the patients with respect to age and gender. Results There was a significant decrease in the mean value of serum vitamin D in the hemodialysis patients, i.e., their mean value was 20.47 ± 9.60 whereas the controls had a mean value of 37.15 ± 7.67. Thus, there was a highly-significant, negative correlation between vitamin D and left ventricular mass (LVM) in the patients. We found that there was a highly-significant increase in the mean PTH levels of the patients (820.22 ± 393.51), whereas it was 57.60 ± 13.72 for the controls. The statistical significance was less than 0.001, a highly-significant increase in the mean of the T score levels in the patients (−2.15 ± 2.56), whereas it was −0.47 ± 0.71 for the controls with a statistical significance of less than 0.001. There also was a highly-significant correlation between the T score and LVM. Conclusion A significant correlation was found between bone disease and the occurrence of a left ventricular mass. We recommend early strict correction of the serum levels of vitamin D, PTH, calcium, and phosphorus. PMID:27504162

  2. Coronary artery calcifications predict long term cardiovascular events in non diabetic Caucasian hemodialysis patients

    PubMed Central

    Noce, Annalisa; Canale, Maria Paola; Capria, Ambrogio; Rovella, Valentina; Tesauro, Manfredi; Splendiani, Giorgio; Annicchiarico-Petruzzelli, Margherita; Manzuoli, Micol; Simonetti, Giovanni; Di Daniele, Nicola

    2015-01-01

    Vascular calcifications are frequent in chronic renal disease and are associated to significant cardiovascular morbidity and mortality. The long term predictive value of coronary artery calcifications detected by multi-layer spiral computed tomography for major cardiovascular events was evaluated in non-diabetic Caucasian patients on maintenance hemodialysis free of clinical cardiovascular disease. Two-hundred and five patients on maintenance hemodialysis were enrolled into this observational, prospective cohort study. Patients underwent a single cardiac multi-layer spiral computed tomography. Calcium load was quantified and patients grouped according to the Agatston score: group 1 (Agatston score: 0), group 2 (Agatston score 1-400), group 3 (Agatston score 401-1000) and group 4 (Agatston score >1000). Follow-up was longer than seven years. Primary endpoint was death from a major cardiovascular event. Actuarial survival was calculated separately in the four groups with Kaplan-Meier method. Patients who died from causes other than cardiovascular disease and transplanted patients were censored. The “log rank” test was employed to compare survival curves. One-hundred two patients (49.7%) died for a major cardiovascular event during the follow-up period. Seven-year actuarial survival was more than 90% for groups 1 and 2, but failed to about 50% for group 3 and to <10% for group 4. Hence, Agatston score >400 predicts a significantly higher cardiovascular mortality compared with Agatston score <400 (p<0.0001); furthermore, serum Parathyroid hormone levels > 300 pg/l were associated to a lower survival (p < 0.05). Extended coronary artery calcifications detected by cardiac multi-layer spiral computed tomography, strongly predicted long term cardiovascular mortality in non-diabetic Caucasian patients on maintenance hemodialysis. Moreover, it was not related to conventional indices of atherosclerosis, but to other non-traditional risk factors, as serum Parathyroid

  3. Hemodialysis access - self care

    MedlinePlus

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

  4. The effect of N-acetylcysteine on oxidative serum biomarkers of hemodialysis patients

    PubMed Central

    Giannikouris, I

    2015-01-01

    Background The aim of the study was to determine the effect of oral N-acetylcysteine (NAC) on levels of serum oxidative stress biomarkers in hemodialysis patients. Methods Forty eight hemodialysis patients were administered NAC orally for six months. Hematological, biochemical parameters and levels of asymmetric dimethylarginine (ADMA), malondialdehyde (MDA), myeloperoxidase (MPO) and nitrogen oxide (NO) were determined prior to and upon completion of the study period. Results At the end of the study period white blood cells, neutrophil percentage and C-reactive protein levels were significantly lower. Uric acid, albumin and hemoglobin were significantly higher compared to pre-treatment values. Statistically significant increase in NO, and decrease in MDA and ADMA levels were observed. Serum MPO demonstrated a measurable decrease trend, though not significant. Conclusion It is suggested that treatment with NAC appears to be associated with restoration of important parameters of antioxidant defence and reduction in the levels of mediators of oxidative cellular damage. Hippokratia 2015; 19 (2):131-135.

  5. The Effect of Intradialytic Aerobic Exercise on Dialysis Efficacy in Hemodialysis Patients: A Randomized Controlled Trial

    PubMed Central

    Mohseni, Raheleh; Emami Zeydi, Amir; Ilali, Ehteramosadat; Adib-Hajbaghery, Mohsen; Makhlough, Atieh

    2013-01-01

    Objective This study was conducted to determine the impact of an 8-week intradialytic exercise program (consisting of 15 minutes low-intensity exercise during the first 2 hours of dialysis) on dialysis efficacy. Methods In an open randomized controlled trial, a total of 50 clinically stable hemodialysis patients were enrolled into the study and randomly allocated into two groups: the aerobic exercise group (n=25) and the control group (n=25). Aerobic exercises were done in the intervention group for 15 min/day, three times a week for 2 months. The dialysis efficacy was assessed prior to and at the end of each month of the program. Results The efficacy of dialysis increased at the end of the first month and remained elevated for the duration of the program in the exercise group (p<0.05). Conclusion A simplified aerobic exercise program has increased the efficacy of dialysis and may be considered as a safe, complementary and effective modality for hemodialysis patients. PMID:24044062

  6. Relationship between Age and Timely Placement of Vascular Access in Incident Patients on Hemodialysis

    PubMed Central

    Harford, Rubette; Clark, Mary Jo; Norris, Keith C.; Yan, Guofen

    2014-01-01

    Background and purpose Placement of an arteriovenous fistula (AVF) prior to initiating dialysis can affect clinical outcomes for patients who subsequently initiate chronic hemodialysis treatments. Age-related variation in receipt of a functioning AVF prior to initiating dialysis is not well known. The purpose of this study was to examine age-related rates in use of AVF at the first outpatient dialysis treatment among U.S. incident patients on hemodialysis. Findings Among 526,145 identified, the use of AVF at the first outpatient dialysis treatment was lower in the youngest (<55 year) and oldest (≥80 year) vs. both 55–66 year and 67–79 year age groups. These findings persisted after adjusting for demographics, lifestyle behavior, employment and insurance status, physical/functional conditions, and comorbid conditions. Conclusions The presence of a functioning AVF at initial dialysis treatment varies by age. Modifying healthcare policy and/or expanding the role of the renal nurse practitioner should be considered to address this issue. PMID:25802137

  7. Mutational spectrum of Korean patients with corneal dystrophy.

    PubMed

    Chae, H; Kim, M; Kim, Y; Kim, J; Kwon, A; Choi, H; Park, J; Jang, W; Lee, Y S; Park, S H; Kim, M S

    2016-06-01

    Corneal dystrophy typically refers to a group of rare hereditary disorders with a heterogeneous genetic background. A comprehensive molecular genetic analysis was performed to characterize the genetic spectrum of corneal dystrophies in Korean patients. Patients with various corneal dystrophies underwent thorough ophthalmic examination, histopathologic examination, and Sanger sequencing. A total of 120 probands were included, with a mean age of 50 years (SD = 18 years) and 70% were female. A total of 26 mutations in five genes (14 clearly pathogenic and 12 likely pathogenic) were identified in 49 probands (41%). Epithelial-stromal TGFBI dystrophies, macular corneal dystrophy and Schnyder corneal dystrophy (SCD) showed 100% mutation detection rates, while endothelial corneal dystrophies showed lower detection rates of 3%. Twenty six non-duplicate mutations including eight novel mutations were identified and mutations associated with SCD were identified genetically for the first time in this population. This study provides a comprehensive characterization of the genetic aberrations in Korean patients and also highlights the diagnostic value of molecular genetic analysis in corneal dystrophies. PMID:26748743

  8. Genetics of Aldosterone-Producing Adenoma in Korean Patients

    PubMed Central

    Song, Young Shin; Lee, Kyu Eun; Seo, Soo Hyun; Seong, Moon-Woo; Shin, Chan Soo; Kim, Sang Wan; Kim, Seong Yeon

    2016-01-01

    Objectives Recently, somatic mutations in KCNJ5, ATP1A1, ATP2B3, and CACNA1D genes were found to be associated with the pathogenesis of aldosterone-producing adenoma (APA). This study aimed to investigate the prevalence of somatic mutations in KCNJ5, ATP1A1, ATP2B3, and CACNA1D and examine the correlations between these mutations and the clinical and biochemical characteristics in Korean patients with APA. Methods We performed targeted gene sequencing in 66 patients with APA to detect somatic mutations in these genes. Results Somatic KCNJ5 mutations were found in 47 (71.2%) of the 66 patients with APA (31 cases of p.G151R and 16 cases of p.L168R); these two mutations were mutually exclusive. Somatic mutations in the ATP1A1, ATP2B3, and CACNA1D genes were not observed. Somatic KCNJ5 mutations were more prevalent in female patients (66% versus 36.8%, respectively; P = 0.030). Moreover, patients with KCNJ5 mutations comprised a significantly higher proportion of patients younger than 35 years of age (19.1% versus 0%, respectively; P = 0.040). There were no significant differences in pre-operative blood pressure, plasma aldosterone, serum potassium, lateralization index, and adenoma size according to mutational status. Patients with KCNJ5 mutations were less likely to need antihypertensive medications after adrenalectomy compared with those without mutation (36.2% versus 63.2%; P = 0.045). Conclusions The present study demonstrated the high prevalence of somatic KCNJ5 mutations in Korean patients with APA. Carriers of somatic KCNJ5 mutations were more likely to be female. Early diagnosis and better therapeutic outcomes were associated with somatic KCNJ5 mutations in APA. PMID:26807823

  9. Side-hairline Correction in Korean Female Patients

    PubMed Central

    2015-01-01

    Background: To investigate the proper modifications and usefulness of side-hairline correction surgery in Korean female patients depending on different zygomatic bone structures. Methods: Different zygomatic bone structures were classified according to their maximum transverse width among 310 cases of hairline correction surgery in Korean women. The widest transverse width was located on the anterior zygomatic malar area in type 1, on the mid-zygomatic arch in type 2, and on the posterior zygomatic arch in type 3; there was no difference in the transverse width between the anterior and posterior zygomatic arch in type 4. Various modifications of side-hairline correction surgery were performed among the 310 cases according to the zygomatic bone classification. Results: Among 310 patients, 74 had a type 1 zygomatic structure, 106 had type 2, 46 had type 3, and 50 had type 4. Thirty-four patients exhibited different left and right transverse widths: type 1 + 2 (n = 26), type 2 + 3 (n = 6), type 1 + 3 (n = 1), and type 3 + 4 (n = 1). Satisfactory results were obtained in all patients without noticeable side effects. A minor touch-up procedure was performed in 14 patients to achieve density reinforcement 10 months postoperatively, and all 14 patients expressed satisfaction with the results. Conclusions: In East Asian patients, both side-hairline correction surgery and zygoma reduction can be considered eligible treatment options for the purpose of midface slimming. Especially in patients with a type 3 zygomatic bone structure, side-hairline correction surgery may be more effective than zygoma reduction surgery for midface slimming. PMID:25878947

  10. Interaction between nutrition and inflammation in hemodialysis patients.

    PubMed

    Kuhlmann, Martin K; Levin, Nathan W

    2005-01-01

    The excessive cardiovascular mortality of dialysis patients is at least in part related to chronic inflammation, which is associated with the occurrence of malnutrition. The negative effects of chronic inflammation on nutritional status are mediated by proinflammatory cytokines leading to a reduction in appetite and increased muscle catabolism. However, dietary behavior itself may also independently affect inflammation. Reduced dietary supply of vitamins C, B6, B12 and folate, as well as regular coffee consumption and increased intake of dietary advanced glycation end products may trigger chronic inflammation. On the other hand, a Mediterranean dietary pattern and regular soy intake both have been shown to attenuate chronic inflammation. Dietary interventions aiming to attenuate the chronic inflammatory status in dialysis patients need further exploration. PMID:15876844

  11. Antihypertensive medication exposure and cardiovascular outcomes in hemodialysis patients

    PubMed Central

    Shireman, Theresa I.; Phadnis, Milind A.; Wetmore, James B.; Zhou, Xinhua; Rigler, Sally K.; Spertus, John A.; Ellerbeck, Edward F.; Mahnken, Jonathan D.

    2014-01-01

    Background/Aims Our understanding of the effectiveness of cardioprotective medications in maintenance dialysis patients is based upon drug exposures assessed at a single point in time. We employed a novel, time-dependent approach to modeling medication use over time to examine outcomes in a large national cohort. Methods We linked Medicaid prescription claims with United States Renal Data System registry data and Medicare claims for 52,922 hypertensive maintenance dialysis patients. All-cause mortality and a combined cardiovascular disease (CVD) endpoint were modeled as functions of exposure to cardioprotective antihypertensive medications (renin angiotensin system antagonists, β-adrenergic blockers, and calcium channel blockers) measured with three time-dependent covariates (weekly exposure status; proportion of prior weeks with exposure; and number of switches in exposure status) and with propensity-adjustment. Results Current cardioprotective medication exposure status as compared to not exposed was associated with lower adjusted hazard ratios (AHR) for mortality, though the magnitude depended upon the proportion of prior weeks with medication (duration) and the number of switches between active and non-active use (switches) (AHR range, 0.54-0.90). Combined CVD-endpoints depended upon the proportion of weeks on medication: AHR = 1.18 for 10% and AHR = 0.90 for 90% of weeks. Combined CVD-endpoint was also lower for patients with fewer switches. Conclusions Effectiveness depends not only on having a drug available but is tempered by duration and stability of use, likely reflecting variation in clinical stability and patient behavior. PMID:25139551

  12. Nutritional Status in Nocturnal Hemodialysis Patients – A Systematic Review with Meta-Analysis

    PubMed Central

    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.

    2016-01-01

    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. However, it is ambiguous whether transition from conventional hemodialysis (CHD) to NHD leads to improved intake and nutritional status. We studied the effect of NHD on protein intake, laboratory indices of nutritional status, and body composition. Study design Systematic review with meta-analysis. Population NHD patients. Search strategy Systematic literature search from databases, Medline, Cinahl, EMBASE and The Cochrane Library, to identify studies reporting on nutritional status post-transition from CHD to NHD. Intervention Transition from CHD to NHD. Outcomes Albumin, normalized protein catabolic rate (nPCR), dry body weight (DBW), body mass index (BMI), phase angle, protein intake, and energy intake. Results Systematic literature search revealed 13 studies comprising 282 patients that made the transition from CHD to NHD. Meta-analysis included nine studies in 229 patients. In control group controlled studies (n = 4), serum albumin increased significantly from baseline to 4–6 months in NHD patients compared with patients that remained on CHD (mean difference 1.3 g/l, 95% CI 0.02; 2.58, p = 0.05). In baseline controlled studies, from baseline to 4–6 months of NHD treatment, significant increases were ascertained in serum albumin (mean difference (MD) 1.63 g/l, 95% CI 0.73–2.53, p<0.001); nPCR (MD 0.16 g/kg/day; 95% CI 0.04–0.29, p = 0.01); protein intake (MD 18.9 g, 95% CI 9.7–28.2, p<0.001); and energy intake (MD 183.2 kcal, 95% CI 16.8–349.7, p = 0.03). Homogeneity was rejected only for nPCR (baseline versus 4–6 months). DBW, BMI, and phase angle did not significantly change. Similar results were obtained for comparison between baseline and 8–12 months

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

    PubMed Central

    Eleftheriadis, Theodoros; Pissas, Georgios; Antoniadi, Georgia; Liakopoulos, Vassilios; Stefanidis, Ioannis

    2014-01-01

    Hepatitis B virus (HBV) is a major global health problem. Despite the success of the general measures against blood transmitted infections in hemodialysis (HD) units, the prevalence of HBV infection among the HD patients is still high. Thus vaccination against HBV is indicating in this population. However, compared with the general population the seroprotection achieved in HD patients remains relatively low, at about 70%. In this review patient, HD procedure and vaccine-associated factors that affect the efficacy of HBV vaccination are analyzed. Also alternative routes of HBV vaccine administration as well as new and more immunogenic vaccine formulations are discussed. However, besides scientific progress, vigilance of HD physicians and staff regarding the general measures against the transmission of blood borne infections and the vaccination against HBV is also required for reducing the prevalence of this viral infection. PMID:25232238

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

    PubMed

    Eleftheriadis, Theodoros; Pissas, Georgios; Antoniadi, Georgia; Liakopoulos, Vassilios; Stefanidis, Ioannis

    2014-09-14

    Hepatitis B virus (HBV) is a major global health problem. Despite the success of the general measures against blood transmitted infections in hemodialysis (HD) units, the prevalence of HBV infection among the HD patients is still high. Thus vaccination against HBV is indicating in this population. However, compared with the general population the seroprotection achieved in HD patients remains relatively low, at about 70%. In this review patient, HD procedure and vaccine-associated factors that affect the efficacy of HBV vaccination are analyzed. Also alternative routes of HBV vaccine administration as well as new and more immunogenic vaccine formulations are discussed. However, besides scientific progress, vigilance of HD physicians and staff regarding the general measures against the transmission of blood borne infections and the vaccination against HBV is also required for reducing the prevalence of this viral infection. PMID:25232238

  15. Adeno-Associated Virus 2-Mediated Hepatocellular Carcinoma is Very Rare in Korean Patients

    PubMed Central

    Park, Kyoung-Jin; Lee, Jongan; Park, June-Hee; Joh, Jae-Won; Kwon, Choon Hyuck David

    2016-01-01

    Background The incidence and etiology of hepatocellular carcinoma (HCC) vary widely according to race and geographic regions. The insertional mutagenesis of adeno-associated virus 2 (AAV2) has recently been considered a new viral etiology of HCC. The aim of this study was to investigate the frequency and clinical characteristics of AAV2 in Korean patients with HCC. Methods A total of 289 unrelated Korean patients with HCC, including 159 Hepatitis-B-related cases, 16 Hepatitis-C-related cases, and 114 viral serology-negative cases, who underwent surgery at the Samsung Medical Center in Korea from 2009 to 2014 were enrolled in this study. The presence of AAV2 in fresh-frozen tumor tissues was investigated by DNA PCR and Sanger sequencing. The clinical and pathological characteristics of AAV2-associated HCC in these patients were compared with previous findings in French patients. Results The AAV2 detection rate in Korean patients (2/289) was very low compared with that in French patients (11/193). Similar to the French patients, the Korean patients with AAV2-related HCC showed no signs of liver cirrhosis. The Korean patients were younger than the French patients with the same AAV2-associated HCC; the ages at diagnosis of the two Korean patients were 47 and 39 yr, while the median age of the 11 French patients was 55 yr (range 43-90 yr). Conclusions AAV2-associated HCC was very rare in Korean patients with HCC. Despite a limited number of cases, this study is the first to report the clinical characteristics of Korean patients with AAV2-associated HCC. These findings suggest epidemiologic differences in viral hepatocarcinogenesis between Korean and European patients. PMID:27374713

  16. Primary Effusion Lymphoma in an Elderly HIV-Negative Patient with Hemodialysis: Importance of Evaluation for Pleural Effusion in Patients Receiving Hemodialysis.

    PubMed

    Sasaki, Yosuke; Isegawa, Takuya; Shimabukuro, Akira; Yonaha, Tomoki; Yonaha, Hiroyasu

    2014-05-01

    Pleural effusion is a ubiquitous complication in hemodialysis (HD) patients. Common etiologies of pleural effusion in this patient group are heart failure, volume overload, parapneumonic effusion, tuberculotic pleuritis, and uremic pleuritis. Although thoracentesis is a useful diagnostic method of pleural effusion, empirical reduction of the dry weight is often attempted without thoracentesis because pleural effusion is commonly caused by volume overload and responds to the dry-weight reduction. However, this empiricism has a risk of overlooking or delaying the diagnosis of potentially fatal etiologies that need specific treatments. We report an 86-year-old human immunodeficiency virus (HIV)-negative male on HD with primary effusion lymphoma (PEL), a large-cell non-Hodgkin lymphoma presenting with characteristic lymphomatous effusions in the absence of solid tumor masses, which is in association with human herpes virus 8 (HHV8) infection in immunocompromised individuals. The patient presented with left-sided pleural effusion. This is the first case report of PEL developing in a patient receiving HD. Thoracentesis and cytological analysis of the effusion was key to the diagnosis. We also review the literature regarding pleural effusion in HD patients. Further, we examine Kaposi's sarcoma herpes virus/HHV8-negative effusion-based lymphoma, a newly proposed distinct lymphoma that clinically and cytomorphologically resembles PEL, because it can be cured without chemotherapy. This report may arouse clinicians' attention regarding the importance of evaluation for pleural effusion in HD patients, especially when the effusion or symptoms associated with pleural effusion are refractory to volume control. PMID:24987405

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

    PubMed

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

    2003-10-01

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

  18. Hemodialysis access - self care

    MedlinePlus

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

  19. Association of Diabetes and Hemodialysis With Ankle Pressure and Ankle-Brachial Index in Japanese Patients With Critical Limb Ischemia

    PubMed Central

    Takahara, Mitsuyoshi; Kaneto, Hideaki; Iida, Osamu; Katakami, Naoto; Matsuoka, Taka-aki; Ikeda, Masahiko; Shimomura, Iichiro

    2012-01-01

    OBJECTIVE To investigate whether diabetes and regular hemodialysis are associated with false elevation of ankle systolic blood pressure and ankle-brachial systolic pressure index (ABI) because of their arterial calcification in patients with critical limb ischemia (CLI). RESEARCH DESIGN AND METHODS We recruited 269 Japanese patients who underwent endovascular therapy for CLI. Ankle systolic blood pressure and ABI were assessed before endovascular therapy. Arterial stenosis and calcification were evaluated angiographically. We investigated the associations among clinical comorbidities, arterial calcification, and measurements of ankle systolic blood pressure and ABI. RESULTS Ankle systolic blood pressure was 85 ± 56 mmHg, and ABI was 0.59 ± 0.37. Arterial calcification was observed in 69% of the patients. The prevalence of diabetes and regular hemodialysis was 71 and 47%. Diabetes and regular hemodialysis were both significantly associated with the presence of arterial calcification; their adjusted odds ratios were 2.33 (P = 0.01) and 7.40 (P < 0.01), respectively. However, there was no significant difference in ankle systolic blood pressure or ABI level between those with and without these comorbidities. Furthermore, the presence of arterial calcification was not associated with ankle systolic blood pressure or ABI level, whereas arterial stenoses of all segments in the lower body had independent associations with reduced ankle systolic blood pressure and ABI level. CONCLUSIONS Diabetes and regular hemodialysis were significantly associated with arterial calcification, but not with elevated measurements of ankle systolic blood pressure or ABI, in CLI patients. PMID:22723344

  20. Anthocyanin/polyphenolic-rich fruit juice reduces oxidative cell damage in an intervention study with patients on hemodialysis.

    PubMed

    Spormann, Thomas M; Albert, Franz W; Rath, Thomas; Dietrich, Helmut; Will, Frank; Stockis, Jean-Pierre; Eisenbrand, Gerhard; Janzowski, Christine

    2008-12-01

    Hemodialysis patients face an elevated risk of cancer, arteriosclerosis, and other diseases, ascribed in part to increased oxidative stress. Red fruit juice with high anthocyanin/polyphenol content had been shown to reduce oxidative damage in healthy probands. To test its preventive potential in hemodialysis patients, 21 subjects in a pilot intervention study consumed 200 mL/day of red fruit juice (3-week run-in; 4-week juice uptake; 3-week wash-out). Weekly blood sampling was done to monitor DNA damage (comet assay +/- formamidopyrimidine-DNA glycosylase enzyme), glutathione, malondialdehyde, protein carbonyls, trolox equivalent antioxidant capacity, triglycerides, and DNA binding capacity of the transcription factor nuclear factor-kappaB. Results show a significant decrease of DNA oxidation damage (P < 0.0001), protein and lipid peroxidation (P < 0.0001 and P < 0.001, respectively), and nuclear factor-kappaB binding activity (P < 0.01), and an increase of glutathione level and status (both P < 0.0001) during juice uptake. We attribute this reduction in oxidative (cell) damage in hemodialysis patients to the especially high anthocyanin/polyphenol content of the juice. This provides promising perspectives into the prevention of chronic diseases such as cancer and cardiovascular disease in population subgroups exposed to enhanced oxidative stress like hemodialysis patients. PMID:19064553

  1. Progressive Macular Hypomelanosis in Korean Patients: A Clinicopathologic Study

    PubMed Central

    Hwang, Seon Wook; Hong, Soon Kwon; Kim, Sang Hyun; Park, Jeong Hoon; Seo, Jong Keun; Sung, Ho Suk

    2009-01-01

    Background Progressive macular hypomelanosis is characterized by ill-defined, non-scaly, hypopigmented macules primarily on the trunk of the body. Although numerous cases of progressive macular hypomelanosis have been reported, there have been no clinicopathologic studies of progressive macular hypomelanosis in Korean patients. Objective In this study we examined the clinical characteristics, histologic findings, and treatment methods for progressive macular hypomelanosis in a Korean population. Methods Between 1996 and 2005, 20 patients presented to the Department of Dermatology at Busan Paik Hospital with acquired, non-scaly, confluent, hypopigmented macules on the trunk, and with no history of inflammation or infection. The medical records, clinical photographs, and pathologic findings for each patient were examined. Results The patients included 5 men and 15 women. The mean age of onset was 21.05±3.47 years. The back was the most common site of involvement. All KOH examinations were negative. A Wood's lamp examination showed hypopigmented lesions compared with the adjacent normal skin. A microscopic examination showed a reduction in the number of melanin granules in the lesions compared with the adjacent normal skin, although S-100 immunohistochemical staining did not reveal significant differences in the number of melanocytes. Among the 20 patients, 7 received topical drug therapy, 6 were treated with narrow-band ultraviolet B phototherapy, 4 received oral minocycline, and 3 did not receive any treatment. Conclusion Most of the patients with progressive macular hypomelanosis had asymptomatic ill-defined, non-scaly, and symmetric hypopigmented macules, especially on the back and abdomen. Histologically, the number of melanocytes did not differ significantly between the hypopigmented macules and the normal perilesional skin. No effective treatment is known for progressive macular hypomelanosis; however, narrow-band ultraviolet B phototherapy may be a useful

  2. Korean Patients with Superwarfarin Intoxication and Their Outcome

    PubMed Central

    Hong, Junshik; Yhim, Ho-Young; Bae, Sung Hwa; Yuh, Young Jin; Yoon, Sung-Soo; Yoon, Hwi-Joong; Kim, Seung Taik; Chi, Hyun-Sook

    2010-01-01

    This observational study aimed at evaluating recent superwarfarin intoxication of Korean patients. Ten patients were diagnosed as or highly suspicious for superwarfarin intoxication. Case report forms described by attending hematologists of the patients were collected and analyzed. Bleeding symptoms were varied among the patients. Patients uniformly showed prolonged prothrombin time (PT) and activated thromboplastin time (aPTT) with decreased activity of vitamin K dependent coagulation factors. Positive serum brodifacoum test results in 4 of 5 requested patients contributed to confirmatory diagnosis. Psychiatric interview revealed an attempted ingestion in one patient. High dose vitamin K1 therapy promptly corrected prolonged PT and aPTT, but hasty discontinuation caused repeated bleeding diathesis in 6 patients. Route of intoxication was unknown or not definite among 8 of 10 patients. Three patients had a possibility of environmental exposure considering their occupations: there might be intoxication by transdermal absorption or inhalation. Therefore, high dose and prolonged use of vitamin K1 therapy is necessary for effective detoxification. Further detailed investigation on environmental exposure and efforts to improve availability of the blood level test in clinic are requested. PMID:21165290

  3. Comparing the frequency of hypertension determined by peri-dialysis measurement and ABPM in hemodialysis patients.

    PubMed

    Abbasi, Mohammad-Reza; Lessan-Pezeshki, Mahboob; Najafi, Mohammad-Taghi; Gatmiri, Seyed-Mansour; Karbakhsh, Mojgan; Mohebi-Nejad, Azin

    2014-06-01

    Controlling blood pressure in hemodialysis patients is crucial but not always easy. The most common blood pressure measurement method is peri-dialysis measurement, but due to interdialytic blood pressure fluctuations, we are unsure if it is the proper way for evaluating blood pressure. Some studies have shown the superiority of 24-h ambulatory blood pressure monitoring over peri-dialysis blood pressure measurement. We aimed to compare the consistency of these methods in determining hypertension among hemodialysis patients. We studied 50 patients (mean age: 55.8 years) on regular hemodialysis in Imam Khomeini University Hospital, Tehran, Iran. Peri-dialysis blood pressure and interdialytic 24-h ambulatory blood pressure monitoring were recorded for each patient. Patients' demographic data and peri-dialysis weight were recorded too. All data were analyzed using the PASW Statistics 18.0, SPSS Inc. (Chicago, IL). There was a significant difference between pre-dialysis mean systolic blood pressure (146.1 ± 23.3 mmHg) and mean systolic blood pressure recorded by ambulatory blood pressure monitoring (135.3 ± 19.3 mmHg) (p = 0.001). There was also a significant difference between pre-dialysis mean diastolic blood pressure (83 ± 14 mmHg) and mean diastolic blood pressure recorded by ambulatory blood pressure monitoring (77.3 ± 10 mmHg) (p = 0.003). But the frequencies of hypertension measured with both methods were significantly consistent and the Kappa agreement coefficient was 0.525 (p = 0.001). Considering ambulatory blood pressure monitoring as the gold standard for blood pressure measurement, our recommendation for the best cutoff point to diagnose hypertension, with the highest sensitivity and specificity would be 135/80 mmHg for pre-dialysis blood pressure and 115/70 mmHg for post-dialysis blood pressure. PMID:24502240

  4. Pharmacokinetics of fleroxacin after multiple oral dosing in patients receiving regular hemodialysis.

    PubMed Central

    Uehlinger, D E; Schaedeli, F; Kinzig, M; Sörgel, F; Frey, F J

    1996-01-01

    The pharmacokinetic profile of fleroxacin was studied in eight noninfected patients receiving regular hemodialysis (four women and four men; mean age, 63 years; age range, 48 to 73 years). Dialysis clearances (mean +/- standard deviation) calculated from the amount of drug recovered in the dialysate exceeded those calculated from rates of extraction from plasma for fleroxacin (126 +/- 29 versus 73 +/- 11 ml/min) and its metabolite N-demethylfleroxacin (103 +/- 31 versus 72 +/- 15 ml/min) but not that for the metabolite fleroxacin N-oxide (100 +/- 25 versus 100 +/- 12 ml/min). Data were fitted to a two-compartment model over the total observation period of 8 days (six oral daily doses of 200 mg of fleroxacin on days 1 to 6 and hemodialysis treatments on day 1,3, and 6) by nonlinear mixed-effects modeling. The random variability of plasma fleroxacin concentrations was 13% about its prediction. The estimated metabolic clearance was 25 ml/min (coefficient of variation, 43%), and the calculated steady-state volume of distribution was 84 liters (coefficient of variation, 16%). The model was expanded for the two major metabolites by the addition of a two-compartment metabolite distribution. Formation clearances of N-demethylfleroxacin and fleroxacin N-oxide were estimated to be 54 and 33% of fleroxacin's metabolic clearance, respectively. The conclusions were as follows. Because of the slow metabolic clearance and intermittent dialysis treatment, steady-state conditions were not reached after 1 week of oral fleroxacin therapy, and there was relevant accumulation of fleroxacin as well as that of fleroxacin N-oxide in our patients with end-stage renal disease. We recommend that infected hemodialysis patients be treated with an initial oral dose of 400 mg of fleroxacin and then daily oral doses of 200 mg. One cannot recommend the treatment of this patient population with fleroxacin over prolonged time periods until more date about the levels of accumulation of fleroxacin and

  5. Gastrointestinal bleeding due to angiodysplasia in patients on hemodialysis: A single-center study.

    PubMed

    Zajjari, Yassir; Tamzaourte, Mouna; Montasser, Dina; Hassani, Kawtar; Aatif, Taoufiq; El Kabbaj, Driss; Benyahia, Mohammed

    2016-01-01

    Gastrointestinal (GI) bleeding due to angiodysplastic lesions is a common problem among patients receiving hemodialysis (HD). We studied 22 HD patients (5 females and 17 males) who had GI bleeding due to angiodysplasia; the mean age of whom was 54 ± 10 years. All patients had upper and lower GI endoscopy. The most common site for the lesion was the right colon in seven cases (31.8%), followed by stomach in 4 cases (18.1%). In eight (36.3%) patients, there were multiple lesions located in the stomach, duodenum, and the right colon. All patients were treated with coagulation; with argon plasma in 14 (63.6%) patients, bipolar coagulation in five (22.7%) patients, and hot clip in three (13.6%) patients. One patient who presented with persistent bleeding despite endoscopic therapy was well-benefited of a complementary treatment, thalidomide. Hemostasis was obtained in all patients after an average of 6.8 sessions of endoscopic coagulation procedure. We conclude that angiodysplasia is a frequent cause of hemorrhage in chronic renal failure that can be managed in most patients by argon plasma and bipolar coagulation. PMID:27424692

  6. Comparative Study of Outcomes among Patients with Polycystic Kidney Disease on Hemodialysis and Peritoneal Dialysis.

    PubMed

    Yang, Ju-Yeh; Chen, Likwang; Chao, Chia-Ter; Peng, Yu-Sen; Chiang, Chih-Kang; Kao, Tze-Wah; Chien, Kuo-Liong; Wu, Hon-Yen; Huang, Jenq-Wen; Hung, Kuan-Yu

    2015-01-01

    Polycystic kidney disease (PCKD) is the most common hereditary cause of end-stage renal disease, the complications of which may prevent the choice of peritoneal dialysis (PD). The aim of this study was to explore the effects of dialysis modality on outcomes in patients with PCKD. We extracted a cohort of 1417 adult patients with PCKD initiating long-term dialysis therapy in 1999-2010 from the Taiwan National Health Insurance Research Database, among which 125 patients chose PD. The patients on HD were older and had a higher comorbidity index compared to those on PD. We compared the risks for death, hospitalization and medical expenditures between the patients on PD and propensity-score matched patients on hemodialysis (HD). The overall survival did not differ between the patients on PD and HD. The patients on PD tended to have higher hazard ratios (HR) for the first episode of hospitalization (adjusted HR 1.34 [95% CI, 1.04-1.79]). The annual medical expenses were 10% lower for the patients on PD. PD is an equivalent choice of renal replacement therapy to HD for patients with PCKD in terms of survival. Although the patients on PD had a higher risk for hospitalization, the medical expenditure for PD was 10% lower. PMID:26245766

  7. Decreases in PTH in Japanese Hemodialysis Patients with Secondary Hyperparathyroidism: Associations with Changing Practice Patterns

    PubMed Central

    Akizawa, Tadao; Kido, Ryo; Fukagawa, Masafumi; Yamaguchi, Takuhiro; Hasegawa, Takeshi; Fukuhara, Shunichi; Kurokawa, Kiyoshi

    2011-01-01

    Summary Background and objectives Control of serum concentrations of calcium (Ca), phosphorus (P), and parathyroid hormone (PTH) is essential for management of secondary hyperparathyroidism (SHPT). Design, setting, participants, & measurements This is a planned interim analysis of a longitudinal cohort study. The settings are dialysis facilities in Japan. Eligible patients comprise all those who were receiving hemodialysis at one of 86 participating facilities and who have SHPT. Using data from a random sample (n = 3276) of the participants from January 2008 through June 2009, we measured changes in the percentages of patients who were within the national guideline–specified target ranges of Ca (8.4 to 10 mg/dl), P (3.5 to 6.0 mg/dl), and intact PTH (iPTH) (60 to 180 pg/ml), and changes in prescriptions of drugs targeting SHPT. We used regression models to identify factors affecting the achievement of the guideline-specified targets. Results There were no notable changes in the percentage of patients who were within the guideline for Ca, P, or both. The percentage who were within the iPTH guideline increased from 14.5% to 43.3% (P < 0.001). There were no remarkable changes in the percentage of patients receiving vitamin D or phosphate binders. The percentage who received cinacalcet increased from 0% to 29%. Prescription of cinacalcet was associated with improvement or target-achievement for iPTH and for Ca by 16.8 percentage points (95% CI: 8.1 to 17.0) and by 12.6 percentage points (13.7 to 19.9), respectively. Conclusions In the routine care of hemodialysis patients, increasing use of cinacalcet was associated with better control of SHPT. PMID:21836149

  8. Lung ultrasonography for the assessment of rapid extravascular water variation: evidence from hemodialysis patients.

    PubMed

    Trezzi, Matteo; Torzillo, Daniela; Ceriani, Elisa; Costantino, Giorgio; Caruso, Sabrina; Damavandi, Parham Tabaee; Genderini, Augusto; Cicardi, Marco; Montano, Nicola; Cogliati, Chiara

    2013-08-01

    Chest ultrasonography is a useful tool to assess extravascular lung water at bedside. In presence of interstitial-alveolar imbibition, vertical artifacts arising from the pleura are detected; these are called B-lines. Although a positive linear correlation between B-lines and extravascular lung water has been shown in symptomatic heart failure patients, the subclinical phase of pulmonary imbibition and the clearance of B-lines after rapid body fluid removal have been less investigated. The aim of this study was to assess if chest ultrasound could detect lung water imbibition and its variations induced by dialysis, an experimental model of controlled rapid fluid loss. Forty-one patients undergoing hemodialysis were studied. Total number of B-lines from ultrasound chest scanning and vena cava diameters were measured before and after treatment. Before dialysis, most of the patients presented ultrasound signs of pulmonary imbibition despite the absence of dyspnea; the number of B-lines was associated with the accumulated weight before treatment (p < 0.05) as well as with the residual weight after dialysis (p < 0.01); B-lines and end-inspiratory and end-expiratory vena cava diameters were also significantly reduced after dialysis. Moreover, B-lines reduction was significantly related to weight loss. Ultrasound performed at the bedside can detect lung water and intravascular overload and their reduction after dialysis in yet asymptomatic patients. These observations add further evidence regarding the use of lung ultrasound and inferior vena cava measurement in estimating volume overload and monitoring the response to therapy both in hemodialysis and congestive heart failure patients. PMID:21590437

  9. Effect of hope therapy on depression, anxiety, and stress among the patients undergoing hemodialysis

    PubMed Central

    Rahimipour, Meisam; Shahgholian, Nahid; Yazdani, Mohsen

    2015-01-01

    Background: Renal failure is a major public health problem in the world. These patients experience high levels of psychological tension, anxiety, and depression, which leads to their lowered quality of life, increased health care costs, and early mortality. Due to medication side effects in these patients, non-medicational methods are more in demand now. This study aimed to investigate the effect of hope therapy on depression, anxiety, and stress among the patients undergoing hemodialysis. Materials and Methods: This is a clinical trial. Fifty patients undergoing hemodialysis were selected. Patients were assigned to two groups of hope therapy and placebo. Intervention of hope therapy was administered for 60–90 min during dialysis sessions once a week for eight sessions. In the placebo group, non-specific intervention was administered with the same number of sessions. Depression, Anxiety, and Stress scale (DASS)-21 questionnaire was completed at the end of the last session and 4 weeks later. Data were analyzed by paired t-test, repeated measures analysis of variance (ANOVA), and least significant difference (LSD) post hoc test through SPSS 18. Results: There was a significant difference in mean scores of depression, anxiety, and stress in hope therapy group before, immediately after, and 1 month after intervention (P < 0.05), while there was no significant difference in mean scores of depression, anxiety, and stress before and immediately after intervention in the placebo group. Changes in mean scores of depression, anxiety, and stress were significantly higher in hope therapy group compared to placebo (P < 0.05). Conclusions: The obtained results showed that hope therapy is effective on reduction of depression, anxiety, and stress. PMID:26793255

  10. Treating mineral metabolism disorders in patients undergoing long hemodialysis: a search for an optimal strategy.

    PubMed

    Jean, Guillaume; Vanel, Thierry; Terrat, Jean-Claude; Hurot, Jean-Marc; Lorriaux, Christie; Mayor, Brice; Chazot, Charles

    2009-10-01

    In hemodialysis (HD) patients, mineral metabolism (MM) disorders have been associated with an increased mortality rate. We report the evolution of MM parameters in a stable HD population undergoing long hemodialysis by performing an annual cross-sectional analysis for every year from 1994 to 2008. The therapeutic strategy has changed: the dialysate calcium concentration has decreased from a mean of 1.7 +/- 0.1 to 1.5 +/- 0.07 mmol/L and has been adapted to parathyroid hormone serum levels (from 1 to 1.75 mmol/L). The use of calcium-based and aluminum-based phosphate binders has decreased and they have been replaced by sevelamer; alfacalcidol has partly been replaced by native vitamin D. The percentage of patients with a parathyroid hormone serum level between 150 and 300 pg/mL has increased from 9% to 67% (P<0.001); the percentage of patients with phosphataemia between 1.15 and 1.78 mmol/L has increased from 39% to 84% (P<0.001). The percentage of those with albumin-corrected calcemia between 2.1 and 2.37 mmol/L has increased from 29% to 61% (P<0.001), and that of patients with a calcium-phosphorous product (Ca x P) level >4.4 mmol/L decreased from 8.8% to 2% (P=0.02). Although patients undergo long and intensive HD treatment, MM disorders are common. However, an appropriate strategy, mostly consisting of native vitamin D supplementation, progressive replacement of calcium-based phosphate binders with non-calcium-based ones, and individualization of dialysis session duration and dialysate calcium concentration, would result in a drastic improvement. PMID:19758298

  11. Quantification of HDL Proteins, Cardiac Events, and Mortality in Patients with Type 2 Diabetes on Hemodialysis

    PubMed Central

    Kopecky, Chantal; Genser, Bernd; Drechsler, Christiane; Krane, Vera; Kaltenecker, Christopher C.; Hengstschläger, Markus; März, Winfried; Wanner, Christoph; Säemann, Marcus D.

    2015-01-01

    Background and objectives Impairment of HDL function has been associated with cardiovascular events in patients with kidney failure. The protein composition of HDLs is altered in these patients, presumably compromising the cardioprotective effects of HDLs. This post hoc study assessed the relation of distinct HDL-bound proteins with cardiovascular outcomes in a dialysis population. Design, setting, participants, & measurements The concentrations of HDL-associated serum amyloid A (SAA) and surfactant protein B (SP-B) were measured in 1152 patients with type 2 diabetes mellitus on hemodialysis participating in The German Diabetes Dialysis Study who were randomly assigned to double-blind treatment of 20 mg atorvastatin daily or matching placebo. The association of SAA(HDL) and SP-B(HDL) with cardiovascular outcomes was assessed in multivariate regression models adjusted for known clinical risk factors. Results High concentrations of SAA(HDL) were significantly and positively associated with the risk of cardiac events (hazard ratio per 1 SD higher, 1.09; 95% confidence interval, 1.01 to 1.19). High concentrations of SP-B(HDL) were significantly associated with all-cause mortality (hazard ratio per 1 SD higher, 1.10; 95% confidence interval, 1.02 to 1.19). Adjustment for HDL cholesterol did not affect these associations. Conclusions In patients with diabetes on hemodialysis, SAA(HDL) and SP-B(HDL) were related to cardiac events and all-cause mortality, respectively, and they were independent of HDL cholesterol. These findings indicate that a remodeling of the HDL proteome was associated with a higher risk for cardiovascular events and mortality in patients with ESRD. PMID:25424990

  12. Low T3 syndrome and long-term mortality in chronic hemodialysis patients

    PubMed Central

    Fragidis, Stylianos; Sombolos, Konstantinos; Thodis, Elias; Panagoutsos, Stylianos; Mourvati, Euthymia; Pikilidou, Maria; Papagianni, Aikaterini; Pasadakis, Ploumis; Vargemezis, Vasilios

    2015-01-01

    AIM: To investigate the predictive value of low freeT3 for long-term mortality in chronic hemodialysis (HD) patients and explore a possible causative role of chronic inflammation. METHODS: One hundred fourteen HD patients (84 males) consecutively entered the study and were assessed for thyroid function and two established markers of inflammation, high sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6). Monthly blood samples were obtained from all patients for three consecutive months during the observation period for evaluation of thyroid function and measurement of inflammatory markers. The patients were then divided in two groups based on the cut-off value of 1.8 pg/mL for mean plasma freeT3, and were prospectively studied for a mean of 50.3 ± 30.8 mo regarding cumulative survival. The prognostic power of low serum fT3 levels for mortality was assessed using the Kaplan-Meier method and univariate and multivariate regression analysis. RESULTS: Kaplan-Meier survival curve showed a negative predictive power for low freeT3. In Cox regression analysis low freeT3 remained a significant predictor of mortality after adjustment for age, diabetes mellitus, hypertension, hsCRP, serum creatinine and albumin. Regarding the possible association with inflammation, freeT3 was correlated with hsCRP, but not IL-6, and only at the first month of the study. CONCLUSION: In chronic hemodialysis patients, low plasma freeT3 is a significant predictor of all-cause mortality. Further studies are required to identify the underlying mechanisms of this association. PMID:26167466

  13. Phosphate-binding efficacy of crushed vs. chewed lanthanum carbonate in hemodialysis patients.

    PubMed

    How, Priscilla P; Anattiwong, Prathana; Mason, Darius L; Arruda, Jose A; Lau, Alan H

    2011-01-01

    Lanthanum carbonate, a chewable noncalcium-containing phosphorus (P) binder, is useful for treating secondary hyperparathyroidism in patients who have hypercalcemia and cannot swallow whole tablets. However, some patients cannot chew tablets or prefer to crush and mix them with food. This study was conducted to determine the P-binding efficacy of crushed lanthanum and compare it with chewed lanthanum in hemodialysis (HD) patients. After a 1-week washout period, 11 hemodialysis patients (7 men, 4 women) were randomized to receive, in a crossover fashion, lanthanum 1000 mg 3 times daily chewed with meals and lanthanum 1000 mg 3 times daily crushed into a fine powder, mixed with applesauce and taken with meals, for 4 weeks each. Serum P was measured at the end of each washout (baseline) and weekly during treatment. Changes in serum P from baseline for crushed lanthanum were compared with chewed lanthanum using paired sample t test. Administration of crushed lanthanum resulted in a significant reduction in serum P from baseline (P reduction [mg/dL] for crushed lanthanum in week 1: 2.1 ± 0.4, week 2: 1.7 ± 0.5, week 3: 1.7 ± 0.5, week 4: 1.7 ± 0.4, P<0.05). No statistically significant differences were observed in serum P reduction from baseline and serum P attained during treatment with crushed when compared with chewed lanthanum. Crushed lanthanum is effective in reducing serum P and have similar P-binding efficacy to chewed lanthanum. Crushing lanthanum and mixing it with food can thus be an option for patients who are unable to chew or swallow whole tablets. PMID:21138519

  14. Efficacy of oral powder compared with chewable tablets for lanthanum carbonate administration in hemodialysis patients.

    PubMed

    Sakurada, Tsutomu; Oishi, Daisuke; Shibagaki, Yugo; Yasuda, Takashi; Kimura, Kenjiro

    2013-10-01

    Lanthanum carbonate (LC) has been administered in a chewable tablet form for patients with hyperphosphatemia undergoing dialysis. However, some patients have difficulty chewing the tablets. LC oral powder has recently been released in Japan. The purpose of this study was to clarify the efficacy of LC oral powder form compared with that of chewable tablet form. The efficacy and safety of LC oral powder was retrospectively assessed in hemodialysis patients who switched from chewable tablet form to oral powder form without dose modification. Thirty-six patients (mean age, 66.8 ± 10.5 years; male, 64%; 39% with diabetes; mean duration of dialysis treatment, 99.2 ± 95.6 months) were enrolled in this study between June and July of 2012. Changes in clinical data and adverse events after the switch to oral powder form were investigated. The average dose of LC was 1180 ± 520 mg/day. Serum phosphorus levels were significantly decreased after the switch from chewable tablet form to oral powder form (5.3 ± 1.7 mg/dL at baseline vs. 4.9 ± 1.2 mg/dL at after 1 month after, P = 0.038). In contrast, no significant differences were observed in serum calcium and parathyroid hormone levels. Furthermore, no significant differences were evident in weight gain after the switch to oral powder form (2.5 ± 1.2 kg at baseline vs. 2.4 ± 1.1 kg at 1 month after the switch, P = 0.29). No serious adverse events were recorded. Our results suggest that LC is more effective in oral powder form than chewable tablet form for hemodialysis patients. PMID:24134326

  15. Determinants of C-reactive protein in chronic hemodialysis patients: relevance of dialysis catheter utilization.

    PubMed

    Hung, Adriana; Pupim, Lara; Yu, Chang; Shintani, Ayumi; Siew, Edward; Ayus, Carlos; Hakim, Raymond M; Ikizler, Talat Alp

    2008-04-01

    Biomarkers of inflammation, especially C-reactive protein (CRP), have been consistently shown to predict poor outcomes in chronic hemodialysis (CHD) patients. However, the determinants of CRP and the value of its monitoring in CHD patients have not been well defined. We conducted a retrospective cohort study to evaluate possible determinants of the inflammatory response in CHD patients with a focus on dialysis catheter utilization. Monthly CRP were measured in 128 prevalent CHD patients (mean age 56.6 years [range 19-90], 68% African Americans, 39% diabetics [DM]) over a mean follow-up of 12 months (range 2-26 months). There were a total of 2405 CRP measurements (median 5.7 mg/L; interquartile range [IQR] 2.4-16.6 mg/L). The presence of a dialysis catheter (p<0.002), cardiovascular disease (p=0.01), male gender (p=0.005), higher white blood cell count (p<0.0001), elevated phosphorus (p=0.03), and lower cholesterol (p=0.02) and albumin (p<0.0001) concentrations were independent predictors of elevated CRP in the multivariate analysis. Additionally, CRP levels were significantly associated with the presence of a catheter, when comparing the levels before and after catheter insertion (p=0.002) as well as before and after catheter removal (p=0.009). Our results indicate that the presence of a hemodialysis catheter is an independent determinant of an exaggerated inflammatory response in CHD patients representing a potentially modifiable risk factor. PMID:18394058

  16. Overhydration measured by bioimpedance analysis and the survival of patients on maintenance hemodialysis: a single-center study

    PubMed Central

    Kim, Ye Jin; Jeon, Hong Jae; Kim, Yoo Hyung; Jeon, Jaewoong; Ham, Young Rok; Chung, Sarah; Choi, Dae Eun; Na, Ki Ryang; Lee, Kang Wook

    2015-01-01

    Background Bioimpedance analysis (BIA) helps measuring the constituents of the body noninvasively. Prior studies suggest that BIA-guided fluid assessment helps to predict survival in dialysis patients. We aimed to evaluate the clinical usefulness of BIA for predicting the survival rate of hemodialysis patients in Korea. Methods We conducted a single-center retrospective study. All patients were diagnosed with end-stage renal disorder and started maintenance hemodialysis between June 2009 and April 2014. BIA was performed within the 1st week from the start of hemodialysis. The patients were classified into 2 groups based on volume status measured by the body composition monitor (BCM; Fresenius): an overhydrated group [OG; overhydration/extracellular water (OH/ECW) >15%] and a nonoverhydrated group (NOG; OH/ECW ≤15%). Results A total of 344 patients met the inclusion criteria. Of these, 252 patients (73.3%) were categorized into the OG and 92 patients (26.7%) into the NOG. Age- and sex-matching patients were selected with a rate of 2:1. Finally, 160 overhydrated patients and 80 nonoverhydrated patients were analyzed. Initial levels of hemoglobin and serum albumin were significantly lower in the OG. During follow-up, 43 patients from the OG and 7 patients from the NOG died (median follow-up duration, 24.0 months). The multivariate-adjusted all-cause mortality was significantly increased in the OG (odds ratio, 2.569; P = 0.033) and older patients (odds ratio, 1.072/y; P < 0.001). No significant difference of all-cause or disease-specific admission rate was observed between the 2 groups. Conclusion The ratio of OH/ECW volume measured with body composition monitor is related to the overall survival of end-stage renal disorder patients who started maintenance hemodialysis. PMID:26779424

  17. Nutritional Status and Body Composition in Korean Myopathy Patients

    PubMed Central

    Kang, Seong-Woong; Choi, Won Ah; Lee, Jang Woo; Suh, Mi Ri; Lee, Song Mi

    2016-01-01

    In myopathy patients, fat mass increases as the disease progresses, while lean body mass decreases. The present study aimed to investigate the overall nutritional status of Korean myopathy patients through surveys of diet and dietary habits, bioelectrical impedance analysis (BIA), and biochemistry tests, as well as the examination of related factors, for the purpose of using such findings as a basis for improving the nutritional status in myopathy patients. The energy intake of all participants was found to be insufficient at only 44.5% of Dietary Reference Intakes for Koreans 2010 (KDRIs 2010), whereas protein intake was sufficient at 89.8% of KDRIs 2010. Dietary fiber intake was found to be 58.4% of sufficient dietary fiber intake for adults according to KDRIs 2010. Calcium intake was found to be 55.0% and magnesium was 14.9% of the recommended calcium and magnesium intake for adults according to KDRIs 2010. With respect to quality of life (QOL), overall increase in QOL domain score showed significant positive correlations with vegetable fat intake (p < 0.05), vegetable protein intake (p < 0.05), and dietary fiber intake (p < 0.05). With respect to BIA, the mean phage angle of all participants was found to be 2.49 ± 0.93°, which was below the cutoff value. As a study that examined nutrient analysis and dietary habits of myopathy patients in Korea, the present study is meaningful in providing the basic data for future studies that aim to present dietary guidelines for patients suffering from myopathy. PMID:26839876

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

    PubMed Central

    Daud, Zulfitri A Mat; Tubie, Boniface; Sheyman, Marina; Osia, Robert; Adams, Judy; Tubie, Sharon; Khosla, Pramod

    2013-01-01

    Purpose Chronic hemodialysis patients experience accelerated atherosclerosis contributed to by dyslipidemia, inflammation, and an impaired antioxidant system. Vitamin E tocotrienols possess anti-inflammatory and antioxidant properties. However, the impact of dietary intervention with Vitamin E tocotrienols is unknown in this population. Patients and methods A randomized, double-blind, placebo-controlled, parallel trial was conducted in 81 patients undergoing chronic hemodialysis. Subjects were provided daily with capsules containing either vitamin E tocotrienol-rich fraction (TRF) (180 mg tocotrienols, 40 mg tocopherols) or placebo (0.48 mg tocotrienols, 0.88 mg tocopherols). Endpoints included measurements of inflammatory markers (C-reactive protein and interleukin 6), oxidative status (total antioxidant power and malondialdehyde), lipid profiles (plasma total cholesterol, triacylglycerols, and high-density lipoprotein cholesterol), as well as cholesteryl-ester transfer protein activity and apolipoprotein A1. Results TRF supplementation did not impact any nutritional, inflammatory, or oxidative status biomarkers over time when compared with the baseline within the group (one-way repeated measures analysis of variance) or when compared with the placebo group at a particular time point (independent t-test). However, the TRF supplemented group showed improvement in lipid profiles after 12 and 16 weeks of intervention when compared with placebo at the respective time points. Normalized plasma triacylglycerols (cf baseline) in the TRF group were reduced by 33 mg/dL (P=0.032) and 36 mg/dL (P=0.072) after 12 and 16 weeks of intervention but no significant improvement was seen in the placebo group. Similarly, normalized plasma high-density lipoprotein cholesterol was higher (P<0.05) in the TRF group as compared with placebo at both week 12 and week 16. The changes in the TRF group at week 12 and week 16 were associated with higher plasma apolipoprotein A1 concentration (P

  19. Prevention of catheter-related bloodstream infections in patients on hemodialysis: challenges and management strategies

    PubMed Central

    Soi, Vivek; Moore, Carol L; Kumbar, Lalathakasha; Yee, Jerry

    2016-01-01

    Catheter-related bloodstream infections are a significant source of morbidity and mortality in the end-stage renal disease population. Although alternative accesses to undergoing renal replacement therapy exist, many patients begin hemodialysis with a dialysis catheter due to logistic and physiologic factors involved in arteriovenous fistula creation and maturation. Colonization of catheters via skin flora leads to the production of biofilm, which acts as a reservoir for virulent bacteria. Preventative therapies center on appropriate catheter maintenance, infection control measures, and early removal of devices as patients transition to other access. Despite best efforts, when conservative measures fail to prevent infections in a high-risk population, antimicrobial lock therapy should be considered as an option to combat catheter-related bloodstream infections. PMID:27143948

  20. Treatment of confirmed B12 deficiency in hemodialysis patients improves Epogen® requirements

    PubMed Central

    Saifan, Chadi; Samarneh, Mark; Shtaynberg, Norbert; Nasr, Rabih; El-Charabaty, Elie; El-Sayegh, Suzanne

    2013-01-01

    Background Vitamin B12 deficiency may have deleterious effects on end stage renal disease (ESRD) patients on maintenance hemodialysis, and may increase erythropoietin stimulating agent (ESA) resistance, yet little is known about its prevalence in this population. Methods Serum vitamin B12 and methylmalonic acid (MMA) levels were drawn from ESRD patients prior to hemodialysis. All patients with MMA levels greater than 800 nmol/L had peripheral smears evaluated for B12 deficiency. Those with confirmatory smears were considered to be deficient and received intramuscular vitamin B12 injections for 4 months. Post-treatment MMA levels and smears were obtained. Erythropoietin dosages were monitored throughout the treatment period. Results There was a 58% (60/103) prevalence of vitamin B12 deficiency as defined by a positive MMA level and a positive blood smear. Out of 52 patients with positive smears, 36 (69.2%) were negative on repeat analysis after B12 treatment. Mean Epogen® (EPO) dosages significantly decreased by 16,572 ± 41,902 units per month from baseline to the post-B12 t reatment period (P = 0.0082, Wilcoxon signed-rank test). Three months prior to treatment, the mean monthly EPO dose was 82,067 ± 47,906 and post, the mean EPO usage was 65,495 ± 39,691. Post treatment hemoglobin levels were not significantly different from baseline. Conclusion Vitamin B12 supplementation was associated with a decrease in the mean dose of ESA administration while maintaining a stable hemoglobin level. Maintaining serum vitamin B12 levels improves functionality, and may allow a decrease in the use of ESA’s, avoiding their toxicities and significant costs. PMID:23776388

  1. Comparative Effectiveness of Dialyzers: A Longitudinal, Propensity Score-Matched Study of Incident Hemodialysis Patients

    PubMed Central

    Hunt, Abigail; Laplante, Suzanne; Beck, Werner; Gellens, Mary; Brunelli, Steven M.

    2016-01-01

    Differences in dialyzer design may have consequences for patient outcomes. We evaluated the comparative effectiveness of commonly used dialyzers with respect to measures of dialysis treatment, anemia management, inflammation, and dialyzer clotting. Patients receiving hemodialysis between January 1, 2009, and December 31, 2013, and using polyarylethersulfone–polyvinylpyrrolidone (PAS-PVP; Polyflux Revaclear) or polysulfone (PS; Optiflux 160 or Optiflux 180) dialyzers were followed for 1 year or until end of study or censoring for dialyzer switch, modality change, or loss to follow-up. For each comparison, eligible patients were propensity score-matched 1:1 on a range of baseline characteristics. Outcomes were assessed using generalized linear mixed models. Dialysis adequacy was similar in both dialyzer groups. Erythropoiesis-stimulating agent (ESA) doses were lower for patients using PAS-PVP versus patients using PS-160 (difference range: 75–589 units/treatment; statistically significant in months 1–5 and 7) and for patients using PAS-PVP versus patients using PS-180 (difference range: 27–591 unit/treatment; statistically significant in months 1–9). Intravenous iron doses trended lower for patients using PAS-PVP versus patients using PS, but hemoglobin concentrations were equivalent. In conclusion, use of PAS-PVP versus PS dialyzers was associated with equivalent dialysis adequacy, lower ESA doses, modestly lower Intravenous iron doses, and equivalent hemoglobin concentrations. PMID:27442860

  2. Comparative Effectiveness of Dialyzers: A Longitudinal, Propensity Score-Matched Study of Incident Hemodialysis Patients.

    PubMed

    Sibbel, Scott; Hunt, Abigail; Laplante, Suzanne; Beck, Werner; Gellens, Mary; Brunelli, Steven M

    2016-01-01

    Differences in dialyzer design may have consequences for patient outcomes. We evaluated the comparative effectiveness of commonly used dialyzers with respect to measures of dialysis treatment, anemia management, inflammation, and dialyzer clotting. Patients receiving hemodialysis between January 1, 2009, and December 31, 2013, and using polyarylethersulfone-polyvinylpyrrolidone (PAS-PVP; Polyflux Revaclear) or polysulfone (PS; Optiflux 160 or Optiflux 180) dialyzers were followed for 1 year or until end of study or censoring for dialyzer switch, modality change, or loss to follow-up. For each comparison, eligible patients were propensity score-matched 1:1 on a range of baseline characteristics. Outcomes were assessed using generalized linear mixed models. Dialysis adequacy was similar in both dialyzer groups. Erythropoiesis-stimulating agent (ESA) doses were lower for patients using PAS-PVP versus patients using PS-160 (difference range: 75-589 units/treatment; statistically significant in months 1-5 and 7) and for patients using PAS-PVP versus patients using PS-180 (difference range: 27-591 unit/treatment; statistically significant in months 1-9). Intravenous iron doses trended lower for patients using PAS-PVP versus patients using PS, but hemoglobin concentrations were equivalent. In conclusion, use of PAS-PVP versus PS dialyzers was associated with equivalent dialysis adequacy, lower ESA doses, modestly lower Intravenous iron doses, and equivalent hemoglobin concentrations. PMID:27442860

  3. Health self-assessment by hemodialysis patients in the Brazilian Unified Health System

    PubMed Central

    Moreira, Tiago Ricardo; Giatti, Luana; Cesar, Cibele Comini; Andrade, Eli Iola Gurgel; Acurcio, Francisco de Assis; Cherchiglia, Mariângela Leal

    2016-01-01

    ABSTRACT OBJECTIVE To examine whether the level of complexity of the services structure and sociodemographic and clinical characteristics of patients in hemodialysis are associated with the prevalence of poor health self-assessment. METHODS In this cross-sectional study, we evaluated 1,621 patients with chronic terminal kidney disease on hemodialysis accompanied in 81 dialysis services in the Brazilian Unified Health System in 2007. Sampling was performed by conglomerate in two stages and a structured questionnaire was applied to participants. Multilevel multiple logistic regression was used for data analysis. RESULTS The prevalence of poor health self-assessment was of 54.5%, and in multivariable analysis it was associated with the following variables: increasing age (OR = 1.02; 95%CI 1.01–1.02), separated or divorced marital status (OR = 0.62; 95%CI 0.34–0.88), having 12 years or more of study (OR = 0.51; 95%CI 0.37–0.71), spending more than 60 minutes in commuting between home and the dialysis service (OR = 1.80; 95%CI 1.29–2.51), having three or more self-referred diseases (OR = 2.20; 95%CI 1.33–3.62), and reporting some (OR = 2.17; 95%CI 1.66–2.84) or a lot of (OR = 2.74; 95%CI 2.04–3.68) trouble falling asleep. Individuals in treatment in dialysis services with the highest level of complexity in the structure presented less chance of performing a self-assessment of their health as bad (OR = 0.59; 95%CI 0.42–0.84). CONCLUSIONS We showed poor health self-assessment is associated with age, years of formal education, marital status, home commuting time to the dialysis service, number of self-referred diseases, report of trouble sleeping, and also with the level of complexity of the structure of health services. Acknowledging these factors can contribute to the development of strategies to improve the health of patients in hemodialysis in the Brazilian Unified Health System. PMID:27143610

  4. Ferric pyrophosphate citrate (Triferic™) administration via the dialysate maintains hemoglobin and iron balance in chronic hemodialysis patients

    PubMed Central

    Fishbane, Steven N.; Singh, Ajay K.; Cournoyer, Serge H.; Jindal, Kailash K.; Fanti, Paolo; Guss, Carrie D.; Lin, Vivian H.; Pratt, Raymond D.; Gupta, Ajay

    2015-01-01

    Background Administration of ferric pyrophosphate citrate (FPC, Triferic™) via hemodialysate may allow replacement of ongoing uremic and hemodialysis-related iron losses. FPC donates iron directly to transferrin, bypassing the reticuloendothelial system and avoiding iron sequestration. Methods Two identical Phase 3, randomized, placebo-controlled trials (CRUISE 1 and 2) were conducted in 599 iron-replete chronic hemodialysis patients. Patients were dialyzed with dialysate containing 2 µM FPC-iron or standard dialysate (placebo) for up to 48 weeks. Oral or intravenous iron supplementation was prohibited, and doses of erythropoiesis-stimulating agents were held constant. The primary efficacy end point was the change in hemoglobin (Hgb) concentration from baseline to end of treatment (EoT). Secondary end points included reticulocyte hemoglobin content (CHr) and serum ferritin. Results In both trials, Hgb concentration was maintained from baseline to EoT in the FPC group but decreased by 0.4 g/dL in the placebo group (P < 0.001, combined results; 95% confidence interval [CI] 0.2–0.6). Placebo treatment resulted in significantly larger mean decreases from baseline in CHr (−0.9 pg versus −0.4 pg, P < 0.001) and serum ferritin (−133.1 µg/L versus −69.7 µg/L, P < 0.001) than FPC treatment. The proportions of patients with adverse and serious adverse events were similar in both treatment groups. Conclusions FPC delivered via dialysate during hemodialysis replaces iron losses, maintains Hgb concentrations, does not increase iron stores and exhibits a safety profile similar to placebo. FPC administered by hemodialysis via dialysate represents a paradigm shift in delivering maintenance iron therapy to hemodialysis patients. PMID:26175145

  5. Ergocalciferol Supplementation in Hemodialysis Patients With Vitamin D Deficiency: A Randomized Clinical Trial.

    PubMed

    Miskulin, Dana C; Majchrzak, Karen; Tighiouart, Hocine; Muther, Richard S; Kapoian, Toros; Johnson, Doug S; Weiner, Daniel E

    2016-06-01

    Locally produced 1,25-dihydroxyvitamin D3 may have pleiotropic effects outside of bone. Experimental and observational studies suggest that nutritional vitamin D may enhance erythropoiesis in settings of 25-hydroxy vitamin D (25(OH)D) deficiency. We conducted a double-blind, placebo-controlled, randomized clinical trial to assess the effects of supplementation with ergocalciferol on epoetin utilization and other secondary outcomes in patients on hemodialysis with serum 25(OH)D <30 ng/ml. In all, 276 patients were randomized to 6 months of ergocalciferol or placebo. Mean±SD serum 25(OH)D increased from 16.0±5.9 ng/ml at baseline to 39.2±14.9 ng/ml in the ergocalciferol arm and did not change (16.9±6.4 ng/ml and 17.5±7.4 ng/ml, respectively) in the placebo arm. There was no significant change in epoetin dose over 6 months in the ergocalciferol or placebo arms (geometric mean rate 0.98 [95% confidence interval (95% CI), 0.94 to 1.02] versus 0.99 [95% CI, 0.95 to 1.03], respectively) and no difference across arms (P=0.78). No change occurred in serum calcium, phosphorus, intact parathyroid hormone, or C-reactive protein levels, cinacalcet use, or phosphate binder or calcitriol dose in either study arm. Rates of all-cause, cardiovascular, and infection-related hospitalizations did not differ by study arm, although statistical power was limited for these outcomes. In conclusion, 6 months of supplementation with ergocalciferol increased serum 25(OH)D levels in patients on hemodialysis with vitamin D insufficiency or deficiency, but had no effect on epoetin utilization or secondary biochemical and clinical outcomes. PMID:26677862

  6. Malnutrition-Inflammation Score and Quality of Life in Hemodialysis Patients: Is There Any Correlation?

    PubMed Central

    Sohrabi, Zahra; Eftekhari, Mohammad Hassan; Eskandari, Mohammad Hadi; Rezaeianzadeh, Abbas; Sagheb, Mohammad Mahdi

    2015-01-01

    Background: Malnutrition, inflammation and poor quality of life are prevalent among hemodialysis (HD) patients. Health-related quality of life is an important determinant of hospitalization and mortality in HD patients. Objectives: The aim of this study was to assess the correlation between quality of life and malnutrition-inflammation status according to subjective global assessment (SGA) and malnutrition-inflammation scores (MIS) in HD patients. Patients and Methods: We randomly selected 87 of 180 stable HD patients from two HD centers. Those on hemodialysis for at least three months and with malnutrition according to the SGA scores were included in this study. They were divided into two groups of mild to moderate malnutrition (n = 39) and severe malnutrition (n = 49) based on the SGA scores. Serum levels of transferrin, albumin, blood urea nitrogen, creatinine, kt/v, body mass index and malnutrition-inflammation scores were measured in all patients. Health-related quality of life was assessed by validated short form-12 (SF-12) questionnaire for each patient. These values were compared between the two groups of patients by independent sample t-test and Mann-Whitney U test. The correlations of nutritional variables with SGA and MIS scores were determined by Pearson and Spearman correlation tests. Results: There were no differences in measured parameters between the two groups except for MIS scores. Those with severe malnutrition showed higher MIS scores. All quality of life aspects and total scores (PCS, MCS) (rather than social functioning (SF) aspect) were significantly different between the two groups, which showed lower physical and mental scores in severely-malnourished patients. Physical functioning (PF), role limitations due to physical heath (RP), general health (GH), mental health (MH), SF, role limitation due to emotional health (RE), vitality (VT) aspects and total scores (PCS and MCS) had negative significant correlations with MIS and SGA scores (All P

  7. Carotid intima-media thickness as a marker of atherosclerosis in hemodialysis patients.

    PubMed

    Abbasi, M R; Abbaszadeh, S H; Rokni-Yazdi, H; Lessan-Pezeshki, M; Khatami, M R; Mahdavi-Mazdeh, M; Ahmadi, F; Seifi, S; Gatmiri, S M

    2016-01-01

    Atherosclerotic changes in carotid arteries of hemodialysis (HD) patients reflect global atherosclerotic changes in vasculature. Carotid intima-media thickness (CIMT) can be used for atherosclerosis prediction and assessment of cardiovascular risks in HD patients, and thus screening high-risk patients. In this cross-sectional study, CIMT was measured using ultrasonography (B-mode with 5-10-MHz multifrequency linear probe) in HD patients in our hospitals. Additionally, we assessed the relationship between their CIMT and some cardiovascular risk factors. A total of 62 HD patients (64.5% male) were included. Age, body mass index, low-density lipoprotein, fasting blood sugar, history of diabetes mellitus and cardiovascular disease, serum albumin, and duration and adequacy of HD in study patients had significant association with their CIMT. There were no significant relationships between CIMT and patient's gender, smoking, serum calcium, phosphate, calcium x phosphate product, hemoglobin, and uric acid level. More diagnostic modalities must be performed for detecting the impact of atherosclerosis on HD patients with high CIMT. PMID:27051132

  8. Carotid intima-media thickness as a marker of atherosclerosis in hemodialysis patients

    PubMed Central

    Abbasi, M. R.; Abbaszadeh, S. H.; Rokni-Yazdi, H.; Lessan-Pezeshki, M.; Khatami, M. R.; Mahdavi-Mazdeh, M.; Ahmadi, F.; Seifi, S.; Gatmiri, S. M.

    2016-01-01

    Atherosclerotic changes in carotid arteries of hemodialysis (HD) patients reflect global atherosclerotic changes in vasculature. Carotid intima-media thickness (CIMT) can be used for atherosclerosis prediction and assessment of cardiovascular risks in HD patients, and thus screening high-risk patients. In this cross-sectional study, CIMT was measured using ultrasonography (B-mode with 5-10-MHz multifrequency linear probe) in HD patients in our hospitals. Additionally, we assessed the relationship between their CIMT and some cardiovascular risk factors. A total of 62 HD patients (64.5% male) were included. Age, body mass index, low-density lipoprotein, fasting blood sugar, history of diabetes mellitus and cardiovascular disease, serum albumin, and duration and adequacy of HD in study patients had significant association with their CIMT. There were no significant relationships between CIMT and patient's gender, smoking, serum calcium, phosphate, calcium x phosphate product, hemoglobin, and uric acid level. More diagnostic modalities must be performed for detecting the impact of atherosclerosis on HD patients with high CIMT. PMID:27051132

  9. Clinical, patient-related, and economic outcomes of home-based high-dose hemodialysis versus conventional in-center hemodialysis

    PubMed Central

    Mitsides, Nicos; Mitra, Sandip; Cornelis, Tom

    2016-01-01

    Despite technological advances in renal replacement therapy, the preservation of health and quality of life for individuals on dialysis still remains a challenge. The high morbidity and mortality in dialysis warrant further research and insight into the clinical domains of the technique and practice of this therapy. In the last 20 years, the focus of development in the field of hemodialysis (HD) has centered around adequate removal of urea and other associated toxins. High-dose HD offers an opportunity to improve mortality, morbidity, and quality of life of patients with end-stage kidney disease. However, the uptake of this modality is low, and the risk associated with the therapy is not fully understood. Recent studies have highlighted the evidence base and improved our understanding of this technique of dialysis. This article provides a review of high-dose and home HD, its clinical impact on patient outcome, and the controversies that exist. PMID:27462173

  10. High Prevalence of Hepatitis C Virus Infection in Chronic Hemodialysis Patients.

    PubMed

    Carvalho; Branco; Luvizotto; Valderrama; Rabone; Doi; Ivantes; Muzzillo

    1999-08-01

    Hepatitis C virus (HCV) infection is very common among hemodialysis (HD) patients. Transmission of infection in this setting has been related to the number of blood transfusions, the duration of hemodialysis and to nosocomial transmission of virus in the dialysis unit. We conducted a study of 74 HD patients to determine the frequency of HCV at a single point in time (cross-sectional analysis), and to evaluate the association between HCV infection and patients' demographic, clinical and biochemical features. Serum samples were tested for anti-HCV antibodies using a third-generation enzyme-linked immunosorbent assay (ELISA). In the case of a positive result, third-generation recombinant immunoblot and HCV RNA detection by polymerase chain reaction (PCR) tests were performed. Collected data included the patient's age, gender, time on HD, number of blood transfusions and serum alanine aminotransferase (ALT) activity. Twenty-nine patients (29/74.4%) were found to be HCV positive using a third-generation ELISA assay. Of these 29 patients, 27 were also positive by recombinant immunoblot assay and 2 patients had indeterminate results. In the anti-HCV ELISA-positive subgroup, 20 (69%) of the 29 patients had detectable HCV RNA. The HCV RNA-positive patients had received more blood transfusions (15&plusm;3 vs. 5&plusm;1 units of packed red blood cells, p<0.0001) and had been on HD for a longer period of time than the HCV RNA-negative patients (65&plusm;32 vs. 32&plusm;29 months, p<0.0001). Mean serum ALT levels were significantly higher in the HCV RNA positive group (30&plusm;18 vs. 15&plusm;9, p<0.0001). We were unable to determine the most likely mode of transmission in our unit, but these results emphasize the need for strict adherence to blood collecting and handling precautions, careful attention to hygiene in the dialysis units, and sterilization of dialysis machines in order to properly combat this frequent infection. PMID:11096433

  11. Are Korean Patients Different from Other Ethnic Groups in Total Knee Arthroplasty?

    PubMed Central

    Kim, Dong-Kyoon; Seo, Min-Chul; Song, Sang-Joon

    2015-01-01

    Most of the implants used for total knee arthroplasty (TKA) in Asian patients have been produced based on anthropometry of Western people. Since anatomic features and life styles are different between Western and Eastern people, there would be ethnic differences in terms of conformity of implants to the patient's anatomy or clinical results after TKA. Therefore, surgeons in Asia are particularly interested in related surgical techniques and implant designs used in TKA for improved clinical results and patient satisfaction. In this review, we investigated the anthropometric differences of Koreans from Westerners. Koreans are of shorter stature, less weight, and smaller skeletal structure and have a higher incidence of constitutional varus alignment of the lower extremity. Moreover, compared to Westerner TKA populations, the proportion of female patients was large and primary osteoarthritis was prevalent in preoperative diagnosis in Korean TKA patients. Culturally, Koreans have life styles that demand high flexion positions of the knee such as squatting, kneeling, and cross-legged sitting. Although there were no notable differences in the complication and revision rates following TKA between Westerners and Koreans, the incidence of postoperative deep vein thrombosis and pulmonary thromboembolism was lower in Koreans than Westerners. We hope that further research on implant designs and more interest in TKA will improve outcomes in Korean patients. PMID:26675374

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

    PubMed

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

    2016-06-01

    Functional iron deficiency (FID) incidence is gradually increasing in hemodialysis (HD) patients. Recently, high levels of GDF-15 supressed the iron regulatory protein hepcidin and GDF-15 expression increased in iron-deficient patients. The relationship between FID, GDF-15, and hepcidin is currently unknown. The present study aimed to evaluate the association between GDF-15, hepcidin, and FID in chronic HD patients. Serum GDF-15 and hepcidin concentrations were measured in 105 HD patients and 40 controls. FID is defined as serum ferritin >800 ng/mL, TSAT <25 %, Hb levels <11 g/dL, and reticulocyte haemoglobin content (CHr) <29 pg. Serum GDF-15 and hepcidin levels were increased significantly in HD patients with FID, compared to HD patients without anemia and controls. GDF-15 correlated with ferritin, hepcidin, and CRP in the entire cohort. GDF-15 was related to ferritin and CRP in HD patients with FID. GDF-15 is better diagnostic marker than hepcidin for detection of FID [AUC = 0.982 (0.013) versus AUC = 0.921 (0.027); P = 0.0324]. GDF-15 appears to be a promising tool for detection of FID. High levels of ferritin and CRP correlated with GDF-15. Our results support GDF-15 as a new mediator of FID via hepcidin, chronic inflammation, or unknown pathways. PMID:27065587

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

    PubMed Central

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

    2014-01-01

    Patients on dialysis experience psychological distress, which can impact pain perception. Reduction of stress and anxiety in patients provides psychological resources to cope with their physical condition. We examined the efficacy of relaxation training on stress, anxiety, and pain perception of hemodialysis (HD) patients. eighty HD patients were randomized into two groups (intervention and control). Benson relaxation training was implemented in the intervention group for 15 min twice daily during 4 weeks. Pain perception, stress, and anxiety scale were evaluated before and after intervention. There were significant differences between pain perception, stress, and anxiety levels in case group before and after intervention (P < 0.001) and there was a correlation between pain perception with stress and anxiety. Instructing Benson's relaxation technique is accompanied by reducing pain, stress, and anxiety level of HD patients. Reducing stress and anxiety can provide calmness for the patients so that pursuing medical therapy would be accompanied with more tranquility and low pain intensity. We suggest improving and preventing the patients' psychological problems as well as other chronic disorders through applying nonpharmacological interventions. PMID:25484528

  14. Intraepidermal neuron-specific enolase (NSE)-immunoreactive nerve fibres: evidence for sprouting in uremic patients on maintenance hemodialysis.

    PubMed

    Johansson, O; Hilliges, M; Ståhle-Bäckdahl, M

    1989-05-01

    The use of indirect immunohistochemistry in 12 patients on maintenance hemodialysis has shown weak or moderately strong neuron-specific enolase (NSE)-immunoreactive nerve terminals and fibres sprouting throughout the layers of the epidermis. No such terminals or fibres were found in any of 15 controls. There was no difference between uremic patients with pruritus and those without. Furthermore, NSE-positive nerve fibres with a normal appearance were seen in the dermis, at the epidermal-dermal junctional zone and sometimes entering the stratum basale in both patients and controls. The immunoreactive nerves were thin, smooth and, at their terminal fields, varicose. The immunoreactivity seemed to be associated chiefly with sensory nerves. Thus, our results suggest that uremic patients undergoing maintenance hemodialysis develop an abnormal pattern of cutaneous innervation. PMID:2657508

  15. Correlation Between C-reactive Protein and Non-enzymatic Antioxidants (Albumin, Ferritin, Uric Acid and Bilirubin) in Hemodialysis Patients

    PubMed Central

    Beciragic, Amela; Resic, Halima; Prohic, Nejra; Karamehic, Jasenko; Smajlovic, Ajdin; Masnic, Fahrudin; Ajanovic, Selma; Coric, Aida

    2015-01-01

    Introduction: Increased levels of C-Reactive Protein are found in 30-60% on hemodialysis patients and it is closely associated with the progression of atherosclerosis, cardiovascular morbidity and mortality. Non enzymatic antioxidants are antioxidants which primarily retain potentially dangerous ions of iron and copper in their inactive form and thereby prevent its participation in the production of free radicals. Aim: The aim of the study was to examine the relationship of CRP and non enzymatic antioxidants (albumin, ferritin, uric acid and bilirubin) i.e. examine the importance of CRP as a serum biomarker in assessing the condition of inflammation and its relationship to antioxidant protection in patients on hemodialysis. Methods: The study was cross-sectional, clinical, comparative and descriptive. The study involved 100 patients (non diabetic) on chronic hemodialysis. The control group consisted of 50 subjects without subjective and objective indicators of chronic renal disease. In all patients, the concentration of CRP as well as concentrations of non enzymatic antioxidants were determined. Results: In the group of hemodialysis patients 60% were men and 40% women. The average age of hemodialysis patients was 54.13 ± 11.8 years and the average age of the control group 41.72 ± 9.8 years. The average duration of hemodialysis treatment was 91.42 ± 76.2 months. In the group of hemodialysis patients statistically significant, negative linear correlation was determined between the concentration of CRP in and albumin concentration (rho = -0.251, p = 0.012) as well as negative, statistics insignificant, linear correlation between serum CRP and the concentration of uric acid (r = -0.077, p = 0.448). Furthermore, the positive, linear correlation was determined between serum CRP and ferritin (r = 0.159, p = 0.114) and positive linear correlation between CRP and total serum bilirubin (r = 0.121, p = 0.230). In the control group was determined a statistically significant

  16. Role of Residual Renal Function in Phosphate Control and Anemia Management in Chronic Hemodialysis Patients

    PubMed Central

    Penne, E. Lars; van der Weerd, Neelke C.; Grooteman, Muriel P.C.; Mazairac, Albert H.A.; van den Dorpel, Marinus A.; Nubé, Menso J.; Bots, Michiel L.; Lévesque, Renée; ter Wee, Piet M.

    2011-01-01

    Summary Background and objectives There is increasing awareness that residual renal function (RRF) has beneficial effects in hemodialysis (HD) patients. The aim of this study was to investigate the role of RRF, expressed as GFR, in phosphate and anemia management in chronic HD patients. Design, setting, participants, & measurements Baseline data of 552 consecutive patients from the Convective Transport Study (CONTRAST) were analyzed. Patients with a urinary output ≥100 ml/24 h (n = 295) were categorized in tertiles on the basis of degree of GFR and compared with anuric patients (i.e., urinary output <100 ml/24 h, n = 274). Relations between GFR and serum phosphate and erythropoiesis-stimulating agent (ESA) index (weekly ESA dose per kg body weight divided by hematocrit) were analyzed with multivariable regression models. Results Phosphate levels were between 3.5 and 5.5 mg/dl in 68% of patients in the upper tertile (GFR > 4.13 ml/min per 1.73 m2), as compared with 46% in anuric patients despite lower prescription of phosphate-binding agents. Mean hemoglobin levels were 11.9 ± 1.2 g/dl with no differences between the GFR categories. The ESA index was 31% lower in patients in the upper tertile as compared with anuric patients. After adjustments for patient characteristics, patients in the upper tertile had significantly lower serum phosphate levels and ESA index as compared with anuric patients. Conclusions This study suggests a strong relation between RRF and improved phosphate and anemia control in HD patients. Efforts to preserve RRF in HD patients could improve outcomes and should be encouraged. PMID:21030579

  17. Coordinated hospital-home care for kidney patients on hemodialysis from the perspective of nursing personnel1

    PubMed Central

    Tejada-Tayabas, Luz María; Partida-Ponce, Karla Lizbeth; Hernández-Ibarra, Luis Eduardo

    2015-01-01

    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. PMID:26039292

  18. Comparison of survival in patients with end-stage renal disease receiving hemodialysis versus peritoneal dialysis.

    PubMed

    Beladi Mousavi, Seyed Seifollah; Hayati, Fatemeh; Valavi, Ehsan; Rekabi, Fazlollah; Mousavi, Marzieh Beladi

    2015-03-01

    Although the life expectancy of patients with end-stage renal disease (ESRD) has improved in recent years, it is still far below that of the general population. In this retrospective study, we compared the survival of patients with ESRD receiving hemodialysis (HD) versus those on peritoneal dialysis (PD). The study was conducted on patients referred to the HD and PD centers of the Emam Khomini Hospital and the Aboozar Children's Hospital from January 2007 to May 2012 in Ahvaz, Iran. All ESRD patients on maintenance HD or PD for more than two months were included in the study. The survival was estimated by the Kaplan-Meier method and the differences between HD and PD patients were tested by the log-rank test. Overall, 239 patients, 148 patients on HD (61.92%) and 91 patients on continuous ambulatory PD (CAPD) (38.55%) with mean age of 54.1 ± 17 years were enrolled in the study. Regardless of the causes of ESRD and type of renal replacement therapy (RRT), one-, two- and three-year survival of patients was 65%, 51% and 35%, respectively. There was no significant difference between type of RRT in one- (P-value = 0.737), two- (P-value = 0.534) and three- (P-value = 0.867) year survival. There was also no significant difference between diabetic and non-diabetic patients under HD and CAPD in the one-, two- and three-year survival. Although the three-year survival of diabetic patients under CAPD was lower than that of non-diabetic patients (13% vs. 34%), it was not statistically significant (P-value = 0.50). According to the results of the current study, there is no survival advantage of PD during the first years of initiation of dialysis, and the one-, two- and three-year survival of HD and PD patients is also similar. PMID:25758900

  19. Usage of complementary and alternative medicine among patients with chronic kidney disease on maintenance hemodialysis

    PubMed Central

    Arjuna Rao, Aravapalli S. M.; Phaneendra, D.; Pavani, Ch. Divya; Soundararajan, P.; Rani, N. Vanitha; Thennarasu, P.; Kannan, G.

    2016-01-01

    Aim: To determine the prevalence and the type of complementary and alternative medicine (CAM) use among chronic kidney disease (CKD) patients on maintenance hemodialysis (MHD). Materials and Methods: The study was conducted in 200 CKD patients who were on MHD. The patients were subjected to a validated interviewer-administered questionnaire adopted from the National Health Interview Survey Adult CAM. The knowledge on CAM and its usage by the patients were assessed based on the responses given by the patients. Results: Of the 200 patients, 52 (26%) patients were identified to be using CAM therapy. The most commonly used CAM modality by these patients was Ayurveda both alone (30.4%) and in combination with other CAM modalities (23.2%), followed by acupuncture in 17.3% patients. CAM usage was high in the age range of 50–64 years (67%). Of the CAM users, 21% of patients were from a rural area; 16.5% of patients were from upper middle class, and 24% were on dialysis for 1–4 years. There was a statistically significant association between CAM usage and age, gender, place of living, socioeconomic status, and duration of dialysis (P < 0.01). Conclusion: The present survey provides the data on the usage of CAM among dialysis patients and adds to the increasing evidence about CAM use. Because many products are at risk to either accumulate or cause interactions with medication, a better education on the risks and benefits of the CAM therapy by the health care providers to the end stage renal disease patients is needed. PMID:26957870

  20. Clinical Outcomes after Parathyroidectomy in a Nationwide Cohort of Patients on Hemodialysis

    PubMed Central

    Liu, Jiannong; Wetmore, James B.; Lowe, Kimberly A.; Do, Thy; Bradbury, Brian D.; Block, Geoffrey A.; Collins, Allan J.

    2015-01-01

    Background and objectives Patients receiving dialysis undergo parathyroidectomy to improve laboratory parameters in resistant hyperparathyroidism with the assumption that clinical outcomes will also improve. However, no randomized clinical trial data demonstrate the benefits of parathyroidectomy. This study aimed to evaluate clinical outcomes up to 1 year after parathyroidectomy in a nationwide sample of patients receiving hemodialysis. Design, setting, participants, & measurements Using data from the US Renal Data System, this study identified prevalent hemodialysis patients aged ≥18 years with Medicare as primary payers who underwent parathyroidectomy from 2007 to 2009. Baseline characteristics and comorbid conditions were assessed in the year preceding parathyroidectomy; clinical events were identified in the year preceding and the year after parathyroidectomy. After parathyroidectomy, patients were censored at death, loss of Medicare coverage, kidney transplant, change in dialysis modality, or 365 days. This study estimated cause-specific event rates for both periods and rate ratios comparing event rates in the postparathyroidectomy versus preparathyroidectomy periods. Results Of 4435 patients who underwent parathyroidectomy, 2.0% died during the parathyroidectomy hospitalization and the 30 days after discharge. During the 30 days after discharge, 23.8% of patients were rehospitalized; 29.3% of these patients required intensive care. In the year after parathyroidectomy, hospitalizations were higher by 39%, hospital days by 58%, intensive care unit admissions by 69%, and emergency room/observation visits requiring hypocalcemia treatment by 20-fold compared with the preceding year. Cause-specific hospitalizations were higher for acute myocardial infarction (rate ratio, 1.98; 95% confidence interval, 1.60 to 2.46) and dysrhythmia (rate ratio 1.4; 95% confidence interval1.16 to 1.78); fracture rates did not differ (rate ratio 0.82; 95% confidence interval 0.6 to

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

    PubMed Central

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

    2015-01-01

    Chronic kidney disease has a higher prevalence in Indigenous populations globally. The incidence of end-stage kidney disease in Australian Aboriginal people is eight times higher than non-Aboriginal Australians. Providing services to rural and remote Aboriginal people with chronic disease is challenging because of access and cultural differences. This study aims to describe and analyze the perspectives of Aboriginal patients' and health care providers' experience of renal services, to inform service improvement for rural Aboriginal hemodialysis patients. We conducted a thematic analysis of interviews with Aboriginal patients (n = 18) receiving hemodialysis in rural Australia and health care providers involved in their care (n = 29). An overarching theme of avoiding the “costly” crisis encompassed four subthemes: (1) Engaging patients earlier (prevent late diagnosis, slow disease progression); (2) flexible family-focused care (early engagement of family, flexibility to facilitate family and cultural obligations); (3) managing fear of mainstream services (originating in family dialysis experiences and previous racism when engaging with government organizations); (4) service provision shaped by culture (increased home dialysis, Aboriginal support and Aboriginal-led cultural education). Patients and health care providers believe service redesign is required to meet the needs of Aboriginal hemodialysis patients. Participants identified early screening and improving the relationship of Aboriginal people with health systems would reduce crisis entry to hemodialysis. These strategies alongside improving the cultural competence of staff would reduce patients' fear of mainstream services, decrease the current emotional and family costs of care, and increase efficiency of health expenditure on a challenging and increasingly unsustainable treatment system. PMID:25056441

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

    PubMed

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

    2015-01-01

    Chronic kidney disease has a higher prevalence in Indigenous populations globally. The incidence of end-stage kidney disease in Australian Aboriginal people is eight times higher than non-Aboriginal Australians. Providing services to rural and remote Aboriginal people with chronic disease is challenging because of access and cultural differences. This study aims to describe and analyze the perspectives of Aboriginal patients' and health care providers' experience of renal services, to inform service improvement for rural Aboriginal hemodialysis patients. We conducted a thematic analysis of interviews with Aboriginal patients (n = 18) receiving hemodialysis in rural Australia and health care providers involved in their care (n = 29). An overarching theme of avoiding the "costly" crisis encompassed four subthemes: (1) Engaging patients earlier (prevent late diagnosis, slow disease progression); (2) flexible family-focused care (early engagement of family, flexibility to facilitate family and cultural obligations); (3) managing fear of mainstream services (originating in family dialysis experiences and previous racism when engaging with government organizations); (4) service provision shaped by culture (increased home dialysis, Aboriginal support and Aboriginal-led cultural education). Patients and health care providers believe service redesign is required to meet the needs of Aboriginal hemodialysis patients. Participants identified early screening and improving the relationship of Aboriginal people with health systems would reduce crisis entry to hemodialysis. These strategies alongside improving the cultural competence of staff would reduce patients' fear of mainstream services, decrease the current emotional and family costs of care, and increase efficiency of health expenditure on a challenging and increasingly unsustainable treatment system. PMID:25056441

  3. Analysis of a Single Hemodialysis on Phosphate Removal of the Internal Fistula Patients by Mathematical and Statistical Methods

    PubMed Central

    Yu, Qiyao; Bai, Yaling; Zhang, Junxia; Cui, Liwen; Zhang, Huiran; Xu, Jinsheng; Gao, Chao

    2013-01-01

    Chronic kidney disease related mineral and bone disease (CKD-MBD) is a worldwide challenge in hemodialysis patients. In china, the number of dialysis patients is growing but few data are available about their bone disorders. In the current study, we aimed to evaluate the effect of clinical factors on the serum phosphorus clearance in the 80 maintenance hemodialysis (MHD) patients. Six clinical factors were identified for their association with the serum phosphorus clearance using the analysis of Spearman's single linear correlation, including predialysis serum phosphate level, CRR, membrane surface area of the dialyzer, effective blood flow rate, the blood chamber volume, and hematocrit. In an overall multivariate analysis, pre-P, CRR, membrane SA, and Qb were identified as independent risk factors associated with the serum phosphorus clearance. In conclusion, HD could effectively clear serum phosphorus. The analysis of CRR might help to estimate serum phosphorus reduction ratio. PMID:24454542

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

    PubMed Central

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

    2014-01-01

    We evaluated the potential cardiovascular risk protection of bilirubin in hemodialysis (HD) patients. An enlarged set of studies were evaluated in 191 HD patients, including hematological study, lipid profile, iron metabolism, nutritional, inflammatory markers, and dialysis adequacy. The TA duplication screening in the UDP-glucuronosyltransferase 1 A1 (UGT1A1) promoter region was also performed. The UGT1A1 genotype frequencies in HD patients were 49.2%, 42.4%, and 8.4% for 6/6, 6/7, and 7/7 genotypes, respectively. Although no difference was found in UGT1A1 genotype distribution between the three tertiles of bilirubin, significant differences were found with increasing bilirubin levels, namely, a decrease in platelet, leukocyte, and lymphocyte counts, transferrin, oxidized low-density lipoprotein (ox-LDL), ox-LDL/low-density lipoprotein cholesterol ratio, apolipoprotein (Apo) A, Apo B, and interleukin-6 serum levels and a significant increased concentration of hemoglobin, hematocrit, erythrocyte count, iron, transferrin saturation, Apo A/Apo B ratio, adiponectin, and paraoxonase 1 serum levels. After adjustment for age these results remained significant. Our data suggest that higher bilirubin levels are associated with beneficial effects in HD patients, by improving lipid profile and reducing the inflammatory grade, which might contribute to increase in iron availability. These results suggest a potential cardiovascular risk protection of bilirubin in HD patients. PMID:25276769

  5. Effects of sleepiness on survival in Japanese hemodialysis patients: J-DOPPS study.

    PubMed

    Iseki, Kunitoshi; Tsuruya, Kazuhiko; Kanda, Eiichiro; Nomura, Takanobu; Hirakata, Hideki

    2014-01-01

    Sleep disorder and poor sleep quality are common in chronic hemodialysis (HD) patients. They have been claimed as a cause of morbidity and mortality. The relationship between the degree of sleepiness and survival has not been studied. We studied the degree of sleepiness in 1,252 adult HD patients (age ≥20 years) recruited into the Dialysis Outcomes Practice Pattern Study in Japan (J-DOPPS III), using the Japanese version of the Epworth Sleepiness Scale (JESS) questionnaire. Demographic data were presented for three subgroups: low, intermediate, and high JESS score. Cox proportional hazard regression analysis was performed to estimate the independent effect of several variables on survival. The hazard ratio for mortality was 2.312 (95% CI 1.267-4.220; p = 0.006) for those with a high JESS score (vs. those with a low JESS score) after adjusting for age, vintage (length of time on HD), sex, diabetes, body mass index, cardiovascular disease, HD treatment regimen (time, frequency, and single-pool Kt/V), laboratory data (serum albumin, creatinine, and total cholesterol), and medication (antihypertensive drugs, erythropoietin, vitamin D, and phosphate binders). Patients ≥70 years of age with comorbid conditions (congestive heart failure, stroke, and diabetes) showed a significantly higher JESS score (≥16). The JESS score did not show interaction by age. Results showed that the degree of sleepiness is related to survival in Japanese HD patients, particularly in elderly patients. PMID:25572670

  6. Usefulness of Everolimus-Eluting Coronary Stent Implantation in Patients on Maintenance Hemodialysis.

    PubMed

    Ikari, Yuji; Kyono, Hiroyuki; Isshiki, Takaaki; Ishizuka, Shuichi; Nasu, Kenya; Sano, Koichi; Okada, Hisayuki; Sugano, Teruyasu; Uehara, Yoshiki

    2015-09-15

    The outcomes of second-generation drug-eluting stent (DES) are unknown in patients on maintenance hemodialysis (HD) although HD has been reported as a strong predictor of adverse outcome after the first-generation DES implantation. The OUCH-PRO Study is a prospective multicenter single-arm registry design to study clinical and angiographic outcomes after everolimus-eluting stent (EES). Patients who underwent maintenance HD were prospectively enrolled at the time of elective coronary intervention using EES. Quantitative coronary angiography was performed in an independent core laboratory. The primary end point was the occurrence of target vessel failure (TVF) defined as cardiac death, myocardial infarction (MI), and target vessel revascularization at 1 year. A total of 123 patients were enrolled and 161 EES were implanted. The TVF rate at 1 year was 18% (4% cardiac death, 0% MI, 17% target vessel revascularization). No stent thrombosis was documented. Other clinical events at 1 year were 3% noncardiac death, 3% stroke, and 9% non-target-vessel revascularization. Late lumen loss in stent was 0.37 ± 0.63 mm at 8 months. In conclusion, EES had a high TVF rate and great late lumen loss in patients on HD compared with previous huge EES data in non-HD patients. PMID:26219496

  7. Salt-water imbalance and fluid overload in hemodialysis patients: a pivotal role of corin.

    PubMed

    Ricciardi, Carlo Alberto; Lacquaniti, Antonio; Cernaro, Valeria; Bruzzese, Annamaria; Visconti, Luca; Loddo, Saverio; Santoro, Domenico; Buemi, Michele

    2016-08-01

    Natriuretic peptides (NP) play a key role in regulation of salt and water balance. Corin, a serine protease which activates NP, plays a key role in regulation of blood pressure and cardiac function. The aim of the study was to evaluate the involvement of corin in renal physiopathology, analyze its levels in dialyzed patients and evaluate its relation with fluid overload and comorbidities such as heart failure and blood hypertension. We studied serum corin in uremic patients (n = 20) undergoing hemodialysis therapy (HD) and in healthy subjects (HS). Corin levels in uremic patients were higher than in HS (p < 0.0001). Moreover, its concentration did not change after a single HD session. Hypertensive patients and subject suffering from heart failure were characterized by high values of corin. After multivariate analysis, direct correlations were maintained between corin and dialysis vintage (β = 0.83; p = 0.0002), heart failure (β = 0.42; p < 0.0001), systolic blood pressure (β = -0.70; p = 0.0002) and body weight (β = -0.39; p < 0.0001). Corin might be implicated in the regulation of salt and water balance and the disturbances of volume homeostasis of HD patients. However, further studies are warranted to understand the role of corin in kidney diseases and to define its diagnostic and prognostic role. PMID:26206554

  8. Kaposi's sarcoma with HHV8 infection and ANCA-associated vasculitis in a hemodialysis patient.

    PubMed

    Fatma, Lilia Ben; Rais, Lamia; Mebazza, Amel; Azzouz, Haifa; Beji, Somaya; Krid, Madiha; Smaoui, Wided; Maiz, Hedi Ben; Zouaghi, Karim; Zitouna, Moncef; Osmane, Amel Ben; Moussa, Fatma Ben

    2013-11-01

    The association between Kaposi's sarcoma (KS) and human herpes virus eight (HHV-8) infection is rarely reported in hemodialysis (HD) patients. We report here the rare association of KS, HHV-8 and hepatitis C virus (HCV) infection as well as syphilis in a HD patient. We report the case of a 72-year-old woman who presented with microscopic polyangiitis with alveolar hemorrhage and pauci-immune necrosing and crescentic glomerulonephritis as well as renal failure requiring HD. Biological tests showed positive HCV and syphilis tests. The patient was treated by HD and intravenous pulse, followed by oral corticosteroids and six cyclophosphamide monthly pulses with remission of the alveolar hemorrhage, but without renal functional recovery as the patient remained HD dependent. Five months after the first treatment administration, she developed extensive purpuric lesions on her lower limbs, abdomen face and neck. A skin biopsy showed KS. The HHV-8 test was positive, with positive polymerase chain reaction-HHV8 in the serum and skin. After immunosuppression withdrawal, the KS skin lesions regressed rapidly without relapse after 12 months of follow-up, but alveolar hemorrhage relapsed after 16 months of follow-up. Our case showed that the immunosuppressed state related to multiple factors such as aging, vasculitis, HHV-8, HCV, syphilis, immunosuppressive therapy and HD may all have contributed to the development of KS in our patient. PMID:24231484

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

    PubMed

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

    2016-04-01

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

  10. Electronegative Low-density Lipoprotein Increases Coronary Artery Disease Risk in Uremia Patients on Maintenance Hemodialysis.

    PubMed

    Chang, Chiz-Tzung; Wang, Guei-Jane; Kuo, Chin-Chi; Hsieh, Ju-Yi; Lee, An-Sean; Chang, Chia-Ming; Wang, Chun-Cheng; Shen, Ming-Yi; Huang, Chiu-Ching; Sawamura, Tatsuya; Yang, Chao-Yuh; Stancel, Nicole; Chen, Chu-Huang

    2016-01-01

    Electronegative low-density lipoprotein (LDL) is a recognized factor in the pathogenesis of coronary artery disease (CAD) in the general population, but its role in the development of CAD in uremia patients is unknown. L5 is the most electronegative subfraction of LDL isolated from human plasma. In this study, we examined the distribution of L5 (L5%) and its association with CAD risk in uremia patients.The LDL of 39 uremia patients on maintenance hemodialysis and 21 healthy controls was separated into 5 subfractions, L1-L5, with increasing electronegativity. We compared the distribution and composition of plasma L5 between uremia patients and controls, examined the association between plasma L5% and CAD risk in uremia patients, and studied the effects of L5 from uremia patients on endothelial function.Compared to controls, uremia patients had significantly increased L5% (P < 0.001) and L5 that was rich in apolipoprotein C3 and triglycerides. L5% was significantly higher in uremia patients with CAD (n = 10) than in those without CAD (n = 29) (P < 0.05). Independent of other major CAD risk factors, the adjusted odds ratio for CAD was 1.88 per percent increase in plasma L5% (95% CI, 1.01-3.53), with a near-linear dose-response relationship. Compared with controls, uremia patients had decreased flow-mediated vascular dilatation. In ex vivo studies with preconstricted rat thoracic aortic rings, L5 from uremia patients inhibited acetylcholine-induced relaxation. In cultured human endothelial cells, L5 inhibited endothelial nitric oxide synthase activation and induced endothelial dysfunction.Our findings suggest that elevated plasma L5% may induce endothelial dysfunction and play an important role in the increased risk of CAD in uremia patients. PMID:26765403

  11. Analysis of Clinically Relevant Factors for Pulmonary Hypertension in Maintenance Hemodialysis Patients.

    PubMed

    Shen, Shen; Sun, Qianmei

    2015-01-01

    BACKGROUND Pulmonary hypertension (PH) is common in patients with maintenance hemodialysis (MHD) and is associated with high mortality. This study analyzed clinically relevant factors for pulmonary hypertension in MHD patients and the effect of serum pentraxin3 (PTX3) in the pathogenesis of PH to provide the basis for early diagnosis and treatment of MHD patients with PH. MATERIAL AND METHODS This study included 60 MHD patients (group A) and 30 healthy controls (group B). Group A was further divided into PH and non-PH groups. Clinical characteristics, auxiliary examination results and serum PTX3 level of the PH and non-PH groups were compared. Binary logistic regression was used to assess the risk factors for PH in MHD patients. ROC curve was applied to evaluate the diagnostic value of PTX3 in PH. RESULTS The incidence rate of PH in MHD patients was 50%, and most presented as mild to moderate. Compared with the non-PH group, patients in PH group presented significantly longer atrial diameter, right ventricular diameter and main pulmonary artery diameter (P<0.05), as well as higher PTX3 and NT-proBNP level. Atrial diameter and PTX3 level were the risk factors for PH in MHD patients. AUC of PTX3 was 0.721 (95%CI: 0.590-0.851, P=0.003). CONCLUSIONS The prevalence of PH was higher in MHD patients and mostly presented as mild to moderate. Such patients often developed heart structural changes and cardiac ultrasound was highly recommended. Serum PTX3 level was significantly elevated and could be used as a marker of PH in MHD patients. PMID:26706606

  12. Electronegative Low-density Lipoprotein Increases Coronary Artery Disease Risk in Uremia Patients on Maintenance Hemodialysis

    PubMed Central

    Chang, Chiz-Tzung; Wang, Guei-Jane; Kuo, Chin-Chi; Hsieh, Ju-Yi; Lee, An-Sean; Chang, Chia-Ming; Wang, Chun-Cheng; Shen, Ming-Yi; Huang, Chiu-Ching; Sawamura, Tatsuya; Yang, Chao-Yuh; Stancel, Nicole; Chen, Chu-Huang

    2016-01-01

    Abstract Electronegative low-density lipoprotein (LDL) is a recognized factor in the pathogenesis of coronary artery disease (CAD) in the general population, but its role in the development of CAD in uremia patients is unknown. L5 is the most electronegative subfraction of LDL isolated from human plasma. In this study, we examined the distribution of L5 (L5%) and its association with CAD risk in uremia patients. The LDL of 39 uremia patients on maintenance hemodialysis and 21 healthy controls was separated into 5 subfractions, L1–L5, with increasing electronegativity. We compared the distribution and composition of plasma L5 between uremia patients and controls, examined the association between plasma L5% and CAD risk in uremia patients, and studied the effects of L5 from uremia patients on endothelial function. Compared to controls, uremia patients had significantly increased L5% (P < 0.001) and L5 that was rich in apolipoprotein C3 and triglycerides. L5% was significantly higher in uremia patients with CAD (n = 10) than in those without CAD (n = 29) (P < 0.05). Independent of other major CAD risk factors, the adjusted odds ratio for CAD was 1.88 per percent increase in plasma L5% (95% CI, 1.01–3.53), with a near-linear dose–response relationship. Compared with controls, uremia patients had decreased flow-mediated vascular dilatation. In ex vivo studies with preconstricted rat thoracic aortic rings, L5 from uremia patients inhibited acetylcholine-induced relaxation. In cultured human endothelial cells, L5 inhibited endothelial nitric oxide synthase activation and induced endothelial dysfunction. Our findings suggest that elevated plasma L5% may induce endothelial dysfunction and play an important role in the increased risk of CAD in uremia patients. PMID:26765403

  13. Analysis of Clinically Relevant Factors for Pulmonary Hypertension in Maintenance Hemodialysis Patients

    PubMed Central

    Shen, Shen; Sun, Qianmei

    2015-01-01

    Background Pulmonary hypertension (PH) is common in patients with maintenance hemodialysis (MHD) and is associated with high mortality. This study analyzed clinically relevant factors for pulmonary hypertension in MHD patients and the effect of serum pentraxin3 (PTX3) in the pathogenesis of PH to provide the basis for early diagnosis and treatment of MHD patients with PH. Material/Methods This study included 60 MHD patients (group A) and 30 healthy controls (group B). Group A was further divided into PH and non-PH groups. Clinical characteristics, auxiliary examination results and serum PTX3 level of the PH and non-PH groups were compared. Binary logistic regression was used to assess the risk factors for PH in MHD patients. ROC curve was applied to evaluate the diagnostic value of PTX3 in PH. Results The incidence rate of PH in MHD patients was 50%, and most presented as mild to moderate. Compared with the non-PH group, patients in PH group presented significantly longer atrial diameter, right ventricular diameter and main pulmonary artery diameter (P<0.05), as well as higher PTX3 and NT-proBNP level. Atrial diameter and PTX3 level were the risk factors for PH in MHD patients. AUC of PTX3 was 0.721 (95%CI: 0.590–0.851, P=0.003). Conclusions The prevalence of PH was higher in MHD patients and mostly presented as mild to moderate. Such patients often developed heart structural changes and cardiac ultrasound was highly recommended. Serum PTX3 level was significantly elevated and could be used as a marker of PH in MHD patients. PMID:26706606

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

    PubMed Central

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

    2015-01-01

    Background: Hepcidin, as a regulator of body iron stores, has been recently discovered to play a critical role in the pathogenesis of anemia of chronic disease. Atherosclerotic cardiovascular disease is the most common complication and the leading cause of death in chronic hemodialysis (CHD) patients. In the current study, we aimed to explore the relationship between serum hepcidin and uremic accelerated atherosclerosis (UAAS) in CHD patients with diabetic nephropathy (CHD/DN). Methods: A total of 78 CHD/DN and 86 chronic hemodialyzed nondiabetic patients with chronic glomerulonephritis (CHD/non-DN) were recruited in this study. The level of serum hepcidin-25 was specifically measured by liquid chromatography-tandem mass spectrometry. Serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were measured by enzyme-linked immunosorbent assay. Results: High serum level of hepcidin-25 was seen in CHD patients. Serum hepcidin-25 in CHD/DN was significantly higher than that in CHD/non-DN patients. Serum hepcidin-25 was positively correlated with ferritin, high-sensitivity C-reactive protein (hs-CRP), TNF-α, and IL-6 in CHD/DN patients. CHD/DN patients exhibited higher common carotid artery intima media thickness (CCA-IMT), hs-CRP, and hepcidin-25 levels than that in CHD/non-DN patients. Moreover, in CHD/DN patients, CCA-IMT was positively correlated with serum hepcidin, hs-CRP, and low-density lipoprotein-cholesterol. On multiple regression analysis, serum hepcidin and hs-CRP level exhibited independent association with IMT in CHD/DN patients. Conclusions: These findings suggest possible linkage between iron metabolism and hepcidin modulation abnormalities that may contribute to the development of UAAS in CHD/DN patients. PMID:25963357

  15. Circulating growth arrest-specific protein 6 levels are associated with erythropoietin resistance in hemodialysis patients.

    PubMed

    Chen, Miao-Pei; Chen, Chien-Wen; Chen, Jin-Shuen; Mao, Hung-Chung; Chou, Chu-Lin

    2016-01-01

    Growth arrest-specific protein 6 (Gas6) works synergistically with erythropoietin (EPO) to increase the proliferation and maturation of erythroblasts. However, the role of Gas 6 levels on EPO resistance in hemodialysis (HD) patients remains unclear. Therefore, the objective of this study was the first to examine the correlation between plasma Gas6 levels and EPO resistance in HD patients. We enrolled 134 HD patients and 85 healthy individuals. The HD patients were divided into 2 groups: 98 non-EPO-resistant patients and 36 EPO-resistant patients. Plasma levels of Gas6, interleukin 6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), and albumin were quantified. Compared with non-EPO-resistant patients, EPO-resistant patients had elevated plasma concentrations of Gas6 (15.4 ± 3.3 vs. 13.7 ± 3.2 ng/mL, P = 0.006), IL-6 (3.1 ± 3.1 vs. 2.1 ± 1.5 pg/mL, P = 0.009), and hs-CRP (12.7 ± 25.2 vs. 4.5 ± 5.5 mg/L, P = 0.002). In EPO-resistant HD patients, plasma Gas6 levels were negatively correlated with albumin levels (r = -0.388, P < 0.021). Elevated Gas6 levels are associated with EPO resistance in HD patients. Also, EPO resistance is related to inflammation and malnutrition. Thus, circulating Gas6 levels could be used as the potential marker in HD patients with EPO resistance. PMID:26788441

  16. The Effect of Massage With Lavender Oil on Restless Leg Syndrome in Hemodialysis Patients: A Randomized Controlled Trial

    PubMed Central

    Hashemi, Sayyed Hossein; Hajbagheri, Ali; Aghajani, Mohammad

    2015-01-01

    Background: Restless leg syndrome (RLS) is a common problem in patients with chronic renal failure. It can reduce the quality of life and sleep disturbances. This disorder is usually treated pharmacologically. Recently, complementary medicine methods have been suggested because of chemical drugs adverse effects. There is not enough evidence about the effect of aromatherapy on RLS. Objectives: The aim of this study was to determine the effects of massage with lavender oil on RLS symptoms in hemodialysis patients. Patients and Methods: This randomized clinical trial study included 70 hemodialysis patients with RLS that were randomly assigned into two groups in 2014. The experimental group received effleurage massage using lavender oil and control group received routine care for three weeks. Data was collected with RLS questionnaire and analyzed using independent and paired t-test and Chi-square test. Results: The mean RLS scores were not significantly different in the two groups at the start of study (22.41 ± 7.67 vs. 22.90 ± 4.38, P = 0.76). At the end of study, the mean RLS score significantly decreased in the intervention group, while this score remained relatively un-changed in the control group (12.41 ± 5.49 vs. 23.23 ± 4.52, P < 0.0001). Conclusions: Lavender oil massage was effective to improve RLS in hemodialysis patients. It has no adverse effects, is practical and cost-effective. It is suggested to be used along with routine treatment of RLS in hemodialysis patients. PMID:26835466

  17. An international observational study suggests that artificial intelligence for clinical decision support optimizes anemia management in hemodialysis patients.

    PubMed

    Barbieri, Carlo; Molina, Manuel; Ponce, Pedro; Tothova, Monika; Cattinelli, Isabella; Ion Titapiccolo, Jasmine; Mari, Flavio; Amato, Claudia; Leipold, Frank; Wehmeyer, Wolfgang; Stuard, Stefano; Stopper, Andrea; Canaud, Bernard

    2016-08-01

    Managing anemia in hemodialysis patients can be challenging because of competing therapeutic targets and individual variability. Because therapy recommendations provided by a decision support system can benefit both patients and doctors, we evaluated the impact of an artificial intelligence decision support system, the Anemia Control Model (ACM), on anemia outcomes. Based on patient profiles, the ACM was built to recommend suitable erythropoietic-stimulating agent doses. Our retrospective study consisted of a 12-month control phase (standard anemia care), followed by a 12-month observation phase (ACM-guided care) encompassing 752 patients undergoing hemodialysis therapy in 3 NephroCare clinics located in separate countries. The percentage of hemoglobin values on target, the median darbepoetin dose, and individual hemoglobin fluctuation (estimated from the intrapatient hemoglobin standard deviation) were deemed primary outcomes. In the observation phase, median darbepoetin consumption significantly decreased from 0.63 to 0.46 μg/kg/month, whereas on-target hemoglobin values significantly increased from 70.6% to 76.6%, reaching 83.2% when the ACM suggestions were implemented. Moreover, ACM introduction led to a significant decrease in hemoglobin fluctuation (intrapatient standard deviation decreased from 0.95 g/dl to 0.83 g/dl). Thus, ACM support helped improve anemia outcomes of hemodialysis patients, minimizing erythropoietic-stimulating agent use with the potential to reduce the cost of treatment. PMID:27262365

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

    PubMed

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

    2015-06-01

    Vitamin D deficiency is common in dialysis patients with chronic kidney disease. Low levels have been associated with increased cardiovascular risk and mortality. We evaluated the administration of a high, single oral dose of 25-OH cholecalciferol (3 mg of Hidroferol, 180 000 IU) in patients on chronic hemodialysis. The 94 chronic hemodialysis patients with vitamin D deficiency 25 (OH)D <30 ng/mL included in the study were randomized into two groups. Follow-up time was 16 weeks. Neither the usual treatment for controlling Ca/P levels nor the dialysis bath (calcium of 2.5 mEq/L) were modified. Of the 86 patients who finished the study, 42 were in the treated group and 44 in the control group. An increase in 25(OH)D levels was observed in the treated group that persisted after 16 weeks and was associated with a significant decrease in parathyroid hormone (PTH) levels during the 8 weeks post-treatment. Baseline 1,25(OH)2 D levels of the treated group increased two weeks after treatment (5.9 vs. 21.9 pg/mL, P<0.001) but gradually reduced to 8.4 at week 16. The administration of a single 3 mg dose of 25-OH cholecalciferol seems safe in patients on hemodialysis and maintains sufficient levels of 25(OH)D with a decrease in PTH for 3 months. PMID:25656524

  19. Relationship between asymmetric dimethylarginine plasma level and left ventricular mass in hemodialysis patients.

    PubMed

    El Shahawy, Yasser; Soliman, Yasser; Rifaie, Ahmed; Shenawy, Howayda; Behairy, Maha; Mady, Gamal

    2015-01-01

    Left ventricular hypertrophy (LVH) and left ventricular dysfunction are highly prevalent in patients with end-stage renal disease (ESRD). Several studies suggest that left ventricular mass and function is strongly modulated by the nitric oxide (NO) system. Asymmetric dimethylarginine (ADMA), an endogenous inhibitor of endothelial-based NO synthase, is emerging as an important cardiovascular risk factor in ESRD patients. Our objective is to evaluate the relationship between plasma ADMA level and LVH among hemodialysis (HD) patients. Plasma ADMA measurements by enzyme-linked immunesorbent assay and echocardiographic evaluation were performed for 40 patients on regular HD, 20 patients with pre-dialysis chronic kidney disease, 20 hypertensive patients with left ventricular hypertrophy and normal kidney function and 20 healthy age and sex-matched subjects as a control group. Residual renal function (RRF) was measured in HD patients by urea clearance from a urine collection. Mean values of plasma ADMA level were significantly high in all patient groups when compared with the control group (P < 0.001). However, there was no significant difference between groups I, II and III as regards mean values of plasma ADMA (P >0.05) and between ADMA and RRF in HD patients (r = -0.20, P = 0.60). It was also seen that plasma ADMA was not correlated with left ventricular mass index; however, there could be an association between ADMA level and diastolic dysfunction. The plasma ADMA level was found to be high in the three studied patient groups in comparison with the control group. HD is not an effective procedure for adequate removal of ADMA. PMID:25579712

  20. Destructive Spondyloarthropathy in Patients on Long-Term Peritoneal Dialysis or Hemodialysis.

    PubMed

    Hayami, Noriko; Hoshino, Junichi; Suwabe, Tastuya; Sumida, Keiichi; Mise, Koki; Hamanoue, Satoshi; Sawa, Naoki; Kitajima, Izuru; Hirota, Yutaka; Oohashi, Kenichi; Fujii, Takeshi; Okuda, Itsuko; Takaichi, Kenmei; Ubara, Yoshifumi

    2015-08-01

    Destructive spondyloarthropathy (DSA) is the most serious spinal complication of dialysis-related amyloidosis in patients on long-term hemodialysis (HD), but we could not find any information about DSA in patients on peritoneal dialysis (PD) for over 10 years. We retrospectively evaluated factors contributing to DSA in HD and PD patients. Sixty-seven patients on dialysis for 10 to 19 years were compared between a PD group (n = 23) or a HD group (n = 44). In the PD group, nine patients (39%) developed DSA. The mean age of DSA patients was significantly higher than that of non-DSA patients (66.2 ± 10.0 vs. 51.0 ± 12.8 years, P = 0.03). The frequency of cervical spine DSA did not show any difference between the PD and HD groups, but the frequency of lumbar spine DSA showed a significant difference (22% vs. 5%, P = 0.04). The serum beta-2 microglobulin (B2MG) level was significantly higher in PD patients than in HD patients (38.4 mg/L vs. 27.4 mg/L, P = 0.0025). Mechanical stress such as elevation of the intra-abdominal pressure due to infusion of PD fluid (1500 mL to 2000 mL) for over 10 years might contribute to lumbar DSA in patients on long-term PD. PMID:25851461

  1. Correlation of serum parathormone with hypertension in chronic renal failure patients treated with hemodialysis.

    PubMed

    Baradaran, Azar; Nasri, Hamid

    2005-01-01

    To consider the correlation of serum parathormone on severity of hypertension in end-stage renal disesase (ESRD) patients on hemodialysis (HD). A cross-sectional study was done on patients with ESRD on treatment with maintenance HD. Levels of serum calcium, phosphorus, alkaline phosphatase, albumin and intact parathormone (iPTH) were measured. Stratification of hypertensive patients was done from stages one to three. The total number of patients studied was 73 (Females=28, Males=45), consisting of 58 non-diabetic (F=22 M=36) and 15 diabetic patients (F=6 M=9). The mean age of the study patients was 46.5 +/- 16 years.The mean duration on HD of the study patients was 21.5 +/- 23.5 months. The mean serum PTH of the study patients was 309 +/- 349 pg/ml and the mean serum alkaline phosphatase was 413 +/- 348 IU/L. There was a significant positive correlation between the stage of hypertension and serum PTH levels (r =0.200 p=0.045). Also, there was a significant positive correlation between stage of hypertension and calcium-phosphorus product (r = 0. 231 p=0.027).There was no significant correlation between stage of hypertension and serum ALP (r =0.135 p=0.128). Relationship between serum PTH and severity of hypertension in patients on HD needs to be studied in more detail. Hypertention and secondary hyperparathyroidism interact in the process of accelerated atherosclerosis in HD patients thus warranting appropriate measures to control hyperparathyroidism vigorously. PMID:17642794

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

    PubMed

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

    2014-04-01

    At 14:46 on 11 March 2011, northeastern Japan was struck by a major earthquake measuring 9.0 on the Richter scale (the Great East Japan Earthquake). Several reports have suggested a transient blood pressure (BP) increase after a major earthquake, but its impact on BP in chronic dialysis patients has not been reported. In a retrospective review of 25 hemodialysis patients who were residents of Koriyama City, changes in the morning home BP after the earthquake were investigated. Home systolic and diastolic BPs were significantly elevated 1 week after the earthquake (158 ± 16 mm Hg vs. 151 ± 13 mm Hg, P < 0.01, for systolic; 81 ± 13 mm Hg vs. 78 ± 11 mm Hg, P = 0.01, for diastolic). Mean home BP 1 week after the earthquake was unchanged from baseline in patients treated with sympatholytics and/or renin-angiotensin system (RAS) inhibitors. BP values returned to baseline by 4 weeks after the earthquake, but percent changes in mean BP were significantly greater even 2 weeks, 4 weeks, and 6 weeks after the earthquake in patients not treated with RAS inhibitors than in those treated with RAS inhibitors (2 weeks 7.0% ± 4.5% vs. 0.2% ± 5.0%, P < 0.01; 4 weeks 4.4% ± 5.9% vs. -1.8% ± 5.3%, P = 0.02; 6 weeks 4.6% ± 4.9% vs. -1.9% ± 3.9%, P < 0.01). On multiple regression analysis, RAS inhibitor use had an independent relationship with percentage increases in mean BP during the 6 weeks after the earthquake. Home BP was significantly increased after a major earthquake in patients on chronic hemodialysis. Prolonged deterioration of BP control after the earthquake was associated with non-use of RAS inhibitors. PMID:24720405

  3. Carotid Atherosclerotic Disease Predicts Cardiovascular Events in Hemodialysis Patients: A Prospective Study

    PubMed Central

    Nicolau, Carlos; Pons, Mercedes; Cruzado, Josep M

    2015-01-01

    Background To evaluate the predictive value of carotid atherosclerotic disease (CAD) and intima-media thickness (IMT) on incident cardiovascular disease and mortality in hemodialysis patients. Methods Multicenter, observational, prospective study including 110 patients, followed-up to 6 years. Carotid doppler ultrasonographic findings were classified in 4 degrees of severity: 1) IMT <0.9 mm, 2) IMT >0.9 mm, 3) carotid plaque with stenosis <50% and 4) plaque with stenosis >50%. The associations between IMT and CAD and cardiovascular events, total and cardiovascular mortality were assessed. Results 83% of the patients had atherosclerotic plaques (CAD degrees 3-4). During follow-up, 29.1% of patients experienced cardiovascular events, and 28.2% died, 38.7% of cardiovascular origin. The presence of plaques was associated with cardiovascular events (p = 0.03) while calcified plaques were associated with both cardiovascular events (p = 0.01), cardiovascular mortality (p = 0.03) and non-significantly with overall mortality (p = 0.08) in the survival analysis. Carotid IMT was not associated with outcomes. Cardiovascular events correlated with CAD severity (HR 2.27, 95% CI 1.13-4.54), age (HR 1.04, 1.01-1.06), previous cardiovascular disease (HR 1.75, 1.05-4.42), dyslipidemia (HR 2.25, 1.11-4.53), lipoprotein (a) (HR 1.01, 1.00-1.02), troponin I (HR 3.89, 1.07-14.18), fibrinogen levels (HR 1.38, 0.98-1.94) and antiplatelet therapy (HR 2.14, 1.04-4.4). In an age-adjusted multivariate model, cardiovascular events were independently associated with previous coronary artery disease (HR 3.29, 1.52-7.15) and lipoprotein (a) (HR 1.01, 1.00-1.02). Conclusions The presence of carotid plaques and, especially, calcified plaques, are predictors of new cardiovascular events and cardiovascular mortality in hemodialysis patients, while IMT was not. The prognostic value of calcified plaques should be confirmed in future studies. PMID:26029907

  4. Clinical outcomes in pediatric hemodialysis patients in the USA: lessons from CMS' ESRD CPM Project.

    PubMed

    Neu, Alicia M; Frankenfield, Diane L

    2009-07-01

    Although prospective randomized trials have provided important information and allowed the development of evidence-based guidelines in adult hemodialysis (HD) patients, with approximately 800 prevalent pediatric HD patients in the United States, such studies are difficult to perform in this population. Observational data obtained through the Center for Medicare & Medicaid Services' (CMS') End Stage Renal Disease (ESRD) Clinical Performance Measures (CPM) Project have allowed description of the clinical care provided to pediatric HD patients as well as identification of risk factors for failure to reach adult targets for clinical parameters such as hemoglobin, single-pool Kt/V (spKt/V) and serum albumin. In addition, studies linking data from the ESRD CPM Project and the United States Renal Data System have allowed evaluation of associations between achievement of those targets and the outcomes of hospitalization and death. The results of those studies, while unable to prove cause and effect, suggest that the adult ESRD CPM targets may assist in identifying pediatric HD patients at risk for poor outcomes. PMID:18509683

  5. Oral and salivary changes among renal patients undergoing hemodialysis: A cross-sectional study

    PubMed Central

    Kaushik, A.; Reddy, S. S.; Umesh, L.; Devi, B. K. Y.; Santana, N.; Rakesh, N.

    2013-01-01

    We wanted to assess oral and salivary changes in end stage renal disease (ESRD) patients undergoing hemodialysis (HD) and to understand the correlation of such changes with renal insufficiency. The cross-sectional study was performed among 100 ESRD patients undergoing HD. Among these, 25 patients were randomly selected to assess the salivary changes and compared with 25 apparently healthy individuals who formed the control group. Total duration of the study was 15 months. Oral malodor, dry mouth, taste change, increased caries incidence, calculus formation, and gingival bleeding were the common oral manifestations. The flow rates of both unstimulated as well as stimulated whole saliva were decreased in the study group. The pH and buffer capacity of unstimulated whole saliva was increased in the study group, but stimulated whole saliva did not show any difference. ESRD patients undergoing HD require special considerations during dental treatment because of the various conditions inherent to the disease, their multiple oral manifestations and the treatment side-effects. PMID:23716919

  6. Mineral bone disease in maintenance hemodialysis patients: Association with morbidity and mortality

    PubMed Central

    Reddy, Y. N. V.; Abraham, G.; Reddy, Y. N. V.; Nagarajan, P.; Matthew, M.; Jayaseelan, T.; Padma, G.

    2014-01-01

    There is a paucity of data on mineral bone disease in maintenance hemodialysis (MHD) patients from India. This retrospective analysis was undertaken on 858 (males: 599; females: 259) patients from two medical centers on MHD from 1998 to 2010. Age, gender, months on dialysis, hours per session of dialysis, hemoglobin, serum calcium, inorganic phosphorus, intact parathyroid hormone (iPTH), urine output, erythropoietin dosage per week, blood sugar, blood pressure, urea reduction rate, gain in fluid and fluid removed per session, serum albumin, alkaline phosphatase, vitamin D level, supplemental vitamin D and use of phosphate binder for therapy were documented. Overall, 191 patients died (22%) during the observation period. There was an 86% patient survival rate at 1 year on dialysis and an overall predicted 3-year survival rate of 78%. A relatively higher iPTH (P = 0.012), a need for vitamin D supplementation (P = 0.003), less hours on dialysis per session (P = 0.046) and a non-vegetarian diet (P = 0.022) were significantly associated with mortality. PMID:25249720

  7. PTH-dependence of the effectiveness of cinacalcet in hemodialysis patients with secondary hyperparathyroidism

    PubMed Central

    Akizawa, Tadao; Kurita, Noriaki; Mizobuchi, Masahide; Fukagawa, Masafumi; Onishi, Yoshihiro; Yamaguchi, Takuhiro; Ellis, Alan R.; Fukuma, Shingo; Alan Brookhart, M.; Hasegawa, Takeshi; Kurokawa, Kiyoshi; Fukuhara, Shunichi

    2016-01-01

    Cinacalcet lowers parathyroid hormone levels. Whether it can prolong survival of people with chronic kidney disease (CKD) complicated by secondary hyperparathyroidism (SHPT) remains controversial, in part because a recent randomized trial excluded patients with iPTH <300 pg/ml. We examined cinacalcet’s effects at different iPTH levels. This was a prospective case-cohort and cohort study involving 8229 patients with CKD stage 5D requiring maintenance hemodialysis who had SHPT. We studied relationships between cinacalcet initiation and important clinical outcomes. To avoid confounding by treatment selection, we used marginal structural models, adjusting for time-dependent confounders. Over a mean of 33 months, cinacalcet was more effective in patients with more severe SHPT. In patients with iPTH ≥500 pg/ml, the reduction in the risk of death from any cause was about 50% (Incidence Rate Ratio [IRR] = 0.49; 95% Confidence Interval [95% CI]: 0.29–0.82). For a composite of cardiovascular hospitalization and mortality, the association was not statistically significant, but the IRR was 0.67 (95% CI: 0.43–1.06). These findings indicate that decisions about using cinacalcet should take into account the severity of SHPT. PMID:27071541

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2016-07-01

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

  10. PTH-dependence of the effectiveness of cinacalcet in hemodialysis patients with secondary hyperparathyroidism.

    PubMed

    Akizawa, Tadao; Kurita, Noriaki; Mizobuchi, Masahide; Fukagawa, Masafumi; Onishi, Yoshihiro; Yamaguchi, Takuhiro; Ellis, Alan R; Fukuma, Shingo; Alan Brookhart, M; Hasegawa, Takeshi; Kurokawa, Kiyoshi; Fukuhara, Shunichi

    2016-01-01

    Cinacalcet lowers parathyroid hormone levels. Whether it can prolong survival of people with chronic kidney disease (CKD) complicated by secondary hyperparathyroidism (SHPT) remains controversial, in part because a recent randomized trial excluded patients with iPTH <300 pg/ml. We examined cinacalcet's effects at different iPTH levels. This was a prospective case-cohort and cohort study involving 8229 patients with CKD stage 5D requiring maintenance hemodialysis who had SHPT. We studied relationships between cinacalcet initiation and important clinical outcomes. To avoid confounding by treatment selection, we used marginal structural models, adjusting for time-dependent confounders. Over a mean of 33 months, cinacalcet was more effective in patients with more severe SHPT. In patients with iPTH ≥500 pg/ml, the reduction in the risk of death from any cause was about 50% (Incidence Rate Ratio [IRR] = 0.49; 95% Confidence Interval [95% CI]: 0.29-0.82). For a composite of cardiovascular hospitalization and mortality, the association was not statistically significant, but the IRR was 0.67 (95% CI: 0.43-1.06). These findings indicate that decisions about using cinacalcet should take into account the severity of SHPT. PMID:27071541

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

    Alnazly, Eman

    2016-01-01

    Individuals who care for family members receiving chronic hemodialysis (HD) are likely to experience burdens that may adversely impact their patients. Effective coping strategies are shaped by various factors, including sociodemographic characteristics. To assess the relationship between caregivers and their patients, we studied 225 family-member caregivers of chronic HD patients through answering the Ways of Coping Questionnaire-Revised. Sociodemographic data, including caregiver age, gender, educational level, relationship to the patients, length of care time and weekly hours of caregiving were analyzed using the t-test, analysis of variance and least-significant difference post hoc test. Of the eight coping strategies investigated, seven were significantly related to at least one of the analyzed sociodemographic variables; these were confrontive coping, distancing, self-controlling, seeking social support, accepting responsibility, planful problem solving and positive reappraisal. The findings of the present study may be useful for administering dialysis by nurses for identifying coping strategies among caregivers and for establishing plans of care that would promote coping strategies in relation to the caregiver's sociodemographic characteristics. PMID:26787574

  13. Shortening and Migration of Wallstents after Stenting of Central Venous Stenoses in Hemodialysis Patients

    SciTech Connect

    Verstandig, Anthony G.; Bloom, Allan I.; Sasson, Talia; Haviv, Y.S.; Rubinger, D.

    2003-02-15

    Purpose: To report our results for the placement of central venous stents in patients undergoing hemodialysis. Methods: Ten Wallstents (Schneider,Buelach, Switzerland) were placed in 10 patients with shunt thrombosis, shunt dysfunction or arm swelling associated with central vein stenosis or occlusion. Technical success, patency and complications were evaluated. Results: Stent deployment was successful in all cases. In seven cases (70%) there was significant delayed stent shortening. In two of these cases there was also stent migration. All these cases required additional stents.Primary patency rates at 6, 12 and 24 months were 66%, 25% and 0.Twenty-three additional procedures (percutaneous transluminal angioplasty or stenting) were required to achieve secondary patency rates at 6, 12 and 24 months of 100%, 75% and 57%. Conclusion: Stent placement in the central veins of dialysis patients has a high technical success rate resulting in symptomatic relief and preservation of access. Repeat interventions are required to maintain patency. Significant delayed shortening of the Wallstent occurred in 70% of patients which may have affected the patency rates.Strategies are suggested to avoid this problem.

  14. Reactivity of patients with maintenance hemodialysis to erythropoietin in the treatment of renal anemia.

    PubMed

    Hu, J P; Cheng, X; Xu, X F; Yu, G J; Luo, F; Zhang, G S; Yang, N; Shen, P; Yan, X Y

    2016-01-01

    To explore the reactivity of patients with renal anemia (MHD) to erythropoietin (EPO) in maintenance hemodialysis (HD), 31 patients were enrolled in this study. According to the level of serum ferritin (SF), they were divided into two groups; one group received treatment using recombinant human erythropoietin (rHuEPO) and the other group was given iron sucrose. Taking terminal EPO dosage, terminal erythropoietin resistance index (ERI) and rate of change of ERI (ΔERII) as target indexes, the influence of SF level on dosage of EPO was evaluated after usage conditions of relevant substances in a 3-month period. The results revealed that differences of dialysis age, albumin (ALB), blood calcium, initial and terminal SF, variable quantity of hemoglobin (Hb), terminal EPO and ERI between two groups had statistical significance. Furthermore, SF level and terminal EPO (r = -0.37, P < 0. 05) as well as SF level and terminal ERI (r = - 0.39, P <0.05) were negatively correlated. Difference of terminal ERI between the two groups had statistical significance. It can therefore be summarized that supplementing an iron agent intravenously to maintain SF level between 500 ng/ml and 1200 ng/ml may improve reactivity of patients with MHD to EPO. In addition, rHuEPO therapy in treating anemia of patients with MHD has the same effect with intravenous drug delivery, less side effects and is easy to administer. PMID:27358145

  15. Economic Impact of Atopic Dermatitis in Korean Patients

    PubMed Central

    Kim, Chulmin; Park, Kui Young; Ahn, Seohee; Kim, Dong Ha; Li, Kapsok; Kim, Do Won; Kim, Moon-Beom; Jo, Sun-Jin; Yim, Hyeon Woo

    2015-01-01

    Background Atopic dermatitis is a global public health concern owing to its increasing prevalence and socioeconomic burden. However, few studies have assessed the economic impact of atopic dermatitis in Korea. Objective We conducted a cost analysis of atopic dermatitis and evaluated its economic impacts on individual annual disease burden, quality of life, and changes in medical expenses with respect to changes in health related-quality of life. Methods The cost analysis of atopic dermatitis was performed by reviewing the home accounting records of 32 patients. The economic impact of the disease was evaluated by analyzing questionnaires. To handle uncertainties, we compared the results with the data released by the Health Insurance Review & Assessment Board on medical costs claimed by healthcare facilities. Results The direct cost of atopic dermatitis per patient during the 3-month study period was 541,280 Korean won (KRW), and expenditures on other atopic dermatitis-related products were 120,313 KRW. The extrapolated annual direct cost (including expenditures on other atopic dermatitis-related products) per patient was 2,646,372 KRW. The estimated annual indirect cost was 1,507,068 KRW. Thus, the annual cost of illness of atopic dermatitis (i.e., direct+indirect costs) was estimated to be 4,153,440 KRW. Conclusion The annual total social cost of atopic dermatitis on a national level is estimated to be 5.8 trillion KRW. PMID:26082587

  16. Hemodialysis-Induced Myocardial Stunning: A Review.

    PubMed

    Brown, Maxine; Burrows, LaVonne; Pruett, Timothy; Burrows, Thaddeus

    2015-01-01

    Patients on hemodialysis have a high incidence of cardiac morbidity and mortality, and echocardiographic evidence of hemodialysis-related myocardial stunning supports a potential link between the hemodialysis treatment itself and cardiac sequelae. Fluid removal rates exceeding 13 mL/kg/hour during hemodialysis have been implicated in the development of myocardial stunning. Providers caring for patients on chronic hemodialysis might improve patient outcomes by the use of modified treatment monitoring methods, alternative dialysis delivery methods, and enhanced patient education regarding risks of excessive interdialytic weight gains. PMID:26290919

  17. Effect of Blood Cadmium Level on Mortality in Patients Undergoing Maintenance Hemodialysis.

    PubMed

    Hsu, Ching-Wei; Yen, Tzung-Hai; Chen, Kuan-Hsing; Lin-Tan, Dan-Tzu; Lin, Ja-Liang; Weng, Cheng-Hao; Huang, Wen-Hung

    2015-10-01

    Previous studies of general populations indicated environmental exposure to low-level cadmium increases mortality. However, the effect of cadmium exposure on maintenance hemodialysis (MHD) patients is unclear.A total of 937 MHD patients from 3 centers in Taiwan were enrolled in this 36-month observational study. Patients were stratified by baseline blood cadmium level (BCL) into 3 groups: high BCL (>0.521 μg/L; n = 312), intermediate BCL (0.286-0.521 μg/L; n = 313), and low BCL (<0.286 μg/L; n = 312). The mortality rates and causes of death were analyzed.The analytic results demonstrated patients in the high BCL group had a significantly higher prevalence of malnutrition and inflammation than patients in the low and intermediate BCL groups. After 3 years of follow-up, 164 (17.5%) patients died and the major cause of death was cardiovascular disease. A Cox multivariate analysis indicated the high BCL group had increased hazard ratios (HRs) for all-cause mortality (HR = 1.72; 95% confidence interval [CI]: 1.14-2.63; P = 0.018), cardiovascular-related mortality (HR = 1.85; 95% CI: 1.09-3.23; P = 0.032), and infection-related mortality (HR = 2.27; 95% CI: 1.12-4.55; P = 0.035). A Cox multivariate analysis of MHD patients who never smoked (n = 767) indicated the high BCL group had increased HRs for all-cause mortality (HR = 1.67; 95% CI: 1.04-2.63; P = 0.048) and cardiovascular-related mortality (HR = 2.08; 95% CI: 1.08-4.00; P = 0.044).In conclusion, BCL is an important determinant of mortality in MHD patients. Therefore, MHD patients should avoid cadmium exposure as much as possible, such as tobacco smoking and eating cadmium-containing foods. PMID:26496294

  18. Prevention of secondary hyperparathyroidism in hemodialysis patients: the key role of native vitamin D supplementation.

    PubMed

    Jean, G; Vanel, T; Terrat, J-C; Chazot, C

    2010-10-01

    Secondary hyperparathyroidism (SHPT) is a frequent complication in chronic kidney disease, especially in hemodialysis (HD) patients. Treatments for SHPT include calcitriol analogues (CA), phosphate binders, cinacalcet (CC), and surgical parathyroidectomy (PTX). This study aimed to assess the incidence and prevalence of SHPT in a single center during the period when native vitamin D (N-VitD) supplementation and CC treatment became available. All incident and prevalent HD patients were prospectively recorded and compared using 3 periods from 2004 to 2005 (period 1), 2006 to 2007 (period 2), and 2008 to 2009 (period 3). SHPT was diagnosed with serum parathyroid hormone (PTH) levels >300 pg/mL or the need for CA, CC, or PTX. Between periods 1 and 3, in incident patients (n=120 and 101), N-VitD prescription increased from 11% to 68% (P<0.0001), CA prescription remained stable (40%), and patients with PTH>300 pg/mL decreased from 40% to 12% (P<0.0001). In prevalent HD patients (n=235), N-VitD treatment increased from 55% to 91% (P<0.0001), whereas treatment with CA decreased from 67% to 17% (P<0.0001). Patients with serum PTH>300 pg/mL decreased from 38% to 13% (P<0.001), whereas patients with PTH<150 pg/mL remained stable (<30%). New CC prescriptions decreased from 45 to 3 (P<0.0001). Since 2004, SHPT has decreased drastically in incident and prevalent HD patients. The preventive role of N-VitD supplementation appears to be obvious and represents one more argument for its general recommendation in CKD patients. PMID:20955282