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Sample records for in-center hemodialysis patients

  1. Association of Vascular Access Type with Mortality, Hospitalization, and Transfer to In-Center Hemodialysis in Patients Undergoing Home Hemodialysis.

    PubMed

    Rivara, Matthew B; Soohoo, Melissa; Streja, Elani; Molnar, Miklos Z; Rhee, Connie M; Cheung, Alfred K; Katz, Ronit; Arah, Onyebuchi A; Nissenson, Allen R; Himmelfarb, Jonathan; Kalantar-Zadeh, Kamyar; Mehrotra, Rajnish

    2016-02-05

    In individuals undergoing in-center hemodialysis (HD), use of central venous catheters (CVCs) is associated with worse clinical outcomes compared with use of arteriovenous access. However, it is unclear whether a similar difference in risk by vascular access type is present in patients undergoing home HD. Our study examined the associations of vascular access type with all-cause mortality, hospitalization, and transfer to in-center HD in patients who initiated home HD from 2007 to 2011 in 464 facilities in 43 states in the United States. Patients were followed through December 31, 2011. Data were analyzed using competing risks hazards regression, with vascular access type at the start of home HD as the primary exposure in a propensity score-matched cohort (1052 patients; 526 with CVC and 526 with arteriovenous access). Over a median follow-up of 312 days, 110 patients died, 604 had at least one hospitalization, and 202 transferred to in-center hemodialysis. Compared with arteriovenous access use, CVC use was associated with higher risk for mortality (hazard ratio, 1.73; 95% confidence interval, 1.18 to 2.54) and hospitalization (hazard ratio, 1.19; 95% confidence interval, 1.02 to 1.39). CVC use was not associated with increased risk for transfer to in-center HD. The results of analyses in the entire unmatched cohort (2481 patients), with vascular access type modeled as a baseline exposure at start of home HD or a time-varying exposure, were similar. Analyses among a propensity score-matched cohort of patients undergoing in-center HD also showed similar risks for death and hospitalization with use of CVCs. In a large cohort of patients on home HD, CVC use was associated with higher risk for mortality and hospitalization. Additional studies are needed to identify interventions which may reduce risk associated with use of CVCs among patients undergoing home HD. Copyright © 2016 by the American Society of Nephrology.

  2. Hospitalization Rates for Patients on Assisted Peritoneal Dialysis Compared with In-Center Hemodialysis

    PubMed Central

    Al-Jaishi, Ahmed A.; Dixon, Stephanie N.; Perl, Jeffrey; Jain, Arsh K.; Lavoie, Susan D.; Nash, Danielle M.; Paterson, J. Michael; Lok, Charmaine E.; Quinn, Robert R.

    2016-01-01

    Background and objectives Assisted peritoneal dialysis is a treatment option for individuals with barriers to self-care who wish to receive home dialysis, but previous research suggests that this treatment modality is associated with a higher rate of hospitalization. The objective of our study was to determine whether assisted peritoneal dialysis has a different rate of hospital days compared to in-center hemodialysis. Design, setting, participants, & measurements We conducted a multicenter, retrospective cohort study by linking a quality assurance dataset to administrative health data in Ontario, Canada. Subjects were accrued between January 1, 2004 and July 9, 2013. Individuals were grouped into assisted peritoneal dialysis (family or home care assisted) or in-center hemodialysis on the basis of their first outpatient dialysis modality. Inverse probability of treatment weighting using a propensity score was used to create a sample in which the baseline covariates were well balanced. Results The study included 872 patients in the in–center hemodialysis group and 203 patients in the assisted peritoneal dialysis group. Using an intention to treat approach, patients on assisted peritoneal dialysis had a similar hospitalization rate of 11.1 d/yr (95% confidence interval, 9.4 to 13.0) compared with 12.9 d/yr (95% confidence interval, 10.3 to 16.1) in the hemodialysis group (P=0.19). Patients on assisted peritoneal dialysis were more likely to be hospitalized for dialysis-related reasons (admitted for 2.4 d/yr [95% confidence interval, 1.8 to 3.2] compared with 1.6 d/yr [95% confidence interval, 1.1 to 2.3] in the hemodialysis group; P=0.04). This difference was partly explained by more hospital days because of peritonitis. Modality switching was associated with high rates of hospital days per year. Conclusions Assisted peritoneal dialysis was associated with similar rates of all-cause hospitalization compared with in-center hemodialysis. Patients on assisted

  3. Bacteremia in hemodialysis patients

    PubMed Central

    Suzuki, Masashi; Satoh, Nobuhiko; Nakamura, Motonobu; Horita, Shoko; Seki, George; Moriya, Kyoji

    2016-01-01

    Infection is a common complication and is the second leading cause of death in hemodialysis patients. The risk of bacteremia in hemodialysis patients is 26-fold higher than in the general population, and 1/2-3/4 of the causative organisms of bacteremia in hemodialysis patients are Gram-positive bacteria. The ratio of resistant bacteria in hemodialysis patients compared to the general population is unclear. Several reports have indicated that hemodialysis patients have a higher risk of methicillin-resistant Staphylococcus aureus infection. The most common site of infection causing bacteremia is internal prostheses; the use of a hemodialysis catheter is the most important risk factor for bacteremia. Although antibiotic lock of hemodialysis catheters and topical antibiotic ointment can reduce catheter-related blood stream infection (CRBSI), their use should be limited to necessary cases because of the emergence of resistant organisms. Systemic antibiotic administration and catheter removal is recommended for treating CRBSI, although a study indicated the advantages of antibiotic lock and guidewire exchange of catheters over systemic antibiotic therapy. An infection control bundle recommended by the Center for Disease Control and Prevention succeeded in reducing bacteremia in hemodialysis patients with either a catheter or arteriovenous fistula. Appropriate infection control can reduce bacteremia in hemodialysis patients. PMID:27872830

  4. Effect of Lowering Dialysate Sodium Concentration on Interdialytic Weight Gain and Blood Pressure in Patients Undergoing Thrice-Weekly In-center Nocturnal Hemodialysis: A Quality Improvement Study

    PubMed Central

    Mendoza, Jair Munoz; Bayes, Liz Y.; Sun, Sumi; Doss, Sheila; Schiller, Brigitte

    2014-01-01

    Background Patients on in-center nocturnal hemodialysis therapy typically experience higher interdialytic weight gain (IDWG) than patients on conventional hemodialysis therapy. We determined the safety and effects of decreasing dialysate sodium concentration on IDWG and blood pressure in patients on thrice-weekly in-center nocturnal hemodialysis therapy. Study Design Quality improvement, pre-post intervention. Settings & Participants 15 participants in a single facility. Quality Improvement Plan Participants underwent three 12-week treatment phases, each with different dialysate sodium concentrations, as follows: phase A, 140 mEq/L; phase B, 136 or 134 mEq/L; and phase A+, 140 mEq/L. Participants were blinded to the exact timing of the intervention. Outcomes IDWG, IDWG/dry weight (IDWG%), and blood pressure. Measurements Outcome data were obtained during the last 2 weeks of each phase and compared with mixed models. The fraction of sessions with adverse events (eg, cramping and hypotension) also was reported. Results IDWG, IDWG%, and predialysis systolic blood pressure decreased significantly by 0.6 ± 0.6 kg, 0.6% ± 0.8%, and 8.3 ± 14.9 mm Hg, respectively, in phase B compared with phase A (P < 0.05 for all comparisons). No differences in predialysis diastolic and mean arterial or postdialysis blood pressures were found (P > 0.05 for all comparisons). The proportion of treatments with intradialytic hypotension was low and similar in each phase (P = 0.9). In phase B compared with phase A, predialysis plasma sodium concentration was unchanged (P > 0.05), whereas postdialysis plasma sodium concentration decreased by 3.7 ± 1.9 mEq/L (P < 0.05). Limitations Modest sample size. Conclusion Decreasing dialysate sodium concentrations in patients undergoing thrice-weekly in-center nocturnal hemodialysis resulted in a clinical and statistically significant decrease in IDWG, IDWG%, postdialysis plasma sodium concentration, and predialysis systolic blood pressure without

  5. 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

  6. A comparison of quality of life and travel-related factors between in-center and satellite-based hemodialysis patients.

    PubMed

    Diamant, Michael J; Harwood, Lori; Movva, Sujana; Wilson, Barbara; Stitt, Larry; Lindsay, Robert M; Moist, Louise M

    2010-02-01

    Shorter travel times and distance to dialysis clinics have been associated with improved patient outcomes and a higher health-related quality of life (HRQOL). The objective of this study was to compare HRQOL between prevalent in-center and satellite dialysis patients, as well as compare travel-related factors that contribute to HRQOL between in-center and satellite-based patients. DESIGN, SETTING, PARTICIPANTS, & MEASURES: The London Health Sciences Centre is a tertiary care center with in-center and regional satellite hemodialysis units. Patients who consented and completed a questionnaire (n = 202) were enrolled into a cross-sectional, cohort observational study. Patients were administered the Medical Outcomes Short-Form 36 (SF-36) and the Kidney Disease Health Related Quality of Life (KDHRQOL) tool and were asked questions relating to travel to dialysis clinics. Patients who underwent dialysis in the satellites had similar demographics, comorbidities, and laboratory parameters. Patients who underwent dialysis in satellite units reported a significantly superior score on the dialysis stress domain of the KDHRQOL questionnaire. There was no significant difference between in-center and satellite patients on the basis of the SF-36. Satellite patients also reported a significantly decreased cost of transportation, a significantly increased proportion who drive themselves to clinics, and significantly decreased travel time. Patients who underwent dialysis in satellite units demonstrated similar characteristics, comorbidities, surrogate outcomes, and most aspects of HRQOL. Travel time, cost, and receiving treatment in one's own community are important factors that may contribute to a trend toward higher reported HRQOL by patients in satellite dialysis units.

  7. Patient Experience Assessment is a Requisite for Quality Evaluation: A Discussion of the In-Center Hemodialysis Consumer Assessment of Health Care Providers and Systems (ICH CAHPS) Survey.

    PubMed

    Cavanaugh, Kerri L

    2016-01-01

    Patient experience surveys provide a critical and unique perspective on the quality of patient-centered healthcare delivery. These surveys provide a mechanism to systematically express patients' voice on topics valued by patients to make decisions about choices in care. They also provide an assessment to healthcare organizations about their service that cannot be obtained from any other source. Regulatory agencies have mandated the assessment of patients' experience as part of healthcare value based purchasing programs and weighted the results to account for up to 30% of the total scoring. This is a testimony to the accepted importance of this metric as a fundamental assessment of quality. After more than a decade of rigorous research, there is a significant body of growing evidence supporting specifically the validity and use of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, including a version specific to in-center hemodialysis (ICH CAHPS). This review will focus on the ICH CAHPS survey including a review of its development, content, administration, and also a discussion of common criticisms. Although it is suggested that the survey assesses activities and experiences that are not modifiable by the healthcare organization (or the dialysis facility in our case) emerging evidence suggests otherwise. Dialysis providers have an exclusive opportunity to lead the advancement of understanding the implications and serviceability of the evaluation of the patient experience in health care. © 2016 Wiley Periodicals, Inc.

  8. Prevention, assessment and management of post-dialysis fatigue in patients attending in-center hemodialysis: a best practice implementation project.

    PubMed

    Oliver, Veronica; Stephenson, Matthew

    2016-11-01

    The hemodialysis (HD) population experiences a myriad of disease-related symptoms that are often not recognized and/or not treated. Post-dialysis fatigue is a frequent complaint of HD patients following a dialysis session, and there is currently no evidence-based approach to alleviate this problem. The object of this best practice implementation project was to implement evidence-based strategies for the prevention, assessment and management of post-dialysis fatigue, with a view to lessening the disease burden experienced by in-center HD patients. The project used the Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research Into Practice audit tool for promoting change in clinical practice. A baseline audit was conducted, followed by implementation of evidence-based strategies with a focus on staff and patient education. A follow-up audit was performed to assess the effects of the interventions on compliance with best practice. The baseline audit showed that there was no evidence-based approach to prevention, assessment and management of post-dialysis fatigue in place, with only two of the 11 audit criteria showing compliance greater than 50%. Education programs for nursing staff and patients were established, along with the implementation of additional strategies to prevent, assess and manage post-dialysis fatigue. The follow-up audit showed a dramatic increase in the utilization of evidence-based strategies, with ten of the 11 audit criteria achieving above 75% compliance. An evidence-based program to prevent, assess and manage post-dialysis fatigue was successfully implemented. Future studies may reveal if this project has lessened the disease burden experienced by in-center HD patients.

  9. The End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ): Testing The Psychometric Properties in Patients Receiving In-Center Hemodialysis

    PubMed Central

    Evangelista, Lorraine S.; Phillips, Linda R.; Pavlish, Carol; Kopple, Joel D.

    2010-01-01

    Reported treatment adherence rates of patients with end stage renal disease (ESRD) have been extremely varied due to lack of reliable and valid measurement tools. This study was conducted to develop and test an instrument to measure treatment adherence to hemodialysis (HD) attendance, medications, fluid restrictions, and diet prescription among patients with ESRD. This article describes the methodological approach used to develop and test the psychometric properties (such as reliability and validity) of the 46-item ESRD-Adherence Questionnaire (ESRD-AQ) in a cohort of patients receiving maintenance HD at dialysis centers in Los Angeles County. The ESRD-AQ is the first self-report instrument to address all components of adherence behaviors of patients with ESRD. The findings support that the instrument is reliable and valid, and is easy to administer. Future studies are needed in a larger sample to determine whether additional modifications are needed. PMID:20830945

  10. Prospective evaluation of an in-center daily hemodialysis program: results of two years of treatment.

    PubMed

    André, Mauro B; Rembold, Simone M; Pereira, Claudia M; Lugon, Jocemir R

    2002-01-01

    Short duration daily hemodialysis (DHD) emerges as a well-tolerated alternative to standard hemodialysis (SHD). In this prospective study 5 patients in SHD were recruited to participate in an in-center DHD program. The SHD consisted of 3 sessions of 4 h each per week. Nonproportional mixture machines without an ultrafiltration control device and low flow dialyzers were used. For DHD, dialysis equipment and procedures were kept the same. Dialysis sessions, however, began at 6 p.m. (from Monday to Saturday) and lasted 2 h. Data from the last 6 months on SHD of the same patients were compared with the ones from each semester on DHD. Bone biopsy was performed at start and at the end of the 2-year study period. Hypotensive episodes, hypertensive crisis, cramps and headaches became 7-10 times less frequent in daily dialysis. A significant fractional increase ( approximately 12%) was seen in mean values for hematocrit. Predialysis urea levels as well as predialysis creatinine levels declined significantly. Also lower during the daily dialysis period were the mean values for both phosphorus and CaxP product. Significant increases were found in serum bicarbonate, albumin and in dry weight. The frequency of mean blood pressure >/=110 mm Hg on arrival for dialysis was significantly lower in every semester on daily hemodialysis. A significant twofold improvement in quality of life scoring was observed. Finally, daily hemodialysis also seemed to be beneficial to low turnover bone disease and bone aluminum deposition. These beneficial effects occurred despite of an increase in the frequency of missing days. Results from the present study which prospectively addressed the role of in-center short daily hemodialysis in the management of ESRD are encouraging.

  11. Patients receiving frequent hemodialysis have better health-related quality of life compared to patients receiving conventional hemodialysis.

    PubMed

    Garg, Amit X; Suri, Rita S; Eggers, Paul; Finkelstein, Fredric O; Greene, Tom; Kimmel, Paul L; Kliger, Alan S; Larive, Brett; Lindsay, Robert M; Pierratos, Andreas; Unruh, Mark; Chertow, Glenn M

    2017-03-01

    Most patients with end-stage kidney disease value their health-related quality of life (HRQoL) and want to know how it will be affected by their dialysis modality. We extended the findings of two prior clinical trial reports to estimate the effects of frequent compared to conventional hemodialysis on additional measures of HRQoL. The Daily Trial randomly assigned 245 patients to receive frequent (six times per week) or conventional (three times per week) in-center hemodialysis. The Nocturnal Trial randomly assigned 87 patients to receive frequent nocturnal (six times per week) or conventional (three times per week) home hemodialysis. All patients were on conventional hemodialysis prior to randomization, with an average feeling thermometer score of 70 to 75 (a visual analog scale from 0 to 100 where 100 is perfect health), an average general health scale score of 40 to 47 (a score from 0 to 100 where 100 is perfect health), and an average dialysis session recovery time of 2 to 3 hours. Outcomes are reported as the between-treatment group differences in one-year change in HRQoL measures and analyzed using linear mixed effects models. After one year in the Daily Trial, patients assigned to frequent in-center hemodialysis reported a higher feeling thermometer score, better general health, and a shorter recovery time after a dialysis session compared to standard thrice-weekly dialysis. After one year in the Nocturnal Trial, patients assigned to frequent home hemodialysis also reported a shorter recovery time after a dialysis session, but no statistical difference in their feeling thermometer or general health scores compared to standard home dialysis schedules. Thus, patients receiving day or nocturnal hemodialysis on average recovered approximately one hour earlier from a frequent compared to conventional hemodialysis session. Patients treated in an in-center dialysis facility reported better HRQoL with frequent compared to conventional hemodialysis.

  12. Cooling dialysate during in-center hemodialysis: Beneficial and deleterious effects

    PubMed Central

    Toth-Manikowski, Stephanie M; Sozio, Stephen M

    2016-01-01

    The use of cooled dialysate temperatures first came about in the early 1980s as a way to curb the incidence of intradialytic hypotension (IDH). IDH was then, and it remains today, the most common complication affecting chronic hemodialysis patients. It decreases quality of life on dialysis and is an independent risk factor for mortality. Cooling dialysate was first employed as a technique to incite peripheral vasoconstriction on dialysis and in turn reduce the incidence of intradialytic hypotension. Although it has become a common practice amongst in-center hemodialysis units, cooled dialysate results in up to 70% of patients feeling cold while on dialysis and some even experience shivering. Over the years, various studies have been performed to evaluate the safety and efficacy of cooled dialysate in comparison to a standard, more thermoneutral dialysate temperature of 37 °C. Although these studies are limited by small sample size, they are promising in many aspects. They demonstrated that cooled dialysis is safe and equally efficacious as thermoneutral dialysis. Although patients report feeling cold on dialysis, they also report increased energy and an improvement in their overall health following cooled dialysis. They established that cooling dialysate temperatures improves hemodynamic tolerability during and after hemodialysis, even in patients prone to IDH, and does so without adversely affecting dialysis adequacy. Cooled dialysis also reduces the incidence of IDH and has a protective effect over major organs including the heart and brain. Finally, it is an inexpensive measure that decreases economic burden by reducing necessary nursing intervention for issues that arise on hemodialysis such as IDH. Before cooled dialysate becomes standard of care for patients on chronic hemodialysis, larger studies with longer follow-up periods will need to take place to confirm the encouraging outcomes mentioned here. PMID:26981441

  13. Outcomes of Infection-Related Hospitalization in Medicare Beneficiaries Receiving In-Center Hemodialysis

    PubMed Central

    Dalrymple, Lorien S.; Mu, Yi; Romano, Patrick S.; Nguyen, Danh V.; Chertow, Glenn M.; Delgado, Cynthia; Grimes, Barbara; Kaysen, George A.; Johansen, Kirsten L.

    2015-01-01

    Background Infection is a common cause of hospitalization in adults receiving hemodialysis. Limited data are available on downstream events resulting from or following these hospitalizations. Study Design Retrospective cohort study using the US Renal Data System. Setting & Participants Medicare beneficiaries initiating in-center hemodialysis 2005 – 2008. Factors Demographics, dual Medicare/Medicaid eligibility, body mass index, comorbid conditions, initial vascular access type, nephrology care prior to dialysis initiation, residence in a care facility, tobacco use, biochemical measures, and type of infection. Outcomes 30-day hospital readmission or death following first infection-related hospitalization. Results 60,270 Medicare beneficiaries had at least one hospitalization for infection. Of those who survived the initial hospitalization, 15,113 (27%) were readmitted and survived the 30 days following hospital discharge, 1,624 (3%) were readmitted to the hospital and then died within 30-days of discharge, and 2,425 (4%) died without hospital readmission. Complications related to dialysis access, sepsis, and heart failure accounted for 12%, 9%, and 7% of hospital readmissions, respectively. Factors associated with higher odds of 30-day readmission or death without readmission included non-Hispanic ethnicity, lower serum albumin, inability to ambulate or transfer, limited nephrology care prior to dialysis, and specific types of infection. In comparison, older age, select comorbidities, and institutionalization had stronger associations with death without readmission than with readmission. Limitations Findings limited to Medicare beneficiaries receiving in-center hemodialysis. Conclusions Hospitalizations for infection among patients receiving in-center hemodialysis are associated with exceptionally high rates of 30-day hospital readmission and death without readmission. PMID:25641061

  14. The carbon footprints of home and in-center maintenance hemodialysis in the United Kingdom.

    PubMed

    Connor, Andrew; Lillywhite, Robert; Cooke, Matthew W

    2011-01-01

    Climate change presents a global health threat. However, the provision of healthcare, including dialysis, is associated with greenhouse gas emissions. The aim of this study was to determine the carbon footprints of the differing modalities and treatment regimes used to deliver maintenance hemodialysis (HD), in order to inform carbon reduction strategies at the level of both individual treatments and HD programs. This was a component analysis study adhering to PAS2050. Emissions factors were applied to data that were collected for building energy use, travel and procurement. Thrice weekly in-center HD has a carbon footprint of 3.8 ton CO2 Eq per patient per year. The majority of emissions arise within the medical equipment (37%), energy use (21%), and patient travel (20%) sectors. The carbon footprint of providing home HD varies with the regime. For standard machines: 4 times weekly (4 days, 4.5 hours), 4.3 ton CO2 Eq; 5 times weekly (5 days, 4 hours), 5.1 ton CO2 Eq ; short daily (6 days, 2 hours), 5.2 ton CO2 Eq; nocturnal (3 nightly, 7 hours), 3.9 ton CO2 Eq; and nocturnal (6 nightly, 7 hours), 7.2 ton CO2 Eq. For NxStage equipment: short daily (5.5 days, 3 hours), 1.8 ton CO2 Eq; 6 nightly nocturnal (2.1 ton CO2 Eq). The carbon footprint of HD is influenced more by the frequency of treatments than by their duration. The anticipated rise in the prevalence of home HD patients, dialyzing more frequently and for longer than in-center patients, will increase the emissions associated with HD programs (despite reductions in patient travel emissions). Emerging technologies, such as NxStage, might offer a solution to this problem. © 2011 The Authors. Hemodialysis International © 2011 International Society for Hemodialysis.

  15. Longer dialysis session length is associated with better intermediate outcomes and survival among patients on in-center three times per week hemodialysis: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS).

    PubMed

    Tentori, Francesca; Zhang, Jinyao; Li, Yun; Karaboyas, Angelo; Kerr, Peter; Saran, Rajiv; Bommer, Juergen; Port, Friedrich; Akiba, Takashi; Pisoni, Ronald; Robinson, Bruce

    2012-11-01

    Longer dialysis session length (treatment time, TT) has been associated with better survival among hemodialysis (HD) patients. The impact of TT on clinical markers that may contribute to this survival advantage is not well known. Using data from the international Dialysis Outcomes and Practice Patterns Study, we assessed the association of TT with clinical outcomes using both standard regression analyses and instrumental variable approaches. The study included 37,414 patients on in-center HD three times per week with prescribed TT from 120 to 420 min. Facility mean TT ranged from 214 min in the USA to 256 min in Australia-New Zealand. Accounting for country effects, mortality risk was lower for patients with longer TT {hazard ratio for every 30 min: all-cause mortality: 0.94 [95% confidence interval (CI): 0.92-0.97], cardiovascular mortality: 0.95 (95% CI: 0.91-0.98) and sudden death: 0.93 (95% CI: 0.88-0.98)}. Patients with longer TT had lower pre- and post-dialysis systolic blood pressure, greater intradialytic weight loss, higher hemoglobin (for the same erythropoietin dose), serum albumin and potassium and lower serum phosphorus and white blood cell counts. Similar associations were found using the instrumental variable approach, although the positive associations of TT with weight loss and potassium were lost. Favorable levels of a variety of clinical markers may contribute to the better survival of patients receiving longer TT. These findings support longer TT prescription in the setting of in-center, three times per week HD.

  16. Longer dialysis session length is associated with better intermediate outcomes and survival among patients on in-center three times per week hemodialysis: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS)

    PubMed Central

    Tentori, Francesca; Zhang, Jinyao; Li, Yun; Karaboyas, Angelo; Kerr, Peter; Saran, Rajiv; Bommer, Juergen; Port, Friedrich; Akiba, Takashi; Pisoni, Ronald; Robinson, Bruce

    2012-01-01

    Background Longer dialysis session length (treatment time, TT) has been associated with better survival among hemodialysis (HD) patients. The impact of TT on clinical markers that may contribute to this survival advantage is not well known. Methods Using data from the international Dialysis Outcomes and Practice Patterns Study, we assessed the association of TT with clinical outcomes using both standard regression analyses and instrumental variable approaches. The study included 37 414 patients on in-center HD three times per week with prescribed TT from 120 to 420 min. Results Facility mean TT ranged from 214 min in the USA to 256 min in Australia–New Zealand. Accounting for country effects, mortality risk was lower for patients with longer TT {hazard ratio for every 30 min: all-cause mortality: 0.94 [95% confidence interval (CI): 0.92–0.97], cardiovascular mortality: 0.95 (95% CI: 0.91–0.98) and sudden death: 0.93 (95% CI: 0.88–0.98)}. Patients with longer TT had lower pre- and post-dialysis systolic blood pressure, greater intradialytic weight loss, higher hemoglobin (for the same erythropoietin dose), serum albumin and potassium and lower serum phosphorus and white blood cell counts. Similar associations were found using the instrumental variable approach, although the positive associations of TT with weight loss and potassium were lost. Conclusions Favorable levels of a variety of clinical markers may contribute to the better survival of patients receiving longer TT. These findings support longer TT prescription in the setting of in-center, three times per week HD. PMID:22431708

  17. Risk Factors for Infection-Related Hospitalization in In-Center Hemodialysis

    PubMed Central

    Mu, Yi; Nguyen, Danh V.; Romano, Patrick S.; Chertow, Glenn M.; Grimes, Barbara; Kaysen, George A.; Johansen, Kirsten L.

    2015-01-01

    Background and objectives Infection-related hospitalizations have increased dramatically over the last 10 years in patients receiving in-center hemodialysis. Patient and dialysis facility characteristics associated with the rate of infection-related hospitalization were examined, with consideration of the region of care, rural-urban residence, and socioeconomic status. Design, setting, participants, & measurements The US Renal Data System linked to the American Community Survey and Rural-Urban Commuting Area codes was used to examine factors associated with hospitalization for infection among Medicare beneficiaries starting in-center hemodialysis between 2005 and 2008. A Poisson mixed effects model was used to examine the associations among patient and dialysis facility characteristics and the rate of infection-related hospitalization. Results Among 135,545 Medicare beneficiaries, 38,475 (28%) had at least one infection-related hospitalization. The overall rate of infection-related hospitalization was 40.2 per 100 person-years. Age ≥85 years old, cancer, chronic obstructive pulmonary disease, inability to ambulate or transfer, drug dependence, residence in a care facility, serum albumin <3.5 g/dl at dialysis initiation, and dialysis initiation with an access other than a fistula were associated with a ≥20% increase in the rate of infection-related hospitalization. Patients residing in isolated small rural compared with urban areas had lower rates of hospitalization for infection (rate ratio, 0.91; 95% confidence interval, 0.86 to 0.97), and rates of hospitalization for infection varied across the ESRD networks. Measures of socioeconomic status (at the zip code level), total facility staffing, and the composition of staff (percentage of nurses) were not associated with the rate of hospitalization for infection. Conclusions Patient and facility factors associated with higher rates of infection-related hospitalization were identified. The findings from this study

  18. Carnitine in maintenance hemodialysis patients.

    PubMed

    Guarnieri, Gianfranco

    2015-03-01

    Carnitine is a conditionally essential metabolite that plays a critical role in cell physiology. Carnitine is necessary for fatty acid transport to sites of beta-oxidation in the mitochondria, where it also helps to prevent organic acid accumulation. Because of these key regulatory functions, carnitine represents a crucial determinant of mitochondrial energy metabolism, whose deficiency may lead to metabolic and clinical disturbances. Loss of carnitine through dialytic membranes occurs in maintenance hemodialysis, resulting in potential carnitine depletion and relative increments of esterified carnitine forms. Carnitine supplementation has been reported to counteract some of these alterations and has been associated with some clinical benefits, such as enhanced response to erythropoietin as well as improvement in exercise tolerance, intradialytic symptom, hyperparathyroidism, insulin resistance, inflammatory and oxidant status, protein balance, lipid profile, cardiac function, and quality of life. Carnitine supplementation has an attractive theoretical rationale; however, there are no definitive supportive studies and conclusive evidence that L-carnitine supplementation in maintenance hemodialysis patients could improve these conditions. A trial of carnitine administration could be attempted for 6 to 12 months only in selected patients on dialysis who do not adequately respond to standard therapies, in the presence of symptomatology, and in conjunction with patient dialysis age and documented L-carnitine deficiency.

  19. 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

  20. Initial Brazilian experience with short-duration in-center daily hemodialysis.

    PubMed

    Lugon, Jocemir R; Andre, Mauro B

    2005-01-01

    The whole initial Brazilian experience with short-duration in-center daily hemodialysis is summarized here. The study was performed at a time when low-flux membrane and nonproportional dialysis represented the standard dialysis treatment in Brazil. Five patients were treated for 2 years. The subject is developed in a way to narrate the efforts to set the research project and summarize the findings, meeting presentations, and publications that derived from the project. At the end of the study, the main benefits observed consisted of alleviation of the end-stage renal disease anemia; reduction of the frequency of complications during dialysis sessions; a lower degree of azotemia; easier blood pressure control; and improvements in acid-base status, mineral metabolism and bone disease, nutrition, and quality of life.

  1. Comparison of sleep-disordered breathing and heart rate variability between hemodialysis and non-hemodialysis days in hemodialysis patients.

    PubMed

    Sukegawa, Mayo; Noda, Akiko; Soga, Taro; Adachi, Yuki; Tsuruta, Yoshinari; Ozaki, Norio; Koike, Yasuo

    2008-08-01

    Sleep disturbances manifesting as insomnia, daytime sleepiness, fatigue, and other symptoms are frequently found in patients with end-stage renal disease that is being treated with dialysis. Many factors, including neurosis, uremic symptoms, dialysis drugs, and sleep-wake rhythms have been suggested as potential causes for these sleep disturbances. We examined sleep apnea/hypopnea and heart rate variability (HRV) reflecting autonomic activity in hemodialysis patients on their hemodialysis and non-hemodialysis days using a home medical care device (Morpheus C, TEIJIN). Eleven hemodialysis patients and 14 healthy adults were enrolled in this study. We calculated the number of apnea/hypopnea episodes per hour (apnea/hypopnea index: AHI) and HRV (percentage of R-R intervals that differ by at least 50 ms from the previous interval: pNN50, very low frequency: VLF, low frequency: LF, high frequency: HF and LF/ HF). There was no significant difference in the AHI between hemodialysis and non-hemodialysis days. The heart rate in hemodialysis patients on non-hemodialysis days was significantly higher than in the controls, whereas the pNN50 was significantly lower in hemodialysis patients on non-hemodialysis days than in the controls. Although VLF was significantly lower in hemodialysis patients on non-hemodialysis days compared to the controls, there were no significant differences in LF, HF or LF/HF between the two groups. Hemodialysis itself might not be an important contributing factor in sleep-related breathing disturbances. The simultaneous analysis of HRV reflecting autonomic activity and sleep-disordered breathing on both hemodialysis and non-hemodialysis days provides important information.

  2. Sudden Cardiac Death Among Hemodialysis Patients.

    PubMed

    Makar, Melissa S; Pun, Patrick H

    2017-05-01

    Hemodialysis patients carry a large burden of cardiovascular disease; most onerous is the high risk for sudden cardiac death. Defining sudden cardiac death among hemodialysis patients and understanding its pathogenesis are challenging, but inferences from the existing literature reveal differences between sudden cardiac death among hemodialysis patients and the general population. Vascular calcifications and left ventricular hypertrophy may play a role in the pathophysiology of sudden cardiac death, whereas traditional cardiovascular risk factors seem to have a more muted effect. Arrhythmic triggers also differ in this group as compared to the general population, with some arising uniquely from the hemodialysis procedure. Combined, these factors may alter the types of terminal arrhythmias that lead to sudden cardiac death among hemodialysis patients, having important implications for prevention strategies. This review highlights current knowledge on the epidemiology, pathophysiology, and risk factors for sudden cardiac death among hemodialysis patients. We then examine strategies for prevention, including the use of specific cardiac medications and device-based therapies such as implantable defibrillators. We also discuss dialysis-specific prevention strategies, including minimizing exposure to low potassium and calcium dialysate concentrations, extending dialysis treatment times or adding sessions to avoid rapid ultrafiltration, and lowering dialysate temperature. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  3. Individualized reduction in dialysate sodium in conventional in-center hemodialysis

    PubMed Central

    ARRAMREDDY, Rohini; SUN, Sumi J.; MENDOZA, Jair MUNOZ; CHERTOW, Glenn M.; SCHILLER, Brigitte

    2013-01-01

    Recent studies have focused on the association between dialysate sodium (Na+) prescriptions and interdialytic weight gain (IDWG). We report on a case series of 13 patients undergoing conventional, thrice-weekly in-center hemodialysis with an individualized dialysate Na+ prescription. Individualized dialysate Na+ was achieved in all patients through a stepwise weekly reduction of the standard dialysate Na+ prescription (140 mEq/L) by 2–3 mEq/L until reaching a Na+ gradient of −2 mEq/L (dialysate Na+ minus average plasma Na+ over the preceding 3 months). Interdialytic weight gain, with and without indexing to dry weight (IDWG%), blood pressure, and the proportion of treatments with cramps, intradialytic hypotension (drop in systolic blood pressure >30 mmHg) and intradialytic hypotension requiring an intervention were reviewed. At the beginning of the observation period, the pre-hemodialysis (HD) plasma Na+ concentration ranged from 130 to 141 mEq/L. When switched from the standard to the individualized dialysate Na+ concentration, IDWG% decreased from 3.4% ± 1.6% to 2.5% ± 1.0% (P = 0.003) with no change in pre- or post-HD systolic or diastolic blood pressures (all P > 0.05). We found no significant change in the proportion of treatments with cramps (6% vs. 1.3%), intradialytic hypotension (62% vs. 65%), or intradialytic hypotension requiring an intervention (29% vs. 33%). Individualized reduction of dialysate Na+ reduces IDWG% without significantly increasing the frequency of cramps or hypotension. PMID:22554224

  4. Self-Care Ability in Hemodialysis Patients

    PubMed Central

    Atashpeikar, Soulmaz; Jalilazar, Tahereh; Heidarzadeh, Mehdi

    2012-01-01

    Introduction: Considering the numerous physical and psychological problems in hemo-dialysis patients, they are dependent on others in some daily activities and in fact, they do not have full self-care ability. A few studies have ever been done, particularly in Iran, on self-care ability of hemodialysis patients. The present study aimed to determine self-care ability of these patients in addition to evaluate its association with some demo-graphic characteristics. Methods: This was a descriptive study in 2009 done in Marag-heh, Bonab and Miandoab Hospitals. The study population included 115 hemodialysis patients who were eligible. Data were collected using a combined and modified ques-tionnaire including demographic characteristics and self-care ability items. Results: Self-care ability was desirable in 78.3 percent of the patients. The highest desirable self-care ability in the study participants was related to vascular access (73%) and the highest undesirable self-care ability was related to follow the diet. There was a significant asso-ciation between self-care ability and some demographic characteristics including age, gender, marital status and employment status. Conclusion: Hemodialysis patients did not have full self-care ability. It is necessary to enhance their knowledge about diet, complications of hemodialysis and preventive methods through accurate and permanent education so that they can increase their self-care ability. PMID:25276673

  5. Hepatitis G virus infection in hemodialysis patients.

    PubMed

    Sampietro, M; Badalamenti, S; Graziani, G; Como, G; Buccianti, G; Corbetta, N; Ticozzi, A; Archenti, A; Lunghi, G; Penso, D; Pizzuti, A; Fiorelli, G; Ponticelli, C

    1997-01-01

    The increased risk of hemodialysis patients for infections sustained by hepatitis viruses is likely to extend to a newly discovered parenterally transmitted virus, HGBV-C/HGV, able to cause acute and chronic hepatitis. The aim of this study was to assess the prevalence and clinical relevance of this infection in Italian hemodialysis patients. Nineteen of 100 patients (19%) on maintenance hemodialysis were viremic for HGBV-C/HGV, and all of them were infected with a HGV-like genotype. Eight of these patients were coinfected by hepatitis B or hepatitis C viruses. A clinical picture of chronic hepatitis was not appreciable in patients with isolated HGV infection and the presence of HGV did not appear to modify the clinical course of hepatitis B and hepatitis C infections.

  6. Epidemiology of hemodialysis patients in Aleppo city.

    PubMed

    Moukeh, Ghamez; Yacoub, Rabi; Fahdi, Fadi; Rastam, Samer; Albitar, Sami

    2009-01-01

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

  7. 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

  8. Vitreoretinal surgery in diabetic patients on hemodialysis.

    PubMed

    Nawrocki, J; Chrzanowski, W; Koch, D; Dziegielewski, K

    1997-01-01

    The present paper reports our first results after pars plana vitrectomy in patients with diabetic retinopathy and hemodialysis with a follow-up of 6 to 24 months. Between January 1992 and October 1994 we performed vitreoretinal surgery with silicone oil tamponade in nine eyes of seven patients with diabetic nephropathy on hemodialysis. All patients had had type I diabetes for 19-32 years. Over the observation period the retina was completely attached in eight eyes. Final visual acuity of 0.1-0.7 was attained in four eyes, 0.06 two, hand movements in one eye. Two eyes had no useful final visual acuity because of redetachment of the retina or secondary glaucoma with rubeosis iridis. The small number of complications shows that pars plana vitrectomy can be done in diabetic patients with nephropathy on hemodialysis. This significantly improves their quality of life.

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

    PubMed

    Visaya, Marie Angela

    2010-01-01

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

  10. Patient selection and training for home hemodialysis.

    PubMed

    Rioux, Jean-Philippe; Marshall, Mark R; Faratro, Rose; Hakim, Raymond; Simmonds, Rosemary; Chan, Christopher T

    2015-04-01

    Patient selection and training is arguably the most important step toward building a successful home hemodialysis (HD) program. We present a step-by-step account of home HD training to guide providers who are developing home HD programs. Although home HD training is an important step in allowing patients to undergo dialysis in the home, there is a surprising lack of systematic research in this field. Innovations and research in this area will be pivotal in further promoting a higher acceptance rate of home HD as the renal replacement therapy of choice. © 2015 International Society for Hemodialysis.

  11. Is energy intake underreported in hemodialysis patients?

    PubMed

    Vaz, Inaiana Marques Filizola; Freitas, Ana Tereza Vaz de Souza; Peixoto, Maria do Rosário Gondim; Ferraz, Sanzia Francisca; Campos, Marta Izabel Valente Augusto Morais

    2015-01-01

    Underreporting of energy intake is not much studied in hemodialysis population. To evaluate the underreporting of energy intake and associated factors in hemodialysis patients. A cross-sectional study, with 344 patients stable adults, of ten hemodialysis centers in Goiânia-GO. Energy intake was assessed by six 24-hour dietary recalls and basal metabolic rate (BMR) was estimated using the Harris Benedict equation. It was considered as underreporting when the ratio between the average energy intake and basal metabolic rate was lower than1.27. For analysis of factors associated with underreporting, the Poisson regression with robust variance estimation was applied. The prevalence of underreporting was 65.7%, being more significant in individuals who are overweight and in the non dialysis days. The result of the multivariate analysis identified four factors independently associated with the underreporting: being a female (PR = 1.27, CI = 1.10 to 1.46), body mass index ≥ 25 kg/m2 (PR = 1.29, CI = 1.12 to 1.48), three meals or lower/day (PR = 1.31, CI = 1.14 to 1.51) and hemodialysis length lower than 5 years (PR = 1.19CI = 1.01 to 1.40). The population showed a high prevalence of underreporting of energy intake. Being a female, presenting overweight, lower number of meals/day and lower length time on hemodialysis were factors associated with underreporting.

  12. Hypersensitivity reactions in patients receiving hemodialysis.

    PubMed

    Butani, Lavjay; Calogiuri, Gianfranco

    2017-06-01

    To describe hypersensitivity reactions in patients receiving maintenance hemodialysis. PubMed search of articles published during the past 30 years with an emphasis on publications in the past decade. Case reports and review articles describing hypersensitivity reactions in the context of hemodialysis. Pharmacologic agents are the most common identifiable cause of hypersensitivity reactions in patients receiving hemodialysis. These include iron, erythropoietin, and heparin, which can cause anaphylactic or pseudoallergic reactions, and topical antibiotics and anesthetics, which lead to delayed-type hypersensitivity reactions. Many hypersensitivity reactions are triggered by complement activation and increased bradykinin resulting from contact system activation, especially in the context of angiotensin-converting enzyme inhibitor use. Several alternative pharmacologic preparations and dialyzer membranes are available, such that once an etiology for the reaction is established, recurrences can be prevented without affecting the quality of care provided to patients. Although hypersensitivity reactions are uncommon in patients receiving hemodialysis, they can be life-threatening. Moreover, considering the large prevalence of the end-stage renal disease population, the implications of such reactions are enormous. Most reactions are pseudoallergic and not mediated by immunoglobulin E. The multiplicity of potential exposures and the complexity of the environment to which patients on dialysis are exposed make it challenging to identify the precise cause of these reactions. Great diligence is needed to investigate hypersensitivity reactions to avoid recurrence in this high-risk population. Copyright © 2017 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  13. Xerostomia in patients on chronic hemodialysis.

    PubMed

    Bossola, Maurizio; Tazza, Luigi

    2012-01-17

    Xerostomia is the subjective feeling of a dry mouth, which is relatively common in patients on chronic hemodialysis. Xerostomia can be caused by reduced salivary flow secondary to atrophy and fibrosis of the salivary glands, use of certain medications, restriction of fluid intake and old age. In patients undergoing hemodialysis, xerostomia is associated with the following problems: difficulties in chewing, swallowing, tasting and speaking; increased risk of oral disease, including lesions of the mucosa, gingiva and tongue; bacterial and fungal infections, such as candidiasis, dental caries and periodontal disease; interdialytic weight gain resulting from increased fluid intake; and a reduction in quality of life. Unfortunately, no effective treatment exists for xerostomia in patients on chronic hemodialysis. The stimulation of salivary glands by mechanical means (such as chewing gum) or pharmacological agents (such as pilocarpine and angiotensin-converting-enzyme inhibitors, the latter alone or in combination with angiotensin-receptor blockers), as well as saliva substitutes, are all ineffective, or effective only in the short term. Xerostomia remains a frustrating symptom for patients on hemodialysis, and further efforts should be made to find an effective treatment for it in the near future.

  14. QUALITY OF LIFE IN HEMODIALYSIS PATIENTS

    PubMed Central

    Gerasimoula, Kousoula; Lefkothea, Lagou; Maria, Lena; Victoria, Alikari; Paraskevi, Theofilou; Maria, Polikandrioti

    2015-01-01

    Purpose: To explore the quality of life in hemodialysis patients. Material and Methods: The sample studied consisted of 320 patients undergoing hemodialysis in one-day dialysis center. Data were collected by the completion of a specially designed questionnaire which apart from the sociodemographic and clinical variables, it also included the scale Missoula-VITAS Quality of Life Index (MVQOLI) for assessing quality of life. Results: Of the 320 hemodialysis patients, 57,2% were men while 28,1% of the participants were 71-80 years old. The average total score of quality of life was found to be 17.43 (in a range 0-30). The total score of quality of life was found to be higher in participants <60 years (p= 0,009), of higher educational level (p=0.001), being very informed about the health problem (p=0,013), complied with therapeutic recommendations and the proposed diet (p=0,025 & p=0,012, respectively), having very good relations with the medical and nursing staff or other patients (p<0,001), not experiencing difficulties with social or family environment (p=0,001), had help at home (p <0,001) and in those who did not conceal their health problem from the social environment (p<0.001). Furthermore, it was found that the increasing duration of hemodialysis session entailed poorer quality of life (p<0,001). These results were largely confirmed by multiple linear regression. Conclusions: Sociodemographic and clinical characteristics seems to influence the quality of life in hemodialysis patients. PMID:26622195

  15. 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

  16. Vascular calcification in maintenance hemodialysis patients.

    PubMed

    Wang, Mi; Wang, Mei; Gan, Liang-Ying; Li, Si-Jun; Hong, Nan; Zhang, Meng

    2009-01-01

    The objective was to investigate the status of vascular calcification, and to explore factors influencing vascular calcification in maintenance hemodialysis patients. Vascular calcification was quantitatively evaluated using radiographic films of the abdomen, pelvis and hands. Plasma fetuin-A and other parameters related to calcification were examined. 33/50 cases of vascular calcification were identified by radiographic film. Calcifications of the abdominal aorta and peripheral muscular arteries were seen in 90.9 and 36.4%. Patients with moderate to severe calcification were older, more likely to be male, had lower diastolic blood pressure and fetuin-A levels, and a higher incidence of diabetes than those with mild calcification. Logistic regression analysis showed that diabetes and plasma fetuin-A were independent risk factors for vascular calcification. Vascular calcification was present in a large proportion of maintenance hemodialysis patients, most frequently in the abdominal aorta. Diabetes and plasma fetuin-A levels were independent risk factors for vascular calcification in maintenance hemodialysis patients. (c) 2009 S. Karger AG, Basel.

  17. Refractory Abdominal Pain in a Hemodialysis Patient

    PubMed Central

    Qian, Ying; Chen, Xiao-nong; Shi, Hao; Xie, Jingyuan; Chen, Nan

    2015-01-01

    Nonocclusive mesenteric ischemia (NOMI) is a rare disorder. Failure of an early diagnosis may cause progressive intestinal ischemia, leading to abdominal pain, sepsis, and death. Patients with end-stage renal disease are among the highest risk populations for developing this lethal complication. The key to a correct diagnosis at an early stage is a high index of suspicion in predisposed patients. In our case, we present a 62-year-old female undergoing maintenance hemodialysis for 8 years; she complained of abdominal pain after hemodialysis in the last 3 months; NOMI was suspected after a CT angiography. She partially recovered after multiple clinical interventions such as decreased ultrafiltration, an increased dose of low molecular-weight heparin and the use of vasoactive drugs. In conclusion, NOMI can be reversible if it is diagnosed as early as possible and after the necessary diagnostic measurements are initiated. PMID:26266246

  18. Safety of daptomycin in patients receiving hemodialysis.

    PubMed

    Mueller, Bruce A; Crompton, Jason A; Donovan, Brian J; Yankalev, Sara; Lamp, Kenneth C

    2011-07-01

    To determine the safety of daptomycin administered using a variety of doses and dosing frequencies in patients receiving intermittent hemodialysis who had probable or confirmed gram-positive infections. Analysis of data from the Cubicin Outcomes Registry and Experience (CORE), a multicenter, retrospective, observational registry. Fifty-four study sites, mostly (46%) large teaching hospitals. Three hundred ninety-three adults in the CORE registry who received intermittent hemodialysis between 2005 and 2008. The CORE registry is noninterventional and collects standard-of-care data on daptomycin treatment from health care institutions. Of the 393 patients, 370 (94%) could be categorized by daptomycin dosing frequency: every 48 hours (251 patients [64%]), 3 times/week (87 [22%]), and every 24 hours (32 [8%]); the remaining 23 (6%) had unreported dosing frequencies or received a single dose of daptomycin. Three hundred eighty-four patients (98%) received part of their daptomycin therapy as an inpatient and 129 patients (33%) received part of their daptomycin therapy in an intensive care setting. The primary infection type was bacteremia (224 patients [57%]), and the most common pathogen was Staphylococcus aureus (155 patients [39%]). Thirty-eight adverse events possibly related to daptomycin occurred in 28 patients (7%); increased blood creatine kinase level (7 patients [1.8%]) was the most common adverse event. Adverse-event rates were similar across all dosing regimens. In these patients undergoing hemodialysis, daptomycin was a well-tolerated treatment for gram-positive infections across several doses and dosing frequencies. Further study in prospective trials is warranted.

  19. Prescribing dialysate bicarbonate concentrations for hemodialysis patients.

    PubMed

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

    1988-01-01

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

  20. Supporting hemodialysis patients: A phenomenological study

    PubMed Central

    Shahgholian, Nahid; Yousefi, Hojatollah

    2015-01-01

    Background: Chronic renal disease and hemodialysis cause numerous psychological, social, cultural, and spiritual challenges for both patients and their families. Overcoming these challenges is possible only through providing holistic support for the patients. Today, despite the support provided by family and professional caregivers for the patients, patients still express dissatisfaction with the support provided and believe it to be inadequate. In fact, patients and family caregivers and healthcare practitioners seem to have different understandings of the notion of support. Thus, the researcher decided to examine the concept of support from the viewpoint of hemodialysis patients. Materials and Methods: This descriptive phenomenological research was conducted on 17 patients with end-stage renal disease (ESRD) who were undergoing hemodialysis. Purposive sampling was performed and continued until data saturation. Data were collected through 30–60 min unstructured interviews and analyzed using Colaizzi's method. Results: From the analysis of data, 4 themes (psychological support, accompaniment, social support, and spiritual support) and 11 sub-themes were obtained. Psychological support consisted of two sub-themes of psychological support by healthcare practitioners and emotional support by family and relatives. Accompaniment included three sub-themes of assistance in transportation, providing and using medicine, and daily activities. Social support was identified with four sub-themes of promotion of the society's understanding of the patients’ condition, improvement of communication with others, the need for employment, and independence. Spiritual support was identified with two sub-themes of the need for faith and trust in God or Imams and the need to resolve spiritual contradictions. Conclusion: The results showed that from the viewpoint of the participants, the concept of support consisted of psychological support, social support, accompanying the patient

  1. Cardioprotective medication use in hemodialysis patients

    PubMed Central

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

    2006-01-01

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

  2. 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.

  3. L-carnitine supplementation in hemodialysis patients.

    PubMed

    Mitwalli, Ahmed Hassan; Al-Wakeel, Jamal S; Alam, Awatif; Tarif, Nauman; Abu-Aisha, Hassan; Rashed, Mohamed; Al Nahed, Nora

    2005-01-01

    L-Carnitine supplementation has shown beneficial effects in patients on hemodialysis. We studied 36 ESRD adult patients with a mean age of 47.5 +/- 15 years to evaluate the effect of L-Carnitine supplementation on hemoglobin, lipid levels and physical performance in patients on hemodialysis. The study group consisted of 18 randomly selected patients who received L-Carnitine 15 mg/kg and the control group consisted of 18 randomly selected patients who received equal volume of normal saline as a placebo three times a week for six months. Laboratory tests were performed at baseline, then monthly until the end of the study. A significant increase in the hemoglobin (Hb) and hematocrit (HCT) in the presence of unchanged doses of erythropoietin hormonal supplementation was observed (pre 79 +/- 7.5 gm/l, post 103 +/- 10.6 gm/l) P< 0.001 (pre 24+/- 2 %, post 33 +/- 4%) P< 0.001 respectively) in the L-Carnitine treated group. Similarly total serum cholesterol (TCL) and serum triglyceride (TG) levels showed a statistically significant decrease in the study group, TCL (pre 4.6 +/- 1.2, post 3.7 +/- 1.1 mmol/L), P < 0.03 and TG (pre 3.1 +/- 1.7, post 1.8 +/- 0.6 mmol/L) P < 0.004. The physical performance as assessed by mild and moderate exercise showed a trend towards improvement. There was a significant increase in free carnitine and total carnitine levels in the L-Carnitine treated group. In conclusion, these results demostrate positive effect of L-Carnitine supplementation in the hemodialysis patients marked by an increase in Hb, HCT, a decrease in TCL and TG and improved physical performance in comparison to the control group.

  4. 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.

  5. Intradialytic parenteral nutrition in hemodialysis patients: Acute and chronic intervention.

    PubMed

    Avery-Lynch, Margaret

    2006-01-01

    Protein and calorie malnutrition have been encountered more frequently than expected in the hemodialysis patients. Intradialytic parenteral nutrition (IDPN) has been documented to improve nutritional status in hemodialysis patients in both acute and chronic settings (Henrich, 1996). The aim of this study was to support the usage of IDPN in our malnourished hemodialysis patients. Serum concentration of albumin is one of the main indicators of mortality in the dialysis population. The serum albumin concentration for six out of eight of our hemodialysis (HD) patients receiving IDPN increased significantly. There was a mean increase of 7.0 g/L of plasma albumin for the eight patients assessed. These results demonstrate that IDPN is an effective nutritional intervention for malnourished hemodialysis patients.

  6. The effects of single hemodialysis session on arterial stiffness in hemodialysis patients.

    PubMed

    Öğünç, Handan; Akdam, Hakan; Alp, Alper; Gencer, Fatih; Akar, Harun; Yeniçerioğlu, Yavuz

    2015-07-01

    Increased arterial stiffness in hemodialysis patients is a strong predictor of cardiovascular morbidity and mortality. Pulse wave velocity (PWV) and augmentation index (AIx), which are markers of arterial stiffness, were used to determine the severity of vascular damage noninvasively. This study aimed to investigate the effects of solute volume removal and hemodynamic changes on PWV and AIx of a single hemodialysis session. Thirty hemodialysis patients were enrolled in the study. Before initiation of hemodialysis, every 15 minutes during hemodialysis, and 30 minutes after the completion of the session, measurements of PWV and AIx@75 (normalized with heart rate 75 bpm) were obtained from each patient. Body composition was analyzed by bioimpedance spectroscopy device before and 30 minutes after completion of the hemodialysis session. During the hemodialysis, no significant change was observed in AIx@75. However, PWV decreased steadily during the session reaching statistically significant level at 135th minute (P = 0.026), with a maximal drop at 210th minute (P < 0.001). At 210th minute, decrease in PWV correlated positively with the decrease in central systolic blood pressure, central diastolic blood pressure, central pulse pressure, augmentation pressure, and AIx@75. Multiple regression analysis showed that decrease in PWV at 210th minute was associated with decrease in central systolic blood pressure and central pulse pressure. Ultrafiltration during hemodialysis had no significant effect on PWV and AIx@75. Delta urea correlated positively with delta PWV at 240th minute. A significant decrease in PWV was observed during hemodialysis and correlated with urea reduction; however, we were unable to document any effect of volume removal on arterial stiffness.

  7. 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.…

  8. 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.…

  9. [Hemodialysis in patients with chronic renal insufficiency].

    PubMed

    Canaud, Bernard; Leray-Moragués, Hélène; Chenine-Koualef, Leila; Patrier, Laure

    2012-01-01

    Hemodialysis is the most advanced form of artificial renal support. It ensures the survival of almost 2 million patients wordwide. Considerable progress has been made in recent years thanks to a better understanding of uremia, optimization of treatment modalities and more personalized treatment schedules. Increase of uremic toxins removal, improvement of hemodynamic tolerance of the sessions, reduction of proinflammatory reactions due to the bioincompatibility system are major advances that may explain the reduction of morbidity and mortality in dialysis patients. New technologies (nanotechnology, biotechnology, microelectronics) are now expected to introduce further progresses by miniaturizing devices and providing them with an "artificial intelligence" capable of interacting with the patient. The main obstacle remains ageing of uremic patients, increasing prevalence of comorbidities and shortage of social resources that are not conducive to innovation. By promoting a more physiological, longer and more effective hemodialysis performed at home with help of teledialysis monitoring that would probably be an interesting option to evaluate on a medico-economical point of view.

  10. Results of human factors testing in a novel Hemodialysis system designed for ease of patient use.

    PubMed

    Wilcox, Stephen B; Carver, Michelle; Yau, May; Sneeringer, Peter; Prichard, Sarah; Alvarez, Luis; Chertow, Glenn M

    2016-10-01

    Introduction Home hemodialysis has not been widely adopted despite superior outcomes relative to conventional in-center hemodialysis. Patients receiving home hemodialysis experience high rates of technique failure owing to machine complexity, training burden, and the inability to master treatments independently. Methods We conducted human factors testing on 15 health care professionals (HCPs) and 15 patients upon release of the defined training program on the Tablo™ Hemodialysis System. Each participant completed one training and one testing session conducted in a simulated clinical environment. Training sessions lasted <3 hours for HCPs and <4 hours for patients, with an hour break between sessions for knowledge decay. During the testing session, we recorded participant behavior and data according to standard performance and safety-based criteria. Findings Of 15 HCPs, 10 were registered nurses and five patient care technicians, with a broad range of dialysis work experience and no limitations other than visual correction. Of 15 patients (average age 48 years), 13 reported no limitations and two reported modest limitations-partial deafness and blindness in one eye, respectively. The average error rate was 4.4 per session for HCPs and 2.9 per session for patients out of a total possible 1,710 opportunities for errors. Despite having received minimal training, neither HCPs nor patients committed safety-related errors that required mitigation; rather, we noted only minor errors and operational difficulties. Discussion The Tablo™ Hemodialysis System is easy to use, and may help to enable self-care and home hemodialysis in settings heretofore associated with high rates of technique failure. © 2016 International Society for Hemodialysis.

  11. Body Composition and Inflammation in Hemodialysis Patients.

    PubMed

    Mandic, Ante; Cavar, Ivan; Skoro, Ivana; Tomic, Ivan; Ljubic, Kristina; Coric, Slavica; Mikulic, Ivanka; Azinovic, Igor; Pravdic, Danijel

    2017-09-22

    The volume state of dialysis patients is important in guiding the dialysis process. Volume overload in these patients is associated with inflammation. The objectives of the present study were to assess the body composition of patients on hemodialysis; to determine the concentrations of B-type natriuretic peptide (BNP) in plasma and evaluate the association of BNP concentrations with volume overload; to determine the concentrations of C-reactive protein (CRP), albumin and superoxide dismutase (SOD) activities as indicators of inflammatory or antioxidant processes. The study included 79 maintenance hemodialysis patients. Assessment of body compartments was carried out using a body composition monitor (BCM). After BCM measurements, blood samples were taken from the patients for laboratory tests. There were 40 (50.6%) volume-overloaded patients (relative overhydration >15%). These patients had a higher prevalence of arterial hypertension (P < 0.05), significantly higher concentrations of BNP (P = 0.01), lower body mass index (P < 0.05) and lower fat tissue index (P < 0.05). There was a positive correlation between plasma BNP and CRP concentrations (ρ = 0.231; P < 0.05), and a negative correlation between (log) BNP and albumin (r = -0.021; P < 0.05), as well as (log) CRP and albumin concentrations (r = -3; P < 0.01). SOD activity was positively correlated with albumin concentrations (r = 0.254; P < 0.05). The concentrations of BNP in this study were associated with volume overload and inflammatory markers. Patients with a higher albumin concentration had higher SOD activity. © 2017 International Society for Apheresis, Japanese Society for Apheresis, and Japanese Society for Dialysis Therapy.

  12. [DOPPS estimate of patient life years attributable to modifiable hemodialysis practices in France].

    PubMed

    Canaud, Bernard; Combe, Christian; Bragg-Gresham, Jennifer L; Eichleay, Margaret A; Pisoni, Ronald L; Port, Friedrich K

    2008-07-01

    In this study, we used a prevalent cross-sectional sample of French hemodialysis patients from Dialysis Outcomes and Practice Patterns Study (DOPPS) 2 (2002-2004) to determine the percentage of patients whose values failed to meet targets in six different areas of hemodialysis practice (dialysis dose, anemia, serum phosphorus (PO(4)), serum calcium (Ca), serum albumin and catheter use for vascular access). Cox survival models, with adjustments for patient characteristics, were used for these analyses to estimate mortality hazard ratios (HR). Based on the mortality HR, the fraction of patients outside each target and the total HD population in France, we estimated the number of patient life years that could potentially be gained if every chronic, in-center hemodialysis patient in France who is currently outside of the specified target was able to achieve it. The proportion of patients failing to meet one of the six practice targets in France varied from 15% (dialysis dose) to 75% (albumin) while the percentage of patients complying with all six targets was restricted to 1.2%. The relative risk of mortality (RR) associated with being outside these targets varied from 1.12 to 1.46. Based on these two measures the life-years survival was estimated. The projected number of patients and life years potentially gained from adherence to the six targets was estimated close to 10,600 years-patient. In conclusion, this study suggests large opportunities to improve hemodialysis patient care in France still exist. Compliance with two major practice targets, such as albumin and restriction of catheter use will save highly significant life years of hemodialysis patient. Implementing and strict adherence to national and international guidelines should serve as a basic inspiration for continual improvement of hemodialysis patient care.

  13. [Hypertension in hemodialysis patients in Andalucia].

    PubMed

    García Cortés, M J; Ceballos, M

    2004-01-01

    Hypertension is a common and difficult clinic problem in patients undergoing cronical hemodialysis and exerts a deleterious effect on mordibidy and mortality in end stage renal disease. Identification of potentially reversible factors associated with hypertension would be rational fist step in designing and effective therapeutic strategy. Our study aimed to document the prevalence of hypertension in hemodialysis patients in Andalucia and identify and characterise the demographic, epidemiological, clinical factors and dialysis regimens associated with hypertension. The study population included 2,789 patients enrolled in 46 hemodialysis centers in Andalucia on 2002. Hypertension was defined as requiring the use of antihypertensive drugs. Patients wre classified as hypertensive and no hypertensive. Demographic, comorbidity, anaemia, inflammatory and nutritional data were collected in both groups. Hypertensive patients were divided into 4 groups of severity according to the number of antihypertensive drugs received. Comparisons between groups were done. Our results show a hypertension prevalence of 53.8% in comparing clinical data of no hypertensive and hypertensive patients, we observed that patients with hypertension were significantly younger (60.2 +/- 15.6 vs 63.5 +/- 15 years; p < 0.001) and had shorter time on dialysis (months) (56.5 +/- 60 vs 67.3 +/- 68.2; p = 0.001). Coronary heart disease (p < 0.001) and diabetes (p < 0.001) were associated with hypertension. Hypertensive patients had higher levels of creatinine (mg/dl) (8.8 +/- 2.3 vs 8.5 +/- 2.3; p = 0.006) and serum albumin (g/dl) (3.9 +/- 0.4 vs 3.8 +/- 0.4; p < 0.001), and lower C-reactive protein (CRP) (mg/dl) (12.3 +/- 19.7 vs 16.1 +/- 25.15; p < 0.001). Hypertensive patients received less time of dialysis (233 +/- 25 vs 237 +/- 25 minutes/session; p < 0.001 and 703 +/- 85 vs 718 +/- 88 minutes/week; p < 0.001) and lower dialysis dose (urea reduction ratio (URR), Kt/V Daugirdas 2.a gen) (70.7 +/- 7

  14. 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

  15. Bacteremia in hemodialysis and peritoneal dialysis patients.

    PubMed

    Wang, I-Kuan; Chang, Yi-Chih; Liang, Chih-Chia; Chuang, Feng-Rong; Chang, Chiz-Tzung; Lin, Hsin-Hung; Lin, Chung-Chih; Yen, Tzung-Hai; Lin, Po-Chang; Chou, Che-Yi; Huang, Chiu-Ching; Tsai, Wen-Chen; Chen, Jin-Hua

    2012-01-01

    To analyze the incidence rates and risk factors for bacteremia in patients undergoing hemodialysis (HD) and peritoneal dialysis (PD). The records of 898 consecutive patients undergoing dialysis from January 2003 to December 2008 were reviewed retrospectively. Episodes of bacteremia were recorded. China Medical University (Taichung, Taiwan). The overall incidence rate of bacteremia was 7.63 per 100 patient-years in HD patients and 3.56 per 100 patient-years in PD patients and it was higher in HD patients each year from 2003 to 2008. S. aureus (27.53%) was the most common pathogen in HD patients, whereas Coagulase-negative Staphylococcus (21.3%) was the most common pathogen in PD patients. Vascular access infection was the most common etiology in HD patients, whereas peritonitis was the most common etiology in PD patients. Older age, shorter dialysis vintage, use of HD rather than PD, current smoker, use of a venous dialysis catheter, presence of diabetes mellitus, higher comorbidity score, and lower serum albumin were significant risk factors for bacteremia. Diabetes mellitus and lower serum albumin were significant risk factors for bacteremia-associated mortality. Placement of a permanent access (fistula, graft, or PD catheter) prior to initiation of dialysis, smoking cessation, and better nutritional status (i.e. higher serum albumin) were associated with a reduced risk of bacteremia in dialysis patients. Higher serum albumin was also associated with a reduced bacteremia-associated mortality.

  16. 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.

  17. In tandem extracorporeal therapies during hemodialysis in pediatric patients.

    PubMed

    McAlister, Amy E; Geile, Kira; Halabi, Carmen M; Davis, T Keefe

    2016-10-01

    We describe the successful treatment of a pediatric transplant patient with simultaneous intermittent hemodialysis and therapeutic plasma exchange (TPE). The patient presented with kidney graft failure. He had life threatening electrolyte disturbances and fluid overload due to antibody-mediated rejection. Therefore, he was in need of both emergent kidney replacement therapy and TPE. Both extracorporeal circuits were set up, established, and maintained safely and effectively without difficulty or alarms. Running intermittent hemodialysis and TPE simultaneously significantly reduced therapy time, allowed both needed therapies priority, and provided a superior pediatric patient experience in an acute situation. © 2016 International Society for Hemodialysis.

  18. Bone fragility fractures in hemodialysis patients: Croatian surveys.

    PubMed

    Šimunović, Iva; Pavlović, Draško; Kudumija, Boris; Mihaljević, Dubravka; Lovčić, Vesna; Jakić, Marko

    2015-03-01

    Disturbances of bone mineral metabolism are common complications of chronic kidney disease with bone fractures as one of the most important consequences. The aim of this study was to estimate prevalence of bone fractures among Croatian hemodialysis patients and to determine the possible fracture risk. The study was carried out in 767 hemodialysis patients from nine Croatian hemodialysis centers. Demographic, laboratory and bone fracture data were collected from medical records as well as therapy with vitamin D analogs. Fragility fractures were defined according to the World Health Organization definition. In 31 patient a total of 36 fractures were recorded. The prevalence of patients with bone fractures was 4.0%. The mean age of patients with fractures was 68.6 years. There were 9 male and 22 female patients with frac- tures. The mean hemodialysis duration was 63.3 months. Among all fractures the most common were hip fractures (39%) followed by forearm fractures (22%). This is the first study regarding epidemiology of bone fractures in Croatian hemodialysis patients. The prevalence of patients with bone fractures in our group of hemodialysis patients is high. Fractures were more frequent among women and older patients, patients who have been longer on dialysis and in patients with higher concentration of PTH.

  19. 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

  20. Predicting Maintenance Doses of Vancomycin for Hospitalized Patients Undergoing Hemodialysis

    PubMed Central

    El Nekidy, Wasim S; El-Masri, Maher M; Umstead, Greg S; Dehoorne-Smith, Michelle

    2016-01-01

    Background Methicillin-resistant Staphylococcus aureus is a leading cause of death in patients undergoing hemodialysis. However, controversy exists about the optimal dose of vancomycin that will yield the recommended pre-hemodialysis serum concentration of 15–20 mg/L. Objective To develop a data-driven model to optimize the accuracy of maintenance dosing of vancomycin for patients undergoing hemodialysis. Methods A prospective observational cohort study was performed with 164 observations obtained from a convenience sample of 63 patients undergoing hemodialysis. All vancomycin doses were given on the floor after completion of a hemodialysis session. Multivariate linear generalized estimating equation analysis was used to examine independent predictors of pre-hemodialysis serum vancomycin concentration. Results Pre-hemodialysis serum vancomycin concentration was independently associated with maintenance dose (B = 0.658, p < 0.001), baseline pre-hemodialysis serum concentration of the drug (B = 0.492, p < 0.001), and interdialytic interval (B = −2.133, p < 0.001). According to the best of 4 models that were developed, the maintenance dose of vancomycin required to achieve a pre-hemodialysis serum concentration of 15–20 mg/L, if the baseline serum concentration of the drug was also 15–20 mg/L, was 5.9 mg/kg with interdialytic interval of 48 h and 7.1 mg/kg with interdialytic interval of 72 h. However, if the baseline pre-hemodialysis serum concentration was 10–14.99 mg/L, the required dose increased to 9.2 mg/kg with an interdialytic interval of 48 h and 10.0 mg/kg with an interdialytic interval of 72 h. Conclusions The maintenance dose of vancomycin varied according to baseline pre-hemodialysis serum concentration of the drug and interdialytic interval. The current practice of targeting a pre-hemodialysis concentration of 15–20 mg/L may be difficult to achieve for the majority of patients undergoing hemodialysis. PMID:27826151

  1. 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

  2. Predictive factors of restless leg syndrome in hemodialysis patients.

    PubMed

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

    2016-01-01

    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. The correlation between the RLSs on individual, clinical, and laboratory indices in patients undergoing hemodialysis. 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. 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). 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.

  3. 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...

  4. 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...

  5. Peginesatide in patients with anemia undergoing hemodialysis.

    PubMed

    Fishbane, Steven; Schiller, Brigitte; Locatelli, Francesco; Covic, Adrian C; Provenzano, Robert; Wiecek, Andrzej; Levin, Nathan W; Kaplan, Mark; Macdougall, Iain C; Francisco, Carol; Mayo, Martha R; Polu, Krishna R; Duliege, Anne-Marie; Besarab, Anatole

    2013-01-24

    Peginesatide, a synthetic peptide-based erythropoiesis-stimulating agent (ESA), is a potential therapy for anemia in patients with advanced chronic kidney disease. We conducted two randomized, controlled, open-label studies (EMERALD 1 and EMERALD 2) involving patients undergoing hemodialysis. Cardiovascular safety was evaluated by analysis of an adjudicated composite safety end point--death from any cause, stroke, myocardial infarction, or serious adverse events of congestive heart failure, unstable angina, or arrhythmia--with the use of pooled data from the two EMERALD studies and two studies involving patients not undergoing dialysis. In the EMERALD studies, 1608 patients received peginesatide once monthly or continued to receive epoetin one to three times a week, with the doses adjusted as necessary to maintain a hemoglobin level between 10.0 and 12.0 g per deciliter for 52 weeks or more. The primary efficacy end point was the mean change from the baseline hemoglobin level to the mean level during the evaluation period; noninferiority was established if the lower limit of the two-sided 95% confidence interval was -1.0 g per deciliter or higher in the comparison of peginesatide with epoetin. The aim of evaluating the composite safety end point in the pooled cohort was to exclude a hazard ratio with peginesatide relative to the comparator ESA of more than 1.3. In an analysis involving 693 patients from EMERALD 1 and 725 from EMERALD 2, peginesatide was noninferior to epoetin in maintaining hemoglobin levels (mean between-group difference, -0.15 g per deciliter; 95% confidence interval [CI], -0.30 to -0.01 in EMERALD 1; and 0.10 g per deciliter; 95% CI, -0.05 to 0.26 in EMERALD 2). The hazard ratio for the composite safety end point was 1.06 (95% CI, 0.89 to 1.26) with peginesatide relative to the comparator ESA in the four pooled studies (2591 patients) and 0.95 (95% CI, 0.77 to 1.17) in the EMERALD studies. The proportions of patients with adverse and serious

  6. The role of intraoperative hemodialysis in liver transplant patients.

    PubMed

    Sedra, Ashraf H; Strum, Earl

    2011-06-01

    Orthotopic liver transplant (OLT) is a major surgical procedure that can be both challenging and lengthy. One of the common findings in end-stage liver disease is renal failure, whether acute or chronic, which may complicate the intraoperative course. The use of intraoperative hemodialysis is described by several centers to aid during OLT cases with impaired renal function or kidney failure. Unfortunately, there is a paucity of available data, which is limited to sporadic case reports, and only few structured studies in which continuous renal replacement therapy was used versus intraoperative hemodialysis, which is the main focus of this article. The rationale behind the use of intraoperative hemodialysis during OLT in patients with kidney dysfunction or failure is that the procedure is usually complicated by major hemodynamic changes, metabolic derangement, and coagulation abnormalities, which we think can be better managed intraoperatively using hemodialysis. In our institution, we performed over 140 cases of OLT using intraoperative hemodialysis since 2003 until the present. A retrospective cohort study is being conducted during the writing of this article. Preliminary data collection report zero percentage intraoperative mortality and 48 h postoperatively. Hemodialysis is widely acknowledged as a treatment option to stabilize patients with renal failure, and one of the most challenging situations is during OLT in which the role of intraoperative hemodialysis is becoming more important today more than ever before.

  7. Endocarditis is a common stroke mechanism in hemodialysis patients.

    PubMed

    Ishida, Koto; Brown, Mesha Gay; Weiner, Mark; Kobrin, Sidney; Kasner, Scott E; Messé, Steven R

    2014-04-01

    Hemodialysis patients are at high risk for ischemic stroke, and previous studies have noted a high rate of cardioembolism in this population. The aim of this study was to determine ischemic stroke causes among hemodialysis patients and elucidate specific cardioembolic stroke mechanisms. This study is a retrospective cross-sectional study of hemodialysis patients admitted with acute stroke to the University of Pennsylvania Health System between 2003 and 2010. Strokes were classified using modified Trial of Org 10,172 in Acute Stroke Treatment (TOAST) criteria as large vessel, cardioembolism, small vessel, atypical, multiple causes, or cryptogenic. Cardioembolic strokes were further characterized for specific mechanism. We identified 52 patients hospitalized with acute stroke while receiving hemodialysis. Mean age was 64±13 years, 56% were female, and 67% were black. Stroke subtypes included 3 (6%) large vessel, 20 (38%) cardioembolism, 6 (11%) small vessel, 3 (6%) other, 4 (8%) with multiple causes, and 16 (31%) were unknown. Among patients who had an echocardiogram performed, 5 of 52 (10%; 95% confidence interval, 1%-18%) had a patent foramen ovale. Cardioembolic stroke mechanisms included 6 with infective endocarditis (accounting for 12% of all strokes). Cardioembolism and cryptogenic stroke are the predominant stroke mechanisms among hemodialysis patients. Infective endocarditis was identified frequently relative to other stroke cohorts, and a raised index of suspicion is warranted in the hemodialysis population.

  8. Malnutrition, a new inducer for arterial calcification in hemodialysis patients?

    PubMed

    Zhang, Kun; Cheng, Gang; Cai, Xue; Chen, Jie; Jiang, Ying; Wang, Tong; Wang, Jingfeng; Huang, Hui

    2013-03-18

    Arterial calcification is a significant cardiovascular risk factor in hemodialysis patients. A series of factors are involved in the process of arterial calcification; however, the relationship between malnutrition and arterial calcification is still unclear. 68 hemodialysis patients were enrolled in this study. Nutrition status was evaluated using modified quantitative subjective global assessment (MQSGA). Related serum biochemical parameters were measured. And the radial artery samples were collected during the arteriovenous fistula surgeries. Hematoxylin/eosin stain was used to observe the arterial structures while Alizarin red stain to observe calcified depositions and classify calcified degree. The expressions of bone morphogenetic protein 2 (BMP2) and matrix Gla protein (MGP) were detected by immunohistochemistry and western blot methods. 66.18% hemodialysis patients were malnutrition. In hemodialysis patients, the calcified depositions were mainly located in the medial layer of the radial arteries and the expressions of BMP2 and MGP were both increased in the calcified areas. The levels of serum albumin were negatively associated with calcification score and the expressions of BMP2 and MGP. While MQSGA score, serum phosphorus and calcium × phosphorus product showed positive relationships with calcification score and the expressions of BMP2 and MGP. Malnutrition is prevalent in hemodialysis patients and is associated with arterial calcification and the expressions of BMP2 and MGP in calcified radial arteries. Malnutrition may be a new inducer candidate for arterial calcification in hemodialysis patients.

  9. Malnutrition, a new inducer for arterial calcification in hemodialysis patients?

    PubMed Central

    2013-01-01

    Background Arterial calcification is a significant cardiovascular risk factor in hemodialysis patients. A series of factors are involved in the process of arterial calcification; however, the relationship between malnutrition and arterial calcification is still unclear. Methods 68 hemodialysis patients were enrolled in this study. Nutrition status was evaluated using modified quantitative subjective global assessment (MQSGA). Related serum biochemical parameters were measured. And the radial artery samples were collected during the arteriovenous fistula surgeries. Hematoxylin/eosin stain was used to observe the arterial structures while Alizarin red stain to observe calcified depositions and classify calcified degree. The expressions of bone morphogenetic protein 2 (BMP2) and matrix Gla protein (MGP) were detected by immunohistochemistry and western blot methods. Results 66.18% hemodialysis patients were malnutrition. In hemodialysis patients, the calcified depositions were mainly located in the medial layer of the radial arteries and the expressions of BMP2 and MGP were both increased in the calcified areas. The levels of serum albumin were negatively associated with calcification score and the expressions of BMP2 and MGP. While MQSGA score, serum phosphorus and calcium × phosphorus product showed positive relationships with calcification score and the expressions of BMP2 and MGP. Conclusions Malnutrition is prevalent in hemodialysis patients and is associated with arterial calcification and the expressions of BMP2 and MGP in calcified radial arteries. Malnutrition may be a new inducer candidate for arterial calcification in hemodialysis patients. PMID:23506394

  10. [The Experience of Fluid Management in Hemodialysis Patients].

    PubMed

    Kim, Yoonsoo; Kim, Miyoung

    2015-10-01

    The purpose of this study was to explore the experience of fluid management in hemodialysis patients by describing how they manage fluid intake and what affects fluid management. Purposive sampling yielded 11 patients who have received hemodialysis for one year or longer in one general hospital. Data were collected through in-depth interviews and analysed using Giorgi's phenomenological method. Data collection and analysis were performed concurrently. The findings regarding how hemodialysis patients manage fluid intake were classified into four constituents: 'recognizing the need for fluid control', 'observing the status of fluid accumulation', 'controlling fluid intake and output', 'getting used to fluid management'. The factors that affect fluid management of hemodialysis patients were revealed as 'willpower', 'change in the mindset', 'support system', and 'emotional state'. The study results show that hemodialysis patients manage fluid intake through food and exercise as well as interpersonal relationships. These findings suggest that strategies in the development of nursing interventions for hemodialysis patients should be directed at assisting them in familiarization with fluid management based on an understanding of their sociocultural contexts.

  11. 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.

  12. The dose of dialysis in hemodialysis patients: impact on nutrition.

    PubMed

    Schulman, Gerald

    2004-01-01

    Multiple lines of evidence have indicated that the dose of hemodialysis impacts upon patient outcome. Among these outcome measures, nutrition is inextricably linked to the adequacy of the treatment. All of the methods of determining dialysis adequacy are based on assessing the removal of toxic substances retained in renal failure, the majority of which are derivatives of protein metabolism. Urea kinetics, employing urea as a surrogate for quantifying the elimination of small molecular weight nitrogenous substances, is the method that has been most thoroughly validated to date as defining a dose range for thrice-weekly hemodialysis: Both inadequate and optimal levels of hemodialysis dose have been identified by prospective, randomized clinic trials utilizing Kt/V(urea) as the index of adequacy. The impact of urea kinetics on nutritional status during thrice-weekly hemodialysis is discussed. Recently, in an attempt to improve outcome beyond that achievable with thrice-weekly hemodialysis, alternative regimens, consisting of daily treatments, have received increasing interest. In order to compare the dose of hemodialysis associated with these regimens with conventional thrice-weekly regimens in terms of removal of small molecular weight substances, standard Kt/V(urea), a parameter that combines treatment dose with treatment frequency, and thus allows for various intermittent therapies to be compared to continuous therapy, must be used. In addition, membrane flux and middle molecule removal, factors that have not yet been well defined as parameters of adequacy during thrice-weekly regimens, may be shown to be important indices with longer hemodialysis treatments, particularly daily nocturnal hemodialysis. The impact that these alternative regimens have had on nutritional status in hemodialysis patients and how they compare to conventional therapy are important considerations.

  13. Structural visualization of expert nursing: Hemodialysis patient education program "behavior modification program for hemodialysis patients".

    PubMed

    Oka, Michiyo; Kamiya, Chizuru; Sagawa, Mieko; Yamana, Eiko; Tsuru, Satoko

    2006-01-01

    Behavior modification programs (BMP) have been suggested to be useful for the self-management of hemodialysis (HD) patients. To provide more systematic care, we structured the procedure of the thinking process and care in BMPs as an algorithm. BMP developers produced a temporary algorithm based on previous studies, discussed it with nurses with BMP experience, and added and revised necessary items. As a result, an algorithm of BMP with high reproducibility that allows maintenance of consistent quality for the self-management of HD patients could be developed.

  14. 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.

  15. Nocturnal home hemodialysis for a patient with type 1 hyperoxaluria.

    PubMed

    Plumb, Troy J; Swee, Melissa L; Fillaus, Jennifer A

    2013-12-01

    Type 1 primary hyperoxaluria is a genetic disorder caused by deficiency of the liver-specific peroxisomal enzyme alanine-glyoxylate aminotransferase. This enzyme deficiency leads to excess oxalate production and deposition of calcium oxalate salts, resulting in kidney failure and systemic oxalosis. Aside from combined liver/kidney transplantation, no curative treatment exists. Various strategies for optimizing dialysis treatment have been evaluated, but neither conventional hemodialysis nor peritoneal dialysis can keep pace with oxalate production in this patient population. In this report, we describe a patient with end-stage renal disease from type 1 primary hyperoxaluria managed with nocturnal home hemodialysis. Performing hemodialysis 8-10 hours each night with blood flow of 350 mL/min and total dialysate volume of 60 L, she has maintained pre- and postdialysis serum oxalate levels at or below the level of supersaturation. We also review published literature regarding oxalate removal in various modalities of dialysis in patients with type 1 primary hyperoxaluria. In our patient, nocturnal hemodialysis has controlled serum oxalate levels better than conventional hemodialysis therapies. Home nocturnal hemodialysis should be considered an option for management of patients with end-stage renal disease from type 1 hyperoxaluria who are awaiting transplantation.

  16. Melatonin improves sleep quality in hemodialysis patients

    PubMed Central

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

    2013-01-01

    Disturbed sleep is common in end-stage renal disease (ESRD). Exogenous melatonin has somniferous properties in normal subjects and can improve sleep quality (SQ) in several clinical conditions. Recent studies have shown that melatonin may play a role in improving sleep in patients undergoing dialysis. The goal of the present study was to assess the effect of exogenous melatonin administration on SQ improvement in daytime hemodialysis patients. Lipid profile and the required dose of erythropoietin (EPO) are also reported as secondary outcomes. In a 6-week randomized, double-blind cross-over clinical trial, 3 mg melatonin or placebo was administered to 68 patients at bedtime. A 72-h washout preceded the switch from melatonin to placebo, or vice versa. SQ was assessed by the Pittsburgh sleep quality index (PSQI). Sixty-eight patients completed the study protocol and were included in the final analysis. Melatonin treatment significantly improved the global PSQI scores (P < 0.001), particularly subjective SQ (P < 0.001), sleep efficiency (P = 0.005) and sleep duration (P < 0.001). No differences in sleep latency and daytime sleepiness were observed. Melatonin also increased the high-density lipoprotein (HDL) cholesterol (P = 0.003). The need for EPO prescription decreased after melatonin treatment (P < 0.001). We conclude that melatonin can improve sleep in ESRD. The modest increase in HDL cholesterol and decrease in the EPO requirement are other benefits associated with this treatment PMID:23960341

  17. Increased bone fractures among elderly United States hemodialysis patients.

    PubMed

    Wagner, John; Jhaveri, Kenar D; Rosen, Lisa; Sunday, Suzanne; Mathew, Anna T; Fishbane, Steven

    2014-01-01

    Fractures are an important cause of morbidity in hemodialysis patients. Multiple advances in the treatment of mineral and bone disease in hemodialysis patients have occurred. The purpose of this study was to determine whether the rate of fractures in hemodialysis patients has changed over time. We studied US Renal Data System (USRDS) datasets to determine the rates of hospitalized fractures among hemodialysis patients. The primary outcome was incidence of fractures requiring hospitalization. The fracture rate per 1000 person-years was calculated by year from 1992 to 2009. The first 90 days after initiating dialysis were excluded from analysis. The incidence of hip and vertebral fractures increased from 12.5 fractures per 1000 patient-years in 1992 to 25.3 per 1000 patient-years in 2004 (P < 0.0001). Arm and leg fractures increased from 3.2 per 1000 patient-years in 1992 to 7.7 per 1000 patient-years in 2009 (P < 0.0001). The greatest increase in hip and verterbral fracture rate was seen in white patients >65 years of age. After 2004, the incidence rate of these fractures stabilized and subtly declined, but did not decrease significantly. Fracture rates increased significantly in hemodialysis patients from 1992 to 2004, with most of the increase occurring in elderly white patients. Assessment of fracture risk and management in dialysis patients at greatest risk requires greater emphasis and further study.

  18. High fluoride exposure in hemodialysis patients.

    PubMed

    Bello, V A; Gitelman, H J

    1990-04-01

    The observation of higher plasma flouride levels in our hemodialysis (HD) patients than our continuous ambulatory peritoneal dialysis (CAPD) patients (4.0 +/- 0.5 mumol/L [n = 17] v 2.5 +/- 0.3 mumol/L [n = 17], P less than 0.005) prompted an evaluation of fluoride metabolism during HD. We found that serum fluoride was completely ultrafiltrable across cuprophane membranes (99% +/- 4%) and that HD produced acute changes in plasma fluoride levels that correlated well with the fluoride gradient between plasma and dialysis fluid at the start of dialysis. Our HD fluids contained significantly higher fluoride concentrations than were present in commercially prepared peritoneal dialysis fluid. Our fluids are prepared from fluoridated tap water that is purified by reverse osmosis (RO). We conclude that the different concentrations of fluoride in our dialysis fluids account for the differences in the plasma flouride concentrations between our dialysis groups. Since many HD units rely on RO systems to purify fluoridated tap water, it is likely that many HD patients are being exposed inadvertently to increased concentrations of fluoride.

  19. Central Venous Occlusion in the Hemodialysis Patient.

    PubMed

    Krishna, Vinay Narasimha; Eason, Joseph B; Allon, Michael

    2016-11-01

    Central venous stenosis (CVS) is encountered frequently among hemodialysis patients. Prior ipsilateral central venous catheterization and cardiac rhythm device insertions are common risk factors, but CVS can also occur in the absence of this history. Chronic CVS can cause thrombosis with partial or complete occlusion of the central vein at the site of stenosis. CVS is frequently asymptomatic and identified as an incidental finding during imaging studies. Symptomatic CVS presents most commonly as an upper- or lower-extremity edema ipsilateral to the CVS. Previously unsuspected CVS may become symptomatic after placement of an ipsilateral vascular access. The likelihood of symptomatic CVS may be affected by the central venous catheter (CVC) location; CVC side; duration of CVC dependence; type, location, and blood flow of the ipsilateral access; and extent of collateral veins. Venous angiography is the gold standard for diagnosis. Percutaneous transluminal angioplasty and stent placement can improve the stenosis and alleviate symptoms, but CVS typically recurs frequently, requiring repeated interventions. Refractory symptomatic CVS may require ligation of the ipsilateral vascular access. Because no available treatment option is curative, the goal should be to prevent CVS by minimizing catheters and central vein instrumentation in patients with chronic kidney disease and dialysis patients. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  20. 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.

  1. Vascular calcification in Mexican hemodialysis patients.

    PubMed

    Rojas-Campos, Enrique; Herrera-Llamas, Rebeca; Montañez-Fernández, José L; Martínez-Martínez, Petra; Andrade-Sierra, Jorge; Avila-Baray, Angel A; Cueto-Manzano, Alfonso M

    2013-11-01

    Vascular calcification (VC) is a predictor of poor survival and cardiovascular outcome in end-stage renal disease (ESRD) patients; however, there is scarce information of VC in Latin America, and virtually no data in our setting. We undertook this study to evaluate the prevalence and characteristics of VC in a hemodialysis (HD) population from western Mexico and to determine possible associated factors. This was a cross-sectional study performed in 52 patients. VC was evaluated using plain X-ray films (Adragao's score) of hands and pelvis; clinical and biochemical variables were also collected. Statistical analysis was carried out with Student t and χ(2) tests performed as appropriate and logistic regression to determine predictors of VC. Mean age was 43 years, 48% were female, 23% had diabetes mellitus (DM), and median time on dialysis was 46 months. Percentage prevalence was 52% with a mean calcification score of 2.0 ± 2.6; 23% of patients had severe calcification. VC was present in about 23-37% among the different vascular territories evaluated (radial, digital, femoral and iliac). Patients with calcification were significantly older, had a higher frequency of DM, higher alkaline phosphatase and lower HDL lipoproteins than those without VC. In the multivariate analysis, VC in these patients was significantly predicted only by an older age (OR [95% CI]: 1.15 [1.01-1.31], p = 0.04); lower HDL-cholesterol and higher alkaline phosphatase were marginal predictors. Half of our HD patients had VC. Territories of radial, iliac, femoral and digital arteries were roughly equally affected, and 25% of patients had a calcification considered as severe. Older age was the only significant predicting variable for VC, with low HDL-cholesterol and high alkaline phosphatase as marginal predictors. Copyright © 2013 IMSS. Published by Elsevier Inc. All rights reserved.

  2. Anorexia in hemodialysis patients: an update.

    PubMed

    Bossola, M; Tazza, L; Giungi, S; Luciani, G

    2006-08-01

    Anorexia, defined as the loss of the desire to eat, is relatively common in hemodialysis (HD) patients, occurring in one-third of cases. The pathogenesis is essentially unknown. It has been proposed that uremic toxins as middle molecules, inflammation, altered amino-acid pattern, leptin, ghrelin, and neuropeptide Y are involved. Anorexia reduces oral energy and protein intakes, thus contributing to the development of malnutrition and cachexia. Unquestionably, it contributes to poor quality of life. The clinical relevance of anorexia as an independent prognostic factor in HD patients is a matter of debated issue. The treatment of this debilitating condition is based on a therapeutic strategy which may include daily dialysis sessions and nutritional counseling. Normalization of plasma branched-chain amino acids through branched-chain amino acids supplementation may decrease anorexia and improve energy and protein intake. The role of megestrol acetate as appetite stimulant needs to be validated through adequate randomized trials. Subcutaneous ghrelin administration and melanocortin-receptor antagonists appear promising therapeutic interventions.

  3. Intradialytic parenteral nutrition in chronic hemodialysis patients.

    PubMed

    Snyder, S; Bergen, C; Sigler, M H; Teehan, B P

    1991-01-01

    The effects of intradialytic parenteral nutrition (IDPN) were studied in chronic hemodialysis (CHD) patients who had a normalized protein catabolic rate (PCRN) of less than or equal to 0.8 g/kg/day, and KT/V = 0.94 +/- 0.04. Intradialytic parenteral nutrition was administered during thrice weekly CHD for 3-6 months, and consisted of essential and nonessential amino acids (42.5 g), glucose (125 g), and lipid emulsion (50 g). Blood urea nitrogen, creatinine, total protein, albumin, transferrin, pre-albumin, total lymphocyte count, anthropometrics, protein catabolic rate, 3 day historic dietary protein intake, and dietary energy intake (DEI) were measured at baseline, before IDPN, during IDPN, and at completion of IDPN. Six of nine enrolled patients completed the study. Reasons for withdrawal included nausea and hyperglycemia or hypoglycemia. DPI normalized for body weight (DPIN) increased significantly from 0.75 +/- 0.1 to 1.02 +/- 0.18 (p = 0.02). Increases in PCRN (0.57 +/- 0.18 to 0.78 +/- 0.2) and DEI (1495 +/- 266 to 1681 +/- 358) did not reach statistical significance. More aggressive IDPN or a longer study period may be necessary to assess this form of nutritional intervention.

  4. Evaluation of neopterin levels in patients undergoing hemodialysis.

    PubMed

    Asci, Ali; Baydar, Terken; Cetinkaya, Ramazan; Dolgun, Anil; Sahin, Gonul

    2010-04-01

    Neopterin is a diagnostic or a prognostic biomarker for several pathologies including renal diseases. However, the association between neopterin status and causative main reasons such as diabetes and hypertension for renal disease remains unclear. The aim of the study was to evaluate neopterin levels in diabetes and hypertension patients treated with/without hemodialysis. According to primary renal disorders, the patients undergoing hemodialysis were classified into 4 groups as diabetic nephropathy, hypertensive nephropathy, reflux nephropathy or interstitial nephritis, and others. The controls consisted of healthy subjects, hypertensive subjects, and diabetic individuals without any renal disorder. In the study, both urinary and serum neopterin levels were measured using high performance liquid chromatography and enzyme-linked immunosorbant assay in patients undergoing regular hemodialysis therapy (n=71). The effects of the duration of hemodialysis and treatment of erythropoietin and/or iron on neopterin levels were also evaluated. Neopterin levels were found to be higher in hemodialysis patients than in the healthy controls (P<0.05). A significant difference in neopterin levels was also found between diabetic control patients and diabetic nephropathy patients (P<0.05). A similar significant difference was detected in neopterin levels between hypertensive patients with/without nephropathy (P<0.05). Neopterin may be an early critical marker for progression of nephropathy in diabetic and hypertensive patients in early stages.

  5. Effect of acupressure on fatigue in patients on hemodialysis

    PubMed Central

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

    2013-01-01

    Background: Fatigue is considered as a major problem in hemodialysis patients and can impair their quality of life. The purpose of this study was to investigate the effectiveness of acupressure on fatigue in hemodialysis patients. Materials and Methods: This is a clinical trial study in which 96 hemodialysis patients participated. Patients were randomly assigned into acupressure, placebo, and control groups (32 subjects fulfilling the inclusion criteria assigned to each group). The measures included the form of demographic characteristics, visual analog scale of fatigue, and Piper Fatigue Scale. Patients in the acupressure and placebo groups received acupressure intervention during the early 2 h of dialysis on six acupoints with massage for 20 min/day, 3 days per week for 4 weeks. In the placebo group, acupressure intervention was performed as mentioned above with a distance of 1 cm away from the actual intervention site. Patients in the control group received routine unit care only. Chi- quare test, Kruskal-Wallis, paired t-test, one-way analysis of variance (ANOVA), and Duncan test were used for data analysis. Results: One-way ANOVA tests showed significant differences in the total mean score of fatigue and fatigue mean scores in the behavioral, emotional, sensory, and cognitive dimensions in the acupressure, placebo, and control groups. Conclusion: The results of this study showed that acupressure may reduce fatigue in hemodialysis patients, and use of this non-pharmacologic technique for hemodialysis nurses is suggested. PMID:24554938

  6. Sensorineural hearing loss in hemodialysis patients.

    PubMed

    Jakić, Marko; Mihaljević, Dubravka; Zibar, Lada; Jakić, Marijana; Kotromanović, Zeljko; Roguljić, Hrvoje

    2010-03-01

    Chronic renal failure affects all organ systems. Senses are not exception and hearing impairment is common, particularly sensorineural hearing loss (SNHL). The term SNOS of unknown origin or uremic deafness is related to only a smaller part of the cases with unclear etiology of the impairment. The study searched for SNOS in 66 chronic hemodialysis (HD) patients, mean age 51.50 +/- 12.70 years. They were treated by HD for 69.70 +/- 53.80 months. The relation between the severity of the impairment and the patients' age, duration of HD treatment (months) and a set of laboratory parameters typical for chronic HD patients was examined. The aim of the study was to detect potential causes of the impairment. The increased hearing threshold (HT) of above 20 dB for all frequencies was found in 42 patients (mean HT 26 +/- 10.50 dB), for speaking area frequencies in 22 patients (mean HT 19.70 +/- 8.80 dB), and in 56 patients for high frequencies (mean HT 41.70 +/- 19.70 dB). The significant positive correlation of HT was found only with the patients' age (r = 0.49, p < 0.01). The patients older than 45 years had higher mean HT than those younger, and those older than 65 also had higher HT than the younger ones. Patients with pathological value of HT were significantly more common among the older subgroup of patients, when divided according to the age at both cutoff values of 45 and of 60 years. Mean HT did not differ significantly according to the duration of HD treatment (subgroups A- no longer than 60 months, B- from 61 to 120 months, and C- longer than 120 months). The patients with pathological HT did not differ significantly in frequency among those subgroups, and the subgroups were not different according to the mean age (A--50.30 +/- 13.20 years; B--51.40 +/- 12.75 years; C--55.80 +/- 10.55 years). In conclusion, our results along with other authors'published data report on SNHL as very frequent finding among chronic HD patients and suggest multifactorial etiology

  7. Patient Care Staffing Levels and Facility Characteristics in U.S. Hemodialysis Facilities

    PubMed Central

    Yoder, Laura A. G.; Xin, Wenjun; Norris, Keith C.; Yan, Guofen

    2013-01-01

    Background Higher numbers of registered nurses per patient have been associated with improved patient outcomes in acute care facilities. Variation and associations of patient-care staffing levels and hemodialysis facility characteristics have not been previously examined. Study Design Cross-sectional study using Poisson regression to examine associations betwee patient-care staffing levels and hemodialysis facility characteristics. Setting & Participants 4,800 U.S. hemodialysis facilities in the 2009 CMS ESRD Annual Facility Survey (CMS-2744), USRDS. Predictors Facility characteristics, including profit status, freestanding status, chain affiliatio and geographic region, adjusted for facility size, capacity, functional type, and urbanicity. Outcomes Patient care staffing levels, including ratios of Registered Nurses (RN), Licensed Practical Nurses (LPN), Patient Care Technicians (PCT), composite staff (RN+LPN+PCT), Social Workers, and Dietitians to in-center hemodialysis patients. Results After adjusting for background facility characteristics, the ratios of RNs and LPNs to patients were 35% (p<0.001) and 42% (p<0.001) lower, but the PCT-to-patient ratio was 16% (p<0.001) higher in for-profit facilities than those in nonprofit facilities (Rate ratio, 0.65, 95%CI, 0.63–0.68; 0.58, 0.51–0.65; 1.16, 1.12–1.19; respectively). Regionally, compared to the Northeast, the adjusted RN-to-patient ratio was 14% (p< 0.001) lower in the Midwest, 25% (p< 0.001) lower in the South, and 18% (p< 0.001) lower in the West. Even after additional adjustments, the large for-profit chains had significantly lower RN and LPN ratios than the largest nonprofit chain, but a significantly higher PCT-to-patient ratio. The overall composite staffing levels were also lower in for-profit and chain-affiliated facilities. The patterns hold when the hospital-based units were excluded. Limitations Nursing hours were not available. Conclusions The significant variation in patient-care staffing

  8. Antihypertensive Agents in Hemodialysis Patients: A Current Perspective

    PubMed Central

    Inrig, Jula K.

    2011-01-01

    Hypertension affects most hemodialysis patients and is often poorly controlled. Adequate control of blood pressure is difficult with conventional hemodialysis alone but is important to improve cardiovascular outcomes. Nonpharmacologic interventions to improve blood pressure include educating patients about limiting sodium intake, ensuring adequate sodium solute removal during hemodialysis, and achieving target “dry weight.” However, most patients require a number of antihypertensive medications to achieve an appropriate blood pressure. First-line antihypertensive agents include angiotensin converting enzyme inhibitors and angiotensin receptor blockers given their safety profile and demonstrated benefit on cardiovascular outcomes in clinical trials. β-blockers and combined α- and β-blockers should also be used in patients with cardiovascular disease or congestive heart failure and may improve outcomes in these populations. Calcium channel blockers and direct vasodilators are also effective for controling blood pressure. Many blood pressure agents can be dosed once daily and should preferentially be administered at night to control nocturnal blood pressure and minimize intradialytic hypotension. In patients who are noncompliant with therapy, renally eliminated agents (such as lisinopril and atenolol) can be given thrice weekly following hemodialysis. Older antihypertensive agents which require thrice daily dosing ought to be avoided given the high pill burden with these regimens and the concern for noncompliance resulting in rebound hypertension. Newer antihypertensive agents, such as direct renin inhibitors, may provide alternative options to improve blood pressure but require testing for efficacy and safety in hemodialysis patients. PMID:20374548

  9. Antihypertensive agents in hemodialysis patients: a current perspective.

    PubMed

    Inrig, Jula K

    2010-01-01

    Hypertension affects most hemodialysis patients and is often poorly controlled. Adequate control of blood pressure is difficult with conventional hemodialysis alone but is important to improve cardiovascular outcomes. Nonpharmacologic interventions to improve blood pressure include educating patients about limiting sodium intake, ensuring adequate sodium solute removal during hemodialysis, and achieving target "dry weight." However, most patients require a number of antihypertensive medications to achieve an appropriate blood pressure. First-line antihypertensive agents include angiotensin converting enzyme inhibitors and angiotensin receptor blockers given their safety profile and demonstrated benefit on cardiovascular outcomes in clinical trials. beta-blockers and combined alpha- and beta-blockers should also be used in patients with cardiovascular disease or congestive heart failure and may improve outcomes in these populations. Calcium channel blockers and direct vasodilators are also effective for controlling blood pressure. Many blood pressure agents can be dosed once daily and should preferentially be administered at night to control nocturnal blood pressure and minimize intradialytic hypotension. In patients who are noncompliant with therapy, renally eliminated agents (such as lisinopril and atenolol) can be given thrice weekly following hemodialysis. Older antihypertensive agents which require thrice daily dosing ought to be avoided given the high pill burden with these regimens and the concern for noncompliance resulting in rebound hypertension. Newer antihypertensive agents, such as direct renin inhibitors, may provide alternative options to improve blood pressure but require testing for efficacy and safety in hemodialysis patients.

  10. Epidemiology, surveillance, and prevention of bloodstream infections in hemodialysis patients.

    PubMed

    Patel, Priti R; Kallen, Alexander J; Arduino, Matthew J

    2010-09-01

    Infections cause significant morbidity and mortality in patients undergoing hemodialysis. Bloodstream infections (BSIs) are particularly problematic, accounting for a substantial number of hospitalizations in these patients. Hospitalizations for BSI and other vascular access infections appear to have increased dramatically in hemodialysis patients since 1993. These infections frequently are related to central venous catheter (CVC) use for dialysis access. Regional initiatives that have shown successful decreases in catheter-related BSIs in hospitalized patients have generated interest in replicating this success in outpatient hemodialysis populations. Several interventions have been effective in preventing BSIs in the hemodialysis setting. Avoiding the use of CVCs in favor of access types with lower associated BSI risk is among the most important. When CVCs are used, adherence to evidence-based catheter insertion and maintenance practices can positively influence BSI rates. In addition, facility-level surveillance to detect BSIs and stimulate examination of vascular access use and care practices is essential to a comprehensive approach to prevention. This article describes the current epidemiology of BSIs in hemodialysis patients and effective prevention strategies to decrease the incidence of these devastating infections.

  11. Hyperglycemic hyperosmolar non-ketotic syndrome in hemodialysis patients.

    PubMed

    Wang, Y H; Lee, C T; Hsu, K T; Chen, J B

    1999-09-01

    Hyperglycemic hyperosmolar non-ketotic syndrome (HHNK) is an emergency complication of diabetes mellitus. The conventional treatment modality often includes massive fluid supplementation. In maintenance hemodialysis patients, dehydration via the renal route may not occur, and fluid management is rather complicated. In this study, we investigated the precipitating factors, treatment modalities, clinical course and prognosis of HHNK patients who received maintenance hemodialysis. From January 1988 through August 1998, 16 diabetic patients who had developed HHNK were enrolled. Eight of them were end stage renal disease (ESRD) patients on maintenance hemodialysis, and another group included 8 acute renal failure (ARF) diabetes mellitus patients who received their first hemodialysis during the HHNK episode. We retrospectively reviewed their medical charts and recorded each patient's age, treatment modalities, especially fluid supplementation, predisposing factors, and biochemical data during the HHNK episode. Complications and the final outcome were also recorded. There were no significant differences in biochemical data and patients' ages between the two groups (p > 0.05). The major predisposing factor for the ARF patients was infection, but irregular use of or discontinuing oral hypoglycemic agents (OHA) or insulin was the major predisposing factor for the ESRD patients. Less fluid supplementation was given in the ESRD group as compared to the ARF group and no deaths occurred in the ESRD group of patients. However, 6 patients expired in the ARF group of patients. Regular medical care, early diagnosis and recognition, and easier management of fluid administration explain the rather smooth course and better prognosis in the ESRD group of patients.

  12. Hepatitis C Is Less Aggressive in Hemodialysis Patients than in Nonuremic Patients

    PubMed Central

    Trevizoli, Jose Eduardo; de Paula Menezes, Raissa; Ribeiro Velasco, Lara Franciele; Amorim, Regina; de Carvalho, Mauro Birche; Mendes, Liliana Sampaio; Neto, Columbano Junqueira; de Deus Macedo, José Roberto; de Assis, Francisco; Neves, Rocha

    2008-01-01

    Background and objectives: The severity of liver disease among hepatitis C patients on hemodialysis is controversial. The aim of this study was to compare the clinical, biochemical, and liver histologic characteristics of hepatitis C virus (HCV) in hemodialysis patients and in those with normal renal function. Design, setting, participants, & measurements: A case-control study was carried out with 36 HCV patients on hemodialysis and 37 HCV patients with normal renal function matched for gender, age at infection, and estimated time of infection. Results: HCV patients on hemodialysis had lower levels of alanina aminotransferase and lower viral load. Hepatic fibrosis was significantly higher in the patients with normal renal function (73%) than in hemodialysis patients (47.2%, P < 0.025); the same was observed for inflammatory activity (control group 59.5% versus hemodialysis patients 27.7%, P = 0.003). In addition, the risk of tissue inflammation was four times lower in hemodialysis patients (odds ratio = 0.23, P < 0.004), and severe inflammatory activity on biopsy was the only independent risk factor for fibrosis (P < 0.001). Conclusions: The lower biochemical and inflammatory activities observed in hemodialysis patients suggest that hemodialysis and uremia may have a protective role against progression of the disease caused by HCV. PMID:18650408

  13. 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

  14. Satellite hemodialysis services for patients with end stage renal disease.

    PubMed

    Organ, Kathy; MacDonald, Sandra

    2014-01-01

    More than 40,000 Canadians are living with end stage renal disease and approximately 22,400 of those are currently being treated with hemodialysis (The Kidney Foundation of Canada, 2013). Long distance travel to access hemodialysis services can be a serious burden for patients, and travelling more than 60 minutes can mean a 20% greater risk for death, as compared with those who travel 15 minutes or less (Moist et al., 2008). Satellite hemodialysis units are seen as one solution to this problem. This study assessed the impact of services provided by one satellite hemodialysis unit on patients' satisfaction, access to care and quality of life using a qualitative interview research design. Seven patients were interviewed and three themes emerged including the burden of long distance travel before satellite services (safety, time and cost), satisfaction with satellite services (pleasant environment and continuity of care), and improved quality of life. This study showed that a satellite hemodialysis unit improved access to services and enhanced the quality of life of those patients who participated in the study.

  15. Safety and functionality of transhepatic hemodialysis catheters in chronic hemodialysis patients.

    PubMed

    Şanal, Bekir; Nas, Ömer Fatih; Doğan, Nurullah; Korkmaz, Mehmet; Hacıkurt, Kadir; Yıldız, Abdulmecid; Kan Aytaç, İrem İris; Hakyemez, Bahattin; Erdoğan, Cüneyt

    2016-01-01

    We aimed to investigate the safety and functionality of tunneled transhepatic hemodialysis catheters in chronic hemodialysis patients. Thirty-eight patients (20 women aged 56±10 years and 18 men aged 61±11 years) with transhepatic tunneled hemodialysis catheters were evaluated. The date of the first transhepatic catheterization, indications, procedure details, functional time periods of catheters, reasons for the removal or revision of catheters, catheter-related complications, and current conditions of patients were retrospectively analyzed. A total of 69 catheters were properly placed in all patients (100% technical success) under imaging guidance during the 91-month follow-up period. The functionality of 35 catheters could not be evaluated: five catheters were removed because of noncomplication related reasons (surgical fistulas were opened in two cases [2/35, 5.7%], transplantation was performed in three cases [3/35, 8.6%]), 18 patients died while their catheters were functional (18/35, 51.4%), and 12 catheters were still functional at the time of the study (12/35, 34.3%). The functionality of catheters was evaluated the remaining 34 catheters that necessitated revision because of complications. Furthermore, only half of the catheters were functional on day 136 when evaluated using Kaplan-Meier analysis. The four main complications were thrombosis (16/34, 47%; complication rate of 0.37 days in 100 catheters), infection (8/34, 23.5%; 0.18 days in 100 catheters), migration (8/34, 23.5%; 0.18 days in 100 catheters), and kinking (2/34, 6%; 0.04 days in 100 catheters). Transhepatic venous catheterization is a safe and functional alternative route in chronic hemodialysis patients without an accessible central venou route. The procedure can be performed with high technical success and low complication rates under imaging guidance.

  16. Safety and functionality of transhepatic hemodialysis catheters in chronic hemodialysis patients

    PubMed Central

    Şanal, Bekir; Nas, Ömer Fatih; Doğan, Nurullah; Korkmaz, Mehmet; Hacıkurt, Kadir; Yıldız, Abdulmecid; Aytaç, İrem İris Kan; Hakyemez, Bahattin; Erdoğan, Cüneyt

    2016-01-01

    PURPOSE We aimed to investigate the safety and functionality of tunneled transhepatic hemodialysis catheters in chronic hemodialysis patients. METHODS Thirty-eight patients (20 women aged 56±10 years and 18 men aged 61±11 years) with transhepatic tunneled hemodialysis catheters were evaluated. The date of the first transhepatic catheterization, indications, procedure details, functional time periods of catheters, reasons for the removal or revision of catheters, catheter-related complications, and current conditions of patients were retrospectively analyzed. RESULTS A total of 69 catheters were properly placed in all patients (100% technical success) under imaging guidance during the 91-month follow-up period. The functionality of 35 catheters could not be evaluated: five catheters were removed because of noncomplication related reasons (surgical fistulas were opened in two cases [2/35, 5.7%], transplantation was performed in three cases [3/35, 8.6%]), 18 patients died while their catheters were functional (18/35, 51.4%), and 12 catheters were still functional at the time of the study (12/35, 34.3%). The functionality of catheters was evaluated the remaining 34 catheters that necessitated revision because of complications. Furthermore, only half of the catheters were functional on day 136 when evaluated using Kaplan-Meier analysis. The four main complications were thrombosis (16/34, 47%; complication rate of 0.37 days in 100 catheters), infection (8/34, 23.5%; 0.18 days in 100 catheters), migration (8/34, 23.5%; 0.18 days in 100 catheters), and kinking (2/34, 6%; 0.04 days in 100 catheters). CONCLUSION Transhepatic venous catheterization is a safe and functional alternative route in chronic hemodialysis patients without an accessible central venou route. The procedure can be performed with high technical success and low complication rates under imaging guidance. PMID:27601303

  17. Bicytopenia, especially thrombocytopenia in hemodialysis and non-hemodialysis patients treated with linezolid therapy.

    PubMed

    Kato, Hideo; Hamada, Yukihiro; Hagihara, Mao; Hirai, Jun; Yamagishi, Yuka; Matsuura, Katsuhiko; Mikamo, Hiroshige

    2015-10-01

    One of the major adverse events associated with linezolid treatment is pancytopenia. However, there are few reports about the tolerability of linezolid among patients undergoing hemodialysis. This study retrospectively investigated the frequency of bicytopenia (thrombocytopenia and erythropenia) secondary to linezolid treatment in patients undergoing and not-undergoing hemodialysis. In total, 181 patients treated with linezolid from January 2010 to July 2012 at Aichi Medical University Hospital were divided into three groups; patients undergoing hemodialysis (HD group), those with creatinine clearance (CLCR) of <50 mL/min (CLCR < 50 group) and those with CLCR of ≥ 50 mL/min (CLCR ≥ 50 group). The incidence of thrombocytopenia, and changes in the platelet (PLT) counts during and after linezolid therapy were compared among three groups. Thrombocytopenia (<75% of the baseline level) occurred in 125 patients (69.1%). PLT reached its nadir 3-4 days after the end of linezolid therapy. In particular, the PLT nadir in HD group occurred earlier than that in non-HD groups (HD, 11.5 days [4-31 days]; CLCR < 50, 14 days [5-43 days]; CLCR ≥ 50, 15.5 days [4-49 days]; p = 0.11). HD group exhibited the greatest rate of reduction of PLT (HD, 24.0% [0.4-93.8%]; CLCR < 50, 23.8% [0.8-92.9%]; CLCR ≥ 50, 22.4% [0.92-92.9%]; p = 0.003). Finally, HD group exhibited the slowest recovery of PLT to its baseline level (HD, 10 days [5-29 days]; CLCR < 50, 9 days [2-16 days]; CLCR ≥ 50, 8 days [3-17 days]; p = 0.09). The incidence of erythropenia was not significantly different among three groups. These results indicate the need to monitor the PLT count during and after linezolid treatment in patients undergoing hemodialysis.

  18. Sleep Quality and Spiritual Well-Being in Hemodialysis Patients

    PubMed Central

    Eslami, Ahmad Ali; Rabiei, Leili; Khayri, Freidoon; Rashidi Nooshabadi, Mohammad Reza; Masoudi, Reza

    2014-01-01

    Background: Sleep disorders are considered as one of the most important problems in hemodialysis patients, making their everyday life a serious hazard. Sleep quality of hemodialysis patients and consequences of sleep disorders on other aspects of health such as spiritual well-being are important issues. Objectives: This study examined the relationship between spiritual well-being and quality of sleep in hemodialysis patients in Isfahan, Iran. Patients and Methods: This study was a correlation research, carried out on 190 hemodialysis patients. Data collection Questionnaires included demographic forms, Pittsburgh sleep quality index (PSQI), and Ellison and Paloutzian spiritual well-being scale. Data were analyzed using descriptive and inferential statistics (Pearson correlation and linear regression analysis) at P < 0.05 significance level, by SPSS software version 18. Results: Of 190 study participants, 163 (85.78%) with scores more than five index had sleep disturbances and 27 (14.12%) had no sleep disturbance; 3 (1.52%) had mild, 163 (85.78%) moderate, and 24 (12.30%) good spiritual health conditions. Pearson correlation test showed significant relationship between the sleep quality items of Pittsburg and spiritual well-being (P < 0.04, r = 0.149). Through the regression analyses of spiritual health, family, education, financial status, marital status, occupation, and use of sleep medication, the predictive power of these variables was found 0.417% and prediction of spiritual well-being was more than others (ß = 0.209). Conclusions: Considering bed as one of the most vital physical, mental, and emotional needs, it is very important in mental and spiritual well-being of hemodialysis patients as an influencing factor in mental relaxation and reducing disease tensions. Paying attention to sleep quality and spiritual well-being components of hemodialysis patients in formulating and promoting healthcare programs is recommended. PMID:25237580

  19. Exercise improves albumin fractional synthetic rate in chronic hemodialysis patients.

    PubMed

    Pupim, L B; Flakoll, P J; Ikizler, T A

    2007-05-01

    To determine whether exercise augments the improvements in fractional synthetic rate (FSR) of albumin observed with nutrition alone. Randomized crossover study. Each patient randomly participated in two protein metabolism kinetic studies using primed-constant infusion of (13C) leucine 2 h before, during and 2 h after hemodialysis. Plasma enrichments of (13C) leucine and (13C) ketoisocaproate were examined to determine the FSR of albumin. General Clinical Research Center at Vanderbilt University Medical Center. Five chronic hemodialysis (CHD) patients. Intra-dialytic parenteral nutrition (IDPN) with or without exercise. Exercise performance during hemodialysis significantly improves the FSR of albumin beyond what is observed with IDPN alone (26.2+/-3.1% per day versus 17.7+/-1.9% per day, P<0.05). Exercise improves albumin fractional synthetic rate beyond what is observed with IDPN alone in the acute setting in CHD patients.

  20. Hypomagnesemia and Mortality in Incident Hemodialysis Patients

    PubMed Central

    Li, Lin; Streja, Elani; Rhee, Connie M.; Mehrotra, Rajnish; Soohoo, Melissa; Brunelli, Steven M.; Kovesdy, Csaba P.; Kalantar-Zadeh, Kamyar

    2015-01-01

    Background In the general population, low serum magnesium (Mg) levels are associated with poor outcomes and death. While limited data suggest that low baseline Mg levels may be associated with higher mortality in hemodialysis (HD) patients, the impact of changes in Mg over time is unknown. Study Design We examined the association of time-varying serum Mg levels with all-cause mortality using multivariable time-dependent survival models adjusted for clinical characteristics and other time-varying laboratory measures. Setting & Participants 9,359 maintenance HD patients treated in a large dialysis organization between 2007 and 2011. Predictor Time-varying serum Mg levels across 5 Mg increments (<1.8, 1.8–<2.0, 2.0–<2.2, 2.2–<2.4, ≥2.4 mg/dl). Outcomes All-Cause Mortality Results 2,636 individuals died over 5 years. Time-varying serum Mg <2.0 mg/dl was associated with higher mortality after adjustment for demographics and co-morbidities including hypertension, diabetes, and malignancies (reference: Mg 2.2–<2.4 mg/dL): adjusted HRs for serum Mg <1.8 and 1.8–<2.0 mg/dl were 1.39 (95% CI, 1.23–1.58; p<0.001) and 1.20 (95% CI, 1.06–1.36; p=0.004), respectively. Some associations were attenuated to the null after incremental adjustment for laboratory tests, particularly serum albumin. However among patients with serum albumin measurements, low albumin levels (<3.5 g/dl) and Mg <2.0 mg/dl was associated with an additional death risk (adjusted HR, 1.17; 95% CI, 1.05–1.31; p=0.004), while patients with high serum albumin levels (≥3.5 g/dl) exhibited low death risk (adjusted HRs of 0.53 and 0.53 [p≤0.001] for Mg <2.0 mg/dl and ≥2.0 mg/dl, respectively; reference: albumin <3.5 g/dl and Mg ≥2.0 mg/dl). Limitations Causality cannot be determined, and residual confounding cannot be excluded given the observational study design. Conclusions Lower serum Mg levels are associated with higher mortality in HD patients including in those with hypoalbuminemia

  1. Vascular Access Choice in Incident Hemodialysis Patients: A Decision Analysis

    PubMed Central

    Drew, David A.; Lok, Charmaine E.; Cohen, Joshua T.; Wagner, Martin; Tangri, Navdeep

    2015-01-01

    Hemodialysis vascular access recommendations promote arteriovenous (AV) fistulas first; however, it may not be the best approach for all hemodialysis patients, because likelihood of successful fistula placement, procedure-related and subsequent costs, and patient survival modify the optimal access choice. We performed a decision analysis evaluating AV fistula, AV graft, and central venous catheter (CVC) strategies for patients initiating hemodialysis with a CVC, a scenario occurring in over 70% of United States dialysis patients. A decision tree model was constructed to reflect progression from hemodialysis initiation. Patients were classified into one of three vascular access choices: maintain CVC, attempt fistula, or attempt graft. We explicitly modeled probabilities of primary and secondary patency for each access type, with success modified by age, sex, and diabetes. Access-specific mortality was incorporated using preexisting cohort data, including terms for age, sex, and diabetes. Costs were ascertained from the 2010 USRDS report and Medicare for procedure costs. An AV fistula attempt strategy was found to be superior to AV grafts and CVCs in regard to mortality and cost for the majority of patient characteristic combinations, especially younger men without diabetes. Women with diabetes and elderly men with diabetes had similar outcomes, regardless of access type. Overall, the advantages of an AV fistula attempt strategy lessened considerably among older patients, particularly women with diabetes, reflecting the effect of lower AV fistula success rates and lower life expectancy. These results suggest that vascular access-related outcomes may be optimized by considering individual patient characteristics. PMID:25063436

  2. Patient Perspectives on Fluid Management in Chronic Hemodialysis

    PubMed Central

    Smith, Kimberly; Coston, Melinda; Glock, Kimberly; Elasy, Tom A.; Wallston, Kenneth A.; Ikizler, T. Alp; Cavanaugh, Kerri L.

    2009-01-01

    Objective To describe the perspectives and experiences of chronic hemodialysis (CHD) patients regarding self-care and adherence to fluid restrictions. Design Semi-structured focus groups. Setting Two outpatient hemodialysis centers. Participants 19 patients on chronic hemodialysis. Intervention Patients were asked a series of open-ended questions to encourage discussion about the management of fluid restriction within the broad categories of general knowledge, knowledge sources or barriers, beliefs and attitudes, self-efficacy, emotion, and self-care skills. Main outcome measure We analyzed session transcripts using the theoretical framework of content analysis to identify themes generated by the patients. Results Patients discussed both facilitators and barriers to fluid restriction which we categorized into 6 themes: knowledge, self-assessment, psychological factors, social, physical, and environmental. Psychological factors were the most common barriers to fluid restriction adherence, predominantly involving lack of motivation. Knowledge was the most discussed facilitator with accurate self-assessment, positive psychological factors, and supportive social contacts also playing a role. Dialysis providers were most commonly described as the source of dialysis information (54%), but learning through personal experience was also frequently noted (28%). Conclusion Interventions to improve fluid restriction adherence of chronic hemodialysis patients should target motivational issues, assess and improve patient knowledge, augment social support, and facilitate accurate self-assessment of fluid status. PMID:19913443

  3. Patient perspectives on fluid management in chronic hemodialysis.

    PubMed

    Smith, Kimberly; Coston, Melinda; Glock, Kimberly; Elasy, Tom A; Wallston, Kenneth A; Ikizler, T Alp; Cavanaugh, Kerri L

    2010-09-01

    We sought to describe the perspectives and experiences of chronic hemodialysis (CHD) patients regarding self-care and adherence to fluid restrictions. Semistructured focus groups. Two outpatient hemodialysis centers. Nineteen patients on chronic hemodialysis. Patients were asked a series of open-ended questions to encourage discussion about the management of fluid restriction within the broad categories of general knowledge, knowledge sources or barriers, beliefs and attitudes, self-efficacy, emotion, and self-care skills. We analyzed session transcripts using the theoretical framework of content analysis to identify themes generated by the patients. Patients discussed both facilitators and barriers to fluid restriction, which we categorized into six themes: knowledge, self-assessment, psychological factors, social, physical, and environmental. Psychological factors were the most common barriers to fluid restriction adherence, predominantly involving lack of motivation. Knowledge was the most discussed facilitator with accurate self-assessment, positive psychological factors, and supportive social contacts also playing a role. Dialysis providers were most commonly described as the source of dialysis information (54%), but learning through personal experience was also frequently noted (28%). Interventions to improve fluid restriction adherence of chronic hemodialysis patients should target motivational issues, assess and improve patient knowledge, augment social support, and facilitate accurate self-assessment of fluid status. (c) 2010 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  4. Occult hepatitis C virus infection among hemodialysis patients.

    PubMed

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

    2008-12-01

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

  5. Peritoneal or hemodialysis for the frail elderly patient, the choice of 2 evils?

    PubMed

    Brown, Edwina A; Finkelstein, Frederic O; Iyasere, Osasuyi U; Kliger, Alan S

    2017-02-01

    Management of older people on dialysis requires focus on the wider aspects of aging as well as dialysis. Almost all frail and older patients receiving dialysis will default to in-center hemodialysis, although the availability of assisted peritoneal dialysis enables dialysis at home. As with any disease management decision, patients approaching end-stage renal disease need all the appropriate facts about their prognosis, the natural history of their disease without dialysis, and the resulting outcomes and complications of the different dialysis modalities. Hemodialysis in the older age group can be complicated by intradialytic hypotension, prolonged time to recovery, and vascular access-related problems. Peritoneal dialysis can be difficult for older patients with impaired physical or cognitive function and can become a considerable burden. Use of incremental dialysis, changes in hemodialysis frequency, and delivery and use of assistance for peritoneal dialysis can ameliorate quality of life for older patients. Understanding each individual's goals of care in the context of his or her life experience is particularly important in the elderly, when overall life expectancy is relatively short, and life experience or quality of life may be the priority. Indeed, some patients select the option of no dialysis or conservative care. With multifaceted assessments of care, physicians should be able to give individual patients the ability to select and continue to make the best decisions for their care.

  6. Cerebral Microbleeds Predict Intracerebral Hemorrhage in Hemodialysis Patients.

    PubMed

    Naganuma, Toshihide; Takemoto, Yoshiaki; Shoji, Tetsuo; Ishimura, Eiji; Okamura, Mikio; Nakatani, Tatsuya

    2015-08-01

    In hemodialysis patients, previous reports have described a high prevalence of cerebral microbleeds (CMBs), but no longitudinal studies have been performed to determine the clinical significance of CMBs in these patients. In this study, we investigated whether the presence of CMBs was a predictor of future strokes in hemodialysis patients. Cranial MRI, including T2*-weighted magnetic resonance imaging, was performed on 179 hemodialysis patients with no past history of cerebrovascular events. The patients were followed prospectively until death or renal transplantation. We used the Cox proportional hazards model with inverse probability of treatment weighting using the propensity score to compare the event-free survivals of patients with/without CMBs. For sensitivity analyses, stratification by propensity score quintile and regression adjustment were used. CMBs were detected in 45 of the 179 patients. During a median follow-up period of 5.0 years, stroke occurred in 24 patients, including 12 with intracerebral hemorrhage and 12 with cerebral infarctions. Cox proportional hazards analysis with inverse probability of treatment weighting using the propensity score revealed that the presence of CMBs was a strong and significant predictor of intracerebral hemorrhage (hazard ratio, 26.53; 95% confidence interval, 2.88-244.90) but not cerebral infarction (hazard ratio, 0.91; 95% confidence interval, 0.25-3.34). Sensitivity analyses yielded similar results. This study showed that the presence of CMBs was an independent and strong predictor of intracerebral hemorrhage in stroke-free hemodialysis patients, indicating that hemodialysis patients with CMBs should be carefully monitored for future onset of intracerebral hemorrhage. © 2015 American Heart Association, Inc.

  7. Evaluation of dialysis adequacy in hemodialysis patients: A systematic review.

    PubMed

    Barzegar, Hengameh; Moosazadeh, Mahmoud; Jafari, Hedayat; Esmaeili, Ravanbakhsh

    2016-08-25

    Hemodialysis is the common kidney replacement therapy in Iran. Doing an adequate and effective dialysis can improve patients' quality of life and reduce kidney failure complications. Additionally, dialysis quality is an important factor in reducing mortality in patients with chronic kidney failure. This systematic review has investigated the adequacy of dialysis in studies done on hemodialysis patients of Iran. All articles related to the dialysis adequacy in hemodialysis patients in English and Farsi (contemporary Persian) were identified by searching the related keywords in various electronic databases. According to the inclusion criteria 21 studies were identified. The results were analyzed using Stata software version 11. A number of 6677 patients had been enrolled in 21 studies that were chosen for this systematic review. Based on the random effects model, the overall dialysis adequacy (KT/V) (K: clearance of urea, T: duration of dialysis, V: distribution of urea) more than 1.2 and confidence interval were 36.3% and 46.2-26.4, respectively. Also, based on random effects model more than 65% urea reduction ratio in all studies was 28.8% and the confidence interval was 43.3-14.4. KT/V and urea reduction ratio were much less desirable in hemodialysis patients and the dialysis quality was also undesirable. It seems that inadequate dialysis prescription, use of inappropriate filters, low pump speed (blood flow speed), and the short duration and few times of dialysis are the major causes of this inadequacy. .

  8. Restless leg syndrome in chronic hemodialysis patients in Mashhad hemodialysis centers.

    PubMed

    Zadeh Saraji, Niloufar; Hami, Maryam; Boostani, Reza; Mojahedi, Mohammad Javad

    2017-01-01

    Introduction: Restless leg syndrome (RLS) is a sensory motor disorder. Patients with this syndrome have serious and uncontrollable desire to move their legs, which is mostly due to an uncomfortable feeling intensified when they are motionless. It may be a genetic disorder or secondary to iron deficiency, neurodegenerations, pregnancy, some drugs and severe kidney diseases. Objectives: This study was designed to find out the prevalence and its risk factors of RLS in hemodialysis patients. Patients and Methods: This multicenter cross-sectional study was done on 260 hemodialysis patients. The prevalence of RLS was measured using International Restless Legs Syndrome Study Group (IRLSSG)'s RLS Questionnaire (RLSQ). Potential risk factors for RLS including underlying cause of chronic renal failure, duration on dialysis, biochemical tests, dialysis adequacy, and erythropoietin and also venofer dosage in recent month and demographic data were also evaluated. Results: The prevalence of RLS was 55% including 59.4% males and 40.6% females. Their mean age of RLS patients and their dialysis duration were significantly higher than other group (P<0.05). Their body mass index (BMI) and serum calcium were significantly higher (P<0.05). However erythropoietin dosage and serum hemoglobin level were lower in RLS patients (P<0.05). Significant predictors of RLS were history of diabetes mellitus (DM), hypertension (HTN), smoking (P<0.05). There was not significant relation between RLS and dialysis adequacy, serum intact parathyroid hormone (iPTH), urea, ferritin and venofer dosage (P>0.05). Conclusion: According to the results, RLS is a common disorder in hemodialysis patients which can affect strongly on their life. So particular attention and sooner diagnosis of RLS in high risk patients for better management is necessary.

  9. Second-Degree Interatrial Block in Hemodialysis Patients

    PubMed Central

    Enriquez, Andres; D'Amato, Anna; de Luna, Antoni Bayes; Baranchuk, Adrian

    2015-01-01

    Interatrial conduction delays manifest as a prolonged P-wave duration on surface ECG and the term interatrial block (IAB) has been coined. They are usually fixed, but cases of intermittent IAB have been described, suggesting functional conduction block at the Bachmann bundle region. We report 2 cases of patients on chronic hemodialysis therapy presenting with intermittent IAB. PMID:25755895

  10. Left atrial calcification in a hemodialysis patient with cor triatriatum.

    PubMed

    Peces, R; Pobes, A; Rodriguez, M; Simarro, C; Iglesias, G; Simarro, E

    2000-05-01

    Myocardial calcification is a rare manifestation of abnormal calcium metabolism seen in some patients with chronic renal failure. This report describes the transesophageal echocardiographic and spiral computed tomography (CT) findings in a young hemodialysis female with severe secondary hyperparathyroidism. These findings included calcification of the multiperforated membrane of a cor triatriatum and the wall of the left atrium.

  11. 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

  12. 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…

  13. 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…

  14. High hemodialysis vascular access flow and impaired right ventricular function in chronic hemodialysis patients.

    PubMed

    Yilmaz, S; Yetim, M; Yilmaz, B K; Dogan, T; Aksoy, E; Yuksel, N; Dogan, I

    2016-09-01

    There are limited data showing right ventricular preload increase due to high-flow arteriovenous fistulas (AVFs). This cross-sectional study investigated whether high AVF flow had an impact on right ventricular function in patients undergoing hemodialysis. Sixty-four patients aged between 18 and 85 years who were on routine hemodialysis with >2 hemodialysis sessions per week for at least 3 months via an AVF were studied. Patients with inadequate flow fistulas, severe chronic obstructive pulmonary disease, history of pulmonary embolism, primary pulmonary hypertension, severe mitral, aortic or pulmonary regurgitation, and/or stenosis were excluded. After an initial evaluation, 44 patients (mean age: 58.50 ± 16.84, male:female = 23:21) were considered eligible. Right ventricular function was assessed by tricuspid annular plane systolic excursion (TAPSE). AVF blood flow was measured with duplex ultrasound. There were 15 patients (34.1%) with a TAPSE of <16 mm. AVF blood flow was significantly higher in patients with impaired versus normal right ventricular function (1631.53 ± 738.17 vs. 1060.55 ± 539.92 min/ml, respectively, P = 0.003). Low left ventricular ejection fraction (odds ratio [OR]: 1.15, 95% confidence intervals [CI]: 1.007-1.334, P = 0.04), high interventricular septum thickness (OR: 1.64, 95% CI: 1.104-2.464, P = 0.01), and high AVF blood flow (OR: 1.00, 95% CI: 1.000-1.003, P = 0.03) were independent predictors of impaired right ventricular function. In addition to known risk factors that predominantly increase right ventricular afterload, excessive AVF blood flow was found to be independently associated with impaired right ventricular function, possibly by increasing right ventricular preload.

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

    PubMed

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

    2016-04-01

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

  16. Clinical decision support to improve blood pressure control in hemodialysis patients: a nonrandomized controlled trial.

    PubMed

    Thompson, Stephanie; Hemmelgarn, Brenda; Wiebe, Natasha; Majumdar, Sumit; Klarenbach, Scott; Jindal, Kailash; Manns, Braden; Mortis, Garth; Campbell, Patricia; Tonelli, Marcello

    2012-01-01

    Computer-based clinical decision support aims to improve the quality of patient care. The utility of decision support for improving blood pressure control in hemodialysis patients is unknown. This was a nonrandomized controlled trial of adult patients receiving chronic in-center hemodialysis during the period of April 1, 2005, to September 30, 2006, in 1 of the 2 major university-based renal programs in Alberta, Canada. Physicians in the intervention center were provided with twice-monthly audits and printed management suggestions based on guideline-recommended blood pressure targets. The same data were available to physicians in the control group but without audit and feedback decision support. Eight hundred and thirty hemodialysis patients were receiving dialysis treatment at the time the study was initiated. Preintervention and postintervention blood pressure data were available for 361 patients. The primary outcome, the proportion of postdialysis systolic blood pressures at target over 12 months, did not differ between the intervention and the control programs (unadjusted odds ratio 0.59; 95% confidence interval [95% CI], 0.34-1.02, p = 0.06; adjusted odds ratio 0.62; 95% CI, 0.35-1.11, p = 0.11). There was no significant difference between the intervention and control groups in other measures of blood pressure such as the mean change in postdialysis systolic blood pressures (unadjusted mean difference 4 mm Hg, 95% CI, -1 to 9, p = 0.36; adjusted mean difference 2 mm Hg, 95% CI, -1 to 5, p = 0.19). In this population of chronic hemodialysis patients, a computer-based clinical decision support system was not associated with improved blood pressure control.

  17. Residual Kidney Function Decline and Mortality in Incident Hemodialysis Patients.

    PubMed

    Obi, Yoshitsugu; Rhee, Connie M; Mathew, Anna T; Shah, Gaurang; Streja, Elani; Brunelli, Steven M; Kovesdy, Csaba P; Mehrotra, Rajnish; Kalantar-Zadeh, Kamyar

    2016-12-01

    In patients with ESRD, residual kidney function (RKF) contributes to achievement of adequate solute clearance. However, few studies have examined RKF in patients on hemodialysis. In a longitudinal cohort of 6538 patients who started maintenance hemodialysis over a 4-year period (January 2007 through December 2010) and had available renal urea clearance (CLurea) data at baseline and 1 year after hemodialysis initiation, we examined the association of annual change in renal CLurea rate with subsequent survival. The median (interquartile range) baseline value and mean±SD annual change of CLurea were 3.3 (1.9-5.0) and -1.1±2.8 ml/min per 1.73 m(2), respectively. Greater CLurea rate 1 year after hemodialysis initiation associated with better survival. Furthermore, we found a gradient association between loss of RKF and all-cause mortality: changes in CLurea rate of -6.0 and +3.0 ml/min per 1.73 m(2) per year associated with case mix-adjusted hazard ratios (95% confidence intervals) of 2.00 (1.55 to 2.59) and 0. 61 (0.50 to 0.74), respectively (reference: -1.5 ml/min per 1.73 m(2) per year). These associations remained robust against adjustment for laboratory variables and ultrafiltration rate and were consistent across strata of baseline CLurea, age, sex, race, diabetes status, presence of congestive heart failure, and hemoglobin, serum albumin, and serum phosphorus levels. Sensitivity analyses using urine volume as another index of RKF yielded consistent associations. In conclusion, RKF decline during the first year of dialysis has a graded association with all-cause mortality among incident hemodialysis patients. The clinical benefits of RKF preservation strategies on mortality should be determined. Copyright © 2016 by the American Society of Nephrology.

  18. Pulmonary hypertension and right ventricular dysfunction in hemodialysis patients.

    PubMed

    Zhao, L-J; Huang, S-M; Liang, T; Tang, H

    2014-01-01

    Hemodialysis treatment has been revealed to increased the systolic pulmonary artery pressure (sPAP). Right ventricular dysfunction (RVD) had been demonstrated to predict mortality in chronic renal failure patients. We investigate the prevalence of pulmonary hypertension and RVD among patients and possible contributing factors for pulmonary hypertension. A cross-sectional survey consisted of 70 hemodialysis patients was performed in our hemodialysis center. By using echocardiography, an estimated systolic pulmonary artery pressure of > 35 mmHg at rest met the criterion of pulmonary hypertension. Tissue Doppler imaging (TDI) of the right ventricle was performed in all patients. 27 out of 70 (38.57%) patients met the definition of pulmonary hypertension, while 32 out of 70 (45.71%) patients met the definition of RVD. Compared to patients without pulmonary hypertension, patients with pulmonary hypertension demonstrated higher systolic blood pressure and lower left ventricular ejection fraction (LVEF). RVD, indicated by TDI myocardial performance index (MPI), was worse impaired in patients with pulmonary hypertension. Echocardiographic findings suggested elevated MPI values of right ventricular and right ventricular wall thickness were significantly associated with sPAP. While a high level of LVEF and Kt/V values was inversely correlated with sPAP. The multivariate determinants of pulmonary hypertension were systolic blood pressure and Kt/V values. Among hemodialysis patients, pulmonary hypertension is extraordinary common and is significantly associated with RVD. The poor control of systolic blood pressure and volume overload have played an important role in the mechanism of pulmonary hypertension in chronic uremia patients.

  19. Antihypertensive medications and risk of death and hospitalizations in US hemodialysis patients

    PubMed Central

    Shafi, Tariq; Sozio, Stephen M.; Luly, Jason; Bandeen-Roche, Karen J.; St. Peter, Wendy L.; Ephraim, Patti L.; McDermott, Aidan; Herzog, Charles A.; Crews, Deidra C.; Scialla, Julia J.; Tangri, Navdeep; Miskulin, Dana C.; Michels, Wieneke M.; Jaar, Bernard G.; Zager, Philip G.; Meyer, Klemens B.; Wu, Albert W.; Boulware, L. Ebony

    2017-01-01

    Abstract Antihypertensive medications are commonly prescribed to hemodialysis patients but the optimal regimens to prevent morbidity and mortality are unknown. The goal of our study was to compare the association of routinely prescribed antihypertensive regimens with outcomes in US hemodialysis patients. We used 2 datasets for our analysis. Our primary cohort (US Renal Data System [USRDS]) included adult patients initiating in-center hemodialysis from July 1, 2006 to June 30, 2008 (n = 33,005) with follow-up through December 31, 2009. Our secondary cohort included adult patients from Dialysis Clinic, Inc. (DCI), a national not-for-profit dialysis provider, initiating in-center hemodialysis from January 1, 2003 to June 30, 2008 (n = 11,291) with follow-up through December 31, 2008. We linked the USRDS cohort with Medicare part D prescriptions-fill data and the DCI cohort with USRDS data. Unique aspect of USRDS cohort was pharmacy prescription-fill data and for DCI cohort was detailed clinical data, including blood pressure, weight, and ultrafiltration. We classified prescribed antihypertensives into the following mutually exclusive regimens: β-blockers, renin–angiotensin system blocking drugs-containing regimens without a β-blocker (RAS), β-blocker + RAS, and others. We used marginal structural models accounting for time-updated comorbidities to quantify each regimen's association with mortality (both cohorts) and cardiovascular hospitalization (DCI-Medicare Subcohort). In the USRDS and DCI cohorts there were 9655 (29%) and 3200 (28%) deaths, respectively. In both cohorts, RAS compared to β-blockers regimens were associated with lower risk of death; (hazard ratio [HR]) (95% confidence interval [CI]) for all-cause mortality, (0.90 [0.82–0.97] in USRDS and 0.87 [0.76–0.98] in DCI) and cardiovascular mortality (0.84 [0.75–0.95] in USRDS and 0.88 [0.71–1.07] in DCI). There was no association between antihypertensive regimens and the risk of

  20. Clinical Practices and Outcomes in Elderly Hemodialysis Patients: Results from the Dialysis Outcomes and Practice Patterns Study (DOPPS)

    PubMed Central

    Tong, Lin; Tentori, Francesca; Akiba, Takashi; Karaboyas, Angelo; Gillespie, Brenda; Akizawa, Tadao; Pisoni, Ronald L.; Bommer, Juergen; Port, Friedrich K.

    2011-01-01

    Summary Background and objectives Demand for hemodialysis among elderly patients is increasing worldwide. Although clinical care of this high-risk group is complex and challenging, no guidelines exist to inform hemodialysis practices. The Dialysis Outcomes and Practice Patterns Study (DOPPS) provides a unique opportunity to assess dialysis practices and associated outcomes among elderly versus younger patients on chronic in-center hemodialysis in 12 countries. Design, setting, participants, & measurements Clinical characteristics, dialysis practices, and outcomes of elderly versus younger patients were compared among participants in four DOPPS regions in 2005 through 2007. Results Although participant mean age increased over time in all DOPPS countries, the percentage of elderly varied widely. Overall, comorbidities and malnutrition were more common in the elderly. Fistulae were used less frequently among elderly versus younger patients in Europe and North America but not in Australia, New Zealand, and Japan. No difference in treatment time was observed between elderly and younger patients after normalizing for body weight. In all regions, ultrafiltration rates were lower among elderly patients. Elderly patients reported poorer quality of life with respect to the physical but not mental component scores. Mortality risk was three- to sixfold higher in the elderly group, whereas causes of death overall were similar for elderly and younger patients. Conclusions Elderly patients represent a different proportion of DOPPS participants across countries, possibly reflecting differences in policies and clinical practices. In general, hemodialysis practices in the elderly reflected each region's clinical patterns, with some variation by age group depending upon the practice. PMID:21734085

  1. Hepatitis C infection in hemodialysis patients: A review.

    PubMed

    Ozer Etik, Digdem; Ocal, Serkan; Boyacioglu, Ahmet Sedat

    2015-04-28

    Hepatitis C virus (HCV)-related liver disease is a significant cause of morbidity and mortality in patients with end-stage renal disease (ESRD) who is treated with dialysis or kidney transplantation (KT). The survival rate for HCV-infected renal transplant recipients is better than that for HCV-infected hemodialysis patients on transplant waiting lists. Early diagnosis and treatment HCV infection prior to KT prevents complications post-transplantation and reduces mortality. In addition to screening for anti-HCV antibodies and detecting HCV RNA, percutaneous liver biopsy is particularly valuable for assessing the stage of liver damage in HCV-infected patients, because the stage of fibrosis is important determining optimal treatment for HCV. Studies have been demonstrated that with conventional interferon (IFN) monotherapy or pegylated IFN monotherapy are similar efficacy and safety in HCV-infected hemodialysis patients. Sustained viral responses (SVRs) with these monotherapies have ranged approximately 30% to 40%. Limited reports support the use of IFN and ribavirin combination therapy as antiviral treatment for ESRD patients or patients on hemodialysis. Ribavirin can be started at low dose and careful monitoring for side effects. Patients that show SVR after treatment are strong candidates for KT. It is also generally accepted that ESRD patients with decompensated cirrhosis and portal hypertension should be referred to the liver transplant team for consideration of combined liver-KT.

  2. Hepatitis C infection in hemodialysis patients: A review

    PubMed Central

    Ozer Etik, Digdem; Ocal, Serkan; Boyacioglu, Ahmet Sedat

    2015-01-01

    Hepatitis C virus (HCV)-related liver disease is a significant cause of morbidity and mortality in patients with end-stage renal disease (ESRD) who is treated with dialysis or kidney transplantation (KT). The survival rate for HCV-infected renal transplant recipients is better than that for HCV-infected hemodialysis patients on transplant waiting lists. Early diagnosis and treatment HCV infection prior to KT prevents complications post-transplantation and reduces mortality. In addition to screening for anti-HCV antibodies and detecting HCV RNA, percutaneous liver biopsy is particularly valuable for assessing the stage of liver damage in HCV-infected patients, because the stage of fibrosis is important determining optimal treatment for HCV. Studies have been demonstrated that with conventional interferon (IFN) monotherapy or pegylated IFN monotherapy are similar efficacy and safety in HCV-infected hemodialysis patients. Sustained viral responses (SVRs) with these monotherapies have ranged approximately 30% to 40%. Limited reports support the use of IFN and ribavirin combination therapy as antiviral treatment for ESRD patients or patients on hemodialysis. Ribavirin can be started at low dose and careful monitoring for side effects. Patients that show SVR after treatment are strong candidates for KT. It is also generally accepted that ESRD patients with decompensated cirrhosis and portal hypertension should be referred to the liver transplant team for consideration of combined liver-KT. PMID:25937865

  3. Intensive Hemodialysis Associates with Improved Survival Compared with Conventional Hemodialysis

    PubMed Central

    Lindsay, Robert M.; Cuerden, Meaghan S.; Garg, Amit X.; Port, Friedrich; Austin, Peter C.; Moist, Louise M.; Pierratos, Andreas; Chan, Christopher T.; Zimmerman, Deborah; Lockridge, Robert S.; Couchoud, Cécile; Chazot, Charles; Ofsthun, Norma; Levin, Adeera; Copland, Michael; Courtney, Mark; Steele, Andrew; McFarlane, Philip A.; Geary, Denis F.; Pauly, Robert P.; Komenda, Paul; Suri, Rita S.

    2012-01-01

    Patients undergoing conventional maintenance hemodialysis typically receive three sessions per week, each lasting 2.5–5.5 hours. Recently, the use of more intensive hemodialysis (>5.5 hours, three to seven times per week) has increased, but the effects of these regimens on survival are uncertain. We conducted a retrospective cohort study to examine whether intensive hemodialysis associates with better survival than conventional hemodialysis. We identified 420 patients in the International Quotidian Dialysis Registry who received intensive home hemodialysis in France, the United States, and Canada between January 2000 and August 2010. We matched 338 of these patients to 1388 patients in the Dialysis Outcomes and Practice Patterns Study who received in-center conventional hemodialysis during the same time period by country, ESRD duration, and propensity score. The intensive hemodialysis group received a mean (SD) 4.8 (1.1) sessions per week with a mean treatment time of 7.4 (0.87) hours per session; the conventional group received three sessions per week with a mean treatment time of 3.9 (0.32) hours per session. During 3008 patient-years of follow-up, 45 (13%) of 338 patients receiving intensive hemodialysis died compared with 293 (21%) of 1388 patients receiving conventional hemodialysis (6.1 versus 10.5 deaths per 100 person-years; hazard ratio, 0.55 [95% confidence interval, 0.34–0.87]). The strength and direction of the observed association between intensive hemodialysis and improved survival were consistent across all prespecified subgroups and sensitivity analyses. In conclusion, there is a strong association between intensive home hemodialysis and improved survival, but whether this relationship is causal remains unknown. PMID:22362910

  4. [Atrial fibrillation and anticoagulation in hemodialysis patients: A complex decision].

    PubMed

    Delanaye, Pierre; Bouquegneau, Antoine; Dubois, Bernard E; Sprynger, Muriel; Mariat, Christophe; Krzesinski, Jean-Marie; Lancellotti, Patrizio

    2017-04-01

    Cardiovascular mortality of hemodialysis patients remains a major problem. The prevalence and incidence of atrial fibrillation in this population are more important than in the general population. The indication of antivitamin K therapy (AVK) in this context of atrial fibrillation must be weighted against the increased risk of bleeding. Unfortunately, and contrary to the general population, an indication of anticoagulation based on embolic or hemorrhagic risk scores is not as clearly established in the hemodialysis population. No prospective randomized study has investigated the benefit/risk balance of anticoagulant treatment in hemodialysis subjects. This article is a review of the current literature on this topic, showing the prevalence of thromboembolic but also bleeding events in the hemodialysis population. The impact of AVK treatment in this specific population is also reviewed. To the best of our knowledge, the indication of treatment must be individualized. Copyright © 2016 Association Société de néphrologie. Published by Elsevier Masson SAS. All rights reserved.

  5. Unusual presentation of tuberculosis in chronic hemodialysis patients.

    PubMed

    Amedia, C; Oettinger, C W

    1977-08-01

    Four patients developed miliary tuberculosis while undergoing chronic hemodialysis. Two patients had diabetes mellitus. Three of the four patients were hemodialyzed 18--24 months prior to the onset of symptoms. Signs and symptoms included prolonged fever, pleural effusion, pericarditis with pericardial effusion, abdominal pain, weight loss, and ascites. All patients were PPD negative and without historical or radiographic evidence of latent tuberculosis. Disseminated tuberculosis was proven at autopsy in three patients. M. tuberculosis was eventually recovered from pleural fluid and urine in the fourth patient. The immune deficiencies of chronic renal failure and diabetes mellitus are suspected predisposing factors to the development of miliary tuberculosis in these patients.

  6. Nutritional status, psychological issues and survival in hemodialysis patients.

    PubMed

    Cohen, Scott D; Kimmel, Paul L

    2007-01-01

    There is a high prevalence of protein-energy malnutrition in the end-stage renal disease population. There are a number of causes of malnutrition in hemodialysis patients, which can often be directly linked to the uremic state. Laboratory measures including albumin, prealbumin, and serum cholesterol, as well as anthropometric measures, have been used to assess malnutrition in this patient population. There is, however, no single accepted measure of malnutrition in patients with chronic kidney disease. Failure to achieve adequate nutritional goals may lead to protein-energy malnutrition, which has been linked to decreased survival. Several studies have also shown a direct association between psychosocial variables, including depression, and the nutritional status of hemodialysis patients, in particular the serum albumin concentration. Interventions such as oral nutritional supplements or intradialytic parenteral nutrition may be necessary to improve nutritional status if conservative measures such as nutritional counseling and regular dietician follow-up fail to produce the changes needed to sustain health. In addition, given the potential link between psychological conditions, such as depression, and overall nutritional status, interventions designed to screen for and treat psychiatric disorders may lead to improvements in nutritional status and therefore increased survival rates of patients with end-stage renal disease treated with hemodialysis. Further study is needed to evaluate the association between depression, malnutrition, and survival in patients with chronic kidney disease.

  7. Oral manifestation and salivary changes in renal patients undergoing hemodialysis

    PubMed Central

    Honarmand, Marieh; Nakhaee, Alireza; Sargolzaie, Fahimeh

    2017-01-01

    Background Salivary changes in hemodialysis patients may result in various oral manifestations. This research intended to determine oral manifestations and some salivary markers in hemodialysis patients. Material and Methods This cross-sectional study was conducted on 30 hemodialysis patients (the patient group) and 30 healthy individuals (the control group). Saliva urea and calcium levels and pH values of the participants were measured, and oral manifestations such as pale mucosa, xerostomia, halitosis, changes in the sense of taste, increased calculus formation, gingival bleeding, etc. were recorded in the information collection form. The data was analyzed using T-test and chi-square, and p<0.05 was considered to be significant. Results The mean salivary urea level and pH value in the patient group were significantly higher compared to those of the control group (P<0.05), but there were no significant differences between the two groups with respect to salivary calcium. Halitosis, xerostomia, and increased calculus were the most prevalent manifestations, and gum bleeding was the least prevalent among the patients. Conclusions Advanced chronic renal insufficiency can increase salivary urea level, pH value, halitosis, xerostomia, and calculus formation, and may cause pale mucosa. Key words:Renal dialysis, biomarkers, oral manifestation, saliva. PMID:28210437

  8. Efficacy of intradialytic parenteral nutrition in malnourished hemodialysis patients.

    PubMed

    Cherry, Nancy; Shalansky, Karen

    2002-09-15

    The efficacy of intradialytic parenteral nutrition (IDPN) in malnourished hemodialysis patients was studied. All patients at a large tertiary care institution who received IDPN for one month or longer between June 1997 and December 2000 were included in the study. The IDPN formulation contained 10% amino acids 250 or 500 mL, 50% dextrose 250 mL, and 20% fat emulsion 250 mL. IDPN was administered during each thrice-weekly hemodialysis session. Patient data were collected 6 and 3 months before IDPN therapy began, at baseline, and 3, 6, 9, and 12 months after the therapy began. Therapeutic efficacy was assessed by the percent change from baseline in dry body weight and serum albumin concentration. Twenty-six courses of IDPN in 24 patients met the study's inclusion criteria. The mean duration of treatment was 4.3 months. Dry body weights were significantly lower 6 and 3 months before the start of IDPN therapy than at baseline and significantly higher 6, 9, and 12 months after the start of therapy. Serum albumin levels were also significantly higher at 3 and 9 months than at baseline. The percentage of treatment courses in which patients had a serum albumin concentration of > or = 34 g/L was 12% at baseline, 39% at 6 months, and 47% at 9 months. Adverse effects consisted primarily of excess fluid gain and hyperglycemia. IDPN therapy significantly increased body weight and serum albumin levels in malnourished hemodialysis patients.

  9. Oral manifestation and salivary changes in renal patients undergoing hemodialysis.

    PubMed

    Honarmand, Marieh; Farhad-Mollashahi, Leila; Nakhaee, Alireza; Sargolzaie, Fahimeh

    2017-02-01

    Salivary changes in hemodialysis patients may result in various oral manifestations. This research intended to determine oral manifestations and some salivary markers in hemodialysis patients. This cross-sectional study was conducted on 30 hemodialysis patients (the patient group) and 30 healthy individuals (the control group). Saliva urea and calcium levels and pH values of the participants were measured, and oral manifestations such as pale mucosa, xerostomia, halitosis, changes in the sense of taste, increased calculus formation, gingival bleeding, etc. were recorded in the information collection form. The data was analyzed using T-test and chi-square, and p<0.05 was considered to be significant. The mean salivary urea level and pH value in the patient group were significantly higher compared to those of the control group (P<0.05), but there were no significant differences between the two groups with respect to salivary calcium. Halitosis, xerostomia, and increased calculus were the most prevalent manifestations, and gum bleeding was the least prevalent among the patients. Advanced chronic renal insufficiency can increase salivary urea level, pH value, halitosis, xerostomia, and calculus formation, and may cause pale mucosa. Key words:Renal dialysis, biomarkers, oral manifestation, saliva.

  10. On the Importance of Pedal Edema in Hemodialysis Patients

    PubMed Central

    Agarwal, Rajiv; Andersen, Martin J.; Pratt, J. Howard

    2008-01-01

    Background and objectives: Volume control is a key component of treatment of hemodialysis patients. The role of pedal edema as a marker of volume is unknown. The objective of this study was to determine factors that are associated with edema. Design, setting, participants, & measurements: A cross-sectional study of asymptomatic hemodialysis patients (n = 146) in four university-affiliated hemodialysis units was conducted. Echocardiographic variables, blood volume monitoring, plasma volume markers (plasma renin and aldosterone and N-terminal pro B-type natriuretic peptide), and inflammation markers (C-reactive protein and IL-6) were measured as exposures, and edema was measured as outcome. Results: In a multivariate logistic regression analysis, age, body mass index, and left ventricular hypertrophy were independent determinants of edema. Compared with patients with normal or low weight, overweight patients had odds ratio for edema of 5.7 (95% confidence interval [CI] 1.0 to 31.8), and obese patients of 44.8 (95% CI 9.0 to 223). Patients in the top quartile of left ventricular mass index and normal to low weight had odds ratio of edema of 7.7 (95% CI 2.3 −25.9), those who were overweight of 43.5 (95% CI 3.9 to 479.8), and those who were obese of 344.8 (95% CI 33.8 to 3515). Inferior vena cava diameter, blood volume monitoring, plasma volume markers, and inflammation markers were not determinants of edema. Conclusions: Pedal edema correlates with cardiovascular risk factors such as age, body mass index, and left ventricular mass but does not reflect volume in hemodialysis patients. PMID:18057304

  11. Anthropometric Indicators Predict Metabolic Syndrome Diagnosis in Maintenance Hemodialysis Patients.

    PubMed

    Vogt, Barbara Perez; Ponce, Daniela; Caramori, Jacqueline Costa Teixeira

    2016-06-01

    Obesity has been considered the key in metabolic syndrome (MetS) development, and fat accumulation may be responsible for the occurrence of metabolic abnormalities in hemodialysis patients. The use of gold-standard methods to evaluate obesity is limited, and anthropometric measures may be the simplest methods. However, no study has investigated the association between anthropometric indexes and MetS in these patients. Therefore, the aim was to determine which anthropometric indexes had the best association and prediction for MetS in patients undergoing hemodialysis. Cross-sectional study that included patients older than 18 years, undergoing hemodialysis for at least 3 months. Patients with liver disease and cancer or those receiving corticosteroids or antiretroviral therapy were excluded. Diagnostic criteria from Harmonizing Metabolic Syndrome were used for the diagnosis of MetS. Anthropometric indexes evaluated were body mass index (BMI); percent standard of triceps skinfold thickness and of middle arm muscle circumference; waist circumference (WC); sagittal abdominal diameter; neck circumference; waist-to-hip, waist-to-thigh, and waist-to-height ratios; sagittal index; conicity index; and body fat percentage. Ninety-eight patients were included, 54.1% male, and mean age was 57.8 ± 12.9 years. The prevalence of MetS was 74.5%. Individuals with MetS had increased accumulation of abdominal fat and general obesity. Waist-to-height ratio was the variable independently associated with MetS diagnosis (odds ratio, 1.21; 95% confidence interval, 1.09-1.34; P < .01) and that better predicts MetS, followed by WC and BMI (area under the curve of 0.840, 0.836, and 0.798, respectively, P < .01). Waist-to-height ratio was the best anthropometric predictor of MetS in maintenance hemodialysis patients. © 2015 American Society for Parenteral and Enteral Nutrition.

  12. Skin autofluorescence predicts cardiovascular mortality in patients on chronic hemodialysis.

    PubMed

    Kimura, Hiroshi; Tanaka, Kenichi; Kanno, Makoto; Watanabe, Kimio; Hayashi, Yoshimitsu; Asahi, Koichi; Suzuki, Hodaka; Sato, Keiji; Sakaue, Michiaki; Terawaki, Hiroyuki; Nakayama, Masaaki; Miyata, Toshio; Watanabe, Tsuyoshi

    2014-10-01

    Tissue accumulation of advanced glycation end products (AGE) is thought to contribute to the progression of cardiovascular disease (CVD). Skin autofluorescence, a non-invasive measure of AGE accumulation using autofluorescence of the skin under ultraviolet light, has been reported to be an independent predictor of mortality associated with CVD in Caucasian patients on chronic hemodialysis. The aim of this study was to assess the predictive value of skin autofluorescence on all-cause and cardiovascular mortality in non-Caucasian (Japanese) patients on chronic hemodialysis. Baseline skin autofluorescence was measured with an autofluorescence reader in 128 non-Caucasian (Japanese) patients on chronic hemodialysis. All-cause and cardiovascular mortality was monitored prospectively during a period of 6 years. During the follow-up period, 42 of the 128 patients died; 19 of those patients died of CVD. Skin autofluorescence did not have a significant effect on all-cause mortality. However, age, carotid artery intima-media thickness (IMT), serum albumin, high-sensitivity C-reactive protein (hsCRP), skin autofluorescence and pre-existing CVD were significantly correlated with cardiovascular mortality. Multivariate Cox regression analysis showed skin autofluorescence (adjusted hazard ratio [HR] 3.97; 95% confidence interval [CI]1.67-9.43), serum albumin (adjusted HR 0.05; 95% CI 0.01-0.32), and hsCRP (adjusted HR 1.55; 95% CI 1.18-2.05) to be independent predictors of cardiovascular mortality. The present study suggests that skin autofluorescence is an independent predictor of cardiovascular mortality in non-Caucasian (Japanese) patients on chronic hemodialysis.

  13. Do psychological interventions reduce depression in hemodialysis patients?

    PubMed Central

    Xing, Lu; Chen, Ruiqi; Diao, Yongshu; Qian, Jiahui; You, Chao; Jiang, Xiaolian

    2016-01-01

    Abstract Background: Depression is highly prevalent in hemodialysis patients and results in poor patient outcomes. Although psychological interventions are being developed and used for these patients, there is uncertainty regarding the effectiveness of these interventions. The purpose of this meta-analysis is to evaluate the effects of psychological interventions on depression treatment in hemodialysis patients. Methods: All randomized controlled trials (RCTs) relevant to the depression treatment of hemodialysis patients through psychological interventions were retrieved from the following databases: Embase, Pubmed, PsycINFO, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials. The reference lists of identified RCTs were also screened. The Cochrane risk of bias tool was used to evaluate the quality of the studies, RevMan (5.3) was used to analyze the data, and the evidence quality of the combined results was evaluated using GRADE (3.6.1). Results: Eight RCTs were included. The combined results showed that psychological interventions significantly reduced the scores of the Beck Depression Inventory (P<0.001) and interdialysis weight gain (P<0.001). However, due to the high heterogeneity, effect size combinations of sleep quality and quality of life were not performed. Conclusion: Psychological interventions may reduce the degree of depression and improve fluid intake restriction adherence. More rigorously designed research is needed. PMID:27559971

  14. Hepcidin levels in chronic hemodialysis patients: a critical evaluation.

    PubMed

    Valenti, Luca; Messa, Piergiorgio; Pelusi, Serena; Campostrini, Natascia; Girelli, Domenico

    2014-05-01

    Altered systemic iron metabolism is a key element of uremia, and functional iron deficiency mainly related to subclinical inflammation makes it difficult to maintain proper control of anemia in chronic hemodialysis patients (CHD). In the last decade, the hepatic hormone hepcidin has been progressively recognized as the master regulator of circulating iron levels through the modulation of cellular iron fluxes in response to iron stores, as well as to erythroid and inflammatory stimuli. Hepcidin is cleared by the kidney and progression of renal disease has been associated to increased serum hepcidin levels. This, in turn, reduces iron availability for erythropoiesis, suggesting anti-hepcidin strategies for improving anemia control. Moreover, hepcidin has been recently implicated in the pathogenesis of long-term complications of dialysis, like accelerated atherosclerosis. Initial studies almost invariably reported a sustained increase of serum hepcidin in chronic hemodialysis patients. Noteworthy, such studies included relatively few patients and controls that were poorly matched for major determinants of serum hepcidin at population level, i.e., age and gender. More recent data based on accurately matched larger series challenge the view that hepcidin is intrinsically increased in hemodialysis patients, showing a marked inter- and intra-individual variability of hormone levels. Here we take a critical look to the data published so far on hepcidin levels in CHD, analyze the reasons underlying the discrepancies in available studies and the hepcidin variability in CHD, and point out the need for further studies in large series of well-characterized CHD patients and controls.

  15. Evaluation of Results of Diagnostic Ureteroscopy in Chronic Hemodialysis Patients.

    PubMed

    Kilinc, Muhammet Fatih; Doluoglu, Omer Gokhan; Karakan, Tolga; Yildiz, Yildiray; Sonmez, Nurettin Cem; Dalkilic, Ayhan

    2016-04-01

    To investigate the safety of diagnostic ureteroscopy (dURS) in chronic hemodialysis patients. The data of chronic hemodialysis patients (group I) and the patients with normal estimated glomerular filtration rate (eGFR) (group II) who had dURS between 2004 and 2014 were analyzed retrospectively. eGFR, complications, and postoperative stent placement were noted in all patients. Continuous and categorical variables were compared between the groups. p < 0.05 was considered as statistically significant. Overall complication rate of group I was 10.5%, while this rate was 4.8% in group II (p = 0.16). No statistically significant differences were noted in terms of gender, age, or laterality between two groups. The mean duration of surgery and the rates of balloon dilatation and postoperative stent placement were higher in group I when compared with group II, and differences were statistically significant (p < 0.05). In this study, we determined that dURS was a safe method in chronic hemodialysis patients. However, duration of surgery and the rates of balloon dilatation and postoperative stent placement were high in our study.

  16. Is There any Time Dependant Echocardiographical Finding in Chronic Hemodialysis Patients?

    PubMed Central

    Abbasnezhad, Mohsen; Tayyebi-Khosroshahi, Hamid; Ghanbarpour, Amin; Habibzadeh, Afshin

    2012-01-01

    Background Cardiac disease is the main cause of death in hemodialysis patients. In hemodialysis patients cardiovascular complications are great clinical challenge, and function, shape and left ventricle abnormalities are present in 70 - 80 percent of dialysis patients. Changes in heart function occur in hemodialysis period and are effective in patient’s prognosis. In this study we aim to evaluate time dependant clinical and echocardiographical findings in chronic hemodialysis patients. Methods In a cross-sectional study, 100 adult hemodialysis patients (51% male and 49% female with mean age 52.13 ± 12.69 years) visiting dialysis unit in Imam Reza and Madani hospitals between years 2010 and 2011 were studied in group 1 (hemodialysis ≤ 6 months), group 2 (hemodialysis for 6 months to 3 years) and group 3 (hemodialysis ≥ 3 years). Demographic, laboratory and echocardiographic findings were compared between groups. Results Among demographic findings, group 3 had significantly higher diastolic blood pressure and weight gain and was older than other two groups (P < 0.05). By increase in hemodialysis period, patients had higher blood urea nitrogen and lower serum albumin levels (P < 0.05). Potassium level in group 2 was significantly higher than group 3 and that was higher than group 1. There was no difference between groups in left ventricular hypertrophy (LVH), left atrium dilatation, ejection fraction and mitral insufficiency. Diastolic dysfunction increased in line with increase in hemodialysis period (P = 0.007). Hemodialysis period was higher in patients with LVH than those without (34.80 ± 9.2 months versus 18.51 ± 2.22 months, P = 0.01). Conclusion In hemodialysis patients, diastolic dysfunction increases by the hemodialysis time (years). LVH and LA dilation also increase during time, but not significantly.

  17. Exploring the reasons for the tiny percentage of patients on home hemodialysis.

    PubMed

    Koester, Lisa

    2013-01-01

    The number of patients requiring renal replacement therapy continues to grow. When patients are told they need a life-sustaining treatment, it is a profound experience that impacts all aspects of their lives and the lives of their families. In the United States, the stark reality is the majority of patients are treated with in-center hemodialysis, and only a very small percentage with a home dialysis therapy, such as peritoneal dialysis or home hemodialysis. Why is this? Do patients not factor in preference, independence, or quality and maintenance of a normal life? Or is it that as a renal community, nephrology nurses do not expose patients to the knowledge they need and promote involvement in this decision-making? Is patient autonomy being fostered? This article explores the reasons for the tiny percentage of patients on home dialysis and suggests strategies to address the education needed, the dynamics of why patients decide on a therapy, patient selection characteristics, and myths of who is and is not a candidate.

  18. Nutritional knowledge in hemodialysis patients and nurses: focus on phosphorus.

    PubMed

    Cupisti, Adamasco; Ferretti, Valerio; D'Alessandro, Claudia; Petrone, Isabella; Di Giorgio, Adriana; Meola, Mario; Panichi, Vincenzo; Conti, Paolo; Lippi, Alberto; Caprioli, Raffaele; Capitanini, Alessandro

    2012-11-01

    To assess the knowledge of adult hemodialysis patients and nurses working in dialysis units, specifically with regard to knowledge of phosphorus and other nutrients related to dietary management of end-stage renal disease. Cross-sectional cohort study. Hemodialysis unit. One hundred ninety-one hemodialysis patients and 105 dialysis nurses, as well as 86 control hospital employees who are not health professionals. Nutritional knowledge was assessed by a 25-item chronic kidney disease knowledge assessment tool for nutrition, which includes 15 questions on phosphorus and 10 questions on protein, sodium, and potassium knowledge. The scores obtained by patients were much lower than those of nurses (11.6 ± 3.9 vs. 16.0 ± 2.2, P < .001) but slightly higher than those of controls (10.6 ± 3.2, P < .05). Patients with phosphorus serum level >5.5 mg/dL showed chronic kidney disease knowledge assessment tool for nutrition scores similar to those of patients with a serum phosphorus level <5.5 mg/dL. The prevalence of right answers to questions regarding knowledge of phosphorus was lower than that regarding knowledge of the other nutrients, both for patients (38.4% ± 17.8% vs. 57.3% ± 19.9%, P < .001) and nurses (55.6% ± 11.1% vs. 74.8% ± 11.7%, P < .001) as well as for controls (30.7% ± 14.5% vs. 60.1% ± 17.4%, P < .001). Our study suggests that nutritional knowledge of hemodialysis patients, although higher than the general population, is lower for phosphorus with respect to the other nutrients, such as protein, sodium, and potassium. This occurs even in patients with hyperphosphatemia or those taking phosphate binder medications. Nurses showed the best scores; however, improvement is necessary, especially with regard to knowledge of phosphorus. Training programs on nutrition for nurses and on information for patients should be implemented. They can contribute to achievement of a more effective control of phosphate balance, reduction of costs, and improvement of the

  19. 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.

  20. Distribution characteristics of mitoxantrone in a patient undergoing hemodialysis.

    PubMed

    Boros, L; Cacek, T; Pine, R B; Battaglia, A C

    1992-01-01

    The pharmacokinetic profile of mitoxantrone in a patient undergoing hemodialysis is described. Significant characteristics of our patient included lymphoma with liver involvement, tumor lysis syndrome, renal and hepatic failure. Combination chemotherapy consisted of mitoxantrone, vincristine, and cyclophosphamide. Mitoxantrone plasma samples were obtained prior to dosing and at 0, 0.25, 0.5, 0.75, 1.0, 1.5, 2.0, 2.5, 3.0, 3.5, 4.0, 4.5, 5.5, 7.0, and 12 h after the intravenous infusion of a 17-mg dose over 20 min. Serum concentrations were determined by high-performance liquid chromatography. The serum concentration versus time curve was consistent with a three-compartment model. However, rebounds in serum drug concentrations were detected during the last portion of dialysis and after its completion. The gamma elimination half-life could not be determined due to the continued detection of rebounds in drug concentrations throughout the postdialysis sampling period. The alpha and beta distribution phases did not appear to be affected by hemodialysis. The peak mitoxantrone concentration fell within the reported range. Mitoxantrone does not appear to be eliminated by hemodialysis, and dose adjustments are not needed in patients undergoing this procedure.

  1. Association between the hemodialysis eating index and risk factors of cardiovascular disease in hemodialysis patients.

    PubMed

    Chiu, Yi-Fang; Chen, Yi-Chun; Wu, Pei-Yu; Shih, Chun-Kuang; Chen, Hsin-Hung; Chen, Hsi-Hsien; Chen, Tso-Hsiao; Yang, Shwu-Huey

    2014-05-01

    In this study, a Hemodialysis Eating Index (HDEI) suitable for hemodialysis (HD) patients in Taiwan was developed based on the dietary recommendations of the U.S. National Kidney Foundation for HD patients and the Taiwanese 2011 Daily Food Guide. The HDEI was used to explore HD-associated cardiovascular disease (CVD) risk factors. In this prospective study, 108 HD patients from 2 HD centers in Taiwan were recruited as participants in 2010. All participants were older than 20 years. Patient CVD risk factor and 3-day dietary data were collected, and their HDEI scores were calculated. The HDEI scores comprise 12 food-related factors: the consumption of vegetables, fruits, total grains, whole grains, high-protein foods, high biological values, red and white meat, fish, oils, saturated fatty acids or trans fatty acids, nuts, and the duration of multivitamin use. The scores ranged from 5 to 100, and SAS software version 9.3 was used to perform statistical analyses. A P value less than .05 was considered statistically significant. The HDEI scores and serum albumin (Alb) levels were significantly and positively correlated. The participants were divided into 2 groups on the basis of the median HDEI score of 72.2. Two months after HDEI evaluation, the high-HDEI scoring group exhibited significantly decreased levels of serum total cholesterol and increased hemoglobin (Hb) levels. The HDEI can be used to reflect selected nutritional status markers, such as Alb and Hb levels and CVD risk factors, for HD patients. The HDEI can also serve as an eating index for HD patients in Taiwan to facilitate CVD prevention. Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  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. [Superior vena cava thrombosis in a patient on hemodialysis].

    PubMed

    Saval, N; Pou, M; López Pedret, J; Burrell, M; Cases, A

    2004-01-01

    We present a patient with end-stage renal disease on maintenace hemodialysis through a permanent catheter (Permcath) on the right subclavian vein. One month after the catheter placement the patient exhibited a superior vena cava syndrome due to a pericatheter thrombosis. The patient was initially managed with anticoagulation with early clinical improvement. Nevertheless, the reappearance of the symptoms forced the removal of the catheter and percutaneous angioplasty of the superior vena cava. After those measures and anticoagulation with coumarin the patient remains stable with complete clinical resolution and angiographical improvement.

  4. Impact of BMI Variations on Survival in Elderly Hemodialysis Patients.

    PubMed

    Villain, Cédric; Ecochard, René; Genet, Leslie; Jean, Guillaume; Kuentz, François; Lataillade, Dominique; Legrand, Eric; Moreau-Gaudry, Xavier; Fouque, Denis

    2015-11-01

    In elderly hemodialysis patients, protein-energy wasting is associated with poor outcome; however, the association between body mass index (BMI) changes over time, and survival has been seldom studied in this particularly frail population. This prospective study recruited 502 hemodialysis patients aged ≥75 years from the French cohort ARNOS and followed them from 2005 to 2009. BMI changes over time were modeled by individual linear regression models. Survival analyses used frailty Cox models. The population average age was 80.9 years. Forty-one percent of the patients died during follow-up. A 1 kg/m(2) lower baseline BMI was associated with a 4% increase in the risk of death over the study period (hazard ratio [HR] 1.04, 95% confidence interval [1.01-1.08], P = .02). A 5% BMI loss per year was associated with a 52% increase in the risk of death (HR 1.52, 95% confidence interval [1.32-1.75], P < .001). In patients who lost weight (>5% BMI loss per year), the lower was the baseline BMI, the higher was the HR for death. There was a similar trend in the patients with stable weight (5% BMI loss-5% BMI gain per year). In patients who gained weight, the HR was unexpectedly higher than in those with stable weight. In elderly hemodialysis patients, the impact of the BMI percent change on survival was stronger than that of the baseline BMI. Patients with stable weight had longer survivals than patients who lost or gained weight. Thus, in this population, BMI changes should be regularly assessed. Further studies should assess the safety of weight gain strategies. Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  5. [Study of the metabolic syndrome and obesity in hemodialysis patients].

    PubMed

    Quero Alfonso, Angel I; Fernández Gallegos, Ruth; Fernández Castillo, Rafael; Gomez Jimenez, Francisco Javier; García Rios, María Del Carmen; García García, Inmaculada

    2014-10-23

    The metabolic syndrome (MS) consists of a set of clinical and biochemical changes. It is very common among chronic hemodialysis patients, being the leading cause of death in these patients, 44% of all patients undergoing this therapy. The aim of this study was to investigate the prevalence of MS and risk factors associated with its development, as well as the prevalence of obesity in HD patients. This study has followed 90 patients of both sexes with chronic renal failure (CRF) who were treated with hemodialysis periodically in our unit for ten years. All patients were performed quarterly measurements of plasma albumin (A1b) and other biochemical analysis; besides, they underwent some anthropometric measurements like weight, height and body mass index (BMI). This was calculated using weight / size2 formula and grouped in BMI values according to WHO criteria. The data concerning hypertension and glucose were also considered. The prevalence of MS was 25% and obesity was presented as follows: 45% with type I overweight; 30.8% with type II overweight and 12 patients (2%) were obese. Being statistically significant as risk factors, BMI, overweight, triglycerides, total cholesterol, HDL cholesterol as well as hypertension and elevated glucose levels were obtained. The metabolic syndrome compromises the patient survival causing a high prevalence in these patients. The principal risk factors in MS are monitoring weight, BMI, triglycerides, HDL cholesterol, hypertension and diabetes. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

  6. Comparison of Goals of Care Between Hemodialysis Patients and Their Health Care Providers

    PubMed Central

    Lefkowitz, Ariel; Henry, Blair; Bottoms, Jennifer; Myers, Jeffery; Naimark, David M. J.

    2016-01-01

    Background: Patient-centered care requires knowledge of patients’ goals of care (GoC) on the part of health care providers (HCPs). Whether HCPs caring for in-center hemodialysis patients meet this criterion is uncertain. Objective: We designed and conducted a GoC survey among patients and HCPs within a single in-center hemodialysis (ICHD) program to determine whether HCPs have an understanding of their patients’ GoC. Design: This was a prospective comparative quantitative survey study. Setting: The study included a single Canadian maintenance ICHD center. Participants: These included hemodialysis patients and their primary nephrologists, nurses, social workers, pharmacists, and dietitians. Methods and Measurements: Two surveys, one for patients and another for primary HCPs, were designed, piloted, and administered. For each participating patient, HCPs consisted of the primary nephrologist, nurse, social worker, pharmacist, and dietitian. Surveys included questions pertaining to 7 GoC themes. Patient-HCP agreement on the importance of each domain individually and the most important domain overall was assessed with kappa statistics. Factors influencing agreement were assessed with logistic regression in a secondary analysis. Results: A total of 173 patients were invited to participate, of whom 137 (79%) completed surveys. Fifty HCPs completed 623 corresponding surveys: 132 by physicians, 112 by nurses, 126 by pharmacists, 127 by social workers, and 126 by dietitians. A total of 70.1% and 78.8% of patients agreed with the importance of and would feel comfortable having GoC discussions, respectively, with their HCPs; 42.7% of physicians reported not having provided prognostic information to the corresponding patient. Patient-HCP agreement regarding GoC was poor (all κ < .25, all P values > .05). In adjusted analyses, only patients choosing “Be Cured” as the most important GoC was significantly associated with poorer HCP-patient agreement than expected (odds

  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.

  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. 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

  10. Magnesium Modifies the Cardiovascular Mortality Risk Associated with Hyperphosphatemia in Patients Undergoing Hemodialysis: A Cohort Study

    PubMed Central

    Sakaguchi, Yusuke; Fujii, Naohiko; Shoji, Tatsuya; Hayashi, Terumasa; Rakugi, Hiromi; Iseki, Kunitoshi; Tsubakihara, Yoshiharu; Isaka, Yoshitaka

    2014-01-01

    Background In vitro studies have shown inhibitory effects of magnesium (Mg) on phosphate-induced calcification of vascular smooth muscle cells, raising the possibility that maintaining a high Mg level may be useful for reducing cardiovascular risks of patients with hyperphosphatemia. We examined how serum Mg levels affect the association between serum phosphate levels and the risk of cardiovascular mortality in patients undergoing hemodialysis. Methods A nationwide register-based cohort study was conducted using database of the Renal Data Registry of the Japanese Society for Dialysis Therapy in 2009. We identified 142,069 patients receiving in-center hemodialysis whose baseline serum Mg and phosphate levels were available. Study outcomes were one-year cardiovascular and all-cause mortality. Serum Mg levels were categorized into three groups (lower, <2.7 mg/dL; intermediate, ≥2.7, <3.1 mg/dL; and higher, ≥3.1 mg/dL). Results During follow-up, 11,401 deaths occurred, out of which 4,751 (41.7%) were ascribed to cardiovascular disease. In multivariable analyses, an increase in serum phosphate levels elevated the risk of cardiovascular mortality in the lower- and intermediate-Mg groups, whereas no significant risk increment was observed in the higher-Mg group. Moreover, among patients with serum phosphate levels of ≥6.0 mg/dL, the cardiovascular mortality risk significantly decreased with increasing serum Mg levels (adjusted odds ratios [95% confidence intervals] of the lower-, intermediate-, and higher-Mg groups were 1.00 (reference), 0.81 [0.66–0.99], and 0.74 [0.56–0.97], respectively.). An interaction between Mg and phosphate on the risk of cardiovascular mortality was statistically significant (P = 0.03). Conclusion Serum Mg levels significantly modified the mortality risk associated with hyperphosphatemia in patients undergoing hemodialysis. PMID:25545498

  11. Cinacalcet Lowers Serum Alkaline Phosphatase in Maintenance Hemodialysis Patients

    PubMed Central

    Belozeroff, Vasily; Goodman, William G.; Ren, Lulu; Kalantar-Zadeh, Kamyar

    2009-01-01

    Background and objectives: Studies suggest an association between elevated serum alkaline phosphatase (AP) and increased mortality in hemodialysis patients, but the effect of existing therapies on AP is not fully understood. We assessed the effects of cinacalcet on AP in a secondary analysis of controlled trial data. Design, setting, participants, & measurements: This was a post hoc analysis of data from three 26-wk randomized, double-blind, placebo-controlled, phase 3 trials and a 26-wk double-blind, placebo-controlled extension trial that investigated cinacalcet in secondary hyperparathyroidism treatment in dialysis patients. Hemodialysis patients (n = 890) with intact parathyroid hormone ≥300 pg/ml and serum calcium ≥8.4 mg/dl received cinacalcet plus standard therapy or standard therapy alone for up to 52 wk. Total, not bone-specific, AP was assessed (proportion of cinacalcet/control subjects achieving a ≥20% or any AP reduction from baseline; the proportion of subjects with AP ≥120 U/L) at baseline; the end of titration; and study weeks 26, 42, and 52. Results: At 52 wk, a greater proportion of cinacalcet-treated patients had either a ≥20% (39 versus 18%) or any (58 versus 36%) AP reduction compared with control subjects, respectively. The likelihood of achieving either a ≥20% or any AP reduction (determined by relative proportion) was 2.33 (95% confidence interval 1.50 to 3.61) and 1.74 (95% confidence interval 1.31 to 2.31), respectively, at week 52. Cinacalcet treatment tended toward a decreased percentage of patients with AP ≥120 U/L (baseline, 42.6%; week 52, 30.6%) compared with control (35.0 to 48.6%, respectively). Conclusions: In this combined analysis of controlled trials of patients who were receiving hemodialysis, cinacalcet lowered total serum AP. PMID:19261825

  12. Nutritional status and interdialytic weight gain of chronic hemodialysis patients.

    PubMed

    Ferraz, Sanzia Francisca; Freitas, Ana Tereza Vaz de Souza; Vaz, Inaiana Marques Filizola; Campos, Marta Isabel Valente Andrade Morais; Peixoto, Maria do Rosário Gondim; Pereira, Edna Regina Silva

    2015-01-01

    The nutritional status (NS) of patients on hemodialysis (HD) is a major concern and challenge. Malnutrition is common in these patients and is related to poorer clinical outcomes. To assess the association between the NS and the interdialytic weight gain (IDWG) of patients with chronic kidney disease (CKD) on HD. Cross-sectional study with 322 patients older than 18 years. The NS was assessed by body mass index (BMI), percentage body fat estimated by the sum of four skinfolds (triceps, biceps, subscapular and supra iliac), lean body mass (LBM), serum creatinine and albumin and rate of nitrogen appearance (PNA). The IDWG was evaluated from the sum of the weight difference of 12 hemodialysis sessions (IDWGm). Considering the sample into quartiles IDWGm, it was found that BMI, LBM, serum creatinine ( p < 0.001) and PNA ( p = 0.011) were directly correlated. There was no association between IDWGm and serum albumin. Using multivariate analysis, it was found that the prevalence of patients with BMI suitability and serum creatinine were significantly higher for patients in the bottom quartile with respect to the first IDWGm. The NS is positively associated with IDWG. The results point to the need for individualized assessment of IDWG and cautious in order not to generalize a recommendation that does not meet the expectations of maintaining and promoting the nutritional status of these patients.

  13. Discussion groups for chronic hemodialysis patients and their families.

    PubMed

    Steinglass, P; Gonzalez, S; Dosovitz, I; Reiss, D

    1982-04-01

    The family as well as the patient undergoes many psychological stresses in the adjustment to end stage renal disease and maintenance hemodialysis. Despite the apparent need for psychological support services for families, few are offered. Renal social workers have found it difficult to elicit interest in discussion groups for families dealing with problems associated with dialysis. This report presents two discussion groups that were recruited and conducted for dialysis patients and their families. The process and development of the two groups are described, and recommendations are given for conducting multiple-family groups as an adjunct to the biologic treatment of severe long-term illness.

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

    PubMed

    Tsuchida, Yohei; Takata, Takuma; Ikarashi, Toshihiko; Iino, Noriaki; Kazama, Junichiro J; Narita, Ichiei

    2013-11-18

    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. 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. 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.

  15. Fatigue experienced by patients receiving maintenance dialysis in hemodialysis units.

    PubMed

    Letchmi, Santhna; Das, Srijit; Halim, Hasliza; Zakariah, Farid Azizul; Hassan, Hamidah; Mat, Samsiah; Packiavathy, Ruth

    2011-03-01

    The fatigue that is observed in patients who are undergoing dialysis is usually associated with an impaired quality of life. The present cross-sectional study was conducted from January to April 2009 in three hemodialysis units in Kuala Lumpur, Malaysia. In this study, the Multidimensional Fatigue Inventory and Depression Anxiety and Stress Score 21 were used to determine the level of fatigue, depression, anxiety, and stress of patients who were undergoing dialysis. The data were obtained from a calculated sample of 116 and a total of 103 respondents participated in the study. A total of 56 (54.4%) and 47 (45.6%) respondents experienced a high level and a low level of fatigue, respectively. There was a significant relationship between the duration of treatment and the level of fatigue. The respondents who had been receiving treatment for > 2 years experienced more fatigue, compared to the respondents who had been undergoing hemodialysis for > 2 years. There was a significant difference in relation to the age of the participants regarding the level of fatigue. No significant relationship between the sex of the participants, anemia, depression, anxiety, stress, and the level of fatigue was observed. Special attention needs to be paid to both the younger and older adults who are receiving treatment. In addition, proper planning is needed for the patients regarding their daily activities in order to reduce fatigue. Nurses who work in hemodialysis units are recommended to provide exercise classes or group therapy in order to boost the energy levels among patients who are undergoing dialysis. Health professionals should provide appropriate treatment for patients who are experiencing fatigue in order to prevent any other complications that could arise.

  16. [Pulmonary hypertension in hemodialysis patients: Prevalence and associated factors].

    PubMed

    Reque, Javier; Quiroga, Borja; Ruiz, Caridad; Villaverde, Maria Teresa; Vega, Almudena; Abad, Soraya; Panizo, Nayara; López-Gómez, J Manuel

    2016-02-19

    Pulmonary hypertension (PH) is a progressive disorder that can be caused by several underlying conditions or an intrinsic alteration of the pulmonary vasculature. Chronic increased pressure in the pulmonary vasculature leads to changes in the architecture of the vessels that can perpetuate PH and produce right ventricular dysfunction. These structural and functional alterations can decrease survival and quality of life of patients on hemodialysis; however, there is a lack of evidence about this problem in this population. The aim of this study is to establish the prevalence of PH in patients on hemodialysis and its association with specific factors related to this patient population. We included 202 prevalent patients on hemodialysis for at least 6 months and who were clinically stable. We collected demographic data, routine laboratory parameters and data of 2D Doppler-echocardiography. PH was defined as a systolic pulmonary artery pressure (SPAP) estimated by Doppler ultrasound above 35mmHg. Hydration status was assessed by determining the plasma concentration of N-terminal pro brain natriuretic peptide (Nt-proBNP). PH prevalence was 37.1% (75 patients). The average SPAP in the entire study population was 32±12mmHg and in the group with PH it was 45±11mmHg. We found a direct and statistically significant correlation between the presence of PH and age (P=.001), time on renal replacement therapy (P=.04), the presence of systolic dysfunction (P=.007), diastolic dysfunction (P= 01), mitral valve disease (P=.01) and double mitral and aortic disease (P=.007). Volume overload was closely associated with PH, as demonstrated by the correlation between the SPAP and Nt-proBNP levels (P=.001). We conclude that prevalence of PH in hemodialysis patients is high. And one of the most important associated factors is volume overload. More studies are needed to establish the impact of PH on morbidity and mortality of patients and to assess whether a better volume control improves

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

    USDA-ARS?s Scientific Manuscript database

    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...

  18. Digital infarction in a hemodialysis patient due to embolism from a thrombosed brachial arteriovenous fistula.

    PubMed

    Yj, Anupama

    2015-10-01

    Acute onset of digital ischemia and infarction is an unusual complication in patients undergoing hemodialysis. This is a report of a patient on regular hemodialysis who presented with acute distal extremity ischemia, progressing to digital infarction and on evaluation was found to have thrombosis of brachial arteriovenous fistula with embolization to the distal arteries causing digital artery occlusion.

  19. 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

  20. [Nutritional status of old patients on programmed hemodialysis].

    PubMed

    Revkovskaia, N S; Denisov, A Iu; Borisov, I A

    2008-01-01

    To study nutritional status of old patients on programmed hemodialysis. A total of 82 patients aged 60-88 years were divided into two groups by age: group 1 (n = 41) consisted of 60-75 year-olds, group 2 (n = 41) included 76-year-olds and older. The nutritional status (NS) was assessed by anthropometric and laboratory data, a prognostic hypotrophy index. In group 1 NS was normal in 65.9% patients while in group 2--only in 29.2%. Older patients had obesity in 21.9% cases. It is shown that two thirds of presenile and senile patients have abnormal nutritional status. Taking into consideration the fact that protein-energy insufficiency is an unfavourable factor affecting the patients'survival, old patients need a special control of nutritional status and its early correction.

  1. The evaluation of iron status in hemodialysis patients.

    PubMed

    Fishbane, S; Kowalski, E A; Imbriano, L J; Maesaka, J K

    1996-12-01

    Effective treatment of anemia in hemodialysis patients requires ongoing monitoring of iron status. The purpose of this study was to determine levels of commonly used iron indices predictive of iron deficiency in this population. Forty-seven patients with baseline serum ferritin levels < 600 ng/mL were treated with intravenous iron dextran (INFeD; Schein Pharmaceutical Inc., Florham Park, NJ), 1000 mg over ten hemodialysis treatments. Patients whose hematocrit value increased by 5% or who had a 10% decrease in their erythropoietin dose by 2 months were classified as having iron deficiency (N = 31; 66%). All other subjects were classified as having adequate iron (N = 16; 34%). There was no statistically significant difference in baseline serum ferritin, transferrin saturation, mean cell volume, mean cell hemoglobin content, or red cell distribution width between the two groups. Receiver operator curves demonstrated that none of the iron indices had a high level of utility (both sensitivity and specificity > 80%). Two tests had marginal utility, serum ferritin at a level of < 150 ng/mL, and transferrin saturation < 21%. It was concluded that because of the tests' marginal utility, they should only be interpreted in the context of the patient's underlying erythropoietin, responsiveness. In patients who are responsive to erythropoietin, a transferrin saturation value < 18% or serum ferritin level < 100 ng/mL should be used to indicate inadequate iron. When erythropoietin resistance is present, transferrin saturation of < 27% or serum ferritin < 300 ng/mL should be used to guide iron management.

  2. Hemodialysis patients have plasmatic hypercoagulability and decreased fibrinolytic vulnerability: role of carbon monoxide.

    PubMed

    Matika, Ryan W; Nielsen, Vance G; Steinbrenner, Evangelina B; Sussman, Amy N; Madhrira, Machaiah

    2014-01-01

    Chronic hemodialysis is associated with significant thrombophilia. Of interest, hemodialysis patients have increased carboxyhemoglobin (COHb) and exhaled carbon monoxide (CO), signs of upregulated heme oxygenase (Hmox) activity. Given that CO enhances plasmatic coagulation, we determined whether patients requiring chronic hemodialysis had an increase in endogenous CO, plasmatic hypercoagulability and decreased fibrinolytic vulnerability. Carbon monoxide was determined by noninvasive pulse oximetry measurement of COHb. Blood samples were obtained just before hemodialysis. Thrombelastographic methods to assess plasma coagulation kinetics, fibrinolytic kinetics, and formation of carboxyhemefibrinogen (COHF) were used. Hemodialysis patients (n = 45) had abnormally increased COHb concentrations of 2.2 ± 1.9%, indicative of Hmox upregulation. Coagulation and fibrinolytic parameter normal values were determined with normal individual (n = 30) plasma. Thirty-seven patients of the hemodialysis cohort had COHF formation (82.2%, [67.9%-92.0%]; mean, [95% confidence interval]), and many of this group of patients had abnormally great velocity of clot growth (73.3%, [58.1%-85.4%]) and strength (75.6%, [60.5%-87.1%]). Furthermore, over half of COHF positive patients had a hypofibrinolytic state, evidenced by an abnormally prolonged time to maximum rate of lysis (53.3%, [37.9%-68.6%]) and clot lysis time (64.4%, [48.8%-78.1%]). Carbon monoxide enhanced coagulation and diminished fibrinolytic vulnerability in hemodialysis patients. Future investigation of hemodialysis, CO-related thrombophilia is warranted.

  3. Fibroblast Growth Factor 23 and Mortality among Patients Undergoing Hemodialysis

    PubMed Central

    Gutiérrez, Orlando M.; Mannstadt, Michael; Isakova, Tamara; Rauh-Hain, Jose Alejandro; Tamez, Hector; Shah, Anand; Smith, Kelsey; Lee, Hang; Thadhani, Ravi; Jüppner, Harald; Wolf, Myles

    2010-01-01

    Background Fibroblast growth factor 23 (FGF-23) is a hormone that increases the rate of urinary excretion of phosphate and inhibits renal production of 1,25-dihydroxyvitamin D, thus helping to mitigate hyperphosphatemia in patients with kidney disease. Hyperphosphatemia and low 1,25-dihydroxyvitamin D levels are associated with mortality among patients with chronic kidney disease, but the effect of the level of FGF-23 on mortality is unknown. Methods We examined mortality according to serum phosphate levels in a prospective cohort of 10,044 patients who were beginning hemodialysis treatment and then analyzed FGF-23 levels and mortality in a nested case–control sample of 200 subjects who died and 200 who survived during the first year of hemodialysis treatment. We hypothesized that increased FGF-23 levels at the initiation of hemodialysis would be associated with increased mortality. Results Serum phosphate levels in the highest quartile (>5.5 mg per deciliter [1.8 mmol per liter]) were associated with a 20% increase in the multivariable adjusted risk of death, as compared with normal levels (3.5 to 4.5 mg per deciliter [1.1 to 1.4 mmol per liter]) (hazard ratio, 1.2; 95% confidence interval [CI], 1.1 to 1.4). Median C-terminal FGF-23 (cFGF-23) levels were significantly higher in case subjects than in controls (2260 vs. 1406 reference units per milliliter, P<0.001). Multivariable adjusted analyses showed that increasing FGF-23 levels were associated with a monotonically increasing risk of death when examined either on a continuous scale (odds ratio per unit increase in log-transformed cFGF-23 values, 1.8; 95% CI, 1.4 to 2.4) or in quartiles, with quartile 1 as the reference category (odds ratio for quartile 2, 1.6 [95% CI, 0.8 to 3.3]; for quartile 3, 4.5 [95% CI, 2.2 to 9.4]; and for quartile 4, 5.7 [95% CI, 2.6 to 12.6]). Conclusions Increased FGF-23 levels appear to be independently associated with mortality among patients who are beginning hemodialysis

  4. FGF-23 and cognitive performance in hemodialysis patients.

    PubMed

    Drew, David A; Tighiouart, Hocine; Scott, Tammy M; Lou, Kristina V; Fan, Li; Shaffi, Kamran; Weiner, Daniel E; Sarnak, Mark J

    2014-01-01

    Although cognitive impairment is common in hemodialysis patients, the etiology of and risk factors for its development remain unclear. Fibroblast growth factor 23 (FGF-23) levels are elevated in hemodialysis patients and are associated with increased mortality and left ventricular hypertrophy. Despite FGF-23 being found within the brain, there are no prior studies assessing whether FGF-23 levels are associated with cognitive performance. We measured FGF-23 in 263 prevalent hemodialysis patients in whom comprehensive neurocognitive testing was also performed. The cross-sectional association between patient characteristics and FGF-23 levels was assessed. Principal factor analysis was used to derive two factors from cognitive test scores, representing memory and executive function, which carried a mean of 0 and a standard deviation of 1. Multivariable linear regression adjusting for age, sex, education status, and other relevant covariates was used to explore the relationship between FGF-23 and each factor. Mean age was 63 years, 46% were women and 22% were African American. The median FGF-23 level was 3098 RU/mL. Younger age, lower prevalence of diabetes, longer dialysis vintage, and higher calcium and phosphorus were independently associated with higher FGF-23 levels. Higher FGF-23 was independently associated with a lower memory score (per doubling of FGF-23, β = -0.08 SD [95% confidence interval, CI: -0.16, -0.01]) and highest quartile vs. lowest quartile (β = -0.42 SD [-0.82, -0.02]). There was no definite association of FGF 23 with executive function when examined as a continuous variable (β = -0.03 SD [-0.10, 0.04]); however, there was a trend in the quartile analysis (β = -0.28 SD [-0.63, 0.07], P = 0.13, for 4th quartile vs. 1st quartile). FGF-23 was associated with worse performance on a composite memory score, including after adjustment for measures of mineral metabolism. High FGF-23 levels in hemodialysis patients may contribute to

  5. Serum hepcidin level and its clinical significance in maintenance hemodialysis patients.

    PubMed

    Zhang, P; Yang, L-N; Wang, G; Li, F-E; Tang, F

    2014-11-27

    Hepcidin is a key protein of iron metabolism, which may play an important role in the prognosis of patients with chronic renal failure on maintenance hemodialysis. The purpose of this study was to investigate the relationship between the prognosis of maintenance hemodialysis patients and serum hepcidin level. We enrolled 60 patients on maintenance hemodialysis and 30 healthy controls from March 2012 to December 2012 in our hospital. Peripheral blood samples were collected to determine hepcidin by an ELISA method. Hepcidin levels of hemodialysis patients were significantly higher than those of the healthy control group. Hepcidin level was positively correlated with the degree of anemia in the dialysis group. Therefore, we conclude that hepcidin level is significantly increased in patients with chronic renal failure on maintenance hemodialysis and that increased hepcidin seriously affects the prognosis of chronic renal failure.

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

    PubMed Central

    Kalantar-Zadeh, Kamyar; Alp Ikizler, T

    2013-01-01

    In individuals with chronic kidney disease surrogates of protein-energy wasting (PEW) including a relatively low serum albumin and fat or muscle wasting are by far the strongest death risk factor than any other condition. There are data to indicate that hypoalbuminemia responds to nutritional interventions, which may save lives in the long run. Monitored, in-center provision of high-protein meals and/or oral nutritional supplements during hemodialysis is a feasible, inexpensive and patient-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), anti-myostatin agents, and anti-oxidative 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 patient is not capable of enteral interventions, e.g. due to swallowing problems, parenteral interventions such as intra-dialytic 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 the expensive medications of dialysis patients with no proven outcome improvement, this is also an economically feasible strategy. PMID:23313434

  7. Does pharmacotherapy improve cardiovascular outcomes in hemodialysis patients?

    PubMed

    Mittal, Mayank; Aggarwal, Kul; Littrell, Rachel L; Agrawal, Harsh; Alpert, Martin A

    2015-10-01

    Cardiovascular disease (CVD) occurs commonly in patients with chronic kidney disease (CKD) including those treated with hemodialysis (HD), and is associated with poor outcomes in this population. Pharmacologic management of hypertension, dyslipidemia, acute and chronic coronary artery disease, and atrial fibrillation in the general population is supported by the results of high-quality, randomized, controlled clinical trials. Pharmacotherapy of these disorders in the general population is effective in improving clinical outcomes. In contrast, information concerning the effect of pharmacotherapy on mortality and cardiovascular outcomes in patients with CKD, and particularly in HD patients, is limited. Available data suggest that, in general, pharmacotherapy of hypertension and dyslipidemia, anti-platelet therapy of CVD, and anticoagulant therapy in patients with atrial fibrillation are less effective in HD patients than in the general population or even in patients with early stage of CKD.

  8. 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.

  9. Central venous disease in hemodialysis patients: an update.

    PubMed

    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.

  10. Approach to permanent hemodialysis access in obese patients.

    PubMed

    Feezor, Robert J

    2011-06-01

    Obesity has reached an epidemic in the United States and, not surprisingly, there has been a dramatic increase in obesity-associated comorbidities, complete with a host of new, related surgical challenges. The creation and maintenance of permanent hemodialysis access, particularly autogenous access, is generally considered more difficult in the obese patient because of the increased risk of perioperative complications, as well as a decreased maturation rate. Most of the data documenting these adverse outcomes come from retrospective studies and, therefore, the reliability of the data is somewhat limited, given the inherent selection bias. In the United States, most obese patients dialyze through prosthetic access, despite the national initiatives targeted at maximizing autogenous access. However, it is possible to construct an autogenous access in most patients, including obese patients, presenting for permanent access using proper, diligent preoperative imaging and an aggressive postoperative surveillance protocol until access maturation. This is facilitated by careful preoperative planning and liberal use of multiple diagnostic and therapeutic maneuvers to improve overall access function. In this review, the outcomes associated with permanent hemodialysis access in the obese are discussed and helpful suggestions to facilitate a functional access provided.

  11. Habitual coffee consumption enhances attention and vigilance in hemodialysis patients.

    PubMed

    Nikić, Petar M; Andrić, Branislav R; Stojimirović, Biljana B; Trbojevic-Stanković, Jasna; Bukumirić, Zoran

    2014-01-01

    Coffee drinking is the main source of caffeine intake among adult population in the western world. It has been reported that low to moderate caffeine intake has beneficial effect on alertness and cognitive functions in healthy subjects. The aim of this study is to evaluate the impact of habitual coffee consumption on cognitive function in hemodialysis patients. In a cross-sectional study, 86 patients from a single-dialysis centre underwent assessment by the Montreal Cognitive Assessment tool and evaluation for symptoms of fatigue, mood, and sleep disorders by well-validated questionnaires. The habitual coffee use and the average daily caffeine intake were estimated by participants' response to a dietary questionnaire. Sixty-seven subjects (78%) consumed black coffee daily, mostly in low to moderate dose. Cognitive impairment was found in three-quarters of tested patients. Normal mental performance was more often in habitual coffee users (25% versus 16%). Regular coffee drinkers achieved higher mean scores on all tested cognitive domains, but a significant positive correlation was found only for items that measure attention and concentration (P = 0.024). Moderate caffeine intake by habitual coffee consumption could have beneficial impact on cognitive function in hemodialysis patients due to selective enhancement of attention and vigilance.

  12. Habitual Coffee Consumption Enhances Attention and Vigilance in Hemodialysis Patients

    PubMed Central

    Nikić, Petar M.; Andrić, Branislav R.; Stojimirović, Biljana B.; Trbojevic-Stanković, Jasna; Bukumirić, Zoran

    2014-01-01

    Objective. Coffee drinking is the main source of caffeine intake among adult population in the western world. It has been reported that low to moderate caffeine intake has beneficial effect on alertness and cognitive functions in healthy subjects. The aim of this study is to evaluate the impact of habitual coffee consumption on cognitive function in hemodialysis patients. Methods. In a cross-sectional study, 86 patients from a single-dialysis centre underwent assessment by the Montreal Cognitive Assessment tool and evaluation for symptoms of fatigue, mood, and sleep disorders by well-validated questionnaires. The habitual coffee use and the average daily caffeine intake were estimated by participants' response to a dietary questionnaire. Results. Sixty-seven subjects (78%) consumed black coffee daily, mostly in low to moderate dose. Cognitive impairment was found in three-quarters of tested patients. Normal mental performance was more often in habitual coffee users (25% versus 16%). Regular coffee drinkers achieved higher mean scores on all tested cognitive domains, but a significant positive correlation was found only for items that measure attention and concentration (P = 0.024). Conclusions. Moderate caffeine intake by habitual coffee consumption could have beneficial impact on cognitive function in hemodialysis patients due to selective enhancement of attention and vigilance. PMID:24895603

  13. Determinants of Compliance Behaviours among Patients Undergoing Hemodialysis in Malaysia

    PubMed Central

    Chan, Yoke Mun; Zalilah, Mohd Shariff; Hii, Sing Ziunn

    2012-01-01

    Background Patients with end stage renal disease often fail to follow prescribed dietary and fluid regimen, leading to undesirable outcomes. This study aimed to examine and identify factors influencing dietary, fluid, medication and dialysis compliance behaviours in patients undergoing hemodialysis. Methods This was a cross-sectional study which employed purposive sampling design. A total of 188 respondents were recruited from 14 dialysis centres in Malaysia between 2008–2011. Self-reported compliance behaviours and biochemical measurements were used as evaluation tools. Results Compliance rates of dietary, fluid, medication and dialysis were 27.7%, 24.5%, 66.5% and 91.0%, respectively. Younger, male, working patients and those with longer duration on hemodialysis were found more likely to be non-compliant. Lacks of adequate knowledge, inadequate self-efficacy skills, forgetfulness and financial constraints were the major perceived barriers towards better compliance to fluid, dietary, medication and dialysis, respectively. Conclusions Healthcare professionals should recognise the factors hindering compliance from the patients' perspective while assisting them with appropriate skills in making necessary changes possible. PMID:22870215

  14. Recurrent symptomatic intraocular pressure spikes during hemodialysis in a patient with unilateral anterior uveitis

    PubMed Central

    2013-01-01

    Background The relationship between intraocular pressure (IOP) changes and hemodialysis has been evaluated for several decades. However, no report on an IOP rise in uveitis patients during hemodialysis has been previously documented. This report describes the case of an uveitis patient with repetitive IOP spikes associated with severe ocular pain during hemodialysis sessions, which resolved after glaucoma filtering surgery. Case presentation A 47-year-old male with diabetes and hypertension had complained of recurrent ocular pain in the left eye during hemodialysis sessions. A slit-lamp examination showed diffuse corneal epithelial edema with several white keratic precipitates and inflammatory cells (Grade 3+) in the anterior chamber of the left eye. No visible neovascularization or synechiae were visible on the iris or angle. Topical glaucoma eye-drops and intravenous mannitol before hemodialysis did not prevent subsequent painful IOP spikes in the left eye. At the end of hemodialysis, IOP averaged ~40 mmHg. After trabeculectomy with mitomycin C in the left eye, his IOP stabilized in the low-teens (range, 10–14 mmHg) and no painful IOP spikes occurred during hemodialysis over the first postoperative year. Conclusion We present a case of recurrent painful IOP spikes during hemodialysis in a patient with unilateral anterior uveitis unresponsive to conventional medical treatment prior to hemodialysis. To our knowledge, this is the first case report of repetitive symptomatic IOP rise during hemodialysis in an uveitic glaucoma patient. This case highlights the importance of the awareness of the possibility that IOP may rise intolerably during hemodialysis in uveitis patients with a compromised outflow facility. PMID:23384186

  15. [Functional dependency evaluation of hemodialysis patients: a multicentric study].

    PubMed

    Arenas, M D; Alvarez-Ude, F; Angoso, M; Berdud, I; Antolín, A; Lacueva, J; García Marcos, S; Fernández, A; Gil, M T; Soriano, A

    2006-01-01

    There has been a change in the hemodialysis population characteristics over the last years with a progressive increase in patient,s age and associated comorbility and mortality. This older hemodialysis population are more functionally and medically dependent increasing the time taken to perform nursing work. The objective of this study was to evaluate the degree of functional dependency on hemodialysis patients and the need of care by nursing workload. A transversal descriptive study was done during 1 month (april 2005) on 586 patients from 10 HD Units in Spain. No exclusion criteria were used. The Delta Test, who was used to evaluate the patients dependency needs, is a workload measure instrument base on three subscales: dependency, Physical Deficiency and mental deficiency. The indicators are measure on a scale of one to three with each level representing an increasing demand on nursing time. The results obtained from the Delta Test were analyzed taking into account the following variables: age, average time in dialysis, Charlson comorbidity Index, geographic location and HD unit. 46% of the patients show some degree of dependency, of these 12.8% were moderated and 8.1% severe; the subscale analysis showed that 19.6% and 6.7% had, respectively, a moderate to severe physical and mental health deficiency. The dependency degree varied significantly between HD Units and geographic location with a range of 0% to 59.8%. The degree of dependency were statistically associated with age and CCI. The higher CCI (r: 0,21; p < 0.001) and age (r: 0,26; p < 0.001) the higher was the Delta Test Score for dependency level. Patients times of initiation on dialysis were not associated with an increase in the degree of dependency. The aspects evaluated by the Delta Test that showed a higher score were those related to patients mobility. The patients assistance requirements during the HD session are basically related to a lack of mobility due to musculoskeletal disease and to a

  16. Maintenance Hemodialysis Using Native Arteriovenous Fistula in a Patient with Severe Generalized Recessive Dystrophic Epidermolysis Bullosa

    PubMed Central

    Ito, Takayasu; Ishikawa, Eiji; Matsuo, Hiroshi; Fujimoto, Mika; Murata, Tomohiro; Isoda, Kenichi; Mizutani, Hitoshi; Ito, Masaaki

    2016-01-01

    Renal failure and infectious disease are strongly associated with morbidity and mortality in patients with severe generalized recessive dystrophic epidermolysis bullosa (RDEB-sev gen). However, it is reportedly difficult to introduce hemodialysis with an arteriovenous fistula (AVF). We encountered a 32-year-old man with RDEB-sev gen in whom hemodialysis with a native AVF was introduced that favorably affected his long-term survival. This patient eventually died because of cachexia related to the recurrence of cutaneous squamous cell carcinoma 51 months after hemodialysis introduction. We believe that in this patient, the frequency of vascular access troubles related to infection or reduction of blood flow was probably low as a result of hemodialysis with his native AVF. Thus, it seems likely that patients with RDEB-sev gen with end stage kidney disease who are on hemodialysis can be successfully managed with a native AVF. PMID:27722157

  17. Altered taste perception and nutritional status among hemodialysis patients.

    PubMed

    Lynch, Katherine E; Lynch, Rebecca; Curhan, Gary C; Brunelli, Steven M

    2013-07-01

    The objective of this study was to examine the association between altered taste perception and nutritional status among hemodialysis patients. We performed a post hoc analysis of data from the Hemodialysis study (n = 1,745). Taste perception was assessed at baseline and then updated annually using an item from a quality of life survey that asked "During the past 4 weeks, to what extent were you bothered by loss of taste?" Responses were categorized as normal taste perception if subjects answered "not at all" or altered taste perception if they reported any degree of bother. Time-updated logistic regression models were used to evaluate predictors of altered taste perception. Time-updated linear regression models were used to examine the association between altered taste perception and indices of nutritional status. Multivariable proportional hazards and Poisson models were used to assess association between altered taste perception and mortality and hospitalization, respectively. At baseline, 34.6% reported altered taste perception, which was associated with poorer baseline nutritional status. On time-updated analysis, altered taste perception was associated with a persistently higher proportion of subjects requiring enteral nutritional supplements and lower serum albumin, serum creatinine, normalized protein catabolic rate, protein intake, sodium intake, and mid-arm muscle circumference. Altered taste perception at baseline was independently associated with increased all-cause mortality: adjusted hazard ratio (95% confidence interval) of 1.17 (1.01-1.37), although not with increased rate of hospitalization. Altered taste perception was common among prevalent hemodialysis patients and was independently associated with poorer indices of nutritional status and increased all-cause mortality. Copyright © 2013 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  18. Personal paths of fluid restriction in patients on hemodialysis.

    PubMed

    Tovazzi, Maria Elena; Mazzoni, Valentina

    2012-01-01

    The aim of this study was to explore the perspectives of patients on hemodialysis about their experience of fluid restriction. Qualitative interviews were conducted to grasp the patients' lived experience, and from a phenomenological analysis, several categories emerged that describe patients' understanding. Three themes in particular from patients' experiences are described and discussed because of their relevance for health professionals. These include (a) fluid restriction introduces the perception of individuals to see themselves as addicts who deal with a constant inner conflict, (b) the difficulty in finding the right boundaries between common sense and scientific knowledge about fluid restriction, and (c) the role of personal motivations and willingness in pursuit of compliance. Recognizing the force of personal meaning for individuals with renal disease will support health professionals to help patients in pursuing the regime of fluid restriction.

  19. Hemodialysis effect on serum boron level in the patients with long term hemodialysis.

    PubMed

    Usuda, K; Kono, K; Iguchi, K; Nishiura, K; Miyata, K; Shimahara, M; Konda, T; Hashiguchi, N; Senda, J

    1996-11-22

    Serum and dialysate boron levels in 17 patients with long term hemodialysis (HD) were determined by inductively coupled plasma emission spectrometry (ICPES). Serum boron level was compared with the value of age matched 467 healthy controls and the relationship between serum and dialysate boron level was analyzed. The results showed that serum boron level was significantly higher at the beginning of HD, and lower at the completion of HD in comparison with controls. Although the dialysate was contaminated with trace boron, HD resulted in an excessive decrease of serum boron, rather than boron exposure from the dialysate. Boron hemodialyzability was almost proportional to the gradient of the boron level at the beginning of HD and it could be controlled by the adjustment of the gradient. In conclusion, the serum boron level was very much disturbed in long term HD patients. If boron excess in serum at the beginning of HD, or deficiency at the completion of HD may contribute to the complications of HD patients, fine adjustment and close surveillance of the gradient should be taken into account.

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

    PubMed

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

    1987-01-01

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

  1. Acute hepatitis C in patients receiving hemodialysis.

    PubMed

    Griveas, I; Germanidis, G; Visvardis, G; Morice, Y; Perelson, A S; Pawlotsky, J M; Papadopoulou, D

    2007-01-01

    Hepatitis C virus (HCV) infection is frequent in patients with end-stage renal disease treated by chronic dialysis, with a prevalence varying from 10-65% according to the geographical data. The prevalence is significantly associated with the duration of dialysis and the number of transfused blood products[1,2] and has dramatically declined with efficient blood screening.[3] We studied patients with acute HCV infection in a dialysis unit. The diagnosis was based on both anti-HCV detection and HCV-RNA detection. Other virological tools including HCV genotype determination was also used to tailor treatment to the individual patient and determine its efficacy for a one-year follow-up period. Seventeen patients (7 male and 10 female, mean age: 63.7 +/- 11.6 SD) with acute hepatitis C were enrolled to our study. All of them were followed up for a period of one year after the diagnosis was established. Phylogenetic analysis distinguished two separate HCV subtypes 1b, which were both responsible for this acute infection (see Figure 1). These types did not differ in their behavior on the clinical situation of our patients, as confirmed by the fact that in both groups of patients, there was only one patient who presented with acute illness. Six patients of our study group, three months after the acute infection, received pegylated interferon (Peg-IFNa2a) 135 mug for a six-month period. Four of them responded very well to therapy and at the first determination HCV RNA was below the cutoff point. One of our patients with very high HCV levels (HCV RNA > 50,000,000 IU/mL), despite receiving the same therapy, did not respond well and developed cirrhosis. In conclusion, it is clear from our experience that better information is needed about the current incidence, prevalence, and risk factors for HCV infection in dialysis patients. Algorithms for the diagnosis and management of hepatitis C should be developed by academic societies. Routine screening for hepatitis C also would allow

  2. 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…

  3. 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…

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

    USDA-ARS?s Scientific Manuscript database

    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...

  5. Needs of Hemodialysis Patients and Factors Affecting Them

    PubMed Central

    Xhulia, Dhima; Gerta, Jaku; Dajana, Zefaj; Koutelekos, Ioannis; Vasilopoulou, Chrysoula; Skopelitou, Margitsa; Polikandrioti, Maria

    2016-01-01

    Purpose: Of this study was to explore the needs of hemodialysis patients and the factors that affect them. Material & Methods: The sample of the study included 141 patients undergoing hemodialysis. Data collection was performed by the method of interview using a specially designed questionnaire which served the purposes of the study. The needs were grouped into six categories. Patients were asked to answer how important was for them each of the statements in the questionnaire. Furthermore, there were collected socio-demographic characteristics, information on health status and relations with the physicians and nurses, as well as data on the incidence of the disease in their social life. Results: The results of this study showed that patients evaluated as fairly important all six categories of their needs, with similar results in both sexes. Age was found to be statistically significantly associated with ’the need for support and guidance’, ’the need to be informed’ and ’the need to meet the emotional and physical needs’, (p=0.023, p=0.012, p=0.028 respectively). Education level was found to be statistically significantly associated with all patients’ needs with the exception of ’the need to trust the medical and nursing staff’, (p=<0.05). Place of residence was statistically significantly associated with ’the need for support and guidance’, (p=0.029). Furthermore, difficulties in relations with family members was found to be statistically significantly associated with ’the need for support, the need for communication and individualization of care’, (p=0.014, p=0.040, p=0.041). After multivariate analysis, however, it was shown that the only independent factor affecting ’the need for support and guidance’, ’the need for individualized care’ and ’the need to meet the emotional and physical needs’, was if the patients reported themselves as anxious or not (p=0,024, p=0,012 and p=0,004, respectively). In particular, patients who

  6. Multistate outbreak of hemolysis in hemodialysis patients traced to faulty blood tubing sets.

    PubMed

    Duffy, R; Tomashek, K; Spangenberg, M; Spry, L; Dwyer, D; Safranek, T J; Ying, C; Portesi, D; Divan, H; Kobrenski, J; Arduino, M; Tokars, J; Jarvis, W

    2000-04-01

    Hemolysis associated with hemodialysis is rare. The most frequent causes of hemodialysis-associated hemolysis are chemical contamination, heat, or mechanical injury of erythrocytes from occluded or kinked hemodialysis blood lines. When patients in three states developed hemolysis while undergoing hemodialysis between May 13 and 23, 1998, an investigation was initiated. A case-patient was defined as any patient at healthcare facilities A (Nebraska), B (Maryland), or C (Massachusetts) during May 13 through 23, 1998 (epidemic period), who had hemolysis diagnosed > or =48 hours after undergoing hemodialysis. To identify case-patients and to determine background rates, the medical records of patients from facilities A, B, and C who were undergoing hemodialysis during the epidemic and pre-epidemic (that is, May 5 through 19, 1998) periods were reviewed. Experiments simulating hemodialysis with the same lot numbers of hemodialysis blood tubing cartridge sets used on case- and control-patients were conducted. The rates of hemolysis among patients at facilities A, B, and C were significantly higher during the epidemic than the pre-epidemic period (13 out of 118 vs. 0 out of 118, P < 0.001; 12 out of 298 vs. 0 out of 298, P = 0.001; and 5 out of 62 vs. 0/65, P = 0.03, respectively). All case-patients had hemolysis. Twenty (66%) had hypertension. Eighteen (60%) had abdominal pain, and 10 (36%) were admitted to an intensive care unit. There were two deaths. The only commonality among the three outbreaks was the use of the same lot of disposable hemodialysis blood tubing from one manufacturer. Examination of the implicated hemodialysis blood tubing cartridge sets revealed narrowing of an aperture through which blood was pumped before entering the dialyzers. In vitro experiments with the hemodialysis blood tubing revealed that hemolysis was caused by increased pressure on erythrocytes as they passed through the partially occluded hemodialysis blood tubing. Our investigation

  7. Validating Appetite Assessment Tools among Patients Receiving Hemodialysis

    PubMed Central

    Molfino, Alessio; Kaysen, George A.; Chertow, Glenn M.; Doyle, Julie; Delgado, Cynthia; Dwyer, Tjien; Laviano, Alessandro; Fanelli, Filippo Rossi; Johansen, Kirsten L.

    2016-01-01

    Objective To test the performance of appetite assessment tools among patients receiving hemodialysis. Design Cross-sectional. Setting Seven dialysis facilities in Northern California. Subjects 221 patients receiving hemodialysis. Intervention We assessed five appetite assessment tools [self-assessment of appetite, subjective assessment of appetite, visual analogue scale (VAS), Functional Assessment of Anorexia/Cachexia Therapy (FAACT) score and the Anorexia Questionnaire (AQ)]. Main outcome measures Reported food intake, normalized protein catabolic rate (nPCR), and change in body weight were used as criterion measures, and we assessed associations among the appetite tools and biomarkers associated with nutrition and inflammation. Patients were asked to report their appetite and the percentage of food eaten (from 0% to 100%) during the last meal compared to usual intake. Results Fifty-eight (26%) patients reported food intake ≤50% (defined as poor appetite). The prevalence of anorexia was 12% by self-assessment of appetite, 6% by subjective assessment of appetite, 24% by VAS, 17% by FAACT score, and 12% by AQ. All tools were significantly associated with food intake ≤50% (p<0.001), except self-assessment of appetite. The FAACT score and the VAS had the strongest association with food intake ≤50% (c-statistic 0.80 and 0.76). Patients with food intake ≤50% reported weight loss more frequently than patients without low intake (36% vs 22%) and weight gain less frequently (19% vs 35%; p=0.03). nPCR was lower among anorexic patients based on the VAS (1.1 ± 0.3 vs 1.2 ± 0.3, p=0.03). Ln IL-6 correlated inversely with food intake (p=0.03), but neither IL-6 nor CRP correlated with any of the appetite tools. Furthermore, only the self-assessment of appetite was significantly associated with serum albumin (p=0.02), prealbumin (p=0.02) and adiponectin concentrations (p=0.03). Conclusions Alternative appetite assessment tools yielded widely different estimates of the

  8. 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

  9. Parathyroidectomy Improves Restless Leg Syndrome in Patients on Hemodialysis.

    PubMed

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

    2016-01-01

    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. 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. 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. 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.

  10. 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.

  11. Predialysis systolic BP variability and outcomes in hemodialysis patients.

    PubMed

    Shafi, Tariq; Sozio, Stephen M; Bandeen-Roche, Karen J; Ephraim, Patti L; Luly, Jason R; St Peter, Wendy L; McDermott, Aidan; Scialla, Julia J; Crews, Deidra C; Tangri, Navdeep; Miskulin, Dana C; Michels, Wieneke M; Jaar, Bernard G; Herzog, Charles A; Zager, Philip G; Meyer, Klemens B; Wu, Albert W; Boulware, L Ebony

    2014-04-01

    BP variability (BPV) is an important predictor of outcomes in the general population, but its association with clinical outcomes in hemodialysis patients is not clear. We identified 11,291 patients starting dialysis in 2003-2008 and followed them through December 31, 2008 (median=22 months). Predialysis systolic BPV was assessed over monthly intervals. Outcomes included factors associated with BPV, mortality (all-cause and cardiovascular), and first cardiovascular event (cardiovascular death or hospitalization). Patients' mean age was 62 years, 55% of patients were men, and 58% of patients were white. Modifiable factors associated with higher BPV included obesity, higher calcium-phosphate product levels, and lower hemoglobin concentration; factors associated with lower BPV included greater fluid removal, achievement of prescribed dry weight during dialysis, higher hemoglobin concentration, and antihypertensive regimens without β-blockers or renin-angiotensin system blocking agents. In total, 3200 deaths occurred, including 1592 cardiovascular deaths. After adjustment for demographics, comorbidities, and clinical factors, higher predialysis BPV was associated with increased risk of all-cause mortality (hazard ratio [HR], 1.18; 95% confidence interval [95% CI] per 1 SD increase in BPV, 1.13 to 1.22), cardiovascular mortality (HR, 1.18; 95% CI, 1.12 to 1.24), and first cardiovascular event (HR, 1.11; 95% CI, 1.07 to 1.15). Results were similar when BPV was categorized in tertiles and patients were stratified by baseline systolic BP. In summary, predialysis systolic BPV is an important, potentially modifiable risk factor for death and cardiovascular outcomes in incident hemodialysis patients. Studies of BP management in dialysis patients should focus on both absolute BP and BPV.

  12. Risk factors associated to hospital mortality in patients with acute kidney injury on hemodialysis.

    PubMed

    Linares-Linares, Mariela Alejandra; Figueroa-Tarrillo, Jorge Arturo; Cerna Viacava, Renato; Carreazo, Nilton Yhuri; Valdivia-Vega, Renzo P

    2017-03-06

    The worldwide incidence of acute kidney injury is 18% and the overall hospital mortality can rise above 50%. In Peru, there are few series about mortality of acute kidney injury in hemodialysis patients. To identify risk factors associated to hospital mortality of acute kidney injury in hemodialysis patients. This is a retrospective cohort of patients with acute kidney injury in hemodialysis of Hospital Nacional Edgardo Rebagliati Martins gathered between January 2013 and December 2015. The sample size was 154 patients which allowed a power of 80% and a CI of 95%. ICD-10 codes were used to identify medical records of patients with acute kidney injury (N.17) and hemodialysis (Z.49). The independent variable was oliguria, and the primary outcome was hospital mortality. Poisson regression was used for multivariate analysis. We identified a total of 285 patients; 212 medical records were analyzed and 44 were excluded. Out of the 168 medical records, 129 belonged to living patients and 39 to deceased ones. The overall mortality incidence was 17.2%. The principal etiologies of acute kidney injury while in hemodialysis were sepsis (39.2%), and severe dehydration (10.8%). In the adjusted model, the risk factors associated to hospital mortality of acute kidney injury while in hemodialysis were elevated serum lactate (RR 1.09), elevated serum potassium (RR 0.93), and mean arterial pressure (RR 0.97). Lactate is an objective parameter that can predict prognosis and contributes to a better management of acute kidney injury in hemodialysis patients.

  13. A study of parenteral iron regimens in hemodialysis patients.

    PubMed

    Besarab, A; Kaiser, J W; Frinak, S

    1999-07-01

    The administration of parenteral iron dextran to hemodialysis patients is typically intermittent. We sought to determine the most appropriate intervals for sampling iron parameters during intermittent need-based and continuous maintenance regimens and to quantify differences in efficacy between such regimens during long-term therapy. After a single course of 10 consecutive 100-mg iron doses administered to 14 patients on 16 occasions, transferrin saturation (TSAT) and ferritin were unreliable indices of iron status for the next 2 and 6 weeks, respectively. TSAT and ferritin levels at 1 week were virtually identical to those at 2 weeks after the administration of a single 50-mg or 100-mg iron dextran dose to 16 other patients. Twelve patients on maintenance iron therapy (25 to 100 mg/wk; TSAT, 30% to 50%) had a statistically significant decrease in the amount of recombinant human erythropoietin (rHuEPO) needed to maintain hemoglobin (Hb) levels between 10 and 11 g/dL compared with 12 patients receiving intermittent need-based dosing, an effect that persisted from week 16 to week 72 of the study. Maintenance iron was feasible even in a third group of eight patients targeted to sustain an Hb level of 14 g/dL. In both iron maintenance groups, iron indices could be measured at weekly intervals, and ferritin levels did not progressively increase over time. Continuous maintenance iron dextran used to maintain TSATs of 30% to 50% significantly reduced rHuEPO requirements and resulted in no adverse side effects in chronic hemodialysis patients. After weekly maintenance 25- to 100-mg iron dextran doses, iron indices can be measured after 1 week; a delay of 2 weeks is not necessary.

  14. Virological features of hepatitis C virus infection in hemodialysis patients.

    PubMed Central

    Silini, E; Bono, F; Cerino, A; Piazza, V; Solcia, E; Mondelli, M U

    1993-01-01

    The clinical and epidemiological relevance of circulating antibodies to hepatitis C virus (HCV) in hemodialysis patients is uncertain, since clinical signs of infection are often mild or absent, with alanine aminotransferase (ALT) values that are virtually always normal, and liver biopsies are only rarely performed. Determination of HCV RNA in serum is therefore critical for distinguishing chronic HCV infection from previous exposure to the virus. We studied HCV viremia by reverse transcription polymerase chain reaction (RT-PCR) in the 5'-noncoding region of the viral genome in 77 dialysis patients who were screened for anti-HCV by a second-generation enzyme-linked immunosorbent assay (the enzyme immunoassay II; Ortho HCV, 2nd generation, Ortho Diagnostic Systems Raritan, N.J.) and a second-generation recombinant immunoblot assay (Chiron Corporation and Ortho Diagnostic Systems) and prospectively evaluated for ALT elevations over a period of 5 years. Of 77 patients tested, 29 (38%) had active infection as shown by a positive PCR assay result, and of these, 26 were anti-HCV positive. Although a good correlation was found between circulating anti-HCV and HCV RNA in serum, 10 (28%) of 36 anti-HCV-positive patients were HCV RNA negative by PCR, suggesting either low levels of viremia or past exposure to HCV and subsequent recovery. On the other hand, 3 (7.3%) of 41 anti-HCV-negative patients had HCV RNA in their sera, indicating seronegative HCV infection. The ALT level had no predictive value for HCV infection, because it was repeatedly normal in 18 (62%) of 29 viremic patients. HCV genotyping was also performed and indicated that all four known genotypes of HCV were present in our group. In conclusion, serological assays are reliable for detecting exposure to HCV in hemodialysis patients; however, direct identification of the viral genome is required to document current infection. PMID:7505292

  15. Long-duration submaximal exercise conditioning in hemodialysis patients.

    PubMed

    Zabetakis, P M; Gleim, G W; Pasternack, F L; Saraniti, A; Nicholas, J A; Michelis, M F

    1982-07-01

    Objective changes in exercise tolerance were evaluated in five chronic hemodialysis patients (HD) following a ten week aerobic treadmill exercise conditioning program designed to exercise patients at a level approximating their anaerobic threshold (AT). This exercise conditioning program resulted in a 21% increase in peak oxygen consumption, an increase in test duration from 17.40 +/- 1.26 to 22.60 +/- 0.87 min (P less than 0.025), and an increase in AT from 0.81 +/- 0.08 to 0.97 +/- 0.08 1/min (P less than 0.05). These physiologic changes in exercise tolerance resulted in an overall increase in work capacity permitting the HD patient to perform a larger portion of the imposed work load aerobically.

  16. Serum ferritin concentration in patients receiving maintenance hemodialysis.

    PubMed

    Lynn, K L; Mitchell, T R; Shepperd, J

    1980-09-01

    Studies in 144 patients on maintenace hemodialysis have shown that serum ferritin concentration is influenced by the period the patient has been on dialysis, the presence of liver disease and to some extent the underlying diagnosis. It was observed that parenteral iron therapy could still produce an increase in hemoglobin concentration when the serum ferritin was as high as 60--55 micrograms/l. This suggests that the target serum ferritin, whatever the route of iron replacement, should be at least 55 micrograms/l. The higher levels of ferritin at which an increase in hemoglobin concentration can occur, together with the variable increment in serum ferritin after parenteral iron, indicates that the simple relationship between serum ferritin and marrow iron stores may be distrubed in some patients.

  17. Predictive modeling of cardiovascular complications in incident hemodialysis patients.

    PubMed

    Ion Titapiccolo, J; Ferrario, M; Barbieri, C; Marcelli, D; Mari, F; Gatti, E; Cerutti, S; Smyth, P; Signorini, M G

    2012-01-01

    The administration of hemodialysis (HD) treatment leads to the continuous collection of a vast quantity of medical data. Many variables related to the patient health status, to the treatment, and to dialyzer settings can be recorded and stored at each treatment session. In this study a dataset of 42 variables and 1526 patients extracted from the Fresenius Medical Care database EuCliD was used to develop and apply a random forest predictive model for the prediction of cardiovascular events in the first year of HD treatment. A ridge-lasso logistic regression algorithm was then applied to the subset of variables mostly involved in the prediction model to get insights in the mechanisms underlying the incidence of cardiovascular complications in this high risk population of patients.

  18. [Assessment of dietary habits in hemodialysis and peritoneal dialysis patients].

    PubMed

    Kardasz, Małgorzata; Małyszko, Jacek; Stefańska, Ewa; Ostrowska, Lucyna

    2011-01-01

    Adherence to a proper diet has a vast impact on the correct course of dialyses, wellbeing, and the results of some laboratory investigations in patients with declining renal failure. The nutritional status of dialysis patients is closely related to food and specific nutrients intake. The aim of study was assessment of dietary habits in dialysis patients. The study included 27 patients peritoneal dialysis (PD) and 92 hemodialysis (HD). In all of dialysis patients the following measurements were taken: body weight and height. The food intake was assessed by 24-hour dietary recall, (according to nutritional components). The portion size was estimated on the "Album of portions of products and dishes". The results were compared with dietary recommendations for dialysis patients and analyzed by computer software Dietetic 2 designed in the Institute of Food and Nutrition in Warsaw but computer program Statistica 7.0 was used for calculations. In all studied dialysis patients an irregular diet were observed. The diet was characterized by a low energetic value and low intake of proteins, carbohydrates, fiber and calcium, as well as by a too high fats. Among women's and man's in both groups were noted underweight: (W in PD patients--7%, M in DO patients--8%, W in HD patients--4%), overweight (W in PD patients--33%, M in DO patients--25%, W in HD patients--38%, M in HD patients--36%) and obesity (W in PD patients--26%, M in DO patients--33%, W in HD patients--22%, M in HD patients--21%). The study revealed that the daily food rations of peritoneal dialysis women were found to have a significantly higher the average intake dietary fiber (18.3 +/- 5.5 g/day) and higher potassium intake (2758.5 +/- 787.5 mg/day) as compared to the average intake dietary fiber (11.7 +/- 5.4 g/ day; p < 0.0001) and potassium intake (1612.9 +/- 822.9 mg/day; p < 0.0001) of hemodialysis women. The regular dietician advice is necessary for monitoring of patients nutrition.

  19. 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

  20. 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.

  1. Successful daily home hemodialysis patient-care partner dyads: benefits outweigh burdens.

    PubMed

    Wise, Meg; Schatell, Dorian; Klicko, Kristi; Burdan, Amy; Showers, Mary

    2010-07-01

    Understanding and communicating the benefits vs. burdens of short daily home hemodialysis (SDHD) is presumed to be important to the success of recruiting patients and care partners and preventing dropout. We conducted an in-depth qualitative study of 13 patient and care partner couples (dyads) who completed at least 6 months of SDHD after at least 6 months of in-center hemodialysis to inform strategies for screening, training, and support to improve SDHD retention. In this exploratory descriptive study, all patients reported better well-being since starting SDHD. Considering the relationship and psychosocial factors, 4 profiles for dyadic coping emerged: (1) Thriving (n=5)--patients and care partners were flourishing; (2) Surviving (n=4)--strong couples were adjusting to challenges; (3) Martyrdom (n=3)--1 partner defers his/her needs and resentments to make SDHD work; and (4) Seeking another option (n=1)--patient unwilling to burden an anxious partner. Overall, patients who did more SDHD self-care, particularly self-cannulation, were more likely to thrive, regardless of dyad profile, and strong relationships tended to become stronger when faced with the challenge of SDHD. Training that was unhurried and valued care partners as well as patients, used a mix of learning strategies, and provided a home visit for the first home treatment was associated with Thriving dyads; training that was directive, inflexible, and focused on the patient at the expense of the partner was not. We recommend that centers screen dyads for relationship quality and integrate couple relationship education into SDHD training as required. Further, we recommend a large-scale, multi-center prospective study to test this model of how couple relationship and coping styles affect clinical outcomes and rates of continuation with SDHD.

  2. Calcitriol resistance in hemodialysis patients with secondary hyperparathyroidism.

    PubMed

    Negri, Armando L; Brandenburg, Vincent M; Brandemburg, Vincent M

    2014-06-01

    Nonselective vitamin D receptor activators (VDRA), such as calcitriol and alfacalcidol, have been successfully used in the treatment of secondary hyperparathyroidism (SHPT) in hemodialysis. Despite their beneficial effects on the control of serum PTH levels, their use has been limited by intolerance (development of hypercalcemia and hyperphosphatemia with consecutive cardiovascular toxicity). Apart from becoming intolerant, in 20-30 % of patients who use nonselective VDRA, serum PTH levels do not decrease appropriately despite increasing doses of these agents. These patients are considered calcitriol-resistant patients. Thus, calcitriol resistance and intolerance are two sides of the same coin: active vitamin D failure. Despite the clinical relevance of active vitamin D failure, definitions of resistance and intolerance are imprecise and have varied over time. More selective VDRA claim to produce less hypercalcemia and hyperphosphatemia and could help clinicians to overcome intolerance. Also, some studies have also shown that paricalcitol can be even useful in resistant patients. Significant limitations of iPTH as a reliable and useful clinical biomarker have been increasingly appreciated. There is evidence that intact PTH concentration must differ by 72 % between any two measurements before it can be considered a significant change. VDR polymorphisms could be involved in the development of SHPT in CKD patients. Interestingly, a higher incidence of the b allele of the VDR BsmI gene variant has been shown to be present in SHPT. The BsmI genotype can also affect the response of hemodialysis to IV calcitriol. A challenge for the future will be to establish biomarkers such as laboratory determinations or ultrasound findings that can help us to early identify those patients who will not respond appropriately to calcitriol or exhibit intolerable side effects .

  3. Dialysis headache in patients undergoing peritoneal dialysis and hemodialysis.

    PubMed

    Stojimirovic, Biljana; Milinkovic, Marija; Zidverc-Trajkovic, Jasna; Trbojevic-Stankovic, Jasna; Maric, Ivko; Milic, Miodrag; Andric, Branislav; Nikic, Petar

    2015-03-01

    Headache is among most frequently encountered neurological symptom during hemodialysis (HD), but still under investigated in peritoneal dialysis (PD) patients. The aim of this study was to assess the incidence and clinical characteristics of dialysis headache (DH) in HD and PD patients. A total of 409 patients (91 on PD and 318 on HD) were interviewed using a structured questionnaire, designed according to the diagnostic criteria of the International Headache Classification of Headache Disorders from 2004. Patients with DH underwent a thorough neurological examination. DH was reported by 21 (6.6%) HD patients and 0 PD patients. PD patients had significantly lower serum sodium, potassium, calcium, phosphate, urea and creatinine, calcium-phosphate product, and diastolic blood pressure than HD patients. HD patients had significantly lower hemoglobin compared to PD patients. Primary renal disease was mostly parenchymal in HD patients, and vascular in PD patients. DH appeared more frequently in men, mostly during the third hour of HD. It lasted less than four hours, was bilateral, non-pulsating and without associated symptoms. Biochemical alterations may be implicated in the pathophysiology of DH. Specific features of DH might contribute to better understanding of this secondary headache disorder.

  4. Effects of far infrared acupoint stimulation on autonomic activity and quality of life in hemodialysis patients.

    PubMed

    Su, Ling-Hwa; Wu, Kwan-Dun; Lee, Li-Shan; Wang, Harrison; Liu, Chi-Feng

    2009-01-01

    Patients receiving regular hemodialysis sessions have been known to suffer from fatigue and depression. This experiment was designed to determine the effects of far infrared ray (FIR) stimulation on acupoints of patients suffering from renal failure who are receiving regular hemodialysis. Patients receiving long-term and regular hemodialysis who volunteered for this procedure were randomly selected to undergo either FIR or heat pad (HP) therapy to determine the impact of FIR treatment on these patients. Both the activities of the autonomic nervous system and changes in quality of life were measured before and after treatment to determine the effectiveness of the FIR treatment. Results from this study show that FIR therapy decreases both stress and fatigue levels of these patients. It also stimulates autonomic nervous system (ANS) activity in patients who are diagnosed with end-stage renal disease (ESRD) and are receiving regular hemodialysis (HD). Therefore, benefits of FIR stimulation on these patients are clearly demonstrated in this preliminary study.

  5. Effect of hemodialysis on autonomic dysfunction in patients with chronic renal failure - biomed 2009.

    PubMed

    Kamal, Ahmed

    2009-01-01

    The main objective of this study is to use the method of complex demodulation combined with posture entrainment protocol (changing from supine to standing position) to characterize the autonomic dysfunction before and after hemodialysis session. Twenty patients maintained on hemodialysis for an average 18 months were studied. All patients were dialyzed regularly three times a week, each time for 4 hours. Electroencephalograms were measured for ureamic patients before and after hemodialysis. Heart rate variability signals derived from electroencephalograms were recorded during the supine and standing positions. Complex modulation method is employed to investigate the sympathetic and parasympathetic activity before and after hemodialysis. It is possible by using experimental posture entrainment protocol (supine and standing positions) combined with the method of complex demodulation to produce the average low and high frequency response of heart rate variability mediated by autonomic nervous system for twenty uraemic patients before and after hemodialysis sessions in both supine and standing position. The high amplitude of low and high frequency response of heart rate variability of twenty uraemic patients on standing and post standing after hemodialysis sessions indicates the improvement of autonomic function compared with the same patients before hemodialysis sessions (p > 0.001). The decrease of level of chemical components in blood such as creatinine and urea after hemodialysis increases the modulation of stimulus (posture entrainment) and the better function of autonomic system The analysis of heart rate variability signals for twenty uraemic patients before and after hemodialysis using complex demodulation combined with posture entrainment protocol seems promising in assessing the autonomic function in chronic renal failure patients. Further studies may be needed to develop quantitative indices for possible screening and early diagnosis of autonomic dysfunction

  6. Nocturnal hemodialysis.

    PubMed

    Ranganathan, D; John, G T

    2012-09-01

    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.

  7. Carriage of Staphylococcus aureus in the nose of patients on regular dialysis treatment using hemodialysis catheters.

    PubMed

    Maamoun, Hoda Abdel Hamid; Soliman, Amin Roshdy; El Sherif, Rasha

    2011-10-01

    In the hemodialysis population, the incidence of Staphylococcus aureus colonization has been documented to be as high as 80%; effective prophylaxis of vascular access infection and bacteremia is a worthwhile goal in the management of hemodialysis population. Surveillance of 50 hemodialysis patients for S. aureus-positive nasal cultures was performed by monthly nasal swabs over a 12-month period. All patients were performing dialysis using hemodialysis catheters thrice weekly. All positive cultures were treated with a prophylactic antibiotic regimen. Thirty-one patients (62%) had one or more positive cultures. The surveillance period was longer in the S. aureus nasal carriers (p < 0.01). The frequency of positive cultures correlated with the duration of surveillance (p < 0.05). The incidence of S. aureus bacteremia was greater in patients with three or more positive cultures (p < 0.05). This study suggests that continuous surveillance for S. aureus nasal colonization is essential to properly identify all hemodialysis patients using catheters at risk of developing S. aureus bacteremias. © 2011 The Authors; Hemodialysis International © 2011 International Society for Hemodialysis.

  8. Iron administration and clinical outcomes in hemodialysis patients.

    PubMed

    Feldman, Harold I; Santanna, Jill; Guo, Wensheng; Furst, Howard; Franklin, Eunice; Joffe, Marshall; Marcus, Sue; Faich, Gerald

    2002-03-01

    To evaluate the impact of parenteral iron administration on the survival and rate of hospitalization of US hemodialysis patients, a nonconcurrent cohort study of 10,169 hemodialysis patients in the United States in 1994 was conducted. The main outcome measures were patient survival and rate of hospitalization. After adjusting for 23 demographic and comorbidity characteristics among 5833 patients included in multivariable analysis, bills for 10 vials showed a statistically significant elevated rate of death (adjusted RR = 1.11; 95% CI, 1.00 to 1.24; P = 0.05). Bills for 10 vials showed statistically significant elevated risk (adjusted RR = 1.12; 95% CI, 1.01 to 1.25; P = 0.03). Prescribing iron in quantities of 10 vials (1000 mg) of iron dextran over a period of 6 mo.

  9. Interleukin-2 deficit in hemodialysis patients. Role of prostaglandins.

    PubMed

    Glez-Gutiérrez, M; de Francisco, A L; Sanz de Castro, S; Ruiz, J C; Prieto, M; García Fuentes, M; Arias, M

    1992-01-01

    Uremic patients suffer from various immunological alterations, whose pathogenesis is still unknown. Here, we studied 37 hemodialysis patients in order to investigate the role of prostaglandins (PGs) in uremic immunological deficiency, specifically in relation to interleukin-2 (IL-2) synthesis. We confirmed previous published data on deficient response to PHA in chronic renal failure patients (cpm, mean +/- SEM: 15,400 +/- 2,100 in uremics vs. 29,500 +/- 3,380 in controls, p < 0.04) and established a correlation between this deficiency and diminished IL-2 synthesis (r = 0.619, p < 0.05). The direct measurement of PGs in lymphocyte cultures showed greatly increased concentrations in the presence of uremic serum (US). We found that PGs synthesis can be inhibited by up to 80% if cultures are supplemented with indomethacin (IND--a cyclooxigenase inhibitor) or by removal of monocytes (producers of PGs). Both methods situated the uremic proliferative response within the normal range in cultures with FCS, and close to the normal range in cultures with US. We observed a deficit of IL-2 in hemodialysis patients (means +/- SD: 8,940 +/- 6,420 in uremics vs. 16,900 +/- 3,890 in controls). Addition of exogenous IL-2 normalized lymphocyte response even in US cultures, with no additive effect between PGs inhibition and exogenous IL-2 except in US cultures. It is suggested that IL-2 deficit of uremics depends, at least in part, on an increase in PGs synthesis induced by US.(ABSTRACT TRUNCATED AT 250 WORDS)

  10. Ferumoxytol as an Intravenous Iron Replacement Therapy in Hemodialysis Patients

    PubMed Central

    Provenzano, Robert; Schiller, Brigitte; Rao, Madhumathi; Coyne, Daniel; Brenner, Louis; Pereira, Brian J.G.

    2009-01-01

    Background and objectives: Intravenous iron is a key component of anemia management for chronic kidney disease (CKD). Ferumoxytol is a unique intravenous iron product that can be administered as a rapid injection in doses up to 510 mg. Design, setting, participants, & measurements: This was a randomized, open-label, controlled, multicenter Phase 3 trial to evaluate the safety and efficacy of intravenous ferumoxytol compared with oral iron. Anemic patients with CKD stage 5D on hemodialysis and on a stable erythropoiesis-stimulating agent regimen received either two injections of 510 mg of ferumoxytol within 7 d (n = 114) or 200 mg elemental oral iron daily for 21 d (n = 116). The primary efficacy endpoint was the change in hemoglobin from baseline to day 35. Safety was closely monitored. Results: Ferumoxytol resulted in a mean increase in hemoglobin of 1.02 ± 1.13 g/dl at day 35 compared with 0.46 ± 1.06 g/dl with oral iron (P = 0.0002). Twice as many ferumoxytol-treated patients than oral iron-treated patients achieved a ≥1 g/dl hemoglobin increase at day 35 (P = 0.0002). There was a greater mean increase in transferrin saturation (TSAT) with ferumoxytol compared with oral iron at day 35 (P < 0.0001). The larger hemoglobin increase after ferumoxytol compared with oral iron at day 35 persisted after adjustment for baseline hemoglobin, TSAT, and serum ferritin. Overall adverse event rates were comparable between groups. Conclusions: In patients on hemodialysis, rapid intravenous injection of 510 mg of ferumoxytol led to significantly greater hemoglobin increases compared with oral iron, with comparable tolerability. PMID:19176796

  11. Yellow fever vaccination status and safety in hemodialysis patients.

    PubMed

    Facincani, Tila; Guimarães, Maia Nogueira Crown; De Sousa Dos Santos, Sigrid

    2016-07-01

    The adverse effects of yellow fever (YF) vaccine in dialysis patients are not well known. There is concern about the risks and benefits of the vaccine in immunocompromised patients living in endemic areas, particularly given the risk of resurgence of urban YF with the spread of Aedes aegypti mosquitoes. The purpose of this study was to assess the coverage and safety of YF vaccine in chronic dialysis patients. A cross-sectional study of 130 chronic dialysis patients was performed. Data were collected on clinical characteristics and YF vaccine status. Patients not vaccinated against YF or without a booster vaccination within the last 10 years were referred to receive the vaccine, and adverse effects were monitored. Previous vaccination was verified in 44 patients within the last 10 years and in 26 patients at more than 10 years ago, with no mention of adverse effects. Thirty-six patients had never been vaccinated and 24 had an unknown vaccination status. Of the total 86 patients referred for immunization, 45 actually received the YF vaccine, with 24.4% experiencing mild local adverse effects and 4.4% experiencing fever. No serious adverse effects attributable to YF vaccine were observed (anaphylaxis, neurological or viscerotropic disease). YF vaccine coverage among hemodialysis patients is low, and the vaccine appeared to be safe in this population with a small sample size. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  12. Serum human T-lymphotropic virus 1 proviral load in patients on hemodialysis.

    PubMed

    Hekmat, Reza; Gholami, Farhad; Ahmadnia, Hassan; Ahmadi, Mostafa; Hassannia, Tahere

    2013-03-01

    Patients on hemodialysis are a high-risk group for human T-lymphotropic virus 1 (HTLV1) infection and other viruses transmitted by blood or blood products. The Razavi and South Khorasan provinces in Iran are the endemic areas for this virus. This study compares proviral load of HTLV1 in patients on hemodialysis with otherwise healthy carriers of HTLV1. In this case-control study the proviral load of the HTLV1 virus was compared between 25 patients on long-term hemodialysis who were positive for HTLV1 and 25 healthy carriers of HTLV1, to determine The effect of uremia and chronic hemodialysis on the proviral load. virus proviral load was determined using a real-time polymerase chain reaction method. There was a significant difference in the proviral load between the hemodialysis patients and the control group (903 +/- 182 copies per mL versus 117 +/- 186 copies per mL, respectively; P = .008). No significant correlation was found between the proviral load and haematocrit or serum levels of urea, creatinine, parathyroid hormone, calcium , and phosphorus level in hemodialysis patients, but proviral load of HTLV1 was significantly correlated with leukocyte count (r = -0.46, P = .02), hemodialysis duration (r = 0.48, P = .02), and the numbers of blood transfusions (r = 0.71, P < .01). Conclusions. The immune deficiency related to end-stage renal disease and uremia is the probable cause of significantly higher HTLV1 proviral load in hemodialysis patients compared to healthy HTLV1 carriers. This high HTLV1 proviral load might be due to immune dysfunction in chronic hemodialysis patients.

  13. Modified Mininutritional Assessment can effectively assess the nutritional status of patients on hemodialysis.

    PubMed

    Tsai, Alan C; Lu, Shu-Jen; Chang, Tsui-Lan

    2009-09-01

    We sought to determine whether the MNA (Mininutritional Assessment) would be an effective tool for assessing the nutritional status of patients undergoing hemodialysis. Purposive sampling. Two hospital-managed hemodialysis centers in central Taiwan. Subjects were 95 ambulatory patients older than 40 years without acute diseases or infections who had received hemodialysis treatment at the center for longer than 30 days. Each subject was interviewed with a structured questionnaire to elicit basic personal data and health- and lifestyle-related information and answered questions on the Council on Nutrition Appetite Questionnaire and MNA. Serum biochemical data were obtained from their routine measurement. The nutritional status of each subject was graded with two modified MNA versions. MNA-TI adopted population-specific anthropometric cut-points, and MNA-TII further had the body mass index question deleted from the scale and question scores adjusted but maintained the same 30 total points. Based on the strength of correlation with the key nutrition-related parameters including appetite status, serum creatinine, percent weight loss, hospital length of stay, number of prescribed drugs, and hemodialysis time, both modified MNA versions reflected the nutritional status of Taiwanese hemodialysis patients better than the Council on Nutrition Appetite Questionnaire. Serum albumin did not reflect nutritional status well in these hemodialysis patients. MNA-TI predicted 26.4% and MNA-TII predicted 29.5% of hemodialysis patients were either malnourished or at risk of malnutrition. Both versions of the modified MNA are effective in assessing the nutritional status of hemodialysis patients. MNA-TII without body mass index is a significant improvement for hemodialysis patients because body weights fluctuate significantly between dialysis sessions.

  14. Association between high-molecular-weight adiponectin and bone mineral density in hemodialysis patients.

    PubMed

    Amemiya, Nobuyuki; Otsubo, Shigeru; Iwasa, Yuko; Onuki, Takako; Nitta, Kosaku

    2013-06-01

    Chronic kidney disease-mineral and bone disorder is a regular complication seen in hemodialysis patients and leads to substantial increases in the fracture rate, morbidity, and mortality. Discovered a few years ago, several clinical studies have shown a negative correlation between adiponectin and bone mineral density (BMD) independently of confounding factors. The relationship between adiponectin and bone metabolism in hemodialysis patients has not been fully described yet. We conducted this study to investigate the relationship between serum adiponectin concentration and the BMD in hemodialysis patients. We enrolled 92 hemodialysis patients who were receiving maintenance hemodialysis therapy at Towa Hospital. A peripheral blood sample was obtained, and standard biological data and the serum high-molecular-weight (HMW) adiponectin level were measured. BMD was assessed using dual-energy X-ray absorptiometry scans. In male hemodialysis patients, BMD was negatively related to age (r = -0.299, P = 0.012), duration of hemodialysis therapy (r = -0.31, P = 0.009), and log [HMW-adiponectin] (r = -0.31, P = 0.009) and positively related to body weight (r = 0.332, P = 0.004) and BMI (r = 0.297, P = 0.013). In female hemodialysis patients, BMD was negatively related to age (r = -0.499, P = 0.018) and log [HMW-adiponectin] (r = -0.46, P = 0.030) and positively related to triglyceride (r = 0.491, P = 0.020). HMW adiponectin may affect bone metabolism in both male and female hemodialysis patients.

  15. Video-assisted thoracoscopic surgery for lung cancer in patients on hemodialysis.

    PubMed

    Matsuoka, Katsunari; Kuroda, Ayumi; Kang, Angyoung; Imanishi, Naoko; Nagai, Shinjiro; Ueda, Mitsuhiro; Miyamoto, Yoshihiro

    2013-01-01

    Surgical treatment of lung cancer in patients receiving hemodialysis carries a high risk because of poor cardiac function and a fragile electrolyte balance. Because the number of patients receiving hemodialysis has increased, the proportion of such patients with lung cancer is expected to rise. However, few studies have examined the results of surgery for lung cancer in hemodialysis patients, especially by video-assisted thoracoscopic surgery (VATS). We conducted a retrospective analysis of 5 hemodialysis patients who underwent VATS for lung cancer. All patients were men, and the mean age was 70.4 years. The operative procedure was lobectomy in 4 patients and segmentectomy in 1. During the perioperative period, none required urgent hemodialysis. There were no critical complications and in-hospital deaths. Three of the 5 patients are currently alive and recurrence-free. One patient died of recurrence at 4 month after surgery, and the other patient died at 17 months after surgery without cancer recurrence. VATS appears to be a safe procedure for hemodialysis patients with lung cancer, and the long-term outcome is satisfactory.

  16. Factors affecting response to hepatitis B vaccine among hemodialysis patients in a large Saudi Hemodialysis Center.

    PubMed

    Al Saran, Khalid; Sabry, Alaa; Al Halawany, Zakaria; Ismail, Mahmoud

    2014-01-01

    The aim of this study is to determine the response to hepatitis B virus (HBV) vaccination in patients on hemodialysis (HD) and to identify the factors that could affect this response. This retrospective study was carried out during the period from January 2009 to December 2009 in the Prince Salman Center for Kidney Diseases (PSCKD), Riyadh, and included 144 patients (78 males and 66 females) on regular HD, all of whom received hepatitis B vacci-nation. Patients were divided into two groups according to the level of hepatitis B surface antibodies (HBsAb): Responders group (>10 IU/L) and non-responders group (<10 IU/L). The study looked at the factors that may affect the responsiveness to hepatitis B vaccination, like gender, age, co-existence of hepatitis C virus (HCV) infection, dialysis adequacy that was evaluated by urea reduction ratio (URR) and Kt/V, hemoglobin level, albumin level, protein catabolic rate (PCR), body mass index (BMI), subjective global nutritional status (SGA) and HbA1c. There were 129 patients (89.6%) in the responders group including 69 males and 60 females and 15 patients (10.4%) in the non-responders group including nine males and six females. The mean age in the responders group and the non-responders group was 50.56 ± 15.35 and 56.87 ± 12.52 years, respectively (P = 0.128). The mean value of the PCR was 1.03 ± 0.17 and 0.88 ± 0.17 g/kg/day in the responders group and non-responders group, respectively (P = 0.002). There was no statically significant difference between the two groups regarding the presence or absence of HCV infection, age, gender, diabetes mellitus, URR, Kt/V, hemoglobin level and albumin level. We report a high response rate (89%) for HBV vaccination in our HD patients. The PCR was the only factor that affected the response to HBV vaccination in these patients.

  17. Midodrine-induced vascular ischemia in a hemodialysis patient: a case report and literature review.

    PubMed

    Rubinstein, Sofia; Haimov, Moshe; Ross, Michael J

    2008-01-01

    Midodrine is an alpha-agonist that causes peripheral vasoconstriction, resulting in increased blood pressure. It has been reported to be safe and effective in patients with end stage renal disease (ESRD) and is widely used for hemodialysis-associated hypotension. We report a case report of midodrine-induced ischemia in a patient on hemodialysis and review the literature relating to the safety of midodrine in patients with end stage renal disease.

  18. Nutritional predictors of early mortality in incident hemodialysis patients

    PubMed Central

    Lukowsky, Lilia R.; Kheifets, Leeka; Arah, Onyebuchi A.; Nissenson, Allen R.

    2013-01-01

    Purpose Low serum albumin concentration and low dietary protein intake are associated with protein-energy wasting (PEW) and higher mortality in maintenance hemodialysis patients. The role of these nutritional markers is less clear in clinical outcomes of the first several months of dialysis therapy, where mortality is exceptionally high. Methods In a cohort of 17,445 incident hemodialysis patients, we examined variation in serum albumin and the normalized protein catabolic rate (nPCR), a surrogate of dietary intake, and quarterly mortality in the first 2 years of dialysis therapy. Cox proportional hazard models were fitted to estimate the association between mortality and combined albumin/nPCR categories for eight quarters. We investigated the associations between mortality and baseline and subsequent serum albumin levels per cohort quarter as well as changes in albumin and nPCR over time. Results Patients were 64 ± 15 years old (mean ± SD) and included 45 % women, 24 % African Americans and 58 % diabetics. Correlations between quarterly serum albumin and nPCR varied from 0.18 to 0.25. Serum albumin <3.5 g/dL was consistently associated with high mortality as was nPCR <1 g/kg/day (except for qtr1). Low serum albumin and nPCR greater than 0.2 g/dLg/dL or g/kg/day, respectively, were associated with increased risk of death. Quarterly rise in nPCR (>+0.2 g/kg/day) showed reverse effect on mortality from the 2nd to the last quarter. Conclusions Low serum albumin and nPCR are associated with mortality. A rapid rise in nPCR by the end of the second year may indicate pre-existing PEW. PMID:23703546

  19. Assessment of Fatigue in End Stage Renal Disease Patients Undergoing Hemodialysis: Prevalence and Associated Factors

    PubMed Central

    Zyga, Sofia; Alikari, Victoria; Sachlas, Athanasios; Fradelos, Evangelos C.; Stathoulis, John; Panoutsopoulos, Georgios; Georgopoulou, Maria; Theophilou, Paraskeui; Lavdaniti, Maria

    2015-01-01

    Background: Fatigue is a common symptom referred by many patients undergoing hemodialysis. Fatigue is associated with poor health-related quality of life (HRQoL) and is an important predictor for survival of hemodialysis patients. Aim: To assess the levels of fatigue and demographic factors affecting it among patients with End Stage Renal Disease undergoing hemodialysis. Methods: This quantitative study was carried out in two Dialysis Units of Hospitals in Athens Region. Between January 2015 and June 2015, 129 hemodialysis patients completed the Greek Version of the Fatigue Assessment Scale (FAS). Demographic data of patients was recorded. For the statistical analysis IBM SPSS Statistics version 20 was used. Results: The mean FAS score was 24.99. 49 patients (38.0%) were non fatigued, 61 patients (47.3%) were fatigued, and 19 patients (13.7%) were extremely fatigued. Higher levels of fatigue were reported among hemodialysis patients residing in urban areas, in those with low educational level and unemployed. Conclusion: The findings of this study can be used in the assessment of fatigue and early identification of high-risk patients (especially of the unemployed, those who occupy with domestic works, those with low educational level and of urban citizens). Use of this knowledge by hemodialysis nurses may lead to a better understanding of the factors of fatigue in ESRD, which in turn may lead to a more effective treatment. PMID:26843728

  20. Blood Pressure Management in Hemodialysis Patients: What We Know And What Questions Remain.

    PubMed

    Miskulin, Dana C; Weiner, Daniel E

    2017-03-06

    Despite having thousands of blood pressure (BP) readings on individual dialysis patients over the course of a year, our knowledge about the optimal assessment of BP, the mechanisms underlying hypertension and its management remain incomplete. Observational studies reveal that BP is lower at home than when measured in the dialysis unit. However, we do not know if using home vs. in-center measurements to guide treatment decisions improves BP control and/or clinical outcomes. Moreover, a recent US study suggests that typical hemodialysis patients are unlikely to adhere to home monitoring over the long term. Volume excess is one of probably many factors mediating hypertension in this population. A randomized clinical trial of aggressively challenging dry weight in patients without overt signs of fluid overload was shown to reduce BP, but there was an increase in vascular access thrombosis and intradialytic hypotension episodes. Long-term studies have not been done; thus, we do not know whether "squeezing dry weight" as a means to control BP is of more benefit than harm. Daily or prolonged nocturnal dialysis consistently has been shown to lower BP. To what extent this is a result of enhanced solute clearance vs. removal of excess volume is not clear. Use of bioimpedance or relative blood volume monitoring to guide fluid management has been tested in small studies, but more data are needed to determine whether their use impacts clinical outcomes. Well-designed clinical trials to determine whether a specific antihypertensive drug class is of benefit, independent of BP lowering, are lacking. The BP target that optimizes outcomes HD patients is also unknown. Observational studies consistently show poorer survival with predialysis BP <140/90 mmHg, although such studies likely are confounded by low BP due to cardiovascular disease and other comorbidities. In this review, we discuss what is known and the questions that remain regarding the epidemiology, diagnosis, etiology

  1. High rates of death and hospitalization follow bone fracture among hemodialysis patients.

    PubMed

    Tentori, Francesca; McCullough, Keith; Kilpatrick, Ryan D; Bradbury, Brian D; Robinson, Bruce M; Kerr, Peter G; Pisoni, Ronald L

    2014-01-01

    Altered bone structure and function contribute to the high rates of fractures in dialysis patients compared to the general population. Fracture events may increase the risk of subsequent adverse clinical outcomes. Here we assessed the incidence of post-fracture morbidity and mortality in an international cohort of 34,579 in-center hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS). We estimated country-specific rates of fractures requiring a hospital admission and associated length of stay in the hospital. Incidence rates of death and of a composite event of death/rehospitalization were estimated for 1 year after fracture. Overall, 3% of participants experienced a fracture. Fracture incidence varied across countries, from 12 events/1000 patient-years (PY) in Japan to 45/1000 PY in Belgium. In all countries, fracture rates were higher in the hemodialysis group compared to those reported for the general population. Median length of stay ranged from 7 to 37 days in the United States and Japan, respectively. In most countries, postfracture mortality rates exceeded 500/1000 PY and death/rehospitalization rates exceeded 1500/1000 PY. Fracture patients had higher unadjusted rates of death (3.7-fold) and death/rehospitalization (4.0-fold) compared to the overall DOPPS population. Mortality and hospitalization rates were highest in the first month after the fracture and declined thereafter. Thus, the high frequency of fractures and increased adverse outcomes following a fracture pose a significant health burden for dialysis patients. Fracture prevention strategies should be identified and applied broadly in nephrology practices.

  2. Listeria monocytogenes meningitis in a human immunodeficiency virus-positive patient undergoing hemodialysis.

    PubMed

    Calubiran, O V; Horiuchi, J; Klein, N C; Cunha, B A

    1990-01-01

    Listeria monocytogenes bacteremia without meningitis has been reported in patients who have undergone long-term hemodialysis and have transfusional iron overload. On the other hand, cases of Listeria bacteremia without meningitis have occurred sporadically among the acquired immunodeficiency syndrome population, mostly homosexuals. There have been no reports of Listeria meningitis occurring among persons who are antibody positive to human immunodeficiency virus or are intravenous drug abusers having chronic renal failure and undergoing hemodialysis. This patient represents the first case of Listeria bacteremia and meningitis to occur in an intravenous drug abuser who is human immunodeficient antibody positive, is receiving hemodialysis, and has transfusional iron overload.

  3. Advanced thymic cancer treated with carboplatin and paclitaxel in a patient undergoing hemodialysis.

    PubMed

    Miura, Satoru; Kagamu, Hiroshi; Sakai, Takehito; Nozaki, Koichiro; Asakawa, Katsuaki; Moro, Hiroshi; Okajima, Masaaki; Watanabe, Satoshi; Yamamoto, Suguru; Iino, Noriaki; Goto, Shin; Kazama, Junichiro James; Yoshizawa, Hirohisa; Narita, Ichiei

    2015-01-01

    A 53-year-old man with an asymptomatic anterior mediastinal tumor undergoing hemodialysis was referred to our institution. He was diagnosed with thymic basaloid carcinoma based on the findings of a chest tomography-guided biopsy and successfully treated with carboplatin (300 mg/m(2)/day) and paclitaxel (200 mg/m(2)/day) on day 1 for six three-week cycles. To our knowledge, this is the first report regarding the efficiency of a carboplatin dose-definition method based on the body surface area with paclitaxel in a hemodialysis patient. This report may therefore be useful for treating hemodialysis patients who are candidates for carboplatin and paclitaxel therapy.

  4. Comparing effects of clonazepam and zolpidem on sleep quality of patients on maintenance hemodialysis.

    PubMed

    Dashti-Khavidaki, Simin; Chamani, Nastaran; Khalili, Hossein; Hajhossein Talasaz, Azita; Ahmadi, Farokhlegha; Lessan-Pezeshki, Mahboob; Ghaeli, Padideh; Dalili, Shirin; Alimadadi, Abbas

    2011-11-01

    Poor sleep quality is very common among maintenance hemodialysis patients and has negative impacts on patients' quality of life. Benzodiazepines have traditionally been used in this population; however, they may induce physical dependence and sleep apnea. Nonbenzodiazepine hypnotic medications with less side effects are introduced as alternatives. This study was designed to compare the effect of zolpidem and clonazepam on sleep quality of hemodialysis patients. In a randomized crossover study on 23 hemodialysis patients, sleep quality was assessed using the Pittsburgh Sleep Quality Index at baseline, at the initiation of a 1-week washout period after a 2-week treatment with zolpidem (1 mg) and clonazepam (5 mg to 10 mg), and after the second 2 weeks of treatment. Patients who suffer from any concurrent situations that may affect sleep quality or psychiatric disorders and those on medications affecting sleep quality were excluded. The prevalence of poor sleep quality was 87.8% of the 88 hemodialysis patients who were initially approached. There was a significant negative correlation between iron deficiency and poor sleep quality. Both clonazepam and zolpidem significantly improved sleep quality; however, clonazepam was more effective in decreasing the Pittsburgh Sleep Quality Index scores (P = .03). Zolpidem was better tolerated in the hemodialysis patients. Clonazepam was more effective than zolpidem in the improvement of sleep quality of hemodialysis patients, while zolpidem was better tolerated in these patients.

  5. Variability of oxidative stress biomarkers in hemodialysis patients.

    PubMed

    Dahwa, Rumbidzai; Fassett, Robert G; Wang, Zaimin; Briskey, David; Mallard, Alistair R; Coombes, Jeff S

    2014-03-01

    Oxidative stress biomarkers may have a role in the future to assist clinical decisions regarding the use of antioxidant therapies and their efficacy. The aims of this study were to evaluate the within and between-individual variability of plasma oxidative stress biomarkers and investigate factors affecting their variability. Plasma F2-isoprostanes and protein carbonyls were measured in 14 hemodialysis patients every 2 weeks for 10 weeks. Within-individual coefficients of variation (CVs) were isoprostanes = 30.4% (range = 6.1-66.7%) and protein carbonyls = 16.3% (8.4-29.5%). Between-individual CVs were isoprostanes = 34.4% (28.9-40.2%) and protein carbonyls = 19.5% (15.6-24.5%). There were no significant (p > 0.05) relationships between the oxidative stress biomarkers and dietary antioxidant intake, medications, clinical and demographic parameters.

  6. Prognostic impact of peritonitis in hemodialysis patients: A national-wide longitudinal study in Taiwan

    PubMed Central

    Lee, Cheng-Chia; Wu, Patricia W.; Chang, Chee-Jen; Tian, Ya-Chung; Yang, Chih-Wei

    2017-01-01

    Background Peritonitis has been independently associated with increased morbidity and mortality in peritoneal dialysis patients. However, there are few reports on peritonitis in hemodialysis patients. We aim at investigating both the risk profiles and prognostic impact of peritonitis in hemodialysis patients. Methods This nation-wide longitudinal study uses claims data obtained from the Taiwan National Health Insurance Research Database. A total of 80,733 incident hemodialysis patients of age ≥ 20 years without a history of peritonitis were identified between January 1, 1998 and December 31, 2009. Predictors of peritonitis events were estimated using Cox proportional hazard models. Time-dependent Cox proportional hazard models were used to estimate hazard ratio for mortality attributed to peritonitis exposure. Results Of 80,733 incident hemodialysis patients over a 13-year study period, peritonitis was diagnosed in 935 (1.16%), yielding an incidence rate of 2.91 per 1000 person-years. Female gender, liver cirrhosis and polycystic kidney disease were three of the most significant factors for peritonitis in both non-diabetic and diabetic hemodialysis patients. The cumulative survival rate of patients with peritonitis was 38.8% at 1 year and 10.1% at 5 years. A time-dependent Cox multivariate analysis showed that peritonitis had significantly increased hazard ratio for all cause mortality. Additionally, the risk of mortality remained significantly higher for non-diabetic hemodialysis patients that experienced peritonitis. Conclusions The risk of peritonitis in hemodialysis patients is higher in female gender, liver cirrhosis and polycystic kidney disease. Although peritonitis is a rare condition, it is associated with significantly poorer outcome in hemodialysis patients. PMID:28301536

  7. Prognostic impact of peritonitis in hemodialysis patients: A national-wide longitudinal study in Taiwan.

    PubMed

    Lu, Yueh-An; Tu, Kun-Hua; Lee, Cheng-Chia; Wu, Patricia W; Chang, Chee-Jen; Tian, Ya-Chung; Yang, Chih-Wei; Chu, Pao-Hsien

    2017-01-01

    Peritonitis has been independently associated with increased morbidity and mortality in peritoneal dialysis patients. However, there are few reports on peritonitis in hemodialysis patients. We aim at investigating both the risk profiles and prognostic impact of peritonitis in hemodialysis patients. This nation-wide longitudinal study uses claims data obtained from the Taiwan National Health Insurance Research Database. A total of 80,733 incident hemodialysis patients of age ≥ 20 years without a history of peritonitis were identified between January 1, 1998 and December 31, 2009. Predictors of peritonitis events were estimated using Cox proportional hazard models. Time-dependent Cox proportional hazard models were used to estimate hazard ratio for mortality attributed to peritonitis exposure. Of 80,733 incident hemodialysis patients over a 13-year study period, peritonitis was diagnosed in 935 (1.16%), yielding an incidence rate of 2.91 per 1000 person-years. Female gender, liver cirrhosis and polycystic kidney disease were three of the most significant factors for peritonitis in both non-diabetic and diabetic hemodialysis patients. The cumulative survival rate of patients with peritonitis was 38.8% at 1 year and 10.1% at 5 years. A time-dependent Cox multivariate analysis showed that peritonitis had significantly increased hazard ratio for all cause mortality. Additionally, the risk of mortality remained significantly higher for non-diabetic hemodialysis patients that experienced peritonitis. The risk of peritonitis in hemodialysis patients is higher in female gender, liver cirrhosis and polycystic kidney disease. Although peritonitis is a rare condition, it is associated with significantly poorer outcome in hemodialysis patients.

  8. Selection of artificial valve for the patients on hemodialysis.

    PubMed

    Takemura, Hirofumi

    2013-06-01

    The selection of artificial valve for the hemodialysis patients is still controversial. Initially ACC/AHA guideline recommended using mechanical valve because of concern on the durability of bioprosthesis after replacement on the dialysis patients; however, revised guideline deleted that recommendation. Although many reports recognized rapid deterioration of bioprosthesis mainly due to calcification after valve replacement, there is no difference on survival between both types of valve. The recently conducted meta-analysis reported the same conclusions. Actually the long-term survival of the dialysis patients is poorer than that of non-dialysis people; however, it differs according to the etiology of renal failure. For example, the long-term survival of the non-diabetic patients seems longer than that of diabetic patients requiring longer durability of artificial valve. According to ACC/AHA guideline and the meta-analysis, surgeon should not hesitate to use bioprosthetic valve; however, surgeon should consider stratification of the dialysis patients by prediction for the long survival of each patient.

  9. A study of plasma bicalutamide concentrations in hemodialysis patients.

    PubMed

    Ito, Fumio; Goya, Nobuyuki; Nakazawa, Hayakazu; Suzuki, Toshiaki; Suzuki, Keiko; Kubo, Kazuo; Kihara, Takeshi

    2012-01-01

    Bicalutamide is an anti-androgen that is used worldwide to treat prostate cancer (CaP). However, there are no data on blood bicalutamide concentrations in hemodialysis (HD) patients with CaP. Therefore, we investigated the plasma levels of bicalutamide during the peridialysis period in this population. The study group included 5 HD patients with CaP who had been treated with bicalutamide (80 mg/day) for at least 3 months. Blood samples were taken during and between HD sessions and the plasma concentrations of the active R enantiomer (R-bicalutamide) were assessed using an HPLC assay. The plasma R-bicalutamide levels on the non-dialysis day were measured in 2 patients (patients 1 and 2) immediately before dosing and 8 and 24 h after dosing. These levels were 18,730, 19,090 and 19,420 ng/ml (patient 1), and 4,522, 4,581, and 5,296 ng/ml (patient 2), respectively. The mean plasma levels of R-bicalutamide in all 5 subjects just before HD, and 2 and 4 h after the start of HD were 8,726, 9,354 and 10,068 ng/ml, respectively. These results show that bicalutamide does not accumulate and is not diluted in the blood circulation of HD patients when given at the normal dosage used in the general population. Copyright © 2012 S. Karger AG, Basel.

  10. Exercise Training Alters the Bone Mineral Density of Hemodialysis Patients.

    PubMed

    Marinho, Sandra M; Moraes, Cristiane; Barbosa, Jorge Eduardo Dos Santos Monteiro; Carraro Eduardo, José Carlos; Fouque, Denis; Pelletier, Solenne; Mafra, Denise

    2016-10-01

    Marinho, SM, Moraes, C, Barbosa, JEdSM, Eduardo, JCC, Fouqe, D, Pelletier, S, and Mafra, D. Exercise training alters the bone mineral density of hemodialysis patients. J Strength Cond Res 30(10): 2918-2923, 2016-Patients with chronic kidney disease undergoing hemodialysis (HD) frequently present low bone mineral density (BMD), and exercise may be useful for treating bone loss. This study aimed to assess the effects of an intradialytic resistance exercise training program (RETP) on BMD in HD patients. Twenty-one patients were enrolled into 2 groups; 10 patients performed exercise (80.0% men; 46.9 ± 12.1 years; 27.0 ± 3.4 kg·m) and 11 patients were in the control group (54.5% men; 50.5 ± 11.5 years; 24.1 ± 8.7 kg·m). Dual-energy x-ray absorptiometry was used to measure the BMD, lean mass, and body fat before and after the supervised RETP (performed with elastic bands and ankle cuffs in both lower limbs 3 times a week for 24 weeks-72 sessions). In the exercise group, 30.0% of patients presented with osteopenia and 20.0% osteoporosis and in the control group, 45.5% osteopenia and 36.4% osteoporosis. Only in the exercise group, the osteoporosis percentage was reduced to 10.0% and the femoral neck BMD and T-score improved from 0.89 ± 0.1 to 0.93 ± 0.1 g·cm and from -1.3 ± 0.8 to -1.0 ± 0.8 g·cm (p ≤ 0.05), respectively, after the intervention. In contrast, these parameters were reduced in the control group. The results suggest that resistance exercise may be useful for improving the BMD in HD patients. In summary, 24 weeks of the supervised RETP played a role in improving the BMD of HD patients.

  11. Levamisole Usage as an Adjuvant to Hepatitis B Vaccine in Hemodialysis Patients, Yes or No?

    PubMed Central

    Sanadgol, Houshang

    2012-01-01

    Background Hepatitis B virus (HBV) infection is much more common in hemodialysis patients than the general population. These patients have an impaired immune response to HBV vaccination; to that end there are certain studies that have evaluated levamisole as an immunomodulator agent improving HBV vaccination response rate in hemodialysis patients. Objectives In the current review, we have assembled all of the results to determine whether lavamisole is of value as an adjuvant to HBV vaccination in hemodialysis patients. Materials and Methods Science Direct (Elsevier), ProQuest, Springer, MD Consult, BMJ Journals, Pubmed and Wiley were searched for levamisole application to HBV vaccination in hemodialysis patients. All studies revealed a seroconversion response level between levamisole plus HBV vaccine versus HBV vaccine alone. Results From 10 relevant studies, 5 studies fulfilled our inclusion criteria. Three of them suggested the significant benefit of adding levamisole to the HBV vaccine to increase augment seroprotection level in hemodialysis patients. Another study reported a decrease in seroprotection level and another study showed no significant difference caused by levamisole administration. Conclusions Due to the limited number of studies evaluated, it is challenging to perform a definite decision about routinely administering levamisole in addition to the HBV vaccine for all hemodialysis patients. However, it does seem reasonable to recommend administration of levamisole for impaired immune response patients. PMID:23577329

  12. Reduced antibody reactivity to hepatitis C virus antigens in hemodialysis patients coinfected with hepatitis B virus.

    PubMed Central

    Devesa, M; Khudyakov, Y E; Capriles, F; Blitz, L; Fields, H A; Liprandi, F; Pujol, F H

    1997-01-01

    Antibody reactivities to hepatitis C virus (HCV) antigens and to synthetic peptides derived from different parts of the HCV genome (core, NS4, and NS5) were evaluated in HCV-infected hemodialysis patients. In the RIBA 3 assay, NS5 was significantly less recognizable by sera of hemodialysis patients compared to other HCV-infected subjects. Among hemodialysis patients, those coinfected with hepatitis B virus (HBV) (positive for hepatitis B surface antigen [HBsAg+]) showed a reduction in reactivity to C33 and C100. Sera of only 23% of the hemodialysis patients (37 of 161) reacted with more than three of eight peptides tested, significantly fewer than the 60% (12 of 20) of the sera of other HCV-infected patients tested (P = 0.001). This immunosuppression was also manifested by a reduced frequency of recognition of additional peptides on follow-up. An even more reduced reactivity was observed among the HBV-coinfected patients (HBsAg+). The low-responder hemodialysis patients were not infected with any particular genotype of HCV, and the same HCV genotypes observed in the whole group of hemodialysis patients (1a, 1b, 2a, and 3a) were found circulating in the low-responder group. Even in this low-responder population, the good performance of two peptides (peptide 716, corresponding to a portion of the core, and peptide 59, corresponding to a portion of NS4) corroborates the immunodominance of the conserved epitopes within these peptides. PMID:9384281

  13. Liver enzymes serum levels in patients with chronic kidney disease on hemodialysis: a comprehensive review.

    PubMed

    Sette, Luís Henrique Bezerra Cavalcanti; Almeida Lopes, Edmundo Pessoa de

    2014-01-01

    We reviewed the literature regarding the serum levels of the enzymes aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyl transferase in patients with chronic kidney disease on hemodialysis with and without viral hepatitis. Original articles published up to January 2013 on adult patients with chronic kidney disease on hemodialysis were selected. These articles contained the words "transaminases" "aspartate aminotransferase" "alanine aminotransferase" "gamma glutamyl transferase," "liver enzymes", AND "dialysis" OR "hemodialysis". A total of 823 articles were retrieved. After applying the inclusion and exclusion criteria, 49 articles were selected. The patients with chronic kidney disease on hemodialysis had reduced serum levels of aminotransferases due to hemodilution, lower pyridoxine levels, or elevated homocysteine levels. The chronic kidney disease patients on hemodialysis infected with the hepatitis C virus also had lower aminotransferase levels compared with the infected patients without chronic kidney disease. This reduction is in part due to decreased viremia caused by the dialysis method, the production of a hepatocyte growth factor and endogenous interferon-α, and lymphocyte activation, which decreases viral action on hepatocytes. Few studies were retrieved on gamma-glutamyl transferase serum levels; those found reported that there were no differences between the patients with or without chronic kidney disease. The serum aminotransferase levels were lower in the patients with chronic kidney disease on hemodialysis (with or without viral hepatitis) than in the patients with normal renal function; this reduction has a multifactorial origin.

  14. Effects of music on complications during hemodialysis for chronic renal failure patients.

    PubMed

    Koca Kutlu, Adalet; Eren, Ayşe Gül

    2014-10-01

    The study was planned as a case-control study to examine the effects of music on some of the complications experienced by chronic renal failure (CRF) patients during hemodialysis. A total of 60 patients (30 intervention and 30 control) diagnosed with end-stage renal failure undergoing hemodialysis treatment participated in this study. The study was conducted in Manisa Merkez Efendi State Hospital Hemodialysis Unit and Manisa Özel Anemon Hemodialysis between April 2012 and July 2012. The intervention group listened 30 minutes in each session (12 total sessions) Turkish art music at the beginning of the third hour of their hemodialysis sessions. Patient Information Form and visual analog scale to assess pain, nausea, vomiting, and cramps during hemodialysis session were used. For the analysis of data, the number, percentage, chi-square test, and significance test of independent group differences between two averages were conducted. According to the findings of the study, the average of the intervention and control group ages, respectively, was 50.86 ± 11.3 and 55.13 ± 9.68. The primary duration of hemodialysis treatment for both intervention and control groups was "1 year and above" (70.0%). The intervention group's pain and nausea scores were lower than the control group for all 12 sessions. The difference between the intervention and the control group's pain scores was significant (P < 0.05). However, in pain scores from the first session to 12th session, continuous decreasing trend was not observed. According to the results, music can be used as an independent nursing practice for reduction of complications for CRF patients receiving hemodialysis treatment. © 2014 International Society for Hemodialysis.

  15. 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.

  16. Human herpesvirus 6 infection in hemodialysis and peritoneal dialysis patients.

    PubMed

    Altay, Mustafa; Akay, Hatice; Ünverdi, Selman; Altay, Filiz; Ceri, Mevlüt; Altay, F Aybala; Cesur, Salih; Duranay, Murat; Demiroz, Ali Pekcan

    2011-01-01

    Human herpesvirus 6 (HHV-6) infection occurs worldwide and can be reactivated from latency during periods of immunosuppression, especially after organ transplantation. No previous study has evaluated the influence of dialysis type on HHV-6 infection. The aim of the present study was to determine the prevalence of HHV-6 antibodies in hemodialysis (HD) and peritoneal dialysis (PD) patients. We studied 36 PD patients, 35 HD patients, and 20 healthy subjects, all with no history of organ transplantation. After systematic inquiries and a physical examination, blood was drawn for determination of biochemical parameters, cytomegalovirus immunoglobulin M (IgM) and immunoglobulin G (IgG), hepatitis B surface antigen, and the hepatitis C and human immunodeficiency virus antibodies. Titers of HHV-6 IgM and IgG antibodies were determined by ELISA. Titers for HHV-6 IgM antibody were positive in 9 HD patients (25.7%), 8 PD patients (22.2%), and 2 control subjects (10.0%, p > 0.05). More HD patients (20.0%) than PD patients (5.6%, p = 0.07) or control subjects (0.0%, p = 0.03) were positive for HHV-6 IgG antibody. In HD patients, HHV-6 IgG seropositivity and duration of dialysis were positively correlated (R = 0.33, p = 0.05). Infection with HHV-6 is not rare in PD and HD patients. In addition, HHV-6 IgG seropositivity was significantly higher in HD patients than in control subjects and approached significance when compared with seropositivity in PD patients. Moreover, in HD patients, HHV-6 IgG seropositivity correlated with duration on HD. These preliminary findings provide insight into the pre-transplantation period for patients and may aid our understanding of how to best protect patients against HHV-6 after transplantation.

  17. Nutritional Predictors of Mortality in Long Term Hemodialysis Patients

    PubMed Central

    Weng, Cheng-Hao; Hu, Ching-Chih; Yen, Tzung-Hai; Hsu, Ching-Wei; Huang, Wen-Hung

    2016-01-01

    Serum albumin had been noted to be a predictor of mortality in hemodialysis (HD) patients. Normalized protein catabolic rate (nPCR) less than 0.8 or greater than 1.4 g/kg/d was also associated with greater mortality. There was no previous study to show the effectiveness of combination of serum albumin and nPCR to predict the mortality in chronic HD patients. Eight hundred and sixty-six patients were divided into 4 groups according to their nPCR and serum albumin levels. Biochemical, and hematological parameters were recorded. The associations between groups, variables mentioned above and mortality were analyzed. Multivariate Cox regression analysis showed that age, diabetes mellitus, fistula as blood access, nPCR <1.2 g/kg/day combined with albumin <4 (Group A), nPCR ≧ 1.2 g/kg/day combined with albumin <4 g/dL (Group B) (nPCR ≧ 1.2 g/kg/day combined with Albumin ≧ 4 g/dL as reference group), non-anuria, hemoglobin, creatinine, and log (high sensitivity C reactive protein) were correlated with 36 months mortality. Group A and group B patients had higher 36 months cardiovascular (CV) and infection related mortality rates as compared with group D patients. In conclusion, Group A and Group B patients had significantly higher rate of all-cause, CV and infection related mortality. PMID:27752119

  18. Nutritional status and food insecurity in hemodialysis patients.

    PubMed

    Wilson, Gloria; Molaison, Elaine Fontenot; Pope, Janet; Hunt, Alice E; Connell, Carol L

    2006-01-01

    The purpose of this study was to determine whether a relationship exists between nutrition status and food security of patients on hemodialysis (HD). A descriptive correlation study. This study consisted of HD patients undergoing treatment at three northeast Louisiana dialysis centers. Ninety-eight HD patients participated in the study. The mean age of subjects was 59.1 +/- 14.2 years. The sample was 44% white and 56% black; 49% male and 51% female. Multiple linear regression and chi2 analysis were used to assess relationships between demographics and food insecurity scores and Subjective Global Assessment scores. Race significantly predicted food insecurity (beta = 0.248; P = .019), with black patients being more food insecure than white subjects. A significant positive relationship was found between the level of education and Subjective Global Assessment scores (beta = 0.222; P = .037). In this sample, 16.3% of the subjects were found to be food insecure, and 64.3% of the patients were mildly to moderately malnourished, whereas another 13.3% were severely malnourished. Future research in this area should include food security questions related to the ability to obtain foods for health. Renal health care professionals should assess patients for possible food insecurity so that appropriate interventions can be implemented.

  19. 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.

  20. Artificial nutritional support in chronic hemodialysis patients: a narrative review.

    PubMed

    Bossola, Maurizio; Tazza, Luigi; Giungi, Stefania; Rosa, Fausto; Luciani, Giovanna

    2010-07-01

    Malnutrition is common in hemodialysis (HD) patients and is a powerful predictor of morbidity and mortality. While much progress has been made in identifying the causes and pathogenesis of malnutrition in patients on HD, no consensus has been reached on its management. Nutritional counseling, appetite stimulants, growth hormone, androgenic anabolic steroids, and anti-inflammatory drugs have been tested with contradictory and nonconclusive results. Oral nutritional supplements (ONSs) and intradialytic parenteral nutrition (IDPN) also have been studied. We searched the MEDLINE and PubMed databases for randomized clinical trials, comparative nonrandomized clinical trials, studies with patients who were controls for themselves, and single-arm studies on ONS and IDPN. Thirty-four studies (3223 patients) have been identified and analyzed. Seventeen studies were on ONS (778 patients) and 17 were on IDPN (2475 patients). ONS may improve serum albumin levels and/or other nutritional parameters, whereas there are insufficient data on clinical outcome. IDPN improves serum albumin and body weight. Data on survival are conflicting but the only study with an adequate population sample shows that IDPN does not influence survival. Randomized, controlled studies are needed to clarify the role of ONS and IDPN in the treatment of malnutrition in HD. Copyright 2010 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  1. Association of coronary artery calcium score and vascular dysfunction in long-term hemodialysis patients.

    PubMed

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

    2013-04-01

    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. We examined the cross-sectional DTM-CAC associations in a group of long-term hemodialysis patients, and their 1:1 matched normal counterpart. 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 electron beam computed tomography or multidetector computed tomography scan. 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% confidence interval: 1.12-1.93, P = 0.007). 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.

  2. Biotin ameliorates muscle cramps of hemodialysis patients: a prospective trial.

    PubMed

    Oguma, Shiro; Ando, Itiro; Hirose, Takuo; Totsune, Kazuhito; Sekino, Hiroshi; Sato, Hiroshi; Imai, Yutaka; Fujiwara, Masako

    2012-01-01

    Patients with renal failure undergoing hemodialysis often have muscle cramps during and after the dialysis therapy. Muscle cramps are defined as the sudden onset of a prolonged involuntary muscle contraction accompanied with severe pain, resulting in early termination of a HD session and inadequate dialysis. The etiology of the cramps is unknown and effective anti-cramp medicine is not available. We have hypothesized that water-soluble vitamins are deficient in HD patients. Accordingly, we administrated biotin to 14 patients who had frequent muscle cramps during HD sessions. Oral administration of 1 mg/day biotin promptly reduced the onset and the severity of cramps in 12 patients both during and after HD. Then, the plasma biotin levels were measured by an enzyme-linked immunosorbent assay method (ELISA) in HD patients, including 14 patients with cramps and 13 patients without cramps, and 11 healthy volunteers. Plasma biotin levels were elevated in 27 HD patients at baseline compared with healthy volunteers [451 (377 - 649) vs. 224 (148 - 308) ng/l, median (lower-upper quartiles); p < 0.0001]. Unexpectedly, among the 14 cramp patients, the biotin levels were significantly higher in biotin-ineffective 7 patients than biotin-effective 7 patients [1,064 (710 - 1,187) vs. 445 (359 - 476) ng/l; p < 0.001]. Thus, the biotins measured by ELISA may consist of not only intact biotin but also its metabolites that do not function as a vitamin. In conclusion, biotin administration is one choice to relieve HD patients from muscle cramps regardless of their elevated plasma biotin levels.

  3. Outpatient 131I Treatment for a Patient with Graves' Disease Receiving Hemodialysis

    PubMed Central

    Suzuki, Miho; Yoshimura Noh, Jaeduk; Sugino, Kiminori; Ito, Koichi

    2016-01-01

    A patient presented with hyperthyroidism and end-stage renal disease requiring hemodialysis that was difficult to control despite increased dosages of anti-thyroid drugs. The condition could finally be controlled by 131I radioactive iodine therapy (RIT) and hemodialysis provided under a hospital-linkage system. During three hemodialysis sessions after the oral administration of 131I, we measured the radioactivity released from the patient and the radioactivity of the devices/tools used. The radioactivity of the devices/tools was managed by allowing the isotope to decay into non-radioactive elements. Our experience suggests that outpatient RIT may provide a safe and convenient means of treating Graves' disease, even in patients receiving hemodialysis. PMID:27853074

  4. The absorption of dietary phosphorus and calcium in hemodialysis patients.

    PubMed

    Ramirez, J A; Emmett, M; White, M G; Fathi, N; Santa Ana, C A; Morawski, S G; Fordtran, J S

    1986-11-01

    Absorption of dietary phosphorus plays a critical role in the development of metabolic bone diseases in patients with chronic renal failure. However, phosphorus absorption is difficult to quantitate in dialysis patients because the dialysis treatments complicate metabolic balance studies. Utilizing a recently developed technique which permits measurement of net absorption of dietary constituents after a single meal, we measured phosphorus absorption in dialysis patients. The following observations were made: A.) Following a meal containing approximately 300 mg phosphorus, mean phosphorus absorption in five hemodialysis patients (with severe vitamin D deficiency) was only slightly less than in matched controls (186 +/- 35 vs. 242 +/- 30). B.) After dialysis patients were treated with 1,25(OH)2-D3, phosphorus absorption increased from 186 +/- 35 to 272 +/- 16 mg (P less than 0.025). C.) The effect of three aluminum containing antacids on phosphorus absorption was studied; each slightly reduced the absorption of phosphorus compared to placebo (P less than 0.01), but there was no significant difference between them. D.) Aluminum hydroxide and calcium carbonate each reduced dietary phosphorus absorption to approximately the same extent. Calcium carbonate ingestion was associated with sharply increased calcium absorption. The absorption of dietary phosphorus is influenced only modestly by 1,25(OH)2-D3 and is inhibited to an equal but only modest degree by various aluminum antacids and by calcium carbonate.

  5. 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.

  6. Forearm bone mass predicts mortality in chronic hemodialysis patients.

    PubMed

    Orlic, Lidija; Mikolasevic, Ivana; Crncevic-Orlic, Zeljka; Jakopcic, Ivan; Josipovic, Josipa; Pavlovic, Drasko

    2016-07-27

    We aim to determine the relationship between bone mineral density (BMD), measured by T- and Z-score, and mortality risk in hemodialysis (HD) patients. We also investigate which are the most suitable skeletal sites for predicting mortality rate. We analyzed the survival of 102 patients who had been treated with chronic HD according to BMD. Patients with a T-score ≤2.5 at the middle, ultradistal and proximal part of the forearm had a higher mortality risk than those with a T-score of -2.5 or higher. Furthermore, no statistically significant association was found between loss of bone mass at other measuring points-lumbar spine (anteroposterior orientation from L1-L4) and hip (neck, trochanter, intertrochanter, total and Ward's triangle)-and mortality risk. We were also interested in exploring the relationship between Z-score at different skeletal regions and mortality risk. We found that patients with a Z-score of -1 or lower at all three parts of the forearm had a greater mortality risk. It is also worth noting that the Z-score at all three parts of the forearm was a more apparent predictor of mortality, compared to the T-score at the same skeletal regions. This empirical analysis showed that BMD assessments should be obtained at the forearm, due to the good predictability of this skeletal site regarding mortality of HD patients. Moreover, data concerning bone density should be reported as Z-scores.

  7. Risk factors for in-hospital mortality in patients starting hemodialysis

    PubMed Central

    Bae, Eun Hui; Kim, Ha Yeon; Kang, Yong Un; Kim, Chang Seong; Ma, Seong Kwon; Kim, Soo Wan

    2015-01-01

    Background Incident hemodialysis patients have the highest mortality in the first several months after starting dialysis. This study evaluated the in-hospital mortality rate after hemodialysis initiation, as well as related risk factors. Methods We examined in-hospital mortality and related factors in 2,692 patients starting incident hemodialysis. The study population included patients with acute kidney injury, acute exacerbation of chronic kidney disease, and chronic kidney disease. To determine the parameters associated with in-hospital mortality, patients who died in hospital (nonsurvivors) were compared with those who survived (survivors). Risk factors for in-hospital mortality were determined using logistic regression analysis. Results Among all patients, 451 (16.8%) died during hospitalization. The highest risk factor for in-hospital mortality was cardiopulmonary resuscitation, followed by pneumonia, arrhythmia, hematologic malignancy, and acute kidney injury after bleeding. Albumin was not a risk factor for in-hospital mortality, whereas C-reactive protein was a risk factor. The use of vancomycin, inotropes, and a ventilator was associated with mortality, whereas elective hemodialysis with chronic kidney disease and statin use were associated with survival. The use of continuous renal replacement therapy was not associated with in-hospital mortality. Conclusion Incident hemodialysis patients had high in-hospital mortality. Cardiopulmonary resuscitation, infections such as pneumonia, and the use of inotropes and a ventilator was strong risk factors for in-hospital mortality. However, elective hemodialysis for chronic kidney disease was associated with survival. PMID:26484040

  8. 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

  9. Effectiveness of beraprost sodium in maintaining vascular access patency in patients on hemodialysis.

    PubMed

    Kim, Miyeon; Kim, Ji Ung; Kim, So Mi; Kim, HyunWoo

    2017-07-01

    Hemodialysis vascular access dysfunction, mostly attributed to neointimal hyperplasia, is a major cause of morbidity and hospitalization in patients on hemodialysis. It has been reported that prostaglandin I2 has pleiotropic effects including anti-platelet, vasodilating, anti-inflammatory, and anti-atherogenic properties. In addition, several studies have shown that prostaglandin I2 can inhibit neointimal formation after vascular injury. This study aimed to investigate the effects of beraprost sodium, an oral synthetic analog of prostaglandin I2, on vascular access patency in patients on hemodialysis who experienced primary hemodialysis vascular access failure. Fifty-five patients with end-stage renal disease who were on hemodialysis were prospectively selected for this study. Twenty-three patients were assigned to be treated with 120 µg/day of beraprost sodium, while remaining patients (n = 32) were assigned to a control group. The primary outcome was primary unassisted vascular access patency at 2 years. The incidence of primary unassisted patency at 2 years was 83% in the beraprost sodium group and 38% in the control group (p = 0.001). Analysis of covariables indicated that this effect occurred mainly as a result of beraprost sodium administration. No life-threatening adverse event or severe bleeding was recorded in any of the groups. Our data indicated that an oral prostaglandin I2 analog, beraprost sodium, is effective and safe for the maintenance of vascular access patency in patients on hemodialysis with primary vascular access failure.

  10. Restless legs syndrome among Saudi end-stage renal disease patients on hemodialysis

    PubMed Central

    Wali, Siraj O.; Alkhouli, Abeer F.

    2015-01-01

    Objectives: To determine the prevalence of restless legs syndrome (RLS) in Saudi patients with end-stage renal disease (ESRD) on hemodialysis. Methods: A cross-sectional study was carried out in 3 hemodialysis centers in Jeddah, Saudi Arabia, between June 2012 and September 2013. All patients were individually interviewed and data was collected on the following demographic features, medical history, laboratory test, the International Restless Legs Syndrome Study Group questionnaire, Epworth Sleepiness Scale (ESS), and Berlin Questionnaire. Results: Three hundred and fifty-five patients were recruited. The prevalence of RLS among ESRD patients was 19.4%, with most patients having moderate to severe disease. The RLS was significantly associated with obstructive sleep apnea (p<0.0001) and excessive daytime sleepiness based on the ESS (p=0.009). The RLS showed no correlation with hemodialysis adequacy, chronicity, frequency per week, and hemodialysis duration per session; however, there was a weak negative relation between adequacy of hemodialysis and RLS severity. None of the comorbidities showed any association with RLS. The odds of developing RLS increased significantly with an increasing body mass index (p=0.001). Administration of aspirin (p=0.037) and anticoagulants (p=0.035) were also associated with increased risk of RLS. Conclusion: Restless legs syndrome is common in ESRD patients on hemodialysis, and it is an important source of sleep disruption. In addition to body mass index, Aspirin and anticoagulants may be important risk factors. PMID:25719586

  11. 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.). Copyright © 2016, American Society for Microbiology. All Rights Reserved.

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

    PubMed Central

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

    2016-01-01

    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

  13. Levels of hepatocyte growth factor in serum correlate with quality of life in hemodialysis patients.

    PubMed

    Baum, Ewa; Pawlaczyk, Krzysztof; Maćkowiak, Beata; Sosinska, Patrycja; Matecka, Monika; Kolodziejczak, Barbara; Musielak, Michał; Breborowicz, Andrzej

    2015-01-01

    Patients with end stage renal failure (ESRD) report low quality of life and inflammation may be one of the contributing factors. We studied if the hemodialysis induced inflammation correlates with the patients quality of life. Study was performed in 76 (35 males and 41 females) ESRD patients treated with hemodialysis. Effect of one dialysis session on blood concentration of Vascular Endothelial Growth Factor (VEGF), Hepatocyte Growth Factor (HGF), Interleukin 6 (IL6) and Monocyte Chemoattractant Protein-1 (MCP-1) was studied. Results were correlated with answers given by patients to a short questionnaire composed of questions from Kidney Disease Quality of Life Short Form (KDQoL-SF) questionnaire. Hemodialysis induced increase of serum level of HGF (+117%) and IL-6 (+17%). Declared by patients health status correlated with their age, GFR, kt/V and hemodialysis induced change in serum IL6 and HGF level (R(2) = 0469, P < 0.001). Physical activity correlated with age, serum IL-6 and hemodialysis induced change in serum HGF and VEGF (R(2) = 0.362, P < 0.001). Presence of social/mental problems during previous 4 weeks correlated with age, serum HGF and hemodialysis induced changes in serum HGF and VEGF levels (R(2) = 0.333, P < 0.001). Interference of the kidney disease with daily life activities correlated with age, serum VEGF and hemodialysis induced change in serum HGF and IL6 levels (R(2) = 0.422, P < 0.001). Inflammation correlates with reduced quality of life in ESRD. Low hemodialysis-induced release of the anti-inflammatory cytokine HGF correlates with impaired quality of life in that group of patients.

  14. The Results of Proximal Femoral Nail for Intertrochanteric Fracture in Hemodialysis Patient

    PubMed Central

    Song, Kyung Sub; Lee, Su Keon; Lee, Seung Hwan; Yang, Bong Seok; Park, Byeong Mun; Yang, Ick Hwan; Lee, Beom Seok; Yeom, Ji Ung

    2017-01-01

    Purpose Hip fractures in hemodialysis patients are accompanied by high rates of complications and morbidities. Previous studies have mainly reported on nonunion and avascular necrosis of femoral neck fractures in this patient group. In this study the complication and clinical results of hemodialysis patients with intertrochanteric fractures treated with proximal femoral intramedullary nailing have been investigated through comparison with patients with normal kidney function. Materials and Methods Forty-seven patients were included; the hemodialysis group (n=17) and the control group with normal kidney function (n=30). The medical history and clinical findings including preoperative and postoperative blood examinations, radiological examinations and ambulatory status (measured using the Koval score). The rate of complications and morbidities were also investigated and compared. Results Preoperative hemoglobin/hematocrit was lower but a significant increase in partial thromboplastin time was observed in the hemodialysis group. The amount of bleeding/transfusions were higher and operative time was longer in the hemodialysis group. Upon radiologic examination, there was no significant difference in rate of unstable fracture and nonunion between the two groups. However the postoperative Koval score was significantly worse and the odds ratio of inability to walk after surgery was 13.5 times higher in the hemodialysis group. Conclusion There was no significant difference in radiological results, but the risk of inability to walk after surgery was 13.5 times higher in the hemodialysis group. Hemodialysis patients have more morbidities and are hemodynamically unstable therefore require special attention. Accurate reduction and firm fixation is required and attentive postoperative rehabilitation is needed. PMID:28316963

  15. 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

  16. High-Efficiency Postdilution Online Hemodiafiltration Reduces All-Cause Mortality in Hemodialysis Patients

    PubMed Central

    Moreso, Francesc; Pons, Mercedes; Ramos, Rosa; Mora-Macià, Josep; Carreras, Jordi; Soler, Jordi; Torres, Ferran; Campistol, Josep M.; Martinez-Castelao, Alberto

    2013-01-01

    Retrospective studies suggest that online hemodiafiltration (OL-HDF) may reduce the risk of mortality compared with standard hemodialysis in patients with ESRD. We conducted a multicenter, open-label, randomized controlled trial in which we assigned 906 chronic hemodialysis patients either to continue hemodialysis (n=450) or to switch to high-efficiency postdilution OL-HDF (n=456). The primary outcome was all-cause mortality, and secondary outcomes included cardiovascular mortality, all-cause hospitalization, treatment tolerability, and laboratory data. Compared with patients who continued on hemodialysis, those assigned to OL-HDF had a 30% lower risk of all-cause mortality (hazard ratio [HR], 0.70; 95% confidence interval [95% CI], 0.53–0.92; P=0.01), a 33% lower risk of cardiovascular mortality (HR, 0.67; 95% CI, 0.44–1.02; P=0.06), and a 55% lower risk of infection-related mortality (HR, 0.45; 95% CI, 0.21–0.96; P=0.03). The estimated number needed to treat suggested that switching eight patients from hemodialysis to OL-HDF may prevent one annual death. The incidence rates of dialysis sessions complicated by hypotension and of all-cause hospitalization were lower in patients assigned to OL-HDF. In conclusion, high-efficiency postdilution OL-HDF reduces all-cause mortality compared with conventional hemodialysis. PMID:23411788

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

    PubMed

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

    2010-08-01

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

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

    PubMed Central

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

    2002-01-01

    Decreased dietary protein intake and hemodialysis-associated protein catabolism are among several factors that predispose chronic hemodialysis (CHD) patients to protein calorie malnutrition. Since attempts to increase protein intake by dietary counseling are usually ineffective, intradialytic parenteral nutrition (IDPN) has been proposed as a potential therapeutic approach in malnourished CHD patients. In this study, we examined protein and energy homeostasis during hemodialysis in seven CHD patients at two separate hemodialysis sessions, with and without IDPN administration. Patients were studied 2 hours before, during, and 2 hours following a hemodialysis session, using a primed constant infusion of L-(1-13C) leucine and L-(ring-2H5) phenylalanine. Our results showed that IPDN promoted a large increase in whole-body protein synthesis and a significant decrease in whole-body proteolysis, along with a significant increase in forearm muscle protein synthesis. The net result was a change from an essentially catabolic state to a highly positive protein balance, both in whole-body and forearm muscle compartments. We conclude that the provision of calories and amino acids during hemodialysis with IDPN acutely reverses the net negative whole-body and forearm muscle protein balances, demonstrating a need for long-term clinical trials evaluating IDPN in malnourished CHD patients. PMID:12189242

  19. Serum Magnesium and Mortality in Maintenance Hemodialysis Patients.

    PubMed

    Yu, Ling; Li, Han; Wang, Shi-Xiang

    2017-01-01

    The study aimed to investigate the potential contributing effect of serum magnesium on mortality in maintenance hemodialysis (MHD) patients. The patients receiving regular MHD in March 2013 were involved. Baseline data including clinical data, anthropometrics and biochemical measurement were collected. After being followed for 36 months, the time of death and reason were recorded. One hundred and thirty-five MHD patients were enrolled in the study and analyzed, with mean serum magnesium of 1.11 ± 0.15 mmol/l. The level of serum magnesium in 64 patients was normal (47.4%), and it was elevated in 71 of the 135 patients (52.6%). And none of MHD patients had hypomagnesemia. The levels of serum albumin (Alb), urea nitrogen, creatinine (Cr), uric acid and phosphorus were significantly higher, but high-sensitivity C-reactive protein (Hs-CRP) and lipoprotein A were significantly lower in hypermagnesemia group compared to the normal serum magnesium group (p < 0.05). Serum Alb, serum Cr, serum phosphorus and Hs-CRP were related factors of hypermagnesemia by multivariate logistic regression analysis (p < 0.05). During the 36 months of follow-up, 27 patients died (20.0%), of whom 55.6% died of cardiovascular (CV) events. Kaplan-Meier curves showed that cumulative incidence of CV mortality were significantly higher in the normal serum magnesium group than in the hypermagnesemia group (p = 0.027); however, there was no significant difference in all-cause mortality (p > 0.05). Serum magnesium was elevated, which was related with nutrition and inflammation markers including serum Alb, serum Cr, serum phosphorus and Hs-CRP. Lower serum magnesium is a risk factor of CV mortality in MHD patients. Intervention studies are needed to clarify whether magnesium supplementation is beneficial for improving patient prognosis, when MHD patients had inflammatory and malnutrition. © 2016 S. Karger AG, Basel.

  20. Vascular access in patients receiving hemodialysis in Libya.

    PubMed

    Alashek, Wiam A; McIntyre, Christopher W; Taal, Maarten W

    2012-01-01

    A native arteriovenous fistula (AVF) represents the optimal form of Vascular Access (VA) for patients receiving hemodialysis (HD). In Libya there are several barriers to AVF creation including lack of adequate preparation for dialysis and surgical services. We aimed to conduct the first comprehensive study of VA utilisation in HD patients in Libya. A prospective observational study included all adult patients receiving HD treatment in 25 HD facilities in Libya from May 2009 to Nov 2011. Researchers gathered data regarding VA through interviews with staff and patients as well as medical records. Patients with definitive VA were re-interviewed after 1 year. At baseline the majority of patients (91.9%; n=1573) were using permanent VA in the form of AVF or arteriovenous graft. Patients with permanent VA were more likely to be male and less likely to be diabetic than those with CVCs. Most patients had commenced HD using a temporary CVC (91.8%). VA-related complications were: thrombosis (46.7%), aneurysm (22.6%), infection (11.5%) and haemorrhage (10.2%). Incident VA thrombosis was reported by 14.7% in 1 year. Independent risk factors for incident thrombosis were female gender and diabetes. Hospitalisation for VA related complications was reported by 31.4%. Few patients in Libya initiate HD with definitive VA, but most achieve it thereafter. Improved dialysis preparation and increased provision of surgical services are required to increase the proportion of patients initiating HD with definitive VA and should be a priority in rebuilding health services in Libya after the recent conflict.

  1. [Skin diseases in hemodialysis and kidney transplant patients].

    PubMed

    Gerhardt, Clarissa Morais Busatto; Gussão, Bruna Calvi; de Matos, Jorge Paulo Strogoff; Lugon, Jocemir Ronaldo; Pinto, Jane Marcy Neffá

    2011-01-01

    Recently, the world is facing an escalate in the incidence of chronic kidney disease (CKD). Databases containing information about patients in end stage renal disease (ESRD), especially in the United States, were the sources of initial information about it. Brazil has the third largest population on dialysis in the world, and there are about 680 dialysis centers, spread across all units of the federation in the present, providing treatment to an estimated population of almost 90,000 patients. Cutaneous involvement in the chronic renal failure is characterized by a number of manifestations, which may be related to three processes: the primary renal disease, the uremic state, or the therapeutic measures used in their handling. The skin changes in these two classes of patients, dialysis and transplant recipients, have been the subject of several studies. n recent years, however, great progress has been achieved in these two therapeutic modalities, which may have changed not only the type of the dermatologic disorders associated with these two conditions, but also their intensity or frequency. This article aims to yield an update as to the topic skin diseases in hemodialysis and kidney transplant patients.

  2. Relationship between resistin and mortality in maintenance hemodialysis patients.

    PubMed

    Chi, Po-Jui; Liou, Hung-Hsiang; Hsu, Bang-Gee; Tasi, Jen Pi

    2016-09-01

    Determine the relationship of serum resistin level with outcome in maintenance hemodialysis (HD) patients. This 49-month prospective study enrolled 101 HD patients and examined their clinical and demographic characteristics. 23 of the 87 patients in the cohort died. Survivors were younger, had higher body mass index, diastolic blood pressure, and serum levels of albumin, creatinine, potassium, and phosphate, and lower serum levels of resistin. Receiver operating characteristic (ROC) curve analysis indicated the optimal cut-off value of resistin for prediction of mortality was 127.4 ng/mL (area under the curve (AUC) = 0.667, p = 0.01). Cox proportional-hazards regression analysis indicated that advanced age (p < 0.001) and resistin level above 127.4 ng/mL (p = 0.004) were associated with increased mortality risk. Albumin (p = 0.048), creatinine (p = 0.014), potassium (p = 0.023), calcium (p = 0.021), and phosphate (p = 0.001) were associated with decreased mortality risk. Multivariate regression analysis indicated that advanced age (adjusted hazard ratio (aHR) = 1.11, p < 0.0001) and elevated resistin concentration (aHR = 2.442, p = 0.0387) increased the risk for mortality. Advanced age and serum resistin concentration above 127.4 ng/mL are independent risk factors for mortality in patients undergoing maintenance HD.

  3. A Study on the Attitude Toward Kidney Transplantation and Factors Among Hemodialysis Patients in China.

    PubMed

    Qiao, B; Liu, L; Liu, J; Xie, J

    2016-10-01

    Kidney transplantation (KT) is the most effective treatment for patients with end-stage renal disease. However, objective data regarding the willingness of patients with end-stage renal disease to undergo transplantation are lacking in China. The purpose of this study was to examine the attitudes and impact factors regarding KT among patients with end-stage renal disease undergoing hemodialysis. This study used a cross-sectional approach. Between June and July 2015, a total of 326 hemodialysis outpatients completed a self-designed questionnaire to assess their attitudes toward KT and satisfaction with dialysis. Patients' mean age was 49.47 years, and the mean duration of hemodialysis was 52 months. Among these patients, 34.9% would like to undergo transplantation, and 4.23% of patients have a potential related living donor. Among the patients wishing to undergo transplantation, 43.93% had started a procedure to be grafted. The minority of patients (45.93%) stated that KT offers a better quality of life; 78.5% believe that it is more expensive than hemodialysis. Overall, 13.36% of patients are willing to become organ donors after death. The main motivating factor for KT was because of study or work difficulties (56.1%). The effects of the following 7 independent variables on attitude were assessed: age, education level, monthly income, sex, duration of hemodialysis, dialysis satisfaction, and reimbursement level. To improve hemodialysis patients' accessibility to KT, better information must be provided to patients, their families, and other support providers. Transplantation is the best treatment for patients undergoing hemodialysis, which should be given more attention and political support economically and publicly by the government and some closely related agencies. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Views of Japanese patients on the advantages and disadvantages of hemodialysis and peritoneal dialysis.

    PubMed

    Nakamura-Taira, Nanako; Muranaka, Yoshimi; Miwa, Masako; Kin, Seikon; Hirai, Kei

    2013-08-01

    The preference for dialysis modalities is not well understood in Japan. This study explored the subjective views of Japanese patients undergoing dialysis regarding their treatments. The participants were receiving in-center hemodialysis (CHD) or continuous ambulatory peritoneal dialysis (CAPD). In Study 1, 34 participants (17 CHD and 17 CAPD) were interviewed about the advantages and disadvantages of dialysis modalities. In Study 2, 454 dialysis patients (437 CHD and 17 CAPD) rated the advantages and disadvantages of CHD and CAPD in a cross-sectional survey. Interviews showed that professional care and dialysis-free days were considered as advantages of CHD, while independence, less hospital visits, and flexibility were considered as advantages of CAPD. Disadvantages of CHD included restriction of food and fluids and unpleasant symptoms after each dialysis session. Catheter care was an additional disadvantage of CAPD. Survey showed that the highly ranked advantages were professional care in CHD and less frequent hospital visits in CAPD, while the highly ranked disadvantages were concerns about emergency and time restrictions in CHD, and catheter care and difficulty in soaking in a bath in CAPD. The total scores of advantages and disadvantages showed that CHD patients subjectively rated their own modality better CHD over CAPD, while CAPD patients had the opposite opinion. The results of this study indicate that the factors affecting the decision-making process of Japanese patients are unique to Japanese culture, namely considering the trouble caused to the people around patients (e.g., families, spouses, and/or caregivers).

  5. Occult hepatitis C virus infection in Iranian hemodialysis patients

    PubMed Central

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

    2015-01-01

    Background: Occult hepatitis C virus (HCV) infection is defined as the presence of HCV-RNA in liver or peripheral blood mononuclear cells (PBMCs) in the absence of detectable hepatitis C antibody (anti-HCV) or HCV-RNA in the serum. Low concentrations of HCV-RNA may be detected in PBMCs of hemodialysis (HD) patients and this could have a great impact on the management of HD patients. Objectives: The aim of this study was to detect the occult HCV infection in Iranian HD patients. Patients and Methods: A total of 70 anti-HCV negative HD patients from three dialysis units in Tehran, Iran were included in this study. In these cases, presence of HCV-RNA in plasma samples was tested by reverse transcriptase-nested polymerase chain reaction (RT-nested PCR). In cases with negative anti-HCV and plasma HCV-RNA, genomic HCV-RNA was checked in PBMC specimens by RT-nested PCR. Results: Seventy anti-HCV negative HD patients were enrolled in the study. 32.85% and 1.43% of cases had elevated levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) respectively. 7.14% of patients had elevated levels of both ALT and AST. HCV-RNA was negative in plasma samples of all anti-HCV negative HD subjects. The genomic HCV-RNA was not detected in any PBMC samples of HD cases with negative anti-HCV and plasma HCV-RNA. Conclusions: Occult HCV infection was not detected in our HD patients despite of elevated levels of liver enzymes in some participants. Further studies involving larger number of HD patients are required to elucidate the rate of occult HCV infection in HD cases. PMID:26457258

  6. Factors associated with regular dental visits among hemodialysis patients

    PubMed Central

    Yoshioka, Masami; Shirayama, Yasuhiko; Imoto, Issei; Hinode, Daisuke; Yanagisawa, Shizuko; Takeuchi, Yuko; Bando, Takashi; Yokota, Narushi

    2016-01-01

    AIM To investigate awareness and attitudes about preventive dental visits among dialysis patients; to clarify the barriers to visiting the dentist. METHODS Subjects included 141 dentate outpatients receiving hemodialysis treatment at two facilities, one with a dental department and the other without a dental department. We used a structured questionnaire to interview participants about their awareness of oral health management issues for dialysis patients, perceived oral symptoms and attitudes about dental visits. Bivariate analysis using the χ2 test was conducted to determine associations between study variables and regular dental check-ups. Binominal logistic regression analysis was used to determine factors associated with regular dental check-ups. RESULTS There were no significant differences in patient demographics between the two participating facilities, including attitudes about dental visits. Therefore, we included all patients in the following analyses. Few patients (4.3%) had been referred to a dentist by a medical doctor or nurse. Although 80.9% of subjects had a primary dentist, only 34.0% of subjects received regular dental check-ups. The most common reasons cited for not seeking dental care were that visits are burdensome and a lack of perceived need. Patients with gum swelling or bleeding were much more likely to be in the group of those not receiving routine dental check-ups (χ2 test, P < 0.01). Logistic regression analysis demonstrated that receiving dental check-ups was associated with awareness that oral health management is more important for dialysis patients than for others and with having a primary dentist (P < 0.05). CONCLUSION Dialysis patients should be educated about the importance of preventive dental care. Medical providers are expected to participate in promoting dental visits among dialysis patients. PMID:27648409

  7. Complications of tunneled cuffed hemodialysis catheters in patients with human immunodeficiency virus infection.

    PubMed

    Naoum, Joseph J; Weakley, Sarah M; Athamneh, Husam; Kougias, Panagiotis; Bechara, Carlos F; Lin, Peter H

    2011-01-01

    Although increased infectious and thrombotic complications have been reported in patients with human immunodeficiency virus (HIV), little is known regarding hemodialysis catheter-related complications in HIV patients. In this report, we reviewed our experience and complication rates for tunneled cuffed catheters (TCCs) in HIV patients requiring hemodialysis. A total of 85 patients with HIV infection underwent TCC placement for hemodialysis between 1996 and 2009. Hospital records were reviewed to determine causes and risk factors for TCC-related complications in HIV patients. For comparison, we studied 85 age- and sex-matched low-risk HIV case controls who received TCC for hemodialysis during the same period. A total of 119 and 102 TCCs were inserted in the HIV and control group, respectively. Total numbers of catheter days in the HIV and control groups were 17,321 and 15,620 days, respectively. The primary unassisted TCC patency rates at 6 months in the HIV and control groups were 74% ± 11% and 86% ± 8%, respectively (NS). There was an increased TCC bacteremia rate in HIV patients compared with control subjects (5.38 vs. 2.66 per 1,000 TCC days, p=0.03). There was also a higher TCC tunnel infection rate in HIV patients compared with control cohorts (3.72 vs. 1.87 per 1,000 TCC days, p=0.04). Factors associated with increased catheter infection rate in HIV patients were 1) low CD4+ lymphocyte counts (<200/mm3), 2) low albumin level (<2.5 g/dl), and 3) history of illicit intravenous drug use. TCCs are associated with an increased risk of infection in HIV patients requiring hemodialysis. Moreover, HIV infection is associated with an increased risk of mortality among hemodialysis patients. Hypoalbuminemia, history of intravenous drug use, and low CD4+ lymphocyte counts are associated with increased risk of catheter infection in HIV patients requiring hemodialysis.

  8. Receipt of Intravenous Iron and Clinical Outcomes among Hemodialysis Patients Hospitalized for Infection.

    PubMed

    Ishida, Julie H; Marafino, Ben J; McCulloch, Charles E; Dalrymple, Lorien S; Dudley, R Adams; Grimes, Barbara A; Johansen, Kirsten L

    2015-10-07

    Anemia guidelines for CKD recommend withholding intravenous iron in the setting of active infection, although no data specifically support this recommendation. This study aimed to examine the association between intravenous iron and clinical outcomes among hemodialysis patients hospitalized for infection. This was a retrospective observational cohort study using data from the US Renal Data System of 22,820 adult Medicare beneficiaries on in-center hemodialysis who had received intravenous iron in the 14 days preceding their first hospitalization for bacterial infection in 2010. In multivariable analyses, the association between receipt of intravenous iron at any point from the day of hospital admission to discharge and all-cause 30-day mortality, mortality in 2010, length of hospital stay, and readmission for infection or death within 30 days of discharge was evaluated. There were 2463 patients (10.8%) who received intravenous iron at any point from the day of admission to discharge. Receipt of intravenous iron was not associated with age, dialysis vintage, or comorbidities. There were 2618 deaths within 30 days of admission and 6921 deaths in 2010 (median follow-up 173 days; 25th and 75th percentiles, 78-271 days). The median length of stay was 7 days (25th and 75th percentiles, 5-12 days). Receipt of intravenous iron was not associated with higher 30-day mortality (odds ratio, 0.86; 95% confidence interval [95% CI], 0.74 to 1.00), higher mortality in 2010 (hazard ratio, 0.92; 95% CI, 0.85 to 1.00), longer mean length of stay (10.1 days [95% CI, 9.7 to 10.5] versus 10.5 days [95% CI, 10.3 to 10.7]; P=0.05), or readmission for infection or death within 30 days of discharge (odds ratio, 1.08; 95% CI, 0.96 to 1.22) compared with no receipt of intravenous iron. This analysis does not support withholding intravenous iron upon admission for bacterial infection in hemodialysis patients, although clinical trials are required to make definitive recommendations. Copyright

  9. Receipt of Intravenous Iron and Clinical Outcomes among Hemodialysis Patients Hospitalized for Infection

    PubMed Central

    Marafino, Ben J.; McCulloch, Charles E.; Dalrymple, Lorien S.; Dudley, R. Adams; Grimes, Barbara A.; Johansen, Kirsten L.

    2015-01-01

    Background and objectives Anemia guidelines for CKD recommend withholding intravenous iron in the setting of active infection, although no data specifically support this recommendation. This study aimed to examine the association between intravenous iron and clinical outcomes among hemodialysis patients hospitalized for infection. Design, setting, participants, & measurements This was a retrospective observational cohort study using data from the US Renal Data System of 22,820 adult Medicare beneficiaries on in-center hemodialysis who had received intravenous iron in the 14 days preceding their first hospitalization for bacterial infection in 2010. In multivariable analyses, the association between receipt of intravenous iron at any point from the day of hospital admission to discharge and all-cause 30-day mortality, mortality in 2010, length of hospital stay, and readmission for infection or death within 30 days of discharge was evaluated. Results There were 2463 patients (10.8%) who received intravenous iron at any point from the day of admission to discharge. Receipt of intravenous iron was not associated with age, dialysis vintage, or comorbidities. There were 2618 deaths within 30 days of admission and 6921 deaths in 2010 (median follow-up 173 days; 25th and 75th percentiles, 78–271 days). The median length of stay was 7 days (25th and 75th percentiles, 5–12 days). Receipt of intravenous iron was not associated with higher 30-day mortality (odds ratio, 0.86; 95% confidence interval [95% CI], 0.74 to 1.00), higher mortality in 2010 (hazard ratio, 0.92; 95% CI, 0.85 to 1.00), longer mean length of stay (10.1 days [95% CI, 9.7 to 10.5] versus 10.5 days [95% CI, 10.3 to 10.7]; P=0.05), or readmission for infection or death within 30 days of discharge (odds ratio, 1.08; 95% CI, 0.96 to 1.22) compared with no receipt of intravenous iron. Conclusions This analysis does not support withholding intravenous iron upon admission for bacterial infection in hemodialysis

  10. 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.

  11. 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

  12. 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

    2016-06-02

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

  13. Relationship between quality of life and self-care ability in patients receiving hemodialysis

    PubMed Central

    Heidarzadeh, Mehdi; Atashpeikar, Solmaz; Jalilazar, Tahereh

    2010-01-01

    BACKGROUND: Although hemodialysis has a therapeutic effect on end stage renal disease (ESRD), these patients encounter many physical, psychological, and social stressful factors that lead to a decrease in their quality of life (QOL). One of the factors that are effective on increasing the QOL is the self-care ability. Review of literature demonstrated a few studies done on different aspects of QOL in ESRD patients under hemodialysis and their relationships with self-care ability in Iran. So, in this research besides determining the quality of life and its dimensions and self-care ability of hemodialysis patients, we evaluated their relationships with each other. METHODS: For this purpose, all hemodialysis patients who had inclusion criteria and were hospitalized in hemodialysis wards of Bonab, Maragheh, and Miandoab hospitals were selected and data were collected by interview using a questionnaire that included three parts, demographic factors, quality of life, and self-care ability. RESULTS: The results indicated that quality of life in 34%, and self-care ability in 78.3% of hemodialysis patients were desirable, and there was a direct and significant relationship between these two variables (p < 0.001, r = 0.4), as self-care ability explained 29% of variance of QOL. In quality of life subsectors, social dimension in 98.3% of patients was desirable, while physical dimension (80%) and psychological dimension (63.5%) in most patients were undesirable. Physical dimension was the most impressible dimension of quality of life in self-care ability whereas self-care ability explained 27% of total variance of physical dimension of QOL. CONCLUSIONS: Nearly two thirds of mentioned patients had no desirable QOL and regarding the positive relationship between QOL and self-care ability, it is suggested that health care planner and managers prepare the condition that through educating and reinforcing self-care ability in these patients improve the QOL in hemodialysis patients

  14. Effects of protein supplementation in chronic hemodialysis and peritoneal dialysis patients.

    PubMed

    Moretti, Heidi D; Johnson, Andrea M; Keeling-Hathaway, Tammy J

    2009-07-01

    We evaluated the impact of oral protein supplementation given during hemodialysis and peritoneal dialysis on nutritional status, number of hospitalizations, and length of stay. We used a randomized crossover design in which serum albumin, normalized protein catabolic rate (nPCR), total hospitalizations, and length of stay were compared in patients who received protein supplements with those who did not. The study was conducted for 1 year (November 2005 to October 2006). This study was conducted at an outpatient dialysis facility. Forty-nine patients were treated with hemodialysis or peritoneal dialysis for at least 3 months. The nPCR significantly increased by month 4 of treatment from a baseline of 1.05 to 1.16 (P = .007). The control group had a significant decline in nPCR during the first 6 months, from 1.11 to 0.98 (P = .038). Improvement was evident in albumin by month 3, from 3.49 to 3.52 (P = .035), but this was not sustained. In the second 6 months, the control group had a significant drop, from 3.35 to 3.19 (P = .014), and the difference between the protein-supplementation and control groups was significant during the second 6 months (P = .037). The nPCR also dropped significantly (P = .024) for the control group in the second 6 months. When protein supplementation ended, weight dropped significantly for those with a body mass index of <20. Trends toward a reduction in hospitalization admissions and hospital days were seen in both crossover treatment groups. In-center supplementation of protein generally improves serum markers of nutrition overall, and when it is discontinued, these markers decline. Larger studies are needed to confirm the trends that we observed regarding nutritional markers and reductions in hospitalizations and hospitalization days.

  15. Autonomic neuropathy in hemodialysis patients: questionnaires versus clinical tests.

    PubMed

    Nowicki, Michał; Zwiech, Rafał; Dryja, Przemysław; Sobański, Wiktor

    2009-04-01

    Uremic neuropathy (UN) is a typical complication of long-term dialysis therapy and may manifest as distal, symmetric, and both senso-motoric and autonomic nerve dysfunction. Its clinical picture is highly variable and it is not known how the symptoms of UN reported by chronic dialysis patients correspond to positive results of clinical tests for autonomic dysfunction. The objective of this study was to compare the prevalence of self-reported symptoms of autonomic neuropathy (AN) revealed in patient questionnaires with the prevalence of findings from objective clinical tests. The study group included 45 patients (26 males, 19 females), mean age 60 +/- 15.5 years, on chronic hemodialysis for 7.8 +/- 2.6 years. In all subjects, blood pressure (BPci) and heart rate (HRci) variability indexes (calculated as BP and HR during Ewing and Clarke' tests divided by HR and BP at rest) were measured using the Finapres which records beat-to-beat blood pressure and heart rate. Additionally, patients completed seven-question questionnaires which assessed the presence of most typical AN symptoms. The control group comprised 12 healthy subjects (age 52 +/- 19.5 years). The results from the questionnaires showed that falls of BP occurred in 73% of patients, itching of skin in 42%, constipation or diarrhea in 33%, filling of stomach in 25%, and decreased sweating in 17%. Altogether 85.9% of patients reported one or more subjective symptoms of neuropathy. In contrast, modified Ewing and Clarke's test revealed that only 17.7% of participants demonstrated overt pathologies. Neither blood pressure nor heart rate changeability indexes in patients and healthy subjects showed significant differences with the exception of intense inhalation and static effort. Our results show much higher frequency of subjective symptoms of AN in chronic dialysis patients than objective symptoms detected with clinical tests.

  16. Hemoglobin Variability Does Not Predict Mortality in European Hemodialysis Patients

    PubMed Central

    Kim, Joseph; Kronenberg, Florian; Aljama, Pedro; Anker, Stefan D.; Canaud, Bernard; Molemans, Bart; Stenvinkel, Peter; Schernthaner, Guntram; Ireland, Elizabeth; Fouqueray, Bruno; Macdougall, Iain C.

    2010-01-01

    Patients with CKD exhibit significant within-patient hemoglobin (Hb) level variability, especially with the use of erythropoiesis stimulating agents (ESAs) and iron. Analyses of dialysis cohorts in the United States produced conflicting results regarding the association of Hb variability with patient outcomes. Here, we determined Hb variability in 5037 European hemodialysis (HD) patients treated over 2 years to identify predictors of high variability and to evaluate its association with all-cause and cardiovascular disease (CVD) mortality. We assessed Hb variability with various methods using SD, residual SD, time-in-target (11.0 to 12.5 g/dl), fluctuation across thresholds, and area under the curve (AUC). Hb variability was significantly greater among incident patients than prevalent patients. Compared with previously described cohorts in the United States, residual SD was similar but fluctuations above target were less frequent. Using logistic regression, age, body mass index, CVD history, dialysis vintage, serum albumin, Hb, angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) use, ESA use, dialysis access type, dialysis access change, and hospitalizations were significant predictors of high variability. Multivariable adjusted Cox regression showed that SD, residual SD, time-in-target, and AUC did not predict all-cause or CVD mortality during a median follow-up of 12.4 months (IQR: 7.7 to 17.4). However, patients with consistently low levels of Hb (<11 g/dl) and those who fluctuated between the target range and <11 g/dl had increased risks for death (RR 2.34; 95% CI: 1.24 to 4.41 and RR 1.74; 95% CI: 1.00 to 3.04, respectively). In conclusion, although Hb variability is common in European HD patients, it does not independently predict mortality. PMID:20798262

  17. Association between vascular access failure and microparticles in hemodialysis patients

    PubMed Central

    Ryu, Jung-Hwa; Lim, Su-Young; Ryu, Dong-Ryeol; Kang, Duk-Hee; Choi, Kyu Bok; Kim, Seung-Jung

    2012-01-01

    Background Vascular access failure, a major cause of morbidity in hemodialysis (HD) patients, occurs mainly at stenotic endothelium following an acute thrombotic event. Microparticles (MPs) are fragments derived from injured cell membrane and are closely associated with coagulation and vascular inflammatory responses. Methods We investigated the relationship between levels of circulating MPs and vascular access patency in HD patients. A total of 82 HD patients and 28 healthy patients were enrolled. We used flow cytometry to measure endothelial MPs (EMPs) identified by CD31+CD42− or CD51+ and platelet-derived MPs (PMPs) identified by CD31+CD42+ in plasma samples of participants. Vascular access patency was defined as an interval from the time of access formation to the time of first access stenosis in each patient. MP counts were compared according to access patent duration. Results The levels of EMP (both CD31+CD42− and CD51+) and CD31+CD42+PMP were significantly higher in patients than in healthy participants. Levels of CD31+CD42−EMP and CD31+CD42+PMP showed a positive correlation. In non-diabetic HD patients, CD31+CD42−EMPs and CD31+CD42+PMPs were more elevated in the shorter access survival group (access survival <1 year) than in the longer survival group (access survival ≥ 4 years). Conclusion Elevated circulating EMP or PMP counts are influenced by end-stage renal disease and increased levels of EMP and PMP may be associated with vascular access failure in HD patients. PMID:26889407

  18. Probiotic supplementation in diabetic hemodialysis patients has beneficial metabolic effects.

    PubMed

    Soleimani, Alireza; Zarrati Mojarrad, Malihe; Bahmani, Fereshteh; Taghizadeh, Mohsen; Ramezani, Mohammad; Tajabadi-Ebrahimi, Maryam; Jafari, Parvaneh; Esmaillzadeh, Ahmad; Asemi, Zatollah

    2017-02-01

    This study determined the effects of probiotic supplementation on glycemic control, lipid concentrations, biomarkers of inflammation and oxidative stress in 60 diabetic patients on hemodialysis in a parallel randomized double-blind placebo-controlled clinical trial. Participants were initially matched based on sex, duration of dialysis and diabetes, body mass index and age. Subsequently, they were randomly divided into two groups to take either a capsule containing the probiotics Lactobacillus acidophilus, Lactobacillus casei and Bifidobacterium bifidum or placebo for 12 weeks. Based on three-day dietary records throughout the trial, there was no significant change in dietary macro- and micro-nutrients or total dietary fiber to confound results. After the 12 weeks, analysis of patients who received probiotic supplements compared with the placebo showed they had significantly decreased fasting plasma glucose (-22.0 vs. +6.6 mg/dl), serum insulin (-6.4 vs. +2.3 μIU/ml), homeostasis model of assessment-estimated insulin resistance (-2.9 vs. +2.5), homeostasis model of assessment-estimated beta-cell function (-14.1 vs. +6.1) and HbA1c (-0.4 vs. -0.1%,), and improved quantitative insulin sensitivity check index (+0.03 vs. -0.02). Additionally, compared with the placebo, probiotic supplementation resulted in significant reductions in serum high-sensitivity C-reactive protein (-1933 vs. +252 ng/ml), plasma malondialdehyde (-0.3 vs. +1.0 μmol/l), subjective global assessment scores (-0.7 vs. +0.7) and total iron binding capacity (-230 vs. +33 μg/dl), and a significant increase in plasma total antioxidant capacity (+15 vs. -88 mmol/l). Thus, probiotic supplementation for 12 weeks among diabetic hemodialysis patients had beneficial effects on parameters of glucose homeostasis, and some biomarkers of inflammation and oxidative stress.

  19. Hopelessness, suicide ideation, and depression in chronic kidney disease patients on hemodialysis or transplant recipients.

    PubMed

    Andrade, Sibela Vasconcelos; Sesso, Ricardo; Diniz, Denise Helena de Madureira Pará

    2015-01-01

    Hopelessness, suicide ideation and depression symptoms affect life quality and expectancy of chronic kidney disease patients. To verify whether there are differences in hopelessness, suicide ideation and depression symptoms between chronic kidney disease patients on hemodialysis or transplant recipients. We also analyzed the influence of sociodemographic factors in these symptoms. Cross-sectional study in which 50 clinically stable chronic hemodialysis patients and 50 renal transplant patients matched by gender and age. Instruments-Beck Hopelessness Scale (BHS), Beck Scale for Suicide Ideation (BSI) and Beck Depression Inventory (BDI). BHS: 2% of each group scoring > 8 (p = 1.00). BSI: 4% in hemodialysis and 6% of the transplant patients scoring > 1 (p = 1.000). BDI: 20% in hemodialysis and 12% of transplant patients scoring > 14 (p = 0.275). Patients who did not have a labor activity presented more depressive symptoms (average BDI score: 10.5 vs. 7.3, p = 0.027). Transplant patients from deceased donor presented more depressive symptoms compared with those with transplant from living donors (average BDI score: 11.0 vs. 6.7, p = 0.042). There was no difference in the intensity of hopelessness, suicide ideation and depression symptoms between stable hemodialysis and transplant patients. Not performing a labor activity and receiving the transplant from deceased donor lead to more depressive symptoms. The high prevalence of depressive symptoms and the finding of suicide ideation in both modalities of renal replacement therapy point to the need to monitor and care for those patients.

  20. Patterns of medication exposures in hospitalized pediatric patients with acute renal failure requiring intermittent or continuous hemodialysis.

    PubMed

    Rizkalla, Nicole A; Feudtner, Chris; Dai, Dingwei; Zuppa, Athena F

    2013-11-01

    Care for the pediatric patient with acute renal failure who requires hemodialysis (including continuous renal replacement therapy) is made more complex, as this intervention may significantly affect drug clearance, potentially altering, to a degree that is largely unknown, the effectiveness and safety of the multiple medications used to manage this complex patient population. This study aims to describe patterns of drug utilization among a large cohort of pediatric patients requiring hemodialysis and to document the easily accessible existing data available for dosing guidance of frequently prescribed medications. Retrospective cohort using the Pediatric Health Information System database. Forty freestanding children's hospitals throughout the United States. Two thousand seven hundred thirty-eight pediatric patients with acute renal failure treated with hemodialysis from 2007 to 2011. A retrospective review of all patients requiring hemodialysis from 2007 to 2011 was conduction using the Pediatric Health Information System Database. Over 6% of pediatric patients with acute renal failure treated with hemodialysis were exposed to hemodialysis for over 2 weeks. Cumulative exposure to distinct drugs increased substantially with more prolonged courses of hemodialysis. Of the 50 most frequently prescribed medications in the cohort with acute renal failure treated with hemodialysis, 10% have readily available and easily accessible information to guide dosing adjustments with the use of hemodialysis. Furthermore, only 18% of these medications have clear recommendations for dosing in pediatric patients of all age groups with renal failure. Pediatric patients with acute renal failure managed with hemodialysis are exposed to a broad variety of medications, with a high prevalence of polypharmacy. There is a trend for longer courses of hemodialysis in these patients, which leads to an increase in cumulative drug exposure, complexity of drug interactions, and potential toxicity

  1. Left and right ventricular diastolic function in hemodialysis patients.

    PubMed

    Rudhani, Ibrahim Destan; Bajraktari, Gani; Kryziu, Emrush; Zylfiu, Bejtush; Sadiku, Shemsedin; Elezi, Ymer; Rexhepaj, Nehat; Vitia, Arber; Emini, Merita; Abazi, Murat; Berbatovci-Ukimeraj, M; Kryeziu, Kaltrina; Hsanagjekaj, Venera; Korca, Hajrije; Ukimeri, Aferdita

    2010-11-01

    The aim of this prospective study was the assessment of left ventricular and right ventricular diastolic function in patients on hemodialysis (HD) and the correlation of this function with the duration of HD. The study included 42 patients (22 females and 20 males) with chronic renal failure (CRF), treated with HD, and 40 healthy subjects (24 females and 16 males) with no history of cardiovascular disease and with normal renal function, who constituted the control group. The groups were matched for age and sex. All study patients and control subjects underwent detailed history taking and physical examination. They also underwent electrocardiogram, echocardiography and biochemical and hematological blood analyses. Significant differences were noted between the two groups in the two-dimensional and M-mode echocardiography findings concerning aortic root dimension, transverse diameter of the left atrium, thickness of the interventricular septum, thickness of the left ventricular posterior wall, left ventricular diastolic diameter, left ventricular systolic diameter, shortening fraction, ejection fraction as well as findings from the pulse Doppler study, including E wave, A wave, E/A ratio, deceleration time of E wave (DT-E), acceleration time of E wave (AT-E), tricuspid E and A waves (E tr and A tr ) and E tr /A tr , ratio. There were significant changes in HD patients without arterial hypertension as well in the control group subjects. Our study suggests that the left ventricular and left atrial dimensions as well as the left ventricular wall thickness are augmented in patients with CRF treated with HD compared with the control group. Additionally, the left and right ventricular diastolic function is also reduced in these patients. These differences were also noted in patients with CRF without arterial hypertension. Left ventricular diastolic dysfunction had no correlation with the duration of HD.

  2. Potassium binders in hemodialysis patients: a friend or foe?

    PubMed

    Chaaban, Ahmed; Abouchacra, Samra; Gebran, Nicole; Abayechi, Faiz; Hussain, Qutaiba; Al Nuaimi, Noura; Hassan, Muhy Eddin

    2013-01-01

    There is insufficient evidence on the utility of potassium-binding resins in patients with end-stage renal disease on dialysis. In addition, their poor tolerability raises concerns of patient adherence. We aimed to assess the efficacy of calcium resonium and investigate the impact of counseling on adherence pattern as well as treatment response. Adult patients on hemodialysis receiving calcium resonium were enrolled with a control group not on treatment. Adherence patterns and adverse effects were recorded following patient interviews. Patients were stratified into 28 adherent (A), 42 non-adherent (NA), and 30 controls (C). Patient education was undertaken, and serum potassium levels were evaluated for 3 months pre- and post-counseling with inter- and intra-group comparison. A statistically significant difference was observed between potassium levels at baseline in A and NA groups but not post-education, which was related to worsening control in former and not due to improvement in NA patients. The poor effectiveness of calcium resonium in the control of hyperkalemia was likely related to non-compliance due to gastrointestinal (GI) intolerability. Dietary indiscretions as well as lack of consistent use of cathartics may have also contributed. No difference in dialysis adequacy was noted among groups, although the contribution of residual renal function was not assessed. These findings raise concern regarding cost-efficacy of this medication and lend credence to investing in traditional measures in hyperkalemia management, namely dietary compliance and adequate dialysis. Further long-term trials are awaited to better define the role of calcium resonium in the dialysis setting.

  3. Circulating cell-free DNA in hemodialysis patients predicts mortality.

    PubMed

    Tovbin, David; Novack, Victor; Wiessman, Maya Paryente; Abd Elkadir, Amir; Zlotnik, Moshe; Douvdevani, Amos

    2012-10-01

    Circulating cell-free DNA (CFD) appears following cell damage and DNA release, and increases in hemodialysis (HD) patients particularly following HD. We hypothesized that CFD is an integrative marker of tissue damage and can be an independent predictor for all-cause mortality in HD patients. In a prospective study, CFD levels before and after HD were evaluated in 31 chronic HD patients with no acute disease, using the reported rapid non-cumbersome inexpensive fluorometric assay developed in our laboratory. Follow-up levels were assessed at 18 months in 22 patients. All-cause mortality was a primary endpoint. During 42 months of follow-up, 13 of the 31 (41.9%) patients died. The decedents were older than the survivors (mean age 69.9 versus 61.5 years, P = 0.06), but did not differ in end-stage renal disease (ESRD) duration, gender, albumin and hemoglobin, diabetes mellitus and weight. Post-dialysis CFD levels were significantly lower in survivors (median 688 versus 880 ng/mL, P = 0.01). The sensitivity and specificity of CFD levels of 850 ng/mL to predict 42 months (3.5 years) mortality were 73 and 75%, respectively, and the area under the receiver-operating characteristic curve was 0.77 [95% confidence interval (CI) 0.60-0.94]. The Cox proportional hazard regression model showed that CFD higher than 850 ng/mL adjusted for age, ESRD duration, weight and creatinine (stepwise model) was highly predictive of all-cause death with a hazard ratio of 8.0 (95% CI 2.3-28.5, P = 0.001). Post-dialysis CFD level is an independent predictor of all-cause mortality in patients undergoing HD. We propose that CFD detection is an inexpensive applicable tool for identifying patients at risk and their follow-up.

  4. Adherence to hemodialysis dietary sodium recommendations: influence of patient characteristics, self-efficacy, and perceived barriers.

    PubMed

    Clark-Cutaia, Maya N; Ren, Dianxu; Hoffman, Leslie A; Burke, Lora E; Sevick, Mary Ann

    2014-03-01

    To identify characteristics of hemodialysis patients most likely to experience difficulty adhering to sodium restrictions associated with their dietary regimen. Secondary analysis using baseline data from an ongoing randomized clinical trial examining the effects of a technology-supported behavioral intervention on dietary sodium intake in hemodialysis patients. Thirteen dialysis centers in southwestern Pennsylvania. We included 122 participants (61% women; 48% African American) aged 61 ± 14 years undergoing maintenance, intermittent hemodialysis for end-stage renal disease. Normalized dietary sodium intake, adjusted interdialytic weight gain, perceived problems, and self-efficacy for restricting dietary sodium. Younger participants were more likely to report problems managing their hemodialysis diet and low self-efficacy for restricting sodium intake. Consistent with these findings, younger participants had a higher median sodium intake and higher average adjusted interdialytic weight gain. Females reported more problems managing their diet. Race, time on dialysis, and perceived income adequacy did not seem to influence outcome measures. Our findings suggest that patients who are younger and female encounter more difficulty adhering to the hemodialysis regimen. Hence, there may be a need to individualize counseling and interventions for these individuals. Further investigation is needed to understand the independent effects of age and gender on adherence to hemodialysis dietary recommendations and perceived self-efficacy. Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  5. Adherence to Hemodialysis Dietary Sodium Recommendations: Influence of Patient Characteristics, Self-Efficacy and Perceived Barriers

    PubMed Central

    Clark-Cutaia, Maya N.; Ren, Dianxu; Hoffman, Leslie A.; Burke, Lora E.; Sevick, Mary Ann

    2014-01-01

    Objective To identify characteristics of hemodialysis patients most likely to experience difficulty adhering to sodium restrictions associated with their dietary regimen. Design Secondary analysis using baseline data from an ongoing randomized clinical trial examining the effects of a technology-supported behavioral intervention on dietary sodium intake in hemodialysis patients. Setting 13 dialysis centers in southwestern Pennsylvania. Subjects 122 participants (61% women, 48% African American) aged 61 ± 14 years receiving maintenance, intermittent hemodialysis for end stage renal disease. Main outcome measure Normalized dietary sodium intake, adjusted interdialytic weight gain, perceived problems and self-efficacy for restricting dietary sodium. Results Younger participants were more likely to report problems managing their hemodialysis diet and low self-efficacy for restricting sodium intake. Consistent with these findings, younger participants had a higher median sodium intake and higher average adjusted interdialytic weight gain. Females reported more problems managing their diet. Race, time on dialysis and perceived income adequacy did not appear to influence outcome measures. Conclusion Our findings suggest patients who are younger and female encounter more difficulty adhering to the hemodialysis regimen. Hence, there may be a need to individualize counseling and interventions for these individuals. Further investigation is needed to understand the independent effects of age and gender on adherence to hemodialysis dietary recommendations and perceived self-efficacy. PMID:24462498

  6. Nutritional profile and inflammatory status of hemodialysis patients.

    PubMed

    Faintuch, Joel; Morais, Alvaro A C; Silva, Maria A T; Vidigal, Erica J; Costa, Rozilene A; Lyrio, Daniele C; Trindade, Celia R; Karoline, K Pitanga

    2006-01-01

    Malnutrition and abnormal inflammatory markers are prominent features of the uremic syndrome, but associations and repercussions are somewhat controversial. To determine nutritional and clinical profile of hemodialysis patients, aiming at potential diagnostic recommendations for stable subjects with elevated C-reactive protein. Prospective observational cross-sectional clinical study in a stable chronic hemodialysis population; Renal and Nutritional Service of a mid-size charity academic hospital; Subjects (n=44) were analyzed concerning nutritional status and C-reactive protein. Some displayed acute infections (Group I, n=9) and others did not (Group II, n=35). Age was 47.0 +/- 16.9 years with 63.6% males. Body mass index (BMI) was 22.2 +/- 3.9 kg/m2, calorie intake was 1262 +/- 601 kcal/day (20.7 +/- 6.7 kcal/kg/day), and protein ingestion was 74.3 +/- 16.6 g protein/day (1.2 g/kg/day); No nutritional supplement or artificial modality of alimentation was employed in this series; Subjective global assessment and C-reactive protein. Malnutrition estimated by subjective global assessment (SGA) was very common (>90%), despite acceptable BMI and serum albumin. C-reactive protein was moderately elevated in 40.9% and was positively associated with SGA and negatively with plasma proteins. Comorbidities were associated positively with extracellular water and negatively with reactance (bioimpedance). When infected versus non-infected cases were analyzed, 100% of the former displayed high CRP concentrations in contrast with 22.9% of remaining patients. (1) Malnutrition profile was rather unique, with relatively favorable objective findings (body mass index, serum albumin) and more deranged SGA; (2) Bioimpedance analysis suggested that phase angle could be used as an indicator of nutritional status; (3) Creactive protein was negatively associated with plasma proteins; (4) Infected subjects, although few and displaying moderate clinical troubles, were responsible for most C

  7. Purple urine bag syndrome in a hemodialysis patient.

    PubMed

    Wang, I-Kuan; Ho, Dong-Ru; Chang, Hung-Yu; Lin, Chun-Liang; Chuang, Feng-Rong

    2005-08-01

    Purple urine bag syndrome (PUBS) is an uncommon disorder, in which the plastic disposable urinary catheter bag turns purple or blue following hours or days of urinary catheterization. The purple discoloration results from indirubin dissolved in the plastic mixing with indigo in the urine. Bacteria possessing indoxyl sulfatase degrade indoxyl sulfate into indirubin and indigo. Indoxyl sulfate is derived from the metabolism of tryptophan. PUBS usually occurs in chronic catheterized elderly women who are constipated and poorly ambulant. The clinical course is benign and rarely causes sepsis. This investigation reports a 61-year-old female diabetic patient with end-stage renal disease on maintenance hemodialysis, who had two episodes of blue or purple urine bag discoloration. The urine culture of the first episode yielded Klebsiella pneumoniae, whereas that of the second episode yielded Escherichia coli, Enterococcus faecalis, and Proteus vulgaris. Both episodes resolved following oral antibiotics treatment and placement of new foley catheters. To our knowledge, this is the first recorded case of PUBS in a dialysis patient.

  8. Seasonal Variations of Nutritional Status in Maintenance Hemodialysis Patients.

    PubMed

    Ilić Begović, Tanja; Radić, Josipa; Radić, Mislav; Kovačić, Vedran; Šain, Milenka; Ljutić, Dragan

    2016-10-01

    Nutritional status of hemodialysis (HD) patients is influenced by a multitude of factors and it strongly correlates with morbidity and mortality. The aim of this study was to investigate the influence of seasonal changes on nutritional status in maintenance HD patients. A selected population of 84 adult (40 females and 44 males, aged 68.98 ± 13.45 years) HD (5.94 ± 6.44 years) patients were investigated. Clinical, biochemical and nutritional parameters (BMI, creatinine, urea, serum albumin, total cholesterol and Dialysis Malnutrition Score (DMS) were measured in cold (January and December) and mild (June and September) months, altogether in 336 HD sessions. Statistically significant differences between cold and mild months were found in BMI (P = 0.046), creatinine before HD (P = 0.011), urea before HD (P ≤ 0.001), urea after HD (P ≤ 0.001) and glucose (P =  0.001). Differences between male and female patients in DMS, serum albumin and creatinine level in cold and mild months were found; where females altogether had higher DMS score and lower serum albumin and creatinine levels. These results suggest that seasonal variations of clinical and laboratory variables that reflect nutritional status occur commonly among maintenance HD patients and might lead to biases in the interpretation of results in clinical studies in which measurement schedules vary during the year. Also, results suggested that female HD patients may constitute an especially vulnerable population for seasonal oscillations of nutritional status. The reasons for most of these variations are not apparent and require further investigation. © 2016 International Society for Apheresis, Japanese Society for Apheresis, and Japanese Society for Dialysis Therapy.

  9. 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.

  10. Oral carnitine supplementation for dyslipidemia in chronic hemodialysis patients.

    PubMed

    Naini, Afsoon Emami; Sadeghi, Masoumeh; Mortazavi, Mojgan; Moghadasi, Mojdeh; Harandi, Asghar Amini

    2012-05-01

    Carnitine deficiency is a commonly observed problem in maintenance hemodialysis (MHD) patients, which results in altered metabolism of fatty acids and subsequently development of dyslipidemia. To evaluate the effect of oral L-carnitine (LC) supplementation on lipid profile of adult MHD patients, we studied 30 of them (19 males, 11 females) who received LC supplementation of 250 mg tablets three times a day for eight weeks. They were compared with 30 matched patients as a control group. Serum lipid profiles were compared before and after the intervention between the two groups. There was a significant decrease of the values of the lipid profile in the intervention group before and after carnitine supplementation including the mean values of total cholesterol (190 ± 36.8 vs. 177 ± 31.2 mg/dL), triglyceride (210 ± 64.7 vs. 190 ± 54.1 mg/dL) and LDL-cholesterol (117 ± 30.1 vs. 106 ± 26.3 mg/dL), while the values did not change siginificantly from base line in the control group. However, the difference for HDL-cholesterol in intervention group was not statistically significant. None of the patients dropped out of the study due to drug side effects. Oral LC supplementation (750 mg/day) is able to improve lipid profile in patients on MHD. Further long-term studies with adequate sample size are needed to define the population of patients who would benefit more from carnitine therapy and the optimal dose and the most efficient route for administration of the drug.

  11. Fibroblast growth factor-23 levels in maintenance hemodialysis patients in India

    PubMed Central

    Anandh, U.; Mandavkar, P.; Das, B.; Rao, S.

    2017-01-01

    Fibroblast growth factor-23 (FGF-23) levels start rising early in patients with chronic kidney disease and is implicated in cardiovascular and overall mortality of hemodialysis patients. We conducted a prospective observational cohort study in stable dialysis patients looking into the levels of FGF-23 in hemodialysis patients and its association with various demographic and biochemical variables and mortality. A total of 91 patients were enrolled in the study. The mean FGF-23 levels were very high (1152.7 pg/ml). FGF-23 levels were significantly associated with serum phosphorus and parathyroid hormone (PTH) levels in univariate and multivariate analysis. No significant association between FGF-23 and cardiovascular comorbidities and overall mortality was seen. FGF-23 levels rise exponentially in maintenance hemodialysis patients. There is a strong association between FGF-23 and phosphorus and PTH levels. No association between FGF-23 and mortality was noted in our patients. PMID:28182071

  12. Elimination of non-ionic contrast medium by hemodialysis in patients with impaired renal function.

    PubMed

    Horiuchi, K; Yoshida, K; Tsuboi, N; Akimoto, M; Tajima, H; Kumazaki, T

    1999-10-01

    The elimination rate of iohexol, a non-ionic contrast medium, from the blood by hemodialysis, and the elimination rate of iohexol by a dialyzer were studied in 15 patients with chronic renal dysfunction who required angiography or enhanced CT. The elimination rate of iohexol was 19.8% at 15 min after the start of hemodialysis, 30.6% after 30 min, 44.2% after 1 hour, 62.1% after 2 hours and 72.9% after 3 hours. The dialyzer elimination rate was maintained at about 75% from 1 to 3 hours after the start of hemodialysis. If only about 70% of iohexol in the blood needs to be eliminated, hemodialysis for 3 hours with a blood flow rate of 120 ml/min and a dialysate flow of 500 ml/min using a 0.7 m2 cellulose triacetate membrane is sufficient.

  13. Evaluation of nutritional status using anthropometric measurements and MQSGA in geriatric hemodialysis patients

    PubMed Central

    Yigit, Irem Pembegul; Ulu, Ramazan; Celiker, Huseyin; Dogukan, Ayhan

    2016-01-01

    OBJECTIVE: Malnutrition is common among hemodialysis patients and is associated with higher rates of morbidity and mortality. The aim of this study was to evaluate nutritional status of geriatric hemodialysis patients. METHODS: Total of 163 hemodialysis patients were initially screened, and 55 patients (28 males, 27 females; mean age: 72.9±8.4 years) met the criteria for inclusion. Patients were divided into 3 groups according to modified quantitative subjective global assessment (MQSGA) scores: Group I (n=22) normal nutrition, Group II (n=20) mild-to-moderate malnutrition, and Group III (n=13) severe malnutrition. RESULTS: When we assessed the correlation between MQSGA nutrition score and data of malnourished patients (n=33), positive significant correlation was found between age, C-reactive protein level, and malnutrition-inflammation score. Negative significant correlation was found between body mass index, bicep skinfold, tricep skinfold, mid-arm circumference, mid-arm muscle circumference, and phosphate and albumin levels. CONCLUSION: Malnutrition is very common and increasing with aging in geriatric hemodialysis patients. MQSGA score and anthropometric measurements can be used to assess nutritional status in geriatric hemodialysis patients. PMID:28058399

  14. QuantiFERON-TB Gold test for screening latent tuberculosis infection in hemodialysis patients.

    PubMed

    Sayarlioğlu, Hayriye; Gül, Mustafa; Eren Dağli, Canan; Doğan, Ekrem; Sahin, Murat; Uçar, Mehmet Ali; Köksal, Nurhan; Sayarlioğlu, Mehmet; Tahta, Mümtaz Kerim

    2011-01-01

    Hemodialysis patients are at increased risk of latent tuberculosis infection (LTBI) compared with the general population. QuantiFERON-TB Gold (QFT-G) for LTBI detection is more promising than tuberculin skin test (TST) in hemodialysis patients. The aim of this study is to determine whether the QFT-G is more sensitive than the TST in hemodialysis patients in LTBI. Eighty nine hemodialysis patients were evaluated for latent tuberculosis infection with the TST and QFT-G. Blood was obtained for QFT-G, and then TST was administered to all patients. Demographic information, laboratory tests, chest radiography results and BCG vaccination status were collected on standardized patient medical files. Forty patients had positive QFT-G results. 56 patients had TST induration above 5 mm, 28 patients above 10 mm. 61 patients had BCG vaccination scar. Statistically significant correlation was detected between TST and QFT-G (p< 0.05). In the BCG non-vaccinated subgroup, TST was positive in 8 (29%) patients and the QFT-G was positive in 11 (39%). Among the 21 non vaccinated patients with results for both tests, the concordance between the TST and QFT-G was 82%, k= 0.61, p= 0.001. We found good agreement between the TST and QFT-G test for LTBI in non vaccinated hemodialysis patients, whereas we found poor agreement in vaccinated patients. Because BCG vaccination is widely used in our country, the QFT-G test might be more useful for the diagnosis of LTBI than TST in hemodialysis patients who are suspected to have LTBI.

  15. Short Daily versus Conventional Hemodialysis for Hypertensive Patients: A Randomized Cross-Over Study

    PubMed Central

    Zimmerman, Deborah L.; Ruzicka, Marcel; Hebert, Paul; Fergusson, Dean; Touyz, Rhian M.; Burns, Kevin D.

    2014-01-01

    Background Treatment of end stage renal disease patients with short daily hemodialysis has been associated with an improvement in blood pressure. It is unclear from these studies if anti-hypertensive management had been optimized prior to starting short daily hemodialysis. Also, the potential mechanism(s) of blood pressure improvement remain to be fully elucidated. Study Design, Setting and Participants We undertook a randomized cross-over trial in adult hypertensive patients with ESRD treated with conventional hemodialysis to determine: 1) if short-daily hemodialysis is associated with a reduction in systolic blood pressure after a 3-month blood pressure optimization period and; 2) the potential mechanism(s) of blood pressure reduction. Blood pressure was measured using Canadian Hypertension Education Program guidelines. Extracellular fluid volume (ECFV) was assessed with bioimpedance. Serum catecholamines were used to assess the sympathetic nervous system. Interleukin-6 (IL-6) and thiobarbituric acid reactive substances (T-BARS) were used as markers of inflammation and oxidative stress respectively. Results After a 3-month run-in phase in which systolic blood pressure improved, there was no significant difference in pre-dialysis systolic pressure between short-daily and conventional hemodialysis (p = 0.39). However, similar blood pressures were achieved on fewer anti-hypertensive medications with short daily hemodialysis compared to conventional hemodialysis (p = 0.01). Short daily hemodialysis, compared to conventional hemodialysis, was not associated with a difference in dry weight or ECFV (p = 0.77). Sympathetic nervous system activity as assessed by plasma epinephrine (p = 1.0) and norepinephrine (p = 0.52) was also not different. Markers of inflammation (p = 0.42) and oxidative stress (p = 0.83) were also similar between the two treatment arms. Conclusions Patients treated with short daily, compared to conventional hemodialysis

  16. Quality-of-care indicators among remote-dwelling hemodialysis patients: a cohort study.

    PubMed

    Thompson, Stephanie; Bello, Aminu; Wiebe, Natasha; Manns, Braden; Hemmelgarn, Brenda; Klarenbach, Scott; Pelletier, Rick; Tonelli, Marcello

    2013-08-01

    We hypothesized that the higher mortality for hemodialysis patients who live farther from the closest attending nephrologist compared with patients living closer might be due to lower quality of care. Population-based longitudinal study. All adult maintenance hemodialysis patients with measurements of quality-of-care indicators initiating hemodialysis therapy between January 2001 and June 2010 in Northern Alberta, Canada. Hemodialysis patients were classified into categories based on the distance by road from their residence to the closest nephrologist: ≤50 (referent), 50.1-150, 150.1-300, and >300 km. Quality-of-care indicators were based on published guidelines. Quality-of-care indicators at 90 days following initiation of hemodialysis therapy and, in a secondary analysis, at 1 year. Measurements were available for 1,784 patients. At baseline, the proportions of patients residing in each category were 69% for ≤50 km to closest nephrologist; 17%, 50.1-150 km; 7%, 150.1-300 km; and 7%, >300 km. Those who lived farther away from the closest nephrologist were less likely to have seen a nephrologist 90 days prior to the initiation of hemodialysis therapy (P for trend = 0.008) and were less likely to receive Kt/V of 1.2 (adjusted OR, 0.50; 95% CI, 0.30-0.84; P for trend = 0.01). Remote location also was associated with suboptimal levels of phosphate control (P for trend = 0.005). There were no differences in the prevalence of arteriovenous fistulas or grafts or hemoglobin levels across distance categories. Registry data with limited data for non-guideline-based quality indicators. Although several quality-of-care indicators were less common in remote-dwelling hemodialysis patients, these differences do not appear sufficient to explain the previously noted disparities in clinical outcomes by residence location. Copyright © 2013 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  17. 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

  18. Status of antioxidant and homocysteine-lowering vitamins related to cardiovascular diseases in hemodialysis patients

    PubMed Central

    Kooshki, Akram; Yazdi, Mitra Eftekhari; Moghaddam, Manidgeh Yousefi; Akbarzadeh, Roya

    2017-01-01

    Background and aim Cardiovascular disease is the major cause of mortality in hemodialysis patients. Oxidative stress and hyperhomocysteinemia may contribute to an increased risk of CVD. Therefore, we assessed the status of antioxidant and homocysteine-lowering vitamins related to cardiovascular disease in hemodialysis patients at Vasei hospital in Sabzevar. Methods In this cross-sectional study, we enrolled 75 hemodialysis patients by using census method at Vasei Hospital in Sabzevar (Iran) in 2014. After measuring height and body weight, food intake was assessed by a 24-hour dietary recall questionnaire for at least two days (a non-dialysis and dialysis day), and food frequency was recorded with Nutritionist IV software. Data were analyzed by SPSS version 16, using descriptive statistical tests, one sample t-test and independent samples t-test and p<0.05 was considered statistically significant. Results This study was carried out on 75 patients. Mean age and BMI of patients were 49.95±17.22 years and 20.04±3.38 kg/m2, respectively. Intake of all vitamins with the exception of vitamin B12 in hemodialysis patients studied, were less than the recommended dietary allowance (RDA) (p<0.05). Conclusion According to the survey, consumption of antioxidants and B-vitamins related to cardiovascular disease was less than RDA in hemodialysis patients. PMID:28894552

  19. Status of antioxidant and homocysteine-lowering vitamins related to cardiovascular diseases in hemodialysis patients.

    PubMed

    Kooshki, Akram; Yazdi, Mitra Eftekhari; Moghaddam, Manidgeh Yousefi; Akbarzadeh, Roya

    2017-07-01

    Cardiovascular disease is the major cause of mortality in hemodialysis patients. Oxidative stress and hyperhomocysteinemia may contribute to an increased risk of CVD. Therefore, we assessed the status of antioxidant and homocysteine-lowering vitamins related to cardiovascular disease in hemodialysis patients at Vasei hospital in Sabzevar. In this cross-sectional study, we enrolled 75 hemodialysis patients by using census method at Vasei Hospital in Sabzevar (Iran) in 2014. After measuring height and body weight, food intake was assessed by a 24-hour dietary recall questionnaire for at least two days (a non-dialysis and dialysis day), and food frequency was recorded with Nutritionist IV software. Data were analyzed by SPSS version 16, using descriptive statistical tests, one sample t-test and independent samples t-test and p<0.05 was considered statistically significant. This study was carried out on 75 patients. Mean age and BMI of patients were 49.95±17.22 years and 20.04±3.38 kg/m(2), respectively. Intake of all vitamins with the exception of vitamin B12 in hemodialysis patients studied, were less than the recommended dietary allowance (RDA) (p<0.05). According to the survey, consumption of antioxidants and B-vitamins related to cardiovascular disease was less than RDA in hemodialysis patients.

  20. Effect of predialysis verapamil on intradialytic blood pressure in chronic hemodialysis patients.

    PubMed

    Sherman, R A; Casale, P; Cody, R; Horton, M W

    1990-01-01

    Decreased left ventricular compliance because of hypertrophy or fibrosis may contribute to hypotension during hemodialysis. While calcium channel blockade may reduce intradialytic hypotension in patients with left ventricular hypertrophy and refractory pulmonary congestion, it is unknown whether such an effect might be seen in unselected hemodialysis patients. Verapamil (40 mg) or a placebo was given 1 hour before hemodialysis to 10 patients in a double-blind crossover study. Two 2 week verapamil periods alternated with two 2 week placebo periods. Patients received bicarbonate for either 3 hours (7 patients, high-flux, Filtral, Gambro-Hospal Inc., Williamsburg, VA) or for 4 hours (3 patients, Travenol 15.11 or CA 110, Baxter Healthcare, Deerfield, IL). Left ventricular hypertrophy was present by ultrasound in 7 of 8 patients tested and by electrocardiogram in 1 of the remaining 2. Intradialytic blood pressures were similar during the drug and placebo trials. The number of episodes of symptomatic hypotension per hemodialysis was 0.99 with verapamil and 0.93 during the placebo periods (p less than 0.05). Thus, a single predialysis dosage of verapamil has no effect on intradialytic blood pressure in an unselected hemodialysis population.

  1. Clinical factors associated with serum copper levels and potential effect of sevelamer in hemodialysis patients.

    PubMed

    Ikee, Ryota; Tsunoda, Masataka; Sasaki, Naomi; Sato, Naritsugu; Hashimoto, Nobuo

    2013-06-01

    Copper is an essential mineral nutrient for humans. Serum copper levels of hemodialysis patients are higher than those of healthy subjects, but it remains to be elucidated whether increased serum copper may have harmful effects. In addition, a recent in vitro study has shown that sevelamer can adsorb copper. In the present study, we searched for clinical factors associated with serum copper levels in hemodialysis patients. This cross-sectional study included patients undergoing hemodialysis for more than 6 months. In these patients, we statistically tested associations between serum copper levels and other parameters, including nutritional markers, lipid profiles, oxidative stress, inflammation, and sevelamer administration. Among 48 patients (male/female = 28:20, age 71 ± 10 years, hemodialysis duration 84 ± 72 months), sevelamer hydrochloride was administered in 39 patients (81.3 %). In univariate analysis, serum copper levels showed significant positive correlations with serum levels of total cholesterol, low-density lipoprotein (LDL) cholesterol, high-sensitivity C-reactive protein (hs-CRP), and malondialdehyde modified-LDL and negative correlations with plasma total homocysteine levels and the administered dose of sevelamer. In multivariate analysis, serum levels of LDL-cholesterol and hs-CRP were found to be independent determinants of serum copper levels. We found that serum copper levels were independently associated with dyslipidemia and inflammation in hemodialysis patients, but the pathogenic roles of copper remain to be elucidated. In addition, potential effect of sevelamer on serum copper levels should be examined in appropriately designed studies.

  2. Management of Pain and Quality of Life in Patients with Chronic Kidney Disease Undergoing Hemodialysis.

    PubMed

    Zyga, Sofia; Alikari, Victoria; Sachlas, Athanasios; Stathoulis, John; Aroni, Adamantia; Theofilou, Paraskevi; Panoutsopoulos, Georgios

    2015-10-01

    An important dimension that influences the quality of life of hemodialysis patients is the pain they experience. Quality of life and self-efficacy in pain can play an important role in chronic kidney disease and treatment outcomes. The purpose of the study was to examine self-efficacy in pain and quality of life among patients with end stage renal disease undergoing hemodialysis. Between April 2013 and June 2013, 224 hemodialysis patients completed the Missoula-VITAS Quality of Life Index-15 and the Pain Self-Efficacy Questionnaire. The study was conducted in four dialysis units in hospitals of the Peloponnese region. Sociodemographic data of patients and their individual medical history were recorded. Statistical analysis was performed using SPSS version 19. The more effective the self-efficacy in pain, the lower the quality of life enjoyed by hemodialysis patients. The majority of respondents described the overall quality of life as "moderate," while the self-efficacy in pain depended on comorbidity or complications that accompany the process of hemodialysis. The findings of this study can be used in the development and improvement of health services for the management of patients. Healthcare professionals should understand the concerns and treat the symptoms of patients that affect quality of life, providing thereby holistic health care.

  3. 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.

  4. Estimating patient-borne water and electricity costs in home hemodialysis: a simulation

    PubMed Central

    Nickel, Matthew; Rideout, Wes; Shah, Nikhil; Reintjes, Frances; Chen, Justin Z.; Burrell, Robert; Pauly, Robert P.

    2017-01-01

    Background: Home hemodialysis is associated with lower costs to the health care system compared with conventional facility-based hemodialysis because of lower staffing and overhead costs, and by transferring the treatment cost of utilities (water and power) to the patient. The purpose of this study was to determine the utility costs of home hemodialysis and create a formula such that patients and renal programs can estimate the annual patient-borne costs involved with this type of treatment. Methods: Seven common combinations of treatment duration and dialysate flows were replicated 5 times using various combinations of home hemodialysis and reverse osmosis machines. Real-time utility (electricity and water) consumption was monitored during these simulations. A generic formula was developed to allow patients and programs to calculate a more precise estimate of utility costs based on individual combinations of dialysis intensity, frequency and utility costs unique to any patient. Results: Using typical 2014 utility costs for Edmonton, the most expensive prescription was for nocturnal home hemodialysis (8 h at 300 mL/min, 6 d/wk), which resulted in a utility cost of $1269 per year; the least expensive prescription was for conventional home hemodialysis (4 h at 500 mL/min, 3 d/wk), which cost $420 per year. Water consumption makes up most of this expense, with electricity accounting for only 12% of the cost. Interpretation: We show that a substantial cost burden is transferred to the patient on home hemodialysis, which would otherwise be borne by the renal program. PMID:28401120

  5. 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

  6. 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

  7. Nutritional Markers and Body Composition in Hemodialysis Patients.

    PubMed

    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/height(2)) 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/ height(2)) 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.

  8. 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.

  9. Lipoprotein alterations in hemodialysis: differences between diabetic and nondiabetic patients.

    PubMed

    González, Ana Inés; Schreier, Laura; Elbert, Alicia; Berg, Gabriela; Beresan, Hugo; López, Graciela; Wikinski, Regina

    2003-01-01

    Both renal failure and type 2 diabetes may contribute synergistically to the dyslipemia of diabetic renal failure with the development of atherosclerosis as the possible consequence. It has not yet been conclusively evaluated whether diabetic patients with end-stage renal failure under maintenance hemodialysis (HD) show accentuated alterations in plasma lipids and lipoproteins in comparison to nondiabetics under HD. These abnormalities would involve hepatic lipase activity and the regulation of triglyceride-rich lipoprotein metabolism. The purpose of the present study was to evaluate whether type 2 diabetic patients undergoing HD exhibited a lipid-lipoprotein profile different from that of nondiabetic hemodialyzed patients. We compared plasma lipids, apoprotein (apo) A-I and B, and lipoprotein parameters among 3 groups: 25 type 2 diabetics, 25 nondiabetics, both undergoing HD, and 20 healthy control subjects. Intermediate-density lipoprotein (IDL) and low-density lipoprotein (LDL) were isolated by sequential ultracentrifugation. Hepatic lipase activity was measured in postheparin plasma. Both groups of HD patients showed higher triglyceride and IDL cholesterol (P <.001), and lower high-density lipoprotein (HDL) cholesterol (P <.01) and apo A-I (P <.001) levels compared to the control group, even after adjustment for age and body mass index (BMI). However, no differences were found in lipid, lipoprotein, and apoprotein concentrations between diabetic and nondiabetic HD patients, except for high LDL triglyceride content of diabetic HD patients (P <.01). Nondiabetics undergoing HD also presented higher LDL triglyceride levels than controls (P <.05). LDL triglyceride correlated with plasma triglycerides (r = 0.51, P <.001). A lower LDL cholesterol/apo B ratio was found in each group of HD patients in comparison to controls (P <.02). Comparing the diabetic and nondiabetic patients, hepatic lipase activity remained unchanged, but significantly lower than control subjects

  10. Endoscopic Approaches to the Treatment of Variceal Hemorrhage in Hemodialysis-Dependent Patients

    PubMed Central

    Ma, Lili; Zeng, Xiaoqing; Wang, Jian; Chen, Jie

    2016-01-01

    Background. Esophagogastric variceal hemorrhage leads to challenging situation in chronic kidney disease patients on maintenance hemodialysis. Aims. To determine the safety and efficacy of endoscopic approaches to patients with hemodialysis-dependent concomitant with esophagogastric varices. Methods. Medical records were reviewed from January 1, 2004, to December 31, 2015, in our hospital. Five consecutive hemodialysis-dependent patients with variceal hemorrhage who underwent endoscopic treatments were retrospectively studied. Results. The median age of the patients was 54 years (range 34–67 years) and the median follow-up period was 21.3 months (range 7–134 months). All the patients received a total of three times heparin-free hemodialysis 24 hours before and no more than 24 hours and 72 hours after endoscopic treatment. They successfully had endoscopic variceal ligation, endoscopic injection sclerotherapy, and/or N-butyl cyanoacrylate injection. The short-term efficacy is satisfying and long-term follow-up showed episodes of rebleeding. Conclusions. Endoscopic approaches are the alternative options in the treatment of upper gastroenterology variceal hemorrhage in hemodialysis-dependent patients without severe complications. PMID:28105048

  11. Association between serum pregnancy-associated plasma protein-A and bicarbonate in hemodialysis patients.

    PubMed

    Bicik, Zerrin; Coskun, Abdurrahman; Serteser, Mustafa; Bulur, Atilla; Mese, Meral; Unsal, Ibrahim

    2014-03-01

    Acidosis is associated with protein-energy malnutrition, inflammation, and bone disease, and low bicarbonate levels have been implicated in higher mortality rates in chronic kidney disease. Recently, the concentration of serum pregnancy-associated plasma protein-A (PAPP-A) has become accepted as a prognostic marker in hemodialysis patients. This study determined the relationship between PAPP-A and bicarbonate levels in these patients. The study enrolled 65 hemodialysis patients (41 males, 24 females) and 26 control subjects (11 males, 15 females). Serum PAPP-A, intact parathormone (iPTH), calcium, phosphorus (P), and bicarbonate levels were measured. Correlations between PAPP-A and bicarbonate, iPTH, calcium, and phosphorus were evaluated. Median PAPP-A levels were significantly higher in hemodialysis patients [15.1 (<0.03-158.8) ng/ml] than in control subjects [6.6 (<0.03-16.4) ng/ml] (P < 0.05). There were statistically significant correlations between serum PAPP-A and bicarbonate, iPTH, and P in hemodialysis patients but not in control subjects. Elevation of serum PAPP-A has been found in hemodialysis patients and its significant correlation with bicarbonate suggests that it may be a prognostic factor. © 2014 Wiley Periodicals, Inc.

  12. 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

  13. Sudden cardiac death in hemodialysis patients: an in-depth review.

    PubMed

    Green, Darren; Roberts, Paul R; New, David I; Kalra, Philip A

    2011-06-01

    Sudden cardiac death (SCD) is the leading cause of death in hemodialysis patients, accounting for death in up to one-quarter of this population. Unlike in the general population, coronary artery disease and heart failure often are not the underlying pathologic processes for SCD; accordingly, current risk stratification tools are inadequate when assessing these patients. Factors assuming greater importance in hemodialysis patients may include left ventricular hypertrophy, electrolyte shift, and vascular calcification. Knowledge regarding SCD in hemodialysis patients is insufficient, in part reflecting the lack of an agreed-on definition of SCD in this population, although epidemiologic studies suggest the most common times for SCD to occur are toward the end of the long 72-hour weekend interval between dialysis sessions and in the 12 hours immediately after hemodialysis. Accordingly, it is hypothesized that the dialysis procedure itself may have important implications for SCD. Supporting this is recognition that hemodialysis is associated with both ventricular arrhythmias and dynamic electrocardiographic changes. Importantly, echocardiography and electrocardiography may show changes that are modifiable by alterations to dialysis prescription. The most effective preventative strategy in the general population, implanted cardioverter-defibrillator devices, are less effective in the presence of chronic kidney disease and have not been studied adequately in dialysis patients. Last, many dialysis patients experience SCD despite not fulfilling current criteria for implantation, making appropriate allocation of defibrillators uncertain.

  14. Impact of Lanthanum Carbonate on Prognosis of Chronic Hemodialysis Patients: A Retrospective Cohort Study (Kawashima Study).

    PubMed

    Tsuchida, Kenji; Nagai, Kojiro; Yokota, Narushi; Minakuchi, Jun; Kawashima, Shu

    2016-04-01

    In hemodialysis patients, mineral and bone disorder is an important risk factor for cardiovascular disease and subsequent death through the progression of vascular calcification. Serum phosphorus plays a major role in this process. In the present study, we retrospectively analyzed the effects of oral phosphate binder, lanthanum carbonate (LC), on the mortality in hemodialysis patients. Among a total of 841 patients who underwent maintenance hemodialysis on 1 July 2010, patients who were treated with LC (LC group, N = 324) and those who were treated without LC (NLC group, N = 517) were compared with respect to their all-cause mortality for a long-term observation period of up to 36 months. The mortality rate was compared using the Cox proportional hazard model adjusted by the propensity score. The adjusted hazard ratio for mortality in the LC group versus NLC group was 0.515 (95% confidence interval, 0.328-0.807), suggesting that the use of LC is associated with an almost 50% reduction in the mortality rate. The present retrospective study including all hemodialysis patients demonstrated, for the first time, an association between the use of LC and improved prognosis in hemodialysis patients. Randomized controlled trials should be done in the future to validate our present findings.

  15. The effect of foot reflexology and back massage on hemodialysis patients' fatigue and sleep quality.

    PubMed

    Unal, Kevser Sevgi; Balci Akpinar, Reva

    2016-08-01

    The aim of this study is to examine the effectiveness of foot reflexology and back massage on optimizing the sleep quality and reducing the fatigue of hemodialysis patients. The study includes 105 volunteer patients who were registered at a private dialysis clinic and were receiving hemodialysis treatment. Foot reflexology and back massage were administered to the patients two times a week for four weeks. The Visual Analogue Scale for Fatigue and the Pittsburg Sleep Quality Index were used to collect data. The differences between the pretest and posttest score averages of the patients on the Visual Analogue Scale for Fatigue and the Pittsburg Sleep Quality Index were statistically significant (p < 0.001). Foot reflexology and back massage were shown to improve the sleep quality and reduce the fatigue of hemodialysis patients. Compared to back massage, foot reflexology was determined to be more effective. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. B-type (brain) natriuretic peptide and pruritus in hemodialysis patients

    PubMed Central

    Shimizu, Yoshio; Sonoda, Ayano; Nogi, Chieko; Ogushi, Yoko; Kanda, Reo; Yamaguchi, Saori; Nohara, Nao; Aoki, Tatsuya; Yamada, Kaori; Nakata, Junichiro; Io, Hiroaki; Kurusu, Atsushi; Hamada, Chieko; Horikoshi, Satoshi; Tomino, Yasuhiko

    2014-01-01

    Introduction and objective While pruritus is a common complication in hemodialysis patients, the pathophysiological mechanisms remain obscure. Recently, B-type (brain) natriuretic peptide (BNP) has been defined as an itch-selective neuropeptide in pruriceptive neurons in mice, and higher serum levels of BNP are frequently observed in hemodialysis patients. The objective of the present study was to evaluate the role of serum BNP in pruritus in patients undergoing hemodialysis. Patients and methods The current cross-sectional study was performed on 43 patients undergoing maintenance hemodialysis. A visual analog scale (VAS) measuring the general severity of pruritus (values from 0 to 10, with higher values indicating more severe pruritus) in daytime and at night was self-reported by patients. Each patient’s background and laboratory tests, including serum BNP in the post-hemodialysis period, were collected. The correlation between VAS and clinical parameters was evaluated. Results Both daytime and nighttime VAS scores in diabetic patients were significantly less than those in nondiabetic patients. Multiple regression analysis revealed that pruritus in daytime was worsened by serum BNP (β=2.0, t=2.4, P=0.03), calcium (β=4.4, t=5.2, P<0.0001), and β2-microglobulin (β=2.0, t=3.0, P=0.007), while it was eased by age (β=−2.2, t=−3.2, P=0.0004). Nocturnal pruritus was severe in nondiabetic patients (β=1.7, t=3.8, P=0.0005) and weakened by the total iron binding capacity (β=−2.9, t=−3.1, P=0.004). Conclusion It is suggested that a higher level of serum BNP increases the pruritus of hemodialysis patients in daytime and that diabetic patients are less sensitive to itch, especially at nighttime. PMID:25187733

  17. 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

  18. The effect of frequent hemodialysis on nutrition and body composition: frequent Hemodialysis Network Trial.

    PubMed

    Kaysen, George A; Greene, Tom; Larive, Brett; Mehta, Ravindra L; Lindsay, Robert M; Depner, Tom A; Hall, Yoshio N; Daugirdas, John T; Chertow, Glenn M

    2012-07-01

    We investigated the effects of frequency of hemodialysis on nutritional status by analyzing the data in the Frequent Hemodialysis Network Trial. We compared changes in albumin, body weight, and composition among 245 patients randomized to six or three times per week in-center hemodialysis (Daily Trial) and 87 patients randomized to six times per week nocturnal or three times per week conventional hemodialysis, performed largely at home (Nocturnal Trial). In the Daily Trial, there were no significant differences between groups in changes in serum albumin or the equilibrated protein catabolic rate by 12 months. There was a significant relative decrease in predialysis body weight of 1.5 ± 0.2 kg in the six times per week group at 1 month, but this significantly rebounded by 1.3 ± 0.5 kg over the remaining 11 months. Extracellular water (ECW) decreased in the six times per week compared with the three per week hemodialysis group. There were no significant between-group differences in phase angle, intracellular water, or body cell mass (BCM). In the Nocturnal Trial, there were no significant between-group differences in any study parameter. Any gain in 'dry' body weight corresponded to increased adiposity rather than muscle mass but was not statistically significant. Thus, frequent in-center hemodialysis reduced ECW but did not increase serum albumin or BCM while frequent nocturnal hemodialysis yielded no net effect on parameters of nutritional status or body composition.

  19. The Effect of Frequent Hemodialysis on Nutrition and Body Composition: Frequent Hemodialysis Network Trial

    PubMed Central

    Kaysen, George A.; Greene, Tom; Larive, Brett; Mehta, Ravindra, L.; Lindsay, Robert; Depner, Tom A.; Hall, Yoshio N.; Daugirdas, John T.; Chertow, Glenn M.

    2012-01-01

    We investigated the effects of frequency of hemodialysis on nutritional status by analyzing the data in the Frequent Hemodialysis Network Trial. We compared changes in albumin, body weight and composition among 245 patients randomized to 6- or 3-times per week in-center hemodialysis (Daily Trial) and 87 patients randomized to 6-times per week nocturnal or 3-times per week conventional hemodialysis, performed largely at home (Nocturnal Trial). In the Daily Trial, there were no significant differences between groups in changes in serum albumin or the equilibrated protein catabolic rate by 12 months. There was a significant relative decrease in pre-dialysis body weight of 1.5 ± 0.2 kg in the 6 times per week group at one month, but this significantly rebounded by 1.3 ± 0.5 kg over the remaining 11 months. Extracellular water decreased in the 6 times per week compared to the 3 per week hemodialysis group. There were no significant between-group differences in phase angle, intracellular water or body cell mass. In the Nocturnal Trial, there were no significant between-group differences in any study parameter. Any gain in “dry” body weight corresponded to increased adiposity rather than muscle mass but was not statistically significant. Thus, frequent in-center hemodialysis reduced extracellular water but did not increase serum albumin or body cell mass while frequent nocturnal hemodialysis yielded no net effect on parameters of nutritional status or body composition. PMID:22456602

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

    PubMed

    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.

  1. 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

  2. Application of Parametric Models to a Survival Analysis of Hemodialysis Patients

    PubMed Central

    Montaseri, Maryam; Charati, Jamshid Yazdani; Espahbodi, Fateme

    2016-01-01

    Background Hemodialysis is the most common renal replacement therapy in patients with end stage renal disease (ESRD). Objectives The present study compared the performance of various parametric models in a survival analysis of hemodialysis patients. Methods This study consisted of 270 hemodialysis patients who were referred to Imam Khomeini and Fatima Zahra hospitals between November 2007 and November 2012. The Akaike information criterion (AIC) and residuals review were used to compare the performance of the parametric models. The computations were done using STATA Software, with significance accepted at a level of 0.05. Results The results of a multivariate analysis of the variables in the parametric models showed that the mean serum albumin and the clinic attended were the most important predictors in the survival of the hemodialysis patients (P < 0.05). Among the parametric models tested, the results indicated that the performance of the Weibull model was the highest. Conclusions Parametric models may provide complementary data for clinicians and researchers about how risks vary over time. The Weibull model seemed to show the best fit among the parametric models of the survival of hemodialysis patients. PMID:27896235

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

    PubMed

    Davaridolatabadi, Elham; Abdeyazdan, Gholamhossein

    2016-03-01

    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. 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. 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. 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.

  4. Improving adherence and biomedical markers in hemodialysis patients: the effects of relaxation therapy.

    PubMed

    Pasyar, Nilofar; Rambod, Masoume; Sharif, Farkhondeh; Rafii, Forough; Pourali-Mohammadi, Nasrin

    2015-02-01

    This study aimed to assess the effectiveness of Benson's relaxation technique in improving the hemodialysis patients' dietary and fluid adherence and biomedical markers. This randomized controlled trial with a pre-post test design was conducted on 86 hemodialysis patients randomly divided into an intervention (receiving Benson's relaxation technique) and a control group (usual care). The setting of the study was two hemodialysis units affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. The patients listened to the audiotape of Benson's relaxation technique twice a day each time for 20min for 8 weeks. Dietary and fluid adherence and some biomedical markers were measured in both the intervention and the control group at baseline and at the 8th week after the intervention. The results showed significant differences between the two groups regarding blood urea nitrogen and phosphate as dietary adherence and interdialytic weight gain as fluid adherence in the 8th week of the intervention (P<0.05). Also, a significant difference was found between the two groups concerning blood glucose level after the intervention (P<0.05). This study highlighted the importance of Benson's relaxation technique in improvement of adherence and some biomedical markers in hemodialysis patients. Thus, Benson's relaxation therapy could be used as a part of the nursing care practice for hemodialysis patients and those suffering from chronic diseases. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

    PubMed Central

    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

  6. 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.

  7. Development and testing of the Attitude Scale for the Dietary Therapy of Hemodialysis Patients.

    PubMed

    Onbe, Hiromi; Kanda, Kiyoko

    2017-05-04

    To develop an attitude scale regarding the dietary therapy of hemodialysis patients and to examine its reliability and validity. An initial item pool of 37 items was extracted from a conceptual model that had been developed in the authors' previous study and the literature was reviewed. An expert panel examined the content validity. A total of 381 Japanese hemodialysis patients then were recruited. Exploratory factor analyses and a confirmatory factor analysis were used to test the construct validity and an item analysis, internal consistency coefficients, and test-retest were used to verify the reliability. The expert panel judged the content validity index to be satisfactory. The data from the final 16 items consisted of three factors (propensity of behavior that is affected by cognition, propensity of behavior that is affected by the food culture, and negative affect that modifies the diet). Regarding the subscales, the Cronbach's coefficient alpha values were confirmed to be reliable, showing medium-to-high internal consistency. The test-retest method confirmed the stability of the scale. With the reliability and validity confirmed, it was established that the Attitude Scale for the Dietary Therapy of Hemodialysis Patients described herein is capable of determining the attitude of hemodialysis patients towards their dietary therapy. This scale makes it possible to quantitatively evaluate hemodialysis patients' attitudes toward dietary therapy. The accuracy of the scale needs to be improved by further examining its reliability and validity. © 2017 Japan Academy of Nursing Science.

  8. Clinicoepidemiological study of skin manifestations in patients of chronic renal failure on hemodialysis

    PubMed Central

    Deshmukh, Supriya P.; Sharma, Yugal K.; Dash, Kedarnath; Chaudhari, Nitin C.; Deo, Kirti S.

    2013-01-01

    Background: Chronic renal failure (CRF) is associated with a variety of cutaneous manifestations as a result of underlying etiology as well as the various treatment modalities. Aim: To evaluate the prevalence of various dermatoses in patients with CRF on hemodialysis and to study the effect of hemodialysis on the intensity of pruritus. Materials and Methods: A total of 35 patients of CRF on hemodialysis having at least one cutaneous manifestation were included in the study. Results: Twenty-four (68.71%) cases in our study belonged to the age group of 50-69 years, out of which 16 cases were in the sixth decade. Xerosis and pruritus occurred in 80% and 65.71% of cases, respectively. Other common findings included pallor (68.57%), dyspigmentation (34.29%), cutaneous infections (34.39%), acquired perforating dermatosis (17.4%), and nail changes (60%). Hemodialysis failed to improve pruritus in 17 (73.9%) of our patients. Twenty-six patients (74.28%) suffered from hypertension, 13 of them also were known cases of type II diabetes mellitus. Five patients suffered exclusively from type II diabetes mellitus. Conclusions: In our small study, xerosis was the commonest finding and pruritus, the commonest symptom. The intensity of pruritus was largely unaffected by hemodialysis. PMID:23439945

  9. Correlates of physical activity level among hemodialysis patients in Selangor, Malaysia.

    PubMed

    Wong, S W; Chan, Y M; Lim, T S

    2011-12-01

    There is mounting evidence demonstrating the importance of adequate physical activity to promote better well-being among hemodialysis patients. Available data pertaining to the levels of physical activity and its determinants among hemodialysis patients is, however, scarce in Malaysia. The objectives of this study are hence to determine the levels of physical activity and it associated factors among hemodialysis patients. A total of 70 subjects were recruited from three dialysis centres in Selangor. A face-to-face interview was conducted to obtain socio-demographic data and subjects' knowledge on dietary sources. Medical history, biochemical parameters and weight status were obtained from medical records. Physical activity level (PAL) was assessed using the Global Physical Activity Questionnaire (GPAQ). A total of 81.4% and 18.6% of the respondents had low and moderate PALs, respectively. Thus, none of the respondents had high PAL. Serum creatinine, education level, personal income and knowledge score on potassium-related medical complications were factors found to correlate significantly with PAL. Multiple linear regression analysis showed that higher PAL was predicted by a lower knowledge score on dietary sodium source, higher education and higher serum creatinine. Despite consistent documentation of the potential positive impact of physical exercise on hemodialysis outcomes, the level of physical activity remains low among these patients. It is hoped that these findings can add to the existing body of knowledge and serve as a supporting document for the formulation of appropriate interventions to improve the status of physical activity among hemodialysis patients in Malaysia.

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

    PubMed

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

    2015-01-01

    The prevalence of end-stage renal disease has increased dramatically in developing countries. Hepatitis B virus (HBV) infection is a global health problem that represents a significant co-morbidity event that has led to outbreaks of hepatitis B. There are inadequate data concerning occult HBV infection among Egyptian chronic hemodialysis patients. This study aimed to detect occult HBV infection among chronic hemodialysis patients in Alexandria, Egypt. A cross-sectional study was performed on 100 patients with end-stage renal disease that received maintenance hemodialysis and had tested negative for HBV surface antigen. Blood samples were collected before the initiation of hemodialysis. Sera were tested for hepatitis C virus (HCV) and hepatitis B core (HBc) antibodies using ELISA, and HBV DNA was detected by SYBR Green real-time PCR using specific primers for the s and c genes and by nested PCR using pol gene-specific primers. The serum activity of alanine and aspartate aminotransferase (ALT and AST) were also measured. Anti-HCV and anti-HBc antibodies were detected in 34% and 48% of patients, respectively, and 70.6% of anti-HCV positive patients were also positive for anti-HBc antibodies. This association was statistically significant (p=0.001). HBV DNA was detected in 32% of the hemodialysis patients. A significant association was determined between the presence of HBV DNA and anti-HCV positivity (p=0.021). Aminotransferases were elevated in 21% of the studied patients, more often in patients with positive anti-HCV profiles than in patients negative for anti-HCV (p<0.05). In conclusion, the serological markers of HBV infection should be verified with molecular tests to investigate possible occult infections, especially among anti-HBc-positive hemodialysis patients, to improve our understanding of their clinical, laboratory, and epidemiological characteristics.

  11. The effect of hemodialysis on the transport of sodium in erythrocytes from chronic renal failure patients maintained on hemodialysis.

    PubMed

    Gambhir, K K; Parui, R; Agarwal, V; Cruz, I

    2002-08-23

    Studies were undertaken to evaluate the modulatory effect of maintenance hemodialysis on ouabain sensitive (OS) and ouabain insensitive (OIS) 22Na(+) uptake in erythrocytes (E) of 8 chronic renal failure patients of both sexes. Following the receipt of informed consent, the blood samples were obtained just before and after Dialysis. The % 22Na(+) uptake of the total 22Na(+) present in the assay media was determined in the purified E just before and after Dialysis. The assay medium was composed of 100 mM NaCl, 5 mM KCl, 10 mM trisbase, 10 mM MOPS, 10 mM D-glucose and 60 mM sucrose, pH 7.4 with and without ouabain. Five different concentrations of E, ranging from 0.75 to 2.00 x 10(9)/mL were used for this study. We observed a linear relationship between the 22Na(+) uptake and E concentrations in both of the assay systems (OS and OIS). The mean total 22Na(+) uptake per 6.5 x 10(9) E/mL in OS and OIS before and after hemodialysis were 3.28 +/- 0.4 (OS) and 3.26 +/- 0.42 (OIS), and 3.42 +/- 0.54 (OS) and 3.42 +/- 0.68 (OIS) respectively. The relative % differences between pre- and post-Dialysis were 4 and 5%, which were statistically not significant. From this study, we conclude that hemodialysis does not affect E membrane properties influencing 22Na(+) transport.

  12. C-reactive protein and other markers of inflammation in hemodialysis patients

    PubMed Central

    Heidari, Behzad

    2013-01-01

    Hemodialysis patients are at greater risk of cardiovascular disease. Higher than expected cardiovascular morbidity and mortality in this population has been attributed to dislipidemia as well as inflammation. The causes of inflammation in hemodialysis patients are multifactorial. Several markers were used for the detection of inflammatory reaction in patients with chronic renal disease. These markers can be used for the prediction of future cardiovascular events. Among the several parameters of inflammatory markers, serum, CRP is well known and its advantages for the detection of inflammation and its predictor ability has been evaluated in several studies. This review addressed the associated factors and markers of inflammation in hemodialysis patients. In addition, their ability in predicting future atherosclerosis and effect of treatment has been reviewed. However, this context particularly in using CRP as a prediction marker of inflammation and morbidity requires further studies. PMID:24009946

  13. Impact of sleep quality on cardiovascular outcomes in hemodialysis patients: results from the frequent hemodialysis network study.

    PubMed

    Unruh, Mark; Kurella Tamura, Manjula; Larive, Brett; Rastogi, Anjay; James, Sam; Schiller, Brigitte; Gassman, Jennifer; Chan, Christopher; Lockridge, Robert; Kliger, Alan

    2011-01-01

    Poor sleep quality is a common, persistent, and important problem to patients with end-stage renal disease (ESRD). This report examines whether sleep quality is associated with dialysis treatment factors and other modifiable clinical factors in a large group of hemodialysis (HD) patients. Cross-sectional analyses were conducted on baseline data collected from participants in the Frequent Hemodialysis Network trials. Sleep quality was measured using the Medical Outcomes Study Sleep Problems Index II (SPI II), a 9-item measure of sleep quality with higher scores reflecting poorer sleep quality. The participants had an age of 51.2 ± 13.6 years, 61% were male, 38% were black, and 42% had diabetes. Higher pre-dialysis serum phosphorus (per 0.5 mg/ml) (OR 0.91; 95% CI 0.85, 0.96) and depression (OR 0.16; 95% CI 0.10, 0.25) were independently associated with decrements in sleep quality. There was also a difference in time to recovery from dialysis for the fourth versus the first SPI II quartile (5.1 h; p < 0.0001). These findings underscore the link between sleep and daytime function and suggest that improving sleep may provide an opportunity to improve outcomes in ESRD. Whether sleep problems may be improved by reduction of serum phosphorus or treatment of depression in the HD population merits further investigation. Copyright © 2011 S. Karger AG, Basel.

  14. Assessment of hemodialysis adequacy in patients with chronic kidney disease in the hemodialysis unit at Tanta University Hospital in Egypt

    PubMed Central

    El-Sheikh, M.; El-Ghazaly, G.

    2016-01-01

    Worldwide, hemodialysis (HD) constitutes the most common form of renal replacement therapy. Many studies have shown strong correlation between HD dose and clinical outcome. The cross-sectional study was conducted on 100 patients in Hemodialysis Unit at Tanta University Hospital, Egypt. Data were collected using a reliable questionnaire (including clinical, demographic, dialysis, laboratory, and radiological data). SpKt/V was used to assess the adequacy of HD. The results revealed inadequate HD dose among 60% of the study population. The results also showed that increasing time and frequency of dialysis, blood flow rates, low recirculation percentages, reduction of intradialytic complaints, and well-functioning vascular access are associated with better HD adequacy. Our findings showed a positive correlation between dialysis dose and hemoglobin, serum albumin, normalized protein catabolic rate, and physical health. A great percentage of patients had inadequate HD. HD adequacy was influenced by several factors such as duration and frequency of dialysis session, patients’ complaints, and well-functioning vascular access. PMID:27942169

  15. Clinical characteristics of patients with hemodialysis-associated pneumonia compared to patients with non-hemodialysis community-onset pneumonia.

    PubMed

    Lee, Jong Hoo; Moon, Jae Chol

    2016-02-01

    The 2005 ATS/IDSA guidelines included hemodialysis-associated pneumonia (HDAP) as a category of healthcare-associated pneumonia (HCAP). However, the clinical epidemiology of HDAP has been not well established. This study aimed to evaluate the clinical and microbiological characteristics of HDAP patients compared to community-acquired pneumonia (CAP) or other HCAP except HDAP (O-HCAP). We conducted a retrospective observational study on HDAP patients who were admitted between January 2012 and December 2014. We compared clinical features, distribution of microorganisms, antibiotic regimens, and clinical outcomes among the three groups. A total of 914 patients, comprised of 595 patients with CAP, 24 with HDAP, and 295 with O-HCAP, were evaluated. The median PSI score of the HDAP group was higher than that of the CAP group and similar to that of the O-HCAP group. The major pathogens of the HDAP group were Staphylococcus aureus and Klebsiella pneumoniae. The isolation rate of multidrug-resistant (MDR) pathogens and total in-hospital mortality of the HDAP group was similar to those of the CAP group (8.3% vs. 6.8%, p = 1.000 and 4.1% vs. 7.5%, p = 0.821, respectively). Otherwise, the isolation rate of MDR pathogens and total in-hospital mortality rate in the O-HCAP group were at 15.2% and 16.9%, respectively, and were the highest among the three groups. Based on microorganisms and clinical outcomes, the HDAP group was clinically more similar to the CAP group than the O-HCAP group. Therefore, the 2005 ATS/IDSA guidelines that include HDAP as a category of HCAP might be reassessed. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. 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…

  17. 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…

  18. 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. © 2015 International Society for Hemodialysis.

  19. Perceived social support and quality of life in Iranian hemodialysis patients.

    PubMed

    Rambod, Maasoumeh; Rafii, Forough

    2010-09-01

    To describe the relationship between perceived social support and the quality of life in hemodialysis patients from an Islamic cultural background in Iran. A cross-sectional, correlational design was used. Data were collected in hemodialysis units affiliated to Iran University of Medical Sciences. Two hundred and two Muslim hemodialysis patients were selected by census during 2007. The Persian versions of the Personal Resources Questionnaire 85 (PRQ-85) Part II and the Ferrans and Powers Quality of Life Index-dialysis version were used. The data were analyzed using chi-square test and Spearman's rho correlation coefficients. There were a statistically significant relationship between perceived social support and health-functioning (r = .65, p < or = .05), socioeconomic (r = .67, p < or = .05), psychological-spiritual (r = .63, p < or = .05), and family subscales of quality of life (r = .51, p < or = .05). Total quality of life was also significantly correlated with perceived social support (r = 0.72, p= .00). Perceived social support is associated with quality of life in Iranian hemodialysis patients. It is important to reflect on the impact of culture and religion of Iran on quality of life of hemodialysis patients and their perceived social support.

  20. Peritoneal dialysis versus hemodialysis in patients with delayed graft function.

    PubMed

    Thomson, B K A; Moser, M A J; Marek, C; Bloch, M; Weernink, C; Shoker, A; Luke, P P

    2013-01-01

    Delayed graft function (DGF) in kidney transplantation affects adverse outcomes. It remains unclear whether the post-transplant dialysis modality alters perioperative or long-term graft outcomes. We performed a retrospective observational quality initiative at two Canadian renal transplant centers, in which DGF occurred in the recipient, necessitating one of peritoneal dialysis (PD) or hemodialysis (HD). There was no difference in baseline factors between patients with post-transplant PD (n = 14) or HD (n = 63). The use of PD was associated with an increased risk of wound infection/leakage (PD 5/14 vs. HD 6/63, p = 0.024), shorter length of hospitalization (13.7 vs. 18.7 d, p = 0.009) and time requiring dialysis post-operatively (6.5 vs 11.0 d, p = 0.043). There were no differences in readmission to hospital within 6 months (4/14 vs. 23/63, p = 0.759), graft loss (0/14 vs. 2/63, p = 1.000) or acute rejection episodes (1/14 vs. 4/63, p = 1.000) at one yr, and GFR did not differ between the PD or HD groups at 30 d (35.7 vs. 33.8 mL/min/m(2), p = 0.731), six months (46.9 vs. 45.5 mL/min/m(2), p = 0.835) or one yr (46.6 vs. 44.5 mL/min/m(2), p = 0.746). Further research is needed to determine which transplant patients are most appropriate to undergo PD catheter removal at the time of transplantation. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  1. 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

  2. Factors associated with subendocardial ischemia risk in patients on hemodialysis.

    PubMed

    Silva, Bruno Caldin da; Sanjuan, Adriano; Costa-Hong, Valéria; Reis, Luciene Dos; Graciolli, Fabiana; Consolim-Colombo, Fernanda; Bortolotto, Luiz Aparecido; Moyses, Rosa Maria Affonso; Elias, Rosilene Motta

    2016-01-01

    Bone metabolism disorder (BMD) and vascular dysfunction contribute to excess cardiovascular mortality observed in hemodialysis patients. Vascular dysfunction, a new marker of atherosclerosis, can play a role in this risk. Even though associated with higher mortality in the general population, such vascular evaluation in patients on hemodialysis has not been extensively studied. In this cross-sectional study, hemodialysis patients were submitted to flow-mediated dilation, subendocardial viability ratio (SEVR) and ejection duration index assessment, in order to estimate the impact of BMD markers on vascular dysfunction. A matched cohort of patients with (n = 16) and without (n = 11) severe secondary hyperparathyroidism (SHPT) was studied. Additionally, time spent under severe SHPT was also evaluated. Patients with severe SHPT had lower SEVR and higher ejection duration index, indicating higher cardiovascular risk. Lower SEVR was also associated to diastolic blood pressure (r = 0.435, p = 0.049), serum 25-Vitamin-D levels (r = 0.479, p = 0.028) and to more time spent under severe secondary hyperparathyroidism (SHPT), defined as time from PTH > 500pg/ml until parathyroidectomy surgery or end of the study (r = -0.642, p = 0.027). In stepwise multiple regression analysis between SEVR and independent variables, lower SEVR was independently associated to lower serum 25-Vitamin-D levels (p = 0.005), female sex (p = 0.012) and more time spent under severe SHPT (p = 0.001) in a model adjusted for age, serum cholesterol, and blood pressure (adjusted r² = 0.545, p = 0.001). Subendocardial perfusion was lower in patients with BMD, reflecting higher cardiovascular risk in this population. Whether early parathyroidectomy in the course of kidney disease could modify such results still deserves further investigation. Distúrbios do metabolismo ósseo (DMO) e alterações da função vascular contribuem para a elevada mortalidade de pacientes em hemodiálise. A disfunção vascular

  3. 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. PMID:27275159

  4. The prevalence of intestinal parasites in hemodialysis patients in Bushehr, Iran.

    PubMed

    Barazesh, Afshin; Fouladvand, Moradali; Tahmasebi, Rahim; Heydari, Ali; Fallahi, Jamal

    2015-07-01

    Hemodialysis patients, due to a dysfunction of the immune response, are prone to a variety of opportunistic infections. Studies of intestinal parasitic infections in these patients are limited. Therefore, the present study was performed to determine the prevalence of these infections in patients on hemodialysis in Bushehr. In this cross-sectional study, fecal samples have been collected from all hemodialysis patients who were continuously referred from September 2011 to September 2012 to the dialysis center at Bushehr and tested using routine parasitological methods. From a total of 88 patients studied, 25 patients (28.4%) were infected with one or more intestinal parasites. Blastocystis hominis and Entamoeba coli with 13.6% and 6.7% prevalence had the highest prevalence among the patients, respectively. The age group 51-70 years had the highest rates of infection. Statistical analysis showed no relationship between sex and the risk of intestinal parasites. Seventeen percent of infected patients showed up with diarrhea and this relationship was statistically significant. Considering the high prevalence of intestinal parasitic infection among hemodialysis patients in Bushehr and also the high probability of infection in these patients, it is recommended that periodic examinations and screening patients during dialysis and before kidney transplantation should be a part of routine medical care.

  5. Gastrointestinal bleeding in patients with renal failure under hemodialysis treatment: a single-center experience.

    PubMed

    Can, Özgür; Koç, Gözde; Ocak, Sema Berk; Akbay, Nursel; Ahishali, Emel; Canbakan, Mustafa; Şahin, Gülizar Manga; Apaydin, Süheyla

    2017-05-01

    Gastrointestinal bleeding remains the leading cause of morbidity and mortality for patients who need hemodialysis treatment. Our aim was to evaluate patients who needed hemodialysis and presented with bleeding during their hospital stay (uremic bleeding patients). Factors that increased the risk of bleeding and death were evaluated. Additionally, uremic bleeding patients were compared to non-uremic bleeding patients regarding gastrointestinal findings. Fifty-one uremic bleeding patients were compared to two control groups which included uremic (hemodialysis dependent and non-bleeding) and non-uremic (no renal insufficiency and bleeding) patients. NSAIDs and anti-ulcer drug usage were more common in uremic bleeding and in uremic non-bleeding groups, respectively. Dialysis vintage was longer in uremic bleeding group. Comparison of uremic bleeding and non-bleeding uremic patients regarding the usage of ACEI or ARB drugs yielded non-significant results. Acute kidney injury, lower plasma albumin level and high CRP level were significantly increased the risk of mortality in uremic bleeding patients. Hospital stay more than 1 week was the only strong factor for mortality when multivariate analysis was performed. Gastroduodenal and duodenal ulcers were significantly detected in uremic bleeding and non-uremic bleeding patients; respectively. Hemodialysis patients presenting with gastrointestinal bleeding should be evaluated regarding use of prescriptions and efforts should be done in order to shorten their hospital stay and decrease their mortality. Effect of ACEI or ARB drugs should also be evaluated in future studies.

  6. Association of anxiety, sleepiness, and sexual dysfunction with restless legs syndrome in hemodialysis patients.

    PubMed

    Dikici, Suber; Bahadir, Anzel; Baltaci, Davut; Ankarali, Handan; Eroglu, Mustafa; Ercan, Nurten; Sav, Tansu

    2014-10-01

    Restless legs syndrome (RLS) is characterized by unpleasant sensations, pain in the legs along with irresistible urges to move the legs when at rest. It is often accompanied by sleep disturbance. The purpose of this study was to assess the association of anxiety and sleepiness with sexual function in hemodialysis patients with and without RLS. Sociodemographic parameters, laboratory data of hemodialysis patients from three dialysis centers were collected prospectively. Anxiety, sleepiness, sexual function, and presence of RLS symptoms were assessed with standardized questionnaires as the RLS Diagnosis and Scale, Hamilton Anxiety Rating Scale, Epworth Sleepiness Scale (ESS), Arizona Sex Experiences Scale (ASEX). Univariate, regression tree method were used for statistical analysis. RLS was observed in 45.9% (n = 113) of hemodialysis patients (n = 246). The mean age of patients and duration of hemodialysis were 59.7 ± 14.0 and 4.9 ± 4.2 years, respectively. The correlation between Arizona Sexual Experiences Scale (ASEX) and sociodemographic features was significant (P < 0.0001). Patients with RLS had higher scores for anxiety (9.4 ± 7.8 with RLS and 6.8 ± 6.0 without), higher ESS (ESS, 6.6 ± 5.2 with RLS and 4.6 ± 4.0 without), and higher ASEX (24.6 ± 5.7 with RLS and 22.5 ± 6.8 without) than did those without RLS. The presence of RLS symptoms in hemodialysis patients was associated with sleepiness, anxiety, and sexual dysfunction. A regression tree method, which is a different statistical method, can help physicians estimate patients ASEX, RLS, ESS, and anxiety scores. © 2014 International Society for Hemodialysis.

  7. 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

  8. Iliopsoas abscess as a complication of tunneled jugular vein catheterization in a hemodialysis patient.

    PubMed

    Hsiao, Po-Jen; Tsai, Ming-Hsien; Leu, Jyh-Gang; Fang, Yu-Wei

    2015-04-01

    Iliopsoas abscess is a rare complication in hemodialysis patients that is mainly due to adjacent catheterization, local acupuncture, discitis, and bacteremia. Herein, we report a 47-year-old woman undergoing regular hemodialysis via a catheter in the internal jugular vein who presented with low back pain and dyspnea. A heart murmur suggested the presence of catheter-related endocarditis, and this was confirmed by an echocardiogram and a blood culture of methicillin-resistant Staphylococcus aureus. A computed tomography indicated a pulmonary embolism and an incidental finding of iliopsoas abscess. Following surgical intervention and intravenous daptomycin, the patient experienced full recovery and a return to usual activities. This case indicates that an iliopsoas abscess can be related to a jugular vein catheter, which is apparently facilitated by infective endocarditis. The possibility of iliopsoas abscess should be considered when a hemodialysis patient presents with severe low back pain, even when there is no history of adjacent mechanical intervention.

  9. 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. © 2016 International Society for Hemodialysis.

  10. Diffuse uremic tumoral calcinosis in a patient on long-term hemodialysis.

    PubMed

    Akasbi, Nessrine; Houssaini, Tarik Sqalli; Rabhi, Samira; Lahlou, Mariam; Boukhrissa, Amal; Tahiri, Latifa; El Maaroufi, Chakib; Berrady, Rhizlane; Harzy, Taoufik; Bono, Wafaa

    2011-08-01

    Tumoral calcinosis is an uncommon and severe complication of hemodialysis therapy. The most important pathogenic factor involved in uremic tumoral calcinosis is an increase in calcium-phosphorus product, not necessarily related to hyperparathyroidism. We report here a patient on hemodialysis who presented with increasing multifocal and uncommon sites of massive calcifications. The patient was examined, and a diagnosis of uremic tumor calcinosis was made. The patient was treated with the noncalcemic phosphate binder sevelamer, a strict diet, multiple hemodialysis sessions per week, and a low calcium dialysate, with improvement on biological findings a decrease in the volume of some tumors on his fingers and a global stable disease. Some nodes in hands and feet disappeared; in other sites, their diameter was reduced, and the largest nodule decreased from 5- to 2-cm diameter.

  11. Chromatographic analysis of urine and dialysate from schizophrenic patients undergoing hemodialysis.

    PubMed

    Foss, I; Schulman, A; Trygstad, O; Wetterberg, L

    1983-08-01

    Maladjustments in the central nervous system may result in altered concentrations of neuropeptides in cerebrospinal fluid and urine. Urinary protein-peptide precipitates from psychiatric patients have previously been observed to have different chromatographic profiles with regard to the ultraviolet absorbancy at 280 nm. Hemodialysis has previously been reported to improve some schizophrenic patients and has been recommended in treatment trials. Seven chronic schizophrenic patients were selected for hemodialysis in a double-blind crossover study. Specimens of 24-h urine collections were obtained the day before, the day of, and the day after active and sham dialysis. The chromatographic profiles obtained on Sephadex G-25 gel columns did not change with active dialysis. Materials with ultraviolet absorbancy at 280 nm also precipitated from dialysates and showed the same pattern following active and inactive dialysis. Thus, no biochemical evidence for removal of any pathogenetic humoral substance during hemodialysis could be provided.

  12. Hemodialysis in a patient with severe hemophilia A and factor VIII inhibitor.

    PubMed

    Gopalakrishnan, Natarajan; Usha, Thiruvengadam; Thopalan, Balasubramaniyan; Dhanapriya, Jeyachandran; Dineshkumar, Thanigachalam; Thirumalvalavan, Kaliaperumal; Sakthirajan, Ramanathan

    2016-10-01

    Hemophilia A is a hereditary X-linked recessive disease caused by mutations in the gene encoding factor VIII (FVIII), occurring in 1 out of 10,000 persons. Life expectancy and quality of life have dramatically improved recently in patients with hemophilia. Chronic kidney disease and need for renal replacement therapy in these patients are rare. The development of inhibitors to FVIII is the most serious complication of hemophilia and makes treatment of bleeds very challenging. We describe here a 28-year-old male patient with severe hemophilia A with presence of factor VIII inhibitor, who had end stage renal disease. Central venous access device was inserted along with infusion of factor eight inhibitor bypass activity before and after the procedure. He is currently on thrice weekly hemodialysis and doing well for 6 months without bleeding episodes. To our knowledge, hemophilia A with factor VIII inhibitor managed with hemodialysis has not been reported so far. © 2016 International Society for Hemodialysis.

  13. Consumption of Argan Oil Improves Anti-Oxidant and Lipid Status in Hemodialysis Patients.

    PubMed

    Eljaoudi, Rachid; Elkabbaj, Driss; Bahadi, Abdelali; Ibrahimi, Azeddine; Benyahia, Mohammed; Errasfa, Mourad

    2015-10-01

    Virgin Argan oil (VAO) is of interest in oxidative stress and lipid profile because of its fat composition and antioxidant compounds. We investigated the effect of VAO consumption on lipid profile and antioxidant status in hemodialysis patients after a 4-week period of consumption. In a crossover, controlled trial, 37 patients (18 men, 19 women) with end-stage renal disease on maintenance hemodialysis, were randomly assigned to a 4-week VAO diet. Fasting plasma lipids, vitamin E and oxidized LDL (ox-LDL) were analyzed. Malondialdehyde (MDA) was determined before and after hemodialysis session. There was no significant change in serum total cholesterol and ox-LDL. However, VAO consumption decreased the levels of triglyceride (p = 0.03), total cholesterol (p = 0.02) and low-density lipoprotein (p = 0.03) and increased the levels of high-density lipoprotein (p = 0.01). Plasma vitamin E contents significantly increased from baseline only in VAO-group (p < 0.001). Hemodialysis session increased MDA levels, but the increase in VAO group was less than in control group. VAO consumption improved lipid profile and oxidative stress status in hemodialysis patients. Copyright © 2015 John Wiley & Sons, Ltd.

  14. Cold Dialysis Solution for Hemodialysis Patients With Fatigue: a Cross-over Study.

    PubMed

    Sajadi, Mahbobeh; Gholami, Zohreh; Hekmatpou, Davood; Soltani, Parvin; Haghverdi, Farshid

    2016-09-01

    The purpose of this study was to explore the effect of cold dialysis on fatigue in hemodialysis patients. In a double-blinded cross-over clinical trial, 46 participants were recruited from a hemodialysis unit in Iran. The participants were allocated into 2 groups through simple random sampling method. Each group received 3 sessions of hemodialysis with a dialysis solution temperature of either 37°C 3 or 35.5°C during the first week and then with for another week with the other temperature.  The self-report Piper Fatigue Scale questionnaire was filled out by the participants. The Piper Fatigue Scale scores in the cold dialysis groups were significantly lower than those in the conventional dialysis solution temperature (P < .001). Reducing the temperature of hemodialysis solution brought a 31.3% reduction in the fatigue score. Cold dialysis can be used for all hemodialysis patients as a routine intervention, and in particular, it is recommended dialysis patients who have severe fatigue as a convenient and inexpensive therapeutic option.

  15. 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

  16. Overhydration, Cardiac Function and Survival in Hemodialysis Patients.

    PubMed

    Onofriescu, Mihai; Siriopol, Dimitrie; Voroneanu, Luminita; Hogas, Simona; Nistor, Ionut; Apetrii, Mugurel; Florea, Laura; Veisa, Gabriel; Mititiuc, Irina; Kanbay, Mehmet; Sascau, Radu; Covic, Adrian

    2015-01-01

    Chronic subclinical volume overload occurs very frequently and may be ubiquitous in hemodialysis (HD) patients receiving the standard thrice-weekly treatment. It is directly associated with hypertension, increased arterial stiffness, left ventricular hipertrophy, heart failure, and eventually, higher mortality and morbidity. We aimed to assess for the first time if the relationship between bioimpedance assessed overhydration and survival is maintained when adjustments for echocardiographic parameters are considered. A prospective cohort trial was conducted to investigate the impact of overhydration on all cause mortality and cardiovascular events (CVE), by using a previously reported cut-off value for overhydration and also investigating a new cut-off value derived from our analysis of this specific cohort. The body composition of 221 HD patients from a single center was assessed at baseline using bioimpedance. In 157 patients supplemental echocardiography was performed (echocardiography subgroup). Comparative survival analysis was performed using two cut-off points for relative fluid overload (RFO): 15% and 17.4% (a value determined by statistical analysis to have the best predictive value for mortality in our cohort). In the entire study population, patients considered overhydrated (using both cut-offs) had a significant increased risk for all-cause mortality in both univariate (HR = 2.12, 95%CI = 1.30-3.47 for RFO>15% and HR = 2.86, 95%CI = 1.72-4.78 for RFO>17.4%, respectively) and multivariate (HR = 1.87, 95%CI = 1.12-3.13 for RFO>15% and HR = 2.72, 95%CI = 1.60-4.63 for RFO>17.4%, respectively) Cox survival analysis. In the echocardiography subgroup, only the 17.4% cut-off remained associated with the outcome after adjustment for different echocardiographic parameters in the multivariate survival analysis. The number of CVE was significantly higher in overhydrated patients in both univariate (HR = 2.46, 95%CI = 1.56-3.87 for RFO >15% and HR = 3.67, 95%CI = 2

  17. 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.

  18. Cytokine Signature in End-Stage Renal Disease Patients on Hemodialysis

    PubMed Central

    Pinheiro, Melina Barros; de Oliveira Junior, Wander Valadares; Carvalho, Andréa Teixeira; Martins-Filho, Olindo Assis; Dusse, Luci Maria Sant'Ana

    2017-01-01

    Hemodialysis is a modality of blood filtration in which accumulated toxins and water are removed from the body. This treatment is indicated for patients at the end stage of renal disease. Vascular access complications are responsible for 20–25% of all hospitalizations in dialyzed patients. The occurrence of thrombosis in the vascular access is a serious problem that may severely compromise or even make the hemodialysis impossible, which is vital for the patient. The aim of this study was to investigate inflammatory profile in patients undergoing hemodialysis as well as the association between these alterations and vascular access thrombosis. A total of 195 patients undergoing hemodialysis have been evaluated; of which, 149 patients had not experienced vascular access thrombosis (group I) and 46 patients had previously presented this complication (group II). Plasma levels of cytokines including interleukin (IL-) 2, IL-4, IL-5, IL-10, TNF-α, and IFN-γ were measured by cytometric bead array. Our results showed that patients with previous thrombotic events (group II) had higher levels of the IL-2, IL-4, IL-5, and IFN-γ when compared to those in group I. Furthermore, a different cytokine signature was detected in dialyzed patients according to previous occurrences or not of thrombotic events, suggesting that elevated levels of T-helper 1 and T-helper 2 cytokines might, at least in part, contribute to this complication. PMID:28819334

  19. Lactic acidosis induced by metformin in a chronic hemodialysis patient with diabetes mellitus type 2.

    PubMed

    Altun, Eda; Kaya, Bülent; Paydaş, Saime; Sarıakçalı, Barış; Karayaylalı, Ibrahim

    2014-04-01

    Metformin is a biguanide group oral antidiabetic drug used for the treatment of type 2 diabetes mellitus. Nausea, vomiting, diarrhea, abdominal pain, and anorexia are the most common adverse effects encountered during treatment. Lactic acidosis is a serious side effect seen with metformin use, and while the incidence of lactic acidosis is similar to other oral antidiabetics, metformin is not recommended to patients with certain risk factors, such as cardiovascular, pulmonary, and renal and liver failure. We describe a chronic hemodialysis patient treated with metformin, presenting to the nephrology department with altered mental status. © 2013 International Society for Hemodialysis.

  20. Incremental Hemodialysis, Residual Kidney Function, and Mortality Risk in Incident Dialysis Patients: A Cohort Study

    PubMed Central

    Obi, Yoshitsugu; Streja, Elani; Rhee, Connie M.; Ravel, Vanessa; Amin, Alpesh N.; Cupisti, Adamasco; Chen, Jing; Mathew, Anna T.; Kovesdy, Csaba P.; Mehrotra, Rajnish; Kalantar-Zadeh, Kamyar

    2016-01-01

    Background Maintenance hemodialysis is typically prescribed thrice-weekly irrespective of patient's residual kidney function (RKF). We hypothesized that a less frequent schedule at hemodialysis initiation is associated with greater preservation of RKF without compromising survival among patients with substantial RKF. Study Design A longitudinal cohort Setting & Participants 23,645 patients who initiated maintenance hemodialysis in a large dialysis organization in the United States (1/2007–12/2010), who had available RKF data during the first 91 days (or quarter) of dialysis, and who survived the first year. Predictor Incremental (routine twice-weekly for >6 continuous weeks during the first 91 days upon transition to dialysis) versus conventional (thrice-weekly) hemodialysis regimens during the same time. Outcomes Changes in renal urea clearance (KRU) and urine volume (UV) during one year after the first quarter, and survival after the first year. Results Among 23,645 included patients, 51% had substantial KRU (≥3.0 mL/min/1.73m2) at baseline. Compared to 8,068 patients with conventional hemodialysis regimen matched based on baseline KRU, UV, age, gender, diabetes, and central venous catheter use, 351 patients with incremental regimen exhibited 16% (95% CI, 5%-28%) and 15% (95% CI, 2%-30%) more preserved KRU and UV at second quarter, respectively, which remained across the following quarters. Incremental regimen showed higher mortality risk in patients with inadequate baseline KRU (≤3.0 mL/min/1.73m2; HR, 1.61; 95% CI, 1.07-2.44), but not in those with higher baseline KRU (HR, 0.99; 95% CI, 0.76-1.28). Results were similar in subgroup defined by baseline UV of 600 mL/day. Limitations Potential selection bias and wide CIs. Conclusions Among incident hemodialysis patients with substantial RKF, incremental hemodialysis may be a safe treatment regimen and associated with greater preservation of RKF while higher mortality is observed after a year in those with

  1. 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

  2. Incremental Hemodialysis, Residual Kidney Function, and Mortality Risk in Incident Dialysis Patients: A Cohort Study.

    PubMed

    Obi, Yoshitsugu; Streja, Elani; Rhee, Connie M; Ravel, Vanessa; Amin, Alpesh N; Cupisti, Adamasco; Chen, Jing; Mathew, Anna T; Kovesdy, Csaba P; Mehrotra, Rajnish; Kalantar-Zadeh, Kamyar

    2016-08-01

    Maintenance hemodialysis is typically prescribed thrice weekly irrespective of a patient's residual kidney function (RKF). We hypothesized that a less frequent schedule at hemodialysis therapy initiation is associated with greater preservation of RKF without compromising survival among patients with substantial RKF. A longitudinal cohort. 23,645 patients who initiated maintenance hemodialysis therapy in a large dialysis organization in the United States (January 2007 to December 2010), had available RKF data during the first 91 days (or quarter) of dialysis, and survived the first year. Incremental (routine twice weekly for >6 continuous weeks during the first 91 days upon transition to dialysis) versus conventional (thrice weekly) hemodialysis regimens during the same time. Changes in renal urea clearance and urine volume during 1 year after the first quarter and survival after the first year. Among 23,645 included patients, 51% had substantial renal urea clearance (≥3.0mL/min/1.73m(2)) at baseline. Compared with 8,068 patients with conventional hemodialysis regimens matched based on baseline renal urea clearance, urine volume, age, sex, diabetes, and central venous catheter use, 351 patients with incremental regimens exhibited 16% (95% CI, 5%-28%) and 15% (95% CI, 2%-30%) more preserved renal urea clearance and urine volume at the second quarter, respectively, which persisted across the following quarters. Incremental regimens showed higher mortality risk in patients with inadequate baseline renal urea clearance (≤3.0mL/min/1.73m(2); HR, 1.61; 95% CI, 1.07-2.44), but not in those with higher baseline renal urea clearance (HR, 0.99; 95% CI, 0.76-1.28). Results were similar in a subgroup defined by baseline urine volume of 600mL/d. Potential selection bias and wide CIs. Among incident hemodialysis patients with substantial RKF, incremental hemodialysis may be a safe treatment regimen and is associated with greater preservation of RKF, whereas higher mortality

  3. Pharmacokinetics and pharmacodynamics of pegloticase in patients with end-stage renal failure receiving hemodialysis.

    PubMed

    Bleyer, Anthony J; Wright, David; Alcorn, Harry

    2015-05-01

    Phase 3 trial data indicate that treatment of chronic tophaceous gout with pegloticase, a recombinant uricase conjugated to polyethylene glycol, does not reduce estimated glomerular filtration rate in chronic kidney disease (CKD) patients and that pegloticase therapeutics are independent of CKD stages 1 - 4. We determined the pharmacokinetics/pharmacodynamics of pegloticase after a single-dose in non-gout subjects with stage 5 CKD receiving hemodialysis. In this open-label phase 1 study, 12 subjects received a single intravenous dose of pegloticase 8 mg 3 hours prior to hemodialysis. Blood samples for determination of serum pegloticase concentrations and serum uric acid (SUA) levels were collected immediately predose and at regular intervals before, during, and after hemodialysis. Mean serum pegloticase concentrations remained stable and were unaffected by dialysis sessions. Mean SUA fell to undetectable levels within 3 hours and remained undetected for up to 72 hours postdose. Our findings indicate no significant effect of hemodialysis on either the stability of serum pegloticase concentrations after a single dose or the capacity of pegloticase to lower SUA. No new safety signals were detected. Administration of pegloticase in patients with comorbid chronic tophaceous gout and endstage renal failure requiring hemodialysis appears feasible.

  4. Extreme hyperglycemia with ketoacidosis and hyperkalemia in a patient on chronic hemodialysis.

    PubMed

    Gupta, Arvin; Rohrscheib, Mark; Tzamaloukas, Antonios H

    2008-10-01

    A patient on hemodialysis for end-stage renal disease secondary to diabetic nephropathy was admitted in a coma with Kussmaul breathing and hypertension (232/124 mmHg). She had extreme hyperglycemia (1884 mg/dL), acidosis (total CO(2) 4 mmol/L), hyperkalemia (7.2 mmol/L) with electrocardiographic abnormalities, and hypertonicity (330.7 mOsm/kg). Initial treatment with insulin drip resulted in a decrease in serum potassium to 5.3 mmol/L, but no significant change in mental status or other laboratory parameters. Hemodialysis of 1.75 hours resulted in rapid decline in serum glucose and tonicity and rapid improvement of the acidosis, but no change in mental status, which began to improve slowly after the hemodialysis was stopped, but with ongoing treatment with continuous insulin infusion. The rate of decline in tonicity during hemodialysis (14.5 mOsm/kg/h) was high, raising concerns about neurological complications. In this case, extreme hyperglycemia with ketoacidosis, hyperkalemia, and coma developing in a hemodialysis patient responded to insulin infusion. Monitoring of the clinical status and the pertinent laboratory values is required to assess the need for other therapeutic measures including volume and potassium replacement and emergency dialysis. The indications for and risks of emergency dialysis in this setting are not clearly defined.

  5. Factors related to the absence of anemia in hemodialysis patients.

    PubMed

    Verdalles, Ursula; Abad, Soraya; Vega, Almudena; Ruiz Caro, Caridad; Ampuero, Jara; Jofre, Rosa; Lopez-Gomez, Juan Manuel

    2011-01-01

    A small number of hemodialysis (HD) patients have normal hemoglobin (Hb) levels without the need for erythropoiesis-stimulating agents (ESAs). The factors associated with this condition have been little studied. The objective of this prospective study was to determine these factors in a prevalent population of HD patients. All patients who had normal Hb levels and who had not received ESAs in the last 6 months (non-ESA group) were included. Epidemiological and laboratory data were collected and we performed an abdominal ultrasound to assess hepatic and renal cysts. This group was compared to a control group of 205 prevalent HD patients on ESA therapy (control group). We included 45 patients (16% from the whole group) in the non-ESA group. In this group, there was a higher proportion of men (76.5 vs. 61%), patients were younger (61.1 ± 14.7 vs. 67.5 ± 15.2 years), had a longer duration of renal replacement therapy (RRT) (9.4 ± 8.3 vs. 5.3 ± 5.8 years) and had a higher prevalence of adult polycystic kidney disease (APKD) and hepatitis C virus (HCV) liver disease (42.2 vs. 10.2%), p < 0.01. In the non-ESA group, HCV+ patients had a lower prevalence of APKD (2.2 vs. 38.4%) and hepatic cysts (2.2 vs. 19.2%), but significantly higher endogenous erythropoietin levels (55.8 ± 37.1 vs. 30.9 ± 38.4 mU/ml). No significant differences in anemia, iron metabolism, insulin, IGF-1 and renin were found between non-ESA and control groups. Non-ESA patients had a significantly higher number of renal (90.6 vs. 36.5%) and hepatic cysts (12.5 vs. 3.4%), and these were also larger in size (3.3 ± 2.4 vs. 1.5 ± 0.8 cm). In the multivariate Cox analysis, independent predictor factors for absence of anemia in HD patients were number of renal cysts >10 cysts (95% CI 1.058-1.405; p = 0.00), HCV+ liver disease (95% CI 1.147-1.511; p = 0.05) and time on RRT (95% CI 1.002-1.121; p = 0.05). The absence of anemia in HD patients is not infrequent. Its frequency is higher in men and younger

  6. 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…

  7. 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…

  8. Renin-angiotensin system blockade and the risk of hyperkalemia in chronic hemodialysis patients.

    PubMed

    Knoll, Greg A; Sahgal, Arjun; Nair, Rama C; Graham, Janet; van Walraven, Carl; Burns, Kevin D

    2002-02-01

    Blockade of the renin-angiotensin system by angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers can cause hyperkalemia in patients with chronic renal insufficiency who are not on dialysis, but the risk of hyperkalemia in hemodialysis patients is unknown. We conducted a prospective study of 251 adult hemodialysis patients to determine if renin-angiotensin system blockade was associated with hyperkalemia, defined as a predialysis serum potassium concentration of 5.5 mmol/L or higher. Medication use was determined by chart review and patient interview. Predialysis serum potassium concentration was measured monthly. There were 367 episodes of hyperkalemia during 1877 person-months of follow-up. After adjustment for potential confounding variables and for clustering of episodes by patient, use of an ACE inhibitor or an angiotensin receptor blocker was associated with a significantly higher risk of hyperkalemia (odds ratio [OR] = 2.2; 95% confidence interval [CI]: 1.4 to 3.4). The increased risk of hyperkalemia with renin-angiotensin system blockade was seen in anuric dialysis patients (OR = 2.3; 95% CI: 1.3 to 4.2), as well as those with residual renal function (OR = 2.1; 95% CI: 1.0 to 4.1). The use of ACE inhibitors or angiotensin receptor blockers is independently associated with an increased risk of developing hyperkalemia in chronic hemodialysis patients. The serum potassium concentration should be closely monitored when these medications are prescribed for hemodialysis patients.

  9. The effect of vibration on the severity of restless legs syndrome in hemodialysis patients.

    PubMed

    Hosseini, Habibollah; Kazemi, Majid; Azimpour, Somayeh

    2017-01-01

    Introduction: The restless legs syndrome (RLS) is a neurological disorder in patients undergoing hemodialysis. This syndrome causes individual's disturbed rest, discomfort, and stress, and secondarily to weakened functioning and disturbance in occupational activities and familial life. Objectives: The present study aimed at investigate the effect of vibration on the severity of the manifestation of symptoms of RLS in hemodialysis patients. Patients and Methods: This is an interventional before-after study conducted on 80 patients with RLS in hemodialysis wards of Yazd hospitals. The samples were selected randomly and intervention was performed on the patients as vibration for 10 minutes three times per week during 4 succeeding weeks. The questionnaire of severity of RLS was completed before the study and at the last day of intervention before and after vibration. The data were analyzed with SPSS 23 using descriptive statistics and paired t test (P<0.05). Results: Our findings showed that most patients were at the moderate level of severity of symptoms before (68.8%) and after (78.8%) intervention and there was a significant difference in the mean score of RLS between before (18.99) and after (12.82) intervention (P=0.001). Conclusion: Based on the results of this study, it can be concluded that vibration decreases the severity of symptoms of RLS in hemodialysis patients. Hence, it is recommended that vibration be used as a cost-effective and safe procedure to improve the symptoms of RLS in this group of patients.

  10. Spontaneous rupture of a caseous calcification of the mitral annulus in a hemodialysis patient.

    PubMed

    Hamasaki, Azumi; Uchida, Tetsuro; Sadahiro, Mitsuaki

    2017-02-01

    We report a 56-year-old hemodialysis patient with a spontaneously ruptured caseous calcification of the mitral annulus resulting in multiple cerebral emboli. The mass was resected without replacing the mitral valve. The patient has remained symptom-free 3.5 years following surgery.

  11. 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…

  12. Anemia in patients on chronic hemodialysis in Cameroon: prevalence, characteristics and management in low resources setting.

    PubMed

    Kaze, Francois Folefack; Kengne, Andre-Pascal; Mambap, Alex Tatang; Halle, Marie-Patrice; Mbanya, Dora; Ashuntantang, Gloria

    2015-03-01

    Anemia is a common complication of chronic kidney disease. We investigated the prevalence, characteristics and management of anemia in patients on chronic hemodialysis and assessed the response to blood-transfusion based management in Cameroon. This was a cohort study of five months' duration (August-December 2008) conducted at the Yaoundé General Hospital's hemodialysis center, involving 95 patients (67 men, 70.5%) on chronic hemodialysis by a native arteriovenous fistula. A monthly evaluation included full blood counts, number of pints of red cell concentrates transfused, and vital status. At baseline, 75 (79%) patients had anemia which was microcytic and hypochromic in 32 (43%). Anemia was corrected in 67 (70.5%) patients using blood transfusion only, while 28 (29.5%) patients were receiving erythropoietin (11 regularly, 39%). Only 77.2% of 342 pints (median 3.0, range 0-17 per patients) of red cell concentrates prescribed were effectively received during the follow-up at an unacceptably high cost to patients and families. Mean hemoglobin and mean corpuscular hemoglobin levels remained stable during follow-up, while mean corpuscular volume increased. Erythropoietin treatment was the main determinant of favorable trajectories of hematological markers. Patients on chronic hemodialysis have predominantly microcytic hypochromic anemia, with limited capacity for correction using blood transfusion.

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

    PubMed

    Abe, Yoshifumi; Matsunaga, Atsuhiko; 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.

  14. Estimation of liver parameters and oxidative stress in chronic renal failure patients on hemodialysis in Erbil governorate

    NASA Astrophysics Data System (ADS)

    Kakey, Musher Ismail Salih; Abdoulrahman, Kamaran Kaiani

    2017-09-01

    The present study aims to evaluate iron related parameters in chronic renal failure (CRF) patients on hemodialysis (HD). The study was carried out in Kidney Dialysis Center of Hawler Teaching Hospital in Erbil governorate. This study comprised (76) patients with chronic renal failure on hemodialysis and 41 healthy subjects as a control group of same ages. All hemodialysis patients were taking erythropoietin. The blood samples were taken from the patients before and after the process of hemodialysis for liver parameters and oxidative stress estimations. The results of this study showed lower levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin, total bilirubin, total protein and total antioxidant capacity (TAC), while higher levels of alkaline phosphatase (ALP), direct bilirubin and malondialdeyhde (MDA) before analysis was seen. Hemodialysis causes increasing in AST, ALT, albumin, total bilirubin, total protein and decreasing in ALP, direct bilirubin MDA and TAC.

  15. 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. © 2014 Wiley Periodicals, Inc.

  16. Proton pump inhibitors use in hemodialysis patients and serum magnesium levels

    PubMed Central

    Erdem, Emre

    2015-01-01

    Hypomagnesemia is reported in patients who use proton pump inhibitors (PPIs). We investigated the effect of PPIs use on serum magnesium levels in hemodialysis patients. Our study was conducted in a hemodialysis center including 75 end stage renal disease patients. PPI use and duration were investigated. All patients were dialyzed using a dialysate magnesium level of 0.5-0.75 mmol/L. After at least one month of hemodialysis with the mentioned dialysate, laboratory tests were performed. Fifty-four patients (72%) used PPIs while 21 (28%) did not. The mean duration of PPI use was 42.5 ± 35 months. There was no significant difference between serum magnesium levels of patients who used and did not use PPIs (2.73 ± 0.3 vs. 2.88 ± 0.3 mg/dL, P = ns). There were 15 patients (20%) with a dialysate magnesium level of 0.5 mmol/l and 60 patients (80%) with a dialysate magnesium level of 0.75 mmol/L. The mean serum magnesium levels of patients with a dialysate magnesium level of 0.5 mmol/L was 2.45 ± 0.3 mg/dL while that of patients with a dialysate magnesium level of 0.75 mmol/L was 2.85 ± 0.3 mg/dL (P<0.0001). In hemodialysis patients, PPI use did not affect serum magnesium levels. The most important factor affecting the serum magnesium levels in hemodialysis patients is the dialysate magnesium concentration. PMID:26885127

  17. [Sofosbuvir and daclatasvir combination therapy in hemodialysis patient with liver transplantation].

    PubMed

    Hachicha, Mourad; Botta-Fridlund, Danielle

    2016-12-01

    We report a case of sustained remission of a liver transplant patient infected with hepatitis C virus (HCV) genotype 1 undergoing hemodialysis treatment. Oral treatment regimen of the HCV infection consists of a combination of sofosbuvir 400 mg after each hemodialysis session and daclatasvir 60 mg daily, for a period of 3 months. Laboratory testing indicate that the combination regimen was well-tolerated with no sign of drug-drug interaction. Confirmation of these clinical observations in large clinical studies may help improve morbidity and decrease mortality outcome in patients infected with HCV and undergoing hemodialysis treatment. Copyright © 2016 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

  18. Successful tunneled catheter placement in a hemodialysis patient with idiopathic multiple central venous stenoses.

    PubMed

    Zhao, Yuliang; Cui, Tianlei; Yu, Yang; Liu, Fang; Fu, Ping; Zhou, Li; Li, Xiao

    2014-01-01

    Central venous stenosis (CVS) in hemodialysis patients could be secondary to central venous catheterization, high flow arteriovenous fistula, as well as extrinsic compression. However, we report a senile hemodialysis patient of left internal jugular vein stenosis and right innominate vein occlusion unrelated to any known risk factors. Aided by computed tomography and digital subtraction angiography, we managed to dilate the stenosis by percutaneous balloon angioplasty, followed by successful tunneled catheter placement. Nephrologists should be aware of idiopathic CVS and its impact on the creation and preservation of vascular access. When confronted with difficulties in catheter placement, practitioners need to consider the possibilities of idiopathic CVS and refer to radiological tests. © 2013 International Society for Hemodialysis.

  19. Pre-existing arterial pathologic changes affecting arteriovenous fistula patency and cardiovascular mortality in hemodialysis patients.

    PubMed

    Lee, Ja Young; Kim, Young Ok

    2017-09-01

    The radiocephalic arteriovenous fistula (AVF) provides optimal vascular access for hemodialysis; it has a higher long-term patency rate and fewer complications than other vascular access methods. However, the AVF has a high primary failure rate. The presence of small-diameter vessels at anastomosis sites is an important risk factor for AVF failure. However, in a recent study, despite selecting an adequate artery and vein for creating an AVF by routine preoperative vascular mapping, AVF maturation and primary failure occurred. Thus, pre-existing arteriosclerosis at AVF anastomosis sites likely contributes to AVF failure. In this review, we discuss the relationship between pathologic changes and AVF patency in hemodialysis patients. Because arteriosclerosis of the major arteries such as the coronary and carotid arteries is associated with cardiovascular mortality, we also review the impact of arteriosclerosis of upper arm arteries at AVF anastomosis sites on cardiovascular mortality in hemodialysis patients.

  20. 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

  1. [Management of iodine-131 ablation therapy for thyroid carcinoma in a patient on chronic hemodialysis].

    PubMed

    Zenasni, Nadia; Elkhayat, Salma; Taleb, Sara; Zamd, Mohammed; Medkouri, Ghizlaine; Benghanem Gharbi, Mohammed; Ramdani, Benyounes; Aschawa, Hind; Guensi, Amal

    2015-04-01

    Iodine-131 ablation therapy for thyroid cancer in the patient on chronic hemodialysis represents a real problem since the main route of elimination of radioiodine is urinary. There is no recommendation on the management of this treatment in the patient on hemodialysis. We report our experience of management of this treatment in a patient aged 38 years, undergoing hemodialysis for chronic renal failure, and who have been indicated the treatment with iodine-131 for papillary thyroid carcinoma high risk. After multidisciplinary discussions (nephrologists and specialists in nuclear medicine and radiation safety), it has been decided to treat the patient with continuous ambulatory peritoneal dialysis therapy (CAPD). Because of the low but continuous elimination of iodine in the case of CAPD, the patient received a reduced ablative (131)I dose of 1850 MBq, which is 30% of the usual dose delivered in subjects with normal renal function. The patient was hospitalized for four days in nuclear medicine unit and the (131)I radioactivity emitted from him was 2.5 μSv/h at one meter at his hospital discharge. In conclusion, CAPD in relay of hemodialysis is a technique of renal replacement therapy that can be suggested to minimize exposure to radioactivity to the patient, his family and the medical staff. Copyright © 2015 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

  2. Cardiovascular and Stroke Risk in Japanese Hemodialysis Patients With Atrial Fibrillation.

    PubMed

    Hasegawa, Jumpei; Bieber, Brian; Larkina, Maria; Robinson, Bruce M; Wakai, Sachiko; Akizawa, Tadao; Saito, Akira; Fukuhara, Shunichi; Akiba, Takashi

    2016-12-01

    Atrial fibrillation is one of the most common arrhythmias in hemodialysis patients. We evaluated its clinical outcomes among hemodialysis patients with atrial fibrillation in Japan. Using data derived from the Japanese Dialysis Outcomes and Practice Patterns Study, we analyzed backgrounds and outcomes among hemodialysis patients with and without atrial fibrillation in Japan. Among 7002 hemodialysis patients, the prevalence of atrial fibrillation was 5.7% and the incidence was 0.2 per 100 patient-years. Atrial fibrillation was independently associated with all-cause mortality (hazard ratio, 1.32; 95% confidence interval, 1.02-1.71) and cardiovascular events (hazard ratio, 1.39; 95% confidence interval, 1.15-1.68), but not with stroke events (hazard ratio, 0.77; 95% confidence interval, 0.55-1.06) after adjustment for other variables. We conclude that patients with atrial fibrillation experienced higher mortality and more cardiovascular events than did patients without atrial fibrillation, although the risk of stroke was lower than expected.

  3. The effect of frequent hemodialysis on self-reported sleep quality: Frequent Hemodialysis Network Trials.

    PubMed

    Unruh, Mark L; Larive, Brett; Eggers, Paul W; Garg, Amit X; Gassman, Jennifer J; Finkelstein, Fredric O; Kimmel, Paul L; Chertow, Glenn M

    2016-06-01

    Many patients who receive maintenance hemodialysis experience poor sleep. Uncontrolled studies suggest frequent hemodialysis improves sleep quality, which is a strong motivation for some patients to undertake the treatment. We studied the effects of frequent in-center ('daily') and nocturnal home hemodialysis on self-reported sleep quality in two randomized trials. Participants were randomly assigned to frequent (six times per week) or conventional (three times per week) hemodialysis in the Frequent Hemodialysis Network Daily (n = 245) and Nocturnal (n = 87) Trials. We used the Medical Outcomes Study Sleep Problems Index II (SPI II), a validated and reliable instrument in patients with end-stage renal disease, to measure self-reported sleep quality. The SPI II is scored from 0-100, with a higher value indicating poorer quality of sleep. A mean relative decline in SPI II would suggest improved sleep quality. The primary sleep outcome was the change in the SPI II score over 12 months. In the Daily Trial, after adjustment for baseline SPI II, subjects randomized to frequent as compared with conventional in-center hemodialysis experienced a 4.2 [95% confidence interval (CI) 0.4-8.0] point adjusted mean relative decline in SPI II at 4 months and a 2.6 (95% CI -2.3-7.5) point adjusted mean relative decline at 12 months. In the Nocturnal Trial, subjects randomized to frequent nocturnal as compared with conventional home hemodialysis experienced 2.9 (95% CI -3.4-9.3) and 4.5 (95% CI -3.2-12.2) point mean relative declines at Months 4 and 12, respectively. Although a possible benefit of frequent in-center hemodialysis was observed at 4 months, neither frequent in-center hemodialysis nor home nocturnal hemodialysis demonstrated significant improvements in self-reported sleep quality compared with conventional hemodialysis at 12 months. Published by Oxford University Press on behalf of ERA-EDTA 2016. This work is written by (a) US Government employee(s) and is in the public

  4. Frailty and Cognitive Function in Incident Hemodialysis Patients

    PubMed Central

    Tan, Jingwen; Salter, Megan L.; Gross, Alden; Meoni, Lucy A.; Jaar, Bernard G.; Kao, Wen-Hong Linda; Parekh, Rulan S.; Segev, Dorry L.; Sozio, Stephen M.

    2015-01-01

    Background and objectives Patients of all ages undergoing hemodialysis (HD) have a high prevalence of cognitive impairment and worse cognitive function than healthy controls, and those with dementia are at high risk of death. Frailty has been associated with poor cognitive function in older adults without kidney disease. We hypothesized that frailty might also be associated with poor cognitive function in adults of all ages undergoing HD. Design, setting, participants, & measurements At HD initiation, 324 adults enrolled (November 2008 to July 2012) in a longitudinal cohort study (Predictors of Arrhythmic and Cardiovascular Risk in ESRD) were classified into three groups (frail, intermediately frail, and nonfrail) based on the Fried frailty phenotype. Global cognitive function (3MS) and speed/attention (Trail Making Tests A and B [TMTA and TMTB, respectively]) were assessed at cohort entry and 1-year follow-up. Associations between frailty and cognitive function (at cohort entry and 1-year follow-up) were evaluated in adjusted (for sex, age, race, body mass index, education, depression and comorbidity at baseline) linear (3MS, TMTA) and Tobit (TMTB) regression models. Results At cohort entry, the mean age was 54.8 years (SD 13.3), 56.5% were men, and 72.8% were black. The prevalence of frailty and intermediate frailty were 34.0% and 37.7%, respectively. The mean 3MS was 89.8 (SD 7.6), TMTA was 55.4 (SD 29), and TMTB was 161 (SD 83). Frailty was independently associated with lower cognitive function at cohort entry for all three measures (3MS: −2.4 points; 95% confidence interval [95% CI], −4.2 to −0.5; P=0.01; TMTA: 12.1 seconds; 95% CI, 4.7 to 19.4; P<0.001; and TMTB: 33.2 seconds; 95% CI, 9.9 to 56.4; P=0.01; all tests for trend, P<0.001) and with worse 3MS at 1-year follow-up (−2.8 points; 95% CI, −5.4 to −0.2; P=0.03). Conclusions In adult incident HD patients, frailty is associated with worse cognitive function, particularly global cognitive

  5. Evaluation of psychological distress using the K6 in patients on chronic hemodialysis.

    PubMed

    Katayama, Akihiko; Miyatake, Nobuyuki; Nishi, Hiroyuki; Hashimoto, Hiroo; Uzike, Kazuhiro; Sakano, Noriko; Tanaka, Keiko; Koumoto, Kiichi

    2015-03-01

    The aim of this study was to evaluate psychological distress in patients on chronic hemodialysis. A total of 72 patients on chronic hemodialysis were enrolled in this study. We evaluated psychological distress by using the K6 questionnaire, health-related quality of life (HRQOL) by using the EQ-5D questionnaire, and clinical parameters. Among the 72 patients, we also evaluated changes in K6 scores in 58 patients at 1-year follow-up. The mean K6 score was 3.7 ± 3.7 and 2 subjects (2.8%) were defined as having psychological distress. K6 scores were significantly correlated with body fat percentage, albumin level, and EQ-5D scores in total subjects. K6 scores were also significantly and negatively correlated with EQ-5D scores in men and women. In the 1-year follow-up group, changes in K6 scores were weakly and negatively correlated with changes in EQ-5D scores. Psychological distress was closely associated with HRQOL in patients on chronic hemodialysis. Coping strategies for psychological distress might be useful in improving HRQOL in patients on hemodialysis.

  6. Low Resistin Level is Associated with Poor Hospitalization-Free Survival in Hemodialysis Patients

    PubMed Central

    Chung, Wookyung; Jung, Eul Sik; Shin, Dongsu; Choi, Shung Han; Jung, Ji Yong; Chang, Jae Hyun; Lee, Hyun Hee; Kim, Dong Ki

    2012-01-01

    Malnutrition and inflammation are related to high rates of morbidity and mortality in hemodialysis patients. Resistin is associated with nutrition and inflammation. We attempted to determine whether resistin levels may predict clinical outcomes in hemodialysis patients. We conducted a prospective evaluation of 100 outpatients on hemodialysis in a single dialysis center (male, 46%; mean age, 53.7 ± 16.4 yr). We stratified the patients into 4 groups according to quartiles of serum resistin levels. During the 18-month observational period, patients with the lowest quartile of serum resistin levels had poor hospitalization-free survival (log rank test, P = 0.016). After adjustment of all co-variables, patients with the lowest quartile of serum resistin levels had poor hospitalization-free survival, compared with reference resistin levels. Higher levels of interleukin-6 were an independent predictor of poor hospitalization-free survival. In contrast, serum resistin levels were not correlated with interleukin-6 levels. The current data showed that low resistin levels may independently predict poor hospitalization free survival in hemodialysis patients. PMID:22468100

  7. 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.

  8. 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.

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

    PubMed

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

    2015-08-01

    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. 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. 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). 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. 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.

  10. 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.

  11. The Fate of Patients Who Started Hemodialysis during Childhood or Adolescence: Results of an Interregional Moroccan Survey

    PubMed Central

    Souilmi, F. Z.; Sqalli Houssaini, T.; EL Bardai, G.; Kabbali, N.; Arrayhani, M.; Hida, M.

    2014-01-01

    Hemodialysis is the most used renal replacement therapy for children in Morocco. The objective of this study was to determine the prevalence of patients who started hemodialysis in childhood and study their characteristics and specificities of their care. For this we conducted a multicentric descriptive cross-sectional study of all chronic hemodialysis patients who started dialysis in pediatric age, in hemodialysis centers in four of the sixteen regions of Morocco. We collected 2066 patients undergoing dialysis in 39 hemodialysis centers; from these, only 72 patients (3.48%) started hemodialysis in childhood. The average age of patients was 20.64 ± 6.5 years with a sex ratio of 1.9. Duration of dialysis was 78.2 ± 56 months. The cause of end stage renal disease was urological abnormalities in 18% of cases and glomerulopathy in 12.5% of cases; however, it remains unknown in half of the patients. Over 18 years, 74% of patients are without profession, it is active in 13% of cases, and pursuing studies are only in 13% of cases. Patients under 5 years and those with a low weight are rarely taken care of in chronic hemodialysis with little individualization of prescription. Greater attention should be paid to renal transplantation that is desired by the majority of these patients (92%). PMID:27355073

  12. Therapeutic plasma exchange performed in tandem with hemodialysis for patients with M-protein disorders.

    PubMed

    Mahmood, Aftab; Sodano, Donata; Dash, Anthony; Weinstein, Robert

    2006-07-01

    M-proteins are monoclonal immunoglobulins or immunoglobulin fragments that aberrantly accumulate in the plasma. Hemodialysis (HD) patients with M-proteins may, under certain circumstances, also need therapeutic plasma exchange (TPE). We employed a protocol for tandem TPE/HD in patients with M-protein disorders. We followed the urea reduction ratio (URR), a measure of the efficiency of HD, to compare the effect of TPE on HD efficiency during tandem procedures versus the efficiency of HD performed as a stand-alone procedure in the same patients. Three men (J.M., R.T., M.M.) underwent 23, 80, and 25 tandem TPE/HD over 3, 17, and 7 months, respectively, almost all in the outpatient setting. Mean whole blood flow rate (in ml/min) was slower during hemodialysis alone than during TPE/HD for J.M. (289 +/- 24 vs. 332 +/- 22, P < 0.0001) and R.T. (310 +/- 20 vs. 367 +/- 15, P < 0.0001) but not for M.M. (395 +/- 65 vs. 404 +/- 62, P = 0.6844). URR was equivalent during hemodialysis alone and during TPE/HD for J.M. (54 +/- 4.2 vs. 58 +/- 1.4, P = 0.3333), R.T. (69 +/- 4.9 vs. 70 +/- 2.5, P = 0.9804), and M.M. (71 +/- 2.4 vs. 67 +/- 1.5, P = 0.1143). J.M.'s renal function recovered sufficiently to permit discontinuation of hemodialysis. R.T. experienced both subjective and objective improvement of his arthritic symptoms. M.M. achieved hemostatic control but ultimately died of amyloidosis. TPE/HD is feasible using disparate pieces of equipment when the therapeutic plasma exchange circuit is connected in parallel with the low-pressure side of the hemodialysis circuit. Our experience illustrates that therapeutic plasma exchange did not adversely impact hemodialysis when the two procedures were performed in tandem.

  13. The association between serum adiponectin levels and nutritional status of hemodialysis patients.

    PubMed

    Lee, Yu-Ji; Cho, Seong; Kim, Sung Rok

    2011-01-01

    Adiponectin plays an important role in the regulation of body weight, insulin sensitivity, lipid metabolism, and the inflammatory response. Adiponectin is elevated in hemodialysis patients. We investigated the association between altered serum adiponectin levels and the nutritional-inflammation status of hemodialysis patients. Forty-four hemodialysis patients (21 men and 23 women; mean age 53.9 ± 9.2 years) were enrolled and 32 healthy volunteers were included as the control group. Serum adiponectin was measured using a commercial radioimmunoassay kit. Serum albumin, cholesterol, triglyceride, high-sensitivity C-reactive protein, urea, creatinine, transferrin, lean body mass, fat mass, body mass index (BMI), the subjective global assessment (SGA) score, and the malnutrition-inflammation score (MIS) were measured in all patients. Adiponectin levels were significantly elevated in the hemodialysis patients compared with the healthy subjects (24.8 ± 10.4 μg/mL and 6.8 ± 4.2 μg/mL, respectively, p < 0.0001). Serum adiponectin correlated positively with SGA (r = 0.47) and MIS (r = 0.38), and negatively with BMI (r = -0.34), triglyceride (r = -0.53), and glucose levels (r = -0.42). Serum adiponectin levels were significantly higher in malnourished patients than in well-nourished patients when assessed with SGA (20.5 ± 10.4 μg/mL and 29.0 ± 8.7 μg/mL, respectively, p = 0.005). In conclusion, serum adiponectin levels reflect the nutritional-inflammation status of hemodialysis patients. Adiponectin may also be associated with insulin resistance, dyslipidemia, and the inflammatory response in these patients.

  14. 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.

  15. 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

  16. The effects of lavender aromatherapy on pain following needle insertion into a fistula in hemodialysis patients.

    PubMed

    Bagheri-Nesami, Masoumeh; Espahbodi, Fatemeh; Nikkhah, Attieh; Shorofi, Seyed Afshin; Charati, Jamshid Yazdani

    2014-02-01

    This study sought to determine the effects of lavender aromatherapy on pain following needle insertion into a fistula in patients undergoing hemodialysis. This is a randomized controlled clinical trial in which 92 patients undergoing hemodialysis with arteriovenous fistulas were randomly divided into two groups. The experimental-group patients inhaled lavender essence with a concentration of 10% for 5 min during 3 hemodialysis sessions, while the control-group patients received aromatherapy free of lavender essence. The mean VAS pain intensity score in the experimental and control groups before the intervention was 3.78 ± 0.24 and 4.16 ± 0.32, respectively (p = 0.35). The mean VAS pain intensity score in the experimental and control groups after three aromatherapy sessions was 2.36 ± 0.25 and 3.43 ± 0.31, respectively (p = 0.009). Lavender aromatherapy may be an effective technique to reduce pain following needle insertion into a fistula in hemodialysis patients. Copyright © 2013 Elsevier Ltd. All rights reserved.

  17. Association of Beta-2 Microglobulin with Inflammation and Dislipidemia in High-Flux Membrane Hemodialysis Patients.

    PubMed

    Topçiu-Shufta, Valdete; Miftari, Ramë; Haxhibeqiri, Valdete; Haxhibeqiri, Shpend

    2016-10-01

    Higher than expected cardiovascular mortality in hemodialysis patients, has been attributed to dyslipidemia as well as inflammation. Beta2-Microglobulin (β2M) is an independent predictor of outcome for hemodialysis patients and a representative substance of middle molecules. In 40 patients in high-flux membrane hemodialysis, we found negative correlation of β2M with high density lipoprotein (r=-0.73, p<0.001) and albumin (r= -0.53, p<0.001) and positive correlation with triglycerides (r=0.69, p<0.001), parathyroid hormone (r=0.58, p < 0.05) and phosphorus (r= 0.53, p<0.001). There was no correlation of β2M with C- reactive protein (CRP) and interleukin-6 (IL-6). During the follow-up period of three years, 6 out of 40 patients have died from cardiovascular events. In high-flux membrane hemodialysis patients, we observed a significant relationship of β2M with dyslipidemia and mineral bone disorders, but there was no correlation with inflammation.

  18. Association of Beta-2 Microglobulin with Inflammation and Dislipidemia in High-Flux Membrane Hemodialysis Patients

    PubMed Central

    Topçiu–Shufta, Valdete; Miftari, Ramë; Haxhibeqiri, Valdete; Haxhibeqiri, Shpend

    2016-01-01

    Background: Higher than expected cardiovascular mortality in hemodialysis patients, has been attributed to dyslipidemia as well as inflammation. Beta2-Microglobulin (β2M) is an independent predictor of outcome for hemodialysis patients and a representative substance of middle molecules. Results: In 40 patients in high-flux membrane hemodialysis, we found negative correlation of β2M with high density lipoprotein (r=-0.73, p<0.001) and albumin (r= -0.53, p<0.001) and positive correlation with triglycerides (r=0.69, p<0.001), parathyroid hormone (r=0.58, p < 0.05) and phosphorus (r= 0.53, p<0.001). There was no correlation of β2M with C- reactive protein (CRP) and interleukin-6 (IL-6). During the follow-up period of three years, 6 out of 40 patients have died from cardiovascular events. Conclusion: In high-flux membrane hemodialysis patients, we observed a significant relationship of β2M with dyslipidemia and mineral bone disorders, but there was no correlation with inflammation. PMID:27994294

  19. Prevalence and demographic and clinical associations of health literacy in patients on maintenance hemodialysis.

    PubMed

    Green, Jamie A; Mor, Maria K; Shields, Anne Marie; Sevick, Mary Ann; Palevsky, Paul M; Fine, Michael J; Arnold, Robert M; Weisbord, Steven D

    2011-06-01

    Although limited health literacy is estimated to affect over 90 million Americans and is recognized as an important public health concern, there have been few studies examining this issue in patients with chronic kidney disease. We sought to characterize the prevalence of and associations of demographic and clinical characteristics with limited health literacy in patients receiving maintenance hemodialysis. As part of a prospective clinical trial of symptom management strategies in 288 patients treated with chronic hemodialysis, we assessed health literacy using the Rapid Estimate of Adult Literacy in Medicine (REALM). We defined limited health literacy as a REALM score ≤60 and evaluated independent associations of demographic and baseline clinical characteristics with limited health literacy using multivariable logistic regression. Of the 260 patients who completed the REALM, 41 demonstrated limited health literacy. African-American race, lower educational level, and veteran status were independently associated with limited health literacy. There was no association of limited health literacy with age, gender, serologic values, dialysis adequacy, overall symptom burden, quality of life, or depression. Limited health literacy is common among patients receiving chronic hemodialysis. African-American race and socioeconomic factors are strong independent predictors of limited health literacy. These findings can help inform the design and implementation of interventions to improve health literacy in the hemodialysis population.

  20. Efficacy of statin on vascular access patency in diabetic hemodialysis patients.

    PubMed

    Sanada, Satoru; Miyasaka, Yasunori; Kanno, Atsuhiro; Sato, Kozo; Sato, Mitsuhiro; Sugai, Hisako; Kitamura, Hiroshi; Sato, Toshinobu; Taguma, Yoshio

    2017-07-14

    An effective approach to prevent hemodialysis vascular access dysfunction is still unclear despite previous studies, which have shown conflicting results of several drugs on vascular access outcomes. In this study, we focused on diabetic hemodialysis patients with native arteriovenous fistula and evaluated the impact of statin treatment on vascular access patency. A retrospective cohort study of 268 consecutive patients who newly started hemodialysis due to diabetic nephropathy between January 2011 and December 2013 at Japan Community Health Care Organization Sendai Hospital was performed and the patients were followed for two years. The primary outcome was vascular access dysfunction. Effect of statin treatment was examined using Kaplan Meier analysis and Cox proportional hazard, after adjusting for covariates. The mean follow-up period was 426.7 days, and 117 (52.2%) patients developed vascular access dysfunction. The two-year patency rate was 55.0% among statin users and 36.1% in non-users. Vascular access survival period was significantly longer among statin users (log-rank test, p = 0.004). In multivariable analysis, statin treatment is significantly associated with better vascular access outcomes, in which the hazard ratio was 0.71 (95% CI, 0.52 to 0.97; p = 0.028) in the unadjusted model and 0.63 (95% CI, 0.45 to 0.88; p = 0.007) after adjustment for covariates. Statin treatment could be associated with improved vascular access dysfunction among diabetic hemodialysis patients.

  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. The diagnosis of sarcopenia is mainly driven by muscle mass in hemodialysis patients.

    PubMed

    Bataille, Stanislas; Serveaux, Marianne; Carreno, Elisa; Pedinielli, Nathalie; Darmon, Patrice; Robert, Alain

    2016-10-22

    Sarcopenia is a well-known complication of protein energy wasting in hemodialysis patients. Its diagnosis requires measurements of muscle mass and muscle function. Few studies have reported its prevalence in hemodialysis patients. In this study, we report the prevalence of sarcopenia in this population and evaluate the performance of other parameters for its diagnosis. In this observational cross-sectional study, data from hemodialysis patients from our nephrology department were recorded. Body composition measured by bioimpedancemetry analysis and muscle strength measured by handgrip were recorded. Normal values for sarcopenia were those recommended by the European Working Group on Sarcopenia in Older People (EWGSOP). The median age (interquartile range) of the 111 patients was 77.5 (70.8-84.8) years. A large majority of 88.3% (n = 98) of patients had a low muscle strength; a low muscle mass index was present in 33.3% (n = 37) of the population. Finally, 31.5% (n = 35) of patients had sarcopenia. These latter were older, had longer dialysis vintage, lower BMI, mid-arm circumference and mid-leg circumference, and a lower prealbumin. The best parameter predicting sarcopenia was BMI (ROC curve AUC of 0.79 [0.68-0.91] (p < 0.001) in men and 0.81 [0.68-0.93] (p = 0.003) in women). Mid-arm circumference predicted sarcopenia, but was less accurate than BMI. Mid-leg circumference predicted sarcopenia only in men. Predialysis creatinine or creatinine index could not predict sarcopenia. We report a 31.5% prevalence of sarcopenia in hemodialysis patients. The diagnosis of sarcopenia was mainly driven by muscle mass measurement because muscle strength is low in the large majority of hemodialysis patients. Copyright © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  3. The Survival Benefit of "Fistula First, Catheter Last" in Hemodialysis Is Primarily Due to Patient Factors.

    PubMed

    Brown, Robert S; Patibandla, Bhanu K; Goldfarb-Rumyantzev, Alexander S

    2017-02-01

    Patients needing hemodialysis are advised to have arteriovenous fistulas rather than catheters because of significantly lower mortality rates. However, disparities in fistula placement raise the possibility that patient factors have a role in this apparent mortality benefit. We derived a cohort of 115,425 patients on incident hemodialysis ≥67 years old from the US Renal Data System with linked Medicare claims to identify the first predialysis vascular access placed. We compared mortality outcomes in patients initiating hemodialysis with a fistula placed first, a catheter after a fistula placed first failed, or a catheter placed first (n=90,517; reference group). Of 21,436 patients with a fistula placed first, 9794 initiated hemodialysis with that fistula, and 8230 initiated dialysis with a catheter after failed fistula placement. The fistula group had the lowest mortality over 58 months (hazard ratio, 0.50; 95% confidence interval, 0.48 to 0.52; P<0.001), with mortality rates at 6, 12, and 24 months after initiation of 9%, 17%, and 31%, respectively, compared with 32%, 46%, and 62%, respectively, in the catheter group. However, the group initiating hemodialysis with a catheter after failed fistula placement also had significantly lower mortality rates than the catheter group had over 58 months (hazard ratio, 0.66; 95% confidence interval, 0.64 to 0.68; P<0.001), with mortality rates of 15%, 25%, and 42% at 6, 12, and 24 months, respectively. Thus, patient factors affecting fistula placement, even when patients are hemodialyzed with a catheter instead, may explain at least two thirds of the mortality benefit observed in patients with a fistula.

  4. Overhydration, Cardiac Function and Survival in Hemodialysis Patients

    PubMed Central

    Voroneanu, Luminita; Hogas, Simona; Nistor, Ionut; Apetrii, Mugurel; Florea, Laura; Veisa, Gabriel; Mititiuc, Irina; Kanbay, Mehmet; Sascau, Radu; Covic, Adrian

    2015-01-01

    Background and objectives Chronic subclinical volume overload occurs very frequently and may be ubiquitous in hemodialysis (HD) patients receiving the standard thrice-weekly treatment. It is directly associated with hypertension, increased arterial stiffness, left ventricular hipertrophy, heart failure, and eventually, higher mortality and morbidity. We aimed to assess for the first time if the relationship between bioimpedance assessed overhydration and survival is maintained when adjustments for echocardiographic parameters are considered. Design, setting, participants and measurements A prospective cohort trial was conducted to investigate the impact of overhydration on all cause mortality and cardiovascular events (CVE), by using a previously reported cut-off value for overhydration and also investigating a new cut-off value derived from our analysis of this specific cohort. The body composition of 221 HD patients from a single center was assessed at baseline using bioimpedance. In 157 patients supplemental echocardiography was performed (echocardiography subgroup). Comparative survival analysis was performed using two cut-off points for relative fluid overload (RFO): 15% and 17.4% (a value determined by statistical analysis to have the best predictive value for mortality in our cohort). Results In the entire study population, patients considered overhydrated (using both cut-offs) had a significant increased risk for all-cause mortality in both univariate (HR = 2.12, 95%CI = 1.30–3.47 for RFO>15% and HR = 2.86, 95%CI = 1.72–4.78 for RFO>17.4%, respectively) and multivariate (HR = 1.87, 95%CI = 1.12–3.13 for RFO>15% and HR = 2.72, 95%CI = 1.60–4.63 for RFO>17.4%, respectively) Cox survival analysis. In the echocardiography subgroup, only the 17.4% cut-off remained associated with the outcome after adjustment for different echocardiographic parameters in the multivariate survival analysis. The number of CVE was significantly higher in overhydrated

  5. 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

  6. Peginesatide for maintenance treatment of anemia in hemodialysis and nondialysis patients previously treated with darbepoetin alfa.

    PubMed

    Fishbane, Steven; Roger, Simon D; Martin, Edouard; Runyan, Grant; O'Neil, Janet; Qiu, Ping; Locatelli, Francesco

    2013-04-01

    Peginesatide (Omontys) is a novel, synthetic, PEGylated, peptide-based erythropoiesis-stimulating agent (ESA) that is designed to specifically stimulate the erythropoietin receptor. This study evaluated maintenance of hemoglobin levels in patients after conversion from darbepoetin alfa to once-monthly peginesatide. This open-label, multicenter study included 101 CKD patients, 52 of whom were receiving dialysis. The duration of the study was 24 weeks. The primary endpoint was the mean change in hemoglobin from baseline to the evaluation period (weeks 19-24). The study was conducted during the period from September 22, 2008 to December 24, 2009. The mean change among hemodialysis patients was -0.42 g/dl (95% confidence interval, -0.65 to -0.19) and the mean change among CKD nondialysis patients was 0.49 g/dl (95% confidence interval, 0.26-0.71). The percentages of patients who maintained hemoglobin levels within ±1.0 g/dl of baseline values were as follows: 80.0% for hemodialysis and 68.1% for nondialysis, and73.3% for hemodialysis and 68.1% for nondialysis within the target range of 10.0-12.0 g/dl. Few patients received red blood cell transfusions (hemodialysis, 5.8%; nondialysis, 2.0%). Seventy-nine patients experienced adverse events, the majority of which were mild or moderate in severity. There were 40 serious adverse events and 2 deaths reported. In this study, once-monthly peginesatide resulted in a slight decrease in mean hemoglobin levels in individuals on hemodialysis and a small increase in individuals with CKD who were not on dialysis.

  7. Peginesatide for Maintenance Treatment of Anemia in Hemodialysis and Nondialysis Patients Previously Treated with Darbepoetin Alfa

    PubMed Central

    Roger, Simon D.; Martin, Edouard; Runyan, Grant; O’Neil, Janet; Qiu, Ping; Locatelli, Francesco

    2013-01-01

    Summary Background and objectives Peginesatide (Omontys) is a novel, synthetic, PEGylated, peptide-based erythropoiesis-stimulating agent (ESA) that is designed to specifically stimulate the erythropoietin receptor. This study evaluated maintenance of hemoglobin levels in patients after conversion from darbepoetin alfa to once-monthly peginesatide. Design, setting, participants, & measurements This open-label, multicenter study included 101 CKD patients, 52 of whom were receiving dialysis. The duration of the study was 24 weeks. The primary endpoint was the mean change in hemoglobin from baseline to the evaluation period (weeks 19–24). The study was conducted during the period from September 22, 2008 to December 24, 2009. Results The mean change among hemodialysis patients was –0.42 g/dl (95% confidence interval, –0.65 to –0.19) and the mean change among CKD nondialysis patients was 0.49 g/dl (95% confidence interval, 0.26–0.71). The percentages of patients who maintained hemoglobin levels within ±1.0 g/dl of baseline values were as follows: 80.0% for hemodialysis and 68.1% for nondialysis, and73.3% for hemodialysis and 68.1% for nondialysis within the target range of 10.0–12.0 g/dl. Few patients received red blood cell transfusions (hemodialysis, 5.8%; nondialysis, 2.0%). Seventy-nine patients experienced adverse events, the majority of which were mild or moderate in severity. There were 40 serious adverse events and 2 deaths reported. Conclusions In this study, once-monthly peginesatide resulted in a slight decrease in mean hemoglobin levels in individuals on hemodialysis and a small increase in individuals with CKD who were not on dialysis. PMID:23243269

  8. Effect of cryotherapy on arteriovenous fistula puncture-related pain in hemodialysis patients

    PubMed Central

    P. B., Sabitha; Khakha, D. C.; Mahajan, S.; Gupta, S.; Agarwal, M.; Yadav, S. L.

    2008-01-01

    Pain during areteriovenous fistula (AVF) cannulation remains a common problem in hemodialysis (HD) patients. This study was undertaken to assess the effect of cryotherapy on pain due to arteriovenous fistula puncture in hemodialysis patients. A convenience sample of 60 patients (30 each in experimental and control groups) who were undergoing hemodialysis by using AVF, was assessed in a randomized control trial. Hemodialysis patients who met the inclusion criteria, were randomly assigned to experimental and control groups using a randomization table. Objective and subjective pain scoring was done on two consecutive days of HD treatment (with cryotherapy for the experimental and without cryotherapy for the control group). The tools used were a questionnaire examining demographic and clinical characteristics, an observation checklist for assessing objective pain behavior, and a numerical rating scale for subjective pain assessment. Descriptive statistics were used as deemed appropriate. Chi square, two-sample and paired t-tests, the Mann Whitney test, Wilcoxon's signed rank test, the Kruskal Wallis test, and Spearman's and Pearson's correlations were used for inferential statistics. We found that the objective and subjective pain scores were found to be significantly (P = 0.001) reduced within the experimental group with the application of cryotherapy. This study highlights the need for adopting alternative therapies such as cryotherapy for effective pain management in hospital settings. PMID:20142927

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

    USDA-ARS?s Scientific Manuscript database

    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...

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

    PubMed Central

    Damholt, Mette B.; Strange, Ditte G.; Kelsen, Jesper; Møller-Sørensen, Hasse; Møller, Kirsten

    2017-01-01

    Dialysis disequilibrium syndrome (DDS) is a serious neurological complication of hemodialysis, and patients with acute brain injury are at increased risk. We report a case of DDS leading to intracranial hypertension in a patient with anoxic brain injury and discuss the subsequent dialysis strategy. A 13-year-old girl was admitted after prolonged resuscitation from cardiac arrest. Computed tomography (CT) revealed an inferior vena cava aneurysm and multiple pulmonary emboli as the likely cause. An intracranial pressure (ICP) monitor was inserted, and, on day 3, continuous renal replacement therapy (CRRT) was initiated due to acute kidney injury, during which the patient developed severe intracranial hypertension. CT of the brain showed diffuse cerebral edema. CRRT was discontinued, sedation was increased, and hypertonic saline was administered, upon which ICP normalized. Due to persistent hyperkalemia and overhydration, ultrafiltration and intermittent hemodialysis were performed separately on day 4 with a small dialyzer, low blood and dialysate flow, and high dialysate sodium content. During subsequent treatments, isolated ultrafiltration was well tolerated, whereas hemodialysis was associated with increased ICP necessitating frequent pauses or early cessation of dialysis. In patients at risk of DDS, hemodialysis should be performed with utmost care and continuous monitoring of ICP should be considered. PMID:28409034

  12. Protein-energy nutritional status and kidney disease-specific quality of life in hemodialysis patients.

    PubMed

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

    2011-09-01

    Health-related quality of life (HRQOL) is an important outcome in dialysis care. Previous research has related protein-energy nutritional status to generic HRQOL domains, but it is still not clear as to how it relates to HRQOL domains that are unique to hemodialysis patients. Therefore, our aim was to study the relation between protein-energy nutritional status and kidney disease-specific HRQOL domains in hemodialysis patients. This was a cross-sectional study. This study was performed at multiple centers. We evaluated the first 590 hemodialysis patients who had enrolled in the Convective Transport Study. We measured protein-energy nutritional status by using the Subjective Global Assessment, albumin, normalized nitrogen appearance, creatinine, body mass index, and cholesterol. HRQOL was assessed by using the Kidney Disease Quality Of Life-Short Form. In all, 83% of the cohort was found to be well-nourished on the basis of the Subjective Global Assessment. Multiple nutritional parameters were positively related to the physical summary of generic HRQOL and to the following kidney disease-specific HRQOL scales: the effects of the kidney disease on daily life, the burden of the kidney disease, and overall health. This study showed that, even in predominantly well-nourished hemodialysis patients, protein-energy nutritional status was significantly related to kidney disease-specific HRQOL. Copyright © 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  13. Effect of iron as a new type of phosphate binder in hemodialysis patients.

    PubMed

    Kuroda, S; Komori, M; Nagamatsu, K; Ninomiya, R; Maejima, K; Hasegawa, K; Samejima, M; Kuroda, M; Fujimori, H; Kasai, M

    1995-08-01

    Hyperphosphatemia is one of the major problems requiring management in the majority of hemodialysis patients and they require phosphate-binding agents to control the hyperphosphatemia. Aluminum hydroxide and calcium compounds are used currently as phosphate-binding agents to treat hyperphosphatemia, but these compounds can cause undesirable side effects. Therefore, the development of new phosphate-binding agents is imperative. It is well known that oral and intravenous administration of iron causes hypophosphatemia. We hypothesized that this side effect of iron may be beneficial for the treatment of hyperphosphatemia in hemodialysis patients. Consequently, we conducted a fundamental and clinical investigation of the effects of iron administration. Membrane permeability of phosphorus in a mixture of sodium ferrous citrate and dessicated aluminium hydroxide in the presence of hydrog