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Haemodialysis

Distribution by Scientific Domains

Medical Sciences	98%

Distribution within Medical Sciences

Nephrology	34%
Nursing General	14%
General & Internal Medicine	13%
Surgery & Surgical Specialties	4%
Dermatology	3%
Pharmacology & Pharmaceutical Medicine	2%
12 Other Subdomains	30%

Kinds of Haemodialysis

chronic haemodialysis

maintenance haemodialysis

undergoing haemodialysis

Terms modified by Haemodialysis

haemodialysis patient

haemodialysis treatment

Selected Abstracts

QUALITY OF LIFE OF GREEK PATIENTS WITH END STAGE RENAL DISEASE UNDERGOING HAEMODIALYSIS

JOURNAL OF RENAL CARE, Issue 3 2010
Maria Kastrouni RN
SUMMARY An evaluation of the quality of life of patients with end stage kidney disease undergoing haemodialysis in the Greek population was conducted to understand whether this quality could be improved. Comparisons were made with a similar study conducted in United States in regards to the effects of kidney disease in daily life, burden of kidney disease, work status, cognitive function, quality of social interaction, sexual function, social support, physical functioning, role physical on daily routine, pain, general health perceptions, role emotional, emotional well being, social function and energy/fatigue. Any differences are discussed and analysed. Sexual problems were found to be more prominent in this study, but the emotional status has greater influence in quality of life in the US study. The results were more positive in Greece with respect to dialysis staff encouragement, patient satisfaction, as well as acceptance and the understanding of illness. The results from our study reflect the differences of the health care systems in various countries as well as population-related beliefs and values. [source]

PSEUDOTUMOUR CEREBRI AS A COMPLICATION OF PARATHYROIDECTOMY IN A PATIENT UNDERGOING HAEMODIALYSIS

NEPHROLOGY, Issue 1 2008
IRENA MAKULSKA
[source]

PHARMACOKINETICS OF FRAGMIN, CLEXANE AND ORGARAN IN STABLE CHRONIC HAEMODIALYSIS (HD) PATIENTS

NEPHROLOGY, Issue 1 2002
Kevan R Polkinghorne
[source]

Haemodialysis induces mitochondrial dysfunction and apoptosis

EUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 12 2007
D. S. C. Raj
Abstract Background Mitochondria play a crucial role in the regulation of the endogenous pathways of apoptosis activated by oxidant stress. Nuclear factor-,B (NF-,B) is a central integration site for pro-inflammatory signals and oxidative stress. Materials and methods Peripheral blood mononuclear cells (PBMC) were isolated from eight end-stage renal disease (ESRD) patients before haemodialysis (Pre-HD) and during the last 10 min of HD (End-HD). A new polysulfone membrane (F70, Fresenius) was used for dialysis. Intracellular generation of reactive oxygen species (ROS), mitochondrial redox potential (,,m) and PBMC apoptosis were determined by flow-cytometry. Results Plasma levels of interleukin-6 (IL-6) (24·9 ± 7·0 vs. 17·4 ± 5·5 pg dL,1, P < 0·05), IL-6 soluble receptor (52·2 ± 4·9 vs. 37·6 ± 3·2 ng dL,1, P < 0·02) and IL-6 gp130 (405·7 ± 41·0 vs. 235·1 ± 38·4 ng dL,1, P < 0·02) were higher end-HD compared to pre-HD. IL-6 secretion by the isolated PBMC (24·0 ± 2·3 vs. 19·3 ± 3·5 pg dL,1, P < 0·02) increased end-HD. Percentage of lymphocytes exhibiting collapse of mitochondrial membrane potential (43·4 ± 4·6% vs. 32·6 ± 2·9%, P < 0·01), apoptosis (33·4 ± 7·1% vs. 23·7 ± 7·7%, P < 0·01), and generation of superoxide (20·7 ± 5·2% vs. 12·5 ± 2·9%, P < 0·02) and hydrogen peroxide (51·1 ± 7·8% vs.38·2 ± 5·9%, P < 0·04) were higher at end-HD than pre-HD. NF-,B activation (3144·1 ± 208·1 vs. 2033·4 ± 454·6 pg well,1, P < 0·02), expression of B-cell lymphoma protein-2 (6494·6 ± 1461 vs. 3501·5 ± 796·5 ng mL,1, P < 0·03) and heat shock protein-70 (9·81 ± 1·47 vs. 6·38 ± 1·0 ng mL,1, P < 0·05) increased during HD. Conclusions Intra-dialytic activation of cytokines, together with impaired mitochondrial function, promotes generation of ROS culminating in augmented PBMC apoptosis. There is concomitant activation of pathways aimed at attenuation of cell stress and apoptosis during HD. [source]

Nocturnal Haemodialysis , A Preliminary Cost Comparison with Conventional Haemodialysis in Australia

HEMODIALYSIS INTERNATIONAL, Issue 1 2003
JWM Agar
A 6 night/wk, home-based, government funded nocturnal haemodialysis (NHDx) program, believed to be the first outside North America, commenced in July 2001. Previously published Canadian and US costs suggest NHDx to be more cost-efficient than conventional haemodialysis (CHDx) as, although consumable-expensive, NHDx is home-based and is thus highly infrastructure, wage and hospital inpatient bed-day efficient. Comparable Australian cost evaluation is essential, however, before NHDx is widely encouraged as a new modality here. Cost comparisons for 3 × wk CHDx vs preliminary costs for 9/12 pts on 6 × wk NHDx (3 excluded for inadequate program time) include: consumables/fluids CHDx @$A8781/pt/yr vs NHDx @$A17562/pt/yr; estimated nursing costs CHDx (62.25 nurse hrs/wk with a nurse/pt ratio of 3:9)@$A12666/pt/yr vs NHDx (40 nurse hrs/wk with a nurse/pt ratio of 1:9)@$A8111/pt/yr with projected reduction to A$4866 for nurse/pt ratio of 1:15; pharmaceutical costs (includes all medication & Fleet® for dialysate but excludes EPO/iron polymaltose) CHDx one month prior to NHDx @$A1412/pt/yr vs NHDx costs after one month starting home-based treatment @$A1273/pt/yr. Though the NHDx pts have been carefully selected, only 3 hospitalizations for a total of 4 bed-days have been necessary in 348.5 pt wks of experience to September 2002. Our preliminary cost analyses confirm prior North American data. Cumulative financial modeling shows NHDx is more costly than CHDx at low pt numbers, reaching approximate equivalence @ 12 pts and progressively dropping below CHDx costs thereafter. NHDx appears cost-competitive with CHDx whilst yielding superior biochemical, life-style and rehabilitation results (see accompanying clinical data abstract). [source]

Seroprevalence of hepatitis C in patients with type 2 diabetes mellitus and non-diabetic on haemodialysis

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 6 2006
S. Ocak
Summary Type 2 diabetes mellitus (DM) has emerged as the commonest cause of end-stage renal disease. Haemodialysis (HD) treatment constitutes a high-risk environment for the transmission of hepatitis C virus (HCV). The aim of this study was to establish a potential relationship between type 2 DM and HCV infection in HD patients. Of the 267 HD patients, 67 (25.1%) had type 2 DM and 200 (74.9%) were with diverse aetiology for end-stage renal disease. The serum markers of HCV infection were tested by a second-generation enzyme-linked immunosorbent assay test for antibodies and by qualitative reverse-transcription polymerase chain reaction technique for viral RNA. The overall prevalence of anti-HCV antibodies and HCV RNA was found to be 12.7% (34/267) and 10.1% (27/267), respectively. Patients with type 2 DM were found to have a higher HCV prevalence compared with non-diabetic patients [20.8% (14/67) vs. 10% (20/200)] (p < 0.05). The mean period on dialysis of anti-HCV-positive patients with type 2 DM was shorter than that observed for anti-HCV-positive non-diabetic patients (43.9 ± 9.8 months vs. 59.7 ± 28.4 months) (p < 0.05). This study has shown that although the period on dialysis of diabetic patients are shorter than non-diabetic patients, the prevalence of HCV in HD patients with type 2 DM is higher than that detected in non-diabetic HD patients. [source]

Molecular analysis and patterns of ALT and hepatitis C virus seroconversion in haemodialysis patients with acute hepatitis

NEPHROLOGY, Issue 3 2008
ELISABETH LAMPE
SUMMARY: Background: Haemodialysis (HD) continues to carry the risk of hepatitis C virus (HCV) transmission, with delayed seroconversion and often normal alanine aminotransferase (ALT) values increasing the likelihood of undetected infection and thus uninterrupted spread of HCV. The aim of this study was to identify the characteristic patterns of ALT changes and seroconversion during an outbreak of HCV in a HD unit. We also wanted to establish the relationship between infecting viruses using molecular analysis. Methods: All patients (n = 72) and staff (n = 23) of the HD unit were prospectively followed for 14 months. Serial measurements for ALT, HCV antibody and HCV-RNA were performed besides HCV sequence analysis. Results: The initial screening for anti-HCV and HCV-RNA confirmed chronic infection in 16/72 (22%) subjects and identified three subjects with recent seroconversion. In addition, five cases were reverse transcription-polymerase chain reaction positive alone for a total of eight recent cases. The interval between the initial observation of ALT changes and seroconversion varied from 1 to 8 months, and in several individuals ALT fluctuations only below the upper limit of normal were detected. However, relating each subject's ALT values to ALT at baseline, ALT levels increased between 1.6- and 4.7-fold. Molecular analysis provided evidence for transmission from two chronically infected source patients, probably because of inappropriate infection control measures. Conclusion: Our data highlight the importance of well-implemented safety precautions and regular HCV-RNA testing to prevent the further spread of HCV in this population, and suggest the use of ALT baseline values to identify infections that may remain unnoticed otherwise. [source]

Low health-related quality of life is associated with all-cause mortality in patients with diabetes on haemodialysis: the Japan Dialysis Outcomes and Practice Pattern Study

DIABETIC MEDICINE, Issue 9 2009
Y. Hayashino
Abstract Aims, Whether health-related quality of life (HRQoL) can be accurately predicted in patients with extremely low HRQoL as a result of diabetic complications is unclear. We investigated the impact of HRQoL on mortality risk in patients with diabetes on haemodialysis. Methods, Data from the Dialysis Outcomes Practice Pattern Study (DOPPS) were analysed for randomly selected patients receiving haemodialysis in Japan. Information regarding the diagnosis of diabetes and clinical events during follow-up was abstracted from the medical records at baseline and HRQoL was assessed by a self-reported short form (SF)-36 questionnaire. The association between physical component score and mental component score in the SF-36 and mortality risk was analysed using a Cox proportional hazard model. Results, Data from 527 patients with diabetes on haemodialysis were analysed. The mortality age-adjusted hazard ratio of having a physical component score greater than or equal to the median was 0.27 [95% confidence interval (CI) 0.08,0.96] and the multivariable-adjusted mortality hazard ratio of having an mental component score greater than or equal to the median was 1.21 (95% CI 0.44,3.35). Conclusions, The physical component score derived from the SF-36 is an independent risk factor for mortality in patients with diabetes on haemodialysis who generally had very low HRQoL scores. Baseline mental component score was not predictive of mortality. Patient self-reporting regarding the physical component of health status may aid in risk stratification and clinical decision making for patients with diabetes on haemodialysis. [source]

Haemodialysis induces mitochondrial dysfunction and apoptosis

Protein kinase C and extracellular signal regulated kinase are involved in cardiac hypertrophy of rats with progressive renal injury

EUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 2 2004
H. Takahashi
Abstract Increased cardiovascular mortality is an unresolved problem in patients with chronic renal failure. Cardiac hypertrophy is observed in the majority of patients with chronic renal failure undergoing haemodialysis. However, the mechanisms, including signal transduction pathways, responsible for cardiac hypertrophy in renal failure remain unknown. We examined the subcellular localization of protein kinase C (PKC) isoforms and phosphorylation activities of 3 mitogen-activated protein (MAP) kinase families in hypertrophied hearts of progressive renal injury rat model by subtotal nephrectomy (SNx). We also examined the effects of a novel angiotensin II type-1 receptor antagonist, CS-866, on the PKC translocation, MAP kinase activity and cardiac hypertrophy in SNx rats. The left ventricle/body weight ratios were significantly larger in SNx rats than in sham rats at 1, 2, and 4 weeks after surgery. The translocation of PKC, and , isoforms to membranous fraction was observed in SNx rat hearts at 1, 2, and 4 weeks after surgery. Activation of extracellular signal regulated kinase (ERK) 1/2, but not p38 MAP kinase and c-Jun N-terminal kinase (JNK), was observed at 1 and 2 weeks after surgery. Angiotensin II receptor blockade with CS-866 (1 mg kg,1 day,1) prevented cardiac hypertrophy, PKC translocation and ERK1/2 activation in SNx rats without significant changes in blood pressure. These data suggest that PKC and ERK1/2 are activated by an angiotensin II receptor-mediated pathway and might play an important role in the progression of cardiac hypertrophy in renal failure. [source]

Correction of an anemia in patients with a terminal stage chronic renal insufficiency on haemodialysis

HEMODIALYSIS INTERNATIONAL, Issue 1 2005
R.Z. Ismagilov
One of the basic symptoms of a terminal stage chronic renal insufficiency is anemia. From everything, used methods of correction of an anemia, it is considered the most effective application of preparations recombinant human erythropoietin (r-Hu EPO). Since 1994 in the Scientific Centre of Surgery begins application r-Hu EPO. Application r-Hu EPO in patients with a terminal stage chronic renal insufficiency in 90,95% of cases had a positive effect, but 5,10% of patients have intolerance to erythropoietin, that has induced to search of new effective methods of correction of anemia. During research were determined quantity erythrocytes, hemoglobin, reticulocyte in peripheral blood and acid-alkaline condition of blood. All hematology parameters were defined at the beginning of treatment, over 5 day and for 15 day of stimulation of a bone marrow. For 15 days after stimulation of a bone marrow by the laser there was an authentic increase of quantity erythrocyte, hemoglobin, hematocrit. The initial contents erythrocytes made 2.22 ± 0.1 10 × 12, hemoglobin 67.7 ± 3.2 g/l and hematocrit 18.2 ± 1.2%. During treatment by the laser parameters erythrocytes have increased up to 2.9 ± 0.8 10 × 12, hemoglobin up to 89.6 ± 2.9 g/l and hematocrit up to 28.2 ± 1.3%(P < 0,005). Hematology parameters in blood of control group authentically have not changed. [source]

Nocturnal Haemodialysis , A Preliminary Cost Comparison with Conventional Haemodialysis in Australia

Histomorphometric assessment of bone turnover in uraemic patients: comparison between activation frequency and bone formation rate

HISTOPATHOLOGY, Issue 6 2001
P Ballanti
Histomorphometric assessment of bone turnover in uraemic patients: comparison between activation frequency and bone formation rate Aims:,The histomorphometric assessment of bone formation rate (BFR/BS) in bone biopsies from uraemic patients is of crucial importance in differentiating low from high turnover types of renal osteodystrophy. However, since BFR/BS relies on osteoblasts, activation frequency (Ac.f), encompassing all remodelling phases, has recently been preferred to BFR/BS. This study was carried out to consider whether estimation of Ac.f is superior, in practical terms, to that of BFR/BS in distinguishing between different rates of bone turnover in uraemic patients. Methods and results:,Bone biopsies from 27 patients in predialysis (20 men and seven women; mean age 53 ± 12 years) and 37 in haemodialysis (22 men and 15 women; mean age 53 ± 12 years) were examined. The types of renal osteodystrophy were classified on the basis of morphology. Bone formation rate and Ac.f were evaluated according to standardized procedures. The Ac.f was calculated both as a ratio between BFR/BS and wall thickness (W.Th) and as a reciprocal of erosion, formation and quiescent periods (EP, FP and QP). Patients were affected by renal osteodystrophy with predominant hyperparathyroidism (two predialysis and 16 dialysis), predominant osteomalacia (three predialysis and seven dialysis) or that of advanced (nine predialysis and five dialysis) or mild (seven predialysis and four dialysis) mixed type or adynamic type (six predialysis and five dialysis). Activation frequency, which with either formula requires the measurement of W.Th, i.e. the thickness of bone structural units (BSUs), was not calculated in three dialysis patients with severe hyperparathyroidism and in one predialysis and four dialysis patients with severe osteomalacia, because only incomplete BSUs were found. In dialysis, EP was higher in the adynamic than in the other types of osteodystrophy. During both predialysis and dialysis, FP was higher in osteomalacia than in the other forms of osteodystrophy, and in adynamic osteopathy than in hyperparathyroidism or in advanced and mild mixed osteodystrophy. During predialysis and dialysis, QP was higher in the adynamic than in the other forms of osteodystrophy. Correlations were found between BFR/BS and Ac.f, during predialysis (r=0.97) and dialysis (r=0.95). Conclusions:,The superiority of Ac.f in assessing bone turnover, in comparison to BFR/BS, is conceptual rather than practical. The highest values for FP in osteomalacia and for QP in adynamic bone allow a clearer characterization of these low turnover conditions. [source]

Testing the outcome score of spontaneous intracerebral haemorrhage in haemodialysis patients

INTERNAL MEDICINE JOURNAL, Issue 10 2009
B.-R. Huang
Abstract The aim of this study is to determine the predictive value of the spontaneous intracerebral haemorrhage (ICH) outcome score (which we described previously) in haemodialysis (HD) patients who develop spontaneous ICH. The validation cohort consisted of all HD patients with spontaneous ICH presenting to Chang Gung Memorial Hospital in Taiwan during 2005,2007. The data were collected from one hospital and prospectively analysed, and the predictive model was tested using an external validation dataset. The prognostic factors were confirmed by chi-squared testing. We calculated the 30-day mortality in different groups of the validation cohort divided according to outcome score and tested the predictive value of the outcome score. The overall mortality rate was 52.6% in 38 HD patients. The originally identified prognostic factors were Glasgow Coma Scale score, age ,70 years, systolic blood pressure <130 or ,200 mmHg, ICH volume ,30 mL, presence of intraventricular haemorrhage and serum glucose ,8.8 mmol/L. All but one (serum glucose ,8.8 mmol/L (P= 0.07)) were subsequently found to be associated with 30-day mortality. In patients scoring 6 and 7, mortality was 100%, but in patients scoring 0, it was only 11.1%. The 30-day mortality in the validation cohort increased steadily with score and had good predictive value (correlation coefficient = 0.986, P < 0.001). Similar results in two different cohorts indicate that the ICH outcome score is a reliable outcome measure. [source]

Intravenous iron attenuates postvaccination anti-HBsAg titres after quadruple hepatitis B vaccination in dialysis patients with erythropoietin therapy

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 3 2009
J.-H. Liu
Summary Background:, Anaemia in patients with end-stage renal disease (ESRD) is commonly treated with recombinant human erythropoietin (rHuEPO), often in combination with an adjuvant iron supplement. There is much evidence that rHuEPO can influence the immune response by its effect on lymphocytes. Also, iron catalyses the formation of radicals and increases the risk of major infections by negatively affecting the immune system. The relationship between antibodies to hepatitis B surface antigen (anti-HBsAg) responsiveness after hepatitis B vaccination and rHuEPO/adjuvant iron supplementation has not been reported before. Aim:, To determine the effects of subcutaneous erythropoietin and intravenous (i.v.) iron therapy on the responsiveness of anti-HBsAg after quadruple hepatitis B vaccination among ESRD patients. Methods:, Retrospective medical records were reviewed in a hospital with a tertiary teaching facility. Eighty-three ESRD patients, including 51 who underwent haemodialysis and 32 who underwent peritoneal dialysis therapy, received a quadruple recombinant hepatitis B vaccine. We investigated anti-HBsAg titres in those patients who either received rHuEPO alone (n = 50) or rHuEPO in combination with i.v. iron (n = 33). Results:, We found that the postvaccination anti-HBsAg titre was significantly lower in the rHuEPO plus i.v. iron group when compared with the group with rHuEPO alone (p < 0.05). The increment of anti-HBsAg between the initial month and the seventh month was positively correlated with therapeutic rHuEPO dosages in the group with rHuEPO alone (r = 0.303, p = 0.033). This relationship was not present in the rHuEPO with i.v. iron group (r = ,0.289, p = 0.229). Conclusions:, The levels of anti-HBsAg after hepatitis B vaccination are positively correlated with the dose of rHuEPO treatment during the vaccinated period among ESRD patients without i.v. iron supplementation. Also, i.v. iron negatively impacts the responsiveness of anti-HBsAg titre after hepatitis B vaccination in ESRD patients who have undergone rHuEPO therapy. [source]

Efficacy and long-term immunogenicity of hepatitis B vaccine in haemodialysis patients

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 3 2009
A. Ramezani
Summary Background:, Hepatitis B vaccine is effective in protection against hepatitis B virus (HBV) infection in haemodialysis (HD) patients, but the antibody response is variable in this population and the persistence of immunity in them remains largely unknown. In this study we aimed to evaluate the efficacy and long-term immunogenicity of hepatitis B vaccine in HD patients. Methods:, In this study, we initially offered HBV vaccination as double dose, four vaccine series schedule (40 ,g injections intramuscularly in the deltoid muscle at 0, 1, 2 and 6 months) to 54 HD patients who were negative for hepatitis B core antibody and did not receive any dose of HBV vaccine previously. Serum levels of hepatitis B surface antibody (anti-HBs) tested 1,2 months after completion of vaccination. Then we follow the patients up to 1 year after primary vaccination to evaluate the persistence of immunity (as indicated by serum levels of anti-HBs higher than or equal to 10 IU/l). Results:, After primary vaccination, 87% of patients developed anti-HBs levels above 10 IU/l. 27.8% and 59.2% of them were weak responders and high responders respectively. 13% of patients were non-responders. After 1-year follow-up, 18.18% of responders had lost their anti-HBs (transient responders). All of them were initially in weak responders group and had lower anti-HBs levels. Conclusion:, We found an average percentage of seroconversion after primary HBV vaccination in HD patients. Our study also supported this fact that an antibody titre above 100 IU/l following primary vaccination is necessary to maintain that level of antibody 1 year later. [source]

Quality of life in chronic kidney disease: effects of treatment modality, depression, malnutrition and inflammation

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 4 2007
B. Kalender
Summary In the present study, our aim is to investigate the effects of the treatment modality, depression, malnutrition and inflammation on quality of life (QoL) in chronic kidney disease (CKD). Twenty-six patients with CKD on conservative management, 68 patients on haemodialysis (HD), 47 patients on continuous ambulatory peritoneal dialysis (CAPD) and 66 healthy controls were enrolled in the study. QoL was measured by means of the Short Form-36 (SF-36) and subscale scores were calculated. All patients were evaluated for the presence of depression using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I Disorders , Clinician Version. The severity of depression was evaluated by means of the Beck Depression Inventory (BDI). Serum C-reactive protein (CRP), ferritin, albumin, haemoglobin and haematocrit (Hct) levels were measured. All the SF-36 subscale scores were lower in the patient groups compared with control group. The SF-36 scores were higher and BDI scores were lower in the CAPD group than CKD and HD groups. In patients with depression, all SF-36 subscale scores were lower than that of the patients without depression. There was a significant negative correlation between all the SF-36 subscale scores and the BDI scores. There was a significant positive correlation between the SF-36 physical and total summary scores and the Hct value and serum albumin levels, but an inverse correlation between the SF-36 physical, mental and total summary scores and the serum CRP level in the HD patients. The authors suggest that the treatment modality, depression, malnutrition and inflammation have an important role on QoL in CKD. [source]

Severe pulmonary haemorrhage accompanying hepatorenal failure in fulminant leptospirosis

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 1 2007
B. Dursun
Summary Leptospirosis is a re-emerging spirochetal zoonosis with a worldwide distribution affecting both animals and humans. The clinical syndromes may vary from a subclinical infection to a severe illness. Although it may potentially have a fulminant and fatal course, leptospirosis usually remains as an underdiagnosed cause of multiorgan failure. In this study, we report a patient with leptospirosis who presented with a fulminant course of diffuse alveolar haemorrhage and hepatorenal failure. His clinical condition deteriorated, despite appropriate antibiotic therapy and haemodialysis. However, he showed prompt clinical improvement when corticosteroids and plasma exchange were instituted in addition to the original therapy. We conclude that leptospirosis should be considered in any case presenting with pulmonary haemorrhage and hepatorenal failure. Plasma exchange and corticosteroids may be a choice of treatment in selected patients unresponsive to conventional therapy. Potential benefits of plasma exchange and corticosteroids may be based on a toxin- and/or cytokine-mediated pathogenesis of the disease. [source]

Seroprevalence of hepatitis C in patients with type 2 diabetes mellitus and non-diabetic on haemodialysis

Anticardiolipin antibody and Taiwanese chronic haemodialysis patients with recurrent vascular access thrombosis

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 7 2005
F-R Chuang
Summary Vascular access failure is a major cause of morbidity in chronic haemodialysis (HD) patients. However, some factors (such as homocysteine levels) are known regarding the risk factors predisposing certain HD patients to vascular access thrombosis (VAT). Immunoglobulin-G anticardiolipin antibody (IgG-ACA) is strongly associated with venous and arterial thrombosis in patients with normal renal function. Previous investigations have reported the characteristics of patients with raised IgG-ACA titre and recurrent VAT of HD in Western countries, but few equivalent studies exist for Taiwan. This retrospective study attempts to determine whether raised IgG-ACA titres are associated with an increased risk of recurrent VAT in chronic HD patients. This study enrolled 483 patients undergoing HD. IgG-ACA titre and hepatitis B&C marker were measured for all patients. A history of recurrent (VAT more than one) and/or VAT was elicited by using information from the patient questionnaires and was verified by means of careful inpatient and outpatient chart review. Raised IgG-ACA titres were present in 21.7% (105/483) of patients. In both groups (raised IgG-ACA and normal IgG-ACA), the type of shunt differed significantly (p = 0.029). In predicting for more or one episodes of VAT by using multiple logistic regression with all significant factors, synthetic graft was also a significant factor (p < 0.0001). The 105 raised IgG-ACA titres and 378 normal IgG-ACA titres were associated between chronic HD patients and recurrent VAT (p = 0.034). In predicting for more or one episode of VAT by using multiple logistic regression with all significant factors, raised IgG-ACA titre was a non-significant factor (p = 0.336). The presence of hepatitis C had a higher percentage in group with raised IgG-ACA titres of HD patients (p = 0.042). In predicting for more or one episode of VAT by using multiple logistic regression with all significant factors, the presence of hepatitis C was also a significant factor (p = 0.022). In conclusion, the prevalence of raised IgG-ACA titres was 21.7% among HD patients. There was a weak association between raised IgG-ACA titre and recurrent VAT and this finding may be the consequence of pathogenetic role of raised IgG-ACA titres in the development of VAT status for chronic HD patients. The presence of hepatitis C was a cofactor. [source]

Barriers to kidney transplants in Indonesia: a literature review

INTERNATIONAL NURSING REVIEW, Issue 1 2009
P.N. Bennett rn
Background:, People living with chronic kidney disease will require renal dialysis or a kidney transplant to maintain life. Although Indonesia has a developing healthcare industry, Indonesia's kidney transplant rates are lower than comparable nations. Purpose:, To explore the healthcare literature to identify barriers to kidney transplants in particular in relation to Indonesia. Methods:, Healthcare databases were searched (CINAHL, Medline, EBSCOhostEJS, Blackwell Synergy, Web of Science, PubMed, Google Scholar and Proquest 5000) using the search terms: transplant, kidney disease, renal, dialysis, haemodialysis, Indonesia and nursing. The search was limited to English and Indonesian language data sources from 1997 to 2007. Reference lists of salient academic articles were hand searched. Results:, The results of our search identified six articles that met our criteria. Costs are the major barrier to kidney transplant in Indonesia, followed by cultural beliefs, perception of the law, lack of information and lack of infrastructure. In addition, kidney disease prevention strategies are required. Conclusions:, There are many complex socio-economic, geographical, legal, cultural and religious factors that contribute to low kidney transplant rates in Indonesia. Although an increase in transplantation rates will require strategies from various agencies, healthcare professionals, including nurses, can play a role in overcoming some barriers. Community education programmes, improving their own education levels and by increasing empowerment in nursing we may contribute to improved kidney transplant rates in Indonesia. [source]

Coping strategies and health-related quality of life among spouses of continuous ambulatory peritoneal dialysis, haemodialysis, and transplant patients

JOURNAL OF ADVANCED NURSING, Issue 6 2000
Ragny Lindqvist RN PhD
Coping strategies and health-related quality of life among spouses of continuous ambulatory peritoneal dialysis, haemodialysis and transplant patients In the study reported here 55 spouses of patients living with end-stage renal disease (ESRD) were investigated with respect to coping strategies and health-related quality of life. Findings from the study were compared to two random samples of the Swedish general population (n = 454, and n = 1200). The study design was correlational and comparative. Coping was measured by the Jalowiec Coping Scale, and quality of life (QoL) by the Swedish Health-Related Quality of Life Survey (SWED-QUAL). Data were analysed using a number of statistical tests including Pearson's product moment correlations, Student's t -test and two way ANOVAs. The combined sample of spouses used significantly more optimistic and palliative coping than the general population, but less confrontative, self-reliant, evasive and emotive coping. In the study fatalistic, evasive and emotive coping was associated with low perceived efficiency in handling various aspects of the partners' situation. The male spouses used significantly less optimistic, supportive and palliative coping than did the female spouses. The spouses of transplant patients had better overall quality of life than the continuous ambulatory peritoneal dialysis and haemodialysis spouse groups, most likely due to the lower age of the former group. The study findings suggest that emotive, evasive and fatalistic coping are less than optimal ways to deal with problems occasioned by the partner's treatment. [source]

Herbal product use in a sample of Turkish patients undergoing haemodialysis

JOURNAL OF CLINICAL NURSING, Issue 15 2009
Belgüzar Kara
Aim., To examine herbal product use among patients with end-stage renal disease undergoing haemodialysis. Background., Herbal therapy is a very popular choice for many patients. However, little information is available about herbal product use in renal patients. Design., The study was designed as a cross-sectional survey. The data were obtained from 114 end-stage renal disease patients in two haemodialysis centres in Ankara, Turkey between June,August 2007. Methods., Data were collected through face-to-face structured interviews. Descriptive statistics and the chi-square test were conducted. Results., Approximately one-third of the patients (28·1%) used a herbal product after the diagnosis of chronic kidney disease. Of these, 13·2% reported currently taking herbal products. A minority of participants (12·5%) informed their physician of herbal product use. Marital status was the only variable significantly associated with herbal product use. Conclusions., The results of this study showed that many patients used herbal products, but most did not disclose this use to their physician. Herbal product use was more prevalent among the participants who were married. Relevance to clinical practice., Understanding the patterns and reasons of herbal use is beneficial in efforts to improve the care of patients with end-stage renal disease. Nurses should be aware of the potential health risks caused by herbal products and should educate the patient and the family. [source]

Central venous access for haemodialysis: prospective evaluation of possible complications

JOURNAL OF CLINICAL NURSING, Issue 2 2007
Denise De Andrade PhD
Aims and objectives., The combination of chronic renal insufficiency and haemodialysis represents a challenge for health professionals. Chronic renal insufficiency patients undergoing haemodialysis treatment through a temporary double-lumen catheter were prospectively studied in order to identify the type and frequency of local and systemic complications. Methods., A six-month period was established with a view to the inclusion of new cases. Data were acquired through interviews, clinical assessment and patient records, and entered into a Microsoft Excel database through a double entry system and exported to the Statistical Package Social Sciences software. Sixty-four patients were evaluated prospectively, of which thirty-eight (59.4%) were men and 35 (54.7%) required catheter insertion for immediate treatment. During the study period, 145 catheters were inserted, ranging from 1 to 7 implants per patient, 29 (45.3%) were single insertions and 127 (87.6%) catheters were inserted into the jugular vein. The catheters were left in place for an average of 30 days. Results., Forty-one (64%) presented inadequate functioning, after about 26 days. A febrile state occurred in 24 (37.5%) patients after 34 days, secretion at the catheter entry site in 27 (42.2% after 26 days and bloodstream infection was encountered in 34(53%) after 34 days. Of the 61 blood culture samples, thirty (49%) were positive for Staphylococcus aureus that was the microorganism most frequently isolated. Conclusion., The findings indicate worrying aspects such as the catheters permanence time, exposing patients to different complications, including infection. Furthermore, inadequate catheter functioning leads to inefficient haemodialysis treatment. Relevance to clinical practice., Knowledge about complications allows for systematic care planning, prevention and control actions. [source]

Percutaneous endoscopic gastrostomy feeding in haemodialysis out-patients

JOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 5 2000
H. A. Sayce
Introduction Malnutrition is highly prevalent in haemodialysis (HD) patients and plays a major role in influencing outcome. Although use of home enteral feeding is expanding rapidly in the UK, it is a method of nutritional support which remains under-utilized in HD out-patients. We report our experience and outcomes in a series of eight cases. Methods Home gastrostomy feeding was initiated in eight malnourished HD out-patients, administered either continuously overnight or as daily bolus feeds. Nutritional parameters were monitored weekly by the renal dietitian and included dry weight, upper-arm anthropometry and serum albumin. The number and duration of hospitalizations during the period of feeding were recorded. Results After 3 months of feeding, median dry weight increased from 43.0 to 48.3 kg (P = 0.012), mid-upper arm circumference increased from 20.2 to 24.8 cm (P = 0.018), triceps skinfold thickness increased from 7.3 to 11.3 mm (P = 0.046), mid-upper arm muscle circumference increased from 17.7 to 19.8 cm (P = 0.027) and serum albumin increased from 29.5 to 36.5 g L,1 (P = 0.011). Few complications were encountered and hospital admission rates were low. Conclusion Home gastrostomy feeding, with appropriate monitoring and support, is an effective method of improving and maintaining nutritional status in this vulnerable group. [source]

A2. The carer's perception of dietitians' advice and its impact on the management of patients receiving haemodialysis

JOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 5 2000
M. A. Rezaie
Background Patients with end stage renal disease and their carers suffer many changes in their daily life style as a result of haemodialysis (HD) treatment. Information and education concerning the management of dietary requirements and restrictions for renal patients should be aimed at both patients and their carers. Aim This study investigated the impact of dietitians' involvement and advice on the carers' ability to manage patients' dietary/fluid requirements. Method A total of 36 carers of renal patients receiving unit haemodialysis treatment were randomly recruited into this study from a hospital in Cardiff, Wales. All the carers completed the Haemodialysis carers questionnaire (HCQ), specifically designed for this study, delivered to them in the outpatient clinic by the dietitian. Results Of the 36 carers, 22 (61%) were female, six (16.7%) were male and eight (22%) did not report their gender. Thirteen (36%) of the carers were between the ages of 20,54 years and 23 (64%) were 55 years of age and older. Twenty-six (72%) of the carers involved in this study were spouses and 34 (94.4%) of the carers lived with the patient. The mean duration of haemodialysis treatment for the patient was found to be 20 months. The results indicated that although the majority of the carers were informed about patients' dietary and fluid restrictions, 45% had not received any dietary information. Dietitians' one-to,one interactions with the carer was the most effective way of providing information in enabling them to better manage the patient compared to other methods such as leaflet and information packs (P = 0.01). The majority of the carers knew how to contact the renal dietitian, however, many did not (P = 0.001). Almost all the carers considered receiving information about the purpose of HD, feed back on the patients' condition, fluid/dietary restriction and details of available community resources as very important. Those carers who had the benefit of a dietitian's involvement believed that their advice was very helpful and enabled them to cope better with the management and complications of patient fluid and dietary requirements (P < 0.02). Strong correlations were found (rs = 0.67; P < 0.01) between the amount of information received by the carers and the level of the carers satisfaction with this information. In contrast, there were no significant correlations between the amount of information received by the carers and different aspects of managing the patients' diet, because 45% of the carers received none or little information. Conclusions Dietitians should involve the carers in the management of HD patient's dietary/fluid requirements and restrictions in order to provide better quality of care and quality of life for both the patient and the carer. [source]

Methanol outbreak in Norway 2002,2004: epidemiology, clinical features and prognostic signs

JOURNAL OF INTERNAL MEDICINE, Issue 2 2005
K. E. HOVDA
Abstract. Objectives., Knowledge on methanol poisoning does mainly come from clinical studies. We therefore report epidemiological, clinical and prognostic features from the large methanol outbreak in Norway in 2002,2004 where the new antidote fomepizole was the primary antidote in use. Design and subjects., Combined prospective and retrospective case series study of 51 hospitalized patients who were confirmed poisoned with methanol, of whom nine died. In addition, eight patients died outside hospital. Most patients were admitted in a late stage and because of symptoms. Treatment consisted of alkali, fomepizole (71%) and haemodialysis (73%). Results., The median serum methanol was 25.0 mmol L,1 (80 mg dL,1) (range 3.1,147.0 mmol L,1), median pH was 7.20 (6.50,7.50), and median base deficit 22 mmol L,1 (range 0,31). The most frequent clinical features reported were visual disturbances (55%), dyspnoea (41%), and gastrointestinal symptoms (43%). Twenty-four per cent were comatose on admission, of whom 67% died. There was a trend towards decreasing pCO2 with decreasing pH amongst the patients surviving. The opposite trend was demonstrated in the dying; the difference was highly significant by linear regression analyses (P < 0.001). Conclusions., Methanol poisoning still has a high morbidity and mortality, mainly because of late diagnosis and treatment. Respiratory arrest, coma and severe metabolic acidosis (pH < 6.90, base deficit >28 mmol L,1) upon admission were strong predictors of poor outcome. Early admission and ability of respiratory compensation of metabolic acidosis was associated with survival. [source]

Homocysteine, malondialdehyde and endothelial markers in dialysis patients during low-dose folinic acid therapy

JOURNAL OF INTERNAL MEDICINE, Issue 5 2002
T. Apeland
Abstract. Apeland T, Mansoor MA, Seljeflot I, Brønstad I, Gøransson L, Strandjord RE (Rogaland Central Hospital, Stavanger; and Ullevål University Hospital, Oslo; Norway). Homocysteine, malondialdehyde and endothelial markers in dialysis patients during low-dose folinic acid therapy. J Intern Med 2002; 252: 456,464. Objectives. Haemodialysis patients have elevated levels of the atherogenic amino acid homocysteine. We wanted to assess the effects of small doses of intravenous folinic acid (the active form of folic acid) on some biochemical risk factors of cardiovascular disease. Design. Longitudinal and open intervention study. Setting. Two dialysis units in the County of Rogaland. Subjects. All patients on maintenance haemodialysis were invited, and 32 of 35 patients gave their informed consent. Interventions. After each dialysis session, the patients were given 1.0 mg of folinic acid intravenously thrice a week for a period of 3 months. Prior to and during the study, all patients were on maintenance supplementation with small doses of vitamins B1, B2, B3, B5, B6 and B12. Main outcome measures. Changes in the levels of (i) plasma total homocysteine (p-tHcy) and folate, (ii) circulating endothelium related proteins , markers of endothelial activation and (iii) serum malondialdehyde (S-MDA) , a marker of oxidative stress and lipid peroxidation. Results. The p-tHcy levels were reduced by 37% (P < 0.0001), whilst the serum and erythrocyte folate levels increased by 95 and 104%, respectively (P < 0.0001 for both). The circulating levels of endothelium related cellular adhesion molecules and haemostatic factors remained high and unchanged, except the thrombomodulin (TM) levels increased (P = 0.0004). The high levels of S-MDA were reduced by 26% (P = 0.003). Conclusions. Low doses of folinic acid given intravenously to dialysis patients reduced their levels of p-tHcy and S-MDA and thus improved their cardiovascular risk profile. The concurrent increment in TM levels was unexpected and of unknown clinical significance. [source]

Activity of the Chinese prescription Hachimi-jio-gan against renal damage in the Otsuka Long-Evans Tokushima Fatty rat: a model of human type 2 diabetes mellitus

JOURNAL OF PHARMACY AND PHARMACOLOGY: AN INTERNATI ONAL JOURNAL OF PHARMACEUTICAL SCIENCE, Issue 4 2006
Noriko Yamabe
Currently, in Japan, approximately 95% of patients with diabetes mellitus have non-insulin-dependent (type 2) diabetes mellitus (NIDDM), and diabetic nephropathy is a major cause of patients requiring chronic haemodialysis. A previous study showed that Hachimi-jio-gan has a protective effect in rats subjected to subtotal nephrectomy plus streptozotocin injection, a model of insulin-dependent (type 1) diabetic nephropathy. In this study, we used the Otsuka Long-Evans Tokushima Fatty (OLETF) rat, a model of human NIDDM, to investigate whether long-term administration of Hachimi-jio-gan affects glycaemic control and renal function in NIDDM. Male OLETF rats, aged 22 weeks, were divided into 4 groups of 10 and given Hachimi-jio-gan (50, 100 or 200 mg kg,1 daily) orally or no treatment for 32 weeks. Male Long-Evans Tokushima Otsuka (LETO) rats (n = 6) were used as non-diabetic normal controls. Hachimi-jio-gan reduced hyperglycaemia dose-dependently from 16 weeks of the administration period. Urinary protein excretion decreased significantly from an early stage, and creatinine clearance levels improved at 32 weeks. In addition, the levels of serum glycosylated protein and renal advanced glycation end-products were effectively reduced. Hachimi-jio-gan also significantly reduced the levels of thiobarbituric acid-reactive substances in renal mitochondria, although it showed only a tendency to reduce these in serum. Furthermore, long-term administration of Hachimi-jio-gan reduced renal cortical expression of proteins, such as transforming growth factor-,1 (TGF-,1), fibronectin, inducible nitric oxide synthase and cyclooxygenase-2. The 100- and 200-mg kg,1 daily doses of Hachimi-jio-gan significantly reduced TGF-,1 and fibronectin protein expression to levels below those of LETO rats. These data suggest that Hachimi-jio-gan may have a beneficial effect on the progression of diabetic nephropathy in OLETF rats by attenuating glucose toxicity and renal damage. [source]

THE EFFICACY OF SHORT DAILY DIALYSIS,A SINGLE-CENTRE EXPERIENCE

JOURNAL OF RENAL CARE, Issue 3 2010
Glenda Rayment M Nursing (Renal)
SUMMARY Studies have shown that patients converted to short daily haemodialysis (SDHD) have reported many clinical benefits, decreased complications during dialysis and a better quality of life. A six-month prospective cohort study was conducted to examine the efficacy of SDHD to patients previously receiving three times per week haemodialysis therapy. Following informed consent, participants received haemodialysis daily, Monday,Saturday, between 2 and 2.5 hours for each treatment and followed-up for a six-month period. The participants continued to experience hypotension, cramping and headache and were noncompliant with fluid intake. There was a gradual reduction in blood pressure, cessation of antihypertensives and reduction of erythropoietin therapy (ERT). There were no hospital admissions or reports of access complications. The nursing staff reported an increase in activity levels and nursing interventions with the participants following conversion to SDHD. However, the participants reported a better quality of life. [source]