Maintenance HD (maintenance + hd)

Distribution by Scientific Domains


Selected Abstracts


Implantable cardioverter defibrillator in maintenance hemodialysis patients with ventricular tachyarrhythmias: A single-center experience

HEMODIALYSIS INTERNATIONAL, Issue 1 2009
Itaru ITO
Abstract Patients with hemodialysis (HD) are at risk of death due to cardiac arrhythmias, worsening congestive heart failure (CHF), and noncardiac causes. This study reviews our experience with the use of implantable cardioverter defibrillators (ICDs) in patients with ventricular tachycardia who are under maintenance HD. We retrospectively reviewed 71 consecutive patients who underwent an ICD implantation in our hospital. There were 11 patients under maintenance HD and 60 patients without HD. The group of patients with HD (HD group) was compared with the patients without HD (control group). The mean follow-up period was 30±9 vs. 39±4 months in the HD group vs. the control group, respectively. Among these patients, 6 in the HD group and 26 in the control group received appropriate ICD therapies. There was no difference in appropriate ICD therapy, time to the first therapy, and electrical storm between the 2 groups. In the HD group, 1 patient underwent surgical removal of the ICD system due to infective endocarditis. There were 5 deaths in the HD group (4 from CHF) and 8 deaths in the control group (4 from CHF). There were no sudden cardiac deaths or arrhythmic deaths in both groups of patients during the follow-up period. However, the overall death rate was significantly higher in the HD group (P<0.01). In HD patients, ICD therapy prevented arrhythmic death, but their rate of nonarrhythmic adverse outcomes was high. This risk-benefit association should be considered before implantation of the device. [source]


Prevention of hemodialysis-related muscle cramps by intradialytic use of sequential compression devices: A report of four cases

HEMODIALYSIS INTERNATIONAL, Issue 3 2004
Muhammad Ahsan
Background:, Hemodialysis (HD)-related lower extremity (LE) muscle cramps are a common cause of morbidity in end-stage renal disease patients on maintenance HD. Numerous pharmacologic and physical measures have been tried with variable success rates. Methods:, Sequential compression devices (SCD) improve venous return (VR) and are commonly used to prevent LE deep venous thrombosis in hospitals. We hypothesized that LE cramps are triggered by stagnant venous flow during HD and are preventable by improving VR. We prospectively studied four adult patients (mean age 61 ± 14 years) on thrice-weekly HD who experienced two or more episodes of LE cramping weekly in the month before the study. SCD were applied before each HD on both legs and compressions were intermittently applied at 40 mmHg during treatment. Results:, All four patients reported complete resolution of cramping during the study period that lasted 1 month or 12 consecutive dialysis treatments. Conclusion:, Application of SCD to LE may prevent the generation of LE HD-related cramping in a select group of patients. Larger, controlled studies are needed to establish the utility of this noninvasive alternative for the prevention of LE HD-related cramps. [source]


Outcome of aneurysmal subarachnoid haemorrhage in patients on maintenance haemodialysis

NEPHROLOGY, Issue 1-2 2000
Gakusen Nishihara
SUMMARY: To investigate the outcome of aneurysmal subarachnoid haemorrhage (SAH) in patients on maintenance haemodialysis (HD), eight patients on maintenance HD and 245 patients not on HD who suffered from SAH, all of whom were surgically treated at our institution between 1993 and 1997, were reviewed. The clinical features and 3-month outcome of SAH were analysed in the eight HD patients (three males, five females) and compared with those in the 245 non-HD patients (77 males, 168 females). Although there were no significant differences in the patient's age, gender and pre-operative grading of SAH with the Hunt and Hess grading scale, the mortality rate in HD patients was significantly higher than that in non-HD patients (50% [4/8] vs 13% [32/245]; P < 0.01). It was concluded that the outcome of aneurysmal SAH in HD patients was extremely poor. The explanation for the worse prognosis in HD patients seems not to lie in systemic heparization but in a vulnerability to SAH, because SAH in all HD patients occurred after anticoagulant activity from the previous dialysis had already disappeared. [source]


Trace Metals' Abnormalities in Hemodialysis Patients: Relationship with Medications

ARTIFICIAL ORGANS, Issue 11 2000
Su-Hui Lee
Abstract: A multicenter collaborative study was performed to investigate the prevalence of abnormal blood contents of 6 trace metals, copper (Cu), zinc (Zn), aluminum (Al), lead (Pb), cadmium (Cd), and mercury (Hg), in hemodialysis (HD) patients and to analyze their relationship with the medications, such as CaCO3, Ca acetate, Al containing phosphate-binding agents, 1,25-dihydroxy vitD3, 1-hydroxy vitD3, and erythropoietin (EPO), as well as hematocrit level, by chi-square statistics. From 6 medical centers in Taiwan, we included 456 patients in maintenance HD for more than 4 months for this study, and they had continued the previously mentioned medications for at least 3 months. Blood samples were collected before initiating HD, and atomic absorption spectrophotometry was used to measure plasma levels of Cu, Zn, and Al as well as whole blood levels of Pb, Cd, and Hg. Three hundred seventy-five (78%) of the HD patients had low plasma Zn levels, that is, <800 ,g/L, and the mean (±SD) concentration was 705.8 (±128.23) ,g/L in all subjects. One hundred forty-one (31%) of the HD patients had high plasma Al, that is, >50 ,g/L, and the mean (±SD) was 44.30 (±28.28) ,g/L in all subjects. Three hundred thirty-three (73%) of the dialysis patients had high Cd levels, that is, >2.5 ,g/L, and the mean (±SD) was 3.32 (±1.49) ,g/L in all subjects. The majority of HD patients had normal blood levels of Cu, PB, and Hg. Only 21 (4.6%), 5 (1.1%), and 3 (0.06%) patients had elevated blood levels of Cu, Pb, and Hg, respectively. Their mean (±SD) blood concentration of Cu, Pb, and Hg were 1,049.78 (±233.25) ,g/L, 7.45 (±3.95) ,g/dL, and 3.17 (±25.56) ,g/L, respectively. Three patients had elevated plasma Hg concentrations, that is, 546, 12.6, and 24.0 ,g/L, respectively. In the 152 normal healthy age and sex matched control group, the blood levels of Al, Cd, and Pb were all significantly lower than the HD patients. However, the levels of Cu and Zn were higher in the control group. The Hg level was not significantly different in both groups. There was no statistical difference between patients with normal and abnormal blood levels of trace metals in various medications except Al containing phosphate binder. The Al containing phosphate binder users had significantly higher plasma Al levels (54.71 ± 26.70 versus 41.15 ± 28.03 ,g/L, p < 0.001) and hematocrit levels (29.61 ± 4.61 versus 27.81 ± 3.91, p < 0.0005). There was no statistical correlation between erythropoietin (EPO) dose and hematocrit level in these patients. In conclusion, the blood level of trace metals of these HD patients except Al was not related to their medications. However, caution must be exercised in interpreting this result as dose and duration of medication; efficiency of HD and water treatment may play an important role. Otherwise, environmental factors, diet, and the aging process may contribute to the trace metal burden in uremia. Thus, Zn and Cu are abundant in seafood, and Cd is abundant in contaminated plants such as rice. [source]