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Hekmat R, Talebi S, Mohebati M,
Volume 65, Issue 5 (8-2007)
Volume 65, Issue 5 (8-2007)
Abstract
Background: Cardiovascular problems including arterial hypertension, coronary artery diseases, congestive heart failure are prevalent among chronic hemodialyzed patients. Ultrafiltration of hemodialyzed patient's serum, which culminating in intravascular volume reduction, is frequently used during hemodialysis. One of the restrictions of the echocardiographic evaluation of the diastolic heart function is the intravascular volume dependency of some echocardiographic parameters. In this study we have evaluated the volume dependency of certain echocardiography parameters in chronically hemodialyzed patients.
Methods: Thirteen patients undergoing chronic hemodialysis in Ghaem Hospital Hemodialysis Center in Mashhad, Iran, were evaluated one hour before and immediately after hemodialysis for the following: all diastolic echocardiographic parameters, left ventricular function, left ventricular systolic function, inferior vena cava (IVC) diameter and IVC collapsibility with inspiration, and systolic and diastolic blood pressure. The echocardiographic parameters were analyzed using the paired Student's t-test.
Results: With hemodialysis, there was no significant change in left ventricular function, A wave amplitude and E/F slope, however, there was a significant reduction of the E wave amplitude, increment in E wave deceleration time (p= 0.001, t=-4.14) and a decrease in the E/A ratio (p=0.03, t=2.46). Tissue Doppler echocardiography showed no significant change in mitral annular diastolic motion, E'/A' waves, with hemodialysis (p=0.728, t= - 0.356), although there was a reduction of the E/E' ratio.
Conclusion: Tissue Doppler imaging and color M-mode echocardiographic parameters are independent of the intravascular value status. With no change associated with hemodialysis, these parameters can be used as reliable criteria for evaluating ventricular diastolic function even when the volume status varies.
Azadibakhsh N, Shaker Hosseini R, Atabak Sh, Nateghiyan N, Golestan B, Houshiar Rad A,
Volume 65, Issue 8 (11-2007)
Volume 65, Issue 8 (11-2007)
Abstract
Background: Hyperhomocysteinemia is an independent risk factor for cardiovascular diseases. The frequency of hyperhomocysteinemia is higher in hemodialysis (HD) patients than the general population. The objective of this study is to assess the efficacy of high-dose folic acid supplementation with and without vitamin B12 on lowering plasma total homocysteine (tHcy) concentrations in HD patients.
Methods: Thirty-six HD patients at Imam Hossein Hospital, Tehran, Iran, who had been given folic acid supplements (5 mg/d) for at least 3 months before, were enrolled in this clinical trial. Subjects were also checked for other inclusion and exclusion criteria. The subjects were divided randomly into four groups and underwent two months of supplementation as follows: 5 mg/d oral folic acid + placebo in group one, 5 mg/d oral folic acid + vitamin B12 (1 mg/d orally) in group two, 15 mg/d oral folic acid + placebo in group three and 15 mg/d oral folic acid + vitamin B12 (1 mg/d orally) in group four. Concentrations of plasma tHcy and serum folic acid and vitamin B12 were measured at baseline and after the supplementation period. Dietary intake of patients was also determined during the supplementation period.
Results: Of the folic acid supplemented patients, 27.8% had normal levels of tHcy at baseline and 72.2% had hyperhomocysteinemia. After the supplementation period, plasma tHcy increased by 1.35% in group one and decreased by 6.99%, 14.54% and 30.09% in groups two, three and four respectively. Changes in plasma tHcy and serum vitamin B12 were only significant in group four however, no significant changes were seen for serum folic acid. The percentage of subjects reaching normal levels of plasma tHcy was 5.6 fold higher in group four than in the reference group.
Conclusions: Supplementation with 15 mg/d folic acid together with 1 mg/d oral vitamin B12 is more effective in reducing tHcy levels in HD patients.
Hekmat R, Mojahedi M J, Garevani H,
Volume 65, Issue 13 (3-2008)
Volume 65, Issue 13 (3-2008)
Abstract
Background: The effect of kind of dialysis solution on the control of blood pressure and adequacy and efficacy of hemodialysis is a most debated and controversial issue.
Methods: Twenty six chronic hemodialized patients in Ghaem hemodialysis center, Mashhad, Iran, in winter of the year 2004, enrolled this study for one month. The patients were dialyzed with bicarbonate buffer and were dialyzed in the next month with acetate. The kind of membranes and the dialysis machines were the same in both months. Systolic and diastolic pressures were measured before and after hemodialysis in at least three hemodialysis sessions, and he means recorded. The mean of the body weight were also recorded. In the same sessions of hemodialysis by measuring the urea, before and after hemodialysis, urea reduction ratio (URR), was also calculated. Statistical analysis was done with paired student t test for paired measurement, and independent t test for evaluating the effect of the kind of dialysate buffer on the measured parameters.
Results: There were no significant statistical differences between acetate and bicarbonate dialysis solution buffers in the control of diastolic blood pressure. But use of acetate buffer resulted in more significant systolic blood pressure reduction compared with bicarbonate buffer (p=0.045). When adequacy of hemodialysis were compared between two kinds of buffers there were no significant statistical differences between them. When the effect of dialysate sodium concentration in the range utilized in two buffers, was evaluated on the systolic and diastolic pressure reduction, no significant differences, between two types of buffers attributable to the difference between dialysates sodium concentrations were found.
Conclusion: Hemodialysis with both, acetate and bicarbonate buffers results in significant reductions in systolic and diastolic blood pressure, weight and urea ratio. Use of acetate buffer is more significantly associated with systolic blood pressure reduction compared to bicarbonate buffer (p=0.045), this effect is independent of the dialysate buffer sodium concentration.
Hemmati M, Kadkhodaee M, Zahmatkesh M, Mahdavi-Mazde M, Ghaznavi R, Mirershadi F,
Volume 66, Issue 1 (3-2008)
Volume 66, Issue 1 (3-2008)
Abstract
Background: The risk of atherosclerosis and cancer is high in hemodialysis (HD) patients. There is evidence that HD causes oxidative stress. However, the causative factors of oxidative stress are unknown. It has been suggested that HD imposes an additional oxidative stress on patients with chronic renal failure by activation of granulocytes on dialyzer membranes resulting in an imbalance between oxidants and antioxidants. In this regard, a number of reports, either measuring specific analytes or enzymes, or estimating the total antioxidant activity of the plasma have given contradictory and inconclusive results. To investigate the oxidative stress status in Iranian HD patients, in this study, we evaluated GSH and FRAP levels along with Ca and pH in the blood of these patients.
Methods: Along with 20 healthy age and gender matched control subjects, 24 patients underwent dialysis, three times per week, for four hours in each session. Before and after dialysis, blood was taken for biochemical and liver function tests and to evaluate oxidative stress markers and measure Ca and pH levels.
Results: There was a significant decrease in FRAP and GSH levels after dialysis compared to those before treatment. Dialysis caused an increase in pH and Ca levels compared to levels in control subjects after dialysis.
Conclusion: In general, before dialysis, there is a balance between oxidants and antioxidants however, due to higher levels of oxidants as well as the possible binding of antioxidants to the dialyzer membrane during dialysis, an imbalance occurs. The instability in the balance of oxidants and antioxidants may be the major cause of cellular oxidative damage found in HD patients. This study indicates that there is a significant level of oxidative stress in renal chronic patients and this stress is augmented by dialysis. Antioxidant therapy should be considered in these patients.
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Volume 66, Issue 4 (7-2008)
Volume 66, Issue 4 (7-2008)
Abstract
Background: The annual amount of mortality in ESRD exceeds the expectation and represents the recent evidences of the inflammation as its etiology. The etiology of inflammation is not clearly known. Chronic inflammation is a dominant occurrence of ESRD which increases the risk of atherosclerosis, malnutrition and peripheral vascular disease. Inflammatory responses are orchestrated by cytokines. Some of the proinflammatory cytokines like IL-6 have a crucial role in this phenomenon. The IL-6 and its receptor activity is up regulated in ESRD patients and the increased level of IL-6 predicts cardiovascular mortality and morbidity in normal and CRF patients. This study devotes itself to determining the serum level of IL-6 and factors affecting it in patients undergoing chronic hemodialysis in Imam Khomeini Hospital which can represent the Iranian Society. By identifying factors affecting the serum level of IL-6 and high-risk patients we can provide treatment possibilities, a decrease in mortality and an improvement in its prognosis.
Methods: In this study 42 patients in Imam Dialysis Center were chosen and their serum IL-6 levels were measured at 2 times at three month interval and at the same time blood sample analysis were done for the following: Alb CPR, Ca, P, PTH, TIBC, Ferritin, TG, Chol, LDL, HDL, Uric Acid, Hb, WBC and urea.
Results: The mean serum level of IL-6 in hemodialysis patients was 6.35±4.47pg/ml (minimum: 0.55, maximum: 18.25) with the normal range of 1.3±3.2pg/ml.
Conclusions: The IL-6 level was higher than normal range in the 52% of the patients. The serum IL-6 level had a significant correlations with CPR, Ferritin, TIBC, WBC and their serum IL-6 level was significantly higher in patients with hypertension, but no significant correlation was observed between other parameters and IL-6
Keshvari A, Jafari- Javid M, Najafi I, Chaman R, Nouri Taromloo Mk,
Volume 66, Issue 7 (10-2008)
Volume 66, Issue 7 (10-2008)
Abstract
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Methods: A
total of 115 catheters (two-cuff, swan-necked, coiled) were
inserted into the peritoneal cavity of 109
patients with end-stage chronic renal failure during a 16-month
period. The method of insertion was a two-port laparoscopic technique with
local anesthesia and sedation. All patients were followed for 12
to 28 months. We prospectively evaluated mechanical
and infectious complications and survival rates of the catheters.
Results: The
average age of the patients was 51.5 years (range: 15-84
years) 54.8% of these patients were female. The overall
one-year and two-year catheter survival rates using this approach were 88%
and 73%, respectively. Event-free catheter survival
was 35%. The most common infectious and mechanical
complications were peritonitis in 52
cases (45.2%) and temporary dialysate leakage in 10
cases (8.7%) respectively.
Conclusion: Laparoscopic insertion of
peritoneal dialysis catheter with local anesthesia is a safe and simple
procedure, giving reasonable rates of catheter survival and complications.
Rahimi A, Maziar S, Ahmadi F, Shahriari S, Fattahi F, Jam S, Moradmand Badie B, Kourorian Z,
Volume 66, Issue 9 (12-2008)
Volume 66, Issue 9 (12-2008)
Abstract
Background: Anemia is a common complication accompanied by high morbidity and mortality in hemodialysis patients. Considering the fact that the reduction of erythropoietin (EPO) synthesis is the main cause of uremic anemia, receiving recombinant human erythropoietin (rHuEPO) can improve the condition in these patients. Some of these hemodialysis patients, however, have acceptable hemoglobin levels without any need to EPO. Higher BMI, higher albumin and leptin plasma levels and longer durations of hemodialysis are possible factors contributing to the reduced need for rHuEPO in these patients. The present study is designed to asses the relationship between the plasma levels of leptin and the reduced EPO need.
Methods: Fifty eligible hemodialysis patients with hemoglobin levels higher than 11 mg/dl were enrolled in the cross-sectional study. The information on age, sex, hemodialysis duration and the cause of renal dysfunction were extracted from the files. The baseline plasma levels of Leptin and albumin were measured. The patients BMI and the weekly need for rHuEPO were also calculated.
Results: There was no correlation between the weekly need for rHuEPO and sex, BMI, the cause of renal dysfunction and the plasma levels of albumin and leptin it, however, was related with age and the duration of dialysis. While age negatively influences the weekly need, the duration of dialysis has a positive effect on the need.
Conclusion: The plasma levels of leptin are not directly correlated with the required amounts of rHuEPO, indicating that leptin is not an effective factor in erythropoiesis. Conversely, older age and shorter hemodialysis durations are accompanied by reduced need for rHuEPO.
Abbasi Larki R, Seifi S, Lesan Pezeshki M,
Volume 68, Issue 11 (2-2011)
Volume 68, Issue 11 (2-2011)
Abstract
Background: Prohepcidin, a liver-derived peptide with antimicrobial properties, is regulated by factors such as iron load and inflammation. Hepcidin is a central player in iron homeostasis. It downregulates the iron exporter ferroportin, thereby inhibiting iron absorption, release and recycling. Thus, prohepcidin increases the possibility of iron-limited erythropoiesis and development of anemia. In end-stage renal disease (ESRD), plasma hepcidin levels are elevated, which may contribute to iron deficiency in these patients. This study was undertaken to investigate the relationship between prohepcidin and serum biochemical parameters related to anemia and inflammation in the aforesaid patients.
Methods: Fifty-four stable patients with uremia who were on chronic hemodialysis were enrolled in the study. The patients were withheld from intravenous iron two weeks prior to laboratory measurements. Later, (total) prohepcidin was measured by ELISA method as were other parameters including serum iron, TIBC, TSAT, Hct, ferritin, albumin, CRP, ESR, cholesterol and triglyceride.
Results: Serum prohepcidin levels were higher than normal values in the patients, but they were not correlated to the serum iron, TIBC, TSAT, Hct, ferritin, albumin, cholesterol and triglyceride (p>0.05). No significant association were also found with ESR (p=0.97, r= -0.005) or CRP (p=0.053, r =0.26).
Conclusion: Serum prohepcidin level was higher in chronic hemodialysis patients but it was not predictive of iron status or inflammatory conditions in these patients. Confirmation of these results may necessitate studies with larger sample sizes or measurement of the biologically active form of hepcidin.
Rohani Zohre , Sanadgol Hooshang , Khajehnasiri Samaneh ,
Volume 69, Issue 12 (3-2012)
Volume 69, Issue 12 (3-2012)
Abstract
Background: Atherosclerotic vascular disease is a major cause of morbidity and mortality in patients with end-stage renal diseases on maintenance hemodialysis. Early atherosclerotic changes of the arterial wall can be evaluated by measuring intima-media thickness (IMT), and looking for the presence and structure of plaques and parameters of vascular resistance. In this study we investigated the relationship between carotid IMT and pulsatility index (PI) or resistive index (RI) values in hemodialysis patients.
Methods: Sixty hemodialysis patients (27 females and 33 males median age 41.7 years) and 60 healthy volunteers (32 females and 28 males, median age 37.8 years) underwent ultrasonography of common carotid artery for the determination of IMT, PI and RI.
Results: Bilateral IMT was significantly higher in hemodialysis patients than in control group (P<0.001). Left carotid artery RI and PI were found to be significantly higher in hemodialysis patients than in the controls (P<0.001). Right carotid artery RI and PI had no significant statistical differences between the two groups (P=0.18 and P=0.78, respectively). There was a moderately significant negative correlation between the left carotid IMT and left RI and PI in the controls (r= -0.42, P=0.001 and r=- 0.43, P<0.001, respectively).
Conclusion: PI and RI values of the left coronary artery increased as did IMT in hemodialysis patients. Therefore, measurement of RI and PI values together with IMT are recommended for early diagnosis of atherosclerosis in hemodialysis patient.
Roghayyeh Borji , Mohammad Reza Khatami, Mohammad Reza Abbasi , Alipasha Meysamie , Khosro Barkhordari , Farah Ayatollah Esfahani, Mina Pashang, Laleh Ghadirian ,
Volume 71, Issue 12 (3-2014)
Volume 71, Issue 12 (3-2014)
Abstract
Background: The mortality due to Coronary Artery Bypass Graft (CABG) in patients with chronic renal failure is more common than normal population. This study evalu-ates the impacts of prophylactic dialysis on decreasing mortality and morbidity of non- dialysis-dependent patients with renal failure after CABG surgery. Methods: In this study, fifty non-dialysis-dependent patients who were suffering from renal failure and needed to CABG, were selected by convenience sampling method. Se-quentially, they were allocated to prophylactic dialysis (n=20) and no prophylactic dialysis (n=30) groups, using a randomized block design. Exclusion criteria were under 18 year old patients and doing CABG for second time. Mortality rate and some complications such as acute renal failure, brain accident and atrial arrhythmias were compared between two groups after CABG. All cardiac surgeries were performed in a single centre and through a median sternotomy. P value less than 0.05 was considered as significant. Results: The mean age of patients was (65.3±9.9). The patients included %16 (n.8) of women and %84 (n.42) of men. There were 20 patients in intervention and 30 patients in control groups. Baseline characteristics were similar in two groups. Comparison be-tween intervention and control groups after surgery did not show any difference in mortality (P=0.14), acute renal failure (P=0.4), cerebrovascular accidents (P=1) and atrial arrhythmias (P=0.3), need to second surgery due to bleeding (P=1), need to dialysis (P=0.14), need to rehospitalization (P=1), duration of ventilator use (P=0.4), duration of need to hospitalization (P=0.11), duration of a patients stay in the Intensive Care Unit (P=0.4) and deep sternal infection (P=0.7) rates. Conclusion: According the results of this study, prophylactic dialysis, before conduct-ing CABG, does not have any significant effect on mortality and other complications. The only exception is lung complications in non-dialysis-dependent patients with renal failure.
Maryam Rahbar , Zahra Chitsazan, Bahram Moslemi , Tayeb Ramim ,
Volume 73, Issue 1 (4-2015)
Volume 73, Issue 1 (4-2015)
Abstract
Background: One of the toxins accumulated in the body of hemodialysis patients is beta-2 microglobulin which is caused and increased by various factors. The one of this factors that can affect beta-2 macroglobulin is of membrane type that using in hemodialysis. In the present study, we examined the impact of C-reactive protein (CRP) as an inflammatory factor on beta-2 microglobulin in high-flux membrane hemodialysis patients. Methods: This cross-sectional study was done in 44 hemodialysis patients that have been dialyzed in two academic centers Sina and Amir Alam Hospitals, Tehran, Iran from 2013 to 2014. The patients were hemodialyzed via fistula or permanent catheters three times a week for 4 hours for more than three months. Patients with known infectious disease, hemodialysis with low-flux membrane and dialysis less than three times a week were excluded. All patients were hemodialyzed using Fresenius biocompatible high-flux membrane (FX 100, Fresenius, Massachusetts, USA). Arterial blood sampling was performed. beta-2 microglobulin, CRP, BUN and creatinine tests were conducted for all patients. Results: Forty-four patients among the chronic hemodialysis patients were selected for final analysis. 20 males (44.5%) and 24 females (54.5%) were included in this study. The frequencies of underlying disease in patients participating in the study were as follows: hypertension, 23 cases (52.3%) diabetes mellitus, 11 cases (25%) hypertension and diabetes mellitus, 2 cases (4.5%) obstructive disorder, 2 cases (4.5%). In 23 patients (52.3%), beta-2 macroglobulin was >12 mg/l and in 21 (47.7%), it was <12 mg/l. 29 cases (65.9%) had CRP values less than or equal 6 mg/l. However, there was no significant differences between beta-2 microglobulin and CRP levels (P= 0.460). Also regression analysis of data showed no relationship between beta-2 microglobulin and CRP levels (r= -047, P= 0.763). Conclusion: Although it seems that inflammatory factors can be effective in increasing beta-2 microglobulin, the present study did not find such a relationship between CRP and beta-2 microglobulin.
Javad Hashemi , Zahra Hesari , Ali-Reza Golshan ,
Volume 75, Issue 1 (4-2017)
Volume 75, Issue 1 (4-2017)
Abstract
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Background: Nowadays, chronic kidney disease (CKD) is known as an epidemic disease all around the world. Chronic kidney disease considered as a serious health problem with numerous side effects, including complications progressive in reducing glomerular filtration rate (GFR), imbalances in the homeostasis of the body and decreased quality of life and finally an increase in mortality due to cardiovascular problems. End-stage renal disease leads to hypocalcemia and hyperphosphatemia, that as a result of, parathyroid hormone (PTH) will increased that secondary hyperparathyroidism will occurred eventually. So it is essential to routine examination of electrolytes in these patients. The current study have been done to determine the electrolytes in saliva as a non-invasive sample in hemodialysis patients in order to the saliva to be presented as an appropriate samples for clinical laboratories. Methods: In the present case-control study that has been performed at Imam Ali Hospital, Bojnord, North Khorasan Province, Iran, in the summer of 2016, 44 hemodialysis patients and 44 aged, gender and body mass index (BMI) matched healthy controls were selected and then their cell count, Hb, HCT, iron, ferritin, total iron binding capacity (TIBC), glucose, CRP, triglycerides, cholesterol, urea, creatinine, calcium, phosphorus, potassium and PTH were measured. Results: Calcium and phosphorus were higher in hemodialysis patients in comparison to the control group. Furthermore, there are not any significant relationship between levels of calcium, phosphorus and potassium in both serum and saliva samples. In addition, we observed the positive relationship between PTH in serum as well as phosphorus and potassium in the saliva. Conclusion: The findings of current study have been shown that salivary levels of calcium and phosphorus in hemodialysis patients is higher than healthy people, therefor could be a non- invasive suitable marker for diagnosis. In addition, blood PTH levels in hemodialysis patients is associated with salivary levels of phosphorus and potassium, so, perhaps these parameters marked PTH's representative in the blood with further investigation of saliva’s electrolytes. |
Parviz Saleh , Mohammadamin Rezazadehsaatlou , Sara Tofighi ,
Volume 75, Issue 8 (11-2017)
Volume 75, Issue 8 (11-2017)
Abstract
Background: Studies indicate a prevalence of 39.2% diabetes mellitus (DM) as the most common underlying cause in patients with dialysis. Statistics showed that the rates of morbidity and mortality were higher in hemodialysis patients with diabetes compared with hemodialysis patients without diabetes. The aim of this study was to evaluate the risk factors responsible for infections in patient’s chronic renal failure on hemodialysis patients having diabetic foot ulcers.
Methods: In this cross-sectional study, data were collected from 30 randomly selected hemodialysis patients who were referred to Imam Reza hospital, Tabriz from April 2016 to April 2017. The patients' records were taken according to inclusion and exclusion criteria and data were collected in designed questionnaires for further analysis.
Results: 63.3% of patients were males and 36.7% were females. The average age of study population was 51.23±12.74. Duration of dialysis was 5.15±3.58 years. The average HBA1C was 9.08±1.48. Bacterial cause of feet ulcer was isolated only in 56.7% of cases. Isolated bacteria were anaerobic (47.05%), gram-positive (35.29%) and gram negative (17.64%). Amputation was performed in 26.7% of cases. Mortality was reported in 13.3% of patients. Low personal hygiene, presence of vasculopathy, mortality and amputation was higher in anaerobic infections. Most infections were seen in patients with inadequate dialysis. Low dialysis adequacy, amputation, vasculopathy, increased duration of dialysis, poor hygiene was seen in patients with higher HbA1C.
Conclusion: These results indicate the importance of diabetic foot ulcers caused by anaerobic infections, because of the outcome of amputation and higher mortality rates in these patients, the prognosis is worse than other cases. Also, due to the direct relationship between personal hygiene and the development of anaerobic infections, it is possible to prevent these infections significantly by following these considerations. Most infections were found to be inappropriate in dialysis adequately. Therefore, accurate monitoring of patient's diabetes in the long run and the importance of this can control the complications of diabetes, including vasculopathy, followed by the need for amputation for fighting against diabetic foot ulcers.
Methods: In this cross-sectional study, data were collected from 30 randomly selected hemodialysis patients who were referred to Imam Reza hospital, Tabriz from April 2016 to April 2017. The patients' records were taken according to inclusion and exclusion criteria and data were collected in designed questionnaires for further analysis.
Results: 63.3% of patients were males and 36.7% were females. The average age of study population was 51.23±12.74. Duration of dialysis was 5.15±3.58 years. The average HBA1C was 9.08±1.48. Bacterial cause of feet ulcer was isolated only in 56.7% of cases. Isolated bacteria were anaerobic (47.05%), gram-positive (35.29%) and gram negative (17.64%). Amputation was performed in 26.7% of cases. Mortality was reported in 13.3% of patients. Low personal hygiene, presence of vasculopathy, mortality and amputation was higher in anaerobic infections. Most infections were seen in patients with inadequate dialysis. Low dialysis adequacy, amputation, vasculopathy, increased duration of dialysis, poor hygiene was seen in patients with higher HbA1C.
Conclusion: These results indicate the importance of diabetic foot ulcers caused by anaerobic infections, because of the outcome of amputation and higher mortality rates in these patients, the prognosis is worse than other cases. Also, due to the direct relationship between personal hygiene and the development of anaerobic infections, it is possible to prevent these infections significantly by following these considerations. Most infections were found to be inappropriate in dialysis adequately. Therefore, accurate monitoring of patient's diabetes in the long run and the importance of this can control the complications of diabetes, including vasculopathy, followed by the need for amputation for fighting against diabetic foot ulcers.
Farzad Firouzi Jahantigh, Iraj Najafi , Maryam Ostovare ,
Volume 75, Issue 10 (1-2018)
Volume 75, Issue 10 (1-2018)
Abstract
Background: Peritoneal dialysis is one of the most commonly used treatment methods for the patients with end stage renal failure. In recent years, the mortality rate of patients under this treatment has decreased; however, long-term survival is still an important challenge for health systems. The present study aimed to predict the survival of continuous ambulatory peritoneal dialysis patients.
Methods: In this retrospective study, according to the difference of relative importance of demographic characteristics, laboratory data, dialysis adequacy parameters and nutritional status in various patients, the factors affecting the survival of peritoneal dialysis patients have been identified by random forest algorithm. Then, the clinical and laboratory data of patients undergoing continuous ambulatory peritoneal dialysis treatment were evaluated retrospectively from July 1996 to April 2014 in 18 peritoneal dialysis centers, using multi-class one against all support vector machine (OAA-SVM) and multi-space mapped binary tree support vector machine (MBT-SVM) algorithms.
Results: 3097 patients were studied with the mean age of 50.63±15.67 years and average follow-up time of 24.48±19.13 months. The results of the random forest algorithm have identified 35 factors as the most important predictors of peritoneal dialysis patient’s survival. Then, the prediction of peritoneal dialysis patients’ survival status was evaluated using one against all support vector machine and multi-space mapped binary tree support vector machine algorithms in 5 classes of patients including “still on peritoneal dialysis”, “transferred to hemodialysis”, “received a kidney transplant”, “died” and “improved kidney function”. The reliability of survival prediction algorithms were 51.99% and 89.57% respectively.
Conclusion: An accurate prediction model would be a potentially useful way to evaluate patients’ survival at peritoneal dialysis that increased clinical scrutiny and timely intervention could be brought to bear. So, in this research, the multi-space mapped binary tree support vector machine algorithm has a high precision in predicting the survival of continuous ambulatory peritoneal dialysis patients considering multiple evaluation indices and different class distribution functions.
Methods: In this retrospective study, according to the difference of relative importance of demographic characteristics, laboratory data, dialysis adequacy parameters and nutritional status in various patients, the factors affecting the survival of peritoneal dialysis patients have been identified by random forest algorithm. Then, the clinical and laboratory data of patients undergoing continuous ambulatory peritoneal dialysis treatment were evaluated retrospectively from July 1996 to April 2014 in 18 peritoneal dialysis centers, using multi-class one against all support vector machine (OAA-SVM) and multi-space mapped binary tree support vector machine (MBT-SVM) algorithms.
Results: 3097 patients were studied with the mean age of 50.63±15.67 years and average follow-up time of 24.48±19.13 months. The results of the random forest algorithm have identified 35 factors as the most important predictors of peritoneal dialysis patient’s survival. Then, the prediction of peritoneal dialysis patients’ survival status was evaluated using one against all support vector machine and multi-space mapped binary tree support vector machine algorithms in 5 classes of patients including “still on peritoneal dialysis”, “transferred to hemodialysis”, “received a kidney transplant”, “died” and “improved kidney function”. The reliability of survival prediction algorithms were 51.99% and 89.57% respectively.
Conclusion: An accurate prediction model would be a potentially useful way to evaluate patients’ survival at peritoneal dialysis that increased clinical scrutiny and timely intervention could be brought to bear. So, in this research, the multi-space mapped binary tree support vector machine algorithm has a high precision in predicting the survival of continuous ambulatory peritoneal dialysis patients considering multiple evaluation indices and different class distribution functions.
Ziba Aghsaiefard , Ziba Hossenifard , Reza Alizadeh , Tayeb Ramim ,
Volume 76, Issue 4 (7-2018)
Volume 76, Issue 4 (7-2018)
Abstract
Background: The role of high levels of parathyroid hormone in the development of anemia either directly or by mediating mechanisms is unclear, and there is a controversy about the pathophysiological role of parathyroid hormone (PTH) in the development and intensification of anemia associated with renal disease. The aim of this study was to investigate the relationship between anemia and parathyroid hormone and dialysis adequacy in chronic hemodialysis patients.
Methods: A cross-sectional study was performed in patients undergoing dialysis in Soodeh Hemodialysis Center, Vavan city, Tehran province, Iran, in two years (September 2013 to September 2015). Patients with age>18 years who underwent dialysis for at least three months were enrolled. Anemia was calculated based on the absolute amount of hemoglobin, hematocrit, and the percentage of patients who achieved the hemoglobin treatment goal of more than 11 g/dL. Parathyroid hormone levels were measured intact PTH and enzyme immunoassay (EIA) method.
Results: 176 patients who had entry criteria participated in this study. Patients included 102 males (58%) and 74 women (42%). The mean age of the patients was 54.14±13.98 years (18-85 years). The mean weight of patients was 68.07±14.17 kg (36-120 kg). 23 (13.1%) of the patients had a previous history of kidney transplantation. Of the 176 patients, only one had a history of parathyroidectomy (0.6%). The mean dialysis time in the patients was 6.38±5.29 years (1-28 years). The type of dialysis access in 132 patients (75%) was AV fistula and in 44 patients (25%) was Shaldon catheter. The mean erythropoietin intake of patients was 10,000 units per week. The mean of hemoglobin, hematocrit and PTH were 10.73 g/dl 33.6% and 403 pg/ml, respectively.
Conclusion: The findings of the study showed that there was no significant correlation between hemoglobin and hematocrit levels with parathyroid hormone levels and dialysis adequacy. Increased levels of serum iron, total iron binding capacity (TIBC) and resistance to erythropoietin were associated with a decrease in hematocrit levels due to decreased hemoglobin levels and resistance to erythropoietin.
Methods: A cross-sectional study was performed in patients undergoing dialysis in Soodeh Hemodialysis Center, Vavan city, Tehran province, Iran, in two years (September 2013 to September 2015). Patients with age>18 years who underwent dialysis for at least three months were enrolled. Anemia was calculated based on the absolute amount of hemoglobin, hematocrit, and the percentage of patients who achieved the hemoglobin treatment goal of more than 11 g/dL. Parathyroid hormone levels were measured intact PTH and enzyme immunoassay (EIA) method.
Results: 176 patients who had entry criteria participated in this study. Patients included 102 males (58%) and 74 women (42%). The mean age of the patients was 54.14±13.98 years (18-85 years). The mean weight of patients was 68.07±14.17 kg (36-120 kg). 23 (13.1%) of the patients had a previous history of kidney transplantation. Of the 176 patients, only one had a history of parathyroidectomy (0.6%). The mean dialysis time in the patients was 6.38±5.29 years (1-28 years). The type of dialysis access in 132 patients (75%) was AV fistula and in 44 patients (25%) was Shaldon catheter. The mean erythropoietin intake of patients was 10,000 units per week. The mean of hemoglobin, hematocrit and PTH were 10.73 g/dl 33.6% and 403 pg/ml, respectively.
Conclusion: The findings of the study showed that there was no significant correlation between hemoglobin and hematocrit levels with parathyroid hormone levels and dialysis adequacy. Increased levels of serum iron, total iron binding capacity (TIBC) and resistance to erythropoietin were associated with a decrease in hematocrit levels due to decreased hemoglobin levels and resistance to erythropoietin.
Mohsen Soleimani , Rahimeh Nabavi , Nadia Karimi , Abbasali Ebrahimian ,
Volume 78, Issue 3 (6-2020)
Volume 78, Issue 3 (6-2020)
Abstract
Background: Uremic pruritus is one of the important problems in patients undergoing hemodialysis. Causing the mechanism of uremic pruritus in hemodialysis patients is complex and multifactorial. Almost 60 percent of hemodialysis patients suffer from uremic pruritus. Oral hydroxyzine is a common treatment for uremic pruritus of this patients. This study aimed to survey effect of hydroxyzine on uremic pruritus of hemodialysis patients.
Methods: This quasi-experimental study (pre and post design) performed on 40 patients with eligible criteria. All of the hemodialysis patients who suffer from pruritus received a tablet of hydroxyzine 25 mg daily for 6 weeks. In this time, drugs and the plan of hemodialysis were constant. Pruritus score of patients, evaluated with 5-D pruritus scale that had 8 items with 5-score Likert scale and evaluate duration, direction, disability, and distribution of pruritus. Severity scores of pruritus before and after treatment with tablet of hydroxyzine were compared. This study was conducted on hemodialysis patients in the Soodeh Center of Hemodialysis in the south of Tehran, Iran, from September 2016 to February 2017.
Results: The findings of this study showed that most of the patients in this study were male (55%) with mean age of 55.97±11.59 years. The most cause of chronic renal failure in these patients was diabetes (37.5%). This study showed that 32.5% of the hemodialysis patients had moderate to severe uremic pruritus. The mean score of pruritus before the treatment with hydroxyzine was 16.73±3.4 and the most effect of this drug was in the social activity item (2.47±0.6). After treatment with hydroxyzine, the mean score of pruritus in the patients was 9.65±2.15 that was decreased significantly (P<0.001). The findings showed that there was no significant relationship between decrease of pruritus and characteristics of patients.
Conclusion: This study showed that uremic pruritus is still a challenge in hemodialysis patients. According to this study use of hydroxyzine, regardless of uremic pruritus mechanism, could be decreased uremic pruritus of hemodialysis patients.
Methods: This quasi-experimental study (pre and post design) performed on 40 patients with eligible criteria. All of the hemodialysis patients who suffer from pruritus received a tablet of hydroxyzine 25 mg daily for 6 weeks. In this time, drugs and the plan of hemodialysis were constant. Pruritus score of patients, evaluated with 5-D pruritus scale that had 8 items with 5-score Likert scale and evaluate duration, direction, disability, and distribution of pruritus. Severity scores of pruritus before and after treatment with tablet of hydroxyzine were compared. This study was conducted on hemodialysis patients in the Soodeh Center of Hemodialysis in the south of Tehran, Iran, from September 2016 to February 2017.
Results: The findings of this study showed that most of the patients in this study were male (55%) with mean age of 55.97±11.59 years. The most cause of chronic renal failure in these patients was diabetes (37.5%). This study showed that 32.5% of the hemodialysis patients had moderate to severe uremic pruritus. The mean score of pruritus before the treatment with hydroxyzine was 16.73±3.4 and the most effect of this drug was in the social activity item (2.47±0.6). After treatment with hydroxyzine, the mean score of pruritus in the patients was 9.65±2.15 that was decreased significantly (P<0.001). The findings showed that there was no significant relationship between decrease of pruritus and characteristics of patients.
Conclusion: This study showed that uremic pruritus is still a challenge in hemodialysis patients. According to this study use of hydroxyzine, regardless of uremic pruritus mechanism, could be decreased uremic pruritus of hemodialysis patients.
Alireza Rai, Siros Amiri, Mohammadreza Sobhiyeh,
Volume 78, Issue 4 (7-2020)
Volume 78, Issue 4 (7-2020)
Abstract
Background: The ineffectiveness of hemodialysis fistulas causes high costs and increases mortality and morbidity rates. The efficacy of drug-coated balloon and nondrug-coated balloon in dysfunctional arteriovenous Fistula was evaluated over six month period.
Methods: In this randomized clinical trial, a total of a total of 50 hemodialysis patients who referred to Imam Reza Hospital in Kermanshah for failing of arteriovenous fistula in 2018 year, were randomly divided into two separate groups of drug-coated balloon angioplasty and non-drug coated balloon angioplasty. All of these procedures were done with the same surgeon. Patients were followed-up for 6 months. Variables and data of patients like age, gender, diabetes mellitus, hypertension, and location of arteriovenous fistula were documented and analyzed by SPSS software, version 21 (SPSS Inc., Chicago, IL, USA) using statistical tests. T-test and chi-square test were used for data analysis and the significance level was considered less than 0.05.
Methods: In this randomized clinical trial, a total of a total of 50 hemodialysis patients who referred to Imam Reza Hospital in Kermanshah for failing of arteriovenous fistula in 2018 year, were randomly divided into two separate groups of drug-coated balloon angioplasty and non-drug coated balloon angioplasty. All of these procedures were done with the same surgeon. Patients were followed-up for 6 months. Variables and data of patients like age, gender, diabetes mellitus, hypertension, and location of arteriovenous fistula were documented and analyzed by SPSS software, version 21 (SPSS Inc., Chicago, IL, USA) using statistical tests. T-test and chi-square test were used for data analysis and the significance level was considered less than 0.05.
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Results: The success rate of drug-coated balloon angioplasty versus plain balloon angioplasty in the efficacy of arteriovenous fistulas increased significantly (19 vs. 6 and 13 vs. 12, respectively, P<0.05). There is also a significant relationship between age and diabetes over the lifetime of the arteriovenous fistula. According to results, the efficacy of arteriovenous fistula in the elderly patients (>65 years) and the diabetes mellitus patients were lower than other risk factors causing end-stage renal disease.
Conclusion: According to the results of this study, the use of drug-coated balloons rather than non drug-coated balloon is more effective in the efficiency of arteriovenous artery fistula. |
Zeinab Saremi, Mohammad Khodashenas Roudsari, Zahra Tanaki,
Volume 78, Issue 6 (9-2020)
Volume 78, Issue 6 (9-2020)
Abstract
Background: Chronic kidney disease is considered as one of the most common health problems in the world. High mortality and morbidity in these patients, are due to cardiovascular disease and infections. Neutrophil to lymphocyte ratio is recently known as an inflammatory marker. This study aimed to determine the ratio of neutrophil to lymphocyte count in hemodialysis patients in Birjand Special Disease Center, and its role in mortality and morbidity during one-year follow-up.
Methods: This is an analytical descriptive study that was performed on 59 End-Stage Renal disease patients referred to the dialysis department of Special Disease Center, Birjand University of Medical Sciences Birjand, Iran. The levels of neutrophil to lymphocyte ratio, erythrocyte sedimentation rate, and C reactive protein were measured and cases divided into 4 groups according to the NLR: less than 1, 1-1.5, 1.5-2.5, 2.5-3.5, and>3.5. All patients were followed up for one year to determine rate of mortality, cardiovascular and infectious events.
Methods: This is an analytical descriptive study that was performed on 59 End-Stage Renal disease patients referred to the dialysis department of Special Disease Center, Birjand University of Medical Sciences Birjand, Iran. The levels of neutrophil to lymphocyte ratio, erythrocyte sedimentation rate, and C reactive protein were measured and cases divided into 4 groups according to the NLR: less than 1, 1-1.5, 1.5-2.5, 2.5-3.5, and>3.5. All patients were followed up for one year to determine rate of mortality, cardiovascular and infectious events.
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Results: The mean NLR was 2.89±1.38. There was no significant difference in mortality rate between groups according to NLR with P=0.052, also no remarkable difference in infectious and cardiovascular morbidity events in groups with P=0.09 and P=0.21, respectively. The mean NLR in patients with cardiovascular or infectious events was 4.2 and 3.75 respectively, which were notably higher than patients without cardiovascular (NLR:2.49) and infectious (NLR:2.68) events, P=0.02 and P=0.03 respectively. In the bivariate correlation analysis, NLR was positively correlated with CRP in hemodialysis patients.
Conclusion: ESRD patients with NLR>2.5 have higher cardiovascular and infectious events than patients with NLR<2.5 but there was no difference in mortality rate between them. |
Mohammad Hossein Kamaloddini, Khadije Saravani,
Volume 78, Issue 12 (3-2021)
Volume 78, Issue 12 (3-2021)
Abstract
Background: Given the huge mental, psychological, and economic impact imposed on patients with chronic renal failure, it seems quite necessary to study life satisfaction in such individuals in to order to provide the necessary information and plan for appropriate services. In form of a systematic review and meta-analysis, the present study was conducted in to order to compare the quality of life in two groups of patients, one undergoing hemodialysis and the other recipients of a kidney transplant.
Methods: In order to fulfill the objective of the present study, among innumerable researches carried out in this field, through the implementation of a meta-analysis checklist nine researches were found to be qualified for the final meta-analysis (specific consideration was given to the following criteria: hypothesis, research method, statistical population, sample size, sampling method, measurement tool, and statistical analysis method). All related studies conducted from June 1995 to July 2016 in Iran.
Methods: In order to fulfill the objective of the present study, among innumerable researches carried out in this field, through the implementation of a meta-analysis checklist nine researches were found to be qualified for the final meta-analysis (specific consideration was given to the following criteria: hypothesis, research method, statistical population, sample size, sampling method, measurement tool, and statistical analysis method). All related studies conducted from June 1995 to July 2016 in Iran.
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Results: Out of 310 articles that had been selected initially, 262 were removed after reviewing their full text, then, 39 more articles were removed due to over-similarity of titles or exact repetition of the same topic. Finally, 9 studies Were found to be for the meta-analysis process. The sample size included 1736 subjects. The results of the analysis of total quality of life scores in renal transplant patients and hemodialysis patients showed that the mean overall quality of life of transplanted patients was 42.26±42.2 and the mean score for patients with hemodialysis was 42.9±36.36. The difference in the mean quality of life in renal transplant patients and hemodialysis patients was statistically significant (P<0.05), and renal transplant patients had a better quality of life in comparison with patients undergoing hemodialysis.
Conclusion: Patients undergoing hemodialysis experience more severe suffering due to their specific circumstances. Recognizing and applying the predictive factors for the quality of life of these patients can help to design more suitable care and treatment programs. It is also desirable to take effective steps to improve the quality of life of these patients in planning health-care services; the final hope is to provide considerable enhancement within the quality of life for patients with renal failure. |
Kowsar Sadat Ashrafi, Nasser Saeedi, Parvin Soltani, Ali Sadough Abbasian , Mohammad Rafiei, Fereshteh Nejati, Mahdieh Gholamzadeh, Mojtaba Ahmadlou,
Volume 80, Issue 12 (3-2023)
Volume 80, Issue 12 (3-2023)
Abstract
Background: Adequacy of dialysis is a very important issue in dialysis patients, so comparing the adequacy of dialysis in different dialysis methods is very important. Therefore, due to the fact that the number of people undergoing dialysis through fistulas and catheters varies in different centers, and depending on different centers, there is a possibility of decreasing or increasing the adequacy of dialysis, so we decided to do this comparison in Arak support center.
Methods: In this analytical-cross-sectional study, the dialysis patients of Hami Arak Center from April 2019 to September 2019 were divided into two groups (the first group with permanent catheter, the second group with arteriovenous fistula) based on vascular access. The both groups were matched in terms of age, sex, weight, pump speed, filter size and also the duration of dialysis. All patients were dialyzed with the same type of dialysis machine, and the duration of hemodialysis for all samples was 4 hours in each session. To confirm the reliability of the device, it was calibrated before each use and the same setting was used for all samples. The blood samples were taken from the arterial route before dialysis and starting the dilution with heparin or normal saline. Statistical models of dialysis adequacy of patients in two groups were measured using the Kt/V criterion, SPSS and AMOS data analysis was performed.
Methods: In this analytical-cross-sectional study, the dialysis patients of Hami Arak Center from April 2019 to September 2019 were divided into two groups (the first group with permanent catheter, the second group with arteriovenous fistula) based on vascular access. The both groups were matched in terms of age, sex, weight, pump speed, filter size and also the duration of dialysis. All patients were dialyzed with the same type of dialysis machine, and the duration of hemodialysis for all samples was 4 hours in each session. To confirm the reliability of the device, it was calibrated before each use and the same setting was used for all samples. The blood samples were taken from the arterial route before dialysis and starting the dilution with heparin or normal saline. Statistical models of dialysis adequacy of patients in two groups were measured using the Kt/V criterion, SPSS and AMOS data analysis was performed.
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Results: In the analysis of covariance of BUN before dialysis, there is a statistically significant difference in the studied groups (P<0.05), also in the UF and URR variables, dialysis time and the number of times of dialysis in three consecutive repetitions, there is a statistically significant difference in the studied groups. (dime fistula and catheter) are not present (P<0.05).
Conclusion: In this study, during repeated repetitions, 22% of the dialysis adequacy in the two groups did not have good adequacy, and 78% of the patients in the two groups had appropriate dialysis adequacy. |
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