ABSTRACT
Introduction: Dialysis still remains the most common modality for the treatment of end stage kidney disease and it could be maneuvered to augment its dose, minimize complications and improve outcome. Dialysis prescription is a brief of how dialysis is to be given and involves adjustments in patients' characteristics, disease or dialytic procedure. This study aimed to assess the determinants of the prescribed dialysis and its relationship with intradialytic complications and the dialysis dose. Methods: A prospective study in which 1248 sessions for 232 consented participants with end stage kidney disease on maintenance hemodialysis were studied from 2017-2020. Biodata was taken, participants were examined and blood samples were taken to determine electrolytes, urea/creatinine and hematocrit. Pearson's correlation was used to determine the strength of association between dialysis dose and some variables. Results: Determinants of the prescribed dose were dialysis frequency (P<0.001), and predialysis systolic blood pressure (P<0.001) and packed cell volume (P<0.001). Dialysis sessions without significant intradialytic blood pressure changes were most likely to be completed, as sessions with intra-dialysis hypotension were most likely to be terminated. Participants dialyzed with high flux dialyzers, via an arterovenous fistula, higher blood flow and ultrafiltration rates had higher dialysis doses (P<0.001 in all instances). Conclusion: Higher dialysis doses were achieved with higher blood flow and ultrafiltration rates. Intradialytic hypotension was common with dialysis termination, higher blood flow and ultrafiltration rates. Intradialytic hypertension was common with low flux dialyzers. An optimized dialysis prescription is needed to deliver an adequate dialysis dose and minimize complications
Subject(s)
Humans , Male , Female , Blood Circulation , Renal Dialysis , Dialysis , Prescriptions , Kidney Diseases , TherapeuticsABSTRACT
Les patients en hémodialyse présente un risqué élevé d'infection à SARS-Cov-2. Les stratégies préventives doivent donc être mises en place pour réduire le risque de transmission de la maladie en hémodialyse parmi lesquelles, l'éducation du staff médical ainsi que des patients, le screening de la maladie à COVID-19 ainsi que la séparation des patients infectés ou symptomatiques des non infectés
Subject(s)
COVID-19 , Coronavirus Infections , Democratic Republic of the Congo , Dialysis , Hemodialysis Units, Hospital , Practice GuidelineSubject(s)
Dialysis , Health Services Accessibility , Quality of Life , Renal Insufficiency, ChronicABSTRACT
Background: Chronic kidney disease (CKD) has an increased risk of not only end-stage renal disease (ESRD); but majority of moderate CKD patients do die from cardiovascular disease (CVD) before reaching ESRD. The prognosis of these patients is very poor in most developing countries because of late presentation; inadequate diagnostic facilities; and inability to pay for treatment. Knowledge about CVD in CKD is crucial because of unpredictable progressive nature of the disease and increased risk of premature death from cardiovascular events. We sought to determine prevalence and pattern of electrocardiographic abnormalities in dialysis naive CKD patients. Materials and Methods: This is a 10-year prospective cross-sectional study carried out at the University of Ilorin Teaching Hospital; Ilorin. Patients were recruited from the nephrology clinic and renal wards and all who met diagnostic criteria for stages 4 and 5 CKD were included. All had their standard 12-lead electrocardiogram (ECG) recorded and various findings were critically studied and interpreted independently by two consultant physician including a cardiologist. Data analysis was done using SPSS version 16. Results: Overall; 86of the patients had at least one form of ECG abnormality; with hypertension (HTN) and anemia being the main contributory factors. These include left ventricular hypertrophy (LVH) (27.6); left atrial enlargement (LAE) (21.6); combination of LVH and LAE (17.2); and ventricular premature contractions (6). Etiology of CKD appears to have influence on ECG changes as prevalence of LVH and LAE were high among hypertensive renal disease; chronic glomerulonephritis (CGN); and diabetic nephropathy patients. Conclusion: LVH and LAE were very common ECG abnormalities in our dialysis naive CKD patients. HTN; CGN; anemia; late presentation; and male gender appear to be the main risk factors for the ECG abnormalities. There is need for gender-specific intervention strategies directed at early detection and treatment of HTN; anemia; and underlying kidney disease; especially in resource poor nations where the burden of CKD is assuming epidemic proportion
Subject(s)
Dialysis , Electrocardiography , Renal InsufficiencyABSTRACT
Introduction: Psychiatric illness is common among patients with chronic disorders; particularly in those with end-stage renal disease on renal replacement therapy (RRT). Patients with a functioning renal allograft have an improved quality of life (QOL) compared to patients on dialysis. Objective: to evaluate the psychological disorders and QOL among dialysis patients and renal transplant recipients. Patients and Methods: This is a prospective cross-sectional study that included 168 patients on RRT. Their psychological health status was assessed through clinical examination and relevant designed questionnaires .The data obtained were fed to the SPSS for analysis. Significance was assumed at P 0.05. Results: Out of 168 ESRD Sudanese patients; 43 (25.6) received renal allograft. The frequency of depression was 90 (72) and nine (25.6) of patients on dialysis; and kidney transplant recipients respectively. Anxiety was reported with significant difference (p 0.001) in the dialyzed patients compared to kidney transplant recipients. Sleep disorders were experienced by 81 (64.8) of dialyzed; and nine (20.9) of kidney transplant recipients (P0.001). Conclusion: Psychological disorders in dialyzed ESRD patients have significant effect on the quality of life and may have a tremendous impact on mortality and morbidity. For this reason; supportive management by psychologist and or psychiatrist is recommended for early detection and alleviation of symptoms of mood and mind disturbances. For most patients with ESRD kidney transplantation offers the greatest potential for restoring healthy productive life
Subject(s)
Dialysis , Quality of Life/psychology , Renal Insufficiency , Renal Replacement Therapy/psychologyABSTRACT
Objectives: This is a prospective cross sectional study carried out in Gezira Hospital for Renal Diseases and Surgery (Sudan) to assess the adequacy of hemodialysis in 206 patients with end stage kidney disease on regular hemodialysis twice per week using. Methods: Pre and post hemodialysis blood sample were obtained from the study group, spKt/V and urea reduction ratio were calculated. Results: Mean Kt/v was found to be 1.19 and urea reduction ratio was 59.55%. None of the patients in this study group achieved the National Kidney Foundation Dialysis Outcomes Quality Initiative (K/DOQI) recommendations for adequate hemodialyis, since it requires three hemodialyis sessions per week and our patients are receiving two sessions per week. Conclusion: In order to improve the situation herewith we recommended increased number of sessions from two to three times per week and /or increase the duration of hemodialysis session, increase blood flow rate and dialysate flow rate. Moreover, decrease the number of patients on regular hemodialysis by encouraging the patients to take the other renal replacement therapy (peritoneal dialysis and renal transplantations)
Subject(s)
Dialysis/methods , Kidney Diseases , Prospective StudiesABSTRACT
Renal failure is a common finding in human immunodeficiency virus infected patients; and it contributes significantly to their morbidity and mortality. Most dialysis centres in Nigeria currently do not accept HIV positive patients for dialysis therapy for many reasons. The prevailing high level of stigmatization of HIV positive patients and the lack of job security for infected staff are two major reasons for the non-acceptance of HIV infected patients for dialysis by these centres. Following a pathetic encounter with an HIV positive patient who required dialysis and the success of his treatment; our centre currently perform dialysis for HIV positive patients on routine basis. In this article; we present our clinical observations on the characteristics of HIV patients dialyzed in our unit between 1st January 2004 and 31st December 2004. A total of 142 patients dialyzed in our centre during this period. 24 (16.9) were HIV positive. Acute renal failure was significantly more common in the HIV positive patients. [14(31.8) of 44 patients who presented with acute renal failure. X2 = 8.95; p 0.05]. Aetiologically; septicaemia was the most common cause of acute renal failure [7(50) of 14 patients]. HIV associated nephropathy accounted for 8(80) out of 10 HIV positive patients dialyzed with chronic renal failure. Outcome of therapy was not significantly different when compared with the HIV negative patients. We conclude that renal function impairment is common in patients with HIV infection. Treatment outcomes are essentially similar to HIV seronegative patients. The main determining factor being the ability of the patient to finance dialysis therapy
Subject(s)
HIV , AIDS-Associated Nephropathy , Dialysis , Renal InsufficiencyABSTRACT
Renal failure is a common finding in human immunodeficiency virus infected patients; and it contributes significantly to their morbidity and mortality. Most dialysis centres in Nigeria currently do not accept HIV positive patients for dialysis therapy for many reasons. The prevailing high level of stigmatization of HIV positive patients and the lack of job security for infected staff are two major reasons for the non-acceptance of HIV infected patients for dialysis by these centres. Following a pathetic encounter with an HIV positive patient who required dialysis and the success of his treatment; our centre currently perform dialysis for HIV positive patients on routine basis. In this article; we present our clinical observations on the characteristics of HIV patients dialyzed in our unit between 1st January 2004 and 31st December 2004. A total of 142 patients dialyzed in our centre during this period. 24 (16.9) were HIV positive. Acute renal failure was significantly more common in the HIV positive patients. [14(31.8) of 44 patients who presented with acute renal failure. X2 = 8.95; p 0.05]. Aetiologically; septicaemia was the most common cause of acute renal failure [7(50) of 14 patients]. HIV associated nephropathy accounted for 8(80) out of 10 HIV positive patients dialyzed with chronic renal failure. Outcome of therapy was not significantly different when compared with the HIV negative patients. We conclude that renal function impairment is common in patients with HIV infection. Treatment outcomes are essentially similar to HIV seronegative patients. The main determining factor being the ability of the patient to finance dialysis therapy
Subject(s)
AIDS-Associated Nephropathy , Acquired Immunodeficiency Syndrome , Dialysis/therapy , Renal InsufficiencyABSTRACT
The potential benefits of early referral to a nephrologist of chronic uremics include slowing the rate of decline associated with progressive renal insufficiency and facilitating efficient entry into dialysis programs. Late referral is associated with complications that are uncommon among early referrals. This study aim to evaluate the pattern of referral among chronic uremics with a view to identifying associated problems. All the patients seen with chronic renal failure during a five-year period in the dialysis unit of the hospital had their medical records reviewed. Information was extracted on the clinical data and laboratory records. Ninety patients were seen in the dialysis unit of the hospital during this period. The mean age was 38.3+ 1.6 years (range 10-69 years) with a peak incidence in the second decade. Most patients were referred late from the private medical clinics 34(37.8 % ) and the general hospitals 32(35.6 % ). Seventy (77.8 % ) patients were initially diagnosed as chronic uremics, six months prior to referral. The aim of referring in most cases was persistent uremic symptoms and necessity for dialysis. Only 14(15.6 %) patients presented without complications. The commonest were pulmonary edema, (28.9 % ) biventricular failure (22.2 % ) and hypertension (20 % ). The majority of the patients were referred late to nephrologists and presented with complications. Chronic Renal Failure patients should be referred early to nephrologists so as to prevent/reduce morbidity and mortality