Comparison of enterocystoplasty and ureterocystoplasty before kidney transplantation

Augmentation cystoplasty before or after renal transplantation is an option for patients with end-stage renal disease who are candidates for renal transplantation and have low capacity and poorly compliant bladders. To compare two surgical methods of bladder augmentation-enterocystoplasty [EC] and ureterocystoplasty [UC]-before kidney transplantation, and their outcome with that in kidney recipients who had normal bladder function. During a 20-year period [1988-2008], 1406 renal transplantation were performed in our center by our team. In 16 patients having a mean age of 18.8 years, EC [group A] and in 8 with mean age of 11.5 years, UC [group B] were performed before renal transplantation. These two groups were compared with a control group of 30 recipients with normal bladder [group C] with mean age of 15.6 years, for kidney function, graft and patient survival, and the frequency of urinary tract infection [UTI]. There was normal graft function in 11 of group A, 7 of group B, and 24 of group C patients, during a mean follow-up of 73.1 months. The mean +/- SD serum creatinine in follow-up was 1.72 +/- 0.31, 1.37 +/- 0.13 and 1.33 +/- 0.59 mg/dL in groups A, B and C, respectively. No statistically significant differences were observed among the 3 studied groups in terms of 1-, 5- and 10-year graft and patient survivals. Number of episodes of febrile UTI requiring hospitalization was 23, 6 and 2 in groups A, B and C, respectively. UTI and urosepsis were significantly more frequent in group A than groups B [p=0.025] and C [p=0.001]; no significant difference was observed in the frequency between groups B and C [p=0.310]. Both EC and UC are equally recommended before renal transplantation for reconstruction of the lower urinary tract; use of each method should be individualized depending on specific conditions of recipient

Comparison of the effect of food and non-food ingestion during hemodialysis on early acute side effects of hemodialysis

Background and purpose: Food ingestion during hemodialysis may aggravate early side effects of hemodialysis due to hemodynamic changes. Therefore, this study was carried out to investigate the effect of food and non-food ingestion during hemodialysis on its early symptoms

Methods and materials: This clinical trial was conducted on the research population of ESRD Patients; 31 cases were selected through convenient and purposeful sampling. They were NPO during hemodialysis first, and received one meal [containing 325 Kcal] one hour after the second hemodialysis started. Their blood pressure, intensity of nausea and vomiting immediately before and after hemodialysis, and every 30 minutes during hemodialysis were measured and recorded. The obtained data were analyzed in SPSS using paired and independent t-test, Pearson and Spearman correlation coefficients, Wilcoxon and McNemar tests

Results: Blood pressure reduced 6.1 +/- 4.1 mmHg 60 minutes after hemodialysis started but in non-food hemodialysis, the reduction was 1067 +/- 2.57 mmHg, and the difference was significant. Also nausea intensity after food ingestion increase in 11 patients [35.5%], but it increased in 5 cases [16.1%] after non- food hemodialysis, and the difference was significant. Vomiting intensity after food ingestion increased in 8 cases [25.8%] and in 1 patient [302%] upon non-food hemodialysis, the difference of which was significant

Conclusion: Food ingestion during hemodialysis causes a decline in blood pressure, and increases the intensity of nausea and vomiting. Therefore, food ingestion during hemodialysis should be avoided