ABSTRACT
Objective: To determine frequency of hepatitis-C in dialysis patients at start of hemodialysis, seroconversion from HCV negative to HCV positive over study duration and factors affecting seroconversion
Methods: This descriptive prospective observational study done in dialysis center of DHQ hospital Sheikhupura, Punjab, Pakistan. The study was conducted from October 2016 to October 2017. Data was collected on Performa and later followed prospectively in same cohort of patients. All the patients on maintenance hemodialysis for more than one month were included in the study. Patients with acute kidney disease and on dialysis less than one month were excluded. Patients were analyzed by dividing them in three groups, group-I patients who were HCV positive at start of dialysis, Group-II who were negative and seroconvert to HCV positive, Group-III who were negative and remained negative. All seronegative patients were followed at one, three, six and twelfth months on being hemodialysis for seroconversion
Results: Out of 230 surveyed patients 52 were HCV positive at start of dialysis and 19 were loss of follow up. Out of remaining 159 HCV negative patients 95 became HCV positive, only 64 patients remained HCV negative by end of study
Conclusion: Frequency of HCV seroconversion among chronic hemodialysis patient is found to be 53.37%. Arteriovenous access, number of dialysis, reuse of dialyzer and blood transfusions are important risk factors
ABSTRACT
Objective: To determine the outcome of chronic kidney disease [CKD] patients presenting for dialysis on the basis of referral to nephrologist. Study Design: Observational study. Place and Duration of Study: Nephrology Department of King Edward Medical University/Mayo Hospital, Lahore, from January 2014 to January 2016
Methodology: All patients who were presented in nephrology outpatients department and with the indication of dialysis were included in study. Patients who refused dialysis, and with acute kidney failure were excluded from the study. Proforma was designed for demographics, vital signs, volume status, and laboratory data [hemoglobin, urea, creatinine, albumin, bicarbonate etc.] of all the patients. On the basis of referral, patients were divided into two groups, i.e. early referral and late referral. Early referrals were those patients who were referred to a nephrologist more than three months before dialysis initiation. Late referrals were those patients who were referred to a nephrologist less than three months before dialysis initiation. Patients were followed up at one, three, six, and 12 months for outcome, i.e. still on dialysis or died
Results: One hundred and seventy-six patients were enrolled in the study, and 141 were followed up to one year. Seventy two [51.1%] patients were male, 69 [48.9%] were female and most [n=69, 48.9%] were in the middle age group. Major causes of end-stage renal disease [ESRD] were hypertension 70 [49.6%] and diabetes mellitus 66 [46.8%]. Seventy-six [53.9%] patients were in fluid overload and acidotic [n=123, 87.2%]. Twenty-seven [19.1%] patients were referred early and 114 [80.9%] were referred late. Overall mortality was 78 [55.3%] at one year. Factors affecting mortality were financial status and metabolic acidosis, but not referral. Temporary access for hemodialysis has 1.38 times more risk for mortality than the patients with permanent access
Conclusion: There is no difference on the outcome of dialysis patients on the basis referral to nephrologist. Factors affecting overall mortality in both groups were financial status, metabolic acidosis, and temporary access for dialysis. Most of the patients were referred late to the nephrologists
ABSTRACT
Objective: The objective of the study was to determine the demographic factors affecting Quality Of Life [QOL] of hemodialysis [HD] patients
Methods: This observational study was conducted at Shalamar Hospital, Lahore. Patients of End Stage Renal Disease [ESRD] and on maintenance HD for more than three months were included during the period March to June 2012. Patient of ESRD not on dialysis and Acute Renal Failure were excluded. One hundred and twenty five patients who fulfilled the criteria were included. Demographic data containing age, sex, residence, socio economic status, education, mode of traveling for dialysis, total time consumed in dialysis were collected by the investigators. QOL index was measured using 26 items, WHO QOL BRER
Results: There were 89 [71.2%] male and 36[28.8%] female patients. Environmental domain score was highest [p=0.000] than all other domains in HD Patients. In overall analysis age, marital status and total time consumed in getting HD effect QOL significantly [p= < 0.05]
In domain wise analysis, male has better QOL in social relationship domain than female. Age has negative relationship with physical health and psychological health domain. QOL of unmarried and literate patients is significantly better [p= < 0.05] in physical health domain. Employed patients have better QOL in physical, psychological and social relationship domain [p= < 0.05] than unemployed patients. Patients of residence of rural areas have better QOL in physical and environment domain. Financial status of HD patients affect QOL in social domain. Distance covered to reach hospital effect QOL in psychological domain [p= < 0.05]
Patients traveling in private transport have better QOL in environmental domain [p=<0.05]
Total time consumed in getting HD effect social relation in QOL [p= < 0.05]
According to linear regression model, marital status is positive predictor and unemployment is negative predictor of QOL in physical health domain
Age is negative predictor of QOL in psychological domain, monthly income is positive predictor of QOL in domain. Unemployment is positive predictor of QOL in social relation domain. Monthly income and place of residence is positive predictor of QOL in environment domain
Conclusion: Gender, age, marital status, unemployment, residence of rural area, economical status, distance covered to reach hospital, mode of transport, total time consumed in getting HD, effect QOL in HD patient. Education level is a positive factor for improving QOL of HD patients