Correlation between asymptomatic intradialytic hypotension and regional left ventricular dysfunction in hemodialysis patients

Cardiovascular disease and heart failure are common in dialysis patients. Recurrent subclinical myocardial ischemia is an important event which may lead to the heart failure. We examined whether this phenomenon occurs secondary to the intradialytic hypotension in hemodialysis patients. Twelve patients prone to intradialytic hypotension who had been on maintenance hemodialysis for more than 12 months and 15 hemodialysis patients without any history of intradialytic hypotension were included in this study. Echocardiography was performed before hemodialysis [baseline], and at 60 minutes and 120 minutes during hemodialysis [climax], and 30 minutes postdialysis [recovery]. Left ventricular end-diastolic diameter, left ventricular systolic diameter, left ventricular ejection fraction, fractional shortening of left ventricular, and regional wall motion abnormality score and index were measured during the four stages in all patients. Regional wall motion abnormality preceded reduction in the left ventricular ejection fraction and fractional shortening in patients with intradialytic hypotension. However, decreased systolic blood pressure and increased regional wall motion abnormality were accompanied. This study showed that reversible myocardial dysfunction occurs during the hemodialysis. It may be contributed to the intradialytic hypotension. In addition, we showed that regional wall motion abnormality less frequently occurred in patients without intradialytic hypotension. This suggests that confronting with intradialytic hypotension may prevent cardiovascular dysfunction

Correlation of pretransplant hyperglycemia and delayed graft function in kidney transplantation

Hyperglycemia is common and a contributing factor to the undesirable outcomes in kidney transplant recipients. This study investigates the relationship of pretransplant blood glucose levels and the occurrence of delayed graft function among kidney transplant recipients without a diagnosis diabetes mellitus before transplantation. Eighty-one patients on long-term hemodialysis with no history of clinically diagnosed diabetes mellitus were enrolled in this study. Correlation of the occurrence of delayed graft function with age, gender, donor source, underlying cause of kidney failure, insulin resistance, and blood glucose levels before transplantation was evaluated. There was a significant correlation between abnormal glucose metabolism categories and occurrence of delayed graft function [P=.004]. Logistic regression analysis showed that fasting blood glucose before kidney transplantation is an independent predictor of delayed graft function immediately after transplantation [odds ratio=1.042, P=.04]. Hyperglycemic patients have an increased risk for delayed graft function and should be treated by more potent immune therapy and further restriction of blood glucose regulation in peritransplantation period

effect of the type of hemodialysis buffer on the QTc interval in Patients on chronic hemodialysis

Identifying the sources of variation in QTc measurements is important for preventing arrhythmias during and after hemodialysis. The present study was designed to determine the correlation between the type of hemodialysis buffer and the changes in QTc interval in patients on chronic hemodialysis. Fifty-nine patients on chronic hemodialysis who referred in winter 2007 to hemodialysis centers of Ghaem and Hashemi Nejad hospitals, in Mashhad, Iran, were divided into two groups according to their last dialysate buffer: acetate or bicarbonate. Electrocardiography, arterial blood gas parameters, serum K+, Na+, ionized calcium, and albumin levels were measured prior to and after hemodialysis in all patients. All arterial blood gas parameters and serum electrolytes concentrations were increased except K+ levels that were significantly decreased with hemodialysis. PCO[3] and QTc intervals were slightly increased in all patients, however this increase was not statistically significant. We found that the type of dialysate affected the QTc interval, HCO[3], base excess, base excess of extra cellular fluid, and base buffer changes with no effect on ionized calcium, pH, PCO[2], and serum albumin concentration. QTc interval was prolonged by using bicarbonate and shortened by using acetate dialysate buffer. We found no correlation between the variations of QTc interval and serum electrolytes or arterial blood gas parameters in either group Bicarbonate buffer use in hemodialysis prolonged QTc interval and acetate buffer shortened it. This effect is independent of serum electrolytes and pH changes during hemodialysis. The effect of bicarbonate buffer is probably due to more tolerability of ultra filtration, more effective edema reduction and augmented body electro-conductivity

Acute glomerulonephritis in southern Iran

Acute post streptococcal glomerulonephritis [APSGN] is the most common type of in-patient glomerulonephritis [GN] in childhood. It has not been studied well in this region yet. Here, we report our experience with APSGN in a tertiary referral center during a five-year period. Hospital records of all 137 children who had been admitted to Nemazee hospital, between 2001 and 2006, with diagnosis of acute glomerulonephritis [AGN] were reviewed. All demographic, clinical, paraclinical data and consumed medications were obtained. Among 137 children diagnosed as AGN, 122 [89%] had APSGN. Other 15 [11%] children had membranoproliferative glomerulonephritis [n=4], mesangioproliferative glomerulonephritis [n=4], IgA nephropathy [n=2], lupus nephritis [n=2], rapidly progressive glomerulonephritis [n=2], and focal segmental glomerulosclerosis [n=1]. Mean [SD] age in children with APSGN was 8.5 [3.5] [range, 3.5-13] years, 117 [96%] children developed APSGN following a sore throat and 5 [4%] following an impetigo, with 95 [78%] during the cold seasons of the year. Periorbital edema was found in 97.5%, hypertension 75%, gross hematuria 72%, oliguria 37%, generalized edema 19%, azotemia [BUN > 20] 80%, and nephrotic-range proteinuria 24.5%. A high anti streptolysin-O [ASO] titer and a low C3 level was detected in 84% and 86%, respectively. There was dilutional anemia in 51.5%, hyponatremia in 27%, and hyperkalemia 14%. With regard to medications, 19 patients received only furosemide, 73 cases furosemide and nifidipine, and 10 patients furosemide, nifidipine, and another antihypertensive medication. Hypertensive encephalopathy occurred in 3 cases, but no mortality was reported during the study period. APSGN is the most common type of glomerulonephritis in this region. It follows sore throat in the majority of cases. It usually has an uneventful course

Nasal and skin colonization of staphylococcus aureus in hemodialysis patients in northeast of Iran

Staphylococcal infections are a major cause of morbidity and mortality in patients on hemodialysis. We conducted a study of nasal and skin colonization in patients receiving maintenance hemodialysis. From September 2003 through June 2004, we evaluated 69 patients who were receiving maintenance hemodialysis via an internal fistula or graft. Four samples were obtained for culture from both nares and needle insertion sites on the skin by standard methods. The growth of Staphylococcus aureus was recorded during the study. Of the 69 patients, 28 [40.5%] had S aureus present in the nose and 9 [13.0%] had it present on the skin around the access site at some times during the study period. The presence of S aureus on the skin of the access site was significantly related to the simultaneous presence of this organism in the nose [P = .03]. From our observations, it can be concluded that the nose provides an environment in which S aureus can propagate and maintain itself for prolonged periods. As skin colonization with S aureus is a risk factor for the development of staphylococcal infection, it could be recommended that effective removal of S aureus from the nose would be critical for prevention of vascular access site infection