[ evaluation of dialysis adequacy by KTN in hemodialysis patients]

Patients with ESRD need adequate dialysis. According to DOQI guidelines, minimum dialysis dose by KT/V in patients under hemodialysis [HD] is 1.2 or greater. In a cross- sectional study, we evaluated the value of KT/V among HD patients in shahid Beheshti Hospital of Abadan, Iran. HD was performed for 3 to 4 hours, using synthetic dialyzer and the bicarbonate- based dialysate. Blood flow rate, dialysate flow rate and ultrafiltration rate were 250 to 300 cc /min, 500cc/min and zero or 1 to 3 liters, respectively. Blood sampling for BUN was done immediately before and after the dialysis session. We used the following equation to estimate the KT/V from the percent reduction in urea [PRU]. KT/V = [0.026 xPRU] - 0.460 54 HD patients [28 females and 26 males] with the mean age of 39 +/- 14.2 years were enrolled in the study. The most common cause of ESRD was hypertension [24.07%] followed by, unknown [22.22%], DM [18.51%], Chronic Glomerulonephritis [14.81%], urinary tract abstraction [12.96%] and poly cystic kidney disease [7.40%]. KT/V was less than 1.2 in 87.03 patients [n=47]. There was no significant difference in the valve of KT/V in men and women [P= 0.54] and in different hemoglobin concentration [p=0.58]. The results of the study show that the most of our HD patients have not received minimum dialysis dose and we should evaluate and correct its causes

[Comparison of temporary dialysis catheter and A-V fistula use at the time of starting chronic hemodialysis among end-stage renal diseases patients]

The preferred type of access for chronic hemodialysis [HD] is an Arterio-Venous [A-V] Fistula. However most of the ESRD patients does not have a mature fistula at the time of starting HD due to late referral to the nephrologists so the managing physicians have to use temporary catheters with high rate of complications. In a retrospective study we determined and compared the prevalence of temporary catheters or A-VFistula use at the time of starting chronic HD from November 1995 to June 2009. We have divided our patients in three different groups. Group A: HD patients between 1995-2005, Group B: HD patients between 2006-2007, and Group C: HD patients after 2007. A total of 473 ESRD patients [288 male, 185 female; mean age, 55.8 +/- 16.4 years] were included in the study. Causes of ESRD were HTN 34.1%, DM 20. 08%, glomeronephritis 9.72%, obstructive uropathy 8.46%, ADPKD 5.92%, and unknown 21.77%. Overall the prevalence of temporary catheters and A-V Fistula use were 86.5 and 13.5 percent. But the prevalence was different in the studied groups: group A [93.6% and 6.4%], in group B [85.0% and 15.0%] and in group C [67.5% and 29. 5%] respectively. There was a significant increase in A-V Fistula use after 2005 [p=0.00] and especially after 2007 [p=0.000]. Although there was a significant increment in the A-V Fistula use, it is not still enough and general physicians, nurses and chronic kidney disease patients have to be educated about the benefits of early A-V Fistula creation

Survival at 1, 3, and 5 years in diabetic and nondiabetic patients on hemodialysis

We analyzed survival of 185 adult patients on maintenance hemodialysis [9 h/wk to 12 h/wk] at Emam Khomini Hospital in Ahvaz, Iran. Patient survival at 1, 3, and 5 years was 89.2%, 69.2%, and 46.8%, respectively. There was no significant difference between diabetic and nondiabetic patients in 1-year survival [87.1% versus 89.7%, P = .66]. But, 3- and 5-year survival rates of diabetic patients were significantly lower than those of nondiabetic patients [52.2% versus 73.8%, P = .04; zero versus 56.9%, P < .001; respectively]. Based on our findings, the survival of diabetic patients undergoing hemodialysis was much worse than survival of nondiabetic patients. Thus, prevention of diabetic nephropathy should be more emphasized; and if end-stage renal disease is present, other renal replacement therapies such as kidney transplantation must be considered as soon as possible

Evaluation of acquired cystic kidney disease in patients on hemodialysis with ultrasonography

Acquired cystic kidney disease [ACKD] occurs in patients with prolonged uremia, and early detection is important, because clinically significant complications, especially renal cell carcinoma, are associated with ACKD. In a cross-sectional study, we evaluated our patients on hemodialysis, in Ahvaz, Iran, using ultrasonography. The criteria for the diagnosis of ACKD were the presence of at least 4 bilateral renal cysts in patients with noncystic primary kidney diseases as the leading cause of kidney failure. A total of 148 patients [95 men and 53 women] were included in the study. The prevalence of ACKD was 20.3% [18.9% in men and 22.6% in women]. The mean age in patients with and without ACKD was 60.6 +/- 16.8 years and 53.6 +/- 14.9 years, and the mean hemodialysis duration was 44.2 +/- 18.7 months and 34.3 +/- 23.5 months, respectively. There were no significant differences in the frequency of ACKD in the men and the women [P = .59] and in the etiology of end-stage renal disease [P = .64]. It was significantly more likely to see ACKD in patients with a history of 3 years or longer being on hemodialysis than in those with a shorter dialysis duration [P = .001]. Acquired cystic kidney disease is common in patients on hemodialysis, and we suggest that renal ultrasonography be performed in patients with 3 years or more history of being on renal replacement therapy