Clinical Profile and Quality of Life of Incident Hemodialysis Patients

Hemodialysis is the most commonly used treatment modality for end stage renal disease. A 6 months observational study was conducted in the Dialysis unit of Kasturba Hospital, Manipal to study the clinical profile, quality of life with the help of KDQoL SF 36 questionnaire and factors affecting quality of life of hemodialysis patients. A total of 45 participants were included who initiated dialysis in the year 2018 and 2019 and were receiving dialysis in our hospital. Out of 45 participant 77.8% were males and 22.2% were females, the mean age was 55.29 (11.29) years. 23 patient-initiated dialysis in the year 2018 22 patients-initiated dialysis in the year 2019. The prevalence of hypertension, diabetes mellitus and cardiovascular diseases in this population were found to be 95.2%, 35.6% and 8.9% respectively. The mean scores of the sub scales were analyzed with the help of scoring manual and descriptive statistics. In the result it was found the hemoglobin, intradialytic weight gain were found to be positively correlated with the Physical component summary (PCS) and Mental component summary (MCS). Effects of kidney disease was found to be very strongly and positively correlated with dialysis vintage. In the result of the study due to its smaller population we cannot determine more factors which were affecting the Quality of life scores.

Effects of hemodialysis and hemoperfusion combination treatment on maintenance hemodialysis patients / 上海交通大学学报（医学版）

Objective:To investigate the effects of hemodialysis (HD) and hemoperfusion (HP) combination treatment on maintenance hemodialysis (MHD) patients. Methods:A total of 80 MHD patients in Chongming Branch of Xinhua Hospital, Shanghai Jiao Tong University School of Medicine from July 2017 to July 2018 were randomly divided into two groups, i.e., HD+HP group (n=40) and HD group (n=40). The patients were followed up every 3 months for 1 year. The changes of laboratory indexes, dialysis adequacy indicators and quality of life scores of Kidney Disease Quality of Life-Short Form (KDQOL-SF) were compared between the two groups, and the prognosis, causes of death and adverse events were recorded. Results:At the end of one-year treatment, levels of parathyroid hormone (PTH), β2-microglobulin (β2-MG), high sensitive C-reactive protein (hsCRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and left ventricular mass index (LVMI) were significantly lower in HD+HP group than those in HD group (P0.05). The overall mortality rates of HD+HP group and HD group were 12.5% and 32.5%, respectively. No significant adverse events were observed during the follow-up. Conclusion:The effects of HD combined with HP on clearing middle and large molecular toxins, reducing microinflammation status, and improving renal anemia and left ventricular hypertrophy are better than those of only HD. There may be potential advantages of HD and HP combination in improving quality of life in MHD patients as well.

Blood Urea & Salivary Urea levels in End Stage Renal Failure.

Elevation of Blood Urea Nitrogen in renal diseases results concomitant increase in Salivary Urea levels. Aims : Determine if there was any correlation between the Salivary Urea levels with that of Blood Urea levels. Material & Methods : samples of blood and saliva were taken from Hemodialysis and control groups to assess the Blood Urea Nitrogen (BUN) and Salivary Urea (SU) levels respectively under strict aseptic precautions. Informed consent was taken from patients and ethical committee approval taken. Results : showed no statistically significant difference between Blood Urea and Salivary Urea in the Hemodialysis group (p>0.05). There was a statistically significant difference between Hemodialysis group and Control group with respect to Blood Urea and Salivary Urea levels. (p<0.001). Conclusion : saliva can be used as a noninvasive diagnostic marker tool.

<b>Effect of Traditional Japanese Herbal (Kampo) Medicine, Goreisan, </b><b>for Disdialysis and Muscle Cramps in Patients undergoing </b><b>Maintenance Hemodialysis </b> / 日本東洋医学雑誌

Goreisan, a well-known hydrostasis modulating formula, has been traditionally used against edema, thirst, spontaneous sweating, and oliguria. Patients undergoing maintenance hemodialysis (HD) have a condition of chronic water metabolism abnormality. Acute changes in water metabolism due to HD therapy frequently cause disdialysis syndrome (including muscle cramps), therefore, the prevention and treatment of disdialysis syndrome is of importance. In this study, 20 patients with history of disdialysis syndrome undergoing HD were administered goreisan (5.0 g/day) and its effect was investigated. After 8 weeks of goreisan therapy, diagnostic <i>suitai </i>syndrome criteria (pre-treatment 40.9 ± 8.7, post-treatment 33.2 ± 7.8 points), total 10% NaCl dosages (20 mL/syringe) to treat muscle cramps during HD (pre 2.9 ± 0.6, post 1.9 ± 0.6 syringes/week), serum brain natriuretic peptide (BNP) concentrations after HD (pre 165.4 ± 48.3, post 148.4 ± 39.0 pg/mL), and systolic blood pressures (pre 90.8 ± 15.0, post 100.1 ± 13.5 mmHg) indicted statistical improvement (p < 0.01).These effects were observed not only in patients with no diabetes mellitus (DM), but also in patients with DM.These results indicate the possibility that goreisan is effective for prevention of disdialysis syndrome and muscle cramps in patients under HD.

A case of diabetic hyperosmolar coma treated successfully with conversion to hemodialysis in a chronic renal failure patient on CAPD treatment / 대한내과학회지

Continuous ambulatory peritoneal dialysis(CAPD) is now the most important and effective therapeutic modality as well as hemodialysis(HD) and renal transplantation in patients with chronic renal failure. It is frequently recommended to diabetic renal failure patients because of poor, athersclerotic vascularity of them. Hyperglycemia and obesity are not uncommon complications of CAPD therapy. But there were only few reports of very severe hyperglycemia or hyperosmolar coma in CRF patients on CAPD therapy, especially with 7% dextrose CAPD dialysate in foreign countries in the past. Moreover, no specific management for hyperosmolar coma is established in those situations yet. In Korea, only three cases of hyperosmolar coma in non diabetic renal failure patient on CAPD therapy have been reported in one case report. And only one case among them whose CAPD therapy was changed to HD survived. Authors also experienced a case of diabetic hyperosmolar coma treated successfully with conversion to HD in chronic renal failure patient on CAPD therapy. So we report this case with a review of literature. Taken together with this case and review of literature, changing CAPD therapy to HD is regarded to be an important part of treatment when hyperosmolar coma develops in chronic renal failure patients.

A case of diabetic hyperosmolar coma treated successfully with conversion to hemodialysis in a chronic renal failure patient on CAPD treatment / 대한내과학회지

Continuous ambulatory peritoneal dialysis(CAPD) is now the most important and effective therapeutic modality as well as hemodialysis(HD) and renal transplantation in patients with chronic renal failure. It is frequently recommended to diabetic renal failure patients because of poor, athersclerotic vascularity of them. Hyperglycemia and obesity are not uncommon complications of CAPD therapy. But there were only few reports of very severe hyperglycemia or hyperosmolar coma in CRF patients on CAPD therapy, especially with 7% dextrose CAPD dialysate in foreign countries in the past. Moreover, no specific management for hyperosmolar coma is established in those situations yet. In Korea, only three cases of hyperosmolar coma in non diabetic renal failure patient on CAPD therapy have been reported in one case report. And only one case among them whose CAPD therapy was changed to HD survived. Authors also experienced a case of diabetic hyperosmolar coma treated successfully with conversion to HD in chronic renal failure patient on CAPD therapy. So we report this case with a review of literature. Taken together with this case and review of literature, changing CAPD therapy to HD is regarded to be an important part of treatment when hyperosmolar coma develops in chronic renal failure patients.

Effcts of Hemodialysis and Contiuous Ambulatory Peritoneal Dialysis on Thyroid Function in Chronic Renal Failure / 대한신장학회잡지

The changes of thyroid hormones are expected in patients with chronic renal failure(CRF) because the kidney plays an important role in metabolism and excretion of thyroid hormones. In spite of many studies about this issue, there have not been full consensus about the nature and mechanism of thyroid hormone changes. We undertook the present study to reveal the dialysis effects on these hormones. We measured basal levels of serum total T3 (T3), total T4(T4), free T4(FT4), reverse T3(rT3) and TSH, and then calculated the ratio of T3/T4, rT3/T3 and rT3/T4. The following groups were identifed : Group I-10 cases of normal controls, Group II-18 cases of pre-dialysis or treated conservatively, Group III-20 cases treated by maintenance hemodialysis(HD), Group IV-18 cases treated by continuous ambulatory peritoneal dialysis(CAPD). Patients from group II, III and IV revealed significantly decreased levels of T3 and T4, and increased ratio of rT3/T4 in comparison to the control group(P36months), the mean concentrations of free T4 levels revealed signifcantly decreased in comparison to the short-term dialysis group(P<0.05). Thyroid dysfunction are observed in CRF patients with partial recovery after dialysis therapy. Especially, CAPD achieves significantly improved thyroid dysfunction compared to HD, but further study would be necessary.