HAEMODIALYSIS: A KING OR A CLOWN FOR COVID POSITIVE PATIENTS WITH PRE-EXISTING PULMONARY DISEASES!

Background: COVID-19 infection in patients with pre-existing respiratory diseases, manifesting as ARDS, while simultaneously affecting multiple organs severely worsened the outcome, raising the need to explore various treatment modalities. To study the impact of haemodialysis on outcomes of COVID-19 pati Objective: ents with pre-existing pulmonary diseases. Methods: Data of patients with known pulmonary comorbities admitted to COVID wards, undergoing haemodialysis for AKI at tertiary care centre, was collected from July 2020 to January 2022. The demographics, baseline parameters and outcomes were recorded. Total 61 Results: patients were included in this retrospective observational study. The percentage of different pre-existing pulmonary pathologies (COPD, Asthma, ILD, and Pulmonary Tuberculosis) were equally distributed among survivors(n=47) and non-survivors(n=14). The non-survivors were older(p=0.003), and had a higher percentage of males (p=0.02), higher percentage of smokers (p=0.02) and alcohol consumers(p=0.011), a lower mean systolic blood pressure, higher pulse rate, higher respiratory rate and lower SpO2. The non-survivors had a lower mean hemoglobin, platelet count, and a higher mean TLC, NLR, and D-dimer levels. On admission, the non-survivors had a higher mean blood urea level and serum creatinine level (p<0.001). The number of hemodialysis done was significantly higher(p=0.041) in the survivors as compared to non-survivors. Conclusion: Our study strongly suggests that haemodialysis can be used as a life saving treatment modality for AKI in COVID positive patients with pre-existing pulmonary disease. Also protocols need to be rede?ned for early initiation and increased frequency of haemodialysis in patients with acute on chronic multisystem insult.

Quality of Life of Chronic Kidney Disease Patients on haemodialysis in a tertiary care centre

Background: End-stage renal failure is a chronic disease that greatly impacts a pa?ent’s health-related quality of life mainly due to the imposed limita?ons in almost all domains of their daily lives affec?ng >10% of the general popula?on worldwide, amoun?ng to >800 million individuals. Haemodialysis consists of a complex procedure for pa?ents that requires frequent hospital or dialysis centre visits, three ?mes a week, Objec?ves: To assess Quality of life and to find an associa?on between QOL, socio-demographic factors, and clinical variables among chronic kidney disease pa?ents on haemodialysis Material and methods: The sample consisted of 89 pa?ents undergoing haemodialysis. Data was collected by a specially designed ques?onnaire (KDQOL-36) which apart from the socio-demographic and clinical variables, also included the kidney disease variables for assessing the quality of life. Results: The results indicated that haemodialysis pa?ents’ QOL was impacted by socio-demographic and clinical factors related to dialysis. The study majorly reported that these factors played a major role directly and indirectly, with social ac?vi?es affec?ng more followed by emo?onal disturbances and physical ac?vi?es. Conclusion: QOL of haemodialysis pa?ents can be improved by correctable factors like anemia, diabetes, and hypertension. Healthcare prac??oners can create personalised interven?ons that are tailored to the needs of haemodialysis pa?ents by having a deeper grasp of the variables like treatment of co-morbidi?es decrease in the number of hospitaliza?ons, be?er management of anemia and decreasing the distance between home & dialysis center.

Indirect costs associated with "free" paediatric haemodialysis: Experience from Karachi, Pakistan

Treatment of children with end-stage kidney disease (ESKD), requiring maintenance dialysis, poses unique challenges. In low- and middle-income countries, lifelong treatment leads to significant stress on the overall family unit. Families face serious financial, social and psychological consequences despite free treatment. This pilot study, utilising primarily quantitative methods, supplemented by two case studies, is set in Sindh Institute of Urology and Transplantation, a tertiary care hospital in Karachi, Pakistan, providing free medical treatment. Fifty-two caretakers of children receiving haemodialysis for more than five years participated in the quantitative arm. Findings reveal that additional financial challenges may send the entire household into financial catastrophe. Social problems include migration from native cities, impact on the education of the sick child along with changes in lives of siblings. One-third of primary caretakers screened positive for anxiety/depression. Healthcare professionals 'practising' in developing countries face considerable ethical dilemmas in their practice when offering “free” paediatric dialysis services knowing the financial and psychological burden imposed on families.

Prevalence and Susceptibility of Staphylococcus aureus Nasal Carriage Strains Isolated from Haemodialysis Patients

@#Introduction: Staphylococcus aureus is part of the normal human flora that can commonly be found on the skin and mucous membranes of the nasal area. However, in immunosuppressed patients such as those with kidney failures, colonization can potentially lead to infection. There is a concern of increasing antibiotic resistance in S. aureus. This study aimed to determine the prevalence of S. aureus nasal colonization and its antimicrobial susceptibility among haemodialysis-dependent populations. Methods: A cross-sectional study at the Nephrology Unit, Hospital Canselori Tuanku Mukhriz (HCTM) was conducted among haemodialysis-dependent patients between February 2017 to February 2018. Nasal swabs were obtained and cultured on mannitol salt agar. S. aureus isolates were identified by gram staining, tube coagulase and Deoxyribonuclease (DNase). Cefoxitin disc (30 µg) were used to identified the presence of MRSA (methicillin-resistance S. aureus). The S. aureus colonies were further tested against six antibiotics using Kirby Bauer disc diffusion. Result: A total of 134 patients were recruited. S. aureus isolates were detected from 27 patients (20.1%). All S. aureus were phenotypically identified as methicillin-sensitive S. aureus (MSSA) based on the cefoxitin disc. Teicoplanin and linezolid were the most effective with 100% susceptibility. S. aureus exhibited a high resistance rate towards erythromycin (29.6%). No MRSA was isolated in this study. Conclusion: This study highlighted the high prevalence of S. aureus nasal colonization in haemodialysis patients. Teicoplanin and linezolid were found to be the most effective antibiotics against isolated S. aureus.

Intervenções de enfermagem frente a complicações apresentadas por pacientes hemodialíticos: uma revisão integrativa / Nursing interventions in the face of complications presented by hemodialytic patients: an integrative review / Intervenciones de enfermeros ante complicaciones presentadas por pacientes hemodiálicos: una revisión integrativa

Objetivo: Identificar as evidências disponíveis na literatura acerca das intervenções de enfermagem frente aos cuidados diante das complicações inerentes ao tratamento hemodialítico. Metodologia: Trata-se de uma revisão integrativa da literatura através de buscas nas bases de dados PubMed; BVS e Scopus, em abril de 2023. Estabeleceu-se a pergunta norteadora: "Quais são as evidências disponíveis na literatura acerca das intervenções de enfermagem frente a complicações apresentadas por pacientes submetidos à hemodiálise?". Foram excluídos protocolos de revisão sistemática ou meta análise e estudos incompletos, que não fazem referências ao objetivo da pesquisa. Resultados: Na busca foram selecionados 09 estudos para essa revisão, que atenderam aos critérios de elegibilidade. Foi evidenciado na literatura que a implementação de medidas preventivas específicas durante o processo de HD pode reduzir significativamente a incidência de complicações em pacientes submetidos a esse procedimento. Quanto as complicações mais frequentes em pacientes em tratamento, são elas: náuseas, cefaleia, hipotensão, cãibras, coagulação e infecções. Evidencia-se que a identificação e gerenciamento precoce dessas complicações podem melhorar os resultados clínicos e a qualidade de vida dos pacientes. Os cuidados de enfermagem como monitorização frequente dos sinais vitais, higienização adequada, administração correta de fármacos, orientações voltadas para o autocuidado, além de medidas inovadoras são importantes para garantir a segurança do paciente durante tratamento. É necessário o conhecimento dos profissionais sobre as complicações associadas à HD para que assim estejam aptos a intervir da maneira correta. Considerações finais: Os estudos mostraram que é imprescindível que os profissionais de saúde envolvidos na assistência, especialmente enfermeiros, estejam aptos para intervir em possíveis complicações durante a terapia, a fim de minimizar os impactos à saúde do paciente.

Objective: To identify the evidence available in the literature about nursing interventions in the face of complications inherent to hemodialysis treatment. Methodology: This is an integrative review of the literature through searches in the PubMed databases; VHL and Scopus in April 2023. The guiding question was established: "What is the evidence available in the literature about nursing interventions in the face of complications presented by patients submitted to hemodialysis?" Systematic review protocols or meta-analysis and incomplete studies were excluded, which do not make reference to the purpose of the research. Results: In the search, 09 studies were selected for this review, which met the eligibility criteria. It was evidenced in the literature that the implementation of specific preventive measures during the HD process can significantly reduce the incidence of complications in patients undergoing this procedure. The most common complications in patients undergoing treatment are: nausea, headache, hypotension, cramps, clotting, and infections. Evidence shows that early identification and management of these complications can improve clinical outcomes and patients' quality of life. Nursing care such as frequent monitoring of vital signs, proper hygiene, correct drug administration, self-care guidelines, and innovative measures are important to ensure patient safety during treatment. Professionals need to be aware of the complications associated with HD so that they are able to intervene in the right way. Final considerations: Studies have shown that it is essential that healthcare professionals involved in care, especially nurses, are able to intervene in possible complications during therapy in order to minimize the impacts on patient health.

Propósito: identificar la evidencia disponible en la literatura sobre intervenciones de enfermería frente a la atención ante complicaciones inherentes al tratamiento hemodiáltico. Metodología: Se trata de una revisión integral de la literatura a través de búsquedas en bases de datos de PubMed; BVS y Scopus en abril de 2023. Se planteó la siguiente pregunta: "¿Cuál es la evidencia disponible en la literatura sobre intervenciones de enfermería frente a complicaciones presentadas por pacientes sometidos a hemodiálisis?". Se excluyeron los protocolos de revisión sistemática o metaanálisis y los estudios incompletos, que no hacen referencia al objetivo de la investigación. Resultados: En la búsqueda se seleccionaron 09 estudios para esta revisión, que cumplieron con los criterios de elegibilidad. Se ha demostrado en la literatura que la aplicación de medidas preventivas específicas durante el proceso de HD puede reducir significativamente la incidencia de complicaciones en los pacientes sometidos a este procedimiento. Las complicaciones más frecuentes en los pacientes tratados son náuseas, cefalea, hipotensión, calambres, coagulación e infecciones. Es evidente que la identificación y manejo tempranos de estas complicaciones pueden mejorar los resultados clínicos y la calidad de vida de los pacientes. La atención de enfermería, como la vigilancia frecuente de los signos vitales, la higiene adecuada, la administración adecuada de medicamentos, la orientación sobre el autocuidado y las medidas innovadoras son importantes para garantizar la seguridad de los pacientes durante el tratamiento. Los profesionales deben ser conscientes de las complicaciones asociadas a la HD para que puedan intervenir de la manera correcta. Consideraciones finales: los estudios han demostrado que es esencial que los profesionales de la salud involucrados en la atención, especialmente las enfermeras, puedan intervenir en posibles complicaciones durante el tratamiento para minimizar el impacto en la salud del paciente.

Prevalence and factors associated with the severity of anaemia among patients on chronic haemodialysis in Lagos, Nigeria

Anaemia is a global public health problem with high mortality and morbidity. It is also a common consequence of chronic kidney disease (CKD). There is a paucity of data on the actual burden of anaemia among patients on chronic haemodialysis (CHD) in Lagos, Nigeria. Objectives: To determine the prevalence and factors associated with the severity of anaemia among Nigerian patients undergoing chronic haemodialysis. Methods: This was a retrospective analysis of adult patients with end-stage renal disease (ESRD) on maintenance haemodialysis at the Lagos State University Teaching Hospital, Ikeja, Lagos. The data extracted from the clinical case files included the bio-demographic and clinical parameters, including the treatment modalities. Results: A total of 92 patients comprising 69 (75%) males and 23 (25.0%) females with the overall mean age of 48.2±14.0 years were included. Hypertension was the commonest aetiology of CKD and the average duration of haemodialysis was 16.6 months. The commonest access route for haemodialysis was a central line while 96.7% and 81.5% received erythropoietin and intravenous iron sucrose respectively. Seventy-three (79.3%) patients have had intra-dialysis blood transfusions in the past. Mild, moderate, and severe anaemia were recorded in 17%, 67%, and 16% respectively. The use of erythropoietin, iron sucrose, and increased frequency of blood transfusions correlated with the severity of anaemia. Conclusion: Anaemia is highly prevalent among patients with CKD on chronic haemodialysis. Increased frequency of blood transfusions, inadequate utilization of erythropoietin, and iron sucrose administration are associated with anaemia severity.

Prevalence of Hepatitis B and Hepatitis C Virus Infection in Patients with Advanced Renal Failure: A Tertiary Care Centre Study from North Indian Population

Abstract: Viral hepatitis (Hepatitis B Virus (HBV) & Hepatitis C Virus (HCV)) related liver disease is a leading cause of morbidity and mortality especially in the patients with advanced renal failure who are treated with dialysis, and this is due to high number of blood transfusion sessions and/or cross contamination from the dialysis circuits. Aims & Objectives: This study aimed to determine the prevalence of HBV and HCV infections in patients with advanced renal failure (ARF). Materials & Methods: A cross-sectional study was done in joint collaboration of Department of Nephrology and Department of Gastroenterology, KGMU, Lucknow, from June 2018 to June 2020 among, CRF patients. Clinical data such as age, gender, duration of dialysis; number of transfusions, Serum sample was collected from each patient. Serological markers for HBV and HCV were determined with ELISA by using commercial diagnostic kits. HCV-RNA and HBV-DNA were determined quantitatively by polymerase chain reaction (PCR) assay. Results: A total 934 patients with advanced renal failure attended the nephrology OPD. Out of 934 patients, 65 (6.96%) patients screened positive for HBV/HCV infection. The results of this study also showed that the prevalence of viral hepatitis infection in the haemodialysis (HD) and without HD patients is 8.25% and 6.3% respectively. Conclusion: It has been found that viral infections, particularly HBV and HCV infections are common in advanced renal failure patients who are on HD.

Hyperphosphatemia In Haemodialyzed Patients

Dietary regulation of serum phosphate levels is one of the most important therapies for the haemodialyzed patients. This is particularly difficult to apply since these patients must take huge amount of animal proteins that contain a large quantity of phosphate. However, a diet with a small amount of phosphate is required. This guideline is difficult to be implemented because patients get at least 50% of their phosphate from sources that are not obvious and from foods that are easily processed and preserved. In this retrospective study, serum levels of phosphate, calcium and parathyroid hormone were assessed in 123 haemodialyzed patients to determine their levels and differences, depending on age. Patients were grouped into two according to their age. Group A included those who were ? 70 years old (n = 55, 29M/26F), and Group B were those > 71 years old (n = 68, 39M/29F). Higher phosphate levels were found in Group A with a statistically significant level of p < 0.0001, while overall serum phosphate levels of 47% of patients were below 4.6 mg/dl. Elderly patients with more diabetics (Group B) had lower serum phosphate levels than the younger ones (Group A). Thus, a large percentage of our patients have satisfactory serum phosphate levels, and the younger ones have less satisfactory phosphate levels, compared with the elderly

Research progress of advance care planning for elderly hemodialysis patients / 中国实用护理杂志

With the rapid development of hospice care, more and more people pay attention to the quality of life of patients at the end of life. Due to the dialysis-related complications, heavy burden of comorbidities and cognitive impairment, elderly hemodialysis patients have poor quality of life, which brings heavy physiological, psychological and economic burdens to patients, families and society. Advance care planning can improve patients′ quality of life and save limited medical resources. By referring to relevant literature at home and abroad, this paper reviewed the overview of advance care planning, the necessity of discussing advance care planning with elderly hemodialysis patients, the implementation status and the obstacle factors. The purpose was to provide theoretical reference for better implementation of intervention treatment in elderly hemodialysis patients in China in the future.

Influence of chronic kidney disease and haemodialysis on stroke outcome

INTRODUCTION@#Stroke patients with underlying chronic kidney disease (CKD) and those on haemodialysis have complex rehabilitation needs, and their survival and functional outcomes are limited. This study aimed to review post-stroke survival and functional outcomes following rehabilitation in patients with CKD and those on haemodialysis.@*METHODS@#We conducted a retrospective analysis of consecutive stroke patients with underlying CKD (Stages G3b, G4 and G5; n = 30) and those on dialysis at the time of stroke (n = 7), who underwent in-patient rehabilitation between June 2008 and May 2017. The mean duration of follow-up was 56 months. Demographic details, associated comorbidities and laboratory parameters were reviewed. Baseline and follow-up scores of the National Institute of Health Stroke Scale (NIHSS) and Functional Independence Measure (FIM), and dates of death of the patients were analysed.@*RESULTS@#Of the 37 consecutive stroke patients (mean age 64.7 years), 34 had ischaemic stroke and three had haemorrhagic transformation. Significant improvements in NIHSS and FIM scores were observed from the time of admission to after discharge. Older age, longer duration of hospital stay, lower estimated glomerular filtration rate and low haemoglobin levels were all significantly related to mortality.@*CONCLUSION@#Despite significant functional and neurological improvements following rehabilitation, stroke patients with underlying CKD had higher average duration of hospital stay, more recurrent hospitalisations and poorer survival outcomes than those without underlying CKD. This could be attributed to the complications associated with CKD rather than stroke. Multidisciplinary community rehabilitation may be an alternative to reduce recurrent hospitalisations and morbidity in this group of patients.

Caracterización de los pacientes con fístulas arterio-venosas para hemodiálisis / Description of patients with arterio-venous fistulas for haemodialysis

Introducción: La fístula arterio-venosa para hemodiálisis es el acceso vascular utilizado con mayor frecuencia. De su adecuada funcionalidad depende la calidad de vida de los pacientes con enfermedad renal crónica. Objetivo: Caracterizar a los pacientes a los que se les confeccionó fístulas arterio-venosas para hemodiálisis. Métodos: Se realizó un estudio descriptivo retrospectivo en 73 pacientes, a los que se les confeccionó una fístula arterio-venosa para hemodiálisis. Las variables de estudio fueron: edad, sexo, tipo de fístula arterio-venosa, localización, complicaciones y tratamiento quirúrgico de las complicaciones. Resultados: Se encontró un predominio del sexo masculino y del grupo etario entre 51 y 60 años. El 94,6 por ciento de las fístulas realizadas fueron autólogas; y, de estas, el 44,1 por ciento, radio-cefálicas. El 27,3 por ciento de las autólogas y el 20 por ciento de las protésicas se presentó trombosis, y el 18,2 por ciento y el 40 por ciento presentaron hipertensión venosa para las autólogas y protésicas, respectivamente. El 43,5 por ciento de los tratamientos realizados frente a las complicaciones resultó la confección de una nueva fístula. Conclusiones: Los pacientes a los que se les confeccionó fístulas arterio-venosas eran predominantemente adultos mayores del sexo masculino y las fístulas más realizadas fueron las autólogas radio-cefálicas. Como principal complicación de las fístulas se encontró la trombosis y se realizaron escasos procederes para el rescate de estas(AU)

Introduction: Arterio-venous fistula for haemodialysis is the most commonly used vascular access. Its proper functionality depends on the quality of life of patients with chronic kidney disease. Objective: Describe patients to whom were made arterio-venous fistulas for haemodialysis. Methods: A retrospective descriptive study was conducted in 73 patients to whom were made an arterio-venous fistula for haemodialysis. The study variables were: age, sex, type of arterio-venous fistula, location, complications and surgical treatment of complications. Results: It was found a predominance of male sex and the age group of 51 to 60 years. 94.6 percent of the fistulas made were autologous; and, of these, 44.1 percent were radio-cephalic. 27.3 percent of the autologous fistulas and 20 percent of the prosthetics ones developed thrombosis, and 18.2 percent and 40 percent showed venous hypertension for autologous and prosthetic fistulas, respectively. 43.5 percent of the treatments performed to face complications resulted in the making of a new fistula. Conclusions: The patients to whom were made arterio-venous fistulas were predominantly older adults of the male sex and the most performed fistulas were the radio-cephalic autologous. As the main complication of fistulas, thrombosis was found and a few practices were performed to rescue them(AU)

A propósito de un caso: Pseudomonas stutzeri, una causa inusual de artritis séptica / A Case Report: Pseudomonas Stutzeri, An Unusual Cause Of Septic Arthritis

RESUMEN Se presenta un caso de artritis séptica de rodilla por Pseudomonas stutzeri, bacilo gramnegativo aerobio ampliamente distribuido en la naturaleza y que rara vez ocasiona infecciones graves en el ser humano. Se trata de una mujer de 84 arios, hemodializada, que desarrolla una artritis séptica de rodilla derecha tras una inflitración con ácido hialurónico y que evoluciona favorablemente tras terapia antibiótica. Se debe tener en cuenta esta etiología cuando hay antecedentes de invasión local de la articulación y en estados de inmunosupresión tal y como sucede en nuestra paciente.

A B S T R A C T A case is presented of septic knee arthritis caused by Pseudomonas stutzeri, which is an aerobic gram-negative bacillus widely distributed in nature and rarely causes serious infections in humans. The patient is an 84-year-old woman on haemodialysis, who developed a septic arthritis of the right knee after a hyaluronic acid injection. There was a favourable outcome after antibiotic therapy. This aetiology should be taken into account when there is a history of local invasion of the joint and in states of immunosuppression, as occurred in this patient.

Cardiovascular risk factors in chronic renal failure patient at Soavinandriana Hospital Antananarivo

Background: Cardiovascular disease (CVD) is the primary cause of morbidity and premature mortality in chronic kidney disease (CKD). The aim of this study was to assess the frequency of cardiovascular disease and cardiovascular risk in haemodialysis population for chronic kidney disease.Methods: This was a retrospective and descriptive study for a period of 4 years from January 2016 to December 2019, performed at hemodialysis unit in Soavinandriana Hospital Center Antananarivo, including all patients, following regular hemodialysis for chronic renal failure. Demographic data, cardiovascular disease, cardiovascular risk factors, aetiology of nephropathy, haemoglobin <11 g/dl, phosphocalcic metabolism disorders and uricemia were analyzed.Results: Seventy-six patients were recorded, including 46 males (60.52%) and were women (39.47%). The average age was 59.98 years old. The risk factors of cardiovascular disease were smoking (22.36%), diabetes mellitus (46.05%), high blood pressure (71.05%), dyslipidemia (47.36%) and obesity (11.84%). Fifty-eight patients (76.31%) had a high cardiovascular risk factor. Seventy patients (22.36%) had had a history of cardiovascular diseases. Fifty-nine patients had a haemoglobin concentration under 11 g/dl (77.63%). There were 23 cases of hypocalcemia (30.26%), 22 cases of hyperphosphatemia (28.94%) and 37 cases of hyperuricemia (48.68%).Conclusions: There was a high cardiovascular risk factor in this study population. Early detection of cardiovascular diseases should be done in patients who have a high-risk factor of cardiovascular disease to decrease the mortality rate in chronic kidney diseases population. The appropriate management of modifiable risk factors is important to improve the survival of this study patients.

Investigation of the relation between symptoms seen in haemodialysis patients with dialysis adequacy and personality traits / Investigación sobre la relación entre síntomas observados en pacientes en hemodiálisis con la adecuación de diálisis y rasgos de personalidad

ABSTRACT Objectives: Investigate the relation between the symptoms seen in haemodialysis patients with haemodialysis adequacy and character traits. Background: Investigation of the factors affecting symptoms seen in haemodialysis patients would lead to better understanding of the causes behind the symptoms and enable efficient symptom control management. Design: This descriptive and analytical study was conducted between January and June 2019 at two dialysis centres in Turkey. Methods: The data was collected through Demographic Information Form, The Dialysis Symptom Index, the Big Five Inventory and by calculating Kt/V and URR (Urea Reduction Rate) values for dialysis adequacy. Results: It was found that 77.6% of the haemodialysis patients experience 6 or more symptoms and the most common symptoms are feeling tired or lack of energy (70.7%), and the most severe symptom is numbness or tingling in feet (3.13±3.12). While 70.9% of the participants' Kt/V value was calculated as above 1.4; no statistically significant relation was found between Kt/V value and psychological and physiological symptoms (p>0.05). It was determined that haemodialysis patients with high neuroticism trait experience increased symptoms of tiredness, irritability, sadness, worrying; and patients with extraversion trait experience these symptoms less severely (p<0.05). Conclusion: Although this study found a relation between experienced symptoms and personality traits (neuroticism, extraversion); no relation was observed with dialysis adequacy. Nurses need to plan nursing initiatives by considering not only the patients' biochemical parameters but also their personality traits in managing haemodialysis symptoms of the patients.

RESUMEN Objetivos: Se investigó la relación entre los síntomas detectados en pacientes en hemodiálisis con la adecuación de diálisis y rasgos de personalidad. Antecedentes: El estudio de los factores que afectan los síntomas observados en los pacientes en hemodiálisis ayudaría a entender mejor las causas detrás de dichos síntomas y permitiría un mejor manejo del control de estos. Diseño: El presente estudio descriptivo y analítico se desarrolló entre enero y junio de 2019 en dos centros de diálisis en Turquía. Material y métodos: Los datos se obtuvieron a través del formulario de información demográfica, índice de síntomas dialíticos, el modelo de los cinco grandes, y se calcularon los valores de Kt/V y tasa de reducción de urea (TRU) para la adecuación de diálisis. Resultados: Se encontró que el 77,6% de los pacientes de hemodiálisis experimentan 6 o más síntomas; los síntomas más comunes son cansancio o falta de energía (70,7%), y el síntoma más grave es entumecimiento u hormigueo en los pies (3,13 ± 3,12). Si bien se determinó que el cálculo del valor Kt/V del 70,9 % de los participantes fue superior a 1,4, no se encontró una relación estadísticamente significativa entre el valor de Kt/V y los síntomas psicológicos y fisiológicos (p> 0,05). Se observó que los pacientes de hemodiálisis con alto rasgo de neuroticismo experimentan síntomas aumentados de cansancio, irritabilidad, tristeza, preocupación; y los pacientes con rasgo de extraversión desarrollan estos síntomas con menos gravedad (p <0,05). Conclusión: Aunque este estudio halló una relación entre los síntomas experimentados y los rasgos de personalidad (neuroticismo, extraversión), no se observó relación con la adecuación de la diálisis. Es necesario que el personal de enfermería planifique iniciativas considerando no solo los parámetros bioquímicos de los pacientes, sino también sus rasgos de personalidad al lidiar con los síntomas de hemodiálisis.

Study of correlation between adequacy of dialysis and glycemic control in patients of type 2 diabetes mellitus with chronic kidney disease stage 5

Background: The adequacy of haemodialysis in patients of type 2 diabetes mellitus with chronic kidney disease stage 5 depends on several clinical as well as laboratory parameters. Previous studies from Western literature have identified several clinical and laboratory markers for predicting adequacy of dialysis. There is a dearth of literature regarding the same in Indian patient populace. Authors aimed to find correlation, if any, between glycemic control and adequacy of dialysis in this cohort of patients.Methods: A set of 200 patients of type 2 diabetes mellitus who have undergone hemodialysis at a tertiary care hospital were included in the study. Random blood sugar (RBS), Glycated hemoglobin (HbA1c) were measured at admission. After 4 hours of dialysis, the urea reduction ratio (URR) and Kt/V was measured for each patient. The correlation coefficient as well as linear equation of the association between these variables were calculated. Standard statistical method and software were used in the process.Results: The study revealed a linear negative correlation between the variables RBS, HbA1c and URR as well as Kt/V. This suggests the importance of pre dialysis glycemic control in patients undergoing hemodialysis.Conclusions: Authors formulate the hypothesis that glycated hemoglobin and random blood sugar at admission correlate well with the outcome and adequacy of dialysis in patients of stage 5 chronic kidney disease undergoing haemodialysis.  Good glycemic control (HbA1c <6.5 % and RBS <120 mg/dL) have shown to be important predictive markers of adequate dialysis. The hypothesis needs to be tested with a larger study.

Plasma Lipid Profile and Cardiac Risk Markers in Diabetic Nephropathy.

Nephropathy is one of the serious diabetic complications and haemodialysis the common modality employed generally aimed to correct the altered crystalloids as well as to remove accumulated nitrogenous waste products. But it rarely corrects the vascular lipid levels, hence increasing the thrust of dyslipidaemia and dyslipidaemia induced cardiovascular complications in these patients. A study was planned to assess the cardiovascular risk factors, Cardiac Risk Ratio, Atherogenic Index of plasma and Atherogenic Coefficient in these patients to evaluate the cardiovascular risk.METHODSPatients of type 2 diabetes suffering from diabetic nephropathy undergoing haemodialysis at Subbaiah Institute of Medical Sciences, Shivamogga, and its affiliated hospitals in the age group of 30-60 years were randomly selected. A heparinised blood sample was collected after obtaining a written consent. Plasma lipid profile, Cardiac Risk Ratio, Atherogenic index of plasma and Atherogenic Coefficient were estimated. Aged matched non-diabetic subjects and type 2 diabetic patients without renal complications served as normal controls and diabetic controls respectively.RESULTSLevels of FPG, TC, TAG, HDLC, LDLC, VLDLC, CRR, AIP and AC were significantly elevated in patients of diabetic nephropathy.CONCLUSIONSPatients of diabetic nephropathy undergoing regular haemodialysis must be screened frequently for cardiovascular complications.

Peripheral neuropathy in Chronic Kidney Diseases: prevalence and its correlates

Background: Peripheral polyneuropathy is most common Chronic Kidney Diseases (CKD) related complication with prevalence of more than 60%. The prevalence of peripheral neuropathy is directly proportional to duration and severity of CKD. Objective of the study was to study and assess the prevalence of peripheral neuritis and its correlates in patients with chronic kidney diseases.Methods: The present study was a cross sectional; descriptive study was conducted in October 2016 to October 2018. Data analysed by using SPSS 23.0 version.Results: Out of 90 subjects, majority were from 45-54 years age group (26). 70% were male and 30% were females. Out of 60 pre-HD patients, 33(55%) showed peripheral neuropathy. Out of 30 HD patients, 24(80%) showed peripheral neuropathy. Maximum percentage of PN seen in 45-54 age group (76.92%) amongst the 60 males 39 (65%) and amongst 30 females 18(60%) showed peripheral neuropathy. Maximum percentage of PN seen in >5 years age group (79.31%). Pure axonal sensory motor neuropathy (28.88%) was most common pattern.Conclusions: Peripheral neuropathy is very common in CKD, more common in dialysis patients as compared to predialysis patients.

Contemporary management and outcomes of infective tunnelled haemodialysis catheter-related right atrial thrombi: a case series and literature review

INTRODUCTION@#Infective haemodialysis catheter-related right atrial thrombus (CRAT) is a complication of tunnelled catheter use. Management recommendations are based mainly on published case series prior to 2011. We report our institution's recent experience in managing infective haemodialysis CRAT and correlate treatment with outcomes.@*METHODS@#We conducted a retrospective analysis of haemodialysis CRAT cases diagnosed on transthoracic echocardiography between 1 January 2011 and 31 December 2017. Clinical outcomes, including mortality at 180 days post diagnosis and thrombus resolution, were traced from electronic medical records.@*RESULTS@#There were 14 cases identified. The median age was 59 (range 47-88) years and 11 (78.6%) were male. Sepsis was the most common reason for hospitalisation (71.4%). Blood cultures identified Staphylococcus aureus in seven cases, of which two were methicillin-resistant. Three had coagulase-negative Staphylococcus. All cases received antibiotics with infectious disease physician input. Seven were treated with catheter removal alone, of which three died within 180 days. Both cases treated with catheter removal plus anticoagulation survived at 180 days. Of the two cases who had anticoagulation without catheter removal, one died within 180 days and the other did not have thrombus resolution. Three underwent surgical thrombus removal, of which two died postoperatively and the last required repeated operations and prolonged hospitalisation. Mortality at 180 days post diagnosis was 42.9%.@*CONCLUSION@#Catheter removal and anticoagulation are modestly effective. Surgery is associated with poor outcomes. Despite contemporary management, infective haemodialysis CRAT still results in high mortality. Prospective studies are needed to identify the optimal management.

Electrocardiogram changes in patients with end stage renal disease on chronic haemodialysis

Background: End stage renal disease (ESRD) is irreversible loss of renal function which is physiologically defined by a GFR of less than 15 ml / minute. ESRD is associated with a higher incidence of coronary artery disease and serious arrhythmia especially ventricular arrhythmia. The goal of study is to determine whether ESRD and haemodialysis (HD)are associated with occurrence of significant electrocardiogram (ECG) changes or not.Methods: This is a cross-sectional study design which involved 22 patients with ESRD on regular HD in Al Sadre teaching hospital / Al Najaf. Both sexes was included in this study. All patients underwent full medical history and examination which included the following aspects: Age, Sex, Occupation, BP, HR, RBS, B.urea, S.creatinine , Serum electrolyte (Na+, K+, Cl-, Ca++), Lipid profile (Cholesterol , Triglyceride, HDL, LDL), Duration of CRF, Duration of dialysis, Social history including (smoking, alcohol) and Drug used by the patient. Resting EGC and Hotler ECG.Results: Eighteen patients exhibited emergence of simple ectopic activity premature atrial complex (PAC) and premature ventricular complex (PVC) events and four patients exhibited (ST,T changes). Potentially lethal arrhythmias and other serious ECG changes are not detected in our patient’s sample.Conclusion: In this study, neither ESRD nor haemodialysis were associated with development of serious ECG changes or emergence of significant arrhythmia.

Burden and resilience in caregivers of patients on maintenance haemodialysis

Background: Chronic renal failure is one among the chronic illness which due to persistence of the disease has various effects on the physiological, psychological and functional ability of the patient and his family. Although haemodialysis has become a highly safe medical procedure that significantly extended life of such patients, it is nevertheless a stressful and lengthy treatment process. The task of personal life care for such patients falls primarily on the family members. The caregiver is expected to aid in patient’s daily life activities resulting in increased physical and emotional burden. With the considerable level of burden involved the concept of resilience thus become crucial as they could function as protective factors. The current study aims to assess the level of caregiver burden and resilience in caregivers of haemodialysis patients.Methods: A cross sectional observational study was done in 120 caregivers of patients diagnosed as having ESRD on maintenance hemodialysis. Zarit Burden Interview was used for assessing caregiver’s burden. Brief Resilience Scale was used to assess caregiver’s resilience.Results: 35.8% of caregivers had severe caregiver burden while looking after dialysis patients while 45% of caregivers had moderate burden. Caregivers showed low resilience about 72.5% which displays poor problem solving and emotion-focused coping strategies.Conclusions: The study shows that more than 80% of caregivers suffered from moderate to severe burden and poor resilience among them would be a contributing factor. The study also shows that female caregivers were most affected. The burden was significantly higher in caregivers as the years spent on caregiving increased and more hours spent per day looking after the patients. Health-care providers need to address these concerns based on both patient- and caregiver-focused approaches, rather than only patient focused.