Predictors of mortality in hemodialysis

One hundred and five patients enrolled in the maintenance haemodialysis programme at The Kidney Centre were studied retrospectively to identify patient characteristics associated with increased mortality. Hypertension [relative risk 10.03, P<0.001], serum albumin <3 G/dl [relative risk 2.60, p<0.05], diabetes mellitus as a cause of End Stage renal disease [relative risk 2.54, p<0.001], age >55 years [relative risk 1.8, p] were associated with higher risk of mortality, while sex had no statistically significant effect

Nutritional assessment of patients on maintenance haemodialysis

Nutritional assessment was carried out on fifty haemodialyzed patients by demographic, anthropometric, biochemical and dietary indices. The mean age of the patients was 49 years with a male to female ratio of 2.3:1. The duration of dialysis ranged from 6 to 40 months with a mean of 25 months. Fifty percent of the patients were moderately nourished based on their body weight 44%, body mass index 40% and mid-arm circumference 66%. Seventy percent patients had albumin and total proteins within the normal range. Blood urea nitrogen, creatinine, cholesterol, potassium and phosphorus did not significantly change from the previous reports. The caloric and protein intake in 60-70% cases was less than recommended. Overall there was a tendency to caloric and to a lesser degree protein malnutrition in our patients. It is suggested that preventing malnutrition by economical, aggressive and ongoing dietary intervention may minimize malnutrition in haemodialyzed patients

Hepatitis-C virus antibodies[Anti HCV] in haemodialyzed vs non-dialyzed patients

Anti HCV was checked using Enzyme Immuno assay [EIA] [C100-3- Abbott] in 68 patients with chronic renal failure [CRF] who were on maintenance haemodialysis and 48 patients on conservative management. Mean age of the patients was 50 years. The duration of illness ranged from 3 months to 18 years [mean 3 years]. All patients were Hepatitis B surface antigen [HBsAg] negative. In haemodialyzed group 31 [46%] and in conservative group only 3 [6%] were Anti HCV positive. High Frequency of Anti HCV positivity in haemodialyzed group was related to period on dialysis [1 year] and number of blood transfusions [>4 units]. Patients in whom dialyzer was re-used showed 60% positivity as compared to only 17% in those with single use. Anti HCV positivity predominated in females as compared to males. 42.6% vs 20.3%. Nine out of 10 patients with a history of jaundice and six out of 8 patients with raised transaminase levels were Anti HCV positive. Fifteen of 37 Anti HBC [IgG] positive cases were Anti HCV +ve

Experience of hemodialysis at the kidney centre

Seventy-nine patients of end stage renal disease [ESRD] on maintenance haemodialysis were studied. Most of the cases were in their prime of life. The disease was equally common in both sexes and all ethnic groups. Chronic glomerulonephritis was the commonest cause followed by diabetes mellitus. Hypertension was the commonest associated illness. All patients were screened for hepatitis B surface antigen and antibody and those found negative were vaccinated. A-V fistula in the upper extremity was used as the vascular access in 93% cases. In 68% cases dialyzer was reused without any ill effect. Amongst the complications observed, hypotension was seen in 65%, psychological disorders in 52%, followed by nausea, vomiting, itching and cramps. Technical complications were related to A-V fistula in 45% cases. Forty three percent patients were maintained without blood transfusion and 88% showed improvement in their quality of life