Doppler ultrasound assessment of well-functioning native hemodialysis access: comparison with sufficient dialysis

Malfunction of vascular accesses is a common cause of morbidity in hemodialysis patients. The purpose of the present study was to evaluate the flow volume and the diameter of the feeding artery in asymptomatic, well-functioning hemodialysis access with Doppler ultrasound. From March 2006 to February 2007, we examined the functioning mature arteriovenous fistula [AVF] of 69 hemodialysis patients by Doppler ultrasound in Imam Reza hospital, Mashhad. The measured flow volume, primary renal disease, AVF type and location, and the demographic data were recorded. All statistical analyses were performed with the Chi square test, the Student's t test and one-way ANOVA. Pearson correlation coefficient was also calculated. Of the 69 patients, 30 [43%] had an antecubital AVF. Overall, the mean +/- SD flow volume was 1665 +/- 554 mL/min. The majority of accesses [n = 52] had normal flow volume [500-1200 mL/min], 15 patients had high-flow fistulas [>1200 mL/min] and 4 had critical flow rates of < 500 mL/min. The flow volume was significantly higher in the antecubital AVF than that placed in more distal positions. The mean diameter of the feeding artery at the measurement site was 6.0 mm. There is a linear correlation between the diameter of the feeding artery and the mean flow rate [r = 0.76, p < 0.001]. No significant difference was observed between the type of anastomosis and the flow rate [p = 0.14]. There is a high level of abnormalities, especially high flow volume, in well-functioning mature AVFs. Color Doppler ultrasonography makes early detection of the patients with a higher risk possible and it can also guide the surgeon to select the surgical procedure

[ comparative study on results of anemia treatment between peritoneal dialysis and hemodialysis patients]

Anemia is one of the most serious complications in patients under dialysis. The aim of this study was to investigate the influence of haemodialysis and continuous ambulatory peritoneal dialysis on anaemia during the first six months of treatment by Erythropoentin. This cross - sectional descriptive study was done in Dialysis Center of Imam Reza Hospital in the year 2005. 53 patients on haemodialysis and 47 patients on CAPD were analyzed. They received low doses of erythropoietin ranging from 50 U/Kg/wk to 100 U/Kg/wk. The EPO dose/week, hemoglobin, ferritin, transferrin saturation [TS], albumin and intact parathyroid hormone [iPTH] were analyzed befor and six months after study. Erythropoetin treatment was prescribed if HB < 11. Individual and laboratory data were gatherd in a questionnaire and analyzed by descriptive statistics and frequency distribution tables. In the CAPD group, the mean hemoglobin level increased from 8.7 +/- 0.2 to 10.87 +/- 1.67 g/dl [P < 0.001] and hematocrit from 25.3 +/- 1.0 to 32.76 +/- 4.92% [P < 0.001], while in the HD group the mean hemoglobin rose from 8.7 +/- 0.6 to 9.25 +/- 1.8 g/dl [P < 0.001] and Hct from 25.7 +/- 2.3 to 28.07 +/- 6.22% [P < 0.001]. The CAPD group needed a significantly lower weekly dosage of erythropoietin than HD group [72 -/+ 18 U/Kg/wk vs. 92 -/+ 8 U/kg, p < 0.01]. At the end of the study TS was similar in both groups, while ferritin was higher in HD patients, with a higher percentage of HD patients using intravenous iron [HD 77% vs. PD 49%, p=0.001]. Serum albumin and iPTH were lower in PD patients [p<0.05 in both]. Patients on CAPD exhibited significant correction of anaemia during the first six months of treatment and had a better erythropoietin response than the hemodialysis patients

[Factors affecting the hospitalization period of kidney transplantation recipients]

Nowadays, as many of the problems confronting kidney transplantation have been solved, the number of operations has increased dramatically. So, resource utilization and financial issues have been cited as a new problem for transplantation centres. This study was done to find and assess the factors which can reduce the hospitalization period, while this factor claims the biggest share of the total cost of the treatment process. In this retrospective study, done in kidney transplantation word of Imam Reza Hospital, the medical history of 170 kidney transplantation recipients and donors, whose operations were performed between 2000 and 2002, were studied. Collected information of recipient's characteristics included gender, age, reason for kidney failure, weight, height, blood group, dialysis period, transplantation history, immunosuppressant regimes, complications after operation, and hospitalization after the first discharge due to transplantation operation complications; and for the donors, age, sex and blood group of the donor and the type of donor [cadaver or living] and the relationship between the recipients and the donors were gathered in a questionnaire and analyzed by descriptive statistics and T - test. Among all pre-transplant variables only length of dialysis before transplantation and the relationship between donors and recipients were found to be independently significant in predicting the increased hospitalization period and consequently charges. It is shown that by reducing the waiting time and performing more operations on relative donors and recipients, we can significantly decrease hospitalization period and as a result the cost of treatment

[Efficacy of IL-2 receptor blockers in live donor renal transplantation]

In the early post-transplantation period, acute rejection is the major cause of graft failure. It is also one of the most important predictors for long-term graft survival following renal transplantation. This study was aimed to compare the rate of acute rejection [AR] between patients receiving and those not receiving IL-2 Receptor Blockers for induction therapy. Ninety four patients undergoing renal transplantation from living donor were randomized into a prospective controlled trial. The patients were divided into two groups: D+ including 47 cases [26 men, 21 women with the mean age of 27.8 +/- 15.2 years] received Prednisolone, Cyclosporine, Mycophenolate Mofetil, plus Daclizumab and D- including 47 cases [28 men, 19 women, mean age 28.4 +/- 12.8 years] received all above drugs except for Daclizumab. They were matched considering the age of recipients and donors, recipient-donor relationship, underlying diseases and panel reactivity test status. Individual and laboratory data were recorded in the questionnaire. Data was analyzed using qualitive statistics and frequency distribution tables. All patients completed the 6 month study. The acute tolerability for Daclizumab injection was good without any evidence of cytokine-release syndrome. D+ patients had less AR as compared with D-treated patients [17.02% vs. 8.51%]. Graft survival at 6 months was higher with Daclizumab [100%] as compared with no induction [97.4%]. Serious infection was seen in five cases [10.41%] in D+ group and 4 cases [8.33%] in control group. Patient death or malignancies did not occur in any group. Our study demonstrates that induction with Daclizumab results in reduction of early renal allograft rejection. The therapy with anti-IL-2R antibody is simple and is well tolerated

[Evaluation of stressors and copping methods among haemodialysis patients]

Patients with ESRD who receive dialysis must confront the burdens of long-term illness and numerous treatment-associated stressors. One of the most important factors in decreasing psychiatric disorders in these patients is using copping methods with physiological and psychosocial stressors. The purpose of the study was to determine the stressors and how the degree of subjective stress depends on sex and age; and to evaluate copping methods in chronic haemodialysis patients. This was a descriptive survey study performed in the Mashhad University of Medical Sciences during the year 1383. 120 patients [49 females and 71 male], regularly treated with hemodialyses were chosen through sensor sampling. Patients filled in the Hemodialysis Stressors Scale [HSS] to determine the prevalence and severity of physicopsychosocial stressors [CES - D]. This scale contained 29 items and was scored at the basis of four - point ctiteria of Likert's scale [0- 4]. Data was Analyzed using SPSS software and qualitive statistics using Student T-test, chi[2] and kruskal- wallis statistical tests. Values of p less than 0.05 were considered significant. The mean age of patients was 31.9 +/- 3.12 years [between 15 to 64 years].59.4% of patients had duration of dialysis less than 3 years. Results revealed that the average score of physiological stressors was 12.09 +/- 4.89 and the average score of psychosocial stressors was 38.51 +/- 14.45. Fluid restriction was ranked as the most prevalent psychosocial stressor followed by decrease in social life, and the top physiological stressors were muscle cramps and fatigue. There was a consistent trend for almost all stressors to become more intense over time, with some specific stressors increasing significantly. A positive relationship was demonstrated between emotionoriented copping and psychosocial and physiological stressors, though 67.8% of patients have been using problem - oriented methods. Psychosocial stressors are more common than physiological ones in hemodialytic patients. In attention to copping methods and their benefits for decreasing stress and depression levels, guidance of patients and their families is necessary. Nurses need to be educated about the factors that are stressful to patients, so they can support them appropriately

Risk factors affecting second renal transplants outcomes

Introduction: Despite the dramatic improvement in the short-term outcome of kidney transplantation 30% or more of patients will lose their allograft before the fifth transplant anniversary. Second renal allograft survival rates are lower than those of primary allograft in many studies. This study is carried out to identify risk factors associated with decreased second regraft survival

Material and Method: from 1989 through 2002, 650 primary and 37 first repeat transplans were performed on Imam Reza hospital. Graft survival rates for primary transplants at 12, 36 and 60 months after transplantation were 93%, 89%, 76% respectively, compared with 87%, 79%, 68%, for transplants at the same time periods

Result: we observed no effect of recipient age and sex, time interval between primary graft loss and second transplantation or allograft nephrectomy on outcome for patients who had undergone retransplantation or allograft nephrectomy on outcome for patients who had undergone retransplantation. Causes of the first graft failure were analyzed. Regraft failure is more common in patients who lost their first graft because of acute rejection than patients who had chronic rejection

Conclusion: The result showed a significant relationship between primary allograft survival, PRA and PPRA level and retransplant outcome

Skin cancer after renal transplantation

Introdaction: The incidence of skin cancer in transplant recipient is higher than general population. Therefore, careful phyiscal examination to detect skin malignancies is essential in the long-term prognosis of these patients. This study was carried out to identify risk factors associated with variant of skin tumor from 1989 to 2002

Material and Method: 620 kidney transplants [223 women and 397 men] were performed in Imam Reza hospital. The patients were followed up for one to 14 years. They were treated with cyclosporine, prednisolone, Azathioprine or Mycophenolate Mofetiel

Results: Skin tumor was observed in 12 patients [10 men and 2 women]. Diagnosis was based on biopsy. Kaposi sarcoma was occurred earlier than other tumor and accounted for 50% [6 out of 12] of post-transplantation skin tumor. Five patients had SCC and one of them had BCC. Kaposi sarcoma on the average appeared 14 months after transplantation. SCC appeared later than other type of cancers occurring after transplantation [90 +/- 36 months]. All patients who had SCC and BCC were male and they were older than 40 years old, when they received kidney. SCC and BCC occurred on the head and neck in all patients who did have these tumors. All patients with kaposi sarcoma had skin involvement. 33.3% of these patients had visceral lesions. In our study the incidence of malignancy was observed to be less than those reported in other reports [2% instead of 6% - 24%] and kaposi sarcoma was the most frequent neoplasm. The result showed a significant relationship between recipient's age and sex with skin tumor. Skin tumor was observed to be more common in men and older patients

Conclusion: In addition to standard established treatment for each malignancy, reduction of immunosuppression was performed. Complete remission was observed in two patients who had kaposi sarcoma and three patients who had SCC while the other patients didn't respond to the treatment