ABSTRACT
Mood disorders are common in end-stage renal disease (ESRD) and may increase morbidity and mortality in adults on chronic hemodialysis (HD), affecting their quality of life (QOL). We aimed to investigate the prevalence of and factors associated with anxiety and depression in ESRD patients on chronic HD. Thirty-nine HD patients were assessed for anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) questionnaire. The HADS scores were correlated with demographic, clinical, and laboratory parameters. According to the HADS scores, depression and anxiety were found, respectively, in 11 (28.2%) and in nine (23.1%) patients. Both depression and anxiety were found in four (10.3%) patients. The average depression score was 7.4 ± 4.2; the average anxiety score was 7.7 ± 4.6. The depression score correlated significantly with the number of medications (r = 0.46, P = 0.003) and phosphatase alcalin (r = -0.37; P = 0.022); the anxiety score correlated significantly with the number of medications only (r = 0.36, P = 0.022). The risk factors associated with anxiety were age [odds ratio (OR) = 1.12; 95% confidence interval (CI): 1.01-1.2; P = 0.025] and sleep disturbances (OR = 6.74; 95% CI: 1.49-30.4; P = 0.016), and only diabetes was a risk factor associated with depression (OR = 4.4; 95% CI: 1.94-16.9; P = 0.009). The screening and management of depression and anxiety would improve the QOL of patients on chronic HD.
Subject(s)
Kidney Failure, Chronic , Quality of Life , Humans , Adult , Depression/diagnosis , Depression/epidemiology , Anxiety/diagnosis , Anxiety/epidemiology , Renal Dialysis/adverse effects , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/epidemiology , Kidney Failure, Chronic/therapyABSTRACT
Antiphospholipid antibody syndrome is a thrombophilia characterized by the association of a clinical or obstetric arterial and/or venous thromboembolic event with persistent antiphospholipid antibodies. We here report the case of a young patient admitted with acute renal failure associated with bilateral renal artery thrombosis. Immunology tests showed lupus-like circulating anticoagulant on the basis of which the diagnosis of antiphospholipid antibodies was retained. Early angioplasty was performed enabling renal function recovery.
Subject(s)
Acute Kidney Injury/etiology , Antiphospholipid Syndrome/diagnosis , Renal Artery/pathology , Thrombosis/etiology , Adolescent , Angioplasty/methods , Antibodies, Antiphospholipid/immunology , Antiphospholipid Syndrome/complications , Antiphospholipid Syndrome/immunology , Female , Humans , Lupus Coagulation Inhibitor/immunologyABSTRACT
The antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis mainly affect small vessels. They are an exceptional etiology of visceral artery aneurysms, which are themselves unusual and potentially serious vascular disease. We report the case of a patient followed for vasculitis associated with ANCA with kidney disease who presented with symptomatic aneurysm of the inferior mesenteric artery and aneurysm of the superior mesenteric artery.
Subject(s)
Aneurysm/etiology , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/complications , Mesenteric Artery, Inferior , Mesenteric Artery, Superior , Aged , Aneurysm/diagnostic imaging , Aneurysm/surgery , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis , Biopsy , Computed Tomography Angiography , Female , Humans , Ligation , Mesenteric Artery, Inferior/diagnostic imaging , Mesenteric Artery, Inferior/surgery , Mesenteric Artery, Superior/diagnostic imaging , Mesenteric Artery, Superior/surgery , Treatment Outcome , Ultrasonography, Doppler, Color , Ultrasonography, Doppler, Pulsed , Vascular Surgical ProceduresABSTRACT
INTRODUCTION: Patients in end stage renal disease on hemodialysis are in higher risk of bleeding related to the anticoagulation used during a session, so only the lowest effective dose of anticoagulation must be used. The aim of this study was to evaluate the efficacy of predilution in hemodiafiltration with reduced dose of anticoagulation compared to hemodialysis in preventing coagulation of circuits. PATIENTS AND METHODS: This study was conducted in stable hemodialysis patients without high bleeding risk. All patients were treated by two different treatments: (A) conventional hemodialysis, (B) predilution hemodiafiltration with the half dose of anticoagulation used during treatment (A). Other confounding parameters were kept constant during the study. The primary endpoint was the incidence of major thrombotic events judged on a subjective visual score. RESULTS: Twenty-one patients were included (105 sessions for each treatment). Major incidents are occurring more frequently in predilution hemodiafiltration with reduced dose of anticoagulation (P=0.03). The premature discontinuation of sessions was more frequent in predilution hemodiafiltration, this difference was not significant (P=0.07). Duration of sessions was significantly shorter in predilution hemodiafiltration (P=0.03). The higher frequency of thrombotic events in predilution hemodiafiltration has no effect on net ultrafiltration volume achieved in both treatments. CONCLUSION: Predilution hemodiafiltration with a lower dose of anticoagulation did not prevent major clotting of extracorporeal circuit manner at least equivalent to a reference method.
