Tuberculosis in hemodialysis.

Chronic uremia puts patients at increased risk of infectious complications, in particular, tuberculosis. In this prospective study, we analyzed the clinical, paraclinical, and therapeutic features as well as outcome for all patients on chronic hemodialysis with tuberculosis from January 2010 through August 2012. Sixty-one patients were admitted for bacterial infections, 23% of them for tuberculosis. Fever was present in 71% of cases, and CRP elevated in all cases. The tuberculin skin test was positive in only 2 of 9 cases, and Mycobacterium tuberculosis isolated in 2 of 10 cases. Histological evidence was obtained in 7 of 9 cases. Plain radiographs and computed tomography evoked tuberculosis. The location was extrapulmonary in 71% of cases. Chemotherapy for tuberculosis was based on a quadruple therapy for 10 patients and triple therapy for 3. The outcome was favorable in 11 patients and fatal for 3. Tuberculosis is much more common in hemodialysis patients than in the general population. The telltale signs are nonspecific. Prognosis is closely linked to early diagnosis and treatment.

[Screening and risk factors of cardiac calcification in hemodialysis: contribution of ultra-fast multi-slice scanner and transthoracic echocardiography]. / Dépistage et facteurs de risque des calcifications cardiaques chez l'hémodialysé : apport du scanner multi-coupe ultra-rapide et de l'échocardiographie transthoracique.

INTRODUCTION: Cardiovascular disease is the first leading cause of death in hemodialysis patients. In this population, cardiovascular calcifications occur at an earlier age and progress faster than in general population. PATIENTS AND METHODS: In order to determine the prevalence and risk factors of cardiac calcifications, 49 patients on chronic hemodialysis were screened in the coronary arteries and cardiac valves by the 64 multi-slice ultra-fast CT and the transthoracic echocardiography. Different clinical and biological parameters were studied by the SPSS 10.0 statistical software to determine risk factors. RESULT: Cardiac calcifications were identified in 81.6% of cases in at least one of the two studied sites. The coronary artery involvement was more common than valvular and concerned 69.4% of cases. The mean Agatston coronary artery calcium score (ACACS) was 331.1 and 522.2 in coronary patients and was correlated to alteration of systolic function of LV (r=-0.287, P=0.045). The severity of CACS was positively correlated with age (r=0.332, P=0.02). Coronary calcifications were associated with cardiovascular risk common to those of the general population (age, male sex, systolic blood pressure, diabetes, history of ischemic heart disease), but also to a lesser quality of dialysis. Valvular calcifications were present in 49% of cases and were correlated with left ventricular hypertrophy (P=0.006). The exclusive involvement of the aortic valve was the most common valvular abnormality. Phosphocalcic and lipid parameters, levels of hemoglobin, CRP and uric acid did not predisposed to cardiac calcifications in our patients. DISCUSSION: In hemodialysis patients, the pathogenesis of cardiovascular calcification is complex and cannot be attributed to a passive process. This process involves several factors that can promote or inhibit calcification. The new multi-slice ultra-fast scanner is a very sensitive method for topographic and quantitative assessment of coronary calcification and is a better alternative to invasive techniques. CONCLUSION: Our study confirms the high prevalence of cardiac calcification in hemodialysis, and highlights the importance of early screening and treatment of predisposing factors.

Partially thrombosed aneurysm of the abdominal aorta: Unusual cause of chronic inflammation and resistance to recombinant human erythropoietin.

Diagnosis of chronic inflammatory syndrome is often a challenge. In dialysis patients, this condition leads to resistance to recombinant human erythropoietin (rHuEPO). We here report a case of a 72-year-old male undergoing chronic hemodialysis and developed rHuEPO resistance without any obvious etiology. Investigations showed a partially thromosed aneurysm of the infrarenal aorta. Antiplatelet therapy was started with a satisfactory outcome.

Effect of the quality of water used for dialysis on the efficacy of hemodialysis: a single-center experience from Morocco.

The quality of the water used for dialysis has been suggested as a factor causing inflammation in patients on hemodialysis (HD). We therefore conducted this study to identify the effect of quality of the water on nutritional state, inflammation and need for human recombinant erythropoietin (EPO) in patients undergoing HD at Agadir, Morocco. This prospective study included patients on HD for at least one year. The water treatment was done according to the standard protocol, which was followed by additional enhancement of ultrafiltration using an additional polysulfone filter (diasafe, Fresenius, Bad Homburg, Germany) before the dialyser. Water was monitored regularly during the study period to ensure acceptable levels of bacterial count as well as endotoxin levels. Various parameters including dry weight, systolic and diastolic blood pressure (PA) before and after an HD session, need for human recombinant EPO, levels of hemoglobin (Hb), albumin, ferritin, C-reactive protein (CRP), and the dose of dialysis delivered (Kt/V) were measured first at the beginning of the study and thereafter, in the third, sixth and 12 th months of the study. The study involved 47 patients, and after 12 months of the study, an improvement in median dry weight (1.2 kg, P = 0017) and a simultaneous median reduction of 20.7 IU/kg/week of EPO, with an in-crease of the median level of Hb, was noted. The results of our study suggest that by improving the biocompatibility of HD with the use of good quality water, patients acquire a better nutritional, inflammatory and hematologic status.

Characteristics of intradialytic hypotension: experience of Agadir Center-Morocco.

We report in this retrospective study the experience of our hemodialysis (HD) center in the incidence of intradialytic hypotension (IDH) over 18 months. We first studied the demographic, clinical, biological and morphological data of our 52 HD patients and compared the characteristics of patients with frequent IDH and those without. We found that factors significantly associated with IDH include diabetes, left ventricular hypertrophy, impaired diastolic function, weight gain and high ultrafiltration rates. Despite these results, further larger studies are required to confirm them.