Physical activity in Sahara Moroccan hemodialysis patients.

OBJECTIVE: The evaluation of physical activity for chronic hemodialysis patients is a new approach for patient global care. The objective of this work is to evaluate the physical activity in chronic hemodialysis patients and identify the risk factors associated with reduced physical activity. This is a prospective study for 6 months including 150 chronic hemodialysis patients in the Guelmim-Oued Noun Regionin Moroccan Sahara. We use Baecke's survey, translated and validated in Arabic local language. The socio-demographic, clinical, and biological data were completed during the interrogation and from the medical records of the patients. RESULTS: The mean age of our patients was 54.6 ± 16.4 years, with male predominance (59%). Most patients have a low education level and 60% were illiterate. Hypertension was found in 54% of our patients, diabetes in 39%, and cardiovascular disease in 10% of patients. Low Physical activity was associated with gender (OR = 4.05), age (OR = 1.03) and high education level (OR = 0.2). Our work has met the various pre-established objectives, however other more specific studies must be conducted to better characterize the profile of physical activity in chronic hemodialysis patients.

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.

[Prevalence and risk factors of hepatitis C virus infection in patients on hemodialysis: results of a Moroccan study]. / Prévalence et facteurs de risque de l'hépatite virale C en hémodialyse : résultats d'une étude marocaine.

INTRODUCTION: Infection with the hepatitis C virus (HCV) is the leading cause of chronic hepatitis in patients on hemodialysis. The objective of this study was to determine the prevalence of infection with this virus and its main risk factors among chronic hemodialysis patients treated at the Mohammed V military teaching hospital in Rabat, Morocco. PATIENTS AND METHODS: Retrospective study of 141 patients with chronic end-stage kidney disease receiving hemodialysis between April 2010 and September 2012, including testing for anti-HCV antibodies and HCV RNA. RESULTS: The prevalence of HCV assessed by PCR in chronic hemodialysis patients treated at our hospital was 12.1%. Risk factors associated with this prevalence included duration of hemodialysis and transfusions. CONCLUSION: The prevalence of HCV among patients receiving hemodialysis in Morocco is gradually declining and the most important risk factors (transfusions and duration of hemodialysis) are becoming progressively less important.

[Diagnosis and evaluation of hepatitis C virus among haemodialysis patients]. / Diagnostic et evaluation de l'hépatite virale C chez I'hémodialysé.

Hepatitis C is a health problem worldwide. The World Health Organization estimates that 3% of world's population is infected with hepatitis C virus (HCV). In haemodialysis patients, the prevalence reaches 80% in some countries. In Morocco, HCV prevalence is 32% according to the Moroccan register of dialysis. The natural history of hepatitis C infection in chronic haemodialysis patients is characterized by a silent evolution. There are different methods to diagnose HCV and they are becoming increasingly sensitive. There are indirect tests for antibodies to HCV: these are reproducible but false negatives are common and there is direct testing of viral RNA: this is more sensitive but not always available and is more expensive. The use of these tests has been categorized through new recommendations from learned societies. However, the evaluation of liver disease is still controversial and liver biopsy remains the gold standard. This paper reviews the approaches for diagnosing and evaluating hepatitis C in haemodialysis patients.

Diagnosis and evaluation of hepatitis C virus among haemodialysis patients

Hepatitis C is a health problem worldwide. The World Health Organizion world's population is infected with hepatitis C virus [HCV]. In haemodialysis patients, the prevalence reaches 80% in some countries. In Morocco/ HCV prevalence is 32% according to the Moroccan register of dialysis. The natural history of hepatitis C infection in chronic haemodialysis patients is characterized by a silent evolution. There are different methods to diagnose HCV and they are becoming increasingly sensitive. There are indirect tests for antibodies to HCV: these are reproducible but false negatives are common and there is direct testing of viral RNA: this is more sensitive but not always available and Is more expensive. The use of these tests has been categorized through new recommendations from learned societies. However, the evaluation of liver disease is still controversial and liver biopsy remains the gold standard. This paper reviews the approaches for diagnosing and evaluating hepatitis C in haemodialysis patients

Bisalbuminemia during remission of nephrotic syndrome.

The bisalbuminemia acquired outside of the long-term antibiotic treatment is an exceptional event. It is a rare condition characterised by the presence of two distinct fractions of serum albumin on electrophoresis. This anomaly reflects the presence, at the same time, of a normal albumin and a modified albumin. These changes of albumin may be related to various causes. Their association with nephrotic syndrome is exceptional. We report a case of bisalbuminemia during a period of remission of nephrotic syndrome.

Predictors of early vascular-access failure in patients on hemodialysis.

Vascular access management is key and critical in the successful management of hemodialysis patients, and an arteriovenous fistula (AVF) is considered the access of choice. This study was conducted between January 2007 and October 2009 at the Military Hospital in Rabat. Data on 115 patients who underwent 138 AVFs were retrospectively studied. Wrist AVF was the most common site of use. The primary course was uncomplicated in 63% of the patients, while primary failure occurred in 23.9% of the patients. Presence of diabetes was the most important risk factor for primary failure.

The Kt/V by ionic dialysance: Interpretation limits.

The availability of hemodialysis machines equipped with online clearance monitoring (OCM) allows frequent assessment of dialysis efficiency and adequacy without the need for blood samples. Accurate estimation of the urea distribution volume (V) is required for Kt/V calculated from OCM to be consistent with conventional blood sample-based methods. A total of 35 patients were studied. Ionic dialysance was measured by conductivity monitoring. The second-generation Daugirdas formula was used to calculate the Kt/V single-pool (Kt/VD). Values of V to allow comparison between OCM and blood-based Kt/V were determined using Watson formula (VWa), bioimpedance spectroscopy (Vimp), and blood-based kinetic data (Vukm). Comparison of Kt/Vw ocm calculated by the ionic dialysance and Vw (Kt/Vw ocm) with Kt/VD shows that using VW leads to significant systematic underestimation of dialysis dose by 24%. Better agreement between Kt/V ocm and Kt/VD was observed when using Vimp and Vukm. Bio-impedancemetry and the indirect method using the second-generation Daugirdas equation are two methods of clinical interest for estimating V to ensure greater agreement between OCM and blood-based Kt/V.

[Prevalence of metabolic syndrome in chronic haemodialysis patients in Morocco]. / Prevalence du syndrome métabolique chez les hemodialyses chroniques au Maroc.

We determined the prevalence of metabolic syndrome in 25 chronic haemodialysis patients in the haemodialysis centre of the Mohammed V military teaching hospital in Rabat. The mean age of the patient as was 46.5 (SD 14.8) years and mean haemodialysis duration 62.9 (SD 38.4) months. We evaluated the 5 parameters of metabolic syndrome: waist circumference, hypertriglyceridaemia, high-density lipoprotein (HDL) cholesterol, blood pressure and blood glucose. In all, 11 (44%) patients had metabolic syndrome: 7 women and 4 men. Low HDL cholesterol was found in 100% of the patients, hypertriglyceridaemia in 90.9% and hypertension in 63.6%. There were significant differences between patients with and without metabolic syndrome with regard to levels of hypertriglyceridaemia and HDL cholesterol, and waist circumference. Factors significantly associated with the presence of metabolic syndrome were abdominal obesity, and systolic hypertension and aypertriglyceri daemia.

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.

Prevalence of metabolic syndrome in chronic haemodialysis patients in Morocco

We determined the prevalence of metabolic syndrome in 25 chronic haemodialysis patients in the haemodialysis centre of the Mohammed V military teaching hospital in Rabat. The mean age of the patients was 46.5 [SD 14.8] years and mean haemodialysis duration 62.9 [SD 38.4] months. We evaluated the 5 parameters of metabolic syndrome: waist circumference, hypertriglyceridaemia, high-density lipoprotein [HDL] cholesterol, blood pressure and blood glucose, In all, 11 [44%] patients had metabolic syndrome: 7 women and 4 men. Low HDL cholesterol was found in 100% of the patients, hypertriglyceridaemia in 90.9% and hypertension in 63.6%. There were significant differences between patients with and without metabolic syndrome with regard to levels of hypertriglyceridaemia and HDL cholesterol, and waist circumference. Factors significantly associated with the presence of metabolic syndrome were abdominal obesity, and systolic hypertension and hypertriglyceridaemia

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.