The Effect of Gradual Reduction in Sodium Dialysate on Occurrence of Muscular Cramp, and the Serum Level of Calcium and Magnesium in Patients Undergoing Hemodialysis: A Cross-Over Clinical Trial

Background: The aim of study was to determine the effect of gradual reduction in sodium dialysate on occurrence of muscular cramp, and the serum level of calcium and magnesium in patients undergoing hemodialysis. Methods: This triple-blinded cross-over clinical trial was conducted on 56 hemodialysis patients. After random allocation of patients into group A by the routine method (fixed sodium dialysate) and group B with gradual reduction in sodium dialysate, they underwent a 3-session dialysis. After one week of dialysis through routine method (wash out), patients underwent 3-session dialysis in group B by routine method and in group A by gradual reduction in sodium dialysate. Occurrence of muscular cramp was recorded by using a check list. Patients, serum level of calcium and magnesium before and after intervention was measured. Descriptive statistics indices and inferential statistics tests (repeated measures Analysis of variance) were used. Results: The rate of muscular cramp in routine method was 3.8% in one muscle, 1.9% in two or more muscles, and in the method of gradual reduction of sodium dialysate was 1.9% in one muscle, and 7.5% in two or more muscles. The mean difference of plasma calcium and magnesium before and after the dialysis with routine method was 0.43 and 0.26, respectively, and in the method of gradual reduction of sodium dialysate was 0.45 and 0.34. In this study no significant difference was observed for the rate of occurrence of muscular cramp and serum level of calcium and magnesium between two methods. Conclusions: The results showed that gradual reduction of sodium dialysate, has no effect on occurrence of muscular cramp during dialysis, serum level of calcium and magnesium in hemodialysis patients. Further investigations are needed to better understand the exact effect of this method, and also eliminate the study limitations. Keywords: Calcium, Hemodialysis, Magnesium, Muscle cramp, Sodium dialysate

The Relationship between Caring Burden and Quality of Life in Caregivers of Type 2 Diabetes

Background: Taking care of patients with chronic diseases such as diabetes exerts great tiredness and stress on the caregivers. The aim of this study was to determine the extent of the caring burden and its relationship with the quality of life of caregivers of diabetic patients. Methods: In this cross-sectional study, 154 caregivers of patients with type 2 diabetes referred to Imam Hossein hospital in Shahroud city were evaluated. The data collection tools included a demographic questionnaire, SF-36 standard quality of life questionnaire, and Novak & Guest care burden questionnaire. The accessible sampling was used and the data were collected by self-reporting. The data was analyzed using descriptive and inferential statistics (Pearson correlation coefficient and regression analysis). Significant level was set at 0.05. Results: The mean age of caregivers was 41.86 ± 12.78 years old. The mean scores of care burden and quality of life of the participants were 53.21 ± 49.61 and 61.02 ± 20.71 respectively. There was a significant inverse correlation between the mean score of care burden and caregivers’ quality of life. Conclusions: According to the results of this study, providing social and informational support for caregivers is recommended to reduce the care burden and subsequently improve the quality of life. Key words: Caring pressure, Quality of life, Diabetes, Caregiver

The Effect of Gradual Reduction in Sodium Dialysate on Occurrence of Muscular Cramp, and the Serum Level of Calcium and Magnesium in Patients Undergoing Hemodialysis: A Cross-Over Clinical Trial: The effect of gradual reduction in sodium dialysate on occurrence of muscular cramp

Background: The aim of study was to determine the effect of gradual reduction in sodium dialysate on occurrence of muscular cramp, and the serum level of calcium and magnesium in patients undergoing hemodialysis. Methods: This triple-blinded cross-over clinical trial was conducted on 56 hemodialysis patients. After random allocation of patients into group A by the routine method (fixed sodium dialysate) and group B with gradual reduction in sodium dialysate, they underwent a 3-session dialysis. After one week of dialysis through routine method (wash out), patients underwent 3-session dialysis in group B by routine method and in group A by gradual reduction in sodium dialysate. Occurrence of muscular cramp was recorded by using a check list. Patients, serum level of calcium and magnesium before and after intervention was measured. Descriptive statistics indices and inferential statistics tests (repeated measures Analysis of variance) were used. Results: The rate of muscular cramp in routine method was 3.8% in one muscle, 1.9% in two or more muscles, and in the method of gradual reduction of sodium dialysate was 1.9% in one muscle, and 7.5% in two or more muscles. The mean difference of plasma calcium and magnesium before and after the dialysis with routine method was 0.43 and 0.26, respectively, and in the method of gradual reduction of sodium dialysate was 0.45 and 0.34. In this study no significant difference was observed for the rate of occurrence of muscular cramp and serum level of calcium and magnesium between two methods. Conclusions: The results showed that gradual reduction of sodium dialysate, has no effect on occurrence of muscular cramp during dialysis, serum level of calcium and magnesium in hemodialysis patients. Further investigations are needed to better understand the exact effect of this method, and also eliminate the study limitations. Keywords: Calcium, Hemodialysis, Magnesium, Muscle cramp, Sodium dialysate

The Impact of the Gradual Reduction of Sodium Dialysis Fluid on Occurrence of the Hypotension and Plasma Sodium Level in Hemodialysis Patients

Background: Dialysis is the most common method of caring end-stage kidney disease, but it has some complications despite its several advantages. The aim of study was to investigate the impact of the gradual reduction of dialysate sodium on occurrence of the hypotension and plasma sodium in hemodialysis patients. Methods: 56 hemodialysis patients participated in this randomized triple-blind crossover clinical trial. The patients were randomly divided into two groups of A and B. The routine method (Sodium Dialysis Solution) was performed on Group A, whereas the gradual reduction of sodium dialysis fluid was given to Group B for three sessions. These dialysis methods were again implemented three sessions, after one week of routine dialysis (Wash Out).The routine method (Sodium Dialysis Solution) was performed on Group B, and the gradual reduction of sodium dialysis fluid was performed on Group A, for three sessions. Patients' blood pressure was measured three separate times: 15 minutes before dialysis, during dialysis (first, second, third and fourth hours of dialysis) and 15 minutes after of it. Moreover, Patients' sodium level was also measured before and after the intervention. In this way, the descriptive statistics and inferential statistics (repeated measure analysis of covariance) were utilized to implement data analysis. Results: in the case of routine method, the percentages of the prevalence of hypotension in above mentioned different hours were declared 6.2%, 26.6%, 44.5%, 32.8%, respectively. On the other hand, in the case of the gradual reduction of sodium dialysis fluid, these corresponding percentages were  cleared 2.3%, 1.7%, 5.31%, 44.46%, respectively. The mean differences of plasma sodium before and after dialysis in the mentioned methods were obtained as 0.58 in the case of routine method, whereas it is 2.36 in the case of gradual reduction of sodium dialysis fluid method. In this research, there was no significant difference between the rate of hypotension and plasma sodium in the gradual reduction of sodium dialysis fluid by the routine method under 80% powers. Conclusions: The experimental results revealed that a gradual reduction of the sodium dialysis fluid did not play a significant role in the reduction of blood pressure during dialysis and plasma sodium in hemodialysis patients. However, either confirmation or rejection of this issue will require further studies and resolving the limitations.  Keywords: Sodium Dialysis Fluid, Hypotension, Plasma Sodium, Hemodialysis

The Impact of the Gradual Reduction of Sodium Dialysis Fluid on Occurrence of the Hypotension and Plasma Sodium Level in Hemodialysis Patients

Background: Dialysis is the most common method of caring end-stage kidney disease, but it has some complications despite its several advantages. The aim of study was to investigate the impact of the gradual reduction of dialysate sodium on occurrence of the hypotension and plasma sodium in hemodialysis patients. Methods: 56 hemodialysis patients participated in this randomized triple-blind crossover clinical trial. The patients were randomly divided into two groups of A and B. The routine method (Sodium Dialysis Solution) was performed on Group A, whereas the gradual reduction of sodium dialysis fluid was given to Group B for three sessions. These dialysis methods were again implemented three sessions, after one week of routine dialysis (Wash Out).The routine method (Sodium Dialysis Solution) was performed on Group B, and the gradual reduction of sodium dialysis fluid was performed on Group A, for three sessions. Patients' blood pressure was measured three separate times: 15 minutes before dialysis, during dialysis (first, second, third and fourth hours of dialysis) and 15 minutes after of it. Moreover, Patients' sodium level was also measured before and after the intervention. In this way, the descriptive statistics and inferential statistics (repeated measure analysis of covariance) were utilized to implement data analysis. Results: in the case of routine method, the percentages of the prevalence of hypotension in above mentioned different hours were declared 6.2%, 26.6%, 44.5%, 32.8%, respectively. On the other hand, in the case of the gradual reduction of sodium dialysis fluid, these corresponding percentages were  cleared 2.3%, 1.7%, 5.31%, 44.46%, respectively. The mean differences of plasma sodium before and after dialysis in the mentioned methods were obtained as 0.58 in the case of routine method, whereas it is 2.36 in the case of gradual reduction of sodium dialysis fluid method. In this research, there was no significant difference between the rate of hypotension and plasma sodium in the gradual reduction of sodium dialysis fluid by the routine method under 80% powers. Conclusions: The experimental results revealed that a gradual reduction of the sodium dialysis fluid did not play a significant role in the reduction of blood pressure during dialysis and plasma sodium in hemodialysis patients. However, either confirmation or rejection of this issue will require further studies and resolving the limitations.  Keywords: Sodium Dialysis Fluid, Hypotension, Plasma Sodium, Hemodialysis

The Relationship between Caring Burden and Quality of Life in Caregivers of Type 2 Diabetes: Caring burden and quality of life in caregivers

Background: Taking care of patients with chronic diseases such as diabetes exerts great tiredness and stress on the caregivers. The aim of this study was to determine the extent of the caring burden and its relationship with the quality of life of caregivers of diabetic patients. Methods: In this cross-sectional study, 154 caregivers of patients with type 2 diabetes referred to Imam Hossein hospital in Shahroud city were evaluated. The data collection tools included a demographic questionnaire, SF-36 standard quality of life questionnaire, and Novak & Guest care burden questionnaire. The accessible sampling was used and the data were collected by self-reporting. The data was analyzed using descriptive and inferential statistics (Pearson correlation coefficient and regression analysis). Significant level was set at 0.05. Results: The mean age of caregivers was 41.86 ± 12.78 years old. The mean scores of care burden and quality of life of the participants were 53.21 ± 49.61 and 61.02 ± 20.71 respectively. There was a significant inverse correlation between the mean score of care burden and caregivers’ quality of life. Conclusions: According to the results of this study, providing social and informational support for caregivers is recommended to reduce the care burden and subsequently improve the quality of life. Key words: Caring pressure, Quality of life, Diabetes, Caregiver