Quality of life, depression and self-perceived burden among geriatric and non-geriatric hemodialysis patients

Background: Many hemodialysis patients need support at various levels from their relatives while performing their daily activities. The ‘burden’ of these needs of patients on their relatives and their negative effects on their lives have been shown in the literature. The aim of the study was to evaluate the ‘care burden’ in terms of the patient.Methods: The patient who had received hemodialysis for at least 3 months was included in the study. A patient identification form including demographic data and medical history data was prepared. The Perceived care burden scale, Beck depression scale and WHO Quality of life questionnaire were applied to the patients.Results: A statistically significant positive correlation was found between SPBS and BDI (p<0.001, r=0.820). A statistically significant negative correlation was observed between the perceived care burden and all sub-dimensions of the quality of life scale (p<0.001). The frequency of comorbidity in the geriatric group was higher than non-geriatric group. A statistically significant positive correlation was found between comorbidity and QOL (p<0.001).   The median scores of all sub-dimensions of the QOL scale were lower in geriatric group and there were significance differences except environment dimension.Conclusions: The self-perceived burden on caregivers of hemodialysis patients was positively associated with depression and negatively associated with QOL. Decrease in QOL was more pronounced in geriatric patients

Atherosclerosis in geriatric patients known to be healthy

Background: The aim of the present study is to determine the presence of atherosclerosis in geriatric patients who are known to be healthy and examine sociodemographic and laboratory parameters affecting the presence of atherosclerosis.Method: 90 healthy volunteers including 66(73.3%) non-geriatric ones and 24(26.7%) geriatric ones were included in the study. It was analyzed whether there was a correlation between the two groups in terms of the parameters of gender, age average, alcohol consumption, smoking, carotid intima-media thickness (CA-IMT), and pulse wave velocity (PWV). Sociodemographic and laboratory parameters of the volunteers with and without atherosclerosis in the geriatric group were examined. Results: Among geriatric volunteers (Group 1), 13(54.2%) were male; whereas, among non-geriatric volunteers (Group 2), 41(62.1%) were male. CA-IMT was determined to be higher in Group 1 (averagely 0.80±0.12 mm) than Group 2 (averagely 0.62±0.14 mm) (p:<0.001). PWV was significantly higher in Group 1 (averagely 10.32±1.44 m/s) than Group 2 (6.26±1.09 m/s) (p:<0.001). After PWV or CA-IMT examination, atherosclerosis findings were determined in 12 healthy geriatric volunteers (50%) in Group 1.Conclusion: It should be remembered that even though atherosclerosis can be frequently observed in geriatric individuals who are known to be healthy, it may also go unnoticed. Determination of atherosclerosis with noninvasive methods will be helpful in preventing complications that might be caused by atherosclerosis.

Successful treatment of excessive dose of carbamazepine

Carbamazepine is used in the treatment of epilepsy; it is also prescribed for treatment of neuralgic pain syndromes and certain affective disorders. Carbamazepine intoxication with suicide attempt is a relatively common clinical problem that can result in coma, respiratory depression, arrhythmia, hemodynamic instability, and death. There is no specific antidote. Multiple-dose activated charcoal and hemodialysis are the main treatment for carbamazepine intoxication. In this paper, we report the case of a 19-year-old woman with excessive dose carbamazepin intoxication and our successful treatment with multiple-dose activated charcoal and hemodialysis

The effect of oral supplementation with a combination of beta-hydroxy-beta-methylbutyrate, arginine and glutamine on wound healing: a retrospective analysis of diabetic haemodialysis patients

WOS: 000315798600001PubMed ID: 23311725Background: Diabetes is an important reason for end-stage renal failure and diabetic foot wounds worsen the life qualities of these patients. Protein and amino acid support accelerates the wound healing. The purpose of this retrospective study is to examine the effect of beta-hydroxy-beta-methylbutyrate, arginine and glutamine (Abound (R)) supplementation on the wound healing. Methods: A total of 11 diabetic dialysis patients were included in this retrospective study aiming to evaluate the effect of the diet support with beta-hydroxy-beta-methylbutyrate, arginine and glutamine on wound healing in diabetic dialysis patients. Pre-treatment and post-treatment wound depth and wound appearance were scored in accordance with the "Bates-Jensen" wound assessment tool. The results of 4-week treatment with beta-hydroxy-beta-methylbutyrate, arginine and glutamine (Abound (R)) support were evaluated in terms of wound healing. Results: The mean age of patients was 66 (SD: 10, range: 51-81) and 9 (81.8%) of them were males. After the 4-week treatment, in accordance with the Bates-Jensen scoring, healing was observed on the wound depth score of 7(63.6%) patients and on wound appearance score of 8(72.7%) patients out of 11. While the wound depth score of 4(36.4%) cases and wound appearance score of 3(27.3%) cases remained the same, no deterioration was observed on any cases throughout the follow-up period. Conclusion: In conclusion, our findings revealed that Abound treatment makes a positive contribution to the wound healing in diabetic dialysis patients.Abbott Nutrition TurkeyWe thank to Cagla Isman, MD and Prof. Sule Oktay, MD, PhD. from KAPPA Consultancy Training Research Ltd, Istanbul who provided editorial support, and to Mehmet Berktas, MD, MICR from KAPPA Consultancy Training Research Ltd, Istanbul for statistical analysis, and these services were supported by an unconditional research grant from Abbott Nutrition Turkey. Abbott Nutrition Turkey was not involved in study design, in the collection, analysis, and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication

The risk factors and associations of coronary artery calcification in hemodialysis patients

44th ERA-EDTA Congress -- JUN 22-24, 2007 -- Barcelona, SPAINWOS: 000253320600418ERA-EDT

DOES IMMUNOSUPPRESSIVE TREATMENT AMELIORATE MORPHOLOGY CHANGES IN ENCAPSULATING PERITONEAL SCLEROSIS?

12th Congress of the International-Society-for-Peritoneal-Dialysis -- JUN 20-24, 2008 -- Istanbul, TURKEYWOS: 000263937100042PubMed ID: 19270219Encapsulating peritoneal sclerosis (EPS) is a clinical syndrome associated with ileus symptoms and irreversible sclerosis of the peritoneal membrane. Inflammation, fibrosis, and neoangiogenesis are the main features of the pathophysiology. No evidence-based therapy is currently available for EPS. In recent years, anti-inflammatory and immunosuppressive (IS) treatment modalities have become more popular. The aim of the present study was to investigate the effects of various IS treatment strategies-glucocorticosteroid (GC), azathiopurine (AZT), and cyclosporin (CsA)-on regression of EPS. We divided 52 nonuremic Wistar albino rats into six groups: Control group-2 mL isotonic saline injected intraperitoneally (IP) daily for 3 weeks; CG group-2 mL/200 g 0.1% chlorhexidine gluconate (CG) and 15% ethanol dissolved in saline injected IP daily for 3 weeks; Resting group-CG (weeks 1-3), plus peritoneal rest (weeks 4-6); Corticosteroid (GC) group-CG (weeks 1-3), plus 10 mg/L prednisolone in drinking water (weeks 4-6); AZT group CG (weeks 1-3), plus 100 mg/L azathioprine in drinking water (weeks 4-6); and CsA group-CG (weeks 1-3), plus cyclosporin 7.5 mg/kg by subcutaneous injection daily (weeks 4-6). At the end of the study, under ketamine HCl anesthesia, the rats were humanely killed by bleeding. Parietal peritoneal samples were then taken from same location (away from the injection site) and changes of parietal peritoneum morphology were examined by a single pathologist. The CG severely disturbed parameters of peritoneal morphology, increasing peritoneal thickness, inflammatory activity, vascularity, and fibrosis score as compared with the Control group (p < 0.05). No benefit was observed for any parameter in the Resting group as compared withthose parameters in the CG group (p < 0.05). We observed a lower fibrosis score and less peritoneal thickness in the GC group as compared with the Resting group (p < 0.05). No beneficial effects of AZT on peritoneal morphology were observed as compared with the effects of peritoneal rest or corticosteroid therapy. Treatment with cyclosporin resulted in more fibrosis, vascularity, and inflammation than was seen with corticosteroid therapy (p < 0.05). Immunosuppressive therapies, especially those that are corticosteroid-based, may have therapeutic value in the management of EPS. Patients treated with cyclosporin may have a risk for developing EPS.Int Soc Peritoneal Dialysi

THE EFFECTS OF COLCHICINE ON THE PROGRESSION AND REGRESSION OF ENCAPSULATING PERITONEAL SCLEROSIS

12th Congress of the International-Society-for-Peritoneal-Dialysis -- JUN 20-24, 2008 -- Istanbul, TURKEYWOS: 000262915200011PubMed ID: 19008543Background: Encapsulating peritoneal sclerosis (EPS) is an infrequent but extremely serious complication of long-term peritoneal dialysis. Fibrosis of the submesothelial compact zone and neoangiogenesis underlie the pathophysiology of EPS. Colchicine is a well-known anti-inflammatory and antifibrotic agent that has been used for some fibrosing clinical states, such as liver fibrosis. Objective: To determine the antifibrotic and anti-inflammatory effects of colchicine in an EPS rat model in both progression ( P) and regression ( R). Methods: 48 nonuremic albino Wistar rats were divided into 5 groups: control group, 2 mL isotonic saline intraperitoneally (IP) daily for 3 weeks; CG group, IP injection of 2 mL/200 g chlorhexidine gluconate ( CG) (0.1%) and ethanol (15%) dissolved in saline, daily for 3 weeks; resting group, CG (0 - 3 weeks) + peritoneal resting (4 - 6 weeks); C-R group, CG ( 0 - 3 weeks) + 1 mg/L colchicine ( 4 - 6 weeks); C-P group, CG ( 0 - 3 weeks) + 1 mg/L colchicine in drinking water ( 0 - 3 weeks). At the end, a 1-hour peritoneal equilibration test was performed with 25 mL 3.86% peritoneal dialysis solution. Dialysate-to-plasma ratio of urea (D/P urea), dialysate WBC count, ultrafiltration volume, and morphological changes of parietal peritoneum were examined. Result: Exposure to CG for 3 weeks resulted in alterations in peritoneal transport ( increased D/P urea, decreased ultrafiltration volume; p < 0.05) and morphology ( increased inflammation, neovascularization, fibrosis, and peritoneal thickness; p < 0.05). Resting had some beneficial effects on peritoneal derangements; however, once the peritoneum had been stimulated, resting alone was not enough to reverse these pathological changes. Colchicine had more pronounced effects on membrane integrity via decreased inflammation, cell infiltration, and vascularity compared to the resting group. Conclusion: We suggest that colchicine may have therapeutic value in the management of EPS.Int Soc Peritoneal Dialysi