Effects of hemodialysis on circulating adrenomedullin concentrations in patients with end-stage renal disease

To characterize the determinants of circulating levels of adrenomedullin (AM), the plasma levels of this peptide were measured in 58 patients with end-stage renal disease on hemodialysis, Predialysis plasma levels of AM were more than twice as high in patients on hemodialysis as compared to controls. In hemodialysis patients with heart failure (NYHA classes II-IV) or hypertensive HD patients plasma levels of AM were significantly higher than in patients with end-stage renal disease only. Plasma levels of AM were clot altered immediately by hemodialysis but decreased significantly 14-20 h after hemodialysis, AM plasma levels before hemodialysis and 14-20 h after hemodialysis were correlated with the corresponding mean arterial pressure

The effect of frequent hemodialysis on nutrition and body composition: frequent Hemodialysis Network Trial.

We investigated the effects of frequency of hemodialysis on nutritional status by analyzing the data in the Frequent Hemodialysis Network Trial. We compared changes in albumin, body weight, and composition among 245 patients randomized to six or three times per week in-center hemodialysis (Daily Trial) and 87 patients randomized to six times per week nocturnal or three times per week conventional hemodialysis, performed largely at home (Nocturnal Trial). In the Daily Trial, there were no significant differences between groups in changes in serum albumin or the equilibrated protein catabolic rate by 12 months. There was a significant relative decrease in predialysis body weight of 1.5 ± 0.2 kg in the six times per week group at 1 month, but this significantly rebounded by 1.3 ± 0.5 kg over the remaining 11 months. Extracellular water (ECW) decreased in the six times per week compared with the three per week hemodialysis group. There were no significant between-group differences in phase angle, intracellular water, or body cell mass (BCM). In the Nocturnal Trial, there were no significant between-group differences in any study parameter. Any gain in 'dry' body weight corresponded to increased adiposity rather than muscle mass but was not statistically significant. Thus, frequent in-center hemodialysis reduced ECW but did not increase serum albumin or BCM while frequent nocturnal hemodialysis yielded no net effect on parameters of nutritional status or body composition

Changes in the Conformational State of Hemoglobin in Hemodialysed Patients with Chronic Renal Failure

The aim of this study was to evaluate the properties of internal components of erythrocytes in chronic renal failure (CRF) patients undergoing hemodialysis (HD) in comparison to control subjects. For investigation of conformational state of hemoglobin and nonheme proteins (NHP) the maleimide spin label (MSL) in electron paramagnetic resonance (EPR) was applied. The studies were performed using MSL in whole cells and hemolysate as well as proteins separated by ion exchange chromatography and checked by electrophoresis. Additionally the level of –SH groups in hemolysate and isolated internal proteins of CRF erythrocytes was determined using 4,4′-dithiodipyridine. All measurements were performed before and after hemodialysis. Oxidative stress accompanying CRF/hemodialysed patients caused a significant decrease in the mobility of internal components inside erythrocytes indicated by MSL (P < 0.02). The significant decrease in mobility of spin labeled HbA1c and HbA both before and after HD (P < 0.0002) as well as in nonheme proteins before hemodialysis (P < 0.05) versus control was indicated. Decrease in mobility of internal components of erythrocytes was accompanied by loss of thiols before and after hemodialysis versus control in NHP (P < 0.05), HbA1c (P < 0.0002), and HbA (P < 0.0005). These findings showed oxidative influence of hemodialysis on hemoglobins and internal nonheme proteins in erythrocytes of CRF patients

The effect of intravenous vitamin C on the phosphorus level reduction in hemodialysis patients: A double blind randomized clinical trial

Aim The majority of hemodialysis patients are hyperphosphate-mic. Hyperphosphatemia in these patients can lead to renal oste-odystrophy, vascular calcifcation, cardiovascular events, and is independently associated with mortality risk. The aim of this study was to evaluate the effect of intravenous vitamin C on phosphorus level in hemodialysis patients. Methods Using a double blind randomized clinical trial, a total of 60 qualified hemodialysis patients were randomly allocated in two intervention and control groups and serum phosphorus, CRP, calcium, albumin and PTH levels were measured. At the end of each hemodialysis session, intervention group received vitamin C vial (500mg/5cc) intravenously three times a week for 8 weeks and control group received normal saline in the same way. Data were collected before and after two months of treatment. Data were analyzed using independent t-test, paired t-test and chi-square test. Results Vitamin C treated group had a significant decrease in phosphorus (p=0.01), CRP level (p=0.01) and Ca�P product (p=0.03). In contrast, there was no significant difference in phosphorous (p= 0.5) and CRP levels (p= 0.6) and Ca�P product (p=0.7) in the control group. In addition, there was no statistically significant change in calcium (p=0.1), PTH (p=0.4) and albumin (p=0.4) levels in both groups. Conclusion Intravenous vitamin C can significantly decrease phosphorus level in hemodialysis patients

KOMBINASI LANTUNAN ASMAUL HUSNA DAN SLOW DEEP BREATHING DALAM MENURUNKAN TINGKAT KECEMASAN PASIEN HEMODIALISIS

Background:Patients undergoing hemodialysis can experience anxiety due to fear or worry about the disease they are suffering from. The purpose of this study was to analyze the effectiveness of the combination of chanting asmaul husna and slowing deep breathing in reducing the anxiety level of hemodialysis patients. Research method:This research uses a case study approach, namely research that is focused on a case to be observed and analyzed carefully until it is finished. The case study was conducted when the author was practicing medical surgical nursing in the Hemodialysis Room of the Muhammadiyah University General Hospital in Malang. The author conducted a case study from July 17 2023 to July 22 2023 which was used from data collection or assessment to evaluation of 3 patients who had the same characteristics. Results:The results of the intervention for 3 patients showed that blood pressure had decreased considerably, pulse frequency had decreased sufficiently, sleep patterns had improved sufficiently, and verbalization of worries due to their condition had decreased considerably after being given the intervention. Conclusion:The combination of Asmaul Husna chanting and slow deep breathing is effective in reducing the anxiety level of hemodialysis patients. This combination intervention can be an easy, practical, economical non-pharmacological alternative that can be done anywhere to reduce the anxiety level of hemodialysis patients

Hepatitis C in hemodialysis centers of golestan province, northeast of Iran (2005)

Background and Aims: Nosocomial transmission of blood-borne pathogens is common in a dialysis setting. Hepatitis C virus (HCV) infection is a common problem that increases morbidity and mortality in hemodialysis patients. Blood transfusion and the duration of hemodialysis are the most important factors in HCV transmission. The aim of the study was to determine the incidence rate of HCV antibody in hemodialysis patients and its association with some factors. Methods: In this descriptive-analytical study, HCV antibody was measured in 93 hemodialysis patients in all hospitals affiliated to Golestan University of Medical Sciences. Standard infection prevention measures in hospital settings and dialysis units were performed including serologic testing for HCV antibody for every new patient in the dialysis unit as well as routine testing of all patients. Negative cases of hepatitis C antibody (confirmed with ELISA 2nd generation and RIBA II Immunoblot methods) were selected and followed for 18 months. Some predisposing factors such as transfusion, duration of hemodialysis, medical procedures including surgery, transplantation, invasive odontology, suspicious sexual contact, diagnostic or therapeutic manipulation, tattooing, and IV drug abuse, were registered and considered. Other rare procedures like acupuncture, manicure and pedicure blood brotherhood rituals, perinatal risk factors, common circumcision rituals and history of abortion were also considered. Ve used a tight control policy through the separation of the rooms within the unit, specific hemodialysis apparatus for suspicious patients and a separate staff caring for the patients. We maintained a low rate of staff turnover in dialysis units and tried to control hepatitis B viral infection. Results: Marital status and living area were significantly related to HCV antibody positivity. It means that more HCV antibody positive cases were observed in married people in urban areas. History of tattooing, medical procedures including surgery, transplantation, invasive odontology and IV drug usage were not significantly related to HCV antibody status. During the follow up, three cases (4.3%) converted to positive. There was a relationship between numbers of hemodialysis per week and HCV antibody positivity (P<0.001). Conclusions: Tight control of transmission routes and severe isolation policy in this study explains an almost ideal decrease in incidence rate of HCV antibody positivity. We suggest periodical screening programs (at least every 6 months) for blood samples that remain in the dialysis apparatus and all procedures used for hemodialysis in these specific patients to achieve a better infection control

Missed Treatments of Hemodialysis Patients after Hurricane Maria in Puerto Rico

The consequences of a natural event such as a hurricane can especially have a negative impact on vulnerable patients such as hemodialysis patients. In former incidences such as Hurricane Katrina, factors such as living relocations disrupted hemodialysis patients’ ability to adhere to their thrice-weekly treatments (Anderson et al, 2009). In this study, 44% of the 386 hemodialysis patients who experienced Hurricane Katrina reported missing one or more dialysis sessions. Thus, the hurricane had significant negative influence on patients’ attendance at the dialysis clinic. In the aftermath of Hurricane Maria, Puerto Rico suffered extensive road blockages, electricity shortages, and lacking natural resources. Recovery procedures such as clearing of roads were not completed until several months afterward. By October, there was still a significant portion of people without sufficient resources. The primary objectives of this study are to assess the percentage of hemodialysis patients who missed dialysis sessions in the aftermath of Hurricane Maria and the social factors influencing their missed sessions. From a total of 16 facilities, three dialysis clinics in cities most highly impacted by the hurricane will be selected to participate. Data will be collected through patient interviews, surveys, and charts, to examine potential demographic characteristics and social factors that may have affected the patients’ attendance to these dialysis facilities. If there is a significant correlation between the social factors and missed treatments, then management strategies can be suggested to help hemodialysis patients adjust to post-disaster conditions and help develop planning strategies in case of future natural disasters

Effect of frequent hemodialysis on residual kidney function.

Frequent hemodialysis can alter volume status, blood pressure, and the concentration of osmotically active solutes, each of which might affect residual kidney function (RKF). In the Frequent Hemodialysis Network Daily and Nocturnal Trials, we examined the effects of assignment to six compared with three-times-per-week hemodialysis on follow-up RKF. In both trials, baseline RKF was inversely correlated with number of years since onset of ESRD. In the Nocturnal Trial, 63 participants had non-zero RKF at baseline (mean urine volume 0.76 liter/day, urea clearance 2.3 ml/min, and creatinine clearance 4.7 ml/min). In those assigned to frequent nocturnal dialysis, these indices were all significantly lower at month 4 and were mostly so at month 12 compared with controls. In the frequent dialysis group, urine volume had declined to zero in 52% and 67% of patients at months 4 and 12, respectively, compared with 18% and 36% in controls. In the Daily Trial, 83 patients had non-zero RKF at baseline (mean urine volume 0.43 liter/day, urea clearance 1.2 ml/min, and creatinine clearance 2.7 ml/min). Here, treatment assignment did not significantly influence follow-up levels of the measured indices, although the range in baseline RKF was narrower, potentially limiting power to detect differences. Thus, frequent nocturnal hemodialysis appears to promote a more rapid loss of RKF, the mechanism of which remains to be determined. Whether RKF also declines with frequent daily treatment could not be determined

Narrative Review of Incremental Hemodialysis.

The prescription of hemodialysis (HD) in patients with incident end-stage kidney disease (ESKD) is fundamentally empirical. The abrupt transition from nondialysis chronic kidney disease (CKD) to thrice-weekly in-center HD of much the same dialysis intensity as in those with prevalent ESKD underappreciates the progressive nature of kidney disease whereby the decline in renal function has been gradual and ongoing-including at the time of HD initiation. Adjuvant pharmacologic treatment (i.e., diuretics, acid buffers, potassium binders), coupled with residual kidney function (RKF), can complement an initial HD regimen of lower intensity. Barriers to less intensive HD in incident ESKD include risk of inadequate clearance of uremic toxins due to variable and unexpected loss of RKF, lack of patient adherence to assessments of RKF or adjustment of HD intensity, increased burden for all stakeholders in the dialysis units, and negative financial repercussions. A stepped dialysis regimen with scheduled transition from time-delineated twice-weekly HD to thrice-weekly HD could represent an effective and safe strategy to standardize incremental HD in patients with CKD transitioning to early-stage ESKD. Patients' adherence and survival as well as other clinical outcomes should be rigorously evaluated in clinical trials before large-scale implementation of different incremental schedules of HD. This review discusses potential benefits of and barriers to alternative dialysis regimens in patients with incident ESKD, with emphasis on twice-weekly HD with pharmacologic therapy, and summarizes in-progress clinical trials of incremental HD schedules

Disappearance of diabetic macular hard exudates after hemodialysis introduction.

We report herein the disappearance of macular hard exudates after the introduction of hemodialysis in diabetic patients. A 62-year-old woman and a 52-year-old man with diabetes mellitus showed hard exudates in the macula of the left eyes. Both patients had previously undergone panretinal photocoagulation in both eyes. During the follow-up, hemodialysis was introduced for deteriorating chronic renal failure caused by diabetic nephropathy. Half a year later, macular hard exudates in the left eyes disappeared dramatically in both patients, but the visual acuity remained the same. No additional laser treatment was done during the observation period. Hemodialysis is considered to have accelerated the resolution of macular hard exudates in both patients. The deposition of macular hard exudates in diabetic patients is due in part to concurrent poor renal function.</p