Average Duration Of Hemodialysis Research Articles

#620 Remaining life expectancy of Korean hemodialysis patients: how much longer can they live?

Abstract Background and Aims Hemodialysis (HD) patients have a higher mortality rate compared to general population. However, no study has investigated life expectancy in Korean HD patients so far. Therefore, this study aimed to calculate the remaining life expectancy among Korean maintenance HD patients and compare it to those of general population as well as HD patients from other countries. Method Baseline data were retrieved from HD quality assessment data from October to December 2015. Among the total number of patients who were alive at the beginning of 2016 (20,537 men and 14,404 women), a total of 22,439 (12,848 men and 9,591 women) were still alive at the end of 2021 while 12,502 (7,689 men and 4,813 women) were deceased during 6 years of follow-up. We used the life table method to calculate the expected remaining years of life in two-year increments. Results The mean age of the patients was 60.5 ± 12.4 years, and 58.7% were male. The average duration of HD was 5.63 ± 5.11 years. The most common cause of end-stage kidney disease was diabetes mellitus (42.0%), followed by hypertension (27.1%) and glomerulonephritis (10.9%). The remaining life expectancy for 60-year-old patients were 11.64 years for men and 14.64 years for women. The average remaining lifetimes of the HD population were only about a half of the general population (Fig.). Diabetic patients demonstrated shorter life expectancy compared to the patients with hypertension or glomerulonephritis. The remaining life expectancy of Korean HD patients was similar to that of Japanese and was almost double that of HD patients in Western countries such as Europe and United States. Conclusion HD population showed shorter life expectancy compared to the general population. Asian HD population seemed to demonstrate better patient survival compared to other countries. Longitudinal analysis should be warranted to analyze the effect of advanced dialysis technology upon improved survival rate among HD population.

Risk of sarcopenia, fear of COVID-19, anxiety, depression and physical activity levels: Associations across patients on hemodialysis within Greece.

The purpose of this multicenter cross-sectional study was to investigate the association between SARC-F, fear of COVID 19, anxiety, depression and physical activity in patients undergoing hemodialysis. This study was conducted in 3 hemodialysis centers in Greece during the period of the COVID-19 pandemic. Sarcopenia risk was assessed using the Greek version of SARC-F (≥4). Demographic and medical history were collected from the patient's medical charts. The participants were also asked to fill the Fear of COVID-19 Scale (FCV-19S), the Hospital Anxiety and Depression Scale (HADS), and the International Physical Activity Questionnaire (IPAQ) questionnaire. A hundred and thirty-two (132) patients on hemodialysis (92 men, 70.75±13.14 years) were enrolled. Sarcopenia risk (utilizing the SARC-F) was found in 41.7% of patients on hemodialysis. The average duration of hemodialysis was 3.94±4.58 years. The mean score values for SARC-F, FCV-19S and HADS were 3.9±2.57, 21.08±5.32, and 15.02±6.69, respectively. The majority of patients were physically inactive. The SARC-F scores were strongly associated with age (r=56; p<0.001), HADS (r=0.55; p<0.001), levels of physical activity (r=0.5; p<0.001), but not with FCV-19S (r=0.27; p<0.001). A statistically significant relationship was recorded between sarcopenia risk and age, anxiety/depression and levels of physical inactivity in patients on hemodialysis. Future studies are necessary in order to evaluate the association of specific characteristics of patients.

The effect of superoxide dismutase supplementation on TNF-α and TGF-β levels in patients undergoing hemodialysis.

Chronic kidney disease stage 5 on dialysis (CKD-5D) remains a global health problem associated with an increased risk of morbidity and mortality owing to cardiovascular disease. This condition is associated with chronic inflammation, which is characterized by an increase in cytokines, including tumor necrosis factor-α (TNF-α) and transforming growth factor-β (TGF-β). Superoxide dismutase (SOD) is a first-line endogenous enzymatic antioxidant capable of neutralizing the effects of inflammation and oxidative stress. Therefore, the main aim of this study was to determine the effect of SOD supplementation on serum TNF-α and TGF-β levels in patients undergoing hemodialysis (CKD-5D). A quasi-experimental study with a pretest-posttest design was conducted from October to December 2021 in the Hemodialysis Unit of Dr. Hasan Sadikin Hospital, Bandung. Patients with CKD-5D who routinely underwent hemodialysis therapy twice a week were included in the study. All participants received SOD-gliadin 250 IU twice a day for 4 weeks. Serum TNF-α and TGF-β levels were assessed before and after the intervention, and statistical analyses were performed. This study enrolled 28 patients undergoing hemodialysis. The median age of the patients was 42 ± 11 years, with a male-to-female ratio of 1:1. The average duration of hemodialysis in the participants was 24 (5-72) months. A statistically significant decrease in serum TNF-α and TGF-β levels from 0.109 (0.087-0.223) to 0.099 (0.083-0.149) pg/mL (p=0.036) and 15.38 ± 3.64 to 13.47 ± 3.07 pg/mL (p=0.031), respectively, after SOD administration was noted. Exogenous SOD supplementation decreased serum TNF-α and TGF-β levels in patients with CKD-5D. Further randomized controlled trials are required to confirm these findings.

Karakteristik Kualitas Tidur Pasien ESRD yang Menjalani Hemodialisis

This study aims to describe the sleep quality characteristics of ESRD patients undergoing Hemodialysis at dr. Bratanata Jambi. This research method is observational research with a descriptive approach. The results showed that based on the characteristics of ESRD undergoing Hemodialysis, the majority were female (61.10%), the mother's education level was low (58.35%), the average duration of Hemodialysis was 3.72 ± 1.17, the average age average 53.33 ± 4.35. In conclusion, the characteristics that affect the sleep quality of ESRD patients undergoing Hemodialysis are gender, low level of education, age 45-59&#x0D; &#x0D; Keywords: Hemodialysis, Sleep Quality, Duration of HD, Education, Age

MO819: The Negative Impact of Reuse of Dialyzers on Survival Rates of Dialysis Patients

Abstract BACKGROUND AND AIMS Until 2019, in Uzbekistan, disposable dialyzers for dialysis were reused several times due to underfunding of the system. But in 2018, the President of the Republic of Uzbekistan Shavkat Mirziyoyev signed a decree on improving the nephrological and dialysis services in the country. After that, there is a sharp increase in funding and attention to the provision of hemodialysis care to the population of our country. Thanks to this Resolution, since 2019, in all regions of Uzbekistan, only disposable dialyzers are used for hemodialysis. To prospectively study the negative impact of the reusable use of disposable dialyzers on dialysis patients in Uzbekistan. METHOD The study took place in three dialysis centers in the country at different levels. Our observation of 165 (90 men and 75 women) patients took place for 2 years: from the beginning of 2018 to the end of 2019. The average age of the patients was 49.7 ± 14.1 years. During the first 12 months (before the release of the decree of the President of the Republic and funding), dialysis patients underwent multiple uses of dialyzers. The next 12 months were completely switched to single use. The average age of the patients was 48.1 ± 14.3 years. The average duration of hemodialysis was 37 (6–252) months. Survival was assessed using the Kaplan–Meier method. The confidence interval was determined by Greenwood. RESULTS During the 24 months of observation, out of 165 patients, 29.1% (n = 48) patients died, 70.9% (n = 117) survived (of which 11 patients underwent Tx). During 1 year of follow-up (the period of repeated use of disposable dialyzers), 21.2% (n = 35) patients died, 78.8% (n = 130) survived and continued to receive hemodialysis (6 patients Tx). A total of 68.6% (n = 24) of patients died from cardiovascular complications. The survival rate for 1 year (miltiple use period) was S(t) = 0.796 [95% confidence interval (95% CI) 0.736–0.856]. Over the next 12 months (single use period), out of 124 patients continuing to receive hemodialysis, 10.5% (n = 13) patients died, 89.5% (n = 111) patients survived (5 patients Tx). A total of 53.8% (n = 7) of these deceased patients died from CVD. The survival rate at the second year (single use period) was S(t) = 0.894 [95% CI 0.839–0.948]. CONCLUSION Compliance with the standards for hemodialysis, in particular, the single use of disposable dialyzers for hemodialysis sessions, leads to a decrease in the lethality of dialysis patients. The transition from multiple to single use of disposable dialyzers in one dialysis center in Uzbekistan showed a significant increase in survival of 12.3%.

MO832: Survival of Dialysis Patients With Cardiovascular Comorbidity

Abstract BACKGROUND AND AIMS Kidney disease is associated with a huge economic burden. High-income countries spend up to 2%–3% of their annual health care budget on end-stage kidney disease. Even if &amp;lt;0.03% of the total population receive such treatment. In 2010, 2.62 million people worldwide received dialysis, and the demand for dialysis is projected to double by 2030. The most common cause of death in patients with CKD is complications from cardiovascular disease. They are the main factor determining the decrease in the effectiveness of renal replacement therapy, especially among young and middle-aged people. Mortality from cardiovascular disease in people with end-stage CKD is 10–30 times higher than in the general population. Purpose of the work: to comparatively study the survival rates in dialysis patients, depending on the presence of cardiovascular diseases. METHOD In our study, we conducted a prospective cohort study of 210 patients (117 men and 93 women) in three different dialysis centers in Uzbekistan. The study lasted 36 months (from January 2018 to December 2020). The average age was 49.2 ± 13.8 years. The main primary diseases were glomerulonephritis (44%), diabetes mellitus (29%) and urolithiasis (7%). The duration of hemodialysis at the time of enrollment of patients in the study ranged from 6 to 172 months. Among the examined dialysis patients, 53% (n = 112) of patients (62 men and 50 women) had CVD and 47% (n = 98) of patients (52 men and 46 women) had no CVD. The main CVDs were arterial hypertension, ischemic heart disease, heart failure and various arrhythmias. Survival was determined by the Kaplan–Meier method. The [95% confidence interval (95% CI)] was determined using the Greenwood method. RESULTS After 36 months of follow-up, 43.8% (n = 92) of all patients died, 56.2% (n = 118) of patients survived (17 of them underwent kidney transplantation). When analyzing the causes of mortality, the main causes of death in dialysis patients were sudden cardiac death, acute respiratory failure, acute cerebrovascular accident, coma and acute bleeding. In dialysis patients with CVD, sudden cardiac death was 67% (n = 42) of all causes of death, while in patients without CVD, it was 57% (n = 17). The average age of the deceased (54.2 ± 1.4) was significantly higher than in patients continuing to receive HD (44.3 ± 1.1). The average duration of hemodialysis in the survivors (34.1 ± 4.7) was higher than in the deceased (27.6 ± 2.8). Upon further analysis of these patients, it was found that among the deceased patients, 70.6% (n = 65) of the patients were patients with cardiovascular diseases, and among the survivors, 54.3% (n = 64) had no cardiovascular diseases. Among those continuing to receive dialysis, there were 32.6% more patients without CVD than among patients with diagnosed CVD. In dialysis patients with CVD who died within 36 months of prospective follow-up, there were 38.7% more deaths than in patients without CVD. The survival rate of patients with CVD was 0.44 (95% CI 0.33–0.51), and in patients without CVD it was 0.65 (95% CI 0.52–0.74). CONCLUSION Our scientific research has shown that &amp;gt;70% of dialysis patients with CKD die due to cardiovascular disease. The main place in the structure of mortality is taken by sudden cardiac death, which is the cause of death in 67% of deceased patients. Cardiovascular comorbidity adversely affects the survival of dialysis patients in Uzbekistan. In dialysis patients without cardiovascular disease in our country, the survival rate is &amp;gt;30% higher than in patients with CVD.

MO759COMPERATIVE STUDY OF THE CARDIOVASCULAR SYSTEM IN PATIENTS WITH CKD ON HEMODIALYSIS IN URBAN AND RURAL POPULATIONS OF UZBEKISTAN

Abstract Background and Aims According to recently published WHO data, kidney disease has been the 10th leading cause of death in the world over the past 20 years. The lethality of dialysis patients with cardiovascular pathology is 3 times higher than that of patients without CVD. This is especially pronounced in developing countries. Uzbekistan is a country with a population of 34 million and has an equal urban and rural population. In this regard, it is of interest to comparatively study the structure of CVD in patients with CKD stage 5D of the rural and urban population of Uzbekistan. Method We examined 165 (90 men and 75 women) patients with CKD stage 5 receiving dialysis in urban and rural areas of Uzbekistan. The patients were divided into 2 groups depending on their permanent place of residence and the medical center where they receive hemodialysis. 104 (51 men and 53 women) patients were included in the Urban group and 61 (39 men and 22 women) patients were included in the Rural group. The average age of the urban population was 49.7 ± 1.38 years, the rural population was 45.5 ± 1.83 years. All patients underwent programmed hemodialysis according to the standard scheme for 4 hours 3 times a day (12 hours/week). The average duration of hemodialysis in the Urban group was 37.0 ± 4.77 months (M ± m) and 16.6 ± 2.4 months in the Rural group. The main causes of CKD 5D in both groups were glomerulonephritis (Urban-36.5%, Rural-62%) and type 2 diabetes (Urban-31.7%, Rural-18%). Results CVD comorbidity occurred in 55,8% (n=92) of all 165 examined patients, of which 52 were men and 40 were women. The most common CVDs in all groups were hypertension (51%, n=84), coronary heart disease, presented as angina (28%, n=47), heart failure (14%, n=23) and various types of arrhythmias (5%, n=8). 77% (n=127) of patients had anemia due ESRD. In the group Urban(n=104), 62.5% (n=65) had CVD. The main CVD was Hypertension. It was found in 92% (n=60) of patients with CVD in this group. Less (65%, n=42) were patients with angina. Heart failure was detected in 31% (n=20) of patients. Arrhythmia was diagnosed in only 5% (n=5). A large number of combined CVD have been identified. 69% (n=45) of all patients with CVD had a combined CVDs in different combinations. The most common combination was hypertension + angina (n = 26). It accounted for almost 58% of all combined cases. Only 28% (n=17) of all cases with hypertension had "isolated" hypertension. The main combination with hypertension was hypertension + angina (43%, n=26), 11% (n=11) of patients had hypertension + angina + heart failure, a combination in the form of hypertension + angina + arrhythmia had 3% (n=3) patients. Relatively fewer (n = 27, 44%) CVD were found in the Rural group. The most frequent CVD was also a hypertension. Patients with hypertension made up 89% (n = 24) of all patients with CVD in this group. The second place is occupied by angina, it was found in 18.5% (n=5) cases among patients with CVD. Combined CVS pathologies were less common in the rural group. A total of 8 patients (29.6% of all CVD cases) had several CVDs. Conclusion Сardiovascular diseases in the urban population (62.5%) occur almost one and a half times more often than in the rural population (44%). Combined CVD pathology occupies a leading place in the structure of CVD in patients with CKD 5D, both urban and rural.

MO528INFLUENCE OF CARDIOVASCULAR DISEASES ON SURVIVAL RATES IN DIALYSIS PATIENTS IN A COHORT OF THE UZBEK POPULATION

Abstract Background and Aims The mortality rate of patients on hemodialysis is 6.3-8.2 times higher than in the general population. The presence of cardiovascular comorbidity worsens the prognosis and survival in this category of patients. According to various sources, the mortality rate in patients with CVD is 3 times higher than in patients without CVD. The aim of our study was to study the effect of comorbidity of the CVD on survival in patients with end-stage CKD receiving programmed hemodialysis among the population of Uzbekistan. Method We conducted a multicenter prospective cohort study of 165 patients among the Uzbek population. The study took place in 3 different dialysis centers in the country for 30 months (from January 2018 to July 2020). All patients received programmed hemodialysis due to ESRD. All patients were of Uzbek nationality, there were 90 men, 75 women. The average age was 48.1 ± 14.1 years. The duration of hemodialysis at the time of inclusion of patients in the study ranged from 6 to 165 months. The main primary diseases were glomerulonephritis (46%), diabetes mellitus (27%) and urolithiasis (8%). 56% (n = 92) of patients (52 men and 40 women) had CVD and 44% (n = 73) of patients (38 men and 35 women) had no CVD. The main CVDs were hypertension, coronary heart disease, heart failure and various arrhythmias. All patients were observed during the observation period, at the end of which the outcome was noted: patients either died or continued to receive hemodialysis. The survival rate was determined using the Kaplan-Meier method. The 95% confidence interval was determined using the Greenwood method. Results After 30 months of follow-up, 43.6% (n = 72) of all observed patients died, 56.4% (n = 93) patients survived (of which 11 underwent kidney transplantation). The average age of the deceased (53.6 ± 1.6) was significantly higher than that of patients continuing to receive HD (45.6 ± 1.5). The average duration of hemodialysis in survivors (33.0 ± 5.4) was higher than in the dead (28.6 ± 3.9). The study of the further fate of patients, depending on the presence or absence of cardiovascular diseases, showed that among the deceased patients, 68.1% (n = 49) of patients were patients who had CVD, while among those who survived, 53.7% ( n = 44) had no CVS pathologies. Among those continuing to receive programmed hemodialysis, there were 31.7% more patients without CVD than among patients with diagnosed CVD. In dialysis patients with CVD who died within the period of 30 months of prospective observation was 39.6% higher than in patients without CVD. The survival rate of patients with CVD was 0.44 [95% CI 0.34-0.55], while in patients without CVD it was 0.67 [95% CI 0.55-0.78]. Conclusion The concomitant pathology of the cardiovascular system affects the survival rate of patients with end-stage CKD on hemodialysis. Dialysis patients of the population of Uzbekistan who do not have concomitant cardiovascular pathology have a 33% higher survival rate than patients without CVD.

MO667SWITCHING TO ONE-TIME USE OF DIALYZERS FOR HEMODIALYSIS: A ONE-YEAR SURVIVAL ANALYSIS IN TASHKENT

Abstract Background and Aims Until recently, for various reasons in Uzbekistan, it was often necessary to reuse disposable dialyzers for hemodialysis procedures. On June 13, 2018, a Resolution of the President of the Republic of Uzbekistan was issued on measures to improve the effectiveness of the provision of nephrological and dialysis care to the population of our country. Thanks to this, funding and provision of all nephrological and dialysis centers have sharply increased, as well as the country's transplant service has been re-established. Since the end of 2018, dialyzers are used exclusively once in all dialysis centers in our country. We were interested in comparatively studying the survival rate of dialysis patients during one year, before and after the transition to the use of single dialyzers in our center. Method We conducted a prospective observation of 120 (63 men and 57 women) patients with end-stage CKD and receiving programmed hemodialysis at our dialysis center in Tashkent. Our observation took place for 2 years: from the beginning of 2018 to the end of 2019. The study took place in 2 stages, 1 year each: at the first stage, within 1 year (from the beginning to the end of 2018), the survival rate of the observed patients receiving hemodialysis with repeated use of disposable dialyzers was assessed. At the second stage (after the transition to one-time use of dialyzers throughout the country), also for 1 year (from the beginning to the end of 2019), all the patients we observed received hemodialysis sessions with a single use of dialyzers. All patients were diagnosed with end-stage CKD. The average age of the patients was 49.7 ± 14.1 years. The average duration of hemodialysis was 29.4 (6-252) months. All patients underwent hemodialysis sessions with identical apparatus and dialyzers of the same manufacturer. The primary diseases in the patients were glomerulonephritis (n = 44, 36.7%), type 2 diabetes (n = 38, 31.7%), urolithiasis (n = 13, 10.8%), polycystic kidney disease (n = 7, 5.8%), lupus (n = 5, 4.2%) and others (n = 13, 10.8%). Survival was assessed using the Kaplan-Meier method, the confidence interval was determined by Greenwood. Results During the entire period (24 months) of observation, out of 120 patients, 26.7% (n = 32) patients died, 73.3% (n = 88) survived (of which 10 patients underwent kidney transplantation). We will assess the survival rate depending on the periods of dialyzer use. During 1 year of follow-up (the period of repeated use of disposable dialyzers), 19.2% (n = 23) patients died, 80.8% (n = 97) survived and continued to receive hemodialysis, of which 2 (1.7%) patients underwent a kidney transplant and knocked out of observation. The main cause of death was cardiovascular complications (sudden cardiac death, myocardial infarction, stroke, etc.), as a result of which 69.6% (n = 16) of patients died. The survival rate for 1 year was S (t) = 0.815 [95% CI, 0.745-0.885]. Over the next 12 months (single use period), out of 95 patients continuing to receive hemodialysis, 9.5% (n = 9) patients died, 82.1% (n = 78) patients survived. 8.4% (n = 8) of the observed patients underwent kidney transplantation. 55.6% (n = 5) of all deceased patients died from cardiovascular complications. The survival rate at 1 year was S (t) = 0.901 [95% CI, 0.839-0.962]. Conclusion Compliance with the standards for hemodialysis, in particular, the single use of disposable dialyzers for hemodialysis sessions leads to a decrease in the lethality of dialysis patients. The transition from multiple to single use of disposable dialyzers in one dialysis center in Uzbekistan showed a significant increase in survival by 10.6%.

POS-250 HYPERPARATHYROIDISM: A CARDIOVASCULAR RISK FACTOR IN CHRONIC HEMODIALYSIS?

Secondary hyperparathyroidism (SHPT) is an increased secretion of PTH due to parathyroid hyperplasia caused by triggers such as hypocalcemia, hyperphosphatemia, or decreased active vitamin D. It is a common complication in patients with chronic kidney disease (CKD). The aim of our study is to study the relationship between alterations in phosphocalcic metabolism and cardiovascular risk. This is a cross sectional study conducted on 20 chronic hemodialysis patients in our department in which biological parameters were collected: serum calcium, phosphorus, parathyroid hormone (iPTH) as well as echocardiographic parameters: left ventricular ejection fraction % (LVEF%) the presence or not of hypertrophic cardiomyopathy and/or valvulopathy.The iPTH was determined by a commercial kit (reference range 12–64 pg/mL) and the other parameters were determined by a standard autoanalyzer.Patients who had parathyroidectomy or those on steroids, phenytoin, phenobarbitone or other factors that affect the bone biochemical parameters were excluded. Twenty patients were collected with a mean age of 52.5 years (31-73 years) with a male predominance (sex ratio=1.5). The average duration of hemodialysis was 75.8 months (29 – 109 months). The average iPTH was 374.3pg/ml (234 – 1385 pg/ml). 72% of patients had a PTH > 300 pg/ml. Mean blood calcium was 1.88 mmol/l (1.8-2.38 mmol/l). Mean phosphorus was 1.63 mmol/l (0.77-2.67 mmol/l). At echocardiographic The average LVEF was 61% (43 – 70%). Mitral Valvulopathy and aortic valvulopathy were present respectively in 15% and 10% of patients. Hypertensive cardiomyopathy and ischemic cardiomyopathy were present respectively in 20% and 15% of patients. 66% of patients with hypertrophic cardiomyopathy and 75% of patients with valvulopathy had a PTH> 300pg/ml. This study shows that hyperparathyroidism play a key role in the increased cardiovascular mortality and morbidity in chronic hemodialysis. It is one of the non-traditional risk factors. Hence the importance of early and adequate management in these patients.

Hand Grip Strength in Patients on Hemodialysis: An Observational Study.

The objective of this study is to evaluate hand grip strength (HGS) in patients on hemodialysis and to investigate associated factors (anthropometric characteristics, body composition, and quality of life). An observational study of 60 patients in one hemodialysis center (Filoxenia Dialysis center, Aigio, Greece) was conducted. Measures of HGS were performed with a hydraulic dynamometer (Saehan Corporation, South Korea) on the non-fistula hand before the hemodialysis session. Demographic and clinical data (dialysis start date, comorbidities, and etiology of chronic kidney disease) were collected from the patients' medical charts. Body composition was determined by bioelectrical impedance analysis and calf circumference with inelastic tape. Quality of life was assessed via EuroQol (EQ-5D) questionnaire. Descriptive statistics were used for data analyses. The association between variables was calculated using Pearson's r correlation coefficients. The experimental design of this study was approved by the Ethics Committee of the Technological Educational Institute of Western Greece. A total of 54 patients (71.2±10.9years old, 24% diabetic, BMI of 26.34±5.2) participated in this study (response rate 90%). The average duration of hemodialysis was 4.29±6.36years. The maximum HGS in the dominant was 19.19±12.1 kg (female 12.04±7.26kg, male 21.82±12.52kg, p<0.001). HGS was significantly correlated with age (r=0.5; p<0.001) and moderately correlated with gender (r=0.36; p=0.008), BMI (r=0.3; p=0.03), calf circumference (r=0.4; p=0.03), and quality of life (r=0.37; p=0.006). The use of hand-held dynamometry could be a fundamental element of the physical examination of patients receiving hemodialysis, particularly if they are older adults.

P1470PREGNANCY IN HEMODIALYSIS: EXPERIENCE OF HEMODIALYSIS CENTERS IN SOUTHERN TUNISIA DURING 34 YEARS

Abstract Background and Aims Women with chronic kidney disease are much less likely to become pregnant and pregnany has always been considered as a challenging event both for the mother and the fetus. The challenge is harder in patients undergoing dialysis. The main objective of our work is reporting our experience of pregnancy’s cases in hemodialysis centers in southern Tunisia. Method It was a retrospective study looked at 25 spontaneous pregnancies in 19 patients treated with periodic hemodialysis in different hemodialysis centers in southern Tunisia over a period of 34 years. All pregnancies were spontaneous and are counted even spontaneous or voluntary abortions during the 1st and 2nd trimester of pregnancy Results The maternal age at the onset of pregnancy was, on average, 35.63 years ± 5.62 (between 23 and 44 years). Our study included 19 patients from southern Tunisia, 6 of them belonged to the governorate of Medenine. Hypertension was present in 7 patients (37%). The average duration of hemodialysis before conception is 4.56 years ± 3.55 (1 - 17 years). Seven patients (37%) had residual diuresis of: 1 liter per 24h in 2 cases, 500ml per 24h in other cases and the rest of the patients were anuric. All our patients were anemic before pregnancy with a mean hemoglobin level at 8 ± 1.54 g / dl (5.1 - 10.6 g / dl) with erythropoietin use in 12 (48%), folate in 11 cases (44%), intravenous iron in 11 cases (44%) and transfusion in 6 cases (24%).In our series, the average urea level was 22.19 ± 4.29 mmol / L .The urea level was lower or equal to 20 mmol / L in 8 cases (42%) and greater than 20 mmol / L in 11 cases (58%). Among the 25 pregnancies, 16 (64%) resulted in the birth of a live child: 4 intra-uterine malformations, 4 early abortions and one voluntary termination of pregnancy. There were 2 deaths within 28 days after birth. Pregnancy was considered a success if it resulted in the birth of a newborn surviving at least 28 days. Thus, the success rate was estimated at 56%. Among the maternal complications, hypertension was the most frequently complication (35% of cases). There were 2 cases of hemorrhage’s delivery as obstetrical complication. Among fetal complications, prematurity was frequent and was present in 15 cases (60%): 10 cas (40%) of average prematurity, 4 cases (16%) of great prematurity and 1 case (4%) of extreme immaturity. Hydramnios was found in 3 cases (16%). Intra-uterine growth retardation was found in 13 cases (52%) and 6 cases of death (24%) were described. Conclusion Pregnancy during chronic end stage renal failure is rare but possible. The chance of giving birth to a live child has increased in parallel with advances in hemodialysis techniques and early weight-bearing. Thus, a successful pregnancy in woman on dialysis requires collaboration among nephrologists, dialysis unit staff and obstetricians.

The Predictive Value of NT-Pro-Brain Natriuretic Peptide for Risk of Pneumonia in Patients on Maintenance Hemodialysis

Background/Aims: Pneumonia is a common type of infection in maintenance hemodialysis (MHD) patients, while the treatment and prevention progress still keep limited. N-terminal-pro-brain natriuretic peptide (NT-proBNP) is an important marker in reflecting cardiac failure which also is a risk factor for pneumonia. This study aimed to determine the possible predictive value of NT-proBNP for pneumonia in MHD patients. Methods: In this prospective study, the basic information of 276 MHD patients was collected in Fudan university Zhongshan hospital, followed up for 1 year. The primary endpoint was the first pneumonia event during follow-up. The value of NT-proBNP in patients with pneumonia and without pneumonia was analyzed, to elucidate the predictive value of the NT-proBNP in hemodialysis patients with pneumonia. Results: Two hundred and seventy-six patients were finally enrolled in this prospective study, including 170 men. The mean age was 59.7 ± 14.0 years old. The average duration of hemodialysis is 56 (30–82.8) months. Enrolled patients were followed up for 1 year. During follow-up, 38 patients got pneumonia. After adjustment for other confounding factors, age (hazard ratio [HR] 1.031, 95% CI 1.003–1.060, p = 0.028), log NT-proBNP (HR 2.512, 95% CI 1.124–5.612, p = 0.025), history of smoking (HR 6.326, 95% CI 2.505–15.974, p < 0.001), β2-microglobin (HR 1.042, 95% CI 1.007–1.079, p = 0.019), and history of cerebrovascular disease (HR 2.303, 95% CI 1.107–4.719, p = 0.026) were independent predictors of pneumonia. Receiver operating characteristic curves of log NT-proBNP to predict 1 year pneumonia cases, log NT-proBNP had an area under the curve of 0.647 (95% CI [0.564–0.729], p < 0.01). Conclusions: NT-proBNP is a predictive factor of pneumonia in hemodialysis patients.

Clinicodemographic Profile and Outcome of Maintenance Hemodialysis Patients in a Tertiary Hospital of Central Nepal, Chitwan

Background Maintenance hemodialysis is a popular treatment modality of renal replacement therapy for end stage renal disease patients; however their mortality seemed to be rising in our centre. There were no previous studies regarding the clinicodemographic profile and outcome of maintenance hemodialysis patients from this region. Objective This study was carried out with an objective to know the clinicodemographic profile and outcome of maintenance hemodialysis patients in our centre. Method This study was a hospital based prospective observational study carried out over a period of three year, from May 2016 to April 2019, in the hemodialysis unit of the department of nephrology. All the consecutive end stage renal disease patients on maintenance hemodialysis were included in the study. The patient's demographic profile and outcome were studied and analysed using appropriate statistical tools. Result A total of 156 patients were enrolled in the study. Males were 96(61.5%) and females were 60(38.5%). The mean age of the patient was 52.2±15.6 years. The commonest causes of end stage renal disease and reasons for admission were Type 2 diabetes mellitus 68(43.6%) and volume overload with heart failure 101(64.7%) respectively. At the end of three years, 39(25%) were expired, 14(8.9%) were transferred to other centre and four (2.6%) underwent kidney transplantation. The average duration of hemodialysis was 20.3± 17.5 months. Majority of the patients 154(98.7%) had repeat admission ranging from 1 time 21(13.5%) to 10 times two (1.3%). There was a significant association between age ≥ 40 years and diabetes with mortality (p value < 0.003 and < 0.028 respectively). Conclusion The commonest cause of end stage renal disease and the reason of admission were Type 2 diabetes mellitus 68 (43.6%) and volume overload with heart failure 101 (64.7%) respectively. The overall mortality was 39 (25%) and the commonest cause of mortality was sepsis/health care associated pneumonia 30 (76.9%). There was significant association between age ≥ 40 years and diabetes with mortality (p value < 0.003 and < 0.028 respectively).

Interest of Beta-2-Microglobilin Plasma Assay in Iterative Haemodialysis in the Nephrology and Haemodialysis Department of University Teaching Hospital of Point G, Bamako, Mali

Beta-2-microglobulin (B2M) is a low molecular weight polypeptide (11,800 Da) that exists in a free form and a form bound to cell membranes (light chains of HLA class I molecules). Their dosage is used in the exploration and monitoring of renal function in haemodialysis patients, hence the interest of this study, the objective of which is to study the different players involved in the increase of beta-2-microglobulin. Materials and Methods: This was a prospective and descriptive study from January 1st, 2017 to August 31, 2017 (08 months). All patients with chronic hemodialysis for 3 years or more were included. We analyzed sociodemographic, clinical and paraclinical data. Results: We collected 50 patients. The mean age was 50 ± 4.6 years with extremes of 30 and 82 years. The female sex predominated (52%). Chronic end-stage renal failure was hypertensive (86%), diabetic (4%). All patients benefited from intermittent hemodialysis for 8 hours per week using a low permeability membrane (cuprophane). The average duration of hemodialysis was 68 ± 6.4 months with extremes of 36 and 204 months. Twenty percent (20%) and four percent (4%) of chronic dialysis patients had joint pain and sensory deficit. Phalen’s sign was positive in 2% (1 case), Tinel’s sign in 2% (1 case) and carpal tunnel syndrome in 2% (1 case). The mean serum beta-2-microglobulin level was 58.34 ng/l with extremes of 16.99 and 112.24 ng/l. There was a correlation between hypertensive nephropathies and beta-2-microglobulin levels above 50 ng/l (P < 0.001). The mortality rate was 6%. Conclusion: Our study has objectified factors such as inadequate dialysis (8 hours/week), use of low permeability membrane in the increase of beta-2-microglobulin. The increase in serum beta-2-microglobulin levels in our patients is evidence of poor purification of medium molecules. Its reduction can be established by improving the quality of dialysis, in particular by using a high-permeability membrane.

Dialysis dose in end-stage renal disease patients undergoing regular hemodialysis at Ibn-Sena and AlNao hospitals in Sudan

Introduction: Ne Hemodialysis (HD) plays a fundamental role in the treatment of end-stage renal disease (ESRD) patients. A minimal duration between 9 to 12 hours per week is required for maintaining adequate HD to restore excretory function of the kidney. Objectives: To measure the average duration of HD among Sudanese patients, and compare with the universal recommended duration. Patients and Methods: A cross-sectional, descriptive study at IBN-SENA hospital and ALNAO teaching hospital was conducted. All patients were subjected to full medical history and examination to identify their age, gender, original kidney disease and duration and route of HD. Results: A total of 121 ESRD patients under regular HD participated in this study. The majority [78 (64.5%)] had an average duration of HD of 8 h/wk. Conclusion: A large proportion of our patients on HD are below target dialysis dose; mainly due to reducing in the number of sessions per week and average duration per each session.

Valvular calcifications in a patient on hemodialysis in Morocco

IntroductionLes calcifications valvulaires constituent une des complications cardiovasculaires majeures de l'hémodialysé de par sa prévalence et son caractère prédictif de morbidité et de mortalité. De nombreux facteurs de risque sont à l'origine de ces calcifications. Le but de notre étude est d’évaluer à la fois la prévalence des calcifications valvulaires chez nos patients hémodialysés ainsi que leurs facteurs de risque.MéthodesIl s'agissait d'une étude transversale monocentrique, descriptive et analytique, ayant inclus 111 patients adultes hémodialysés depuis plus de 6 mois au centre d'hémodialyse du CHU Ibn Rochd de Casablanca et qui ont eu à bénéficier d'une ETT durant l'année 2013.RésultatsL’âge moyen de nos patients était de 44 ± 14 ans. L'ancienneté moyenne en hémodialyse était de 146 ± 80 mois. La pression artérielle moyenne était de 123 ± 23 mmHg pour la systolique et de 72 ± 13 mmHg pour la diastolique, la PTHi moyenne de 529±460 pg/ml, la calcémie moyenne de 86±10 mg/l et la phosphatémie moyenne de 40±15 mg/l. La CRP moyenne était de 11±19,8 mg/L. Sur le plan thérapeutique, 96% des patients étaient sous carbonate de calcium, 11% sous 25 OH vitamine D, 55,5% sous 1 hydroxy-vitamine D3. La prévalence des calcifications valvulaires était de 15% avec une localisation valvulaire aortique dans 41,2% et valvulaire mitrale dans 41,2%. En analyse univariée, seule la durée d'hémodialyse semble être associée à la survenue des calcifications avec p = 0,09 proche du seuil de significativité.ConclusionLa prévalence des calcifications valvulaires chez nos patients hémodialysés reste élevée même si elle parait relativement moindre comparée aux données de la littérature. Aucun facteur de risque connu n'est apparu significativement associé à ces calcifications.

Epidemiological Profile of Chronic Hemodialysis Patients in Ouagadougou

Goal: By describing the epidemiology of chronic hemodialysis patients in the single hemodialysis unit of Burkina Faso, we want to contribute to the prevention and improvement of chronic renal failure management (CRF) in this country. Patients and Methods: A descriptive cross-sectional study was conducted in the hemodialysis unit of the University Hospital Center Yalgado Ouedraogo (UHC-YO) during the period from February 12 to May 15, 2015. The patients who started hemodialysis in this unit and were treated for at least three months were included in this study. The sociodemographic and clinical data were collected. The statistical significance was defined for a probability (p ≤ 0.05). Results: One hundred and seventy-two patients (71.2% of the 240 patients of the unit) have been included. The sex ratio was 1.6. The average age was 45.2 ± 12.4 years old. The presumed causes of CRF have been identified in 134 cases (77.9%). The most frequent were hypertensive nephropathy (65 cases; 48.5%), chronic glomerulonephritis (41 cases; 30.6%; including 11 viral origin and 16 with history of recurrent otorhinolaryngologic infections and/or urinary schistosomiasis). Hemodialysis began in an emergency context in 118 cases (68.6%). The average duration of hemodialysis was 29.4 ± 28.4 months. Conclusion: The main suspected causes of CRF were hypertension and chronic glomerulonephritis. The origin of the latter seemed more often infectious. Prevention of CRF in Burkina Faso should be focused on that of hypertension and infectious diseases.

The impact of multidisciplinary rehabilitation on the quality of life of hemodialysis patients in Iran.

Hemodialysis contributes to changes in lifestyle and the health status of patients. The aim of this study was to evaluate the impact of participatory rehabilitation on the quality of life of patients. This quasi-experimental before and after study was conducted on 30 patients in the hemodialysis center at Hazrat-e-Rasoul Hospital in Javanrood during 2013. The rehabilitation program was executed with participation of experts in the fields of nursing, physiotherapy, and clinical psychology for 8 weeks. The instrument used for data collection was the hemodialysis version of Ferrans and Powers Quality of Life Index (QLI) which was completed by the research assistant by interview before and after the rehabilitation program. The mean age of patients was 55.8±14.3 years, 60% were male, and 93.3% were married. The average duration of hemodialysis was 3±2.4 years. The quality of life score of all patients before the intervention was between 10 and 19 (moderate level), which after intervention, improved to a good level in half of the patients (p<0.001). Rehabilitation programs improve the quality of life of hemodialysis patients. By this finding, implementation of rehabilitation programs is recommended in hemodialysis centers with participation of experts from different fields including nurses, physiotherapists, and clinical psychologists.

Correlation Between Parathormon and Sexual Hormones in Patients on Haemodialysis

Chronic renal failure is associated with endocrine abnormalities, which in some cases cause polyendocrinopathy responsible for the symptoms and complications. The consequence of secondary hyperparathyroidism is not only bone disease but may be cardiovascular disorders, peripheral nerve damage and impact on the level of sex hormones. To evaluate the interactions between parathyroid hormone and sexual hormones and the effect of elevated levels of parathyroid hormone secretion on various sexual hormones. The study included 72 patients who were undergoing chronic hemodialysis program 3 times a week at the clinic for hemodialysis. Patients were divided into two groups according to parathyroid hormone values and child-bearing age. The study is a retrospective-prospective and lasted for 1 year. At the beginning, after 6 months, and at the end of the study were determined the PTH, FSH, LH, progesterone, testosterone, beta-estradiol, prolactin. During the study period followed are the values of sexual hormones and PTH in 72 patients of which 41 men and 31 women. Of these 33.3% (24) men were in the reproductive age, and 23.6% (17) were women in the reproductive age. The mean age of patients was 53.2 +/- 12.16, and the average duration of hemodialysis was 7.57 +/- 4.0. PTH showed a slight tendency to increase 274.45 +/- 220.74 pg/dL at baseline, at the end of study 383 +/- 313.2 also increased during the study was recorded and the values progesterone. Statistically significant effect of PTH showed the FSH p < 0.01 LH p < 0.05 and prolactin p < 0.01. On average, patients who have elevated PTH levels have lower values of FSH and LH, but higher prolactin values. Parathormone also shows the effect on beta estradiol at level p < 0.01, patients with higher PTH values have lower levels of beta estradiol. The increase in the number of younger people with terminal renal insufficiency treated by repeated hemodialysis, often have endocrine disorders and elevated PTH. Normalization of PTH levels affects the normalization of sexual hormone levels and improves quality of life of patients on hemodialysis.