Average Duration Of Hemodialysis Research Articles

Detection of SEN virus in the general population and different risk groups in Slovakia

Sera of 426 adult persons were examined to assess the prevalence of SEN virus (SENV) infection in Slovakia and to determine the importance of different risk factors for parenteral transmission. SENV prevalence was determined by the PCR method using primers of SENV-D and SENV-H strains. Positive results were found in 10 of 37 patients with acute hepatitis of unknown etiology, 7 of 38 with acute hepatitis B, 17 of 44 with chronic hepatitis B, 29 of 102 with chronic hepatitis C, 36 of 72 hemodialysis patients, 2 of 33 health care workers and 24 of 100 persons from the control group. The highest prevalence of SENV was among hemodialysis patients, significantly higher than in the groups of health care workers, acute hepatitis B and controls. The lowest prevalence was in health care workers group, significantly lower also in comparison with groups of chronic hepatitis B and C. Among the possible risk factors of virus transmission the average duration of hemodialysis (1.15 vs. 0.50 years), number of surgeries (1.60 vs. 1.10) and transfusions (1.34 vs. 0.94) showed notable differences in terms of SENV infection. Bilirubin and aminotransferase levels did not differ between SENV-positive and -negative groups. No pathogenetic role of SEN virus in liver injury was confirmed.

Infective endocarditis in patients with end-stage renal disease: clinical presentation and outcome.

Infective endocarditis is a common complication of vascular access in patients undergoing long-term hemodialysis. However, available data are either dated or gathered from small samples. The goal of this study was to investigate the clinical characteristics and outcome of infective endocarditis occurring in patients with end-stage renal disease. Patients were identified by computerized discharge diagnosis and manual chart review at 3 major hospitals in Honolulu, Hawaii. The search covered an 11-year period, through December 2001. Modified Duke criteria were retrospectively applied. Patients fulfilling criteria for definite endocarditis were included in this study. Forty patients were identified. Average age was 59.4 years, and average duration of hemodialysis before endocarditis was 3.3 years; arteriovenous fistulas were the most commonly used access sites. Predominant organism was Staphylococcus aureus in 20 (50%) of the 40 cases. The mitral valve was affected in 29 cases (73%); aortic and mitral valve endocarditis was seen in 8 cases (20%). Overall in-hospital mortality was 52% (21/40). Patients with an unfavorable outcome more often had fever on admission, fewer negative blood cultures, and bivalvular infective endocarditis, and more often underwent valve replacement surgery. The perioperative mortality in patients undergoing valve replacement was 73% (11/15). Mortality of infective endocarditis in patients with end-stage renal disease remains high and has been essentially unchanged during the past decade. If patients require valve replacement surgery, mortality is even higher. A randomized, controlled trial is needed to clarify whether the increased mortality is due solely to more severe disease in patients requiring valve replacement surgery.

血液透析患者における大腿骨頚部骨折の検討

In order to examine the pathogenesis and related problems of femoral neck fracture in hemodialytic patients, 16 patients with hemodialysis (HD) who were operated on for femoral neck fracture from November 1998 to December 2000 were reviewed. Average age at operation was 71 years and the average duration of HD was 17.4 years. Two out of the 16 cases had no obvious history of trauma. Thirteen cases had subcapital fracture and three cases had trochanteric fracture. All three cases with trochanteric fracture showed severe anemia and required blood transfusion before operation, whereas all cases of subcapital fracture did not. Subcapital fracture seemed more likely to occur in patients with HD presumably due to bone fragility and anatomical weakness of the femoral neck. In addition, appropriate volume control and early transufusion, when necessary, are considered very important for patients with HD, because they lack self-regulatory capacity.

The analysis of gastrointestinal amyloidosis in 78 patients with chronic renal failure

Systemic amyloidosis is not a single disease, but the product of a variety of diseases. Amyloid proteins are insoluble fibrils that are deposited extracellularly in many organ tissues. They stain with Congo red and appear apple green under polarized light. Definitive diagnosis and classification of amyloidosis requires histologic examination of tissue samples. Gastrointestinal tract involvement is common, and all parts of the system can be affected. Immuno–histochemical studies have shown that amyloid deposited in the gastrointestinal system is most often of the AA, A kappa, or A lambda types. Another type of amyloid protein, beta–2 microglobulin (β2M), predominantly affects the musculoskeletal system, and is usually seen in patients who have been on long–term hemodialysis. Mixed systemic amyloidosis (β2M and AA) is seen only rarely in these patients. In this study, we attempted to answer why this is so, and examined whether or not mixed amyloidosis is related to amyloidogenesis.We studied gastrointestinal tissues from 78 chronic renal failure patients who had systemic amyloidosis with gastrointestinal involvement. A total of 115 endoscopic samples and 1 jejunal resection specimen were analysed immunohistochemically. Immunohistochemical testing using a panel of antisera directed against two major amyloid fibril proteins (AA–Monoclonal, Dako–, and β2 MPolyclonal, Dako–) showed that all samples contained AA amyloid, but not β2M type protein. These findings can be explained by the patients' relatively short average duration of hemodialysis and the predominance of endoscopic biopsy samples in our study.

Failed hip prostheses in hemodialysis patients. Amyloid deposition at the bone-implant interface in 4 cases.

4 hemodialysis patients with failed bipolar hip prostheses underwent 6 revision arthroplasties. Their average age was 55 years, the average duration of hemodialysis was 14 years and the average interval from the primary arthroplasty to revision was 7 years. The interface membranes revealed amyloid deposits in all specimens. There were few polyethylene wear particles, and cement debris or foreign body reactions were rare. It appears that amyloid may cause osteolysis and early prosthetic loosening.

Cardiac operations in patients with end-stage renal disease

Factors influencing the survival of 35 consecutive patients in end-stage renal disease who required 40 open heart surgical procedures over the past 8 years were studied. The mean age in these patients was 57.7 ± 3 years (range, 32 to 77 years); 74.3% of the patients were male; and the average duration of hemodialysis was 3.6 ± 0.6 years. Twenty-nine myocardial procedures (20 of 29 for unstable angina), six valve replacements, and five combined procedures were performed. The actuarial survivals at 1 and 3 months, and at 1,5, and 8 years were 90%, 85%, 76%, 55%, and 43%, respectively. Based on the results of univariate analysis, the most significant predictor of both early and late mortality was New York Heart Association (NYHA) class IV congestive heart failure. The 5-year survival in the patients 60 years and older was less favorable than that in patients younger than 60 years (45% versus 63%) ( p < 0.05). The 5-year survival in the patients in NYHA class IV was only 27%, as compared to 63% in the patients in class II or III ( p < 0.001). All survivors have remained free of angina and 19 of the 21 survivors showed an improvement in their NYHA class. Four patients under 40 years of age have subsequently been able to undergo renal transplantation. Overall, these results justify proceeding with an open heart surgical procedure in dialysis patients, when needed, but before the onset of congestive heart failure.