Dialysis Ward Research Articles

Visual supports and informative material not to forget counselling on reproductive health in dialysis: a point of view.

Contraception, pregnancy and fertility are seldom discussed with women receiving dialysis and the medical staff of dialysis centres. Since the majority of women on dialysis are past childbearing age, these themes are not always given proper consideration and this category of patients may be missing important information. Young women of childbearing age who are on dialysis frequently experience sexual dysfunction and hormonal disorders of the hypothalamic-pituitary-gonadal axis. In addition, dialysis often has a relevant psychological impact and affects the person's social role. Physical changes may accompany kidney failure, including the presence of a vascular or peritoneal access. The dialysis ward is not a place that facilitates privacy, and discussing contraception is not always easy, particularly in some cultural contexts, or between a male doctor and a young woman. While pregnancy and contraception are routinely addressed with women waiting for a kidney transplant, they are less frequently discussed with women on dialysis. Numerous studies have found that over half of the pregnancies in women on dialysis are unplanned. How frequently patients are seen (at each dialysis session, or during periodic visits) does not necessarily make things better, as often some issues are taken for granted or discussing them is postponed. In our centre, over 160 patients are on chronic hemodialysis (HD) and 20 are on peritoneal or home HD. Only nine women were of childbearing agein our center, all on HD. We discussed with them on counselling about pregnancy, and to ensure that all women of childbearing age would be offered counselling on contraception and pregnancy, we designed simple leaflets and an infographic, in collaboration with our nursing team and residents, as a guide and a reminder for our staff to discuss these topics with the patients.

Hepatitis C Virus Seroprevalence and Genotypic Distribution Among Hemodialysis Patients at a Teaching and Training Hospital in Western Rajasthan, India.

Background Hepatitis C virus (HCV) infection is a chronic hepatotropic blood-borne infection. The transmission of HCV in patients undergoing hemodialysis (HD) is more common in comparison to the general population due to factors such as frequent blood transfusions, prolonged vascular access, and the potential for nosocomial infections. Western Rajasthan in India is home to numerous teaching and training hospitals that cater to a large number of HD patients. Understanding the seroprevalence and genotypic distribution of HCV in this specific patient population is crucial for assessing the extent of infection within this vulnerable group for targeted surveillance and developing effectively tailored treatment protocolsin healthcare settings. Hence, this study was conducted with an aim to determine seroprevalence, seroconversion, and genotypes of HCV in HD patients at a tertiary care hospital. Methods This was a cross-sectional observational study. The duration of the study was from July 2019 to March 2022. In this study, the patients undergoing maintenance HD due to chronic kidney disease (CKD) were recruited. The data collected include patients' demographics, etiology of CKD, underlying other co-morbidities, duration of dialysis, and biochemical and blood count parameters. The patients recruited at the start of the study were screened for anti-HCV antibodies by HCV enzyme-linked immune sorbent assay (ELISA). The anti-HCV antibody-negative patients were followed up for the detection of anti-HCV antibodies. At the end of the follow-up period, all anti-HCV antibody negative samples in the pool of five and all anti-HCV antibody positive samples were subjected to a real-time polymerase chain reaction (RT-PCR) of 5' untranslated region (5'UTR) and core region, followed by line probe assay (LiPA). Results In this study, after applying inclusion and exclusion criteria, a total of 109 patients were recruited, out of which 64 (58.7%) were males and 45 (41.3%) were females. The age range of participants was 11-88 years with a mean and standard deviation of 46.75 and 16.35 years, respectively. A total of 39 patients (20 on screening, 19 on follow-up) were detected anti- HCV antibody positive. By RT-PCR, 24 patients tested HCV RNA positive (10 on screening, 14 on follow-up). Among 24 HCV RNA-positive samples, LiPA showed, HCV genotype 1a (n=21), genotype 3b (n=1), and two samples were detected to be inconclusive. Conclusion The increasing duration of dialysis is significantly associated with acquiring HCV infection. The majority of the cases of CKD in this geographical region are due to hypertensive nephropathy. There can be discordance between antibody and viral RNA positivity in HCV infection. The predominant HCV genotype identifiedin the dialysis ward of tertiary care hospital was genotype 1a.

Insights into the real-world practice of vascular access care pathways in Italy: data from a national survey.

International guidelines issued recommendations for vascular access (VA) care for hemodialysis, but there are no registry data regarding this topic in Italy. A survey consisting of 17 items was sent to all Italian dialysis wards, via the Italian Society of Nephrology (SIN) website, from April to June 2021.The items were defined,discussedand approved by experts in vascular access management within the Italian Society of Nephrology. A total of 124 dialysis units answered, accounting for 14% of all dialysis units. The survey thus encompasses all regions within the country, with some regional variations in terms of adherence. One hundred twenty-four facilities provided data, regarding 12,276 patients: 61% had an arteriovenous fistula (AVF), 34% had a central venous catheter (CVC), and 5% had an arteriovenous graft (AVG). Among them, two-thirds of the facilitiesreported having a vascular access care pathway, formally standardized in 79% of cases. Forty-six % of centers had a fully equipped vascular access care pathway, encompassing preoperative mapping (80%), vascular access setup (71%), arteriovenous fistula maturation monitoring (76%), first-level (80%) and second-level (78%) monitoring, and surgical and/or endovascular treatment of complications (66%). Vascular access monitoring was computerized in 39% of facilities. First-level monitoring (physical examination) was primarily done by nurses in two-thirds of facilities. Of note, 45% of centers had nurses who were skilled in ultrasound-guided cannulation. Quite surprisingly, facilities with less than 100 patients had a greater prevalence of arteriovenous fistulas than those with more than 100 patients (p = 0.0023). A protocolled vascular access care pathway was associated with a higher likelihood of having an arteriovenous fistula (70% AVF vs 42,1% CVC; p = 0.04). The presence in the facilityof interventional nephrologists or nurses with ultrasound-guided cannulation skills significantly reduced the prevalence of central venous catheters. These survey data further strengthen the need for formal and shared vascular access monitoring protocols.

#1119 Iodine contrast does not contribute to impaired kidney function or need for dialysis

Abstract Background and Aims Imaging diagnostics play a crucial role in the management of patients with acute and critical conditions or suspected underlying disease like infections or malignancy. These examinations are often enhanced by intravenous iodine-based contrast, to improve the imaging quality and the diagnostic accuracy. For long, there has been a conception that these contrast materials are nephrotoxic, but the last decade has provided a significant quantity of modern studies suggesting that this is not the case. The present study evaluates if earlier contrast exposure has contributed to progress in CKD and the need of initiating dialysis treatment in patients who were in maintenance dialysis treatment at the Västerås hospital at the time of inclusion. Method All patients admitted to the dialysis ward in Västerås the 1st of January 2022 were included and copies of all radiology surveys and all lab values from the electronical records for this study population for the last 10 years were extracted to check for contrast exposure. For some patients, this occurred when they were already on maintenance dialysis treatment, others were pre-dialytic at the time or had not yet developed any kidney impairment. For every contrast exposure, we checked the previous creatinine and the earliest creatinine after the examination to check for acute kidney injury, AKI, as defined by KDIGO. As a secondary outcome, we investigated the frequency of examinations where contrast otherwise would be indicated, but was withhold, due to fear of contrast induced AKI. Results In total, 83 patients were included in this study, and among them there were 121 cases of contrast exposure. There were no events of AKI when eGFR was > 30 ml/min. In the subgroup of patients with eGFR < 30 ml/min, but not in dialysis at the time of the examination, there were only 25 cases of contrast exposure, and only one event of AKI, but this was considered largely due to overhydration and decompensated heart failure and resolved with proper treatment. Among the patients already in dialysis, there were 65 contrast exposures, and no event where any subjects lost their residual kidney function due to contrast induced AKI. In the meantime, there were 249 examinations where contrast material was withheld due to low eGFR, even though it normally would be indicated by the reason of the examination. Conclusion There was none significant event of potential contrast induced AKI among the patients in our study and no patient had any lasting impact on their kidney function from contrast exposure. Contrast exposure does not seem to be a common contributing cause of progressing to end stage renal disease. This is well in line with previous, modern observation studies, suggesting that the risk of contrast induced nephropathy is overrated or possible even a myth. Perhaps even more importantly, contrast enhancement was often inadequately withheld, even though it normally would be necessary to accurately make the diagnosis that was the purpose of ordering the study. Poor imaging quality limits the ability to make correct diagnoses, resulting in substandard treatment for the CKD-population.

#1094 Hemodiafiltration improves solute clearance without increasing water consumption: an educational bench model for the dialysis ward

Abstract Background and Aims Recently, the positive results of the CONVICE trial have raised the question whether the improved outcome of postdilution high volume HDF (oHDF-p) compared to high flux HD (hfHD) requires increased water consumption. From mathematical modelling it can be shown that oHDF-p always leads to higher low molecular clearance than hfHD at equal total dialysate consumption Qd_tot = Qd_dial + Qs (Qd_dial: dialysate flow through the dialyzer, Qs: substitution flow). This has also been shown in a clinical trial (Mesic et al, HDI 15, p. 522-529). However, mathematical modelling might not be intuitive for everyone, and clinical trials are always influenced by multiple confounders. To add a more intuitive way of reasoning, a simple educational bench model was designed based only on equipment easily available in a standard dialysis clinic which allows to compare dialysis efficiencies based on the urea concentrations as surrogate parameter. Since the fundamental task of dialysis is to cleanse blood from uremic solutes, the treatment modality which at equal resource utilization reduces solute concentration most is the more efficient one! Method Dialysis treatments were simulated in single pass setup using a Fresenius 5008S machine (Fig. 1). Blood inlet was simulated as a fixed urea concentration of 170 mg/dL in dialysate from a 110 L reservoir “cbi”. Treatment parameters were set such that they correspond to effective values in in-vivo treatments: As the mass transfer coefficient is always much higher in vitro with water than in vivo with blood, a small high-flux dialyzer (Fresenius FX40) was used. Blood flow Qb was set to 300 mL/min, corresponding to the in vivo blood water flow for Qb_set ∼ 350 mL/min. Alternating experiments in oHDF-p and hfHD were carried out in triplicate with Qd_tot=400 mL/min and 300 mL/min. This resulted in the settings HDF400, HD400, HDF300 and HD300 (cf. Fig. 1). Qs was set to 100 ml/min in oHDF-p. In each setting the fluid from blood and dialysate outlet were collected (recipients “cbo” and “cdo”, resp.) for 8 min. To be independent of the machine accuracy of set flow rates, sample volumes were measured by weighing, and effective flow rates of blood Qb_eff and total dialysate Qd_tot_eff were calculated. Samples were taken into monovettes from “cbi”, “cbo” and “cdo”. Urea concentrations cbi, cbo and cdo were determined by sending the samples to two commercial clinical labs who delivered consistent results. Blood and dialysate side urea clearances were calculated as KUB= Qb_eff*(cbi-cbo)/cbi and KUD=Qd_tot_eff*cdo/cbi. Results The table in Fig. 1 includes the measure values of Qb_eff and Qd_tot_eff for each setting. Blood and dialysate outlet concentrations (cbo and cdo, resp.) and calculated blood and dialysate side clearances are shown in Fig. 2. Lab results in repeated settings were highly reproducible with a SD < 2 mg/dL. Switching from hfHD to oHDF-p at equal Qd_tot always decreased cbo, corresponding to a higher clearance in oHDF-p. Reducing total dialysate flow from 400 to 300 ml/min caused a slight decrease in clearance in both modalities. KUB and KUD were in good agreement, showing that urea mass balance was well controlled in the experiment. Conclusion The educational bench model demonstrates the superior low molecular clearance of oHDF-p compared to hfHD at equal Qd_tot, reflected by lower urea cbo values in oHDF-p. Although the clinical outcome advantage of oHDF-p is rather related to middle molecular clearance, the model shows that the improved treatment quality of oHDF-p can be provided with no extra resource utilization compared to hfHD, and that dialysis adequacy as measured by urea clearance is even increased despite of the fact that a part of Qd_tot is deviated as substitution fluid. As moderately reducing Qd_tot in many cases only results in acceptable clearance reductions, the automated adjustment of both dialysate and substitution flow rates for oHDF-p could improve patient outcome at even reduced resource utilization.

Prevalence of Hepatitis C Virus and Its Occult Infection in Hemodialysis Patients

Background: Hepatitis C virus (HCV) is one of the most common infections in hemodialysis patients, which has been associated with increased incidence of morbidity and mortality, particularly in low- and middle-income countries. Objectives: The current study aimed to evaluate the HCV antibody, occult HCV infection (OCI), and related risk factors among hemodialysis patients. Methods: In this cross-sectional study, 100 hemodialysis patients referred to a dialysis center in Kerman between December 2021 and March 2022 were assessed for HCV, OCI, and their related risk factors. The information related to risk factors was collected by questionnaire, while HCV and OCI were detected through serology and real-time polymerase chain reaction (PCR) methods, respectively. Results: Among the patients participating in the study, 61 were men, and 39 were women. The average age was 58.1 ± 14.9 years in men and 63.6 ± 11.4 years in women. Diabetes and hypertension history, old age, low education, self-employment, and urban living were more common in chronic kidney disease patients. The enzyme-linked immunosorbent assay (ELISA) revealed 3% positive seroprevalence HCV infection, but only 1% was positive for OCI. Although no statistically significant relationship was found between the presence of HCV (antibody and OCI) and other parameters, all positive HCV cases were identified in patients with low education and freelance employment. Conclusions: Hemodialysis patients had a low prevalence of HCV antibody and OCI. Improving various factors and conditions such as lifestyle, occupation, educational level, and dialysis ward and machine disinfection could be beneficial in managing and controlling hemodialysis complications such as HCV and OCI.

Relationship of sleep duration and sleep quality with health-related quality of life in patients on hemodialysis in Neyshabur

BackgroundAs a public health priority, health-related quality of life (HRQoL) is associated with some factors like sleep disorders. Taking this into consideration, this study aimed at investigating the relationship between sleep duration and sleep quality with HRQoL in patients on hemodialysis. MethodsThis cross-sectional study was carried out among 176 patients on hemodialysis who were admitted to the dialysis ward of 22 Bahman hospital and a private renal clinic in Neyshabur (a city in North-East of Iran) in 2021. Sleep duration and quality were measured using an Iranian version of Pittsburgh Sleep Quality Index (PSQI) and HRQoL was evaluated with the Iranian version of a 12-Item Short Form Survey (SF-12). To analyze the data and examine the independent association of sleep duration and quality with HRQoL, multiple linear regression model was performed. ResultsThe mean age of the participants was 51.6 ± 16.4 and 63.6% were male. Moreover, 55.1% and 5.7% of subjects reported a sleep duration shorter than 7 h and equal to or more than 9 h, respectively, and the value prevalence of poor sleep quality was reported as 78.2%. Furthermore, the reported overall score of HRQoL was 57.6 ± 17.9. According to the adjusted models, poor sleep quality was negatively associated with the total HRQoL score (B = −14.5, P < 0.001). Shedding light on sleep duration and Physical Component Summary (PCS), the result indicated that insufficient sleep duration (<7 h) had a borderline negative association with PCS (B = −5.96, p = 0.049). ConclusionsSleep duration and quality have important effects on HRQoL in patients on hemodialysis. Therefore, in line with improving sleep quality and HRQoL among these patients, essential interventions should be planned and performed.

Frequency Distribution of Oral Manifestations in Diabetic and Non-Diabetic Patients Undergoing Hemodialysis

Introduction: Chronic renal failure, as it affects different systems of the body, can cause major changes in the oral cavity. Therefore, the aim of this study was to compare oral manifestations in diabetic and non-diabetic patients undergoing hemodialysis. 60 patients under hemodialysis treatment referred to the dialysis departments of the teaching hospitals of Shahid Sadougi University of Medical Sciences, Yazd were examined.&#x0D; Methods: In this descriptive cross-sectional study, 60 patients undergoing hemodialysis in the dialysis wards of teaching hospitals of Shahid Sadoughi University of Medical Sciences were studied. Patients were divided into two groups of diabetic and non-diabetic (n=30). The oral cavity was examined with a mirror, explorer and flashlight. Gender, age, duration of hemodialysis, oral signs and symptoms were recorded in the patients' checklists. Data analysis was run by SPSS17 statistical software, T-tests, Fisher Exact and Chi-square.&#x0D; Results: 37 (61.7%) of the patients were male and 23 (38.3%) were female. The mean age of the patients was 57.17 ±16.15 years (age range 15-88 years). Dry mouth (76.7%) and dental erosion (50%) were the highest frequency in diabetic and non-diabetic patients, respectively. There was a statistically significant difference between the two groups in dry mouth and candidiasis (P &lt;0.05).&#x0D; Conclusion: The combined effect of diabetes and renal failure in diabetic patients undergoing hemodialysis has increased oral complications in these individuals, so close collaboration between the patient and health care team to rapid diagnosis of oral lesions could lead to promotion of the patient’s oral health and quality of life and also a decrease in the burden of disease.

Blood count of patients of the dialysis ward in Mitrovica

Laboratory blood examination is one of the most important indicators of the state of the organism. When we are sick, this analysis reveals where the focus is, but even when there are no clear symptoms, the blood count and biochemical parameters can indicate a smoldering, as yet undetected problem. Disturbances in the blood count and biochemical parameters can be a reason to suspect various pathological conditions such as: anemia, vitamin deficiency, autoimmune diseases, bone marrow diseases, infections, inflammation, thalassemia (lack of hemoglobin and red blood cells), and the negative effect of using different medicines... - Any deviation, jump or fall, from normal values ​​does not always mean that the disease is present, just as values ​​in the "normal" range do not always mean the absence of the disease. A blood test is a test that gives us not only an insight into the general state of health, but also serves to confirm the diagnosis of a particular disease. For example, if the doctor suspects an infection, a blood test can confirm that diagnosis based on accelerated sedimentation, elevated CRP value, changes in the leukocyte formula. In this way, it is possible to monitor the patient's health condition, the effects of the applied therapy, because taking certain medications can be reflected in the blood count. - Through a blood examination, we get information about the parameters related to the basic components of blood, such as red blood cells that carry oxygen, white blood cells that help fight infection, and then blood platelets that are important for blood clotting. - We also check hemoglobin (the protein to which oxygen and carbon dioxide bind and is found in red blood cells), hematocrit (the proportion of cellular elements in the liquid part of the blood), and we can also gain indirect insight into the work of other organs such as the liver , kidneys, glands with internal secretion. Sometimes the results of the blood count need to be supplemented with a biochemical blood analysis. (Testa NG,Molineux G (ur). Haemopoiesis: A Practical approach. Oxford University Press, New York 1993). Biochemical analyzes involve testing numerous parameters whose values ​​provide insight into the functioning of individual organs and the organism as a whole. - The goal of every laboratory analysis is to obtain accurate and reliable findings that will show whether changes have occurred in physiological functions and processes. (ISBT Committee on Terminology for Red Cell Surface Antigens). When it comes to laboratory testing of blood, it includes two types of analysis: those aimed at examining the type, number, relationship and appearance of cellular elements of the blood (blood count, hematological parameters) and others, which check the biochemical composition of the blood and based on that establishes the work or condition of individual organs and tissues. - The goal of this work is to determine the biochemical and hematological status of patients in Mitrovica. The data are retrospective from the medical documentation (protocol) in the period from March 7, 2021 to March 7, 2022. In the regional hospital "Dr. Sami Haxhibeqiri", in Mitrovica.

Strategies to prevent SARS-CoV-2 transmission in hemodialysis centres across Europe-lessons for the future.

Early reports on the pandemic nature of coronavirus disease 2019 (COVID-19) directed the nephrology community to develop infection prevention and control (IPC) guidance. We aimed to make an inventory of strategies that dialysis centres followed to prevent infection with COVID-19 in the first pandemic wave. We analyzed IPC measures taken by hemodialysis centres treating patients presenting with COVID-19 between 1 March 2020 and 31 July 2020 and that completed the European Renal Association COVID-19 Database centre questionnaire. Additionally, we made an inventory of guidelines published in European countries to prevent spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in dialysis centres. Data from 73 dialysis units located in and bordering Europe were analyzed. All participating centres implemented IPC measures to mitigate the impact of SARS-CoV-2 during the first pandemic wave. Measures mentioned most often included triage with questions before entering the dialysis ward, measuring body temperature, hand disinfection, masking for all patients and staff, and personal protective equipment for staff members. These measures were also recommended in most of the 14 guidelines that were identified in the inventory of national guidelines and were also scored as being among the most important measures by the authors of this paper. Heterogeneity existed between centres and national guidelines regarding the minimal distance between dialysis chairs and recommendations regarding isolation and cohorting. Although variation existed, measures to prevent transmission of SARS-CoV-2 were relatively similar across centres and national guidelines. Further research is needed to assess causal relationships between measures taken and spread of SARS-CoV-2.

The effect of evidence-based nursing education on nurses' clinical decision making: A randomized controlled trial.

IntroductionNurses are the largest group of health‐care providers and their clinical decisions have an essential role in patients' clinical condition. Evidence‐based nursing has been proposed as a health‐care method based on the latest findings and evidence. Therefore, we aimed to determine the effect of evidence‐based nursing education on dialysis nurses' clinical decision‐making.Material and MethodsThis single‐blind experimental study conducted in 2021 at dialysis wards of teaching hospitals affiliated to Urmia University of Medical Sciences. In this study, a total of 60 dialysis nurses were recruited using convenience sampling and allocated to two groups of intervention (n = 30) and control (n = 30). Data were collected at three time points of before, 1 week after, and 1 month after the intervention using a demographic questionnaire and the Lauri and Salantera Clinical Decision‐Making Questionnaire (LSCD‐MQ). Nurses in the intervention group received 12 sessions of evidence‐based nursing education, while nurses in the control group received no intervention.ResultsThe results showed the mean score of clinical decision‐making had a significant decreasing trend over time (p < 0.001) so that it decreased significantly 1 week after the intervention (72.83 ± 4.90) compared with before the intervention (69.5 ± 67.34) in the intervention group. Moreover, participants' decision‐making moved toward analytical decision‐making. The results also indicated there was a significant difference between the baseline mean score of clinical decision‐making and the postintervention mean scores obtained 1 week (p = 0.025) and 1 month (p = 0.001) after the intervention. However, this difference was not found to be significant in the control group (p = 1.000).ConclusionsThe study results indicate the positive effect of evidence‐based education on nurses' clinical decision‐making. Therefore, nurses are recommended to apply evidence‐based education methods to improve their level of clinical decision‐making. Health officials are also recommended to hold in‐service evidence‐based workshops to update nurses' knowledge.

Angiotensin 1 Converting Enzyme Encoding Gene Polymorphism in Renal Patients

Background: Angiotensin I is converted to angiotensin II by an angiotensin-converting enzyme, which is an important component of renin-angiotensin framework. Multifactorial chronic kidney disease includes risk factors such as hypertension, obesity, inherited factors, and diabetes. A genetic factor associated with premature signs of renal failure is predominantly increased arterial hypertension and albumin excretion, which add to the pathophysiological movement of disintegration in renal capacity. This enzymatic assay aimed to detect ACE levels in various renal patients compared with controls to confirm the relationship between ACE quality polymorphism and enzymatic ACE levels. Materials and Methods: The study population of our study included 56 patients with chronic kidney disease. Who was confirmed to have chronic kidney disease after being diagnosed in the dialysis ward of the tertiary care hospital. Results: A total of 56 chronic kidney disease were enrolled. Mean age of patients were 55.1±13.6. Among total recruited patients, 60% male patients and 40% were female patients. The HDL, and LDL were lower in chronic kidney disease patients than control group. While BMI, total cholestrol, triglyceride, systolic blood pressure, diastolic blood pressure, and ACE level were found higher in CKD patients than control group. The frequency of genotypes ACE II, ID, and DD in patients groups was 12 (12.43%), 28 (48.21%), and 17 (30.35%). Conclusion: Our study result indicates that the D allele is involved in the progression of chronic diseases. When we look at the frequency of I and D alleles it clearly shows that the frequency of the D allele is significantly higher in patients with CKD than the frequency of the I allele. Keywords: ACE, CKD, Renal patients, Polymorphism

Relationship between oral cinacalcet therapy with CRP and anemia in hemodialysis patients with secondary hyperparathyroidism

Background: Cinacalcet is one of the newest calcium mimetic drugs in the treatment of patients with parathyroid cancer, secondary hyperparathyroidism in adults with chronic kidney disease. Due to the possible association between the effect of Cinacalcet on C-reactive protein and the pathophysiology of anemia in end-stage renal disease patients. The aim of this study was to evaluate the effect of oral Cinacalcet on rate of CRP and anemia in ESRD patients with secondary hyperparathyroidism. Methods: This descriptive cross-sectional study was done on all 40 hemodialysis patients over 18 years of age underwent hemodialysis for at least 6 months. The levels of C-reactive protein, phosphorus, calcium, parathyroid hormone, ferritin, Total iron binding capacity, iron, hemoglobin before the start of treatment and based on the routine dialysis ward were repeated once every three months and recorded in the, in the checklist. Also, age, sex, weight, underlying disease, duration of dialysis and duration of use and dose of Cinacalcet were entered. The results of these experiments were reviewed and analyzed before and after treatment with Cinacalcet.Results: In these patients, after treatment with Cinacalcet, the amount of hemoglobin increased and the amount of inflammation decreased and these changes were significant in hemoglobin rate but not significant in CRP rate. The relationship between patients' weight and inflammation was significant.Conclusions: Treatment with Cinacalcet in hemodialysis patients, at least in this study, could be increased hemoglobin and decreased CRP rate and can be a hypothesis for large analytical studies.

Haemodialysis patient's adherence to treatment: Relationships among nurse-patient-initiated participation and nurse's attitude towards patient participation.

To evaluate the relationship between nurse-patient-initiated participation, nurses' attitudes towards patient's participation, and patients' adherence to treatment. Specifically, to (1) explore nurse-patient participation during haemodialysis and quantify the information into measurable indices; (2) determine the haemodialysis patient's adherence to treatment; (3) describe nurses' attitudes towards patient participation; and (4) establish the relationships between nurse-patient-initiated participation, nurses' attitudes towards patient participation and patients' adherence to treatment. To improve haemodialysis patients' health, it is crucial to identify nurses' and patients' factors facilitating adherence to treatment. An exploratory-sequential mixed-methods (quantitative and qualitative) design. All nurses working at a dialysis ward (n=30) and their randomly selected patients (n=102) participated. Qualitative data on nurse-patient-initiated participation were derived from transcribed nurse-patient conversations and quantified for further analyses. Nurses' attitudes towards patient participation were collected via questionnaire, and adherence to treatment via observed reduction in prescribed haemodialysis time. [CONSORT-SPI guidelines]. Content analysis of the conversations indicated that nurse-initiated participation focused on patient's medical condition, treatment plan and education; while patients initiated more small talk. Non-adherence to treatment was significant (Mean=0.19 h; SD=0.33). Regression analyses indicated that nurses' attitude towards participation was negatively linked to patient adherence, while patient-nurse-initiated participation was unrelated. Nurses' attitudes towards patient participation moderated the relationship between nurse-patient-initiated participation and patient adherence: the more positive the attitude towards inclusion the more negative the link between patient or nurse-initiated participation and patient adherence. The findings provided paradoxical insights: Nurses' positive attitudes towards participation lead them to accept the patient's position for shortening haemodialysis treatment, so that adherence to care decreases. Nurses require education on negotiating methods to help achieve patient adherence while respecting the patient's opinion. Patients should be educated how to approach nurses, seeking the information they need.

The Effect of Vitamin D Deficiency Treatment on Hemoglobin Levels in Hemodialysis Patients: A Double-blind, Randomized Controlled Trial

Background: The role of vitamin D deficiency and hemoglobin levels in renal anemia is well established. However, few studies with inconsistent findings have examined the relationship between vitamin D supplementation and the prevalence and severity of anemia in the chronic kidney disease. Objectives: The present study aimed to evaluate the effect of vitamin D deficiency treatment on hemoglobin levels in hemodialysis patients. Methods: The present study was a double-blind, randomized controlled trial on 60 hemodialysis patients aged 18 - 83 years, who were undergoing maintenance dialysis and receiving erythropoietin. All patients with vitamin D (&lt; 30 ng/mL) referred to the dialysis wards of Imam Khomeini, Razi, and Sina hospitals in Ahvaz in 2019, were assigned into two groups. One group was treated with 500 mg oral calcium-D tablets three times a day, and another group was treated with 50,000 units of D-Pearls weekly. The two groups were treated for 12 weeks. Then they were re-evaluated in terms of response to treatment and the rate of improvement in hemoglobin levels and erythropoietin dose. Results: In each intervention group, vitamin D levels increased significantly (P &lt; 0.001). D-Pearls improved vitamin D deficiency; however, the difference was not statistically significant. This study also showed a significant increase in hemoglobin (&gt; 1 unit) in the calcium-D group; however, such a change was not observed in the D-Pearls group (P = 0.3824). Moreover, there was no difference between the two groups in terms of erythropoietin dose (P = 0.98), blood calcium level (P = 0.57), parathyroid level (P = 0.20), and phosphorus (P = 0.99). Conclusions: Despite its significant limitations,this study revealed vitamin D supplements improved vitamin D deficincy, and calcium-D tablets could improve hemoglobin levels in patient.

Adherence Medication Promotion Program among Hemodialysis Patients: An Application of Capability, Opportunity, and Motivation-Behavior Model (COM-B)

Background and Objective: The increasing incidence of chronic kidney disease around the world highlights the need for more attention and appropriate actions to enhance therapeutic outcomes and improve patients’ quality of life. This study aimed to evaluate the efficacy of a program to promote medication adherence among hemodialysis patients using the Capability, Opportunity, and Motivation-Behavior (COM-B) model. Materials and Methods: The present study was a quasi-experimental interventional study conducted on 140 chronic kidney patients referred to the Dialysis ward of Imam Reza Hospital (Kermanshah, Iran) divided into two groups of 70 patients as intervention and control during 2021. The program was developed by conducting a needs assessment based on the COM-B model and evaluating it in two stages, before and three months after the implementation. Data were collected by a questionnaire based on the COM-B model and analyzed using the SPSS software (version 16). Results: After the implementation of the program, the components of capability and medication adherence behavior had a significantly higher average rank in the intervention group. The effect sizes of the intervention components, including capability, opportunity, motivation, and medication adherence behavior, were calculated to be 0.69, 0.19, 0.23, and 0.43, respectively. Conclusion: Considering the effect sizes of each component, especially behavior, it seems that the developed program based on the COM-B model has enough efficiency and that the employed model is effective for developing programs to promote medication adherence.

Detection of Legionella Pneumophila MIP and 16srRNA Genes in Kidney Transplant and Dialysis Wards by Polymerase Chain Reaction

Background: Legionella is a fastidious Gram-negative bacterium that is responsible for Legionnaires’ disease. Legionella is a ubiquitous aquatic bacterium, especially in cooling systems. Several studies have investigated Legionella contamination in natural and man-made water resources. Legionella is resistant to chlorine and other disinfectants; thus, it is important to consider it in places where people with immunodeficiency are kept. Objectives: The aim of this study was to detect the Legionella pneumophila mip gene in clinical samples, kidney transplants, and dialysis wards by the polymerase chain reaction (PCR) method. Methods: In this study, 156 samples were taken from the kidney transplant and dialysis wards. DNA extraction was done. After confirmation of primers, PCR was performed to amplify 16srRNA and mip genes. The PCR product was electrophoresed on agarose gel 1%. Results: Among the samples, 23 samples were infected with Legionella (14.7%), of which 7 samples were identified for the mip gene (4.5%) and 16 samples for 16srRNA (10.2%). The confirmation of the presence of these genes was done by sequencing. In serum, tissue, urine, hot water, and cold water samples were positive for the 16srRNA gene (7.5%, 26.66%, 7.14%, 20%, and 6.66%, respectively). Among these samples, 50% of tissue samples, 25% of urine, and 33.33% of hot water were positive for the mip gene. Conclusions: The presence of L. pneumophila in aqueous samples of transplant and dialysis wards is important. Therefore, rapid detection of this bacterium or the mip gene by a molecular method can play an important role in reducing infection and transplant rejection.

Influence of Advanced Organ Support (ADVOS) on Cytokine Levels in Patients with Acute-on-Chronic Liver Failure (ACLF).

Background: ADVanced Organ Support (ADVOS) is a novel type of extracorporeal albumin dialysis that supports multiorgan function in patients with acute-on-chronic liver failure (ACLF). No data exist on whether ADVOS affects inflammatory cytokine levels, which play a relevant role in ACLF. Aim: Our aim was to quantify cytokine levels both before and after a single ADVOS treatment in patients with ACLF at a regular dialysis ward. Methods and results: In this prospective study, 15 patients (60% men) with ACLF and an indication for renal replacement therapy were included. Patient liver function was severely compromised, reflected by a median CLIF-consortium ACLF score of 38 (IQR 35; 40). Blood samples were directly taken before and after ADVOS dialysis. The concentration of cytokines for IL-1β, IFN-α2, IFN-γ, TNF-α, MCP-1, IL-6, IL-8, IL-10, IL-12p70, IL-17A, IL-18, IL-23, IL-33 were quantified via a cytometric bead array. We found no significant (p > 0.05) change in cytokine levels, even when patients were stratified for dialysis time (<480 min versus ≥480 min). The relevance of the assessed cytokines in contributing to systemic inflammation in ACLF was demonstrated by Ingenuity pathway analysis®. Conclusion: Concentrations of pathomechanistically relevant cytokines remained unchanged both before and after ADVOS treatment in patients with ACLF.

MO820: Comparison of All-Cause-Mortality Before and After COVID-19 Vaccination in a Hemodialysis Center

BACKGROUND AND AIMSControl of COVID-19 outbreaks in hemodialysis wards has been a great challenge for dialysis ward managers during the pandemic. Besides, frequent patient education and provision of sanitation and prevention protocols, COVID-19 vaccination brought light to systematic control of COVID mortality. The aim of this study was to assess the effect of the COVID-19 vaccination on all-cause mortality in our hemodialysis ward.METHODCrude and age-adjusted mortality rates of 2-time frames, i.e. 6 July–6 December 2020 and the same period in 2021 (before and four weeks after full vaccination against COVID-19 with Sinopharm (Beijing): BBIBP-CorV) were compared. The data were processed with SPSS software version 26.RESULTSFrom 6 July to 6 December 2020, the crude all-cause-morality rate of our hemodialysis center was 9.12% (23 out of 252 patients). Between 6 July 2021 and 5 December 2021, the crude all-cause-morality rate was 6.74% (17 out of 252 patients). The same result was found after age adjustment of the morality rates.CONCLUSIONCOVID-19 vaccination reduced the all-cause mortality in our hemodialysis ward, as reported in the general population. Further multi-center studies are encouraged to study the effect of vaccination on the number of severe cases and the rate of hospitalization in this group of patients.

Performance in Organ Donation Process in Nurses Working in Critical Care Units of Hospitals in Qazvin City, Iran

Aims: Considering that the correct management of patients with brain death in critical care units is a basis for organ transplantation and given the importance of nursing care in the organ donation process, this study aims to assess the performance of nurses in critical care units of hospitals in Qazvin, Iran regarding organ donation. Methods &amp; Materials: This is a cross-sectional study performed in hospitals affiliated to Qazvin University of Medical Sciences in 2019. Participants were 190 nurses working in critical care units of these hospitals who were selected using a stratified random sampling method. To collect data, a demographic form and a researcher-made nursing performance questionnaire regarding organ donation were used. Collected data were analyzed using descriptive statistics and statistical tests (t-test, ANOVA, Pearson correlation test, and Spearman correlation test). Findings: The highest and lowest mean scores of performance belonged to ICU nurses in Kowsar Hospital (2.75±0.61) and the nurses in dialysis ward of Velayat Hospital (0.85±0.48), respectively. Only 22.8% of nurses had organ donation card. Majority of them (76.8%) signed for organ donation, and were reluctant to receive money for organ donation (96.9%). There was a significant difference in the mean scores of nurses’ performance between different wards (P&lt;0.001). The organ donation performance was higher in female nurses than males and in married nurses than singles, but these differences were not statistically significant. Conclusion: Nurses in critical care units of hospitals in Qazvin city have poor performance regarding organ donation. They should be informed about their role in the organ donation process, and coherent and targeted training courses should be developed to improve their performance.