Disorders In Hemodialysis Patients Research Articles

Mineral Bone Disorders in Hemodialysis Patients in the West of Libya

Background and Objectives: Chronic kidney disease (CKD) is affecting 5%–10% of the world population. As kidney function declines, there is progressive deterioration in minerals homeostasis manifesting as disruption of serum and tissue concentrations of phosphorus, calcium (Ca), and parathyroid hormone (PTH). CKD-mineral bone disorder (CKD-MBD) is a systemic disorder of mineral and bone metabolism manifested by any or a combination of the following: abnormalities of Ca, phosphorus, PTH, Vitamin D metabolism, abnormalities of bone turnover, and vascular or soft-tissue calcification, associated with fractures, cardiovascular disease, and mortality in CKD patients. The study aims to identify the prevalence and pattern of CKD-MBD among hemodialysis patients in the west of Libya. Patients and Methods: A cross-sectional study was carried out on 186 regular hemodialysis patients from five hemodialysis centers in the west of Tripoli-Libya District. All patients were investigated for complete blood count, blood sugar, serum albumin, blood urea, serum creatinine, total Ca level, serum phosphate, serum alkaline phosphatase, and serum intact PTH (iPTH) level. Results: According to the Kidney Disease Outcomes Quality (KDOQ) iPTH level guideline, 88.10% of the studied patients had metabolic bone disorders, and 39.80% showed low bone turnover. About 48.40% were high bone turnover; only 11.80% of studied patients were within the target range according to the KDOQ Initiative guidelines. About 40.36% of studied patients had low calcium levels (below 8.5 mg%), and 35.48% had high phosphorus levels (more than 5.5 mg%). About 61.10% of high bone turnover patients complain of bone pain and 50.50% complain of muscle weakness. Among low bone turnover patients, 36.48% had no symptoms, and 28.38% were complaining of both muscle weakness and bone pain. Conclusions: The prevalence of MBDs among studied patients with abnormal PTH levels is 87.6%, distributed as 39.2% in abnormal low PTH (low bone turnover), and 48.4% in abnormal high PTH (high bone turnover).

Investigating the Effect of Cold Water Bags on the Severity of Restless Leg Syndrome and Sleep Quality in Hemodialysis Patients

Background: Restless legs syndrome is a neurological disorder in hemodialysis patients that causes disturbance and disability in rest, discomfort, sleep disturbance, fatigue, and stress. Objectives: This study was done to evaluate the effect of cold water bags on the severity of restless leg syndrome and sleep quality in hemodialysis patients. Methods: This is a quasi-experimental study (before and after) performed on patients referring to three hospitals in Yazd province. In this study, 40 patients with restless legs syndrome were selected from all patients who were referred to the hemodialysis ward by simple random sampling. The samples completed the Restless Legs Syndrome Symptoms Severity Questionnaire before and after using the cold water bag. Data were analyzed by SPSS 20 software and descriptive statistics and paired t-test at the significance level of < 0.05. Results: This study showed a significant difference between the mean score of restless leg syndrome and sleep quality before and after the interventions (P = 0.000). Furthermore, the mean scores of restless leg syndrome and sleep quality were different between the two intervention groups and statistically significant (P = 0.000). Conclusions: Based on the results, using a water bag reduces the symptoms of restless leg syndrome. Therefore, it is suggested that cold water bags should be used as an effective, safe, low-cost method.

Analysis of the Improvement of Sleep Disorder in Hemodialysis Patients by Exercise Rehabilitation

Analysis of the Improvement of Sleep Disorder in Hemodialysis Patients by Exercise Rehabilitation

The Association of Sleep Quality and Vitamin D Levels in Hemodialysis Patients.

Background To date, hemodialysis (HD) is the most common therapy for chronic kidney disease (CKD) patients. However, it causes different complications such as sleep disorders. Sleep regulation is connected to vitamin D; hence, its deficiency might influence the quality and duration of sleep. This study is aimed at evaluating the correlation of sleep quality and vitamin D levels in 80 HD patients. Methods This cross-sectional study was performed on 80 hemodialysis patients admitted to 29 Bahman hospitals in Tabriz, Iran. Before beginning of dialysis, serum 25 (OH) D levels were assessed among patients and the sleep patterns and sleep quality of patients were accurately calculated by the Pittsburgh sleep quality index (PSQI) standard questionnaire. Results Our results showed that 22 HD patients (27.5%) had severe sleep disorders. In addition, it was found that serum levels of vitamin D had significant correlation with sleep quality (r = −0.341, p = 0.002) in general, even after adjusting confounding factors such as calcium (Ca), phosphate (P), and parathyroid hormone (PTH) level. In poor sleepers (PSQI ≤ 5), a negative correlation was observed between the levels of vitamin D and PSQI score (r = −0.397, p = 0.004). PSQI scores in the normal range of PTH (r = −0.377, p = 0.006) and in >600 pg/ml of PTH (r = −0.675, p = 0.011) had a correlation with vitamin D levels. The level of vitamin D was the single independent predictor of sleep efficiency (β coefficient = −0.386, p = 0.001). Conclusion The present project reported that the positive effect of vitamin D is associated with sleep disorder in HD patients. In future studies, normal levels of Ca and P should be considered along with normal vitamin D levels among the included patients.

Effect of Magnesium Supplementation on Chronic Kidney Disease-Mineral and Bone Disorder in Hemodialysis Patients: A Meta-Analysis of Randomized Controlled Trials

Research about the effects of magnesium (Mg) supplementation on chronic kidney disease-mineral bone disorder (CKD-MBD) among hemodialysis (HD) patients is controversial. Thus, we conducted a meta-analysis to examine Mg supplementation's effects on CKD-MBD in patients requiring dialysis.The PubMed and EMBASE databases were searched for English language studies up to September 2020. The main indicators of our study were changes in serum Mg, calcium (Ca), phosphate, parathyroid hormone (PTH), and C-reactive protein levels, and carotid intima-media thickness (CIMT) after Mg supplementation. Mg efficacy was evaluated by weighted mean difference (WMD) and confidence intervals (CIs), and subgroup analyses of intervention type and intervention duration were also performed.Eight eligible studies comprising 309 HD patients were included in our meta-analysis. Mg supplementation alone produced a negative effect on serum PTH levels (WMD = -236.56; 95% CI -349.71 to -123.41) and CIMT (WMD = -0.18; 95% CI -0.34 to -0.01). A subgroup analysis based on intervention type showed a significant improvement in serum Mg (WMD = 1.08; 95% CI 0.51-1.64) and Ca (WMD = -0.50; 95% CI -0.77 to -0.23) levels when Mg was administered via dialysate and oral medication, respectively. Different intervention durations had no effect on serum Mg levels. Mg supplementation had no significant effect on serum phosphate (WMD = -0.25; 95% CI -0.64 to 0.14) and C-reactive protein levels (WMD = -0.02; 95% CI -2.80 to 2,76).Our results showed that Mg supplementation alone could improve CKD-MBD by regulating serum Ca and PTH metabolism and decreasing CIMT among HD patients.

Appetite Disorder in Hemodialysis Patients and its Impact on Dietary Intake: A Cross-sectional study.

Background: Lack of appetite (anorexia) is a relatively common symptom among hemodialysis patients and contributes to development of malnutrition; moreover, it is associated with unfavorable outcomes. The aim of this study was to explore the socio-demographic aspects of end- stage renal disease (ESRD) patients receiving hemodialysis, the clinical characteristics of such patients, and to assess their appetite and its impact on daily dietary intake. Methods: This was a cross-sectional study that was carried out at Mansoura Nephrology and Dialysis Unit (MNDU), Mansoura University and Aga Hospital Dialysis Unit, Dakahlia, Egypt. The study was carried on patients with ESRD on hemodialysis. Patients who met inclusion and exclusion criteria were included in the study. Demographic and clinical characteristics were collected and appetite was assessed using subjective assessment of appetite then compared to dietary intake. Results: The current study included 162 hemodialysis patients whose age 48.72±12.64 years, and males constituted 57.4% of them. The two main causes of ESRD in the present study were hypertension (51.9 %), followed by diabetic nephropathy (9.3 %). Hepatitis C virus (HCV) prevalence was found to be 36.4%. Median energy intake was 1348.5 kcal/day with (minimum-maximum) 519.78-3214.17 kcal/day, protein intake was 58.53 g/day. Significant lower values of dietary nutrient intake were observed among patients with diminished appetite category than those with normal appetite when assessed by subjective assessment of appetite. Conclusion: Diminished appetite is associated with decreased nutrient intake. Dietetic counseling is essential in HD patients to reduce rates of malnutrition.

Study of Red Blood Cell Indices and Biochemical Parameters of Mineral Bone Disorders in Hemodialysis Patients

Background: Chronic kidney disease (CKD) is a worldwide public health problem and a major cause of suffering and having a reduced quality of life for those affected. Objective: We aimed to study the changes in red blood cell indices and mineral bone metabolism in hemodialysis patients and to explore the correlation between these studied parameters. Patients and Methods: This is a case control study included 55 adult patients with end stage renal disease on maintenance hemodialysis as well as 55 healthy individuals as a control group. All participants were subjected to laboratory investigations included complete blood count and serum levels of creatinine, urea, total calcium, albumin, phosphate and intact parathyroid hormone (iPTH). Results: Our study showed thathemoglobin (Hb), hematocrit and red blood cell count were significantly reduced in the hemodialysis patients (P<0.001 for all). Regarding mean corpuscular volume, mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration, no significant differences were found between the hemodialysis patients and the control group (P= 0.362, 0.116, 0.22, respectively). In the hemodialysis group, the albumin-corrected serum calcium level was significantly lower while the serum phosphate and iPTH levels were significantly higher compared to the control group (P<0.001 for all). Hb was inversely correlated with serum iPTH (r=-0.359, P=0.007) and serum phosphate (r=-0.570, P<0.001) in the hemodialysis group and was inversely correlated with serum phosphate (r=-0.495, P<0.001) in the control group. Conclusion: Hemodialysis patients are at high risk of anemia, hypocalcemia, hyperphosphatemia and hyperparathyroidism. In hemodialysis patients, an association was found between anemia and each of hyperphosphatemia and hyperparathyroidism.

POS-531 LIPID PROFILE AND CARDIOVASCULAR RISK IN CHRONIC HEMODIALYSIS PATIENTS

Dyslipidemia is a major risk factor for the occurrence of atherosclerosis and cardiovascular diseases. Associated with chronic renal failure, the cardiovascular risk becomes very high. Hence the interest of screening lipid disorders in patients with end-stage renal failure at the hemodialysis stage. We conducted an observational study of the prevalence of lipid disorders in hemodialysis patients in our unit with assessment of their cardiovascular risk in correlation with the Framingham score. The survey involved 40 patients with an average age of 48,775 years [25-78]. The sex ratio was 0.81. Initial nephropathy was dominated by vascular nephropathy in 15 hemodialysis patients, followed by glomerular nephropathy in 13 patients, and tubule-interstitial nephropathy in the remaining 12. The prevalence of dyslipidemia was 52.5%. Lipid disorders were, in decreasing order of frequency; an isolated hypertriglyceridemia at 52.38%; mixed dyslipidemia associating hypercholesterolemia and hypertriglyceridemia at 47.61%. However, 47.5% did not have lipid disorders. Cardiovascular risk assessment according to the Framingham score revealed a high risk in 12.5% of patients who were predominantly male smokers with physical inactivity, a moderate risk in 20% and a low risk in the majority with a frequency of 67.5%. This survey found a high prevalence of dyslipidemia with an important cardiovascular risk. This should lead to develop a better strategy to prevent cardiovascular diseases. Dyslipidemia should be detected and treated in patients with predisposing factors because they are at high cardiovascular risk. The lipid profile should not be interpreted according to laboratory standard but according to target values.

The effect of the progressive muscle relaxation combined withs lavender aromatherapy on insomnia of hemodialysis patients

disorder in hemodialysis patients, which will cause a decrease in quality of life. Aromatherapy combined with progressive muscle relaxation are expected to increase the effects of relaxation on the patient so that the patient's sleep quality can improve optimally.Objective: The study aimed to investigate the effect of the progressive muscle relaxation combined with lavender aromatherapy on insomnia among patients undergoing hemodialysis. Material and Methods: The design of this study included a quasi-experiment with a pretest-posttest control group approach. The sample selection was performed using a consecutive sampling technique and involved 50 respondents, divided into two equal control and study group. Patients in study group recommended to do progressive muscle relaxation at least four times per week for three weeks and were told to drop two – three drops lavender aromatherapy on a pillow 30 minutes before bedtime at least 4 nights per week for three weeks. The control group recommended to do muscle relaxation and daily routine care at least four times per week for three weeks. Results: The results showed that both study and control groups were equal in terms of demographics, and scores of insomnia at the baseline. There no significant difference between the mean insomnia scores of two group before intervention, while the difference was statistically significant after the intervention. The mean insomnia scores were lower in study group than in the control group.Conclusion: Progressive muscle relaxation and lavender aromatherapy were effective in decreasing insomnia scores among patients undergoing hemodialysis.

Real World Use and Effects of Calcimimetics in Treating Mineral and Bone Disorder in Hemodialysis Patients

Background: Calcimimetics are used to treat mineral and bone disorder by reducing parathyroid hormone (PTH), calcium (Ca), and phosphorus (Phos). The study objectives were to assess the control of PTH, Ca, and Phos over time in patients receiving cinacalcet or etelcalcetide as well as dosing and time to discontinuation for etelcalcetide. Methods: This was a retrospective cohort study using electronic medical records from small and independent dialysis centers. Adults ≥18 years of age were identified as cinacalcet or etelcalcetide users based on the first calcimimetic received in 2018 (index date). Patients were followed from the index date until parathyroidectomy, kidney transplant, death, or end of data (December 31, 2018). Analyses of mean PTH, Ca, and Phos, as well as target achievement of PTH, Ca, and Phos were conducted over a 9-month period. Discontinuation with etelcalcetide was measured with the Kaplan-Meier estimator. Results: There were 1,346 cinacalcet patients (mean age 60.5 years, 43.5% female, and 47.1% Black) and 1,255 etelcalcetide patients (mean age 63.4 years, 46.6% female, and 38.5% Black). At baseline, the proportions in target were similar for etelcalcetide versus cinacalcet: 36 versus 38% for PTH, 79 versus 80% for Ca, and 43 versus 44% for Phos. Overall, 40–47% of cinacalcet users and 48–62% of etelcalcetide users were observed to be in target for PTH over 9 months. The proportion in target for Phos ranged from 41 to 46% for cinacalcet and 46–51% for etelcalcetide. The proportion in target for Ca ranged from 74 to 78% for cinacalcet and 60–73% for etelcalcetide. Etelcalcetide 12-month discontinuation was 37.4%. Conclusion: Both calcimimetics were effective in keeping PTH, Ca, and Phos levels within target. Patients receiving etelcalcetide tended to have lower laboratory values for PTH, Ca, and Phos over time, while patients receiving cinacalcet tended to be more likely to be in target for Ca over time.

P1560ANXIETY AND DEPRESSION AMONG HEMODIALYSIS PATIENTS

Abstract Background and Aims Procedure of haemodialysis (HD) treatment is associated with an impaired quality of life in chronic kidney disease patients. It is due to changes in family, social and professional relationships. These changes can also lead to mental health problems. The purpose of our study is to determine the prevalence of depressive and anxiety disorders in hemodialysis patients. Method Fifty chronic hemodialysis patients were enrolled in our cross-sectional study during four months (September -October- November- December 2019). The HADS (Hospital Anxiety and Depression Scale) survey was used to assess depressive and anxiolytic disorder in our hemodialysis population. Were excluded patients aged less than 18 yearsold as well as kidney transplant patients and psychiatric patients. Results The mean age of our patients was 49.5 range (24-79).The sex ratio was 1.27. The prevalence of anxiety syndrome was 40% with a female predominance of 54.5% versus 54,5%. Depressive syndrome was noted in 48% of our patients with a male predominance of 58.3% versus 41,7%. 48% of our HD patients have shown depression in various degrees. It was about mild depression of 20,8% of pts, moderate depression of 41,6% of pts and severe depression of 37,5% of pts. Somatic symptoms of depression in our population were respectively noted in 52,8% of loss of energy, 57,5% fatigue, 63,4% sleep disturbances, and 38,5% changes in appetite. The most common psychological symptoms were: pessimism (79,1%), loss of interest in appearance (41,6%), psychomotor retardation (75%). On the other hand, 37, 5% of patients felt cheerful and 16,6% still enjoy doing some activities. For patients with anxiety syndrom, we noted: concentration disturbance (45,4%), palpitations (50%), abdominal pain (59,09%) and headache (81,8%). With regard to psychological symptoms, the most emphasized were: sudden feelings of panic (54,5%), worrying thoughts (72,7%),77,2% are feeling restless and 59,09% are feeling wound up. On the other hand, 68,1% feel relaxed especially after the hemodialysis session. It seems that gender, marital status and HD duration did not influence significantly in occurrence of depression with respectively (p=0,08, p=0.1 and p= 0.08). Older patients were significantly more depressed in compared to younger patients (p= 0.003). Unemployed patients were significantly more depressed in relation to employed patients(p=0.01). Finally, as the educational level of patients increased, level of depression significantly decreased (p=0,04). Conclusion Depression is the most frequent psychological complication of hemodialysis (HD) patients. Our results showed a high prevalence of depressive symptoms among the study group. The exact prevalence of depression in dialysis patients is unclear because of different criteria utilized for diagnosis of depression. A close collaboration between nephrologists and psychiatrists is needed to ensure a better quality of life in HD patients.

P1487EFFECT OF PREDIALYSIS FLUID OVERLOAD ON SLEEP QUALITY IN HEMODIALYSIS PATIENTS

Abstract Background and Aims Sleep disorders are common among end stage renal disease (ESRD)patients undergoing hemodialysis (HD). The etiology of sleep disorders in these patients is known to be multifactorial. However, the role of hydration status in sleep disorders in HD patients is not well studied. Therefore, our aim was to study the effect of predialysis fluid overload on sleep quality in HD patients. Methods This cross-sectional study included 100 prevalent HD patients from HD unit of El Sahel teaching hospital. fluid status and fluid compartments [total body water (TBW)], extracellular water (ECW)] and overhydration index (OH) were analyzed by a portable whole-body bio-impedance spectroscopy (Body Composition Monitor ‘BCM’) before mid-week dialysis session. Overhydration was defined as OH/ECW ≥15%. HD patients were then classified into 2 groups: Group 1 (non- overhydrated) and Group 2 (Overhydrated) according to OH/ECW. Sleep quality were assessed in all patients by Pittsburgh Sleep Quality Index (PSQI) questionnaire. Patients with Concurrent diagnosis of either obstructive sleep Apnea or psychiatric disorder and patients on any medications which affect the sleep pattern were excluded. Results our study included 100 HD patients (49 male, 51 female - mean age 49.3 ±11). 42 patients (42%) had overhydration (i.e. Group 2). Poor sleep quality (defined as PSQI score ≥5) was reported in 57% (n=57) of HD patients included in our study. Poor sleep quality was significantly higher in the HD patients with overhydrated (Group 2). Total PSQI scores were significantly higher in overhydrated patients (Group2) compared to non-overhydrated patients (Group1) (7.92±3.32 vs 4.83±2.27, P= &amp;lt;0.001). The component scores 1, 2, 3, 4, 6 and 7 of the PSQI showed significant differences between the overhydration and non-overhydration groups with higher values (i.e poor sleep quality) in overhydrated patients (Group2). Moreover, there was significant positive correlation between total PSQI score and overhydration index (OH/ECW %) in all HD patients included in the study (r=0.283, P= 0.004). Conclusion We may conclude from our study that sleep disorders are prevalent in HD patients. Predialysis fluid overload in HD patients may be associated significantly with poor sleep quality.

Musculoskeletal disorders in hemodialysis patients: different disease clustering according to age and dialysis vintage.

Musculoskeletal disorders remain a major problem in hemodialysis patients. The aim of the study was to estimate the prevalence of musculoskeletal manifestations in hemodialysis patients and identify disease cluster profiles. We performed a cross-sectional study including all adult patients in the hemodialysis unit at Hotel-Dieu de France Hospital. We collected demographic characteristics, musculoskeletal symptoms, biologic parameters, and treatments. Musculoskeletal disorders were classified by a rheumatologist into predefined diagnostic categories. Prevalence was presented, and a cluster analysis was performed. Eighty-nine patients were included, mean age was 67.5 ± 12years, and 43.8% were female. Dialysis vintage was 5.7 ± 5.37years. Musculoskeletal symptoms were reported by 76.4% of the patients. Pain was the most frequent symptom (44.9%). The main diagnoses were osteoarthritis (53.9%) and fracture (27%). Musculoskeletal symptoms and disorders were significantly associated with dialysis vintage and age. Cluster analysis identified three patient profiles: younger with low calcium levels, younger but long dialysis vintage with osteoarthritis and carpal tunnel syndrome, and older with long dialysis vintage and fractures. The prevalence of musculoskeletal manifestations is high in the hemodialysis population and increases with dialysis vintage. Musculoskeletal disorders cluster according to age and dialysis vintage. Key Points• Musculoskeletal symptoms are highly prevalent among hemodialysis patients (76.4%).• All musculoskeletal disorders are associated with dialysis vintage and age.• Three clusters are identified among hemodialysis patients: young with low calcium levels, young but long dialysis vintage with osteoarthritis and carpal tunnel syndrome and old with long dialysis vintage with fractures.

The Effect of Nutritional Knowledge Levels of Hemodialysis Patients on Nutritional Status

Amaç: Hemodiyaliz hastalarındaki beslenme bozuklukları mortalite ve morbitidenin enönemli belirleyicilerindendir. Hemodiyaliz hastalarının diyetlerine uyumunusağlamanın ve onları beslenme bozukluğundan korumanın en etkili yollarından birisininhastaların beslenme hakkında ki bilgi düzeylerinin arttırılması olduğu bilinmektedir.Araştırmamızda beslenme bilgi düzeyinin hemodiyaliz hastalarında ki beslenmebozukluğu durumuna etkisinin araştırılması amaçlanmıştır.Gereç ve Yöntem: Kesitsel tipteki ki araştırmamızın evrenini bir üniversitehastanesinin hemodiyaliz ünitesinde takip edilen hastalar oluşturmuştur.Araştırmamızda ki veriler Mini nutrisyonel değerlendirme anketi, beslenme bilgi düzeyianketi ve sosyodemografik anket formu ile elde edilmiştir. Kategorik verilerinistatistiksel analizinde Ki-kare testi kullanılmıştır. Normal dağılım gösteren süreklideğişkenlerin analizinde Student-t testi kullanılmıştır. Verilerin değerlendirilmesi %95güven aralığında ve p &amp;lt;0.05 istatistiksel olarak anlamlı kabul edilmiştir.Bulgular: Araştırmamıza katılan 109 kişinin yaş ortalaması 52,76±14,14 idi.Katılımcıların %20,2’sinde malnutrisyon, %32,1’inde malnutrisyon riski, %47,7’si isemalnutrisyon riski taşımayan grupta idi. Eğitim düzeyi (p=0.01) ve beslenme bilgipuanı arttıkça (p&amp;lt;0.001) katılımcıların beslenme bozukluğu azalırken, Hemodiyalizsüresi uzadıkça beslenme bozukluğunun arttığı görüldü (p= 0.03).Sonuç: Katılımcıların beslenme bozukluğunun eğitim durumu ve beslenme bilgidüzeyleri ile ilişkili olması hemodiyaliz hastalarının bilgi düzeylerinin arttırılması ilebeslenme bozukluklarının azaltılabileceğini düşündürmüştür.

Relationship Among Coping Strategies, Quality of Life, and Anxiety and Depressive Disorders in Hemodialysis Patients.

Patients with hemodialysis face many physical and emotional stressors; yet little is known regarding coping strategies and their effects on patients' quality of life (QOL) and anxiety and depressive disorders. A total of 117 patients were enrolled in this cross-sectional study between October 2016 and April 2017. This study assessed QOL (Medical outcome short form 36-MOS 36), coping (Assessment Scale for Coping Attitudes-COPE) and psychiatric comorbidities in hemodialysis patients. Beck Depression Scale and Beck Anxiety Scale were also applied. Differences between groups were evaluated using Student's t-tests and anova. Correlations among parameters were performed. Patients with any depressive disorder (22.2%, n = 26) and patients with any anxiety disorder (19.6%, n = 23) reported more impaired QOL. The most frequently used coping strategy in all patients was religious coping. Use of instrumental social support, humor, and positive reinterpretation scores were lower in patients with any depressive disorder (P = 0.009, P = 0.034, P = 0.047).The total score of emotion-focused coping strategies was lower with patients with any depressive disorder (P = 0.021) and emotion-focused coping strategies were positively correlated with QOL scores. Younger age and longer duration of hemodialysis have significant negative correlation with emotion-focused coping strategies' total score (P = 0.01, P = 0.02). Patients with hemodialysis use variety of coping strategies. The use of emotion-focused coping was associated with better QOL and reducing the risk of depressive disorder. Interventions to facilitate the use of adaptive coping strategies may improve patients' QOL and mood.

Prevalence of Pulmonary Disorders in Patients with End Stage Renal Disease on Hemodialysis

Background: The prevalence of patients with end stage renal disease is increasing. Pulmonary diseases have been suggested to be more common in end stage renal disease patients on haemodialysis. Aim of the work: It was to evaluate the pulmonary function state and the prevalence of pulmonary disorders in hemodialysis patients. Subjects and methods: A retrospective study on 61 patients with chronic renal failure on regular Hemodialysis at El-Hussein University Hospital, Al-Azhar University. Results: The study included 61 chronic renal failure patients fulfilling the inclusion criteria with mean age 54.23 ± 10.07 years that ranged from 26 – 77 years old. Females represent 62.3%, about one third of patients (31.15%) were smokers and slightly more than half of them living in rural areas Pulmonary functions were affected in nearly half of them (restrictive 27.87%, obstructive 14.75% and mixed 6.56%). Variety of pulmonary disorders coexisted in about 69% of patients with 22.95% suffered from pleural effusion, 16.39% had TB, 11.48% and 8.20% developed pulmonary embolism and pulmonary edema respectively and finally community acquired pneumonia and uraemic asthma. Conclusion: Respiratory disorders especially restrictive lung pattern, pleural effusion, pneumonia and pulmonary embolism were associated with end stage renal disease on regular hemodialysis. Recommendation: Any patient with chronic renal failure, especially patients on regular hemodialysis should be observed early for detection of any pulmonary diseases or disorders.

Assessment Quality of Sleep in Patients undergoing Hemodialysis

Quality of sleep is the satisfaction of sleep experience, integrating aspect of sleep initiation, sleep maintenance, sleep quantity, refreshment upon awakening and a well -recognized predictor of physical and mental health. This study aimed to assess quality of sleep in hemodialysis patients. Research design: This study is Descriptive research design. Sample: A convenience samples of (60) adult patients among regular hemodialysis, their age range between (20 - 60) by Mean ± SD 39.48±11.75from both sexes and are willing to participate in the study. Setting: The study was conducted in Hemodialysis unit at Assiut University Hospital. Tools: Two tools were used: structured interview questionnaire and Sleep Quality Scale. Results: There were severe sleep disorders in hemodialysis patients. Conclusion: sleep affected by many factors that effect on quality of sleep in hemodialysis patients. Recommendations: In addition to medical treatment to eliminate sleep problems and increase their sleep quality, the implementation of sleep hygiene intervention could also be beneficial .Further researcher should focus on identifying new methods and treatments technique to improved sleep quality.

Factors Affecting Gastrointestinal Disorders in Patients Undergoing Regular Hemodialysis

Background: Chronic Kidney Disease (CKD) is an immense health issue. The prevalence is increasing each year worldwide, including Indonesia. Consistent with this trend, the prevalence of hemodialysis (HD) as a therapy is also increasing. CKD as well as HD often result in some complications, one being gastrointestinal disorders. Many factors are correlated with the incidence of gastrointestinal disorders in CKD patients undergoing HD. Objective: This research is held to observe the factors affecting gastrointestinal disorders in regular HD patients. Method: This is an observational analytical research with cross-sectional study at RS Khusus Ginjal Rasyida Medan. The datas used in the research are primary datas, obtained from Gastrointestinal Symptoms Rating Scale (GSRS) questionnaire to assess severity of gastrointestnal disorders in HD patients, and secondary datas, obtained from medical records of age, smoking history, use of aspirin, HD duration, BUN, and Kt/V (as a parameter of HD adequacy). Then the datas are analyzed univariately, bivariately, and mutivariately using biner logistic regression model. It is considered significant if the obtained p value is &lt;0,05 (p&lt;0,05). Result: All patients (100%) suffer from gastrointestinal disorders, with the most common being mild ones (67,1%). Final multivariate analysis shows that the duration of HD, BUN level, and Kt/V are significantly correlated with worsening gastrointestinal disorders (OR:14,157 ,95%CI 2,851 ± 71,183, p=0,001; OR: 8,352, 95%CI 0,914 ± 76,344, p= 0,060; OR:8,219 ,95%CI 0,893 ± 75,674, p= 0,063). Conclusion: The duration of HD, BUN level, and Kt/V are correlated with worsening gastrointestinal disorders in HD patients.

Alpha lipoic acid supplementation improved antioxidant enzyme activities in hemodialysis patients.

Background: Cardiovascular disease (CVD) is the main cause of death in hemodialysis (HD) patients and oxidative stress is an important risk factor for CVD. Superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) are primary antioxidant enzymes in human cells acting against toxic reactive oxygen species (ROS) and their reduced activity may contribute to oxidative disorders in HD patients. Alpha lipoic acid (ALA) as a potent strong antioxidant may affect these enzymes. Objective: We examined the effects of ALA supplementation on antioxidant enzyme activities in HD patients. Method: In this double-blinded, randomized clinical trial, 63 HD patients (43 males and 20 females; age range: 22-79 years) were assigned into the ALA group (n: 31), receiving a daily dose of ALA (600 mg), or a control group (n: 32), receiving placebo for 8 weeks. Body mass index (BMI), antioxidant enzymes, albumin (Alb) and hemoglobin (Hb) were determined before and after intervention. Results: At baseline, the mean blood activities of SOD, GPx, and CAT in ALA group were 1032±366, 18.9±5.09 and 191±82.7 U/gHb which increased at the end of study to 1149±502, 19.1±7.19 and 208±86.6 U/gHb respectively. However, only the increase of SOD was statistically significant in comparison with placebo group (P = 0.04). The mean levels of Alb, Hb, weight and BMI were not significantly changed in study groups (P>0.05). Conclusion: ALA may be beneficial for HD patients by increasing the activity of antioxidant enzymes; however, further studies are needed to achieve precise results.

Additional hemoperfusion is associated with improved overall survival and self-reported sleep disturbance in patients on hemodialysis.

Patients with maintenance hemodialysis have experienced long-standing sleep disturbance. In this study, we attempted to explore whether long-term hemoperfusion could improve sleep and increase the overall survival in hemodialysis patients. A total of 158 patients, who underwent routine hemodialysis, were assessed in this study. These patients were computer-matched into two groups, with one group including 80 patients with absolute hemodialysis and the other consisting of 78 cases with hemodialysis in combination with hemoperfusion. Hemoperfusion was performed 1-2 times biweekly, with each session lasting 2 h. Self-reported sleep disturbance was evaluated before and after the observational time (2-year period); sleep quality was measured using the Pittsburgh Sleep Quality Index. Using multivariate regression analyses, we found sleep duration was associated with age, diabetes, low income, pruritus, hyperphosphatemia, hypercalcemia, high parathyroid hormone, and hemoglobin (P < 0.001). The overall survival rate of the hemodialysis in combination with hemoperfusion group was significantly higher than that of the absolute hemodialysis group (P < 0.05) after adjusting for sex, age, and diabetes. A 2-year hemoperfusion therapy was associated with improved sleep disturbance and sleep efficiency; this was accompanied by an increase in nocturnal melatonin levels. Furthermore, there was a significant difference in the first hospitalization between the hemodialysis and hemodialysis in combination with hemoperfusion groups (P < 0.01). Our results indicated that hemoperfusion in combination with hemodialysis is associated with an increase in the overall survival and improved sleep disorders in hemodialysis patients.