Duration Of Hemodialysis Research Articles

Tirzepatide Reduces Fat Mass and Provides Good Glycaemic Control in Type 2 Diabetes Patients Undergoing Haemodialysis: A Single-Centre Retrospective Study.

Tirzepatide is an injectable peptide approved by the US Food and Drug Administration for the treatment of Type 2 diabetes (T2DM). Its weight-loss effect primarily targets fat reduction; however, such effect on patients with chronic kidney disease (CKD) undergoing haemodialysis (HD) has not been reported. Nine patients with CKD undergoing HD received weekly tirzepatide doses (2.5-7.5 mg) once a week. Evaluations encompassed tirzepatide's impact on dry weight (DW) and body composition assessed at baseline and study conclusion using bioelectrical impedance analysis. This longitudinal study included nine patients, with a median age of 53 years and median HD duration of 4 years. Tirzepatide treatment significantly decreased glycated albumin compared with the value at baseline (22.7 ± 5.4 vs. 18.3 ± 2.5%, p = 0.028, respectively). Significant reductions were observed in DW (-1.0 kg, p = 0.024) and body mass index (-0.6 kg/m2, p = 0.050) following tirzepatide administration. Total fat mass was also reduced, but not significantly (- 2.51% from baseline, p = 0.214). In contrast, skeletal muscle mass was not decreased (-1.02% from baseline, p = 0.722). No serious side effects other than nausea were observed during the study period. Tirzepatide effectively provides good glycaemic control in T2DM patients undergoing HD, decreasing DW by reducing body fat mass without increasing frailty risk.

Data-Informed Insights on Thriving Through Challenges: Exploring Posttraumatic Growth, Resilience, and Social Support in Hemodialysis Patients

Hemodialysis is one treatment option for end stage renal disease which does not cure the disease completely but increases the patients’ span of life. It imposes a lot of physical and psychological burden on the patients. Identification of factors protecting the patients from these burdens is needed. Recent studies have focused on posttraumatic growth (PTG) as a protective factor against the distressing health outcomes. The aim of this cross-sectional study is to investigate the occurrence of PTG in patients on maintenance hemodialysis and examine its association with perceived social support and resilience. A convenience sample of 200 patients receiving maintenance hemodialysis was recruited from two government hospitals of Lahore, Pakistan. Data was collected using Posttraumatic Growth Inventory, Perceived Social Support Scale, and Trait Resilience Scale. Individuals undergoing hemodialysis showed high levels of PTG and the mean total score for PTGI was 60.1+ 11.5. Resilience (r = .79, p<.001) and perceived social support (r = .51, p<.001) were significantly correlated with PTG. Hierarchical multiple regression indicated increasing age, longer duration of hemodialysis, and resilience to be significant predictors (p<.001) of PTG in patients and explained 52% of the variance. The results provide helpful information which could be used to develop interventions for patients to transform their adversity into positive growth by improving their resilience and social support.

The Administration of Intradialytic Parenteral Nutrition Does Not Affect the Anemia Status of Chronic Kidney Disease Patients Undergoing Hemodialysis

Background: Hemodialysis (HD) patients are susceptible to malnutrition, and there is a close relationship between malnutrition and the incidence of anemia. Parenteral nutrition plays a role in treating malnutrition. Objective: This study aims to determine the effect of parenteral nutrition on anemia in HD patients. Methods: Quasi-experimental research which is part of the nutritional research tree at the Hemodialysis Unit of RSUP Dr. Soetomo Surabaya for 3 months. A total of 45 malnourished CKD patients (SGA B & C) undergoing routine HD were included in this study (n=26 received regular diet & education, n=17 received regular diet, education and intradialytic parenteral nutrition, and n=2 dropped out of school due to blood transfusion). Measurements of body mass index (BMI), hemoglobin (Hb), serum iron (SI), and total iron binding capacity (TIBC) were carried out before and 8 weeks after therapy. Between groups used the Mann-Whitney test, while pre and post used the Wilcoxon matched-pairs sign rank test. Results: The treatment group was older than the control group. There was no difference in duration of HD between groups. Intradialytic parenteral nutrition had no effect on BMI (24.71±3.939 vs 24.71±4.026; p=0.3802), Hb (9.746±1.309 vs 9.162±1.960; p= 0.3525), SI (62.33±34.74 vs. 53.78±24.89; p=0.3594), and TIBC (242.8±119.0 vs. 197.3±43, 65; p=0.4258). Conclusion: In HD patients, intradialytic parenteral nutrition for 8 weeks did not affect Hb, SI and TIBC levels. Long-term observations with larger samples are needed to confirm these findings.

Serum Vitamin B12 Deficiency in Chronic Hemodialysis Patients.

Introduction Essential vitamins like folate and vitamin B12 are crucial for many physiological functions. Patients with renal failure undergoing regular hemodialysis in the general population may experience harmful effects from vitamin B12 deficits. Therefore, this study aimed to determine the frequency of vitamin B12 deficiency in hemodialysis patients and its association with other clinical parameters. Methods This cross-sectional study was conducted at the dialysis unit of Patel Hospital and Lifeline Hospital, Karachi, using a non-probability consecutive sampling technique after obtaining ethical approval from Lifeline Hospital (LLH/HR/02-22). The study duration was sixmonths, from January 10, 2023, to July 22, 2023. A total of 135 adult renal failure patients with ages >18 and <70 yearson maintenance hemodialysis for >1 year were included in the study. The chi-square testwas usedto determine the association between vitamin B12 deficiency and age and gender. A p-value of 0.05 was considered statistically significant. Results The study findings showed that out of 135 patients, 82 (60.7%) were males and 53 (39.3%) were females, with a mean age of 50.80 ± 10.03 years. The duration of hemodialysis was approximately 1-2 years in 98 (72.6%) patients, 2-3 years in 27 (20.0%) patients, and 3-4 years in only 9 (6.7%) patients. The mean serum vitamin B-12 levels were 411.61 ± 224.95 pg/ml, with 30 (22.2%) of the subjects being deficient. In terms of duration of hemodialysis, there was a significant association (p= 0.013). Between patients withnormal4 (4%) and deficient 5 (17%) vitamin B12 and 3-4 years of hemodialysis. Conclusion In this study, we found that a significant proportion of patients on chronic hemodialysis had vitamin B12 deficiency. Moreover, vitamin B12 deficiency was significantly associated with duration of hemodialysis. Therefore, we recommend periodic vitamin B12 testing in hemodialysis patients to avoid any associated complications.

Cerebral blood flow changes in maintenance hemodialysis patients with restless legs syndrome and their clinical significance:a cross-sectional case-control study

ObjectiveRestless legs syndrome (RLS) stands as a prevalent neurological complication within maintenance hemodialysis (MHD) patients. However, the alterations in cerebral blood flow (CBF) among MHD-RLS patients remain uncharted. Through the utilization of the arterial spin labeling (ASL) technique, we evaluated the fluctuations in CBF within distinct brain regions and analyzed the risk factors for the development of RLS in MHD patients in the context of the clinic.MethodsThirty-one MHD patients with concomitant RLS (MHD-RLS group) and thirty-one non-RLS patients matched based on age, gender, as well as cognitive function (MHD-nRLS group) were included. Through image preprocessing and data analysis, the changes in CBF values in distinct brain regions were obtained, and the CBF values of brain regions with substantial differences between the two groups were correlated with the RLS scores. Furthermore, the differences in baseline data were compared, and through the utilization of multifactorial logistic regression, the independent risk factors for the development of RLS were examined.ResultsCompared with the MHD-nRLS group, the MHD-RLS group had increased CBF in the right superior temporal gyrus, reduced CBF in the right hippocampus, left middle frontal gyrus, inferior frontal gyrus of right triangle, middle frontal gyrus of left orbit, left precentral gyrus, and left precuneus. Only left precentral gyrus CBF were negatively correlated with RLS scores after correction for dialysis duration(r = -0.436, P = 0.016). Accordingly, multifactorial regression analysis by stepwise method yielded that the left precentral gyrus CBF values(OR: 0.968, 95%CI: 0.944–0.993, P = 0.012) remained an independent risk factor for RLS in MHD patients. In addition, the results showed that hemodialysis duration (OR: 1.055, 95%CI: 1.014–1.098, P = 0.008) and serum iron levels (OR: 0.685, 95%CI: 0.551–0.852, P = 0.001) were also risk factors for the development of RLS.ConclusionPatients afflicted with MHD-RLS exhibit alterations in CBF across several brain regions. Notably, the left precentral gyrus might serve as a pivotal region influencing the onset of RLS among MHD patients. Furthermore, extended hemodialysis duration and a relative insufficiency in serum iron levels independently contribute as risk factors for RLS development within the MHD patient population.

Relationship Between Hyperuricemia and Hypertension in Diabetic Patients Undergoing Hemodialysis

Background: Diabetes is a prevalent chronic disease and is considered a risk factor for other chronic diseases. Various studies have pointed out the relationship between uric acid and type 2 diabetes. Objectives: This study aimed to investigate the relationship between hyperuricemia and hypertension in diabetic patients undergoing hemodialysis. Methods: The descriptive-analytical cross-sectional study was conducted on dialysis patients referred to the Comprehensive Center for the Treatment of Special Diseases in Birjand in 2022. Data were collected through a checklist, which included information such as age, sex, duration of hemodialysis, duration of diabetes, history of underlying diseases, blood pressure, and serum uric acid level. The data were analyzed using SPSS 26 software and chi-square, Fisher's exact, Mann-Whitney tests with a significance level of 0.05. Results: Hypertension was present in 61 (85.9%) of patients. The average uric acid level was 5.9 ± 1.12, and hyperuricemia was observed in 11 (15.5%) of patients. Although the rate of hyperuricemia was higher in patients with high blood pressure [10 (16.4%) vs. 1 (10%)], no significant relationship between hyperuricemia and high blood pressure was observed (P = 0.605). Additionally, no significant relationship was observed between the average uric acid level and demographic factors (age, sex, duration of dialysis, and average blood sugar) (P &gt; 0.05). Conclusions: According to the present study's results, the rate of hyperuricemia in dialysis patients with high blood pressure is higher than in patients without high blood pressure. However, due to the non-significance of this relationship, there is a need to conduct studies with a larger sample size to truly understand its relationship with high blood pressure in diabetic patients undergoing hemodialysis.

Interplay of Sleep Quality, Insomnia and Quality of Life in Individuals Undergoing Hemodialysis

Insomnia is the most commonly occurring disorder of sleep experienced by individuals with chronic kidney disease. It is associated with physical and psychological health issues specifically the ones on hemodialysis. Objective: To find out the frequency of insomnia in individuals undergoing hemodialysis and to examine the relationship between sleep quality and quality of life. Methods: It was a cross sectional study and non-probability purposive sampling technique was used for selecting the sample of patients undergoing hemodialysis from a dialysis center of Lahore. The sample consisted of both men and women (N=100) with age range 40 and above (M=51.40, SD=7.25). Insomnia, general sleep scale and quality of life scale were used to collect data from the participants. Results: Insomnia was found to be prevalent in 6% of the patients. Quality of Life (QOL) was significantly poor in individuals with insomnia and poor sleep quality as compared to the ones with better sleep. Older age, increasing duration of hemodialysis and poor sleep quality were significant predictors of quality of life in our sample. Conclusions: Insomnia and/or poor-quality sleep have a detrimental effect on patients’ quality of life in kidney disease. These findings can provide basis for awareness campaigns and health promotion programs aimed at timely diagnosis and management of insomnia and improvement in sleep quality as well as quality of life in individuals undergoing hemodialysis

The Javanese Cultural Beliefs and Practices Among Patients With End-Stage Renal Disease Undergoing Hemodialysis.

Introduction: Poor prognosis and higher mortality of chronic kidney disease are linked with cultural beliefs and practices. This study explored cultural beliefs and practices of Javanese people with end-stage renal disease undergoing hemodialysis for ≥5 years. Methods: A qualitative narrative inquiry was applied in this study. Data were collected through in-depth narrative interviews, followed by text messages, calls, and audio-visual calls for 6 weeks. Results: There were 14 participants; their mean age was 51.15 years and hemodialysis duration was 5 years and 2 months up to 10 years and 9 months. Four themes emerged: life-and-death acceptance, expectation of end-of-life care, contemplation of withdrawal from hemodialysis, and wishing for a good death. Discussion: Life values guided the ability to survive for the individual. Adherence to renal disease management regimen clashed with cultural values on occasions, such as social gatherings. Therefore, the unmet needs of patients should be addressed with a transcultural approach to modify personal health behaviors.

A Systematic Review on Hearing and Balance in Patients with Chronic Kidney Disease with and Without Hemodialysis.

Exploring the auditory and vestibular manifestations associated with chronic kidney disease (CKD) has been growing in recent years. Understanding these complaints in CKD patients is crucial for comprehensive patient care. This review aimed to investigate the audiological findings and profiles across various stages of CKD and guide for informed decision-making in their management. Relevant articles from PubMed, ScienceDirect, EBSCO Medline, SCOPUS, Google Scholar, and Clinical Key were identified for review. The selected articles were published from 2008 to 2023 and written in English language. A total of 41 articles on auditory and vestibular assessments in CKD were eligible for review. Pure tone audiometry (PTA), immittance audiometry (IA) and otoacoustic emissions (OAEs) were the most commonly employed hearing tests respectively, with a higher frequency of utilization in hemodialysis cases compared to non-hemodialysis ones. Also, vestibular evoked myogenic potentials (VEMPs) emerged as the most popular vestibular test among hemodialysis patients while questionnaires were frequently employed in CKD patients. Moreover, our analysis suggests a potential association between the duration of hemodialysis and the development of tinnitus and vertigo. Abnormalities were also observed in auditory brainstem response (ABR), speech audiometry, central auditory processing tests and videonystagmography (VNG) assessment in hemodialysis and non-hemodialysis patients. CKD patients, particularly those undergoing hemodialysis, face a higher risk of hearing loss, tinnitus, and vestibular complaints. Performing otoacoustic emissions and vestibular-evoked myogenic potentials along with PTA on CKD patients, regardless of the disease stage is recommended to more effective management of audiovestibular complaints in these population.

Concordance between muscle mass assessed by bioelectrical impedance analysis and by muscle ultrasound: a cross-sectional study in a cohort of patients on chronic hemodialysis

BackgroundSarcopenia is a common problem in hemodialysis (HD) patients, and it is diagnosed by low muscle mass, strength and/or low physical performance. Muscle ultrasound (US) is a non-invasive portable tool that might be used for assessment of muscle mass. The aim of the current study was to investigate the concordance between muscle US and bioelectrical impedance analysis (BIA) in diagnosis of sarcopenia in HD patients.MethodsThis cross-sectional study included 41 HD patients. Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People (EWGSOP). The skeletal mass index was measured by BIA and the muscle strength was measured by handgrip strength. Muscle US was used to measure cross-sectional area (CSA) and thickness of quadriceps and biceps muscles.ResultsThe current study included 41 patients on HD (25 males), with a mean (SD) age of 44.18 (13.11) years and a median HD duration of 48 months. Sarcopenia was diagnosed in 58.5% of the patients. Patients with sarcopenia had significantly lower quadriceps muscle CSA than those without sarcopenia. The optimal cut-offs of quadriceps muscle CSA for both males and females for the diagnosis of sarcopenia were 2.96 and 2.92 cm2, respectively.ConclusionSarcopenia is prevalent among Egyptian HD patients. US on quadriceps muscle CSA could be used for diagnosis of sarcopenia in these patients.

Benefit finding in chronic kidney disease patients receiving hemodialysis: a cross-sectional study

Background and objectivesThe psychological problems of hemodialysis (HD) patients are prominent, and benefit finding (BF) have been proven beneficial to physical and mental health, fewer researchers explored BF in HD patients. The aim of this study was to investigate the current status of BF in patients with chronic kidney disease and to analyze the factors influencing it in order to provide a reference for subsequent interventions.MethodsA cross-sectional study was done on 246 HD patients by convenience sampling in the hemodialysis center of a 3 A hospital in Shanghai from March to September 2019. The measures include General Information Questionnaire, Benefit Finding Scale, Perceived Social Support Scale, General Self-efficacy Scale, and Simplified Coping Style scale.ResultsThe median (interquartile range, IQR) score of BF was 66 (IQR = 19) and it was lower compared with other chronic diseases. Significant differences in BF scores were found between different age groups, HD duration categories, and understanding degrees of HD. Taking BF as the dependent variable, the results of multiple linear regression analysis showed that age, duration of HD, family support, other support, positive coping, and self-efficacy entered the regression equation to explain 43.8% of the total variation. Social support played an indirect effect in the relationship between positive coping and BF, accounting for 54.1% of the total effect.ConclusionThe BF of HD patients is worrisome and affected by many factors. Medical staff could pay attention to the positive psychology of HD patients, and construct individualized interventions according to the influencing factors to improve their BF level and achieve physical and mental health.

Relationship between Subclinical Hypothyroidism and Uremic Pruritis in Hemodialysis Patients.

Uremic pruritus (UP) is one of the most distressing symptoms in hemodialysis (HD) patients. Subclinical hypothyroidism (SCH) is a biochemical condition with high prevalence in HD patients. The present multicentric study aimed to assess the relationship between UP and SCH in HD patients. The present cross-sectional study included 328 HD patients. All patients were submitted to careful history through clinical examination and standard laboratory assessment. Pruritis was evaluated using the pruritis visual analog scale (VAS). Patients were diagnosed with SCH if they had TSH levels above the upper limit of the normal reference range in association with normal free thyroxine (FT4) levels. Among the studied patients, there were 196 patients (59.8 %) with UP. Comparison between patients with UP and patients without revealed that patients in the former group had significantly longer HD duration (median (IQR): 47.5 (27.0-72.5) versus 36.0 (23.0-50.5) months, p < 0.001) and lower Kt/v (median (IQR): 1.4 (1.09-1.7) versus 1.54 (1.12-1.91), p = 0.009). Moreover, they had significantly higher ferritin (median (IQR): 653.0 (526.0-800.0) versus 628.0 (470.8- 716.0) ng/mL), hsCRP (median (IQR): 12.0 (8.0-14.0) versus 8.0 (6.0-9.0) mg/dL, p < 0.001) and TSH levels (median (IQR): 4.34 (1.98-5.2) versus 3.34 (1.9-4.85) μIU/ml) with a significantly higher frequency of SCH (45.9 % versus 28.8 %, p = 0.002). Logistic regression analysis identified hemodialysis duration (OR (95%) CI): 1.02 (1.009-1.028), p < 0.001), ferritin levels (OR (95% CI): 1.002 (1.001-1.003), p < 0.001), and SCH (OR (95% CI): 0.54 (0.32-0.89), p = 0.016) as significant predictors of UP. The present study suggested a possible link between SCH and the development of UP in HD patients.

Association between white matter hyperintensities and altered cerebral blood flow in maintenance hemodialysis patients: a longitudinal study

ObjectivesTo explore changes in cerebral blood flow (CBF) and white matter in hemodialysis patients.MethodsThirty-three hemodialysis patients who underwent two brain MRI at an interval of three years and 33 age- and sex-matched healthy controls (HC) underwent structural and arterial spin-labeling MRI examinations. Intergroup differences in CBF in the gray matter, white matter, and whole matter, and regional white matter hyperintensities (WMH) were analyzed. Based on the changes in CBF between the baseline and follow-up groups, the hemodialysis patients were divided into two subgroups: an increased CBF group and a decreased CBF group. Differences in CBF and WMH between the subgroups and HC were analyzed.ResultsPatients undergoing hemodialysis exhibited increased cerebral watershed (CW) WMH, deep WMH, and periventricular WMH (P < 0.01). The CBF of patients with decreased CBF was higher than that of HC at baseline (,P < 0.01) and lower than that of HC at follow-up (P < 0.01). Compared with the increased CBF group, obvious development of deep WMH was found in the decreased CBF group for the gray matter, white matter, and whole matter (P < 0.01).ConclusionsWMH in hemodialysis patients were distributed in the deep white matter, periventricular white matter and CW, and progressed with the extension of hemodialysis duration. CBF in hemodialysis patients could manifest as both increased and decreased, and WMH in patients with decreased CBF developed severely with prolongation of hemodialysis duration.Advances in knowledgeThese findings provide a basis for exploring neuropathological changes of hemodialysis patients.

The Plasma Neurofilament Light Chain, Brain-Derived Neurotrophic Factor, and Risk of Depression in Chronic Hemodialysis Patients.

Depression is highly prevalent among hemodialysis patients. Understanding the relationship between the plasma neurofilament light chain (NfL) and brain-derived neurotrophic factor (BDNF) may help us to better understand the mechanisms of depression. This study determined their impact, alongside that of other factors, on the risk of depression in hemodialysis patients. The study enrolled 82 patients undergoing chronic hemodialysis. Serum NfL, BDNF, uric acid, urea, potassium, calcium, phosphorus, intact parathyroid hormone, and C-reactive protein (CRP) levels were measured. The patients completed the Beck Depression Inventory (BDI). Blood pressure values, body mass before and after hemodialysis, and weekly duration of hemodialysis in hours were assessed. For 19-month survival analysis, the patients were stratified according to baseline BDI scores. Based on the BDI score, 18.3% of the patients had an increased risk of depression. Lower scores were associated with significantly longer duration of hemodialysis treatment (37.5 (25-57) 24 (14-37) months, p = 0.01). Within the 19-month survival analysis, 31.7% of patients died. The patients with BDI scores above the median had significantly lower survival than those below the median (log-rank test p = 0.02). No significant differences in serum BDNF levels (192.7 [125.2-278.2]; 207.7 [142.8-265.8] pg/mL, p = 0.40), or NfL concentrations (1431.5 [1182.6-1625.7]; 1494.6 [1335.7-1667] kDa, p = 0.52) were found between patients with lower and higher risk of depression. Patients with BDI scores above the median had significantly higher levels of CRP (9.6 [4.4-14]) than those with scores below the median (3.6 [2.2-7.5], p = 0.01). A significant positive correlation was found between the BDI score and serum CRP level (r = 0.38, p = 0.01). A significant negative correlation was observed between the BDI score and URR% value (r = -0.36, p = 0.02). Patients with lower BDI scores had a longer dialysis duration, indicating a potential negative association between depression risk and length of dialysis treatment. Neither serum NfL nor BDNF levels can serve as markers of depression risk in the dialysis population.

The Relationship of Neutrophil Lymphocyte Ratio (NLR), Nutritional Status and Length of Hemodialysis to The Incidence of Inpatient Community Pneumonia in Regular Hemodialysis Patients

Background: Pneumonia, a leading cause of death worldwide, is common in chronic kidney disease (CKD) patients undergoing hemodialysis due to pulmonary infections and poor nutritional status. Prolonged hemodialysis worsens nutritional disorders, increasing pneumonia risk. Biomarkers like the neutrophil-lymphocyte ratio (NLR) and low albumin can indicate infection and inflammation. This study explores the relationship between NLR, nutritional status, and hemodialysis duration with pneumonia in CKD patients. Methods: This study was an observational analytic study with a cross-sectional design. Using SPSS to univariate analysis in the form of tables with frequency, mean and media; bicariat analysis using chi square test and multivariate analysis with logistic regression. Results: 72 patients undergoing regular hemodialysis, ROC analysis obtained an NLR cut off value of 6.09. Chi Square test results showed a significant association between NLR and pneumonia (OR 2.04; p &lt; 0.05; CI 95% 1.26-3.33) and Hemeodyalisis (HD) duration with pneumonia (OR 4.71 times; CI 95% 1.72-12.93; p 0.004), while there was no significant difference in nutritional status between community pneumonia and non-community pneumonia. Based on the results of multivariate analysis, it was found that NLR levels &gt; 6.09, HD duration &gt; 1 year, and the presence of comorbid heart failure were risk factors that significantly increased the incidence of community pneumonia in patients undergoing regular HD. Conclusion: There is a significant association between NLR &gt;6.09 and HD duration and comorbid heart failure with community pneumonia in patients undergoing regular HD at Prof. I.G.N.G. Ngoerah Hospital.

Effect of Sacubitril/Valsartan on Patients Having Heart Failure With Preserved Left Ventricular Ejection Fraction Undergoing Hemodialysis: A Long-term Observational Study.

Sacubitril/valsartan (SV), a novel pharmacological class of angiotensin receptor neprilysin inhibitors, is effective in treating heart failure (HF) by inhibiting the degradation of natriuretic peptides and the renin-angiotensin-aldosterone system. However, no studies have observed the long-term effects of SV on patients with HF and preserved left ventricular ejection fraction (LVEF) undergoing hemodialysis (HD) over a long period. This single-center retrospective study of 21 months duration involved consecutive patients with HF and preserved LVEF undergoing HD, who received 50-200 mg/day. All patients were followed up regularly, and clinical, biochemical, and echocardiographic parameters were recorded at baseline and during follow-up. The efficacy and safety of SV were also analyzed. This longitudinal study included nine patients, with a median age of 76 years. The median HD duration was 7 years. At baseline, the mean brain natriuretic peptide (BNP) was 133±73.6 pg/ml and that of LVEF was 66%±9%. After SV therapy, the systolic blood pressure, diastolic blood pressure, and heart rate decreased, albeit without statistical significance. BNP levels, LVEF, left atrial anteroposterior dimension, and left ventricular mass index did not change, compared to baseline values. No adverse effects were observed in any of the patients. SV tended to decrease blood pressure and heart rate in patients with HF and preserved LVEF undergoing HD but did not alter cardiac function assessments, such as BNP or echocardiography.

PREVALENCE AND PATTERN OF COGNITIVE IMPAIRMENT IN PATIENTS ON MAINTENANCE HEMODIALYSIS

Background: Cognitive impairment is defined as a deficit in at least two aspects of cognitive function. The important aspects of cognition are attention, memory, language, visuo-spatial skills, and frontal/executive functions. Different pattern of cognitive impairment are seen in patients with CKD not on hemodialysis and those on hemodialysis. This study was conducted to know the prevalence and pattern of cognitive impairment in patients on chronic hemodialysis. Methods: This was a cross sectional study and was conducted at hemodialysis unit of Shifa International Hospitals, Islamabad. The study was performed over a period of six months and 250 hemodialysis patients were recruited through consecutive non probability sampling technique and were looked for cognitive impairment by using minimental state examination questionnaire translated in Urdu. Results: Out of 250 patients, mean age was 49 + 8.4 years. 92 (37%) were females and 158 (63%) were male patients. Education level of 133 (53%) patients were up to secondary school, 99 (40%) patients were higher secondary and 18 (7%) patients were masters. 43(17%) of patients were on hemodialysis for 4-6 months, 95(38%) of patients for 7-12 months, 78(31%) of patients for 13-24 months and 34(13%) of patients for&gt; 24 months. The minimum MMSE score of patients were minimum of 26 and maximum of 30 with mean score of 28.5+0.811. Out of 250, 230(92%) patients had cognitive impairment. Mean scores in different MMSE domains like for orientation score was 9.5+0.497, for registration 2.9 +0.289, attention and calculation score was 4.738+ 0.5000, recall score was 2.8+0.352, language score was 8.5 +0.538. Conclusion: The study concluded that patients on hemodialysis have cognitive impairment and there is no relation of cognitive impairment with duration and frequency of hemodialysis, age , gender, level of education of patients. P value was insignificant.

Total Knee Arthroplasty in Hemodialysis Patients: Routine or Complex Surgery?

Background. Chronic hemodialysis significantly increases the risks associated with knee replacement. Among the late complications of knee arthroplasty in hemodialysis patients, deep periprosthetic joint infection (PJI) and aseptic loosening are more frequent. The frequency of revision interventions in patients with end-stage kidney disease (ESKD) is substantially higher compared to patients with normal kidney function.&#x0D; The aim of the study — based on the perioperative parameters and midterm outcomes to justify the primary knee replacement in chronic hemodialysis patients as complex case of arthroplasty.&#x0D; Methods. A retrospective randomized single-center cohort study was conducted, including 62 patients with various forms of knee osteoarthritis. Patients were divided into two groups: Group 1 — 29 (46.8%) patients with end-stage renal disease (ESRD) undergoing dialysis, Group 2 — 33 (53.2%) patients without kidney pathology. The average follow-up period in both groups was 3.7 years (min — 1, max — 6). The following parameters were assessed: patient age, length of hospital stay, morphocortical index, body mass index (BMI), duration of hemodialysis, functional assessment of the knee joint using the KSS Function Score and Forgotten Joint Score-12 (FJS-12), radiological results on the KRESS, and the frequency of various complications.&#x0D; Results. In Group 1, patients had significantly lower BMI compared to Group 2. Length of hospital stay in Group 1 were 1.7 times longer. According to the KSS Function Score, no significant differences were observed between the groups in the first 36 months after the operation. However, by the 4th year of follow-up, average KSS Function Score in Group 1 decreased to 77.3 points, which was due to infectious complications. The FJS-12 showed worse scores in Group 2, averaging 68.7 points. After more than three years post-operation, no statistically significant differences were observed between the groups, which was associated with an increase in the number of complications in Group 1. Results on the KRESS after 43 months did not differ between the groups and averaged 4.8 points. Group 1 had more orthopedic complications and cases of PJI, accounting for 7 out of 37.&#x0D; Conclusion. Age and constitutional characteristics of patients undergoing hemodialysis significantly differ from the normal population. The frequency of complications in Group 1 was 23.5%. These patients require the implantation of more constrained implant components and modular systems. Therefore, primary knee replacement in hemodialysis patients can be classified as a complex case of arthroplasty.

Anxiety in patients treated with hemodialysis

Patients with renal failure undergoing hemodialysis often experience anxiety due to various individual, socioeconomic, and environmental factors. This study aimed to analyze the factors associated with anxiety in these patients. This was a quantitative, cross-sectional study. The risk factors for anxiety investigated in this study were education, duration of hemodialysis, knowledge, and family support. The study included 50 patients with renal failure undergoing hemodialysis (total sampling). Data were collected directly by distributing questionnaires to the patients. Data were analyzed using the chi-square test and logistic regression analysis (α=0.05). The results showed that education level was not significantly associated with anxiety in these patients (p= 0.816). However, the duration of hemodialysis (p= 0.023) and patient knowledge (p= 0.048) were significantly associated with the anxiety experienced by the patients. Family support was a protective factor against anxiety in these patients (P = 1.00). The dominant variable affecting patient anxiety is the duration of hemodialysis (p=0.041; PR = 4.1; 95%CI 1.061-16.107). This means that patients undergoing hemodialysis for more than 6 months are 4.1 times more likely to experience moderate anxiety compared to patients who have been undergoing hemodialysis for 6 months or less.

Evaluation of Risk Factors for Development of Pulmonary Hypertension in Patients with End Stage Renal Disease Undergoing Hemodialysis

Background: Pulmonary arterial hypertension (PAH) has recently been identified as a common complication in patients with end-stage renal disease (ESRD) who are undergoing hemodialysis (HD) or peritoneal dialysis (PD). The risk factors for the development of PAH in those patients are not well understood. Objective: To investigate the risk factors for the development of PAH in patients with ESRD on HD. Patients and Methods: This is a hospital-based cross-sectional study of 50 ESRD patients undergoing HD. The pulmonary artery systolic pressure (PASP) was measured using echocardiography. PASP ˃ 25 mmHg at rest was defined as PAH. As a result, patients were divided into two groups: those who had PAH and those who did not. Each patient's demographic, biochemical, and echographic findings were documented. Results: Out of 50 patients, 19 (38%) had PAH, while the remaining 31 (62%) had normal PASP. In multivariate analysis, HD duration &gt; 3.4 years (OR= 2.13, 95%CI=1.45-31.38, p= 0.025), hypertension as a cause of ESRD (OR=6.12, 95%CI=1.4-26.77, p=0.031), hemoglobin (Hb) ≤ 10.0 g/dl (OR= 4.35, 95%CI=1.88-9.84, p= 0.018), and left ventricular ejection fraction (LVEF)≤ 55% (OR= 6.75, 95%CI=1.87-23.74, p=0.021) were independent factors associated with PAH. PASP had a significant positive correlation with the rate of fistula flow (r= 0.295, p= 0.038) and E/A ratio (r= 0.368, p= 0.008), but a significant negative correlation with LVEF (r= -0.345, p= 0.014). PASP had a positive significant correlation with each of rate of fistula flow (r= 0.295, p= 0.038) and E/A ratio (r= 0.368, p= 0.008), while it has a negative significant correlation with LVEF (r= -0.345, p= 0.014). Conclusion: Longer duration of HD, hypertensive nephropathy as a cause of ESRD, Hb≤ 10 g/dl, and LVEF ≤55% are among the demographic, biochemical, and clinical factors associated with the development of PAH in patients with ESRD under HD. The PASP has a positive correlation with fistula flow rate and E/A ratio and a negative correlation with LVEF. Keywords: Pulmonary arterial hypertension, End stage renal disease, Hemodialysis.