End-stage Renal Disease Patients Undergoing Maintenance Hemodialysis Research Articles

#658 Analysis of cerebral blood volume and flow changes in ESRD patients undergoing hemodialysis using functional near-infrared spectroscopy

Abstract Background and Aims End stage renal disease (ESRD) patients undergoing hemodialysis experience diverse neurological complications. However, studies regarding how hemodialysis is related to these neurological problems are limited. This study investigated cerebral blood volume (CBV) and cerebral blood flow (CBF) during hemodialysis using functional near-infrared spectroscopy (fNIRS) to analyze cerebral hemodynamic changes. Method ESRD patients undergoing maintenance hemodialysis without a history of neurological disorders were enrolled prospectively. The fNIRS data were collected using a NIRSIT Lite device. The fNIRS values were recorded three times for each patient: before the start of hemodialysis (pre-HD), 1 h after the start of hemodialysis (mid-HD), and after the end of hemodialysis (post-HD). The average changes in oxy-hemoglobin (HbO2), deoxy-hemoglobin (HbR), total hemoglobin (HbT, calculated as HbO2 + HbR) concentrations, and in hemoglobin concentration difference (HbD, calculated as HbO2 – HbR) were analyzed. We then compared the differences in changes in HbO2, HbR, HbT, and HbD according to the hemodialysis period. Results Thirty hemodialysis patients were analyzed. Between the Pre-HD and Post-HD periods, there were significant differences in changes in HbO2 (0.005 ± 0.001 µM vs. 0.015 ± 0.004 µM, p=0.046) and HbT (0.006 ± 0.001 µM vs. 0.016 ± 0.008 µM, p=0.029). Additionally, between Pre-HD and Post-HD periods, HbD tended to increase; however, this was not statistically significant (0.005 ± 0.001 µM vs. 0.014 ± 0.004 µM, p=0.094). Conclusion We demonstrated that during one hemodialysis session, the relative change in CBV increased post-HD compared with pre-HD. These results are expected to help understand the mechanisms underlying the effects of hemodialysis on brain function.

Effect of Short-Term Exposure to Air Pollutants on Hospital Admissions for End-Stage Renal Disease Patients Undergoing Hemodialysis

To evaluate the association between short-term exposure to air pollutants of end-stage renal disease (ESRD) patients on maintenance hemodialysis and the number of daily hospital admissions. The data on hospitalizations were obtained from the database of the municipal Urban Employees' Basic Medical Insurance and Urban Residents' Basic Medical Insurance of a city in Southwest China. Single and multiple pollutant generalized additive models were utilized to estimate the effect of air pollutants (CO, NO2, O3, PM10, PM2.5, and SO2) on patient admissions after the lag time of different numbers of days. In addition, subgroup analyses stratified by sex, age, PM2.5 and PM10 concentration thresholds, seasonality, and comorbidity status for cardiovascular diseases and hypertension were conducted. In the single pollutant models, the pollutants significantly associated with patient admissions and the corresponding lag time of the strongest association were as follows, every time CO increased by 0.1 mg/m3, there was a 2.39% increase (95% confidence interval [CI]: 0.96%-3.83%) in patient admissions after 7 days of lag time; every time NO2, O3, PM2.5, PM10, and SO2 increased by 10 μg/m3, patient admissions increased by 4.02% (95% CI: 1.21%-6.91%) after 7 days of lag time, 3.57% (95% CI: 0.78%-6.44%) after 0-4 days of lag time, 2.00% (95% CI: 1.07%-2.93%) after 6 days of lag time, 1.19% (95% CI: 0.51%-1.88%) after 7 days of lag time, and 8.37% (95% CI: 3.08%-13.93%) after 7 days of lag time, respectively. In the multiple pollutant model, every time O3 and PM2.5 increased by 10 μg/m3, there was an increase of 3.18% (95% CI: 0.34%-6.09%) in daily patient admissions after 0-4 days of lag time and an increase of 1.85% (95% CI: 0.44%-3.28%) after 7 days of lag time. Furthermore, subgroup analyses showed that seasonality, the severity of air pollution, and patients' comorbidities might be the effect modifiers for the association between ambient air pollution and hospital admissions in ESRD patients receiving maintenance hemodialysis. Air pollution is closely associated with hospital admissions in ESRD patients undergoing maintenance hemodialysis and the strength of this association varies according to seasonality, the severity of air pollution, and patients' status of comorbidities.

Successful Pregnancy Outcome in end-stage Renal Disease (ESRD) Patient : A Case Report

Pregnancy in women with chronic kidney disease (CKD) has always been considered as a challenging event both for the mother and the fetus . Outcomes of pregnancy in patients with End stage renal disease ( ESRD ) have long been considered to be extremely poor and challenges are harder in ESRD patients undergoing maintenance hemodialysis( MHD) . The cases of successful full term pregnancy occurring in an ESRD patient are still very few in whole world even after the evolutionary improvement of medical care. Development of well established multidisciplinary center make it possible to bring a successful pregnancy outcome among ESRD patients who are on going MHD. Patients with CKD are usually amenorrheic and fertility is markedly reduced . Women with chronic kidney disease, who get pregnant have poor pregnancy outcome in term of fetus and mother. Here we report a case of 34 years old lady, mother of two children , housewife presented in Bangladesh Specialized Hospital with a diagnosis 3 rd G 29 weeks of pregnancy with ESRD (on maintenance hemodialysis) with Hypertension. She was treated conservatively with joint consultation with Consultant Obstetrician, Nephrologist and Pediatrician. Her elective Lower uterine segment Cesarean section (LUCS) was done at her 35 weeks of pregnancy due to fetal distress with previous history of 2 LUCS. Both the mother and baby were healthy while discharge from hospital. Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 162-164

Association of Serum Prealbumin With Nutritional Status of End-Stage Renal Disease Patients Under Maintenance Hemodialysis

Background: End-stage renal disease (ESRD) patients undergoing maintenance hemodialysis often suffer from malnutrition. The primary objective of the study was to measure the level of serum prealbumin, assess the correlation of serum prealbumin with modified subjective global assessment score and determine a cut-off value for prealbumin that can estimate the nutritional status of the study population with highest accuracy, among ESRD patients under maintenance hemodialysis. Methods: A one year long cross-sectional study from July 2016 to June 2017 was conducted at hemodialysis unit of SSMC & MH, BSMMU, BIRDEM hospital and NIKDU, Dhaka, among 80 maintenance hemodialysis patients. Adult patients over the age of 18 years and on regular (≥2 sessions per week) hemodialysis for more than 3 months without any acute infection were enrolled. Nutritional status of the patients was evaluated using modified subjective global assessment score. Serum prealbumin level was compared with both anthropometric and biochemical parameters, as well as with modified SGA score. Using modified SGA score as gold standard, receiver operating characteristic curve was used to estimate best fitting cut-off value for serum prealbumin for nutritional assessment among ESRD patients under maintenance hemodialysis. Results: Mean age of study population was 52.3 years and 66.3% respondents were male. Most prominent primary renal diseases were diabetic nephropathy (48.8%). According to modified SGA score, 10% of the study population had normal nutritional status and 90% had mild to moderate malnutrition. Mean serum prealbumin was 27.8 mg/dl. Serum prealbumin showed significant negative correlation with age, modified SGA score and triglyceride; significant positive correlation was shown with BMI, serum creatinine and serum albumin. Using receiver operating characteristic curve, 32.6 mg/dl was found to be the best fitting cut-off value for nutritional assessment with 73.6% sensitivity, 62.5% specificity and 72.5% accuracy. Conclusion: Data obtained from this study strongly indicates that serum prealbumin can be used as a marker for nutritional assessment among ESRD patients undergoing maintenance hemodialysis. JOPSOM 2021; 40(2):9-15

POS-561 PERSISTENT COAGULATION ABNORMALITIES IN END-STAGE RENAL DISEASE AFTER 1-YEAR OF FOLLOW UP

Common to end-stage renal disease (ESRD), coagulation abnormalities can lead to severe bleeding events or excessive thrombi formation and engender increased morbidity and mortality in this population. Repeated heparin administration to ESRD patients during maintenance hemodialysis may also contribute to changes in the coagulation system. Thus, profiling coagulation parameters in ESRD patients over 1-year may provide insight to long-term coagulation dysfunction in this population. Blood samples were collected at baseline and 1-year from ESRD patients undergoing maintenance hemodialysis (n=95) 48-hours post-dialysis. Plasma samples were analyzed using clot-based methods including activated partial thromboplastin time (aPTT), prothrombin time (PT), and thrombin time (TT). Chromogenic assays measured heparin levels by anti-Xa and anti-IIa methods. Patients were categorized by heparin administration during dialysis (n=44) and compared via statistical method and percent change. In the clotting and chromogenic assays, all parameters were elevated in the baseline and 1-year ESRD cohorts compared to controls, as shown on Figure 1. Only anti-IIa levels demonstrated a significant difference in ESRD patients after 1-year (p<0.0001). Heparin administration varied in aPTT, TT, and anti-Xa (p<0.05). These results suggest ESRD patients on dialysis exhibit a long-term, hypo-coagulable state as shown by prolonged aPTT and TT. Elevated parameters maintained over 1-year suggests persistent dysregulation of clotting factors in ESRD patients. Circulating levels of heparin, as evidenced by anti-Xa and anti-IIa assays may be due to impaired clearance of heparin components via dialysis.

Factors Affecting Carpal Tunnel Syndrome in End Stage Renal Disease with Maintenance Hemodialysis: A Systematic Review

Introduction: The number of patients with End Stage Renal Disease (ESRD) is increasing every year, as well as those who have to undergo hemodialysis. Most hemodialysis must be undertaken in a long time. Long term hemodialysis is known to be associated with the incidence of Carpal Tunnel Syndrome (CTS).&#x0D; Method: This study aimed to systematically review factors contributing in the mentioned problem. Literature research was done using three search engines, consist of Google Scholar, Pubmed and ProQuest. Journals used are limited to the last 5 years or those deemed to be relevant. The studies obtained were further read and and appraised critically.&#x0D; Result and Discussion: From a total of 423 journals, 4 articles were selected based on inclusion and exclusion criteria. The prevalence of CTS was found to be higher in ESRD patients undergoing maintenance hemodialysis (MHD). Age, Gender, MHD Duration, β2-Microglobulin are factors that have long been known to play a role. Several other factors such as serum prealbumin, serum albumin, Blood Lead Levels, hepatitis infection, wrist injury, predialytic urea serum and BMI have been implicated in the incidence of CTS in ESRD patients undergoing MHD in some literatures.&#x0D; Conclusion: The factors mentioned earlier were found to have different roles and it is interesting for further reviewed. However, unfortunately there is still very little research that discuss these matters and more research needs to be done related to the factors above.

Profiling of Inflammatory Biomarkers and Coagulation Factors in End‐Stage Renal Disease

BackgroundEarly diagnosis of chronic kidney disease (CKD) is necessary in preventing complications that develop into kidney failure and vascular complications. Currently, the detection of early stages of CKD is lacking predictive values, delaying the application of specific diagnostics and therapeutic interventions. End‐stage renal disease (ESRD) patients are at risk for cardiovascular complications and vascular thrombosis, exhibiting numerous coagulation and fibrinolytic abnormalities.ObjectivesProfiling inflammatory biomarkers and coagulation factors in ESRD patients may allow early onset detection and severity of kidney damage, furthering the understanding of the pathogenesis of this disease.Materials &amp; MethodsCitrated blood samples were collected from 95 confirmed ESRD patients undergoing maintenance hemodialysis under an IRB approved protocol. Biomarkers of inflammation and coagulation, including PAI‐1, TAFI, CRP, MMP‐9, MP, D‐Dimer, Factor VII, IX, X, and XIII were measured using commercially available ELISA methods. Normal controls were comprised of commercially available male and female citrated plasma (George King Biomedical). All results were compiled as mean ± SEM, and percent change in comparison to normal human plasma.ResultsBiomarkers including CRP (7ug/ml ± 0.6, 183%), MMP‐9 (88ng/ml ±8, 58%) D‐Dimer (1059ng/ml±138), Factor IX (124%±3, 23%), and Factor XIII (104%±1, 27%) showed significant increase when compared to normal plasma. Elevated CRP indicates severe inflammatory response and elevated D‐Dimer indicates endogenous fibrin formation. MP and PAI‐1 suggest endothelial dysfunction.DiscussionThese results indicate that the upregulation of inflammatory responses and hemostatic defects contribute to the multifactorial pathophysiology of ESRD. Profiling of these biomarkers may be helpful in the prognostic management of these patients.

The influence of atrial fibrillation on the mortality of incident ESRD patients undergoing maintenance hemodialysis.

BackgroundAtrial fibrillation (AF) is highly prevalent, occurring in 1%–2% of the adult population, increasing the risk of stroke, and resulting in considerable healthcare costs. While stroke is a major complication of AF, end-stage renal disease (ESRD) patients also have a high risk of stroke, suggesting that AF is a possible risk factor for mortality of ESRD patients. However, whether the existence of AF at the initiation of hemodialysis predicts higher mortality risk of incident ESRD patients remains to be defined.MethodsThis retrospective cohort study was performed at Wanfang Hospital from January 2004 to May 2018. The end points were mortality of patients or the end of the study. Incident ESRD patients who were on maintenance hemodialysis for more than 3 months were eligible for inclusion. Cox proportional regression and Kaplan–Meier survival curves were used to determine the association between predictors and mortality. The association between AF and echocardiographic parameters, causes of death were also investigated.ResultsOf the 393 incident ESRD patients at initiation of hemodialysis, 57 (14.5%) had AF and the median age was 71 years. Patients with AF were significantly older; showed significantly higher C-reactive protein levels, more heart failure, chronic obstructive pulmonary disease and mortality. Multivariate Cox regression showed that AF had a hazard ratio of 4.1 (95% confidence interval: 2.4–7.0) for mortality. Age-specific analysis showed that AF was significantly associated with mortality in all age groups. Echocardiography measurements including ejection fraction and left ventricular hypertrophy (LVH) were similar in AF and non-AF patients. Cause-specific analysis showed that AF significantly associated with overall cardiovascular death and death due to acute myocardial infarction/coronary artery disease and sepsis.ConclusionsAF at the initiation of hemodialysis predicts higher mortality risk of incident ESRD patients regardless of age. The systolic function and degree of LVH were similar in AF and non-AF patients. The association between AF and sepsis-related death suggested the role of systemic inflammation on the pathogenesis of AF.

HYPERPHOSPHATEMIA IN END STAGE RENAL DISEASE: PREVALENCE AND PATIENTS CHARACTERISTICS OF MULTIETHNIC POPULATION OF UNITED ARAB EMIRATES

Objective: Hyperphosphatemia is significantly associated with increased mortality among end stage renal disease (ESRD) patients on hemodialysis. There is paucity of data on hyperphosphatemia in ESRD patients of the multiethnic population of United Arab Emirates (UAE). The study aimed to investigate the prevalence and characteristics of hyperphosphatemia in ESRD patients of the multiethnic population of UAE undergoing maintenance hemodialysis.Methods: Adults ESRD patients undergoing maintenance hemodialysis for more than six months at the study site were included. Demographic, clinical and biological data of the patients were collected. Patient characteristics were compared as per the serum phosphate level, between patients with or without hyperphosphatemia. Univariate and multivariate logistic regression analyses were carried out to identify the predictors of hyperphosphatemia.Results: Hyperphosphatemia was present in 73.8% of the study population, while 31.3% presented with high calcium-phosphate product. Univariate logistic analysis revealed that hyperphosphatemia was inversely correlated with age, hemoglobin, serum calcium, and hypertensive nephropathy as cause of renal disease, and positively correlated with female gender, expatriate status, body mass index (BMI), higher number of comorbidities, calcium-phosphate product and parathyroid hormone (PTH). Multivariate logistic regression model revealed that only age, BMI, hemoglobin and PTH independently correlated with hyperphosphatemia.Conclusion: We report a high prevalence of hyperphosphatemia in multiethnic study population undergoing maintenance hemodialysis at a secondary care hospital in UAE. In this study population, only age, BMI, hemoglobin and PTH were identified as independent predictors of hyperphosphatemia.

Pulmonary hypertension among patients undergoing hemodialysis.

Introduction: The epidemiology of pulmonary hypertension (PHT) among long-term hemodialysis patients has been described in relatively small studies in Iran. Objectives: The purpose of this study was to evaluate the prevalence of PHT and its relationship among end-stage renal disease (ESRD) patients undergoing long-term hemodialysis (HD). Patients and Methods: In a cross-sectional study, patients with ESRD treated with HD for at least 3 months in the Imam hospital enrolled for the study. PHT was defined as an estimated systolic pulmonary artery pressure (PAP) equal to or higher than 25 mm Hg using echocardiograms performed by cardiologist. Results: A total of 69 HD patients were included in the investigation. The mean of age of our patients was 52.6±15.3 years. The mean duration of HD was 39±36 months. The mean ejection fraction was 45±7%. The prevalence of PHT was 62.3%. These patients were more likely to have lower ejection fraction. The PHT was more common among female HD patients. We did not find any association between PHT and cause of ESRD, duration of HD, anemia and serum calcium, phosphor and parathyroid hormone levels. Conclusion: Our findings show that PHT is a common problem among ESRD patients undergoing maintenance HD and it is strongly associated with heart failure. It is necessary to screen this disorder among these patients.

A comparative study of platelet parameters in end stage renal disease patients undergoing haemodialysis and healthy individuals

Background: With the rising trend of diabetes mellitus and hypertension in developing countries like India, there is also a rise in chronic complications like end stage renal disease (ESRD). ESRD poses a huge financial burden on family and health care sector due to a high morbidity and mortality associated with it. Cardiovascular complications remain the most common cause of death among ESRD patients and those undergoing hemodialysis (HD). Hemodialysis patients behave in a distinct way that they are relatively more prone for bleeding than thrombotic manifestations. In recent days abnormalities in platelet parameters are found to be an effective tool in risk stratification of patients with chronic kidney disease (CKD) to develop coronary artery disease. Due to scarcity of literature especially from India, the present study was taken to find the association of various platelet parameters among hemodialysis patients. The aim was to study the platelet distribution width (PDW), mean platelet volume, platelet count, plateletcrit and platelet large cell ratio (PLCR) among ESRD patients undergoing maintenance hemodialysis and compare with healthy age and sex matched controls. Methods: The present study was done on two groups. Group A (Cases) consisting of 40 ESRD patients receiving HD for more than 6 months, and group B (controls) consisting of 40 healthy controls from hospital staffs and healthy volunteers matched for age and sex. Results: The mean values of platelet distribution width (PDW), mean platelet volume, platelet count, plateletcrit and platelet large cell ratio (PLCR) were found to be lower in cases when compared to healthy controls. PDW, platelet count and plateletcrit attained statistical significance, while others did not. Conclusions: Abnormality in platelet parameter to assess CVD risk may be applicable in general population as well as in CKD patients, but its role in hemodialysis patient’s further need to be evaluated.

Upregulation of Microparticles, Tissue Factor, Adhesion Molecules, Nitric Oxide and Adiponectin in End Stage Renal Disease

Introduction: End stage renal disease (ESRD) represents the final stage of chronic kidney disease characterized by kidney failure (GFR <15 mL/min/1.73 m2). To understand the pathophysiology of hemostatic dysregulation in ESRD, we measured the circulating levels of microparticles (MP), tissue factor (TF), adhesion molecules, such as p-selectin (P-Sel), soluble ICAM (s-ICAM), nitric oxide (NO) and adiponectin (AD).Methods: Citrated blood plasma samples were collected from 119 ESRD patients undergoing maintenance hemodialysis to profile various thrombotic inflammatory biomarkers. 100 normal plasma samples were collected from healthy individuals and were used as controls. MP levels were measured using an annexin binding method (Hyphen Biomedical, Paris, France). NO were measured using a kit from R&D systems (Minneapolis, Minnesota) and ELISA based methods for TF, P-Sel, s-ICAM and adiponectin were obtained from R&D systems. Chromogenic substrate methods were used to measure the heparin levels and thrombin generation.Results: MP levels were elevated in the ESRD group (28.1nm + 6.1nm vs. the control 8.9nm +1.3nm). Tissue factor levels were found to be increased in the ESRD group (20.4±6.1pg/ml) vs the control (11.9±2.8pg/ml). The nitric oxide level was markedly higher in the ESRD group (32±17uM) vs the controls (7±3uM). The p-selectin levels were also elevated in the ESRD group (46±20ng/ml) vs the control (31±3ng/ml). The soluble ICAM levels were higher in the ESRD group (250±112ng/ml) vs the control (180±19ng/ml). Interestingly, the adiponectin levels were also increased in the ESRD group (19.2±9.3ug/ml) vs the control (11.2±4.1ug/ml). Measured variations in thrombin generation parameters were noted. Detectable levels of heparin (.05 - 0.20 U/ml) were present in the ESRD group.Summary/Conclusions: These studies suggest that MP, TF, NO, p-selectin and s-ICAM levels are increased in the ESRD patient. It is of interest to note that despite that a significant number of ESRD patients were diabetic; the AD levels were increased in this group. These results also suggest that while ESRD represents a pro-inflammatory/hypercoagulable state, the repeated administration of heparin and other drugs may contribute to the regulation of the hemostatic process and inflammatory balance in these patients. DisclosuresNo relevant conflicts of interest to declare.

Dyspepsia is Associated with Low Protein and Caloric Intake among End-Stage Renal Disease Patients.

Dyspepsia is highly prevalent and easily assessed in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD) and is not a traditional predictor of malnutrition. We sought to establish an association between dyspeptic symptoms and nutritional status in ESRD patients undergoing maintenance HD. We studied 106 ESRD patients on HD. Dyspepsia was assessed through the Porto Alegre Dyspeptic Symptoms Questionnaire (PADYQ). Scores equal to or greater than 6 classified patients as dyspeptic. Nutritional status was evaluated using serum chemistry, total body mass, muscle mass, and dietary intake. Nutritional status was compared between dyspeptic and non-dyspeptic patients. The association of PADYQ scores and the presence of dyspepsia with nutritional variables were tested. Multivariate analysis was performed to test dyspepsia as an independent predictor for dietary intake. There were 41 (38.7 %) dyspeptics. Protein intake (g/kg/day) and calorie intake (kcal/kg/day) were lower among dyspeptics compared to non-dyspeptics, 1.0 ± 0.5 vs 1.3 ± 0.5 (p = 0.01) and 23.0 ± 9.2 vs 27.4 ± 10.0 (p = 0.02), respectively. More dyspeptics than non-dyspeptics presenting protein-energy wasting based on protein and calorie intake, 41.4 vs 15.3 % (p = 0.01) and 68.2 vs 38.4 % (p = 0.02), respectively. PAQYQ score was negatively correlated with protein intake (r = - 0.20; p = 0.03) and calorie intake (r = - 0.19; p = 0.04). Dyspepsia was able to predict protein (b = - 0.26; p = 0.01) and calorie (b = - 4.42; p = 0.02) intake. Dyspepsia is associated with low protein and calorie intake. Screening of dyspeptic symptoms can be routinely performed aiming to improve HD patients' nutritional status.

Restless Legs Syndrome: Associated Risk Factors in Hemodialysis Patients

Background:Restless legs syndrome (RLS) may be associated with increased morbidity and mortality among end-stage renal disease (ESRD) patients; however, it is a disorder that is neglected in dialysis centers.Objectives:The goal of this study was to investigate the clinical factors associated with RLS among ESRD patients.Patients and Methods:This cross-sectional study was conducted on ESRD patients undergoing maintenance hemodialysis (HD) in three HD centers in Ahvaz city in Southwest Iran. Blood samples were obtained prior to a dialysis session to check the routine laboratory test results and assess the adequacy of dialysis. The presence of RLS was assessed by using the international RLS study group (IRLSSG) diagnostic criteria. The IRLSSG rating scale was also used to evaluate the severity of the RLS symptoms.Results:Of the 139 HD patients enrolled in this study, 60 were female (43.2%) and 79 were male (56.8%), with a mean age of 51.82 ± 13.31 years. The prevalence of RLS was 15.8% (22 patients), with 50% of them (11 patients) having severe or very severe symptoms. There was a significant relationship between RLS and longer durations of dialysis (P < 0.001). The mean level of serum ferritin was lower in patients without RLS, but it was not significant (P = 0.065). No significant differences were found according to age, gender, dialysis shifts, and hemoglobin (Hb) level among patients with and without RLS.Conclusions:We conclude that a significant percentage of ESRD patients undergoing maintenance HD have severe or very severe RLS symptoms. The presence of RLS is associated to longer durations of dialysis.

Epidemiology of hepatitis e virus infection in patients on chronic hemodialysis.

Background:Many studies have been done on the epidemiology of Hepatitis E on general population, but the data among patients with end stage renal disease (ESRD) are few and give conflicting results.Objectives:The aim of this study was to investigate the prevalence of hepatitis E virus (HEV) infection and its relationship in ESRD patients undergoing maintenance hemodialysis (HD).Patients and Methods:This cross-sectional study was carried out on ESRD patients treated with HD in Imam Khomeini Hospital, Ahvaz city, Southwest of Iran. Blood sampling of patients was collected immediately before the dialysis session and the serum were evaluated for anti-HEV IgG titers by enzyme-linked immunosorbent assays. The statistical package for social sciences (SPSS) version 15 software was used for data analysis.Results:Out of 47 ESRD patients, 27 were male (57.4%) and 20 were female (42.6%), with mean age of 55.27 ± 8.1 years. The prevalence of anti-HEV antibody was 10.6 % (five patients, four male and one female). The mean age of HEV positive and negative patients were 58 ± 5.52 and 53.82 ± 15.55 years, respectively without any significant difference (P = 0.058). There also was no significant association between HEV and gender (P = 0.28). The mean time of HD in HEV positive and negative patients were 1224.2 and 1168.5 days, respectively with no significant association (P = 0.88). In addition, there also was no association between HEV and HCV (P = 0.61).Conclusions:According to the present study, the prevalence of anti-HEV IgG antibody was 10.63 % among chronic HD patients and there was no association between HEV, age, gender, duration of HD and HCV antibody titer.

Emergency laparoscopic cholecystectomy in patients with acute cholecystitis on maintenance hemodialysis

Laparoscopic cholecystectomy (LC) is widely accepted as the standard treatment for acute cholecystitis. Emergency LC is associated with significantly high morbidity and mortality rates in high-risk patients, including those who are critically ill, those who are elderly, end-stage renal disease (ESRD) patients, and those with septicemia. To evaluate the safety and outcomes of emergency LC in ESRD patients on maintenance hemodialysis. Between January 2006 and December 2011, the medical records of 22 ESRD patients with acute calculous cholecystitis who were undergoing maintenance hemodialysis and had received emergency LC were reviewed retrospectively. The patients were 10 men and 12 women with a mean age of 69.3 years. Emergency LC was successfully performed on 20 patients, and two patients converted to open cholecystectomy. The conversion rate was 9% and the mean hospital stay was 4.8 (range 3–8) days. Wound infection occurred in two patients and common bile duct injury in one; no other complications and no perioperative mortality occurred in this study. Emergency LC can be performed safely in ESRD patients undergoing maintenance hemodialysis. The duration of hospital stay, outcomes, and surgical conversion rate of patients undergoing this procedure are similar to those of the general population not undergoing emergency LC.

Factor structure and reliability of the Hungarian version of the Illness Intrusiveness Scale: Invariance across North American and Hungarian dialysis patients

Objectives The objectives of this study were to compare the factor structure and to assess the reliability of the Hungarian version of the Illness Intrusiveness Rating Scale (IIRS), testing internal validity and employing simultaneous confirmatory factor analysis (SCFA) in two large samples of North American versus Hungarian patients with end-stage renal disease (ESRD). Methods Translation was conducted according to current recommendations. Following pilot testing, 365 maintenance haemodialysis patients completed the scale. Hungarian data were compared with IIRS data from North American ESRD patients undergoing maintenance hemodialysis to evaluate item bias (Group×Item ANOVA). Results Confirmatory factor analyses indicated a good fit between the previously hypothesized three-factor model (“relationships and personal development”, “intimacy”, and “instrumental” life domains) of the original English version and the Hungarian translation. Although statistically significant ( P<.05), the effect size for the Groups×Items interaction was not substantial. Internal consistency was very good (Cronbach's α=.80) for the total score, and, although somewhat lower than ideal, it was still in the acceptable range for the subscales (.64–.67). These numbers are similar to values reported for the original English version. Test–retest reliability was also acceptable. Conclusion The Hungarian translation of the IIRS has the same three-dimensional factor structure as the original English-language version does. Furthermore, it is sufficiently reliable for research applications. These features satisfy important requirements of cultural equivalence.

Pyrazinoylguanidine in End-Stage Renal Disease: A Prospective, Placebo-Controlled Pilot Study

Cardiovascular disease is the leading cause of mortality in end-stage renal disease (ESRD) patients receiving dialysis. In these patients, hypertriglyceridemia appears to increase the risk of accelerated atherosclerosis. The present placebo-controlled study evaluated prospectively lipid-lowering effects of pyrazinoylguanidine (PZG) in 6 ESRD patients undergoing maintenance hemodialysis. The design of the study entailed a placebo phase of 1 week followed by 3 weeks of PZG, 400 mg three times a day. Compared to placebo, PZG reduced serum triglycerides (PZG vs. placebo 370 ± 171 vs. 414 ± 182 mg/dl; p = 0.01). PZG also tended to decrease total cholesterol. In addition, PZG selectively lowered blood glucose in hyperglycemic patients. PZG was well tolerated; it did not interfere with hemodynamic parameters or alter liver function tests, nutritional parameters or dialysis clearance.