Hemodialysis For Chronic Renal Failure Research Articles

Development of acute pancreatitis caused by sodium valproate in a patient with bipolar disorder on hemodialysis for chronic renal failure: a case report

BackgroundCases of acute pancreatitis caused by sodium valproate (VPA) have been reported by many authors thus far. However, most of these were cases with epilepsy. Chronic renal failure is also regarded as a risk factor for acute pancreatitis. Here, we report a case of acute pancreatitis development due to VPA in a patient with bipolar disorder on hemodialysis for chronic renal failure.Case presentationThe patient was a 52-year-old Japanese male who was diagnosed as bipolar disorder on hemodialysis for renal failure. He was treated with VPA and manic symptoms gradually stabilized. However, the patient complained of severe abdominal pain. Blood amylase was found to be markedly high, and computed tomography revealed pancreatomegaly and an increased amount of peripancreatic fat. Hence, we diagnosed the case as acute pancreatitis caused by VPA. We discontinued oral medication, and he was started on a pancreatic enzyme inhibitor, antibiotics, and transfusion, and he showed improvement.ConclusionIt has been reported that acute pancreatitis induced by VPA is caused by intermediate metabolites of VPA. We consider that patients with renal failure are prone to pancreatitis caused by VPA because of the accumulation of these intermediate metabolites. We need close monitoring for serious adverse effects such as pancreatitis when we prescribe VPA to patients with bipolar disorder on hemodialysis for chronic renal failure, although VPA is safer than other mood stabilizers.

Prevalence of cardiovascular risk factors in hemodialysis patients - The CORDIAL study.

BackgroundThere are scarce epidemiological data on cardiovascular risk profile of chronic hemodialysis patients in Brazil.ObjectiveThe CORDIAL study was designed to evaluate cardiovascular risk factors and follow up a hemodialysis population in a Brazilian metropolitan city.MethodsAll patients undergoing regular hemodialysis for chronic renal failure in all fifteen nephrology centers of Porto Alegre were considered for inclusion in the baseline phase of the CORDIAL study. Clinical, laboratory and demographic data were obtained in medical records and in structured individual interviews performed in all patients by trained researchers.ResultsA total of 1215 patients were included (97.3% of all hemodialysis patients in the city of Porto Alegre). Their average age was 58.3 years old, 59.5% were male and 62.8% were white. The prevalence of cardiovascular risk factors observed was 87.5% for hypertension, 84.7% for dyslipidemia, 73.1% for sedentary lifestyle, 53.7% for tobacco use, and 35.8% for diabetes. In a multivariate adjusted analysis, we found that sedentary lifestyle (p = 0.032, PR 1.08 - 95%CI: 1.01-1.15), dyslipidemia (p = 0.019, PR 1.08 - 95%CI: 1.01-1.14), and obesity (p < 0.001, PR 1.96 - 95%CI: 1.45-2.63) were more frequent in women; and hypertension (p = 0.018, PR 1.06 - 95%CI: 1.01-1.11) and tobacco use (p = 0.006, PR 2.7 - 95%CI: 1.79-4.17) were more often found among patients under 65 years old. Sedentary lifestyle was independently associated with time in dialysis less than 12 months (p < 0.001, PR 1.23 - 95% CI: 1.14-1.33).ConclusionHemodialysis patients in this southern metropolitan Brazilian city have a high prevalence of cardiovascular risk factors resembling many northern countries.

A case of long myotomy and fundoplication for diffuse esophageal spasm

We report a case of diffuse esophageal spasm (DES) successfully treated by esophageal long myotomy and Dor’s fundoplication. The patient was a 52-year-old man with a history of hepatitis C and severe chronic heart failure due to hypertensive cardiomyopathy. He had also undergone hemodialysis for chronic renal failure for 10 years. He had complained of dysphagia for 10 years. Diffuse esophageal spasm was diagnosed by fluoroscopy and esophageal manometry. We performed esophageal long myotomy through the opened hiatus and Dor’s fundoplication. The upper extent of the myotomy was confirmed by intraoperative endoscopic ultrasonography used to detect muscle thickening and low compliance of the esophageal wall. The procedure and postoperative recovery were uneventful, and the patient’s symptoms were relieved. This approach appears to be a potentially useful means of treating severe symptoms of DES resistant to conservative therapy, with ultrasound endoscopy being a helpful means of confirming the extent of esophageal myotomy.

Quality of life of patients with chronic renal failure hemodialysis – to kidney transplant

ABSTRACT Objective : to analyze the quality of life (QOL) of people with Chronic Renal insufficiency (CRI) who are undergoing hemodialysis treatment compared to transplanted, with application of the SF-36. Method : quantitative study, descriptive, transversal, with 34 patients on dialysis and transplant unit 34 of Hemodialysis and Renal Transplantation outpatient clinic of a hospital of Florianopolis (Santa Catarina), randomly selected by the criteria: IRC carrier; over the age of 18 years; without restrictions on oral communication; who are undergoing hemodialysis or kidney transplanted. In the analysis of the data, we used descriptive statistics. The Research Ethics Committee, Protocol No. 2011/0033, has approved the research project. Results : scores of QOL of transplanted showed statistically significant differences in six areas: functional capacity, physical/social and emotional aspects, general health, vitality, compared to on dialysis. Conclusion: kidney transplant recipients have better QOL, in general health and limitations on physical aspects, compared to patients on dialysis. Descriptors : Quality of Life; Chronic Renal Failure; Hemodialysis; Kidney Transplant; SF-36. RESUMO Objetivo: analisar a qualidade de vida (QV) de pessoas com Insuficiencia Renal Cronica (IRC) em tratamento hemodialitico comparada a de transplantados, com aplicacao do SF-36. Metodo: estudo quantitativo, descritivo, transversal, com 34 pacientes hemodialiticos e 34 transplantados da Unidade de Hemodialise e Ambulatorio de Transplante Renal de um hospital de Florianopolis (Santa Catarina), selecionados aleatoriamente pelos criterios: portador de IRC; idade superior a 18 anos; sem restricoes a comunicacao oral; hemodialitico ou transplantado renal. N a analise dos dados utilizou-se estatistica descritiva. O projeto de pesquisa foi aprovado pelo Comite de Etica em Pesquisa, Protocolo no 2011/0033. Resultados: os escores da QV dos transplantados apontaram diferencas estatisticamente significantes em seis dominios: capacidade funcional, aspectos fisicos/sociais e emocionais, estado geral de saude, vitalidade, comparado aos hemodialiticos. Conclusao: transplantados renais apresentam melhor QV, nos dominios estado geral de saude e limitacoes por aspectos fisicos, comparados aos pacientes em tratamento dialitico . Descritores: Qualidade de Vida; Insuficiencia Renal Cronica; Hemodialise; Transplante de Rim; SF-36. RESUMEN Objetivo: analizar la calidad de vida (CDV) de personas con Insuficiencia Renal Cronica (IRC) sometidos a tratamiento de hemodialisis en comparacion con trasplantados, con aplicacion del SF-36. Metodo: estudio cuantitativo, descriptivo, transversal, con 34 pacientes en dialisis y trasplante 34 de la unidad de hemodialisis y Trasplante Renal clinica ambulatoria de un hospital de Florianopolis (Santa Catarina), seleccionado al azar por los criterios: portador IRC; mayores de 18 anos; sin restricciones en la comunicacion oral; que se someten a hemodialisis o rinon trasplantado. En el analisis de los datos se utilizo estadistica descriptiva. El proyecto de investigacion ha sido aprobado por el Comite de etica de la investigacion, Protocolo no 2011/0033. Resultados: puntuaciones de CDV de trasplantados mostraron diferencias estadisticamente significativas en seis areas: capacidad funcional, aspectos fisico social y emocionales, salud general, vitalidad, en comparacion con dialisis. Conclusion: receptores de trasplante renal tienen mejor CDV, en el estado general de salud y limitaciones en aspectos fisicos, comparados con los pacientes en dialisis. Descriptores : Calidad de Vida; Insuficiencia Renal Cronica; Hemodialisis; Trasplante de Rinon; SF-36. Normal 0 21 false false false PT-BR X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:Tabela normal; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:Calibri,sans-serif; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:Times New Roman; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Times New Roman; mso-bidi-theme-font:minor-bidi;}

Frequency-Domain Optical Coherence Tomography Assessment of Stent Constriction 9 Months After Sirolimus-Eluting Stent Implantation in a Highly Calcified Plaque

A 60-year-old man with a history of chronic renal failure in hemodialysis was admitted due to angina symptoms. Coronary angiography showed an eccentric lesion of distal unprotected left main coronary artery involving the ostium of left anterior descending artery ([Fig. 1][1]A). Frequency-domain

Cementless Bipolar Hemiarthroplasty of Hip Fracture in Patients on Hemodialysis

목적: 투석 환자의 고관절 골절에서 시행한 무시멘트 인공 고관절 반치환술의 임상적, 방사선적 결과와 합병증을 조사하였다. 대상 및 방법: 투석 환자에서 고관절 골절로 무시멘트 인공 고관절 반치환술을 시행 받은 35명, 36예를 대상으로 하였다. 임상적으로 수술 후 해리스 고관절 점수, 서혜부 및 대퇴부 통증, 정형외과 및 내과적 합병증을 조사하였고 방사선적으로 대퇴 삽입물 주위 골내성장, 삽입물의 해리, 골용해, 불유합을 조사하였다. 결과: 해리스 고관절 점수는 술 후 평균 85.7점으로 29예에서 수상 전 기능을 회복하였다. 술 후 서혜부 통증은 경도 4예, 대퇴부 통증은 경도 4예, 고도 1예였다. 정형외과적 합병증은 6예(16.7%)로 경도의 혈종 3예, 표재성 감염 2예, 탈구 1예였다. 내과적 합병증은 10예(27.8%)로 패혈증 5예, 다발성 장기 부전 2예, 소화기 궤양 천공 2예, 흡인성 폐렴 1예였다. 5예(13.9%)가 수술 후 1년 내 사망했다. 대퇴 삽입물 주위 골내성장은 스템 해리 1예를 제외한 전 예에서 일어났고, 골용해나 불유합은 없었다. 결론: 투석 환자의 고관절 골절에서 무시멘트 인공 고관절 반치환술은 중기 추시 상 양호한 결과를 보여 효과적인 치료 방법이 될 것으로 생각되나 전신상태 불량에 따른 합병증 발생에 주의를 요한다.

Successful management of chemotherapy in a stage IV ovarian cancer patient with chronic renal failure

Because the number of hemodialysis patients is increasing, chemotherapy will need to be performed on more of these patients in the future. Carboplatin is metabolized by the kidneys and excreted in the urine, so delayed excretion caused by renal dysfunction can lead to severe adverse effects. Here, we report on the successful and safe performance of chemotherapy in a hemodialysis patient with stage IV ovarian cancer, based on alteration of the dialysis time and pharmacokinetic monitoring. A 60-year-old woman on hemodialysis for chronic renal failure was referred to our hospital with a left ovarian tumor and multiple metastases. After surgery, she received adjuvant chemotherapy with paclitaxel and carboplatin on a weekly basis. Initially, hemodialysis was done the next morning (16 h after chemotherapy), and grade 3 neutropenia occurred on day 8 of her first course. Pharmacokinetic analysis revealed the persistence of a high total blood platinum concentration until the start of hemodialysis. Therefore, hemodialysis was performed only 2 h after the second course of chemotherapy. At that time, the total platinum concentration had decreased to the range found in patients with normal renal function, and adverse effects were mild. For the third to sixth courses, chemotherapy was performed safely on an outpatient basis. Her multiple metastases were eliminated by chemotherapy. At 14 months after surgery, there is no evidence of recurrence.

Effect of anticoagulant and antiplatelet agents on outcome of AV Fistula made for hemodialysis access

Background: Arteriovenous fistula (AVF) is the primary mode of achieving vascular access for hemodialysis in chronic renal failure (CRF). Because of high complication rates like thrombosis, maintenance of the fistula is a major challenge. Although antiplatelets and anticoagulants are emerging rapidly for improving the outcome of AVF but fear of bleeding, hematoma, subsequent compression of AV fistula and blockade restrict their use in many dialysis centers. Methods: Seventy five patients for whom AVF was created for hemodialysis access from Feb 2005-April 2009 in Manipal Teaching Hospital, Pokhara, Nepal were included in a retrospective study. Analysis of results was done in two different age and sex matched groups; Group I had patients where no anticoagulants or antiplatelets were used and Group II had patients in which antiplatelets/anticoagulants were used. Results: There were 27 patients in group I and 48 patients in group II. Both the groups were followed up till 2 years post operatively to check for the patency of the fistula. AV fistula was repeated in 16 cases altogether. In group II there were 5 (10%) cases of repeat fistula while in group I it was repeated in 11 (40%) cases. Conclusion: Judicious use of antiplatelet/anticoagulant agents in cases of AVF for hemodialysis access can be beneficial in preventing the chances of occlusion of AVF and thus helps in its long term patency. DOI: http://dx.doi.org/10.3126/njms.v1i2.6607 Nepal Journal of Medical Sciences. 2012;1(2): 93-6

Prevalência de diabetes mellitus em pacientes renais crônicos sob hemodiálise em Porto Alegre, Brasil

The most common cause of chronic renal failure (CRF) among patients who are starting on dialysis in developed countries is diabetes mellitus (DM), with growing rates approaching 50%. In Brazil, the available data indicate a lower prevalence, around 27%, even though it is also increasing. To estimate the prevalence of DM in the adult population of patients on hemodialysis for CRF in Porto Alegre, Brazil. Cross-sectional, descriptive, quantitative and analytical survey study on the prevalence of DM among the 1,288 patients on hemodialysis (HD) in all the 15 clinics in the city from June to July, 2009. 488 diabetic patients were identified, a prevalence of 37.9%, ranging from 21 - 75% in the different clinics of the city. The prevalence of DM among chronic HD patients in Porto Alegre is higher than what was previously published as a cause of CRF in the country, which indicates the possibility that this etiology of CRF may have been underestimated.

Abnormalities of the Small Intestine Detected by Capsule Endoscopy in Hemodialysis Patients

Many patients on hemodialysis for chronic renal failure suffer from progressive anemia. In hemodialysis patients with gastrointestinal bleeding, endoscopic examination often fails to identify hemorrhagic lesions. We surveyed hemodialysis patients with obscure gastrointestinal bleeding (OGIB) for the presence of intestinal lesions by capsule endoscopy (CE). Among 90 patients who underwent CE, 13 had hemodialysis-related anemia (8 men and 5 women, age 66.5 ± 7.9 years, Hb 8.8 ± 1.9 g/dL, mean ± SD) and 77 had non-hemodialysis anemia (47 men and 30 women, age 55.7 ± 19.9 years, Hb of 11.9 ± 3.1 g/dL). The types and distribution of hemorrhagic lesions were investigated by CE. All patients had signs or symptoms of gastrointestinal bleeding but no active bleeding site was detected by endoscopy. The CE-observed lesions were classified into reddening, erosions/ulcers, vascular lesions, and tumors. The characteristic features of each lesion and patient demographic data were compared. Vascular lesions were significantly more frequent in the hemodialysis group than in the controls (p<0.001). Reddening was observed in all patients of the hemodialysis group and mainly found in the ileum. Erosions/ulcers were observed in 4 patients (30.7%) and were more frequent in the jejunum. Vascular lesions were observed in 8 patients (61.5%) and they were more frequent in the ileum. A submucosal tumor was seen in one patient. There were no significant differences in demographic factors between patients with erosions/ulcers and those with a vascular lesion. Vascular lesions are common in anemic hemodialysis patients with OGIB and should be considered in the differential diagnosis of anemia in patients on hemodialysis with OGIB.

Retropharyngeal hematoma from parathyroid hemorrhage in a hemodialysis patient

A case of a spontaneous retropharyngeal hematoma in a patient on chronic hemodialysis is described. A 75-year-old man presented with a 5-day history of throat discomfort and neck swelling. He had been on hemodialysis for chronic renal failure with secondary hyperparathyroidism. Examination showed a massively enlarged neck and bruising on his left neck and anterior chest. Flexible nasopharyngoscopy revealed bluish bulging of the posterior pharyngeal wall, and CT showed widening of prevertebral soft tissue. Hemodialysis reduced the swelling of the posterior pharyngeal wall, and conservative management including steroids and antibiotics was adequate for managing the airway and hematoma. Retropharyngeal swelling of this patient seemed to be derived not only from the hematoma itself, but also from the lymphatic and venous congestion. Follow-up CT and MRI indicated that the enlarged left parathyroid was the bleeding source. To the best of our knowledge, this is the second report of a retropharyngeal hematoma from parathyroid hyperplasia in a chronic hemodialysis patient. Physicians should be aware that rare parathyroid hemorrhage in chronic hemodialysis patients could lead to airway obstruction by retropharyngeal swelling.

The effect of glycosylation on plasma N-terminal proBNP-76 levels in patients with heart or renal failure

ObjectivePro-brain natriuretic peptide (proBNP)-108 and N-terminal proBNP-76 (NT-BNP) contain seven sites for O-linked oligosaccharide attachment. Currently, levels of glycosylated NT-BNP are probably underestimated because it is not recognised by one...

Calciphylaxis and bilateral optic neuropathy

A 51-year-old woman on hemodialysis for chronic renal failure complained of visual loss in her right eye. Right optic disc edema was observed on fundus examination. An arteritic optic neuropathy was suspected. However, a first biopsy did not reveal any inflammatory cells. Two months later, the patient experienced sudden visual loss in her left eye and presented with necrotic cutaneous lesions at the distal phalanges of several fingers of the right hand. Necrotic lesions also appeared on the inner aspect of the thighs. Biopsy of the cutaneous lesions revealed calcification in the wall of a small artery. A new biopsy of the temporal artery showed large calcium deposits in the artery's tunica media. The diagnosis of optic neuropathy secondary to calciphylaxis was made. A temporal artery biopsy should be repeated if the first one is inconclusive. An early diagnosis leading to appropriate treatment may help to prevent an irreversible loss of vision in these patients.

Tinzaparin reduces health care resource use for anticoagulation in hemodialysis

Anticoagulation is required during hemodialysis to prevent thrombus formation within the extracorporeal circuit. The low-molecular-weight heparin tinzaparin is more expensive than unfractionated heparin (UFH) in Canada but more convenient to administer. We conducted a time-and-motion study to test the hypothesis that tinzaparin may reduce nursing time and total health care costs compared with UFH. Data on health care resource use associated with anticoagulation during hemodialysis for chronic renal failure were collected at an academic hospital in Quebec. Nursing time was recorded for 8 nurses performing 16 dialysis sessions for 4 patients receiving tinzaparin and 4 receiving UFH (2 dialysis sessions per patient). Nurses had ≥ 1 year of experience supervising hemodialysis. We estimated total annual costs of nursing time and health care resources (anticoagulants, medical supplies, and laboratory testing) associated with anticoagulation. In sensitivity analyses, drug costs were varied ± 30% of their base-case values. Estimated annual nursing times per patient were 0.8 vs. 11.5 hours in the first year and 0.6 vs. 10.2 hours in subsequent years for tinzaparin vs. UFH, respectively. Annual drug costs per patient were CAD 898.56 for tinzaparin and 546.75 for UFH. Estimated total annual costs were CAD 1061.03 vs. 1012.71 in the first year and CAD 917.75 vs. 895.23 in subsequent years for tinzaparin vs. UFH, respectively. Use of tinzaparin was cost saving relative to UFH if tinzaparin price was reduced 30%. Most of the price differential between tinzaparin and UFH is offset by substantial time savings to nephrology nurses.

Initiation of Hemodialysis in Chronic Renal Failure: Is Earlier Better?

Trends toward earlier initiation of dialysis for patients with chronic renal failure have been noted in Europe and North America. To determine whether

The Effect of Glucose Added to the Dialysis Fluid on Blood Pressure, Vasoactive Hormones and Energy Transfer during Hemodialysis in Chronic Renal Failure

Background: Previous studies showed that blood pressure was reduced in patients with chronic renal failure during hemodialysis with glucose added to the dialysis fluid. We wanted to test the hypotheses that blood pressure is reduced in non-diabetic and diabetic dialysis patients, when glucose is added to the dialysis fluid, and that blood pressure changes are caused by changes in plasma concentrations of vasoactive hormones or to vasodilation secondary to an increase in body temperature. Methods: The effect of dialysis with glucose added to the dialysis fluid was measured in three randomized, placebo-controlled, un-blinded and cross-over studies with periods of one week duration. In non-diabetic nephropathy (Study 1, n = 19) and diabetic nephropathy (Study 2, n = 15), we measured blood pressure (BP) and pulse rate (PR), plasma concentrations of glucose (p-Glucose), renin (PRC), angiotensin II (p-AngII), endothelin (p-Endot), insulin (p-Ins), glucagon (p-Glu), and human growth hormone (p-hGH). In non-diabetic nephropathy (Study 3, n = 24), we measured the effect of dialysis with glucose added to the dialysis fluid on energy transport from form the body using body temperature control. Results: Study 1 and 2 showed that BP, PRC, p-AngII, and p-Ins were unchanged, whereas P-Endot increased and P-hGH decreased, in dialysis patients with or without glucose added to the dialysis fluid. In diabetics, a marginal increase in p-Glu was measured during dialysis with glucose, but not without glucose. Study 3 showed that SBP increased significantly using dialysis with temperature control of dialysis fluid compared with no temperature control (145 versus 138 mm Hg). In parallel with the increase in SBP, the energy flux from the patients was significantly higher with temperature control than without. Conclusion: In non-diabetics and diabetics, blood pressure was unchanged during dialysis with glucose added to the dialysis fluid in a short-term study. Vasoactive hormones in plasma were changed in the same way independently of glucose in the dialysis fluid. Systolic blood pressure increased using dialysis with temperature control of dialysis fluid, presumably due to vasoconstriction to prevent or antagonize a fall in body temperature.

Quality-of-life experiences from the perspective of patients receiving haemodialysis for chronic renal failure

This study describes the experiences of patients receiving haemodialysis for chronic renal failure at the only dialysis centre in Windhoek, Namibia. A qualitative, explorative and descriptive design was used. Data were collected by means of in-depth interviews and analysed using Tesch’s process.Four themes emerged from the data, relating to (1) financial constraints, (2) loss of independence and spontaneous activities, (3) strain on relationships and (4) feelings of significant physiological changes and weakness. Based on the results, recommendations were submitted for psychosocial support and the establishment of support groups.OpsommingHierdie studie beskryf die ervarings van pasiënte wat gehemodialiseer word vir chroniese nierversaking in die enigste dialise-eenheid in Windhoek. ʼn Kwalitatiewe, verkennende en beskrywende studie is gedoen. Die data is deur middel van diepte-onderhoude ingesamel, waarna die data aan die hand van Tesch se metode geanaliseer is. Daar het vier temas uit die studie na vore gekom (1) finansiële beperkings, (2) verlies van onafhanklikheid en spontane aktiwiteite, (3) druk in verhoudings en (4) gewaarwordings van beduidende fisiologiese veranderinge en swakheid.Na aanleiding van hierdie bevindings is die daarstel van psigososiale ondersteuning asook ondersteuningsgroepe aanbeveel.

Colagenosis perforante reactiva adquirida: Caso clínico

Acquired reactive perforating collagenosis is a perforating dermatosis characterized by transepidermal elimination of collagen. It is frequently associated to diabetes mellitus and chronic renal insufficiency, but it is also related to other systemic diseases. The lesions tend to resolve once the underlying condition is treated. We report two patients with the condition. A 65 year-old diabetic female on hemodialysis consulted for multiple itching cutaneous ulcers lasting one year. On physical examination, hyperpigmented papules and nodules were observed. A 65 year-old female with chronic renal failure in hemodialysis consulted for itching lesions in hands, forearms and arms. On physical examination, hyperpigmented lesions with ulcers, erosions and crusts were observed. In both cases, the pathological study of the lesions disclosed a reactive perforating collagenosis.

Operative treatment of hip fractures in patients receiving hemodialysis

Fifteen hips in 13 patients with hip fracture were treated in patients receiving hemodialysis for chronic renal failure. There were four intertrochanteric and 11 femoral neck fractures. 10 of the 11 femoral neck fractures and one of the four intertrochanteric fractures were treated with cemented bipolar hemiarthroplasty. Two intertrochanteric fractures fixed with sliding compression screws. External fixation was used for stabilization in two patients who had femoral neck and intertrochanteric fractures. Two intertrochanteric fractures that were treated with sliding hip screw showed radiological union postoperatively at the 6th month. Of the 11 hemiarthroplasty, four hips developed aseptic loosening (36%). According to Harris hip score grading system, three (37.5%) poor, two (25%) fair, two (25%) good and one (12.5%) case had excellent outcome in the hemiarthroplasty group. The survival of dialysis patients with a hip fracture is markedly reduced. Initial treatment of hemiarthroplasty allows early mobilization and prevents revision surgery.

Avaliação dos principais fatores etiológicos em indivíduos portadores de insuficiência renal crônica em hemodiálise

Introdução: A Insuficiência Renal Crônica (IRC) caracteriza-se pela redução progressiva das funções renais. Quando seu estágio terminal se instala, torna-se necessária a instituição de alguma das modalidades de Terapia Renal Substitutiva, por exemplo, a hemodiálise (HD). Objetivo: Identificar as etiologias mais prevalentes em pacientes portadores de IRC em HD. Método: Foram analisados 80 prontuários e observados dados, tais como etnia, sexo, idade, grau de escolaridade e doença de base que evoluiu para IRC. Resultados: Do total da amostra, 72,5% eram portadores de Hipertensão Arterial Sistêmica (HAS); 32,5%, de Diabetes Melito (DM) tipo 2, e 25% apresentavam as duas patologias. Quanto à escolaridade, apenas 27,5% possuíam o Ensino Fundamental completo. Conclusão: A criação ou a drástica reformulação de campanhas que visem prevenir as complicações da HAS e do DM, sobretudo entre indivíduos com baixa escolaridade, talvez possa contribuir para a redução do número de casos de IRC, reduzindo os custos aos sistemas de saúde e, principalmente, melhorando a qualidade de vida de seus portadores, que podem prevenir ou, pelo menos, retardar a sua admissão em programas de TRS.