Iranian Hemodialysis Patients Research Articles

Farsi Version of the Body Image Concern Inventory in Iranian Hemodialysis Patients: Validity and Reliability

Background and Purpose:Patients on hemodialysis often struggle with their body image. This study was conducted with the aim of investigating the validity and reliability of the Persian version of the body image concern questionnaire for the first time in hemodialysis patients in Iran.Methods:In this cross-sectional study, 400 hemodialysis patients from Iran were assessed using the Body Image Concern Inventory (BICI). By using exploratory factor analysis (EFA; with Maximum Likelihood Factor Analysis and Promax Rotation) and confirmatory factor analysis, the construct validity of BICI was assessed. To check for internal consistency, the average interitem correlation, Cronbach’s alpha, and McDonald’s omega coefficients were used. Stability was assessed with intraclass correlation coefficient (ICC).Results:The participants’ average age was 53.2 (SD= 13.2) years, and more than half of them were women (54.60%). Four factors extracted from exploratory factor analysis (EFA) show that the total cumulative variance explained by these factors was 44.46% of the total variance. Item factor loadings varied between 0.415 and 0.970. Internal consistency coefficients were considered acceptable (>0.7). Also, stability was evaluated as good (ICC = .839).Conclusions:The Farsi version of the BICI scale as a self‐report measure of concerns about dysmorphic appearance has 19 items and shows acceptable reliability and validity. Consequently, the scale can be used by nurses to evaluate body image among Farsi-speaking hemodialysis patients, which can help them to take necessary actions to decrease the level of concerns in these patients.

Dietary acid load and markers of malnutrition, inflammation, and oxidative stress in hemodialysis patients.

The present study was conducted to examine the association between dietary acid load (DAL) and markers of inflammation, oxidative stress, and malnutrition in a group of Iranian hemodialysis (HD) patients. This cross-sectional study was performed on individuals aged ≥18 years who were on HD at least 6 months before their enrollment in the study. A 4-day dietary recall was used for the evaluation of dietary intake. DAL was calculated using two methods including potential renal acid load (PRAL) and net endogenous acid production (NEAP). For assessing the malnutrition status, we used the subjective global assessment (SGA), dialysis malnutrition score (DMS), and malnutrition inflammation score (MIS). Fasting blood samples were collected from each participant to assess serum levels of high-sensitivity C-reactive protein (hs-CRP), soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular adhesion molecule-1 (sVCAM-1), sE-selectin, malondialdehyde (MDA), nitric oxide (NO), and endothelin-1. In total, 291 patients with a mean age of 57.73 ± 0.88 years and HD vintage of 4.27 ± 0.25 months were enrolled in the current study. Significant positive associations were observed between PRAL and hs-CRP (β = 1.77, 95% CI: 0.88, 2.65), sICAM-1 (β = 83.21, 95% CI: 10.39, 156.04), sVCAM-1 (β = 194.63, 95% CI: 74.68, 314.58), and sE-selectin (β = 6.66, 95% CI: 1.81, 11.50) among participants with the highest PRAL scores, compared to those with the lowest PRAL scores. NEAP was positively correlated with hs-CRP (β = 1.34, 95% CI: 0.46, 2.22), sICAM-1 (β = 88.83, 95% CI: 16.99, 160.67), and MDA (β = 0.35, 95% CI: 0.005, 0.71). Additionally, marginally significant higher odds of SGA (OR = 1.98, 95% CI: 0.95, 4.11) and DMS (OR = 1.94, 95% CI: 0.92, 4.05) were observed in individuals in the third tertile of PRAL vs. the first tertile of PRAL. NEAP had also a marginally significant positive correlation with DMS (OR = 2.01, 95% CI: 0.93, 4.31). This study illustrates that higher consumption of acidic foods is correlated with markers of inflammation, oxidative stress, and malnutrition in HD patients.

The Effect of the Holy Quran Recitation on Inflammatory Markers in Hemodialysis Patients in Iran: A Randomized Clinical Trial.

Increased inflammation is a common complication in chronic hemodialysis (HD) patients. Addressing the psychological symptoms of patients may help reduce inflammation and its negative impact on the body. Considering the calming effects of listening to the Holy Quran, this may help reduce mental, psychological, and physical problems in Muslim patients. The present study sought to examine the effects of listening to Holy Quran recitation on the level of inflammatory markers in HD patients. This was a randomized controlled trial involving 50 HD patients at Kowsar Hospital in Semnan, Iran, in 2019-2020. The participants were divided into experimental and control groups using simple randomization by sealed envelopes. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and interleukin-6 (IL-6) levels in blood were measured before the intervention. The participants in the experimental group listened by headphones to the Holy Quran being recited three times a week, 20 min each time, for one month. For those in the control group, headphones were placed but on silent mode. At the end of the intervention one month later, inflammatory markers were measured again for participants in both groups. Data were analyzed in SPSS-16 using descriptive and inferential statistics (t test, Wilcoxon, and Mann-Whitney U). Mean IL-6 level decreased by 20.2pg/ml, mean ESR level by 16.8mm/hr, and mean CRP level by 19.9mg/dl in the experimental group, while these values increased in the control group. The between-group differences in the intervention and control groups at follow-up were significant for all three inflammatory markers (p < 0.05). Listening to the Holy Quran being recited is recommended as a complementary therapy for reducing systemic inflammation (as indicated by inflammatory markers) in Muslim HD patients.Trial registration: Iranian Registry of Clinical Trials, Trial No: IRCT20120109008665N9. Registered 4 Nov 2019.

Association between the dietary inflammatory index and markers of endothelial and systemic inflammation in hemodialysis patients.

The current survey aimed to investigate the link between energy-adjusted dietary inflammatory index (E-DII) and risk factors for CVD including markers of endothelial and systemic inflammation in Iranian hemodialysis patients. Patients on hemodialysis for at least 6 months prior to enrollment were considered eligible in this cross-sectional study. The usual dietary intakes of the hemodialysis individuals were examined through 4 non-consecutive days including 2 dialysis days and 2 non-dialysis days using a 24-h recall approach to calculate E-DII. Multiple linear regression analysis was utilized to investigate the link between E-DII and selected biomarkers of inflammation and oxidative stress including high-sensitive C reactive protein (hs-CRP), serum intercellular adhesion molecule (sICAM), serum vascular cell adhesion molecule (sVCAM), malondialdehyde, and nitric oxide (NO), sE-selectin, and endothelin-1, and beta (β) and 95% confidence interval (CI) was reported. Value of p < 0.05 was considered statistically significant. Overall, 291 hemodialysis patients make up our study population. In the crude model, the E-DII score was positively associated with a higher sVCAM-1 (β = 177.39; 95% CI: 60.51, 294.26; ptrend = 0.003). Further adjustment for potential confounders attenuated the findings in a way that an increase of 128.72 in the sVCAM-1 was observed when the E-DII score increased from -2.68 to -1.14 (95% CI: 13.50, 243.94). After controlling for potential confounders, E-DII was associated with sE-selectin in hemodialysis patients in the highest category of E-DII as compared to the lowest category (β = 4.11; 95% CI: 0.22, 8.00; ptrend = 0.039). The present findings suggest that adherence to a pro-inflammatory diet among hemodialysis patients is associated with a higher inflammatory status as evidenced by sVCAM-1 and sE-selectin; however, bidirectionality may exist and the role of residual confounders should be taken into account. Therefore, more longitudinal investigations are needed to elucidate the role of diet on the inflammatory status of hemodialysis patients.

High Prevalence of Occult Hepatitis B Virus Infection among Iranian Hemodialysis Patients.

Considering the potential risks associated with occult hepatitis B virus (HBV) infection, this study was designed to investigate the magnitude and genotypic pattern of occult HBV infection among hemodialysis patients. All patients on regular hemodialysis attending the dialysis centers located in southern Iran and 277 nonhemodialysis controls were invited to participate in this study. Serum samples were tested for detection of hepatitis B core antibody (HBcAb) and hepatitis B surface antigen (HBsAg) by competitive enzyme immunoassay and sandwich ELISA, respectively. The molecular evaluation of HBV infection was conducted by two nested polymerase chain reaction (PCR) assays, targeting S, X, and precore regions of HBV genome, and sequencing by Sanger dideoxy sequencing technology. Moreover, HBV viremic samples were tested for hepatitis C virus (HCV) coinfection by HCV Ab ELISA and seminested reverse transcriptase PCR. Of 279 hemodialysis patients, five (1.8%) were positive for HBsAg, 66 (23.7%) were positive for HBcAb, and 32 (11.5%) had HBV viremia with HBV genotype D, sub-genotype D3 and subtype ayw2. Moreover, 90.6% of the hemodialysis patients with HBV viremia had occult HBV infection. Hemodialysis patients (11.5%) had significantly higher prevalence of HBV viremia than nonhemodialysis controls (1.08%; P = 0.0001). The prevalence of HBV viremia among hemodialysis patients was not statistically associated with duration of hemodialysis, age and gender distribution. In contrast, HBV viremia was significantly associated with place of residency and ethnicity, with residents of Dashtestan and Arab having had significantly higher prevalence of HBV viremia compared with the residents of other cities and Fars patients. Notably, 27.6% and 6.9% of hemodialysis patients infected with occult HBV infection were also positive for anti-HCV antibodies and HCV viremia, respectively. High prevalence of occult HBV infection was detected in hemodialysis patients, whereas 62% of patients with occult HBV infection were negative for HBcAb. Therefore, screening of all hemodialysis patients by sensitive molecular tests, regardless of the pattern of HBV serological markers, is recommended to increase the diagnosis rate of HBV infection.

Role of self-management program based on 5A nursing model in quality of life among patients undergoing hemodialysis: a Randomized Clinical Trial

IntroductionVarious nursing models are usually employed to achieve self-management and improve the quality of life in chronic conditions. Given its person-based characteristics, the 5 A nursing model can improve the quality of life of hemodialysis patients.PurposeThis study aimed to determine the role of a self-management program based on the 5 A nursing model in the quality of life of patients undergoing hemodialysis.Materials and methodsThis clinical trial was conducted on hemodialysis patients in Iran. Random sampling was adopted to assign 60 patients to intervention and control groups. After the participants completed a demographic questionnaire and the Kidney Disease Quality of Life–Short Form (KDQOL–SF), routine measures were taken in the control group. However, the 5 A nursing model was implemented in the intervention group for three months. The self-care program was executed in face-to-face sessions or via phone calls and SMSs. After three months, the quality of life was measured again in both groups.FindingsThere were significant differences after the intervention between the intervention and control groups in specific dimensions of quality of life, such as cognitive functions, symptoms, sleep, dialysis, social support, and renal complications (P < 0.05). The two groups also had significant differences in the general scores of quality of life (P < 0.05).ConclusionThe 5 A self-management intervention as a person-based model could improve self-care in hemodialysis patients. Nurses can implement this model to mitigate care costs, enhance interventions, and improve patients’ quality of life.Trial registrationIranian Registry of Clinical Trials (IRCT20211103052955N1; 19/11/2021).

Natural Acquired Immunity Against Haemophilus influenzae Type-B in Patients Undergoing Hemodialysis Jahrom, Iran, 2022

Background: End stage renal disease (ESRD) patients who undergo hemodialysis treatment suffer from immune system disorders. The immunodeficiency of these patients makes them prone to various infections. Objectives: To investigate the prevalence of naturally acquired immunity against Haemophilus influenzae type-B (Hib) and its association with the duration of dialysis treatment, gender, and age of patients in hemodialysis patients in Jahrom city, Iran. Methods: This cross-sectional descriptive was conducted on ESRD patients undergoing hemodialysis treatment, referred to Jahrom Hemodialysis Center, June - August,2022. In order to determine the presence or absence of an immunity to Hib in the patients, the qualitative level of anti-Hib Polyribosyl-ribitol-phosphate (anti-Hib PRP) antibodies in the serum of the patients were determined using the ELISA test using a specialized commercial kit. SPSS-21 was used to analyze the data. The chi-square test, univariate and multivariable logistic regression were used for data analysis. Results: The prevalence of naturally acquired immunity to Hib in patients was 26.13% (10.22% short-term immunity, 15.91% long-term immunity). A significant relationship was found between the prevalence of long-term immunity to Hib in patients and the number of dialysis sessions three times and more per week (P &lt; 0.001). Conclusions: Considering that hemodialysis patients in Iran are not vaccinated against Hib, 26.13% prevalence of natural immunity against Hib indicates the same prevalence of Hib infection history in hemodialysis patients. A case-control study with a large sample size on hemodialysis patients is recommended to accurately determine the prevalence of Hib and to decide whether to implement a Hib vaccination program in these patients.

Development and psychometric properties evaluation of caregiver burden questionnaire in family caregivers of hemodialysis patients

BackgorundThis study aimed to design and psychometrically evaluate the caregiver burden questionnaire for family caregivers of hemodialysis patients.MethodsThis study was conducted using an exploratory sequential mixed method on family caregivers of hemodialysis patients in Iran. In the first phase, the generation of the items was done based on results of directed qualitative content analysis according to the Structural model of the caregiver burden and review of the literature. After developing the item pool, face and content validity, item analysis, structural, convergent and discriminant validity, internal consistency, reliability, interpretability, and feasibility were evaluated.ResultsThe primary tool entered the psychometric evaluation phase with 64 items. After performing face and content validity and item analysis, the number of items was reduced to 28. Exploratory factor analysis was performed with 28 items and 300 caregivers, and finally, four subscales with 21 items were developed. The results of confirmatory factor analysis indicated a good fit of the model. Cronbach's alpha and the Intraclass Correlation Coefficient of all subscales were higher than 0.7 and 0.9, respectively. The standard error of measurement was 1.39. All subscales had acceptable values in convergent validity criteria and the HTMT index less than the threshold value. The total score of the questionnaire had no ceiling and floor effect; the percentage of unanswered items was within the acceptable range.ConclusionThe results show that the caregiver burden questionnaire for caregivers of patients undergoing hemodialysis has good psychometric properties and can measure the caregiver burden in these caregivers.

Evaluation of Evidence-Based Nursing Interventions on Fatigue of Hemodialysis Patients in Iran: A Systematic Review

Introduction: Fatigue is one of the most annoying complaints reported in people undergoing hemodialysis. However, the lack of awareness of health care providers about evidence-based interventions in one hand and unavailability of information in a coherent manner on the other hand is an important barrier to taking more effective measures. Therefore, it was decided to investigate evidence-based nursing interventions on the fatigue of hemodialysis patients in Iran.&#x0D; Methods: Data collection in this systematic review study was conducted without any time limit in both Persian and English articles by searching on different databases of Iran medical articles bank such as IranDoc databases, elmnet, SID, Google scholar, Magiran, PubMed, Library Cochrane CINAHL, and Scopus. Finally, the findings of each study were entered into the data entry form as a data collection tool.&#x0D; Results: Out of 119 available articles, 25 related articles were reviewed. These studies were conducted between 2012 to 2019.Various interventions such as massage therapy, aromatherapy, care patterns, nutrition therapy, exercise and laugh therapy have been investigated to reduce the fatigue of hemodialysis patients. The results of studies on fatigue reduction have shown that all the proposed interventions can be effective in reducing the fatigue of hemodialysis patients.&#x0D; Conclusion: A look at the evidence-based interventions of various studies shows an increased tendency to control health using complementary medicine and it expresses the importance of combining complementary and clinical medicine, however, its use in hospitals has been neglected.&#x0D;

Prevalence of Restless Legs Syndrome in Iranian Patients under Hemodialysis: A Systematic Review and Meta-Analysis Study

Introduction: Recent studies have contradictory reports of the overall prevalence of restless legs syndrome in hemodialysis patients. Therefore, the aim of this study was to help eliminate ambiguity about the prevalence of restless legs syndrome in Iranian hemodialysis patients by systematic review and meta-analysis study.&#x0D; Methods: This study was performed based on PRISMA checklist. Documents were obtained from English and Persian databases such as Magiran, Sid, Medilib, Iranmedex, Irandoc, CIVILICA, ISC, Pubmed, Scopus, Springer, and Google Scholar Engine from 2000 to 2021. All reviewed articles with selection criteria were evaluated qualitatively with the STROBE checklist. Comprehensive Meta-analysis (CMA-2) software was used to analyze the data by meta-analysis random effects method.&#x0D; Results: Prevalence of restless legs syndrome in the patients under hemodialysis was estimated to be 49.6% (95% CI: 39.9-59.3) in 13 studies with 2431 Iranian samples that 62.3% of whom were men. The prevalence of this disorder was 54.2% in Iranian women (95% CI: 41.7-66.3) and 43.5% in Iranian men (95% CI: 31.6-56.3). The most and least prevalence of restless legs syndrome in hemodialysis patients was respectively in Yazd (66.4%) and in Tehran (35.3%). In addition, regression analysis showed that there was a significant relationship between sex, urban areas, sample size and age of patients with restless legs syndrome.&#x0D; Conclusion: The prevalence of restless legs syndrome is high in Iranian hemodialysis patients, which early diagnosis, prevention and treatment of this disorder in adults seems necessary.

The Effect of Emotional Disclosure by Writing on the Depression of Hemodialysis Patients in Iran: A Randomized Clinical Trial

Introduction: Depression is the most common psychological problem in patients with renal failure, and it can lead to mortality in severe cases. Effective interventions are required to promote mental health in patients on hemodialysis with various types of mental disorders. The current study aimed to evaluate the effect of emotional disclosure by writing on depression of patients on hemodialysis in Iran. Methods: This clinical trial study was carried out on 140 patients undergoing hemodialysis in hemodialysis centers of Kerman. Patients were randomly assigned into two groups of intervention and control after signing the written consent forms and completing the Depression Anxiety Stress Scale (DASS 21). The intervention group was requested to write daily the deepest emotions and intrusive thoughts within 15 to 20 minutes in four consecutive days. The control group received routine care. Then, the questionnaire was recompleted two weeks later. Finally, the data were analyzed by SPSS (version 13) using independent t-test and paired t-test. Results: The mean depression score was either moderate or high. While depression scores seemed to decrease in the intervention group after the intervention, the depression scores continued to rise following the intervention in the control group. The difference in depression scores was statistically significant between the two groups before and after the intervention. Conclusion: Emotional disclosure by writing can be effective on the level of depression in patients on hemodialysis.Simus adi omnimodipsa sam fugita dolenistiae inveles est doluptat.

Relationship Between Depression and Its Severity with Dialysis Adequacy in Hemodialysis Patients in Ahvaz Teaching Hospitals

Background: Depression is a prevalent psychological disorder among hemodialysis patients and is associated with a variety of adverse outcomes. Dialysis adequacy also affects hemodialysis patients' survival rates. Objectives: This study aimed to investigate the prevalence of depression in hemodialysis patients and its association with dialysis adequacy. Methods: In this cross-sectional study, 205 individuals undergoing hemodialysis at Ahvaz teaching hospitals in 2019 were included. The depression level was determined using the Beck Depression Inventory (BDI-II) for the participants aged below 65 years and Geriatric Depression Scale (GDS) for the patients aged above 65 years. Dialysis adequacy measures, including the Kt/V and urea reduction rate (URR), were calculated using standard formulas. Results: In this study, 60.5% of the participants suffered from depression, and the overall prevalence of depression was 54.6% in individuals aged below 65 and 67% in those aged above 65 years. Among the patients with age below 65 years, 19 persons (17.6%) were suffering from mild depression, 22 individuals (20.4%) were suffering from moderate depression, and 18 individuals (16.7%) had severe depression. Among the patients aged above 65 years, moderate depression was found to affect 45 persons (46.4%), and 20 individuals (20.6%) had severe depression. The mean values of Kt/V and URR were not significantly correlated with depression scores (P &gt; 0.05). Conclusions: Depression is a common disorder among hemodialysis patients in Iran; however, it is not significantly associated with dialysis adequacy. However, the results of studies on the relationship between depression and dialysis adequacy cannot be analyzed simply.

Evaluation of Long-term Survival and Predictors of Mortality in Hemodialysis Patients by Using Time Dependent Variables, A Single Centre Cohort Analysis.

Introduction. Despite significant improvement in End Stage Kidney Disease (ESKD) patient’s management, and better availability of dialysis for caregivers, mortality among these patients is unacceptably high. Methods. We collected the data of 751 incident hemodialysis patients from March 2004 to November 2018. Survival curves was created by using the Kaplan-Meier method. Comorbidities, as well as time-dependent values of laboratory findings, were examined as independent factors by three models of Cox regression analysis. Results. The median follow-up period was 31.7 months (1.08 to 169.28). Patient survival rates were 88%, 77%, 56%, 32%, 26% ,16% and 12%, at 1, 2, 4,6, 8, 10, 12 and 14 years of follow-up, respectively. The most common cause of mortality was cardiovascular disease. We observed lower survival rates in patients ≥ 65 years (HR = 2.684, 95% CI: 1.133 to 3.377; P 1.2 (HR = 0.743, 95% CI: 0.635 to 0.870; P < .001) and high serum creatinine level (HR = 0.842, 95% CI: 0.811 to 0.874; P < .001) showed protective effects. Conclusion. Our study showed a high survival rate in a single center cohort of hemodialysis patients in Iran. Traditional risk factors of mortality in general population, as well as indices of dialysis efficacy and general health status were the main predictors of mortality. Nationwide registries are necessary to investigate the dialysis survival rates and their predictors in our country. DOI: 10.52547/ijkd.6435

High prevalence of hepatitis E among regular hemodialysis patients in South of Iran.

Hepatitis E virus (HEV) is one of the prevalent nosocomially transmitted agents among patients on maintenance hemodialysis due to parenteral transmission of HEV and immunocompromised condition of chronic hemodialysis patients. Therefore, this study aimed to investigate prevalence, risk factors, and genotypic pattern of HEV infection among hemodialysis patients in South of Iran. All patients on maintenance hemodialysis attending the hemodialysis centers of Bushehr, Borazjan, and Genaveh cities for regular hemodialysis were enrolled in this study. Serum samples were tested for the presence of anti-HEV antibodies using ELISA kit. The serum samples were further tested for detection of HEV RNA using nested RT-PCR. Of 226 hemodialysis patients, 155 patients (68.6%, 95% CI: 62.3%-74.3%) were positive for anti-HEV IgG antibody, of which 33 patients (14.6%, 95% CI: 10.6%-19.8%) had anti-HEV IgM antibody. The prevalence of anti-HEV IgG and anti-IgM antibodies in non-hemodialysis controls were 65.1% and 9.6%, respectively. Although the hemodialysis patients had higher prevalence of HEV than the controls, the difference was not significant. All samples were negative for HEV RNA. HEV seroprevalence among hemodialysis patients was not significantly associated with place of residency, ethnicity, level of education, gender distribution, hemodialysis duration, and levels of liver enzymes. HEV seropositive patients had significantly higher mean age compared to seronegative patients. This study reports the highest seroprevalence of HEV among hemodialysis patients in Iran. Inapparent HEV infection in the dialysis setting calls for regular screening of hemodialysis patients regardless of the hemodialysis duration, clinical symptoms, and liver function parameters.

Causes of Delay in Establishing Permanent Vascular Access in Hemodialysis Patients in Iran

Causes of Delay in Establishing Permanent Vascular Access in Hemodialysis Patients in Iran

The Efficacy and Safety of Sofosbuvir/Daclatasvir Fixed-Dose Combination in Iranian Hemodialysis Patients with Hepatitis C Virus Infection

Background: Although several regimens have been approved for the treatment of hepatitis C virus (HCV) infection, sofosbuvir-based regimens are not approved for the treatment of HCV infection in patients with severe renal impairment. Methods: This study was conducted on hemodialysis patients infected with HCV. The patients received a constant dose of sofosbuvir/daclatasvir (SOF/DCV). Sustained virologic response (SVR) was evaluated 12 weeks after completion of treatment. Results: Fifty-one hemodialysis patients with HCV infection were selected and treated with a combination of SOF/DCV. Eleven patients expired during the anti-HCV treatment due to causes not related to liver disease or antiviral therapy. Finally, 40 patients finished the treatment, and 36 cases were evaluated for SVR. Among those tested for SVR, 35 (97.2%, 95% CI: 85.5 - 99.9%) achieved SVR and one (2.8%, 95% CI: 0.1 - 14.5%) relapsed. No patient reported severe adverse events. Conclusions: The combination of SOF/DCV showed great efficacy and safety in hemodialysis patients with severe renal impairment and chronic HCV infection.

Prevalence of Hepatitis Delta Virus in Hemodialysis Patients with Hepatitis B Virus in Benghazi, Libya as Starting Point

Hepatitis delta virus (HDV) is a subviral satellite RNA virus. It is consisting of approximately 1700 nucleotides long genomic circular RNA with one open reading frame encoding for two proteins (small delta antigens (HDAg-S) and large delta antigens (HDAg-L) coated with Hepatitis B virus (HBV) surface antigen (HBsAg). HDV was discovered in 1977 in an Italian patient who had chronic HBV infection. HDV infection is of particular concern in hemodialysis (HD) units due to HD patient’s segregation into groups, lack of HDV diagnosis, irreversible complications of the infection, and controversial treatments. Several different studies were conducted in different parts of the world to explore the prevalence HDV in HD patients. The prevalence was ranging from zero to 58%. In France HDV infection in chronic HD and kidney transplant patients was zero. HDV antibody was detected in 1.7% of HD and renal transplantation patients in Brazil. In Khartoum State, Sudan prevalence of HDV among hepatitis B patients on HD was 13.3%. The prevalence of HDV in HD patients in Iran was 44.5%. HDV antibody was positive in 58% of the HD patients in Menoufiya, Egypt there is no study so far conducted on the prevalence of HDV in HD patients in Libya. The aim of this study was to call for medical personal managing HD units to apply new restriction rolls in managing their work environments for the wellbeing of their patients.

Estimating the Loss in Expectation of Life and Relative Survival Rate among Hemodialysis Patients in Iran.

Background: Information regarding the prognosis and burden of diseases can be used by policymakers to determine competing health priorities. We aimed to assess the Relative Survival Rate (RSR) and loss of expectation of life (LEL) to evaluate the prognosis and burden of diseases in Hemodialysis (HD) patients. Study design: A retrospective cohort study. Methods: We recruited 648 HD patients referred to three referral centers in Kerman City, Iran, from 2008 to 2019. RSR, was defined as the ratio of the observed and the expected survival rates of general population for persons of the same age and sex as patients in the current study. LEL was determined as the difference between corresponding life expectancies (LE). The extended Cox proportional hazard model was used to identify variables associated with the outcome. Results: Variables associated with outcome were diabetic status and age. In the 5th year of the follow-up study, the overall RSR was 0.57. In general, for HD patients, the estimation of LE and LEL was 22.6 and 12.36 year, respectively. Conclusion: HD patients, especially older patients, showed a very poor prognosis, with a large amount of lost life expectancy. Therefore, they need more care and attention from health authorities. It is suggested to estimate the cost of eliminating the risk factors causing kidney diseases.

Development, reliability and validity of health action process approach questionnaire for predicting treatment adherence among Iranian hemodialysis patients

Introduction: End-stage renal disease (ESRD) is an advanced stage of chronic kidney disease requiring hemodialysis (HD). The long-term efficacy of HD in ESRD patients highly depends on treatment adherence. Objectives: This study aimed to validate the health action process approach (HAPA) questionnaire to predict treatment adherence in HD patients. Patients and Methods:This cross-sectional study was conducted in teaching hospitals in Shiraz during 2018. A total of 220 patients with ESRD under HD were selected using convenience sampling method. Furthermore, the validity, clarity, and comprehensiveness of the questionnaire were validated by a group of patients and experts. Then the exploratory factor analysis (EFA) was performed, and the reliability was determined using Cronbach’s alpha. Internal consistency was assessed using test-retest method (one-month interval) and calculating intra-class correlation coefficient (ICC) index. Results: Content validity index (CVI) and content validity ratio (CVR) were obtained 0.98 and 0.95 respectively indicating adequate content validity. Six constructs (risk perception, action self-efficacy, behavioral intention, planning, maintenance self-efficacy and recovery self-efficacy) were extracted using EFA. These constructs explained 51.4% of total variance. The Cronbach’s alpha of different constructs ranged from 0.68 to 0.82. Furthermore, the ICC ranged from 0.67 to 0.78 indicating an acceptable internal consistency. Conclusion: The HAPA questionnaire is a valid and reliable tool for assessing treatment adherence in HD patients. Further studies are recommended on larger sample sizes and other Iranian populations.

The effect of a care plan based on the Roy adaptation model on general health in hemodialysis patients; a randomized controlled clinical trial

Introduction: Evidence suggests that end-stage renal disease (ESRD) significantly affects general health in the patients, causing their general health to be poorer compared to the general population. The Roy adaptation model (RAM) is the best one for ESRD patients. Objectives: The present study aimed to determine the effect of a RAM-based care plan on general health in hemodialysis patients. Patients and Methods: This randomized controlled clinical trial conducted on 60 hemodialysis patients in Iran. The data collected using a demographic questionnaire and the general health questionnaire-28 (GHQ-28). In the intervention group, the Roy assessment form was completed and the RAM-based care plan was then trained in four group sessions over 4 weeks. Individual sessions were also held if required and patients followed-up for 2 weeks. The control group received only routine care. At the end of the follow-up, general health was re-assessed in the patients. The findings were analysed using t test, the chi-square test and the McNemar test. Results: Despite observing no significant differences between the two groups in terms of general health levels before the intervention (P=0.530), the difference was significant after the intervention (P=0.028), since the mean score of general health decreased by 4.07 in the intervention group compared to before the intervention (P=0.003). The intervention significantly affected the subscales of somatic symptoms (P=0.013), anxiety and insomnia (P=0.006), social dysfunction (P=0.016) and depression (P=0.031). Conclusion: The findings suggested the positive effects of using the RAM on general health in hemodialysis patients. The RAM is therefore recommended that be used as a holistic care approach to improving general health in these patients