Hemodialysis Program Research Articles

EFIKASI DIRI DAN DUKUNGAN SOSIAL BERHUBUNGAN DENGAN KEPATUHAN HEMODIALISIS

Patients with Chronic Kidney Disease (CKD) require renal replacement therapy, one of which is Hemodialysis (HD). HD that needs to be maintained to maintain the quality of life of CKD patients. Adequate hemodialysis can be achieved by increasing adherence to HD. The purpose of this study was to determine the relationship between self-efficacy and support for hemodialysis social compliance. The research design used cross sectional with consecutive sampling. This study involved 110 respondents. Collecting data using CKD Self Efficacy questionnaire, MOS social support survey and study documentation. Data analysis using Chi-Square test. The results showed that the proportion of patients who complied with hemodialysis was 60%, there was a significant relationship between self-efficacy (p= 0.000) and social support (p= 0.002) with HD adherence. The recommendation from this study is that nurses need to improve patient self-efficacy and involve social support to improve patient compliance with the hemodialysis program.

TERAPI SPIRITUAL TERHADAP KECEMASAN DAN DEPRESI PADA PASIEN HEMODIALISIS : LITERATUR REVIEW

In the end-stage renal disease of CKD, the patients should be hemodialysis to stabilize the state of the kidney function. Increased psychological problems such as anxiety and depression resulting from CKD complications and the consequences of hemodialysis programs performed on patients. It is important for nurses to provide psychological support to patients. The application of complementary therapies such as spiritual therapy is essential. The purpose of this study was to explore various forms of spiritual therapy in hemodialysis for anxiety and depression. This study used electronic database were identified from MEDLINE, CINAHL, Proquest, and GARUDA. The criteria of the paper in this study are : articles published at 2012 – 2020, full text, the article using English or Bahasa Indonesia, and the method of study using experimental study. We extracted 6 intervention studies and critical analyzes used PICO (Population, Intervention, Comparator, Outcome) method. After applying spiritual therapy, several studies resulted in average scores of anxiety and depression that decreased in the intervention group, including Self Paced Therapy, Prayer, Dhikr, Murotal Holy Quran and Spiritual Counseling. In addition, this therapy also has a positive impact on some aspects of the patient's life include the physical and social relationships. Based on the analysis of the results some studies on CKD patients with hemodialysis therapy for anxiety and depression experienced the results obtained that spiritual therapy like include self-paced, prayer and dhikr therapy, and spiritual counselling can decrease anxiety and depression.

A cascade of care analysis on the elimination of hepatitis C from public hospitals in Madrid

BackgroundDirect-acting antivirals can cure ≥95% of hepatitis C virus (HCV) cases, but do not reach everyone in need. This cross-sectional study analyses the HCV cascade of care (CoC) in Madrid, Spain, in high-risk patients, to inform micro-elimination measures.MethodsFrom September 2019 to May 2021, data from medical records were collected and analysed from six public hospitals in Madrid, including seven adult, high-risk patient groups: patients in haemodialysis or pre-dialysis programmes, co-infected with HIV, with advanced liver disease (ALD), with hereditary haematological diseases, with transplants and people who inject drugs (PWID).ResultsHere we present an analysis of 3994 patients (68.8% male), 91.2% were tested for anti-HCV and 28.9% were positive. Of the total, 34.5% were tested for HCV–RNA and 62.4% of these were positive. Of those HCV–RNA positive, 98.0% were treatment-eligible: in 7.4%, treatment is ongoing and in 89.3% completed. Of the latter, 92.2% obtained a sustained virological response 12 weeks post treatment (SVR12). Of those with ongoing or completed treatment, 9.8% experienced loss to follow-up (LTFU) or had unknown SVR12, 50.3% developed hepatic and 20.3% extrahepatic complications. ALD patients had the highest proportion of HCV–RNA positives (32.5%). The lowest proportion of patients treated were PWID (85.2%).ConclusionsAlmost one in ten high-risk patients in six of Madrid’s public hospitals remains untested for HCV antibodies. An almost equal percentage of those untested have experienced LTFU, with the highest proportion in PWID. This approach to monitoring the HCV CoC is vital to inform measures to eliminate HCV in hospitals.

Програмний гемодіаліз у пацієнтів із полікістозом нирок й алопротезуванням мітрального та трикуспідального клапанів у періопераційному періоді: клінічний випадок

У статті подано клінічний випадок проведення замісної ниркової терапії у вигляді програмного гемодіалізу в пацієнта з полікістозом нирок і термінальною нирковою недостатністю, лікування яких здійснювалося в періопераційному періоді алопротезування клапанів серця.

Infectious outcomes of fibrin sheath disruption in tunneled dialysis catheters.

Fibrin sheath (FS) formation around tunneled central venous catheters (CVC) increases the risk of catheter-related bloodstream infections due to bacterial adherence to a biofilm. We sought to investigate whether FS disruption (FSD) at the time of CVC removal or exchange affects infectious outcomes in patients with CVC-related infections. Retrospective cohort study of 307 adult maintenance hemodialysis patients aged 18 years or older at a single center academic-based hemodialysis program (UHN, Toronto) who developed CVC-related infections requiring CVC removal or exchange between January 2000 and January 2019. Exposure was FSD at the time of CVC removal or exchange. Outcomes were infectious metastatic complications, recurrent infection with the same organism within 1 year, or death due to infection. We created a Markov Multi-State Model (MMSM) to assess patients' trajectories through time as they transitioned between states. A time-to-event analysis was performed, adjusted for clinically relevant factors. There was no significant relationship between FSD status at the time of CVC removal, the development of infectious complications in the multivariable model (adjusted HR = 0.71, 95% CI 0.09-5.80, p = 0.76), or mortality from infection (HR = 0.84, 95% CI 0.34-2.11, p = 0.73). FSD at the time of CVC removal was not associated with increased risk of infectious complications or death due to infection. Further prospective study is needed to determine whether FSD contributes to reducing CVC infectious related complications.

Efficacy of Adjusted Dose Tadalafil for Treating Erectile Dysfunction in Patients on Chronic Hemodialysis.

Although erectile dysfunction is frequently seen in hemodialysis patients, little information is documented about the efficacy of phosphodiesterase type 5 (PDE5) inhibitors and almost all the articles evaluate sildenafil. We aimed to evaluate the efficacy of chronic low dose tadalafil in this group of patients. The International Index of Erectile Function (IIEF) questionairre was administered to patients under hemodialysis program. A total of 58 patients with ED (International Index of Erectile Function (IIEF) score < 26), each having a stable partner, between 18-60 years, receiving routine outpatient HD matched the inclusion criteria and divided into two equal groups; placebo and tadalafil 5 mg/3 days. Changes of the IIEF score was recorded after one month of treatment. The mean age of the patients was 50.0±9.93 years. Duration of dialysis was 57.5(12-108) months. Hemoglobin (g/dl) and creatinin clearence (ml/Min) values of placebo and tadalafil groups were not significantly different; 10.9(8.8-14) vs 10.7(8.9-13) and 5.7±1.3 vs 6.0±1.4 respectively. There was a statistically significant increase for all subgroups related erectile dysfunction 9.28±4.17 vs 21.07±5.99 (p=0.037), intercourse satisfaction 8(3-9) vs 10(5-15) (p<0.001), orgasmic function 4(1-10) vs 8(4-10) (p<0.001), sexual desire 4(2-10) vs 7(3-9) (p<0.001) and general satisfaction 5(2-9) vs 6(2-9) (p<0.001) with low dose of tadalafil at the end of four weeks without any major side effects. There was only a significant increase in sexual desire 4(3-9) vs 6(4-10) (p<0.001),in placebo group with an insignificant change in all other IIEF domains. Total IIEF score of the placebo group was insignificantly increased from 21.13±7.73 to 21.99±7.04 (p=0.771) while there was a statistically significant increase in tadalafil group; from 20.87±8.84 to 30.75±7.04 (p<0.001). Tadalafil 5 mg once in three days is appear to be efficacious and well tolerated for the treatment of ED in hemodialysis patients.

How COVID-19 crisis influenced kidney transplant recipients in Slovakia.

The aim of our analysis was to evaluate the impact of the COVID-19 pandemic on the procurement program and kidney transplantation in Slovakia and to identify the risk factors for a severe course of COVID-19 disease, as well as the risk factors for COVID-19 fatalities, with the focus on the parameters preceding the infection. We compared morbidity and mortality from COVID-19 before and after the spread of the alpha variant of the virus and the same among transplant (KTRs) and haemodialysis patients in Slovakia. 305 KTRs (68.8 % males) with confirmed SARS-CoV-2 positivity were included in the multicentric retrospective analysis. The patients were split into subgroups based on the time of falling ill and their clinical course. The procurement program and kidney transplants in Slovakia dropped in the observed period by 28.6 % (p<0.0001) and by 33.5 % (p<0.0001) respectively. Age over 59 years (p=0.0088) and diabetes mellitus (p=0.0106) were identified as independent risk factors for severe course of the disease. Risk factors for death were the age over 59 years (p=0.0003) and graft dysfunction with CKD-EPI<0.5 mL/s (p=0.0029). The prevalence of the alpha variant in Slovakia was associated with a severe course in KTRs treated with corticoids (p=0.0273) and in graft dysfunction with CKD-EPI<0.5 mL/s (p=0.0076); the risk of death was higher in KTRs over 59 years (p=0.0173) and again with CKD-EPI<0.5 mL/s (p=0.0393). KTRs had a 3.7 times lower risk of infection compared to the haemodialysis patients (p<0.0001), with mortality of 9.8 % vs 30 % (p<0.0001). The procurement and transplant program is sustainable even during apandemic, provided that measures are set up quickly. Morbidity and mortality from COVID-19 in KTRs was comparable to the situation in EU countries. Patients in the haemodialysis program had aworse prognosis (Tab. 5, Fig. 1, Ref. 21) Keywords: COVID-19, kidney transplantation, dialysis, immunosuppression, obesity, diabetes mellitus.

ОСОБЕННОСТИ ВЕДЕНИЯ БЕРЕМЕННОСТИ У ПАЦИЕНТКИ С ТЕРМИНАЛЬНОЙ ПОЧЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ

It is known that pregnancy in women with kidney diseases, even if the kidney function is preserved, has serious problems for both the mother and the foetus. These abstracts present a clinical case of a pregnant young woman with end-stage renal disease eceiving renal replacement therapy using program hemodialysis. Introduction to hemodialysis carried out during this pregnancy.

Thyroid Function Disorders in Patients with Chronic Kidney Disease

Background: Various thyroid functional test abnormalities are commonly observed in chronic kidney disease (CKD) due to alterations in thyroid hormone synthesis, metabolism, and regulation. Objectives: The study aims at investigating the prevalence of thyroid function disorders in patients with CKD and its association with the degree of renal failure. Methods: A cross-sectional study was performed on patients with CKD, at the Nephrology unit, Hawler Teaching Hospital, Erbil, Iraq from 1 July 2020 to 31 December 2020. Demographic features such as age, sex, and body mass index (BMI) were recorded; blood tests were done, including serum-free triiodothyronine (FT3), free thyroxin (FT4), thyrotropin (TSH), and creatinine. The CKD-EPI (epidemiological) equation was used to estimate glomerular filtration rate (eGFR).The participants were classified according to their thyroid function, age, BMI, and eGFR. The association of thyroid dysfunction with gender, age, BMI, and eGFR was studied. Results: A total of 104 patients with CKD enrolled in the current study: Half of them were on conservative treatment, and the other half were on a chronic hemodialysis (HD) program. Fifty four (51.9%) of them were male, mean age was 53.99 ± 14.59 years, mean BMI was 25.19 ± 3.14 kg/m2, and most of them (63.5%) were overweight. According to eGFR classification, most of the participants (70.2%) were at stage 5 CKD, 20.2% at stage 4, and 9.6% at stage 3. From the study population, it was observed that 34 out of 104 (32.7%) participants presented with thyroid function disorders. Among them, 22 (21.2%) patients presented with subclinical hypothyroidism, seven (6.7%) had overt hypothyroidism, three (2.9%) hyperthyroidism, and two (1.9%) subclinical hyperthyroidism. Hypothyroidism (clinical and subclinical) was positively associated with increasing age and advanced CKD. Conclusion: Thyroid function disorders are common among patients with CKD. Hypothyroidism, the most prevalent one, was positively associated with increasing age, low eGFR, and in patients on HD therapy.

Temporal muscle thickness predicts mortality in prevalent hemodialysis patients.

Ultrasonographic temporal muscle thickness measurement has recently emerged as a promising method of nutritional assessment in various conditions; hence, we aimed to determine the relationship between temporal muscle thickness and mortality in prevalent hemodialysis patients. Adult patients who were on a regular in-center hemodialysis program for ≥3 months were included, and patients with severe nonrenal organ failure or any recent significant disease inception were excluded. Baseline demographic; clinical, laboratory, and anthropometric data, including malnutrition inflammation score; and outcomes data were collected using a standardized form. A total of 60 patients (32 males, diabetes prevalence: 26.6%) who met the eligibility criteria participated in the study, with a mean follow-up of 33.3±11.5 months, a median age of 66.5 (interquartile range 52.7-74) years, time on hemodialysis of 36 months, and a body mass index of 25.9 kg/m². Infections and cardiovascular events were the most common causes of overall mortality that occurred in 41.6% of the patients. Temporal muscle thickness was significantly lower in nonsurvivors (8.8 vs. 10.6 mm, p<0.001). Multivariate Cox regression analysis involving age, albumin, spKt/V, and malnutrition inflammation score revealed that temporal muscle thickness was a significant predictor of mortality (hazard ratio=0.740, p=0.035). Receiver operating characteristic curve analysis has shown 68% of sensitivity and 81.8% of specificity for a cutoff value of 9.4 mm (p<0.001). Temporal muscle thickness was weakly or mildly correlated with hemodialysis vintage, body mass index, albumin, and malnutrition inflammation score and moderately correlated with age (r=-0.536, p<0.001). Ultrasonographic temporal muscle thickness has been found as a significant predictor of mortality in prevalent hemodialysis patients. Temporal muscle thickness could be a novel marker of nutritional status and predictor of mortality; hence, further studies are warranted.

Sestrinske intervencije kod komplikacija arteriovenske fistule

Chronic kidney disease is a public health problem, not only because of its mass, but also because of its chronic and progressive course, which results in significant comorbidity and mortality. Patients need to be prepared in time for active treatment with one of the methods for replacing renal function. Hemodialysis is not possible without an adequate vascular approach, and the ideal vascular approach should enable repeated and long-term access to the circulation, high blood flow and a minimal number of complications. The most common reason for hospitalization of patients who are on a chronic hemodialysis program are complications related to the vascular approach, which leads to high treatment costs. Due to the least number of complications, arteriovenous fistula is usually the first choice compared to other vascular approaches for hemodialysis. The most common complications of arteriovenous fistula are thrombosis, stenosis and infection. The nurse should recognize the signs and symptoms of complications and participate in their care. The patient plays an essential role in the early recognition of complications, so educating the patient is vital in reacting in time and reducing the number of complications.

Factors contributing to the recovery from anemia in hemodialysis patients during the administration of recombitant erythropoietin

Introduction/Aim: Anemia is the commonest complication in patients on a chronic hemodialysis program and is the cause of reduced quality of life. The aim of this study was to identify the factors that contribute to the better control of anemia with the help of recombinant erythropoietin in persons undergoing hemodialysis. Methods: The cross-sectional study was conducted in 2017 and it included 52 persons on hemodialysis at the Clinical Center of Montenegro. The participants were divided into those, in whom hemoglobin values increased to satisfactory values (110 g/l or more) after three months of application of recombinant erythropoietin (group 1), and those, in whom hemoglobin values were lower than 110 g/l (group 2). Data were collected from the medical history of all participants. T-test was used for the statistical analysis of data. Results: After the three-month administration of erythropoietin, the target value of hemoglobin of 110 g/l or more (group 1) was achieved in only 21 patients (40.4%), while hemoglobin values were below 110 g/l in 59.6% of patients. Participants, in whom target values of hemoglobin were not achieved, received significantly higher average doses of erythropoietin and they had higher body mass index in comparison to participants, in whom the target values were achieved. There was no significant difference between the examined groups regarding the response to erythropoietin, duration of erythropoietin therapy, duration of hemodialysis, participants' age, skin-fold thickness, upper arm width, transferrin values, number of erythrocytes, value of albumin, hemoglobin, hematocrit and iron. Conclusion: Possible factors that contribute to worse control of anemia are higher doses of erythropoietin and greater level of nutritional status estimated according to the body mass index. Further research is necessary aimed at finding factors that would contribute to the elimination of anemia in persons on hemodialysis, because non-treated anemia may lead to numerous unfavorable outcomes (poor quality of life, cardiovascular diseases, cerebrovascular insult, decreased survival rate etc.).

Role of β2-microglobulin and lactoferrin in differential diagnosis of uremic pseudoperitonitis and peritonitis in patients with renal replacement therapy (program hemodialysis)

The significance of the serum concentrations of 2-microglobulin and lactoferrin of the patients on a renal replacement therapy (program hemodialysis) for differential diagnosis of uremic pseudoperitonitis and peritonitis is considered. The study included 56 patients with a suspected peritonitis, admitted urgently to the hospital, who received renal replacement therapy (programmed hemodialysis) in the history. The control group included 50 outpatients on a programmed hemodialysis. The study did not include patients with suspected peritonitis who did not receive programmed hemodialysis in the history. Serum concentrations of 2-microglobulin and lactoferrin were determined in the test groups. Serum 2-microglobulin concentration was found to be statistically higher than the normal in all the patients receiving a history of program hemodialysis procedures. The highest statistically significant concentration of 2-microglobulin was detected in patients with the suspected uremic pseudoperitonitis, both compared to the control group and the group of the patients with diagnosed peritonitis. The highest statistically significant concentration of lactoferrin was detected in patients with the suspected peritonitis receiving a history of program hemodialysis procedures, which is significantly higher both compared to the control group and the patients with a suspected uremic pseudoperitonitis. In the control group of outpatient patients receiving program hemodialysis procedures, no statistically significant differences in serum concentrations of 2-microglobulin and lactoferrin were detected. A statistically significant increase in the concentration of 2-microglobulin was found in uremic pseudoperitonitis, and lactoferrin in peritonitis. The obtained data do not exclude the possibility of using 2-microglobulin to diagnose the uremic pseudoperitonitis, and lactoferrin with a high probability makes it possible to establish the fact of peritonitis.

Humoral response to BNT162b2 mRNA COVID-19 vaccine in peritoneal and hemodialysis patients: A comparative study.

IntroductionMaintenance dialysis patients (MDP) are at higher risk of exposure with increased mortality from COVID‐19 with generalized immunization becoming the cornerstone in prevention. This study aims to compare humoral response between hemodialysis (HD) and peritoneal dialysis (PD) patients.Materials and MethodsObservational prospective study following HD and PD programs from a Portuguese Center receiving BNT162b2 vaccine. Specific anti‐Spike IgG quantification to compare both for absolute value and non‐responders (NR) between modalities and against risk factors.ResultsOf 67 MDP, 42 were HD and 25 PD patients. PD developed higher antibody titers after both first (median 5.44 vs. 0.99 AU/ml, p < 0.01) and second dose (median 170.43 vs. 65.81 AU/ml; p < 0.01). HD associated with NR after the first dose (p < 0.01).ConclusionThis study demonstrated improved humoral immunogenicity with BNT162b2 in PD compared to HD patients. These differences are attributed to comorbidity burden and age differences, rather than dialysis modality.

Pediatric renal transplantation; 10 years experience.

Although renal transplantation (RT) is the first treatment option for children with end-stage renal failure, the number of transplanted chil- dren remains low compared to adults. Experience of the individual pediatric transplant center is very important in the prognosis of pediatric transplant recipients. In this study, our pediatric RT experience was presented. We retrospectively analyzed the data of 27 patients who had RT in our clinic between April 2009 and April 2019. Fifteen of the patients were males, and mean age of all patients was 12.36 ± 4.18 years (range 4-17 years). The most frequent etiology for end- stage renal disease (ESRD) was vesicourethral reflux. Eighteen (66.7%) of the transplanted kidneys came from cadaveric donors and 9 (33.3%) from live donors. One patient had preemptive RT and one patient had a re-RT. Twenty-two patients were on peritoneal dialysis program and four patients were on hemodialysis program. Mean dialysis time before transplantation was 29 (3-104) months. Bleeding was the most common surgical complication. Delayed graft function developed in four patients, and all of their grafts were from cadaveric donors. Rejection developed in 12 of our patients, graft loss was observed in only four of them. Considering all patients, graft survival rates were 100% in the 1st and 3rd years, and 92% in the 5th year. Pediatric RT program is difficult to establish, maintain and develop. Complications after transplantation are not uncommon; therefore, early detection and appropriate management are needed. Strategies are still needed to increase post-transplant success.

Irritable Bowel Syndrome in Dialysis Patients and Symptom Check List Revised (SCL 90-R) Screening.

Irritable bowel syndrome (IBS) is a frequently seen functional bowel disease. Although not lifethreatening, it impairs quality of life and leads to economic losses. IBS symptoms are widespread in dialysis patients. Psychopathological disorders are known to increase in both IBS and dialysis patients. The purpose of this study was to investigate the prevalence of IBS, IBS-related factors, and psychopathological disorders in patients. One hundred fifty patients followed-up in hemodialysis (HD) or peritoneal dialysis (PD) programs were included in this prospective study. Patients were divided into groups with and without diagnoses of IBS based on the Rome-III diagnostic criteria. The Symptom Check List Revised (SCL90-R) test was then applied to the patients. Patients with and without IBS were compared according to the scores obtained from the questionnaire. IBS was determined in 59 (39.3%) of the dialysis patients. The prevalence of IBS was significantly higher in women (P = .030). The presence of coronary artery disease (CAD) and use of erythropoietin (EPO) were significantly higher in patients with IBS (P = .029, P = .031). Somatization, obsessive-compulsive disorder, interpersonal sensitivity, depression, anxiety, phobic anxiety, psychoticism, and additional items were also higher in patients with IBS. Subscale scores for somatization, depression, and additional parameters in dialysis patients with IBS were above the threshold values for screening. IBS is common in dialysis patients. The presence of CAD or use of EPO were frequently observed in dialysis patients with IBS, and psychopathologies in depression, somatization, and additional subparameters were also higher in these patients.

Iatrogenic scleroderma renal crisis: A case report and mini literature review for renal crisis

Background: Systemic sclerosis is a connective tissue disease characterized by fibrosis of the skin and organs, marked changes in microvascular structure, cellular and humoral immune disorders. Renal involvement is more frequent and mainly characterized by moderate proteinuria, elevated serum creatinine levels, and hypertension. The most common kidney involvement in SSc is scleroderma renal crisis (SRC) that is fatal without prompt intervention.Case report: A 52-year-old Caucasian male with known diffuse cutaneous systemic sclerosis was hospitalized with communityacquired pneumonia. On the fifth day after appropriate antibiotic therapy and 60 mg/day methylprednisolone, decreased urine output, arterial hypertension, decreased renal function and pulmonary edema developed. The patient was diagnosed with a scleroderma renal crisis. Emergency hemodialysis was applied to the patient, and captopril 6 × 25 mg/day and nifedipine 2*60 mg/day treatment were given. He received a routine hemodialysis program for about three months. The hemodialysis program was terminated when the patient’s urine quality and quantity increased.Conclusions: SRC, characterized by malignant hypertension, azotemia, microangiopathic hemolytic anemia, and kidney failure, is one of the most important complications of systemic sclerosis with a poor prognosis without prompt intervention. Steroid use is one of the important risk factors that precipitate SRC development. With angiotensin-converting enzyme inhibitors, survival increased after SRC, the need for dialysis decreased, and usually allowed the discontinuation of dialysis treatment within about 6-18 months. Suspicion of SRC in the presence of the above-mentioned findings in patients with a diagnosis or suspected systemic sclerosis can be considered the most important treatment step.

Some indicators of hemostasis and mortality from thrombotic complications in patients with CKD stage VD who were treated by programmed hemodialysis (five-year follow-up)

Annotation. Thrombotic complications in patients with stage VD chronic kidney disease (CKD), treated by program hemodialysis is one of the causes of high mortality in this category of patients; its major pathogenetic component proved to be hemostatic system disturbances characterized by systemic activation of blood clotting process leading to the development of thrombophilia. Objective – to study the biochemical molecular markers of hemostasis in patients with stage VD CKD, treated by program hemodialysis, and to determine their long-term effect on the development of thrombotic complications and mortality. The study included 88 patients (52 males and 36 females) aged 26 to 65 years with stage VD CKD, treated by program hemodialysis. The patients were followed up for five years. Soluble fibrin (sF) level was determined by two-site enzyme-linked immune-sorbent quantitative assay; D-dimer – by enzyme immunoassay using specific monoclonal antibodies to D-dimer epitopes; protein C (pC) activity in blood plasma was estimated by its activation with copperhead snake venom followed by spectrophotometry with wavelength 405 nm. Blood plasma fibrinogen was determined using thrombin-like enzyme Antsistron-H by spectrophotometry with wavelength 280 nm. Blood plasma fibrinolytic activity was evaluated by the relationship between D-dimer and soluble fibrin. Processing of materials was carried out using the methods of variation statistics and correlation analysis. During five years of follow up there were 13 deaths (14.8%), 7 among males and 6 among females, caused by thrombotic complications. The main thrombotic complications were myocardial infarction (6), ischemic stroke (4), mesenteric thrombosis (2) and disseminated intravascular coagulation syndrome (DIC) (1) (according to pathomorphological data). The patients of general group were found to have significantly increased sF level, decreased pC as compared to the control group, as well as twofold increase of fibrinogen concentration along with decreased D-dimer/sF ratio and no response of D-dimer to increased soluble fibrin level. The tendency of D-dimer/sF ratio to increase in those who died because of thrombotic complications could be indicative of microthrombosis with formation of fibrin derivatives along with mild activation of fibrinolysis. Correlation relationships between soluble fibrin and D-dimer, fibrinogen and protein C in general group were assessed, and the following data were obtained: medium direct relationship between soluble fibrin and D-dimer (r= 0.56) (p&lt;0.001), and absence of correlation with fibrinogen (r= -0.12) and protein C (r= -0.10) (p˃0.1). Besides, strong positive correlation was demonstrated between D-dimer and soluble fibrin (r= 0.87) (p&lt;0.001), and moderately negative one between D-dimer and protein C (r= -0.21) (p&lt;0.05). It should be noted that in patients with thrombotic complications, positive correlations between soluble fibrin and D-dimer become stronger (r= 0.51) (p&lt;0.001), as well as negative ones between soluble fibrin and protein C (r= -0.22) (p&lt;0.05). Depressive state of anticoagulant component along with activation of coagulation factors are supposed to be one of the indicators predicting thrombophilia in this category of patients.

“CHANGES IN THE NERVOUS SYSTEM IN PATIENTS WITH DIABETES MELLITUS TYPE 2 WITH NEPHROPATHY AND PROGNOSTIC SIGNIFICANCE OF NEUROMARKERS OF BRAIN INJURY. LITERATURE REVIEW"

THE PURPOSE OF THE STUDY is to carry out an analysis of the literature evaluating diabetic encephalopathy by determining neuromarkers.&#x0D; MATERIAL AND METHODS. In this article, the authors analyzed the literature on the role of neuromarkers in patients with type 2 diabetes mellitus undergoing program hemodialysis.&#x0D; RESEARCH RESULTS. Among biochemical markers, the determination of the level of neurospecific proteins is actively being investigated. The main part of them is autoantigens, entering the bloodstream, can cause the appearance of autoantibodies, which, when the blood-brain barrier is impaired, enter the brain from the blood vessel and cause morphological changes, destructive processes in neurons, as well as the development of nonspecific acute-phase reactions like edema or inflammation. Biomarker studies for the diagnosis of various brain lesions have been under way for more than 20 years, but at present no ideal biomarker has been found. Among biochemical markers, the determination of the level of neurospecific proteins is being actively studied. In patients with type 2 diabetes mellitus undergoing hemodialysis, this issue is also relevant in view of the frequent vascular cerebrovascular complications, but few studies have been conducted.&#x0D; CONCLUSIONS. All of the above emphasizes the need to identify the features of clinical and functional changes in the nervous system in patients with type 2 diabetes mellitus receiving program hemodialysis and to evaluate the prognostic value of neuromarkers in early detection of the degree of brain damage.

Functional impairment associated with increased severity of mental health disorders in Latin American chronic hemodialysis patients

Background: End-Stage Kidney Disease (ESKD) and associated complications are related with increased prevalence of psychological disorders. There is a growing trend of elderly and high comorbid individuals beginning chronic Hemodialysis Programs (HD) while there is limited knowledge about the influence of functional impairment and comorbidity burden in the prevalence of mental health disorders and life satisfaction on HD population. The purposes of this study were to report the local prevalence of psychological disorders, life satisfaction and self-reported health status as well to describe differences in functional status and comorbidity burden scores between patients with moderate/severe psychological disorders and those none/mild alterations of a Latin American chronic HD cohort. Methods: Transversal uni-center study in 139 Ecuadorian chronic and stable HD patients. Once patients were eligible to participate six tests were applied to explore functional status (Barthel Index and PPS score), depression, anxiety and stress prevalence (DASS-21 scale) comorbidity burden (Charlson Index), self-rated health state (EQ-5D/VAS) and satisfaction with life (SWLS score) Exclusion criteria were: Time in HD less than 6 months, recent hospitalization (less than 3 months) and severe cognitive impairment. Continuous symmetric variables were described as mean ± standard deviation or median and interquartile range if asymmetric. T-test was used for symmetric continuous variables, U-Mann-Whitney if asymmetric and chi-square for qualitative variables. Results: A total of 79 (55%) patients were male. Mean time in HD was 73 ± 47 months, with mean age 56 ± 15,7 years. Prevalence of moderate/severe mental health disorders were: depression (28%), anxiety (37%) and stress (34%). Moderate/severe depressed patients scored significatively lower in Barthel Index (p=0.048) and those with moderate/severe stress scored significatively lower in Barthel Index (p=0.025) and PPS score (p=0.030). Time in HD > 92 months was significatively related with moderate severe/anxiety (0.044). Unsatisfaction with life was found in 20% of patients and it was significatively related with lower functional Barthel Index (p=0.017) and PPS score (p=0.041) when compared with those satisfied with life. Patients with self-rated health status <70% on EQ-5D VAS scored significatively lower in Barthel Index (p=0.022) and PPS score (0.003) vs those with ≥70% score. No differences were found with age, CKD etiology, civil and laboral status. Conclusions: Prevalence of mental health disorders is similar to other series reported. Patients with moderate/severe depression, stress, unsatisfaction with life, and low self-reported health state had worst functional status than those with none/mild alterations. Time in HD over 7.6 years was associated with higher intensity of anxiety.