Hemodialysis Unit Research Articles

Investigating overall health and life quality of patients undergoing dialysis in chronic dialysis units

Background: Dialysis patients experience intense psychological and emotional changes and symptoms that affect their daily quality of life. Aim: The aim of this study is to investigate the factors affecting the overall health and life quality of patients undergoing dialysis. Methods and Material: This cross-sectional study involves 49 patients undergoing dialysis, during June and August of 2019 in the hemodialysis units in Athens. Intentional sampling was used as the sampling method and the research tool was the questionnaire (KDQOL-SF ™ –2009). IBMSPSS 25.0 was used for data analysis. Frequency distributions were calculated, 95% confidence intervals with bootstrap techniques, while the non-parametric rho-Spearman correlation coefficients of the KDQOL-SF subscales were also calculated and followed by multiple linear regressions of the Total Health Scale that determine the quality of life. Results: The most important and positive findings regarding the quality of life of the participants were the social support the patients received 57.1%, the encouragement from the staff of the nephrology department 44.9%, the cognitive function 82.4%, and patients satisfaction 84.3%, while work status 16.3%, pain 64,4%, sexual function 37%, the physical function 58.8%, scored the worst results. Scores representing the emotional well-being of the patient, a value closely related to the quality of life, were moderate. Conclusions: The present study shows the need for intervention planning for patients with ongoing monitoring, as well as creative employment and work programs to achieve an improvement in their overall health and quality of life.

Infection Control Practices in In-Center Hemodialysis Units During Wave 1 of the COVID-19 Pandemic in Ontario, Canada: Research Letter.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a virus that caused coronavirus disease 2019 (COVID-19), the multisystem disease central to the COVID-19 pandemic. As patients receiving in-center maintenance hemodialysis require treatment 3 times weekly, they were unable to fully isolate. It was important for in-center hemodialysis units to implement robust infection control practices to ensure patient safety and minimize risk of transmitting SARS-CoV-2 among patients and staff. There are 27 renal programs within Ontario, Canada, providing care for about 9000 people across about 100 in-center hemodialysis units. These units are funded by the Ontario Renal Network (ORN), which is part of the provincial agency Ontario Health. The objective was to track infection control practices that were implemented by in-center hemodialysis units and be able to provide a descriptive narrative of the COVID-19 pandemic response of Ontario's hemodialysis units between March and September 2020. Between May and September 2020, data were collected from Ontario's 27 renal programs on the implementation of key infection control practices, including symptom screening, use of personal protective equipment, testing, practices specifically related to patients from congregate living settings, other prevention practices, and outbreak management. There were 4 data collection cycles, each approximately 1 month apart. The results were compiled and shared across the province, and infection control practices were also discussed at provincial COVID-19 teleconferences hosted by the ORN. By March 2020, all but one renal program had implemented one or more forms of symptom screening, all renal programs had implemented physical distancing in waiting rooms and restricted visitors, and 74% of renal programs had implemented universal masking for all staff. By April 2020, 89% of renal programs had implemented universal masking for all patients, 52% had implemented enhanced contact and droplet precautions for suspected or positive cases, and 59% of renal programs tested all patients from congregate living settings regularly (with a low symptom threshold for testing). Infection control practices became more homogeneous across renal programs over time, and most practices were in place as of the last data collection. The renal system in Ontario was able to respond quickly within the first 2 months of the pandemic to minimize the spread of COVID-19 within in-center hemodialysis units. Through provincial teleconferences, infection control practices were shared across the province as the pandemic and hemodialysis unit responses evolved. This supported renal programs to advocate locally if their hospital was lagging in practices felt to be of value in other hemodialysis units. Although no direct correlation can be made regarding the implementation of infection control practices within in-center hemodialysis units and the number of COVID-19 cases in this population, the limited number of outbreaks in hemodialysis units may have been influenced by the proactive response of renal programs. Practices described in this article may support management and response to subsequent waves of COVID-19 or future similar infectious diseases.

Fungal identification in the air and water of a hemodialysis unit in Brazil.

The presence of fungi in healthcare settings, including hemodialysis units, represents a significant risk for immunocompromised patients. This study aimed to investigate the occurrence of fungi in the air and water of a hemodialysis unit located in a tertiary public hospital in Maceió, Alagoas, Brazil. Over a period of three consecutive months, monthly air samples were collected and analyzed using the spontaneous sedimentation technique on Petri dishes containing Sabouraud Dextrose Agar (SDA). Simultaneously, water samples (100 mL) were collected from four specific water distribution points and subjected plating on SDA. Fungi were phenotypically identified based on their macroscopic and microscopic characteristics. In total, 498 colony-forming units (CFUs) of fungi were isolated, with 86 CFUs originating from the air and 412 CFUs from the water. Regarding the water samples, a higher concentration of fungal CFUs was observed in the potable water from the supply network (229 CFUs). Unexpectedly, 23 CFUs were identified in the reverse osmosis samples and 11 CFUs in the storage tank, which are post-treatment points where the presence of microorganisms is not desired. The fungus Cladosporium spp. was the most prevalent in both air and water samples, followed by Penicillium spp. in the air and Rhodotorula spp. in the water. These findings underscore the need to implement effective control and monitoring measures for fungi in the hemodialysis unit to ensure patient safety.

From Alpha to Omicron: anatomy of the SARS-CoV-2 pandemic in an outpatient haemodialysis unit in Johannesburg, South Africa

Background Recipients of kidney replacement therapy are more susceptible to severe disease and mortality from SARS-CoV-2 infection. We evaluated disease kinetics and clinical outcomes across four COVID-19 outbreak waves in the haemodialysis unit of a tertiary-level hospital in South Africa.

Perceptions of Teamwork and Knowledge Attitudes of Hemodialysis Unit Nurses on Infection Prevention.

The Nurses of Hemodialysis Units: it is necessary to face HAIs (hospital-acquired infections) as a "well-tuned" teamwork. The aim of this study was to investigate the perceptions of the teamwork as well as the knowledge attitudes of the nurses of hemodialysis units on infection prevention in Greece. A cross-sectional survey was conducted with a sample of 1018 HCWs (health care workers) of hemodialysis units in Greece. The questionnaires used were: Teamwork Perceptions Questionnaire (T-TPQ) TeamSTEPPS®-Instructor Manual, and questionnaire APPENDIX A. The majority of them were nurses (69.45%) and nurse assistants (23.87%). About teamwork perceptions per factor, we observed uniformity in their responses with very high rates of agreement. The attitudes of nurses of hemodialysis units on the prevention of infections were distinguished in particularly high rates of compliance with a high perception of the risk of transmission of infections with better compliance being that of women. Also, women seem to be more knowledgeable about diseases that mostly affect the pediatric population. It seemed that level of knowledge between the two sexes did not differ regarding HBV (63.16% vs. 66.71%, p=0.430), HCV (63.91% vs. 66.71%, p=0.553), HIV infection (78.95% vs. 81.76%, p=0.471), and influenza (55.64% vs. 59.61%, p=0.394). This study highlighted for the first time the high level of perceptions of teamwork of the HCWs of the hemodialysis units in Greece. It is recommended to investigate the correct application of prevention measures and to detect the causes of deviation from good practices with subsequent investigations on hemodialysis units of Greece.

Electronic Decision Support for Deprescribing in Patients on Hemodialysis: Clinical Research Protocol for a Prospective, Controlled, Quality Improvement Study.

Patients on dialysis are commonly prescribed multiple medications (polypharmacy), many of which are potentially inappropriate medications (PIMs). Potentially inappropriate medications are associated with an increased risk of falls, fractures, and hospitalization. MedSafer is an electronic tool that generates individualized, prioritized reports with deprescribing opportunities by cross-referencing patient health data and medications with guidelines for deprescribing. Our primary aim was to increase deprescribing, as compared with usual care (medication reconciliation or MedRec), for outpatients receiving maintenance hemodialysis, through the provision of MedSafer deprescribing opportunity reports to the treating team and patient empowerment deprescribing brochures provided directly to the patients themselves. This controlled, prospective, quality improvement study with a contemporary control builds on existing policy at the outpatient hemodialysis centers where biannual MedRecs are performed by the treating nephrologist and nursing team. The study takes place on 2 of the 3 outpatient hemodialysis units of the McGill University Health Centre in Montreal, Quebec, Canada. The intervention unit is the Lachine Hospital, and the control unit is the Montreal General Hospital. A closed cohort of outpatient hemodialysis patients visit one of the hemodialysis centers multiple times per week for their hemodialysis treatment. The initial cohort of the intervention unit includes 85 patients, whereas the control unit has 153 patients. Patients who are transplanted, hospitalized during their scheduled MedRec, or die before or during the MedRec will be excluded from the study. We will compare rates of deprescribing between the control and intervention units following a single MedRec. On the intervention unit, MedRecs will be paired with MedSafer reports (the intervention), and on the control unit, MedRecs will take place without MedSafer reports (usual care). On the intervention unit, patients will also receive deprescribing patient empowerment brochures for select medication classes (gabapentinoids, proton-pump inhibitors, sedative hypnotics and opioids for chronic non-cancer pain). Physicians on the intervention unit will be interviewed post-MedRec to determine implementation barriers and facilitators. The primary outcome will be the proportion of patients with 1 or more PIMs deprescribed on the intervention unit, as compared with the control unit, following a biannual MedRec. This study will build on existing policies aimed at optimizing medication therapy in patients undergoing maintenance hemodialysis. The electronic deprescribing decision support tool, MedSafer, will be tested in a dialysis setting, where nephrologists are regularly in contact with patients. MedRecs are an interdisciplinary clinical activity performed biannually on the hemodialysis units (in the Spring and Fall), and within 1 week following discharge from any hospitalization. This study will take place in the Fall of 2022. Semi-structured interviews will be conducted among physicians on the intervention unit to determine barriers and facilitators to implementation of the MedSafer-supplemented MedRec process and analyzed according to grounded theory in qualitative research. Deprescribing can be limited due to nephrologists' time constraints, cognitive impairment of the hemodialyzed patient stemming from their illness and complex medication regimens, and lack of sufficient patient resources to learn about the medications they are taking and their potential harms. Electronic decision support can facilitate deprescribing for the clinical team by providing a nudge reminder, decreasing the time it takes to review and effectuate guideline recommendations, and by lowering the barrier of when and how to taper. Guidelines for deprescribing in the dialysis population have recently been published and incorporated into the MedSafer software. To our knowledge, this will be the first study to examine the efficacy of pairing these guidelines with MedRecs by leveraging electronic decision support in the outpatient dialysis population. This study was registered on Clinicaltrials.gov (NCT05585268) on October 2, 2022, prior to the enrolment of the first participant on October 3, 2022. The registration number is pending at the time of protocol submission.

Discrete-event simulation for outpatient flow and emergency patient arrival in a haemodialysis unit

Emergency cases among dialysis patients are uncertain and if these patients failed to obtain treatment within allocated treatment, it might risk their health conditions. In relation to that, we would like to accommodate outpatients together with the emergency patients in patient scheduling problem. Discrete-event simulation is used to estimate the outpatients flow based on the mean arrival rate, λ. A modified integer linear programming model is presented in this paper which highlighted on the patients' arrival time, patients' departure time and bed availability for emergency case. A rescheduling algorithm is also presented to accommodate existing outpatients and emergency patients. The results show that by rescheduling the existing outpatients and emergency patients in the system, there is no delaying for the outpatients' dialysis treatment. Hence, the emergency patients are able to accommodate in the system.

Self-efficacy and adherence to medication and fluid restriction among patients undergoing hemodialysis

Background Self-efficacy is the confidence in one's ability to overcome barriers and perform a given task such as taking one's medications and restrict the intake of fluids to attain the desired health outcomes for patients undergoing hemodialysis (HD). Aim To determine the relationship between self-efficacy and adherence to medication and fluid restriction among patient undergoing HD. Design A descriptive correlational design was used. Sample A purposive sample of 116 adult male and female patients undergoing HD was recruited. Setting The study was conducted at the HD unit in Kom Hamada Specialized Hospital affiliated to Ministry of Health. Tools Four tools were used to collect data: Demographic and Medical Form, Morisky Medications Adherence Questionnaire, Self-Efficacy Scale, and Fluid Control in Hemodialysis Patients Scale. Results The mean age of patients under the study was 52.5±13.7 years. A positive correlation was found between fluid control and self-efficacy (r=0.23; P=0.01). Medication adherence among HD patients was low, with a mean of 7.4±2.3. Conclusion There was an inverse correlation between self-efficacy and medication adherence. A statistically significant positive correlation was found between fluid control and self-efficacy. Recommendations Periodic counseling and educational sessions among HD patients can improve confidence and adherence to medication and fluid restriction.

Single-Centre Descriptive Epidemiological Study of Emergency Haemodialysis Patients in the Haemodialysis Unit of the CHU Point G (Mali)

Single-Centre Descriptive Epidemiological Study of Emergency Haemodialysis Patients in the Haemodialysis Unit of the CHU Point G (Mali)

Determination of the relationship between self-care agency and sleepiness in chronic hemodialysis patients.

This study was conducted to determine the relationship between self-care agency and sleepiness in chronic hemodialysis patients. The study was conducted with 75 patients with chronic renal failure in the hemodialysis unit of a training and research hospital in our country. In the descriptive study, the data were collected through a face-to-face questionnaire. The IBM SPSS Statistics 22.0 program was used to evaluate the data. It was determined that there was no significant relationship between self-care agency and sleepiness total scores in chronic hemodialysis patients (p>0.05) and a significant relationship between sleepiness and drug use compliance and mental status in female patients and between diet compliance and sleepiness in patients younger than 52 years of age (p<0.05). As a result, it was observed that there was no relationship between self-care agency and sleepiness in chronic hemodialysis patients. We think that working with a larger sample group can lead to clearer results.

Alignment Among Patient, Caregiver, and Health Care Provider Perspectives on Hemodialysis Vascular Access Decision-Making: A Qualitative Study.

Updates to the Kidney Disease Outcomes Quality Initiative Clinical Practice Guideline for Vascular Access emphasize the "right access, in the right patient, at the right time, for the right reasons." Although this implies a collaborative approach, little is known about how patients, their caregivers, and health care providers engage in vascular access (VA) decision-making. To explore how the perspectives of patients receiving hemodialysis, their caregivers, and hemodialysis care team align and diverge in relation to VA selection. Qualitative descriptive study. Five outpatient hemodialysis centers in Calgary, Alberta. Our purposive sample included 19 patients receiving maintenance hemodialysis, 2 caregivers, and 21 health care providers (7 hemodialysis nurses, 6 VA nurses, and 8 nephrologists). We conducted semi-structured interviews with consenting participants. Using an inductive thematic analysis approach, we coded transcripts in duplicate and characterized themes addressing our research objective. While participants across roles shared some perspectives related to VA decision-making, we identified areas where views diverged. Areas of alignment included (1) optimizing patient preparedness-acknowledging decisional readiness and timing, and (2) value placed on trusting relationships with the kidney care team-respecting decisional autonomy with guidance. Perspectives diverged in the following aspects: (1) differing VA priorities and preferences-patients' emphasis on minimizing disruptions to normalcy contrasted with providers' preferences for fistulas and optimizing biomedical parameters of dialysis; (2) influence of personal and peer experience-patients preferred pragmatic, experiential knowledge, whereas providers emphasized informational credibility; and (3) endpoints for VA review-reassessment of VA decisions was prompted by access dissatisfaction for patients and a medical imperative to achieve a functioning access for health care providers. Participation was limited to individuals comfortable communicating in English and from urban, in-center hemodialysis units. Few informal caregivers of people receiving hemodialysis and younger patients participated in this study. Although patients, caregivers, and healthcare providers share perspectives on important aspects of VA decisions, conflicting priorities and preferences may impact the decisional outcome. Findings highlight opportunities to bridge knowledge and readiness gaps and integrate shared decision-making in the VA selection process.

The Feasibility of a Transitional Care Unit for Patients Newly Started on In-Center Hemodialysis: A Research Letter.

Patients with end-stage kidney disease face high mortality and morbidity after dialysis initiation. Transitional care units (TCUs) are typically 4- to 8-week structured multidisciplinary programs targeted toward patients starting hemodialysis during this high-risk time in their care. The goals of such programs are to provide psychosocial support, provide dialysis modality education, and reduce risks of complications. Despite apparent benefits, the TCU model may be challenging to implement, and the effect on patient outcomes is unclear. To assess a newly created multidisciplinary TCUs' feasibility for patients newly started on hemodialysis. Before-and-after study. Kingston Health Sciences Centre hemodialysis unit in Ontario, Canada. We considered all adult patients (age 18+) who initiated in-center maintenance hemodialysis eligible for the TCU program, although patients on infection control precautions and evening shifts were not able to receive TCU care due to staffing limitations. We defined feasibility as eligible patients completing the TCU program in a timely fashion without additional need for space, no signal of harm, and without explicit concerns from TCU staff or patients at weekly meetings. Key outcomes at 6 months included mortality, proportion hospitalized, dialysis modality, vascular access, initiation of transplant workup, and code status. The TCU care consisted of 1:1 nursing and education until predefined clinical stability and dialysis decisions were satisfied. We compared outcomes among the pre-TCU cohort who initiated hemodialysis between June 2017 and May 2018, and TCU patients who initiated dialysis between June 2018 and March 2019. We summarized outcomes descriptively, along with unadjusted odds ratios (ORs) and 95% confidence intervals (CIs). We included 115 pre-TCU patients and 109 post-TCU patients, of whom 49/109 (45%) entered and completed the TCU. The most common reasons for not participating in the TCU included evening hemodialysis shifts (18/60, 30%) or contact precautions (18/60, 30%). The TCU patients completed the program in a median of 35 (25-47) days. We observed no differences in mortality (9% vs 8%; OR = 0.93, 95% CI = 0.28-3.13) or proportion hospitalized (38% vs 39%; OR = 1.02, 95% CI = 0.51-2.03) between the pre-TCU cohort and TCU patients. There was also no difference in use of home dialysis (16% vs 10%; OR = 1.67, 95% CI = 0.64-4.39), non-catheter access (32% vs 25%; OR = 1.44, 95% CI = 0.69-2.98), initiation of transplant workup (14% vs 12%; OR 1.67; 95% CI = 0.64-4.39), and choosing "do not resuscitate" (DNR) orders (22% vs 19%; OR = 1.22, 95% CI = 0.54-2.77). There was no negative patient or staff feedback on the program. Small sample size and potential for selection bias given inability to provide TCU care for patients on infection control precautions or evening shifts. The TCU accommodated a large number of patients, who completed the program in a timely fashion. The TCU model was determined to be feasible at our center. There was no difference in outcomes due to the small sample size. Future work at our center is required to expand the number of TCU dialysis chairs to evening shifts and evaluate the TCU model in prospective, controlled studies.

Monitoring the microbiological quality of dialysis water: a case study in selected hemodialysis units in Amman, Jordan before and during COVID-19 pandemic

Monitoring the microbiological quality of dialysis water: a case study in selected hemodialysis units in Amman, Jordan before and during COVID-19 pandemic

Effect of predialysis fluid overload on sleep quality in hemodialysis patients

Background Sleep disorders are common among end-stage renal disease patients undergoing hemodialysis (HD). The etiology of sleep disorders in these patients is known to be multifactorial. However, the role of hydration status in sleep disorders in HD patients is not well studied. Therefore, our aim was to study the effect of predialysis fluid overload on sleep quality in HD patients. Patients and methods This cross-sectional study included 100 prevalent HD patients from the HD unit of El Sahel Teaching Hospital. Fluid status and fluid compartments [total body water), extracellular water (ECW),and overhydration (OH) index] were analyzed by a portable whole-body bioimpedance spectroscopy (body composition monitor) before a mid-week dialysis session. OH was defined as OH/ECW% more than or equal to 15%. HD patients were then classified into two groups: group 1 (normohydrated) and group 2 (overhydrated) according to the relative OH index (OH/ECW%). Sleep quality was assessed in all patients by the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Patients with concurrent diagnosis of either obstructive sleep apnea or psychiatric disorder and patients on any medications that affect the sleep pattern were excluded. Results Our study included 100 HD patients (49 male, 51 female; mean age, 49.3 ± 11); 42 (42%) patients had OH (i.e. group 2). Poor sleep quality (defined as PSQI score ≥5) was reported in 57% (n=57) of HD patients included in our study. Poor sleep quality was significantly higher in the HD patients with OH (group 2). Total PSQI scores were significantly higher in overhydrated patients (group 2) compared with normohydrated patients (group 1) (7.92 ± 3.32 vs. 4.83 ± 2.27, P≤0.001). The component scores 1, 2, 3, 4, 6, and 7 of the PSQI showed significant higher values (i.e. poor sleep quality) in overhydrated patients (group 2). Moreover, there was significant positive correlation between total PSQI score both of OH (r=0.259, P=0.009) and OH index (OH/ECW%) (r=0.283, P=0.004) in all HD patients included in the study. Conclusion We may conclude from our study that sleep disorders are prevalent in HD patients. Predialysis fluid overload in HD patients may be associated significantly with poor sleep quality.

Low Lean Tissue Index and Muscle Strength Combined with High Fat Tissue Index Are Associated with Cardiovascular Disease-Related Hospitalisation in Patients on Haemodialysis

Introduction: The combined clinical impact of muscle mass, muscle function, and adipose mass on hospitalisation events, especially those that have exact causes, such as cardiovascular diseases (CVDs), had been rarely studied in patients on haemodialysis (HD). This study aimed to determine the influence of lean tissue index (LTI), fat tissue index (FTI), and hand grip strength (HGS) on the risk of CVD-related hospitalisation in patients undergoing chronic HD. Methods: This multi-centre observational study enrolled a total of 2,041 clinically stable patients aged >18 years and who had undergone HD for at least 3 months at 17 HD units in 2019. The follow-up period was up to 2 years. LTI and FTI were assessed using a body composition monitoring machine, and HGS was measured by a CAMRY® dynamometer. Cox regression models were fit to estimate the associations of body composition and HGS with CVD-related hospitalisation risk. Results: During a mean follow-up of 22.6 months, CVD-related hospitalisation occurred in 492 patients. Compared with the non-CVD group, patients with CVD-related hospitalisation were older; had lower diastolic blood pressure; were more likely to have a history of diabetes; had worse activity status scores and lower levels of LTI, HGS, serum uric acid, and serum creatinine; and had higher FTI levels, body mass index, and extracellular water/intracellular water ratio. In the Cox regression models, low LTI and high FTI were independently associated with CVD-related hospitalisation in both men and women. In men, low HGS was an independent risk factor for CVD-related hospitalisation. When patients were further stratified into four distinct groups according to the sex-specific median values of LTI and FTI, the combination of low LTI and high FTI was an independent risk factor for CVD-related hospitalization (hazard ratio [HR] = 1.79 in men, 95% confidence interval 1.26–2.55; HR = 2.48 in women, 95% confidence interval 1.66–3.71; reference: high LTI/low FTI group). Conclusions: Among patients on chronic HD, low LTI, and high FTI were associated with CVD-related hospitalisation in men and women, whereas HGS was an independent risk factor for CVD-related hospitalisation in men but not in women. Combining low LTI and high FTI increased the association with hospitalisation risk and was an independent predictor of CVD-related hospitalisation.

Relationship between Dialysate Bicarbonate Concentration and All-Cause Mortality in Hemodialysis Patients

Introduction: The optimal dialysate bicarbonate concentration (DBIC) for hemodialysis (HD) remains controversial. Herein, we analyzed the effect of dialysate bicarbonate levels on mortality in HD patients. Methods: Patients undergoing maintenance HD were recruited from the HD unit of the Daping Hospital. Patients were categorized into quartiles according to their DBIC level (quartile 1: <31.25 mmol/L, n = 77; quartile 2: 31.25–32.31 mmol/L, n = 76; quartile 3: 32.31–33.6 mmol/L; n = 81; quartile 4: ≥33.6 mmol/L, n = 79). Demographic and clinical data were collected. Survival curves were estimated using the Kaplan-Meier method. A Cox proportional hazards regression model was used to estimate the association between DBIC and all-cause mortality. Results: We included 313 patients undergoing maintenance HD with a mean DBIC of 32.16 ± 1.59 mmol/L (range, 27.20–34.72 mmol/L). The patients in quartile 4 were more likely to have higher pre- and post-HD serum bicarbonate concentrations than those in other quartiles. The mortality rate was lowest in quartile 2 (10.53%). The survival time was significantly lower in the quartile 4 group than in the other quartiles (p = 0. 008, log-rank test). After full adjustment, the hazard ratio (per 3 mmol/L higher DBIC) for all-cause mortality was 4.29 (95% confidence interval, 2.11–8.47) in all patients, whereas no significant association was observed between DBIC and initial hospitalization. Conclusions: Our data indicate that DBIC is positively associated with all-cause mortality. A DBIC concentration of 31–32 mmol/L may benefit patient outcomes. This study provides an evidence-based medical basis for optimal dialysis prescription in the future.

Reduction in Thrombolytic Usage in Hemodialysis Patients Following a Quality Assurance Review: A Research Letter.

Catheter malfunction in hemodialysis (HD) is increasingly managed with recombinant tissue plasminogen activator (rt-PA, alteplase), though evidence of improved catheter function is lacking. To evaluate the effect of a standardized rt-PA administration protocol on rt-PA usage, catheter function, and adverse events. Observational quality improvement study. Single, urban, community HD unit in Calgary, Alberta. Patients treated with maintenance in-center HD through central venous catheter. Incidence of rt-PA usage, catheter interventions, hospitalizations, and measures of dialysis efficacy. The rt-PA protocol was designed following a consultative and iterative design period with dialysis shareholders, which included focusing on standard objective criteria before use and targeting use to the problematic lumen. Protocol implementation occurred over a 6-month period in 2021. Patient and dialysis data were collected through our regional dialysis electronic health record. Implementation of the rt-PA protocol resulted in decreased rt-PA use (standardized per 100 dialysis sessions) compared to the preprotocol period (incidence rate ratio [IRR] of 0.57, 95% confidence interval [CI]: [0.34, 0.94]). Line procedures were also less frequent (IRR = 0.42, 95% CI: [0.18, 0.89]). Hospitalization rates and measures of dialysis efficacy were similar in both periods. Small sample size with single dialysis center and short duration of follow-up. Implementation of a multidisciplinary designed rt-PA administration protocol decreased incident rt-PA usage.

PREVELENCE OF HEPATITIS B AND HEPATITIS C INFECTION AMONG PATIENTS UNDERGOING DIALYSIS

Background &#x0D; The prevalence rate of Hepatitis C is higher among patients who undergoes hemodialysis than general population. Due to frequent contact with blood transfusion patients with hemodialysis are very prone to Hepatitis C infection.Both Hepatitis B and C virus infection is a lead cause of mortality and morbidity among patients who are on hemodialysis. Still, very little research has focused on the morbidity measures of these serious disorders in low and middle income countries like India.&#x0D; Aims &amp; objectives&#x0D; This study is conducted to investigate prevalence of Hepatitis C infection in patient who undergoes hemodialysis. The study aims to estimate the prevalence of hepatitis B virus and hepatitis C virus infections among hemodialysis patients in the civil hospital of Gandhinagar.&#x0D; Material &amp; methods &#x0D; A retrospective study was carried out from September 2020 to September 2021 in General hospital Gandhinagar with the use of ELISA kit by detecting anti-HCV antibody and Hipatitis B surface antigen from serum sample.. Total 100 sample collected from hemodialysis unit in General hospital Gandhinagar ..&#x0D; Observation and results &#x0D; This study was done in GMERS Medical College and General hospital Gandhinagar with 100 samples of hemodialysis patient from September 2020 to September 2021.Approach used in this study is retrospective. For diagnosis of HCV infection ELISA is used. Out of 100 patients, 21 patients were positive and 79 patients were negative for Hepatitis C and hepatitis as well as both. &#x0D; Conclusion &#x0D; Risk of hepatitis infection is more associated with patients with chronic renal failure due to high frequency of transfusion of blood and blood products and extracorporeal circulation during hemodialysis. For prevention of spread of hepatitis infection among patients with hemodialysis, dialysis unit has to use proper universal precautions, has to properly maintain the machines of dialysis, and also has to follow proper disposal of material used in the unit. So that chances of getting cross infection of hepatitis become less.&#x0D; Discussion &#x0D; The prevalence of HCV was 12% among hemodialysis patients which is intermediate comparing to other study done in Andhra Pradesh and Kerala showing prevalence of 23% and 8%.Strict adherence to universal precautions to control infection practices will remain key to prevent transmission of hepatitis c and also other infections that can spread through parenteral route.In this study result shows that prevalence of hepatitis B and C infection in hemodialysis patients is 7% and 12%, respectively. While both hepatitis B and C positive cases are only 2%. Since hepatitis B and C share a common mode of transmission, we searched for co-infection with HBV and HCV among the patients, as seen in patients, 14 male and 7 female. Research studies on prevalence of hepatitis B and C co-infection in hemolysis are very rare. So the study suggested to conduct more research on this topic to prevent further prevalence of HCV and HBV.

LINFECTION A COVID 19 CHEZ LES HEMODIALYSES CHRONIQUES A BRAZZAVILLE

Background: Due to their immunosuppression to varying degrees and significant comorbidity, patients on chronic dialysis have an increased risk of developing severe acute respiratory syndrome 2 (SARS-CoV-2) at Covid 19. We wanted to describe the incidence, risk factors and outcomes of Covid 19 infection in these patients in Brazzaville. Patients and methods: The study was carried out in a private hemodialysis center in Brazzaville (Congo). The data was collected retrospectively. Included were chronic hemodialysis patients who tested positive for Covid-19 between April 1, 2020 and November 30, 2021. We assessed disease characteristics, mortality, risk factors for infection and mortality from multivariate logistic regression analyses. Results: During the study period, 14 out of 46 hemodialysis patients (30.4%) were diagnosed with Covid-19 infection. Their average age was 42.3 ± 8.7 years with a male predominance (sex-ratio = 2.5). Among them, 13 (92.8%) presented with respiratory distress requiring hospitalization and the mortality rate was 42.8% only one was vaccinated against covid-19 (Vaccine from the Johnson Johnson laboratory). Significant predictors associated with infection included HIV (OR= 12.4 95% CI 17.1–43.7) and diabetes mellitus (OR= 9.7 95% CI 17.1– 43.7), the main risk factor for death is the suspension of hemodialysis sessions (OR= 14 95% CI 16.9–68.7). Conclusion: Patients on chronic hemodialysis are at increased risk of SRASCoV-2 infection and mortality from the Covid-19 coronavirus disease. It will be necessary to work to vaccinate these patients as a priority and to maintain the regularity of their weekly sessions by creating an intra-hospital emergency hemodialysis unit.

Hemodiyaliz Hastalarının Manevi Durumlarının Umutsuzluk Düzeylerine Etkisi

Aim: This study was conducted descriptively to determine the effects of the spiritual orientation of hemodialysis patients on their levels of hopelessness. &#x0D; Method: The study sample consisted of 100 hemodialysis patients treated at Ondokuz Mayıs University Health Application and Research Center (OMUHARC) hemodialysis unit, nephrology service and City Health Center affiliated to OMUHARC between July 2017 and May 2018. The data were collected using patient introductory information forms, Spiritual Orientation Scale (SOS) and Beck Hopelessness Scale (BHS). The compliance of the data to normal distribution was examined using the Shapiro Wilk test. Kruskal Wallis and Mann Whitney U tests were used to compare data that did not conform to normal distribution. Spearman correlation analysis was used to examine the relationship between the sub-dimensions of the scales. &#x0D; Result: The patients' average age was 56.7±14.4, 59% were male, 80% were married, 53% were diagnosed with chronic renal failure 1-5 years ago, 75% had been receiving hemodialysis treatment for 1-5 years and 63% had another chronic disease. The mean total score of SOS was 99.57±15.51. The mean BHS total score was 5.68 ± 4.43; while the emotions and expectations about the future sub-dimension mean total score was 1.2 ± 1.29, that of the motivation loss sub-dimension was 2.56±1.89, whereas that of the hope sub-dimension was 1.91±1.82. A moderately negative significant correlation was found between SOS and BHS (r: -0.385, p