Inadequate Hemodialysis Research Articles

The Association Between Fluid Overload and Endothelial Dysfunction in Chronic Kidney Failure Patients Undergoing Hemodialysis Twice a Week.

Fluid overload causes excessive systemic vasoconstriction and decreased perfusion of peripheral tissues, leading to abnormalities in cardiopulmonary physiological functions. Prolonged fluid overload caused by inadequate hemodialysis may cause heart dilatation, left ventricular hypertrophy, hypertension, and a decrease in coronary reserves, which later will develop into coronary ischemia, leading to increased morbidity and mortality of cardiovascular disease (CVD). Endothelial dysfunction plays a role in excessive vasoconstriction on fluid overload. Brain natriuretic peptide (BNP) and asymmetric dimethylarginine (ADMA) are used as parameters of fluid overload and endothelial dysfunction, respectively. This study is conducted to describe the relationship between fluid overload with endothelial dysfunction. This study is a cross-sectional study of kidney failure patients who underwent hemodialysis twice weekly for at least three months. BNP and ADMA were used as parameters for fluid overload and taken prior to hemodialysis. From 126 subjects, the proportion with fluid overload (BNP>356 pg/ml) was found to be 64.3% with the median age of subjects being 52 years (47-62). There was 47.6% population with endothelial dysfunction (ADMA>100 ng/ml). Presumptive causes of primary chronic kidney disease (CKD) were hypertension (38.9%), diabetes mellitus (DM) (28.6%), and glomerulonephritis (21.4%). There was no significant association between fluid overload and endothelial dysfunction (PR=1,042, p=0.832 CI 95%=0.714-1.521). There was no relationship between fluid overload and endothelial dysfunction.

Dialyzer reprocessing: Considerations and pitfalls for effective and safe hemodialysis.

Dialyzer reprocessing for dialyzer reuse in the same patient has been developed since the early time in hemodialysis history to save cost and time related to reassembling the new dialyzer during that time. The procedure can reduce the first-use and allergic reactions from using incompatible cellulosic dialyzer membrane by altering some manufacturing chemicals. All of established literatures regarding recent dialyzer reprocessing methods and considerations were extensively reviewed and summarized. Dialyzer reprocessing can be performed by multiple protocols but involves common steps including bedside rinsing after use, cleaning, dialyzer testing to prevent excessive drop in dialyzer clearance and membrane integrity, high-level disinfection or sterilization either by chemicals or heat, storage, and preparation for subsequent dialysis session by adequate rinsing to reduce the residual reprocessing chemical to the safe level. Compared with the single-use strategy, evidence is conflicting for the mortality advantages or disadvantages of dialyzer reuse, with some showing increased mortality in patients receiving peracetic acid sterilization. Keys for the effective and safe dialyzer reuse involve strict adherence to specific manufacturer's protocol, adequate dialysis water quality complied with the Association for the Advancement of Medical Instrumentation standard, measurement of the total cell volume to prevent inadequate hemodialysis, and infectious control consideration. In the present era, single-use strategy is increasingly adopted due to the decreased cost for dialyzer manufacturing. Environmental concerns of higher solid waste from dialyzer disposal in single-use dialysis should be compared with the liquid waste from reprocessing chemicals along with plastic waste and cardboard in reuse dialysis. Dialyzer reprocessing with adequate regulation is considered as an acceptable option for cost-effective hemodialysis, compared with the single-use strategy.

Could uric acid to high density lipoprotein-cholesterol ratio be considered as a marker of hemodialysis sufficiency?

Aim: Hemodialysis (HD) is one of the most widely utilized renal replacement therapies in individuals with end-stage chronic kidney disease (CKD). The purpose of this study was to compare the Uric acid to HDL cholesterol ratio (UHR) levels of well-treated HD patients to those of those who had inadequate HD therapy.
 Materials and Methods: Data on HD patients were acquired from patient files and the institution's database. A URR value of more than 70% designated the sufficient HD group, whereas less than 70% defined the insufficient HD group. Furthermore, laboratory data, such as the UHR of the study groups, were compared.
 Results: The UHRs for adequate and inadequate HD were 0.160±04 and 0.20±0.07, respectively. The UHR of patients with insufficient HD was substantially greater than that of the subjects with sufficient HD (p=0.004). Besides, UHR was substantially and positively connected with urea before HD (r=0.37, p=0.001), urea after HD (r=0.39, p=0.001), serum creatinine before HD (r=0.48, p0.001), serum creatinine after HD (r=0.45, p0.001), and negatively correlated with URR (r=-0.29, p=0.008), according to correlation analyses. In individuals with chronic renal disease, a UHR value higher than 0.16 exhibited 67% sensitivity and 57% specificity in detecting inadequate HD.
 Conclusion: We propose that UHR, in addition to URR, might be used to determine HS sufficiency in CKD patients undergoing HD therapy.

Erythropoietin resistance-secondary to watermelon stomach: a forgotten story in chronic kidney disease patients.

Watermelon stomach, also known as gastric antral vascular ectasia (GAVE), is a rarely seen cause of acute upper gastrointestinal bleeding or chronic iron deficient anemia, revealed when gastroscopy is performed. GAVE affects predominantly women of advanced aged and is usually associated with certain underlying co-morbidities including liver cirrhosis, autoimmune diseases and chronic kidney disease. Based on the above, we report the case of a 75-year old woman under hemodialysis for six consecutive years due to end-stage renal disease attributable to hypertensive nephrosclerosis. The patient also suffered from chronic ischemic heart disease, severe peripheral artery disease and an unidentified connective tissue-disease characterized by high levels of anti-nuclear antibodies and clinical symptoms restrained in flares of non-erosive polyarthritis. Six months prior, she developed hyporesponsiveness to recombinant human erythropoietin (rEPO) due to iron deficiency despite the administration of the appropriate dose of intravenous iron as well as the exclusion of other co-existing causes of resistance, namely inadequate hemodialysis, inflammation, malnutrition, severe hyperparathyroidism and underlying hematologic disorders. Surprisingly, the patient experienced a sudden episode of severe upper gastrointestinal bleeding characterized by hemodynamic instability, hemoglobin fall and melena that required blood transfusions. Once hemodynamic stabilization was achieved, an upper endoscopic exam was performed showing the pathognomonic extensive vascular ectasias and patchy erythematosus lesions at the distal antrum. Thus, GAVE should be considered in the differential diagnosis of chronic kidney disease patients who present not only with acute blood loss but also with resistance to rEPO due to inadequate iron stores.

Comparison of urea reduction ratio and dialysis efficacy in evaluating haemodialysis adequacy in chronic kidney disease patients in Wangaya Hospital

Background: An increasing number of patients with chronic kidney disease (CKD) impact an increased need for hemodialysis. Inadequate hemodialysis affects morbidity in patients with CKD. Determination of the urea removal index can be accomplished by several invasive and non-invasive methods. The purpose of this study was to compare the urea reduction ratio (URR) and dialysis efficiency (Kt/V) calculated automatically by hemodialysis machines to assess the adequacy of hemodialysis in patients with CKD.Methods: A cross-sectional analysis study was conducted on 58 CKD patients with age ≥18 years, conventional 5-hour hemodialysis sessions twice weekly, using single use-hollow fiber dialyzers, and who had been receiving hemodialysis for ≥6 months in the hemodialysis unit at Wangaya Hospital from April 2022 to May 2022. Study data were obtained from medical records then described and analyzed using the statistical package for the social sciences (SPSS) program.Results: The mean of URR was 70.74±10.04, while the mean of Kt/V delivered by machine was 1.27±0.19. More hemodialysis patients received adequate hemodialysis based on URR parameters compared to Kt/V parameters (84.5% versus 1.7%). There was no significant difference between age, sex, body mass index (BMI), comorbidities, vascular access and duration of dialysis with adequacy hemodialysis. There was a significant difference between URR and Kt/V in the evaluation adequacy of hemodialysis (p=0.000). In addition, there was a positive correlation between URR and Kt/V in the evaluation adequacy of hemodialysis (r=0.592, p=0.000).Conclusions: The URR is a more accurate parameter, but the Kt/V delivered by machine can help the URR demonstrate the adequacy of haemodialysis patients with CKD.

Arteriovenous Hemodialysis Access Stenosis Diagnosed by Duplex Doppler Ultrasonography: A Review.

Arteriovenous fistula (AVF) is currently the hemodialysis access with the longest life expectations for the patients. However, even the AVF is at risk for many complications, especially the development of stenosis. The latter can not only lead to inadequate hemodialysis but also lead to AVF thrombosis. Duplex Doppler ultrasonography is a very precise method, in the hands of experienced professionals, for the diagnosis of AVF complications. In this review, we summarize the ultrasound diagnostic criteria of significant stenoses and their indication for procedural therapy.

Frequency of Dyslipidemia among End-Stage Renal Disease Patients on Thrice Weekly Maintenance Hemodialysis

Background: Serum lipid abnormalities are strongly related to cardiovascular as well as all-cause mortality. The most common dyslipidemia among dialysis patients is low HDL followed by hypertriglyceridemia. Total cholesterol and LDL levels are normal. Dyslipidaemia in end-stage renal disease is multifactorial in addition to abnormalities in lipid metabolism, malnutrition, inflammation, low albumin, and inadequate hemodialysis also contribute to premature atherosclerosis. That’s why treatment of dyslipidemia in hemodialysis patients should be individualized. Objective: To determine the frequency of dyslipidemia among patients of end-stage renal disease on thrice-weekly hemodialysis. Study Design: Cross-sectional study Place and Duration of Study: Dialysis Unit, Department of Nephrology Sir Ganga Ram Hospital, Lahore from 1s9th March 2021, to 18th September 2021 Methodology: Seventy two patients having maintenance HD at our center were enrolled. The data included the patient's name, age, gender, duration of maintenance hemodialysis, BMI, HTN, DM, IHD, and smoking status. Fasting lipid samples of patients were collected in serum vials and samples were analyzed in the major laboratory for any lipid abnormality. Results: Forty four (61.1%) patients have dyslipidemia among which 27 (61.4%) were males and 17 (38.6%) were females. The mean age was 47.5±11.5 years. The most common lipid abnormality in our patients was low HDL levels i.e., 56.8% followed by hypertriglyceridemia 6.9%. Total cholesterol and LDL levels are normal in 98% and 100% respectively. Conclusion: The frequency of dyslipidemia among patients of thrice-weekly maintenance hemodialysis is 61.1%. Low HDL is the most common lipid abnormality followed by hypertriglyceridemia 56.8% and 6.9% respectively. Key words: Dyslipidemia, End-stage renal disease (ESRD), Hemodialysis

HUBUNGAN ANTARA DURASI HEMODIALISIS DENGAN STATUS HEMODINAMIK PASIEN GAGAL GINJAL KRONIS

Backgorund: Hypotension in patients on dialysis may result from inadequate hemodialysis doses. Purpose: The purpose of this study was to identify the duration of hemodialysis with the hemodynamics of patients undergoing hemodialysis. Method: This study used a case-control design. A total of 36 samples of medical record data were selected purposively. Selected data identified hemodynamics during the intradialytic period. The results obtained were analyzed using a chi-square. Result: The results of the analysis showed that hypotension (50%), cramps (41.7%), nausea (2.8%), dizziness (8.3%), and shortness of breath (2.8%). The results showed that there was no relationship between the duration of hemodialysis and the hemodynamic status of patients with chronic renal failure (p=1). Conclussion: Patients undergoing hemodialysis need to be monitored during the intradialytic period. Patients may not report symptoms during the intradialytic phase

Psychological Stressors among Hemodialysis Patients in Selected County Dialysis Centre's in Kenya

Introduction: Though hemodialysis treatment modality remains the most sought option among patients with kidney disease, the modality is associated with multiple psychological stressors that confronts the hemodialysing patients and subject them to mental disturbances and poor quality of life. Study aim: The study aimed at describing the psychological stressors faced by the hemodialysis patients in the new county dialysis centers in Kenya and to correlate the psychological stressors to the patients’ demographic characteristics. Methodology: This was a descriptive correlation study among hemodialysis patients in four selected county dialysis centers in Kenya. Sample size was determined through a census method. Data was collected by means of a semi-structured questionnaire and analyzed using a Statistical Package for Social Sciences (SPSS) version 25.0.Findings were presented using graphs and frequency tables while Chi-square was used to test for the association between study variables. Results: Despite opening new county dialysis centers, majority of the respondents identified inadequate number of hemodialysis machines as the major psychological stressor (M=2.9, SD ± 0.8) uncertainty in life (M=2.74, SD ± 0.6) and lack of hemodialysis commodities (M=2.69, SD=0.7) as the leading psychological challenges faced by the patients who are dialyzing in the newly opened county dialysis centres in Kenya. There was a statistically significant association (p=0.016) between waiting time for hemodialysis sessions and gender and also a significant association (p=0.04) between marital status and dependency on others to bring them for dialysis session. Conclusion: Despite the Government initiative to increase the availability and accessibility of the hemodialysis services to hemodialysis patients, inadequate hemodialysis machines, lack of hemodialysis commodities and difficulties in raising the cost of treatment still remains the major psychological stressors among hemodialysis patients. Therefore, opening of new dialysis centers should be accompanied with adequate resource allocation to guarantee positive patient outcomes.

Recirculation and adequacy of dialysis in end stage renal disease patients on regular hemodialysis at Menoufia university hospitals

Background Early detection of vascular access complication prevents more severe conditions and reduces hospitalization periods of patients on regular hemodialysis (HD). Access recirculation (AR) is one of the tools for early evaluation of arteriovenous fistula (AVF) complication for early intervention. The aim of our study was to evaluate the AV AR as a risk factor for inadequate HD in patients with end-stage renal disease in Menoufia university hospitals. Patients and methods This is a cross-sectional study that included 300 patients on regular HD sessions at four centers at Menoufia university hospitals. All patients were subjected to detailed history taking, clinical examination, laboratory investigation, and measurement of recirculation by urea-based method. Results This study included 300 patients on regular HD. It showed that 51.7% presented with aneurysm, whereas the infected AV access was presented in 6% of patients. AR was found in 17.7% of patients, being more frequent in patients with the left brachiocephalic AVF (37.7%), and it showed highly significant relation with duration of dialysis and duration of AVF creation. The risk factors for recirculation were the distance between arterial and venous needle sites, puncture site aneurysm, and stenosis. There were negative correlations between AR and both urea reduction ratio and KT/V and positive with both serum potassium and parathyroid hormone level. Conclusion AR in our unit was associated mainly with stenosis, aneurysm, and improper needle puncture sites, so screening for recirculation may be used as a surveillance technique for the early detection of AVF in concomitant with regular training of dialysis staff in cannulation of the AVF.

Influence of Dialysis Modality on the Treatment of Anemia in Patients with End-Stage Kidney Disease

Abstract Anemia is a common complication among the patients with end-stage kidney disease. Management of anemia is influenced by several factors: iron deficiency, subtherapeutic dosage of erythropoietin, microinflammation, vitamin D deficiency, increased iPTH levels and inadequate hemodialysis. The aim of the study was to examine impact of dialysis modality on blood hemoglobin level as well as status of iron, status of vitamin D, hemodialysis adequacy and erythropoietin dose. The study included 120 patients which were divided into two groups: the group of patients treated with hemodiafiltration and the group of patients treated with standard hemo-dialysis. For statistical analysis Kolmogorov-Smirnov test, Student’s t-test and Mann-Whitney U-test were used. Blood hemoglobin level and parameters of hemodialysis adequacy (Kt/V index, spKt/V index, URR index), hematocrit ad protein catabolic rate (nPCR) were statisticaly significant lower in patients treated with regular hemodialysis compared to patients treated with regular hemodiafiltration. Serum ferritin level, C-reactive protein level and average monthly dose of intravenous iron were higher in the patients treated with regular hemodialysis compared to patients treated with hemodiafiltration. Patients treated with hemodiafiltration have lower grade of microinflammation, better iron status and better control of anemia compared to the patients treated with regular hemodialysis. Dialysis modality is an important factor that influences management of anemia in the patients with end-stage kidney disease.

Restless Leg Syndrome in the Setting of Patients With End-Stage Renal Disease on Hemodialysis: A Literature Review.

Restless Leg Syndrome (RLS), or Willis-Ekbom disease (WED), is an irresistible urge to move the legs, predominantly while resting, sitting, or sleeping, which disrupts sleep and impairs quality of life. RLS can occur secondary to uremia in chronic kidney disease (CKD) patients due to inadequate hemodialysis. Early diagnosis is essential to prevent muscular atrophy and to improve the quality of life of RLS patients, especially those with end-stage renal disease (ESRD). Cardiac mortality high in uremic RLS patients due to associated discomfort and lowering the duration of hemodialysis treatment. This review focuses on and discusses the diagnosis, treatment, and associated comorbid conditions of uremic RLS. Though the exact pathophysiology is unknown, altered transferrin expression in the choroid plexus, increased glutamate levels in the thalamus, decreased opioid receptors, dopamine system dysfunction, calcium/phosphate imbalance, and single nucleotide polymorphisms in the BTBD9 and MEIS1 genes are a few nonconfirmatory pathophysiological concepts for uremic RLS. Nonpharmacological options include lowering the temperature of dialysate by 1 degree C and home-based therapies like massages, warm/cold baths, and aerobic exercises. Pharmacological therapy like dopamine agonists ropinirole and pramipexole reduces the symptoms effectively. However, surgical options like parathyroidectomy and renal transplantation are stated as the best treatment options in patients suffering from uremic RLS.

Adequacy of Hemodialysis and Its Associated Factors among Patients Undergoing Chronic Hemodialysis in Dar es Salaam, Tanzania.

The worldwide prevalence of maintenance hemodialysis continues to rise. An adequate delivery of hemodialysis dose as measured by Kt/V or urea reduction ratio is a crucial determinant of clinical outcome for chronic hemodialysis patients. The aim of this study was to assess the adequacy of hemodialysis and its associated factors among patients undergoing chronic hemodialysis in Dar es Salaam. This was a cross-sectional study done on patients undergoing chronic hemodialysis in four dialysis centers in Dar es Salaam. Sociodemographic information and treatment characteristics were collected. Urea reduction rate and single-pool Kt/V were calculated to determine the adequacy of hemodialysis. The data were analyzed and any associated factors for inadequate hemodialysis were determined using a chi-square test and a logistic regression analysis. A total of 143 patients participated in the study. Males represented 65.7% of the study population. The mean age (±SD) was 51.7 ± 1.2 years. Only 34.3% (based on urea reduction ratio (URR)) and 40.6% (based on Kt/V) of patients received adequate hemodialysis. The univariate analysis showed that males were more likely to have inadequate dialysis (65.6% versus 48.0%, p=0.048 based on Kt/V). Patients using hemodialyzers with dialyzer surface area less than 1.4 m2 received significantly less hemodialysis dose than those with more than 1.4 m2 (69.0% versus 41.2%, p=0.02, by URR) (62.7% versus 35.3%, p=0.03, by Kt/V criteria). Patients who had hemoglobin <10 g/dl received significantly inadequate hemodialysis dose as compared to patients with hemoglobin ≥10 g/dl by Kt/V criteria (69.8% versus 51.3%, p=0.03). None of the factors acquired significance in the multivariate analysis. The proportion of patients receiving an adequate hemodialysis dose is low (34.3% based on URR and 40.6% based on Kt/V). Male gender, dialyzer surface area of <1.4 m2, and hemoglobin level of <10 g/dl were associated with an inadequate delivered dose of hemodialysis in the univariate analysis but not in the multivariate analysis. This study can increase awareness about the importance of measuring hemodialysis adequacy and giving the correct hemodialysis dose to achieve the intended benefit.

Influence of secondary hyperparathyroidism in management anemia in patients on regular hemodialysis

Background/Aim. Anemia is a common complication in hemodialysis patients. Treatment of anemia is affected by iron deficiency, insufficient dose of erythropoietin, microinflammation, vitamin D deficiency, increased intact parathyroid hormone concentration and inadequate hemodialysis. The aim of the study was to determine the prevalence of vitamin D deficiency and its impact on hemoglobin con-centration, iron status, microinflammation, malnutrition, dialysis adequacy and erythropoietin dose in patients on regular hemodialysis. Methods. The study involved 120 patients divided into three groups: severely deficient of vitamin D: 25- hydroxyvitamin D[25(OH)D] &lt; 10 ng/mL; deficient ? 25(OH)D within range of 10?20 ng/mL, and insufficient ? 25(OH)D &gt; 20 ng/mL. For statistical analysis Kolmogorov- Smirnov test, the single-factor parametric analysis of variance ? ANOVA and Kruskal-Wallis test were used. Results. The prevalence of vitamin D deficiency in patients on regular hemodialysis was 75.83%, while the prevalence of severe vitamin D deficiency was 24.7%. Patients with severe vitamin D deficiency had lower blood concentration of hemoglobin, hematocrit, serum concentration of total proteins and albumin, and dialysis indices were also lower compared to the other two groups of patients. The level of C-reactive protein was significantly higher in the group of patients with severe vitamin D deficiency than in the two rest groups. Conclusion. Hemodialysis patients with severe vitamin D deficiency have lower hemoglobin, lower dialysis adequacy, significant microinflammation, malnutrition, bone metabolism disorders and need higher dose of erythropoietin than patients whose vitamin D was higher than 10 ng/mL. Vitamin D is important risk factor for development of anemia in hemodialysis patients and important factor that can affect treatment of anemia in these patients.

Association of high sensitive C reactive protein and dialysis adequacy with uremic pruritus in hemodialysis patients

ABSTRACT Introduction Uremic pruritus is one of the most common and complicated symptom affecting hemodialysis patients, it can be persistent, distressing and having a significant impact on the quality of life. We aimed to study the relationship between high sensitive C reactive protein and adequacy of dialysis with uremic pruritus in hemodialysis patients. Patients and Methods In this Case control study one hundred prevalent hemodialysis patients were enrolled from hemodialysis units in Ain Shams University hospitals, fifty of them had pruritus and the other fifty patients had no pruritis, all of them underwent urea reduction ratio for dialysis adequacy assessment, pruritus assessment by using visual analog scale and high sensitive C reactive protein serum level. Results Uremic pruritus has statistically significant negative correlation with urea reduction ratio and consequently with dialysis adequacy. However, uremic pruritus has statistically significant positive correlation with highly sensitive C reactive protein serum levels in hemodialysis patients. Conclusion Inadequate hemodialysis and increased hsCRP serum level play an important role in aggravating intensity and severity of uremic pruritus.

Erythropoietin Resistance in Hemodialysis Patients

Summary Anemia is defined as blood hemoglobin concentration of less than 120 g/l in women and less than 130 g/l in men. The main cause of the development of anemia in patients treated with regular hemodialysis is the lack of endogenous erythropoietin, and its main clinical consequences are: progressive decline in residual renal function, development of cardiovascular disorders, disorders of cognitive functions and a decrease in the quality of life of these patients. Despite the administration of an appropriate dose of erythropoietin, in 5-10% of patients treated with regular hemodialysis, there is resistance to erythropoietin activity. The main risk factors for the development of resistance to the effects of erythropoietin are: iron deficiency, microinflammation, deficiency of vitamin D, secondary hyperparathyroidism, deficiency of vitamin C, and inadequate hemodialysis. The main side effects of erythropoietin are: hypertension, thrombosis of the vascular approach to hemodialysis, and the red blood cell precursor aplasia in the bone marrow. Early detection and elimination of risk factors, optimization and indi-vidualization of hemodialysis prescription prevent the development of resistance to erythropoietin activity, enable the achievement of target blood hemoglobin, reduce the development of cardiovascular morbidity, and improve the quality of life of these patients.

The Determinants of Hemoglobin Variability in Hemodialysis Patients

Abstract Introduction. Factors that have been reported to affect erythropoietin (EPO) responsiveness in hemodialysis (HD) patients include iron deficiency, chronic inflammation, secondary hyperparathyroidism, malnutrition and inadequate HD dose. The aim of the study was to analyze the deteminants of hemoglobin variability in HD patients. Methods. The study encompassed 526 patients (197 F and 329 M). According to HD vintage at the beginning of the study the patients were divided into two groups: group-1 encompassed 153 patients with HD vintage bellow 24 months, and group-2 encompassed 329 patients with HD vintage over 24 months. Over a period of 21 months after admission the following parameters were analyzed: hemoglobin (Hb), EPO dose, iron dose, HD dose (eKT/V), transferrin saturation (TSAT), C-reactive protein (CRP), ferritin and serum albumin at 3 months and parathyroid hormone (PTH) at 6 months. Results. The percentage of patients with Hb&gt;=105g/L significantly improved, and the average Hb level significantly increased in both groups over a period of 21 months. The average EPO and iron dose significantly decreased, but TSAT and ferritin levels significantly increased over a period of 21 months. The average eKT/V and s-albumin values significantly increased, but the average CRP and PTH levels significantly decresead over a period of 21 months. In group-1 EPO dose and CRP, but in group-2 EPO dose, ferritin, HD vintage, and iron dose were statistically significant predictors of the Hb level 9 months after admission. Conclusions. Insufficient EPO therapy, iron deficiency and chronic inflammation were the main factors of inadequate correction of anemia in HD patients before admission.

Detection and adequacy evaluation of erythrocyte glutathione transferase on levels of circulating toxins in hemodialysis patients

To explore detection and adequacy evaluation of erythrocyte glutathione S transferase (GST) on levels of circulating toxins in hemodialysis patients in Qinhuangdao region in China, this study divided 84 cases of long-term, end-stage hemodialysis patients into 2 groups: one group of 33 cases of adequate hemodialysis (spKt/V ≥ 1.3) and another group of 51 cases of inadequate hemodialysis (spKt/V < 1.3), according to the urea index value of the unit chamber model (spKt/V). Another 50 cases of subjects found healthy by a physical examination were taken as the control group, and the differences in the related clinical and biochemical indexes of the 3 groups were compared and analyzed. The levels of GST, creatinine, high sensitivity C-reactive protein (hs-CRP), transferrin saturation (TSAT), parathyroid hormone (PTH), interleukin-2,6,8 (IL-2,6,8) and tumor necrosis factor-a (TNF-a) in the hemodialysis group were significantly higher than those in the control group (P < 0.05), and GST, IL-2, 6, 8, and TNF-a levels in the inadequate hemodialysis group were significantly higher than in the adequate hemodialysis group (P < 0.05). Pearson's relevant analysis showed that the levels of GST and spKt/V, IL-2, IL-6, IL-8, and TNF-a have a positive correlation (P < 0.05), and they have no correlation with levels of creatinine, hs-CRP, TSAT, and PHT (P > 0.05). There were 23 patients with levels of spKt/V ≥ 1.3 after adjusting the dialysis solution for 51 cases of inadequate hemodialysis patients, and the GST level after the adjustment was significantly lower than that before the adjustment, but still higher than that in the adequate dialysis group. This concludes that the maintenance of hemodialysis in patients has certain relevance on spKt/V and associated inflammatory factors. Through the study, it can be determined that GST can effectively respond to adequate hemodialysis, which has a guiding significance on adjusting the blood dialysis solution in clinical practice.

Assessment of hemodialysis adequacy in patients with chronic kidney disease in the hemodialysis unit at Tanta University Hospital in Egypt.

Worldwide, hemodialysis (HD) constitutes the most common form of renal replacement therapy. Many studies have shown strong correlation between HD dose and clinical outcome. The cross-sectional study was conducted on 100 patients in Hemodialysis Unit at Tanta University Hospital, Egypt. Data were collected using a reliable questionnaire (including clinical, demographic, dialysis, laboratory, and radiological data). SpKt/V was used to assess the adequacy of HD. The results revealed inadequate HD dose among 60% of the study population. The results also showed that increasing time and frequency of dialysis, blood flow rates, low recirculation percentages, reduction of intradialytic complaints, and well-functioning vascular access are associated with better HD adequacy. Our findings showed a positive correlation between dialysis dose and hemoglobin, serum albumin, normalized protein catabolic rate, and physical health. A great percentage of patients had inadequate HD. HD adequacy was influenced by several factors such as duration and frequency of dialysis session, patients’ complaints, and well-functioning vascular access.

Assessment of hemodialysis adequacy in patients with chronic kidney disease in the hemodialysis unit at Tanta University Hospital in Egypt

Background and objectives Worldwide, hemodialysis (HD) constitutes the most common form of renal replacement therapy and many studies have shown strong correlation between HD dose and clinical outcome measured by Kt/V. This study was conducted to evaluate HD adequacy in patients with end-stage renal disease to identify the prevalence and causes of inadequate HD and the impact of HD adequacy on patient outcomes. Patients and methods This cross-sectional study was conducted on 100 patients in the HD unit at Tanta University Hospital. All patients gave their consent and were informed about the study purpose. Data were collected using a reliable questionnaire (including clinical, demographic, dialysis, laboratory, and radiological data). SpKt/V was used to assess the adequacy of HD. Statistical analysis was carried out for all collected data using SPSS 18. Statistical significance was determined at a P-value less than 0.05. Results The results revealed inadequate HD dose in 60% of the study population. The results also showed that, with increasing time and frequency of dialysis, blood flow rates, low recirculation percentages, reduction of intradialytic complaints, and well-functioning vascular access are associated with better HD adequacy. Our findings clearly showed a strong positive correlation between dialysis dose and Hb level, serum albumin level, normalized protein catabolic rate, and physical health. Conclusion A significant percentage of patients had inadequate HD. HD adequacy was influenced by several factors such as duration and frequency of the dialysis session, patients' complaints, and well-functioning vascular access.