Index In Hemodialysis Patients Research Articles

Hazardous effect of the maintenance dose of iron sucrose versus iron dextran on oxidative burst activity of neutrophils in patients on regular hemodialysis; a pilot study

Introduction: Intravenous (IV) iron which is a potent pro-oxidant may decrease the phagocytic function of neutrophils and subsequently leads to repeated bacterial infections in patients on chronic regular hemodialysis (HD).Objectives: We aimed to evaluate the effect of IV iron dextran versus iron sucrose on oxidative burst activity of neutrophils in HD patients.Patients and Methods: A crossover study was included 20 prevalent HD patients were randomly divided into two groups; 10 patients each. Each group received a single dose of 100 mg iron sucrose or iron dextran then shifted to the other type after 4 weeks as a washout period. Patients with evidence of acute infections, diabetes mellitus, chronic liver disease, active collagen disease or any other acquired immune deficiency diseases were excluded. Patients on immunosuppressive drugs or with hypersensitivity to iron therapy or evidence of iron overload (TSAT > 50% and/or ferritin > 800 ng/mL) were also excluded. Erythropoietin maintenance dose was given to all patients. Urea reduction ratio (URR %), C-reactive protein (CRP) titer, complete blood picture and iron study were conducted. Neutrophil oxidative burst test was performed by flow-cytometry with an estimation of stimulation index before and after IV iron dosage. Results: Twenty patients (9 males, 11 females; mean age 49.40 ± 9.02 years) on chronic HD for a mean time of 10 ± 7.32 years. After 100 mg of IV iron infusion in HD patients, a highly significant difference in oxidative burst test of neutrophil cells before and after administration of iron regardless of its type was detected (P < 0.01). This change over time is not significantly different between two types of iron (P > 0.05). However, a significant increase in CRP titer after administration of iron dextran was seen (P = 0.016). Conclusion: Maintenance dosage of either IV iron sucrose or iron dextran (100 mg) had a hazardous effect on the neutrophilic phagocytosis demonstrated by the significant rise in the oxidative burst index in HD patients.

Comparing the effects of intravenous and subcutaneous Erythropoietin on blood indices in hemodialysis patients

Erythropoietin is used routinely in hemodialysis patients to increase hemoglobin levels in patients with ESRD and anemia. Considering the importance of anemia in hemodialysis patients and its complications, in this study, the effect of erythropoietin administration on blood parameters by comparing the methods of subcutaneous and intravenous administrations was investigated. The research was done as a retrospective descriptive-analytic study. The subjects were 300 hemodialysis patients receiving erythropoietin in two groups (intravenous and subcutaneous) from hospitals affiliated to Kurdistan and Kermanshah University of Medical Sciences. Data were extracted from the patients’ records and entered into a researcher-made checklist during 6 months and analyzed using SPSS version 20 and descriptive and inferential statistics. The results showed that there was a significant difference between the mean rank of hematocrit in subcutaneous and intravenous injections (P-value = 0.002) and it was higher in the subcutaneous injection group. Also, independent t-test showed that there was a significant difference between the mean of hemoglobin concentration among subcutaneous and intravenous injections (P-value = 0.001) and it was higher in the subcutaneous injection group. However, there was no significant difference between the mean of ferritin in both groups (P-value = 0.084). According to the results, the injection of erythropoietin in the subcutaneous method was more effective than intravenous. It is recommended to use this approach to improve blood indices in hemodialysis patients.

Far-infrared therapy improves ankle brachial index in hemodialysis patients with peripheral artery disease.

Ankle brachial index (ABI) is a diagnostic tool for peripheral artery disease (PAD), which is an important issue in hemodialysis (HD) patients. We enrolled 198 maintenance HD patients in this study. PAD is defined as ABI ≤ 0.90. Only PAD patients received far-infrared (FIR) therapy using the WS TY101 FIR emitter for 40min during each HD session, three times weekly for 6months. The ABI was measured at the bilateral lower extremities for 4 times [pre-dialytic timing (0min) and 40min after the initiation of HD session at both day 0 and 6months after the FIR therapy]. The primary outcome is the change in ABI. There were 51 out of 198 patients with PAD. In comparison with the period without FIR therapy in the 51 PAD patients, 6months of FIR therapy significantly improved the ABI of the right/left side for 0min (from 0.77 ± 0.19 to 0.81 ± 0.20, p = 0.027/0.79 ± 0.20 to 0.81 ± 0.17, p = 0.049), 40min during HD (from 0.73 ± 0.23 to 0.83 ± 0.19, p < 0.001/from 0.77 ± 0.21 to 0.83 ± 0.18, p < 0.001), and theincremental change between 0 and 40min (from - 0.04 ± 0.14 to 0.05 ± 0.13, p = 0.007/from - 0.05 ± 0.13 to 0.03 ± 0.11, p = 0.012), respectively. In conclusion, the application of FIR therapy for 40min, three times weekly for 6months, has improved the ABI of both lower extremities, thus providing a new strategy of PAD treatment in HD patients.

SERUM ZINC VALUES AND ANKLE BRACHIAL INDEX IN HEMODIALYSIS PATIENTS

Objective: Atherosclerosis is accelerated in hemodialysis patients. There is a proposed link between Zinc level and atherosclerosis, but this relationship remains unclear. The aim of our study was to determine a possible relationship between serum Zinc values and ankle-brachial index as a non-invasive diagnostic marker for atherosclerosis in chronic hemodialysis patients. Design and method: 62 hemodialysis patients were enrolled in our study (mean age 61.2 ± 13.8 years, ranged from 30 to 85 years). The ankle-brachial index was determined using a non-invasive, automated ankle- brachial index measuring device (ABPI MD, MESI®, Slovenia), based on oscillometric method. Serum Zinc values were measured by standard laboratory methods. The patients were divided into two groups using the median value of Zinc (14.1 mcmol/l) as a cut-off. Results: The Zinc values ranged from 9.2 to 23.5 mcmol/l and the ankle-brachial index values ranged from 0.8 to 1.4; majority of enrolled patients (82.3%) had arterial hypertension, 15 (24.2%) patients had diabetes and 23 (37.1%) of them were smokers or ex-smokers. Using t-test statistically significant difference of ankle-brachial index values between the groups was found (p = 0.036). The patients with lower Zinc values had lower ankle-brachial index. Conclusions: The results of our study showed that lower serum Zinc levels are associated with lower ankle- brachial index in hemodialysis patients.

Association between bone mineral density, muscle volume, walking ability, and geriatric nutritional risk index in hemodialysis patients.

Hemodialysis patients are at risk for bone loss and sarcopenia, characterized by reduced muscle mass and limited mobility/function. Osteoporosis and sarcopenia both increase the risk of hospitalization and death in affected individuals. Malnutrition also occurs as a complication of hemodialysis and has been identified as a risk factor for osteoporosis and sarcopenia. In this study, we examined the relationship between osteoporosis, muscle volume, walking ability, and malnutrition in hemodialysis patients. Forty-five hemodialysis patients were evaluated. Bone mineral density (BMD) and muscle volume were measured by dual-energy X-ray absorptiometry. Muscle volume and strength were evaluated using lean mass index (LMI), handgrip strength, and walking ability. The time required for a patient to walk 10 meters was measured to evaluate walking ability. The geriatric nutritional risk index (GNRI) was used to assess malnutrition. Multiple linear regression analysis showed that older age, female sex, lower LMI, and higher total type I procollagen N-terminal propeptide were correlated with lower BMD of lumbar spine. Higher age and lower LMI were correlated with lower BMD of the femoral neck. Female sex and lower GNRI were correlated with lower LMI. Longer duration of hemodialysis was correlated with lower walking ability. Our findings suggest that muscle preservation is required to maintain both lumbar spine and femoral neck BMD. Similarly, nutritional management is necessary to maintain BMD via preservation of muscle volume. Complementary nutritional therapies are needed to improve osteoporosis and sarcopenia in high-risk hemodialysis patients.

Association between the Ankle-Brachial Pressure Index and Geriatric Nutrition Risk Index in Hemodialysis Patients

Association between the Ankle-Brachial Pressure Index and Geriatric Nutrition Risk Index in Hemodialysis Patients

Fibroblast growth factor-23 is independently associated with the left ventricular mass index in hemodialysis patients

Context Left ventricle (LV) hypertrophy is an important cardiovascular complication in chronic kidney disease that leads to LV dysfunction and increased mortality. Studies that tested the association between fibroblast growth factor (FGF)-23 and LV structural and functional changes in hemodialysis (HD) patients have shown conflicting results. Aims The aim of this work was to study whether FGF-23 has a direct association with LV structural and functional changes in HD patients. Settings and design This is a cross-sectional study. Materials and methods Demographic data of 95 HD patients were recorded in a predefined data sheets. The blood samples for FGF-23 and other laboratory variables were collected and measured by the standard methods. Echocardiography area length method was used to calculate left ventricular mass index (LVMI), and modified Simpson’s rule was used to measure ejection fraction. Transmitral Doppler and tissue Doppler of septal e′ were used to measure LV diastolic function. Statistical analysis Multivariate analysis was carried out. Results There were significant positive correlations between FGF-23 and LVMI (r=0.285, P=0.005) and LV E/e′ ratio (r=0.391, P=0.001), while there were insignificant correlations with other echocardiographic parameters including chamber dimensions, chamber volumes and PASP. Multivariate analysis showed a significant association between LVMI and FGF-23 level after adjustment for age and systolic BP (P=0.0001). Conclusion FGF-23 is independently associated with LVMI in HD patients. This result suggests a direct role of elevated FGF-23 in the pathogenesis of LV hypertrophy in patients with HD.

The effect of Hepatitis C Virus infection on cardiovascular complications in end stage kidney disease patients on regular hemodialysis.

IntroductionCardiovascular complications are the most important cause of mortality in patients with ESKD, such as coronary artery disease, left ventricular hypertrophy, heart failure and arrhythmia. Other well-known risk factors, such as diabetes mellitus, hypertension and dyslipidemia are prevalent in ESKD, yet they are not sufficient enough to explain the high prevalence of cardiovascular mortality, hence searching for other hidden risk factors to explain this high prevalence is of an utmost importance. The aim of this study was to identify the exact mechanisms connecting HCV infection, chronic liver disease, and atherogenesis.MethodsThis case control study was done on 80 patients with chronic renal failure undergoing haemodialysis at Sheikh Zayed Specialized Hospital in Giza, Egypt in 2016. The participants were divided into four groups: a control group with HCV negative by PCR (20 patients), and three HCV Positive groups according to viral load by PCR: low, moderate and high viremia. Inclusion criteria were normal serum calcium (8.5–10.5 mg/dL), phosphorus ≤5mg/dL, PTH≤250 pg/ml, Hb 10–12 g/dL, and duration of dialysis less than two years. Data were analyzed using Chi square, t-test, Mann-Whitney U test, ANOVA, and Spearman rank correlation coefficient.ResultsThe study showed significant increase in LVM index in hemodialysis patients with high and moderate viremia compared to low viremia (p<0.001) and to control group (p<0.001). Also, significant increase in end diastolic diameter in high and moderate viremia (p<0.001), significant difference in end systolic diameter in the high viremia group (p<0.001), significant increase in the interventricular septal thickness (p<0.002) and posterior wall thickness (p<0.002) among moderate viremia were determined.ConclusionHCV has a significant effect on the development of cardiovascular diseases in the general population, and in renal disease patients on the structural level.

APOPTOSIS INDEX BETWEEN FEMALES AND MALES IN REGULAR HEMODIALYSIS

Many reports have documented apoptosis index in hemodialysis patients, but to date, no single study has directly compared the apoptosis index of males to females. Data on mortality rate among hemodialytic patients in the hemodialysis center at the Department of Internal Medicine Dr Soetomo General Hospital, Surabaya, Indonesia show a high number predominated by female patients. Therefore, to answer the question of whether there is a gender difference in apoptosis index, the researcher studied leukocyte responses in male and female hemodialysis patients. The apoptosis index of the sample was measured by indirect immunoassay method. Cell lyses, followed by immunochemical determination of histone-complexed DNA fragments in a microtiter plate wells. The apoptosis quantization was obtained by determining the amount of colored product spectrophotometrically. One hundred and four non-diabetic subjects who received hemodialysis (HD), and 24 normal controls (NC), were evaluated. The apoptosis index in ESRD patients group and control group showed no significant difference (0.6172 vs 0.4008, p=0.114), neither did it vary in both sexes and age groups. When the sex factor was analyzed (after exclusion from the diabetic ESRD patients), females apoptosis index was significantly higher than that of the males (0.7325 vs 0.55175, p&lt;0.05). In conclusion, apoptosis index in females among non-diabetic patients undergoing hemodialysis is higher than that occur in males and controls.

C-reactive protein but not hepcidin, NGAL and transferrin determines the ESA resistance in hemodialysis patients

Background: Erythropoiesis-stimulating agents (ESA) are commonly used for the treatment of anemia in hemodialysis (HD) patients, however, 5–10% of these patients have resistance to ESA treatment. Hepcidin and neutrophil-gelatinase associated lipocalin (NGAL) are induced by inflammation and these proteins may take role in ESA resistance. Herein, we aimed to investigate the effects of serum hepcidin, NGAL, transferrin and C-reactive protein (CRP) levels on ESA resistance in HD patients. Methods: A total of 63 chronic HD patients (6.0 ± 17 years, M/F:44/19) and 20 healthy controls (6.0 ± 4 years, M/F:14/6) were enrolled. ESA resistance index (ERI) was calculated as weekly ESA dose (IU)/body weight (kg)/hemoglobin level (g/dL). Patients on ESA treatment were divided into two groups depending on the median ERI value as low and high ERI groups. Results: Serum ferritin, hepcidin and NGAL levels were significantly higher in HD patients compared with controls. Serum transferrin levels were lower in high ESA index group compared with patients without ESA treatment and healthy controls. ERI was significantly correlated with serum CRP levels (r = 0.55, p < 0.001). In HD patients, serum hepcidin levels were associated with ferritin (r = 0.55, p < 0.01) and creatinine (r = 0.27, p = 0.03). Dose of ESA was significantly associated with serum CRP (r = 0.34, p = 0.02), total protein (r = −0.34, p = 0.01), transferrin (r = −0.28, p = 0.04) and ferritin (r = 0.31, p = 0.02). In linear regression analysis to predict ERI, age, gender, serum CRP, hepcidin, NGAL, albumin, ferritin and BMI were included (Model R = 0.62, R2 = 0.38, p = 0.02). Serum CRP was the only significant factor predicting ERI. Conclusion: CRP was the only predictor of ESA resistance index in HD patients. Hepcidin, NGAL and transferrin were not found to be markers of ESA resistance.

Lipid Profile of Hemodialysis Patients at the CHU Sylvanus Olympio in Togo

Objective: To determine the atherosclerotic index in hemodialysis patients at the CHU Sylvanus Olympio in Togo with dyslipidemia. Methodology: It is about a descriptive cross-sectional study from 07 April to 7 June 2011 in the hemodialysis unit of the internal medicine department of the University Hospital of Lome-SO. Our study involved a population of chronic kidney disease (CKD) on dialysis for at least six months. Dyslipidemia was determined on serum lipid results of the various parameters obtained taking into account the biochemistry laboratory standards CHU-SO. Data were collected on a survey form and analyzed by the software Epi Info version 3.5 and Excel 2007. Results: Our study involved sixty (60) chronic hemodialysis patients regularly followed up in the CHU-SO hemodialysis service. The study population consisted of 41 men and 19 women i.e., a sex-ratio of 2.15. The average age was 48.16 ± 13.63 years, ranging from 22 to 77 years. The age group 40 to 49 years was the most represented with 32.69% of cases (n=20). Sixty hemodialysis patients who participated in the study, 50 had at least one cardiovascular risk factor. Hypertension and diabetes mellitus were the most represented risk factors with rates of 75% and 23.3%. Patients had one cardiovascular risk factor (CVRF) in 64.98%, 2 CVRF in 13, 32%, 3 CVRF in 5.32% and no CVRF in 16.66%. The observed lipid disorders were represented by the total hypercholesterolemia (15%), the hypo HDLemia (26, 66%), the hyperLDLemia (12.40%), hypertriglyceridemia (46.66%). Twelve patients (20%) had mixed dyslipidemia. The index of atherogenic was above normal in most represented 36.66% in women (52.64%) than men (17.08%). Conclusion: Dyslipidemia including hypertriglyceridemia and hypo-HDL cholesterol are common and potentially atherogenic in hemodialysis CHU-SO. The interest in the prevention and treatment of any systematic dyslipidemia in hemodialysis IRC prove necessary.

Translation and psychometric properties of the persian version of the dialysis symptom index in hemodialysis patients.

Background:Hemodialysis patients have a high physical and psychosocial symptom burden. There is no valid and reliable tool for assessing symptoms of hemodialysis patients in Iran.Objectives:The aim of this study was to determine psychometric properties of the Persian version of the dialysis symptom index (DSI).Patients and Methods:The forward-backward procedure was applied to translate the DSI from English into Persian (Iranian language). The scale (Persian Version) was tested with a convenience sample of 95 patients with end-stage renal disease referred to main hemodialysis centers from December 2012 to June 2013. Validity was assessed using content, face and convergent validity. To test reliability, the kappa values were calculated for test-retest stability and the Cronbach alpha coefficients were also calculated for internal consistency.Results:The mean age of patients was 50.4 (SD = 15.72) years and % 61.1 of patients were male. The most commonly reported symptoms were fatigue, being irritable and nervous. Divergent validity was mostly supported by the pattern of association between DSI and SF-36 (r = -0.18– -0.48, P< 0.05). Cronbach’s alpha of the DSI was 0.90 and the weighted kappa ranged from 0.21 to 0.93, and it was greater than 0.4 for 25 of the 30 items.Conclusions:The Iranian version of the DSI had good psychometric properties and can be used to assess symptoms of hemodialysis patients.

Homocysteine and hematological indices in hemodialysis patients

Objectives: To explore the relationship between homocysteine and various hematological indices in hemodialysis patients. Patients and Methods: This casecontrol study comprised 60 hemodialysis patients and 60 healthy controls matched for gender and age. Hemodialysis duration was 3.2±2.9 year at frequency of 2.6±0.6/week. Hypertension and diabetes were the most common selfreported disorders among the hemodialysis patients. Results: Serum homocysteine was significantly higher in hemodialysis patients than in controls (50.8±9.7 vs. 13.1±3.7 μmol/l, P=0.000). White blood cell (WBC) and platelet (PLT) counts were significantly higher in hemodialysis patients than in controls [(7.18±2.37 ×109/L and 266.3±111.9 ×109/L vs 5.95±1.37 ×109/L and 222.0±54.1 ×109/L) with P=0.017 and P=0.045, respectively]. In contrast, red blood cell (RBC), hemoglobin, and hematocrit were significantly lower in hemodialysis patients (3.1±0.5 ×1012/L, 8.9±1.5 gm/dl and 26.3±4.6%) than in controls (4.0±0.4 ×1012/L, 12.8±1.6 gm/dl and 45.0±4.6%) with P=0.000. Prothrombin time (PT) and international normalized ratio (INR) were significantly higher in hemodialysis patients compared to controls (16±3 sec and 1±0 vs. 14±0 sec and 1.0±0.1, P=0.000), whereas activated partial thromboplastin time (APTT) was significantly decreased in hemodialysis patients (25±5 vs 33±2 sec, P=0.000). Homocysteine correlated directly with WBC count (r=0.338, P=0.008) and PLT count (r=0.369, P=0.000) whereas inverse correlations were found between homocysteine and RBC count (r=- 0.648, P=0.000), hemoglobin (r=-0.733, P=0.000) and hematocrit (r=-0.836, P=0.000). In addition, homocysteine showed direct correlations with PT (r=0.564, P=0.000) and INR (r=0.657, P=0.000) and inverse correlation with APTT (r=-0.690, P=0.000). Conclusion: Serum homocysteine was significantly higher in hemodialysis patients compared to controls. Homocysteine correlated directly with WBC count, PLT count, PT and INR, and inversely with RBC count, hemoglobin, hematocrit and APTT.

Cost Savings Using a Protocol Approach to Manage Anemia in a Hemodialysis Unit

Background: National guidelines recommend using anemia management protocols to guide treatment. The objective of this study was to determine if an anemia management protocol would improve hemoglobin (Hgb) indices in hemodialysis patients and to measure whether the protocol would reduce the use and cost of darbepoetin alfa (DBO) and intravenous (IV) iron in hemodialysis patients. Methods: An anemia management protocol was created and implemented for hemodialysis patients at our institution. A retrospective observational review of the use of DBO and IV iron as well as changes in Hgb, transferrin saturation and ferritin in 174 patients was conducted 6 months before and after implementation of the anemia protocol. Results: The number of Hgb measurements in the target range increased from 44.3 to 46.0% (p = 0.48) after protocol implementation. The mean weekly dose of DBO was reduced from 34.56 ± 31.12 to 31.11 ± 28.64 μg post-protocol implementation (p = 0.011), which translated to a cost savings of USD 41,649 over 6 months. The mean monthly IV iron dose also decreased from 139.56 ± 98.83 to 97.65 ± 79.05 mg (p < 0.005), a cost savings of USD 18,594 over the same time period. Conclusion: The use of an anemia management protocol resulted in the deprescribing of DBO and iron agents while increasing the number of patients in the target Hgb range, which led to significant cost savings in the treatment of anemia.

Cognition may be related to arterial pulsatility index in HD patients.

Hemodialysis (HD) patients have a heavy burden of subclinical cerebrovascular disease and cognitive changes consistent with a vascular etiology. Pulsatility index is associated with microangiopathy of cerebral blood vessels and an increased risk of cerebral infarction. The proposed study was to determine common carotid artery pulsatility index (CCAPI) and its relation to cognition in well-dialyzed HD patients with no history of stroke or dementia and matched controls. Observational, cross-sectional study of CCAPI and cognition in 37 hemodialysis outpatients and 18 matched controls with normal kidney function. Non-parametric analyses were used to compare variables between groups. Multiple regression and ANOVA models were used to adjust for risk factor differences. Controls had a lower CCAPI than the HD group (1.7 ± 0.3 vs. 2.1 ± 0.4 cm/s, p = 0.006). HD patients scored significantly lower on all cognitive domains. Attention correlated with CCAPI in HD patients, independent of hypertension, diabetes, hyperlipidemia, and years on HD (r2 = -0.36, p = 0.01). CCAPI correlated with years on HD, independent of traditional cardiovascular risk factors. (r2 = 0.26, p = 0.04). In well-dialyzed hemodialysis patients with no history of stroke or dementia, CCAPI may correlate with cognitive function and represent a marker for underlying cerebral microvascular disease.

Ankle Brachial Index in Hemodialysis Patients

Ankle Brachial Index in Hemodialysis Patients

Relationship between fluid status as assessed by bioimpedance analysis and NT-pro BNP, blood pressure and left ventricular mass index in hemodialysis patients.

Maintenance of fluid status within an optimal range and accurate assessment of dry weight (DW) is essential in patients on intermittent haemodialysis (HD) treatment. In this study, we aimed to investigate the association of fluid status measured by bioimpedance analysis (BIA) with N-terminal pro-B natriuretic peptide (NT-proBNP), blood pressure and left ventricular mass index (LVMI) in hemodialysis patients. A total of 45 hemodialysis patients were enrolled in the study. N-terminal pro-B natriuretic peptide (NT-proBNP) was measured by immunoassay. Blood pressure (BP) was recorded. Echocardiographic examinations were performed in all patients. Multifrequency bioimpedance analysis was used to assess pre- and post-dialysis fluid status. Overhydration/ extracellular water (OH/ECW) ratio was used as fluid status index and OH/ECW ratio >0.15 was defined as clinical overhydration. Patients were divided into two groups; overhydrated (OH/ECW>0.15) and non-overhydrated (OH/ECW≤0.15). OH/ECW, systolic blood pressure (SBP), diastolic blood pressure (DBP), LVMI and NT-proBNP levels were significanly reduced after hemodialysis session. The presence of overhydration was more frequent in pre-HD patients compared to post-HD patients (31.1% vs 13.3%, p=0.004). OH/ECW was positively correlated with pre-and post-HD SBP, DBP, LVMI and NT-proBNP (p<0.05). Overhydrated patients had significantly higher values of pre-HD and post-HD SBP, DBP, LVMI and NT-proBNP compared to non-overhydrated patients. In addition, SBP, DBP, LVMI and NT-proBNP levels were significantly reduced after hemodialysis in both overhydrated and non-overhydrated patients group. This study revealed that OH/ECW ratio was significantly associated with SBP, DBP, LVMI and NT-proBNP.

Platelet‐to‐Lymphocyte Ratio: One of the novel and valuable platelet indices in hemodialysis patients

Platelet‐to‐Lymphocyte Ratio: One of the novel and valuable platelet indices in hemodialysis patients

Psychometric assessment of the Persian version of the Ferrans and Powers 3.0 index in hemodialysis patients

This study aimed to assess the psychometric properties of the Persian version of the Ferrans and Powers 3.0 quality of life index (dialysis type) in patients receiving hemodialysis (HD) in order to describe their health-related quality of life (HRQOL). The sample (n = 150) consisted of adult HD patients receiving HD for at least 6 months from the establishment of the study. A total of 88 men and 62 women, with an average age of 50.47, from Shiraz, southern Iran, were enrolled in this study. The questionnaire was translated into Persian language using back translation and bilingual techniques. Convergent, discriminant, and construct validity of the Ferrans and Powers 3.0 dialysis version was evaluated. To check the internal consistency of the data, Cronbach's alpha, which indicates the reliability of the data, was used for the entire questionnaire and for the subscales. The convergent and discriminant validity and success scaling rate for both sexes were 100 %. Cronbach's alpha was 0.95 overall, which was greater than 0.7 for all the subscales except for the family subscale. Our results suggest that HD patients in southern Iran have higher HRQOL scores when compared with those in other countries. Despite the higher mean HRQOL score for men compared with women, men had significantly higher HRQOL scores only in the health and functioning subscale. There was no significant correlation between HD patients' HRQOL and educational level. The Persian version of Ferrans and Powers 3.0 has sufficient reliability and validity for measuring the quality of life of Persian-speaking HD patients. Female HD patients need more support and attention from family and society.

Índice tornozelo-braço em pacientes hemodialíticos

INTRODUÇÃO: Apesar da elevada mortalidade dos pacientes em hemodiálise devido às doenças cardiovasculares, é incomum a realização de exames diagnósticos para doença arterial obstrutiva periférica e artérias pouco compressíveis. OBJETIVOS: Analisar a prevalência de doença arterial obstrutiva periférica e artérias pouco compressíveis em hemodialisados, comparando-os com o Grupo Controle. MÉTODOS: Tratou-se de um estudo transversal, com 78 hemodialisados e 88 pacientes que não faziam hemodiálise com, pelo menos, dois fatores de risco para doença arterial obstrutiva periférica (Grupo Controle). Para aferição da pressão arterial sistólica, utilizou-se Doppler vascular portátil e esfigmomanômetro. Esta foi aferida somente nos membros que não possuíam fístula arteriovenosa. O índice tornozelo-braço foi calculado utilizando cada artéria do membro inferior. Foram considerados normais os valores de 0,9 a 1,3. RESULTADOS: Diagnosticou-se doença arterial obstrutiva periférica e artérias pouco compressíveis em 26,9 e 30,8%, dos hemodialisados, e em 33 e 22,7%, do Grupo Controle. Nos hemodialisados, verificou-se o índice tornozelo-braço alterado em 75% dos sintomáticos (p=0,005), em 67,3% dos homens e 31% das mulheres (p&lt;0,005), em 78,6% dos idosos, 34,8% dos adultos jovens (p&lt;0,01) e em 76,9% dos diabéticos (p&lt;0,005 versus não diabéticos). Esses pacientes apresentaram maior prevalência de doença arterial obstrutiva periférica grave do que o Grupo Controle (p&lt;0,01). CONCLUSÕES: O índice tornozelo-braço anormal foi muito prevalente nos grupos estudados; entretanto, os hemodialisados apresentaram alterações mais graves quando comparados ao Grupo Controle. Diabetes melito, sexo masculino e idade avançada foram fatores de risco importantes para a alteração do índice tornozelo-braço nos hemodialisados. O índice tornozelo-braço foi um bom método de rastreio para alterações pesquisadas. Portanto, a utilização deste na rotina de manejo de pacientes em hemodiálise é sugerida.