Hemodialysis Program Research Articles

Первый случай успешной беременности и естественных родов у больной на программном гемодиализе в Узбекистане

Первый случай успешной беременности и естественных родов у больной на программном гемодиализе в Узбекистане

Percutaneous Nephrostomy as a Procedure in the Treatment of Urinary Tract Obstruction - Experiences in the University Clinic of Urology in Skopje.

Obstructive uropathy encompasses various urinary tract obstructions, leading to changes in urine flow, kidney pressure, and impaired kidney function. Predicting renal recovery from obstructive uropathy, can be challenging and necessitates treatment, as in percutaneous nephrostomy (PNS) drainage. The choice of drainage method depends on patient-specific factors and local expertise. According to the data for the Republic of North Macedonia, in the register of the European Renal Association, in the last few years, there has been an increase in the percentage of patients with obstructive nephropathy from 7.6% to 8.9% who end up on a chronic hemodialysis program. Prompt relief from urinary tract obstruction is essential to preserve renal function and prevent complications. The aim of this study is to present our initial data analysis of recent experience in the use of nephrostomies as a method for temporary or long-term resolution of obstructive nephropathy, in terms of safety and success in preserving kidney function and reducing the number of patients on hemodialysis. This study analyzed the medical records of 24 patients with obstructive uropathy who underwent PNS placement. Data were collected for the type and degree of obstruction from the ultrasonographic examination. A pig tail nephrostomy was used, with a dilator, guided under ultrasound and controlled with contrast and fluoroscope. Obstructive nephropathy was defined as an elevation of the serum creatinine > 109 µmol/L, before the intervention. Glomerular filtration rate (GFR) was calculated according to the formula CKD epi in ml/min. Each placement of the PNS was considered as an individual procedure and the data of 38 placed nephrostomies were analyzed. We compared the laboratory analyses from the day before (D0) PNS placement and on the seventh day (D7) after PNS placement. The reduction of values for red blood cells (RBC) and hemoglobin (Hb) baseline values from D0 to D7 and the need for transfusion after the procedure were defined as a complication-bleeding. The increase in total counts of the white blood cells (WBC) and C-reactive protein (CRP) from the baseline values from D0 to D7 were defined as a complication-infection. Standard statistical methods were used for data processing. Most patients, 17 (70%), had malignant disease as the cause of obstruction. Unilateral obstruction was more common, detected in 24 (63%) of procedures, with a high degree of hydronephrosis. Obstructive nephropathy, marked by elevated serum creatinine, was observed in 23 (60%) cases before PNS placement. Complications included bleeding and infection but did not result in any fatalities. When comparing the laboratory analysis before PNS placement (D0) and seven days later (D7), a statistically significant decrease in serum creatinine (225±161 vs. 162±145, p=0.005) and an increase in GFR (47±39 vs.59±34, p= 0.005) were observed. Percutaneous nephrostomy is a safe and effective treatment option for urinary tract obstruction, especially in patients with malignancies. Continuous monitoring is essential to assess long-term complications and the longevity of PNS functionality. This procedure offers a significant benefit in preserving renal function and minimizing the need for hemodialysis in these patients.

The Influence of the Time Factor and Marital Status on the Quality of Life of Patients After Kidney Transplantation in Uzbekistan

Background: Currently, compared to program hemodialysis and peritoneal dialysis, kidney transplantation is considered to be the preferred method of renal replacement therapy in patients with end-stage chronic kidney disease (CKD) in terms of patient survival and improvement in their quality of life (QOL). This study aimed to investigate the influence of the post-transplantation period and marital status on the health-related QOL of patients with CKD who underwent kidney transplantation.Methods and Results: A cross-sectional study was conducted among 78 patients who had received a kidney transplant from living related donors in the Republican Specialized Scientific and Practical Medical Center for Nephrology and Kidney Transplantation between January and April 2022. Kidney transplant recipients (KTRs) were divided into four groups depending on the time after kidney transplantation: 3, 6, 12 months, and 2 years or more after surgery. The study used 2 questionnaires. The first included questions about the sociodemographic data of patients; the second was the standardized health-related QOL questionnaire SF-36. This study of the QOL of KTRs, residents of the Republic of Uzbekistan, showed an improvement in most scales of physical and mental health components 12 months and 2 years or more after kidney transplantation. On the scales of physical and mental health components, unmarried KTRs had a higher self-assessment of QOL than married KTRs, and among married KTRs, those with children had higher QOL indicators.Conclusion: Clarifying how the time after kidney transplantation and individual sociodemographic and medical factors influence QOL indicators requires further research (including longitudinal studies) in a wider КTR population.

Parada cardiorrespiratoria intradiálisis y anafilaxia a membrana de dializador como probable etiología en un paciente con inicio de terapia sustitutiva renal por enfermedad renal crónica.

Introduction: During the dialysis session, hypersensitivity reactions to the dialyzer may occur. Clinically, these conditions can vary in severity, from pruritus, erythema, and facial edema to more severe conditions such as dyspnea, bronchospasm, tachypnea, cyanosis, shock, and cardiac arrest. We present an unusual case of repeated anaphylactic shock, possibly caused by the use of a dialyzer with a helixone membrane. Clinical case: 60-year-old hypertensive and type 2 diabetic woman who presented uremia with hypervolemia and underwent dialysis treatment in the hemodialysis program. During the sixth session, she witnessed cardiorespiratory arrest, with recovery of spontaneous circulation after advanced cardiopulmonary resuscitation. Management: Required management in intensive care with intravenous nitroprusside and intubation with mechanical ventilation. Evolution: Given a new treatment, he once again developed hemodynamic instability with hypotension at the beginning of treatment. She was transferred to the peritoneal dialysis program. Conclusion: An anaphylactic reaction to helixone associated with hypotension and anaphylactic shock is reported.

Patient Training and Patient Safety in Home Hemodialysis.

The success of a home hemodialysis program depends largely on a patient safety framework and the risk tolerance of a home dialysis program. Dialysis treatments require operators to perform dozens of steps repeatedly and reliably in a complex procedure. For home hemodialysis, those operators are patients themselves or their care partners, so attention to safety and risk mitigation is front of mind. While newer, smaller, and more user-friendly dialysis machines designed explicitly for home use are slowly entering the marketplace, teaching patients to perform their own treatments in an unsupervised setting hundreds of times remains a foundational programmatic obligation regardless of machine. Just how safe is home hemodialysis? How does patient training affect this safety? There is a surprising lack of literature surrounding these questions. No consensus exists among home hemodialysis programs regarding optimized training schedules or methods, with each program adopting its own approach on the basis of local experience. Furthermore, there are little available data on the safety of home hemodialysis as compared with conventional in-center hemodialysis. This review will outline considerations for training patients on home hemodialysis, discuss the safety of home hemodialysis with an emphasis on the risk of serious and life-threatening adverse effects, and address the methods by which adverse events are monitored and prevented.

Nurses' knowledge toward hemodialysis vascular access devices: A cross-sectional study in Palestine.

To assess the nurses' knowledge of vascular access devices for patients undergoing hemodialysis programs in the Gaza Strip, Palestine. A descriptive cross-sectional study was conducted to assess the nurses' knowledge of hemodialysis vascular access using the convenience sampling technique. The assessment tool comprised 60 items related to the nurses' knowledge and 7 items on demographic characteristics at hemodialysis units in 5 governmental hospitals in the Gaza Strip, between March and June 2023. Statistical analysis of the collected data was performed using SPSS version 22. A total of 65 nurses in hemodialysis units were included. Of the majority of study nurses 71% were male, 21.5% of nurses had fair knowledge, and 78.5% had good knowledge about vascular access devices. The overall average score was more than 70% in all dimensions, which revealed good knowledge about vascular access devices. The study indicated that there was a statistically significant association between nurses' knowledge of vascular access devices and (years of experience in the hemodialysis unit, and received training of nurses). The knowledge of hemodialysis nurses toward vascular access devices for patients undergoing hemodialysis was good. The years in the hemodialysis unit and having training have shown significant association with knowledge among hemodialysis nurses on vascular access devices care. Thus, interventions should focus on providing training for nurses about vascular access devices care in hemodialysis units to improve the comprehensive knowledge of nurses and to maintain patient's health status.

Advances in uremic toxin detection and monitoring in the management of chronic kidney disease progression to end-stage renal disease.

Patients with end-stage kidney disease (ESKD) rely on dialysis to remove toxins and stay alive. However, hemodialysis alone is insufficient to completely remove all/major uremic toxins, resulting in the accumulation of specific toxins over time. The complexity of uremic toxins and their varying clearance rates across different dialysis modalities poses significant challenges, and innovative approaches such as microfluidics, biomarker discovery, and point-of-care testing are being investigated. This review explores recent advances in the qualitative and quantitative analysis of uremic toxins and highlights the use of innovative methods, particularly label-mediated and label-free surface-enhanced Raman spectroscopy, primarily for qualitative detection. The ability to analyze uremic toxins can optimize hemodialysis settings for more efficient toxin removal. Integration of multiple omics disciplines will also help identify biomarkers and understand the pathogenesis of ESKD, provide deeper understanding of uremic toxin profiling, and offer insights for improving hemodialysis programs. This review also highlights the importance of early detection and improved understanding of chronic kidney disease to improve patient outcomes.

The effect of hemodialysis on the ocular anterior morphometry and intraocular pressure

Introduction/Objective This study evaluates the effects of hemodialysis (HD) on intraocular pressure (IOP) and ocular anterior chamber morphometry in end-stage renal disease (ESRD) patients. Methods In total, 32 ESRD patients (50 eyes) who were on regular HD program, underwent ocular examination. To all of them, 30 minutes before HD and 30 minutes after the end of the HD session, central corneal thickness (CCT), keratometric values (K1, K2), axial length (AL), anterior chamber depth (ACD), and lens thickness (LT) were measured using the Lenstar 900 Haag-Streit USA device (Haag-Streit Group, Koniz, Switzerland). IOP was measured using Goldman applanation tonometry. Results IOP before HD was 15.74 ? 3,043 while after HD it was 15.14 ? 3,07 (p = 0.125); K1 and K2 values were 43.11 ? 1.68 vs. 43.13 ? 1.73 (p = 0.688) and 43.11 ? 1.60 vs. 43.11 ? 1.66 (p = 0.158); AL increase from 23.25 ? 0.68 to 23.27 ? 0.68 in postHD (p = 0.158) as well as AL from 23.25 ? 0.68 to 23.27 ? 0.68 (p = 0.264); ACD decrease insignificantly from 3.14 ? 0.40 to 3.10 ? 0.42 (p = 0.063); mean LT before HD was 4.66 ? 0.38 while after HD it was 4.67 ? 0.36 (p = 0.290) and CCT was 563.68 ? 42.02 vs. 563.34 ? 42.26 (p = 0.777). Conclusion HD has no significant influences on ocular anterior segment structures such as on CCT, ACD, LT, AL, K values as well as IOP.

Успешный случай ведения беременности и родов на сроке 37 недель у пациентки на программном гемодиализе в Республике Татарстан

The article presents a description of a clinical case of pregnancy management and successful delivery at 37 weeks in a patient who had been receiving program hemodialysis for 17 years. Pregnancy was unexpectedly discovered at 6–7 weeks; intensive hemodialysis was performed 6 times a week during gestation. There are certain difficulties in managing pregnancy in women receiving program hemodialysis, however, a favorable outcome is possible with the coordinated work of a multidisciplinary medical team.

Генетические маркеры тромбогенного риска у больных на программном гемодиализе

Генетические маркеры тромбогенного риска у больных на программном гемодиализе

The role of interleukin-6 in the development of protein-energy deficiency in patients on program hemodialysis

The development of protein-energy malnutrition (PEM) in patients on program hemodialysis is one of the significant problems of modern hemodialysis. Despite the relevance of this problem, there is no single point of view on the mechanisms of development of PEM in this cohort of patients. Objective. To assess the change in the level of interleukin-6 (IL6) in the blood of patients on program hemodialysis, and also to study the relationship between the level of IL6 in the blood serum and PEM indicators in this group of patients. Material and methods. The study involved 645 patients receiving treatment with program hemodialysis (300 men and 345 women; mean age – 56.8±12.8 years). All patients underwent a traditional clinical and laboratory examination. Results. In 66% of patients on hemodialysis, a significant increase in the level of IL6 in the blood was detected. Moreover, in patients with signs of PEM, the level of IL6 in the blood was statistically significantly higher compared to patients without signs of PEM. Also, patients with elevated IL6 levels had statistically significantly lower values of total protein, albumin, prealbumin, total cholesterol, transferrin and blood lymphocyte levels compared to patients with normal IL6 levels. Also, patients with elevated IL6 levels had statistically significantly lower values of body mass index, skeletal muscle mass and body fat mass compared to patients with normal IL6 levels. Conclusion. The data obtained suggest that an increase in the level of IL6 in the blood may be an important pathogenetic link in the development of PEM in patients receiving treatment with program hemodialysis.

Chronic kidney disease in patients with long-term type 1 diabetes mellitus

BACKGROUND: Patients with type 1 diabetes mellitus (T1D) have an earlier age of onset and a longer course of the disease, already by middle age they have the development of microand macrovascular diabetic complications that reduce the quality and duration of life.AIM: To evaluate the prevalence of chronic kidney disease (CKD) and other late complications of T1D depending on renal dysfunction in the population of patients with T1D with disease duration of 20 and more years, who underwent examination and treatment in Endocrinology Research Centre.MATERIALS AND METHODS: A one-stage single-center epidemiological non-randomised study was conducted using the database of Endocrinology Research Centre with the study of 500 patients’medical histories with long-term T1D (20 years and mores), without kidney damage and with CKD at different stages (CKD C1–C5, C5D, after transplantation), examined and treated from 2011 to 2023.RESULTS: Normal renal function was observed in 10.8% of patients (n=54). Terminal stage of CKD was reached in 28.0% (n=140), of which 12.4% were on renal replacement therapy with program hemodialysis (RRT-HD), and 12.0% after isolated kidney transplantation or combined kidney and pancreas transplantation, the rest were at different stages of CKD. Normoalbuminuria was observed in 15.4% (n=77) among 500 patients. The prevalence of late complications of DM among the examined patients was high and increasing with the progression of renal dysfunction: diabetic retinopathy was diagnosed in 96% of patients, distal symmetrical polyneuropathy — in 97% of patients, various forms of autonomic neuropathy — in more than half of patients. About 60% of patients had diagnosed arterial atherosclerosis in the legs, about one third — atherosclerosis of brachiocephalic arteries, 23% — confirmed coronary heart disease, and suffered cardiovascular events (myocardial infarction, acute cerebral circulation disorder) — 19% of patients, about half of whom had CKD of different severity. Factors for increased risk of cardiovascular disease: estimated glomerular filtration rate (eGFR)<60 mL/min/1.73m2, OR=7.1; 95% CI 3.6–8.4; p<0.001), eGFR <30 mL/min/1.73m2 OR=8.7; 95% CI 2.8–8.4; p<0.001), eGFR <15 mL/min/1.73m2 OR=14; 95% CI 6.3–31.3; p<0.001); albuminuria > 30 mg/g OR=2.4; 95% CI 1.6–3.6; p<0.001), dialysis OR=14.1; 95% CI 6.2–32.1; p<0.001), kidney transplant OR=11.7; 95% CI 5.4–24.9; p<0.001). Manifestation of T1D between 1996–2002 reduced the risk of developing CKD by 10.75; 95% CI 4.37; 27.03) vs manifestation of T1D earlier. Age of T1D debut 6–17 years increased the risk of reaching terminal CKD vs age of debut >18 years: OR=2.4; 95% CI 1.22; 5.022; p=0.012).CONCLUSION: Despite a significant reduction in the risk of developing CKD in individuals with T1D debut between 1996 and 2002, renal dysfunction is a frequent complication in patients with a long disease course, combining with other late complications and contributing to a high risk of terminal stage of CKD and cardiovascular events. Early age of T1D debut increases the risk of terminal CKD.

P133: Impairment of Executive Functions in Dialysis Patients. Necessity of Evaluation Cognitive State in Advanced Chronic Kidney Disease

Introduction:Cognitive impairment is common and underdiagnosed in patients in hemodialysis (HD) can be moderate and severe. About 38% of patients in Dialysis has serious deficits in executive function and this affects patients of all ages.Material and methods:Based on the case of an 82-year-old patient in a HD program who enters from Nephrology to the Convalescence Unit for miscontrol of pain due to ganglion and liver recidivism after years of cystectomy by bladder neoplasia and having acute confusional syndrome (ACS) subsequently presented after treatmet with morphine MST and Tramadol. We performed an integral geriatric evaluation that showed a deterioration of the executive functions. Through medical literature we analyze this find of atypical pattern and its possible relationship to renal disease.Results:BI 100/100. No known history of cognitive impairment. Despite optimal pain control with fentanyl patch, pregabalin, paracetamol, metamizol and dexamethasone, without new episodes of ACS, we saw high difficulties in comprehension time schedule, spatial location, bad understanding of medical treatment, etc. Neuropsychological study showed MMSE 24/30; SKT subtest of immediate memory 1/12, null recognition without understanding the task. Memory Imparily Screen 5/8, Test clock 3/7. In summary there were deficits in executive functions such as complex attention, mental control, fluency and reasoning. Fluctuating memory abilities. Mild multiple cognitive impairment executive domain. Atypical Profile.Conclusions:There is a strong correlation between the decrease in GF and the degree of cognitive impairment. This worsens with the Dialysis due to hemodynamic changes. It is essential to evaluate the cognitive situation in all patients with CKD. Being the most affected cognitive domain, the function executive,it can avoid in these patients the correct assesment of established medications and dietary restrictions that are so important in the control of potassium, phosphorus and liquids that cause greater complications and even more mortality.

Serum chloride as a marker of cardiovascular and all-cause mortality in chronic hemodialysis patients: 5-Year follow-up study

BackgroundHypochloremia has been associated with increased mortality in patients with hypertension, heart failure, sepsis, and chronic kidney disease (CKD). The pathophysiological mechanisms of this finding are not clear. There are no studies describing an association between serum chloride levels (Cl−) and mortality in incident chronic hemodialysis (HD) patients. MethodRetrospective cohort study of the incident population in our chronic outpatient hemodialysis program between January 1, 2016, and January 1, 2021 (N=374). Survival time was collected in all patients and analyzed using the Kaplan–Meyer method. A multivariate Cox regression model was performed to predict the probability of survival, applying a stepwise procedure. ResultsDuring the median follow-up period of 20 months, 83 patients died. The 5-year overall survival rate for our patients was 45%. Both natremia and chloremia had no significant differences when compared by sex, vascular access, or etiology. There was an inverse correlation between Cl− and interdialytic weight gain (r=−0.15) (p=0.0038). Patients belonging to the quartile with lower Cl− levels had less probability of survival than patients in the quartile with higher Cl− levels (27% and 68%, respectively, p=0.019). On the other hand, in the multivariate Cox regression model, variables significantly associated with higher mortality were being older, having higher baseline comorbidity by modified Charlson index, not taking diuretics and having lower albumin and chloride levels. Particularly, higher Cl− levels was independently associated with both lower all-cause mortality (adjusted hazard ratio [HR]=0.84; 95% confidence interval [CI], 0.77–0.92; p=0.0001) and cardiovascular mortality (HR 0.9; 95% CI, 0.83–0.97; p<0.0057). ConclusionsLower Cl− levels were associated with higher all-cause and cardiovascular mortality in incident patients on chronic hemodialysis in our health area.

Value of lung ultrasound in detection of volume overload in children chronic kidney disease on regular hemodialysis: prospective cohort study

BackgroundSeveral methods have emerged to predict the occurrence of early volume overload (VO) in pediatric patients with chronic kidney disease undergoing regular hemodialysis (HD). Nevertheless, achieving an accurate assessment remains challenging. Consequently, this study aimed to identify VO in pediatric HD patients using lung ultrasound (LUS). Additionally, the study sought to investigate the relationship between various clinical parameters employed to detect VO and the ultrasonographic B-line score.MethodsThis prospective observational cohort study was conducted on 30 pediatric patients with end-stage renal disease undergoing a maintenance HD program for 4 months. The clinical evaluation of the fluid status of pediatric patients involved using LUS pre-, intra, and post-HD. The study included the dry weight (DW) and non-DW groups; within these groups, the B-line scores were evaluated pre-, intra, and post-HD sessions. Tabulations were conducted to document the variations in body weight and B-line scores during pre-, intra-, and post-dialytic periods.ResultsThe results of the LUSs performed on the 30 pediatric patients pre-, intra, and post-HD revealed that the B-line scores significantly reduced post-HD in all pediatric patients with more significant reduction in non-dry weight group (p < 0.001). There was a positive relation between the total number of B-lines pre-HD and inter-dialytic weight gain, pre-dialytic blood pressure, and clinical fluid score (r = 0.811, p < 0.01; r = 0.59, p < 0.001; and r = 0.75, p < 0.001, respectively) and also post-dialysis. Eventually, dialytic weight loss exhibited a significant direct positive correlation to B-line score reduction (r = 0.891, p < 0.01).ConclusionsLUS is an innovative, simple noninvasive bedside method that provides real-time evaluation of fluid volume alterations in pediatric HD patients with chronic conditions. LUS shows excellent potential as a viable approach for assessing DW and non-dry weight in pediatric HD patients.

Infusion-transfusion therapy and correction of water–electrolyte disorders in simultaneous liver fragment transplantation and kidney retransplantation (clinical case)

A clinical case of simultaneous surgery in the volume of transplantation of the left lateral sector of the liver and kidney retransplantation from one living related donor to a 10-year-old girl with cirrhosis of the liver and after transplantectomy of the donor kidney is presented. The child born in 2013 was transferred to program hemodialysis in 2015 as a result of the development of end-stage chronic kidney disease (CKD) in the outcome of congenital kidney dysplasia. In October 2022, renal replacement therapy was started as a result of a relapse of end-stage CKD. In January 2023, she suffered purulent cystitis. 02.24.2023 – transplantectomy. 05.05.2023, simultaneous transplantation of the left lateral sector of the liver and kidney allotransplantation from a living related donor were performed. Anesthesiologists faced a serious problem in the form of the selection of adequate infusion therapy, taking into account the combination of two surgical interventions that radically differ in the tactics of anesthesiological support, as well as the correction of water – electrolyte disorders in the complete absence of diuresis throughout the fifteen-hour surgical intervention

Correlación entre el sodio plasmático determinado por el laboratorio y el determinado por el monitor de hemodiálisis

IntroductionChanges in plasma sodium concentration (pNa, expressed in mEq/l) are common in hemodialysis (HD) patients. Hemodialysis monitors can estimate pNa by using an internal algorithm based on ionic dialysance measurements. The present study studies the accuracy of the correlation between the pNa estimated by the dialysis monitor and that measured by the biochemistry laboratory at our center. Material and methodsA single-centre prospective observational study in patients on a chronic HD program with the 6008 CAREsystem monitor and standard sodium (138mEq/l) and bicarbonate (32mmol/l) prescriptions. Venous blood samples were drawn from each patient before and after each HD session to ensure inter- and intra-individual validity. The pNa was measured in the biochemistry laboratory using indirect potentiometry and simultaneously the estimated pNa by the HD monitor was recorded at the beginning and at the end of the HD session. For statistical analysis, a scatter plot was made, and Spearman's correlation quotient was calculated. In addition, the differences between both methods were represented as Bland-Altman diagrams. ResultsThe pre-dialysis pNa measured in the laboratory was 137.49±3.3, and that of the monitor, 137.96±2.91, with a correlation with R2 value of 0.683 (P<.001). The post-dialysis pNa measured in the laboratory was 137.08±2.23, and that of the monitor was 138.87±1.88, with an R2 of 0.442 (P<.001). On the Bland-Altman plots, the pre-dialysis pNa has a systematic error of 0.49, in favor of the monitor-estimated pNa, with a 95% confidence interval (CI) of (−3.24 to a 4.22). In the post-dialysis pNa, a systematic error of 1.79 with a 95% CI of (−1.64 to 5.22) was obtained. ConclusionThe correlation between the pNa estimated by Fresnius 6008 CAREsystem HD monitor and that measured by the laboratory is good, especially pre-dialysis measurements. Further studies should verify the external validity of these results.

Incremental Hemodialysis: A Road to a Greener and Personalized Nephrology

Introduction: Healthcare facilities are among the greatest contributors to resource consumption and waste generation. Nephrology is one of the most polluting medical areas, mostly due to hemodialysis (HD). Incremental hemodialysis (iHD) has gained attention due to several clinical advantages, by decreasing the number of sessions while the patient still has residual kidney function. Beyond these benefits, this regimen might also be both more economical and environmentally friendly. The aim of this study was to evaluate the potential reduction of resource consumption, waste generation and carbon footprint associated with the implementation of iHD. Methods: We conducted a single-center retrospective analysis of 157 incidental patients initiating HD in our centre in 2019 (pre-pandemic). Retrospectively, a set of criteria identifying eligibility for an iHD program were applied to those patients. Results: Twenty-three patients (15%) would have been eligible for iHD instead of starting a standard HD program. In that scenario, iHD implementation would have reduced from 36 to 85 tons of CO2 equivalent emissions and 4186 kg of contaminated waste yearly, at our unit. iHD would also allow savings of almost 60 000€ and a reduction in water consumption of 418 600 L in one year. Conclusion: This study shows that iHD can significantly attenuate the environmental and economic impact of HD. These findings encourage kidneycare programs and policymakers to adopt greener options but should never be detrimental to the clinical decision of referencing a patient to iHD.

Risk Factors for Patients with Hepatitis B and C in Hemodialysis Unit

Background: Risk factors for HCV, HBV transmission are blood transfusions and surgeries before 1992, intravenous drug use, contaminated parenteral drugs and other invasive non-medical procedures (tattooing, piercing). Based on these risk factors, high-risk groups are: multiramified patients (i.e., hemophiliacs), health personnel, intravenous drug users, inmates, individuals with high-risk sexual behaviors (early sex life, high number of sexual partners and prostitution). Other populations at risk are patients on extracorporeal circulation system, such as end-stage kidney disease patients on hemodialysis program. Study aim: To determine risk factors for patients with hepatitis B and C in hemodialysis unit. Methodology: A descriptive study design was conducted at Al-Najaf city in the southern region of Iraq in Al-Sadder Medical City and Al-Hakim General Hospital from February 20th, 2023, to May 23th, 2023, in order to assess risk factors for patients with hepatitis B and C in hemodialysis unit. The methodological strategies for data collection used an assessment questionnaire survey. Results: As the study shows, that the risk factors that cause the most infection are hemodialysis sessions, contact with infected persons, and injected medication, while the lowest risk factors to spread infection are children born with infected hepatitis and unprotected sexual contacted. Conclusion: The study concludes that the first leading risk factor for infection is the hemodialysis session, while the contact with infected persons and contaminated injections of medication comes in the second place. Recommendations: Careful monitoring and strict adherence to infection control procedures among patients undergoing hemodialysis treatment, including commitment to sterilization of hemodialysis devices and the use of all preventive measures when starting the hemodialysis procedure.

Sobrevida y desigualdad social en adultos mayores con enfermedad renal crónica estadio 5 en tratamiento de hemodiálisis

Introduction: The access of older adults to hemodialysis programs is increasingly common. The aim of this study was to determine the survival of older adults with Chronic Kidney Disease (CKD) stage 5 on Hemodialysis, after 5 years of follow-up, in relation to social inequality, and the clinical, biochemical and functional characteristics of the population. studied. Methods: The present observational, analytical, retrospective study was carried out at the CLINEF Norte Nephrological Center, in Quito, Ecuador, in the period 2007-2012. Patients &gt;64 years old, with CKD 5-d were included. Clinical, nutritional, economic, sociodemographic, mortality and overall survival (OS) variables were recorded. The sample was non-probabilistic. Survival was measured at 5 years with Kaplan-Meier and the association between the variables was analyzed. Results: 71 cases are analyzed, with an age of 70.7 ± 6.6 years, 64.8% men, 49.3% with income &lt; 530 dollars. The 5-year OS was 48.9%. The variables that were significantly associated with OS were: male sex (OS 49.0 ± 2.4 months, P=0.010), absence of CVD with OS 45.3 ± 2.4 months, P=0.010), albumin &gt; 3.51 g/dl (OS 49.7 ± 2.9 months, P =0.009), Karnofsky &gt; 80 ( OS 52.7 ± 2.2 months, P =0.002). Female sex and a history of CVD presented a statistically significant HR (HR 2.29, 95% CI 1.18 -4.43; HR 2.67, 95% CI 1.21-5.88). When adjusting for low income, together with female sex and low albumin, they maintained their association (HR 2.21, 95% CI 1.01-4.82), (P=0.044). Conclusion: Nutritional status and functional assessment were the main factors associated with greater survival of older adults on hemodialysis. In a subanalysis it was shown that women with low economic income have lower survival.