فاطمه اسپهبدی

This study investigated the relationship between oral health related quality of life and hyposalivation and dry mouth in patients with chronic renal failure (CRF) undergoing hemodialysis.

This descriptive-analytical study was conducted in 200 patients with CRF undergoing hemodialysis attending the dialysis department in Sari Imam Khomeini Hospital, 2021. Patients completed oral health-related quality of life questionnaires (OHIP-14) with additive and simple count assessment methods. To diagnose dry mouth, unstimulated saliva was collected and patients were asked nine questions, of which five positive answers indicated dry mouth. Data analysis was done in SPSS V18. Pearson's or Spearman's correlation coefficient were applied to investigate the association between quality of life score and unstimulated salivary flow, and t-test or Mann-Whitney test were used to compare the quality of life scores between the groups with and without dry mouth.

Hyposalivation was observed in 66 patients (33%). The OHIP-14 score was significantly higher in both additive and simple count methods in patients with dry mouth and hyposalivation (P<0.05). Comparing different variables, the findings showed that 66.7% of the patients with hyposalivation were older than 58 years of age (P=0.007). In addition, 60.6% of patients with dry mouth had diabetes (P=0.01).

Dry mouth and hyposalivation reduce the quality of life in patients with CRF undergoing hemodialysis. Also, dry mouth and hyposalivation were relatively common problems in these patients. The treatment of these problems is necessary because of their impact on patients' quality of life.

Sambucus Ebulus plant is known for its anti-inflammatory and wound healing properties. This study aimed to determine the effect of Sambucus Ebulus Gel 5% on the severity and surface area of pruritus in hemodialysis patients.

A single-blind randomized clinical trial was performed in 150 hemodialysis patients in three groups. We used Detailed Pruritus Score Introduced by Duo (1978) three times. The scale covers areas such as pruritus severity, distribution, frequency (morning and evening), and sleep disturbance. ANOVA test was used to compare the severity of pruritus between the three groups and Repeated Measure was used in each group.

The mean itching score at the beginning of the study was not statistically significant in all groups (P= 0.49), but at weeks four and eight after treatment significant differences were seen between the three groups in mean score for pruritus severity (P=0.03 and P= 0.01, respectively). Acacia gel and placebo reduced the severity of itching (P= 0.00) but in control group no significant changes occurred (P= 0.158). Findings showed significant improvements in dry skin condition among the intervention and placebo groups (P= 0.00).

According to current study, Sambucus Ebulus Gel 5% can be considered as one of the topical treatments to relieve and improve uremic pruritus and dry skin in hemodialysis patients.

Cytomegalovirus (CMV) is one of the most important pathogens in immunocompromised patients, those who need regular blood transfusion, and renal failure patients undergoing hemodialysis. The aim of this investigation was to study the epidemiology of cytomegalovirus in hemodialysis patients in Sari, Iran.

This cross-sectional study was performed in 180 hemodialysis patients attending two referral centers in Sari, 2017-2018. To include the patients we considered sociodemographic characteristics, blood transfusion history and period, and duration and frequency/week of hemodialysis. Blood samples were collected from all patients and after centrifuge, serum samples were examined for CMV-specific immunoglobulin G (IgG) using enzyme-linked immunosorbent assay (ELISA). Statistical tests including Kolmogorov-Smirnov, Mann-Whitney, and Kruskal-Wallis, and descriptive analysis including proportion for qualitative data and median (quartile range 25-75) for quantitative data were used.

The participants were 180 patients, including 93 (51.7%) females and 87 (48.3%) males (mean age: 61.5±14.4). All patients (100%) were positive for anti-CMV IgG antibody. There were no significant relationships between antibody titer and sex, age, dialysis period, dialysis duration, dialysis frequency per week, transfusion, transplantation, or HBV and HCV status (P >0.05).

Our findings showed high frequency of CMV-IgG positive in hemodialysis patients. Due to the possibility of CMV infection progression in immunocompromised patients, especially those who undergo hemodialysis, screening programs should be performed to prevent adverse consequences.

Chronic and debilitating diseases have many psychiatric consequences. Renal diseases followed by dialysis and kidney transplantation have a profound effect on the physical and mental health of individuals. This study aimed to determine the relationship of dialysis adequacy with depression and anxiety among hemodialysis patients in educational hospitals affiliated to Mazandaran University of Medical Sciences, Sari, Iran, in 2016.

This cross-sectional study was performed on 185 patients with chronic renal failure under hemodialysis. The data were collected using a questionnaire consisting of three sections seeking information about demographic characteristics, disease variables, as well as anxiety and depression hospital scale.  

Out of 185 patients, the majority of the cases were male (n=101, 54.6%) with a mean age of 55±1 years and the females (n=84, 45.4%) were with a mean age of 59.8±0.85 years. About 49.5% of the subjects had urea reduction ratio ≥0.65 and KT/V≥1.2. Dialysis adequacy showed a significant relationship with feeling good, anxiety, and depression (P<0.001).

Knowledge of factors related to dialysis adequacy and its promotion can increase the satisfaction of hemodialysis patients with the quality of dialysis and subsequently improve their quality of life.

Contrast-induced nephropathy (CIN) as a common complication of administration of contrast media (CM) is a major source of hospital morbidity and mortality. The aim of this study was to determine the incidence of CIN after contrast-enhanced CT scan and identifying the related risk factors.

A cross-sectional study was carried out in 100 patients attending Sari Imam Khomeini Hospital who underwent contrast-enhanced CT scan in 2016. Predictors of CIN were evaluated in four general categories, including demographic variables, underlying diseases, concomitant medications, and laboratory findings. Data were analyzed in SPSS V20.

In this study, increase in the concentration baseline serum creatinine of more than 25% or 0.5 mg/dl within 48 hours after the injection of contrast material was considered as an indicator of the incidence of CIN. Accordingly, the incidence rate was 7%. The incidence of CIN was significantly different in patients with and without hypertension (P= 0.028) and patients taking angiotensin II receptor blocking drugs (ARBs) (P= 0.019). Compared to creatinine, BUN and eGFR were both observed to be more accurate in predicting the incidence of CIN. BUN was found to have higher sensitivity and lower specificity while eGFR showed higher specificity and lower sensitivity.

In addition to hypertension and the use of ARBs as the major risk factors for the incidence of CIN, BUN was observed to be a better predictor for CIN than eGFR. Higher Efficacy of BUN could have been due to its larger size and therefore fewer laboratory errors.

Adherences to diet is essential for the treatment of hemodialysis patients. Nonadherence to treatment is directly associated with worse clinical outcomes. This study was designed to determine the association between Adherences to diet with perceived social support and self-efficacy among hemodialysis patients.

In this cross-sectional study، 203 hemodialysis patients were selected by census sampling. Data were gathered by demographic questionnaire، multidimensional scale of perceived social support (MSPSS)، strategies used by patients to promote health (SUPPH) questionnaire، and the renal adherence behavior questionnaire (RABQ). The data were analyzed using descriptive and correlation statistics.

Our findings showed that there was significant relationship between perceived social support and self-efficacy with adherence to diet (p=0. 001). In addition، a relationship was found between perceived social support with serum phosphate and potassium levels (p=0. 023، p=0. 043)، moreover، there was a correlation between self-efficacy and between dialysis weight gain (p=0. 004).

The findings indicated that patients with greater perceived social support and self-efficacy had higher levels of adherences to diet. Based on these findings، to enhance adherence with therapeutics regimen it is necessary increasing the perceived social support and self-efficacy in patients with renal failure.

Hemodialysis patients (HD) with functional iron deficiency(FID) often develop resistance to recombinant human erythropoietin (rHuEpo). Recent studies suggest that intravenous ascorbic acid (IVAA) may circumvent rHuEpo resistance, while oral (AA) is readily attainable. The aim of this study was to evaluate efficacy and safety of oral versus intravenous vitamin C on FID and whether this can improve anemia in hemodialysis patients.

In this study, 31 hemodialysis patients with serum ferritin >100 µg/L, transferin saturation (TS)<30% and Hb <11g/dL were selected and randomly divided into the oral and IV groups. The IVAA group received vitamin C 1.5 g, administered weekly and the oral group, 125 mg vitamin C daily for two months. Hb, ferritin, serum iron, Tsat and serum oxalate were measured at the beginning of the study and 2 months later. Independent – sample T-Test were used for intergroup comparison. P value <0/05 was considered significant.

Mean Hb difference was 1.1±0.7g/dL in the oral and 0.1±1g/dL in the IVAA group, being significantly higher in the oral group (p=0.02). There were no significant differences between the two groups in the delta means of ferritin & Tsat (p=0.5,p=0.3). Delta means of serum oxalate in the 2 groups were 0.05±0.4mg/L, and 0.1± 0.3mg/L respectively, difference not significant(p=0.3).

Oral AA significantly increased Hb in HD patients suffering from FID. Considering the feasibility and cost-effectiveness, clinicians could consider oral instead IVAA in rHuEpo hyporesponsive patients undergoing HD.