جستجوی مقالات مرتبط با کلیدواژه « Renal dialysis » در نشریات گروه « پزشکی »

 Hemodialysis (HD) is the treatment of end-stage renal disease (ESRD), which leads to increased inflammation and mortality. This study aimed to investigate the relationship of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) with high sensitivity C-reactive protein (hs-CRP) levels to predict inflammatory conditions in HD patients.

 A total of 100 eligible maintenance HD patients referred to 22 Bahman and 17 Shahrivar hospitals in Mashhad were enrolled in this cross-sectional study. We collected demographic and clinical data, as well as values of inflammatory markers such as NLR, PLR, and hs-CRP, from the patient’s medical records.

 Forty-six of the patients were female. The mean age of the patients was 37.96±10.29 years, and the mean duration of HD was 54.32±50 months. The mean hs-CRP levels, NLR, and PLR were 6.08±5.70 mg/L, 2.79±1.18, and 125.80±57.14, respectively. The results showed a statistically significant and direct relationship between PLR and hs-CRP levels (P=0.01). There was no correlation between NLR and hs-CRP levels (P=0.8). Additionally, PLR was inversely correlated with hs-CRP in hypertensive patients (r=-0.283, P=0.04), female patients (r=0.3, P=0.04), and patients with HD duration of less than five years (r=0.3, P=0.001).

 Based on these findings, the PLR is a useful inflammatory marker in HD patients with ESRD that correlates with hs-CRP levels. We recommend further investigations to establish its accuracy in clinical care.

Dialysis cuffed catheter dysfunction results in inadequate dialysis, increased sepsis risk, and a shortened catheter life. It may be possible to prolong catheter function by identifying the causes of cuffed catheter dysfunction.

This study was a cross-sectional descriptive study conducted in 2021-2022 on hemodialysis patients with jugular cuff catheters. The catheterizations were performed using the Seldinger technique and were confirmed by fluoroscopy. A 12-month follow-up was conducted with respect to the performance of the cuffed catheter. 

A total of 123 patients underwent hemodialysis over 2 years via a cuffed catheter. Catheters were most commonly inserted into the right internal jugular vein, with lengths of 19 cm (tip to cuff). The rate of dysfunction of cuffed catheters was 27.6%. Catheter-related thrombosis was the most common cause in 10 cases (29.4%), followed by catheter tip fibrin sheath in 8 cases (23.5%) and catheter tip malposition in 8 cases (23.5%). Furthermore, 18 patients (52.94%) of cuffed catheter dysfunction occurred within 3 months of catheter placement, based on our study. The dysfunction of cuffed catheters on the left side 23 (67.64%) is more prevalent than the right side 11 (32.35%) (P=0.043); the malposition of catheter tips is more prevalent on the left side (P=0.023).

Most commonly, cuffed catheter dysfunction is caused by thrombosis, fibrin sheath formation, and catheter tip malposition. Cuffed catheter failure can be reduced by carefully monitoring the catheter's path and tip position, searching for fibrin sheaths when investigating cuffed catheter failure, and preventing thrombotic events.

Non‑adherence to treatments increases the rates of hemodialysis complications, hospitalization, and mortality. One strategy for adherence improvement is peer education. This study aimed to investigate the effects of peer education on treatment adherence among patients receiving hemodialysis.

This was a randomized controlled trial. Patients in the control group were provided just with routine care, and the intervention group received peer education. Treatment adherence was assessed both before and after the intervention via the End‑Stage Renal Disease (ESRD) Adherence Questionnaire. Data analysis was conducted by the Chi‑square, the Mann‑Whitney U, the paired‑sample t, and the independent‑sample t tests.

There were no significant between‑group differences in terms of the pre‑test mean scores of Adherence to regular attendance at hemodialysis sessions (t = 0.19, p = 0.85), Adherence to the prescribed medications (t = 0.46, p = 0.64), and Adherence to fluid restrictions (t = 0.24, p = 0.81). The same finding was observed after the intervention, except for the mean score of the adherence to fluid restrictions dimension which was significantly greater in the intervention group (t = 2.86, p = 0.006). Moreover, no significant changes were observed in the mean scores of treatment adherence dimensions in the control group. However, in the intervention group, the mean scores of the adherence to regular attendance at hemodialysis sessions (t = 3.79, p < 0.001) and the adherence to fluid restrictions dimensions were significantly greater than their pre‑test values (t = 4.47, p < 0.001).

Education by peer groups improves the compliance of patients with regard to the consumption of fluids in the interval between two dialysis sessions.

Pruritus is a troublesome symptom in patients with chronic kidney failure (CKF). Topical treatment is the first choice for many skin conditions including pruritus. This study examined the effect of topical lipogel containing Ziziphus jujube and Echium amoenum extracts on pruritus in hemodialysis (HD) patients. A double-blind crossover trial was conducted with 50 HD patients. A demographic and medical information form and the 12-item Pruritus Severity Scale were used to collect data. Participants were randomly assigned into a placebo group and an intervention group. The intervention was carried out for four weeks. The groups were then switched after a 2-week washout period and followed for the next four weeks. The severity of pruritus was measured before and once a week after the intervention for 4 weeks. The independent samples t-test, the Mann-Whitney U test, the chi-square test, and repeat measures analysis of variance (RMANOVA) were used to analyze the data. The mean baseline pruritus scores were 15.14±2.59 and 14.34±2.6 in the intervention and placebo groups, respectively (P=0.581). The mean pruritus score decreased by three points in the intervention group and one point in the placebo group at the end of the intervention. The results of the RMANOVA also showed that over time, the herbal lipogel significantly reduced the mean pruritus scores in the intervention group (P<0.0001), while it remained relatively unchanged in the placebo group. The use of a topical lipogel containing extracts of Ziziphus jujube and Echium amoenum can effectively reduce pruritus in HD patients. Therefore, this lipogel may safely be used to relieve pruritus in patients receiving HD.

 Cerebral small vessel disease (CSVD) is a chronic disorder affecting small vessels within the brain, increasing the risk of stroke in patients with chronic kidney disease (CKD). Diffusion tensor imaging (DTI) is a newer quantitative method for diagnosing CSVD at an early stage of pathogenesis.

 This study compares various DTI parameters in multiple white matter tracts of the brain in CKD patients undergoing maintenance hemodialysis with normal controls in the Indian population using the volume of interest (VOI) method. Additionally, it correlates these DTI parameters with each other at different locations to gain insights into the pathogenesis of CSVD.

 After obtaining institutional ethics approval, a cross-sectional study was conducted at a tertiary care hospital over one year (June 2022 to May 2023). The study comprised seventy-five patients in the hemodialysis group and twenty-five controls. All participants underwent MRI brain examinations on a 3 Tesla MRI scanner, and the four DTI parameters - fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), and mean diffusivity (MD) - were reviewed for nine white matter tracts to evaluate statistical differences and correlations.

 Fractional anisotropy was significantly decreased at anterior locations – corpus callosum genu (P = 0. 357 × 10-7), right anterior corona radiata (P = 0.001), and left anterior corona radiata (P = 0.45 × 10-5). In these locations, FA negatively correlated with RD (R = -0.7904, P < 0.00001), and RD was also significantly increased. Axial diffusivity was significantly increased at posterior locations in the corpus callosum splenium (P = 0.108 × 10-5) and left posterior corona radiata (P = 0.244 × 10-5). However, none of the four DTI parameters showed significant differences between hemodialysis patients and the control group for the subset of patients with normal routine brain MRI features. The intraclass correlation coefficients (ICCs) were high for all four DTI parameters for both patients (0.78 to 0.85) and controls (0.82 to 0.89).

 This study on CKD patients undergoing maintenance hemodialysis reveals significant differences in some DTI parameters in widespread white matter tracts of the brain using the VOI method, with acceptable to excellent interobserver agreement.

Various exercise therapy methods have been devised for dialysis patients. Nonetheless, even the best exercise regimen is ineffective if not sustained. This study aims to determine the dropout rate and factors influencing exercise therapy discontinuation during dialysis.

This observational, retrospective, and descriptive study included 31 people who underwent exercise therapy during hemodialysis sessions between April 2015 and March 2018 at a hospital. The mean age of the participants was 59.29±11.12 years (range 36–78 years), and the male/female ratio was 24/7. The participants were divided into two groups, the continuation group (15 patients who continued exercise) and the discontinuation group (16 patients who discontinued exercise). Data on physical function history (knee extension muscle strength, one-leg standing time (OLS), and 6-minute walking distance (6 MD)) were collected from medical records. All participants were interviewed using a questionnaire on factors involved in exercise discontinuation from April 2018 to March 2022.

About half of the participants dropped out (51.6%). In particular, the results suggested that body pain was strongly associated with exercise discontinuation. In addition, 8 participants in the discontinuation group died during follow-up after exercise discontinuation (50%).

The study results suggest that it is essential to increase self-efficacy and satisfaction by devising exercise content that meets the individual’s wishes to prevent dropouts during dialysis. In addition, measures against body pain are crucial to continue exercising. The relationship between exercise discontinuation during hemodialysis and mortality should be further examined.

 Patients with Chronic Kidney Disease (CKD) undergoing hemodialysis experience psychological symptoms due to the stressful process and are likely to engage in fewer health-promoting behaviors.

 This study aimed to compare health-promoting behaviors and psychological distress in hemodialysis patients and healthy individuals during the COVID-19 pandemic.

 This case-control study was conducted on 139 hemodialysis patients who visited the dialysis unit of Shahid Beheshti Hospital in Iran County and 139 healthy controls between 2020 and 2021. A demographic form, the Hospital Anxiety Depression Scale (HADS), the Health Promoting Lifestyle Profile II (HPLPII), and the Coronavirus Anxiety Scale (CAS) were used to collect data. Data analysis was performed in SPSS version 22, and a P-value of less than 0.05 was considered statistically significant.

 The mean age of the hemodialysis participants was 56.79 ± 13.97, and that of healthy participants was 56.89 ± 13.87 (P = 0.99). The mean score of health-promoting behaviors was significantly lower in hemodialysis patients than in healthy participants (120.53 ± 20.35 vs. 125.92 ± 6.76) (P = 0.005). Furthermore, hospital anxiety-depression (20.49 ± 5.20 vs. 15.28 ± 2.95) and coronavirus anxiety (22.83 ± 7.19 vs. 20.77 ± 4.71) were significantly higher in hemodialysis patients than in healthy participants (P<0.001 and P = 0.001, respectively).

 Hemodialysis patients exhibited lower health-promoting behaviors and higher coronavirus anxiety and depression than healthy individuals.

The problems such as depression, anxiety, hopelessness, stress and suicide in hemodialysis patients shows the need to support these patients to increase adaptation to the disease. Spiritual therapy introduces the person to the search for meaning, purpose, meaning in life, and the important beliefs and values.

The present study was conducted with aim to determine the effect of spiritual therapy on hope and self-efficacy of hemodialysis patients.

This quasi-experimental study was performed in 2020 on 100 patients undergoing hemodialysis in Amol, Iran. The subjects were randomly divided into case (n=50) and control (n=50) groups. The intervention was performed in case group as 9 training sessions during 5 weeks based on spiritual therapy. Snyder’s Hope and Scherer general self-efficacy standard questionnaires were used to collect data. Data were analyzed by SPSS (version 18) and paired t-test, analysis of covariance and independent t-test. p<0.05 was considered statistically significant.

The mean scores of self-efficacy and hope showed a statistically significant difference before and after spiritual therapy in the case group (p=0.011, p=0.006, respectively). Also, the difference between the mean score of patients’ hope in the case and control groups was statistically significant after the intervention (p=0.006). Also, there was a significant difference between the case and control groups regarding self-efficacy after the intervention (p=0.011).

Implications for Practice:

 Spiritual intervention can be done as an effective and cost-effective method in hemodialysis patients to increase the hope and self-efficacy of these patients.

Hyperphosphatemia is an independent risk factor for mortality in chronic kidney disease (CKD) patients.

This systematic review and meta-analysis aimed to investigate the effect of Sevelamer on serum phosphorus levels in CKD and hemodialysis patients.

The data were obtained after searching the international databases of Cochrane, PubMed, Scopus, Web of Science, and the Google Scholar search engine until February 28, 2023. The heterogeneity of articles was assessed using the I2 index. The data were analyzed in STATA 14, and P values < 0.05 were considered significant.

A total of 22 articles were assessed with a total sample size of 3221. Sevelamer reduced calcium levels in CKD and hemodialysis patients compared with those in the comparison group (standardized mean difference [SMD]: -0.67; 95% CI: -1.23, -0.11); however, sevelamer had no significant effect on serum parathyroid hormone (PTH) levels (SMD: 0.07; 95% CI: -0.39, 0.54) and Ca × P product (SMD: -0.20; 95% CI: -0.41, 0). A significant decrease in serum phosphorus level was observed in patients who had taken sevelamer for a maximum of 12 weeks compared with the comparison group (SMD: -0.27; 95% CI: -0.54, -0.01); however, no significant decrease in serum phosphorus level was observed in patients who had taken sevelamer for more than 12 weeks. A significant decrease in serum phosphorus level was observed in sevelamer users compared to placebo group members (SMD: -0.36; 95% CI: -0.68, -0.05).

The administration of sevelamer reduced serum phosphorus levels in CKD and hemodialysis patients compared with those in the placebo group in the short term. Therefore, physicians are recommended to prescribe sevelamer for a maximum period of three months. Registration: This study has been compiled based on the PRISMA checklist, and its protocol was registered on the PROSPERO website (ID: CRD42023406804).

Malnutrition is relatively common in hemodialysis (HD) patients, which increases the risk of mortality. Seven Point Subjective Global Assessment (7-point SGA) tool is recommended to evaluate and monitor malnutrition in HD patients. The aim of this study was to investigate malnutrition using 7-point SGA in HD patients referred to dialysis centers in Gorgan city (north-eastern of Iran) in 2020.

The nutritional status of 133 HD patients referred to Gorgan city dialysis center in 2020 were assessed using the 7-point SGA tool. Weight, percentage of fat, and muscle mass were measured by Omron BF511. Height was measured using the SECA portable stadiometer. Serum hemoglobin levels were recorded based on the latest recorded routine tests during the last month. A demographic information questionnaire was completed for all individuals. Medications and supplements taken by patients as well as visits by a nutrition consultant and adherence to a special diet were investigated by reviewing the medical file and asking the patient.

Out of 133 patients, 43.61% had no malnutrition and 56.39% had moderate malnutrition. The nutrition status was not different regarding gender and education level, but was different regarding household size (P=0.032). Patients with moderate malnutrition were older and had less weight and body mass index (BMI), but there was no statistically significant difference between height, dialysis time span, body fat and muscle mass percentage, and serum hemoglobin concentration.

This study showed a considerable rate of malnutrition in HD patients, which should be regarded by clinicians and health policymakers.

The current study aimed to compare the impact of acupressure and clonazepam tablets on the quality of sleep in hemodialysis patients in light of the rising prevalence of chronic kidney disease (CKD), the high prevalence of sleep disturbance in these patients, and the side effects of hypnotic drugs.

A total of 60 patients were selected for this randomized, controlled clinical trial and randomly assigned to two groups. For two weeks during the researcher's evening shift, one group received acupressure (six spots bilaterally for three minutes each day). The opposing group was administered clonazepam tablets (0.5 mg) for two weeks. The Pittsburgh Sleep Quality Index (PSQI), which measures sleep quality, was used to compare sleep in the two groups before and after the intervention.

There was no statistically significant difference between the two groups prior to the intervention (P = 0.75) in terms of the mean pre-intervention PSQI scores for the acupressure and clonazepam groups, which were 15.83 ± 1.51 and 16.17 ± 0.91, respectively. However, the average PSQI scores after the intervention in the clonazepam and acupressure groups were 13.25 ± 2.88 and 8.97 ± 4.29, respectively, indicating a statistically significant difference (P < 0.0001). Both the acupressure and the clonazepam groups showed improvements in their post-intervention sleep quality among the patients. However, when the percentage changed in the mean scores of the total score and all of the PSQI components were calculated for each group, it became clear that acupressure was more effective at enhancing sleep than clonazepam tablets.

The findings of the present investigation demonstrate that acupressure has a greater impact on patients’ sleep quality compared to clonazepam tablets. Depending on the circumstances, acupressure can be used as a simple, safe, and non-drug way to enhance hemodialysis patients' quality of sleep.

Middle molecules, including some cytokines such as IL-6 and TNF-α, parathyroid hormone, etc., are types of uremic toxins having roles in the development of inflammation in hemodialysis patients. Different studies evaluating effects of coenzyme Q10 (CoQ10) on different inflammation markers in hemodialysis patients have controversial results. Moreover, no study determined the effect of CoQ10 on plasma concentration of IL-6, the most powerful predictor of poor outcomes and mortality, in hemodialysis patients. Therefore, a study was designed to examine the effects of CoQ10 supplementation on IL-6, TNF-α, and intact parathyroid hormone (iPTH) in chronic hemodialysis patients. In this single-blind randomized controlled trial, patients undergoing hemodialysis were randomly assigned to CoQ10 (100 mg/day) or control group. The duration of the study was 12 weeks. The plasma concentrations of IL-6, as the primary outcome, and TNF-α and iPTH, as the secondary outcomes, were measured at baseline and week 12.  Of 73 enrolled patients, 68 completed the study. At the end of the study, there were no significant differences in the concentrations of IL-6 (p=0.570), TNF-α (p=0.301), and iPTH (p=0.642) between the two groups. The standardized mean difference (CoQ10 vs. control) was -0.13 (95% CI -0.60; 0.35) for IL-6, -0.25 (95% CI -0.73; 0.22) for TNF-α, and 0.11 (95% CI -0.36; 0.59) for iPTH.  This study showed a trivial effect of CoQ10 supplemen-tation on the concentrations of IL-6 and iPTH and a small effect on the level of TNF-α in hemodialysis patients.

Basic psychological needs affect intrinsic motivation. However, the relationship between selfcare behaviors and the basic psychological needs of patients undergoing renal dialysis has not been proven. We investigated the validity and reliability of the Basic Psychological Needs scale for patients undergoing renal dialysis.

At hospitals in Busan Metropolitan City, 120 patients with chronic renal failure receiving dialysis treatment were examined. The data were analyzed using SPSS 21.0 and AMOS 21.0 and criteria for positively affecting selfcare behaviors in these patients identified. The Basic Psychological Needs scale consists of two subfactors: autonomy and competence.

The reliability of the 12 items of the scale based on Cronbach’s α was 0.90; first factor autonomy was 0.90; second factor competence was 0.72; and there was homogeneity between the items.

Construct-, convergent-, discriminant-, criterion-related validity and internal consistency were verified. The scale was confirmed as a tool for measuring the basic psychological needs of patients undergoing renal dialysis.

Various studies have assessed the link between the thyroid and kidney and concluded that dysfunction in one organ can disrupt the other. Thyroid dysfunction is more prevalent in individuals with end-stage renal disease (ESRD) compared to the general population. Hypothyroid ESRD patients have higher mortality than euthyroid patients. In this study, we evaluated the prevalence of hypothyroidism in dialysis-dependent ESRD patients and assessed the association of possible prognostic factors with mortality.

Patients who were undergoing dialysis in centers affiliated with the Mashhad University of Medical Sciences were enrolled and followed for a year to obtain survival rates. Lab parameters including thyroid stimulating hormone (TSH), parathyroid hormone (PTH), and magnesium (Mg) were recorded at baseline, and the relationship between these values and mortality was assessed.

The prevalence of hypothyroidism was 23% and 32.5% in hemodialysis and peritoneal dialysis patients, respectively. Blood urea was meaningfully higher in hemodialysis patients, while hypocalcemia and hyponatremia were more common in peritoneal dialysis patients. Higher ages (P=0.006), lower baseline Mg (P=0.044) and PTH (P=0.01), and diabetes (P=0.037) were all linked to a higher risk of mortality.

Hypothyroidism was notably prevalent in our study population. As hypothyroidism is associated with higher mortality, proper screening and intervention in this group are essential. We recommend the prescription of supplementary Mg in dialysis patients as baseline Mg and PTH levels are associated with better outcomes in this group. Diabetes was also associated with higher mortality. Maintaining glycated hemoglobin between 6%-8% is therefore suggested to increase the survival of diabetic patients.

This systematic review and meta-analysis aimed to summarize the evidence regarding the impact of nee-dle direction and distance of arteriovenous fistula (AVF) cannulation on KT/V (where k is the dialyzer urea clearance, t,the duration of dialysis, and V, the volume of distribution of urea) and access recirculation (AR) as hemodialysis (HD) ad-equacy criteria.

A comprehensive systematic search was performed on international and domestic electronicdatabases from the earliest to June 4, 2022 using keywords. Analysis was performed in STATA software v.14.

Three randomized control trials (RCTs) and four non-RCT articles were included in the final review. Six studies reportedthe effects of direction, while four mentioned the effects of distances of AVF cannulation on outcomes of HD adequacybased on KT/V or AR. Results of three non-RCT studies showed that retrograde direction decreased KT/V more than an-tegrade direction (ES: 0.44, 95% CI: -0.38 to 1.27). Two non-RCT studies showed that antegrade decreased AR comparedto the retrograde direction (ES: -0.64, 95%CI: -1.94 to 0.67). However, the results of two RCTs indicated uncertainty aboutthis issue. Two of the four studies suggested that a distance of 5 cm or more in arterial and venous needles had greateradequacy than a distance of less than 5 cm. However, other studies did not confirm this finding.

Overallcomparison of the results qualitatively and quantitatively indicated uncertainty about the effects of direction and dis-tance of AVF cannulation on HD adequacy outcomes. More studies with high-quality designs, such as RCTs, are requiredto better understand and adjudicate the effects of needle direction and distance of AVF cannulation on HD adequacyoutcomes.

Family caregivers of hemodialysis patients experience various physical, psychological, social, economic, and spiritual problems that reduce their quality of life. The present study aimed to determine the effect of a family‑centered education program on the quality of life of family caregivers of patients undergoing hemodialysis.

This was a randomized controlled trial that was performed on 70 caregivers of patients undergoing hemodialysis in the medical centers of Hazrate Ali Asghar and Hazrate Zahraye Marzieh in Isfahan. Caregivers were randomly divided into experimental and control groups, and the experimental group received an eight‑session family‑centered education program. Data were collected using the Quality of Life Scale (QOLS)‑short form immediately after and 1 month after the intervention. Data analysis was performed using the Statistical Package for the Social Sciences (SPSS) software version 18 and analysis of variance and covariance.

The results showed that both experimental and control groups were homogeneous in terms of demographic information and there was no significant difference between them in this regard. Analysis of data on quality of life and its four domains showed that the mean scores of quality of life (P = 0.089) and its four domains including physical health (P = 0.367), mental health (P = 0.429), community relations (P = 0.132), and environmental health (P = 0.232) increased significantly immediately after and 1 month after the intervention (P < 0.001 in all cases).

Educational programs can improve the quality of life of family caregivers of hemodialysis patients. Therefore, it is recommended that programs be developed and evaluated in various studies in the future.