The risk of cardiovascular diseases among hemodialysis patients with energy-protein malnutrition (PEM) is higher compared to well-nourished hemodialysis patients. Traditional risk factors for cardiovascular diseases such as a high body mass index and serum total cholesterol cannot explain the high prevalence of cardiovascular diseases in hemodialysis patients with PEM. Therefore, the present study was designed to study the association of PEM with nontraditional risk factors of cardiovascular diseases in hemodialysis patients. A total of 291 hemodialysis patients were selected with systematic randoml sampling from among 2302 eligible adult hemodialysis patients in Tehran hospitals. The nutritional status of the patients was determined by subjective global assessment (SGA). In addition, dialysis malnutrition score (DMS) and malnutrition inflammation score (MIS) of the patients were determined and their dietary intakes assessed using a 4-day dietary recall including 2 dialysis days and 2 non-dialysis days. Also, after a 12- to 14-hour fast, an 8 mL- sample of blood was taken from each patient before dialysis and serum urea, creatinine, albumin, CRP, sICAM-1, sVCAM-1, sE-selectin, MDA, NO, endothelin-1, and Lp(a) were measured. The serum concentrations of CRP and sICAM-1 were significantly higher in hemodialysis patients with PEM as compared to those without PEM (p<0.01), whereas there were no significant differences in serum concentrations of sVCAM-1, sE-selectin, MDA, NO, endothelin-1 or Lp(a) between the two groups. In addition, compared to hemodialysis patients with PEM types IIa or IIb, those with PEM type I had significantly lower serum CRP and sICAM-1 levels (p <0.01). There were significant direct correlations between DMS and MIS, as two PEM indicators, with serum CRP and sICAM-1 (P <0.01). The results of the present study indicate that nontraditional risk factors of cardiovascular diseases do not increase in hemodialysis patients with PEM type I, whereas serum CRP and sICAM-1, two risk factors of cardiovascular diseases, increase in PEM type II, which is accompanied with inflammation.

Serotonin receptors are present in osteoblasts and osteoclasts, and serotonin affects bone metabolism. The association of plasma serotonin with markers of bone formation and bone resorption in hemodialysis patients was evaluated. Twenty-four hemodialysis patients (11 diabetics) and 22 healthy volunteers were enrolled into the study. Serotonin was assessed in platelet-free plasma, whereas the markers of osteoblastic activity N-terminal midfragment osteocalcin and total procollagen type-1 aminoterminal propeptide as well as the marker of osteoclastic activity β-isomerized C-terminal cross-linked peptide of collagen type I were measured in serum. Serum intact parathyroid hormone was also assessed. Serotonin did not significantly differ between hemodialysis patients and healthy volunteers. All evaluated markers of bone metabolism and intact parathyroid hormone were much higher in hemodialysis patients. Serotonin was significantly correlated with all evaluated markers of bone metabolism in hemodialysis patients. Serotonin was reversely related to the patient's age. Serotonin, osteocalcin, procollagen type-1 aminoterminal propeptide, and β-isomerized C-terminal cross-linked peptide of collagen type I were much lower in diabetic hemodialysis patients. Serotonin may increase both bone formation and bone resorption in hemodialysis patients. The reverse relation of serotonin to patient's age as well as its lower levels in diabetic hemodialysis patients indicate that low plasma serotonin may contribute to the higher incidence of low-turnover bone disease that characterizes old and diabetic hemodialysis patients.

Depression, as an important factor in decreasing patient compliance of treatment, endangers patient health. Available social support also plays a role in vulnerability as well as his resistance power. This paper aims at determining the relation between depression and social support in hemodialysis patients in clinical trial hospitals of Mazandaran.
In a descriptive-correlative research, 230 hemodialysis patients were selected and investigated randomly who had the criteria of research. The tool was questionnaire divided into 3 sections consists of demographic characteristics, Beck depression questionnaire, and Brant & Winret social support questionnaire (PRQ 85).
Mean (± standard deviation) score of depression was 25.57 ±12.84. Mean (± standard deviation) of total social support was 127.97±19.16. There was a significant relationship between social support and depression in hemodialysis patients.
Our findings indicate the relation between social support and depression in hemodialysis patients. Regarding to high prevalence of depression in dialysis patients, social support can decrease depression and eventually help significantly with improving quality life of hemodialysis patients. Keywords: Depression, Social support, Hemodialysis, Iran.

Background and Constipation is one of the most common digestive problems in hemodialysis patients that has negative effects on quality of life in these patients. Non-medical treatments have more benefits compared to medical treatments. This study aimed to investigate the effect of acupressure on fecal impaction in hemodialysis patients.
A double blind clinical trial was conducted in 60 hemodialysis patients suffering from constipation. They were randomly assigned into either intervention or control group. In intervention group, one minute acupressure was applied three times a week for four weeks during hemodialysis in acupressure points while in control group it was done in false points. Fecal impaction was measured before and after the intervention.
There was a significant difference in fecal impaction between the two groups in week four after the intervention (P Acupressure has a positive effect on fecal impaction in hemodialysis patients with constipation. Therefore, it could be used as a complementary treatment of constipation in hemodialysis patients.

Introduction. Mannose-binding lectin (MBL) is a part of the innate immune system. Many studies showed an association of low serum MBL levels with decreased host defense against various infectious agents. Considering paradoxical reports about the serum level of MBL in hemodialysis patients, this study aimed to measure and compare serum MBL levels in hemodialysis patients and healthy individuals.Materials and Methods. In a cross-sectional study, 70 hemodialysis patients and 70 volunteers with normal routine laboratory tests and physical examination were assessed for serum MBL level (measured by an enzyme-linked immunosorbent assay). In addition, serum C-reactive protein levels in hemodialysis patients were measured to rule out correlation of increased serum MBL level with inflammation.Results. In hemodialysis patients, 32 (45.7%) were men and 38 (54.3%) were women. In the control group, 34 (48.6%) were men and 36 (51.4%) were women (P =. 87). The mean age showed no significant difference in hemodialysis (44.5 ± 13.5 year) and control (46.4 ± 12.4 years) groups. Serum level of MBL was significantly higher in hemodialysis patients (2.12 ± 1.49? g/mL) than that in the controls (1.49 ± 2.12? g/mL; P <. 001). No significant correlation was found between serum MBL and C-reactive protein levels (r = 0.002, P =. 98) among the hemodialysis patients.Conclusions. Serum MBL level in hemodialysis patients was significantly higher than that in the control group of healthy individuals. This may have some implications in management of patients and prediction of kidney allograft survival.

Toxoplasmosis is a common disease among humans and animals, that is caused by the infection of the intracellular protozoan parasite, Toxoplasma gondii. Infection by this parasite is generally without any clinical symptoms, but it can have severe effects in people with immune deficiency, such as those experiencing chemotherapy, transplantation, cancer and AIDS, as well as dialysis patients. Considering the high prevalence of parasites in different parts of Iran, we decided to study the prevalence of toxoplasmosis in hemodialysis patients, in selected centers of Tehran.
In this descriptive cross-sectional study, 260 hemodialysis patients attending 5 dialysis centers in Tehran in 2016 were studied. The serum samples were analyzed for anti-Toxoplasma IgG and IgG antibodies by the ELISA method.
In this study, 175 (67.3%) of the hemodialysis patients tested positive for anti-Toxoplasma IgG antibodies and 18 (7%) tested positive for anti-Toxoplasma IgM antibodies.
Considering the high prevalence of toxoplasmosis in hemodialysis patients in Tehran compared to other control people in this region, and considering the fact that this infection is one of the most important risk factors in hemodialysis patients, regular screening and detection of antibodies against Toxoplasma gondii is necessary in these patients.

Coronary heart diseases (CHD) are the main cause of mortality in hemodialysis patients. Lipid profile abnormality in hemodialysis patients including hypertriglyceridemia, normal total cholesterol, modest decline in HDL rise in LDL are effected by omega 3 speculative. The purpose of this study was to investigate the effects of omega 3 fatty acid on lipid profile in hemodialysis patients. this clinical trial was performed on 16 hemodialysis patients with hypertriglyceridemia. They were asked to consume 2 gr pearl omega 3 each day for 3 months. Lipid profile was obtained by enzymatic method before and after treatment with omega 3 and the data were analysed. Consumtion of omega 3 for 3 months lowered the serum triglyceride (p<0.05). HDL increased but there was no change in total cholesterol and LDL. Consumtion of omega 3 lowered the risk of CHD in hemodialysis patients by reducing the serum triglyceride.

Hemodialysis patients suffer from susceptibility to infections. Inflammation upregulates indoleamine 2,3-dioxygenase (IDO) in the antigen-presenting cells, which suppresses T-cell function. Plasma IDO activity or protein expression is increased in hemodialysis patients and is associated with immune disturbances. This observation, however, does not consider many factors, importantly the source of IDO, which has to be the antigen-presenting cells in order IDO to exert its immunosuppressive effect in the microenvironment of the immune response. In this study, monocytes were isolated from 30 hemodialysis patients and 20 healthy volunteers and IDO was assessed by Western blotting. The IDO level in the monocytes of hemodialysis patients was significantly, almost 3-fold, higher than in the monocytes of healthy volunteers. This localization enables IDO to exert its immunosuppressive effect and supports conclusions of previous studies that used more indirect methods for assessing the role of this enzyme in the context of the immune response in hemodialysis patients.

This study compared the efficacy of Acceptance and Commitment Group Therapy (ACT) with Mindfulness-Based Cognitive Therapy (MBCT) on hemodialysis patients in terms of anxiety and depression. In this experimental study, among the hemodialysis patients referred to Imam Khomeini in Shirvan and Imam Ali hospital in Bojnord, 42 hemodialysis patients were selected by convenient sampling method and they were randomly divided in three groups of ACT, MBCT and control (each group 14 people). ACT and MBCT groups were treated for 8 sessions of 90 minutes (one weekly session). In this study, Beck anxiety and depression inventories were used to collect data. Data was analyzed using analysis of covariance. The findings showed that both treatment methods were efficient on anxiety and depression in hemodialysis patients but the efficacy of ACT on the depression variable is greater than MBCT and efficiency of MBCT on anxiety variable is greater than the ACT. It seems that Acceptance and Commitment Group Therapy (ACT) and Mindfulness-Based Cognitive Therapy (MBCT) are effective on hemodialysis patients in terms of anxiety and depression.

Aim and This study was aimed to determine the relationship between positive psychological variables (hope and spirituality) psychopathology (depression، stress، anxiety) and quality of life in hemodialysis patients in Isfahan''s Ali Asghar Hospitals. Methods and Materials: This study was a descriptive one، and its population was all Hemodialysis patients in Ali Asghar Hospital. The participants in this study were 96 Hemodialysis patients. They were selected by a simple random sampling method. The survey tools included demographic questions، (SF-36) quality of life، life expectancy، (DASS) depression، stress، anxiety and spirituality questionnaire. Mean and standard deviation were used to analyze the data and for hypothesis testing the Pearson correlation and simultaneous regression analysis were used. There was a significant relationship between positive psychological variables (hope and spirituality) and psychopathology (depression، stress، anxiety) with quality of life in hemodialysis patients. In other words، participants with higher scores on (spirituality and hope) had a better quality of life، and those who higher score on DASS had a lower quality of life (p<0. 05). These finding indicated that: There was a significant relationship between quality of life and spirituality in hemodialysis patients (p<0. 05). There was a significant relationship between quality of life and hope in hemodialysis patients (p<0. 05). There was a significant relationship between quality of life and (stress، depression and anxiety) in hemodialysis patients (p<0. 001). These finding indicated that quality of life in Hemodialysis patients can be predicted by hope and (stress، depression، anxiety)