Quality of life of patients with chronic renal insufficiency in hemodialysis treatment

This is a convergent-assistance research, which has as its objective the identification of the factors affecting the quality of life of people suffering from Chronic Kidney Failure and who are undergoing hemodialysis. Data were collected in a health education program, developed for a companionship group, across hemodialysis sessions. During the analysis, four categories were identified, representing the elements that are considered as causes for the life quality conditions of those people: health assistance; acceptance and coping with the health condition; support received, and hoping for a better future. In spite of living with an illness which has important consequences on the physical well-being and social roles, persons referred to a life where quality can be achieved, although sometimes it may be difficult to perceive or conquer such quality.     

Assessment of thiamin status in chronic renal failure patients, transplant recipients and hemodialysis patients receiving a multivitamin supplementation

The thiamin status of patients with chronic renal failure (CRF, n = 14), dialysis patients (DP, n = 24) and patients after renal transplantation (RT, n = 19) was assessed. Thiamin intake was calculated at mean levels of 1.26 mg/d (CRF), 0.83 mg/d (DP) and 1.42 mg/d (RT). Corresponding mean plasma concentrations were 64.2 nmol/l (CRF), 78.3 nmol/l (DP) and 55.1 nmol/l (RT). Thiamin supplements of 1.5 mg or 8.0 mg orally given to patients of the DP-group after each dialysis session showed slightly higher thiamin concentrations in plasma. Transketolase activity coefficients (ETK-AC) were in the same range (1.11...1.19) except for RT-patients who had a slightly but not significantly higher ETK-AC of 1.22. During dialysis treatment (DT), thiamin plasma concentrations dropped to 75 and/or 82% in patients supplemented with 1.5 and/or 8.0 mg. They both reached initial levels again 44 hours later. Despite large inter-individual differences, thiamin concentrations increased in the non-supplemented DP-group. ETK-AC did not change after a 14-day interruption of supplementation and did not deteriorate after a single dialysis session, both in supplemented and non-supplemented patients. A daily thiamin supplementation which complies with the RDA for healthy subjects is indicated in DP and is sufficient to keep thiamin status within the normal range.     

Increase of electronegative-LDL-fraction ratio and IDL-cholesterol in chronic kidney disease patients with hemodialysis treatment

ABSTRACT: BACKGROUND: It is known that the increased level of IDL and oxidized LDL are associated with risk of cardiovascular disease, and the lipoprotein abnormalities accelerate atherosclerosis. Cardiovascular disease is a major cause of mortality in chronic kidney disease patients with hemodialysis treatment (HD-Ps). Therefore, the estimation of lipoprotein profiles is important for prevention of cardiovascular disease in HD-Ps. We previously established an anion-exchange chromatographic method for measurement of cholesterol level in subclasses of HDL and LDL, IDL, VLDL, and chylomicron. An electronegative-LDL-fraction contained minimally oxidized-LDL. Lipoprotein profile can be accurately and conveniently determined by the new method.FindingIn this study, lipoprotein profiles in HD-Ps and age-matched healthy subjects were estimated by using our established anion-exchange chromatographic method. The ratio of electronegative-LDL-cholesterol to total LDL-cholesterol and IDL-cholesterol in HD-Ps were significant higher than those in healthy subjects. CONCLUSIONS: The results suggest that the ratio of electronegative-LDL-cholesterol to total LDL-cholesterol and IDL-cholesterol obtained by the new method may serve as useful markers for risk of cardiovascular disease in HD-Ps.     

血液灌流联合血液透析在慢性肾衰竭患者药物性脑病中的应用

目的 探讨血液灌流(HP)联合血液透析(HD)在慢性肾衰竭患者药物性(头孢菌素)脑病中的临床疗效,以进一步指导临床治疗.方法 收集2004年9月-2011年11月收治的24例头孢菌素脑病患者,进行血液透析和(或)联合血液灌流治疗,观察两组脑病的缓解率,评定其临床效果.结果 发生头孢菌素脑病的慢性肾衰竭患者24例,12例应用HP+HD治疗,12例单纯应用HD治疗,HP+HD组完全缓解和部分缓解率分别为41.7％和58.3％,较单纯HD组缓解率高(P＜0.05),且临床症状明显改善;β2-微球蛋白(β2-MG)HP+HD组明显降低(P＜0.05),HD组降低不明显(P＞0.05).结论 在慢性肾衰竭患者中头孢菌素脑病一旦诊断应及时停药,并选择合适的血液净化方式,其中HP+HD治疗,对于分子量大或(和)蛋白结合的抗菌药物是一种较好的治疗方法.     

Quality of life of hemodialysis and renal transplantation patients

The quality of life of patients with end-stage renal disease is an important indicator of disease burden. To achieve a better quality of life, some medical treatment might be replaced by other approaches. The aim of this study was to compare the quality of life of renal-transplanted and hemodialysis patients in Iran. Two hundred hemodialysis and 200 renal transplantation patients were recruited from 5 major hospitals and renal patients' support society in Tehran, Iran. The data were collected using the Persian versions of the Ferrans and Powers Quality of Life Index-Dialysis and Transplantation Version. The quality-of-life mean scores of renal transplantation patients were significantly better compared with those of the hemodialysis patients (21.36 [SD, 4.06] vs 20.35 [SD, 5.14]; P = .03). The questionnaire demonstrated significant differences in health/functioning and familial subscale of quality of life between the transplanted and hemodialysis patients (p < .05). The better quality of life of transplant patients, in comparison with hemodialysis patients, is an important reason for advising kidney transplants in renal failure patients. To improve the patients' quality of life, kidney transplantation might be effective for the end-stage renal disease. With regard to socioeconomic problem in most of the patients with renal failure, comprehensive insurance and referral to renal and transplanted patients' support society are suggested for those who have undergone different renal replacement therapies.     

慢性肾衰血液透析患者并发急性左心衰48例治疗体会

目的探讨慢性肾衰血液透析患者合并急性左心衰的原因及防治措施.方法对48例慢性肾衰患者合并急性左心衰进行回顾性分析.结果48例急性左心衰经序贯超滤透析均改善.结论高血压容量负荷过重和贫血是诱发急性左心衰的主要原因.序贯超滤透析、严格控制水钠摄入量、控制血压、改善贫血等是治疗慢性肾衰血液透析患者并发急性左心衰的有效措施.     

营养透析防治慢性肾功能不全时营养不良的疗效观察

目的：探讨营养透析（ＮＨＤ）对慢性肾功能不全（ＣＲＦ）病人的疗效。 方法：观察３０例ＣＲＦ病人进行ＮＨＤ前、后各营养评价指标的变化，以ＮＨＤ前、后自身对照，数据以比用配对ｔ检验。 结果：ＮＨＤ后病人血ＰＡＢ、ＡＬＢ、ＴＬＣ、Ｈｇｂ及Ｈｃｔ均提高，而血脂质及载脂蛋白水平无明显变化。 结论：营养透析作为防治ＣＲＦ营养不良的新型疗法具有良好的疗效。     

Hope predicted quality of life in dyads of community-dwelling patients receiving hemodialysis and their family caregivers

Quality of Life Research - End-stage renal disease (ESRD) patients on hemodialysis (HD) and their family caregivers (FCGs) reported poor quality of life (QoL). Hope has shown association with QoL...     

An outbreak of hospital-acquired hepatitis B virus infection among patients receiving chronic hemodialysis.

OBJECTIVE: To investigate a cluster of hepatitis B virus (HBV) infections between December 1995 and May 1996 among chronic hemodialysis patients in one county. SETTING: Two dialysis centers (A and B) and a hospital (C) in one county. PATIENTS: Six case-patients who were dialyzed in one of two centers, A and B, and had all been hospitalized between January and February 1996 at hospital C. METHODS: Patient 1, usually dialyzed in center A, sero-converted to hepatitis B surface antigen (HBsAg) in December 1995 and could have been the source of infection for the others, who seroconverted between March and April 1996. Two cohort studies were conducted: one among patients dialyzed in center A, to determine where transmission had occurred, and one among patients dialyzed at hospital C at the time patient 1 was hospitalized, to identify factors associated with infection. RESULTS: Four (15%) of the 26 susceptible patients dialyzed at center A became infected with HBV. Hospitalization at hospital C when patient 1 was hospitalized was associated with infection (P = .002). A cohort study of the 10 susceptible patients dialyzed at hospital C during the time patient 1 was hospitalized did not identify specific risk factors for infection. However, supplies and multidose vials were shared routinely among patients, providing opportunities for transmission. CONCLUSION: When chronic hemodialysis patients require dialysis while hospitalized, their HBsAg status should be reviewed, and no instrument, supplies, or medications should be shared among them.     

慢性心力衰竭治疗质量指标体系的建立

目的 建立一套适合中国慢性心力衰竭治疗质量评价的指标体系,为下一步慢性心衰治疗质量评价提供量化工具.方法 检索PubMed、EMBASE等数据库,同时参考〈慢性心力衰竭诊断治疗指南〉筛选出候选指标.选择来自北京、上海、哈尔滨的15名专家组成专家组.应用德尔菲法咨询专家意见,根据专家打分的均数和选择率确定最终的指标体系.纳入标准为：均数≥3.5,选择率≥50.0%.结果 发放专家咨询表15份,专家积极系数为100%,每份均符合要求.经过三轮Delphi,由最初52个候选指标筛选出22个指标,构成慢性心衰治疗质量评价的指标体系,包括2个结构指标,18个过程指标（15个院内指标,3个出院指标）,2个结局指标.指标体系中,均数〉4分的有12个,选择率≥80.0%的9个.利尿剂的均数和选择率最大,分别为4.7和100%;院内感染率≤7%的均数和选择率最小,分别为3.5和53.3%.指标均数的范围为3.5~4.7,选择率的范围为53.3%~100.0%.结论 本研究建立的慢性心力衰竭治疗质量评价指标体系与国外相关组织建立的稍有不同,符合我国国情,能全面客观的评价慢性心衰的治疗质量,发现其中的不足,以促进我国慢性心衰治疗质量的改善.     

维持性血液透析患者生活质量及相关因素分析

目的探讨维持性血液透析患者的康复状况的影响康复及其相关因素。方法对维持性血液透析治疗超过3个月以上的125例患者进行调查,在患者来透析中心进行透析时收集患者的年龄、性别、是否合并糖尿病、透析前工作状态等个人情况,记录患者当前的血红蛋白、白蛋白、尿素清除指数（Kt／V）等反映临床治疗情况的指标;并发症情况采用Charlson并发症指数进行量化;患者的活动能力用Kamofsky活动指数进行量化;心理情况根据Hamilton抑郁量表对患者进行评定;生活质量评分采用生活质量量表SF-36评分标准进行逐项评分。变量之间的相关性采用单因素相关分析。结果125例患者中1级（生活不能自理）患者7例（5．6％）,2级患者（生活仅能自理）43例（34．4％）,3级患者47例（37．6％）,4级患者13例（10．4％）。康复状况与患者的年龄存在明显的关系,年轻的患者康复状况较年老患者好（X^2=5．864,P〈0．05）;1级患者大部分为老年人、糖尿病患者,其活动指数、合并症评分和抑郁评分、生活质量评分均较差,与2-4级康复患者相比差异有统计学意义（t=5．263、7．866、6．215、5．474,P〈0．05）。患者的康复状况与年龄、是否糖尿病、透析前是否工作、血白蛋白水平、活动指数、Charlson并发症指数、Hamilton抑郁积分相关（r=-0．618、-0．512、0．593、0．369、0．801、-0．696、-0．516）。结论维持性血液透析患者的康复情况受到生理、心理及其他诸多因素的影响,应加强对患者的人文关怀及情感支持。     

慢性肾衰竭血液透析患者泌尿系感染相关因素分析

目的分析慢性肾衰竭维持性血液透析患者伴发泌尿系感染的病原菌分布情况及危险因素,为临床预防提供依据。方法选取2011年1月-2015年12月于医院收治的慢性肾衰竭维持性血液透析患者420例,通过对泌尿系感染患者进行病原菌培养以对其分布情况进行分析,同时对所有患者临床资料进行回顾性分析,探讨泌尿系感染发生的相关因素,采用SPSS17.0软件进行统计分析。结果 420例慢性肾衰竭维持性血液透析患者中有70例伴发泌尿系感染,感染率为16.7%;70例泌尿系感染患者共检出病原菌102株,其中革兰阴性菌58株,占56.9%,革兰阳性菌34株,占33.3%,真菌10株,占9.8%;单因素分析显示年龄、合并糖尿病肾病、贫血、高血压肾病、慢性肾小球肾炎、肿瘤相关肾病、低蛋白血症及透析龄等是慢性肾功能衰竭血液透析患者伴发泌尿系感染的危险因素(P<0.05);logistic回归分析显示,年龄、合并糖尿病肾病、贫血、慢性肾小球肾炎及合并高血压肾病等是独立危险因素(P<0.05)。结论慢性肾衰竭维持性血液透析患者伴发泌尿系感染较多,其中病原菌主要为革兰阴性菌,感染发生的危险因素包括年龄、合并糖尿病肾病、贫血、慢性肾小球肾炎及合并高血压肾病等,临床上应针对危险因素进行预防性治疗。