维持性腹膜透析患者尿素清除指数达标现状及影响因素分析

目的探讨单中心维持性腹膜透析患者尿素清除指数(Kt/V)达标现状以及影响因素。方法在泰兴市人民医院腹膜透析中心采用横断面调查,选择2014年11月至2015年5月份维持透析3个月以上的完成透析充分性及生化评估结果的腹膜透析患者77例。所有的患者均采用持续性不卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)或日间不卧床腹膜透析(daytime ambulatory peritoneal dialysis,DAPD)透析方式,调查其Kt/V达标现状。按照Kt/V是否达标(Kt/V≥1.7视为达标)分为2组,比较2组人口学资料及临床生化指标,探讨Kt/V的影响因素。结果入选患者的平均Kt/V为1.75±0.57,平均肌酐清除率为(57.44±19.58)L·周~(-1)·(1.73 m~2)~(-1),Kt/V达标率为54.54%。与Kt/V未达标组相比,达标组女性比例较高,糖尿病肾病患者比例较低,身高、体质量、体质量指数较小,24h尿量较多,残余肾功能较好(P0.05);2组患者年龄、腹膜透析治疗方式、腹膜透析月龄及每日腹膜膜透析液治疗剂量无统计学差异(P0.05)。Kt/V与身高(r=-0.444,P=0.001)、体质量(r=-0.457,P=0.001)、体质量指数(r=-0.240,P=0.035)呈负相关,与24h尿量(r=0.357,P=0.001)、残余肾功能(r=0.330,P=0.003)呈正相关,与年龄(r=0.118,P=0.305)、24h腹透液治疗剂量(r=-0.022,P=0.857)不相关。采用二元Logistic回归分析,女性、较小的体格、较好的残余肾功能是Kt/V达标的保护因素。结论单中心腹膜透析Kt/V达标率54.54%,性别、体格大小、残余肾功能是腹膜透析患者Kt/V达标的影响因素。     

非医疗因素对长期腹膜透析患者生存质量的影响

目的研究可能影响长期腹膜透析患者生存质量的非医疗因素,旨在为临床工作中如何提高患者的生存质量提供依据。方法采用横断面研究方法调查79例慢性肾衰竭进行持续非卧床腹膜透析（CAPD）患者。记录患者的年龄、性别、工作状况、文化程度、医疗负担及家庭支持等情况。采用国际通用的KDQOL-SFTM1．2中的短表SF-36评估患者的生存质量。采用汉密尔顿焦虑抑郁量表评估患者的焦虑、抑郁指数。结果SF-36评估患者的生存质量提示：CAPD患者生存质量的8个方面得分均显著低于中国一般人群（P〈0．05或〈0．01）;在职患者和有医疗保障患者sF-36得分分别为（45．78±16．93）分和（49．62±13．20）分,明显高于非在职患者的（32．65±12．26）分和无医疗保障患者的（33．85±6．24）分（P〈0．05）;人均年收入越高的家庭,患者生存质量就越高;有子女和老伴共同照顾的患者生存质量最高,而由保姆或个人照顾的患者生存质量最低;79例患者中焦虑的发生率为54．4％（43/79）,抑郁的发生率为15．2％（12/79）,二者均与生存质量呈显著负相关。结论家庭支持、工作状况、医疗保障和心理障碍均对CAPD患者的生存质量产生重要影响。     

维持性血液透析和持续性不卧床腹膜透析患者生命质量及其影响因素分析

目的:探讨透析治疗患者的生命质量及其影响因素,为提高患者生命质量提供依据.方法:对31例持续性不卧床腹膜透析(CAPD)患者和29例维持性血液透析(MHD)患者,应用生命质量量表(MOS SF-36)、自评抑郁量表(SDS)、家庭功能问卷(Family APGAR)和社会支持评定量表(SSRS)进行测评调查,分析评价维持性透析患者生命质量及其影响因素.结果:60例维持性透析患者生命质量8个维度分值,均显著低于一般人群,CAPD患者躯体功能(PF)、情感角色(RE)2个维度分值以及主观支持得分均显著低于MHD患者;本组研究对象抑郁指数0.519±0.097,45%患者自评轻至中度抑郁状态;维持性透析患者生命质量影响因素主要有年龄、透析持续时间、费用来源、抑郁、主观支持和支持利用等.结论:抑郁在维持性透析患者中常见,CAPD和MHD患者生命质量明显下降,其影响因素除疾病本身外,还包括社会角色的转变和心理压抑.根据透析患者实际情况,采取个体化干预措施,可改善患者生命质量.     

持续性非卧床腹膜透析患者生存质量影响因素的研究

目的评估持续性非卧床腹膜透析(CAPD)患者的生存质量状况,探讨营养状态、透析充分性、微炎症、腹膜转运和残余肾功能对腹透患者生存质量的影响。方法选择稳定的CAPD3个月以上的患者88例,使用KDQOL-SFTM生存质量研究量表计分。同时检测患者营养状态、透析充分性、微炎症、腹膜转运功能和残存肾功能,用SPSS10软件包分析数据。结果(1)CAPD患者肾病、透析相关生存质量(KDTA)评分为:58.6±14.2,SF-36总分为50.4±12.8。(2)营养指标(MQSGA、白蛋白和血红蛋白等)与KDTA和SF-36总分及其部分领域呈显著相关,其中以MOSGA相关性最好。(3)微炎症(IL-6、CRP和TNFα)与KDTA和SF-36总分及其分支领域呈显著相关,其中以IL-6相关性最为显著。(4)腹膜转运功能与KDTA和SF-36总分呈显著等级相关。(5)残存尿量与KDTA和SF-36总分及部分领域呈显著相关。(6)Kt/V与KDTA和SF-36无显著相关。(7)对KDTA的影响分别为腹膜转运功能、残存尿量、MQSGA、IL-6、Kt/V、TNFα、CRP,其中腹膜转运功能、残存尿量、MQSGA、IL-6是独立影响因素。(8)对SF-36的影响分别为腹膜转运功能、MQSGA、残存尿量、IL-6、Kt/V、TNFα、CRP,其中,腹膜转运功能、MQSGA、残存尿量、IL-6是独立影响因素。结论(1)腹膜转运功能、残存尿量影响腹透患者生存质量,但是,     

不同透析剂量对CAPD患者生存质量的影响

目的评估不同透析剂量对持续性非卧床腹膜透析（CAPD）患者生存质量的影响,以寻求更合理的符合中国人特点的腹膜透析剂量。方法将稳定的CAPD3个月的患者随机分为2组,即低剂量组（2L／次,3次／天）和常规剂量组（2L／次,4次／天）。每半年对两组患者进行生存质量、营养状态、炎症状态、残余肾功能、严重心血管事件发生率进行评估,持续2年,比较两组之间的差异,使用KDQOL-SFTM1．2生存质量表进行调查,根据Hays提供的方法进行评分,SPSS10．0软件包分析数据。结果①随着透析时间的延长,患者的生存质量评分逐渐增加;②低剂量组与常规剂量组患者的KDTA和SF-36总分无显著性差异,在KDTA的4个分支领域及SF-36的2个分支领域评分高于常规剂量组;③两组患者的营养状态、全身微炎症状态、高血压的控制、严重心血管事件的发生率无明显差别;④低剂量组残余肾功能优于常规剂量组。结论低透析剂量较常规透析剂量能更好的保护残余肾功能,值得推荐。     

腹腔镜与传统腹膜透析置管术的前瞻性非随机对照研究

目的:比较腹腔镜与传统腹膜透析置管术的近、远期疗效。方法:选择2016年1月至2018年10月行腹膜透析置管术的137例患者,其中62例于腹腔镜下置管(腹腔镜组),75例行传统开腹腹膜透析置管术(开腹组)。主要终点是导管生存时间。收集患者人口学资料、置管方法、并发症及转归等资料进行分析。结果:两组患者年龄、性别、体质指数、肾脏原发病、术前血红蛋白水平、估算肾小球滤过率等方面差异无统计学意义。腹腔镜组手术时间[(36.3±14.9)min vs.(88.2±32.2)min,P<0.01]、术后住院时间[(4.8±2.6)d vs.(6.8±5.2)d,P<0.01]优于开腹组。开腹组11例(14.7%)发生导管失功,腹腔镜组发生2例(3.2%),两组相比差异有统计学意义(P=0.04),主要与腹膜透析导管尖端移位(0 vs.8,P<0.01)有关。Kaplan-Meier曲线与Cox回归模型分析显示,腹腔镜组具有较好的导管生存率(log-rank P=0.03),手术方式是导管生存的独立影响因素(P=0.049,HR=0.22,95%CI:0.05-0.98)。结论:腹腔镜腹膜透析置管术具有手术时间短、术后康复快、导管功能障碍发生率低、导管生存率高等优势。     

螺内酯治疗腹膜透析合并慢性心力衰竭患者的疗效和安全性

目的:评估螺内酯治疗维持性腹膜透析患者合并慢性心力衰竭的疗效和安全性。方法:经2月观察期后,29例维持性腹膜透析及31例肾功能正常的心力衰竭患者入选并完成研究。基线前观察期给予包括ACEI、ARB等基础用药。治疗开始所有入组病人均予螺内酯片20 mg,每日1次,治疗6月。测定基线、治疗后1周及此后每月的血钾浓度,测定基线、治疗后3月、6月的左心室射血分数(LVEF)、左心室质量指数(LVMI)、B型钠尿肽(BNP)和血醛固酮(ALD)浓度。结果:(1)与肾功能正常组比较,治疗6月后腹膜透析组LVEF、LVMI、BNP变化差异无统计学意义(P0.05)。(2)与基线值比较,腹膜透析组治疗6月后LVEF明显提高[(52.42±4.71)%vs(40.12±5.11)%,P0.01],LVMI明显降低[(120.42±19.72)g/m~2vs(135.93±22.75)g/m~2,P0.05]。BNP明显降低[(3 898.2±1 052.7)pg/ml vs(1 535.4±1 044.2)pg/ml,P0.05]。(3)与治疗前比较,腹膜透析患者治疗后血醛固酮水平有所升高,但差异无统计学意义。(4)所有腹膜透析患者在治疗期间血钾浓度均未超过6.0 mmol/L,但与基线值比较,治疗后1周时血钾水平升高[(4.78±0.75)mmol/L vs(4.35±0.54)mmol/L,P=0.05],其余时间点的差异均无统计学意义(P0.05)。结论:螺内酯应用于腹膜透析并心力衰竭患者与肾功能正常患者同样能有效改善心功能,且对血钾影响小,安全性良好。     

不同腹膜透析治疗模式对透析患者钙磷代谢及PTH的影响

目的 比较采用日间非卧床腹膜透析(DAPD)与经典持续非卧床腹膜透析(CAPD)对钙磷代谢及PTH的影响.方法 从新疆维吾尔自治区人民医院肾病科160例行腹膜透析患者中选取符合条件的83例,年龄在20～80岁,平均年龄为(45.26±16.14)岁,根据不同透析方式分为两组:CAPD组:共54例,男33例,女21例;DAPD组:共29例,男16例,女13例.CAPD组每次的透析剂量为6～8L、3～4次交换、夜间留腹(留腹的透析液浓度为1.5％);DAPD组日间采用6～8L的透析剂量,每袋透析液交换时间为3～4h,夜间干腹.观察这些患者相关临床指标包括患者的一般资料、血钙(Ca2+)、血磷(P3-)、甲状旁腺激素(PTH)以及残余肾功能.结果 两组在一般资料比较中差异无统计学意义(P＞0.05),两组在血钙(Ca2+)、血磷(P3-)、甲状旁腺激素(PTH)等方面差异均有统计学意义(P＜0.05),比较两组的超滤量以及比较透前残余肾功能与透后一年后残余肾功能差异均有统计学意义(P＜0.05).结论 行DAPD治疗的患者比经典的CAPD患者能更有效的控制钙磷代谢,并能更好的保护残余肾功能.     

腹膜透析患者血清白蛋白变化与容量变化关系的临床纵向观察

目的:探讨持续性非卧床腹膜透析(CAPD)患者容量动态变化对血清白蛋白水平的影响。方法:对符合入选条件的129例来自南京医科大学附属淮安第一医院肾内科的CAPD患者随访18个月,每6个月对患者容量状态(overhydration,OH)、血清白蛋白(Alb)及透析充分性等指标进行监测。随访前后Alb的变化表示为ΔAlb(Alb18月~Alb0月),OH的变化表示为ΔOH(OH18月~OH0月)。结果:根据△Alb将患者分为三组,即A组(ΔAlb≥3 g/L)、B组(2 g/L≥ΔAlb≥-2 g/L)及C组(ΔAlb≤-3 g/L),结果显示ΔOH在三组间有明显不同[(-1.04±1.6)L,(0.16±1.62)L,(0.26±1.34)L;P0.05)],而患者年龄、透析龄及残余肾尿素清除率(r Kt/V)在各组间差异无统计学意义;基于基线资料的多因素线性回归分析提示OH、年龄及r Kt/V是影响Alb水平的独立因素(R2=0.301,P0.05);而Logistic回归分析表明在矫正性别、糖尿病及r Kt/v下降速率等因素后,随访期间平均OH水平是影响低白蛋白血症发生的独立危险因素(χ2=20.51,P0.05)。结论:腹膜透析患者持续高容量状态或容量负荷增加是导致低白蛋白血症发生的主要危险因素之一,而残肾功能下降并不一定伴有Alb水平的下降。     

不同年龄腹膜透析患者红细胞体积分布宽度的特点及影响因素

目的近年发现红细胞体积分布宽度(red blood cell distribution width,RDW)与慢性透析患者预后密切相关,本研究旨在探讨腹膜透析患者RDw的特点及其影响因素。方法纳入我院103例行持续性非卧床腹膜透析治疗的尿毒症患者,根据患者开始腹膜透析时的年龄分为3组:年龄40岁组(37例);年龄40~59岁组(47例);年龄≥60岁组(19例)。比较各组腹膜透析前以及腹膜透析1、3个月的临床指标(收缩压、舒张压、体质量指数、RDW、血红蛋白、血白蛋白、血肌酐、血尿素氮等)的差异,采用多元线性回归分析腹膜透析患者的年龄和性别对RDW的影响。结果女性患者中RDW≥14.6%的患者所占比例在基线及腹膜透析1、3个月(13.5%、15.4%、17.3%)均高于男性患者(9.8%、7.8%、13.7%)。≥60岁年龄段的基线RDW较其他两个年龄组显著增高(P0.05)。年龄与基线RDW、腹膜透析1个月的RDW呈正相关(r=0.320、0.242,P0.05)。采用多元线性回归分析,并校正相应体质量指数后分析发现,女性(β=0.025,P0.001,95%CI-0.001~0.953)和年龄较大(β=0.025,P0.001,95%CI 0.010~0.040)的患者基线RDW相对较高,同时年龄与腹膜透析1个月的RDW具有显著相关性(β=0.015,P0.05,95%CI 0.001~0.029)。进一步校正同期血红蛋白、血白蛋白和估算肾小球滤过率(或残肾肾小球滤过率)后发现,年龄与基线RDW(β=0.027,P0.001,95%CI 0.011~0.042)及腹膜透析1个月的RDW(β=0.017,P0.05,95%CI0.003~0.031)仍具有显著相关性。结论 RDW是影响透析患者预后的重要因素;老年是RDW的影响因素,这为改善老年透析患者预后提供了新思路。     

The relationship among asymmetric dimethylarginine (ADMA) levels, residual renal function, and left ventricular hypertrophy in continuous ambulatory peritoneal dialysis patients

Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of endothelial-based nitric oxide synthase. Its level is increased by end stage renal disease. However, most studies showing an increase in ADMA in dialysis patients have focused on hemodialysis. Results with peritoneal dialysis patients have been more inconclusive. Recent studies suggest that ADMA may be a new cardiovascular risk factor. The aim of the present study was to evaluate the relationship between ADMA levels, residual renal function, and left ventricular hypertrophy in peritoneal dialysis patients. Serum ADMA measurements and echocardiographic evaluations were performed in 54 peritoneal dialysis patients and 26 healthy volunteers. Residual renal function was measured in peritoneal dialysis patients by urea clearance from a urine collection. Thirty-two of the 54 peritoneal dialysis patients had residual renal function. ADMA levels of the peritoneal dialysis group were found to be significantly higher than those of healthy individuals (p = 0.03). Within the peritoneal dialysis group, ADMA levels of patients with residual renal function were significantly lower than those without residual renal function (p = 0.01), though they were still higher than the ADMA levels of the control group (p = 0.04). Serum levels of ADMA were positively correlated with left ventricular mass index (r = 0.29, p = 0.01) and negatively correlated with early mitral inflow velocity (Em) (r = -0.28, p = 0.01), Em/Late mitral inflow velocity (Am) (r = -0,32, p = 0.00), and isovolumetric relaxation time (r = -0.30, p = 0.01). In conclusion, increased ADMA levels seem to be associated with left ventricular hypertrophy in peritoneal dialysis patients, and residual renal function may lead to a reduction of serum ADMA levels.     

Exercise coaching and rehabilitation counseling improve quality of life for predialysis and dialysis patients.

Advances in medical treatment have improved the rehabilitation potential of predialysis (P) and dialysis (D) patients, but deficits remain in their physical and vocational functioning. We studied 18 P (expected to begin dialysis in 6-12 months) and 18 D patients (on dialysis 1-5 years) for 1 year. Exercise coaching and rehabilitation counseling were provided at no cost for the first 6 months to half of each patient group (rehabilitation group = R); the other half were assigned randomly to controls (C). No R services were provided during 6 months of follow-up. PR walked further in 6 min at 6 months (+3.9 m) and 12 months (+4.1 m) than initially (p < 0.01). Hematocrit increased in R (p < 0.05), but not in C. Symptom scores were stable in D, worsened 21% in PC, and improved 15% in PR. Sickness impact profile scores were better in PR than PC at 6 months (p < 0.05) and 12 months (NS). Comorbidity correlated with symptoms (r = +0.34, p < 0.05), self-rated affect (r = -0.35, p < 0.05), and self-rated Karnofsky index of disability (r = -0.37, p < 0.05), but not with physician-rated affect or physician-rated Karnofsky index of disability. Thus, quality of life was stable or improved in PR, but declined in PC; PR benefited more than DR. Rehabilitation services are more beneficial before than after patients stabilize on dialysis, and quality of life monitoring should continue indefinitely.     

Quality of sleep and health-related quality of life in haemodialysis patients.

BACKGROUND: Sleep complaints are common in haemodialysis patients. In the general population, insomnia impacts negatively on health-related quality of life (HRQoL). The objective of this study was to examine the association between quality of sleep and HRQoL in haemodialysis patients independent of known predictors of HRQoL. METHODS: Quality of sleep was measured using the Pittsburgh Sleep Quality Index (PSQI) and HRQoL was measured using the Medical Outcomes Study 36-item Short Form (SF-36) in 89 haemodialysis patients. RESULTS: Sixty-three (71%) subjects were 'poor sleepers' (global PSQI >5). The SF-36 mental component summary (MCS) and physical component summary (PCS) correlated inversely with the global PSQI score (MCS, r = -0.28, P < 0.01; PCS, r = -0.45, P < 0.01). The PCS score also correlated with age (r = -0.24, P = 0.02), haemoglobin (r = 0.21, P = 0.048) and comorbidity (r = -0.40, P < 0.01), and mean PCS was lower in depressed subjects (26.2 vs 35.9, P = 0.02). Subjects with global PSQI >5 had a higher prevalence of depression, lower haemoglobin and lower HRQoL in all SF-36 domains. The global PSQI score was a significant independent predictor of the MCS and PCS after controlling for age, sex, haemoglobin, serum albumin, comorbidity and depression in multivariate analysis. CONCLUSIONS: Poor sleep is common in dialysis patients and is associated with lower HRQoL. We hypothesize that end-stage renal disease directly influences quality of sleep, which in turn impacts on HRQoL.     

The investigation of sleep quality and the quality of life in end-stage renal disease patients

Objective To evaluate the sleep quality as well as the quality of life in end-stage renal disease (ESRD) patients, analyze the relationships between them and explore the influence factors. Methods A total of 141 ESRD patients from three hospitals were enrolled. The patients' general information including age, gender, degree of education, income, primary disease and years on dialysis were collected. Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep quality of the patients, and the life quality was assessed by using Kidney Disease Quality of Life-short form (KDQOL-SF). Results The incidence of sleep disorder was 56% in these 141 ESRD patients. The patients who suffered from sleep disorder had a higher sleep index score in all aspects of PSQI except in usage of sleep medications (P＜0.05). On the aspect of life-quality-associated factors, dialysis-related symptoms (OR=0.944, P=0.026), and change of health status (OR=1.024, P=1.024) were independent risk factors for sleep disorders. As for family-social factors, sleep quality was closely associated with dialysis (r=-0.252, P=0.003), family support (r=-0.174, P=0.040), and BMI (r=-0.189, P=0.025). Further regression analysis found that hemodialysis or peritoneal dialysis (OR= 0.544, P=0.011), poor family support (OR=0.686, P=0.030) were independently risk factors of sleep disorders. Conclusions Poor sleep quality is common in ESRD patients and it is associated with lower quality of life. More attention should be paid on assessment and management of sleep disorder in ESRD patients in order to improve their quality of life.     

Perceived mental health at the start of dialysis as a predictor of morbidity and mortality in patients with end-stage renal disease (CALVIDIA Study).

BACKGROUND: Health-related quality of life may affect morbidity and survival in end-stage renal disease, but it is not clear whether coexisting comorbidity and other known prognostic variables could account for such an association. METHODS: To study the relationship between health-related quality of life and morbidity and survival, we carried out an inception cohort study in patients starting chronic dialysis, mostly diabetics, with a follow-up of 1-3 years in 34 Spanish hospitals. Health-related quality of life was measured by the SF-36 Health Survey and Karnofsky scale. Charlson age-comorbidity index and other prognostic clinical variables were measured concurrently. The primary outcome variable was time until death and the secondary outcome was hospitalization days. RESULTS: Of 318 patients enrolled (208 diabetics), with a median follow-up of 771 days, 80 died. In the unadjusted analysis, all-cause mortality was associated with lower SF-36 physical and mental component scores and Karnofsky scale. In the adjusted analysis, SF-36 mental component score predicted all-cause mortality (hazard ratio for a 10 point decrease: 1.28; 95% confidence interval: 1.05-1.56). The SF-36 mental component score also predicted more hospitalization days (adjusted risk ratio of each additional hospital day associated with every 10 point decrease: 1.25; 95% confidence interval: 1.08-1.45). Among diabetics, both the SF-36 physical and mental components predicted mortality and hospitalization days. CONCLUSIONS: In end-stage renal disease, perceived mental health is an independent predictor of mortality and morbidity, mainly among diabetics patients.     

The Relationship among Asymmetric Dimethylarginine (ADMA) Levels,Residual Renal Function,and Left Ventricular Hypertrophy in Continuous Ambulatory Peritoneal Dialysis Patients

Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of endothelial-based nitric oxide synthase. Its level is increased by end stage renal disease. However, most studies showing an increase in ADMA in dialysis patients have focused on hemodialysis. Results with peritoneal dialysis patients have been more inconclusive. Recent studies suggest that ADMA may be a new cardiovascular risk factor. The aim of the present study was to evaluate the relationship between ADMA levels, residual renal function, and left ventricular hypertrophy in peritoneal dialysis patients. Serum ADMA measurements and echocardiographic evaluations were performed in 54 peritoneal dialysis patients and 26 healthy volunteers. Residual renal function was measured in peritoneal dialysis patients by urea clearance from a urine collection. Thirty-two of the 54 peritoneal dialysis patients had residual renal function. ADMA levels of the peritoneal dialysis group were found to be significantly higher than those of healthy individuals (p = 0.03). Within the peritoneal dialysis group, ADMA levels of patients with residual renal function were significantly lower than those without residual renal function (p = 0.01), though they were still higher than the ADMA levels of the control group (p = 0.04). Serum levels of ADMA were positively correlated with left ventricular mass index (r = 0.29, p = 0.01) and negatively correlated with early mitral inflow velocity (Em) (r = ?0.28, p = 0.01), Em/Late mitral inflow velocity (Am) (r = ?0,32, p = 0.00), and isovolumetric relaxation time (r = ?0.30, p = 0.01). In conclusion, increased ADMA levels seem to be associated with left ventricular hypertrophy in peritoneal dialysis patients, and residual renal function may lead to a reduction of serum ADMA levels.     

Relation between depression, some laboratory parameters, and quality of life in hemodialysis patients

Depression is common in patients with end-stage renal disease (ESRD) and is associated with increased mortality and morbidity. Several investigators have estimated that depression occurs in about 20% to 30% of dialysis patients. The aim of this study was to investigate the relationship between depression, some laboratory parameters, and quality of life (QOL) in hemodialysis patients. Forty-three hemodialysis patients (mean age 40.5+/-15.2; M=28, F=15) were included in the study. Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and short form with 36 (SF-36) were used for evaluation. Subsequently, patients were divided into two groups according to HAMD scores: group 1, those who had a low HAMD score (between 0 and 7), and group 2, those who had a high HAMD score (over 7). The two groups were compared in terms of anxiety scores, QOL scores, and some laboratory parameters. The group 2 patients (n=21; M= 13, F=8) had lower levels of hemoglobin than the group 1 patients (9.5+/-1.7 vs. 10.7+/- 1.4 g/dL, respectively; p<0.01). Group 2 patients also had lower SF-36 scores than group 1 patients (91.5+/-21.3 vs. 74.9+/- 13.6, respectively; p=0.03). On the contrary, the patients of group 2 had higher HAMA scores than group 1 patients (16.6+/-6.9 vs. 6.3+/-3.5, respectively; p<0.01) and CRP level (10.7+/-4.6 vs. 4.5+/-3.8, respectively; p<0.001). A significant correlation was found between depression scores and C-reactive protein (CRP) (r= 0.57, p < 0.001) and HAMA scores (r=-0.43, p<0.05). In contrast, a negative correlation was found between HAMD scores and albumin (r=-0.43, p<0.05), hemoglobin (r=-0.38, p=0.015) and SF-36 scores (r=0.39, p=0.032). These findings demonstrate that there is a relationship among high depression score, low levels of hemoglobin and albumin, high CRP level, low SF-36 score, and high anxiety score. Evaluation of psychiatric status should be part of the care provided to hemodialysis patients.     

How accurate is measuring postvoid residual volume by portable abdominal ultrasound equipment in peritoneal dialysis patient?

INTRODUCTION: Despite the wide spread use of modern portable ultrasound equipment to measure the postvoid residual urine, its accuracy and reliability has been questioned. We investigated the accuracy of postvoid residual urine measurement by portable abdominal ultrasound equipment in end-stage renal disease patients who are under either hemodialysis or peritoneal dialysis. MATERIALS AND METHODS: A total of 21 male (range: 25-44 years, mean age: 32 years) end-stage renal disease patients were studied. Ten were under peritoneal dialysis and 11 under hemodialysis. After uroflowmetric study, all patients were evaluated with portable abdominal ultrasound equipment (BladderScan BVI 3000, Diagnostic Ultrasound Corporation, WA) by both a technician and a physician and they were subsequently catheterized with a 10F catheter to measure the residual urine volume in the urinary bladder. Postvoid residual urine volume results by portable abdominal ultrasound equipment and urethral catheterization were analyzed. RESULTS: We found portable abdominal ultrasound to be very accurate to measure the volume of postvoid residual urine in hemodialysis patients(r=0.921, P<0.05 by physician and r=0.904, P<0.05 by technician). However, accuracy was the worst in peritoneal dialysis patients (r=0.055, P=0.88 by physician and r=0.336, P=0.343 by technician). The technician or physician use of the equipment did not change the accuracy profile of the equipment in both hemodialysis and peritoneal dialysis patients. CONCLUSIONS: Portable abdominal ultrasound equipment may be an unreliable method to measure postvoid residual urine volume in peritoneal dialysis patients.