Psychosocial issues in children on hospital haemodialysis: nurses' views

In a sample of 21 children and adolescents on hospital haemodialysis, nurses identified a substantial percentage of the children (about half) as having marked problems in psychological adjustment. Nearly half of the children were also regarded as showing poor compliance with aspects of treatment other than dialysis. More children were rated as disturbed by nursing than by research psychiatric assessments; there was limited congruence between nurses' and parent/child ratings of problems in physical well-being or in treatment compliance. The reasons for these discrepancies are explored. Our results highlight the importance that psychological aspects in the nursing of children with chornic renal failure on hospital haemodialysis are recognised.     

Determination of the Acid-base Status in Blood of Patients on Chronic Haemodialysis and of Bicarbonate in Dialysate: Comparison of Three Techniques and Their Mathematically Derived Values

The study deals with the comparison of acid-base parametersin blood of patients on chronic haemodialysis and of bicarbonatedialysate determined by Gas-Check AVL 945, equilibration technique(ET) , and a titrimetric method. The results show that an acceptableagreement exists between AVL and ET with respect to measurementsof pH, pCO₂ HC0₃^– and base excess. However, the valuesobtained for total buffer base related to the actual haemoglobinconcentration are significantly lower (P <0.001) when determinedby AVL. A titrimetric method is proposed for routine measurement ofHCO₃^– in bicarbonate dialysate. Values obtained usingthis method are 3–4 mmol/l higher than those determinedby AVL and ET. However, when the values for pK₁' and for thesolubility coefficient used in the Henderson-Hasselbaich equationare replaced by those for saline-bicarbonate solutions, resultsobtained using the titrimetric determined values agree wellwith those obtained by AVL and ET.     

Characteristics and Analysis of Risk Factors for Mortality in Infective Endocarditis

Objective: The aim of our study was to establish the etiology of and risk factors for infective endocarditis (IE) and determine the prognostic factors for adverse outcome during hospital admission in a Turkish population. Material and Methods: Between January 2002 and January 2004, the clinical and laboratory features of 112 consecutive adult patients (>18 years) with diagnosis of IE who were referred to the infectious diseases clinics/departments of 17 teaching hospitals in Turkey were evaluated. Cases of IE were defined according to the modified Duke Criteria. Mortality was defined as death occurring within 30 days or during hospital stay period. Univariate and multivariate analyses were performed to predict the factors related to fatal outcome. Results: A total of 112 consecutive patients presented with 101 definite and 11 probable IE episodes were defined according to the modified Duke Criteria. The mean age was 45.2±19.9. Fifty percent of the patients were male. Ninety (60.4%) of the 112 patients had risk factors for IE and 48 (42.9%) of them had ≥2 risk factors. On the other hand, 49.1% of patients had cardiac risk factors. Blood cultures were positive in 94 (83.9%) cases. Staphylococci were the most common agents (50.0%), followed by streptococci (28.7%) and enterococi (16.0%). Native cardiac valves were detected in 93 (83%) of the episodes of suspected IE. Valvular involvement was present in 103 (92%) patients; the mitral valve, alone or in combination with other valves, was affected in 70 (62.5%) of the patients. Echocardiography detected vegetations in 105 patients (93.8%). The mortality rate was 28.6%. Three factors were independently associated with mortality: haemodialysis OR: 14.5 (95% CI: 1.5–138.2), mobile vegetation OR: 4.8 (95% CI: 1.5–15.4) and mental alteration OR: 4.1 (95% CI: 1.1–15.6). Conclusion: Mortality is still high in IE. Our data indicate that patients with altered mental status, mobile vegetation, or on haemodialysis had poorer prognosis. Atahan Cagatay, Istanbul University Istanbul Medical School, Turkey; Funda Ergin, Baskent University, Medical School, Turkey; Hurrem Bodur, Ankara Numune Hospital, Turkey; Gulsen Ozkaya Sahin, Hacettepe University, Medical School, Turkey; Irfan Sencan, Abant Izzet Baysal University, Duzce Medical School, Turkey; Saban Gurcan, Trakya University, Medical School, Turkey; Elif Doyuk, Osmangazi University, Medical School, Turkey; Bilgiul Mete, Istanbul University Cerrahpasa, Medical School Turkey; Oral Oncul, Gulhane Academy, Medical School, Turkey     

Serum chromogranin A concentration and intradialytic hypotension in chronic haemodialysis patients

Aim The aim of this study was to investigate the influence of haemodialysis on plasma chromogranin A (CgA) concentration and to assess the relationship between CgA, blood pressure, occurrence of intradialytic hypotension episodes and residual renal function, respectively. Methods The study included 38 chronic haemodialysis patients (24 M, 14 F; mean age 56.2 ± 13.6 years). Plasma CgA and blood pressure were measured before and after a mid-week dialysis. Control group included 10 age- and sex-matched healthy subjects. Results Plasma CgA levels were on average 50-fold higher in HD patients than in the controls (699 ± 138 vs. 14 ± 6 U/L). In HD patients plasma CgA corrected for ultrafiltration rates significantly increased (to 836 ± 214 U/L, P < 0.001) at the end of dialysis procedure. In patients with (n = 8) and without frequent symptomatic intradialytic hypotension episodes predialysis values of CgA were similar (701 ± 169 vs. 698 ± 132 U/L) but post-dialysis were significantly lower in the former group (746 ± 312 vs. 860 ± 177 U/L; P = 0.03) despite a similar rate of ultrafiltration (2675 ± 1009 and 2583 ± 1311 ml, respectively). Accordingly, in patients with intradialytic hypotension an increase of plasma CgA during dialysis was also much lower than in patients without hypotension (45 ± 81 vs. 163 ± 144 U/L; P = 0.001). Conclusions CgA undergoes marked accumulation in renal failure. The increase of plasma CgA during dialysis is impaired in subjects with intradialytic hypotension episodes, which confirms the role of autonomic dysfunction in the pathogenesis of this complication.     

Observations on Lipid Metabolism in Chronic Renal Failure, During Conservative and Haemodialysis Therapy

The main variables of glycolipid metabolism (blood non-esterified fatty acids, triglycerides, cholesterol, insulin, glucose) have been measured in basal conditions in ura-emic patients on conservative treatment and on dialysis of different duration and bath glucose concentration (no glucose, 1 g/1, 2 g/1). Basal values for the patients on conservative dietary treatment are not different from normal. In dialysed patients, the blood non-esterified fatty acid and triglyceride concentrations are increased (p < 0.001) while cholesterol glucose and insulin levels are unchanged. No significant difference is found between the various types of dialysis, having different duration and bath glucose concentration.     

Prevalence of occult HBV infection in haemodialysis patients with chronic HCV

AIM: To study the prevalence and clinical effects of occult HBV infection in haemodialysis patients with chronic HCV. METHODS: Fifty chronic hemodialysis patients with negative HbsAg, and positive anti-HCV were included in the study. These patients were divided into two groups: HCV-RNA positive and HCV-RNA negative, based on the results of HCV-RNA PCR. HBV-DNA was studied using the PCR method in both groups. RESULTS: None of the 22 HCV-RNA positive patients and 28 HCV-RNA negative patients revealed HBV-DNA in serum by PCR method. The average age was 47.2±17.0 in the HCV-RNA positive group and 39.6±15.6 in the HCV-RNA negative group. CONCLUSION: The prevalence of occult HBV infection is not high in haemodialysis patients with chronic HCV in our region. This result of our study has to be evaluated in consideration of the interaction between HBsAg positivity (8%-10%) and frequency of HBV mutants in our region.     

VASCULAR DIALYSIS ACCESS FLOW MEASUREMENT: EARLY INTERVENTION THROUGH EARLY DETECTION

Aim: The aim of the project is to determine the effectiveness of using online access flow measurement, thermodilution method (Fresenius BTM?), in detecting and predicting thrombosis or stenosis of the haemodialysis fistula, so that early intervention could be instituted. Methodology: All haemodialysis patients with permanent vascular dialysis access, either arteriovenous fistula (AVF) or arteriovenous fistula graft (AVG), in a large tertiary referral Dialysis Service in Australia were included in this prospective observational quality project, conducted over 12 months. Results: Out of 165 patients studied, 36 patients were found to have poor dialysis access flow, defined as AVF—flow of <200 ml/min or a decrease of 25% from last measurement or AVG—flow of <600 ml/min or a decrease of 25% from last measurement. Doppler ultrasounds were performed, and confirmed findings of significant stenosis, either on the arterial or venous sites, as indicated by poor dialysis access flow results. Conclusion: Thermodilution technique is a reliable and effective method of detecting poor dialysis access flow for patients with permanent vascular access, comparable with other techniques.     

高通量血液透析对维持性透析患者心血管并发症影响的临床观察

目的 初步探讨高通量血液透析(high-flux hemodialysis,HFD)对维持性血液透析患者(maintence hemodialysis,MHD)心血管疾病的影响,为临床提供资料.方法 将武警北京市总队第三医院44例MHD患者随机分为两组:常规血液透析组(hemodialysis,HD组)20例,高通量血液透析组(HFD组)24例.分别在0、6、12个月时观察两组患者的临床症状,并检测血红蛋白、肌酐、尿素氮、白蛋白、血磷、β2-微球蛋白、甲状旁腺激素、C-反应蛋白等指标;心脏超声检测心脏左室收缩末期内径、左室舒张末期内径、舒张早期、舒张晚期二尖瓣口最大血流速度比,计算心功能指数、左室射血分数,并对结果进行对比分析.结果 HFD组对高血压、心肌缺血的疗效优于HD组,对心律失常的疗效两组比较差异;HFD组左心室腔径明显缩小,射血分数、心脏指数增加,与HD组比较差异有统计学意义(P＜0.05).结论 HFD可以明显改善MHD患者的心功能,减少心血管并发症的发生.     

含糖透析液减少维持性血液透析患者低血压发生

目的探讨含糖透析液是否可以减少维持性血液透析患者低血压的发生。方法选取长期透析伴低血压患者25例。前4周采用常规无糖透析液透析,后4周采用含糖透析液[含糖桶装无菌透析液(5.5 mmol/L)]。检测使用含糖透析液前后血压,血糖,干体重,食欲等变化,低血压发生次数。结果使用含糖透析液治疗1个月后低血压的发生率从117次降低至77次。每例患者平均发生低血压次数明显减少(P<0.01)。使用无糖透析液,透析后有6例患者发生低血糖;而使用含糖透析液后无低血糖发生。结论含糖透析液能够减少在维持性血液透析中低血压的发生。对于透析中血压波动大的患者使用含糖透析液可以稳定血压,其作用机制有待进一步研究。