SP526MODIFIABLE RISK FACTORS AFFECTING THE OUTCOME OF HEMODIALYSIS GRAFT
Jeeeun ParkJin Hae KimDo Hee KimHye Ryoun JangJung Eun LeeWooseong HuhYoon-Goo KimHa Young OhDae Joong Kim
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<i>Background:</i> End-stage renal disease is a major health problem worldwide nowadays. Although conventional hemodialysis is the most widely used modality, short daily hemodialysis has been proposed as a more physiologic treatment. The objective of this article is to compare the quality of life of patients on each hemodialysis modality. <i>Methods:</i> A multicentric cross-sectional study was performed in 9 Spanish hospitals. Patients treated for at least 3 months with conventional or short daily hemodialysis were included and quality of life measured using the Euroqol-5D quality of life questionnaire. Bayesian models were used for analyzing quality of life results. <i>Results:</i> Ninety-three patients were included, 27 were on daily hemodialysis and 66 on conventional hemodialysis. All models demonstrated a better quality of life for daily hemodialysis versus conventional hemodialysis. Only 14% of the patients on conventional hemodialysis were willing to change to a daily schedule. <i>Conclusions:</i> Short daily hemodialysis shows a better quality of life than conventional hemodialysis with all Bayesian approaches considered.
Home hemodialysis
Cross-sectional study
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Objective To investigate the change of IL-17 pre-hemodialysis and post-hemodialysis,and relationship between IL-17and hemodialysis,to find the differentiation direction of CD4+T cells post-hemodialysis.Methods Twenty five CRF patients undergoing hemodialysis treatment more than 1/2 year were chosen in observation group,and 30healthy volunteers were chosen in control group.IL-17,BUN,phosphorus(P)changes were observe in pre-hemodialysis and post-hemodialysis.Results BUN,P,and IL-17 levels of observation group in pre-hemodialysis were significantly higher than those of control group(P0.05),IL-17levels of observation group in pre-hemodialysis were significantly higher than those of observation group in post-hemodialysis(P0.05).BUN,and P levels in pre-hemodialysis were significantly lower than those of observation group in post-hemodialysis(P0.01).Conclusion It suggests that IL-17 may involve in the abnormality of immunity and the pathology of microinflammation in MHD patients after hemodialysis.Uremic symptoms leads to high expression of IL-17.It may suggests that the main differentiation direction of CD4+T cells in post-hemodialysis is IL-17.
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Objective To study the hemodialysis filtration effect on the inflammatory state of hemodialysis patients.Methods We selected 30 cases of maintenance hemodialysis (MHD) patients in hemodialysis room,and randomly divided them into observation group and control group (n=15).Observation group was treated with hemodialysis combined with hemodialysis filtration,the control group was treated with hemodialysis,then observed and recorded the improvement conditions of ALb,BUN,Scr,IL-6,TNF alpha and hs-CRP levels in two groups.Results 12 weeks after treatment IL-6,TNF alpha,hs-CRP levels in observation group patients were significantly lower than those in the control group,ALb propagated level was higher,the comparative differences showed statistical significance (P ＜ 0.05).Conclusion Hemodialysis filtration in treatment for MHD patients can effectively improve the patients' micro inflammatory state,and improve their quality of survival.
Key words:
Hemodialysis filtration; Hemodialysis; Micro inflammation
Filtration (mathematics)
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Objective:To assess the prophylactic effect of sodium modeling hemodialysis on hypotension during hemodialysis in patients with high risk factors(elderly,diabetic nephropathy and cardiac insufficiency).Methods:30regular hemodialysis patients with above risk factors was employed,Under the conditions of same blood flow and constantul trafiltration volume,all patients were performed conventional hemodialysis(CHD) at the first month wth the sodium concertation of Hemodialysis fluid 138mmol/L(A group) and sodium profile hemodialysis(PHD) at the second month with the sodium concertation of Hemodialysis fluid reduced from 148 mmol/L to 135mmol/L(B group),the serum concertations of sodium were detected pre-Hemodialysis and post-Hemodialysis,respectively,the occurrence of hypotension during Hemodialysis was also observed during Hemodialysis.Results:(1)compared with group B,no obvious difference of serum sodium concertation occurred between pre Hemodialysis and post-Hemodialysis in group A(P0.05),(2)the occurrence rate of hypotension in group B was significantly reduced compared with group A(P0.01),(3) compared with group A,PHD plays its therapeutic role without the increase of sodium burden and body weight.Conclusion:sodium modeling hemodialysis can obviously prevent the occurrence of dialysis hypotension in patients with high risk factors.
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Objective To investigate the effect of low-dosage hemodialysis on cytokine and residual renal function.Methods 30 ure- mic patients whose residual renal function could preserve(Ccr5ml/min urine 800 ml/d).Were divided into two groups and then were giv- en hemodialysis treatment.20 patients(experimental group)performed in the low-dosages hemodialysis and hemodialysed 1～1.5 times weekly and the other 10 patients(Routine Hemodialysis)performed routine hemodialysis,2 times weekly.Results Compared with the rou- tine hemodialysis group,the experiment group produced less IL-1,IL-6,TNF-α.But more.IL-10.While residual renal function declined slowly after nine months.There was no significant difference in hemodialysis effect between the two groups.Conclusion Low-dosage hemodialysis 1～1.5 times a week was feasible for uremic patients if their residual renal function preserred(Ccr5ml/min,Urine800ml/d)and dehy- dration was less 2 kg on each hemodialysis.The low-dosage hemodialysis treatment is the optimal therapy for early uremia without dehydra- tion,if the hemodialysis efficacy can be assured.
Dose
Uremia
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To characterize the determinants of circulating levels of adrenomedullin (AM), the plasma levels of this peptide were measured in 58 patients with end-stage renal disease on hemodialysis. Predialysis plasma levels of AM were more than twice as high in patients on hemodialysis as compared to controls. In hemodialysis patients with heart failure (NYHA classes II–IV) or hypertensive HD patients plasma levels of AM were significantly higher than in patients with end-stage renal disease only. Plasma levels of AM were not altered immediately by hemodialysis but decreased significantly 14–20 h after hemodialysis. AM plasma levels before hemodialysis and 14–20 h after hemodialysis were correlated with the corresponding mean arterial pressure.
Adrenomedullin
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Objective: To explore the effects of the eating time on blood pressure of patients during hemodialysis. Methods: The clinical data of 25 patients with hypotension during hemodialysis were investigated using self-control method. The patients were treated with fasting during hemodialysis,eating 250 g food within 2 h of hemodialysis and at 3 h after hemodialysis for 2 weeks,respectively. The mean arterial pressure at 30 min before and after eating,and every hour mean arterial pressure before the hemodialysis and during hemodialysis were analyzed. Results: The differences of mean arterial pressure before and after eating and before the hemodialysis and during hemodialysis,the occurrence rates of hypotension and symptomatic hypotension,and nursing intervention between 3 groups were statistically significant( P 0. 01). The differences of all indexes of patients treated with eating at 3 h after hemodialysis and other two groups were statistically significant( P 0. 01). The differences of mean arterial pressure before the hemodialysis and number of stop hemodialysis caused by hypotension between 3 groups were not statistically significant( P 0. 05). Conclusions: For hypotension-prone patients,the eating time should be within 2 h hours of hemodialysis,and prohibit at 3 h after hemodialysis,which can prevent the hypotension.
Mean arterial pressure
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Objective At present dialysis machines provided online assessment of Kt/V.The aim of our study was to assess the effect of hemodialysis time on the rate of urea removal(K),by measuring K at different times of hemodialysis patients.Methods The K during one hemodialysis session were observed chronologically.The relationship between hemodialysis time and K were analyzed.Results There was no correlation between the hemodialysis time and K(P 0.05).Conclusion The rate of urea removal was uncorrelated with hemodialysis time during one hemodialysis session.Kt / V was positively correlated with hemodialysis time.
Dialysis adequacy
Kt/V
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Hemodialysis is a commonly used therapy for renal failure in critically ill patients. This article reviews components of the hemodialysis system, including vascular access, and provides an explanation of principles underlying the hemodialysis process. Expected patient responses and potential complications of hemodialysis therapy are emphasized. Critical care nursing interventions for the care of patients before, during, and after dialysis also are outlined
Renal replacement therapy
Nursing Interventions Classification
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Hemodialysis adequacy describes a measure of the hemodialysis doses. Automatic measurement of adequacy through a hemodialysis machine has a more efficient advantage and can be accessed at any time. The purpose of this study was to determine the association between adequacy hemodialysis and the quality of life among chronic renal failure patientsundergoing hemodialysis. This study used a correlational analytic observational study with a cross sectional design. Data analysedwith the Spearman Rank correlation test. The subjects were 31 chronic renal failure patients undergoing hemodialysis, determined by consecutive sampling method. Data were collected retrospectively through hemodialysis record and the KDQOL SF-36 questionnaire. The result was there was no significant relationship between the adequacy of hemodialysis and quality of life in all dimensions of quality of life except for the dimensions of the physical composite (p=0,013, α=0,05) r=-0,449. There was a relationship between length of time undergoing hemodialysis and physical composite (p= 0,046, α=0,05), r = -0,367. The conclusion is confirmation of adequacy with blood urea examination is necessary.Monitoring machine monitor curves for smooth access, Qb, duration of hemodialysis and recirculation during hemodialysis is important to support the achievement of the expected adequacy. Evaluating the quality of life of patients needs to be done regularly.
Rank correlation
Chronic renal failure
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