Search

Introduction : Les complications cardiovasculaires sont très létales chez les patients hémodialysés chroniques. Elles constituent la première cause de mortalité dans cette population qui est 3 à 20 fois plus élevée par rapport á la population générale de même âge. L’objectif de ce travail était de déterminer la fréquence des complications cardiovasculaires chez les patients hémodialysés chroniques. Patients et méthodes : Il s’agissait d’une étude prospective descriptive et analytique de 2 mois au centre d’hémodialyse de l’hôpital régional de Ziguinchor. Le recueil des données était effectué grâce á un questionnaire renseignant sur les paramètres épidémiologiques, cliniques, paracliniques. Tous les patients avaient bénéficié d’un électrocardiogramme et d’une échographie cardiaque trans-thoracique faites en post dialyse. Résultats : L’âge moyen des patients était de 41,14 ans et 57,14% des patients étaient hypertendus. La dyspnée d’effort était la principale manifestation clinique soit 47,61% et 28,57% des patients avaient une hypertrophie ventriculaire gauche électrique. A l’échocoeur, l’hypertrophie ventriculaire gauche concentrique était le plus notée dans 47,61%. Conclusion : les patients hémodialysés chroniques sont exposés á des complications cardiovasculaires fréquentes et létales. La prise en charge correcte nécessite une surveillance avec des examens paracliniques périodique pour prévenir les complications., Journal Marocain des Sciences Médicales, Vol 23, No 1

Introduction: Determination of dry weight is one of the daily goals to achieve in hemodialysis. The aim of this study was to validate the use of bioelectrical impedance analysis (BIA) in estimation of dry weight in a population of Senegalese chronic hemodialysis patients. Patients and methods: A 9-week cross-sectional study was carried out at the hemodialysis unit of Aristide Le Dantec University Hospital. Adult patients with no previous hospital history were included. The total body water (TBW) was measured with a single frequency bioelectric impedance foot-to-foot analyzer, before and after six successive hemodialysis sessions. These results were compared with those from clinical measurements with the Watson equation using a Student’s t-test and Bland-Altman analysis. Results: 264 measurements were made in 22 patients (46.6 years, 54.5% men, 92.3 months on dialysis, 62.7 kg mean dry weight). A significant reduction in weight (ΔWeight = 2.0 ± 1.1 kg; p < 0.0001) and in TBW measured by the BIA (ΔTBWBIA = 3.3 ± 1.0 liters; p < 0.0001)) or calculated by Watson’s equation (ΔTBWWatson = 0.5 ± 0.2 liter; p = 0.0001) was observed. There was a strong linear correlation and agreement between the 2 TBW measurements in pre-dialysis. In post-dialysis the concordance diagram indicated a bias = –2.2 and wide agreement limits. Conclusion: The BIA allows reproducible and reliable measurements and a fair estimate of the TBW in pre-dialysis.

Context and objective. For many practitioners, blood pressure is the main indicator of the hydration status of the chronic hemodialysis patient. The objective of this study was to assess the extent to which bioimpedance analysis (BIA) can assist in determining acute changes in fluid volume during the hemodialysis session.Methods. This was a 9-week longitudinal study. The total body water (TBW) was measured with a BIA analyzer, before and after 6 successive sessions. The ΔWeight was compared to the ΔTBW by calculating the P/V ratio (ΔWeight/ΔTBW) with the assumption that the dry weight is reached when P/V = 1.Results. The measurements made in 22 patients (46.6 years, 54.5% men, 92.3 months on dialysis) were reproducible. There was no statistically significant difference between ΔTBW and ΔWeight. However, at the individual level, significant differences had been observed. Using hypertension as a marker for a state of hyperhydration, a 31.8% agreement was noted between the P/V ratio and hypertension.Conclusion. Although the loss of water predicted by the BIA did not always correspond to the weight loss, BIA is a technique that can be used to assess the variations in TBW during the hemodialysis session in patients. Contexte et objectif. La pression artérielle est pour de nombreux praticiens, l’indicateur principal du statut hydrique du patient hémodialysé chronique. L’objectif de la présente étude était d’évaluer dans quelle mesure l’analyse d’impédance bioélectrique (BIA) pourrait aider à la détermination des variations aigues du volume hydrique au cours de la séance d’hémodialyse.Méthodes. Il s’agissait d’une étude de suivi longitudinal sur 9 semaines. Le volume total d’eau (VTE) a été mesuré par BIA, avant et après 6 séances. Le ΔPoids a été comparé au ΔVTE par le calcul du ratio P/V (ΔPoids / ΔVTE) dans l’hypothèse que le poids sec est atteint lorsque P/V = 1.Résultats. Les mesures faites chez 22 patients (46,6 ans, 54,5% hommes, 92,3 mois en dialyse) étaient reproductibles. Il n’y avait pas de différence statistiquement significative entre le ΔVTE et le ΔPoids. Cependant à l’échelon individuel des différences importantes étaient observées. En utilisant l’hypertension artérielle (HTA) comme marqueur d’un état d’hyperhydratation, une concordance de 31,8% était notée entre le ratio P/V et l’HTA.Conclusion. Bien que la perte d’eau prédite par la BIA ne corresponde pas toujours à celle du poids, la BIA est une technique qui peut être utilisée pour évaluer les variations du VTE au cours de la séance d’hémodialyse

Introduction Progressive ultrafiltration (UF) could improve IDH. The aim of this work was to evaluate the effectiveness of progressive UF in the management of IDH. Methods This randomized clinical trial in two groups: interventional group A (UF, n = 12) and control group B (n = 12), was conducted in chronic hemodialysis patients with IDH. A first phase of cross-sectional collection of BP before and after dialysis, during 2 weeks, made it possible to obtain this cohort of 24 patients. A progressive decrease in basal weight of 0.25 kg per session as a function of hemodynamic tolerance was achieved in group A. The primary endpoint, the proportion of patients with disappearance of IDH, was assessed at baseline end of the 4th and 8th week. Results At the 4th week, the IDH disappeared in 83.3% and 41.7% of the patients of the group A and B respectively with a hazard ratio (HR) at 0.29; IC 95 = [0.14-0.59]; p = 0.035. At the 8th week, the IDH was missing in 72.7% and 66.7% of the patients of the group A and B respectively with a HR at 0.76; IC 95 = [0.58-1.00]; p = 0.75. In addition, the decrease in basal weight was associated with the occurrence of side effects (p = 0.0001) with a HR of 5 [1.45-7.27]. UF discontinuation was required in 4 patients in group A (36.4%). Conclusion Progressive UF was associated with a significant reduction in the prevalence of IDH in our patients at week 4.

Introduction: Hemodialysis is a renal replacement technique that uses extracorporeal blood circulation (ECC) to purge the blood of patients with renal failure. It is used urgently in severe acute kidney injury (AKI) and complicated end stage renal disease (ESRD). The objective of this work was to determine the prevalence of each indication of emergency hemodialysis and its prognosis. Methods: We conducted a prospective, mono-centric study of descriptive and analytical type over a period of 6 months at the hemodialysis center of Aristide Le Dantec University Hospital. All patients with acute or chronic renal failure who underwent hemodialysis during an emergency were included. These emergencies were for the AKI or Chronic Kidney disease (CKD) the existence of one or more severity criteria: pulmonary œdema, hyperkalemia, severe metabolic acidosis, poorly tolerated uremia, persistent anuria and / or symptomatic hyponatraemia. Results: Eighty-one emergency hemodialysis patients were received during the study period out of a total of 660 hemodialysis patients serving a hospital prevalence of 12.2%. The mean age of the patients was 39.31 ± 18.78 years with a sex ratio of 1.02. The first indication of emergency hemodialysis was poorly tolerated uremia in 46 patients (56.7%) followed by threatening hyperkalemia with 43.2%. The evolution was highlighted by a complete recovery in 53% of patients with AKI whereas for patients with ESRD lifting the emergency was the rule. Fifteen patients (18.50%) had died, including 12 patients (14.80%) outside dialysis and 3 patients (3.75%) on dialysis. The occurrence of death was statistically correlated with hyperkalemia (p = 0.003) and metabolic acidosis (p = 0.001). Conclusion: Hemodialysis was performed urgently in 12.2% of cases. Poorly tolerated urine was the most common indication (56.7%). In the majority of cases we noted a good evolution with the emergency lifting. However we noted 15 deaths (18.5%).