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Introduction: In hemodialysis (HD) patients procalcitonin (PCT) considered as an early predictor of acute infection. It represents a new and potential marker of inflammation and may correlate with dialysis adequacy. This makes procalcitonin a potential biomarker for obesity-related low-grade inflammation.Objective: The aim of the work was to assess procalcitonin level in obese prevalent hemodialysis patients and its relation to hemodialysis adequacy. Patients and Methods: A cross sectional study was conducted on 90 patients divided into 3 groups, 40 obese (BMI ≥ 30 Kg/m2) ESRD patients on regular hemodialysis (group A), 40 non obese (BMI < 25 Kg/m2) ESRD patients on regular hemodialysis (group B) attending at Dialysis Unit, El-Sahel Teaching Hospital and 10 healthy individuals with BMI < 25 Kg/m2 as a control group (group C). All patients were subjected to detailed history taking and general examination. All patients were laboratory investigated for CBC, serum urea, creatinine, CRP, urea reduction ratio (URR), equilibrated Kt/v. All controls were subjected to written informed consent, full history, examination and CRP level. Procalcitonin level was done by ELISA technique for all patients and controls.Results: In our study, we found that there was a higher level of procalcitonin (PCT) in obese hemodialysis patient than non-obese. We also found that there was no correlation between PCT and hemodialysis adequacy in our study population.Conclusion: It could be concluded that procalcitonin is a potential biomarker for obesity-related low-grade inflammation, but not related to hemodialysis adequacy.

Amaç: Hemodiyaliz (HD), son dönem kronik böbrek hastalığı (KBH) olan bireylerde en yaygın kullanılan renal replasman tedavilerinden biridir. Bu çalışmanın amacı, iyi tedavi edilen HD hastalarının Ürik asit / HDL kolesterol oranı (UHR) düzeylerini, yetersiz HD tedavisi almayanlarınkilerle karşılaştırmaktı.Gereç ve Yöntem: HD hastalarına ilişkin veriler, hasta dosyalarından ve kurumun veri tabanından elde edildi. URR değerinin %70'in üzerinde olması yeterli HD grubunu, %70'in altında olması ise yetersiz HD grubunu tanımlamıştır. Ayrıca, çalışma gruplarının UHR'si gibi laboratuvar verileri karşılaştırıldı.Bulgular: Yeterli ve yetersiz HD için UHR'ler sırasıyla 0,160±04 ve 0,20±0,07 idi. Yetersiz HD'si olan hastaların UHR'si, yeterli HD'si olan deneklerden önemli ölçüde daha yüksekti (p=0.004). Ayrıca UHR, HD öncesi üre (r=0,37, p=0,001), HD sonrası üre (r=0,39, p=0,001), HD öncesi serum kreatinin (r=0,48, p0,001), serum Korelasyon analizlerine göre HD sonrası kreatinin (r=0.45, p0.001) ve URR ile negatif korelasyon (r=-0.29, p=0.008). Kronik böbrek hastalığı olan bireylerde, 0,16'dan yüksek bir UHR değeri, yetersiz HD'yi saptamada %67 duyarlılık ve %57 özgüllük sergilemiştir.Sonuç: HD tedavisi gören KBH hastalarında HS yeterliliğini belirlemek için URR'ye ek olarak UHR'nin kullanılabileceğini öneriyoruz., Aim: Hemodialysis (HD) is one of the most widely utilized renal replacement therapies in individuals with end-stage chronic kidney disease (CKD). The purpose of this study was to compare the Uric acid to HDL cholesterol ratio (UHR) levels of well-treated HD patients to those of those who had inadequate HD therapy.Materials and Methods: Data on HD patients were acquired from patient files and the institution's database. A URR value of more than 70% designated the sufficient HD group, whereas less than 70% defined the insufficient HD group. Furthermore, laboratory data, such as the UHR of the study groups, were compared.Results: The UHRs for adequate and inadequate HD were 0.160±04 and 0.20±0.07, respectively. The UHR of patients with insufficient HD was substantially greater than that of the subjects with sufficient HD (p=0.004). Besides, UHR was substantially and positively connected with urea before HD (r=0.37, p=0.001), urea after HD (r=0.39, p=0.001), serum creatinine before HD (r=0.48, p0.001), serum creatinine after HD (r=0.45, p0.001), and negatively correlated with URR (r=-0.29, p=0.008), according to correlation analyses. In individuals with chronic renal disease, a UHR value higher than 0.16 exhibited 67% sensitivity and 57% specificity in detecting inadequate HD.Conclusion: We propose that UHR, in addition to URR, might be used to determine HS sufficiency in CKD patients undergoing HD therapy.

Background The quality of life of individuals undergoing hemodialysis is related to many factors, including sleep disorders. Objective To determine the prevalence of sleep disorders in individuals undergoing hemodialysis and to assess the effect of clinical and biochemical parameters on their sleep quality. Method We conducted a cross-sectional descriptive survey in multiple hemodialysis centers. Individuals were interviewed using a questionnaire for obtaining general personal information, the Pittsburgh Sleep Quality Index (PSQI) for assessing sleep quality, and the Epworth Sleepiness Scale (ESS) for assessing excessive daytime sleepiness (EDS). Results The study included 338 individuals with a median age of 55 years. Poor sleep quality (PSQ) and EDS were present in 41.4% and 6.5% of the individuals, respectively. The individuals' PSQI scores were significantly proportional to their ESS scores. Concerns about the disease and its treatment (60.7%) and poor physical conditions (35.7%) were major reported reasons for PSQ. In a logistic regression analysis, female gender, household income, ESS score, chronic heart failure, and creatinine and parathormone levels were found to be independent predictors of PSQ; household income, PSQ presence, parathormone and potassium levels, and urea reduction ratio were found to be independent predictors of EDS. Conclusion Sleep disorders are common in individuals undergoing hemodialysis and are related to gender, comorbid diseases, poor economic state, altered biochemical values, dialysis timing, and concerns about the disease and its treatment. Improving these individuals' quality of life through adequate psychological and financial support and early diagnosis of sleep disorders should decrease their mortality and morbidity rates.

The dialysis disequilibrium syndrome (DDS) results from osmotic shifts between the blood and the brain compartments. Patients at risk for DDS include those with very elevated blood urea nitrogen, concomitant hypernatremia, metabolic acidosis, and low total body water volumes. By understanding the underlying pathophysiology and applying urea kinetic modeling, it is possible to avoid the occurrence of this disorder. A urea reduction ratio (URR) of no more than 40%-45% over 2 h is recommended for the initial hemodialysis treatment. The relationship between the URR and Kt/V is useful when trying to model the dialysis treatment to a specific URR target. A simplified relationship between Kt/V and URR is provided by the equation: Kt/V = -ln (1 - URR). A URR of 40% is roughly equivalent to a Kt/V of 0.5. The required dialyzer urea clearance to achieve this goal URR in a 120-min treatment can simply be calculated by dividing half the patient's volume of distribution of urea by 120. The blood flow rate and dialyzer mass transfer coefficient (K0 A) required to achieve this clearance can then be plotted on a nomogram. Other methods to reduce the risk of DDS are reviewed, including the use of continuous renal replacement therapy.

Objective The aim of this evidence implementation project was to identify the barriers and omissions affecting adequacy of hemodialysis and to develop implementable strategies to maintain hemodialysis adequacy among hemodialysis patients with end-stage renal disease. Introduction Assessing adequacy of hemodialysis and improving quality of life are important issues for patients with end-stage renal disease. However, they are often inadequately addressed, and evidence-based practices are not always followed. Methods A clinical audit was undertaken using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice approaches. Seven audit criteria that represent best practice recommendations for maintaining hemodialysis adequacy among hemodialysis patients were used. A baseline audit was performed, which was followed by the implementation of multiple improvement strategies over 20 weeks and the outcomes finalized using a follow-up audit to determine the change to be implemented in practice. Results The baseline audit results showed that most audit criteria were less than 77% in practice. The compliance rates for nurses who had received education regarding hemodialysis, checking the prescription order for each patient at each session, and using the prescribed dialyzer for every session were determined to have reached 100% at the follow-up audit. The compliance rates for completion prehemodialysis checks, using a sterile technique when inserting an arteriovenous catheter, matching a blood flow rate with the prescription, and maintaining a blood flow rate throughout the treatment session were found to be 73-95% at the follow-up audit. The most significant finding was the proportion of hemodialysis patients with inadequate urea reduction ratio was reduced from 4.6 to 3.2% after implementation of the best practice approaches. Conclusion The implementation of institution-specific evidence-based resources brought about immediate improvements in hemodialysis adequacy management and practice. A variety of strategies contributed to the success of this implementation project, such as scenario simulation education, Objective Structured Clinical Examination, the interrelation response system Kahoot, the use of hemodialysis International Organization for Standardization job descriptions, regular weekly audits, and collaboration with physicians when caring for patients during clinical practice.

Introduction: In recent years the burden of chronic kidney disease has increased worldwide. End Stage Renal Disease (ESRD) needs Hemodialysis as a common renal replacement therapy to reduce its morbidity and mortality. Hemodialysis adequacy must be maintained for effective treatment and is measured either by Urea Kinetic Model (Kt/V), Urea Reduction Ratio (URR), natural log Kt/V or Daugirdas 2nd generation formula. Though Kt/V is accurate, URR is commonly used in clinical practice because of its simplicity and clear concept. Objective: To estimate and compare URR with single pool Kt/V in assessing hemodialysis adequacy. Materials and Methods: An experimental prospective study consisting of 100 ESRD patients of either sex between 18-70 years, who were on hemodialysis maintenance. Blood urea was estimated by GLDH- urease method and serum creatinine by Jaffe’s method. Values were substituted in URR and Kt/V formula. Results and Conclusion: There was a significant difference in serum Urea levels after dialysis treatment (P positive correlation with Kt/V. Since the URR and Kt/V are closely related, their predictive power in terms of patient outcome is similar. However, use of Kt/V and urea modelling allows for comparing expected with predicted dialysis dose that can be used to analyse dialysis treatment and dialyzer clearance. Keywords: Urea reduction ratio, Kt/V, ESRD, Hemodialysis adequacy, Renal Dialysis, Urea

There are similarities in hemodialysis (HD) between adults and children and also unique pediatric aspects. In this systematic review, we evaluated the existing HD literature, including vascular access, indications, parameters, and outcomes as a reflection on real-life HD practices. Medline, Embase, CINAHL, Web of Science, and Cochrane Library were systematically searched for literature on HD in children (1–20 years). Two reviewers independently assessed the literature and data on indications; vascular access, outcomes, and specific parameters for HD were extracted. Fifty-four studies (8751 patients) were included in this review. Studies were stratified into age groups 1–5, 6–12, and 13–20 years based on median/mean age reported in the study, as well as era of publication (1990–2000, 2001–2010, and 2011–2019). Across all age groups, both arteriovenous fistulas and central venous catheters were utilized for vascular access. Congenital abnormalities and glomerulopathy were the most common HD indications. HD parameters including HD session duration, dialysate and blood flow rates, urea reduction ratio, and ultrafiltration were characterized for each age group, as well as common complications including catheter dysfunction and intradialytic hypotension. Median mortality rates were 23.3% (3.3), 7.6% (14.5), and 2.0% (3.0) in ages 1–5, 6–12, and 13–20 years, respectively. Median transplantation rates were 41.6% (38.3), 52.0% (32.0), and 21% (25.6) in ages 1–5, 6–12, and 13–20, respectively. This comprehensive systematic review summarizes available literature on HD in children and young adults, including best vascular access, indications, technical aspects, and outcomes, and reflects on HD practices over the last three decades.

Background: Most of hemodialysis patients are unemployed and the few who are working are at risk of losing their jobs. Therefore, factors affecting employment need to be studied. Objective: Our aim was to access factors affecting employment among working-age patients on hemodialysis all over Egypt as it was not assessed before. Patients and Methods: This study was conducted between October 2012 and April 2015 in multiple hemodialysis centers by direct interview of the patients and collecting the data from the medical record in a special data collection sheet. Results: The study was conducted on 16280 hemodialysis patients in 19 Egyptian governorates. 21.2% of the patients were employed, 81.6% of the employed patients were men, and their mean age was 47.25+11.31. Hypertension was the most common etiology of end-stage renal disease (ESRD) and was the commonest comorbidity in employed patients. Employment was affected by age, gender, ESRD etiology and most comorbid conditions apart from comorbid chronic liver disease and chronic obstructive pulmonary disease. Factors affecting employment was dialysis frequency, duration, complications, dialyzer type, material, and surface area, dialysate type, dialysate Na, K and vascular access, haemoglobin (Hb) level, Ca/PO4 ratio, parathormone (PTH), iron injection, blood transfusion, erythropoietin intake, vitamin B complex intake, L carnitine intake, phosphate binders, cinacalcet and folic acid intake while Kt/v and urea reduction ratio and vitamin D supplements did not affect employment. Conclusion: Similar to the other studies we found that employment was not common among hemodialysis patients, which was affected by age, gender, ESRD etiology and comorbidities apart from chronic obstructive pulmonary disease (COPD) and chronic liver disease (CLD) which differed from other studies.

Background: Hemodiafiltration (HDF) is a newly developed renal replacement therapy blood purification technology with more advantageous effects on hemodynamic stability and better removal of B2 microglobulin and phosphorous Objective: The aim of this study is to compare effect of high flux (HF), low flux (LF) dialysis membranes and hemodiafiltration (HDF) on the metabolic status in hemodialysis patients and quality of life of those patients. Patients and Methods: This study included 60 patients more than18 years old, clinically stable with end stage renal disease on regular HD for at least three years (3 yrs), selected from HD unit in (Kobry El Kobba Military Nephrology Hospital) in the period from March 2018 to September 2018. The patients were divided into three groups equally. Group I: 20 patients on low flux dialyzer, Group II: 20 patients on high flux dialyzer, Group III: 20 patients on hemodiafiltration. Results: There was a highly significant decrease in iPTH, B2 microglobulin and Phosphorous in patients received HDF (363.80±149.04, 8.79±7.22 and 4.31±0.74 respectively in comparison with patients received HF hemodialysis (540.10±242.55, 20.47±3.97and 4.58±1.07 respectively) and patients received LF hemodialysis (725.95±270.01, 36.60±7.22 and 5.73±1.34 respectively).Also, there were a highly significant increase in urea reduction ratio in HDF group compared to HF and LF groups (80.43±7.46, 76.03±9.55 and 65.81±7.42 respectively. Conclusion: Hemodiafiltration is the most effective dialysis technique than high flux and low flux dialysis membrane in removal of medium sized molecule and improvement of quality of life.

Background : : While the final goal of renal replacement therapy is to achieve normal social adaptation and employment, many studies to date have focused on the analysis of complications and causes of death. In contrast, the analysis of dialysis patients with normal job employment and exhibiting a good medical status can be important for clinical treatment policy. This study assessed various clinical parameters according to rehabilitation and employment status to elucidate characteristics correlated with better rehabilitation status among hemodialysis patients. Methods : : A total of 29,865 hemodialysis patients who were registered with rehabilitation status information in the Korean Society of Nephrology end-stage renal disease registration program from January 2017 to April 2019 were included and divided into five groups according to their rehabilitation status. Results : : About half (47%) of enrolled patients belonged to the “independent but without a job” group and 21% of patients belonged to the “employed with a full-time job” group. Analysis revealed significantly younger mean age, longer mean hemodialysis duration, a higher proportion of male sex, and a lower proportion of diabetic nephropathy cases in the full-time job group than in the other hemodialysis patient groups. Also, hemoglobin, albumin, and phosphorus levels were higher but the urea reduction ratio was lower in the full-time job group. Conclusion : : A better rehabilitation and employment state of hemodialysis patients was associated with younger age, male sex, and underlying chronic glomerulonephritis. Patients with full-time jobs generally have better laboratory data but lower dialysis efficacy.

Background: Bleeding at fistula sites in patients with end stage renal disease (ESRD) is a common and potentially serious complication that contributes to blood loss (anemia). This study aimed to determine the factors that influence prolonged bleeding at fistula puncture sites following removal of fistula needles.Methods: This was a descriptive cross-sectional study. We consecutively enrolled patients who underwent maintenance hemodialysis between May and October 2017 at Muhimbili National Hospital and Access Dialysis Centre in Dar es Salaam, Tanzania. A case report form (CRF) was used for data collection.Prolonged bleeding was assessed by measuring activated partial thromboplastin time (aPTT) and compression time (CT). Descriptive statistics and regression analysis were used to assess the association between factors and tease out the independent factors associated with prolonged bleeding at fistula puncture site. A two-tailed p-value 31 seconds) and 4 (3.5%) had prolonged compression time (> 15 minutes). The mean aPTT and compression time of the participants were 42 ± 17.6 seconds and 5 ± 2.9 minutes respectively. Over half of participants 67(58.2%) had normal compression time (≤ 15 minutes). Elevated serum urea levels (> 7.4mmol/L) was the only factor significantly associated with elevated aPTT (OR=4.143 95% C.I (1.021-16.810), p=0.047).Conclusion: The findings have demonstrated that elevated serum urea levels are significantly associated with prolonged bleeding time following removal of Arterio-Venous fistula needles after completion of a hemodialysis therapy session. This study suggests that, in hemodialysis procedure where a fixed dose of heparin is generalized to all patients there is a chance of exceeding the individual’s requirements.Recommendations: Serum urea levels should be factored in when gauging the individual risk of arterio-venous fistula site bleeding for patients using heparin for anticoagulation during hemodialysis. Further studies with large sample sizes are recommended to elucidate how other predisposing factors may affect A-V fistula bleeding. Keywords: Hemodialysis, heparin, prolonged bleeding, urea reduction ratio, A-V Fistula, aPTT, Compression time, blood urea.

Rationale & Objectives Conventional monitoring of hemodialysis dose is implemented using urea kinetic modeling based on single-pool Kt/V, which requires both pre- and postdialysis serum urea nitrogen (SUN) measurements. We compared this conventional approach to one in which Kt/V is calculated using conductivity clearance, thereby reducing the need for regular postdialysis SUN measurements. Study Design Comparative study of 2 diagnostic tests. Setting & Participants Prevalent patients receiving maintenance hemodialysis for at least 2 years for whom both urea reduction ratio (URR) and average conductivity clearance (Kecn) were measured. Tests Compared During the initial 8 months (baseline interval), average Kecn and URR were used to calculate a median patient-specific, modeled, calibration solute distribution volume (Vcal). During months 9 to 16 (period 1) and 17 to 24 (period 2), Kt/V was conventionally computed using URR and also by a new method using Vcal and Kecn without postdialysis SUN values. We examined the percentage error between these 2 methods of calculating Kt/V. Outcomes Concordance between the 2 methods of calculating Kt/V. Results Among 1,093 patients, mean individual-level median single-pool Kt/V values derived using the conventional method during the baseline interval, period 1, and period 2 were 1.62±0.24 (SD), 1.66±0.24, and 1.67±0.24, respectively. During periods 1 and 2, patient-level median Kt/V values derived using Kecn were 1.64±0.24 and 1.65±0.24, respectively. Percent differences between patient-level median values of Kt/V (conductivity minus conventional URR methods) were−0.63%±7.7% and−0.75%±8.4% for periods 1 and 2. Normalized protein nitrogen appearance were comparable between the 2 methods. Limitations Data were collected over 2 years. Study was limited to in-center hemodialysis patients dialyzed 3 times per week. Dialysis session length was not adjusted for treatment interruptions. Conclusions A new method of calculating Kt/V based on Kecn that requires fewer postdialysis SUN measurements provided diagnostic data comparable to those from conventional use of URR and has the potential to avoid errors related to postdialysis blood sampling and measurement.

Purpose To compare clinical performance of 2 widely used symmetric-tip hemodialysis catheters. Materials and Methods Patients with end-stage renal disease initiating or resuming hemodialysis were randomized to receive an Arrow–Clark VectorFlow (n = 50) or Palindrome catheter (n = 50). Primary outcome was 90-d primary unassisted catheter patency. Secondary outcomes were Kt/V ([dialyzer urea clearance × total treatment time]/total volume of urea distribution), urea reduction ratio (URR), and effective blood flow (QB). Results Primary unassisted patency rates with the VectorFlow catheter at 30, 60, and 90 d were 95.5% ± 3.3, 87.2% ± 7.3, and 80.6% ± 9.8, respectively, compared with 89.1% ± 6.2, 79.4% ± 10.0, and 71.5% ± 12.6 with the Palindrome catheter (P = .20). Patients with VectorFlow catheters had a mean Kt/V of 1.5 at 30-, 60-, and 90-day time points, significantly higher than the mean Kt/V of 1.3 among those with Palindrome catheters (P = .0003). URRs were not significantly different between catheters. Catheter QB rates exceeded National Kidney Foundation–recommended thresholds of 300 mL/min at all time points for both catheters and were similar for both catheters (median, 373 mL/min). Catheter failure, ie, poor flow rate requiring guide-wire exchange or removal, within the 90-day primary outcome occurred in 3 VectorFlow subjects and 5 Palindrome subjects (P = .72). Infection rates were similar, with 0.98 infections per 1,000 catheter days for VectorFlow catheters compared with 2.62 per 1,000 catheter days for Palindrome catheters (P = .44). Conclusions The 90-day primary patency rates of Palindrome and VectorFlow catheters were not significantly different, and both achieved sustained high QB through 90 day follow-up. However, dialysis adequacy based on Kt/V was consistently better with the VectorFlow catheter versus the Palindrome.

The worldwide prevalence of maintenance hemodialysis continues to rise. An adequate delivery of hemodialysis dose as measured by Kt/V or urea reduction ratio is a crucial determinant of clinical outcome for chronic hemodialysis patients. The aim of this study was to assess the adequacy of hemodialysis and its associated factors among patients undergoing chronic hemodialysis in Dar es Salaam. This was a cross-sectional study done on patients undergoing chronic hemodialysis in four dialysis centers in Dar es Salaam. Sociodemographic information and treatment characteristics were collected. Urea reduction rate and single-pool Kt/V were calculated to determine the adequacy of hemodialysis. The data were analyzed and any associated factors for inadequate hemodialysis were determined using a chi-square test and a logistic regression analysis. A total of 143 patients participated in the study. Males represented 65.7% of the study population. The mean age (±SD) was 51.7 ± 1.2 years. Only 34.3% (based on urea reduction ratio (URR)) and 40.6% (based on Kt/V) of patients received adequate hemodialysis. The univariate analysis showed that males were more likely to have inadequate dialysis (65.6% versus 48.0%, p=0.048 based on Kt/V). Patients using hemodialyzers with dialyzer surface area less than 1.4 m2 received significantly less hemodialysis dose than those with more than 1.4 m2 (69.0% versus 41.2%, p=0.02, by URR) (62.7% versus 35.3%, p=0.03, by Kt/V criteria). Patients who had hemoglobin Kt/V criteria (69.8% versus 51.3%, p=0.03). None of the factors acquired significance in the multivariate analysis. The proportion of patients receiving an adequate hemodialysis dose is low (34.3% based on URR and 40.6% based on Kt/V). Male gender, dialyzer surface area of 2, and hemoglobin level of

Context: One of the main factors associated with the death of chronic renal failure patients is dialysis adequacy. Aims: The present study aimed to investigate the relationship between filter type and blood flow rate with dialysis adequacy in hemodialysis patients referring to educational hospitals of Mazandaran University of Medical Sciences in 2016. Setting and Design: This correlational study was performed in 2016 in educational hospitals of Mazandaran University of Medical Sciences. Materials and Methods: This study was performed on 185 hemodialysis patients. Sampling was done using simple random sampling. The inclusion criteria included at least 6 months of hemodialysis history and two sessions of dialysis per week. Demographic data, as well as information on the filter type and blood flow rate, were collected using a questionnaire. Dialysis adequacy is generally measurable by two methods of urea reduction ratio (URR) and K or urea clearance, T or time of dialysis, and V, or volume of urea distribution in the body (KT/V) (K or urea clearance). Statistical Analysis Used: Data were described with mean, standard deviation, and frequency and analyzed using Chi-square and Fisher's exact tests. Results: Out of a total of 185 patients, 101 patients were male and 84 were female, with a mean age of 57.2 ± 0.7 years. The dialysis adequacy in high-flux and low-flux filters was, respectively, 79% and 1.5% based on the KT/V index and 70.6% and 0% according to the URR index. A statistically significant relationship was found between the filter type and blood flow rate with both KT/V and URR criteria (P < 0.001). Conclusion: It is recommended to use high-flux filters with high blood flow rate to improve dialysis adequacy in patients with hemodialysis. However, other factors affecting dialysis adequacy should be considered.

Background: It is well-known that hemodialysis extends the life of end-stage renal disease (ESRD) patients, who would have otherwise died. Hemodialysis is the commonest modality of renal replacement therapy (RRT) in Egypt and many other countries. The characteristics of long-term patients on hemodialysis (HD) were not evaluated before in Egypt. We aimed at identifying the specific characteristics of the patients who have survived on hemodialysis for more than 20 years in Egypt. Subjects and Methods: During the years 2018 and 2019, the twenty-seven governorate health affairs Directories of the Egyptian Ministry of Health were contacted to participate in data collection. The dialysis physicians in each hemodialysis unit were sent a questionnaire form requesting to submit information, on the characteristics of patients who have been on HD therapy for twenty years or more. Results: Seventy-three patients were encountered from a total number of 26000 HD patients to have been on HD therapy; with a range between 20 and 30 years. Males constituted the majority of these patients. Sixty-eight patients were dialyzed through working arteriovenous fistulas (A-V fistulas). The mean urea reduction ratio (URR) of these patients was 0.65±0.095. Acute intradialytic complications afflicted only 20.3% of these patients. More than three-quarters of the patients had a positive serology test for HCV antibodies. None of these patients has diabetes mellitus. On the other hand, complaints related to the skeletal system were present in 47.4% of the patients. There is a statistically significant higher rate of acute complications in the female gender and a statistically significant higher fertility rate after hemodialysis in the male gender. Conclusion: Long-term dwellers on hemodialysis therapy are not unusual in Egyptian ESRD patients and their characteristics are reasonable.

BACKGROUND AND OBJECTIVES Arteriovenous fistulae (AVF) and grafts (AVG) are preferred permanent vascular access (PVA) for chronic hemodialysis (HD) patients. Our objective was to examine the change in markers of HD efficacy after successful establishment of a PVA among children who started HD with a tunneled cuffed catheter (TCC). MATERIALS AND METHODS Retrospective chart reviews were completed on patients from 20 pediatric dialysis centers. All patients used TCC prior to AVF/AVG, and each patient acted as his/her own control. Data on markers of HD efficacy (single-pool Kt/V, urea reduction ratio (URR), serum albumin and hematocrit (Hct)) were collected at the creation of AVF/AVG and for 2 years thereafter. Statistical methods included hypothesis testing and statistical modeling after adjusting for relevant demographic variables. RESULTS First PVA was created in 98 individual children: 87 (89%) were AVF and 11 (11%) were AVG. The mean TCC vintage prior to AVF/AVG was 10.4 ± 17.3 months. At 1-year follow-up, Kt/V improved by 0.15 ± 0.06 (p = 0.02) and URR improved by 4.54 ± 1.17% (p

Background Patients undergoing hemodialysis are prone to psychiatric symptoms due to considerable changes in their individual, social and occupational life which can influence the course and prognosis of renal diseases. Objective The aim of the present study is to evaluate the prevalence of depression, anxiety, and suicidal ideation among patients with chronic kidney disease undergoing hemodialysis in Qazvin, Iran. Methods This descriptive cross- sectional study was performed on 120 patients with chronic kidney disease undergoing hemodialysis in Qazvin, Iran. Prior to study, their demographic and laboratory data were recorded. Dialysis adequacy was assessed using urea reduction ratio (URR) and KT/V formula. Data collection tools were Beck’s Depression Inventory, Beck’s Anxiety Inventory and Beck Scale for Suicidal Ideation. Collected data were analyzed using Pearson correlation test and t-test. Findings The mean level of depression in patients was 13.72 where 79 (65.8%) had depressive symptoms. The severity of symptoms was mild in 47 (39.2%), moderate in 21 (17.5%), and severe in 11 (9.2%). Moreover, the mean level of anxiety was 9.73 where 16 (13.3%) had anxiety symptoms. Of 120 patients, only 8 (6.7%) had suicidal ideation. There was a significant negative association between dialysis adequacy and the severity of depression, anxiety and suicidal ideation. Anxiety symptoms were more frequent among unemployed patients, and the increase in age was associated with the increase in suicidal ideations (P

Background: Chronic kidney disease is the progressive deficiency of renal function for months and years, may reach life threatening stage.Aim of Study: This study was conducted to determine the effect of aerobic exercise versus resisted exercise on urea reduction ratio and 6 minute walk test.Subjects and Methods: Thirty patients of both sex with chronic renal failure were participated in the study, their age ranged from 25 to 35 years old and recruited from Hemodial-ysis Unit of benha University Hospital. They were randomly assigned into two equal Groups (A & B). Group A was received resistance exercise while Group B was received aerobic exercise. Both groups were received session twice per week for 2 months. Measurements were measured twice, before and after treatment: Urea reduction ratio and, 6 minute walk test.Results: The results showed that there were significant improvement in urea reduction ratio and 6 minute walk test in both groups after treatment while there were no significant difference between two groups after treatment.Conclusion: Both aerobic and resisted training exercise are effective in improvement dialysis efficiency and perform-ance. With no difference between both groups post-treatment.

The purpose of the present study was to evaluate the relationship among the denture status, number of remaining teeth, and malnutrition in patients with chronic kidney disease (CKD). Seventy-three patients (43 men/30 women) who required hemodialysis were included in the study. Weight and height, Kt/V, urea reduction ratio, midweek interdialytic weight gain, ultrafiltration volume, and erythropoietin dosage were determined for all patients. Laboratory measurements and predialysis blood samples for biomarkers were collected within the monthly routine tests. Dental examination focused on the denture status and total number of remaining teeth. Denture status were classified into two groups as prosthesis group (patients have prosthesis) and no prosthesis group (patients do not have any kind of prosthesis). And also, patients were assigned to one of four categories based on the number of remaining natural teeth: (i) edentulous, (ii) 1-7 teeth, (iii) 8-19 teeth, and (iv) >20 teeth. The data were statistically analyzed (a = 0.05). Body mass index values were increased in the prosthesis patients. Serum albumin levels of the CKD patients were under the reference value (3.8 g/dL) both in prosthesis and no prosthesis groups. Patients who have eight and more teeth showed higher serum albumin levels, and patients who had 1-7 teeth showed lower serum albumin levels in prosthesis group. CKD patients' nutritional habits were affected by denture status (having prosthesis or not). The number of the remaining teeth in prosthesis group affected the serum albumin levels of CKD patients.

Objective To compare adequacy of dialysis between single-use and reused dialyzer in order to ascertain whether reuse of dialyzers provides adequate dialysis and thereby enable provision of effective yet affordable renal replacement therapy in resource-limited countries. Study design Observational cross-sectional study. Place and duration of study Department of Nephrology, The Kidney Centre, Postgraduate Training Institute (TKC-PGTI), Karachi, from December 2017 to February 2018. Methodology Equal number of patients on thrice weekly hemodialysis with either single-use (group A; n=33) or reuse (group B; n=33) dialyzer for at least six months were reviewed. Both groups were compared for dialysis adequacy measured as urea reduction ratio (URR); as well as adequacy of patient care in terms of anemia, bone-mineral control and nutritional status. Serum hemoglobin and erythropoietin stimulating agent (ESA) dose were taken as markers for anemia management, serum calcium, phosphate and intact parathyroid hormone (iPTH) for bone-mineral control and serum albumin as index for nutritional status. Results The mean age of patients in Group A was 51.36 +13.9 years and in Group B was 54.78 +15.4 years. Female to male ratio was 1.75:1. The mean number of dialyzer reused in group B was 47.5±27.8. There was no significant difference between the study groups in terms of URR (p=0.362), hemoglobin (p=0.347), ESA dose (p-=0.556), serum calcium, phosphorus and iPTH (p=0.868, p=0.138 and p=0.323, respectively), and serum albumin (p=0.777). All the parameters were in accordance with KDOQI guidelines. Conclusion Reuse of dialyzer does not affect dialysis efficiency. Adequate dialysis therapy can be provided economically through reprocessed dialyzers in at least resource-poor countries.

The End-stage Renal Disease Registry Committee of the Korean Society of Nephrology collects data on the dialysis therapy in Korea through an internet-based registry program and reports it annually. In this article, the method and clinical implications of the mortality hazard ratio analyses of various clinical parameters in the 2017 registry report have been described, with the inclusion of data on four additional parameters. The mortality risk based on clinical parameters was analyzed only for hemodialysis patients. The number of registered patients with laboratory data was 13,943 (8,446 male and 5,497 female patients), and death was reported in 3,139 patients. Analysis of the effects of various clinical parameters on mortality was performed using non-linear Cox proportional hazard model with the R statistics program. For all clinical parameters, univariate and adjusted multivariate hazard ratio analyses were performed. Analysis of the mortality hazard ratio showed that low body mass index, low hemoglobin, low serum albumin, low serum phosphorus, and low urea reduction ratio were associated with a significantly increased mortality risk, whereas paradoxically high serum creatinine levels were associated with low mortality risk.

Background : The objective of this study was to compare the impact of citrate dialysate (CD) and standard acetate dialysate (AD) in hemodialysis by central delivery system (CDS) on heparin demand, and clinical parameters. Methods : We retrospectively evaluated 75 patients on maintenance hemodialysis with CDS. Patients underwent hemodialysis with AD over a six-month period (AD period), followed by another six-month period using CD (CD period). Various parameters including mean heparin dosage, high sensitivity C-reactive protein (hsCRP), calcium-phosphate product (CaxP), intact parathyroid hormone (iPTH), and urea reduction ratio (URR) were collated at the end of each period. Results : Patients were 60.5 ± 14.7 years old, of whom 62.7% were male. Patients required less heparin when receiving CD (AD period: 1,129 ± 1,033 IU/session vs. CD period: 787 ± 755 IU/session, P < 0.001). After the CD period (ΔCD), pre-dialysis total CO2 increased to 1.21 ± 2.80 mmol/L, compared to −2.44 ± 2.96 mmol/L (P < 0.001) after the AD period (ΔAD). After the CD period, concentrations of iPTH (ΔAD: 73.04 ± 216.34 pg/mL vs. ΔCD: −106.66 ± 251.79 pg/mL, P < 0.001) and CaxP (ΔAD: 4.32 ± 16.63 mg2/dL2 vs. ΔCD: −4.67 ± 15.27 mg2/dL2, P = 0.015) decreased. While hsCRP levels decreased after the CD period (ΔAD: 0.07 ± 4.09 mg/L vs. ΔCD: −0.75 ± 4.56 mg/L, P = 0.705), the change was statistically insignificant. URR remained above clinical guideline of 65% after both periods (ΔAD: 72.33 ± 6.92% vs. ΔCD period: 69.20 ± 4.49%, P = 0.046). Conclusion : Our study confirmed that the use of CD in CDS required lower heparin doses compared to the use of AD. The use of CD also provided a more stable acid-base status.

AIM There is limited literature on haemodialysis in island countries in the Central Pacific. The primary aim of this study was to report on the epidemiology of haemodialysis patients and haemodialysis performance in Nauru. METHODS We obtained registry data from the haemodialysis unit in Nauru to calculate the incidence rate, prevalence, and survival probability of haemodialysis patients in Nauru. We also reviewed medical records from January 2015 to February 2017 to evaluate the haemodialysis performance in Nauru. RESULTS In total, 177 patients received long-term haemodialysis in the Nauru dialysis unit from 1987 to 2017. The 1-year, 2-year, and 5-year survival probabilities during the 30-year study period were 76.5%, 58.3% and 25.9%, respectively. From 2011 to 2014, the incidence rate and prevalence of treated end-stage renal disease in Nauru were significantly higher than Australia. From 2015 to 2017, there were 36 patients with a median age of 55 years who received long-term haemodialysis. Of these, 25 patients (69.4%) had diabetes. The median haemoglobin, serum albumin, and urea reduction ratio were 9.6 mg/dL, 35 g/L, and 64.7%, respectively. Multivariate analysis showed that lower serum albumin and lower urea reduction ratio were associated with mortality. CONCLUSION To our knowledge, this is the first study to report the haemodialysis status in Nauru. The epidemiology of haemodialysis patients in Nauru is unique in the Central Pacific. Improvement of primary health care in disease detection and prevention of progression should be considered to decrease the need for dialysis and optimise the care of haemodialysis patients in Nauru.

Background: Patients’ satisfaction is a relevant component in assessing healthcare services. The objective of this study was to study the level of satisfaction of chronic hemodialysis patients and the associated factors in Cotonou CNHU-HKM dialysis center. Patients and Methods: It was a cross-sectional, descriptive and analytical study conducted by administering a questionnaire on days off dialysis. It was carried out from 1st November 2015 to 1st January 2016 in CNHU-HKM Nephrology University Clinic of Cotonou. Hemodialysis patients aged 18 years and above having given their informed consent were included in the study. Patients’ recruitment was comprehensive. Likert scale was used in assessing the level of satisfaction with 4 as “very satisfied” and 1 for “very dissatisfied”. Satisfaction was evaluated on the basis of Ware dimensions. The threshold for satisfaction was 50. Outcomes: Overall, 377 patients were included in the study. Respondents’ mean age was 51.5 ± 13.3 years with 1.37 as sex ratio. Arteriovenous fistula was used for 80.1% of hemodialysis patients. 77.7% of the patients underwent dialysis twice a week while 45.9% were administered a four-hour dialysis. The overall average proportion of “satisfied” was 76.5%. The level of satisfaction was 52% for healthcare environment, 61% for service delivery, 73.9% for healthcare accessibility, 76.1% for healthcare structure, 77.5% for healthcare management, 90.3% for quality of healthcare, 88.3% for interpersonal relationship and 93.2% for efficiency and continuum of healthcare. Factors associated with satisfaction included age (p = 0.02), vascular access (p = 0.04) and urea reduction ratio (p = 0.01). In addition, the degree of satisfaction of hemodialysis patients was not statistically associated with sex, marital status, educational level, history of the disease, age of dialysis, number of sessions per week, and duration per session. Conclusion: The overall level of hemodialysis patients’ satisfaction is above average. There is a need to particularly focus on healthcare environment, so as to better improve the level of satisfaction.