Effect of Metabolic Acidosis on Immunoregulation in Prevalent Hemodialysis Patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Fawzia Hassan Ahmed Abo Ali ◽  
Hossam Moustafa Elkady ◽  
Mohamed Sary Gharib ◽  
Heba William Adly
Keyword(s):  
Metabolic Acidosis ◽  
Hemodialysis Patients ◽  
University Hospital ◽  
Maintenance Hemodialysis ◽  
Serum Bicarbonate ◽  
Beneficial Effects ◽  
Hemodialysis Unit ◽  
Inflammatory State ◽  
Population Maintenance ◽  
Control Study

Abstract Objective to evaluate the relationship between IL-10 and serum bicarbonate and metabolic acidosis in prevalent hemodialysis patients. Methods Type of Study: prospective case control study. Study Setting: The study was conducted at Ain Shams University hospital hemodialysis unit. Sample Size: 40 patients with ESRD on regular HD and 20 healthy control. Study Population: Maintenance hemodialysis patients Results The results suggested that serum IL-10 level was significantly higher in chronic HD patients than healthy subjects and this is compatible with the idea that higher levels of IL‑10 are needed in HD patients to limit their strong inflammatory activation associated with uremia and the dialysis technique. There was no significant differences in IL-10 levels noticed between patients with different causes of ESRD. This study also showed negative correlation between IL-10 and serum bicarbonate levels. We also found that there was significant positive correlation between baseline levels of IL-10 and CRP which may be because of dialysis inadequacy that is associated with chronic inflammatory state resulting in high CRP levels. Conclusion The incidence and prevalence of ESRD have risen dramatically which may be due to the increasing prevalence of diabetes and hypertension. Although regular hemodialysis decreases levels of mortality in these patients, it is still considered a condition associated with inflammation. The current study revealed high IL-10 levels among HD patients who had metabolic acidosis. Further research needs to be done to reveal beneficial effects of these finding.

Chronic Hemodialysis Patients. Part II: Reducing Drug-Related Problems through Application of the Focused Drug Therapy Review Program

1994 ◽  
Vol 28 (3) ◽  
pp. 320-324 ◽  
Author(s):  
Barbara Kaplan ◽  
Leslie A. Shimp ◽  
Nancy A. Mason ◽  
Frank J. Ascione
Keyword(s):  
Drug Therapy ◽  
Pharmacy Practice ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
University Hospital ◽  
Endstage Renal Disease ◽  
Implementation Evaluation ◽  
Hemodialysis Unit ◽  
Therapeutic Recommendations ◽  
The Impact

OBJECTIVE: To test the value and measure the impact of a model of pharmacy practice called the Focused Drug Therapy Review Program (FDTRP)in patients with endstage renal disease on hemodialysis. DESIGN: A modified version of FDTRP, adapted for a hemodialysis population, was assessed for its impact on prescriber behavior. The impact was measured by examining the percentage of pharmacist therapeutic recommendations accepted and implemented by the prescriber. SETTING: Thirty patients at a university hospital-based outpatient hemodialysis unit participated in the study. Twenty-four patients completed the study through the implementation evaluation. RESULTS: The pharmacist generated 114 therapeutic recommendations and 85 informative comments regarding drug therapy. The prescriber accepted 76 percent and implemented 70 percent of the therapeutic recommendations. The prescriber considered the informative comments to be helpful, even if the information was known previously. CONCLUSIONS: The FDTRP has been shown to be useful in the care of chronic hemodialysis patients. In addition, the pharmacist was able to provide clinically important recommendations in a closely monitored patient population.

scholarly journals High serum bicarbonate and adverse outcomes in hemodialysis patients

2021 ◽  
Vol 35 (1) ◽  
pp. 35-38
Author(s):  
Gonçalo Ávila ◽  
◽  
Ivo Laranjinha ◽  
Patrícia Matias ◽  
◽  
...  
Keyword(s):  
Metabolic Acidosis ◽  
Metabolic Alkalosis ◽  
Hemodialysis Patients ◽  
High Serum ◽  
Adverse Outcomes ◽  
Morbidity And Mortality ◽  
Main Concern ◽  
Serum Bicarbonate ◽  
Acid Base ◽  
Blood Ph

Metabolic acidosis is a usual complication of progressive chronic kidney disease and is associated with morbidity and mortality. The correction of metabolic acidosis is a main goal of dialysis. In prevalent hemodialysis patients, acid-base homeostasis depends on many factors, mainly net acid production, amount of alkali given by the dialysate bath and duration of the interdialytic period. At present, the main concern in prevalent hemodialysis patients is not over patients with metabolic acidosis, but rather about the growing numbers of patients with metabolic alkalosis. Several large cohort studies have shown significant associations between high predialysis bicarbonate, as well as blood pH, and morbidity and mortality risk. Based on recent guidelines, we should keep predialysis serum bicarbonate concentrations at 24-26 mEq/L, although this is opinion-based and there is no consensus on the issue. Furthermore, there should be specific focus on the patient´s nutritional status and reversible comorbidities.

Elimination of Nasal Carriage ofStaphylococcus aureusin Hemodialysis Patients

1996 ◽  
Vol 17 (12) ◽  
pp. 793-797 ◽  
Author(s):  
Jan A.J.W. Kluytmans ◽  
Marie-Jose Manders ◽  
Erik van Bommel ◽  
Henri Verbrugh
Keyword(s):  
Nasal Carriage ◽  
Hemodialysis Patients ◽  
University Hospital ◽  
Control Group ◽  
Study Group ◽  
Tertiary Referral Center ◽  
Development Of Resistance ◽  
Hemodialysis Unit ◽  
Historic Control ◽  
The University

AbstractObjective:To study the efficacy of mupirocin for the elimination of nasal carriage ofStaphylococcus aureusin hemodialysis patients.Design:The efficacy of mupirocin was studied in a prospectively followed cohort. The effect of this intervention on the rate ofS aureusbacteremia was evaluated using a historic control group.Setting:Patients on the hemodialysis unit of the University Hospital Rotterdam, a tertiary referral center.Patients:The study group consisted of consecutive patients on hemodialysis from February 1, 1992, until November 1, 1993. They were screened by taking nasal cultures monthly during their time on hemodialysis. IfS aureuswas isolated, treatment with mupirocin nasal ointment was initiated. The control group consisted of patients treated on the same hemodialysis unit from January 1, 1990, until January 1, 1992.Results:The study group consisted of 226 patients, of whom 172 were evaluated to determine the efficacy of mupirocin. Sixty-seven (39%) were identified as nasal carriers. Following the initial treatment, 66 nasal cultures (98.5%) became negative. After 3 months and 6 months, respectively, 63 (94%) and 61 (91%) of the treated carriers had negative cultures. The rate of bacteremia (defined as the number of episodes of5 aureusbacteremia per patient-year on hemodialysis) was significantly lower among the 226 patients in the study group (0.04 per patient-year) than among the 273 patients in the control group (0.25 per patient year;P<.001). Development of resistance and adverse effects were not observed.Conclusions:Mupirocin nasal ointment effectively eliminates nasal carriage of5 aureusin patients on hemodialysis. This was associated with a significant reduction of the incidence of5 aureusbacteremia, as compared to historic controls.

scholarly journals P1382RED CELL DISTRIBUTION WIDTH - A POTENTIAL MARKER FOR IRON OVERLOAD DIAGNOSIS IN CHRONIC HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Radulescu Daniela ◽  
Simona-Daniela Onofrei ◽  
Brinzea Mihaela Madalina ◽  
Vacaroiu Ileana Adela ◽  
CRISTIANA DAVID
Keyword(s):  
Iron Overload ◽  
Reference Interval ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Maintenance Hemodialysis ◽  
Distribution Width ◽  
Mean Values ◽  
Inflammatory State ◽  
Group A ◽  
Group B

Abstract Background and Aims The indication for starting iron supplementation in chronic hemodialysis patients is precisely stipulated in all guidelines, while the criteria for stopping or reducing iron administration are still a subject of debate. Inflammatory status is a characteristic of chronic dialysis patients and it increases ferritin levels in this population; therefore iron overload is difficult to diagnose. The aim of this study was to investigate the relationships between red cell distribution width (RDW) and ferritin levels in stable maintenance hemodialysis patients, in order to help differentiating iron overload-induced increased ferritin from inflammation-induced causes. Method In a retrospective analysis, we studied the biochemical parameters in the last 9 months in 88 patients on maintenance hemodialysis (59.09% males) from 2 dialysis centers, mean age and dialysis duration 66.94 years, and 56 months respectively. Patients with active infections or history of neoplasia, hematologic diseases (other than CKD-associated anemia) or immunosuppressive use were excluded, and also patients having less than 3 months dialysis. Mean values (expressed as average value ± standard deviation) for ferritin, RDW (reference interval 10-15%) and C-reactive protein - CRP (reference interval 0-0.5 mg/dL), assessed every 3 months, were analyzed, and Spearman bivariate correlation test was applied to assess each pair of variables using IBM SPSS 20 for Windows. Results 65 patients were qualified as eligible. Mean values of ferritin, RDW and CRP were 638.57± 530.84 ng/mL, 16.15±2.09 %, and 2.04±5.43 mg/dL respectively. We found a strong positive correlation between RDW and CRP values (p=0.002; rho=0.357; 1-tailed), but no relationship between CRP and ferritin (p=0.273; rho=0.076) or between RDW and ferritin (p=0.329; rho=0.056) at the entire cohort of studied population. According to RDW values, we then divided the patients into two groups: group A with high RDW (≥15%), 48 patients (73.84 %) and group B with normal RDW (10-15%), 17 patients (26.15%), and analyzed correlations between the study parameters. There was no relationship between RDW and ferritin in group A (p=0.286; rho=0.075), and neither between RDW and CRP (p=0.092; rho=0.174). In group B, there was a highly significant correlation between RDW and ferritin levels (p=0.018; rho=0.414), and also between RDW and CRP levels (p=0.037; rho=0.357), pointing out an inflammatory state. Conclusion Elevated levels of RDW are usually associated with iron deficiency, and in dialysis population also with increased CRP as inflammatory marker. We found in the present study that the RDW values used in conjunction with ferritin level may be useful in differentiating between inflammation-caused increased ferritin levels and iron-overload-caused increased ferritin levels. The inflammatory state is a common finding in chronic dialysis patients and it often produces increases in ferritin levels, making RDW a handy and helpful marker in monthly iron prescriptions, additional to CRP.

scholarly journals Hepatitis C virus infection in hemodialysis patients in Maracaibo, Venezuela

2012 ◽  
Vol 54 (1) ◽  
pp. 53-55 ◽  
Author(s):  
Francisca Monsalve-Castillo ◽  
Liliana Gómez-Gamboa ◽  
Leonor Chacín-Bonilla ◽  
Leticia Porto-Espinoza ◽  
Luciana Costa-León
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Preventive Measures ◽  
Hemodialysis Patients ◽  
Hcv Infection ◽  
University Hospital ◽  
Fourth Generation ◽  
Hepatitis C Virus Infection ◽  
Hemodialysis Unit ◽  
The University

Over a two year period, the incidence of hepatitis C virus (HCV) infection was evaluated in 29 hemodialysis patients, aged between 15 and 75 years (mean ± SD: 45 ± 39.5 years), from the University Hospital Hemodyalisis Unit, Maracaibo, Zulia State, Venezuela. Anti-HCV antibodies were determined using a fourth generation ELISA (Innotest HCV Ab IV) kit and positive blood samples were tested using a recombinant assay kit (Inno-LIA HCV Ab III), both kits from Innogenetics N.V., Belgium. The findings indicate a lack of HCV seroconversion in the hemodialysis patients over the study period, confirmed by the recombinant assay. Risk factors for HCV infection were 0.3270 (95% confidence interval: 0.01323-8.080) in patients undergoing hemodialysis. The findings suggest a lack of significant sources for HCV infection due to the preventive measures to avoid its transmission in the hemodialysis unit.

scholarly journals Pulmonary Hypertension in Hemodialysis Patients

2012 ◽  
Vol 4 (2) ◽  
pp. 148-152
Author(s):  
M Moniruzzaman ◽  
MN Islam ◽  
MB Alam ◽  
ABM M Alam ◽  
MMH Khan ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Serum Creatinine ◽  
Systolic Pressure ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Serum Bicarbonate ◽  
Dialysis Patients ◽  
Serum Bicarbonate Level ◽  
Pulmonary Arterial ◽  
Maintenance Dialysis

Background: Pulmonary hypertension (PH) has been reported to be high among maintenance dialysis patients. There is a paucity of data on the incidence and prevalence of pulmonary hypertension in chronic kidney disease(CKD) in Bangladeshi patients. Materials and Methods: A total 70 CKD patients (male 47,female 23), who were on conservative management and maintenance hemodialysis were studied for the presence of pulmonary hypertension. The variables studied were hypertension, diabetes, duration of dialysis and the hemoglobin, serum creatinine and serum bicarbonate levels. Results: 68.6% of the patients on maintenance hemodialysis had pulmonary hypertension compared to 8.6% of the prediadysis CKD patients. 97.1% of maintenance dialysis patients had anaemia (Hb <10gm/dl) and 42.9% of patients had metabolic acidosis. Conclusion: The incidence of pulmonary hypertension was highest in the hemodialysis group. Significant Pearson’s correlation was found between pulmonary arterial systolic pressure with the duration of hemodialysis, hemoglobin level, serum creatinine, blood sugar and serum bicarbonate level in maintenance hemodialysis patients DOI: http://dx.doi.org/10.3329/cardio.v4i2.10459 Cardiovasc. j. 2012; 4(2): 148-152

scholarly journals Are Target Serum Bicarbonate Levels Achieved in Maintenance Hemodialysis Patients: A Single Centre Experience

2018 ◽  
Vol 6 (02) ◽  
Author(s):  
Noble Gracious ◽  
Geo Philip John ◽  
Jacob George ◽  
Mohandas MK ◽  
Sajeev Kumar ◽  
...  
Keyword(s):  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Bicarbonate Level ◽  
Serum Bicarbonate ◽  
Medical College ◽  
Acid Generation ◽  
Routine Monitoring ◽  
Single Centre Experience ◽  
Protein Serum ◽  
Maintenance Hemodialysis Patients

Majority of the maintenance hemodialysis patients donot achieve the target predialysisserum bicarbonate levels. Routine monitoring of serum bicarbonate in diaysis patients is not universally done.We aimed to assess whether our dialysis population attained the predialysis serum bicarbonate target of >22 mEq/L as recommended by the NKF-KDOQI. Correlation between predialysis bicarbonate and clinical and biochemical parameters was also assessed. Fifty patients undergoing maintenance hemodialysis in Government Medical College, Thiruvananthapuram were included in the study.All patients received fixed non-individualizeddialysate bicarbonate concentrations. The mean predialysis bicarbonate obtained was 19 ± 4.2 mEq/L. Thirty six patients(72%) had bicarbonate levels less than 22 mEq/L. Nineteen patients (38%) had bicarbonate level less than 17mEq/L and 5 patients (10%) had level greater than 25 mEq/L. Majority of the patients failed to achieve the target serum bicarbonate. A negative correlation was obtained for predialysis bicarbonate levels with BMI, total protein, serum uric acid, serum phosphorus and serum ferritin. Better nutritional status may be associated with reduction in bicarbonate level because of increased acid generation. In conclusion this study emphasizes the importance of regular monitoring of serum bicarbonate levels in our dialysis patients and the need for adjusting the dialysate bicarbonate concentrations accordingly.

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