Polypharmacy and Medication-Related Problems in Hemodialysis Patients: A Call for Deprescribing

Polypharmacy is a common problem among hemodialysis patients. It is associated with increased hospital admissions, morbidity, mortality, Medication-Related Problems (MRPs), and expenditures. There is a paucity of data on the prevalence of polypharmacy in our setting. This study aims to determine the prevalence of polypharmacy and MRPs and to assess its predictors. We conducted a cross-sectional study in the outpatient hemodialysis unit. A pharmacy resident assessed electronic prescribing records to identify MRPs and discussed therapeutic interventions to enhance effective therapeutic regimens over a three months period. Eighty-three patients were included. The median age was 63 (Interquartile range; IQR = 22), 50% were males, and the mean number of co-morbidities was 3.14 ± 1.64. The prevalence of polypharmacy was 97.6% with a 95% CI (91.6%–99.7%). Medication use without indication, was the highest identified MRPs at 36% (102/280), followed by subtherapeutic dosing at 23% (65/280), and overdosing at 15% (41/280). The number of comorbidities, the presence of ischemic heart disease, and respiratory diseases were the main predictors of the increased number of medications. Polypharmacy is highly prevalent among the Saudi hemodialysis population. A review of the medications prescribed by the pharmacist facilitated the identification of MRPs and provided opportunities for deprescribing to optimize medication use and to reduce polypharmacy in hemodialysis patients.

Download Full-text

Hypomagnesemia in hemodialysis patients taking proton pump inhibitors

Journal of Fatima Jinnah Medical University ◽

10.37018/dezk2659 ◽

2020 ◽

Vol 14 (2) ◽

pp. 55-58

Author(s):

Abdul Malik ◽

Syed Mohkumuddin ◽

Humaira Rahim ◽

Shamima Hanif

Keyword(s):

Proton Pump Inhibitors ◽

Proton Pump ◽

Serum Magnesium ◽

Cross Sectional Study ◽

Hemodialysis Patients ◽

Mean Value ◽

Female Dominance ◽

P Value ◽

Cross Sectional ◽

The Mean

Background: Proton pump inhibitors (PPIs) are in routine widely prescribed to hemodialysis patients. Recent studies have reported the association of PPIs use with hypomagnesemia in patients with long term hemodialysis. This study aims to determine the frequency of hypomagnesemia in patients of hemodialysis taking proton pump inhibitors. Patients and methods: This cross-sectional study was conducted in the Department of Nephrology of Sandman Provincial Hospital Quetta from 01-6-2019 till 01-9-2019. A total of 120 patients (52 PPI users and 68 non-PPI users) who were on HD for more than 06 months were included. Data regarding age, gender, duration of hemodialysis and taking PPIs were collected. Determination of serum magnesium was made by taking 3 different samples at 2 weeks’ interval and the mean value of serum magnesium was calculated. Serum Mg2+ levels <2.0 mg/dL was taken as hypomagnesemia. A Chi-square test was applied to determine the association of PPI use with hypomagnesemia. Results: Demographic variables such as age and gender were not significantly different between the groups. There was female dominance in both groups (73% in PPI groups and 66.1% in the non-PPI group (p-value 0.65). The mean duration of dialysis was 45.3±13.8 months in PPI users versus 48.9±12.9 months in non-PPI users (p-value 0.14). There was a significantly higher frequency of hypomagnesemia in PPI users; 36 (69.3%) versus 27 (39.7%) in non-PPI users (p-value 0.001). Conclusion: The use of PPI is associated with a significant reduction in serum magnesium levels. So serum magnesium levels should be advised as routine monitoring in patients of hemodialysis taking PPIs.

Download Full-text

Associations between midlife chronic conditions and medication use with anxiety and depression: A cross-sectional analysis of the PREVENT Dementia study

Journal of Comorbidity ◽

10.1177/2235042x20920443 ◽

2020 ◽

Vol 10 ◽

pp. 2235042X2092044

Author(s):

Lucy E Stirland ◽

Sarah Gregory ◽

Tom C Russ ◽

Craig W Ritchie ◽

Graciela Muniz-Terrera

Keyword(s):

Anxiety Disorder ◽

Medication Use ◽

Cross Sectional Study ◽

Epidemiologic Studies ◽

Anxiety And Depression ◽

Cross Sectional ◽

Physical Conditions ◽

Antidepressant Use ◽

The Mean ◽

And Gender

Background: Multimorbidity including physical and mental illness is increasing in prevalence. We aimed to investigate the associations between physical conditions and medication use with anxiety and depression in midlife. Methods: We conducted an observational cross-sectional study of volunteers in the PREVENT Dementia study. Using logistic and linear regression, we investigated the association between increasing numbers of self-reported chronic physical conditions and medications with self-reported depression and anxiety disorder, and scores on the Center for Epidemiologic Studies Depression (CES-D) scale and Spielberger State-Trait Anxiety Inventory (STAI) state subtest. Results: Of the 210 participants, 148 (71%) were women and 188 (90%) Caucasian. The mean age was 52 (standard deviation (SD) = 5.5) years. The mean number of physical conditions was 2.2 (SD = 1.9) and medications 1.7 (SD = 2.2). Each additional physical condition was associated with increased odds of self-reported depression (odds ratio (OR) 1.41, 95% confidence interval (CI) 1.11–1.80; p = 0.004, adjusted for age and gender) and anxiety disorder (OR 1.70, 95% CI 1.30–2.37; p < 0.001). Increasing medication use was associated with self-reported depression (adjusted OR per additional medication 1.35, 95% CI 1.08–1.71; p = 0.008) but not anxiety disorder. For each additional condition, CES-D scores increased by 0.72 (95% CI 0.11–1.33; p = 0.020) and for each extra medication, by 0.88 (95% CI 0.32–1.44; p = 0.002). There was no significant association between increasing conditions and medications with STAI scores. In models accounting for antidepressant use, all associations were attenuated. Conclusions: Having more physical conditions is associated with anxiety and depression in midlife, and taking more medications is associated with depression but not anxiety.

Download Full-text

Relationship Between Spiritual Health and Stress, Depression, and Anxiety in Hemodialysis Patients

Health Technology Assessment in Action ◽

10.18502/htaa.v4i4.6864 ◽

2021 ◽

Author(s):

Ali Fanoodi ◽

Hamed Aramjoo ◽

Seyed Hossein Moosavian Khorasani ◽

Amirhossein Saberi ◽

Mostafa Ashrafipour ◽

...

Keyword(s):

Pearson Correlation ◽

Cross Sectional Study ◽

Hemodialysis Patients ◽

Spiritual Health ◽

Depression And Anxiety ◽

Cross Sectional ◽

Standard Questionnaire ◽

Medical Centers ◽

The Mean

Background: Chronic diseases confront the patient with questions about the meaning and the purpose of life, and many patients recognize spiritual health as a factor in creating meaning and purpose in life and improving the quality of life. Objectives: The aim of this study was to determine the relationship between spiritual health and stress, depression, and anxiety in hemodialysis patients of Birjand Special Diseases Center in 2019. Methods: In this descriptive-analytical cross-sectional study, using the census method, all the dialysis patients visiting Birjand Special Diseases Center, Iran, were examined. A three-part questionnaire was used to collect information in this study. The first part deals with patient demographic information (i.e., age, gender, marital status, degree, occupation, duration of dialysis per week, and medical history), the second part includes the DASS21 standard questionnaire, and the third part comprises the Ellison-Palutzian spiritual health standard questionnaire. Data analysis was performed by the Mann-Whitney, ANOVA, and Pearson correlation coefficient. Results: In this study, 119 hemodialysis patients were studied, of which 77 (64.7%) were male. The mean depression, anxiety, and stress scores of the participants in the study were 18.8 ± 7.52, 16.43 ± 7.13, and 19.36 ± 8.31, respectively. The mean spiritual health of the patients studied was 82.37 ± 12.12. The results showed a significant (P < 0.05) inverse relationship between spiritual health and depression, anxiety, and stress in the patients studied. Conclusions: The findings showed that patients with higher spiritual health scores experienced less anxiety, stress, and depression. Thus, more focus should be on improving the spiritual health of hemodialysis patients by medical staff in the process of admitting and dealing with them in hospitals and medical centers.

Download Full-text

Evaluation of Pulmonary Function Among Detergent Powder Factory Workers-A Cross Sectional Study in Semnan, Iran

10.21203/rs.3.rs-853211/v1 ◽

2021 ◽

Author(s):

Farhad Malek ◽

Elham Ranjbari ◽

Majid Mirmohammadkhani ◽

Daryoush Pahlevan

Keyword(s):

Pulmonary Function ◽

Respiratory Diseases ◽

Cross Sectional Study ◽

Sectional Study ◽

Factory Workers ◽

Cross Sectional ◽

Work Related ◽

The Mean ◽

Expiratory Flow ◽

Detergent Powder

Abstract Occupational respiratory diseases are the most prevalent occurring work-related diseases that contribute to global health concerns. The present study aimed to assess pulmonary function among detergent powder factory workers. In a cross-sectional study, 305 employees working at a detergent powder company in Semnan, Iran were enrolled. Demographic characteristics, health- and job-related information were recorded using a checklist. Subsequently, spirometer was used at baseline, before and after shift-working for recording respiratory ailments and pulmonary function tests (PFT). According to the results, the mean percentage of all spirometric indices significantly reduced after shift-work including forced vital capacity (FVC) (P < 0.01), forced expiratory volume in one second (FEV1) (P < 0.01), FEV1/FVC ratio (P = 0.038), peak expiratory flow (PEF) (P = 0.13) and forced expiratory flow at 25 and 75% of the pulmonary volume (FEF (25–75)) (P < 0.01). Although the mean percentage of FEV1 significantly improved upon wearing the protective mask (P = 0.014). Moreover, FVC and FEV1 indices were significantly loss in smoking workers than in non-smoking participants (P = 0.005 and P = 0.003, respectively). This study revealed that using effective preventive measures such as masks would be helpful to promote health conditions. However, despite the occupational health programs for preventing and reducing work-related respiratory diseases, these can be considered as a serious threat for detergent powder factory workers that need to apply more control strategies and health assessment.

Download Full-text

Hypoxaemia in Nigerian Children Presenting to the Children Emergency Ward (CHEW) of a Tertiary Hospital

Asian Journal of Pediatric Research ◽

10.9734/ajpr/2019/v2i230101 ◽

2019 ◽

pp. 1-6

Author(s):

Okoh Boma ◽

Jaja Tamunopriye

Keyword(s):

Respiratory Diseases ◽

Sick Child ◽

Tertiary Hospital ◽

Cross Sectional Study ◽

Sectional Study ◽

Emergency Ward ◽

Cross Sectional ◽

Nigerian Children ◽

The Mean ◽

Low Sensitivity

Aim: To determine the prevalence of hypoxaemia and predictors of signs of hypoxaemia in children with various disease conditions admitted into the CHEW of a tertiary health facility. Place and Duration: Department of Paediatrics (Children Emergency Ward). Study was done from 1st February to 30th April 2015. Methods: This was a descriptive cross sectional study of 129 children admitted into the CHEW with various disease conditions. Biodata and clinical examination was done in all patients. Oxygen saturation (SpO2) was determined at admission using pulse oximeter for every sick child admitted. Hypoxaemia was defined as SpO2 less than 90%. Results: One hundred and twenty nine children were studied. Ages of subjects ranged between 0.08years and 17 years with a mean age of 3.06 ± 3.65 years. The mean age of 3.34 ± 3.97 years for males was higher than 2.70 ± 3.22 years for females. Thirty one (24%) children had hypoxaemia on admission with 20(64.5%) with respiratory diseases. Infants (P=.004) and children with respiratory disease (P=.047) had a significantly higher prevalence of hypoxaemia among the study group. Chest in drawing was a common feature but grunting had the best positive predictive value of more than 80% but with low sensitivity of 3. Conclusion: Hypoxaemia is prevalent in children who are ill and need emergency care. Respiratory diseases and infants account for a major proportion of hypoxaemic children seen in emergency wards. Chest in drawing is a common feature from different studies; presence of grunting was highly predictive in this study although had low sensitivity.

Download Full-text

After the first wave and beyond lockdown: long-lasting changes in emergency department visit number, characteristics, diagnoses, and hospital admissions

Internal and Emergency Medicine ◽

10.1007/s11739-021-02667-2 ◽

2021 ◽

Author(s):

Fulvio Morello ◽

Paolo Bima ◽

Enrico Ferreri ◽

Michela Chiarlo ◽

Paolo Balzaretti ◽

...

Keyword(s):

Emergency Department ◽

Respiratory Diseases ◽

Pediatric Patients ◽

Hospital Admissions ◽

Cross Sectional Study ◽

Rapid Reduction ◽

Cross Sectional ◽

Italian City ◽

Ed Visits ◽

Visit Number

AbstractThe first wave (FW) of COVID-19 led to a rapid reduction in total emergency department (ED) visits and hospital admissions for other diseases. Whether this represented a transient “lockdown and fear” phenomenon, or a more persisting trend, is unknown. We divided acute from post-wave changes in ED flows, diagnoses, and hospital admissions, in an Italian city experiencing a FW peak followed by nadir. This multicenter, retrospective, cross-sectional study involved five general EDs of a large Italian city (January–August 2020). Percent changes were calculated versus 2019, using four 14-day periods (FW peak, early/mid/late post-wave). ED visits were 147,446 in 2020, versus 214,868 in 2019. During the FW peak, visits were reduced by 66.4% (P < 0.001). The drop was maximum during daytime (69.8%) and for pediatric patients (89.4%). Critical triage codes were unchanged. Reductions were found for all non-COVID-19 diagnoses. Non-COVID-19 hospital admissions were reduced by 39.5% (P < 0.001), involving all conditions except hematologic, metabolic/endocrine, respiratory diseases, and traumas. In the early, mid, and late post-wave periods, visits were reduced by 25.4%, 25.3% and 23.5% (all P < 0.001) respectively. In the late period, reduction was greater for female (27.9%) and pediatric patients (44.6%). Most critical triage codes were unchanged. Oncological, metabolic/endocrine, and hematological diagnoses were unchanged, while other diagnoses had persistent reductions. Non-COVID-19 hospital admissions were reduced by 12.8% (P = 0.001), 6.3% (P = 0.1) and 12.2% (P = 0.001), respectively. Reductions in ED flows, led by non-critical codes, persisted throughout the summer nadir of COVID-19. Hospital admissions for non-COVID-19 diseases had transient changes.

Download Full-text

Vancomycin dosing in low-flux hemodialysis; is adjustment of drug dosage necessary?

Journal of Renal Injury Prevention ◽

10.15171/jrip.2019.21 ◽

2018 ◽

Vol 8 (2) ◽

pp. 112-115

Author(s):

Niloofar Khodabandehloo ◽

Arash Fourodi ◽

Aria Jenabi

Keyword(s):

Serum Level ◽

Drug Dosage ◽

Cross Sectional Study ◽

Hemodialysis Patients ◽

Dialysis Session ◽

Sectional Study ◽

Cross Sectional ◽

Gram Positive Bacteria ◽

Before And After ◽

The Mean

Introduction: Vancomycin is a wide useable antibiotic against gram-positive bacteria species in different clinical setting particularly in hemodialysis patients. Objectives: The present study aimed to assess the serum level of vancomycin before and after hemodialysis. Patients and Methods: This cross-sectional study was performed on patients who were hospitalized and medicated by vancomycin with the loading dose of 1000 mg followed by the maintenance dose of 500 mg after each dialysis session every other day. All patients were dialyzed with a low-flux dialyzer membrane. Half an hour before and immediately after dialysis, 2 mL blood sample was taken and stored at -20°C until assaying the level of vancomycin. Results: The average reduction in the serum level of vancomycin was totally 17.65 ± 1.69%. The mean reduction in the serum level of vancomycin was significantly higher in the patients aged higher than 60 years, as compared to other ones. But the level of drug was independent to gender or body mass index. Conclusion: Using low-flux dialyzer membranes, the average reduction in the serum level of vancomycin is expected to be in the range of 12.43% to 21.56% that age was directly associated with the average reduction of the level of vancomycin. Therefore, adjusting and monitoring the serum level of drug in old ages even in the cases of using low-flux dialyzer membranes is recommended.

Download Full-text

The Prevalence of Hepatitis B & C among Hemodialysis Patients in Baghdad Medical City.

Baghdad Medical Journal Of Students ◽

10.48046/bmjos.v1i1.17 ◽

2020 ◽

Vol 1 (1) ◽

Author(s):

Mohammed Taher Al-Khalidi ◽

Misk Al-Marzook ◽

Zainab Hassan

Keyword(s):

Hepatitis C ◽

Hepatitis B ◽

Drug Users ◽

Cross Sectional Study ◽

Hemodialysis Patients ◽

P Value ◽

Cross Sectional ◽

Hemodialysis Unit ◽

B Virus ◽

Medical City

Background Hepatitis B and C are infectious diseases caused by the hepatitis B Virus (HBV) and C virus respectively, that affects the liver. Hepatitis viruses are transmitted by blood-to-blood contact associated with dialysis, poorly sterilized medical equipment, needle-stick injuries, blood transfusion, and intravenous drug users. Methods this is a cross-sectional study conducted in the Hemodialysis Unit of Baghdad Teaching Hospital between the period of April and September 2018. Ninety-eight patients were enrolled in this study after adopting informed consent. All patients were on regular hemodialysis as a renal replacement therapy with different durations. Full history was taken from them including age, gender, occupation, marital status, and past medical and surgical histories. Blood test results were also recorded. all data were analyzed using SPSS20 with 95%confidence which means a p-value less than 0.05 to be statistically significance. Results The percentage of Hemodialysis patients infected with Hepatitis C was (43%) while those infected with Hepatitis B was (3%). There is no statistically significant association between age and infection with Hepatitis B & C (P>0.05). The mean age of patients infected with Hepatitis B was (65.8±8.2), while for patients infected with Hepatitis C it was (45.3±14.7). Conclusion Hepatitis C is more prevalent than Hepatitis B in the Hemodialysis Unit and the infection was not statistically associated with the age or gender of the patients

Download Full-text

MO918INFECTIOUS COMPLICATIONS IN HEMODIALYSIS: INTERSET OF NEUTROPHIL TO LYMPHOCYTE AND PLATELETS TO LYMPHOCYTE RATIOS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab102.0019 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Rania Lahouimel ◽

Toumi Salma ◽

Hanen Abid ◽

Emna Kharrat ◽

Amira Saai ◽

...

Keyword(s):

Cross Sectional Study ◽

Hemodialysis Patients ◽

Infectious Complications ◽

Chronic Hemodialysis ◽

Cross Sectional ◽

Positive Correlation ◽

Literature Reviews ◽

History Of ◽

The Mean ◽

One Year

Abstract Background and Aims Infectious complications represent the leading cause of death among the dialysis population, prompting early diagnosis and increased vigilance. Neutrophil-to-lymphocyte and platelets-to-lymphocyte ratios are newly emerging as more accessible and simple markers for the detection of the onset of infections. The objective of our study is to prove the value of these markers in the diagnosis of infections in hemodialysis patients. Method This is a cross-sectional study spread over one year including 85 chronic hemodialysis patients with duration of at least 6 months. patients with hemopathies, tumors, or with a history of hospitalization during the 3 months before the study were excluded. CRP was used as a biomarker of infections and N / L; P / L ratios were calculated to study the correlation between the two biomarkers. Based on the literature reviews, the threshold of the N / L ratio and the P / L ratio admitted for our stydy were respectively : > = 2.5 and > = 150. Results The mean age of our patients was 49 ± 19 years with a predominance of women (55%) .The average duration in hemodialysis was 67.2 months. An infectious complication was noted in 22% of our patients whose distribution was as follow: 4% as a pulmonary infection with 3 coronavirus cases, 6% a sepsis, one case of abscess of the nephrectomy compartment.The median value of the CRP was 37±10mg/l We found a positive correlation between the 2 ratios associated (RNL and RPL) and infection with (p = 0.03) . We noted throw this study that patients with both high ratios RPL> 150 and RNL> 2.5 have significantly elevated values of CRP. Conclusion N/L and P/L ratios are easy-to-calculate markers that are of great benefit to the hemodialysis population. We have shown through this study the existence of a positive correlation between the N/L and P/L ratios and the occurrence of infections in hemodialysis patients. We therefore encourage the use of this ratios to be included as markers to detect infections occurence.

Download Full-text

Incidence of Infective Endocarditis among Haemodialysis Patients: Experience at a Single Centre in Bangladesh

Journal of Current and Advance Medical Research ◽

10.3329/jcamr.v8i1.52597 ◽

2021 ◽

Vol 8 (1) ◽

pp. 54-58

Author(s):

Md. Zakir Hussain ◽

Muhammad Rafiqul Alam ◽

Muhammad Abdur Razzak ◽

Mohammad Ehasun Uddin Khan

Keyword(s):

Infective Endocarditis ◽

Salmonella Typhi ◽

Cross Sectional Study ◽

Hemodialysis Patients ◽

Cross Sectional ◽

Study Population ◽

The Mean ◽

Medical University ◽

Patients Experience ◽

Dangerous Condition

Background: Infection in hemodialysis is a very dangerous condition for the patients. Objective: The purpose of the present study was to find out the incidence of infective endocarditis among hemodialysis patients. Methodology: This was a cross sectional study which was conducted in the Department of Nephrology at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh during the periods of July 2010 and June 2012. Hemodialysis patients who were attending in the Department of Nephrology at BSMMU, Dhaka were taken as study population. Results: A total number of 50 patients presented with hemodialysis. Out of 50 patients 34(68.0%) cases were male and 16(32.0%) cases were female. The mean with SD of age of the patients was 38.44±13.0 years with a range of 18 to 68 years. Out of 50 patients 6(12.0%) cases had positive blood culture of which 3 cases had shown Staphylococcus aureus, 1 case had Escherichia coli, 1 case had Enterococci species and 1 case had Salmonella typhi, Among the 50 patients 5 (10.0%) had vegetation on cardiac valve. The patients frequency of dialysis 2 times per week showed 01 (2.43%) positive blood C/S and 5 positive in 3 times per week showed 05 (55.55%) positive blood C/S (p>0.001). Conclusion: In conclusion infective endocarditis causes infection with high mortality among the patients of CKD undergoing hemodialysis. Journal of Current and Advance Medical Research, January 2021;8(1):54-58

Download Full-text