Nghiên cứu tình trạng suy yếu trên bệnh nhân cao tuổi suy thận mạn giai đoạn cuối lọc máu chu kỳ

2021 ◽  
Author(s):  
Xuan Thu Pham Thi
Keyword(s):  
Elderly Patients ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
The Elderly ◽  
Maintenance Hemodialysis ◽  
Geriatric Syndrome ◽  
Clinical Frailty Scale ◽  
Cross Sectional ◽  
Stage Renal Disease ◽  
End Stage

Giới thiệu: Suy yếu là một hội chứng lão hóa thường gặp, làm gia tăng các kết cục lâm sàng bất lợi ở người cao tuổi. Suy yếu đặc biệt chiếm tỷ lệ rất cao > 60% ở bệnh nhân cao tuổi suy thận mạn giai đoạn cuối lọc máu chu kỳ. Tuy nhiên, các nghiên cứu tại Việt Nam hiện nay chưa khảo sát trên đối tượng đặc biệt này. Mục tiêu: Xác định tỷ lệ suy yếu theo thang điểm suy yếu lâm sàng và các yếu tố liên quan trên bệnh nhân cao tuổi suy thận mạn giai đoạn cuối lọc máu chu kỳ. Đối tượng và phương pháp nghiên cứu: Cắt ngang mô tả và theo dõi dọc trên 175 bệnh nhân cao tuổi suy thận mạn giai đoạn cuối lọc máu chu kỳ ngoại trú tại Khoa Thận - Thận nhân tạo Bệnh viện Trưng Vương và Bệnh viện Thống Nhất từ 11/2020 đến 06/2021. Kết quả: Tỷ lệ suy yếu trên bệnh nhân cao tuổi suy thận mạn giai đoạn cuối lọc máu chu kỳ là 69,7%. Sau phân tích hồi quy đa biến, có mối liên quan giữa suy yếu và tuổi (PR = 1,23; KTC 95%: 1,12 - 1,35; p < 0,001); suy dinh dưỡng (SDD) (PR = 2,17; KTC 95%: 1,61 - 2,92; p < 0,001) và nguy cơ SDD theo thang điểm MNA - SF (PR = 1,47; KTC 95%: 1,27 - 1,71; p < 0,001); nguy cơ té ngã (PR = 1,63; KTC 95%: 1,28 - 2,07; p < 0,001). Kết luận: Suy yếu chiếm tỷ lệ rất cao ở bệnh nhân cao tuổi suy thận mạn giai đoạn cuối lọc máu chu kỳ và có mối liên quan độc lập với tuổi, tình trạng suy dinh dưỡng và té ngã. Từ khóa: Suy yếu, người cao tuổi, suy thận mạn giai đoạn cuối, lọc máu chu kỳ. ABSTRACT FRAILTY IN ELDERLY PATIENTS WITH END - STAGE KIDNEY DISEASE UNDERGOING HEMODIALYSIS Background: Frailty is a geriatric syndrome which is associated with an increased incidence of adverse clinical outcomes in the elderly. Frailty is particularly high > 60% in elderly patients with end - stage renal disease undergoing hemodialysis. However, research on frailty for this special populationhas not been done in Vietnam. Objective: To determine the prevalence of frailty according to the Canadian Clinical Frailty Scale (CFS) and investigate factors related to frailty in elderly patients with end - stage renal diseaseunder hemodialysis. Methods: Cross - sectional study and longitudinal follow - up, performed on 175 elderly patients with end - stage renal disease on maintenance hemodialysis at the Department of Nephrology at Trung Vuong Hospital and Thong Nhat Hospitalfrom November 2020 to June 2021. Results: The prevalence of frailty in elderly patients with end - stage renal disease on maintenance hemodialysis was 69.7%. After multivariate regression analysis, there was a relationship between frailty and age (PR = 1.23; 95% CI: 1.12 - 1.35; p < 0.001); malnutrition (PR = 2.17; 95% CI: 1.61 - 2.92; p < 0.001) and risk of malnutrition according to the MNA-SF scale (PR = 1.47; 95% CI: 1.27 - 1.71; p < 0.001); risk of falling (PR = 1.63; 95% CI: 1.28 - 2.07; p < 0.001). Conclusion: The prevalence of frailty was very high in elderly patients with end-stage renal disease on maintenance hemodialysis and frailty was independently associated with age, malnutrition, and falls. Keywords: Frailty, clinical frailty scale, elderly people, end - stage renal disease, hemodialysis

scholarly journals Acute Intradialytic Complications in End Stage Renal Disease on Maintenance Hemodialysis

2012 ◽  
Vol 52 (187) ◽  
Author(s):  
R K Agrawal ◽  
S Khakurel ◽  
R Hada ◽  
D Shrestha ◽  
A Baral
Keyword(s):  
Renal Failure ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Maintenance Hemodialysis ◽  
Care Hospital ◽  
Cross Sectional ◽  
Stage Renal Disease ◽  
End Stage

Introduction: Hemodialysis is the preferred method of treatment for Nepalese patients with End Stage Renal Disease. Despite the technological advances and better understanding of physiology associated with hemodialysis, a number of complications are known to be associated with hemodialysis. This study was undertaken to study the frequency of acute intradialytic complications in patients undergoing hemodialysis. Methods: A cross-sectional study was conducted at Nephrology unit of a tertiary care hospital from 15 June, 2007 to 15 December, 2007. A total of 28 patients were included in the study. Patients with acute renal failure and acute on chronic renal failure were excluded from the study. Results: Total sessions of hemodialysis during the period were 1455. Hypotensive episode were 66 (4.5%) and was the commonest complication and followed by hypertensive episodes were 58 (3.8%). Other problems encountered were transfusion reactions were 23 episodes (1.5%), rigors not related to transfusions were 13 episodes (0.8%), nausea/vomiting were 20 episodes (1.4%), muscle cramps were 12 episodes (0.8%), hypoglycemia were 6 episodes 5(0.4%). Conclusions: The frequency of intradialytic complications is low and many of them are not life threatening. Keywords: complications; end stage renal disease; hemodialysis; hypertension; hypotension.

Comparison of pre- and post-hemodialysis PHQ-9 depression scores in patients with end-stage renal disease: A cross-sectional study

2020 ◽  
pp. 009121742097348
Author(s):  
Izzat AlAwwa ◽  
Sarah Ibrahim ◽  
Ahmad Obeid ◽  
Nadeen Alfraihat ◽  
Reham Al-Hindi ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Maintenance Hemodialysis ◽  
Cross Sectional ◽  
Symptoms Of Depression ◽  
Significant Difference ◽  
Before And After ◽  
Stage Renal Disease ◽  
End Stage

Objectives An overlap between the somatic symptoms of depression and those of uremia seen in end-stage renal disease (ESRD) patients may affect the diagnosis of depression. This study aims to evaluate the effect of hemodialysis on the diagnosis of depression among patients on maintenance hemodialysis as dialysis diminishes the uremic symptoms, and to compare depression scores before and after dialysis. Methods This was a cross-sectional analytic study conducted from November 2018 through April 2019, in three tertiary hospitals. Consenting participants aged 18 years or older, who had received hemodialysis for at least three months were included. The Patient Health Questionnaire (PHQ-9) tool was used to collect patients’ data and to identify symptoms of depression Pre- and post-hemodialysis. Depression scores were compared using the paired sample Wilcoxon rank test or the McNemar test, where appropriate. Results Overall, 163 participants were enrolled in the study. The average age of the participants was 56.5 years old, whereas 44.8% were females. The prevalence of depressive symptoms before hemodialysis was 48.5%, with prevalence of mild, moderate and moderately severe of 34.4%, 11.7% and 2.5%, respectively. On the other hand, the prevalence of depressive symptoms after hemodialysis was 46.6% with 36.8%, 9.2% and 0.6% of the participants reporting mild, moderate and moderately severe symptoms, respectively. We found no significant difference in depression scores before and after dialysis (p-values > 0.05). Conclusion Our study supports the fact that the prevalence of depression is high among patients with ESRD on maintenance hemodialysis. We didn’t find a significant difference in depression scores among hemodialysis patients before and after dialysis, with negligible effect of uremic symptoms on the diagnosis of depression. We suggest adopting routine screening of depression among this high-risk group of patients.

scholarly journals Depression in End Stage Renal Disease Patients on Maintenance Hemodialysis at Liaquat University Hospital Hyderabad / Jamshoro

2021 ◽  
Vol 15 (1) ◽  
pp. 60-63
Author(s):  
Rizwan Channa ◽  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Depression Scale ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Maintenance Hemodialysis ◽  
Cross Sectional ◽  
Stage Renal Disease ◽  
End Stage ◽  
Hospital Study

Objective: To determine the depression in end stage renal disease patients on hemodialysis at Liaquat University Hospital. Study Design: Cross sectional study. Settings: Department of Medicine & Nephrology at Liaquat University Hospital Hyderabad Pakistan. Duration: Six months from February 2015 to January 2016. Methodology: All the Male or Female of age 14-70 years having ESRD patients on maintenance hemodialysis for >3 months period were included. Questionnaire proforma was filled and patient who score 5 or more on depression scale were labeled as positive for depression. An informed written consent for the study was obtained from the patients and their relatives. All the data was recorded on a pre-designed proforma. Data was analyzed by using SPSS version 20. Results: The mean age of patients was 52.21±7.90 years. There were 69.9% males and 30.1% female patients. Out of all 35.8% patients were employed while 64.2% patients were unemployed. Most of the patients 92.3% were married and 7.7% were unmarried. The depression in patients with end stage renal disease was found in 47.2%patients. Conclusion: The frequency of depression in end stage renal disease patients on hemodialysis at Liaquat University Hospital was found to be higher as 47.2%. However, there is need to involve the expert Psychiatrists to cope with this higher problem of depression to improve their quality of life by giving them additional anti-depressant along with hemodialysis.

scholarly journals Frequency of anemia in patients with increased level of parathyroid hormone among patients on maintenance hemodialysis.

2020 ◽  
Vol 27 (06) ◽  
pp. 1255-1258
Author(s):  
Saad Muzaffar Azeem ◽  
Anita Haroon ◽  
Ishtiaque Alam ◽  
Sadia Azeem ◽  
Mahrukh Sultana ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Maintenance Hemodialysis ◽  
Cross Sectional ◽  
Number Of Patients ◽  
Study Results ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage

Objectives: One of the most frequently occurring complication of end stage renal disease is anemia. It can be defined as decrease in red blood cells with hemoglobin concentration less than 12 g/dl in women and less than 13 g/dl in men. Parathyroid hormone levels are also raised among patients with end stage renal disease to maintain serum calcium levels. The objective of this study is to evaluate the degree of anemia in patients with end stage renal disease currently on maintenance hemodialysis and have raised PTH levels. Study Design: Cross-sectional study. Setting: Kidney Center, Karachi. Period: November 2015 to July 2016. Material & Method: Patients undergoing maintenance hemodialysis during the study duration with PTH levels greater than 300 ng/L were included in the study. Patients with other co-morbid conditions like chronic liver disease and hypersplenism were excluded from the study. Results: The total number of patients on maintenance hemodialysis in the kidney center that matched our inclusion criteria was 110. Amongst them there were 47.3% (n=52) males and 52.7% (n=58) females. The mean age of patients in our study is 50.15 ± 12.92 years. The mean PTH level of patients was found to be 642 ± 405.9U. Since all the participants of the study are on maintenance dialysis, the mean duration of hemodialysis was found to be 4.2 ± 3.19 months. The mean hemoglobin level of patients was found to be 9.75 ± 1.47 g/dl. Conclusion: Patients with hyperparathyroidism and undergoing maintenance hemodialysis frequently develops anemia. Many factors account for this including raised PTH levels causing bone marrow fibrosis, decreased production of erythropoietin and resistance of produced erythropoietin are some factors responsible for the anemia.

scholarly journals Acquired cystic renal disease in hemodialysis patients.

2020 ◽  
Vol 27 (11) ◽  
pp. 2403-2406
Author(s):  
Suhail Iqbal Malik ◽  
Raheel Khan ◽  
Muhammad Yousuf ◽  
Muhammad Imran ◽  
Yusra Saeed ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Age Groups ◽  
Stone Disease ◽  
Maintenance Hemodialysis ◽  
Cross Sectional ◽  
Female Ratio ◽  
Cystic Renal Disease ◽  
Stage Renal Disease ◽  
End Stage

Objectives: Acquired cystic renal disease is known complication of End stage renal disease and hemodialysis and is also a precursor to renal cell carcinoma in patients who are on long term maintenance hemodialysis. Study Design: Cross Sectional study. Setting: Bahawal Victoria Hospital, Bahawalpur-Pakistan. Period: Jan 2019 to June 2019. Material & Methods: Patients on maintenance hemodialysis were evaluated using ultrasound for acquired cystic renal disease. Results: The study included 220 patients who were on maintenance hemodialysis. The male to female ratio was 2.01:1. Most common causes of renal failure were Diabetes Mellitus and Renal stone Disease (22.3%) each. Acquired cystic renal disease was found in 45 (20.5%). The difference of frequency of acquired cystic renal disease was statistically significant in age groups & anemia. Conclusions: Acquired cystic renal disease is common complication of End stage renal disease and maintenance hemodialysis. Regular monitoring with ultrasound needs to be done for those patients who are on maintenance hemodialysis for more than 3 years.

scholarly journals Adequacy of hemodialysis in Nepalese patients undergoing maintenance hemodialysis

2009 ◽  
Vol 48 (173) ◽  
Author(s):  
P Sultania ◽  
Sanjib Kumar Sharma ◽  
SK Sharma
Keyword(s):  
Observational Study ◽  
Nutritional Status ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Maintenance Hemodialysis ◽  
Inclusion Criteria ◽  
Cross Sectional ◽  
Dialysis Unit ◽  
Stage Renal Disease ◽  
End Stage

 INTRODUCTION:Inadequate dialysis accounts for the high mortality in patients with end stage renal disease (ESRD). In Nepal, due to various factors including financial and logistic limitations, hemodialysis is mostly performed twice-a-week. This study was undertaken to look at adequacy of dialysis in patients undergoing maintenance hemodialysis in Nepal where the patients profile, in terms of diet, body muscle mass, nutritional status etc are different from western world.METHODS:In this cross sectional observational study, 40 patients on maintenance hemodialysis in the dialysis unit were evaluated and enrolled if patients were regularly undergoing twice-a-week hemodialysis in preceding 6 months with each session of dialysis prescription consisting of 4 hours (240 minutes). Patients were excluded if they were admitted in the hospital for some acute problems or had received acute hemodialysis in preceding 6 months. Only 14 patients fulfilled the inclusion criteria. Hemodialysis adequacy was measured using well established urea kinetic modeling.RESULTS:The mean age of the patients was 49 +/- 24 years. Mean predialysis urea and post dialysis urea were 163.7 +/- 60.05 mg/dL, and 73.7 mg/dL +/- 30.55 respectively. Mean URR was 65.3%. Mean Kt/v as assessed by Jindals equation was 0.99.CONCLUSIONS:Our study showed that twice-a-week of maintenance hemodialysis did not achieve recommended adequacy of hemodialysis in our patients.Key words: Adequacy of dialysis, end stage renal disease, hemodialysis.

P1379PLATELET/LYMPHOCYTE RATIO AS A MARKER OF ERYTHROPOIETIN RESPONSIVENESS IN END-STAGE RENAL DISEASE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Sonja Golubović ◽  
Tijana Azasevac ◽  
Siniša Živković ◽  
Bojana Ljubiäiä‡ ◽  
Violeta Knezevic ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Laboratory Data ◽  
Moderate Intensity ◽  
Maintenance Hemodialysis ◽  
Weekly Dose ◽  
Lymphocyte Ratio ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esa Therapy

Abstract Background and Aims Neutrophil/Lymphocyte Ratio (NLR) and Platelet/Lymphocyte Ratio (PLR) are closely associated with increased inflammation in end-stage renal disease, which often contributes to the severity of anemia in these patients. Erythropoiesis stimulating agents (ESA) have become a standard treatment of anemia in hemodialysis patients. Since some patients do not respond well to erythropoietin therapy (EPO) the aim of this study is to investigate if NLR and PLR as markers of increased inflammation, could be associated with resistance to EPO therapy. Method A total of 90 patients (36 females, 54 males; mean age 60,45 ±11,58) undergoing maintenance hemodialysis and who received recombinant human EPO therapy were examined. Patients' clinical characteristics, laboratory data, dialysis adequacy and the applied doses os EPO were examined in a period of 3 months. EPO hyporesponsiveness index (EHRI) was calculated as the weekly dose of EPO divided by kilograms of body weight divided by the hemoglobin level. Results Obtained results show a statistically significant correlation of moderate-intensity between EHRI and NLR ( r = 0.497, p &lt; 0.01) as well as a negative correlation of moderate-intensity between EHRI and hemoglobin levels (Hgb) (r = -0.403, p &lt; 0.01). When it comes to the connection of NLR and PLR with logarithmically converted EHRI values, the results show that there is no statistically significant correlation between NLR and EHRI. Comparison of PLR among 25th, 50th and 75th percentile of EHRI showed that PLR levels increased going from the 25th towards the 75th percentile (p &lt; 0.01). Post hoc analysis indicated that there is also a statistically strong connection for the 25th i 50th percentile (&lt;0 .05) and furthermore for the 50th and 75th percentile (&lt; 0.05). Conclusion PLR was found to be superior to NLR in terms of evaluating ESA therapy resistance. PLR could be used as a predictor of ESA therapy response.

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