Early Complications of Arteriovenous Fistula in patients on maintenance Hemodialysis

Background: Repeated access to circulation is essential to conduct the adequate maintenance hemodialysis. The efficiency of arteriovenous fistula, being permanent source of access to vascular system in hemodialysis, is severely hampered by its complications Aim: To determine the frequency of most common early complications of arteriovenous fistula in patients on maintenance hemodialysis. Methods: This cross sectional study was conducted over a period of five years. Total 450 patients of hemodialysis were included. Informed consent was taken and demographics were noted. Early postoperative complications of AV fistula were recorded. Results: Average age of the patients was 39.61±8.17 years. There were 255 (56.7%) males and 195 (43.3%) females. Radiocephalic fistula was constructed in 198 (44%) cases while brachiocephalic fistula in 252 (56%) cases. Among early complications, 19 (4.2%) cases had wound infection, 27 (6%) had thrombosed AV accesses and 12 (2.6%) had bleeding. Conclusion: Early complications of AVF may compromise its efficacy as source of vascular access for maintenance hemodialysis. Timey detection and management improves patient morbidity. Keywords: Maintenance Hemodialysis, Arteriovenous fistula, Infection, Thrombosis, Bleeding.

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IN-HOSPITAL EARLY COMPLICATIONS IN DIABETICS VS NON DIABETICS WITH ACUTE ST ELEVATION MYOCARDIAL INFARCTION AGE GROUP 30-70 YEARS

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v70isuppl-4.6023 ◽

2021 ◽

Vol 70 (Suppl-4) ◽

pp. S576-80

Author(s):

Gul Khan ◽

Imtiaz Ahmed Khan ◽

Fahad Ahmad Khan ◽

Shaheer Farhan ◽

Javeria Kamran ◽

...

Keyword(s):

Myocardial Infarction ◽

Armed Forces ◽

Cross Sectional Study ◽

Diabetic Group ◽

Diabetic Patients ◽

Age Group ◽

Sectional Study ◽

Early Complications ◽

Cross Sectional ◽

St Elevation

Objective: To determine in hospital early complications in diabetics’ vs non diabetics with acute ST elevation myocardial infarction. Study Design: Comparative cross-sectional study. Place and Duration of Study: The study was conducted in emergency departments and adult cardiology wards of Armed Forces Institute of Cardiology/National Institute of Heart Diseases, from Aug to Nov 2019. Methodology: A comparative cross sectional study was conducted on 380 patients (190 patients with diabetes and 190 patients without diabetes) who presented with acute ST-Elevation MI in age group 30 to 70 years to emergency department of Armed Forces Institute of Cardiology/National Institute of Heart Disease during specified period. Patients with rescue PCI and new onset of LBBB were also included. Patients with age group lesser than 30 years or greater than 70 years with STEMI were excluded. Sampled with consecutive non probability technique in patients was assessed with ECG, cardiac enzymes, transthoracic echocardiography, renal Doppler and RFTs. All patients were admitted in wards and were followed up during hospital stay. Patients were evaluated and their record of Primary PCI and thrombolysis was also noted. Data was entered and analyzed with SPSS-23. Results: A total of 380 patients with STEMI were included in this study consisting of 292 (76.8%) male and 88 (23.1%) female from 30 to 70 years. The patients were divided in two groups i.e. diabetic and non-diabetic, 190 patients were included in each group. It was found that frequency of ST-Elevation MI was higher in diabetic group as compared to non-diabetic group. All the patients were analyzed for complications occurred after STElevation MI. LV failure, Brady arrhythmias, atrial fibrillation, post MI angina and cardiogenic shock were the main complications noted. It was found that all these complications are more in diabetic group post MI angina which occurred most frequently in non-diabetic group. Conclusion: In our study we observed that left ventricular failure and arrhythmias were the major complications. Mortality was higher in diabetic patients than non-diabetic patients. In both groups PPCI and SK reduced mortality. Post MI angina were found more frequent in non-diabetic group.

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Relationship between Dream Anxiety in Recurrent Nightmare and Indefinite Complaints in Patients Undergoing Maintenance Hemodialysis: A Cross-sectional Study

International Journal of Affective Engineering ◽

10.5057/ijae.ijae-d-18-00004 ◽

2018 ◽

Vol 17 (3) ◽

pp. 213-220

Author(s):

Yoshihiro TSUJI ◽

Naoki SUZUKI ◽

Yasumasa HITOMI ◽

Yusuke SAKAI ◽

Toshiko TOKORO ◽

...

Keyword(s):

Cross Sectional Study ◽

Maintenance Hemodialysis ◽

Sectional Study ◽

Cross Sectional

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The management of vascular access in hemodialysis patients during the coronavirus disease 2019 epidemic: A multicenter cross-sectional study

The Journal of Vascular Access ◽

10.1177/1129729820937484 ◽

2020 ◽

pp. 112972982093748

Author(s):

Jia Shi ◽

Jian-Jun Yan ◽

Jian Chen ◽

Qing-Hong Zhang ◽

Yi Yang ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Vascular Access ◽

Cross Sectional Study ◽

Hemodialysis Patients ◽

Sectional Study ◽

Epidemic Disease ◽

Cross Sectional ◽

Flow Reduction ◽

Arteriovenous Access ◽

Access Complications

Background: Coronavirus disease 2019 is an epidemic disease throughout the world. The management of vascular access during the epidemic is currently unknown. Methods: In this multicenter cross-sectional study, we collected vascular access data from hemodialysis patients treated at 44 hospitals in Hubei from 22 January to 10 March 2020. We estimated the management of vascular access during the coronavirus disease 2019 outbreak. Results: Of the 9231 hemodialysis patients included, 5387 patients (58.4%) were men and 2959 patients (32.1%) were older than 65 years. Arteriovenous fistula was the predominant type of vascular access, accounting for 76.5%; 496 patients (5.4%) developed vascular access complications; catheter flow reduction was the most common vascular access complication, and stenosis was the predominant complication among those with arteriovenous access. Overall, 280 vascular access sites were placed in patients newly diagnosed with uremia, of whom 260 (92.8%) underwent catheter insertion; 149 rescue procedures were carried out to treat the vascular access complications, which consisted of 132 catheters, 7 percutaneous transluminal angioplasties, 6 arteriovenous fistula repairs, and 4 arteriovenous fistulas. Occlusion of the arteriovenous access had the highest rescue rate (92.7%), while many other vascular access complications remained untreated; 69 and 142 patients were diagnosed with confirmed and suspected coronavirus disease 2019, respectively. A total of 146 patients died, of whom 29 patients (19.9%) died due to vascular access complications. Conclusion: Catheter flow reduction and stenosis of arteriovenous access were the major vascular access complications. Most of the vascular access sites established were catheters, and many of the vascular access complications remained untreated.

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Blood Pressure of Maintenance Hemodialysis Patients in the Dalmatian Region of Croatia: Differences between Hospital and Out-of-Hospital Dialysis Centers

Blood Purification ◽

10.1159/000474931 ◽

2017 ◽

Vol 44 (2) ◽

pp. 110-121

Author(s):

Marijana Gulin ◽

Dragan Klarić ◽

Mario Ilić ◽

Josipa Radić ◽

Vedran Kovačić ◽

...

Keyword(s):

Blood Pressure ◽

Weight Gain ◽

Beta Blockers ◽

Cross Sectional Study ◽

Hemodialysis Patients ◽

Maintenance Hemodialysis ◽

Sectional Study ◽

Cross Sectional ◽

Interdialytic Weight Gain ◽

Maintenance Hemodialysis Patients

Aims: This study was aimed at comparing the incidence of arterial hypertension and blood pressure (BP) variance in hospital and out-of-hospital hemodialysis (HD) patients during HD sessions. Methods: A cross-sectional study was conducted for 1 week at all the HD centers in Dalmatia, Croatia. The pre-, intra-, and post-dialysis BP values were collected for 3 consecutive HD sessions per patient. Results: Of the 399 subjects, 73.9% were hypertensives, who showed higher interdialytic weight gain compared to the normotensives (2.58 vs. 2.40). Hospital and out-of-hospital HD patients received identical antihypertensive therapies, except that beta blockers were more frequently administered to out-of-hospital HD patients. Higher pre-, intra-, and post-dialysis BP values were recorded in patients at out-of-hospital HD centers. Conclusion: The differences in BP variability and antihypertensive therapies administered to hospital HD patients as compared to out-of-hospital HD patients may reflect differing approaches by the nephrologists at these centers.

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Determinants of the intensity of uremic pruritus in patients receiving maintenance hemodialysis: A cross-sectional study

PLoS ONE ◽

10.1371/journal.pone.0245370 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245370

Author(s):

Jian-Hui Zhao ◽

Qiu-Shuang Zhu ◽

Yi-Wen Li ◽

Li-Li Wang

Keyword(s):

Logistic Regression ◽

Multiple Logistic Regression Analysis ◽

Cross Sectional Study ◽

Maintenance Hemodialysis ◽

Multiple Logistic Regression ◽

Sectional Study ◽

Cross Sectional ◽

Urea Nitrogen ◽

Uremic Pruritus ◽

Hs Crp

Background Uremic pruritus (UP) is a common and frustrating symptom in patients receiving hemodialysis (HD). The majority of patients have mild to moderate itching of the skin, and a small percentage have severe itching, which seriously affects their quality of life and survival rate. However, little is known about factors that influence the intensity of itching in patients. Methods A cross-sectional study on uremic pruritus in male and female patients receiving HD was conducted in September 2019. This study included 148 eligible patients who received HD at the Blood Purification Center of Xinchang County People’s Hospital, Zhejiang Province, China from March 2019 to June 2019. We collected general data consisted of age, sex, body mass index (BMI), place of residence, educational level, diabetes mellitus status and duration of HD; as well as clinical, biochemical indicators, including serum calcium (Ca), serum phosphorus (P), serum albumin (ALB), haemoglobin (Hb), serum intact parathyroid hormone (iPTH), pre-dialysis serum urea nitrogen (BUN), normalized protein catabolic rate (nPCR), urea nitrogen clearance index (KT/V), ferritin (FER) and pre-dialysis serum creatinine (sCR). We also assayed the inflammatory cytokine serum high sensitivity C-reactive protein (hs-CRP). The Five-Dimensional Itching Scale (5DIS) was used to evaluate the degree of skin itching (none, mild, moderate, or severe). We used multiple logistic regression to analyze influencing factors on the degree of skin itching in patients with UP. Results Of the 148 patients, 60 had uremic pruritus (incidence rate, 40.54%). These included 22 cases of mild skin itching (14.86%), 30 of moderate skin itching (20.27%), and 8 of severe skin itching (5.41%). Compared with uremia patients without skin pruritus, patients with UP had higher levels of iPTH, Hb, BUN, nPCR, and hs-CRP. The composition ratio showed significant differences between urban and rural patients with different degrees of skin itching (P = 0.017); moreover, the difference of iPTH and hs-CRP levels were statistically significant (P = 0.009 and < 0.001, respectively). Using no itching as a reference, multiple logistic regression analysis showed that as hs-CRP level increased, the patient’s risks of mild skin itching (odds ratio [OR] = 1.740; 95% confidence interval [CI], 1.061–2.854; P = 0.028), moderate skin itching (OR = 2.8838 95% CI, 1.744–4.718; P < 0.001), and severe skin itching (OR = 9.440; 95% CI, 3.547–25.124; P < 0.001) all increased as well. Compared with urban residents, rural residents have a higher risk of moderate itching (OR = 3.869; 95% CI, 1.099–13.622; P = 0.035). Conclusion Levels of hs-CRP were associated with the intensity of skin itching in patients with UP. Higher hs-CRP levels were closely related to severe skin itching. The relationship between the intensity of skin itching and the environment in maintenance hemodialysis patients needs further clarification.

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Comparison of Body Mass Index with Modified Subjective Global Assessment for Detection of Malnutrition Among Patients Under Maintenance Hemodialysis: A Multi-Center Cross-Sectional Study

Journal of Preventive and Social Medicine ◽

10.3329/jopsom.v40i1.56686 ◽

2022 ◽

Vol 40 (1) ◽

pp. 14-21

Author(s):

Mohammad Syfur Rahman ◽

Mohammad Farhadul Haque ◽

Tayeba Sultana ◽

Tahera Sultana ◽

Syed Asif Ul Alam

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Cross Sectional Study ◽

Maintenance Hemodialysis ◽

Subjective Global Assessment ◽

Sectional Study ◽

Cross Sectional ◽

Cutoff Value ◽

Best Fitting ◽

Study Population

Background: Patients under maintenance hemodialysis are at increased risk of malnutrition, causing from multitude of factors. Present study aims to assess the prevalence of malnutrition among maintenance hemodialysis patients using both modified subjective global assessment score and body mass index, compare them and assess the sensitivity and specificity of body mass index for detecting malnutrition, along with determining a new cutoff value for BMI that better represent the maintenance hemodialysis patient’s nutritional status. Methods: This was a cross-sectional study conducted in the hemodialysis unit of Bangabandhu Sheikh Mujib Medical University, Sir Salimullah Medical College Mitford Hospital, BIRDEM General Hospital and National Institute of Kidney Diseases & Urology; among 80 adult CKD patients who were on regular (≥2 sessions per week) maintenance hemodialysis for more than 3 months without any acute infection, during the period of July 2016 to June 2017. Nutritional assessment was done for each patient using modified SGA score along with BMI. Sensitivity analysis of WHO recommended cutoff value for BMI was done among the study population using modified SGA score as gold standard test for detection of malnutrition among the respondents. ROC curve was used to estimate the best fitting cutoff value of BMI that showed highest sensitivity, specificity and accuracy for detracting malnutrition among maintenance hemodialysis patients. Results: The study participants were predominantly male (66.3%) and from age group 45 to 59 years (36.3%). Modified SGA score detected 90.0% of the study population as malnourished. WHO recommended 18.5 kg/m2 cutoff value was also used to detect malnutrition among study population and 13.8% were found to be malnourished, with a sensitivity and specificity of 12.5% and 75.0% respectively. Accuracy was found to be 18.8%. Using ROC curve, 23.1 kg/m2 was found to be the best fitting cutoff value of BMI for the study population to detect malnutrition. With a sensitivity of 47.2%, specificity of 37.5% and accuracy of 46.3%. Conclusion: BMI showed low sensitivity for detecting malnutrition among patients under maintenance hemodialysis, compared to modified SGA score and should be avoided as a screening tool, but 23.1 kg/m2 cutoff value for BMI showed potential to be used as an easy to use and quick tool for detecting malnutrition among such patients. Further study with larger sample size could shed more light on this. JOPSOM 2021; 40(1): 14-21

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The Association of Awareness and Knowledge of Diabetic Retinopathy with Age and Residential Area In Selangor

Environment-Behaviour Proceedings Journal ◽

10.21834/e-bpj.v2i6.942 ◽

2017 ◽

Vol 2 (6) ◽

pp. 125

Author(s):

Noor Halilah Buari ◽

Nur Izzaty Dian

Keyword(s):

Diabetic Retinopathy ◽

Cross Sectional Study ◽

Residential Area ◽

Sectional Study ◽

Early Complications ◽

Education Programs ◽

Cross Sectional ◽

Residential Population ◽

Area Health

The association of the awareness and knowledge of diabetic retinopathy with the age and residential area were investigated among selected Selangor populations. A cross sectional study was conducted using open-ended questions. Only half of the selected population was aware and had knowledge of diabetic retinopathy. The awareness was significantly associated with the age among urban and rural residential population but not with residential area. Health education programs could be suggested to increase the awareness of diabetic retinopathy among the population. By having awareness and knowledge, early complications of the diabetic can be detected and prevention can be secured, thus, improved one’s quality of life.

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Episiotomy and Its Complications

Zahedan Journal of Research in Medical Sciences ◽

10.5812/zjrms.104127 ◽

2021 ◽

Vol 23 (2) ◽

Author(s):

Seyed Hosein Soleimanzadeh Mousavi ◽

Mina Miri ◽

Farahnaz Farzaneh

Keyword(s):

Vaginal Delivery ◽

Cross Sectional Study ◽

Sectional Study ◽

Maternity Ward ◽

Early Complications ◽

Cross Sectional ◽

Rupture Rate ◽

Pain Frequency ◽

Spss Software

Objectives: This study aimed to evaluate the frequency of episiotomy and its early complications in natural vaginal delivery in the maternity ward of Ali Ibn Abitaleb (AS) Hospital in Zahedan from 2014 - 2016. Methods: In this cross-sectional study, which was conducted in 2017, the archives of women who gave birth between 2014 - 2016 were reviewed. Data were collected using information forms and analyzed by SPSS software. Results: Of 418 women were reviewed, the episiotomy rate was 54.5%; there was a significant association between parity and mother age with episiotomy rate. Moreover, 24-hour pain frequency, perineal rupture rate, hematoma rate was significantly higher in the episiotomy group. First- and fifth-minute Apgar of the neonates in the episiotomy group was significantly lower. Conclusions: In overall, the episiotomy rate was 54.5%, and there was a significant association between parity and mother age with episiotomy rate.

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