Ureum Levels Before and After Hemodialization in Renal Failure Patients

Of chronic kidney failure is a state of decreased kidney function, where the kidneys are no longer able to excrete the rest of the body's metabolism. In end-stage chronic kidney failure hemodialysis is needed to eliminate the rest of the body's metabolism that accumulates in the blood and reduce the risk of death. The effectiveness of hemodialysis can be seen from the decrease in urea levels after hemodialysis. The purpose of this study was to determine the description of urea levels before and after hemodialysis in kidney failure patients. This research method uses descriptive observational data collection with URR (Urea Reduction Ratio) involving 130 patients with kidney failure who undergo hemodialysis. This research was conducted in July and October 2019 in the laboratory unit of the Klaten Islamic Hospital. The results There was a decrease in urea levels before and after hemodialysis. Where ureum levels before hemodialysis averaged 133.19 mg / dl and after hemodialysi s averaged 39.74 mg / dl . Conclusions Urea levels in patients with renal failure before hemodialysis increase / height can be 2 times or more than normal levels, an average of 133.19 mg / dl. Increased urea level increases influenced by several factors, including sex, age, indications such as supplements, medications and diabetes mellitus. Urea levels after hemodialysis average 39.74 mg / dl resulting in a decrease in urea levels before and after hemodialysis 70,16%.

EFFECT OF INTRADIALYTIC EXERCISES ON CLINICAL OUTCOME AMONG PATIENTS UNDERGOING MAINTENANCE HEMODIALYSIS

Background- Although it is widely accepted that exercise is beneficial in patients with end-stage renal disease as in the general population, it is not easy to incorporate exercise programs into routine clinical practice. objectives: To determine the effect of intradialytic exercises on clinical outcome among patients undergoing maintenance hemodialysis and to find the association of clinical outcome with selected socio personal and clinical variables. Material and Method: One group pretest posttest design carried out among 30 patients who fulfilled the selection criteria were consecutively selected from dialysis unit of a tertiary care unit. The tools used were socio personal and clinical data sheet, Urea reduction ratio sheet, Pittsburgh sleep quality index, fatigue severity rating scale and muscle cramp assessment tool.Results:After intradialytic exercises urea reduction ratio was improved significantly from 64.27 ± 9.10 to 68.47 ±7.33, Pittsburgh sleep quality index score decreased significantly from 10.40 ± 4.17 to 8.43 ± 4.67, fatigue severity score decreased significantly from 43.03 ± 15.14 to 28.93± 16.56 and muscle cramp severity score significantly decreased from 2.13± 1.33 to 1.77±1.35. Intradialytic exercises were found to be effective in improving clinical outcome of patients undergoing maintenance hemodialysis. No statistically significant association was found between clinical outcome of dialysis and selected socio personal and clinical variables.

Differences between the Incident and Prevalent Hemodialysis Patients in Egypt

Background and Aim: The number of patients on hemodialysis (HD) increases continuously. The HD population is usually divided into early and late HD patients according to the duration of HD, that are known as incident and prevalent groups. Still, there is a debate about the exact definition of both the incident and prevalent groups. Furthermore, predictors of death of both of these groups are not yet identified, especially in Egyptian HD patients. We aimed to compare between the incident and prevalent HD patients as well as to define predictors of mortality among each of these groups. Study Design and Methodology: This prospective multicenter study was started in June 2016, comprising 2123 HD patients recruited from twenty-five Egyptian HD centers. Patients were classified according to HD duration into two groups: Incident group including patients with HD duration equals to or less than 6 months, and a prevalent group including patients who had been maintained on HD for more than 6 months. All patients were observed for one and half years and their demographic data, laboratory findings and mortality events were recorded. Results: In comparison to the prevalent group, the incident HD patients showed significantly lower hemoglobin, serum albumin, urea reduction ratio, serum phosphorus, and serum ferritin but higher average erythropoiesis stimulating agents (ESA) dose. There was significantly a higher number of patients with hypertension in the incident group, while there was no significant difference in diabetes mellitus or ischemic heart disease in both groups. There were a higher number of patients with positive hepatitis C virus antibodies and hyperparathyroidism in the prevalent group. By the end of the study, the mortality frequency was found to be significantly higher in the incident than the prevalent groups. Older age and corrected serum calcium were significant predictors of mortality in the total studied group as well as the prevalent group. However, no significant predictors of mortality could be detected among the incident group. Conclusion: The incident HD group tends to show higher frequency of hypertension, laboratory findings suggestive of malnutrition as well as higher frequency of mortality with different pattern of mortality predictors compared to the prevalent group.

Intermittent hemodiafiltration as a down-step transition therapy in patients with acute kidney injury admitted to intensive care unit who initially underwent continuous venovenous hemodiafiltration

Background/Aims: Continuous renal replacement therapies (CRRT) are initially employed in patients with acute kidney injury (AKI) in ICU setting. After the period of serious illness, hemodialysis is usually used as a mode of transition from CRRT. Intermittent hemodiafiltration (HDF) is not commonly applied in this scenario. Objectives: To evaluate the feasibility of using HDF as transition therapy after CVVHDF in critically patients with AKI. Methods: An observational and prospective pilot study was conducted in ICU patients with dialysis-requiring AKI. Patients were initially treated with CVVHDF and, after medical improvement, those who still needed renal replacement therapy were switched to HDF treatment. Results: Ten Patients underwent 53 HDF sessions (mean of 5.3 sessions/patient). The main cause of renal dysfunction was sepsis ( N = 7; 70%). The APACHE II mean score was 27.6 ± 6.9. During HDF treatment, the urea reduction ratio was 64.5 ± 7.5%, for β-2 microglobulin serum levels the percentage of decrease was 42.0 ± 7.8%, and for Cystatin C was 36.2 ± 6.9%. Five episodes of arterial hypotension occurred (9.4% of sessions). There were 20 episodes of electrolytic disturbance (37.7% of sessions), mainly hypophosphatemia. No pyrogenic or suggestive episode of bacteremia was observed. Conclusion: Hemodiafiltration was safe and efficient to treat critically ill patients with acute kidney injury during the transition phase from continuous to intermittent dialysis modality. Special attention should be paid regarding the occurrence of electrolytic disturbance, mainly hypophosphatemia.

Performance of a novel dialyzer containing a fluorinated polyurethane surface-modifying macromolecule in patients with end-stage kidney disease

Background By inhibiting the adsorption of protein and platelets, surface-modifying macromolecules (SMMs) may improve the hemocompatibility of hemodialyzers. This trial aims to assess the performance and safety of a novel dialyzer with a fluorinated polyurethane SMM, Endexo™, blended into the membrane during manufacturing. Methods This prospective, sequential, multicenter, open-label study enrolled adults prescribed thrice-weekly hemodialysis. After completing 12 hemodialysis sessions with an Optiflux ® F160NR dialyzer , patients received 38 sessions with the dialyzer with Endexo. Evaluated parameters included the extent of removal of urea, albumin, and β2-microglobulin (β2M), as well as complement activation.Results Twenty-three patients received 268 hemodialysis treatments during the Optiflux period, and 18 patients continued on to receive 664 hemodialysis treatments during the Endexo period. Mean treatment times (208 vs 205 min), blood flow rates (447.7 vs 447.5 mL/min), dialysate flow rates (698.5 vs 698.0 mL/min), urea reduction ratio (82% vs 81%) and spKt/V (2.1 vs 1.9) were comparable for the Endexo and Optiflux periods, respectively. No overt complement activation was observed. Both dialyzers were associated with comparable mean increases in serum albumin levels from pre- to post- hemodialysis (Optiflux: 7.9%; Endexo: 8.0%). The corrected mean β2M removal rate was 47% higher during the Endexo period (67.73%). Three serious adverse events were reported, none of them device-related. Conclusions The performance of the novel dialyzer with Endexo was generally comparable to the Optiflux dialyzer, while exhibiting a higher β2M removal rate. Additional studies are needed to determine whether this novel dialyzer can be incorporated into heparin-free hemodialysis approaches.

PENGARUH RANGE OF MOTION INTRADIALISIS TERHADAP UREA REDUCTION RATIO PADA PASIEN HEMODIALISA

Hemodialisa merupakan terapi pengganti ginjal yang bertujuan membuang sisa pembongkaran tubuh melalui mesin dialisis. Namun, banyak pasien dialisis mengalami gejala seperti kelemahan, keletihan, dan kurang berenergi. Hal ini dapat disebabkan oleh beberapa faktor, salah satunya adekuasi hemodialisa yang kurang efektif. Adekuasi hemodialisa merupakan indikator keberhasilan dialisis yang dapat dinilai dengan urea reduction ratio (URR). Range of motion (ROM) intradialisis adalah salah satu intervensi keperawatan yang mampu meningkatkan bersihan sisa pembongkaran tubuh. Penelitian ini bertujuan untuk mengidentifikasi pengaruh ROM intradialisis terhadap urea reduction ratio pada pasien hemodialisa. Jenis penelitian ini menggunakan quasi experiment, dengan rancangan pre – post test with control group yang melibatkan 32 responden melalui teknik consecutive sampling. Analisis statistik dalam penelitian ini menggunakan uji Mann Whitney. Hasil penelitian menunjukkan tidak ada pengaruh ROM intradialisis terhadap urea reduction ratio pada pasien hemodialisa (p = 0.955; α = 0.05). Pada dasarnya latihan intradialisis yang dilakukan 2 bulan atau lebih dengan durasi 30 menit selama 3 kali seminggu secara rutin dapat mempengaruhi urea reduction ratio. Untuk penelitian selanjutnya, diharapkan intervensi ini tidak hanya dilakukan dalam satu kali pengamatan sehingga akan memberikan hasil yang optimal.

Adequacy of Hemodialysis and Its Associated Factors among Patients Undergoing Chronic Hemodialysis in Dar es Salaam, Tanzania

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 <10 g/dl received significantly inadequate hemodialysis dose as compared to patients with hemoglobin ≥10 g/dl by 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 <1.4 m2, and hemoglobin level of <10 g/dl were associated with an inadequate delivered dose of hemodialysis in the univariate analysis but not in the multivariate analysis. This study can increase awareness about the importance of measuring hemodialysis adequacy and giving the correct hemodialysis dose to achieve the intended benefit.

Frequency Frequency of adequate haemodialysis at haemodialysis unit Nishtar Hospital Multan.

This adequacy of HD is judged by formulas like Urea Reduction Ratio (URR) and Kt/V. Adequate hemodialysis is vital for restoration of body homeostasis towards normal and to avoid potential complications. The aim of the current study was to determine the frequency of adequate hemodialysis at hemodialysis center at Nishtar Hospital Multan. Objectives: The objective of this study was to determine the frequency of adequate hemodialysis at hemodialysis unit Nishtar Hospital Multan. Study Design: Cross-sectional Study. Setting: Department of Medicine, Medical Unit-IV, Nishtar Hospital, Multan. Duration: Six months from 18/01/2018 to 17/07/2018. Material and Methods: This study involved 174 patients undergoing hemodialysis at least 3 sessions in a week for the previous 6 months at hemodialysis center Nishtar Hospital Multan. A formal written consent was taken from every patient. Patient’s demographic details along with duration of disease, calculated Kt/V and adequacy of hemodialysis (Kt/V≥1.2) were recorded in the attached proforma. Data obtained during study were analyzed by using SPSS version 24. Mean and standard deviation were estimated for numerical variables; age, duration of disease, Kt/V values. Frequency and percentage were calculated for categorical variable i-e gender, diabetes mellitus, hypertension, adequate hemodialysis. Stratification was done for parameters like age, gender, diabetes, hypertension and duration of disease. After stratification was done t-test ws applied and value ≤.05 was considered as significant. Results: The age range of our study population was 40-70 years having a mean of 54.24±8.39 years. It included 113 (64.9%) male and 61 (35.1%) female suffers of ESRD. 75 (43.1%) patients were diabetic while 116 (66.7%) patients were hypertensive. The time lapse from diagnosis to dialysis ranged from 6-18 months with a mean of 12.11±3.55 months. The Kt/V value ranged from .80 to 1.90 with a mean of 1.45±.27. Taking a cut-off value of Kt/V≥1.2 for adequate hemodialysis, the frequency of adequate hemodialysis was found to be 85.1% (n=148). Conclusion: The frequency of adequate hemodialysis was found to be 85.1% among ESRD patients undergoing hemodialysis at least 3 times a week for the past 6 months at hemodialysis center Nishtar Hospital Multan. It indicates that Dialysis centre in Nishtar hospital is working effectively.

PENGGUNAAN DIALIZER RE-USE PADA PASIEN HEMODIALISA TERHADAP NILAI UREA REDUCTION RATIO (URR) DI RUMAH SAKIT ADVENT BANDUNG

Pendahuluan: Pemakaian ulang dializer (Dializer Re-Use) merupakan suatu tindakan pemakaian dializer lebih dari satu kali pada pasien yang sama. Dializer setetah digunakan dalam proses hemodialisis dibersihkan dan dilakukan sterilisasi baik menggunakan mesin maupun manual. Pemakaian dializer re-use di Indonesia mulai sekitar tahun 1998 sebagai dampak dari krisis moneter yang melanda Indonesia. Pemakaian dializer secara ulang dapat menurunkan tingkat efektif karena berbagai alasan, diantaranya adalah terjadi penurunan nilai Urea Reduction Ratio (URR) sehingga tidak optimal bila dipakai untuk proses hemodialisis. Tujuan: Penelitian ini bertujuan untuk mengetahui apakah dializer reuse ke-7 masih layak digunakan kembali dengan hasil yang efektif. Metode: Desain penelitian yang digunakan adalah pra-experimental dengan disain one group pretest-posttest. Populasi penelitian ini adalah pasien yang menjalani terapi hemodialisa di Rumah Sakit Advent Bandung, sampel yang digunakan berjumlah 15 pasien yang di pilih secara purposive sampling. Hasil: Hasil penelitian ini menunjukan bahwa nilai rata-rata Urea Reduction Ratio pada dializer re-use ke-2 yaitu 71.00. Hasil nilai rata-rata Urea Reduction Ratio pada dializer re-use ke-7 adalah 67.40. Sehingga dapat disimpulkan adanya perbedaan pada nilai hasil Urea Reduction Ratio dengan nilai thitung adalah 1.020 dan nilai ttabel adalah 1.771 yang artinya 𝐻0 di tolak dan 𝐻𝛼 diterima. Nilai hasil Urea Reduction Ratio dari pamakaian dializer re-use ke-7 masih di atas dari standart ≥ 65% yang berarti dializer pemakaian ke-7 masih dapat digunakan oleh pasien yang melakukan terapi hemodialisa. Diskusi: Bagi peneliti selanjutnya diharapkan untuk melakukan penelitian yang berkaitan dengan dializer re-use yang dilihat dari hasil Urea Reduction Ratio dengan perancu (jenis kelamin, usia, lama menjalani terapi hemodialisa) sehingga dapat menambah khazanah keilmuan yang lebih luas dan mendalam. Kata kunci: dializer, hemodialisa, Urea Reduction Ratio