hemodialysis

摘要： BACKGROUND Secondary hyperparathyroidism,renal osteodystrophy,and cardiovascular adverse events can occur if long-term hyperphosphatemia is not corrected,leading to the adverse prognosis of patients with chronic renal failure.Besides the use of phosphorus binders,clinical control measures for hyperphosphatemia in these patients should also incorporate diet control.AIM To observe doctor-led intensive diet education effects on health-related quality of life in patients with chronic renal failure and hyperphosphatemia.METHODS We assessed 120 patients with hyperphosphatemia and chronic renal failure on hemodialysis admitted to our hospital(July 2018 to March 2020).The control group(n=60)was given routine nursing guidance,and the observation group(n=60)was given doctor-led intensive diet education.The changes in EQ-5D-3L scores,disease-related knowledge,and compliance scores before intervention and 3 and 6 mo after intervention in the two groups were recorded.The levels of serum parathyroid hormone(iPTH),calcium(Ca),phosphorus(P),calciumphosphorus product(Ca×P),serum creatinine(Scr),and blood urea nitrogen(BUN)before intervention and 3 and 6 mo after intervention in the two groups were assessed along with patient satisfaction.RESULTS There was no significant difference in blood iPTH,Ca,P,Ca×P,Scr,or BUN levels between the groups before intervention.After 3 and 6 mo of intervention,the blood iPTH,Ca,P,and Ca×P levels in the two groups decreased gradually(P<0.05),but there were no significant differences in Scr or BUN.The blood iPTH,Ca,P,and Ca×P levels in the observation group were lower than those in the control group(P<0.05).The satisfaction rate in the observation group after 3 mo was 93.33%and after 6,90.00%,which was high compared with the 80.00%and 71.67%,respectively,in the control group(P<0.05).There was no significant difference in EQ-5D-3L score between the two groups before intervention.After 3 and 6 mo of intervention,the visual analogue scale score of the two groups increased gradually(P<0.05);and the scores of action ability,self-care,daily activities,pain and discomfort,and anxiety and depression decreased gradually(P<0.05).The overall EQ-5D-3L score in the observation group was better than that in the control group(P<0.05).There was no significant difference in diseaserelated knowledge or compliance scores between the groups before intervention.After 3 and 6 mo of intervention,the scores of disease,diet,and medication knowledge and compliance in the two groups increased gradually(P<0.05).The scores of disease-related knowledge and compliance were higher in the observation group than in the control group(P<0.05).CONCLUSION Doctor-led intensive diet education can improve patient satisfaction and the quality of life in patients with chronic renal failure and hyperphosphatemia and promote low-phosphorus diet behavior.

摘要： Introduction: Wide adoption of vaccination is the key to successfully control the spread of coronavirus 2019 (COVID-19). Objective: To evaluate the acceptability of COVID-19 vaccines and associated factors in hemodialysis patients in Lomé. Patients and Method: Cross-sectional study was conducted from August 1 to 31, 2021 in hemodialysis patients at the Sylvanus Olympio University Hospital to obtain their opinion on the anti-COVID-19 vaccination. Results: One hundred and twenty-three patients on regular hemodialysis were interviewed;their mean age was 45 years [37 - 55.5 years]. The average number of years patients were on dialysis was 3 years [2 - 5 years]. The general opinion on vaccination was mostly unfavorable (59.3%). Reasons given included: doubts about the quality of the vaccine (49.6%), fear of side effects (51.2%), alarming messages on social networks (36.5%) and doubts about the efficacy of the vaccines (33.3%). Only half of the patients in favor of vaccination were already vaccinated at the time of the survey. The main motivations for getting vaccinated were dominated by: fear of developing a severe form of COVID-19 if infected (32.5%), frailty due to age (19.5%) and medical history (15.4%). Social networks (72.3%), television (60.1%), family and friends (55.2%) were the main sources of information for patients about COVID-19 vaccination. Conclusion: Hemodialysis patients are mostly septic to anti-COVID-19 vaccination.

摘要： Introduction: Infective endocarditis (IE) is a complication associated with high mortality in chronic hemodialysis patients. The aim of our study is to describe the clinical, radiological, microbiological characteristics, and risk factors of mortality in hemodialysis patients with infective endocarditis. Methods: A retrospective study from November 2019 to November 2021 including hemodialysis patients with IE hospitalized in Ibn Sina hospital center in Rabat. Results: Eighteen hemodialysis patients were included. Mean age was 49.5 ± 18 years, sex ratio was 0.8. Catheters were the access sites most commonly used (72.3%). Median duration of hemodialysis was 12 [6;24] months. Staphylococcus species is major causative bacteria in 60%. The mitral valve was the most commonly affected (44%). Frequent complications including valve insufficiency (50%), septic embolism (66.7%). Four patients underwent surgery and eight died during hospitalization (44.5%). Mitral localization of vegetation was the only factor significantly associated with mortality in our study (P < 0.05). Conclusion: The catheter was the most commonly used access site compared to the arteriovenous fistula. This confirms that it’s the vascular access of choice for his low rate of infectious complication compared to the catheter.

摘要： Hyperkalemia,usually associated with predisposing chronic diseases as heart failure(HF),severe kidney disease or diabetes mellitus(DM),[1]is defined as an elevation of potassium concentration more than 5.5 mmol/L,[2].

摘要： BACKGROUND Since the beginning of corona virus disease 2019(COVID-19)pandemic,there has been a widespread use of remdesivir in adults and children.There is little known information about its outcomes in patients with end stage renal disease who are on dialysis.AIM To assess the clinical outcomes with use of remdesivir in adult patients with end stage kidney failure on hemodialysis.METHODS A retrospective,multicenter study was conducted on patients with end stage renal disease on hemodialysis that were discharged after treatment for COVID-19 between April 1,2020 and December 31,2020.Primary endpoints were oxygen requirements,time to mortality and escalation of care needing mechanical ventilation.RESULTS A total of 45 patients were included in the study.Twenty patients received remdesivir,and 25 patients did not receive remdesivir.Most patients were caucasian,females with diabetes mellitus and hypertension being the commonest comorbidities.There was a trend towards reduced oxygen requirement(beta=-25.93,X^(2)(1)=6.65,P=0.0099,probability of requiring mechanical ventilation(beta=-28.52,X^(2)(1)=22.98,P<0.0001)and mortality(beta=-5.03,X^(2)(1)=7.41,P=0.0065)in patients that received remdesivir compared to the control group.CONCLUSION Larger studies are justified to study the effects of remdesivir in this high-risk population with end stage kidney disease on dialysis.

摘要： Background:Chronic kidney disease(CKD)patients undergo hemodialysis to treat their condition.But this treatment comes with its own set of problems like psychiatric and mental disorders.Many of these patients experience low self-esteem,stress,depression,and anxiety,making it difficult to cope with their disease.CKD is a global general medical issue.Psychiatric disorders have been reported in more than 50% of end-stage kidney disease patients undergoing hemodialysis.Unfortunately,their attending doctors and nurses often overlook these psychological problems.Furthermore,the non-psychiatric medication prescribed may not help alleviate the symptoms of emotional distress.Objective:The article aimed to explore and review the literature concerning the psychological impact of CKD and hemodialysis on patients with CKD.Method:A literature review based on previous studies and assessments derived from international databases(PubMed,Medline and Scopus)related to people's psychological problems with CKD.The data collection was conducted from 24 November 2021 to 10 February 2022.Also,was used keywords such as hemodialysis,kidney failure,psychological disorders or factors,economic status,social status,and quality of life.Conclusion:Psychiatric disorders in patients with CKD and undergoing hemodialysis are ignored,negatively impacting their quality of life.Awareness of CKD is lacking among physicians and general public health because the worldwide burden increases.The disease's complexity and chronic nature affect patients'quality of life with CKD and their health.Therefore,nephrology nurses play an essential role in ensuring effective nursing intervention and psychological support of patients with CKD during hemodialysis therapy.

摘要： A 74-year-old man with terminal chronic kidney disease, under hemodialysis and with residual diuresis, was admitted due to myalgia, arthralgia, fever and pyuria in the previous 10 days. The patient had a recent diagnosis of high-grade non-invasive bladder cancer and was doing weekly BCG intravesical administrations. The symptoms started three days before the fifth administration. He had done cefixime as an outpatient and started piperacillin-tazobactam on hospital admission, but the fever persisted, and there was no bacterial isolation in urine or blood culture. On the tenth and seventeenth day after the last BCG intravesical administration Mycobacterium bovis was still isolated in the urine culture. The diagnosis of BCGitis was made and treatment was started, with a good response. Forty days after the last administration and under treatment, the culture remained positive for Mycobacterium bovis in the urine. We raise the question about the safety of BCG administration in patients with residual diuresis.

摘要： BACKGROUND Acute methanol poisoning(AMP)is a systemic disease that mainly affects the central nervous system and is characterized by ocular damage and metabolic acidosis.If appropriate treatments are inadequate or delayed,the mortality can exceed 40%.As the most serious complication,cerebral hemorrhage is rare with reported prevalence of 7%-19%.CASE SUMMARY A 62-year-old man drank liquor mixed with 45%methanol and 35%alcohol.His vision blurred 10 h later and he fell into coma in another 9 h.Serum toxicological tests were performed immediately,and continuous renal replacement therapy(CRRT)was carried out as the lactic acid exceeded 15 mmol/L and blood pH was 6.78.In addition,the toxicological report revealed 1300.5μg/mL of methanol in serum and 1500.2μg/mL in urine.After 59 h of CRRT,the methanol level decreased to 126.0μg/mL in serum and 151.0μg/mL in urine.However,the patient was still unconscious and his pupillary light reflex was slow.Computed tomography showed hemorrhage in the left putamen.After 16 d of life support treatment,putamen hemorrhage developed into diffuse symmetric intracerebral hemorrhage.In the end,his family gave up and the patient was discharged,and died in a local hospital.CONCLUSION Cerebral hemorrhage requires constant vigilance during the full course of treatment for severe cases of AMP.

摘要： Non-small-cell lung cancer(NSCLC)causes significant mortality worldwide.Patients with chronic renal failure have an increased risk of developing lungcancer.NSCLC Patients with chronic renal failure undergoing hemodialysis(HD)often exhibit poor performance,and chemotherapy is generally contraindicated.Oral epidermal growth factor receptor(EGFR)-tyrosine kinase inhibitors(TKIs)are effective treatment agents for NSCLC patients.However,the benefits andadverse effects of EGFR-TKIs in NSCLC undergoing HD are known.There are noclinical studies on the effects of EGFR-TKIs on NSCLC patients undergoing HD.We reviewed all previous case reports about EGFR-TKIs in NSCLC patientsundergoing HD.It is difficult to design studies about the effects of EGFR-TKIs inpatients undergoing HD,and this review is quite important.EGFR-TKIs are welltolerated in patients undergoing HD.The main routes of elimination of EGFRTKIsare metabolism via the liver,and renal elimination is minor.Therecommended doses and pharmacokinetics of these EGFR-TKIs for patientsundergoing HD are similar to those for patients with normal renal function.Theplasma protein binding of EGFR-TKIs is very high,and it is not necessary toadjust the dose after HD.In conclusion,EGFR-TKIs are effective and welltolerated in patients undergoing HD.

摘要： BACKGROUNDMost cancer patients are accompanied by anemia, which will be more seriouswhen combined with end-stage renal disease (ESRD). At present, cancer-relatedanemia and renal anemia treatments mainly include erythropoiesis-stimulatingagents (ESAs), iron supplementation, and blood transfusion, but their effects areoften poor with several safety concerns. We have used roxadustat to treat anemiain a cancer patient with ESRD and achieved a successful outcome for the firsttime.CASE SUMMARYA 64-year-old man was diagnosed with right renal cancer (clear cell renal cellcarcinoma). He did not receive surgery or radiotherapy before admission. He wastreated with oral soltan (sunitinib malate) on April 18, 2017. During oral chemotherapy,he had numerous complications, including anemia, hypertension,thyroid hypofunction, skin pigment loss, and renal function deterioration. At last,he progressed to ESRD and began hemodialysis treatment. We initially treated thepatient with high-dose ESAs, iron supplementation, adequate dialysis, and evenblood transfusion, but his anemia did not improve. Roxadustat is a newlydeveloped drug for renal anemia treatment, but not for cancer-related anemia, letalone to treat anemia in cancer patients with ESRD. We prescribed oral roxadustatto the patient. After a period, his hemoglobin gradually increased. He did nothave obvious discomfort symptoms, and his tumor did not progress significantly.CONCLUSIONOral roxadustat could achieve good results in treating anemia in cancer patients with ESRD.