Introduction: Toxoplasma gondii is a protozoan parasite which causes a zoonotic disease called toxoplasmosis. The main purpose of this study was to investigate the seropositivity rate of specific antibodies “anti-T. gondii IgG and IgM antibodies using enzyme-linked immunosorbant assay” in hemodialysis patients attending the Teaching Hospital, Baquba City, Diyala Province, Iraq and to determine the potentially preventable risk factors. Methods: Eighty five hemodialysis patients with kidney failure and 85 healthy volunteers were selected for this study. Results: The percentage of seropositivity for IgG antibodies in patients with hemodialysis was 54.1% while it was 38.2% among the healthy control subjects and the difference was significant between the two groups [Odds Ratio (OR)= 1.8586; 95% Confidence Interval (CI)= 1.0097-3.4212; P= 0.0465]. In contrast, IgM antibodies were not detected in any of the patients or the healthy subjects. Many risk factors were identified, including contact with cats (OR, 2.62; P= 0.0398); eating undercooked meat (OR, 2.6, P= 0.0439); drinking unfiltered water (OR, 2.86, P= 0.0433); and eating outside the home (OR, 5.6, P= 0.0024) as risk factors for toxoplasmosis. However, smoking was not found to be as a risk factor for toxoplasmosis (OR, 2.1, P= 0.1204). Conclusion: The results of the present study revealed a high prevalence of toxoplasma infection in hemodialysis patients and therefore, we recommend monitoring these patients for T. gondii infection to minimize the spreading of toxoplasmosis via treating the seropositive patients with the available commercial drugs.
Hemodialysis

Introduction: Poor nutritional status is prevalent among hemodialysis patients, with limited studies available on how it is being influenced by other factors in the local context. The current study aimed to determine the nutritional status and its associated factors among hemodialysis patients. Methods: This was a study undertaken in a total of 455 hemodialysis patients (256 men and 199 women). The main outcome measure was Malnutrition Inflammation Score (MIS), which was utilized to identify nutritional and inflammatory status of the hemodialysis patients. Other evaluation tools included anthropometry and biochemical measurements as well as dietary assessment. Results: A high proportion of hemodialysis patients were malnourished (64.4%) and presented with inflammation (67.5%). Using multiple linear regression analysis, factors contributing to malnutrition were older age, lower lean body mass, higher interdialytic weight gain (IDWG), inadequate intakes of energy and protein, as well as presence of comorbidities and inflammation. Conclusion: The presence of malnutrition and inflammation were prevalent among hemodialysis patients. Several determinants of poor nutritional status of hemodialysis patients were modifiable and should be recognized while formulating and implementing appropriate intervention plans for this vulnerable group.
Hemodialysis

Introduction: Health-related quality of life (HRQOL) is one of the main indicators of health and wellbeing among dialysis patients which has attracted mounting interest in recent years in the initiation of intervention measures. Thus, this study aimed to determine the correlations between socio-demographic factors and medical characteristics with HRQOL among elderly on maintenance hemodialysis (HD). Methods: A cross-sectional study was conducted in nine HD centers in Selangor. Socio-demographic data and HRQOL were assessed using structured questionnaire and Kidney Disease Quality of Life Instrument (KDQOL-36), respectively whilst medical profile and laboratory data were collected from subjects’ medical record. Results: The mean age of subjects was 67±6 years where majority (57%) of the subjects was on maintenance HD for less than 5 years. The mean physical component summary and mental component summary scores were 33.89±11.83 and 50.23±8.88, respectively. Symptoms/problems subscale, effects of kidney disease on daily life subscale and burden of kidney disease subscale scores were 73.37±17.01, 72.63±19.74 and 54.62±30.42, respectively. There was a significant correlation between serum sodium with physical component summary (r=0.237, p<0.01) and symptoms/problems subscale (r= 0.245, p<0.01). Conclusion: Subjects perceived their mental health better than physical health but felt burdened by kidney disease the most. Serum sodium was found to be positively associated with physical functioning and symptoms/problems subscales. There is a need for routine assessment on HRQOL and appropriate intervention to enhance the quality of life among elderly on HD.
Quality of life ; Hemodialysis

A prospective study on a group of 129 patient was echocardiographical compared with a group of 109 normal subjects: based on Framingham criteria, the prevalence of LV hypertrophy were 88.4%, LV dilatation - 58.9% and systolic dysfunction - 21.7%. To determine the influence of haemodyalysis on echo-Doppler indices of the heart, 58 patients were studied by Doppler-echocardiography immediately before and after haemodialysis. This procedure resulted in immediate alterations of the heart: decrease in blood pressure, increase in heart rate. Left ventricular diameters and volumes decreased significantly whereas, the systolic function, cardiac output and index increased. Haemodialysis elicited marked changes in the left ventricular filling pattern: mitral peak E, peak A, ratio E/A decreased and pulmonary vein flow S/D ratio increased. The results provide evidence for the pronounced preload-dependence of morphologic, functional and hemodinamic indices of the heart.
Hemodialysis Solutions ; Ultrasonics ; Renal Dialysis

Accelerated atherosclerosis has come to pose a great threat to the lives of hemodialysis patients. In the present study, to determine the characteristics of atherosclerosis in long-term survivors on maintenance hemodialysis (mean age : 57±3 years, mean duration of hemodialysis : 279±11 months), the reference to clinical, biochemical and physiological parameters pertaining to atherosclerosis were examined and the results were compared with those in age-matched short-term hemodialysis patients (mean age : 55±2 years, mean duration of hemodialysis : 23±3 months). Although hypertension is regarded as one of cardiovascular risk factors together with diabetes, smokings and hyperlipidemia, our study found that the incidence of hypertension was significantly lower in long-term survivors on hemodialysis (16.7%) than in short-term hemodialysis patients (83.3%). However, no significant differences in biochemiacal data and carotid artery intima-media thickness were found between the two groups of hemodialysis patients. Levels of pulse wave velocity (PWV) in both short-term hemodialysis patients (1912±165 cm/sec) and long-term survivors on hemodialysis (1627±97 cm/ sec) were significantly higher than those in age-matched healthy subjects (1382±44 cm /sec). The levels of PWV in long-term survivors on hemodialysis tended to be lower than those in short-term hemodialysis patients, although the difference was statistically not significant. These results suggest that atherosclerotic alterations have already advanced in non-dialyzed patients with end-stage renal disease. The relatively lower levels of PWV in long-term survivors on hemodialysis may reflect the higher incidence of cardiovascular-related complications in those patients with highly accelerated atherosclerosis who die or may drop out during hemodialysis treatment.
Hemodialysis ; Atherosclerosis ; Age, NOS ; month ; Cardiovascular

Recent studies showed that high biocompatibility and reduction of uremic toxin contributed to the improvement of freatment outcome in hemodialysis patients.Therefore, a high-flux membrane dialyzer, especially polysulfone (PS) membrane, was generally used in dialysis. However, it was suggested that the higher efficiency of reduction in uremic toxins might cause an increase in the albumin leakage through the dialyzer membrane during dialysis, resulting in a decrease in serum albumin concentration. In this study, we used two different dialyzer membranes with high biocompatibility, namely, ethylenevinylalcohol (EVAL) membrane and improved PS membrane with a very lower leakage of serum albumin. After using these two types of mambrane of six straight months, we examined the effect of each dialyzer membrane characteristic on the serum total protein and albumin concentration. The reduction rates of each uremic solute and serum total protein concentration were significantly higher. The serum albumin concentration and its rate of change with the passing of time tended to increase in the case of the PS membrane. But in the case of EVAL membrane, these values tended to decrease. These results suggested that the differences in the changes in the serum total protein and albumin concentration might result from the differences in the efficiency of the reduction of uremic toxins. Therefore, it is necessary to consider the usage of the dialyzer membrane with a higher reduction of uremic solutes and a lower leakage of serum albumin to add to the higher biocompatibility specially in hemodialysis patients with hypoproteinemia.
Membranes ; Concentration ; Reduction (chemical) ; Serum Albumin ; Hemodialysis

A strong earthquake (magnitude 6.8) off the Sea of Japan struck the Chuetsu area of Niigata Prefecture on July 16, 2007. By way of investigating the impact of the earthquake on the health of maintenance hemodialysis patients, we examined several biochemical parameters including nutritional markers and psychological stress markers and checked up on the incidence of earthquake-induced complications (heart failure and shunt obstruction). Blood samples were collected and the values of several biochemical parameters were measured. Incidences of clinical complications one, three and six months after the quake were scrutinized. Significant decreases in the nutritional markers and a significant increase in the incidence of complications were found one month after the quake. During this period, the supplies of electricity, city gas and water were completely recovered one after another. The significant changes in the nutritional levels and the incidence of complications coincided with the time of the complete recovery of these utilities. The levels of these parameters recovered and the incidence of complications reduced three months after the quake. However, the serum albumin level did not recover and remained significantly lower even six months after. The psychological stress markers increased significantly three months after. These suggested that there was the time lag between the decrease in the nutritional markers, the increase in the incidence of complications (1 month after earthquake) and the increases in the psychological stress markers (3 months after earthquake). We concluded that these findings provided important information for the total medical plan to maintain the physical and psychological states of hemodialysis patients in an earthquake- stricken district.
month ; Complications Specific to Antepartum or Postpartum ; Earthquakes ; incidence of cases ; Hemodialysis

Increasing medical knowledge and improved hemodialysis techniques have permitted longer survival in patients receiving hemodialysis. However, the risk of cardiovascular disease, which is mainly caused by atherosclerosis, substantially increases in proportion to the longer survival of hemodialysis patients. At present, cardiovascular disease is a major cause of morbidity and mortality. The present study was designed to investigate the relations between electrocardiographic abnormalities (e.g. ischemic change, left ventricular hypertrophy, arrhythmia and conduction block) and the progression of atherosclerosis, the atherosclerotic risk factors (e.g. diabetes, hypertension, hyperlipidemia and smoking) and aortic calcification in patients on maintenance hemodialysis. Pulse wave velocity (PWV) was used as the index of atherosclerosis. PWV levels were singficantly higher in ischemic change (1,993±99cm/s), left ventricular hypertrophy (2,103±120cm/s), arrhythmia (2,015±120cm/s), and condition block groups (2,014±119cm/s) than in the nomal group (1,627±69cm/s). Also, PWV levels corrected by diastolic blood pressure in all abnormal groups were significantly higher. Serum Creactive protein levels in all abnormal groups also tended to be higher than those in the normal group. With regard to atherosclerotic risk factors, the incidence of diabetes and hypertention tended to be higher in abnormal groups. Especially the incidence of hypertension was significantly higher in ischemic change (66.7%), left ventricular hypertrophy (50.0%) and conduction block groups (55.6%) than that in the normal group (16.7%). These results suggest that the electrocardiographic changes are related to the progression of atherosclerosis, and among atherosclerotic risk factors, hypertension most affects the electrocardiographic changes in patients on maintenance hemodialysis.
Hemodialysis ; Atherosclerosis ; seconds ; Ventricular hypertrophy ; Hypertension induced by pregnancy

PURPOSE: In this single repeated measures study, an examination was done on the effects of dialysate flow rate on dialysis adequacy and fatigue in patients receiving hemodialysis. METHODS: This study was a prospective single center study in which repeated measures analysis of variance were used to compare Kt/V urea (Kt/V) and urea reduction ratio (URR) as dialysis adequacy measures and level of fatigue at different dialysate flow rates: twice as fast as the participant’s own blood flow, 500 mL/min, and 700 mL/min. Thirty-seven hemodialysis patients received all three dialysate flow rates using counterbalancing. RESULTS: The Kt/V (M±SD) was 1.40±0.25 at twice the blood flow rate, 1.41±0.23 at 500 mL/min, and 1.46±0.24 at 700 mL/min. The URR (M±SD) was 68.20±5.90 at twice the blood flow rate, 68.67±5.22 at 500 mL/min, and 70.11±5.13 at 700 mL/min. When dialysate flow rate was increased from twice the blood flow rate to 700 mL/min and from 500 mL/min to 700 mL/min, Kt/V and URR showed relative gains. There was no difference in fatigue according to dialysate flow rate. CONCLUSION: Increasing the dialysate flow rate to 700 mL/min is associated with a significant nicrease in dialysis adequacy. Hemodialysis with a dialysate flow rate of 700 mL/min should be considered in selected patients not achieving adequacy despite extended treatment times and optimized blood flow rate.
Dialysis* ; Fatigue* ; Hemodialysis Solutions ; Humans ; Prospective Studies ; Renal Dialysis* ; Treatment Outcome ; Urea

BACKGROUND/AIMS: We investigated which dialysis unit blood pressure (BP) is the most useful for predicting home BP in patients undergoing hemodialysis (HD). METHODS: Patients undergoing HD who had been treated > 3 months were included in this study. Exclusion criteria were hospitalized patients with acute illness and changes in dry weight and anti-hypertensive drugs 2 weeks before the study. We used the dialysis unit BP recording data, such as pre-HD, intra-HD, post-HD, mean pre-HD, and post-HD (pre-post-HD), mean pre-HD, intra-HD, and post-HD (pre-intra-post-HD) BP. Home BP (the same period of dialysis unit BP) was monitored as a reference method during 2 weeks using the same automatic oscillometric device. Patients were asked to record their BP three times daily (wake up, between noon and 6:00 PM, and at bedtime). RESULTS: Significant differences were detected between home systolic blood pressure (SBP) and pre-HD, post-HD, and intra-HD SBP (p = 0.003, p = 0.001, p = 0.016, respectively). In contrast, no differences were observed between home SBP and pre-intra-post-HD and pre-post-HD SBP (p = 0.235, p = 0.307, respectively). Areas under the receiver operating characteristic curve for pre-intra-post-HD and prepost-HD SBP with 2-week home BP as the reference standard were 0.812 and 0.801, respectively. CONCLUSIONS: These results suggest that pre-intra-post-HD and pre-post-HD SBP had similar accuracy for predicting mean 2-week home SBP in HD patients. Therefore, pre-intra-post-HD and pre-post-HD SBP should be useful for predicting home SBP in HD patients if ambulatory or home BP measurements are unavailable.
Antihypertensive Agents ; Blood Pressure* ; Dialysis* ; Hemodialysis Units, Hospital ; Humans ; Hypertension ; Methods ; Renal Dialysis* ; ROC Curve