European Journal of Molecular & Clinical Medicine

Background: The intermittent hemodialysis (IHD) has been a useful renal replacement
therapy for critically ill patients.Pulmonary dysfunction in end-stage kidney disease has
been seen as a straight effect of circulating uremic toxins or a secondary effect of
volume overload, anemia, immune suppression, premature airway closure, ventilationperfusion
mismatching, severe mechanical loading, gas transfer defects, malnutrition,
electrolyte disorders, and/or acid/base imbalances.
Aim of the study: To study effect of Hemodialysis on pulmonary function in patients
with end stage renal disease.
Materials and methods: The present study was conducted at Department of Medicine,
D. Y. Patil Hospital, Kolhapur, Maharashtra.We sampled all the hemodialysis patients
from four selected units that met the inclusion and exclusion criteria.
Results: A prospective observational study was conducted at Department of Medicine,
D. Y. Patil hospital, Kolhapur. Total 103 study subjects were selected for study who
were undergoing regular hemodialysis in current institution. Male study subjects were
53 (51.46%) while females were 50 (48.54%). Among study subjects 103 subjects, 57
(55.34%) in stage IV followed by 46 (44.66%) were in stage V. Out of 103 subjects, 46
(44.66%) were doing hemodialysis since last 1 to 3 years followed by 41 (39.81%) of
subjects doing hemodialysis for previous 6 to 12 month. Conclusion: According to our
findings, it can be concluded that patients with ESRD who receive hemodialysis may
have a better pulmonary function after dialysis sessions, which is significant for FVC,
FEV1, FEV1/ FVC ratio and PEFR.

Background: Chronic Kidney Disease (CKD) is a Health-Related Quality of Life
(HRQOL) deteriorating disease which is not only a public health but also a socioeconomic
problem of a country. The aim of this study to assess the health-related
quality of life among patients with chronic kidney disease who are on maintenance
dialysis.
Materials& Methods: A hospital based cross sectional study done on 100 patients with
chronic kidney disease on maintenance dialysis at Holy Family Hospital, Okhla, New
Delhi, Indiafor one year period. The techniques used for data collection were interview
and record analysis. Assessment of health-related quality of life was done by using the
KDQOL-SF 1.3 also includes a 36- item health survey (RAND 36- items Health Survey
1.0 or SF-36). Data were analysed using descriptive and inferential statistics.
Results: Among 100 patients with chronic kidney disease 74% were above the age of 50
years. Males (63%) are more affected than female (37%). Majority of them were hailed
from urban area (70%). Nearly 2/3rd of them (67%) have been undergoing dialysis for
more than 3 years. Diabetes and hypertension were the leading cause of CKD. The
overall HRQOL of CKD patients on maintenancedialysis is 35.65±7.19.The HRQOL
related to mental health composite(26.12±6.78) is the worst affected followed by kidney
disease problem composite(31.56±4.63), physical health composite(34.38±5.60),and
patient satisfaction (50.54±11.78).
Conclusion: Monitoring HRQOL is an important indicator to identify impact of CKD
onphysical, psychological and social wellbeing. So, there is a need for the health
caresystem to develop appropriate evidence-based practice guideline for the assessment
and management of HRQOL on CKD.

Introduction: Chronic kidney disease (CKD) is associated with a complex array of cutaneous
manifestations caused either by the disease or by treatment. Cutaneous manifestations in chronic kidney
disease are polymorphic and diverse. Most patients with severe CKD progress to end stage renal disease
(ESRD) with significant morbidity and mortality. The Aim of our study was to evaluate the prevalence
and pattern of cutaneous disorders among patients with chronic kidney disease.
Materials and Methods: One hundred patients of chronic kidney disease above the age of 18 years with
dermatological manifestation were enrolled in the study. A detailed physical examination and
dermatological examination was done and findings recorded. Relevant investigations including complete
haemogram, diabetic profile, ANA, renal function tests, Liver function tests, electrolytes, viral markers,
serum calcium, phosphorous and PTH (parathormone) levels, KOH mount, culture & sensitivity, woods
lamp examination, biopsy was done if indicated.
Results: In our study we included 100 patients of CKD with cutaneous manifestations. The most
common cause of CKD in our study was found to be diabetic nephropathy which was seen in 47% (n=47)
patients. Pruritus was the most common dermatological manifestation seen in 73% (n=73) of the total
study population followed by xerosis in 68% (n=68). More than 50% of the study population had more
than one dermatological manifestations. Nail and hair changes was seen in 43% and 58% respectively.
Conclusion: Patients with end stage renal disease (ESRD) may present with variety of skin abnormalities
and the most common being pruritus and xerosis as seen in our study. An inter-disciplinary approach
involving dermatologists and nephrologists is essential to improve the quality of life of patients with
ESRD.

Background: Renalase is a blood-secreted protein produced only by the kidney; its
blood level approximately 3–5 μg/ml. The Left ventricular hypertrophy (LVH) is
defined by an augmented left ventricular mass that may be measured via
echocardiography or magnetic resonance imaging (MRI). The aim of the present
study was to study whether Renalase is a marker or has a potential role in
developing myocardial hypertrophy in CKD patients under hemodialysis (HD)
treatment.
Patients and methods: To achieve this target, 90 patients on maintenance HD were
incorporated in the present study.
Results: The mean renalase levels were 61.7±67.5 ng/mL in HD patients. The cutoff
value of Renalase was >57.9 ng/ml with a sensitivity of 92.3% and a Specificity of
84.0%. The mean LVMI of the studied dialysis patients was 138 g/m2. The majority
of cases were severely abnormal (60%). There was a statistically significant
difference between the age groups and the LVMI among dialysis patients. The level
of Renalase was significantly increased with the moderately and severely abnormal
LVMI among dialysis patients. The present study disclosed statistically significant
relations between the duration of dialysis and Renalase, HDL, CRP, and LVMI.
There were significant relations between the serum renalase and s. creat, bl. Urea,
Ph, LVMI and dialysis vintage. Also, there were significant positive relations
between LVMI and Hb, CRP, and dialysis vintage.
Conclusion: Renalase could be a novel predictive biomarker in the assessment of
LVH, which is closely associated with the increased risk of death in HD patients.

Introduction: Arteriovenous fistula (AVF), permanent catheter (PC), and vascular graft are three vascular access types used for hemodialysis (HD) procedure. Due to insufficient reliable information on the comparison between AVF and PC.  This study was conducted to compare AVF and PC regarding adequacy of dialysis.
Material and Methods: This prospective study was carried out in tertiary care center over 6 months (Jan 2021 to June 2021). In this study, 100 HD pts were enrolled and assigned to two unequal groups of AVF and PC. Before and after the dialysis session, blood samples were taken for laboratory examinations and measurement of urea reduction ratio and Kt/V. The patients were followed up for six months, and then laboratory examinations were repeated.
Results: Out Of the 100 HD pts, 40 had AVF and 60 patients on PC. During the 6-month follow-up, 30 patients in PC group but only two  patient in AVF group showed infection (P = 0.050), while in each group,  thrombosis were seen in 6 patients on PC and 4 patients of AVF (P = 0.50). Catheter dysfunction was seen in 15 patients of PC group and one patients of AVF group (P = 0.0001).There was no difference between the two groups in Kt/V and URR at the beginning of the study; however, after six months, Kt/V and URR were greater in AVF group (P< 0.05).
Conclusion: We found better dialysis adequacy in AVF group & there were some advantages of AVF over PC, such as lower rate of infection and thrombosis. We recommend that AVF be created in all of patients with chronic kidney disease who are candidates for HD.

Introduction: Catheter-related bloodstream infection (CRBSI) is a critical problem in dialysis center.
Aim: To study the prevalence of central venous catheter related blood stream infections and to identify the microbiological profile of organisms causing CRBSI.
Materials and Methods: This prospective observational study carried out at Dialysis unit over a period of two years on 145 hemodialysis patients, who had cultures of catheter and blood samples were studied.

Introduction: Catheter-related bloodstream infection (CRBSI) is a critical problem in dialysis
center.
Aim: To study the prevalence of central venous catheter related blood stream infections and to
identify the microbiological profile of organisms causing CRBSI.
Materials and Methods: This prospective observational study carried out at Dialysis unit over
a period of two years on 145 hemodialysis patients, who had cultures of catheter and blood
samples were studied.
Results: A total of 557 haemodialysis catheters (tunnelled and non-tunnelled) were
inserted during the study period, and among them, CRBSIs was seen in 145 cases.Mean
duration of dialysis catheters in situ was 20.6days.99 (68.2%) patients were males, and 46
(31.7%) were females. Diabetes mellitus (76.5 %) was the most common premorbid illness
associated with CRBSI. 81.3% patients found to be below 10 mg/dl of Hb, and
68.3%patients had leucocytosis. Among 145 of CRBSI, blood cultures were positive in 48
patients, and 97 patients were culture negative.45.8% isolates were gram-positive and
52.8% isolates were gram-negative bacteria, and one isolate was found to be fungal
infection.Among gram positive, CONS were most isolated, followed by Enterococcus,
MSSA and MRSA.

The purpose of this study was to determine the relationship between individual characteristics and discharge planning implementation with the compliance level of chronic kidney disease patients undergoing hemodialysis.A cross sectional designduring July - September 2020 with 105 respondents using simple random sampling. The independent variables were individual characteristics and implementation of discharge planning and the dependent variable was adherence.Data were collected using a questionnaire that was tested for validity and reliability, then data were analyzed using Chi Square test with a significance value P <0.05. Respondents with the highest adherence were women (88.9%; P = 0.015), age range 46 - 55 years (87.8%; P = 0.033), married status (81.1%; 0.031), working (89.5%; P = 0.028), Secondary education level (84.2%; P = 0.043), good knowledge (85.1%; P = 0.026), long hemodialysis> 5 years (93.3%; P = 0.016) and had a history of diabetes mellitus (90.9%; P = 0.035).The discharge planning element also has significant relation (all P <0.05), including sufficient medication (90.0%), a good environment (88.9%), good treatment (100.0%), good health teaching (87.0%), good outpatient referral (100.0%) and good diet (86.7). The level of compliance of hemodialysis patients is very important to improve the quality of life of patients, patient compliance is influenced by the demographic characteristics of the individual and discharge planning in the hospital.

Sodium is the major extracellular cation in the body and hence and is the major determinant of
extracellular fluid (ECF) content and serum osmolarity . Volume overload contributed by increased
sodium is a major problem in patients on hemodialysis (HD). Sodium entry occurs in hemodialysis
patients from dietary intake, dialysis fluid or from saline infusions given during the hemodialysis session.
Currently, all patients undergoing maintenance hemodialysis in our centre and hospitals world-wide are
dialysed with dialysate sodium of 138 meq/L and this dialysate sodium level used as a standard value in
all patients irrespective of their blood sodium values. Patients undergoing dialysis have an individualized
sodium and osmolarity value which are known as sodium and osmolar set point . respectively, and are
unique for each patient and is highly conserved.
A higher dialysate sodium concentration more than the patient’s plasma sodium level will cause sodium
gain during dialysis and increase the total body sodium. This promotes interdialytic fluid ingestion in
order to restore an individual’s sodium and osmolar set point. These patients might be actually having a
lower sodium set point and if so, with each hemodialysis session, more sodium is continuously being
added to their body, contributing to increased thirst, interdialytic weight gain (IDWG) and blood pressure.
Long standing fluid overload can lead to uncontrolled hypertension, left ventricular hypertrophy and thus,
lead to cardiovascular morbidity and mortality.
Theoretically, it looks advantageous to use tailor made dialysate sodium to avoid addition of excess
sodium to the body during hemodialysis sessions. Several studies have been done regarding the
individualization of sodium prescription in HD patients but the results have been inconsistent. There are
very few studies from India regarding sodium set points in our HD population and by prescribing
Individualized dialysate sodium prescription, co-morbidities mentioned above will be drastically reduced.
Our aim was to investigate and study the beneficial effects of individualized sodium profiling on patients
undergoing dialysis.

This article describes the features of the clinical course of the disease, assesses the quality of life, diagnostic criteria for the disease, modern classification and tactics of hypotensive therapy in patients with chronic kidney disease, Pathogenetic mechanisms of chronic kidney disease, Correspondence of the stages of chronic kidney disease to the ICD-10 coding.
Various modern studies are described to assess the quality of life of patients using the SF-36 questionnaire, which includes 8 scales: physical functioning, role functioning due to physical state, pain intensity, general health, vital activity, social functioning, role functioning due to emotional state and mental health.

Background: The objective of the study was to study the influence of the combined use of hemodialysis (HD), chemisorption (HS), and metabolic plasmapheresis (PP) for the hemodynamic and defective reduction of intoxication in children with ARF.
Methods: Investigations were performed in 63 children (at the age from 2 to 14 years old) with ARF that was developed as a result of prerenal (hypovolemia, septic shock) and renal (acute glomerulonephritis, pyelonephritis) factors. Depending on the devised detoxification methods, patients were divided into the control group (5) whom it was performed only HD-method and the control group (58) with the use of methods of gravitational surgery, such as HS, HD, and PP.
Results: General clinical presentation in all patients during admission was noted by the significance of intoxication syndrome, signs of respiratory, cardiovascular insufficiencies, in 84,2% of cases it was noted by mental confusion, in 72% of cases it was noted by anemic syndrome, in 78% of cases it was noted by hypoproteinemia and in 93% of cases it was noted by anuria. In 63 cases methods of complex treatment of children were performed once depending on the severity of the condition, a significant degree of the intoxication syndrome, and the level of changes in internal organs.
Conclusion: The influence of sorption methods of detoxification in patients with AKI has a significant advantage over the sessions mono hemodialysis. The corrective effect of complex therapy affects the restoration of organ functions, reduction of intoxication syndrome, and improvement of the clinical condition of patients.

Background: Chronic kidney disease (CKD) is an emerging public health problem that affects 5–10% of the world population. With the availability of recent treatment modalities including renal replacement therapy, the survival of CKD patients has increased considerably which has led to an increased focus on health-related quality of life (HRQoL). Health-related quality of life represents the impact of the disease or its treatment on the subjective feelings of patients about their physical, mental, spiritual, emotional, social, and functional wellbeing. Quality of life among dialysis patients has been shown to be lower as compared to pre-dialysis CKD patients and is an independent risk factor for mortality in dialysis patients. Family support is an important factor that serves as a support system for the patients to face health problems.
Purpose: To examine levels of family support and the correlation of family support and quality of life (QoL) among CKD on hemodialysis (HD) patients.
Methods: This cross-sectional observational study was conducted in August-November 2020 and recruited chronic HD patients from Wahidin Sudirohusodo Hospital in Makassar, Indonesia. The demographic data of HD patients were collected. Quality of life was assessed using the validated Indonesian version of the Short Form-36 (SF-36) questionnaire which consists of Physical Component Summary (PCS) and Mental Component Summary (MCS) and family support that was assessed using the validated “Dukungan Keluarga” questionnaire. The data were analyzed using SPSS version 22.0 statistical software.
Results: A total of 60 subjects (39 males and 21 females) were included. The mean age was 48.9±12.1 years old. About 55% of the subjects was graduated from college. About 86.7% subject was married. About 55% of the subject is not working. About 53.3% of subjects have a family income lower than the regional minimum wage. The mean duration of HD was 22.1±28.6 months. The mean score of family support was 53±8,2. Family support score has a significant positive correlation with each domain of PCS and MCS, the higher score of family support is in accordance with higher score of PCS and MCS.
Conclusion: CKD on HD patients’ quality of life was significantly affected by family support

A growing number of publications in the literature show that chronic pain is
also characteristic of patients with terminal renal failure (TRF). The disease tends to be
moderate or severe and affects virtually all aspects of health and quality of life.
Unfortunately, there is a lack of clinical and research focus in nephrology, and TAPN pain
is poorly understood. The article reflects the main aspects of the problem of pain
medication therapy for patients with terminal renal insufficiency receiving chronic
hemodialysis. The main pathophysiological mechanisms of medication influence on kidney
structures are described.