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Article
Vitamin D Status in Hemodailysis Patients, A Single Center Study

Author: Adnan Abdhuladeem Mahdi , Mohammed Hannon Al-Sodani, Suad Al-Windawi , Mohammed Hannon Al-Sodani
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2015 Volume: 14 Issue: 4 Pages: 499-505
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Vitamin D deficiency and insufficiency are common in patients with End Stage Renal Disease(ESRD). Vitamin D has been found to have beneficial effects on bone, cardiovascular and immune functions. There are little data about vitamin D levels in Iraqi patients on hemodalysis..OBJECTIVE:This study was conducted to determine the vitamin D status of Iraqi patients with ESRD on hemodialysis.PATIENTS AND METHODS:This study is a cross sectional study conducted at The Dialysis Center/ Baghdad Teaching Hospital . An eighty four patients with End Stage Renal Disease (ESRD) on regular Hemodialysis (HD) enrolled in the study from January to February 2013.The basic data of the patients had been obtained (age ,weight ,duration on HD (months), infection with HCV, drugs doses for calcium and alphacalcidol . Blood samples were collected at the start of the HD session from the vascular access for calcium, phosphorus, albumin, cholesterol, uric acid and Vitamin 25(OH) D3 blood levels. These samples were sent for analysis to the Teaching Laboratories at Medical City. Patients were considered as vitamin D3 insufficient if the levels were between 10 and 30 ng/ml , deficient if the levels were less than 10 ng/ml and sufficient if it was ˃30 ng/ml We assess the correlation between vitamin D3 level and other variables tested in the study. RESULTS:The mean age of the patients was 49.8 ± 13.2 years, of these, 40 (47.6٪) were females and 44 (52.4٪) were males. Fifty five (65(٪ patients were infected with hepatitis C virus and 29(35٪)were not . the median dose of calcium carbonate was 1086.1 ± 400 mg per day, The median dose of alphacalcidol was1.9 ± 1.1 mcg /week. Mean weight was 68.8 ± 17.5 kg. Median duration of HD was 24.8 ± 20.8 months (range 2–72 months).The patients were on twice a week (6-8 hours/week) HD sessions.Mean of serum albumin, corrected calcium, phosphorus, Uric acid cholesterol were 3.0 ± 0.8 g/dl., 8.6 ± 1.4 mg/dl, 3.9 ± 1.4 mg/dl , 6.1 ± 2.4 mg/dl, 149.9 ± 39.2 mg/dl respectively .Mean vitamin 25(OH) D3 level was 33.02 ± 7.2 ng/ml. 60(71.4٪) patients were vitamin D3 sufficient, 23(27.4٪) patients were vitamin D3 insufficient and only one (1.2٪) patient was vitamin D3 deficient.There was a significant correlation between vitamin 25(OH)D3 levels and albumin , duration of HD, virology status while there was no correlation between weight, sex ,age , activity, calcium, cholesterol, uric acid , phosphorus ,dose of alphacalcidol or calcium carbonate and vitamin 25(OH)D3 level .CONCLUSION:The vitamin D insufficiency found in about one quarter of patients on hemodialysis while deficiency found only in 1.2% of patients and more than two third of patients had sufficient vitamin D3. There was a significant correlation between vitamin 25(OH)D3 levels and albumin , duration of HD, virology status..


Article
Uremic Pruritus in Haemodialysis Patients; Prevalence, Severity and Possible Associations

Author: Ali J. Hashim Al- Saedi *, Ban Ghassan**, Sabah Al- Alawchi***
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2015 Volume: 14 Issue: 4 Pages: 548-554
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND: Uremic pruritus is a common distressing complication of end stage renal disease and it is a common problem in dialysis patients. It causes serious discomfort and skin damage, negatively affects the quality of life. OBJECTIVE:To determine the prevalence, severity of pruritus and possible association with the laboratory parameters in patients with chronic renal disease on haemodialysis. METHODS: One hundred and three patients on chronic haemodialysis were included in this study. Fasting blood sugar, urea, creatinine, albumin, alkaline phosphatase, parathyroid hormone, sodium, potassium, chloride, calcium, phosphorus, calcium × phosphorus product, were determined. RESULTS: Of the 103 patients included in the study the, 79 patients (76.7%) had pruritus of whom, 27 (34.1%) had mild pruritus, 30 (37.9%) had moderate and 22 (27.8%) had severe pruritus. No significant association (p ˃ 0.05) was found between pruritus and each of sex, age, frequency and duration of haemodialysis. There was a significant association (p ˂ 0.05) between duration of haemodialysis and pruritus onset. No significant difference (p ˃ 0.05) in the FBS, urea, creatinine, albumin, parathyroid hormone, alkaline phosphatase, sodium, potassium, chloride, calcium, phosphorus, calcium phosphorus product, average among patients who had no pruritus, mild, moderate and severe pruritus. A significant positive correlation (p ˂ 0.05) was found between severity of pruritus in pruritic patients and age.CONCLUSION: WE CONCLUDED THAT there was a significant association between duration of haemodialysis and pruritus onset more over the age had a significant positive correlation with the severity of pruritus in pruritic patients..


Article
MAGNESIUM, ZINC, AND COPPER IN SERUM, ERYTHROCYTE, URINE AND DIALYZATE FLUIDS OF HAEMODIALYSIS PATIENTS

Author: Sami, N. Najem
Journal: Iraqi Journal of Pharmaceutical Sciences المجلة العراقية للعلوم الصيدلانية ISSN: 16833597 Year: 2005 Volume: 14 Issue: 1 Pages: 31-35
Publisher: Baghdad University جامعة بغداد

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Abstract

Copper (Cu) Zinc (Zn) and Magnesium (Mg) in serum, RBC, urine and dialyzate fluids were studied in 39 patients, who have been undergoing chronic haemodialysis treatment. They were divided in to polyuric , oliguric and anuric depending on their urinary output. Elevated serum and RBC Mg was observed before dialysis, while decreased serum and RBC level was noticed except serum Mg of polyuric patients. Before dialysis elevated serum and RBC Zn were observed. While after dialysis these parameters were increased. Normal RBC Cu value before dialysis was observed. While low serum Cu was noticed. After dialysis serum Cu showed raised value, while RBC level decreased in oliguric and increased in polyuric patients. Zn / Cu ratio found to be high in those patients. All these results were discussed in relation to urine content and also to the dialyzate fluid.

قيست تراكيز المغنيسيوم والخارصين والنحاس في مصل وكريات الدم الحمر وإدرار ومحلول الغسيل الناتج لدى تسعةوثلاثين مريضا عولجوا بالإنفاذ الدموي واللذين قسموا حسب كمية الإدرار المطروحة إلى غزيري وقليلي وعديمي الإدرار, ظهرارتفاع في تركيز المغنيسيوم في مصل وكريات الدم الحمر قبل المعالجة في حين انخفض تركيز ه بعده ا, عدا مصل غزيريالإدرار, ارتفع تركيز الزنك في المصل وكريات الدم الحمر قبل وبعد المعالجة, وبقي تركيز النحاس طبيعيا في كريات الدم الحمرقبل المعالجة في حين انخفض تركيز ه في المصل , وارتفع بعد المعالجة بينما انخفض في كريات الدم الحمر في مرضى قليليالإدرار, وارتفع لدى مرضى غزيري الإدرار, وارتفعت نسبة الزنك إلى النحاس في جميع المرضى . نوقشت جميع النتائج علىضوء محتوى الإدرار ومحلول الغسيل من هذه العناصر.


Article
DEPRESSION IN A GROUP OF PATIENTS WITH CHRONIC RENAL FAILURE ATTENDING HEAMODIALYSIS UNIT IN TEACHING HOSPITAL IN BAGHDAD

Authors: Makhoola H Kassim --- Uday AJ Khalid عدي عبد الجبار خالد
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2012 Volume: 10 Issue: 1 Pages: 55-59
Publisher: Al-Nahrain University جامعة النهرين

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BackgroundDepression is the most common psychopathological condition among patients with chronic renal disease yet it is still under recognized and underestimated. Depression adversely affects the already disturbed quality of life of patients with chronic renal disease.ObjectivesTo determine the rate of depression in a sample of chronic renal failure patients attending haemodialysis unit in teaching hospital in Baghdad and examine the sociodemographic variables of such patients.MethodsThis is a cross-sectional study done at Al-Kadhimiya Teaching Hospital, during a period of 2 months from 4th of January 2009 to 4th of March 2009. The total of 50 random cases with chronic renal failure coming for haemodialysis were interviewed by semi structured schedule for psychiatric diagnosis. Results were reviewed by simple descriptive and inferential statistical measures.ResultsThe rate of depression in this sample of patients with chronic renal failure was 40%.There was no statistically significant relation between any of the demographic variables and depression.ConclusionThe rate of depression in this study is high. Results were compared with other studies in light of circumstances of this study.Key wordsDepression, chronic renal failure, haemodialysis


Article
VASCULAR ACCESS OUTCOMES IN PATIENTS ON HAEMODIALYSIS IN DUHOK KIDNEY DISEASE CENTER
نتائج الموصلات الدموية للمرضى الخاضعين للديلزة الدموية في مركز دهوك الامراض الكي

Authors: ASHUR Y. IZAC --- ZANA S. MOHAMMED SALEEM
Journal: Duhok Medical Journal مجلة دهوك الطبية ISSN: eISSN: 20717334/ pISSN: 20717326 Year: 2013 Volume: 7 Issue: 2 Pages: 32-40
Publisher: University of Dohuk جامعة دهوك

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ABSTRACTBackground and objectives Patients with chronic renal failure have only two options oftreatment either renal transplantation or dialysis (peritoneal or haemodialysis), haemodialysisneed efficient, comfortable, easy accessible, long duration and least complication vascularaccess. We try to analyze 102 patients and evaluating their vascular access. The aim of thestudy is compare between different types of vascular access and assessing, the efficiency,durability, and complications associated with that vascular access.Methods This is retro and prospective study for patients with vascular access onhaemodialysis; sample is collected from Jun 2009 to 30th June, 2013 in Duhok KidneyDisease Center.Results Hundred two patients included in this study. Diabetes was the most common cause ofend stage renal failure in the studied group. 76.4 % of the studied group was witharteriovenous fistula. Small vein was the most common reason for creation of graft fistula.Edema was the commonest complication among arteriovenous fistula where thrombosis wasamong the graft fistula.Conclusions Only 10% of the studied group present early for creation of vascular accessbefore needing urgent dialysis. Complications seem to be equal in both sexes in arteriovenousfistula type of access but its more than four folds in women with graft fistula. Aneurysm inpatients with arteriovenous fistula is high in this study in compares to other studies.


Article
Atrial natriuretic peptide in chronic renal failure on maintenance hemodialysis : effect of heart failure

Author: Abdul-Aziz A. Aziz عبد العزيز
Journal: Annals of the College of Medicine Mosul مجلة طب الموصل ISSN: 00271446 23096217 Year: 2005 Volume: 31 Issue: 1 Pages: 32-36
Publisher: Mosul University جامعة الموصل

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Abstract

objective: To examine the plasma level of atrial natriuretic peptide(ANP) in patients with
chronic renal failure (CRF) undergoing maintenance hemodialysis ( HD) and to evaluate the
effect of superimposed cardiac functional impairment on the plasma level of this hormone.
Design: A case- series study
Setting: Artificial Kidney and Dialysis Unit of lbn-Sena Teaching Hospital, Mosul; during the
period from June 2003 to August 2004.
Participants: Forty patients with CRF undergoing maintenance HD, were divided into 2 groups depending on presence or absence of heart 6itu[. Group l, includes 20 patients with CRF who did not have heart failure and group Il, includes 20 patients with CRF who had heart failure, The study also includes 20 healthy volunteers as a control group.
Methods: Plasma ANP, serum creatinine, urea and body weights were measured in CRF
patients before and after HD. The same parameters were also measured in the control group.
The paired-t-test was used to examine the difference in the mean of the studied parameters in patients with CRF before and after HD. The unpaired -t- test was used to assess the difference in the mean of the above-mentioned parameters between patients and control group. Pearson correlation coefficient was used to study the relation of the means of differences between pre and post dialysis values of the studied parameters within each patient group.
Results: The mean of plasma ANP level was significantly higher in group I (p<0.0001) and
group ll (p<0.0001) than that in the control group before and after HD. Furthermore, the plasma ANP in group ll was significantly higher (p<0.0001) than that in group I. There was a significant decrease in the plasma ANP in group I (pconclusion: Periodic measurement of plasma ANP level in patients with CRF may be of great
value in evaluating the actual fluid status in patients having CRI and in determination of
frequency and duration of dialysis sessions. lt also may be of value in predicting cardiac
dysfunction in patients with CRF.
Key words: Atrial natriuetic peptide, chronic renal failure, haemodialysis.


Article
Hypertension in Haemodialysis

Author: Jawad K. Manuti
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2010 Volume: 9 Issue: 3 Pages: 225-228
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Relevant factors involved in the pathogenesis of hypertension among dialysis patients include sodium and water retention, dialysate composition and prescription, increased activity of vasoconstrictive systems(sympathetic nervous system, rennin-angiotensin system, endothelin and vasopressin), decrease activity of vasodilatory systems(nitric oxide, kinins), increased intracellular calcium, increased arterial stiffness, sleep apnea, hyperparathyroidism, erythropoietin and renovascular diseaseOBJECTIVE:The objective of this study is to assess the prevalence of hypertension among uremic patients undergoing haemodialysis and to assess difference of blood pressure reading before and after dialysis.PATIENTS AND METHODS:140 patients with chronic renal failure &acute renal failure on regular haemodialysis. blood pressure was measured by doctors before dialysis, within 2 hour of dialysis , after dialysis and after 48 hours of dialysis. we averaged six routine predialysis systolic and diastolic blood pressure. The same was carried out for postdialysis.RESULTS:Patients with preheamodialysis (office BP) >130/85 mmHg are considered as hypertensive in chronic renal failure, who made up of 74% of the study population. 40% patients were on monotherapy antihypertensive drug. 65% are taking calcium channel blocker, angiotensin converting enzyme inhibitor 38%, angiotensin П receptor blockers 26% and beta blocker 20%. Preheamodialysis blood pressure(Office BP) overestimated BP values in relation to 48 h postdialysisCONCLUSION:Significant difference was shown between predialysis office blood pressure and 48 hour postdialysis in the recognition of hypertension in heamodialysis patients. the prevalence of hypertension in heamodialysis patients is high (74%). most of the patients used combination of antihypertensive drugs, calcium channel blocker commonly used 65%.


Article
Hepatitis C virus infection among haemodialysis patients in Al-Anbar governorate
التهاب الكبد الفيروسي نمط ج بين مرضى الكلية الاصطناعية في الانبار

Author: Jalil I. Al-Mashhadani د. جليل ابراهيم المشهداني
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2007 Volume: 20 Issue: 1 Pages: 20-23
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Background: Hepatitis C virus is a major health problem in haemodialysis patients. Many workers described the prevalence of anti-HCV among selected population in Iraq. No study among haemodialysis patients was reported in Al-Anbar governorate.Objective: this study was carried out to determine the prevalence of HCV infection among haemodialysis patients and other risk factors in Al-Anbar province.Materials & Methods: A total of 87 haemodialysis patients together with sixty renal - unit staff members as controls were included in this study. A questionnaire form was filled for each subject. The data requested included demographic data and risk factors for exposure to HCV such as blood transfusion and duration of dialysis. All participants were screened for anti-HCV and HBsAg.Results: A significant higher rate of anti-HCV among haemodialysis patients (11.7%) than controls (1.6%). Anti-HCV rate was significantly higher among haemodialysis patients with history of blood transfusion than those without such a risk factor. Patients with longer duration on dialysis had significantly higher rate of anti-HCV when compared with those with shorter duration on dialysis. We found no significant association between anti-HCV positivity and exposure to hepatitis B or gender.Conclusion: A significant association between HCV infection and haemodialysis patients was suggested by this study. Blood transfusion and duration of haemodialysis are main risk factors for the prevalence of HCV infection. Key words: HCV infection, haemodialysis, Al-Anbar governorate

الخلفية: يشكل التهاب الكبد الفيروسي نمط ج مشكلة صحية لدى مرضى الكلية الاصطناعية. العديد من التقارير اشارت الى انتشار التهاب الكبد الفيروسي نمط ج بين مجاميع محددة في العراق. ولا يوجد اي دراسة حول انتشار المرض بمرضى الكلية الاصطناعية في الانبار.الهدف: لدراسة انتشار مرض التهاب الكبد الفيروسي نمط ج بين مرضى الكلية الاصطناعية وتحديد بعض عوامل الخطورة.الطرق: شملت الدراسة 87 مريضا في الكلية الاصطناعية و 60 من كادر الكلية الاصطناعية كمجموعة سيطرة. المعلومات المطلوبة يشمل معلومات ديموغرافية وعوامل الخطورة للتعرض لفيروس التهاب الكبد الفيروسي نمط ج مثل نقل الدم وفترة العلاج. جميع المرضى ومجموعة السيطرة تم فحصهم لالتهاب الكبد الفيروسي نمط ب و ج.النتائج: انتشار الكبد الفيروسي نمط ج بين مرضى الكلية الاصطناعية (11.7%) اعلى منه بين مجموعة السيطرة (1.6%). وكان انتشار التهاب الكبد الفيروسي نمط ج اعلى لدى المرضى الذين لديهم نقل دم منه لدى ممن لا نقلدم لديهم. المرضى لفترة طويلة اظهروا نسبة اصابة بالتهاب الكبد الفيروسي نمط ج من الاصابة بين المرضى لفترة قصيرة. ولم تظهر اي علاقة بين التهاب الكبد الفيروسي ج والتعرض لالتهاب الكبد الفيروسي ب او جنس المريض. الاستنتاج: هناك ارتباط معنوي بين انتشار مرض التهاب الكبد الفيروسي ومرضى الكلية الاصطناعية. نقل الدم وفترة المعالجة في الكلية الاصطناعية عوامل خطورة رئيسية.


Article
Aortic Valve Calcification in Hemodialyzed Patients at the Iraqi Dialysis Center

Authors: Mohammed Hannon Al-Sodani --- Jawad I Rasheed --- Raed Ahmed Dawood --- Adil S.Ghafour
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2015 Volume: 14 Issue: 3 Pages: 397-402
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND :Aortic valve calcification in End Stage Renal Disease (ESRD) patients occurs ten to twenty years earlier than general population. It is associated with myocardial, coronary arteries and conduction system calcification and it is associated with rapid development of aortic valve stenosis.OBJECTIVE:To study the incidence of aortic valve calcification in hemodialysis patients and to look for risk factors associated with this calcification.PATIENTS AND METHODS:Forty six patients with End Stage Renal Disease (ESRD) on regular haemodialysis in Baghdad Teaching Hospital / Dialysis Unit and forty six patients with no renal disease as control group were studied between February 2005 - January 2006. Duration of dialysis, blood flow rate during dialysis, serum Calcium, serum Phosphorous and their products were included in this study. Echocardiography was done for all patients. RESULT :The incidence of Aortic Valve Calcification (AVC) in ESRD patients on haemodiaysis was 30 % and it was higher than that of general population ( p value 0.0085) . It occurs 10-15 year earlier than in patients with no renal disease. End Stage Renal Disease patients with AVC were older than those with non calcified valves. Only 7.4 % of those ESRD patients with AVC have hemodynamic AV stenosis ( p value 0.5 ). The mean duration of haemodialysis in ESRD patients with AVC was longer than that of ESRD patients without AVC which was statistically significant. Also there was statistically significant association between blood flow rate during haemodialysis and AVC. There was statistically significant association between Calcium phosphate products and AVC in ESRD patients. CONCLUSION:There is ahigher incidence of aortic valve calcification in ESRD patients on haemodialysis . This calcification occurs earlier than that in patients with no renal disease .The duration of haemodialysis is a risk factors for AVC .


Article
Effect of Hemodialysis and Peritoneal Dialysis on some Hematological and Biochemical Parameters in Renal Failure
تأثير غسيل الكلى وغسيل الكلى البريتوني على بعض معلمات الدم والكيمياء الحيوية في الفشل الكلوي

Author: Dara Khorshed Mohammad
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2009 Volume: 13 Issue: 2 Pages: 79-85
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Background and Objectives: The purpose of the present study was to determine the effects of hemodialysis and peritoneal dialysis on some hematological and biochemical parameters in patients with renal failure on the dialysis.Methods: Fifty two patients with renal failure were taken in this experiment on dialysis studied in the dialysis and kidney disease center in hawler teaching hospital, twenty six patients were taken for haemodialysis and the remaining patients were taken for the peritoneal dialysis process. Some hematological and biochemical parameters were taken before and after dialysis.Results: In the Hemodialysis Patients: Hemoglobin concentration (Hb gm/dl), Red blood cells (RBCs x106/μl)) and packed cell volume (PCV %) count, blood sugar (mg/dl), serum calcium (mg/dl), serum sodium (meq/L) and serum potassium (meq/L) were high significantly increased in patient with renal failure after hemodialysis in comparison before hemodialysis, while blood urea (mg/dl) were high significantly decreased in patient with renal failure after hemodialysis in comparison before hemodialysis. In the Peritoneal dialysis patients: Hb (gm/dl) and PCV (%) count, blood sugar (mg/dl) and serum calcium (mg/dl) were high significantly increased in patient with renal failure after peritoneal dialysis in comparison before peritoneal dialysis, while blood Urea (mg/dl) and serum Creatinine (mg/dl) were high significantly decreased in patient with renal failure after peritoneal dialysis in comparison before peritoneal dialysis, while there were non significant differences in serum sodium (meq/L) before and after peritoneal dialysis.Conclusions: Hemodialysis significantly increases some RBC, Hb and PCV. Hemodialysis cause significantly decreases blood sugar and urea. Peritoneal dialysis significantly increases PCV and Hb. Peritoneal dialysis cause decreases the blood urea and blood sugar. Hemodialysis was more useful and gives good results than peritoneal dialysis.

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