Maintenance Hemodialysis (MHD) Patients.

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Triglyceride to high-density lipoprotein cholesterol ratio predicts cardiovascular events in maintenance hemodialysis patients

Triglyceride to high-density lipoprotein cholesterol ratio predicts cardiovascular events in maintenance hemodialysis patients

Background: The triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio has been shown to be a predictor of cardiovascular (CV) outcomes in the general population. The aim of this study was to determine whether the TG/HDL-C ratio is a predictor of CV events and all-cause mortality in maintenance hemodialysis (MHD) patients. Methods: We performed a retrospective, observational cohort study in which we enrolled 193 MHD patients from a single center in Japan who had been followed up for a median of 3.9 years. The outcomes were the occurrence of a CV event and all-cause mortality during the follow-up period. Baseline TG/HDL-C ratios were investigated for associations with outcomes by using Cox regression models adjusted for demographic parameters.
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Iron Indices and Mortality in Maintenance Hemodialysis Patients

Iron Indices and Mortality in Maintenance Hemodialysis Patients

Background: The relationship between the iron indices and mortality in maintenance hemodialysis (MHD) patients has remained unclear. We per- formed a retrospective, observational cohort study to investigate the relation- ships between serum ferritin levels and mortality in MHD patients. Methods : MHD outpatients (n = 150) were followed up for a median period of 49 months. Their ESA and low-dose iron supplement dosages were adjusted to maintain their hemoglobin (Hb) concentrations in the 10 - 11 g/dl range in accordance with Japanese guidelines. The Kaplan-Meier method, log-rank tests, and Cox proportional hazards models were used to perform the statis- tical analyses. The patients were divided into 3 groups according to their se- rum ferritin levels: a serum ferritin < 50 ng/ml group; a 50 - 100 ng/ml group; and a > 100 ng/ml group. Results: During the median follow-up period of 49 months, there were 55 deaths. The multivariate analysis showed no significant associations between the ferritin level groups and all-cause mortality or car- diovascular (CV) events, and the Kaplan-Meier analysis showed no significant differences among the 3 ferritin level groups in all-cause mortality and CV event rates. However, the multivariate analysis revealed that age, CRP level and a history of previous CV disease were independently associated with all-cause mortality, while diabetes, previous CV disease, and iron administra- tion were independently associated with CV events. Conclusion: The results of this study revealed no significant associations of MHD patients between the ferritin ranges and all-cause mortality or CV events. Thus, the adverse clinical outcomes in these patients were independently associated with other markers and not with their serum ferritin levels.
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Satisfaction with Care in Hemodialysis Unit among Maintenance Hemodialysis (MHD) Patients

Satisfaction with Care in Hemodialysis Unit among Maintenance Hemodialysis (MHD) Patients

The study was aimed to assess the Maintenance Hemodialysis (MHD) Patients' Satisfaction with Care in Hemodialysis Unit. A descriptive design was used on 70 Maintenance Hemodialysis (MHD) Patients of hemodialysis unit of Deep Kidney Care Centre, Model Town, Ludhiana, Punjab. With the help of total enumerative sampling technique, 70 Maintenance Hemodialysis (MHD) Patients were selected. Structured Patient Satisfaction Scale (PSS) was used to assess Maintenance Hemodialysis (MHD) Patients' Satisfaction with Care in Hemodialysis Unit. Patient Satisfaction Scale (PSS) included various dimensions of satisfaction related to care like direct nursing care, safe environment, collaboration, therapeutic communication, ethics and documentation in hemodialysis unit. The data was obtained through self-report (interview schedule) method. Analysis was done in accordance with the objectives of the study. Results showed that out of 70 Maintenance Hemodialysis (MHD) Patients, 47(67.1%) of maintenance hemodialysis patients were satisfied with the care, followed by 20(28.6%) of maintenance hemodialysis patients, who were partially satisfied and only 03(4.3%) of maintenance hemodialysis patients were not satisfied with the care and Mean and SD of overall Patients' Satisfaction score was on higher side i.e. 69.36+9.49.
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State Anxiety among Maintenance Hemodialysis (MHD) Patients

State Anxiety among Maintenance Hemodialysis (MHD) Patients

A descriptive study was undertaken on 70 Maintenance Hemodialysis (MHD) Patients selected by total enumerative sampling technique from hemodialysis unit of Deep Kidney Care Centre, Model Town, Ludhiana, Punjab. The subjects were selected based on inclusion and exclusion criteria. Inclusion Criteria: Maintenance Hemodialysis (MHD) Patients who were: more than 18 years of age; coming once, twice or thrice a week for Hemodialysis; willing to participate and were able to understand commonly spoken languages. Exclusion Criteria: Maintenance Hemodialysis (MHD) Patients who were critically ill (Airway, Breathing and Circulation were affected) and were not regular for Hemodialysis treatment. The data was obtained through self-report method with the help of 20-item State Instrument of State-Trait Anxiety Inventory (Spielberger, 1983). The tool was divided in two parts.
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Sexual Health of Patients on Maintenance Hemodialysis. Where are we?

Sexual Health of Patients on Maintenance Hemodialysis. Where are we?

Despite the increased life expectancy associated with advanced dialysis techniques, maintenance hemodialysis (HD) is associated with a substantial impairment of quality of life [1]. The decline in the quality of life of chronic hemodialysis patients is multifactorial, including functional limitation, occupational disturbances, impaired social well-being, and the heavy burden of physical and emotional symptoms. It is often associated with clinical manifestations mainly fatigue, cramps, pain and dyspnea and also by the disorders of the sexual function [2]. Sexual health, even though neglected by the patient as well as the care givers, remains a priority for patients with end stage renal failure (ESRF). It has a significant impact on the couple’s health, mental health and quality of life. Disorders of sexual function are frequent in the CKD and for good reasons considered by some authors as an underappreciated epidemic [3].
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Differential prevalence of hepatitis C virus subtypes in healthy blood donors, patients on maintenance hemodialysis, and patients with hepatocellular carcinoma in Surabaya, Indonesia

Differential prevalence of hepatitis C virus subtypes in healthy blood donors, patients on maintenance hemodialysis, and patients with hepatocellular carcinoma in Surabaya, Indonesia

Unexpectedly, HCV-2a was the most common subtype among HCV clones from blood donors, representing 52% of the total (Table 3). Serotype analysis also showed a high prev- alence of HCV type 2 in this group (Table 4), supporting the result of genotype analysis. One of the possible explanations for the high prevalence of HCV-2a in blood donors is that HCV-2a is less likely to cause clinical disease, which results from liver cell injury mediated either directly by a cytopathic effect or indirectly through immune mechanisms. The idea that HCV-2a is less pathogenic than other subtypes is in agreement with the observation that HCV-1b and -1d are associated with more severe liver damage than HCV-2a and -2b (13, 21, 23). We also observed in the present study that HCV-1a, -1b, and -1d are more strongly associated with elevations in serum ALT levels among blood donors and that the prevalence of HCV-2a is, accordingly, higher in blood donors with normal ALT levels than in those with elevated ALT levels (Table 3). Another possible explanation for the high prevalence of HCV-2a is that it has recently become more common among blood donors in this area than before, whereas HCV-1b was prevalent a few decades ago, when current patients with chronic liver disease had first contracted the virus infection. Such a changing pat- tern of HCV subtype prevalence over time has been reported for patients on maintenance hemodialysis and kidney recipi- ents (22). If this is the case, the prevalence of HCV-2a among patients with chronic liver disease in this area will become higher in the future. In this connection, it should be noted that HCV-2a (35%) was prevalent in chronic liver disease patients in Yogyakarta, Indonesia, ranking as the second most preva- lent subtype after HCV-1b (8). A possibility thus still remains that HCV-1b may not necessarily be more pathogenic than HCV-2a. Therefore, continued surveillance of the genotype prevalence among various populations over time as well as a long-term follow-up study of HCV-infected blood donors, es- pecially those infected with HCV-2a, is needed to better elu- cidate the issue.
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A Study of Determinants of Quality of Life in Patients on Maintenance Hemodialysis

A Study of Determinants of Quality of Life in Patients on Maintenance Hemodialysis

Hemodialysis is a process of removal of the toxins accumulated in the patient ’s body as a result of either complete or incomplete loss of functioning kidney. This is performed by two processes diffusion and convection. The former one is the predominant way of solute clearance in intermittent hemodialysis performed 2 – 3 times per week. The patient survival remains considerably low in patients on maintenance hemodialysis when compared to the renal transplant recipients. Various factors related to the patient and the procedure determines the quality of life and patient survival. So measures to improve the quality of life and patient survival have to be sought for on a continuous basis in all hemodialysis units. Bodies like Kidney Disease Outcomes Quality Initiative (KDOQI) 4 and Kidney Disease: Improving Global Outcomes (KDIGO) 5 had published clinical practice guidelines with a set of targets to be achieved in various aspects of hemodialysis like dialysis adequacy, anemia control, and mineral bone disease in management of CKD patients.
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Is hemodialysis itself a risk factor for dementia? An analysis of nationwide registry data of patients on maintenance hemodialysis in Japan

Is hemodialysis itself a risk factor for dementia? An analysis of nationwide registry data of patients on maintenance hemodialysis in Japan

AD is a major cause of dementia [5], in which accu- mulation of Aβ in the brain results in cognitive impair- ment [6]. Moreover, in these patients, the metabolic degradation of Aβ and its clearance from the brain are impaired [7]. If A β clearance from the brain can be increased, AD might be prevented or even treated. It has been shown that hemodialysis removes Aβ [10] and that the cognitive function of non-diabetic patients was maintained or improved among those undergoing maintenance hemodialysis over a period of 18 to 36 months [11]. Additionally, A β deposition was signifi- cantly weaker in the postmortem brains of patients who had undergone hemodialysis than in age-matched controls who had not undergone hemodialysis [12], and this finding is comparable to the finding in the study by Reusche et al. [13]. Although Lin et al. [4] showed that there is no significant difference in dementia risk between patients undergoing hemodialysis and those undergoing peritoneal dialysis, Jin et al. [20] showed that A β removal from the blood by peritoneal dialysis also reduces A β in the brain interstitial fluid. These reports suggest that hemodialysis might reduce the dementia risk through removal of A β from the blood of patients.
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Effect of cardiovascular risk factors and time of hospital presentation on mortality of maintenance hemodialysis patients presenting with acute pulmonary edema

Effect of cardiovascular risk factors and time of hospital presentation on mortality of maintenance hemodialysis patients presenting with acute pulmonary edema

performance of maintenance hemodialysis for 3 months or longer before admission. Patients were included if they showed pulmonary edema on an initial chest X-ray as de- termined by two observers (S.N. and S.H.). Patients who showed marginal X-ray findings with their clinical course that were inconsistent with APE were excluded after dis- cussion with a third observer using clinical information. Figure 1 shows representative X-rays of the included and excluded patients. Other exclusion criteria are shown in Fig. 2. Patients who required immediate invasive therapy for acute cardiovascular collapse (such as acute coronary syndrome) were excluded because the impact of sudden cardiac dysfunction and procedure-related outcomes may cancel the effects of the factors specifically related to maintenance hemodialysis or ESRD.
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Prognostic utility of plasma S100A12 levels to establish a novel scoring system for predicting mortality in maintenance hemodialysis patients: a two-year prospective observational study in Japan

Prognostic utility of plasma S100A12 levels to establish a novel scoring system for predicting mortality in maintenance hemodialysis patients: a two-year prospective observational study in Japan

The development population included 550 ESRD patients who received maintenance hemodialysis in two indepen- dent dialysis centers belonging to our affiliated hospitals (65% men; mean age, 63.4 years; mean duration of hemodialysis, 9.7 years). Their underlying renal disorders included diabetic nephropathy (DN; 36.7%) and nonDN diseases such as chronic glomerulonephritis, hypertensive nephrosclerosis, polycystic kidney diseases, and others of unknown etiology (63.3%). A history of cardiovascular dis- ease (CVD) was noted in 197 patients (35.8%). The me- dian plasma S100A12 levels in these hemodialysis patients were 18.79 ng/mL (11.70–30.37). The clinical characteris- tics of the patients are listed in Table 1. During the median follow-up of 22.5 months, 50 patients (9%) died. Causes of death included cardiovascular events (n = 19); infection (n = 10); malignancy (n = 8); and other causes such as gastric intestinal bleeding, cachexia and trauma (n = 13). Significantly higher plasma S100A12 levels were observed in these patients than in those who survived [25.10 ng/mL (16.21–47.64) versus 17.93 ng/mL (11.16–29.28); P = 0.001; Table 1]. The Kaplan–Meier survival curves demonstrated that higher plasma S100A12 levels (≥18.79 ng/mL) were associated with higher all-cause mortality than lower S100A12 levels (<18.79 ng/mL; log-rank test, χ 2 = 10.239, P = 0.001; Figure 1).
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Sleep Quality on Maintenance Hemodialysis Patients in Douala General Hospital in Cameroon

Sleep Quality on Maintenance Hemodialysis Patients in Douala General Hospital in Cameroon

We conducted a cross sectional study of 2 weeks from 5 to 17 September 2016 in the Douala General Hospital hemodialysis center of Cameroon. Only patient on maintenance hemodialysis of more than 6 months with arteriovenous fistula were included. Quality of sleep was measured using the Pittsburgh Sleep Quality Index (PSQI). The PSQI [12] evaluates the attitude of patients about their quality of sleep in the past 4 weeks. It contains 19 self-rated questions and 5 questions rated by the roommate. The 19 self-rate questions are combined to form 7 com- ponents scores: quality of sleep, delay in falling asleep (sleep latency), effective duration of sleep, sleep efficacy, sleep disorders, needed amount of sleep-induc- ing pills, and daytime performance. Each component score has a range of 0 - 3 points. In all case, a score of “0” indicate no difficulty while a score of “3” indi- cate severe difficulty. The 7 components scores are add to yield a global PSQI score with a range of 0 to 21 points; higher scores indicate lower quality of sleep. A global PSQI score greater than 5 indicates poor sleep quality. Roommate an- swers can also be scoring 0 - 3 points according to the severity of the symptom, but they are not included in the global PSQI score.
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Geographic and facility variation in initial use of non-tunneled catheters for incident maintenance hemodialysis patients

Geographic and facility variation in initial use of non-tunneled catheters for incident maintenance hemodialysis patients

Regional variation in dialysis practices, either at the facility or geographic level, has been well documented in Canada and other jurisdictions [11 – 20]. Interven- tions targeting a reduction in measured practice vari- ation have translated into improvements in patient care [18, 19]. As such, quantitating practice variation for key dialysis performance metrics, such as vascular access, could facilitate the development of programs and pol- icies to improve care. To our knowledge, no studies have sought to examine practice variation in NTHC use in patients starting maintenance hemodialysis. In this study, we set out to measure facility and geo- graphic variation for the initial use of NTHCs and de- termine the factors among patients and facilities that are associated with greater NTHC use. Identification of these factors and subsequently classifying them as ei- ther modifiable or non-modifiable would potentially help in planning and implementation of process mea- sures designed to reduce variation.
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Serum C1q- binding adiponectin in maintenance hemodialysis patients

Serum C1q- binding adiponectin in maintenance hemodialysis patients

HD patients have much higher levels of adiponectin, compared with the general population [4]. However, low cir- culating levels of adiponectin independently predict cardio- vascular and mortality outcomes in HD patients, the relationship being extensively confounded by various patient-related factors [17-22]. The cross-sectional preset study found that Total-APN did not associate with ACVD (Table 4). Complement activation and C1q binding activity have been described in HD patients [23]. Inoshita et al. [24] found significantly higher levels of functional complement activity of all three pathways, i.e., the classical pathway, the alternative pathway, and the lectin pathway, in HD patients than healthy controls. The present study showed higher Table 4 Correlations between clinical features of patients on maintenance hemodialysis and ACVD
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Review Article Different hemodialysis methods for survival of patients with maintenance hemodialysis: a meta-analysis

Review Article Different hemodialysis methods for survival of patients with maintenance hemodialysis: a meta-analysis

2016. The eligible studies were selected according to the pre-specified inclusion and exclusion criteria. After data extraction and quality assessment by independent reviewers, a meta-analysis was conducted using the RevMan5.2 software, with all-cause mortality as the primary outcome and the rate of death from vascular diseases and the rate of death from infection as secondary outcomes. Results: Nine studies involving 8,662 patients were enrolled. The meta-analysis showed significant lower all-cause mortality in the patients with HFHD than those with LFHD (pooled hazard ratio (HR)=0.71, 95% confidence interval (CI): 0.63-0.82; P < 0.001). Analysis on subsets of follow-up < 3 years and > 3 years revealed that all-cause mortality in HFHD patients was evidently lower than that in LFHD patients (P < 0.001). Among all the hemodialysis patients, there were more deaths from cardiovascular diseases than deaths from infection (P=0.005). The rate of death from cardiovascular diseases was markedly higher in the patients with LFHD than those with HFHD (pooled OR=0.79, 95% CI: 0.65-0.96, P=0.02); but there was no statisti- cal difference in the rate of death from infection between patients with LFHD and HFHD (pooled OR=0.90, 95% CI: 0.69-1.18, P=0.45). Conclusion: Scientific application of HFHD in the treatment of MHD patients resulted in a pronounced improvement in survival and a reduction in death from cardiovascular disease in patients.
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Factors associated with carotid intima-media thickness in patients on maintenance hemodialysis

Factors associated with carotid intima-media thickness in patients on maintenance hemodialysis

This cross-sectional study enrolled 68 subjects on mHD, 41 men and 27 women, with an age range of 26–80 (mean 56.28) years. Parameters including history of CVD, clinical and biochemical parameters, and CIMT were measured and ana- lyzed. Baseline data for all subjects are shown in Table 1. Men had significantly higher mean CIMT compared with women (0.7056 ± 0.1236 mm vs 0.6141 ± 0.1167 mm, P = 0.003), and subjects with CVD had higher CIMT values than those with- out CVD (0.7288 ± 0.1152 mm vs 0.6494 ± 0.1272, P = 0.026); there were no significant differences in mean CIMT between subjects with diabetes and statin use and those without (0.6863 ± 0.1131 vs 0.6640 ± 0.1131, P = 0.549; 0.6633 ± 0.1130 vs 0.6698 ± 0.1304, P = 0.907, respectively; Table 2). The cor- relation test showed that age and hs-CRP were positively cor- related with CIMT (R = 0.607, P < 0.001; R = 0.239, P = 0.030, respectively), while albumin plasma, phosphate serum, and calcium-phosphate product were negatively correlated with CIMT (R =− 0.291, P = 0.016; R =− 0.294, P = 0.015; R =− 0.284, P = 0.019, respectively). The strongest correlation was between age and CIMT (Table 3; Figure 1). In the multiple linear regression analysis, only age consistently had a role in determining the CIMT value ( β= 0.452, P < 0.001; Table 4).
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The ratio of CRP to prealbumin levels predict mortality in patients with hospital-acquired acute kidney injury

The ratio of CRP to prealbumin levels predict mortality in patients with hospital-acquired acute kidney injury

Serum C reactive protein (CRP) was an acute-phase pro- tein synthesized by the liver following stimulus by various cytokines, markedly increased within hours after infection or inflammation. The relatively short half-life of approxi- mately 19 hours makes it a useful monitor for infection and inflammatory disease. In addition, laboratory tests for CRP are easily available and less costly than cytokine tests [9-11]. Some studies suggested that increased CRP level was associated with sepsis and mortality of critical illness [9]. However, no study demonstrated that CRP was a pre- dictor for mortality of AKI patients [12]. Malnutrition was another outstanding problem in AKI patients and has been paid attention to in recent years [13-16]. According to the International Society of Renal Nutrition and Metabolism (ISRNM), the serum chemistry markers including albumin, prealbumin and cholesterol are recommended to assess the nutritional status [17]. Chertow et al reported that prealbu- min is as important as albumin in the nutritional assess- ment of hemodialysis patients [18]. The study by Cano et al showed that an improvement in prealbumin during nutritional therapy was associated with a decrease in mor- bidity and mortality in malnourished hemodialysis patients [19]. Another study also reported that even though baseline serum prealbumin may not be superior to albumin in pre- dicting mortality in maintenance hemodialysis (MHD) patients, prealbumin concentrations <20 mg/dL were asso- ciated with death risk in those patients and a fall in serum prealbumin over 6 month was independently associated with increased death risk [20]. In AKI patients, Perez- Valdivieso et al found that serum prealbumin levels <11 mg/dL were strongly associated with a higher risk of death independent of AKI severity [21]. Besides, few stu- dies reported the predict value of prealbumin in AKI patients. Cholesterol is another nutritional biomarker wildly used in clinic. In 1994, Dunham et al found that patients with severe trauma had a sudden reduction in total serum cholesterol concentration [22]. Hypocholester- olemia has been observed in patients undergoing surgical interventions and in those with multiple-organ dysfunction syndrome [23,24]. However, few studies showed the asso- ciation between cholesterol and the prognosis of AKI patients. In addition, the correlation between inflammation and malnutrition was close and complex because inflam- mation could lead to malnutrition, as well as malnutrition was an adverse factor for the control of inflammation [15].
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Survival patterns of patients on maintenance hemodialysis for end stage renal disease in Ethiopia: summary of 91 cases

Survival patterns of patients on maintenance hemodialysis for end stage renal disease in Ethiopia: summary of 91 cases

For many years the magnitude of ESRD in Ethiopia has not been studied. The use of dialysis in the country as a treatment strategy for ESRD dates less than a decade. In addition, access for dialysis is limited and is a highly unaffordable for the general public. Each dialysis session costs about $100 (1700 Birr) excluding the costs for other supportive cares. Because of the low socio- economic status, dialysis is thus considered as luxury care in the country. There is currently no dialysis center in Public hospitals in Ethiopia with a population surpass- ing 85 million. In addition, there is no national strategy for prevention and care of patients with CKD.
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Impact of risk factors on functional status in maintenance hemodialysis patients

Impact of risk factors on functional status in maintenance hemodialysis patients

numerous response types such as numerical data, cate- gorical data, and ratings; (2) robustness of construction; (3) ease of interpretation; and (4) the ability to deal with missing values in response and explanatory variables. CART analysis complements many traditional statistical techniques, including logistic regression, loglinear mod- els, and linear discriminant analysis [20]. Classification tree analysis captures sequential decision rules that may apply to subgroups of cohort based on variables having clinical utility or theoretical significance. In general, a regression analysis relatively weighs pervasiveness, while a classification tree analysis weighs specificity [21]. Based on our results, we propose that both methods can be complementary to explore the relevant clinical situation in dialysis patients. Nevertheless, additional clinical stud- ies are required to further validate these methods.
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Complement in patients receiving maintenance hemodialysis: functional screening and quantitative analysis

Complement in patients receiving maintenance hemodialysis: functional screening and quantitative analysis

complement activities is that complement regulatory proteins in the serum may be reduced in the patients. To the best of our knowledge, there are no reports on the association between HD and various serum regula- tory proteins. A few reports investigated only erythro- cyte complement receptor type 1 (E-CR1) among HD patients as follows: recombinant human erythropoietin improved anemia and increased the level of E-CR1 [24], and a low level of E-CR1 was associated with poor prog- nosis in HD patients [25]. Meanwhile, deficiency of complement regulatory proteins often occurs along with decreased levels of other complement proteins. For example, C1 esterase inhibitor (C1-INH) deficiency, which is one of the important risk factors of hereditary angioedema (HAE), is associated with an increased clea- vage of C4 by C1, which results in low C4 levels during the attack. Three HD patients with low CP and LP and normal AP activities in our study may also have had low C4 level due to C1-INH deficiency, but we could not measure the complement regulatory protein because we did not have enough serum. Examination of these patients including family history did not reveal symptoms that suggested HAE, such as recurrent and transient swelling of face, extremities and airway. Com- plement regulatory proteins in serum should be studied in the near future to clarify complement-mediated inflammatory manifestations.
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Survival of HIV infected patients on maintenance hemodialysis in Cameroon: a comparative study

Survival of HIV infected patients on maintenance hemodialysis in Cameroon: a comparative study

haemodialysis to death [10]. The widespread of c-ART has improved the outcome of HIV positive patients worldwide [15, 19, 28, 29]. Survival of these patients with ESKD receiving RRT, has also progressively im- proved [15, 30]. Data on survival of HIV positive pa- tients on RRT in SSA are scanty and inexistent in Cameroon. We found that one year survival rate of HIV positive patient was 61.4%. Our survival rate of HIV pa- tients is lower than reported findings in the international literature that range from 74 to 95.2% in HIV positive patient receiving haemodialysis [10, 17, 18, 31–33]. In the USA one year survival of HIV-positive patients re- ceiving chronic haemodialysis was estimated at 74% [10, 31]. In the study of Tourret et al. and Trullas et al. in Europe survival rate was 93.8 and 95.2% respectively [17, 32]. Tayebey et al. in Iran, found a rate of 75% [33], and Fabian et al. in South Africa recently reported a 100% survival rate of HIV-positive patients [18]. In the con- trary our survival rate is higher compared to the studies of Zako et al. in South Africa (51%) [34] and Rodriguez et al. (46%) [31].
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