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Introduction: The main goal of treatment and care of chronic patients including those suffering from end stage chronic renal failure is to promote their health and their quality of life (QOL). Various researches have shown that health level, performance status and QOL, especially for hemodialysis patients are often less than expected. So, an attempt to find effective and cost benefit education methods in this area seems to be necessary. This study is done to compare the effects of two educational methods of direct and indirect (multimedia educational package) self-care program on QOL and physical problems of hemodialysis patients. Materials and Methods: This quasi experimental research was carried out on two groups of hemodialysis patients. Sixty three patients were selected from three main dialysis centers in Tehran and allocated randomly into two groups (group one 32 and group two 31 patients). The first group used the direct educational program and the second group used the indirect educational package (multimedia). Patients were assessed before education using QOL questionnaire (short form SF-36), need assessment questionnaire and checklists. After determining educational needs and status of the patients, a self care educational program was designed based on self care model and the principles of patient education and also through counseling with nephrologists and nutritionists. The educational program was implemented directly on group one (direct education). Also it was recorded and indirectly used for the second group as a multimedia educational package once a week within one month during dialysis. After implementation of the self care educational program, both groups were assessed and measured again by same questionnaires and checklists. Data was analysed using student T, Wilcoxon and Mc Nemar tests. Results: Findings showed that most of studied variables including laboratory tests, blood pressure, weight gain between two dialysis, skin itching, edema and some vascular complications are decreased significantly in each group before and after education. QOL was also significantly improved in each group. But there was no significant difference between the two groups. Conclusion: Since, there was no significant difference between the two groups in terms of efficiency of two methods of direct and indirect (multimedia) educational self care programs and also due to the problems and higher costs of the direct educational program comparing to the indirect method, the indirect method is recommended as an effective, cost benefit, simple and patient-friendly method for hemodialysis patients.

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Introduction: A high prevalence of HCV infection among hemodialysis patients has been reported worldwide. Risk factors such as history of blood transfusion, duration of hemodialysis and recently nosocomial transmission of HCV in hemodialysis units have been identified. In this study the prevalence of Hepatitis C virus antibody and risk factors in hemodialysis patients in Markazi province is investigated. Materials and Methods: In this cross-sectional analythical study, blood samples were obtained from all 204 hemodialysis patients. Samples were tested for anti-HCV antibodies by using third generation enzyme immunoassay. The reactive samples on ELISA were confirmed by the third generation RIBA. Risk factors were evaluated by a questionnaire. Data was analysed using Chi square and logistic regression. Results: The prevalence of anti-HCV antibody among hemodialysis patients was 4.9%.Duration of hemodialysis was identified as a major risk factor in transmission of HCV (p=0.004). There was a significant relationship between anti-HCV positivity and previous renal transplantation (p=0.032). Female sex was another risk factor for HCV infection (p=0.030). There was no significant relationship between anti-HCV positivity and history of blood transfusion. Conclusion: Nosocomial transmission of HCV within hemodialysis units seems to be a route of infection in patients on hemodialysis in Markazi province. Application of dialysis precautions recommended by CDC can reduce the prevalence of HCV infection among hemodialysis patients in this province.

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Introduction:The membranes used in haemodialysis may be manufactured from cellulose, modified cellulose or synthetic polymers. Such membranes, when in contact with blood will activate the complement system, which entails changes in leukocyte and platelet counts. Polysulfone is a synthetic membrane of high biocompatibility standards, whereas haemophane membranes are modified cellulose-based membranes. The biocompatible profiles of these membranes, has been studied by clinical reactions (i.e. hypotension, nausea, pruritis, …) during dialysis sessions. Both kinds of these membranes are used in Iran. The number and severity of these reactions define the degree of dialysis biocompatibility. Materials and Methods: In a clinical trial study which was carried out in Imam Khomeini hospital in Tehran, 100 hemodialysis patients were enrolled to this investigation. Their clinical reactions were compared during 3 sessions of hemodialysis with polysulfone and 3 sessions of hemodialysis with hemophan membrane. Each patient was the control of him/herself. Data was analyzed using Chi square test. Results:Mean age of patients was 48.85±17.56 years and 39% of them were female. The most common complications were hypotension and muscle cramps (each 21.5%). Hypotension was higher in sessions of polysulfon versus hemophane (18% versus 25%) but was not significantly different. Also other complications such as muscle cramp, nausea, vomiting, dyspnea, headache, chills and fever had no significant difference. Seizure did not occur in any patient. Conclusion: According to our findings the membrane’s type has no role in acute clinical complications during hemodialysis and in most patients, membranes can be used according to their availability. It seems their biocompatibility has no considerable clinical difference.

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Introduction: End stage renal disease (ESRD) is a major health problem and each year the number of patients is increasing. If the disease becomes irreversible, patients must always be hemodialyzed. Since mortality rate will increase due to inadequate dialysis, determining the efficacy of hemodialysis and improving its quality is very important. The main goal of this research is investigating the efficiency of hemodialysis. Materials and Methods: This is a cross-sectional analytical study which was conducted on 103 people who were under dialysis treatment in the Vali-e-Asr hospital of Arak in year 2003. Weight, blood pressure (before and after dialyze), time of dialysis, BUN and Cr before dialysis and 5 minutes after turning of the pump and before the second dialysis were measured. Data was analyzed by T test and Pearson correlation. Results: The mean of KT/V was 0.58 ± 0.1 normal protein catabolic rate (nPCR), 0.36 ± 0.11 g/kg per day and time average concentration of urea (TAC), 43.3 ± 14 mg/d which had a significant difference with standard measures (p<0.05). KT/V was 0.49 ± 0.18 and 0.47 ± 0.10 for men and women respectively which was significantly different (p<0.03). There was a positive and linear relationship between education level and TAC, KT/V and number of dialysis per week. Conclusion: Regarding the low efficiency of hemodialysis in 80% of patients and lower levels of hemodialysis efficacy indicators in comparison to standard measures, periodic assessment and also investigating the reasons of low efficacy of hemodialysis is recommended.

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Background: One of the main complications associated with arteriovenous fistula in hemodialysis patients is the median nerve ischemic neuropathy in the wrist. This study was conducted to examine the effect of arteriovenous fistula on the development of carpal tunnel syndrome. Materials and Methods: This cross-sectional study was conducted on 37 hemodialysis patients at Shahid Mohammadi Hospital of Bandar Abbas in 2007-2008. All of the patients had either a distal or a proximal arteriovenous fistula in one hand. Nerve conduction velocity and median nerve distal sensory and motor latency were applied to the diagnosis of carpal tunnel syndrome. The limb with fistula (the case) was compared to the one without it. Data were analyzed through independent t-test and Pearson product correlation. Results: Overall, 17 patients had proximal and the rest had distal fistulas. Fistulas aging more than one year were seen in 15 patients and 22 patients had fistulas less than one year old. Carpal tunnel syndrome had developed in 25 wrists with fistula (17 motor and 8 sensory cases) and 27 wrists without fistula. A significant difference was observed in the median nerve distal sensory latency between the wrists with fistula and those without it. There was not a significant difference between the variables. In addition, there was a significant difference between the age of the fistulas and the incidence of carpal tunnel syndrome. Conclusion: The rate of the development of carpal tunnel syndrome in wrists with or without fistula is the same. Also, the site of the fistula does not have any effects on the incidence of the median nerve ischemic neuropathy.

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Background: Recent studies have shown that nicotinic-amide and niacin induce significant reductions in serum phosphorous in patients undergoing hemo-dialysis. The aim of the present study was to determine the effect of nicotinic acid on serum phosphorous level in patients undergoing long-term hemodialysis. Materials and Methods: In an 8-week cross-over randomized double-blind clinical trial, 37 patients were assigned to nicotinic acid or placebo groups with titration from 400 to 1000 mg/ daily. A 2-week washout preceded the switch from nicotinic acid to placebo or vice versa. Statistical analysis was performed using paired- sample t test. Results: The mean dose of nicotinic acid at the end of the period was 740±204 mg/daily. Nicotinic acid showed a significant decrease in serum phosphorus after the 8-weeks treatment however no significant changes occurred in the placebo group (P =0.01). Also, nicotinic acid resulted in an increase of HDL cholesterol levels after 8 weeks. Conclusion: Nicotinic acid can lead to a decrease and an increase in serum phosphorous and HDL cholesterol levels, respectively. However, there is need for longer trials with larger sample sizes for determining the most effective doses of this drug.

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Background: Prevalence and incidence of end stage renal diseases requiring renal replacement therapies such as dialysis and kidney transplantation is on the rise. However, no qualitative research studies have been done to explore the experiences of people living with dialysis and kidney transplant in depth. Therefore, this qualitative study was done to explore the experiences of patients living with dialysis and those with kidney transplant. Materials and Methods: This qualitative study was carried out through content analysis approach. Sampling was done from the beginning and continued until data saturation. Semi-structured interviews were tools of data collection. A total of 18 participants were interviewed. The interviews were analyzed through Graham and Landman content analysis method. Results: After analyzing the data, two main themes including, dialysis, a grueling event, and renal transplantation, a normal life with healthy kidney transplant, were reported. Conclusion: Compared with hemodialysis, receiving a kidney through transplantation provides a significantly more pleasant quality of life for patients. However, there are certain obstacles in transplantation and graft survival in the views of transplantation patients. Hence, it is suggested that health officials design programs to provide support and instruction to facilitate the process of kidney transplantation for eligible patients even before entering the dialysis stage.

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Background: Adequately delivered hemodialysis dose has been shown to have a distinct impact upon the morbidity and mortality of patients on chronic dialysis therapy. Online conductivity monitoring (OCM) using sodium flux as a surrogate for urea allows for repeated measurement of hemodialysis adequacy in each treatment session. Materials and Methods: In this cross-sectional study, 156 treatment sessions in patients undergoing chronic hemodialysis were assessed by measurement of the conductivity performed by Diascan in AK 96 dialysis machines. Dialysis adequacy was measured by daugirdas logarithmic estimates of single-pool Kt/V. Values of calculated Kt/V and simultaneously obtained online Kt/V were compared. Statistical analysis was performed using paired sample t-test. Results: There was a statistically significant difference between calculated Kt/V and online Kt/V in this study. The mean calculated Kt/V was 1.1±0.18 and mean online Kt/V was 0.77±0.32 (p<0.001). There was a moderate correlation between calculated Sp Kt/V and on-line Kt/V (r =0.44, p=0.012). Conclusion: Despite the underestimation of hemodialysis adequacy by online conductivity monitoring in comparison with Sp Kt/V, it is a useful tool in clinical practice.

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Background: The Infections that are related to vascular access, are regarded as Important factor in mortality and morbidity in the patients with immune deficiency including hemodialysis patients. Staphylococcus aureus is the most common and most Important organism involved in this regard and it cause bacteremia and its complications in the patients is important. This organism can cause carriage states and its most frequent carriage source is in the nose. The aim of this study is determination of staphylococcal carriage states in the Zanjan hemodialysis patients and control group.

Materials and Methods: This cross sectional study is designed in the patients with chronic renal disease who were referred to the hemodialysis wards. Nasal samples were collected with sterile swabs. Then they were inoculated in the blood agar culture media and incubated at (35-37) degree for (24-48) hours. This method was taken for control group too. The collected data were analyzed with SPSS and Chi-Square statistically methods.

Results: Based on this study, 7.4 percent of patients and 11.1 percent of the control group were nasal carriers of staphylococcus aureus. The results did not show any meaningful statistically difference between the cases and control groups. But a meaningful statistically difference was observed in the Staphylococcus hemolyticus carriages and the nasal carriage of this organism was more common in the women of case group.

Conclusion: Based on our study, we don't find high prevalence rate of nasal staphylococcus aureus carriage among our case group, and It seems this organism isnot an important agent in our hemodialysis wards.

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Background: Occult hepatitis C virus (HCV) infection is defined as the presence of HCV-RNA in liver or peripheral blood mononuclear cells (PBMCs) in the absence of detectable hepatitis C antibody (anti-HCV) or HCV-RNA in the serum. Although occult HCV infection is less aggressive than classic chronic HCV infection, nevertheless it is important in management of hemodialysis (HD) patients. Occult HCV infection has been described in two different clinical settings: in patients with normal liver enzymes or in patients with abnormal values of liver enzymes. The aim of this study was to detect the occult HCV infection in hemodialysis patients with elevated liver enzymes.

Materials and Methods: This cross sectional study was performed in hemodialysis patients referring to 3 dialysis units in Tehran. In 30 anti-HCV negative HD patients with elevated liver enzymes, presence of HCV-RNA in plasma samples was tested by Reverse Transcriptase-Nested Polymerase Chain Reaction (RT-nested PCR). In cases with negative anti-HCV and plasma HCV-RNA, HCV-RNA was checked in PBMC specimens by RT-nested PCR.

Results: A total of 30 HD patients with mean age 54.4± 14.1years and mean dialysis duration 81.2 ±64.4 months were enrolled in the study. All HD subjects were negative for HCV-RNA in plasma and occult HCV infection with RT-nested PCR method.

Conclusion: Occult HCV infection was rare in HD patients with elevated levels of liver enzymes.

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Background: Radiocephalic arteriovenous fistula (AVF) at wrist is the vascular choice for dialysis. In the absence of a suitable vein in the wrist, elbow brachiocephalic fistula is the next choice. In this study to create an arteriovenous fistula in antecubital area, we turned to the proximal radial artery in comparison to brachial artery in antecobital area for dialysis.

Materials and Methods: We reviewed 124patients in clinical trial study that candidated for placement of AVF for dialysis in antecubital area .To create AVF ,proximal radial artery in 62 patients and brachial artery in 62 other patients selected as the artery of choice,then patients followed based on complications ,steal syndrome ,primary failure and mean time to prepare for dialysis.

Results: The mean time of maturation of AVF in brachial group was 41 days and in radial group was 43 days. Primary dysfunction in brachial group was 6 cases (10%) and in radial group was 5 cases (8%). Steal syndrome in radial group was not seen but in brachial group 2 cases (3%) were seen.

Conclusion: According to the primary success, steal syndrome and mean time of maturation of these two arteries had no significant statistic differences, but like other previous studies, this study emphasizes on usefulness and less complications. On the other hand, due to the anterior anatomical position and allowing the release of the artery, it causes easy technique for creating AVF anastomosis to the antecubital arteries and its branches.. Therefore, this study recommends use of this artery in creation of AVF in antecubital area.

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Background: There is a relationship between diabetes, dialysis and oxidative stress. The aim of this study was the comparison of structural changes in Hb, oxidative damages in plasma proteins, and antioxidant capacity in diabetic hemodialysis patients with those of control subjects.

Materials and Methods: In this experimental study, blood samples obtained from diabetic hemodialysis patients and control group. Oxidative damages in plasma proteins were determined by carbonyl assay and antioxidant power of plasma was performed by FRAP assay. Conformational changes in Hb were detected by spectrophotometric analysis. Blood glucose, urea, creatinine and uric acid in patients were determined usnig routine laboratory methods. Statistical analysis were performed by using regression analysis and t-test in SPSS20 software.

Results: This study showed a significant correlation between carbonyl content of plasma proteins and optical density of Hb at 630 and 275 nm which corresponds to structural changes in Hb. ferric reducing ability of plasma (FRAP), as an index of total antioxidant capacity of plasma was found to be enhanced significantly in diabetic patients receiving hemodialysis (from 1019.62±129 to 1354.54±129 molare, p<0.05).

Conclusion: The results obtained in the present study showed that inducible factors in diabetic hemodialysis patients contribute to plasma antioxidant activity and probably responsible for prevention of carbonyl formation and oxidative damages in hemoglobin.