Keywords : ESRD

Prevalence of Viral Hepatitis B, C, and Human Immunodeficiency Virus among End Stage Renal Disease Patients on Hemodialysis

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 2, Pages 76-86

Viral hepatitis infections are an important cause of morbidity and mortality in patients with end-stage renal disease (ESRD) on hemodialysis (HD), and its prevalence varies considerably among different areas of the world.
The aim was to investigate the prevalence of the HBV, HCV, and HIV among patients with ESRD on HD in a Hemodialysis Center in Baghdad, and to identify the factors associated with their transmission.
A cross-sectional study was carried out in the HD Center in Al-Kindy Teaching Hospital in Baghdad, Iraq. A total of 302 patients with ESRD on HD were enrolled in the period from February to May 2017. They were tested for the presence of hepatitis B surface antigen (HBs Ag), antibodies for hepatitis C virus (anti-HCV), and antibodies for human immunodeficiency virus (Anti-HIV).
From the 302 patients; the mean age patients was 51.06± 15.15 SD years, 176 (58.27%) were males, and 126 (41.72%) females. Four (1.3%) patients had positive HBs Ag. One (0.3%) male had anti-HIV Ab, and 140 (46.36%) had anti-HCV-Antibodies positive. Male gender, age between 41-60 years, been married, and unemployed patients scored a higher prevalence of anti-HCV positivity. The causes of renal failure in HCV patients were; hypertension in 44 (31.4%), diabetes mellitus in 34 (24.3%), renal diseases (like UTI, AGN, Renal stones) in 21 (15%), congenital renal diseases in 15 (10.7%), and unknown cause in 26 (18.6%). There were highly significant differences in the mean number of blood transfusions and the mean HD duration between HCV and non-HCV groups. There was a significant association between HCV infection and renal failure duration, and a history of surgery. Significant differences were also reported in the mean serum creatinine and hemoglobin levels between HCV and non-HCV groups.
The prevalence of HBV and HIV infections were low and the prevalence of HCV was high. HCV infection was related to the higher number of blood transfusions, longer duration of renal failure, longer duration of HD, a history of surgery, creatinine and Hemoglobin levels. The study recommends local guidelines emphasizing on blood safety strategies, implementation of infection control practices with regular monitoring.

The ECG Manifestation of Hyperkalemia in End Stage Renal Disease Patients on Maintenance Haemodilysis

Sahban Al- Malah

Iraqi Postgraduate Medical Journal, 2008, Volume 7, Issue 3, Pages 245-248

It is speculated that usual electrocardiographic manifestations of hyperkalemia are less pronounced in patients with end stage renal disease ((ESRD)) than in those with normal renal function, those patients usually have tolerance for hyperkalemia and the usual cardiac and neuromuscular sequalaes are less evident possibly due in part to fluctuation in serum calicium concentraton .
We studied 70 consecutivly selected stable haemodialysis patients to determine the prevalence of ECG changes of hyperkalemia, predialysis serum potassium concentration and pther electrolytes were measured and smiltaneous 12- lead electrocardiogram obtained.
The 70 study subjects ((35 males, 35 females )) age 45.5_+10.6((range 24-60)) mean duration of ESRD was 22_+20 months((range4-60 )).
-Mean predialysis serum potassium concentration was 4.7 _+0,9mEq/L(range 3.5-7.1). – Mean precordil leads T wave amplitude for entire group was 5.2_+4.4mm.
- Mean T wave to R wave ratio was 0.4 _+ 0.1 .
- Mean serum calcium concentration was 9.0_+0.61mq/dl(range 7.5-11.8).
-No study subject had evident arrhythmia.
-There was no significant difference in T wave amplitude (p=o.11)or T wave to R wave (p=0.12) between quartiles of serum potassium concentration.
-Total serum calcium concentration had inverse relation with T wave amplitude ( p=0.007).
Haemodialysis patients with hyperkalemia may not exhibit the electrocardiographic changes of hyperkalemia, thus the absence of ECG changes in hyperkalemic haemodialysis patients should interpreted with caution