Hemodialysis-associated muscle cramps (HAMC) are a common complication during hemodialysis (HD) sessions. A number of pharmacologic agents have been evaluated to prevent and or diminish HAMC; however, none of them has an established role. To the best of our knowledge, this is the first study to evaluate the possible effect of gabapentin on HAMC. In a double-blinded clinical trial, we compared the possible effect of gabapentin with a placebo in prevention and or diminishing episodes of HAMC in HD patients who had experienced frequent intradialytic muscle cramps. At first, placebo was given before each dialysis session for four weeks and then, after a two-week washout period, 300 mg of gabapentin was given before each dialysis session for four weeks to verify the effect of gabapentin on HAMC. Overall, 15 patients (seven men and eight women; mean age, 52.02 years) with frequent intradialytic muscle cramps were enrolled in the study. The incidence of symptomatic muscle cramp decreased in the gabapentin group compared with the placebo group, with a significant difference between them (P = 0.001). The intensity of muscle cramps also decreased in the gabapentin group (P = 0.001). There was no significant association between HAMC in male and female patients (P = 0. 397), mean age of HD patients (P = 0.226) and cause of end-stage renal disease (P = 0.551). According to the results of our study, gabapentin prescription before each HD session significantly reduced the frequency and the intensity of muscle cramps during HD without any major side-effects.

Background & Objectives:Saleint decrease in physical activity, including problems that are frequently observed in hemodialysis patients .Inversely, the performance level of hemodialysis patients related to with major health consequences such as health care costs and mortality. This study determined the Effect of Care Plan Based on the ROY ADAPTATION MODEL on Activities of Daily Living of hemodialysis Patients Material & Method: This clinical trial research was performed on 54 hemodialysis patients (28 intervention and 26 control patients). The intervention group received the RAM program through a face to face process with 4 sessions at 3-week interval followed by a follow-up period of 4 weeks, while the control group received the regular services from hospital. The data collected by using of patient identification form, Inventory of Functional Status-Dialysis and Roy assessment tool. Data were analyzed with SPSS. Results: The results indicate that the between two groups were not different on Activities of Daily Living (p=0.060) before the intervention but they were significantly different after the intervention. Patients' Activities of Daily Living improved in patients in the intervention group. Conclusion: The findings of this study indicate that the Care Plan Based on the ROY ADAPTATION MODEL is a low cost nursing intervention for Activities of Daily Living improved in Hemodialysis Patients.

BackgroundThe presence of arterio-venous (A-V) fistula recirculation among hemodialysis (HD) patients markedly decrease adequacy of dialysis.ObjectivesThe present article summarize some of observations about clinical significance, causes, the most common techniques for measurement, and main source of pitfall in calculation of access recirculation.Materials and MethodsA variety of literature sources such as PubMed, Current Content, Scopus, Embase, and Iranmedex; with key words such as inadequate dialysis and arterio-venous fistula access recirculation were used to collect current data. Manuscripts published in English language as full-text articles or as abstract form were included in our review study.ResultsAny access recirculation among HD patients should be considered abnormal and if it presents prompt investigation should be performed for its causes. There are two most common techniques for accurate assessment of access recirculation: Urea (or chemical) and nonurea-based method by ultrasound dilution technique. The most common causes of access recirculation are the presence of high-grade venous stenosis, inadequate arterial blood flow rate, close proximity, or misdirection of arterial and venous needles placement by HD staff especially in new vascular accesses due to a lack of familiarity with the access anatomy.ConclusionsThe presence of access recirculation among HD patients can lead to significant inadequate dialysis thereby resulting in reducing the survival of these patients. Therefore, periodic assessment of access recirculation should be performed in HD wards.

Introduction: Anemia is a common complication of ESRD with different etiologies. The most common cause of anemia in such patients is insufficient production of erythropoietin by kidneys. Another possible reason is copper deficiency, thus, this study is aimed to evaluate the serum copper level among hemodialysis patients with and without anemia and to compare them to healthy controls. Material and Methods: A total number of 56 patients who underwent regular hemodialysis due to their ESRD were enrolled and divided into two groups of 28 according to their Hgb results including patients with anemia (Hgb<11 gr/dl) and patients without anemia (Hgb>11 gr/dl). Also, 28 healthy individuals participated as the control group. Venous blood samples were collected from patients prior to hemodialysis. Spectrophotometry employed for copper measurements. Data were analyzed using t-test and Pearson regression analysis. Results: Mean age of patients was 44.36±15.80 years. No significant difference was present among the three groups with regarding to age and gender. Mean and SD of serum copper in patients with anemia, without anemia, and controls were 180.11±54.48, 139.66±35.57 and 155.82±42.06 µg/dl respectively. Serum copper level was significantly higher in hemodialysis patients with anemia compared with those without anemia (p<0.03). Also a significant inverse regression between serum copper and Hgb was present in all hemodialysis patients (p=0.02, r=-0.37). Conclusion: Higher levels of serum copper in anemic patients could be a result of restraining role of high serum copper on iron absorption that has a negative effect on the production of Hgb. However, complementary studies are required. DOI: http://dx.doi.org/10.3329/bjms.v14i1.16853 Bangladesh Journal of Medical Science Vol.14(1) 2015 p.43-48