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Underdialyzed patients have high hospitalization and mortality rates. It is unclear if such patients receive adequate dialysis during hospitalization. In this cross-sectional study, we evaluated single treatment delivered dialysis dose during hospitalization and compared this to the dosage received at the free-standing outpatient clinics in the same patients. Eighty-four patients (54% male) aged 23–63 years (means ± SD 55.5 ± 14.6) who have been on dialysis for at least 3 months were evaluated. Hypertension and diabetes were the most common diagnoses, while thrombosed graft or fistula accounted for 40% of admissions. The mean dialysis treatment time (Td) was 30 min longer in the outpatient (OP) setting than the hospital (H): 3.6 ± 0.3 vs. 3.1 ± 0.2 h (p < 0.0001). Attained blood flow (QB) was 15% greater in the OP than H: 394 ± 40 vs. 331 ± 54 ml/min (p < 0.0001). The Kt/V was analyzed in 49 of 84 patients; the OP Kt/V was 20% greater than the H Kt/V: 1.38 ± 0.2 vs. 1.11 ± 0.1 (p < 0.0001). A further breakdown of H Kt/V according to access and membrane types showed that patients with functional grafts/fistula had a higher Kt/V than those with temporary accesses 1.14 ± 0.1 vs. 1.07 ± 0.1 (p = 0.01). We conclude that hospitalized patients receive suboptimal dialysis dose, this could have a negative impact on survival if hospitalization is recurrent and prolonged. Kinetic modeling should be routinely performed in such patients and Td should be increased in patients with temporary accesses.

Women with chronic kidney disease are much less likely to become pregnant and pregnany has always been considered as a challenging event both for the mother and the fetus. The challenge is harder in patients undergoing dialysis.The main objective of our work is reporting our experience of pregnancy's cases in hemodialysis centers in southern Tunisia. Methods: It was a retrospective and multicentric study looked at 25 spontaneous pregnancies in 19 patients treated with periodic hemodialysis in different hemodialysis centers in southern Tunisia over a period of 34 years. All pregnancies were spontaneous and are counted even spontaneous or voluntary abortions during the 1st and 2nd trimester of pregnancy Results: The maternal age at the onset of pregnancy was, on average, 35.63 years AE 5.62 (between 23 and 44 years). Our study included 19 patients from the south, 6 of them belonged to the governorate of Medenine. Hypertension was present in 7 patients (37%). The average duration of hemodialysis before conception is 4.56 years AE 3.55 (1 -17 years). Seven patients (37%) had residual diuresis of: 1 liter per 24h in 2 cases, 500ml per 24h in other cases and the rest of the patients were anuric. All our patients were anemic before pregnancy with a mean hemoglobin level at 8 AE 1.54 g / dl (5.1 -10.6 g / dl) with erythropoietin use in 12 (48%), folate in 11 cases (44%), intravenous iron in 11 cases (44%) and transfusion in 6 cases (24%). In our series, the average urea level was 22.19 AE 4.29 mmol / L. The urea level was lower or equal to 20 mmol / L in 8 cases (42%) and greater than 20 mmol / L in 11 cases (58%). Among the 25 pregnancies, 16 (64%) resulted in the birth of a live child: 4 intra-uterine malformations, 4 early abortions and one voluntary termination of pregnancy. There were 2 deaths within 28 days after birth. Pregnancy was considered a success if it resulted in the birth of a newborn surviving at least 28 days. Thus, the success rate was estimated at 56%. Among the maternal complications, hypertension was the most frequently complication (35% of cases). There were 2 cases of hemorrhage's delivery as obstetrical complication. Among fetal complications, prematurity was frequent and was present in 15 cases (60%): 10 cas (40%) of average prematurity, 4 cases (16%) of great prematurity and 1 case (4%) of extreme immaturity. Hydramnios was found in 3 cases (16%). Intra-uterine growth retardation was found in 13 cases (52%) and 6 cases of death (24%) were described. Conclusions: Pregnancy during chronic end stage renal failure is rare but possible. The chance of giving birth to a live child has increased in parallel with advances in hemodialysis techniques and early weightbearing. Thus, a successful pregnancy in woman on dialysis requires collaboration among nephrologists, dialysis unit staff and obstetricians.

its use will prevent a large number of patients from unnecessary exposure to systemic antibiotics, hence reduce the development of antibiotic resistance and the economic impact of using long term prophylactic systemic antibiotics.Introduction: Background: LMWHs are available since 30 years with wide use in the treatment and prevention of medical and surgical thromboembolic events. The use of LMWHs as anticoagulant in hemodialysis (HD) patients is still not a routine or standard practice. We are using LMWH 'Enoxaparin" since 1998 as a standard anticoagulation in our HD unit, and in a previous publication (1), we found that dose of enoxaparin required in our HD patients, is only the 1/3 of the recommended dose, which was (0.36 mg/kg) Aim of the study: In the current study, we are reporting our 15 year experience of using "Enoxaparin", evaluating following points: the current used dose, the dose according to the type of vascular access, etiology of kidney disease (diabetic, none diabetic), and dialytic mode (HD, HDF) Methods: This study includs 252 HD patients, mean age 56.6 (17) year, Male 145 (57.5 %). Mean duration on HD 50 (44.5) months. 139 (55%) were diabetics, 138 (55%) had AVF, 28 (11%) had AVG, and 86 (34%) had tunneled catheter(TC). 187 (74%) patients were on HD, and 65 (26%) were on line HDF. Results: Total number of HD sessions during the 15 years use of " Enoxaparin" was 350,000. The average dose of " Enoxaparin" was 0.31 (0.14) mg/kg/session. 0.29 (0.13), 0.34 (0.17), and 0.34 (0.14) mg/kg/ session, were the average doses used in AVF, AVG, and TC respectively with p¼0.03. The dose used in DM patients was 0.30 (0.13), and 0.34 (0.13) mg/kg in non DM, withp¼0.15. Average dose in HD was o.31 (0.13), and in HDF 0.32 (0.15) mg/kg, p¼0.69 Conclusions: To the best of our knowledge this study is the longest, and the largest experience ever reported with the use of LMWH " Enoxaparin" as a standard anticoagulant in HD. The average dose used continued to be low and stable with time. Only the type of vascular access impact significantly the required dose.

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