Background. Phenols and indoles are fermentation products and putrefactants of intestinal bacterial origin. They present a problem in chronic renal failure and hemodialysis patients because they accumulate in the body as uremic toxins. Methods. A comparative study was performed in groups of patients with chronic renal failure (CRF) before the initiation of dialysis, hemodialysis patients (HD), and healthy adults to investigate changes in intestinal flora and to measure the blood levels of uremic toxins. Results. The level of Escherichia coli was significantly increased in the CRF and HD groups compared with the healthy controls (P ϭ 0.02, controls vs CRF before dialysis; P ϭ 0.0014, controls vs HD). Fecal concentrations of phenol and scatole were most highly elevated in the HD group, and the difference between the CRF and HD groups was significant (P ϭ 0.02 for phenol; P ϭ 0.01 for scatole). Serum concentrations of phenol, p-cresol, and indican were significantly elevated in the CRF group (P ϭ 0.01; P ϭ 0.008; and P Ͻ 0.0001 vs controls, respectively). For indican, a correlation was found between fecal and serum concentrations only in the HD group (correlation coefficient of 0.821; P ϭ 0.04). In the CRF group, a correlation was obtained between the urine and serum concentrations of phenol and p-cresol (0.852, P ϭ 0.01; 0.758, P ϭ 0.02, respectively). A correlation was also found between the serum concentrations of indican and serum creatinine (SCr) (0.610; P ϭ 0.004) and 2-microglobulin ( 2-MG) (0.739; P ϭ 0.005).were observed in the CRF group. The increased concentration of toxins with renal sclerosing effects, such as indican, may contribute to further deterioration of renal function.
Background: Thirty years have passed since hemodialysis therapy first started in Vietnam. However, there have been no reports on information such as the survival rate, mortality, and cause of death of hemodialysis patients on a national level. The aim of this study is to retrospectively analyze the data on hemodialysis patients from the flagship hospital in Ho Chi Minh City and to shed light on the status of hemodialysis patients in Vietnam. Methods: The patients in this report were all 18 years or older who underwent hemodialysis at the Thong Nhat Hospital between April 1997 and December 2014. There were a total of 349 patients, with 225 males and 124 females. Data was collected on the age, sex, primary causes of end-stage renal diseases, starting date of hemodialysis, vascular access, hemodialysis therapy prescription, hemodialysis dose, coexisting conditions, clinical test data, and cause of death. IBM's statistical analysis software SPSS Statistics 23.0 was used. Results: The survival time after hemodialysis introduction was 5.27 ± 0.31 years (mean ± standard deviation). The factors which impacted the survival rate included being 60 years of age or older at the initiation of hemodialysis, being male, coexisting conditions, and vascular access apart from an artery venous fistula. The prognosis of diabetic patients suffering from renal failure was poor when compared to that of patients without diabetes; however, there was no statistical significance. The most common cause of death was cardiovascular disease (46.1%), followed by other causes (11.8%) and unknown causes (23.6%). Conclusions: Our data shows that mean survival time was shorter than that in other countries. One-year and 5-year survival rates were not so different. However, a 10-year survival rate was very low. Significant risk factors were not so special, but we have a problem in medical cost in Vietnam. To improve the long-term survival rate, we are trying to change the situation.
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