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Introduction: Patients undergoing hemodialysis require direct and continuous care. Identifying the barriers to and factors facilitating hemodialysis care can improve care quality. Objectives: The aim of this study was to assess the barriers and facilitators of care for hemodialysis patients. Patients and Methods: This study was conducted as a qualitative study and it utilized content analysis approach. The study was performed in hemodialysis ward of Kowsar hospital in Semnan, in 2014. We used purposive sampling method with maximum diversity. Semi-structured interviews with open questions were used to collect data from a total of 20 participants. Results: The main topic of health care challenges was divided into two main categories, including the facilitators and barriers of hemodialysis care. The facilitators of hemodialysis care had four subcategories, including "intimate relationship", "basic knowledge", "hemodialysis skills", and "experience". The category of barriers had eight subcategories, including "shortage of nurses and heavy workload", "weak authority of the head nurse", "ignorant director of nursing", "shortage of nephrologists", "lack of vascular surgery expert", "lack of nurse’s aide and nursing assistant ", "unskilled staffs", and "interference by patients’ caregivers". Conclusion: The findings of this study showed that access to human resources and their abilities were among the factors facilitating care. However, lack of qualified medical staff at each level of care delivery was one of the barriers to hemodialysis care. Hence, it is of great importance for policy makers, managers, and program designers to recruit human resources who have the characteristics and competencies required for providing hemodialysis care.

BackgroundNephrolithiasis is a widespread multifactorial disorder. Constitutional, environmental and genetic factors play a role in stone formation. Although important advances have been made in understanding the pathophysiology of stone formation, none of the many theories have given a satisfactory explanation of this process.ObjectivesThe objective of study was to evaluate the probable relationship between cigarette smoking and nephrolitiasis in adult men.Patients and MethodsA total of 102 cases diagnosed with nepholithiasis and 121 age-matched healthy controls were recruited from June 2010 to September 2011. Smoking status and resultant data was obtained from both groups.ResultsTwenty seven (26.5%) of the patients with stones and eighteen (14.9%) of the control group were current cigarette smokers. Our findings showed that smoking significantly increases the risk of nepholithiasis (OR = 2.06, 95% CI: 1.06-4.01, P = 0.034). There was no significant difference in the number of cigarettes smoked (P = 0.830) and years of smoking (P = 0.536) between subjects with and without stones (P = 0.536).ConclusionsThis study suggests that cigarette smoking might be an independent risk factor for the development of nephrolithiasis.

The current study was conducted to assess the effects of vitamin D supplementation on insulin metabolism, lipid fractions, biomarkers of inflammation, and oxidative stress in diabetic hemodialysis (HD) patients. This randomized double-blind placebo-controlled clinical trial was carried out among 60 diabetic HD patients. Subjects were randomly allocated into two groups to intake either oral vitamin D3 supplements at a dosage of 50 000 IU (n=30) or placebo (n=30) every 2 weeks for 12 weeks. After 12 weeks of intervention, subjects who received vitamin D supplements compared with the placebo had significantly decreased serum insulin concentrations (-3.4±3.7 vs. +2.0±4.2 μIU/ml, p<0.001), homeostasis model of assessment-estimated insulin resistance (HOMA-IR) (-1.2±1.8 vs. +0.9±2.3, p<0.001), and improved quantitative insulin sensitivity check index (QUICKI) (+0.02±0.03 vs. -0.01±0.02, p<0.001). In addition, compared with the placebo, vitamin D supplementation led to significant reductions in serum high-sensitivity C-reactive protein (hs-CRP) (-1.4±2.5 vs. +1.4±4.8 mg/l, p=0.007), plasma malondialdehyde (MDA) (-0.1±0.2 vs. +0.1±0.2 μmol/l, p=0.009) and a significant increase in plasma total antioxidant capacity (TAC) concentrations (+33.8±56.7 vs. -2.0±74.5 mmol/l, p=0.04). We did not see any significant effect of vitamin D supplementation on lipid profiles and other biomarkers of inflammation and oxidative stress compared with the placebo. Overall, we found that vitamin D supplementation had beneficial effects on serum insulin, HOMA-IR, QUICKI, serum hs-CRP, plasma MDA, and TAC levels among diabetic HD patients for 12 weeks. CLINICAL REGISTRATION:: http://www.irct.ir: IRCT201611155623N92.

Background:Overweight and obesity have become a global public health over the last decades. Obesity has been suggested to be a risk factor for some infections, but studies often showed controversial findings. Few studies examined the relationship between body mass index (BMI) and urinary tract infection (UTI), showing inconsistent results.Objectives:The purpose of this study was to determine the relationship between BMI and UTI in adult patients.Patients and Methods:Adult patients (≥ 18 years old) who were referred to clinics or admitted in hospital with diagnosis of UTI were considered for participation in the study. Control group were selected from healthy adult normal population whom underwent medical check-ups at the same hospital and without history of UTI. Data about age, gender, history of diabetes mellitus and BMI were registered for individuals who met inclusion criteria.Results:A total of 116 patients with UTI and 156 people as the control group were included in the study. Two groups were matched for age, gender and history of diabetes mellitus. Mean BMI ± SD of patients was 25.2 ± 4.0 kg/m2 and the controls was 25.1 ± 3.6 kg/m2. There was no significant correlation between BMI and UTI (P = 0.757). Mean BMI ± SD of patients with upper UTI was 25.6 ± 4.1 kg/m2 and for lower UTI was 24.9 ± 4.0 kg/m2. There was no significant difference between BMI of controls and patients with any type of UTI (P = 0.573).Conclusions:Our findings did not found an association between BMI and UTI and does not support obesity as a risk factor for UTI in adult patients.

Introduction: The most common cause of death from diarrhea is the shock caused by dehydration, electrolytes and acid-base disorders. Objectives: The aim of this study was to evaluate water and electrolytes disorders in diarrhea patients after treating severe acute diarrhea. Patients and Methods: In this study we used a historical cohort and studied patients who were hospitalized due to acute diarrhea and were similarly treated for dehydration and water and electrolyte disorders as recommended by the World Health Organization (WHO) guideline. Electrolytes, pH, serum creatinine (Cr) level on admission and during treatment were recorded. Patients with underlying diseases were excluded from the study. Results: Of 121 patients who were enrolled in the study, 67.8% had hyponatremia on admission (plasma Na <137 mEq/L) and 5.8% had hypernatremia. Around, 33.88% of patients had hypokalemia and 2.4% had hyperkalemia. All hyperkalemia disorders were treated, but 87.1% of patients had hypokalemia or low potassium levels, or they were affected by uncorrected hypokalemia and were in need of further measures. Of all, 56.75% had acidosis and 21% of patients with acidosis were not treated or the severity of their acidosis increased during treatment. There was a significant relationship between acute renal failure (ARF) and hypokalemia at the time of admission (P<0.001), potassium loss during treatment (P<0.001), acidosis (0.005), and cholera-related diarrhea (0.05). Conclusion: The high prevalence of hypokalemia in these patients as well as potassium loss during treatment indicates insufficient level of potassium in the therapeutic solutions. Mild hyponatremia in most patients highlights the need for isotonic solutions to treat dehydration.

Objective: This study was carried out to determine the effects of vitamin D supplementation on signaling pathway of inflammation and oxidative stress in diabetic hemodialysis (HD) patients.Methods: This randomized double-blind placebo-controlled clinical trial was conducted among 60 diabetic HD patients. Subjects were randomly allocated into two groups to intake either vitamin D supplements at a dosage of 50,000 IU (n = 30) or placebo (n = 30) every 2 weeks for 12 weeks. Gene expression of inflammatory cytokines and biomarkers of oxidative stress were assessed in peripheral blood mononuclear cells (PBMCs) of diabetic HD patients with RT-PCR method.Results: Results of RT-PCR indicated that after the 12-week intervention, compared to the placebo, vitamin D supplementation downregulated gene expression of interleukin (IL)-1β (P = 0.02), tumor necrosis factor alpha (TNF-α) (P = 0.02) and interferon gamma (IFN-γ) (P = 0.03) in PBMCs of diabetic HD patients. Additionally, vitamin D supplementation, compared to the placebo, downregulated gene expression of transforming growth factor beta (TGF-β) (P = 0.04), protein kinase C (PKC) (P = 0.001), and mitogen-activated protein kinases 1 (MAPK1) (P = 0.02) in PBMCs of diabetic HD patients. Although not significant, vitamin D supplementation let to a reduction of nuclear factor kappa B (NF-kB) (p = 0.75) expression in PBMCs isolated from diabetic patients compared to the placebo group. There was no statistically significant change following supplementation with vitamin D on gene expression of interleukin (IL)-4, IL-6, and vascular endothelial growth factor (VEGF) in PBMCs of diabetic HD patients.Conclusions: Overall, we found that vitamin D supplementation for 12 weeks among diabetic HD patients had beneficial effects on few gene expression related to inflammation and oxidative stress.Clinical trial registration: IRCT201701035623N101. Registered on January 8, 2017.

Introduction: The existence of a relationship between the level of serum parathyroid hormone (PTH) and bone density can be a warning sign in hemodialysis patients. Objectives: In the studies conducted so far, the relationship between these two factors has not been specifically investigated. Hence, this study was aimed to exclusively evaluate the levels of serum PTH hormone and bone density. Patients and Methods: In this cross sectional study, 85 eligible chronic hemodialysis patients aged over 18 years old who underwent hemodialysis a minimum of two times a week for at least 6 months were enrolled in the study. Serum intact PTH, 25 OH-vitamin D3, CBC, calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), albumin (Alb), and VBG were measured. Additionally, lumbar radiographic profile and densitometry tests were conducted for patients. Results: The mean age of patients was 52.9 years (20 to 86 years old). Of them, 43 patients were male (50.58%). There was a significant correlation between age and the decrease in bone density (P = 0.004). There was a significant relationship between different groups of bone density and serum vitamin D3 level (P < 0.05). Based on the results of Z standard, a significant difference between the mean levels of intact PTH in different groups of bone density was seen (P = 0.037). Conclusion: The prevalence of osteopenia and osteoporosis in hemodialysis patients is high. In addition, the decrease in bone density is associated with high levels of PTH. While this association is mainly associated with Z score, it is necessary to investigate the secondary causes of this condition. Please cite this paper as: Omidvar B, Ghorbani A, Tamadon MR, Sadeghian Broujeni Z, Bahadoram M, Dargahi M. Relationship of bone density with serum parathyroid hormone in hemodialysis patients; a single center study.