BackgroundThe prevalence of chronic kidney disease-associated pruritus (CKD-aP) varies from 22% to 84% among patients receiving hemodialysis. It occurs more frequently at night, and often affects patient’s sleep quality. CKD-aP is often unreported by patients, and many do not receive effective treatment. There is, however, a paucity of available data on the prevalence and impact of CKD-aP on patients receiving hemodialysis in Pakistan.MethodsA multicenter cross-sectional study was undertaken from July 2016 to April 2017 at a tertiary care hospitals in Pakistan.Results354 patients undergoing hemodialysis were studied. 35.6% had CKD for 1–2 years, and 42.4% were receiving hemodialysis for 1–2 years. The prevalence of pruritus was 74%. The median [interquartile range] score for pruritus was 10.0 (out of possible 25) [8.0–12.0]; while the median [interquartile range] Pittsburgh Sleep Quality Index (PSQI) score was 8.0 (out of possible 21) [7.0–10.0]'. Pruritus was significantly correlated with the sleep score (r = 0.423, p<0.001). The results of the multivariate linear regression revealed a positive association between pruritus and age of patients (β = 0.031; 95% CI = 0.002–0.061; p = 0.038) and duration of CKD (β = -0.013; 95% CI = -0.023 –-0.003; p = 0.014). Similarly there was a positive association between sleep score and duration of CKD (β = 0.010; 95% CI = 0.002–0.019; p = 0.012) and pruritus (β = 0.143; 95% CI = 0.056–0.230; p = 0.001).ConclusionsChronic kidney disease-associated pruritus is very common in patients receiving hemodialysis in Pakistan. Pruritus is significantly associated with poor sleep quality.
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Background:Pruritus adds to the complications of chronic kidney disease (CKD) patient and a well-recognized complication among the CKD patients. Majority of the patients on hemodialysis experience a generalized pruritus and patients reported being moderately to extremely disturbed by at least one of the sleep-related condition. This study aim to investigate the effectiveness of zolpidem 10 mg and acupressure therapy on foot acupoints to improve the sleep quality and overall quality of life among hemodialysis patients suffering from CKD-associated pruritus.Methods:A multicentered, open-label, parallel group, prospective randomized controlled trial among patients suffering from CKD-associated pruritus with sleep disturbance, after randomization into control, and intervention group to be held at North West General Hospital and Research Center Peshawar, Pakistan and Institute of Kidney Diseases Peshawar, Pakistan.Results:The primary outcome is to investigate the effectiveness of zolpidem 10 mg and acupressure therapy on foot acupoints to improve the sleep quality and overall quality of life among hemodialysis patients suffering from CKD-associated pruritus. After baseline assessment by Urdu version of 5D itch scale and Urdu version of Pittsburgh Sleep Quality Index (PSQI) and Urdu EQ-5D 3L, the intervention group will be given zolpidem 10 mg oral tablets and control group with acupressure on both foots on KI-1 acupoints for total of 6 minutes. Assessment will be done at weeks 4 and 8 from baseline by using Urdu version of 5D itch scale and Urdu version of PSQI and Urdu EQ-5D 3L, whereas safety profiling of zolpidem 10 mg tablet at week 6 from baseline and acupressure acceptability at week 6 from baseline. Analysis of covariance will be used to examine the differences in treatment effects between the intervention and control groups.Conclusion:Improvement of sleep quality and quality of life among patients with CKD-associated pruritus requires great importance. This study aims to improve the quality of sleep and quality of life among patients with hemodialysis suffering from CKD-associated pruritus.
Background:Chronic kidney disease (CKD)-associated pruritus (CKD-aP) contributes to poor quality of life, including reduced sleep quality and poor sleep quality is a source of patient stress and is linked to lower health-related quality of life. This study aimed to investigate the effectiveness of zolpidem 10 mg and acupressure therapy on foot acupoints to improve the sleep quality and overall quality of life among hemodialysis patients suffering from CKD-aP.Method:A multicenter, prospective, randomized, parallel-design, open label interventional study to estimate the effectiveness of zolpidem (10 mg) oral tablets versus acupressure on sleep quality and quality of life in patients with CKD-aP on hemodialysis. A total of 58 hemodialysis patients having sleep disturbance due to CKD-aP completed the entire 8-week follow-up. The patients were divided into a control (acupressure) group of 28 patients and an intervention (zolpidem) group of 30 patients.Results:A total of 58 patients having CKD-aP and sleep disturbance were recruited. In the control group there was a reduction in the PSQI score with a mean ± SD from 12.28 ± 3.59 to 9.25 ± 3.99, while in the intervention group the reduction in PSQI score with a mean ± SD was from 14.73 ± 4.14 to 10.03 ± 4.04 from baseline to endpoint. However, the EQ5D index score and EQ-visual analogue scale (VAS) at baseline for the control group with a mean ± SD was 0.49 ± 0.30 and 50.17 ± 8.65, respectively, while for the intervention group the values were 0.62 ± 0.26 and 47.17 ± 5.82, respectively. The mean EQ5D index score in the control group improved from 0.49 ± 0.30 to 0.53 ± 0.30, but in the intervention group there was no statistical improvement in mean EQ5D index score from 0.62 ± 0.26 to 0.62 ± 0.27 from baseline to week 8. The EQ 5D improved in both groups and the EQ-VAS score was 2.67 points higher at week 8 as compared to baseline in the control group, while in the intervention group the score was 3.33 points higher at week 8 as compared to baseline. Comparing with baseline, the PSQI scores were significantly reduced after week 4 and week 8 (P = < .001). Furthermore, at the end of the study, the PSQI scores were significantly higher in the control as compared to the intervention group (P = .012).Conclusion:An improvement in sleep quality and quality of life among CKD-aP patients on hemodialysis has been observed in both the control and intervention groups. Zolpidem and acupressure safety profiling showed no severe adverse effect other that drowsiness, nausea and daytime sleeping already reported in literature of zolpidem.
Background: Hemodialysis is a well-established replacement therapy for patient with end stage kidney disease havin a great impact on the patient’s quality of life. Therefore, the purpose of this study is to identify the health-related quality of life of patients undergoing maintenance hemodialysis. Methods: A cross sectional single centere survey was carried out from March 2018 to June 2018 at Department of Nephrology, Institute of Kidney diseases, Peshawar in Pakistan. A 36 item KDQOL validated Urdu version was used to identify the quality of life of patients. Results: A total of n=184 patients having chronic kidney disease undergoing hemodialysis participated,of whom 63.6% were males and 57.1% patients were Pashtun. A multiple linear regression showed that patients having kidney disease caused due to hypertension had 45% higher kidney disease component summary (KDCS) score while 16% higher physical component summary (PCS) score and 60% higher mental component summary (MCS) score and were statistically significant. Similarly; Peshawari patients had 22% lower PCS score as compared to other ethnic groups ; however, in MCS Peshawari patients had 16% higher score and were statistically significant. Conclusion: The patients have poor quality of life receiving hemodialysis therapy in all three domains like PCS, MCS and KDCS.
Objectives: To assess the neurological complications among end stage renal disease (esrd) patients on hemodialysis. Methods: This descriptive study was conducted at the Departments of Internal Medicine and Nephrology, Medical Teaching Institute (MTI), Lady Reading Hospital (LRH), Peshawar, from March 2020 to March 2021 among ESRD patients. All Chronic Kidney Disease (CKD) patients were on Hemodialysis (HD) for more than six months before enrolling in the study. The patients were followed for 06 months on HD. During this time, any neurological event was documented and recorded. All patients on HD, of any gender with age ranging from age 15 to 70 years were included in this study. Patients below the age of 14 years, patients with acute renal failure, congestive cardiac failure, cirrhosis of liver, malignancy, disseminated intravascular coagulation, sepsis; meningitis and encephalitis were excluded from this study. SPSS version 23 was used to analyze the data. Results: This descriptive study was conducted at the Departments of Internal Medicine and Nephrology, Medical Teaching Institute (MTI), Lady Reading Hospital (LRH),, from March 2020 to March 2021 among ESRD patients. All Chronic Kidney Disease (CKD) patients were on Hemodialysis (HD) formore than six months before enrolling in the study. The patients were followed for 06 months on HD. During this time, any neurological event was documented and recorded. All patients on HD,of any gender with age ranging from age 15 to 70 years wereincluded in this study. Patients below the age of 14 years, patients with acute renal failure, congestive cardiac failure, cirrhosis of liver, malignancy, disseminated intravascular coagulation, sepsis; meningitis and encephalitis were excluded from this study. SPSSversion 23 was used to analyze the data. Conclusions: Cerebrovascular diseases and dialysis dementia are the most common neurological complications among patients on hemodialysis in our study. These should be considered ......
Aim: The goal of this study is to characterise the appearance of posterior urethral valves and evaluate the effectiveness of their treatment in settings with limited medical resources. Methods: The Department of Urology at lrh Peshawar performed a retrospective, descriptive research between Jan 2019 and Jan 2021. The presentation, duration of symptoms, complications, and treatment outcome were all considered. Results: There were 460 patients in total. Approximately three years old was the midpoint [02 days–10 years]. The average time from the onset of symptoms to diagnosis was [2.4 years]. 400 (90%) individuals reported urosepsis; 160 (34%) patients showed unilateral or bilateral reflux; 70 (16%) patients presented with big decompensated bladder, and 80 (18%) patients presented with substantial renal insufficiency. The radiological results verified the presumptive diagnosis of the posterior urethral valve. All patients underwent a cystoscopy and valve fulguration; some underwent further vesicostomy or ureterostomy procedures. Conclusion: According to the study, late presentation is common in our setting. High rates of illness and death are linked to this. The medical community must work toward greater awareness and earlier diagnosis to slow the epidemic.
Objective: The aim of this study is to determine the response of sofosbuvir and velpatasvir combination in chronic hepatitis C with hemodialysis patients. Study Design: Prospective/observational study Place and Duration: The study was conducted at department of Nephrology Nawaz Sharif Kidney Hospital, Swat for duration of six months from 1st July to 31st December, 2020. Methods: Total 27 patients of both genders were presented in this study. Patients were aged between 18-85 years. Patients details demographics age, sex and body mass index were recorded after taking written consent. Patients diagnosis hepatitis C with recognized genotypes were presented. Enrolled patients received combination of sofosbuvir and velpatasvir regime (SOF/VLP) for 14 weeks and follow up was taken. Effectiveness and safety among HCV patients on hemodialysis were observed. Complete data was analyzed by SPSS 22.0 version. Results: Out of 27 patients 17 (62.96%) were males 10 (37.04%) were females. Mean age of the patients was 35.14±5.18 years with mean BMI 24.41±6.25 kg/m2. Hypertension was the most common comorbidity found in 15 (55.55%) patients followed by obesity 8 (29.63%) and diabetes found in 3 (14.81%). Among 27 cases 20 (74.04%) were naïve and 7 (25.96%) were treatment experienced. Sustained virological response was found in 26 (96.3%) and 1(3.7%) patients were lost at follow up. Significantly improvement was found in hemoglobin level 12.11 ± 5.24, alanine aminotransferase (ALT) 28.51 ± 9.62 and aspartate aminotransferase (AST) 35.24 ± 7.08 after treatment. Headache, fatigue and nausea were the most common adverse outcomes. Conclusion: We concluded in this study that the use of sofosbuvir and velpatasvir was effective safe and well tolerated in the treatment of hepatitis C patients with hemodialysis. Keywords: Hemodialysis, Hepatitis C, Sofosbuvir, Velpatasvir, Complications
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