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   Table of Contents - Current issue
October-December 2020
Volume 6 | Issue 4
Page Nos. 77-107

Online since Tuesday, July 20, 2021

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Hemodialysis consultancy at doorstep: Telehealth p. 77
Anita Timmy Saxena
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Hub-and-spoke centers model of dialysis supported by cashless government scheme in a resource-poor setting: A successful model p. 80
Srinivas Pathakala, P Hariprasad, Manjusha Yadla
Introduction: Hub-and-spoke Center Model is initiated, in which peripheral dialysis centers (Spoke Centers) are monitored by Hub Center (Nodal Center). Aim: The aim of the study was to analyze the model of dialysis of Hub-and-Spoke dialysis in our tertiary care center. Methods: Data were collected over a period of 1 year in our center. Functioning of 12 spoke centers, clinicoepidemiological profile of dialysis patients was analyzed. Results: Monitoring the spoke centers included daily interaction with spoke center doctor, nurse, technician, patients through video calling, and guiding them in patient-related problems, infrastructure, reverse osmosis (RO) plant, and administrative issues. Monthly visit by nephrologist to spoke centers and providing outpatient department services to the dialysis patients and scrutinizing the patient data registers, RO plant inspection, water quality analysis data, etc., is being done. Among three hub centers, 30% of patients are being dialyzed in Gandhi Hub-and-Spoke model. Around 6770 sessions of dialysis are done per month for 687 patients registered, with 49% of patients receiving twice weekly hemodialysis. Nearly 25% of machines dedicated to hepatitis B surface antigen and hepatitis C virus-positive patients. Sixty-six patients still on waiting list and less technician staff (one technician/nine patients) indicates need for increasing the machines and staff to improve dialysis care at peripheral centers. Conclusion: Hub-and-Spoke model is an excellent model to provide quality dialysis support to patients in remote areas. Due to increase in dialysis patients, machines and staff need to be increased. Continuous surveillance of the model will help to develop measures/guidelines for effective functioning of the model.
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Diet and dialysis to control hypertension in patients on dialysis p. 85
Siddharth Venkat Ramanan, Madhusri Babu, Milly Mathew, Marina Alex, KN Preethi, Georgi Abraham
Introduction: Uncontrolled hypertension in hemodialysis (HD) patients is related to a variety of causes, of which dietary salt intake plays a major role. Excessive interdialytic weight gain (IDWG) with accompanying hypertension can lead to increase cardiovascular morbidity and mortality. Materials and Methods: We conducted a cross-sectional observational study to assess the prevalence of hypertension among patients on maintenance HD (MHD) and its relationship with daily sodium intake. We included participants who were getting MHD at out tertiary care center and in whom a digital brachial blood pressure (BP) was measured. Results: Of the 118 patients studied, 73 (61.9%) were male. AVF was the access for HD in 88 (74.6%) patients, 22 (18.6%) patients were getting HD through a permcath, and the rest through a temporary central venous HD catheter. HD was being done once a week for 3 (2.5%) patients, 80 (67.8%) patients were getting HD twice a week, and the others thrice a week. The mean pre-HD BP was 151.7/80 ± 22.55/12.8 mmHg, and the mean post-HD BP was 168/90.9 ± 23.7/11.3 mmHg. An IDWG of <2 kg was seen in 32 (32.2%) patients; the remaining patients had an IDWG of >2 kg. The mean IDWG was 2.41 kg. Seventeen (14.4%) patients were not on any antihypertensive medications, 48 (40.7%) patients were taking 1–2 antihypertensive drugs, and the rest were on >3 antihypertensive drugs. A urine output of <100 ml/day was present in 45 (38.1%) patients; the rest had a daily urine output of over 100 ml up to 1000–1200 ml. Nutritional assessment by a trained dietician showed that sodium intake ranged from 1700 mg to 2200 mg/day. Conclusion: Dietary sodium intake was controlled in our HD patients with the intake of 1700–2200 mg per day. The weight gain was excessive in 67.8% of our patients, Patients were ingesting 1–5 antihypertensive drugs of different classes and 14.4% were not on any antihypertensive drugs. Dialysis was being done twice a week for 67.8% of our patients and thrice a week for 29.7% of patients. We found hypertension in 85.6% of our cohort.
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Nutritional status of Iraqi adults on maintenance hemodialysis: A multicenter study p. 89
Luay Jebur Mousa, Aseel A Naj, Wedyan A Mohammed, Ala Sh Ali
Objective: The objective is to assess the prevalence of malnutrition and its associated factors in adult patients on hemodialysis (HD). Patients and Methods: A total of 271 participants (149 males and 122 females) from four major dialysis units were included in this descriptive cross-sectional study conducted from October 2020 to March 2021. Nutritional status was measured using a subjective global assessment tool. The anthropometric indices, body mass index (BMI), and biochemical parameters, including albumin and electrolytes, were also measured in all patients. Results: The overall prevalence of estimated nutritional status was as follows: 50.2% were well-nourished, 42.4% were mildly/moderately malnourished, and 7.4% were severely malnourished. The primary etiology of kidney disease was mostly due to hypertension (38.7%) and diabetes (32.8%). No significant association was detected with regard to age, sex, residence, marital status, occupation, and cause of kidney disease (P > 0.05). Higher educational level, lower BMI, and serum albumin were significantly associated with malnutrition (P < 0.02, <0.005, and <0.02, respectively). Conclusion: Approximately 50% of the adults on HD had variable degrees of malnutrition. BMI and serum albumin levels were significantly associated with the state of malnutrition. Comprehensive clinical nutrition services and counseling should be incorporated into the structure of HD units under the care of a dedicated nutritionist.
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Eating during dialysis: An observational cohort study from India p. 97
Sunitha Premlatha, Harika Vasa, A Swetha, G Vaishnavi, S Priyanka, Urmila Anandh
Background: Patients on maintenance hemodialysis often develop malnutrition. Elderly patients with multiple comorbidities often are at risk. The catabolic nature of hemodialysis also contributes to the problem. Multiple interventions such as modifying dialysis timings and oral nutritional supplementation have been tried. Eating during dialysis is increasingly being considered as an intervention with a positive impact on the nutritional status of these patients. Materials and Methods: We designed a study to look into the dietary habits of our stable hemodialysis cohort and the difference in their intake on dialysis and nondialysis days. Results: Our study shows that even though patients hardly achieve their recommended dietary allowances targets, their nutrient intake is better on their dialysis days. They consume a significantly higher amount of protein and fats on dialysis days. Their energy intake is also higher on the days of their dialysis. Patients consume a significantly higher amount of protein and fats on dialysis days. Their energy intake is also higher on the days of their dialysis. Conclusions: Hemodialysis patients eat better on dialysis days and eating during dialysis should be encouraged.
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Management of hyperglycemia in dialysis patients without compromising nutritional status p. 102
Umesh Khanna
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SRNM continuous medical education program 2021 p. 106
Anita Timmy Saxena
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