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Hypertension and nephrology

JUNE 24, 2020

[Covid-19 and the kidney]

PATÓ Éva, DEÁK György

[Covid-19 pandemy has emerged from Wuhan, China in December 2019. The infection affects not only the lung but other organs such as the kidney, as well. The relation between Covid-19 infection and the kidney is bidirectional. On one hand, Covid-19 infection may cause kidney damage in 50-75% of the cases resulting in proteinuria, haematuria and acute kidney injury (AKI). The etiology of AKI is multifactorial. Main pathogenic mechanisms are direct proximal tubular cell damage, sepsis-related haemodinamic derangement, citokine storm and hypercoagulability. The virus enters proximal tubular cells and podocytes via the ACE2 receptor followed by multiplication in the lysomes and consequential cell lesion. Histopathology shows acute tubular necrosis and acute tubulointerstitial nephritis. AKI is a strong predictor of mortality in critically ill patients. On the other hand, the risk of Covid-19 infection and mortality is substantially increased in patients with chronic kidney disease – especially in those with a kidney transplant or on dialysis – due to their immunocompromised status. Among haemodialysis patients, infection may spread very easily due to the possibility of getting contacted in the ambulance car or at the dialysis unit. The mortality rate of patients on renal replacement therapy with Covid-19 infection is 20-35%. In order to avoid mass infection it is obligatory to employ preventive measures and implement restricions along with (cohors) isolation of infected patients. In Hungary, every dialysis or kidney transplant patient with Covid-19 infection should be admitted to dedicated Covid-19 wards.]

Journal of Nursing Theory and Practice

AUGUST 30, 2017

[The importance of serum albumin level in patients with chronic renal disease on maintenance dialysis]

TÓTH Csitkovicsné Tünde, SZAKÁCS Gyuláné, KULCSÁR Imre

[The aim of the study: Evaluation of changes in serum albumin levels and their effects on mortality in chronic haemodialyzed (HD) population. Material and Methods: We analysed the serum albumin values and survival in 253 HD patients, in a retrospective observational study. Data were analyzed using Spearman-correlation, Cox-modell, endpoint analysis and Kaplan-meier analysis. Results: We did not find any significant correlation between serum albumin levels and gender or basic diseases, but the median serum albumin level was lower in patients with ages 65 years or older than in younger ones, and had decreased until observational period (5.4±3.0 years). Lower the serum albumin level the risk of mortality was higher (if the serum albumin level was <35 g/L versus >40 g/L), the HR was 5.69. Conclusions: The serum albumin level is a main indicator of the nutrition in dialyzed patients, but the target level would be different in older and younger patients. The serious malnutrition (lower serum albumin level) increases the risk of mortality in haemodialyzed patients.]

Hypertension and nephrology

OCTOBER 20, 2016

[Dialysis treatment in Hungary: 2010–2015]


[The authors show the data of Hungarian dialysis statistics from 2010 to 2015. The questionnaire - based data collection was made by Dialysis Registry Committee of the Hungarian Society of Nephrology. The number of all patients entered in the dialysis program increased by 8.4% over six years (an average of 1.4/ per year) and the number of new ones increased by 10.5% (1.75% per year). Between 2003 and 2009 the mean annual increasing of new patients was 7.5%! The incidence of new dialyzed patients was 440/1 million population in 2010 and 486/1 million) in 2015. The population point prevalence at the end of the year was 621/1 million in 2010 and 643/1 million in 2015. The penetrance of peritoneal dialysis was 13.5% in 2010, and 13.6% in 2015. The proportion of incident patients with diabetic or hypertensive nephropathies (conditions which lead to end stage renal disease) was about the same in 2010 (27 and 21%) than in 2016 (27 and 22%). The mean age of incident patients entered into dialysis program decreased from 66.9 years (2010) to 62.8 years (2015), surprisingly. The rate of patients on waiting list for renal transplantation was 10.7% in 2009 and increased to 15,8% in 2015. There is also a significant increase in the number of the annual renal transplantations (268 in 2010 and 356 in 2015). The mortality rate of chronically dialyzed patients shows little decrease (14.4-13.1%).]

Journal of Nursing Theory and Practice

FEBRUARY 28, 2016

[Care of the fistula, advantages of the monitoring and the surveillance with thermodilution technique]


[Introduction: The best choice of vascular access for haemodialysis patients is the native arteriovenous fistula (AVF). Therefore, monitoring and surveillance of vascular accesses has a high priority. Aim of the research: The aim of our study was to evaluate the AVF surveillance protocol of our dialysis clinic. Research and sampling methods: We began AVF monitoring and surveillance in our dialysis clinic in February 2003. Until May 2015 we evaluated the data of 307 patients. Results: Besides the regular physical investigation of fistulas we performed measurements of vascular access flow (Qa) with thermodilution technique. In cases of suspected stenosis we performed Colour Doppler Ultrasonography and/or fistulography. Stenosis was verified in 154 cases at 344 patients. Percutan transluminal angioplasty was performed in 241 cases at 127 patients. Creation of a new fistula was necessary only in 24 cases at 21 patients. Within the last three years the percentage of patients treated via AVF has risen from 75% to 84%. Conclusions: Regular monitoring and surveillance of vascular accesses and the timely correction of its complications are able to reduce thrombosis of fistulas and the necessity of using central venous catheters. ]

Journal of Nursing Theory and Practice

FEBRUARY 28, 2016

[About Therapy Data Management System (TDMS) by nurses]

SOMOSI László, LADÁNYI Erzsébet

[Recently, the precise management of dialysis-related documentation has become a big responsibility and burden. As a result, less time is available to perform daily nursing tasks. Therefore, our company has introduced the Therapy Data Management System (TDMS) at 10 dialysis centres. The system was developed to reduce the administrative burden and provide information to the staff about the current dialysis session. The TDMS loads the dialysis treatment prescription from the data recording programme used in our network to the dialysis machine. Two main elements are used: data base for treatment monitoring and current treatment parameters. The database for treatment monitoring is used for data input (using the computers in the unit), while the current treatment parameters are used as data input to the dialysis devices and for data documentation. Patients are identified by patient identification cards recording weight before and after the dialysis session. The programme automatically calculates the current ultrafiltration, but data can be modified if necessary. After loading and validating the parameters, treatment can be initiated. With the introduction of the TDMS the time spent for documentation was reduced by 15-20 minutes per patientshift and nurse. Dialysis can be started more easily and quickly, because the parameters of the current treatment always appear on the screen. Moreover, the risk of administration errors is reduced. This system effectively supports the daily work in clinical practice. It provides quick and easy access for all users of the management of haemodialysis patient. Keywords: dialysis, data recording, Therapy Monitor, TDMS ]

Journal of Nursing Theory and Practice

DECEMBER 25, 2015

[Practice of the Hepatitis B vaccination with non-responder patients in our Centre]

GÓZ Lászlóné, KÖRTVÉLYESINÉ Bari Krisztina, BECS Gergely, SZABÓ P. Réka, BALLA József, KÁRPÁTI István, MÁTYUS János, UJHELYI László, BEN Thomas

[Introduction: End-stage renal disease patients under dialysis have impaired immune system and are more susceptible to infection, even those infections that can be prevented by vaccination (e.g. hepatitis B). If the antibody titer (anti-HBs) remains <10 IU/ml after two consecutive vaccinations, patients are classified as non-responders. Reasons for unsuccessful vaccinations include technical, immunological (e.g. multigene haplotypes) reasons. They are often also associated with chronic diseases. Aim of the research: To re-vaccinate patients after unsuccessful intramuscular vaccination to achieve immunity. Research and sampling methods: Intracutaneous vaccination can be a viable alternative for successful immunity. 6 months after re-immunisation, anti-HBs titer>10 IU/mL indicate a successful immune response. Results: 22 haemodialysed patients received intracutaneous hepatitis B vaccination with the total dosage of 6 μg. An anti-HBs titer elevation (21-100 IU/ml) was observed in 15 cases (68.18%). In those cases, where we failed to achieve successful immunity, we identified malignancies, immunosuppression, amyloidosis, psoriasis diabetes mellitus, or coeliac disease as a possible reason. Conclusions: The rate of successful immunisations against HBV infections can be improved by means of intracutaneous vaccination. ]

Journal of Nursing Theory and Practice

DECEMBER 25, 2015

[Patients with type-1 and type-2 diabetes mellitus in the program of peritoneal dialysis]


[Aim of the research: To evaluate the efficacy of the treatment and incidence of complications in diabetes type 1 and 2 patients treated with peritoneal dialysis. Research and sampling methods: During a retrospective study with 85 diabetic PD patients (19 type 1 patients and 66 type 2 patients) was compared data of 22 years with regard to the following parameters: Glucose metabolism, body weight, changes in residual urine clearance values, distribution of quantity and glucose content of the solutions used, incidence of infections, and average duration in PD programme before transferring to haemodialysis. Results: All patients, irrespective of their type of diabetes: spend the same time in PD on average, gained body weight during PD. Diabetes type 1 patients: had a lower residual urine clearance, had HbA1c values decreasing during PD, reported peritonitis less frequently, had a higher incidence of catheter-related infections. Diabetes type 2 patients: had a better glucose metabolism, had a higher body weight from the beginning of therapy, required PD solution with higher glucose concentration. Conclusions: Diabetes patients, irrespective of the type of diabetes, can successfully be treated with PD, but require more attention because of their underlying disease and associated complications. ]

Journal of Nursing Theory and Practice

OCTOBER 30, 2013

[Causes of leg problems in chronic kidney failure, and opportunities for prevention]


[In patients with chronic kidney failure, especially diabetic haemodialysis patients, the risk of lower-limb complications increases. Through the early recognition of changes in the leg, the definition of risk factors and timely intervention, the prevalence of ulcers and amputations can be reduced. The author aims, through a review of the specialist literature, to provide skills for the recognition of lower-limb complications occurring in chronic kidney patients, and to summarise the most common factors leading to amputation, and the opportunities for prevention. It gives guidance for the definition of risk factors, briefly describes the procedure for assessing the condition of the leg, and the basic principles and options relating to patient education. ]

Hypertension and nephrology

SEPTEMBER 21, 2012

[The prognostic role of serum albumin levels in survival of chronically hemodialized patients]


[The authors have investigated the survival of 238 patients on chronic haemodialysis program regarding serum albumin levels (measured at starting dialysis and at the end of observation) adjusted for age, gender, diabetes, serum haemoglobin and body weight. The mean observational period was 5.5 years. Our investigation has documented a tight positive correlation between the survival and serum albumin levels both at starting and ending of investigation independently of epidemiological parameters. It was demonstrated that serum albumin levels decrease by aging, so the authors recommend a little bit lower serum albumin target level for older dialyzed people, because the normal range is also decreasing by aging. The level of serum albumin has not shown changing in younger patients (less than 60 years) in this long observational period, but there was a significant decrease in olders (especially above 70 years).]

Lege Artis Medicinae

FEBRUARY 22, 2007



[INTRODUCTION - Diffuse large B-cell lymphoma frequently has bone involvement, but primary bone lymphoma is rare (around 4% of primary extranodal lymphomas). Long bones are most often affected, followed in frequency by the ribs, vertebrae, and pelvic bones. The main symptom is bone pain. CASE REPORT - The case of a young man is presented whose disease started with lumboischialgia. Since rheumatological treatment did not relieve the symptoms, MRI was performed, which showed a tumour with massive iliac bone destruction. Three months after the initial symptoms a surgical biopsy from the right ilium showed diffuse large B-cell lymphoma. Soon after acute renal insufficiency developed and the patient was put on haemodialysis. Based on the findings the disease was staged as Ann Arbor IV/B (bone and kidney), ECOG PS 3, International Prognostic Index 4. On the basis of the preliminary histological findings, reduced-dose CHOP chemotherapy was given, which resulted in a significant improvement of the renal function and haemodialysis could be abandoned. This was followed by 6 additional cycles of Rituximab-CHOP treatment and further 2 cycles of Rituximab-DHAP salvage chemotherapy with intrathecal prophylaxis, and, finally, since no response could be detected, R-IVAC treatment was given. After an initial response, the disease became progressive, and the patient died 9 months after the diagnosis was made from a disseminated chemoresistant disease. Autopsy confirmed extensive infiltration of the right iliac bone, kidneys, bone marrow, spleen, supraclavicular and abdominal lymph nodes, pancreas, scalp and brain. CONCLUSIONS - This case was chosen to be presented because of the unusual localisation of the diffuse large B-cell lymphoma, the initial diagnostic difficulty, and the very rapid progression despite the application of several aggressive chemotherapy schemes. A primary bone large B-cell lymphoma represents a diagnostic challenge with its rheumatological symptoms thus delaying diagnosis.]