BackgroundThe effectiveness of health care and health policy developments are often determined by health-related quality of life (HRQOL) assessment.ObjectivesThe objective of this study was to explore the potential corresponding factors and traditional biomarkers of HRQOL in a large number of Iranian hemodialysis patients.Patients and MethodsA total of 6,930 chronic hemodialysis (HD) patients enrolled. KDCS-SF version 1.3 questionnaire was used to assess the health related quality of life (HRQOL). We pooled PCS, MCS and KDCS scores with random effect model from 19 similar studies performed between 1996 and 2010ResultsThe mean age was 54.4 ± 17.1 years. Mean PCS, MCS and KDCS scores obtained for the study cohort were 40.79 ± 20.10, 47.79 ± 18.31 and 57.97 ± 11.70, respectively; the total score of SF-36 plus KDCS was 51.12 ± 13.41 as well. The most common primary known disease was hypertension (31.9%) and the second etiology was diabetes (25.5%). In multilevel logistic regression, Kt/V between 1 and 1.2 and PCS, KDCS more than 50 were considered as a significant reduction in the risk of hospitalization.ConclusionsThis study showed that PCS and MCS score were slightly more than overall results while KDCS was slightly less than overall results. In addition, dialysis adequacy with Kt/V between 1 and 1.2 is associated with lower rate of hospitalization.

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Introduction: Hemodialysis patients should receive hemodialysis three times per week and 140- 160 times annually. The financial and temporal costs of continuing travel to hemodialysis centers affect the type of vascular access, treatment coherence, geographical distribution and mortality of patients. Objectives: In this study, the spatial distribution and geographical accessibility of patients to the hemodialysis center and its effect on mortality and vascular access have been investigated. Patients and Methods: This descriptive-analytic study was conducted on 315 patients with chronic renal failure undergoing hemodialysis in Bou-Ali hospital of Ardabil. Accessibility to the hemodialysis center was determined by calculating the time spent from the residence to the treatment center and analyzed by ArcGIS-10. In this study, accessibility was considered in less than 10 minutes. Logistic regression was used to investigate the relationship between spatial accessibility and mortality and vascular access. To verify the correlation between different variables, Pearson’s correlation, Phi and Cramer’s V, and Eta tests were applied. Results: Among 315 patients, 161 patients (51.1%) were male and 277 (87.9%) patients were married. The mean age of patients was 62.7 ± 16.6 years. There were 170 illiterate patients (54%), 275 patients living in urban area (87.3%) and 132 patients as housewife (41.9%). Hospital records, showed 186 patients with arteriovenous fistula (AVF) (59%), 113 patients with central venous catheter (35.9%), since in 16 patients type of vascular access (5.1%) was not mentioned. Twenty patients (6.3%) died due to end-stage renal disease (ESRD), of which 11 were female. Additionally, eight patients (2.5%) were forced to migrate to nearby areas due to inappropriate accessibility to the hemodialysis services. The results showed a negative correlation between proximity to hemodialysis center and the prevalence of hemodialysis in women and men and the number of population in each time period. The spatial accessibility to the hemodialysis center did not correlate with the patient’s mortality and type of vascular access. Conclusion: Due to the high prevalence of hemodialysis patients in the vicinity of the hemodialysis center, there is a concern that ESRD patients in rural or remote areas are not properly diagnosed or died without referral to health centers. It can be declared that one of the main reasons for the low-prevalence in remote areas is the issue of spatial accessibility. The results of this study indicated the need for further studies on the prevalence and identification of ESRD in rural areas and the causes of the disease, in order to clarify the issue’s dimensions.

Background: Oxidative stress and systemic inflammation is increased in end-stage renal disease (ESRD) patients. Due to the various effects of oxidative stress in ESRD patients, different antioxidants have been evaluated. Objectives: In this study, we evaluated the effect of oral N-acetylcysteine (NAC) as an antioxidant on the serum high-sensitive C-reactive protein (hs-CRP) and plasma hemoglobin levels in the ESRD patients who were under routine hemodialysis. Patients and Methods: In this randomized placebo-controlled clinical trial, 51 ESRD patients under routine hemodialysis were randomly assigned to receive NAC 1200 mg daily for 1 month (n=26) or placebo (n=25). Laboratory findings including hemoglobin, ferritin, hs-CRP were measured in patients before and after treatment. Results: NAC group compared to placebo group had significantly higher ferritin levels before treatment (p=0.02) and lower phosphorus levels after treatment (p=0.03). Comparing the results before and after treatment in each group, a significant reduction in hematocrit (p=0.002), ferritin (p=0.006), hs-CRP (p=0.02) and an increase in alkaline phosphatase levels (p=0.005) in NAC group and significant reduction in calcium levels (p<0.001) in placebo group was detected. No major side effects were seen. Conclusions: One month treatment with oral NAC resulted in reduced levels of hematocrit, ferritin and Hs-CRP, indicative of role of NAC in controlling inflammation in ESRD patients under hemodialysis. However, NAC was not effective in treatment of anemia, although the treatment duration was low.

Background Pruritus is one of the most common problems in patients with chronic renal failure. Of all patients with end‐stage renal disease (ESRD), 60–80% report pruritus during their life. Aim To compare the effect of gabapentin (GBP) and hydroxyzine (HYDZ) in treating pruritus in patients on dialysis. Methods In a double‐blind, randomized, crossover clinical trial, 32 patients on dialysis who reported pruritus were assigned randomly to receive either GBP or HYDZ for 6 weeks; the first group received GBP 100 mg/day orally and the second group received HYDZ 25 mg/day orally for 6 weeks. After this 6‐week period (Period 1) there was a washout period of 2 weeks then patients were crossed over to the other drug (the first group receiving HYDZ and second group receiving GBP) and followed up for a further 6 weeks (Period 2). A visual analogue scale was used to measure pruritus intensity in the groups before and after the first and second period. Results In Period 1, pruritus severity decreased from 7.1 ± 1.46 at baseline to 2.17 ± 1.82 at 6 weeks in the GBP group (P = 0.001) and from 6.83 ± 2.11 to 2.86 ± 1.67 in the HYDZ group (P = 0.001). In Period 2, pruritus severity decreased from 5.1 ± 1.61 at baseline to 1.56 ± 0.82 at 6 weeks in the GBP group (P < 0.01) and from 5.23 ± 2.11 to 2.1 ± 1.87 in the HYDZ group (P = 0.001). Conclusion Results showed that both HYDZ and GBP significantly improved and controlled pruritus in patients on dialysis, with no significant difference observed between the two drugs.