The prevalence of depression and the quality of life in hemodialysis patients and patients with chronic medical illnesses (CMIs) in the Bahamas

OBJECTIVE: To determine the prevalence of depression and the quality of life in hemodialysis patients and patients with chronic medical illnesses (CMIs) in the Bahamas. DESIGN AND METHODS: This study used a cross-sectional design with consecutive sampling. Data about sociodemographic characteristics, depression, and quality of life were collected using a sociodemographic questionnaire, the Beck Depression Inventory BDI-II, and the Short Form36 (SF 36) respectively. Data were analyzed using the Statistical Package for Social Sciences (SPSS). RESULT: 305 individuals (CMI: 106; Dialysis: 199) participated, 22 refused; 50.2% were males, 49.8% were female; mean age was 53.44 (ñ14.44); 45.9% were married; and 32.8% were unemployed for more than 2 years. The prevalence of depression was 43.7% for dialysis patients and 36.8% for CMI patients. Age of patients was associated with marital status, occupational status, ethnicity, and educational level. Hemodialysis patients were shown to have a lower quality of life than CMI patients. Linear regression analysis found that eight quality of life items were statistically significant predictor factors of the Beck score for the CMI and dialysis groups, and accounted for 45.5% of the variance. CONCLUSION: Although, these results did not necessarily demonstrate causality, patients receiving hemodialysis were as likely to be depressed as patients with chronic medical illness. Having to be on hemodialysis detracts significantly from patients’ quality of life.

Dialysis adequacy at two haemodialysis units in Jamaica

A prospective study on adequacy of dialysis was conducted at the haemodialysis units of Kingston Pubic Hospital (KPH) and the University Hospital of the West Indies (UHWI). Dialysis adequacy was better at KPH and morbidity, as measured by patient admission days, was increased at UHWI. Diabetics had a lower mean serum albumin and urea reduction ratio (URR) than non-diabetics. Multiple regression analyses revealed that age of patient (F = 5.30; p = 0.241) and hospital (F = 7.85; p = 0.007) were the variables significantly associated with serum albumin level when the effect of other variables was controlled (F = 2.12; p = 0.34). Similar analyses showed that the hospital at which dialysis was done was the only factor which accounted for significantly higher URR, with KPH having higher rates (F =13; p = 0.006). The differences between hospitals necessitate further investigations, explanations and further intervention strategies. The study provides opportunities for improving patient care and for dialysis health care professionals to assess clinical performance measures and reduce variation between dialysis centres.(Au)

Renal replacement by regular haemodialysis therapy and renal transplantation in Barbados: 1979 to 1997

We have reviewed our delivery of highly sophisticated medical therapy, haemodialysis and renal transplantation in a Caribbean setting. The purpose has been to reflect local outcomes in relation to mortality and survival, but comparisons with a vastly larger database have been attempted. Such comparisons are extremely difficult due to methodological differences and the fact that facilities contributing to that database vary considerably with regard to patient age, gender, ethnicity and comorbidity. Nonetheless, the crude data available provide important justification for the existence of regular haemodialysis and its adjunctive therapy of renal transplantation in the Caribbean.(AU)

Haemodialysis at University Hospital, Mona

Haemodialysis at University Hospital commenced in 1970. One hundred and twenty six patients have been accepted for regular dialysis. Hypertension and chronic glomerulonephritis accounted for 117 patients (93 percent) while 4 patients (3 percent) had polycystic kidneys and 5 patients (4 percent) had diabetes mellitus. Twenty-nine (23 percent) patients received a cadavericrenal transplant. There were eighty-five (68 percent) deaths. Twenty-five patients (30 percent) died in less than one year, twenty-two (25 percent) died between one and two years. Seventeen patients (20 percent) survived over five years before death, and three patients surviving over 10 years. There are twenty patients on regular hospital dialysis at present in the University Hospital, twelve patients have been on dialysis less than 3 years, three patients have been on 3-5 years, and five patients have been on for greater than 5 years and two patients greater than 10 years

Vascular access in diabetics with renal failure - abstract

Good vascular access is essential for successful haemodialysis. The methods currently used to provide reliable long-term access are: 1) The creation of a peripheral arterio-venous fistula; 2) Formation of an internal arterio-venous shunt, using polyfluorotetra ethylene (PFTE); 3) Placement of a double-channel catheter into the vena cava percutaneously or by open surgery; 4) Creation of an externally-placed arterio-venous shunt. Access problems are more common and more serious in diabetics. These may be categorised as technical, early and late complications. The vascular changes in diabetics, which result in atherosclerosis of medium-sized vessels, lead to a high technical failure rate, and increase early complications in the A-V fistula, the internal A-V shunt and the external A-V shunt. The compromised defence mechanism in the diabetic leads to a higher rate of infection with the double-channel catheter, the external A-V shunt and also the internal A-V shunt. The mid-forearm A-V fistula, as used in the haemodialysis units at the University Hospital over the past three years, reduced the high incidence of technical problems associated with the wrist fistula in the diabetic. The risk of infection and thrombosis is also reduced as no synthetic shunting material is used (AU)

Haemodialysis for renal failure in diabetes mellitus - abstract

The prognosis for diabetic patients with end-stage renal disease (ERSD) treated by all modalities of renal replacement therapy is not as good as for non-diabetics. The literature, prior to 1976, reported a very poor prognosis for diabetic patients treated by haemodialysis. With the widespread introduction of continous ambulatory peritoneal dialysis (CAPD) in the 1970s, this was advocated as the dialysis treatment of choice for diabetic patients with ERSD. Several large studies reported after the mid-1980s do not confirm any significant advantage of CAPD over haemodialysis for diabetic patients. The results for long-term haemodialysis in patients with diabetes mellitus have improved tremendously over the last two decades. In most renal failure programmes in the world (England, New Zealand and Southern Europe excepted), diabetes mellitus is the leading cause of ERSD, and over 80 per cent of these patients are treated by haemodialysis. Although transplantation continues to show superior results to dialysis, the fact remains that older and sicker patients are treated by haemodialysis while the younger patients with less co-morbid conditions are accepted for transplantation. Also, haemodialysis for ERSD has results approaching those for cadaveric renal transplantation when adjustments for age and co-morbid conditions are made (AU)

The PermCath for temporary vascular access - abstract

This paper is a report of one year's experience with the PermCath central venous access dialysis catheter in the Bahamas. The PermCath was employed for temporary access in patients requiring chronic haemo-dialysis while awaiting permanent access sites. PermCaths were inserted via internal or external jugular vein cut-down under local anaesthesia. Fifteen catheters were inserted in 13 patients. One patient had three PermCaths. The 15 PermCaths were in situ for a total of 1,224 patient days and 385 dialysis episodes. The catheters were in situ for a range of 3 to 155 days, an average of 81.5 days per patient. Six patients had a catheter in situ longer than four months. Three PermCaths were removed because of sepsis and one for occlusion. There were no exit site infections or clinical thrombosis. It is concluded that PermCaths can be used safely for long term vascular access, with minimal morbidity and their use is recommended if temporary access is required for longer than four weeks (AU)

Dialysis therapy in the Caribbean - abstract

Long-term haemodialysis at the University Hospital of the West Indies, Jamaica, started in 1971 with the training of patients with end-stage renal failure for self-treatment in their own homes. There was no Government Health Insurance or other third party funding for this treatment and, regrettably, patients whose financial and social circumstances did not allow home-dialysis treatment perished from terminal uraemia. Elsewhere in the Caribbean, notably in San Fernando and Port-of-Spain in Trinidad and Tobago, attempts were also being made to introduce dialysis therapy. Again, there was little encouragement in the way of funding from traditional health care sources. The majority of Jamaicans coming to end-stage renal failure did so as the result of benign or malignant nephrosclerosis and the majority of these were from the lower socioeconomic strata of the society. To overcome their relative disadvantagement, dialysis programmes were initiated, first at the Kingston Public Hospital (circa 1972) and subsequently at the University Hospital (1974), to prepare patients with end-stage renal failure for renal transplantation. By September 1980 twenty-five cadaver renal transplants had been performed on patients from these two sources. All patients transplanted in Jamaica have received cadaver transplants. On June 14, 1987 the first successful living-related donor renal transplant in the Commonwealth Caribbean was performed in Barbados. A few months later four similar operations were performed in San Fernando. Dialysis facilities now exist in the Bahamas, Barbados, Bermuda, Jamaica and Trinidad and Tobago. The future holds the prospect of co-operation between these centres and the provision of renal transplantation services for a greater number of West Indian nationals (AU)

Temporary vascular access for chronic haemodialysis: the Bahamian experience - abstract

We report our experience with the Shiley Double Lumen (SDL) and Permacath (PC) central venous access dialysis catheters during the period May 1986 to August 1988. The SDL Catheter study was confined to all patients selected for chronic dialysis and awaiting vascular access by a visiting access surgeon; patients receiving A-V shunts or peritoneal dialysis were excluded. PC was introduced in December, 1987 as an alternative to SDL. SDLs were inserted by standard percutaneous Seldinger technique in the dialysis unit, and PC via an internal jugular vein cutdown under local anaesthesia. Of the group of patients for chronic renal dialysis on temporary SDL access, the 21 patients who eventually had permanent vascular access were reviewed. No patients failing to achieve permanent vascular access died or were discontinued from dialysis due to complications of SDL cannulation. The 21 patients received 40 SDL cannulations (17 right subclavian vein, 21 left subclavian and 2 right femorals) for a total of 1,170 patient days and 393 haemodialysis episodes. SDLs were resited if there was sepsis, luminal thrombosis or clinical signs of subclavian vein thrombosis. One patient was carried for 215 days on SDL catheterizations. The longest site cannulated was 139 days. Seven patients received PC for a total of 720 patient days and 240 dialysis. Four catheters were removed after permanent access was established, 1 after sepsis and 2 remain in situ. We conclude that SDL and PC catheters can be safely used over an extended period for temporary dialysis on an outpatient basis without compromising future permanent access. This is particularly suited for geographical areas lacking a permanent vascular access surgeon (AU)

Cessation of regular haemodialysis therapy in oliguric malignant hypertension treated with Minoxidil

The clinical course in 3 patients with malignant hypertension and severe functional renal impairment is reviewed. All were presumed to be in end-stage renal failure and represented 14.3 percent of patients admitted to a regular haemodialysis therapy (RHDT) programme during a 5-year period. Recovery of renal function permitted cessation of RHDT after periods of combined periods of combined peritoneal dialysis and RHDT lasting 19, 4 and 2.75 months respectively. Aggressive lowering of the blood pressure is stressed and supportive replacement of renal function by peritioneal or haemodialysis is recommended, particularly if the renal sizes are normal and urine output is maintained (AU)

Regular haemodialysis in Barbados: the first five years

The first five years' experience of a small, Caribbean, hospital-based haemodialysis unit is reviewed with particular reference to the aetiology of end-stage renal failure (ESRF), complications of therapy, causes of death and the factors influencing rehabilitation. Malignant hypertension evolved as an important cause of ESRF, accounting for 42 percent of cases among Black Barbadians on the dialysis programme (AU)

Haemodynamic improvements after peritoneovenous shunting in nephrogenic ascites

A patient being treated by regular hemodyalisis for end-stage renal failure had nephrogenic ascites. Despite attempts at fluid removal by ultrafiltration, progressive hypotension and low cardiac output eventually reduced fistula flow so much that haemodylasis became almost impossible. The insertion of a peritoneovenus shunt resulted in reduction of ascites and 78 percent increase in cardiac output, with consequent correction of hypotension and improvement of fistula flow. Peritoneovenous shunting is a simple and beneficial form of treatment for nephrogenic ascites that does not respond to fluid removal by dialysis (Summary)

Impaired peritoneal fluid drainage in nephrogenic ascites

In three chronic hemodialysis patients nephrogenic ascites and in four patients with ascites of other causes the rate of transfer of fluid from peritoneal cavity to plasma was measured by a radio-labelled albumin method. Ascitic fluid removal rate was lowered in the patients with nephrogenic ascites (median 14, range 10 to 21ml/hr) than in those with normal renal function (median 45, range 10 to 73 ml/hr). These results suggest that lymphatic drainage of the peritoneum is impaired in nephrogenic ascites and that this may contributed to the development of the condition and to the propensity of fluid overloaded dialysis patients to develop ascites. A retained substance or one liberated from abnormal kidneys nay be responsible for reversible for reversible depression of lymphatic flow in uremia. (AU)

Long-term haemodialysis in the home: results of seven years' experience in Jamaica - abstract

The training of a Jamaican patient for self-treatment with the artificial kidney in his own home was first attempted in 1971. By 1973 a home dialysis training programme (HDTP) was firmly established and based in a 3-bed haemodialysis unit intended primarily for acute haemodialysis treatments. This paper reviews the experience of the HDTP up to the end of 1978. Between 1971 and 1978, sixteen patients were accepted into HDTP: they were required to provide their own funding. One patient received a successful renal transplant before being discharged to home-dialysis and is not included in the subsequent analysis. No more than 4 patients were accepted in any one year. Ten of the 15 patients were completely rehabilitated. Nine of the 15 patients had died at the time of this assessment, but only one of the deaths could be attributed to faulty dialysis technique. Calculation of the cumulative patient survival showed a survival rate of 85.2 percent at 12 months and 67.3 percent at 24 months. Thereafter there was a rapid decline in the survival rate to 44.8 percent at 36 months. The causes of death were varied but there is no consistent pattern. Our experience has shown that Long-term haemodialysis is entirely feasible in the Jamaican and, presumably a Caribbean setting. Indeed, one of the patients trained in the HDTP has completed one year of home-dialysis in Barbados. Deficiencies in the programme have been identified and it is hoped that the provision of psychological counselling, the services of a social worker and third party funding will permit the maximum advantage to be gained from HDTP. (AU)

The feasibility of regular haemodialysis in Jamaica - abstract

In February, 1971, a Pilot Home-Dialysis Training Programme was instituted at the University Hospital of the West Indies in order to examine the feasibility of applying this form of therapy in Jamaica. All patients were in terminal renal failure with creatinine clearance below 5 mls/min. Dialysis was performed using traveno recirculating single pass machines and disposable coil dialyzers. Patients received treatment twice or thrice weekly for 6 to 6 1/2 hours on each occasion, and the "disposable" coils were re-used up to 5 times before being discarded. 5 patients were accepted into the Training Programme and 4 were discharged to treatment in their own homes. 1 death occurred after 8 months on dialysis. Of the remaining 4 patients, 3 are fully rehabilitated and are fully employed, and the fourth a retired farmer, enjoys an active retirement. The first patient to be accepted into the programme is now in his third-year on regular dialysis. Serious complications of therapy have been few in over 50 patient-months of therapy involving more than 500 haemodialysis treatment. On the basis of our experience it is concluded that there are no technical or other difficulties which might prevent the wider application of home-dialysis in Jamaica (AU)

Re-use of coil dialysers in long-term haemodialysis

More than 100 dialyses using "re-used" coils have been performed in the first 14 months of haemodialysis therapy in the patient who is the subject of this study. Coils can safely be re-used up to 6 times without increasing the haemorrhagic and bacteriologic risks of haemodialysis therapy. The saving in cost brings long-term haemodialysis within the financial capabilities of many West Indian patients.(AU)

Bone histological changes occurring after haemodialysis treatment for chronic renal failure

The changes that occurred in the histological appearances of iliac crest biopsies after haemodialysis for chronic renal failure in 16 patients are described. In the majority there is loss of bone and an increase in resorptive activity that resembles that seen in "disues" osteoporosis. The amount of osteoid present increases in most of the patients and other defects of calcification also make their appearance during the period of dialysis. None of the changes is peculiar to patients treated in this way. The findings are discussed in the light of hypotheses advanced on the condition of "dialysis bone disease".(AU)

A pilot study to evaluate the frequency of human T. lymphocytic virus type 1 infection in haemodialysis patients and chronic renal failure (non-dialysed) patients at the Port-of-Spain General Hospital, Trinidad

In a pilot study of human T. Lumphocytic virus type 1 (HLTV-1) positively in chronic renal failure, 110 patients were evaluated. There was an overall positivity of 6.4 percent. A higher rate of 14.3 percent was found in patients on haemodialysis who had had multiple transfusions. The male to female ratio of patients who tested positive was 6.1