Habitual coffee consumption enhances attention and vigilance in hemodialysis patients.

OBJECTIVE: Coffee drinking is the main source of caffeine intake among adult population in the western world. It has been reported that low to moderate caffeine intake has beneficial effect on alertness and cognitive functions in healthy subjects. The aim of this study is to evaluate the impact of habitual coffee consumption on cognitive function in hemodialysis patients. METHODS: In a cross-sectional study, 86 patients from a single-dialysis centre underwent assessment by the Montreal Cognitive Assessment tool and evaluation for symptoms of fatigue, mood, and sleep disorders by well-validated questionnaires. The habitual coffee use and the average daily caffeine intake were estimated by participants' response to a dietary questionnaire. RESULTS: Sixty-seven subjects (78%) consumed black coffee daily, mostly in low to moderate dose. Cognitive impairment was found in three-quarters of tested patients. Normal mental performance was more often in habitual coffee users (25% versus 16%). Regular coffee drinkers achieved higher mean scores on all tested cognitive domains, but a significant positive correlation was found only for items that measure attention and concentration (P = 0.024). CONCLUSIONS: Moderate caffeine intake by habitual coffee consumption could have beneficial impact on cognitive function in hemodialysis patients due to selective enhancement of attention and vigilance.

Cardiac troponins: outcome predictors in hemodialysis patients.

Cardiovascular diseases represent the main cause of death in hemodialysis (HD) patients. Cardiac troponins (cTnT and cTnI) are indicators of myocardial damage. The aims of this study were to assess the prevalence of increased serum cTn in the absence of acute coronary syndrome, to determine overall and cardiovascular mortality rates, and to investigate the possible predictive values of cTnT and cTnI on the outcome in HD patients over a 2-year follow-up period. The study included 115 patients (71 men and 44 women) with an average age of 53.30 +/- 12.17 years who had undergone regular HD for 4.51 +/- 4.01 years and had a mean HD adequacy (Kt/Vsp) of 1.17 +/- 0.23. Increased serum cTnT concentration was found in 37.39% of patients and elevated serum cTnI concentration was present in 11.30% of HD patients without symptoms or signs of acute coronary syndrome. The average 2-year mortality rate was 13.74% and the average 2-year cardiovascular mortality rate was 8.51%. Patients with serum cTnT levels greater than 0.10 ng/ml had significantly lower overall and cardiovascular survival rates than patients with serum cTnT levels of less than 0.10 ng/ml. Patients with serum cTnI levels greater than 0.15 ng/ml had significantly lower overall and cardiovascular survival rates than patients with serum cTnI of less than 0.15 ng/ml. In patients on regular HD, cTn levels are significant outcome predictors.

[Headache associated with haemodialysis].

INTRODUCTION: Haemodialysis (HD) is one of the most accessible methods for the treatment of the growing number of patients suffering from terminal-stage renal insufficiency. Although headache is the most frequently encountered neurological symptom during HD, there are few studies reporting its prevalence and clinical features. OBJECTIVE: The objective of this study was to examine the frequency, demographic and clinical features of headache during HD, and to compare these parameters among patients with and without headache. METHOD: The study involved 126 patients (48 female and 78 male) with chronic renal failure on regular HD for at least six months, at the Dialysis Unit of Nephrology Department, Krusevac. All patients were inquired about their possible problems with headache using the standardized questionnaire designed according to the diagnostic criteria of the International Headache Classification of Headache Disorders, second edition, published in 2004 (ICHD-II). Subsequently, the patients were clinically evaluated and patients with headaches were further subclassified by a neurologist with special interest in headache disorders. Patients with headache were compared to the patients without headache regarding age, sex, duration of HD, causes of end-stage renal disease, arterial diastolic and systolic blood pressure, and serum values of the most important blood parameters such as sodium, potassium, urea and creatinine. In the group of patients with headache we analyzed the characteristics of specific headache type according to ICHD-II classification. We also analyzed the most important clinical features of haemodialysis headache (HDH). RESULTS: In the group of 126 evaluated patients, 41 (32.5%) patients had headaches. There were no statistically significant differences between the patients with headaches and those without headaches regarding sex, age, BMI, duration of HD, causes of end-stage renal disease, arterial blood pressure, red blood cell count, serum concentration of haemoglobin, blood urea nitrogen, creatinine, glucose, MCHC, total protein, sodium and potassium. Fourteen patients (34% of those with headaches) experienced headache during the HD session and were subclassifled as HDH using diagnostic criteria of the International Headache Society. Tension type headache (41% of those with headaches) and migraine without aura (10%) were most common in the primary headache group and headache due to arterial hypertension (7%) was the most prevalent among the secondary headaches. Although there were some common clinical characteristics, we could not find a unifying clinical pattern in the patients with HDH. CONCLUSION: Haemodialysis headache is the most common headache in patients undergoing haemodialysis, and despite some common symptoms, it does not appear to be uniform in its clinical characteristics.

[Restless legs syndrome prevalence in patients on chronic hemodialysis in central Serbia].

BACKGROUND/AIM: Restless legs syndrome (RLS) is a sensorymotor disorder and the core feature of this syndrome is a distressing, irresistible need or urge to move the legs. RLS is one of the most troublesome conditions experienced by endstage renal disease patients treated with regular hemodialysis, and is significantly associated with their increased mortality. The aim of this study was to assess the prevalence of RLS in the patients with end-stage renal failure in the three dialysis centers in central Serbia, and to investigate the association of the syndrome with clinical characteristics and biochemical variables. METHODS: A cross-sectional multicentric study in which 166 consecutive hemodialysis patients were evaluated using a standard questionnaire based on diagnostic criteria elaborated by the International Restless Legs Syndrome Study Group was performed. All patients were reinterviewed and clinically examined by a qualified neurologist. The data on the patients with and without RLS were compared. RESULTS: The prevalence of RLS was 22.96% (95% CI, 16.57% to 29.35%). There was no significant difference in duration of hemodialysis and clinical characteristics when we compared the patients with RLS with those without RLS. We found significantly higher levels of blood urea nitrogen and creatinine and lower level of Kt/V index in the patients with RLS, which might point to inadequate dialysis in these patients. CONCLUSION: In our study the prevalence of RLS in the patients on the regular hemodialysis was 22.96%. The obtained results are similar to those of other studies using the same methodology in the white population on the regular hemodialysis.

Factors influencing erythropoietin compliance in peritoneal dialysis patients.

BACKGROUND: Peritoneal dialysis patients who manage their own therapy with subcutaneous erythropoietin (EPO) may be at risk for noncompliance. The objectives of this study were to examine the rate of noncompliance and to investigate the factors that are associated with patient noncompliance with the prescribed EPO regimen. METHODS: A multiple-choice questionnaire was mailed to eligible patients, and a review of pharmacy records was conducted for EPO dates of refill. Noncompliance was defined as less than 90% use of the prescribed dose either by pharmacy record review or missed injections on the questionnaire. RESULTS: Of 55 eligible patients, 54 completed the questionnaire. The overall rate of noncompliance was 35%. Patients who were noncompliant were younger (P = 0.005), had fewer comorbidities (P = 0.050), had been on EPO therapy longer (P = 0.011), were more likely to have completed postsecondary education (P = 0.011), and were more likely to admit to missed peritoneal dialysis exchanges (P = 0.011). On multiple regression analysis, the independent predictors of noncompliance, in order of importance, were missing dialysis exchanges, completion of postsecondary education, and younger age. CONCLUSION: These findings suggest that noncompliance with EPO injections is relatively common among peritoneal dialysis patients. The independent predictors of noncompliance were missing dialysis exchanges, completion of postsecondary education, and younger age. Further studies are needed to determine if specific interventions targeting this group of patients can affect compliance.

[Effect of uremia and peritoneal dialysis on peritoneal mesothelial cells]. / Uticaj uremije i peritoneurske dijalize na celije mezotela peritoneuma.

The aim of the study was to investigate the morphology of mesothelial cells of the peritoneum of patients with terminal renal failure (TRF), taken by the biopsy immediately before the onset of peritonal dialysis (PD), and to compare it with the findings in patients with PD. The samples were prepared in the way standard for light microscopy and transmission electron microscopy. In patients with TRF intracytoplasmatic inclusions could be observed, unusual protrusions of mesothelial apical surfaces, deformation of mesothelial cells and their detachment from the basal membrane, as well as the dilatated cisternae of granulated endoplasmatic reticulum with filamentous structures in some of them. In patients on PD cytoplasmic protrusions of different shapes and contents were observed at the surface of mesothelial cells, multiplication of basal membrane, occurrence of young forms of mesothelial cells as well as the detachment of those cells from the basal lamina.