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Background and Objective: Zinc and Copper are the important trace elements for human growth and body’s biological functions. These trace elements are the important cofactors of many enzymes. Serum variation of these trace elements are clinically important and should be taken into consideration, because fluctuation of these elements are behind many clinical manifestation in human. Diarrhea and vomiting can be the clinical symptoms associated with the toxic level of Zinc and Copper in the body. The concept behind this study is to determine the serum levels of Zinc and Copper in hemodialysis patients before and after dialysis, to explain the differences of such trace element concentration in these patients. Materials and Methods: This project is a comparative study. The sample population was 50 of hemodialysis patients chosen randomly from the patients referred to the 5th Azar Hospital in Gorgan (33 male and 17 female). The concentration of Zinc and Copper of these patients was determined before and after the dialysis. Results: The results from this research projects indicated that the average concentration of Zinc and Copper in hemodialysis patients after dialysis were 135.32±59.32 and 136.40±51.52 microgram/deciliter which markedly increase in compare to the serum concentration of these trace elements before the dialysis which were 78.38±37.46 and 89.92±32.54 microgram/deciliter respectively. On the basis of the results, we found in this study the average increased concentration of Zinc and Copper after the process of dialysis among the hemodialysis patients had a meaningful statistical variation (P<0.001). Conclusion: Uremia, dialysis blood tube, heavy metal contamination, the quality of dialysis membrane and the quality of water used for the process of dialysis can be a reason for the increased concentration of Zinc and Copper. Such increase in the serum concentration of these trace elements can be the basis for some clinical abnormalities. Therefore it is suggested to determine the rate of released Zinc and Copper from hemodialysis machine, before the procedure is done To enable the medical team to evaluate the serum Zinc and Copper and correct it by nutritional therapy.

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Background & Objective: Hemodialysis patients quality of life is a significant subject. Style of coping or adjustment among hemodialysis patients is a complicated problem that affects the quality of life status. Responses domain to these problems are different from readjustment to suicide. The object of this study was to determine the relationship between quality of life and copings the problem, which were applied by hemodialysis patients. Materials & Methods: This is a descriptive analytical and correlational study. The study has been done in hospitals of Gorgan, Gonabad and Bandar Torkaman cities. The data were collected using a questionnaire with likert scale (From 1 to 5). Sample population was 167 patients. Results: The results showed that 89 patients were male, 78 patients female, 25.74% between 35-44 years old and hemodialysis of duration of 114 patients was more than 4 years. The quality of life mean score and standard deviatior were respectively 89.58, 8.13. About 75.42% of patient’s quality of life were moderate. The emotional and problem focused strategies were used in moderate way by the hemodialysis patients. Statistic tests between quality of life and emotional focused coping was significant (P<0.05). In general there are relationship between quality of life and total coping (P<0.05). Conclusion: According to study, we conclude that emotional focused coping and total coping influence the quality of life of hemodialysis patients. Therefore hemodialysis patients must be educated and supported, to cope with the problems.

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Background & Objective: Free radicals are formed in all living organisms during normal cell metabolism. Patients with chronic renal failure, which regularly dialyzed are the candidates for, free radical damages. The aim of this study with the discriminative information was to evaluate the effect of hemodialysis on Lipid peroxidation (The level of Lipid peroxidation expressed as malondialdehyde) and erythrocyte antioxidant enzyme (Glutathione peroxidase) before and after the dialysis and compared with control group, to find out the effect of hemodialysis on the level of Lipid peroxidation of plasma and the activity of erythrocyte antioxidant enzyme. Materials & Methods: This investigation was an analytical type of study and sampling procedure was according to purposive method. 22 patients with chronic renal failure (CRF) disease who were hemodialysed at 5th Azar Hospital of Gorgan dialysis center and 22 age and sex matched healthy control were recruited for this study. The data was analyzed by SPSS software using T-test. Results: Plasma malondialdehyde showed significant difference between the predialysis (And control group. It was increased in the postdialysis group (2.32±0.38 nmol/ml) when compared with predialysis (1.27±0.23 nmol/ml) and control group (0.98±0.17 nmol/ml). Erythrocyte antioxidant enzyme was decreased in postdialysis group (22.26±4.76 unit/gram hemoglobin) when compared with predialysis (29.66±5.95 unit/gram hemoglobin) and control group (37.52±6.26 unit/gram hemoglobin). There was also significant difference between control and predialysis group. Erythrocyte antioxidant enzyme was lower than control group in dialysis group. Conclusion: The observation of meaningful differences in reduction of erythrocyte antioxidant enzyme and increasing level of plasma Lipid peroxidation in the hemodialysed patients after the process of dialysis, maybe related with the patient, uremia, dialysis membrane (The loosing antioxidant enzyme through this membrane), and the dialysis process (May increase Lipid peroxidation during the dialysis process). These states of affairs may play an important role in progress of cardiovascular abnormality in hemodialysed patients. Due to this conditions a review of hemodialysis membrane, the techniques used in the dialysis, the consumption of various oral antioxidant, the elimination of active oxygens from the dialysis surrounding are among the measures which can prevent sudden cardiovascular abnormality in the hemodialysis patients and ultimately these important factors up-grade the patients quality of life.

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Background & Objective: Cardiovascular disease is among important factors of mortality in hemodialysis patients. There are some reports that indicate the Carnitine concentration reduction in the tissues accelerate cardiovascular abnormalities in those patients whom regularly are hemodialysed. This research has been set up to study the effect of oral Carnitine on the heart function of hemodialysis patients from Sari and Vali-Asr Hospital in Ghaem-Shahr Fatemeh Alzahra, Imam Khomeini in during 2003. Materials & Methods: In this study 20 patients with at least 3 month duration and 3 times interval hemodialysis in each month were chosen. The sample hemogenously devided in case and control group. One Carnitine tablet with 1 gr dose was given to the case group daily. The placebo was prescribed to the control group EF and LVEDD of patients were determined by echocardiography. The ratio diameter of heart to the chest was determined by chest radiography. The plasma level of hemoglobin, Cholesterol and Triglyceride were determined simultaneously. Results: There was not any meaningful recovery in EF and LVEDD and serum Lipids, between the case and control group 6 months after treatment with 1 gr/day Carnitine. There was only a meaningful difference in EF after 6 months duration of this study. In spite of this, there was a meaningful recovery with these patients anemia (P?0.05). Conclusion: Carnitine does not have a meaningful effect of heart function and serum Lipid level, but it has an efficacy on anemia recovery of such patients.

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Background and Objective: Hemodialysis is one of the common therapulic proceduce for terminal renal failure. Insufficient and low efficient hemodialysis increases the mortality rate, therefore the assessment of hemodialysis efficacy is important. This study was done to determine the hemodialysis efficacy based on urea reduction ratio (URR) model and kt/v (Clearance Time Volume) criteria in Gorgan, Northern Iran. Materials and Methods: In this descriptive and analytical study 113 heomdilysis patients were selected prior to hemodilysis and five minutes after pump stopping, arterial blood urea nitrogen (BUN) was measured and then kt/v and URR were calculated. Also kt/v relations with weight, gender, educational level, length of hemodialysis session, blood flow rate, TMP (Terans Membran Presure), filter Ku/f (Clearance Ultrafiltration), preliminary disease, time of hemodialysis per week and the type of vessel access were determined. Data analyzed using SPSS-13 and independent t-test, chi-square, fisher exact test and Pearson correlation coefficient. Results: The mean of hemodilysis history was 37 months and mean of Patient's ages were 51.6 years. 77.9% of subjects had hemodialysis efficacy according to Kt/v and URR critrial. There was a statistical significant correlation between hemodialysis efficacy and time of hemodialysis session, blood flow rate, time of hemodialysis per week and type of vessels access (P<0.05), but there was not any significant correlation between hemodialysis efficacy and weight, gender, education, TMP, filter Ku/f and preliminary disease. Conclusion: This study suggested that hemodialysis efficacy in this center was better that other studies in Iran.

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Background and Objective: Mucocutaneons manifestations are common in hemodialysis patients.The aim of this study was evaluate the prcvalence of cutaneous and mucosal manifestations in end stage renal disease (ESRD) patients who are on the maintenance hemodialysis.

Materials and Methods: This cross sectional study was performed on 100 (51 males, 49 females) hemodialysis patients in 5 Azar hospital in Gorgan, North of Iran during 2009. Patients selected on randomly based an all of them completely examined by a deramatologist for any changes in skin, hair, nail and mucous membrane. If necessary biopsy perform and refer to a pathologist. Data analysed with SPSS-13, mann-whitney, t-test, Chi-Square and Fisher tests.

Results: The average age was 49±12.3 years. The most common causes of ESRD was dibetes mellitus. The most common skin lesion was xerosis (78.3%), after that pruritis (39.1%) lentigo (34.8%) skin discoloration (32.6%) leukonychia (32%) thining of nail bed (24%) were common lesions. Lentigo was more common in female than male 42.85% vs 21.50% (p=0.042). Xerosis (p<0.01), scaling (p=0.042), lentigo (p<0.01), folliculitis (p<0.01), idio pathic guttate hypopigmentation (p<0.01) leukonychia (p<0.01) and half and half nail (p<0.01) have meaningful correlation with age. There was also meaningful correlation between dialyis duration and skin discoloration (p<0.031) and leukonychia (p<0.041). Clubhing and ca-p product also have meaningful correlation (p<0.027). Pruritis (p<0.048) and skin fungal infection (p<0.047) (tinea versi color) also have meaningful correlation with serum ferritin level.

Conclusion: Mucocutaneous manifestation were common in end stage renal disease patients.

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Background and Objective: Poor sleep quality is common among hemodialysis patients and can potentially predict morbidity, mortality and quality of life in these patients. On the other hand, hemodialysis patients are encountered with vitamin C deficiency. The purpose of this study was to determine the effect of intravenous vitamin C on sleep quality in hemodialysis patients.

Materials and Methods: In this double blind randomized clinical trial, 60 qualified hemodialysis patients were gone under investigation in Sari a city located in North of Iran during 2010. Patients randomly allocated in two equal intervention and control groups. The main measured outcome was the Pittsburg sleep quality index (PSQI) which consists of seven components. At the end of each hemodialysis session, Intervention group received vitamin C vial (500mg/5cc) intravenously, three times a week for 8 weeks and control group received normal saline in a same way. Data were collected at pretreatment and after two months of treatment. Data were analyzed by Independent t test, Paired t test, Wilcoxon and Chi-Square tests.

Results: The result indicated that the sleep quality improves significantly in vitamin C group but not in control group (P<0.001). Vitamin C caused significant improvement in subjective sleep quality, sleep latency, habitual sleep efficiency and sleep disturbances in intervention group (p<0.05). Also, Global PSQI score of intervention group had a greater improvement than control group. Moreover vitamin C caused significant improvement in subjective sleep quality, sleep latency, habitual sleep efficiency and sleep disturbances in intervention group after treatment (p<0.05).

Conclusion: This study showed that intravenous vitamin C can effectively improve sleep quality in hemodialysis patients.

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Background and Objective: Cardiovascular diseases are the most frequent cause of death among hemodialysis patients. Left ventricular hypertrophy and systolic dysfunction are potent predictors of cardiovascular morbidity and mortality in hemodialysis patients. Cardiac troponin T and I are the indices of myocardial cell damage. This study was done to determine the relationship between serum cardiac troponin T and I with left ventricular hypertrophy and systolic dysfunction in hemodialysis patients. Method: In this case-control study, 56 hemodialysis patients were divided into two groups according to echocardiographic findings. The first group included 35 patients with left ventricular hypertrophy as case group and 21 patients without left ventricular hypertrophy as controls. Serum level of cardiac troponin T and I were measured using electro chemiluminscence immune assay. Results: Serum level of cardiac troponin T and I was significantly higher in patients with left ventricular hypertrophy (0.99±0.12 ng/ml and 0.17±0.09 ng/ml, respectively) in comparison with controls (0.37±0.05 ng/ml and 0.13±0.09 ng/ml, respectively) (P<0.05). There was no correlation between serum cardiac troponin T and I level with left ventricular systolic dysfunction. Conclusion: Cardiac troponin I and T do not have any value for the diagnosis of left ventricular systolic dysfunction in hemodialysis patients.

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Background and Objective: Malnutrition is an important health problem in patients with end stage renal disease which increases morbidity and mortality. Early diagnosis of malnutrition can be important for nutritional supports in hemodialysis patients. This study was carried out to evaluate the nutritional status and its related risk factors in hemodialysis patients using subjective global assessment. Methods: This descriptive-analytic study was done on 117 hemodialysis patients in the 5th Azar hospital, in Gorgan, Iran during August to October 2013. The nutritional status was evaluated as normal, mild to moderate or severe malnutrition using subjective global assessment (SGA). The anthropometric and biochemical parameters of hemodialysis patients and its relation with nutritional status were determined. Results: Among 116 patients, 29.66%, 69.82% and 0.9% were well nourished, mild to moderate malnutrition and severe malnutrition, respectively. A significant negative correlation was seen between patient’s weight, BMI, mid-arm circumference and serum albumin with SGA score (P<0.05). Patient’s age and duration of hemodialysis positively correlated with malnutrition (P<0.05). No significant association was found between serum concentration of BUN, Cr and WBC count with nutritional status. Conclusion: This study has shown low prevalence of malnutrition in our population in comparison with other studies. However according to important of malnutrition in patients undergoing hemodialysis, the basic evaluation of nutritional status is needed for every patient.

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Background and Objective: Chronic itching reduces the quality of life of patients undergoing hemodialysis. This study was done to determine the effect of chronic itching on the quality of life of patients under hemodialysis in north of Iran.

Methods: In this descriptive-analytical study, 111 patients with mean age of 58.36±12.7 years were randomly selected from hemodialysis centers of Golestan province from May to December 2017. Demographic data, quality of life (Itchy QOL questionnaire), Xerosis, pruritus intensity (Balaskas 1998), and laboratory tests including calcium, phosphorus, alkaline phosphatase, parathyroid hormone, blood urea nitrogen, creatinine, hemoglobin and hematocrit were evaluated.

Results: The mean score of itching severity and overall quality of life was 29.27±7.46 and 41.4±10.44, respectively. There was a significant correlation between the severity of itching and the overall score of patients' quality of life (P<0.05). Correlation between severity of pruritus with symptom dimension, functional dimension and emotional dimension was significant (P<0.05). There was a significant correlation between severity of itching and Xerosis and serum calcium level (P<0.05). There was a significant correlation between Xerosis and calcium level with increased itching (P<0.05).

Conclusion: Itching reduced the quality of life in hemodialysis patients in north of Iran.

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Background and Objective: Acquired kidney cysts usually occur in end stage renal disease (ESRD) patients undergoing long-term hemodialysis. Increasing growth of cysts is also seen in asymptomatic patients and they can cause complications such as retroperitoneal and intrarenal bleeding, Erythrocytosis, infection of cysts and renal cell carcinoma with distant metastases. This study was designed to evaluate the prevalence of acquired kidney cysts and its related factors in hemodialysis patients.
Methods: In this descriptive-analytical study, 123 patients (mean age 55.22+13.23 years) were selected from hemodialysis patients referred to dialysis center. Patients with autosomal polycystic kidney disease, medullary sponge kidney and medullary cystic kidney disease were not included. Diagnosis of acquired kidney cysts of Patients was performed by ultrasonography.
Results: The overall prevalence of kidney cysts was 44.6%. 30 percent of diabetic patients had kidney cysts, while kidney cysts were present in 51.2% of nondiabetic patients. 32.4% of patients were received twice a week dialysis and 42.4% of patients were received three times a week dialysis had kidney cysts. Mean±SD of duration of dialysis history in patients with cystic kidneys was 22.02±22.65 months, while these measures in patients with noncystic kidneys were 22.65±14.65 months. There was a relationship between kidney cysts and the numder of hemodialysis per week (P<0.05). There was a relationship between prevalence of kidney cysts and the qulity of hemodialysis (P<0.05)
Conclusion: This study showed that there was a relationship between prevalence of kidney cysts and the qulity of hemodialysis and the numder of hemodialysis per week.

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Background and Objective: Hemodialysis is an important replacement therapy for 70-90% of patients with end-stage renal disease (ESRD). Arteriovenous fistula (AVF) is the vascular access of choice in these patients due to its higher efficiency and lower risk of mortality compared to arteriovenous grafts. This study was conducted to determine the frequency of vascular access types used in hemodialysis centers of Gorgan, Iran.
Methods: This descriptive-analytical study was done on 200 hemodialysis patients (101 men and 99 women) at 5 Azar and Sayyad Shirazi hospitals in Gorgan, north of Iran, during April 2020 to July 2021. The subjects were selected by the census method. Information including age, sex, education level, duration of dialysis, the initial and current types of vascular access, site of vascular access, history of diabetes or hypertension, race, and history of smoking were recorded in a checklist.
Results: The mean age of women and men was 58.34±4.71 and 57.95±13.76 years, respectively. In addition, 61.5% of the patients were under 3 years old. The most commonly used vascular access to initiate dialysis was non-cuffed temporary catheters (69%) and AVF (24%). Smoking, ethnicity, diabetes, hypertension, and gender had no significant association with the type of vascular access used. In addition, there was no significant relationship between the duration of dialysis and the type of vascular access.
Conclusion: Considering the diversity of catheters and fistulas, it is necessary to emphasize that the use of AVF in patients undergoing dialysis for the first time and the timely placement of AVF in ESRD patients can improve the quality of life of the patients. It is also recommended to use jugular catheters instead of subclavian catheters when required.
 

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Background and Objective: Ensuring suitable access to hemodialysis, which provides high-quality dialysis over an extended period, is a significant challenge for patients with End-Stage Renal Disease (ESRD). One crucial aspect of this is maintaining the performance of hemodialysis catheters. Our study, which aimed to evaluate the one-year performance of long-term catheters in chronic hemodialysis patients in Golestan Province, is a critical step toward improving patient care in this population.
Methods: This descriptive-analytical study was conducted on 99 patients (34 men and 65 women) with ESRD who were candidates for starting or continuing dialysis with a catheter in the educational and therapeutic centers of Golestan Province, Iran during 2021-22. Transjugular catheters were placed for the patients, and after one year, variables such as age, gender, history of diabetes, history of hypertension, catheter placement site (right or left jugular), and antiplatelet medication use were evaluated concerning the performance of long-term catheters in providing adequate flow for hemodialysis.
Results: In 91 patients (91.9%), the one-year catheter performance was assessed as satisfactory. The age of 61.6% of the patients were over 60 years old. Sixty-nine patients (69.7%) had a history of hypertension, and 58 patients (58.6%) had a history of diabetes. Fifty-seven patients (57.6%) received antiplatelet medication. The catheters were placed on the right side in 82 patients (82.8%). Catheter performance in patients taking antiplatelet medication was non-significantly higher than in those not taking antiplatelet medicines.
Conclusion: The performance of long-term catheters in chronic hemodialysis patients with ESRD showed no significant correlation with age, gender, diabetes, hypertension, antiplatelet medication use, or the side of the jugular vein where the catheter was placed.