Abdelali Bahadi

A model to predict optimal dialysate flow.

Diffusive clearance depends on blood (Qb) and dialysate flow (Qd) rates and the overall mass transfer area coefficient (KoA) of the dialyzer. In this article we describe a model to predict an appropriated AutoFlow (AF) factor (AF factor = Ratio Qd/Qb), that is able to provide adequate Kt/V for hemodialysis patients (HDP), while consuming lower amounts of dialysate, water and energy during the treatment. We studied in vivo the effects of three various Qd on the delivered dose of dialysis in 33 stable HDP. Hemodialysis was performed at Qd of 700 mL/mn, 500 mL/mn, and with AF, whereas specific dialysis prescriptions (treatment time, blood flow rate [Qb], and type and size of dialyzer) were kept constant. The results showed that increasing the dialysate flow rate more than the model of AF predicted had a small effect on the delivered dose of dialysis. The Kt/V (mean ± SD) was 1.52 ± 0.16 at Qd 700, 1.50 ± 0.16 at Qd 500, and 1.49 ± 0.15 with AF. The use of the AF function leads to a significant saving of dialysate fluid. The model predicts the appropriate AF factor that automatically adjusts the dialysate flow rate according to the effective blood flow rate of the patient to achieve an appreciable increase in dialysis dose at the lowest additional cost.

Consumption of Argan Oil Improves Anti-Oxidant and Lipid Status in Hemodialysis Patients.

Objective: Virgin Argan oil (VAO) is of interest in oxidative stress and lipid profile because of its fat composition and antioxidant compounds. We investigated the effect of VAO consumption on lipid profile and antioxidant status in hemodialysis patients after a 4‐week period of consumption. Methods: In a crossover, controlled trial, 37 patients (18 men, 19 women) with end‐stage renal disease on maintenance hemodialysis, were randomly assigned to a 4‐week VAO diet. Fasting plasma lipids, vitamin E and oxidized LDL (ox‐LDL) were analyzed. Malondialdehyde (MDA) was determined before and after hemodialysis session. Results: There was no significant change in serum total cholesterol and ox‐LDL. However, VAO consumption decreased the levels of triglyceride (p = 0.03), total cholesterol (p = 0.02) and low‐density lipoprotein (p = 0.03) and increased the levels of high‐density lipoprotein (p = 0.01). Plasma vitamin E contents significantly increased from baseline only in VAO‐group (p < 0.001). Hemodialysis session increased MDA levels, but the increase in VAO group was less than in control group. Conclusion: VAO consumption improved lipid profile and oxidative stress status in hemodialysis patients. Copyright

Insuffisance rénale aiguë révélant une hypothyroïdie auto-immune

Although the clinic picture is often indicative of muscle manifestations in patients with hypothyroidism, signs and symptoms of this condition are variable from simple elevation of serum muscle enzymes with myalgia, muscle weakness, cramps to rhabdomyolysis with acute renal failure which remains a rare event. Thyroid hormones affect the function of almost every body organ, and thyroid dysfunction produces a wide range of metabolic disturbances. Hypothyroidism is associated with significant effects on the kidney which the pathophysiology seems to be multifactorial, but the exact mechanisms remain poorly understood. Hypothyroidism as a cause of renal impairment is usually overlooked, leading to unnecessary diagnostic procedures. The main objective of our observation is to report a case of acute renal failure revealing an autoimmune hypothyroidism in which thyroid hormone substitution led to a significant improvement in muscular, thyroid and renal disorders.

Diagnostic value of NT-ProBNP for left ventricular hypertrophy in hemodialysis patients

We measured NT-proBNP levels in 30 stable patients on maintenance haemodialysis, before and after hemodialysis session with low-flux polysulfone dialyzers, all mesures were done by a third-generation assay (Elecsys Analyzer, Roche Diagnostics, Mannheim, Germany). We hypothesized that serum NT-proBNP cut-off value could serve as a biochemical marker to detect LVH in patients on haemodialysis treatment, regardless of chronic fluid overload. We assessed LV masse using trans-thoracic echocardiography, LVH was defined as an indexed left ventricular mass> 134 g/m2 in man and 110 g/m2 in woman. NT-proBNP levels increased significantly after hemodialysis sessions (5575,93 ± 5509,53 versus 4114,3856,37 ± pg/ml p<0,0001). A significant positive correlation was found between NT-proBNP level and left ventricular mass (r = 0.75, P<0.0001). NT-proBNP was significantly higher in patients with LVH: (5270,35 ± 3410,23 versus 2477,27 ± 1421,91 pg/ml P = 0,045). In the multivariate regression analysis NT-proBNP was the only independent predictor of LVH (r = 0.75, P<0.0001 Our results suggests that NT-proBNP could be a potential marker of LVH in chronic renal failure patients on hemodialysis.

Assessment of dialysis adequacy guidelines implementation in a developing country.

Dialysis adequacy has been shown to have a significant impact on patient survival, but there are few data concerning the adequacy of the delivered hemodialysis dose in developing countries. To describe the level of implementation of dialysis practice guidelines in a dialysis center in Morocco, we retrospectively reviewed our 1-year experience of managing chronic hemodialysis patients (CHP), from May 2009 to May 2010. Demographic and biochemical data were collected, and the percentage of patients achieving targets recommended by the NKF-KDOQI guidelines were calculated. Our data suggests that dialysis units in a developing country can achieve current guidelines targets for dialysis adequacy, however, our results are not generalizable to all dialysis centers in Morocco.

Bacteremia and thrombotic complications of temporary hemodialysis catheters: Experience of a single center in Morocco

Background: The use of central venous catheters is essential in hemodialysis care, but it is associated with infectious and thrombotic complications. The aim of this study is to determine rates and risk factors of hemodialysis catheter-related bacteremia and thrombotic complications from a Moroccan single center to set prevention policies. Materials and Methods: The trial was designed as a prospective observational study including all patients who required a temporary hemodialysis catheter more than 48 h. Baseline demographic and clinical data including age, sex, causes of kidney failure, comorbidities, indication for insertion, catheter insertion sites, and duration of use were collected. Patients were followed up since the insertion of catheter to its removal. Results: A total of 126 hemodialysis catheters were inserted at different sites in 93 patients for the following reasons: the absence of vascular access in patients with end-stage renal disease in 55 cases (43.65%), vascular access dysfunction or infection in 45 cases (35.71%), and acute kidney injury in 26 (20.63%). During follow-up, 15 catheters (11.9%) were complicated by bacteremia, resulting in a rate of 6.68 per 1000 catheter days. Risk factors associated with catheter-related bacteremia were diabetes (odds ratio [OR] =26.018; P = 0.017) and advanced age (OR = 1.105; P = 0.045). Causative microorganisms were dominated by coagulase-negative staphylococci in 46.66%. Twenty-four thrombotic complications (19.04%) were documented with an incidence of 10.69/1000 catheter-days. Among these complications, 18 were dysfunction of catheter (14.28%, 8.01/1000 catheter-days) and 6 were vein thrombosis (4.76%, 2.67/1000 catheter-days). Lower serum albumin levels was the unique risk factor (OR = 0.801; P = 0.042). Conclusions: Early diagnosis of chronic kidney disease and creation of arteriovenous fistula may lower the incidence of catheter use in hemodialysis.