SPECIAL PROBLEMS IN HEMODIALYSIS PATIENTS Edited by Maria Goretti Penido Special Problems in Hemodialysis Patients Edited by Maria Goretti Penido Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which permits to copy, distribute, transmit, and adapt the work in any medium, so long as the original work is properly cited. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. 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Used under license from Shutterstock.com First published November, 2011 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Special Problems in Hemodialysis Patients, Edited by Maria Goretti Penido p. cm. ISBN 978-953-307-396-5 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Chapter 1 Gastroesophageal Reflux Disease in Chronic Renal Failure Patients 1 Yoshiaki Kawaguchi and Tetsuya Mine Chapter 2 Hepatitis B Virus (HBV) Variants in Hemodialysis Patients 3 Selma A. Gomes, Francisco C. Mello and Natalia M. Araujo Chapter 3 Resistance to Recombinant Human Erythropoietin Therapy in Haemodialysis Patients 35 Elísio Costa, Luís Belo and Alice Santos-Silva Chapter 4 Blood Pressure and Hemodialysis 55 Robert Ekart, Sebastjan Bevc and Radovan Hojs Chapter 5 Antidiabetic Therapy in Type 2 Diabetic Patients on Hemodialysis 85 Georg Biesenbach and Erich Pohanka Chapter 6 Treatment Protocol for Controlling Bone Metabolism Parameters in Hemodialysis Patients 97 Pablo Molina, Pilar Sánchez-Pérez, Ana Peris, José L. Górriz and Luis M. Pallardó Chapter 7 Dialysis Disequilibrium Syndrome: A Neurological Manifestation of Haemodialysis 113 Thomas Flannery Chapter 8 Cardiovascular Disease in End Stage Renal Disease Patients 123 Lukas Haragsim and Baroon Rai Chapter 9 Cardiovascular Morbidity in Hemodialysis: The Reverse Epidemiology Phenomenon 145 Georgios Tsangalis VI Contents Chapter 10 Metabolic Complications of Chronic Kidney Failure and Hemodialysis 155 Roman Cibulka and Jaroslav Racek Chapter 11 The Endothelium and Hemodialysis 167 Hernán Trimarchi Preface This book provides an overview of special cases in hemodialysis patients. Authors have contributed their most interesting findings in dealing with patients suffering of other diseases simultaneously, such as diabetes, cardiovascular disease and other health problems. Each chapter has been thoroughly revised and updated so the readers are acquainted with the latest data and observations in these complex cases, where several aspects are to be considered. The book is comprehensive and not limited to a partial discussion of hemodialysis. To accomplish this we are pleased to have been able to summarize state of the art knowledge in each chapter of the book. This book provides practical and accessible information. It is quite comprehensive as it covers various special circumstances in hemodialysis patients and their treatment. We wish to thank each author for taking considerable time and effort to ensure their chapter provides state of the art information. We hope that readers achieve the same level of acquisition of new knowledge as we have attained by editing this book. Dr. Maria Goretti Penido Department of Pediatrics School of Medicine Federal University of Minas Gerais Minas Gerais Brasil [...]... based on the creatinine level and as follows: 2< Cr < 5 (44 patients [28%]), Cr 5< and patients on predialysis (53 patients [34%]), Cr 5< and patients on hemodialysis (59 patients [38%]) (Table 3) As we could not examine glomerular filtration rate (GFR) of all patients, we used serum creatinine level as renal function These clinical findings were compared with the gastroendoscopic findings retrospectively... infection rates within dialysis units in the developing world can be attributed to several factors, an important one being the higher background prevalence of HBV in the general population Also playing a prominent role are difficulties following infection control strategies against HBV such as, routine hemodialysis precautions, separating HBsAg-positive patients by rooms, machines, and staff, vaccination... deviation (SD) or as the number of patients (n) Table 3 Clinical characteristics of 156 CRF patients 6 Special Problems in Hemodialysis Patients Fig 3 Gastroendoscopic findings of 156 CRF patients who underwent endoscopic examination Fig 4 Relationships between renal function and gastrointestinal symptoms Gastroesophageal Reflux Disease in Chronic Renal Failure Patients Fig 5 Relationships between... Results in other CRF patients, such as patients with uremia but not on dialysis, or patients on HD, have yielded conflicting results Three studies demonstrated delayed gastric emptying in uremic predialysis patients (31-33) The researchers have also documented delayed gastric emptying in hemodialysis patients particularly patients who are hypoalbuminemic (32, 33) In our study, as for total protein, the... GERD in CRF patients who underwent HD (24.2%) was increased In the gastroendoscopic findings of the 156 CRF patients who underwent endoscopic examination, the prevalence of GERD was 34.0% Especially, in symptomatic cases, the prevalence of GERD was 44.0% (7) Although we are now aware of the increasing prevalence of symptomatic GERD in HD patients, little is known about the gastroendoscopic findings... HBV-DNA assays In this context, it is of note that several authors consider occult HBV as a possible source of virus spread in hemodialysis units, thus representing a risk of infection for both patients and staff, and suggest some precautions including HBV DNA screening for all hemodialysis patients (Minuk et al., 2004) 13 HBV variants in the general population vs among hemodialysis patients In this topic,... diagnose GERD in this study We diagnosed GERD in those with a score of four points or more In these 418 stable HD patients, the prevalence of GERD was 101 patients (24.2%) (Table 1) (4) Compared to the reported prevalence of GERD in Japan (16.3%) (6), the prevalence of GERD in CRF patients (24.2%), especially who underwent HD, is increased This increased prevalence of GERD in HD patients was in accordance... living in areas where HBsAg prevalence is 8% or higher, with a risk of infection of more than 60%, mostly during the childhood and with a high risk of chronicity Forty-three percent of worldwide infected people are living in areas of intermediate prevalence with risk of infection of 20-60%, occurring across all age groups Only the remaining 12% are living in areas of low prevalence with risk of infection... HBV infection in patients undergoing regular hemodialysis in the developed world is currently low (Finelli et al., 2005) In developed countries, where the infection control procedures have been implemented, HBV infection declined significantly, reaching HBsAg rates lower than 1.0% (Alter et al., 1986; Tokars et al., 2002) However, outbreaks of HBV infection continue to be reported occasionally in dialysis... worse, although we could not examine serum gastrin level (7) But hypergastrinemia may also be in part to due increased secretion, because the density of G cells is increased in CRF patients (15, 16) possibly owing to a hyperthyroid state Elevated serum gastrin causes an increase in acid production by the parietal cells However, when measured in CRF patients, large variations in the mean gastric acid production . provides an overview of special cases in hemodialysis patients. Authors have contributed their most interesting findings in dealing with patients suffering of other diseases simultaneously,. number of patients (n) Table 3. Clinical characteristics of 156 CRF patients. Special Problems in Hemodialysis Patients 6 Fig. 3. Gastroendoscopic findings of 156 CRF patients. SPECIAL PROBLEMS IN HEMODIALYSIS PATIENTS Edited by Maria Goretti Penido Special Problems in Hemodialysis Patients Edited by Maria Goretti