---

  Background and Objective : Recirculation rate is essential for the quality of Hemodialysis . Since the treatment of patients is based on the Dialysis Adequacy, the evaluation of recirculation is especially important. This study was performed with the aim of measuring arteriovenous fistula recirculation and its relationship with some factors in Hemodialysis patients.

  Material and Methods: In this Descriptive-Analytical study, all Hemodialysis patients (n=100), in Panje Azar Hospital of Gorgan, whose vessels were accessed by arteriovenous Fistula was studied in the summer of 2009. In order to determine recirculation rate ، we used urea based classic method. The cut point of recirculation was considered 10%. The variables studied are Fistula longevity ، direction of needle insertion ، the space between needles and the place of needles fistula and KUF filteration. Data were analyzed by using descriptive statistics and logistic regression test (odds ratio and ci reported) in the SPSS software.

  Results: Patients were male (53) and female (47) with the mean age of 50.93± 17.23. The mean year of Dialysis history was 4.04 ± 5.04. Fifteen percent of patients had recirculation. Average access recirculation of all patients was 0.067 ± 0.118. Recirculation rate had significant relationship (P <0­.­05) with direction of two Arterial-Venous needle and the place of the two needles ، which may have been higher.

Conclusion: Considering the results of this study, we conclude that emphasis should be applied on instructing correct needle insertion in order to decrease recirculation

---

  Background and Objective : Anemia is one of the most common complications of end stage renal diseases. Inadequate production of erythropoietin is the main cause of anemia in these patients, and iron deficiency is the other important factor. We designed this study to survey the prevalence of iron deficiency anemia in hemodialysis patients referred to hemodialysis ward of Panje Azar hospital in Gorgan, Iran.

  Material and Methods: The subjects of this descriptive and cross-sectional study were all 97 patients undergone permanent hemodialysis. Hemoglobin, Serum Iron, Ferritin, Transferrin saturation and Hemoglobin index were measured to assess iron deficiency anemia. We did data analysis by using chi square, fisher exact test and independent T test in spss 13 environment.

  Results: The prevalence of anemia and iron deficiency anemia were 57.6 and 31.1 percent, respectively. Tranferrin saturation in 29.16 percent of the patients is less than 20%. There was no significant correlation between signs of anemia and variables such as, duration of dialysis, causes of the disease and iron- deficiency anemia (p=0.06). But signs of anemia were significantly correlated (p<0.0001) with erythropoietin. In comparison with patients consumed iron orally, those who used injectable iron had higher serum iron, Hemoglobin and Transferrin saturation (p<0.001).

  Conclusion: Because of high frequency of iron- deficiency that may results in resistance to erythropoietin therapy and leads to inappropriate treatment of iron deficiency. We recommend first treating of ID to prevent from useless administering of erythropoietin.

---

  Background and objective : Low blood pressure and Muscle cramps are common complications of Hemodialysis. One approach that has recently been proposed to prevent this complication is the combination of sodium and ultrafiltration. The purpose of this study was to investigate the effect of of sodium and ultrafiltration profile on some of the common complications during Hemodialysis.

  Material and Methods: In this crossover clinical trial study, 22 Hemodialysis patients referred to Panje-­Azar Hospital in 2012 were divided randomly into two groups. For each group, two treatment protocols were conducted, six hemodialysis sessions. The intervention protocol was a linear sodium dialysate and linear ultrafiltration. In routine Protocol, both sodium dialysate and ultrafiltration were considered constant. Using chi-square test and relative risk, the data was analyzed (P<0.05).

  Results: The mean age is 54.73 ± 11.21 year and 59.1% of them are females. The incidence of hypotension and muscle cramps in the experimental protocol procedure is significantly decreased compared with that of control group (P<0.05), but the incidence of headache and vomiting is not significant (P<0.05).

  Conclusion: Because sodium and ultrafiltration profile is simple and cost-free and reduces the incidence of complications during dialysis, we recommend using sodium and UF profile instead of routine one.

---

  Background and Objective: Treatment adherence has an essential role in improving quality of life, survival, decreasing cost and side effects of treatment in patients underwent hemodialysis. This study aimed to determine the effect of individual multi-stage care on the treatment adherence in hemodialysis' patients, ShahrekordHajar hospital.

  

  Material and Methods: This clinical trial was conducted on 66 Hemodialysis patients in 2013. They were randomly allocated into two equal groups of intervention and control. The instrument was the end-stage renal disease adherence questionnaire (ESRD-AQ). The patients in intervention group were participated in 8-session individual care program for one hour in addition to routine treatment. The data was analyzed using Mann–Whitney , Wilcoxon and Spearman (P<0.05). Level.

  

  Results: The study indicated a significant difference between two groups in all dimensions of treatment adherence except dietary and food adherence. Adherence to treatment was better in intervention group (P<0.05). Furthermore, there was a significant correlation between adherence treatment and age of patients (P<0.05, r=0.245).

  

  Conclusion: based on the findings, multi-stage care is effective on different aspects of treatment adherence.

 

---

  Background and Objective: anemia is one of the main problems of chronic renal failure patients undergone Hemodialysis and erythropoietin is not effective for these patients. Since Vitamin C deficiency in Hemodialysis patients is common, this study was performed to compare the effect of intravenous and oral ascorbic acid consumption on anemia in Hemodialysis patients.

  Material and Methods: this clinical trial was conducted on 75 patients, selected via convenience sampling and including criteria (hemoglobin, 11mg/dl ferritin, 100ug/L transferring saturation, < 20%). The subjects were randomly assigned to three equal groups of control , oral ascorbic acid (POAA) and intravenous ascorbic acid (IVAA) After each every-other-day dialysis performed for eight weeks, the patients of IVAA group were given 300mg intravenous vitamin C and the ones of POAA group given 500mg vitamin C orally. The Plasma iron with chemical method, total iron-binding capacity (TIBC) and ferritin level with indirect method, hemoglobin with cell counter and transferring saturation (TSAT) with related formula were measured. Using a checklist, the data of demographic, laboratory results and side effects were recorded and analyzed by SPSS-13, using ANOVA and scheffe post-hoc test (p≤ 0.05).

  

  Results: the baseline hemoglobin, serum iron, ferritin, TIBC and TSAT in three groups were not different significantly. After intervention, the hemoglobin level of IVAA group( 20.1g/dl ) and in POAA group (0.99g/dl) were increased compared to control group(P>0.001). the mean of hemoglobin in IVAA was significantly more than POAA (P>0.05).

  

  Conclusion: based on the results, the use of oral and intravenous vitamin C can be effective in the anemia caused by iron deficiency, especially vitamin C injection that is more beneficial.

 

---

---

Background and objective: The rate of end-stage renal disorder (ESRD) in Iran, 12%, is more than the worldwide range. The people with Hemodialysis are greatly under physical, mental and social pressures that make the acceptance of Hemodialysis difficult. Since the acceptance can be the beginning point of adaptation, this study aimed to explore the challenge in acceptance of Hemodialysis.
Material and Methods: This grounded theory study was undertaken in the Hemodialysis wards of the hospitals affiliated with Shaheed Beheshti University of Medical Sciences in Tehran. The first samples were selected via purposive sampling and the later ones with theoretical sampling till data saturation (N=24).‌ Semi-structured interview, field notes and memos were used for data collection. The data was analyzed by using Strauss and Corbin method. Data rigor was confirmed by Lincoln and Goba criteria, considering ethical points. Results: The challenge in acceptance of Hemodialysis emerged the categories of acceptance (by force, experience, reasoning or social norms) and lack of acceptance (subjective or objective) of necessity of Hemodialysis as well as their related codes.
 Conclusion: The people on Hemodialysis encounter a challenge for acceptance of Hemodialysis. Education as well as personal, familial and social supports can resolve this challenge by changing lack of acceptance (subjective or objective) or acceptance by force to acceptance (by experience, reasoning or social norms).

---

Background and Objective: Fatigue is one of the most common side effect in hemodialysis patients. This study aimed to assess the factors associated with fatigue in hemodialysis patients, such as demographic variables, anxiety, depression and quality of sleep. 

---

Background and Objective: Cool temperature dialysate has been recommended to improve hypotension during dialysis. Thus, we aimed to evaluate the effect of lowering the dialysate temperature on intradialytic hypotension (IDH) and some interventions in patients undergoing hemodialysis (HD). Material and Methods: This randomized controlled trial with a cross over design was conducted on 50 patients divided into two equal groups. Each group was dialyzed for two periods of 12 HD sessions, once with standard temperature (37°C) and in the next period with cool dialysate (35.5°C). Blood pressure and the related interventions were noted during each dialysis. The Data was analyzed using Chi-square, McNemar, Independent and Paired T Tests. 

---

Background and Objective: Patients with  life threatening diseases have to deal with the death issue. One of the common psychological problem is anxiety esp. death anxiety . This study aimed to  determine the level of death anxiety in hemodialysis patients.

Material and Methods: This cross-sectional study  was conducted  on all 150 patients admitted to Panj-azar teaching hospital for hemodialysis, 2013. The data was collected by demographic checklist and Templer Death Anxiety questionnaire scoring 0 to 15 (0-6 for low, 7-9 for moderate and 10-15 for high anxiety).  We analyzed the data  by independent t-test, ANOVA and Pearson correlation coefficient (P<0.05).

Results: Twenty-four point seven percent of the patients had low , 10%  average  and 65.3% of them had high death anxiety. Average scores of death anxiety in men and in women were 8.21±4.82 and 11.95±3.81, respectively. The relationship of death anxiety with sex (P<0.001), employment status (P<0.001), and age (P<0.002) was significant.

Conclusion: Bases on the results, the death anxiety is high in more than half of the patients with hemodialysis.

---

Background and Objective: Patients under hemodialysis are faced with many stressors and psychological problems such as sleep disorder and anxiety. These problems could be a threat to their health and be significant clinically.  Thus, we aimed to determine the relationship between anxiety and sleep quality in hemodialysis patients.

Material and Methods: This descriptive-analytic study was conducted on 74 hemodialysis patients in Hefdahe Shahrivar hospital of Borazjan city, 2014. The data was collected by Pittsburgh Sleep Quality Index (PSQI) and State-Trait Anxiety Inventory (STAI), and analyzed by t-test, ANOVA and correlation Coefficient using SPSS.

Results: Most of the patients (89.2%) had the average anxiety and 63.3% of them had low sleeping quality. The average of patients’ anxiety and sleeping quality were 49±6.5 and 11.7±2/4, respectively. The correlation coefficient between anxiety and sleeping quality was 0.515 (p=0.001), pointing out an acceptable correlation. Along with the increase of anxiety, the dimension of the subjective sleep quality, delay in falling asleep, the sleep disturbances were affected and ended up low sleeping quality. There was no significant correlation between the anxiety and sleeping quality and daily dysfunction.

Conclusion: Given the acceptable correlation between anxiety and sleep quality, there is a direct relation between anxiety and sleep quality of the patients.

---

Background: Dialysis adequacy is one of the determining factors for survival in elderly patients. Improving the dialysis adequacy highly affects the remission and prognosis of old dialysis patients. Current study was conducted to evaluate the effects of Jacobson relaxation technique on dialysis adequacy in elderly people, who are under dialysis treatment.
Methods: ods: This is a clinical trial performed on 80 hemodialysis patients in two hemodialysis centers of Gonabad and Yazd, Iran, in 2013. The patients were selected through purposive sampling method, and randomly assigned into the two groups of control (n=40) and intervention (n=40). The participants in intervention group were provided by three sessions of relaxation training, and were asked to perform the relaxation daily for six weeks, while the control group just received the routine cares. Afterwards, the adequacy of dialysis was compared between the two groups. The data was collected using the demographic information, and the dialysis adequacy was calculated by KT/V equation.
 Results: A significant statistical difference was found between groups regarding the mean difference of dialysis adequacy in pre- and post-intervention (P<0.001).Besides, dialysis adequacy increased post-intervention in the case group and decreased slightly in the control group compared to pre-intervention.
Conclusion: Training and performing the relaxation method lead to an  improved dialysis adequacy in elderly patients under hemodialysis.

---

Background: Fatigue is among the most common complications for hemodialysis patients. The theory of unpleasant symptoms is associated with fatigue in hemodialysis patients. According to this theory, fatigue has three physical, mental and situational factors. Considering this theory,   we aimed to determine some factors related to fatigue in hemodialysis patients.
Methods: In this descriptive-analytical study, of 165 hemodialysis patients admitted to Panje Azar Medical and Educational Center in Gorgan, Iran, 58 eligible ones were randomly selected. Data was  collected using demographic information questionnaire, Fatigue Severity Scale, Beck Anxiety Inventory and Beck Depression Inventory. Data analysis was conducted in SPSS 17, using Mann-Whitney, Kruskal-Wallis and Spearman's rank correlation coefficient tests.
Results: The mean fatigue in all patients was 4.76 ± 1.66 out of 7. Fifty-two patients (89.7%) suffered from some degree (mild to severe) of anxiety and 43 patients (74.1%) suffered from some degrees (mild to severe) of depression. Fatigue only had a direct relationship with psychological factor [anxiety (P = 0.006, r = 0.353, and depression (P <0.001, r = 0.525)].
Conclusion: Considering the high prevalence of fatigue among hemodialysis patients and associated factors, care providers are advised to identify high-risk individuals through conducting periodic psychiatric examinations and to promote their knowledge on available strategies to reduce adverse effects in these patients.

---

Background and objectives: Chronic renal failure has a progressive nature and there is always a need for a person to care for them. A caregiver, who is usually a patient's family member, may face many problems during the care process, which ultimately causes burnout. The aim of this study is to determine the effect of psycho-educational intervention on the caregiver burden of patients undergoing hemodialysis.
Methods: This study was a clinical trial that carry out on 105 caregivers of patients undergoing hemodialysis. The burnout questionnaire of Zarit was completed by the participants. The Caregivers were allocated randomly in two groups of intervention (discussion, workshops) and control. Two weeks after the completion of 6 sessions of the group discussion and 4 sessions of the workshop, caregiver burdon questionnaire of Zarit was completed again. Data was analyzed by using version 16 of spss software and parametric and non-parametric tests.
Results: Results showed that there was no significant difference between the three groups before intervention in the mean scores of burden (p=0.423). However, after the intervention there was significant difference in the mean scores of burden between intervention groups with control group (p<0.001). Tukey post hoc test showed no significant difference between the two intervention groups in the mean scores of burden (P=0.204).
Conclusion: The results of this study can be found that training classes such as group discussion had a significant reduction in the severity of caregiver burden. Therefore, it is recommended that in the health system planning attend to the role of family members in the treatment of these patients also benefit from this training method.

---

Background: Recirculation is a phenomenon in hemodialysis where purified blood re-enters the dialyzer and is cleaned again, which can negatively impact the adequacy and quality of hemodialysis. As quality hemodialysis is crucial for the treatment of hemodialysis patients, this study aimed to determine the prevalence of recirculation and its related factors in patients undergoing hemodialysis in medical centers in Golestan province, Iran in 2019.
Methods: A cross-sectional study was conducted in 2019 on patients with end-stage renal disease (ESRD) undergoing hemodialysis in medical centers in Golestan province, northeastern Iran. The study included 324 patients, selected using a stratified sampling method. Demographic and clinical data were recorded, and recirculation was measured by assessing urea levels based on the two-needle method, with a cut-off point of 10%. Patients were categorized into two groups based on recirculation percentage, with and without recirculation. Data were analyzed using SPSS (version 16) with descriptive statistics (mean, standard deviation, frequency) and inferential statistics (chi-square test and Fisher's exact test for low frequency cases, and t-test to compare quantitative variables) at a confidence level of 0.05.
Results: The study found that the prevalence of recirculation in hemodialysis patients in Golestan province, Iran was 22.5%. There was a significant relationship between pump speed, arterial needle location (above the venous needle), venous-arterial needle distance from each other, and recirculation. The mean pump speed was 251.64 rpm, and the venous-arterial needle distance was 4.12 cm significantly lower in the recirculation group than in the no-recirculation group. There was also a significant relationship between recirculation and the way catheter lines were connected (arterial line connected to venous line) (P=0.0001).
Conclusion: Given the high prevalence of recirculation, and the ability to modify some of its related factors, nurses should take strategies and create suitable conditions for efficient hemodialysis for patients undergoing hemodialysis.