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.

  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: Caregivers of chronic renal failure are faced with Hemodialysis related problems and coping with caring responsibilities.The Caregiver Burden is The negative effect of living with these patients. The aim of this study was to determine The Burden on Cargivers from Hemodialysis Patients and related factors.

  Material and Methods: ­ In this descriptive and analytical study, 120 Caregivers of chronic renal failure­ patients treated by Hemodialysis Gorgon's Panje Hospital were selected via census method . The construment was a demographics chek list and Caregiver Burden scale. We did Data analysis by spss software with, independent T-test, oneway, pearson and spearman test
(p< 0.05).

  Results: The majority of Caregivers (74.2%) have severe Burden. There is a direct significant correlation between total Burden and the duration,of discase and revers significant correlation between total Burden and the ability to perform patients daily life activities ­­(p< 0.05). The caregivers with a disease endure the heavier Burden (p< 0.05). The caregivers with poor economic condition and Caregivers of with high dependenc y patients bear more Burdens
(p< 0.05).

  Conclusion:­ According to the findings, because of high Burden on Caregivers, we recommend that designing some plans to be designed to for improve the coping strategies and control of the factors affected on Caregiver Burden to promote their health .

  Background and Objective: Growing trend of chronic kidney disorders in the world represents the increased problem imposing on patients and their family, and ultimately reduce the quality of their life. ­Thus, dialysis patients are trying to ­increase their quality of lives, in addition to looking for proper treatment. ­ This study was conducted to­ compare the quality of life in hemodialysis patients ( HD) and peritoneal dialysis.­(PD)­

  Materials and Methods: ­ This cross-sectional study was performed on 166 dialysis patients (130 HD and 36 PD patients ) in teaching hospitals of Urmia University of Medical Sciences. The instrument was standard SF-36 questionnaire including demographic part and 36 questions about quality of life. To analyze the data , we used descriptive statistic and independent T- test.

  Results: Most of the participants (n=97) are female and most of HD (43.8%) and PD (50%) patients are in 26-45 and 15-25 age bracket, respectively. The mean of QOL score in HD patients in physical function, role function and mental health sections is more than the mean of PD (P<0.05).

  Conclusion:­ According to the results of the present study, QOL in HD is better than that PD. Hence, recognition of level of QOL in chronic renal failure, and research about promoting ways of QOL is necessary to step practically forward increasing QOL.

  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: 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.