A Study of Complications in Patients Undergoing Maintenance Haemodialysis: An Experience in Tertiary Care Hospital
Keywords:
Hemodialysis complications, Dialyzer, AVG, AVF, Catheter.
Abstract
Background: When the kidneys are unable to eliminate toxic substances (impurities or wastes) from the blood, hemodialysis is a viable option. Hemodialysis is a continuous process that takes approximately 4 hours to complete. Unlike normal kidneys, it cannot continuously monitor body functions. However, after a hemodialysis session, it can remove waste products and restore pH and electrolyte levels. Numerous changes in the fluid and mineral compartment occur during the procedure, which causes patients to experience a range of complications ranging from minor to potentially fatal. The study's objectives are to assess and analyse complications that arise from hemodialysis as well as to ascertain the occurrence of such complications.
Methods: This was a prospective study. A data collection form was used to collect demographic data, surgery, comorbidity and the self-design severity scale to note during hemodialysis.
Results: Of the 190 patients in total, 70 (36.6 %) were female and 120 (63.15 %) were male. In 166 (88 %) of the patients who were interviewed, the venous access used for hemodialysis was an arterio venous fistula (AVF). F6HPS was administered as the dialyzer to 82 patients (43.15 %). Our self-made assessment tool revealed that 141 patients (74.21 %) had severe complications, 23 patients (12.105 %) had moderate complications, and 30 patients (15.78 %) had mild complications. In a different investigation, [Mehmood et al.,2016] 12.5 % of patients experienced cramps, and 37.5% experienced hypotension. In our study, cramps affected 18 patients (28 %) and hypotension affected 25% of patients as an intra dialytic complication. The primary complications in our study involving patients with AKI and CKD were these two issues. In our study, there is no discernible relationship between age and sex distribution.
Conclusions: According to our study, it is concluded that hypotension (47.8 %), muscle cramps (43.6 %), and hypertension (30.5 %) occur commonly and necessary precautionary measures has to be kept in line, if in case an emergency occur. Fever (3.6 %), hypoglycemia (1.57 %), nausea and vomiting (12.6 %). Significant relationship was seen between complications and age and renal failure in contrasting to it no significant relationship not seen between sex and type of access.
References
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6. Assimon M M, Fly the JE. Intra dialytic blood pressure abnormalities: The highs, the lows and all that lies between. AmJ Nephrol [Internet].2015;42(5):337-50. Available from: https://www.karger.com/DOI/10.1159/000441982
7. Atik D, Karatepe H, Karatepe C, Demir S, Çınar S, Sökmen S.The effect of gender on the complications, pain intensity and pain management in hemodialysis patients. Int J Res Med Sci. [Internet] 2016;4(5) [acess oem 06 set 2017].
8. Bender F H. Successful treatment of severe hyponatremiaina patient with renal failure using continuous veno venous hemodialysis. Am J Kidney Dis [Internet]. 1998;32 (5): 829-31. Available from: http://dx.doi.org/10.1016/s 0272-6386(98)70141-6
9. Brown JJ, Curtis JR, Lever AF, Robertson JI, De Wardener HE, Wing AJ. Plasma renin concentration and the control of blood pressure in patients on maintenance haemodialysis. Nephron [Internet]. 1969;6 (3):329-49. Available from: http://dx.doi.org/10.1159/000179737
10. Chang TI, Paik J, Greene T, Desai M, Bech F, Cheung AK, et al. Intradialytic hypotension and vascular access thrombosis. J Am Soc Nephrol [Internet]. 2011 [cited 2022 May 9]; 22(8):1526-33. Available from: https://jasn.asn journals.org/content/22/8/1526. short
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14. Culp K, Flanigan M, Taylor L, Rothstein M. Vascular access thrombosis in new hemodialysis patients. Am J Kidney Dis [Internet]. 1995; 26 (2): 341-6.Availablefrom:http://dx.doi.org/10.1016/0272-6386(95)90655-x.
15. D.Dialysis.Kidney[Internet].2008;17(3):146-51. Available from: http://dx.doi.org/10.1007/s00596-008-0029-2
16. Degoulet P, Legrain M, Réach I, Aimé F, Devriés C, Rojas P, et al. Mortality risk factors in patients treated by chronic hemodialysis. Report of the Diaphane collaborative study. Nephron [Internet]. 1982;31(2):103-10. Availablefrom:https://www.karger.com/DOI/10.1159/000182627
17. Dialyzer reactions-advanced renal education program. (n.d.). Advanced renal education. Com.Retrieved May 20,2022, from https://advanced renal education.com/wparep/article/dialyzer-reactions/.
18. Dobkin J F , Miller M H, Steigbige lNH. Septicemia in patients on chronic hemodialysis. Ann Intern Med [Internet]. 1978;88(1):28-33. Available from: http://dx.doi.org/10.7326/0003-4819-88-1-28.
19. Epstein A, Kay G, Plumb V: Considerations in the diagnosis and treatment of arrhythmias in patients with end-stagerenal disease. Semin Dial 2:31-37,1990
20. Gauckler, P., Shin, J. I., Mayer, G., & Kronbichler, A. (2018). Eosinophilia and kidney disease: More than just an incidental finding ? Journal of Clinical Medicine, 7(12),529. https://doi.org/10.3390/jcm7120529.
21. Hemodialysis. (2021, December 9). National Institute of Diabetes and Digestive and Kidney Diseases; NIDDK|National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/hemodialysis.
22. Hemorrhage–advanced renal education program. (n.d.). Advanced renal education. Com. Retrieved May 20,2022, from https://advanced renal education.com/wparep/article/hemorrhage.
23. Himmel farb J. Hemodialysis complications. Am J Kidney Dis[Internet]. 2005;45(6):1122-31. Available from: http://dx.doi.org/10.1053/j.ajkd.2005.02.031.
24. How does a dialysisma chine work? [Internet]. Davita. com. [cited2022 May 9]. Available from: https://www.davita.com/treatment-services/dialysis/in-center-hemodialysis/how-does-a-dialysis-machine-work.
25. Hypoxia–advanced renal education program. (n.d.). Advanced renal education. Com. Retrieved May 20,2022, from https://advanced renal education.com/wparep/article/hypoxia/.
26. Jha V, Garcia-Garcia G, Iseki K, et al. Chronic kidney disease: global dimension and perspectives. Lancet. Jul 20 2013;382(9888): 260-272.
27. Kidney disease: The basics. (2021, April 8). National Kidney Foundation. https: //www. kidney.org/news/newsroom/fsindex.
28. Kuipers J, Verboom L M, Ipema K J R, Paans W, Krijnen W P, Gaillard CAJM, et al. The prevalence of intradialytic hypotension in patients on conventional hemodialysis: A systematic review with meta-analysis. Am J Nephrol [Internet]. 2019;49(6):497-506. Available from: https://www.karger.com/DOI/10.1159/000500877.
29. Lazarus J M, Morgan A P. Vascular access in hemodialysis. AORNJ [Internet]. 1974;20(5):810-5. Available from: http://dx.doi.org/10.1016/s0001-2092(07)63429-2.
30. LeSar CJ, Merrick HW, Smith MR. Thrombotic complications resulting from hypercoagulable states in chronic hemodialysis vascular access. J Am Coll Surg [Internet]. 1999;189(1):73-9; discussion79-81. Available from: https://www.sciencedirect.com/science/article/pii/S1072751599000861.
31. Lever,M.J.,&Jay,M.T.(1993).Convective and diffusive transport to plasma proteins across the walls of large blood vessels. Frontiers of Medical and Biological Engineering: The International Journal of the Japan Society of Medical Electronics and Biological Engineering, 5(1),45–50.
32. Lundin AP. Maintenance hemodialysis: Survival beyond the first decade. JAMA [Internet]. 1980 [cited 2022 May 9]; 244 (1): 38. Available from: https://jamanet work.com/journals/jama/article-abstract/370535.
33. Man N.K, Zingraff J,Jungers P. Long-Term Hemodialysis. Dordrecht: Springer Netherlands; 1995.
34. Mehmood Y, Ghafoor S, Imran M A, Riaz H, SrA, Saeed M. Intradialytic Complications Found in Patients at a Tertiary Care Hospital. Austin J Pharmacol Ther. 2016;4(1).
35. Metabolicacidosis–advanced renal education program.(n.d.). Advanced renal education. Com. Retrieved May 20, 2022, from https://advancedrenaleducation.com/wparep/article/metabolic-acidosis.
36. Oliveno J J. Severe Hyponatremia in a homedialysis patient. JAMA. 1978;239:108-9.
37. Patel, N., Dalal, P., & Panesar, M. (2008). Dialysis dise quilibrium syndrome: anarrative review: Dialysis disequilibrium syndrome. Seminars in Dialysis, 21(5),493-498. https://doi.org/10.1111/j.1525-139X.2008.00474.x
38. Prabhakar, Singh RG, Singh S, Rathore SS, Choudhary TA. Spectrum of intradialytic complications during hemodialysis and its management: a single-center experience. Saudi J Kidney Dis Transpl [Internet].2015;26(1):168–72. Available from: http://dx.doi.org/10.4103/1319-2442.148771
39. Reilly D T, Wood R F, Bell P R. Prospective study of dialysis fistulas: problem Patients and their treatment. Br J Surg [Internet]. 1982;69(9):549-53. Available from: http://dx.doi.org/10.1002/bjs.1800690918.
40. Shield Square captcha [Internet]. Iop.org. [cited 2022 May 9]. Available from: https://iopscience. iop.org/article/10.1088/0967-3334/35/9/1885/meta
41. Shoji T, T subakihara Y, Fujii M, Imai E. Hemodialysis-associated hypotension as an independent risk factor for two-year mortality in hemodialysis patients. Kidney Int [Internet]. 20-4;66(3):1212-20.
42. Sklar A H, Riesenberg L A, Silber A K, Ahmed W, AliA. Post dialysis fatigue. Am J Kidney Dis [Internet]. 1996;28 (5):732-6. Available from: https://www.sciencedirect.com/science/article/pii/S0272638696902565.
43. The advantages & disadvantages of hemodialysis. (n.d.). Laminate medical. Com. Retrieved May 20, 2022, from.http://www.laminate medical.com/2016/10/05/advantages-disadvantages-hemodialysis/
44. Thomas B, Wulf S, Bikbov B, Perico N, Cortinovis M, Courville de Vaccaro K, et al. Maintenance Dialysis throughout the World in Years 1990 and 2010. J Am Soc Nephrol [Internet]. 2015 [cited 2022May9];26(11):2621-33.Available from: https://jasn.asnjournals.org/content/26/11/2621.short
45. Thomson G E. Hemodialysis for chronic renal failure: Clinical observations. Arch Intern Med[Internet]. 1967 [cited 2022 May 9];120(2):153. Available from:https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/573723.
46. Ulu, M. S., & Ahsen, A. (2015). Muscle Cramps During Hemodialysis: What can we Do? New Approachs for Treatment and Preventing. Electronic Journal of General Medicine, 12(3), 277-281.https://doi.org/10.15197/ejgm.01391
47. Vanholder V, Hoenich N, Ringoir S. Morbidity and mortality of central venous catheter hemodialysis: are view of 10 years’ experience. Nephron [Internet]. 1987; 47 (4): 274-9. Available from: https://www.karger.com/DOI/10.1159/000184523.
48. Vesely T M. Air embolism during insertion of central venous catheters. J V asc Interv Radiol [Internet]. 2001;12 (11): 1291-5. Available from: http://dx.doi.org/10.1016/s1051-0443(07)61554-1.
49. What is a dialyzer ? [Internet]. Nephro Plus. 2021 [cited 2022 May 9]. Available from: .https://www.nephroplus.com/what-is-a-dialyzer/
50. Wiegand, C. F., Davin, T. D., Raij, L., & K jellstrand, C. M. (1981). Severe hypokalemia induced by hemodialysis. Archives of Internal Medicine, 141 (2), 167-170. https://doi.org/10.1001/archinte. 141.2.167
2. Air embolism–advanced renal education program. (n.d.). Advanced renal education.Com. Retrieved May 20, 2022, from. https://advanced renal education.com/wparep/article/air-embolism.
3. Ali, M., Ejaz, A., Iram, H., Solangi, S. A., Junejo, A. M., & Solangi, S. A. (2021). Frequency of intra dialytic complications in patients of end-stage renal disease on maintenance hemodialysis. Cureus, 13(1), e12641. https://doi.org/10.7759/cureus.12641.
4. Al Jaishi A A, Liu A R, Lok C E, Zhang J C, Moist L M. Complications of the arterio venous fistula: A systematic review. Jam Soc Nephrol [Internet]. 2017 [cited 2022 May 9]; 28 (6): 1839-50. Available from: https://jasn.asn journals.org/content/28/6/1839? WT. MCID=TMD01 & utm_campaign=J_Am_Soc_Nephrol_Trend MD_1 & utm_medium=cpc & utm_source=Trend MD.
5. Asgari, M. R., Asghari, F., Ghods, A. A., Ghorbani, R., Hoshmand Motlagh, N., & Rahaei, F. (2017). Incidence and severity of nausea and vomiting in a group of maintenance hemodialysis patients. Journal of Renal Injury Prevention, 6 (1), 49–55. https://doi.org/10.15171/jrip.2017.09.
6. Assimon M M, Fly the JE. Intra dialytic blood pressure abnormalities: The highs, the lows and all that lies between. AmJ Nephrol [Internet].2015;42(5):337-50. Available from: https://www.karger.com/DOI/10.1159/000441982
7. Atik D, Karatepe H, Karatepe C, Demir S, Çınar S, Sökmen S.The effect of gender on the complications, pain intensity and pain management in hemodialysis patients. Int J Res Med Sci. [Internet] 2016;4(5) [acess oem 06 set 2017].
8. Bender F H. Successful treatment of severe hyponatremiaina patient with renal failure using continuous veno venous hemodialysis. Am J Kidney Dis [Internet]. 1998;32 (5): 829-31. Available from: http://dx.doi.org/10.1016/s 0272-6386(98)70141-6
9. Brown JJ, Curtis JR, Lever AF, Robertson JI, De Wardener HE, Wing AJ. Plasma renin concentration and the control of blood pressure in patients on maintenance haemodialysis. Nephron [Internet]. 1969;6 (3):329-49. Available from: http://dx.doi.org/10.1159/000179737
10. Chang TI, Paik J, Greene T, Desai M, Bech F, Cheung AK, et al. Intradialytic hypotension and vascular access thrombosis. J Am Soc Nephrol [Internet]. 2011 [cited 2022 May 9]; 22(8):1526-33. Available from: https://jasn.asn journals.org/content/22/8/1526. short
11. Chertow GM MD, MPH, Levy EMMD, Hammermeister KE MD, Grover F MD, Daley JMD. Independent Association between Acute Renal Failure and Mortality following Cardiac Surgery 11 Access the “JournalClub” discussion of this paper at http://www.elsevier.com/locate/ajmselect/22 The VA Continuous Improvement in Cardiac Surgery Program was initially supported by the Health Services Research and Development Service, Veterans Health Administration, and funded through VA Patient Care Services. Am J Med [Internet].1998;104(4):343-8. Available from: https:// www. Science direct. com/ science/ article/ pii/ S0002934398000588
12. Chronic Kidney Disease. (2014, September 18). World Kidney Day. http:// www. World kidney day.org /faqs/ chronic-kidney-disease
13. Couser, W. G., Remuzzi, G., Mendis, S., & Tonelli, M. (2011). The contribution of chronic kidney disease to the global burden of major non communicable diseases. Kidney International, 80(12), 1258-1270.https://doi.org/10.1038/ki.2011.368
14. Culp K, Flanigan M, Taylor L, Rothstein M. Vascular access thrombosis in new hemodialysis patients. Am J Kidney Dis [Internet]. 1995; 26 (2): 341-6.Availablefrom:http://dx.doi.org/10.1016/0272-6386(95)90655-x.
15. D.Dialysis.Kidney[Internet].2008;17(3):146-51. Available from: http://dx.doi.org/10.1007/s00596-008-0029-2
16. Degoulet P, Legrain M, Réach I, Aimé F, Devriés C, Rojas P, et al. Mortality risk factors in patients treated by chronic hemodialysis. Report of the Diaphane collaborative study. Nephron [Internet]. 1982;31(2):103-10. Availablefrom:https://www.karger.com/DOI/10.1159/000182627
17. Dialyzer reactions-advanced renal education program. (n.d.). Advanced renal education. Com.Retrieved May 20,2022, from https://advanced renal education.com/wparep/article/dialyzer-reactions/.
18. Dobkin J F , Miller M H, Steigbige lNH. Septicemia in patients on chronic hemodialysis. Ann Intern Med [Internet]. 1978;88(1):28-33. Available from: http://dx.doi.org/10.7326/0003-4819-88-1-28.
19. Epstein A, Kay G, Plumb V: Considerations in the diagnosis and treatment of arrhythmias in patients with end-stagerenal disease. Semin Dial 2:31-37,1990
20. Gauckler, P., Shin, J. I., Mayer, G., & Kronbichler, A. (2018). Eosinophilia and kidney disease: More than just an incidental finding ? Journal of Clinical Medicine, 7(12),529. https://doi.org/10.3390/jcm7120529.
21. Hemodialysis. (2021, December 9). National Institute of Diabetes and Digestive and Kidney Diseases; NIDDK|National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/hemodialysis.
22. Hemorrhage–advanced renal education program. (n.d.). Advanced renal education. Com. Retrieved May 20,2022, from https://advanced renal education.com/wparep/article/hemorrhage.
23. Himmel farb J. Hemodialysis complications. Am J Kidney Dis[Internet]. 2005;45(6):1122-31. Available from: http://dx.doi.org/10.1053/j.ajkd.2005.02.031.
24. How does a dialysisma chine work? [Internet]. Davita. com. [cited2022 May 9]. Available from: https://www.davita.com/treatment-services/dialysis/in-center-hemodialysis/how-does-a-dialysis-machine-work.
25. Hypoxia–advanced renal education program. (n.d.). Advanced renal education. Com. Retrieved May 20,2022, from https://advanced renal education.com/wparep/article/hypoxia/.
26. Jha V, Garcia-Garcia G, Iseki K, et al. Chronic kidney disease: global dimension and perspectives. Lancet. Jul 20 2013;382(9888): 260-272.
27. Kidney disease: The basics. (2021, April 8). National Kidney Foundation. https: //www. kidney.org/news/newsroom/fsindex.
28. Kuipers J, Verboom L M, Ipema K J R, Paans W, Krijnen W P, Gaillard CAJM, et al. The prevalence of intradialytic hypotension in patients on conventional hemodialysis: A systematic review with meta-analysis. Am J Nephrol [Internet]. 2019;49(6):497-506. Available from: https://www.karger.com/DOI/10.1159/000500877.
29. Lazarus J M, Morgan A P. Vascular access in hemodialysis. AORNJ [Internet]. 1974;20(5):810-5. Available from: http://dx.doi.org/10.1016/s0001-2092(07)63429-2.
30. LeSar CJ, Merrick HW, Smith MR. Thrombotic complications resulting from hypercoagulable states in chronic hemodialysis vascular access. J Am Coll Surg [Internet]. 1999;189(1):73-9; discussion79-81. Available from: https://www.sciencedirect.com/science/article/pii/S1072751599000861.
31. Lever,M.J.,&Jay,M.T.(1993).Convective and diffusive transport to plasma proteins across the walls of large blood vessels. Frontiers of Medical and Biological Engineering: The International Journal of the Japan Society of Medical Electronics and Biological Engineering, 5(1),45–50.
32. Lundin AP. Maintenance hemodialysis: Survival beyond the first decade. JAMA [Internet]. 1980 [cited 2022 May 9]; 244 (1): 38. Available from: https://jamanet work.com/journals/jama/article-abstract/370535.
33. Man N.K, Zingraff J,Jungers P. Long-Term Hemodialysis. Dordrecht: Springer Netherlands; 1995.
34. Mehmood Y, Ghafoor S, Imran M A, Riaz H, SrA, Saeed M. Intradialytic Complications Found in Patients at a Tertiary Care Hospital. Austin J Pharmacol Ther. 2016;4(1).
35. Metabolicacidosis–advanced renal education program.(n.d.). Advanced renal education. Com. Retrieved May 20, 2022, from https://advancedrenaleducation.com/wparep/article/metabolic-acidosis.
36. Oliveno J J. Severe Hyponatremia in a homedialysis patient. JAMA. 1978;239:108-9.
37. Patel, N., Dalal, P., & Panesar, M. (2008). Dialysis dise quilibrium syndrome: anarrative review: Dialysis disequilibrium syndrome. Seminars in Dialysis, 21(5),493-498. https://doi.org/10.1111/j.1525-139X.2008.00474.x
38. Prabhakar, Singh RG, Singh S, Rathore SS, Choudhary TA. Spectrum of intradialytic complications during hemodialysis and its management: a single-center experience. Saudi J Kidney Dis Transpl [Internet].2015;26(1):168–72. Available from: http://dx.doi.org/10.4103/1319-2442.148771
39. Reilly D T, Wood R F, Bell P R. Prospective study of dialysis fistulas: problem Patients and their treatment. Br J Surg [Internet]. 1982;69(9):549-53. Available from: http://dx.doi.org/10.1002/bjs.1800690918.
40. Shield Square captcha [Internet]. Iop.org. [cited 2022 May 9]. Available from: https://iopscience. iop.org/article/10.1088/0967-3334/35/9/1885/meta
41. Shoji T, T subakihara Y, Fujii M, Imai E. Hemodialysis-associated hypotension as an independent risk factor for two-year mortality in hemodialysis patients. Kidney Int [Internet]. 20-4;66(3):1212-20.
42. Sklar A H, Riesenberg L A, Silber A K, Ahmed W, AliA. Post dialysis fatigue. Am J Kidney Dis [Internet]. 1996;28 (5):732-6. Available from: https://www.sciencedirect.com/science/article/pii/S0272638696902565.
43. The advantages & disadvantages of hemodialysis. (n.d.). Laminate medical. Com. Retrieved May 20, 2022, from.http://www.laminate medical.com/2016/10/05/advantages-disadvantages-hemodialysis/
44. Thomas B, Wulf S, Bikbov B, Perico N, Cortinovis M, Courville de Vaccaro K, et al. Maintenance Dialysis throughout the World in Years 1990 and 2010. J Am Soc Nephrol [Internet]. 2015 [cited 2022May9];26(11):2621-33.Available from: https://jasn.asnjournals.org/content/26/11/2621.short
45. Thomson G E. Hemodialysis for chronic renal failure: Clinical observations. Arch Intern Med[Internet]. 1967 [cited 2022 May 9];120(2):153. Available from:https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/573723.
46. Ulu, M. S., & Ahsen, A. (2015). Muscle Cramps During Hemodialysis: What can we Do? New Approachs for Treatment and Preventing. Electronic Journal of General Medicine, 12(3), 277-281.https://doi.org/10.15197/ejgm.01391
47. Vanholder V, Hoenich N, Ringoir S. Morbidity and mortality of central venous catheter hemodialysis: are view of 10 years’ experience. Nephron [Internet]. 1987; 47 (4): 274-9. Available from: https://www.karger.com/DOI/10.1159/000184523.
48. Vesely T M. Air embolism during insertion of central venous catheters. J V asc Interv Radiol [Internet]. 2001;12 (11): 1291-5. Available from: http://dx.doi.org/10.1016/s1051-0443(07)61554-1.
49. What is a dialyzer ? [Internet]. Nephro Plus. 2021 [cited 2022 May 9]. Available from: .https://www.nephroplus.com/what-is-a-dialyzer/
50. Wiegand, C. F., Davin, T. D., Raij, L., & K jellstrand, C. M. (1981). Severe hypokalemia induced by hemodialysis. Archives of Internal Medicine, 141 (2), 167-170. https://doi.org/10.1001/archinte. 141.2.167
Published
2024-10-20
How to Cite
Dr. Rameshwar S. Rathod, Mr. Rahul N. Patil, Mr. Vikas D. Kedar, Mr. Prashant V. Vyavahare, Mr. Hemant V. Raut, & Ms. Supriya K. Jadhav. (2024). A Study of Complications in Patients Undergoing Maintenance Haemodialysis: An Experience in Tertiary Care Hospital. Revista Electronica De Veterinaria, 25(2), 319-337. https://doi.org/10.69980/redvet.v25i2.1299
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