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Quan Z, Li C, Zhao L, Cui D, Liu S, Yin Y, Tang Q, Zeng D, Song L, Fu X. Effect of banana intake on serum potassium level in patients undergoing maintenance hemodialysis: A randomized controlled trial. Int J Nurs Sci 2024; 11:197-204. [PMID: 38707694 PMCID: PMC11064587 DOI: 10.1016/j.ijnss.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 02/05/2024] [Accepted: 03/12/2024] [Indexed: 05/07/2024] Open
Abstract
Objective This study aimed to assess the effect of banana intake during hemodialysis on serum potassium levels in maintenance hemodialysis (MHD) patients. Methods This study was a single-center, randomized controlled clinical trial conducted from September 15 to December 15, 2021, at a tertiary hospital in southern China. A total of 126 MHD patients were randomly assigned to either the intervention group (n = 64) or the control group (n = 62). Patients in the intervention group consumed approximately 250 g of bananas during hemodialysis, while those in the control group did not consume any food during hemodialysis. Demographic information and hemodialysis-related parameters were collected through case information collection before hemodialysis. Laboratory indicators (such as complete blood count, biochemical indicators, inflammation markers, liver function, kidney function, etc.) were evaluated by collecting pre-hemodialysis blood samples from patients. Serum potassium and blood glucose levels were measured at 2 h and 4 h of hemodialysis, as well as before the next hemodialysis session, and hemodialysis-related complications were recorded. The blood potassium and blood glucose indicators during hemodialysis were compared using repeated measures analysis. Results A total of 122 MHD patients completed the study (61 in each group). The results showed that there was no significant interaction between group and time on serum potassium levels. However, serum potassium levels in the intervention group were higher than those in the control group at 2 h (3.9 ± 0.5 mmol/L vs. 3.6 ± 0.3 mmol/L, P < 0.01) and 4 h (3.5 ± 0.4 mmol/L vs. 3.3 ± 0.3 mmol/L, P < 0.01) of hemodialysis. There was no interaction between group and time on blood glucose levels. The incidence of arrhythmias (8.2% vs. 29.5%, P = 0.003) and hypokalemia (52.5% vs. 80.3%, P = 0.002) during hemodialysis was significantly lower in the intervention group compared to the control group. Conclusion Consuming approximately 250 g of bananas at the start of hemodialysis does not lead to hyperkalemia. It can effectively reduce the incidence of hypokalemia and arrhythmias, and prevent a rapid decline in serum potassium levels during hemodialysis.
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Affiliation(s)
- Zilin Quan
- The Department of Nephrology, The Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Caixia Li
- The Department of Nursing, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Liyan Zhao
- The Department of Nephrology, The Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Dongmei Cui
- The Department of Nephrology, The Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Shuangxin Liu
- The Department of Nephrology, The Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yan Yin
- The Department of Nephrology, The Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Qi Tang
- The Department of Nephrology, The Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Dehan Zeng
- The Department of Nephrology, The Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Li Song
- The Department of Nephrology, The Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Xia Fu
- The Department of Nursing, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
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Ravarotto V, Bertoldi G, Stefanelli LF, Nalesso F, Calò LA. Pathomechanism of oxidative stress in cardiovascularrenal remodeling and therapeutic strategies. Kidney Res Clin Pract 2022; 41:533-544. [PMID: 36239057 PMCID: PMC9576462 DOI: 10.23876/j.krcp.22.069] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/06/2022] [Accepted: 05/16/2022] [Indexed: 11/15/2023] Open
Abstract
The high prevalence of cardiovascular disease in patients with chronic kidney disease indicates significant interactions between pathogenic pathways operating in the kidney and heart. These interactions involve all cell types (endothelial cells, smooth muscle cells, macrophages, and others), components of the vasculature, glomeruli, and heart that are susceptible to oxidative damage and structural alterations. A vicious cycle occurs whereby harmful factors such as reactive oxygen species and inflammation damage of vascular structures that themselves become sources of additional dangerous/toxic components released into the local environment. The evidence of this vicious cycle in chronic kidney disease should therefore lead to add other factors to both traditional and nontraditional risk factors. This review will examine the processes occurring during progressive kidney dysfunction with regard to vascular injury, renal remodeling, cardiac hypertrophy, and the transversal role of oxidative stress in the development of these complications.
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Affiliation(s)
- Verdiana Ravarotto
- Division of Nephrology, Dialysis and Transplantation, Department of Medicine (DIMED), School of Medicine, University of Padova, Padova, Italy
| | - Giovanni Bertoldi
- Division of Nephrology, Dialysis and Transplantation, Department of Medicine (DIMED), School of Medicine, University of Padova, Padova, Italy
| | - Lucia Federica Stefanelli
- Division of Nephrology, Dialysis and Transplantation, Department of Medicine (DIMED), School of Medicine, University of Padova, Padova, Italy
| | - Federico Nalesso
- Division of Nephrology, Dialysis and Transplantation, Department of Medicine (DIMED), School of Medicine, University of Padova, Padova, Italy
| | - Lorenzo A. Calò
- Division of Nephrology, Dialysis and Transplantation, Department of Medicine (DIMED), School of Medicine, University of Padova, Padova, Italy
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Lo LWT, Xu Y, Howe TS, Koh JSB, Lo NN, Yang YO. End stage renal disease patients undergoing hip fracture surgery have increased length of stay, acute hospital bill size, and reduced survivorship-implications on a bundled care program. Arch Osteoporos 2022; 17:59. [PMID: 35385992 DOI: 10.1007/s11657-022-01103-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 03/26/2022] [Indexed: 02/03/2023]
Abstract
UNLABELLED End stage renal disease (ESRD) is an independent risk factor for the development of hip fractures and is associated with a higher mortality and complication rates. As these patients significantly skew healthcare financing in a bundled care payment (BCP) program, a risk stratified approach to BCPs could be done to take into account the difference in resources required. INTRODUCTION End stage renal disease (ESRD) is an independent risk factor for the development of hip fractures and is associated with a higher mortality and complication rate. Hip fracture patients with ESRD may significantly skew healthcare financing in a bundled care payment (BCP) program. MATERIALS AND METHODS ESRD patients undergoing hip fracture surgery from June 2007 to June 2012 within a tertiary hospital in Singapore were identified and matched to two other controls without ESRD based on secondary features of sex, age, fracture type, and surgery performed. Data was collected for American Society of Anesthesiologist (ASA) score, duration of surgery (DOS), length of stay (LOS), 30-day and 1-year mortality, and the presence of 10 other comorbidities: diabetes mellitus (DM), hypertension (HTN), hyperlipidemia (HLD), ischemic heart disease (IHD), arrhythmia (ARR), cerebrovascular disease (CVA), dementia (DEM), asthma (ASTH), peripheral vascular disease (PVD), and anemia (ANE) from electronic medical records. Costs were retrieved from the gross acute hospitalization bill. RESULTS Forty-one ESRD patients were successfully matched with 82 controls. Patients with ESRD had higher ASA scores (3 vs 2, p = 0.0001), had 75% higher LOS (21 vs 12 days, p < 0.0001), were associated with 67% higher healthcare expenditure (median $20542 vs $12236, p < 0.0001), and 1-year mortality (OR: 19.6, p < 0.0001). ESRD patients had an average of 4.1 comorbidities per patient compared to 1.84 in the control group. CONCLUSION ESRD is an outsized factor on the outcome of hip fracture patients who have markedly higher and more variable healthcare utilization.
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Affiliation(s)
- Louise Woon Theng Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
| | - Yanling Xu
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.,Monash School of Medicine, Clayton, Australia
| | - Tet Sen Howe
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Joyce Suang Bee Koh
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Youheng Ou Yang
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
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Yu IC, Liu CY, Fang JT. Effects of hemodialysis treatment on saliva flow rate and saliva composition during in-center maintenance dialysis: a cross-sectional study. Ren Fail 2021; 43:71-78. [PMID: 33327832 PMCID: PMC7751405 DOI: 10.1080/0886022x.2020.1857769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Aim To analyze changes in saliva flow rate and clinical measures from unstimulated whole saliva (UWS) among patients undergoing hemodialysis for end-stage kidney disease (ESKD). Background Chronic hemodialysis causes changes in blood chemistry as well as dry mouth, due to removal of excess fluids. UWS is used to examine saliva flow rate as an indicator of mouth dryness. Whether UWS can be used to measure changes in clinical variables following hemodialysis has not been explored. Design A cross-sectional quantitative study. Methods Patients with ESKD were recruited by purposive sampling (n = 100) between 1 January and 30 June 2015 from a hospital in northern Taiwan. UWS was collected 1-hour pre-dialysis (T1), mid-dialysis (T2), and 1-hour post-dialysis (T3). Saliva flow rate and clinical variables were analyzed. Results Saliva flow rate increased significantly from T1 to T3 (Wald χ2 = 10.40, p < .01). Changes in saliva from T1 to T3 included decreases in blood urea nitrogen and creatinine (Wald χ2 = 97.12, p < .001 and Wald χ2 = 36.98, p < .001, respectively). The pH and osmolality also decreased (p < .001 and p < .01, respectively). Changes in electrolytes included decreases in potassium and calcium (Wald χ2 = 6.71, p < .05 and Wald χ2 = 17.64, p < .01, respectively) and increases in chloride (Wald χ2 = 17.64, p < .001). Conclusion Our findings demonstrated saliva flow rate and several saliva components were altered during hemodialysis. The total volume of saliva secretion increased following dialysis, which can reduce xerostomia. Therefore, medical personnel could provide interventions of relieving dry mouth symptoms and increasing saliva flow rate before hemodialysis treatment.
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Affiliation(s)
- I-Chen Yu
- Department of Nursing, Chang Gung University of Science and Technology, Taiwan.,Department of Nephrology, Chang Gung Memorial Hospital in Linkou, Tao-Yuan, Taiwan
| | - Chieh-Yu Liu
- Department of Speech Language Pathology and Audiology, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Ji-Tseng Fang
- Department of Nephrology, Chang Gung Memorial Hospital in Linkou, Tao-Yuan, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
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Pirklbauer M. Hemodialysis treatment in patients with severe electrolyte disorders: Management of hyperkalemia and hyponatremia. Hemodial Int 2020; 24:282-289. [PMID: 32436307 PMCID: PMC7496587 DOI: 10.1111/hdi.12845] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 05/02/2020] [Accepted: 05/05/2020] [Indexed: 12/16/2022]
Abstract
Significant deviations of serum potassium and sodium levels are frequently observed in hospitalized patients and are both associated with increased all‐cause and cardiovascular mortality. The presence of acute or chronic renal failure facilitates the pathogenesis and complicates the clinical management. In the absence of reliable outcome data in the context of dialysis prescription, requirement of renal replacement therapy in patients with severe electrolyte disturbances constitutes a therapeutic challenge. Recommendations for intradialytic management are based on pathophysiologic reasoning and clinical observations only, and as such, heterogeneous and limited to expert opinion level. This article reviews current strategies for the management of severe hyperkalemia and hyponatremia in hemodialysis patients.
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Affiliation(s)
- Markus Pirklbauer
- Department of Internal Medicine IV-Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
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Woyesa SB, Gebisa WC, Anshebo DL. Assessment of Selected Serum Electrolyte and Associated Risk Factors in Diabetic Patients. Diabetes Metab Syndr Obes 2019; 12:2811-2817. [PMID: 32021344 PMCID: PMC6978677 DOI: 10.2147/dmso.s233053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/11/2019] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The objective of this study was to assess selected serum electrolytes imbalance and associated factors in diabetic patients attending their follow up appointments in Jimma University Medical Center (JUMC) from February 1 to April 1, 2019. PATIENTS AND METHODS A cross sectional study design was used to assess the selected serum electrolytes in diabetic patients attending their follow up appointments at Jimma University Medical Center (JUMC) chronic illness clinic. A convenience sampling technique was used to include 279 diabetic patients in the study and an interviewer based questionnaire was used to include all necessary data from each diabetic patient. Five milliliters of blood were collected from each subject and processed and analyzed for blood glucose and serum electrolyte determination by ABX Pentra400 and Humalyte plus5 ion-selective electrode (ISE) system clinical chemistry analyzers. Pearson's correlation coefficient model and multivariate logistic regression were used respectively to assess the correlation and significant association between abnormal serum electrolytes and independent variables. RESULTS A high prevalence of one or more serum electrolyte abnormalities was determined in diabetic patients. The overall prevalence was 42.0% (n=116/276) in which hyponatremia was the highest followed by hypochloremia and hypercalcemia, 40.6%, 14.9% and 10.9% respectively. Age, type of medication, and high body mass index (BMI) had strong positive correlations with abnormal serum concentration levels of sodium (r=0.611, P=0.731), potassium (r=0.752, P=0.812) and chloride (r=0.645, P=0.459). Being employed (AOR: 3.933, 95% C.I: 1.057-14.637, P value: 0.041), treated with mixed medications (AOR: 2.9, 95% C.I: 1.292-6.441, P value: 0.010) and being unable to control blood glucose level or being hyperglycemic (AOR: 3.2, 95% C.I: 2.179-5.721, P value: 0.000) were statistically identified as risk factors for serum electrolyte abnormalities in diabetic patients. CONCLUSION The serum electrolyte concentration level was highly abnormal in diabetic patients. The prevalence of abnormal concentration was more common in diabetic patients with advanced age, and some variables had strong positive correlation with abnormal serum electrolyte level in diabetic patients.
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Affiliation(s)
- Shiferaw Bekele Woyesa
- Jimma University, Institute of Health Science, School of Medical Laboratory Science, Jimma, Ethiopia
- Correspondence: Shiferaw Bekele Woyesa Tel +251471111875 Email
| | - Waqtola Cheneke Gebisa
- Jimma University, Institute of Health Science, School of Medical Laboratory Science, Jimma, Ethiopia
| | - Delebo Lefebo Anshebo
- Jimma University, Institute of Health Science, School of Medical Laboratory Science, Jimma, Ethiopia
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