Exploring demands of hemodialysis patients in Taiwan: A two-step cluster analysis

A novel scoring system for better management of small bowel obstruction

PURPOSE

Due to the lack of a comprehensive evaluation of the prognosis of small bowel obstruction (SBO), recent clinical strategies have remained subjective and controversial. The recognition of pretreatment risk factors and tailored treatment could improve SBO outcomes.

METHODS

A series of posttreatment laboratory tests were integrated into a two-step clustering (TSC) analysis. The TSC outcome was determined according to different predictor importance (PI). A risk score (RS) system for the TSC outcome model was constructed by multivariable analysis. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were calculated to assess prediction accuracy.

RESULTS

Of the 355 patients, 66 (18.6%) were sorted into the better prognosis group (BPG), 149 (42.0%) were sorted into the poor prognosis group (PPG), and 140 (39.4%) were sorted into the severe prognosis group (SPG) by TSC analysis. For the TSC outcome, four variables with higher PI were identified, namely, Ca (PI = 1), albumin (PI = 0.62), WBC count (PI = 0.5) and NE% (PI = 0.45). Compared with the SPG, the BPG presented better outcomes after surgery events. The TSC outcome model was efficient in distinguishing the duration of bowel function recovery and hospital stay by Kaplan‒Meier curves. Via multivariate analysis, a RS consisting of four risk factors, namely, constipation duration (OR = 1.002), APTT (OR = 0.923), PT (OR = 1.449) and PCT (OR = 1.540), was identified. The AUC of the RS on the TSC outcome model was 0.719 (95% CI, 0.635-0.804).

CONCLUSION

A novel TSC outcome model and RS system was constructed to comprehensively reflect the tailored treatment, surgical events and posttreatment recovery for SBO patients.

Factors Associated with the Quality of Life and Needs of Hemodialysis Patients in Saudi Arabia: A Basis for Improved Care

Background and Objectives: End-stage renal disease threatens individuals' quality of life (QoL) and has a substantial influence on their daily lives. While several studies have explored the QoL of hemodialysis patients, none have comprehensively examined the relationship between patient QoL and their specific needs as well as the factors that predict these outcomes. This study aimed to investigate the intricate relationship and predictive factors between QoL and the needs of hemodialysis patients, serving as a foundational step toward enhancing their care. Materials and Methods: This cross-sectional study included 222 patients undergoing hemodialysis for ESRD between January and March 2023. Data were gathered through structured interviews utilizing the World Health Organization Quality of Life-BREF, and questionnaires were needed. To assess intergroup differences, t-tests and ANOVA were employed, while multiple linear regression and correlation coefficients were used to unveil predictive associations. Results: Our findings revealed that the majority of patients interviewed expressed satisfaction with their health and reported high QoL. Predictors of higher QoL included being under 60 years of age, married, strong familial support, and a body mass index < 30 kg/m2. Conversely, living alone has emerged as a predictor of diminished QoL. Moreover, middle-aged patients who were married and had a normal BMI were identified as having lower needs. Conclusions: A discernible association was observed between higher QoL and reduced need among hemodialysis patients. This study offers valuable insights into the multifaceted factors influencing the QoL and needs of these patients, offering guidance for enhancing patient care and ultimately improving their overall QoL.

Cluster of symptoms in kidney failure: A systematic review

Background

Chronic kidney disease is a global problem characterized by a progressive decrease in kidney function with associated symptoms. A better understanding of these symptoms could lead to the development of personalized strategies.

Objective

This systematic review aims to describe the clusters of symptoms in kidney failure and categorize them according to their time of onset and how disabling they are for patients.

Design

A systematic review was carried out.

Methods

This systematic review was conducted according to the PRISMA declaration standards. The search engines used were initially limited to WOS, Embase, and PubMed, and they were employed between November 2022 and January 2023. In addition, the bibliographic search was supplemented with databases of the grey literature, such as OpenGrey, in May 2023. The following inclusion criteria were established: cross-sectional studies, studies on adult populations, and studies dealing with clusters of symptoms associated with kidney failure. Before an article was definitively selected, the checklist of the STROBE initiative, with a maximum of 22 points, was applied, assessing the quality of cross-sectional articles. Articles were selected independently and blinded by two researchers, and a third researcher was involved in case of disagreement.

Results

After carrying out the bibliographic search, we found that eight articles, out of the 46 articles that were evaluated, fully met the inclusion criteria. Two tables were made, which include important information, such as the participants' profiles or the way the authors extracted a cluster of symptoms.

Limitations

The main area for improvement is that it was not possible to perform a meta-analysis due to the methodology used in the articles analysed. Constraining the selection of articles to those written in Spanish or English could be a limitation as not all articles dealing with symptom clusters in kidney failure were considered.

Conclusions

Common symptoms in clusters of symptoms in kidney failure were nausea or vomiting (gastrointestinal problems), fatigue or muscle weakness (neuromuscular symptoms/problems), low interest in sex or difficulty feeling sexually excited (sexual symptoms), dry skin or skin itching (skin problems), lack of appetite, feeling squeezed, feeling weak or dizzy and difficulty breathing (uraemic), fatigue or muscle weakness (energy/vitality), and chest pain (cardiac-related problems). Providing treatment based on clusters of symptoms would benefit the patient more than providing treatment based on isolated symptoms. The identification of symptom clusters in kidney failure has clinical relevance, and this research could facilitate the development of adequate intervention strategies, simplifying the treatment offered to patients and even reducing the side effects of treatments.

Factors Related to Quality of Life of Hemodialysis Patients during the COVID-19 Pandemic

Taiwan had the second highest number globally of end-stage renal disease patients undergoing treatment in 2018. A meta-analysis of Chen et al. (2021) showed the incidence and mortality rates of COVID-19 were 7.7% and 22.4%, respectively. Few studies have explored the effects of patients' self-participation and perceptions of hemodialysis on their quality of life. This study aimed to explore the factors related to hemodialysis patients' quality of life during the COVID-19 pandemic. This study was a descriptive correlational study. Patients were recruited (n = 298) from the hemodialysis unit of a medical center in northern Taiwan. Variables included patients' sociodemographic, psychological, spiritual, and clinical characteristics (i.e., perceived health level, comorbidities, hemodialysis duration, weekly frequency, transportation, and accompaniment during hemodialysis), perceptions of hemodialysis, self-participation in hemodialysis, and health-related quality of life (KDQOL-36 scale). Data were analyzed using descriptive and bivariate and multivariate linear regression. Multivariate linear regression, after adjusting for covariates, showed that anxiety, self-perceived health status, two vs. four comorbidities, and self-participation in hemodialysis were significantly associated with quality of life. The overall model was significant and accounted for 52.2% (R² = 0.522) of the variance in quality of life during hemodialysis (adjusted R² = 0.480). In conclusion, the quality of life of hemodialysis patients with mild, moderate, or severe anxiety was poorer, whereas that of patients with fewer comorbidities, higher self-perceived health status, and higher self-participation in hemodialysis was better.

Complementary Feeding and Malnutrition among Infants and Young Children Aged 6-23 Months in Rural Areas of China

This study investigated the nutrition and complementary feeding (CF) of infants and young children (IYC) aged 6–23 months in rural areas of China in 2018 and explored the relationship between CF and nutritional status. We measured the length and weight, calculated the z-scores, and detected micronutrients in the hair. The status of CF was obtained from the respondents by a 24-h dietary recall. IYC were classified into clusters using a two-step cluster analysis. The CF and nutritional status of each cluster were analyzed and compared. The prevalence of stunting, wasting, and overweight in the IYC in rural Chinese areas was 7.1%, 3.0%, and 3.7%, respectively. The median levels of Ca, Fe, and Zn in hair were 550.10 µg/g, 62.94 µg/g, and 132.86 µg/g, respectively. The prevalence of meeting the requirements of minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD) was 68.9%, 77.9%, and 46.4%, respectively. IYC with a higher prevalence of MDD, MMF, and MAD were more inclined to maintain a healthy status. The prevalence of undernutrition and overweight of 6- to 23-month-old IYC in rural areas of China was low. However, lack of trace elements was evident, and MAD prevalence remained low.

The Effect of Statins in Cancer Risk Reduction in Patients on Dialysis: A Population-Based Case-Control Study

Simple Summary

The lifetime risk of several cancers is elevated in patients receiving dialysis following kidney failure compared with the general population. Using a large dataset available in Taiwan, we conducted a nationwide population-based cohort study to delineate the relationship between statin use and cancer risk in patients on dialysis. Our study provides an association that statins reduce the risk of malignancy in patients on dialysis, especially with a longer treatment duration, and irrespective of the type of statin prescription. The use of statins in patients on dialysis was associated with significantly lower incidences in developing respiratory, soft tissue and connective tissue, breast, gynecological, prostate, central nervous system, and lymphatic and hematopoietic cancer.

Abstract

Background: To realize whether statins reduce the risk of cancer in susceptible dialysis populations, this study analyzed the relationship between statin use and cancer risk in patients on dialysis. Methods: Patients having a history of chronic kidney disease with hemodialysis or peritoneal dialysis and receiving statin prescriptions or not were enrolled. The main outcome was cancer diagnosis. This study used univariate and multivariate Cox regression analyses. Results: In total, 4236 individuals in the statin group and 8472 individuals in the statin nonuser group were included in the study. Multivariate Cox regression analysis revealed that statin users are significantly less likely to develop cancer than statin nonusers (adjusted hazard ratio (HR) 0.81, 95% confidence interval (CI) 0.78–0.90). Subgroup analyses revealed that statin cumulative defined daily doses >365 were associated with a significantly decreased risk of cancer incidence (adjusted HR 0.59, 95% CI 0.45–0.87), and statin users have a reduced risk of respiratory, soft tissue and connective tissue, breast, gynecological, prostate, central nervous system, and lymphatic and hematopoietic cancer than nonusers. Conclusions: Our population-based cohort study provides an association that statins reduce the risk of malignancy in patients on dialysis, especially with a longer treatment duration, and certain types of cancer.