Hypertension in patients on dialysis: diagnosis, mechanisms, and management

Association between ACEI/ARB and short-term prognosis in dialysis patients with hypertension admitted to intensive care unit

INTRODUCTION

To investigate the association between angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) and short-term prognosis in dialysis patients with hypertension admitted to intensive care unit (ICU).

METHODS

Patients with a diagnosis of hypertension and dialysis who received antihypertensive agents during hospitalisation were included. Based on whether treated with ACEI/ARB, patients were divided to ACEI/ARB group and non- ACEI/ARB group. In-hospital mortality and 30-day all-cause mortality were compared between the two groups in the overall participants and after propensity score matching.

RESULTS

The study included 647 patients, among which 227 (34.70%) were treated with ACEI/ARB. Compared to the non-ACEI/ARB group, fewer patients in the ACEI/ARB group suffered from atrial fibrillation/flutter (17.2% vs 31.9%, p < 0.001). The overall hospital mortality rate was 5.1%, and 9.0% of patients died during the 30-day follow-up period. ACEI/ARB group were with better clinical outcomes during hospitalisation (2.2% vs 6.7%, p = 0.023) and after 30-day follow-up (5.3% vs 11.0%, p = 0.016). ACEI/ARB treatment was independently associated with lower risk of hospital mortality (OR 0.24, 96% CI: 0.051 - 0.82, p = 0.038) and 30-day mortality (HR 0.36, 95% CI:0.15-0.89, p = 0.029) after adjusting confounding factors. After propensity score matching (PSM, 112 pairs), the ACEI/ARB group showed higher in-hospital (99.1% vs 91.1%, p = 0.013) and 30-day (95.5% vs 88.4%, p = 0.048) survival rates compared to the control group. ACEI/ARB was identified as an independent protector for 30-day mortality in the matched cohort (HR 0.33, 95% CI: 0.11-0.95, p = 0.041).

CONCLUSION

ACEI/ARB treatment showed a significant association with improved in-hospital and 30-day outcomes in dialysis patients with hypertension in the ICU.

Masked uncontrolled hypertension in patients with end-stage kidney disease on in-center hemodialysis

BACKGROUND

Masked uncontrolled hypertension (MUCH) is associated with an increasing risk of morbidity and mortality. Current literature on MUCH lacks data on patients with end-stage kidney disease (ESKD) on hemodialysis (HD). We aimed to investigate the prevalence, ambulatory blood pressure (BP) characteristics, and risk factors of MUCH in this population in a low-middle-income Asian country.

METHODS

We conducted a simple random-sampling, cross-sectional study on patients with hypertension and ESKD on HD. The outcome was MUCH, which was confirmed if the participants, who were on 24-hour ambulatory BP monitoring, had at least 1 of the following criteria: (1) daytime mean ambulatory BP ≥ 135 mmHg (systolic) and/or ≥ 85 mmHg (diastolic); (2) night-time mean ambulatory BP ≥ 120 mmHg (systolic) and/or ≥ 70 mmHg (diastolic); or (3) 24-hour mean ambulatory BP ≥ 130 mmHg (systolic) and/or ≥ 80 mmHg (diastolic). Data were presented using descriptive statistics. We used logistic regression to explore the risk factors for MUCH, and the results were reported with odds ratio (OR) and 95% confidence interval (95% CI).

RESULTS

Among 104 participants included for analysis (median age 54.5, 48.1% being female), MUCH was reported on 85 of them (prevalence of 81.7%, 95% CI 73.2-88.0%.). Non-dipping status of BP were found in 98.1% of the participants, with non-dippers dominating the normotension group (prevalence of 57.9%, 95% CI 36.3-76.9%) and reverse dippers dominating the MUCH group (prevalence of 65.9%, 95% CI 55.3-75.1%). We also identified some factors that were associated with a higher risk of MUCH, i.e., being current smoker (adjusted OR = 3.49, 95% CI 1.07 to 11.40), undergoing HD for > 48 months (adjusted OR = 5.69, 95% CI 1.48 to 21.81), taking > 3 antihypertensive medications (adjusted OR = 3.64, 95% CI 1.11 to 11.92), and requiring α2-adrenergic receptor agonists for BP control (adjusted OR = 6.31, 95% CI 1.12 to 35.62).

CONCLUSION

The prevalences of MUCH and non-dipping of BP (non-dipper and reverse dipper) were very high in patients with ESKD who were undergoing HD for a median duration of 6 years without ambulatory BP monitoring. To avoid extra cost and inconvenience, risk factors should be initially screened for MUCH before monitoring out-of-office BP for a confirmed diagnosis.

Efficacy and safety of sacubitril-valsartan in hypertension patients with end-stage kidney disease on maintenance dialysis: a meta-analysis

The aim of this meta-analysis was to assess the efficacy and safety of sacubitril-valsartan in hypertension patients with end-stage kidney disease (ESKD) undergoing dialysis. We searched the Medline, Cochrane, Embase, Web of Science, and ClinicalTrials.gov databases for studies reporting outcomes after SV treatment. All analyses were performed utilizing the random effects models. Nineteen studies comprising 1597 patients with concomitant hypertension and ESKD undergoing dialysis were included. After sacubitril-valsartan treatment, significant reductions in both SBP and DBP were observed (mean change in SBP: -11.09 mmHg [95% confidence interval, 95% CI: -14.51,-7.66] and DBP: -4.37 mmHg [-6.36,-2.38]). Compared to conventional treatment, patients treated with sacubitril-valsartan had a lower risk of cardiovascular hospitalization (risk ratio: 0.63 [0.44,0.90]). Sacubitril-valsartan treatment showed a trend toward reducing the risk of all-cause mortality, although this was not statistically significant (risk ratio: 0.66 [0.27,1.60]). Evaluation of echocardiographic parameters among studies including hypertension patients with heart failure indicated that SV improved LVEF (mean change: +7.04%[+3.19, +10.90]), however this effect was more pronounced in the HFrEF patients ( Pinteraction =0.0003). Sacubitril-valsartan also reduced LVSd, LVDd, LAD, and E/e' ratio ( P  < 0.05). The risks of severe hyperkalemia and symptomatic hypotension were comparable between sacubitril-valsartan treatment and conventional treatment ( P  > 0.05). The present study revealed that sacubitril-valsartan treatment is well tolerated and could have potential benefits in hypertension patients with ESKD on dialysis by effectively controlling blood pressure, improving LVEF, reversing cardiac remodeling, and reducing the risk of cardiovascular hospitalization.

Assessment and management of emergencies during haemodialysis

The haemodialysis unit is a complex clinical environment. Medical emergencies complicating haemodialysis treatment are relatively infrequent but are associated with high morbidity and mortality. The management of intradialytic emergencies is challenging and relevant to the practice of all nephrology and critical care clinicians. There are no dedicated resuscitation guidelines for this unique patient population. This review article provides an outline of the assessment and treatment of important intradialytic emergencies (hypotension, hypertension, haemorrhage, hypoxia, neurologic disturbances, cardiac arrest) based on the best available evidence.

Transition between peritoneal dialysis modalities: Impact on blood pressure levels and drug prescription in a national multicentric cohort

BACKGROUND

Hypertension is a leading cause of kidney failure, affects most dialysis patients and associates with adverse outcomes. Hypertension can be difficult to control with dialysis modalities having differential effects on sodium and water removal. There are two main types of peritoneal dialysis (PD), automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD). It is unknown whether one is superior to the other in controlling blood pressure (BP). Therefore, the aim of our study was to analyse the impact of switching between these two PD modalities on BP levels in a nationally representative cohort.

METHODS

This was a cohort study of patients on PD from 122 dialysis centres in Brazil (BRAZPD II study). Clinical and laboratory data were collected monthly throughout the study duration. We selected all patients who remained on PD at least 6 months and 3 months on each modality at minimum. We compared the changes in mean systolic/diastolic blood pressures (SBP/DBP) before and after modality transition using a multilevel mixed-model where patients were at first level and their clinics at the second level.

RESULTS

We analysed data of 848 patients (814 starting on CAPD and 34 starting on APD). The SBP decreased by 4 (SD 22) mmHg when transitioning from CAPD to APD (p < 0.001) and increased by 4 (SD 21) mmHg when transitioning from APD to CAPD (p = 0.38); consistent findings were seen for DBP. There was no significant change in the number of antihypertensive drugs prescribed before and after transition.

CONCLUSIONS

Transition between PD modalities seems to directly impact on BP levels. Further studies are needed to confirm if switching to APD could be an effective treatment for uncontrolled hypertension among CAPD patients.

Medication burden in patients with dialysis-dependent CKD: a systematic review

This systematic review aimed to statistically profile the medication burden and associated influencing factors, and outcomes in patients with dialysis-dependent chronic kidney disease (DD-CKD). Studies of medication burden in patients with DD-CKD in the last 10 years from 1 January 2013 to 31 March 2024 were searched from PubMed, Embase, and Cochrane databases. Newcastle-Ottawa Scale (NOS) or Agency for Healthcare Research and Quality (AHRQ) methodology checklist was used to evaluate quality and bias. Data extraction and combining from multiple groups of number (n), mean, and standard deviation (SD) were performed using R programming language (version4.3.1; R Core Team, Vienna, Austria). A total of 10 studies were included, and the results showed a higher drug burden in patients with DD-CKD. The combined pill burden was 14.57 ± 7.56 per day in hemodialysis (HD) patients and 14.63 ± 6.32 in peritoneal dialysis (PD) patients. The combined number of medications was 9.74 ± 3.37 in HD and 8 ± 3 in PD. Four studies described the various drug classes and their proportions, in general, antihypertensives and phosphate binders were the most commonly used drugs. Five studies mentioned factors associated with medication burden. A total of five studies mentioned medication burden-related outcomes, with one study finding that medication-related burden was associated with increased treatment burden, three studies finding that poor medication adherence was associated with medication burden, and another study finding that medication complexity was not associated with self-reported medication adherence. Limitations: meta-analysis was not possible due to the heterogeneity of studies.

Posttransplant complications: molecular mechanisms and therapeutic interventions

Posttransplantation complications pose a major challenge to the long-term survival and quality of life of organ transplant recipients. These complications encompass immune-mediated complications, infectious complications, metabolic complications, and malignancies, with each type influenced by various risk factors and pathological mechanisms. The molecular mechanisms underlying posttransplantation complications involve a complex interplay of immunological, metabolic, and oncogenic processes, including innate and adaptive immune activation, immunosuppressant side effects, and viral reactivation. Here, we provide a comprehensive overview of the clinical features, risk factors, and molecular mechanisms of major posttransplantation complications. We systematically summarize the current understanding of the immunological basis of allograft rejection and graft-versus-host disease, the metabolic dysregulation associated with immunosuppressive agents, and the role of oncogenic viruses in posttransplantation malignancies. Furthermore, we discuss potential prevention and intervention strategies based on these mechanistic insights, highlighting the importance of optimizing immunosuppressive regimens, enhancing infection prophylaxis, and implementing targeted therapies. We also emphasize the need for future research to develop individualized complication control strategies under the guidance of precision medicine, ultimately improving the prognosis and quality of life of transplant recipients.

Management of Chronic Heart Failure in Dialysis Patients: A Challenging but Rewarding Path

Chronic heart failure (CHF) is a common complication and cause of death in dialysis patients. Although several clinical guidelines and expert consensus on heart failure (HF) in the general population have been issued in China and abroad, due to abnormal renal function or even no residual renal function (RRF) in dialysis patients, the high number of chronic complications, as well as the specificity, variability, and limitations of hemodialysis (HD) and peritoneal dialysis (PD) treatments, there are significant differences between dialysis patients and the general population in terms of the treatment and management of HF. The current studies are not relevant to all dialysis-combined HF populations, and there is an urgent need for high-quality studies on managing HF in dialysis patients to guide and standardize treatment. After reviewing the existing guidelines and literature, we focused on the staging and diagnosis of HF, management of risk factors, pharmacotherapy, and dialysis treatment in patients on dialysis. Based on evidence-based medicine and clinical trial data, this report reflects new perspectives and future trends in the diagnosis and treatment of HF in dialysis patients, which will further enhance the clinicians' understanding of HF in dialysis patients.

Interdialytic home systolic blood pressure variability increases all-cause mortality in hemodialysis patients

BACKGROUND

The association between Interdialytic home blood pressure variability (BPV) and the prognosis of patients undergoing maintenance hemodialysis (MHD) largely unknown.

HYPOTHESIS

We proposed the hypothesis that interdialytic home BPV exert effect on cardiac and all-cause mortality among individuals undergoing MHD.

METHODS

A total of 158 patients receiving MHD at the hemodialysis unit of Wuhan Fourth Hospital between December 2019 and August 2020 were included in this prospective cohort study. Patients were divided into tertiles according to the systolic BPV (SBPV), and the primary endpoints were cardiac and all-cause death. Kaplan-Meier analysis was used to assess the relationship between long-term survival and interdialytic home SBPV. In addition, Cox proportional hazards regression models were used to identify risk factors contributing to poor prognosis.

RESULTS

The risk of cardiac death and all-cause death was gradually increased in patients according to tertiles of SBPV (3.5% vs. 14.8% vs. 19.2%, p for trend = .021; and 11.5% vs. 27.8% vs. 44.2%, p for trend <.001). The Cox regression analysis revealed that compared to Tertile 1, the hazard ratios for all-cause mortality in Tertile 2 and Tertile 3 were 3.13 (p = .026) and 3.24 (p = .021), respectively, after adjustment for a series of covariates.

CONCLUSIONS

The findings revealed a positive correlation between increased interdialytic home SBPV and elevated mortality risk in patients with MHD.

Case report: Successful treatment of a patient undergoing haemodialysis with multifocal hepatocellular carcinoma using atezolizumab and bevacizumab

In the last five years, the advent of combination immune checkpoint inhibitor atezolizumab and anti-angiogenic agent bevacizumab has transformed treatment of unresectable hepatocellular carcinoma. As patient outcomes improve, healthcare professionals will more frequently encounter patients with concomitant hepatocellular cancer and end stage kidney disease on haemodialysis. We present the first case in the literature of a 58-year-old male with multifocal hepatocellular carcinoma undertaking regular haemodialysis who was successfully treated with atezolizumab and bevacizumab with a partial response and stable disease for two years, who suffered grade 1 fatigue, grade 2 hypertension and eventually grade 3 wound infection leading to cessation of bevacizumab. After disease progression on atezolizumab monotherapy, all chemotherapy was stopped. We embed this case in a review of the current literature of atezolizumab and bevacizumab use in patients undertaking haemodialysis and conclude that both targeted therapies may be safely used in these patients. We recommend joint close management of these patients between oncology and nephrology teams, with initial cardiovascular risk stratification before commencing atezolizumab and bevacizumab therapy. During therapy, there should be regular monitoring of blood pressure, or proteinuria if the patient is oliguric under guidance of the dialysis team if preservation of residual renal function is required.

Water quality and adverse health effects on the hemodialysis patients: An overview

Hemodialysis is considered a treatment of choice for patients with renal failure worldwide, allowing the replacement of some kidney functions by diffusion and ultrafiltration processes. Over 4 million people require some form of renal replacement therapy, with hemodialysis being the most common. During the procedure, contaminants in the water and the resulting dialysate may pass into the patient's blood and lead to toxicity. Thus, the quality of the associated dialysis solutions is a critical issue. Accordingly, the discussion of the importance of a dialysis water delivery system controlled by current standards and recommendations, with efficient monitoring methods, disinfection systems, and chemical and microbiological analysis, is crucial for improving the health outcomes of these patients. The importance of treatment, monitoring, and regulation is emphasized by presenting several case studies concerning the contamination of hemodialysis water and the adverse effects on the respective patients.

Pharmacological management of hypertension and outcome among patients on hemodialysis at Muhimbili National Hospital, Tanzania: a cross-sectional study

Introduction

hypertension is prevalent among patients attending hemodialysis. However, published information on hypertension management among patients on hemodialysis in African countries is scarce. This study assessed antihypertensive medication prescribing patterns and blood pressure control among patients with hypertension on hemodialysis in Tanzania.

Methods

an analytical cross-sectional study was conducted at Muhimbili National Hospital in Dar es Salaam from April to June 2022. The study population consisted of patients with hypertension undergoing hemodialysis. Data on demographic, clinical characteristics and the antihypertensive medications used by the patients was collected using a structured questionnaire. Analysis was performed using Statistical Package for the Social Sciences software version 26. Uncontrolled pre-dialysis blood pressure determinants were assessed using a modified Poisson regression model. A p-value < 0.05 was considered statistically significant.

Results

out of 314 participants, the majority (68.2%, n= 214) were male, and the median age was 52 (interquartile range: 42, 60) years. Only 16.9% (n= 53) of patients had their pre-dialysis blood pressure controlled. The most frequent antihypertensive medications prescribed were calcium channel blockers (73.2%, n= 230). Patients with less than three dialysis sessions were 20% more likely to have uncontrolled blood pressure than those with three sessions in a week (adjusted prevalence ratio = 1.2).

Conclusion

most patients on hemodialysis with hypertension had poor blood pressure control, according to the study. Patients with hypertension should be strongly encouraged to adhere to at least three hemodialysis treatments to achieve optimal blood pressure control.

Posterior Reversible Encephalopathy Syndrome in a Pediatric Patient with End-Stage Renal Disease

Posterior reversible encephalopathy syndrome (PRES) is a clinical and neuroimaging syndrome that can affect both children and adults and has variable etiology. It is clinically defined by headaches, consciousness disorders, seizures and visual disturbances. Early recognition (clinical and imaging) can lead to appropriate general measures to correct the underlying cause of PRES. In this paper, we report a case of PRES in an eight-year-old boy with bilateral renal hypoplasia and end-stage renal disease (ESRD).

Managing Heart Failure in Patients on Dialysis: State-of-the-Art Review

Heart failure (HF) and end-stage kidney disease (ESKD) frequently coexist; 1 comorbidity worsens the prognosis of the other. HF is responsible for almost half the deaths of patients on dialysis. Despite patients' with ESKD composing an extremely high-risk population, they have been largely excluded from landmark clinical trials of HF, and there is, thus, a paucity of data regarding the management of HF in patients on dialysis, and most of the available evidence is observational. Likewise, in clinical practice, guideline-directed medical therapy for HF is often down-titrated or discontinued in patients with ESKD who are undergoing dialysis; this is due to concerns about safety and tolerability. In this state-of-the-art review, we discuss the available evidence for each of the foundational HF therapies in ESKD, review current challenges and barriers to managing patients with HF on dialysis, and outline future directions to optimize the management of HF in these high-risk patients.

Association of serum potassium with decline in residual kidney function in incident hemodialysis patients

BACKGROUND

Hyperkalemia is associated with kidney function decline in patients with non-dialysis dependent chronic kidney disease, but this relationship is unclear for residual kidney function among hemodialysis (HD) patients.

METHODS

We conducted a retrospective cohort study of 6655 patients who started HD from January 2007 to December 2011 and who had data on renal urea clearance (KRU). Serum potassium levels were stratified into four groups (i.e. ≤4.0, >4.0 to ≤ 4.5, >4.5 to ≤ 5.0, >5.0 mEq/L) and 1-year KRU slope for each group was estimated by a linear mixed-effects model.

RESULTS

Higher serum potassium was associated with greater decline in KRU, and the greatest decrease in KRU (-0.20, 95% CI -0.50, -0.06) was observed for baseline potassium > 5.0 mEq/L in the fully adjusted model. Mediation analysis showed that KRU slope mediated 1.78% of the association between serum potassium and mortality.

CONCLUSIONS

In conclusion, hyperkalemia is associated with decline in residual kidney function amongst incident HD patients. These findings may have important clinical implications in the management of hyperkalemia in advanced CKD if confirmed in additional studies including clinical trials.

Tight Blood Pressure Control in Chronic Kidney Disease

Hypertension affects over a billion people worldwide and is the leading cause of cardiovascular disease and premature death worldwide, as well as one of the key determinants of chronic kidney disease worldwide. People with chronic kidney disease and hypertension are at very high risk of renal outcomes, including progression to end-stage renal disease, and, even more importantly, cardiovascular outcomes. Hence, blood pressure control is crucial in reducing the human and socio-economic burden of renal and cardiovascular outcomes in those patients. However, current guidelines from hypertension and renal societies have issued different and sometimes conflicting recommendations, which risk confusing clinicians and potentially contributing to a less effective prevention of renal and cardiovascular outcomes. In this review, we critically appraise existing evidence and key international guidelines, and we finally formulate our own opinion that clinicians should aim for a blood pressure target lower than 130/80 in all patients with chronic kidney disease and hypertension, unless they are frail or with multiple comorbidities. We also advocate for an even more ambitious systolic blood pressure target lower than 120 mmHg in younger patients with a lower burden of comorbidities, to minimise their risk of renal and cardiovascular events during their lifetime.

New onset hypertension after transplantation

It has been reported that up to 90% of organ transplant recipients have suboptimal blood pressure control. Uncontrolled hypertension is a well-known culprit of cardiovascular and overall morbidity and mortality. In addition, rigorous control of hypertension after organ transplantation is a crucial factor in prolonging graft survival. Nevertheless, hypertension after organ transplantation encompasses a broader range of causes than those identified in non-organ transplant patients. Hence, specific management awareness of those factors is mandated. An in-depth understanding of hypertension after organ transplantation remains a debatable issue that necessitates further clarification. This article provides a comprehensive review of the prevalence, risk factors, etiology, complications, prevention, and management of hypertension after organ transplantation.

Chronic Kidney Disease, Metabolic Syndrome and Cardiovascular Risk: Insights and Associated Mechanistic Pathways

Abstract:

This study is a narrative review that aims to address the conceptual, characteristic, pathophysiological, and mechanistic aspects that define the profile of metabolic syndrome and chronic kidney disease. The objective was to investigate current knowledge and elucidate, through discussions on the topic, the main interrelated paths. This review was carried out unsystematically, from March to May 2020, by means of a survey of the literature indexed in the PubMed, Web of Science, and Scopus (Elsevier®) databases. The scientific materials collected showed that the cross-talk between the diseases in question is mainly based on the conditions of resistance to insulin action, endothelial dysfunction, activation pathways of the Renin-Angiotensin-Aldosterone system and adipokine imbalance, also emphasizing the influence of atherosclerotic events in kidney damage. Furthermore, it was reinforced the fact that inflammatory processes play an important role in the worsening and evolution of the clinical condition of patients, especially when they have underlying pathologies chronically treated for subclinical inflammation. It is expected that a greater number of original researches will propose to investigate other possible interactions, with a view to standardized treatment of these diseases or nutritional management.

Excessive fluid volume risk middle-range theory

ABSTRACT Objective to construct a middle range theory for developing the excessive fluid volume risk diagnostic proposition in patients undergoing hemodialysis. Method this is a methodological study, developed for the theoretical-causal validity of a nursing diagnosis. The study was carried out in four stages: study selection, identification of the main concepts of the theory, pictogram construction and proposition elaboration. These steps were operationalized through an integrative literature review, with a sample of 82 articles selected from the Web of Science, PubMed, CINAHL, Scopus and Science Direct databases. Results the data extracted from the sample articles enabled identifying five essential terms to define excessive fluid volume risk. Furthermore, 31 etiological factors of excessive fluid volume risk were identified, in addition to a pictogram and 12 propositions. Conclusion and implications for practice the construction of a middle-range theory focused on excessive fluid volume risk in patients undergoing hemodialysis refines terminology and expands the understanding of nursing phenomena. Thus, the data from this research will provide clear and robust knowledge for the conduct of nurses’ actions in clinical practice.

Accuracy of the defining characteristics of the nursing diagnosis hypothermia in patients on hemodialysis

ABSTRACT Objective: to analyze the accuracy of the defining characteristics of hypothermia in patients on hemodialysis. Methods: a diagnostic accuracy study was assembled within a cross-sectional study with 124 patients from two dialysis centers. A latent class model was used for data analysis. Results: the nursing diagnosis hypothermia was present in 13 (10.48%) study participants. The most prevalent defining characteristics were hypoxia (100%), decrease in blood glucose level (83.1%), hypertension (65.3%), piloerection (45.2%), and skin cool to touch (41.1%). The defining characteristics acrocyanosis (99.96%) and cyanotic nail beds (99.98%) had a high sensitivity. Acrocyanosis (91.8%), skin cool to touch (64.8%), and peripheral vasoconstriction (91.8%) had high specificity. Conclusion: specific and sensitive indicators of hypothermia work as good clinical indicators for confirming this diagnosis in patients on hemodialysis. The study findings can assist nurses in their clinical reasoning for a correct inference of hypothermia.

Teoria de médio alcance do risco de volume de líquidos excessivo

RESUMO Objetivo construir uma teoria de médio alcance para o desenvolvimento da proposição diagnóstica risco de volume de líquidos excessivo em pacientes em hemodiálise. Método trata-se de um estudo metodológico, desenvolvido para a validade teórico-causal de um diagnóstico de enfermagem. O estudo foi realizado em quatro etapas: seleção dos estudos, identificação dos conceitos principais da teoria, construção do pictograma e elaboração das proposições. Essas etapas foram operacionalizadas por meio de uma revisão integrativa da literatura, com uma amostra de 82 artigos selecionados nas bases de dados Web of Science, PubMed, CINAHL, Scopus e Science Direct. Resultados os dados extraídos dos artigos da amostra possibilitaram a identificação de cinco termos essenciais para a definição do risco de volume de líquidos excessivo. Além disso, foram identificados 31 fatores etiológicos do risco de volume de líquidos excessivo, além de construídos um pictograma e 12 proposições. Conclusão e implicações para a prática a construção de uma teoria de médio alcance voltada para o risco de volume de líquidos excessivo em pacientes em hemodiálise refina as terminologias e amplia a compreensão dos fenômenos da enfermagem. Assim, os dados desta pesquisa fornecerão conhecimentos claros e robustos para a condução das ações do enfermeiro na prática clínica.

Co-relation Between Calcium-Phosphorus Product and Hypertension in End-Stage Renal Disease Patients

Objective

In our study, we evaluated the relation between calcium-phosphorus (Ca-P) product and various measurements of pre and post-dialysis blood pressure (BP) in hemodialysis (HD) patients.

Methods

This is a prospective, observational, cross-sectional study in which patients undergoing maintenance HD for > six months were enrolled through non-probability consecutive sampling during a six-month period from October 2020 to March 2021. Linear regression analysis was done to study the effect of the Ca-P product for each parameter of BP and regression coefficients were acquired.

Results

There was a total of 111 patients in our study, of which 59 (53.2%) were male. The mean age was 50.1± 14.4. The most common comorbid was hypertension (98.2%). The mean HD vintage of patients was 5.7 ± 5.8 years. On linear regression analysis, the Ca-P product was strongly correlated with pre-HD diastolic BP (DBP) (0.7) and post-HD mean arterial pressure (MAP) (0.7) while a moderate correlation was present with pre (0.59) and post (0.64) HD systolic BP (SBP), post-HD diastolic BP (0.68), and pre-HD MAP (0.68). On the other hand, the Ca-P product was not correlated with pre and post-HD pulse pressure (0.06 and 0.1, respectively). When the independent effect of serum calcium (Ca), phosphorus (P), and parathyroid hormone on BP was studied, P had a significant correlation with pre and post-HD SBP, DBP, and MAP.

Conclusion

Our study demonstrates a significant association of the Ca-P product and an independent high P level with pre and post-dialysis SBP, DBP, and MAP while no association was found with pulse pressure.

Prevalence and predictors of heart failure among patients on maintenance hemodialysis therapy at Muhimbili National Hospital in Tanzania: a cross-sectional study

BACKGROUND

Heart failure among patients on hemodialysis therapy portends poor outcomes. Traditional risk factors like aging, hypertension and diabetes mellitus are relatively common in these patients and may not accurately predict the occurrence of heart failure. Such patients may have other factors that contribute to heart failure. This study aimed to investigate the prevalence and predictors of heart failure among patients on maintenance hemodialysis at Muhimbili National Hospital in Dar es Salaam, Tanzania.

RESULTS

Among 160 patients on maintenance hemodialysis, 49 (30.6%) were female. The mean age of patients was 52.2 ± 13.3 years. Almost all patients had hypertension and 69 (43.1%) had diabetes mellitus. Heart failure was prevalent in 17 (10.6%) patients. On multivariate analysis, presence of angina, intradialytic hypertension, and anemia were independent predictors of heart failure. Patients with heart failure had significantly higher malnutrition inflammation scores and erythropoietin resistance indexes.

CONCLUSIONS

Heart failure among hemodialysis patients correlates with the presence of angina, intradialytic hypertension, and anemia. Patients with heart failure had a greater degree of malnutrition-inflammation complex, and erythropoietin resistance. Patients with these conditions require a thorough cardiac evaluation and appropriate treatment.

Impacts of mindfulness-based interventions in people undergoing hemodialysis: a systematic review

INTRODUCTION

Chronic kidney disease (CKD) is a serious public health problem worldwide, leading to a series of physical and psychological comorbidities, in addition to costly treatments, lifestyle and dietary restrictions. There is evidence that mindfulness-based interventions (MBIs) offer complementary treatment for people with chronic illnesses, including CKD, with the aim of improving overall health, reducing side effects and treatment costs. This review aims to investigate the MBIs impact on people with CKD undergoing hemodialysis, and to identify the methodological quality of the current literature in order to support future studies.

METHODS

We ran searches in five databases (MEDLINE via PubMed, PsycINFO, Embase, Web of Science and Scopus) in July 2020. The papers were selected and evaluated by two reviewers independently, using predefined criteria, including the Cochrane Group's risk of bias tool and its recommendations (CRD42020192936).

RESULTS

Of the 175 studies found, 6 randomized controlled trials met the inclusion criteria, and ranged from 2014 to 2019. There were significant improvements in symptoms of anxiety, depression, self-efficacy, sleep quality, and quality of life (n=3) in the groups submitted to the intervention, in addition to physical measures such as blood pressure, heart rate and respiratory rate (n=1).

CONCLUSIONS

MBIs can offer a promising and safe complementary therapy for people with CKD undergoing hemodialysis, acting on quality of life and physical aspects of the disease.

The prevalence and associated factors of metabolic syndrome among patients with end-stage renal failure undergoing hemodialysis in Indonesia

BACKGROUND AND AIMS

Various components of Metabolic Syndrome (MetS) have been studied in general population, but few among patients undergoing hemodialysis (HD). This study aims to assess the metabolic profiles and to estimate the prevalence of MetS among patients with End-Stage Renal Failure (ESRF) undergoing HD.

METHODS

Patients undergoing HD during October 2016-August 2017 in three General Hospitals in Aceh - Indonesia were included in the study. MetS was defined according to the modified NCEP-ATP III criteria for South Asians.

RESULTS

The overall prevalence of MetS was 50.2%. Male patients have higher MetS prevalence (58.3%) than female (41.7%). MetS was only associated with gender and history of diabetes, and not with other demographic variables. Alteration central obesity was the most common metabolic abnormality among the patients (57.2%), followed by hypertension (30.7%), diabetes (30%), raised triglycerides (27.4%) and reduced HDL (23.7%). Pre-metabolic syndrome was found in 48.3%, leaving only 1.4% of patients free from metabolic abnormality.

CONCLUSIONS

Half of the patients undergoing HD in Indonesia suffered from MetS and almost half had pre-metabolic syndrome. High rate of metabolic abnormalities in patients with ESRF requires intensive examination and collaboration between nephrologists and endocrinologists to prevent the deterioration of patients' condition during HD.

Fasting plasma glucose, lipid ratios, and atherogenic coefficient are the risk factors for hypertension in chronic kidney disease patients on hemodialysis: A report from the Regional High Speciality Hospital of Peninsular Yucatan, Mexico

Chronic kidney disease (CKD) is associated with the development of cardivascular disease (CVD). CKD is one of the major public health problems in Mexico. Derived parameters of lipid profile, namely atherogenic index of plasma (AIP), atherogenic coefficient (AC), and Castelli risk index (CRI I and CRI II) are useful for predicting hypertension among CKD patients on hemodialysis that are not widely reported from Mexico. Objective of the present study was to find interrelationships among blood pressure, fasting plasma glucose (FPG), and derived parameters of lipid profile (AIP, AC, CRI-I, and CRI-II) among adult CKD patients on hemodialysis in a hospital in Yucatan, Mexico. Methods: An observational study was performed using the medical records (2016 and 2017) of 47 CKD patients on hemodialysis in the Regional High Speciality Hospital of Yucatan Peninsula (HRAEPY in Spanish acronym). Multiple linear regression models were developed to evaluate the use of FPG level and derived parameters of lipid profile (AC, CRI-I, and CRI-II) as risk factors predicting mean arterial pressure (MAP). Results showed remarkable prevalence of excess weight (55% overweight, 15% obesity) and hypertension (64%) in the sample. Correlation coeffcients and multiple linear regression models showed significant rise of blood pressure in association with elevated FPG level and derived lipid profile parameters. The results confirm the use of FPG, AC, CRI-I and CRI-II as the indicators for an early diagnosis of hypertension and related CVDs among CKD patients on hemodialysis.

Troponin Levels Relate to CRP Concentrations in Patients With NAFLD on Maintenance Haemodialysis: A Retrospective Study

Introduction

Several studies have shown that high sensitivity cardiac troponin (hs-cTnT) levels are elevated in patients suffering from end-stage renal disease (ESRD), even in the absence of clinical signs and instrumental features of symptomatic acute coronary syndrome (ACS). In patients undergoing haemodialysis because of ESRD, nephrologists bear witness to this increase, whose origin and clinical impact are not yet well defined.

Methods

By a retrospective study, we evaluated data from records of 70 patients with ESRD on haemodialysis, all of them with a history of NAFLD, not suffering for at least 3 months from symptomatic angina and without a history of ischemic heart disease in the same period.

Results

Hs-cTnT and C-reactive protein (CRP) levels both increased and were correlated, rho = 0.34, P = 0.004. The correlation coefficient between troponin and age was significant, rho = 0.47, P = 0.0001. Serum concentrations of hs-cTnT for the whole population were positively predicted by CRP levels, P = 0.004. On separation of the population by gender, significant correlation between hs-cTnT and CRP was not found in women and was only present in men, P = 0.66 and P = 0.000, respectively.

Discussion

The assessment of hs-cTnT levels could represent a biological marker in particular subgroups of haemodialysis patients, especially for male patients with higher CRP, those at greater risk of silent myocardial ischemia and future major adverse cardiac events.

Conclusions

The evaluation of hs-cTnT in haemodialysed patients with NAFLD could indicate that men with higher CRP should undergo close monitoring in order to adopt specific therapy.

Analysis of risk factors for deep venous thrombosis in patients with gynecological malignant tumor: A clinical study

Objectives:

To determine the clinical characteristics and risk factors of Deep Venous Thrombosis (DVT) in patients with gynecological malignant tumor, facilitating gynecologists better prevent the fatal complication.

Methods:

The patients with gynecological malignant tumor treated in department of gynecology of our hospital between May 2013 and May 2018 were reviewed retrospectively. The clinical data of patients including gender, age, tumor staging, adenocarcinoma, surgery, operation time, hypertension, hyperlipemia, diabetes, coronary heart disease, radiotherapy, chemotherapy, hospital stay, and postoperative rehabilitation exercise were collected to analyze the clinical characteristics of patients and determine the risk factors of DVT.

Results:

In the current study, 67 patients were included in DVT group, and 554 patients were included in Non-DVT group. There were significant differences in age, hypertension, hyperlipemia, operation time, adenocarcinoma, tumor staging, radiotherapy and postoperative rehabilitation exercises between DVT and non-DVT groups (p<0.05). However, there was no significant differences in gender, coronary heart disease, diabetes, surgical treatment and hospital stay (p>0.05). In multivariate analysis, the factors including age, hypertension, adenocarcinoma, radiotherapy, and hyperlipemia were independent risk factors, while rehabilitation exercise was protective factor for DVT.

Conclusion:

In cases of gynecological malignant tumor, DVT screening should be given due importance, especially for those patients with old age, hypertension, hyperlipemia, adenocarcinoma, or history of radiotherapy. Rehabilitation exercise should be encouraged in these patients.