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Harvey JJ, Vrazas JI, Bekhit E, Barnes C, Robinson PJ. Catheter-related superior vena cava syndrome: an increasing problem. Med J Aust 2024; 220:238-240. [PMID: 38357991 DOI: 10.5694/mja2.52233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/14/2023] [Indexed: 02/16/2024]
Affiliation(s)
- John J Harvey
- Royal Children's Hospital Melbourne, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
| | - John I Vrazas
- Royal Children's Hospital Melbourne, Melbourne, VIC
- St Vincent's Private Hospital, Melbourne, VIC
| | | | - Chris Barnes
- Royal Children's Hospital Melbourne, Melbourne, VIC
| | - Philip J Robinson
- Royal Children's Hospital Melbourne, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
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Tayebi P, Ziaie N, Golshan S, Bijani A, Mahmoudlou F. Hemodialysis Patients with High-Flow Arteriovenous Fistulas: An Evaluation of the Impact on Cardiac Function. Vasc Specialist Int 2024; 40:7. [PMID: 38454861 PMCID: PMC10921845 DOI: 10.5758/vsi.230090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/06/2023] [Accepted: 12/14/2023] [Indexed: 03/09/2024] Open
Abstract
Purpose : Patients undergoing hemodialysis often experience changes in cardiac function when they have a high-flow arteriovenous fistula (AVF). This study aimed to assess the effect of high-flow AVFs on cardiac function in patients undergoing hemodialysis. Materials and Methods : A longitudinal study was conducted on hemodialysis patients with high-flow AVFs. Echocardiographic parameters, such as left ventricular ejection fraction (LVEF), left atrial diameter (LAD), left ventricular end-diastolic dimension (LVEDD), right ventricular end-diastolic dimension (RVEDD), inferior vena cava diameter (IVCD), systolic blood pressure, and diastolic blood pressure, were measured and compared before and after AVF creation. Results : One hundred hemodialysis patients with high-flow AVFs (mean age: 55.95±13.39 years, mean body mass index: 24.71±3.43 kg/m²) were studied. LVEF significantly decreased (51.10%±5.39% to 47.50%±5.79%), while LAD, LVEDD, and IVCD significantly increased after AVF creation (P<0.05). Systolic (132.49±16.42 mmHg to 146.60±17.43 mmHg) and diastolic (79.98±8.40 mmHg to 83.33±9.68 mmHg) blood pressure substantially rose post-fistularization (P<0.001). Notably, LVEF reduction was more significant in brachio-cephalic AVFs (46.29%±4.24%) compared to distal radio-cephalic or snuffbox AVFs (49.17%±7.15%) (P=0.014). Conclusion : High-flow AVFs can significantly affect echocardiographic parameters in hemodialysis patients, thereby increasing the risk of cardiac failure. Close cardiac monitoring may be necessary for early intervention. Distal AVFs may be preferable in patients with decreased cardiac function.
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Affiliation(s)
- Pouya Tayebi
- Department of Vascular and Endovascular Surgery, Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Naghmeh Ziaie
- Department of Cardiology, Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Sasan Golshan
- Department of General Surgery, Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Ali Bijani
- Social Determinant of Health Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Fatemeh Mahmoudlou
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
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Chu WM, Tsai HB, Chen YC, Hung KY, Cheng SY, Lin CP. Palliative Care for Adult Patients Undergoing Hemodialysis in Asia: Challenges and Opportunities. J Hosp Palliat Care 2024; 27:1-10. [PMID: 38449832 PMCID: PMC10911979 DOI: 10.14475/jhpc.2024.27.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/03/2024] [Accepted: 02/03/2024] [Indexed: 03/08/2024]
Abstract
This article underscores the importance of integrating comprehensive palliative care for noncancer patients who are undergoing hemodialysis, with an emphasis on the aging populations in Asian nations such as Taiwan, Japan, the Republic of Korea, and China. As the global demographic landscape shifts towards an aging society and healthcare continues to advance, a marked increase has been observed in patients undergoing hemodialysis who require palliative care. This necessitates an immediate paradigm shift to incorporate this care, addressing the intricate physical, psychosocial, and spiritual challenges faced by these individuals and their families. Numerous challenges impede the provision of effective palliative care, including difficulties in prognosis, delayed referrals, cultural misconceptions, lack of clinician confidence, and insufficient collaboration among healthcare professionals. The article proposes potential solutions, such as targeted training for clinicians, the use of telemedicine to facilitate shared decision-making, and the introduction of time-limited trials for dialysis to overcome these obstacles. The integration of palliative care into routine renal treatment and the promotion of transparent communication among healthcare professionals represent key strategies to enhance the quality of life and end-of-life care for people on hemodialysis. By embracing innovative strategies and fostering collaboration, healthcare providers can deliver more patient-centered, holistic care that meets the complex needs of seriously ill patients within an aging population undergoing hemodialysis.
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Affiliation(s)
- Wei-Min Chu
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Post‐Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Epidemiology of Aging, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Hung-Bin Tsai
- Division of Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Chi Chen
- Institute of Clinical Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kuan-Yu Hung
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Cheng-Pei Lin
- Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, United Kingdom
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Cho M, Na H. Factors that Influence Attitudes toward Advance Directives among Hemodialysis Patients. J Hosp Palliat Care 2024; 27:11-20. [PMID: 38449830 PMCID: PMC10911983 DOI: 10.14475/jhpc.2024.27.1.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/15/2023] [Accepted: 12/17/2023] [Indexed: 03/08/2024]
Abstract
Purpose Advance directives (ADs) are legal documents that outline a person's preferences or decisions regarding end-of-life care ahead of time. In Korea, there is insufficient awareness and knowledge about ADs among patients undergoing hemodialysis. This study explored the relationship between perceptions of a good death, knowledge about ADs, and attitudes toward ADs in this patient population. Methods This cross-sectional survey enrolled 119 hemodialysis patients from a secondary hospital in 2021. The participants completed a self-administered questionnaire, and the data were analyzed using the t-test, analysis of variance, Pearson correlation coefficients, Spearman rank correlation coefficients, and multiple regression analysis. Results The average score for perceptions of a good death among hemodialysis patients was 2.80 out of 4, with clinical symptoms identified as the most critical factor. The average scores for knowledge about ADs and attitudes toward ADs were 5.69 out of 9 and 2.79 out of 4, respectively. There was a positive correlation between perceptions of a good death and attitudes toward ADs (r=0.34, P<0.001), as well as between knowledge about Ads and attitudes toward ADs (r=0.19, P=0.037). Factors influencing attitudes toward Ads included employment status (β=0.22, P=0.011), education level (β=0.22, P=0.013), and perceptions of a good death (β=0.29, P=0.001), which accounted for 24.8% of the variance in attitudes toward ADs. Conclusion A positive perception of a good death among patients undergoing hemodialysis was associated with a positive attitude toward ADs. Educational programs are needed to improve individuals' understanding of a good death and encourage the development of end-of-life care plans.
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Affiliation(s)
- Minhee Cho
- The Catholic University of Korea, Uijeongbu ST. Mary’s Hospital, Uijeongbu, Korea
| | - Hyunjoo Na
- College of Nursing, The Catholic University of Korea, Seoul, Korea
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Wu CK, Fang YW, Lin CH. A collaborative model between dialysis clinics and a hospital center improves the quality of vascular access care and intervention for hemodialysis patients. Kidney Res Clin Pract 2024; 43:216-225. [PMID: 37165616 PMCID: PMC11016665 DOI: 10.23876/j.krcp.22.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/06/2022] [Accepted: 12/19/2022] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND This study reports the outcomes of a collaborative program between dialysis clinics and a referral hospital, which consisted of clinical monitoring and supplementary routine surveillance, for improving the quality of vascular access care. METHODS This retrospective observational study was performed at five dialysis clinics as part of a 2-year collaborative program (2019-2020) in conjunction with a hospital-based dialysis access management center. A total of 392 hemodialysis patients (arteriovenous fistula [AVF], n = 339 and arteriovenous graft [AVG], n = 53) were included. Outcome measures included the prognosis of vascular access, clinic satisfaction, and referral rate to the hospital. RESULTS Increased vascular access flow was observed and critical flow events decreased from the first to the second year (AVF: 18.3% vs. 12.7%, p < 0.001; AVG: 26.2% vs. 20.1%, p = 0.30). There were fewer percutaneous transluminal angioplasty events in the AVG group (0.77 per person-year vs. 0.51 per person-year, p = 0.005). New AVF or AVG creation events also remained low. All dialysis clinics were satisfied with the program. The overall referral rate from the participating clinics increased (65.7% vs. 72.0%) during the study period independently of the physical distance between the dialysis clinic and the hospital. CONCLUSION The collaboration between dialysis clinics and a referral hospital for improving the quality of vascular access care was successful in this study, and the model can be used by other clinics and hospitals looking to improve care coordination in dialysis patients.
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Affiliation(s)
- Chung-Kuan Wu
- Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- Dialysis Access Management Center, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- School of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
| | - Yu-Wei Fang
- Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- School of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
| | - Chia-Hsun Lin
- School of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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Ye BM, Kang S, Park WY, Cho JH, Yu BC, Han M, Song SH, Ko GJ, Yang JW, Chung S, Hong YA, Hyun YY, Bae E, Sun IO, Kim H, Hwang WM, Shin SJ, Kwon SH, Kim SR, Yoo KD. Association between dementia diagnosis at dialysis initiation and mortality in older patients with end-stage kidney disease in South Korea. Kidney Res Clin Pract 2024:j.krcp.23.151. [PMID: 38325870 DOI: 10.23876/j.krcp.23.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/22/2023] [Indexed: 02/09/2024] Open
Abstract
Background The prevalence of dementia is 2- to 7-fold higher among patients with end-stage kidney disease (ESKD) than among the general population; however, its clinical implications in this population remain unclear. Therefore, this study aimed to determine whether comorbid dementia increases mortality among older patients with ESKD undergoing newly initiated hemodialysis. Methods We analyzed data from the Korean Society of Geriatric Nephrology retrospective cohort, which included 2,736 older ESKD patients (≥70 years old) who started hemodialysis between 2010 and 2017. Kaplan-Meier survival and Cox regression analyses were used to examine all-cause mortality between the patients with and without dementia in this cohort. Results Of the 2,406 included patients, 8.3% had dementia at the initiation of dialysis; these patients were older (79.6 ± 6.0 years) than patients without dementia (77.7 ± 5.5 years) and included more women (male:female, 89:111). Pre-ESKD diagnosis of dementia was associated with an increased risk of overall mortality (hazard ratio, 1.503; p < 0.001), and this association remained consistent after multivariate adjustment (hazard ratio, 1.268; p = 0.009). In subgroup analysis, prevalent dementia was associated with mortality following dialysis initiation in female patients, those aged <85 years, those with no history of cerebrovascular accidents or severe behavioral disorders, those not residing in nursing facilities, and those with no or short-term hospitalization. Conclusion A pre-ESKD diagnosis of dementia is associated with mortality following dialysis initiation in older Korean population. In older patients with ESKD, cognitive assessment at dialysis initiation is necessary.
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Affiliation(s)
- Byung Min Ye
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Korean Society of Geriatric Nephrology, Seoul, Republic of Korea
| | - Seongmin Kang
- Division of Nephrology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
- Korean Society of Geriatric Nephrology, Seoul, Republic of Korea
| | - Woo Yeong Park
- Division of Nephrology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
- Korean Society of Geriatric Nephrology, Seoul, Republic of Korea
| | - Jang-Hee Cho
- Division of Nephrology, Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Republic of Korea
- Korean Society of Geriatric Nephrology, Seoul, Republic of Korea
| | - Byung Chul Yu
- Division of Nephrology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
- Korean Society of Geriatric Nephrology, Seoul, Republic of Korea
| | - Miyeun Han
- Division of Nephrology, Department of Internal Medicine, National Medical Center, Seoul, Republic of Korea
- Korean Society of Geriatric Nephrology, Seoul, Republic of Korea
| | - Sang Heon Song
- Division of Nephrology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
- Korean Society of Geriatric Nephrology, Seoul, Republic of Korea
| | - Gang-Jee Ko
- Division of Nephrology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
- Korean Society of Geriatric Nephrology, Seoul, Republic of Korea
| | - Jae Won Yang
- Division of Nephrology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- Korean Society of Geriatric Nephrology, Seoul, Republic of Korea
| | - Sungjin Chung
- Division of Nephrology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Korean Society of Geriatric Nephrology, Seoul, Republic of Korea
| | - Yu Ah Hong
- Division of Nephrology, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
- Korean Society of Geriatric Nephrology, Seoul, Republic of Korea
| | - Young Youl Hyun
- Division of Nephrology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Korean Society of Geriatric Nephrology, Seoul, Republic of Korea
| | - Eunjin Bae
- Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Republic of Korea
- Korean Society of Geriatric Nephrology, Seoul, Republic of Korea
| | - In O Sun
- Division of Nephrology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of Korea
- Korean Society of Geriatric Nephrology, Seoul, Republic of Korea
| | - Hyunsuk Kim
- Division of Nephrology, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea
- Korean Society of Geriatric Nephrology, Seoul, Republic of Korea
| | - Won Min Hwang
- Division of Nephrology, Department of Internal Medicine, Konyang University Hospital, Daejeon, Republic of Korea
- Korean Society of Geriatric Nephrology, Seoul, Republic of Korea
| | - Sung Joon Shin
- Division of Nephrology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Goyang, Republic of Korea
- Korean Society of Geriatric Nephrology, Seoul, Republic of Korea
| | - Soon Hyo Kwon
- Division of Nephrology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
- Korean Society of Geriatric Nephrology, Seoul, Republic of Korea
| | - Seo Rin Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Korean Society of Geriatric Nephrology, Seoul, Republic of Korea
| | - Kyung Don Yoo
- Division of Nephrology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
- Basic-Clinic Translational Research Center, University of Ulsan, Ulsan, Republic of Korea
- Korean Society of Geriatric Nephrology, Seoul, Republic of Korea
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Rahimi M, Afrash MR, Shadnia S, Mostafazadeh B, Evini PET, Bardsiri MS, Ramezani M. Prediction the prognosis of the poisoned patients undergoing hemodialysis using machine learning algorithms. BMC Med Inform Decis Mak 2024; 24:38. [PMID: 38321428 PMCID: PMC10845715 DOI: 10.1186/s12911-024-02443-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/28/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Hemodialysis is a life-saving treatment used to eliminate toxins and metabolites from the body during poisoning. Despite its effectiveness, there needs to be more research on this method precisely, with most studies focusing on specific poisoning. This study aims to bridge the existing knowledge gap by developing a machine-learning prediction model for forecasting the prognosis of the poisoned patient undergoing hemodialysis. METHODS Using a registry database from 2016 to 2022, this study conducted a retrospective cohort study at Loghman Hakim Hospital. First, the relief feature selection algorithm was used to identify the most important variables influencing the prognosis of poisoned patients undergoing hemodialysis. Second, four machine learning algorithms, including extreme gradient boosting (XGBoost), histgradient boosting (HGB), k-nearest neighbors (KNN), and adaptive boosting (AdaBoost), were trained to construct predictive models for predicting the prognosis of poisoned patients undergoing hemodialysis. Finally, the performance of paired feature selection and machine learning (ML) algorithm were evaluated to select the best models using five evaluation metrics including accuracy, sensitivity, specificity the area under the curve (AUC), and f1-score. RESULT The study comprised 980 patients in total. The experimental results showed that ten variables had a significant influence on prognosis outcomes including age, intubation, acidity (PH), previous medical history, bicarbonate (HCO3), Glasgow coma scale (GCS), intensive care unit (ICU) admission, acute kidney injury, and potassium. Out of the four models evaluated, the HGB classifier stood out with superior results on the test dataset. It achieved an impressive mean classification accuracy of 94.8%, a mean specificity of 93.5 a mean sensitivity of 94%, a mean F-score of 89.2%, and a mean receiver operating characteristic (ROC) of 92%. CONCLUSION ML-based predictive models can predict the prognosis of poisoned patients undergoing hemodialysis with high performance. The developed ML models demonstrate valuable potential for providing frontline clinicians with data-driven, evidence-based tools to guide time-sensitive prognosis evaluations and care decisions for poisoned patients in need of hemodialysis. Further large-scale multi-center studies are warranted to validate the efficacy of these models across diverse populations.
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Affiliation(s)
- Mitra Rahimi
- Toxicological Research Center, Excellence Center & Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Afrash
- Department of Artificial Intelligence, Smart University of Medical Sciences, Tehran, Iran
| | - Shahin Shadnia
- Toxicological Research Center, Excellence Center & Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Mostafazadeh
- Toxicological Research Center, Excellence Center & Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Peyman Erfan Talab Evini
- Toxicological Research Center, Excellence Center & Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohadeseh Sarbaz Bardsiri
- Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Clinical Toxicology, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Maral Ramezani
- Department of Pharmacology, School of Medicine, Arak University of Medical Sciences, Arak, Iran.
- Traditional and Complementary Medicine Research Center, Arak University of Medical Sciences, Arak, Iran.
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Hosseini T, Hooshmandja M, Noaparast M, Mojtahedzadeh R, Mohammadi A. Virtual reality exposure therapy to decrease anxiety before surgical invasive procedures in hemodialysis patients: an interventional study. BMC Nephrol 2024; 25:30. [PMID: 38267868 PMCID: PMC10807114 DOI: 10.1186/s12882-024-03461-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Hemodialysis patients are prone to anxiety and depression due to physiological changes and psychological tensions that leave irreversible effects on the patients. In this regard, the present study was an attempt to provide a simulated situation by using virtual reality on the anxiety level of dialysis patients before performing surgical procedures. METHODS This non-equivalent groups pre-posttest quasi-experimental study was conducted in 2022 in a hemodialysis ward of Imam Khomeini General Hospital affiliated with Tehran University of Medical Sciences. The study population was patients suffering from kidney failure referred to this hospital. The participants were 30 patients selected from the study population, who were allocated into two groups (15 in each experimental and control group). The control group received routine training in the ward. The experimental group participants watched five educational virtual reality (VR) contents in addition to the routine training. They used head-mounted display VR (VR BOX headset 2.0 virtual reality glasses) to immerse in a virtual environment similar to the real world covering the experience of entering the operating room, during the surgery, and after surgery. The data gathering instrument was a valid and reliable anxiety inventory. The collected data was analyzed at a significance level of 0.05. RESULTS The study findings indicated that the anxiety scores of the experimental and control groups had no significant difference before intervention. However, after the intervention of virtual reality, the state and trait anxiety of the experimental group participants were significantly lower than the control group (P-value < 0.01). CONCLUSION The application of VR for maintenance hemodialysis patients before invasive surgical procedures decreases patients' anxiety. Considering the devastating and undeniable impacts of anxiety on the lives of patients referring to hemodialysis centers, the application of VR is suggested to decrease their anxiety.
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Affiliation(s)
- Tahereh Hosseini
- Department of E-Learning in Medical Education, Center of Excellence for E-learning in Medical Education, School of Medicine, Tehran University of Medical Sciences, Dolatshahi Alley, Naderi St, Keshavarz Blvd, 14166-14741, Tehran, Iran
| | - Manijeh Hooshmandja
- Department of Educational Technology in Medical Sciences, Smart University of Medical Sciences, Tehran, Iran
| | - Morteza Noaparast
- Department of General Surgery, School of Medicine, Prehospital and Hospital Emergency Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Rita Mojtahedzadeh
- Department of E-Learning in Medical Education, Center of Excellence for E-learning in Medical Education, School of Medicine, Tehran University of Medical Sciences, Dolatshahi Alley, Naderi St, Keshavarz Blvd, 14166-14741, Tehran, Iran
| | - Aeen Mohammadi
- Department of E-Learning in Medical Education, Center of Excellence for E-learning in Medical Education, School of Medicine, Tehran University of Medical Sciences, Dolatshahi Alley, Naderi St, Keshavarz Blvd, 14166-14741, Tehran, Iran.
- Health Professions Education Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Kee YK, Park HC, Yoon SJ, Yu S, Ko E, Cho AJ, Kim DH, Kim J, Lee YK. Effectiveness of regdanvimab on mortality in COVID-19 infected patients on hemodialysis. Kidney Res Clin Pract 2024; 43:111-121. [PMID: 38268125 PMCID: PMC10846986 DOI: 10.23876/j.krcp.23.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Although several therapeutic agents have been evaluated for the treatment of coronavirus disease 2019 (COVID-19), there are lack of effective and proven treatments for end-stage renal disease (ESRD). The present study aims to evaluate the effectiveness of regdanvimab on mortality in COVID-19-infected patients on hemodialysis (HD). METHODS We conducted an observational retrospective study in 230 COVID-19-infected patients on HD, of whom 77 (33.5%) were administered regdanvimab alone or in combination with dexamethasone or remdesivir during hospitalization (regdanvimab group) and 153 patients (66.5%) were not (no regdanvimab group). The primary outcome was in-hospital mortality. We compared mortality rates according to the use of regdanvimab and investigated the factors associated with mortality. RESULTS Fifty-nine deaths occurred during hospitalization, 49 in the no regdanvimab group (32.0%) and 10 in the regdanvimab group (13.0%), and the mortality rate was significantly higher in the no regdanvimab group than that in the regdanvimab group (p = 0.001). Multivariate Cox regression analysis showed that malignancy (p = 0.001), SPO2 of <95% at admission (p = 0.003), and administration of antibiotics and regdanvimab (p = 0.007 and p = 0.002, respectively) were significantly associated factors with mortality. CONCLUSION Regdanvimab administration is beneficial in improving prognosis in hospitalized COVID-19 patients on HD. Considering the vulnerability to infection and high mortality of ESRD patients, regdanvimab may be considered as a therapeutic option in COVID-19 patients on HD.
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Affiliation(s)
- Youn Kyung Kee
- Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
- Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Hayne Cho Park
- Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Su Jin Yoon
- Department of Internal Medicine, Good Samaritan Bagae Hospital, Pyeongtaek, Republic of Korea
| | - Sungbong Yu
- Department of General Surgery, Good Samaritan Bagae Hospital, Pyeongtaek, Republic of Korea
| | - Eunsil Ko
- National Emergency Medical Center, National Medical Center, Seoul, Republic of Korea
| | - AJin Cho
- Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Do Hyoung Kim
- Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Jinseog Kim
- Department of Bigdata and Applied Statistics, Dongguk University, Gyeongju, Republic of Korea
| | - Young-Ki Lee
- Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
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10
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da Silva AT, Machado RP, Martins ML, Dorneles LEG, Dalmarco EM, da Silva EL, Hinnig PDF, Wazlawik E. Whey Protein, Vitamins C and E Decrease Interleukin-10 in Chronic Hemodialysis Patients: A Pioneer, Randomized, Double-Blind Pilot Trial. J Ren Nutr 2024; 34:58-67. [PMID: 37598813 DOI: 10.1053/j.jrn.2023.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/13/2023] [Indexed: 08/22/2023] Open
Abstract
OBJECTIVE To evaluate the effects of supplementation with whey protein combined with vitamins C and E on inflammatory markers in hemodialysis (HD) patients. DESIGN AND METHODS This was a pioneer, randomized and double-blinded study. Patients were randomized into two groups and stratified by HD frequency. The supplementation group received 20 g of whey protein, 250 mg of vitamin C, and 600 IU of vitamin E; the placebo group, 20 g of rice flour, and microcrystalline cellulose capsules. The interventions were given after HD, 3 times a week, for 8 weeks. The inflammatory markers were assessed: interleukin (IL) IL-12p70, IL-10, IL-6, IL-8, and tumor necrosis factor alpha. For statistical analysis, the χ2 test, Student's t-test, Mann-Whitney test, analysis of variance for repeated two-way measurements, paired t test, and Wilcoxon test were performed. P < .05 was considered statistically significant. RESULTS Twenty-three patients completed the study. No significant differences were found in inflammatory markers when comparing the groups postintervention. In the intragroup was a decrease in IL-10 in the supplementation group after 8 weeks (P = .0382). IL-6 tended to decrease by 810.95% in the supplementation group and increased by 732.8% (nonsignificant) in the placebo group. CONCLUSION Whey protein combined with vitamins C and E significantly reduced IL-10 in the supplementation group and could be beneficial to reduce IL-6 in HD patients. Future studies are suggested with a larger sample size, different supplementation doses, and longer interventions.
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Affiliation(s)
- Angela Teodósio da Silva
- Postgraduate Program in Nutrition, Department of Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Roberta Pieri Machado
- Postgraduate Program in Nutrition, Department of Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Mayara Lopes Martins
- Postgraduate Program in Nutrition, Department of Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | | | | | - Edson Luiz da Silva
- Department of Clinical Analysis, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Patrícia de Fragas Hinnig
- Postgraduate Program in Nutrition, Department of Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Elisabeth Wazlawik
- Postgraduate Program in Nutrition, Department of Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
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11
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Wang PX, Fan ZJ, Wu LY, Wang SY, Zhang JL, Dong XT, Zhang AH. Serum irisin levels are negatively associated with blood pressure in dialysis patients. Hypertens Res 2023; 46:2738-2745. [PMID: 37794242 DOI: 10.1038/s41440-023-01449-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/10/2023] [Accepted: 08/23/2023] [Indexed: 10/06/2023]
Abstract
Elevated blood pressure is highly prevalent among dialysis patients and is associated with high mortality. Irisin is a newly found myokine that has been indicated to be related to blood pressure regulation in animal experiments. Data regarding the effect of serum irisin levels on blood pressure in dialysis patients are limited. To identify the association between serum irisin levels and blood pressure and examine determinant factors of systolic blood pressure in dialysis patients, we recruited 300 dialysis patients at Xuanwu Hospital Capital Medical University. Serum irisin levels were assessed by enzyme-linked immunosorbent assay kits. Blood pressure was self-measured on 7 consecutive days by an automated sphygmomanometer. The Pearson correlation test showed that the natural logarithm of irisin was negatively correlated with systolic blood pressure (r = -0.462, P < 0.001) and pulse pressure (r = -0.487, P < 0.001), but not correlated with diastolic blood pressure (r = -0.022, P = 0.709). Multivariate analysis revealed that the natural logarithm of irisin (β = -0.336, P < 0.001), lean tissue mass (β = 0.164, P = 0.005), diabetes mellitus (β = 0.165, P = 0.003) and serum calcium (β = -0.135, P = 0.019) were significant determinant factors for systolic blood pressure. This study is the first to demonstrate that serum irisin levels are significantly negatively associated with blood pressure in dialysis patients. Further studies are needed to provide possible mechanisms. We demonstrated that serum irisin levels were negatively associated with blood pressure in dialysis patients, which may provide a new target for antihypertensive treatment.
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Affiliation(s)
- Pei-Xin Wang
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zheng-Jia Fan
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lei-Yun Wu
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shi-Yuan Wang
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jia-Ling Zhang
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xing-Tong Dong
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ai-Hua Zhang
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China.
- National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China.
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12
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Mestres G, Barahona F, Yugueros X, Gamé V, Gil-Sala D, Blanco C, Fontseré N, Riambau V. Inflow Artery Aneurysmal Degeneration After Long Term Native Arteriovenous Fistula for Haemodialysis. Eur J Vasc Endovasc Surg 2023; 66:849-854. [PMID: 37659740 DOI: 10.1016/j.ejvs.2023.08.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 08/16/2023] [Accepted: 08/25/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVE Inflow arterial aneurysms are a rare but serious complication after long term arteriovenous fistulae (AVF), probably due to arterial wall remodelling after an increase in flow and shear stress, and kidney transplantation with immunosuppressive therapy. This study aimed to describe the outcomes of surgical treatment and long term follow up in a large cohort. METHODS This prospective cohort study collected data from patients with a true inflow artery aneurysm after AVF creation that was surgically repaired between 2010 and 2022. Anastomotic and infected aneurysms or post-puncture pseudoaneurysms were excluded. Demographic data, access characteristics, symptoms, treatment strategies, and long term follow up were recorded; patency was estimated using Kaplan-Meier survival analysis. RESULTS During the study period, 28 patients (64% men, mean age 60.1 years) were treated surgically for aneurysmal degeneration of the axillary or brachial (n = 23) or radial (n = 5) artery after an AVF (10 distal, 18 proximal) performed a mean of 18.3 ± SD 7.9 years previously. Most AVFs were ligated or thrombosed, while all patients except one had previously received kidney transplants. Most of the cases (n = 18) were symptomatic: 13 with pain or swelling, four with distal embolisation, and one rupture. They were repaired by aneurysm partial excision and graft interposition (11 great saphenous vein, six ipsilateral basilic vein, three cephalic vein, and two PTFE graft), ligation (n = 3), or direct end to end anastomosis (n = 3). No major complications occurred before discharge, after a mean hospital stay of 2.4 days. After a mean follow up of 4.8 ± 3.3 years, three cases presented complications: two recurrent proximal brachial aneurysms were repaired with an additional proximal interposition graft (one with further late infected pseudoaneurysm) and an asymptomatic post-traumatic graft thrombosis. Five year primary and secondary patency was 84% and 96%, respectively. CONCLUSION Aneurysmal degeneration of the inflow artery is an unusual complication during long term follow up of AVFs. Aneurysm excision and, in general, autogenous graft interposition using the saphenous or ipsilateral arm vein is a safe and effective strategy.
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Affiliation(s)
- Gaspar Mestres
- Vascular Surgery Department, Vascular Access Unit, Hospital Clinic, University of Barcelona, Spain.
| | - Fabricio Barahona
- Vascular Surgery Department, Vascular Access Unit, Hospital Clinic, University of Barcelona, Spain
| | - Xavier Yugueros
- Vascular Surgery Department, Vascular Access Unit, Hospital Clinic, University of Barcelona, Spain
| | - Victoria Gamé
- Vascular Surgery Department, Vascular Access Unit, Hospital Clinic, University of Barcelona, Spain
| | - Daniel Gil-Sala
- Vascular Surgery Department, Vascular Access Unit, Hospital Clinic, University of Barcelona, Spain
| | - Carla Blanco
- Vascular Surgery Department, Vascular Access Unit, Hospital Clinic, University of Barcelona, Spain
| | - Nestor Fontseré
- Nephrology Department, Vascular Access Unit, Hospital Clinic, University of Barcelona, Spain
| | - Vincent Riambau
- Vascular Surgery Department, Vascular Access Unit, Hospital Clinic, University of Barcelona, Spain
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13
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Kim DH, Youn S, Ban TH, Choi BS, Kim BS, Park CW, Yang CW, Park HS. Safety and durable patency of tunneled hemodialysis catheter inserted without fluoroscopy. Kidney Res Clin Pract 2023; 42:723-730. [PMID: 37798846 DOI: 10.23876/j.krcp.22.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/12/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND A tunneled hemodialysis (HD) catheter is preferred due to its lower incidence of infection and malfunction than non-tunneled ones. For safer insertion, fluoroscopic guidance is desirable. However, if the patient is unstable, transfer to the fluoroscopy may be impossible or inappropriate. METHODS From June 2019 to September 2022, 81 tunneled HD catheter insertion cases performed under ultrasound guidance without fluoroscopy and 474 cases with fluoroscopy in our institutional HD catheter cohort were retrospectively compared. RESULTS Immediate complications, later catheter-associated problems, including infections and catheter dysfunction, were comparable between the two groups (p = 0.20 and p = 0.37, respectively). The patency of tunneled catheters inserted without fluoroscopy was comparable to the patency of tunneled catheters inserted with fluoroscopic guidance (p = 0.90). CONCLUSION Tunneled HD catheter insertion without fluoroscopy can be performed safely and has durable patency compared to the insertion with fluoroscopy. Therefore, this method can be considered for the selected unstable patients (e.g., ventilator care) in the intensive care unit.
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Affiliation(s)
- Do Hyoung Kim
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Sojung Youn
- Division of Nephrology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Internal Medicine, Eunpyeong St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae Hyun Ban
- Division of Nephrology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Internal Medicine, Eunpyeong St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bum Soon Choi
- Division of Nephrology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Internal Medicine, Eunpyeong St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung Soo Kim
- Division of Nephrology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Internal Medicine, Eunpyeong St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Cheol Whee Park
- Division of Nephrology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chul Woo Yang
- Division of Nephrology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hoon Suk Park
- Division of Nephrology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Internal Medicine, Eunpyeong St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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14
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Chang JH, Kim YC, Song SH, Kim S, Jo MW, Kim S. Shared Decision Making for Choosing renAl Replacement Therapy in Chronic Kidney Disease Patients (SDM-ART trial): study protocol for randomized clinical trial. Kidney Res Clin Pract 2023; 42:751-761. [PMID: 37098669 DOI: 10.23876/j.krcp.22.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/04/2022] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) should be educated about their condition so that they can initiate dialysis at the optimal time and make an informed choice between dialysis modalities. Shared decision-making (SDM) empowers patients to select their own treatment and improves patient outcomes. This study aimed to evaluate whether SDM affects the choice of renal replacement therapy among CKD patients. METHODS This is a multicenter, open-label, randomized, pragmatic clinical trial. A total of 1,194 participants with CKD who are considering renal replacement therapy were enrolled. The participants will be randomized into three groups in a 1:1:1 ratio: the conventional group, extensive informed decision-making group, and SDM group. Participants will be educated twice at months 0 and 2. Videos and leaflets will be provided to all patients. Patients in the conventional group will receive 5 minutes of education at each visit. The extensive informed decision-making group will receive more informed and detailed education using intensive learning materials for 10 minutes each visit. Patients in the SDM group will be educated for 10 minutes each visit according to illness perception and item-based analysis. The primary endpoint is the ratio of hemodialysis to peritoneal dialysis and kidney transplantation among the groups. Secondary outcomes include unplanned dialysis, economic efficiency, patient satisfaction, patient evaluation of the process, and patient adherence. DISCUSSION The SDM-ART is an ongoing clinical study to investigate the effect of SDM on the choice of renal replacement therapy in patients with CKD.
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Affiliation(s)
- Jae Hyun Chang
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang Heon Song
- Department of Internal Medicine and BioMedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Soojin Kim
- Division of Communication and Media, Ewha Womans University, Seoul, Republic of Korea
| | - Min-Woo Jo
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sejoong Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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15
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Tunnicliffe DJ, Bateman S, Arnold‐Chamney M, Dwyer KM, Howell M, Gebadi A, Jesudason S, Kelly J, Lambert K, Majoni SW, Oliva D, Owen KJ, Pearson O, Rix E, Roberts I, Stirling‐Kelly R, Taylor K, Wittert GA, Widders K, Yip A, Craig J, Phoon RK. Recommendations for culturally safe clinical kidney care for First Nations Australians: a guideline summary. Med J Aust 2023; 219:374-385. [PMID: 37838977 PMCID: PMC10952490 DOI: 10.5694/mja2.52114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 08/23/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION First Nations Australians display remarkable strength and resilience despite the intergenerational impacts of ongoing colonisation. The continuing disadvantage is evident in the higher incidence, prevalence, morbidity and mortality of chronic kidney disease (CKD) among First Nations Australians. Nationwide community consultation (Kidney Health Australia, Yarning Kidneys, and Lowitja Institute, Catching Some Air) identified priority issues for guideline development. These guidelines uniquely prioritised the knowledge of the community, alongside relevant evidence using an adapted GRADE Evidence to Decision framework to develop specific recommendations for the management of CKD among First Nations Australians. MAIN RECOMMENDATIONS These guidelines explicitly state that health systems have to measure, monitor and evaluate institutional racism and link it to cultural safety training, as well as increase community and family involvement in clinical care and equitable transport and accommodation. The guidelines recommend earlier CKD screening criteria (age ≥ 18 years) and referral to specialists services with earlier criteria of kidney function (eg, estimated glomerular filtration rate [eGFR], ≤ 45 mL/min/1.73 m2 , and a sustained decrease in eGFR, > 10 mL/min/1.73 m2 per year) compared with the general population. CHANGES IN MANAGEMENT AS RESULT OF THE GUIDELINES Our recommendations prioritise health care service delivery changes to address institutional racism and ensure meaningful cultural safety training. Earlier detection of CKD and referral to nephrologists for First Nations Australians has been recommended to ensure timely implementation to preserve kidney function given the excess burden of disease. Finally, the importance of community with the recognition of involvement in all aspects and stages of treatment together with increased access to care on Country, particularly in rural and remote locations, including dialysis services.
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Affiliation(s)
- David J Tunnicliffe
- University of SydneySydneyNSW
- Centre for Kidney ResearchChildren's Hospital at WestmeadSydneyNSW
| | - Samantha Bateman
- University of AdelaideAdelaideSA
- Central and Northern Adelaide Renal and Transplantation Services, Central Adelaide Local Health NetworkAdelaideSA
| | | | | | - Martin Howell
- University of SydneySydneyNSW
- Centre for Kidney ResearchChildren's Hospital at WestmeadSydneyNSW
| | - Azaria Gebadi
- University of SydneySydneyNSW
- Centre for Kidney ResearchChildren's Hospital at WestmeadSydneyNSW
| | | | | | - Kelly Lambert
- University of WollongongWollongongNSW
- Illawarra Health and Medical Research InstituteUniversity of WollongongWollongongNSW
| | | | - Dora Oliva
- Drug and Alcohol Services, South Australia HealthAdelaideSA
| | - Kelli J Owen
- University of AdelaideAdelaideSA
- Central and Northern Adelaide Renal and TransplantationRoyal Adelaide HospitalAdelaideSA
| | - Odette Pearson
- Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research InstituteAdelaideSA
- Cancer Research InstituteUniversity of South AustraliaAdelaideSA
| | - Elizabeth Rix
- University of AdelaideAdelaideSA
- Southern Cross UniversityLismoreNSW
| | - Ieyesha Roberts
- University of SydneySydneyNSW
- Centre for Kidney ResearchChildren's Hospital at WestmeadSydneyNSW
| | - Ro‐Anne Stirling‐Kelly
- University of SydneySydneyNSW
- Centre for Kidney ResearchChildren's Hospital at WestmeadSydneyNSW
- NSW Health Mid‐North Coast Local Health DistrictSydneyNSW
| | - Kimberly Taylor
- Aboriginal Communities and Families Health Research Alliance, South Australian Health and Medical Research InstituteAdelaideSA
| | - Gary A Wittert
- University of AdelaideAdelaideSA
- Royal Adelaide HospitalAdelaideSA
| | - Katherine Widders
- University of SydneySydneyNSW
- Centre for Kidney ResearchChildren's Hospital at WestmeadSydneyNSW
| | - Adela Yip
- University of SydneySydneyNSW
- Centre for Kidney ResearchChildren's Hospital at WestmeadSydneyNSW
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16
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King SJ, Reid N, Brown SJ, Brodie LJ, Sia ADH, Chatfield MD, Francis RS, Peel NM, Gordon EH, Hubbard RE. A prospective, observational study of frailty, quality of life and dialysis in older people with advanced chronic kidney disease. BMC Geriatr 2023; 23:664. [PMID: 37845618 PMCID: PMC10580596 DOI: 10.1186/s12877-023-04365-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 09/29/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Frailty is prevalent in older people with chronic kidney disease (CKD) and robust evidence supporting the benefit of dialysis in this setting is lacking. We aimed to measure frailty and quality of life (QOL) longitudinally in older people with advanced CKD and assess the impact of dialysis initiation on frailty, QOL and mortality. METHODS Outpatients aged ≥65 with an eGFR ≤ 20ml/minute/1.73m2 were enrolled in a prospective observational study and followed up four years later. Frailty status was measured using a Frailty Index (FI), and QOL was evaluated using the EuroQol 5D-5L instrument. Mortality and dialysis status were determined through inspection of electronic records. RESULTS Ninety-eight participants were enrolled. Between enrolment and follow-up, 36% of participants commenced dialysis and 59% died. Frailty prevalence increased from 47% at baseline to 86% at follow-up (change in median FI = 0.22, p < 0.001). Initiating dialysis was not significantly associated with change in FI. QOL declined from baseline to follow-up (mean EQ-5D-5L visual analogue score of 70 vs 63, p = 0.034), though commencing dialysis was associated with less decline in QOL. Each 0.1 increment in baseline FI was associated with 59% increased mortality hazard (HR = 1.59, 95%CI = 1.20 to 2.12, p = 0.001), and commencing dialysis was associated with 59% reduction in mortality hazard (HR = 0.41, 95%CI = 0.20 to 0.87, p = 0.020) irrespective of baseline FI. CONCLUSIONS Frailty increased substantially over four years, and higher baseline frailty was associated with greater mortality. Commencing dialysis did not affect the trajectory of FI but positively influenced the trajectory of QOL from baseline to follow-up. Within the limitations of small sample size, our data suggests that frail participants received similar survival benefit from dialysis as non-frail participants.
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Affiliation(s)
- Shannon J King
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia.
- Western Australian Country Health Service, Busselton Health Campus, West Busselton, WA, 6280, Australia.
| | - Natasha Reid
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
| | - Sarah J Brown
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
- Cairns and Hinterland Hospital and Health Service, Brisbane City, QLD, Australia
| | - Lucinda J Brodie
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
| | - Aaron D H Sia
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
- Department of Kidney and Transplantations Services, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Mark D Chatfield
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
| | - Ross S Francis
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
- Department of Kidney and Transplantations Services, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Nancye M Peel
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
| | - Emily H Gordon
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
- Department of Geriatric Medicine, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Ruth E Hubbard
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
- Department of Geriatric Medicine, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
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17
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Michas V, Taghipour M, Papachristodoulou A, Sidiropoulou M, Partovi S, Cokkinos D, Rafailidis V, Gadani S, Gill A, Michell H, Prassopoulos P. Multiparametric ultrasound for upper extremity dialysis access evaluation. Ultrasonography 2023; 42:490-507. [PMID: 37723649 PMCID: PMC10555685 DOI: 10.14366/usg.23064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/12/2023] [Accepted: 07/12/2023] [Indexed: 09/20/2023] Open
Abstract
The evolution of ultrasound (US) techniques has greatly improved the evaluation of many parameters in dialysis vascular access, which is typically achieved through an arteriovenous fistula (AVF) or graft (AVG). These techniques include grayscale B-mode, color Doppler, power Doppler, spectral Doppler, non-Doppler US flow imaging techniques, contrast-enhanced US, and elastography. In conjunction with a patient's medical history and physical examination, US provides crucial information about the native vascular bed prior to the surgical creation of an arteriovenous anastomosis. It also tracks the maturation progress of the newly created AVF or AVG and aids in diagnosing potential complications of the vascular access. These complications include thrombosis, steal syndrome, aneurysms, pseudoaneurysms, hematomas, infection, ischemic neuropathy, exacerbation of preexisting congestive heart failure, and stenosis.
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Affiliation(s)
- Vasileios Michas
- Department of Radiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Mehdi Taghipour
- Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | | | - Maria Sidiropoulou
- Department of Radiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Sasan Partovi
- Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | | | - Vasileios Rafailidis
- Department of Radiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Sameer Gadani
- Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Amanjit Gill
- Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Hans Michell
- Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Panos Prassopoulos
- Department of Radiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
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18
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Wu Z, Huang W, Ding Y, Jiang L, Zhao Y, Zhu X, Huang J. Construction of an evaluation index system of core competencies for critical care blood purification nurses in China: A Delphi study. Nurse Educ Pract 2023; 72:103751. [PMID: 37633075 DOI: 10.1016/j.nepr.2023.103751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/01/2023] [Accepted: 08/15/2023] [Indexed: 08/28/2023]
Abstract
AIM The purpose of this study was to construct a core competencies evaluation index system for critical care blood purification nurses in China. BACKGROUND While nursing is an integral part of critical care blood purification treatment, there are no established indicators to evaluate the core competencies of critical care blood purification nurses. DESIGN A Delphi study. METHODS An initial draft of the competencies evaluation index system for critical care blood purification nurses was developed through a literature review and semi-structured interviews. From February 2023 to March 2023, a two-round Delphi survey was conducted to consult with 18 experts in the field of critical care blood purification from eight provinces in China to rate the importance of each item and propose modifications to the evaluation index system. RESULTS The effective questionnaire recovery rates in two rounds of expert consultation were 94.4 % and 94.1 % and the average expert authority coefficients were 0.88 in both rounds. The core competencies evaluation index system of critical care blood purification nurses consisted of 39 items in five domains, namely theoretical knowledge, practical skills, professional development capability, critical thinking ability and personal qualities and attributes. The Kendall's W coefficients for the first- and second-level indicators were.21 and.20 in the first round and.23 and.25, respectively, in the second round of consultations (p < .01). CONCLUSION The core competencies evaluation index system of critical care blood purification nurses is scientific and reliable and can provide references for the recruitment, training and management of critical care blood purification nurses.
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Affiliation(s)
- Zhishan Wu
- Department of Blood Purification, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Huang
- Department of Blood Purification, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuefeng Ding
- Department of Blood Purification, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liping Jiang
- Department of Nursing, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Zhao
- Department of Blood Purification, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoye Zhu
- Department of Blood Purification, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiayi Huang
- Department of Blood Purification, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Kim KM, Lee S, Shin JH, Park M. A comparative study of epidemiological characteristics, treatment outcomes, and mortality among patients undergoing hemodialysis by health insurance types: data from the Korean Renal Data System. Kidney Res Clin Pract 2023:j.krcp.22.220. [PMID: 37798847 DOI: 10.23876/j.krcp.22.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 05/11/2023] [Indexed: 10/07/2023] Open
Abstract
Background The prevalence of end-stage renal disease (ESRD) requiring dialysis has progressively increased. Therefore, to achieve financial stability by managing the increasing numbers of patients undergoing hemodialysis (HD), a fixed-payment system was introduced in 2001 for medical aid (MA) beneficiaries receiving HD in Korea. Methods We identified patients in the Korean Renal Data System that received HD between 2001 and 2017 and stratified them into the following two groups: the National Health Insurance (NHI) and MA groups. Then, we compared the two groups that differed in demographic characteristics, the treatment process and outcomes, and mortality based on health insurance type. Results Among 52,574 patients, the number of patients aged 65 years or older, hypertension was higher in the NHI group, but diabetes was higher in the MA group. Additionally, the MA group had more weekly dialysis sessions, and expensive drugs tended to be used less frequently. Regarding treatment outcomes, including laboratory test results, the MA group achieved significantly lower goals than the NHI group (p < 0.001). Furthermore, the mortality rate per 1,000 persons was 31 and 27 in the MA and NHI groups, respectively, and the mortality rate ratio was 1.2 (95% confidence interval [CI], 1.076-1.230). Moreover, the hazard ratio for mortality was 1.39 (95% CI, 1.30-1.49, p < 0.001) after adjusting for age, sex, causes of ESRD, and comorbidities. Conclusion There were significant differences in the treatment and mortality indicators between the groups. Therefore, policy support should be strengthened to provide better medical services to MA beneficiaries undergoing HD.
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Affiliation(s)
- Kyeong Min Kim
- Division of Nephrology, Department of Internal Medicine, Daejeon Eulji Medical Center, School of Medicine, Eulji University, Daejeon, Republic of Korea
| | - Soyoung Lee
- Division of Nephrology, Department of Internal Medicine, Daejeon Eulji Medical Center, School of Medicine, Eulji University, Daejeon, Republic of Korea
| | - Jong Ho Shin
- Division of Nephrology, Department of Internal Medicine, Daejeon Eulji Medical Center, School of Medicine, Eulji University, Daejeon, Republic of Korea
| | - Mira Park
- Department of Preventive Medicine, School of Medicine, Eulji University, Daejeon, Republic of Korea
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Changsirikulchai S, Sangthawan P, Janma J, Rajborirug S, Ingviya T. COVID-19 incidence and outcomes among patients with kidney replacement therapy. Kidney Res Clin Pract 2023; 42:649-659. [PMID: 37813525 PMCID: PMC10565457 DOI: 10.23876/j.krcp.22.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/03/2023] [Accepted: 02/20/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND We aimed to investigate the incidence, fatality, and associated factors in patients with hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KT) hospitalized for coronavirus disease 2019 (COVID-19) infection and reimbursed from the National Health Security Office (NHSO). METHODS The retrospective cohort analysis was conducted from an electronic-claimed database, and COVID-19 vaccination status was evaluated in patients with HD, PD, and KT from January 2020 to December 2021. There were 85,305 patients reimbursed for HD, PD, and KT by the NHSO. The rates of COVID-19 infection, COVID-19 vaccination, comorbidities, fatalities, and the cost of treatment were evaluated. RESULTS COVID-19 infection was observed in 1,799 of 36,982 HD cases (4.9%), 1,531 of 45,453 PD cases (3.4%), and 95 of 2,870 KT cases (3.3%). Patients receiving COVID-19 vaccinations were most common in the KT group, followed by those with HD and PD (76.93% vs. 70.65% vs. 51.34%, respectively). KT patients had a lower fatality rate compared to those with PD and HD (8.42% vs. 18.41% vs. 21.40%, respectively). Advanced age, diabetes, cardiovascular diseases, and COVID-19 vaccination status were associated with fatality. The adjusted odds ratios of fatality after receiving one or two doses of vaccines were 0.7 (95% confidence interval [CI], 0.6-0.9) and 0.3 (95% CI, 0.2-0.4), respectively. The cost of treatment was highest in patients with HD, followed by PD and KT. CONCLUSION The incidence of COVID-19 infection was higher in patients with HD than in those with PD or KT. COVID-19 vaccination following the national health policy should be encouraged for these patients to prevent fatality.
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Affiliation(s)
- Siribha Changsirikulchai
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Srinakharinwirot University, Nakhonnayok, Thailand
| | - Pornpen Sangthawan
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Jirayut Janma
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Srinakharinwirot University, Nakhonnayok, Thailand
| | - Songyos Rajborirug
- Department of Epidemiology, Faculty of Medicine, Prince of Songkhla University, Songkhla, Thailand
| | - Thammasin Ingviya
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Wang PH, Lin SY, Liou HH, Chen CC, Shu CC, Lee CY, Tsai MK, Yu CJ. Protective Effect of BCG and Neutrophil-to-Lymphocyte Ratio on Latent Tuberculosis in End Stage Renal Disease. Infect Dis Ther 2023:10.1007/s40121-023-00839-5. [PMID: 37410344 PMCID: PMC10390420 DOI: 10.1007/s40121-023-00839-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/21/2023] [Indexed: 07/07/2023] Open
Abstract
INTRODUCTION Bacillus Calmette-Guérin (BCG) vaccination has been reported to be protective against latent tuberculosis infection (LTBI) in the general population. The aim of this study was to investigate the protective effect of BCG vaccination against LTBI in adult patients with end-stage renal disease (ESRD) and renal transplants. METHODS Patients aged ≥ 20 years with ESRD who received hemodialysis (HD), peritoneal dialysis (PD) or kidney transplant were enrolled from January 2012 to December 2019 at a medical center and a regional hemodialysis center. Patients with active tuberculosis (TB), previously treated TB, active immunosuppressant therapy or human immunodeficiency virus infection were excluded. LTBI status was determined by QuantiFERON-TB Gold In-tube (QFT-GIT). RESULTS After the exclusion of indeterminate results of QFT-GIT, 517 participants were enrolled and 97 (18.8%) were identified as having LTBI. Participants with LTBI were older (55.1 ± 11.4 vs. 48.5 ± 14.6 years, p < 0.001) and had a significantly higher proportion receiving HD than those without LTBI (70.1% vs. 56.7%, p = 0.001). The percentage with BCG scars was higher in the non-LTBI group than in the LTBI group (94.8% vs. 81.4%, p < 0.001), whereas the neutrophil-to-lymphocyte ratio (NLR) (≥ 2.68) was significantly higher in the LTBI group (62.8% vs. 45.5%, p = 0.02). By multivariate logistic regression analysis, presence of BCG scar and high NLR were independent protective factors against LTBI [adjusted OR: 0.19 (0.063-0.58, p = 0.001) and 0.50 (0.28-0.89, p = 0.02)]. CONCLUSION The prevalence of LTBI was as high as 18.8% in patients with end-stage kidney disease or kidney transplant. BCG vaccination and high NLR might have protective effects against LTBI in patients with renal failure or transplant.
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Affiliation(s)
- Ping-Huai Wang
- Division of Thoracic Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shu-Yung Lin
- Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung Shan South Road, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hung-Hsiang Liou
- Division of Nephrology, Department of Internal Medicine, Hsin-Jen Hospital, New Taipei City, Taiwan
| | - Chien-Chia Chen
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Surgery, National Taiwan University Hospital, No 7, Chung Shan South Road, Taipei, Taiwan
| | - Chin-Chung Shu
- Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung Shan South Road, Taipei, Taiwan.
- College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Chih-Yuan Lee
- College of Medicine, National Taiwan University, Taipei, Taiwan.
- Department of Surgery, National Taiwan University Hospital, No 7, Chung Shan South Road, Taipei, Taiwan.
| | - Meng-Kun Tsai
- College of Medicine, National Taiwan University, Taipei, Taiwan
- National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Chong-Jen Yu
- College of Medicine, National Taiwan University, Taipei, Taiwan
- National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
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22
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Kim Y, Jeong T, Jang S. Validation of Basic Psychological Needs Scale in Terms of Autonomy and Competence. Iran J Public Health 2023; 52:1399-1409. [PMID: 37593501 PMCID: PMC10430402 DOI: 10.18502/ijph.v52i7.13241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/05/2023] [Indexed: 08/19/2023]
Abstract
Background Basic psychological needs affect intrinsic motivation. However, the relationship between selfcare behaviors and the basic psychological needs of patients undergoing renal dialysis has not been proven. We investigated the validity and reliability of the Basic Psychological Needs scale for patients undergoing renal dialysis. Methods At hospitals in Busan Metropolitan City, 120 patients with chronic renal failure receiving dialysis treatment were examined. The data were analyzed using SPSS 21.0 and AMOS 21.0 and criteria for positively affecting selfcare behaviors in these patients identified. The Basic Psychological Needs scale consists of two subfactors: autonomy and competence. Results The reliability of the 12 items of the scale based on Cronbach's α was 0.90; first factor autonomy was 0.90; second factor competence was 0.72; and there was homogeneity between the items. Conclusion Construct-, convergent-, discriminant-, criterion-related validity and internal consistency were verified. The scale was confirmed as a tool for measuring the basic psychological needs of patients undergoing renal dialysis.
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Affiliation(s)
- Yoonjung Kim
- Department of Nursing, Changshin University, Changwon, Korea
| | - Taikyeong Jeong
- School of Artificial Intelligence Convergence, Hallym University, Chuncheon, Korea
| | - Seyong Jang
- Department of Taekwondo, College of Arts and Physical Education, Gachon University, Seongnam, Korea
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23
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Choi H, Han S, Kim JS, Park B, Lee MJ, Shin GT, Kim H, Kim K, Park AY, Shin HJ, Park I. Antibody response to COVID-19 vaccination in patients on chronic hemodialysis. Clin Exp Vaccine Res 2023; 12:249-259. [PMID: 37599806 PMCID: PMC10435770 DOI: 10.7774/cevr.2023.12.3.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/23/2023] [Indexed: 08/22/2023] Open
Abstract
Purpose Since patients on hemodialysis (HD) are known to be vulnerable to coronavirus disease 2019 (COVID-19), many studies were conducted regarding the effectiveness of the COVID-19 vaccine in HD patients in Western countries. Here, we assessed antibody response of HD patients for 6 months post-vaccination to identify the duration and effectiveness of the COVID-19 vaccine in the Asian population. Materials and Methods We compared antibody response of the COVID-19 vaccine in HD patients with healthy volunteers. Patient and control groups had two doses of ChAdOx1 nCoV-19 and mRNA-1273, respectively. Immunoglobulin G (IgG) was measured before vaccination, 2 weeks after the first dose, 2 and 4 weeks, 3 and 6 months after the second dose. Neutralizing antibody was measured before vaccination and at 2 weeks, 3 and 6 months after second dose. Since the third dose was started in the middle of the study, we analyzed the effect of the third dose as well. Results Although antibody production was weaker than the control group (n=22), the patient group (n=39) showed an increase in IgG and neutralizing antibody after two doses. And, 21/39 patients and 14/22 participants had a third dose (BNT162b2 or mRNA-1273 in the patient group, mRNA-1273 in the control group), and it did not affect antibody response in both group. Trend analysis showed IgG and neutralizing antibody did not decrease over time. Age, sex, and HD vintage did not affect antibody production in HD patients. Patients with higher body mass index displayed better seroresponse, while those on immunosuppressants showed poor seroresponse. Conclusion Two doses of vaccination led to significant antibody response in HD patients, and the antibody did not wane until 6 months.
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Affiliation(s)
- Heejung Choi
- Department of Nephrology, Ajou University School of Medicine, Suwon, Korea
| | - Sungdam Han
- Malgundam Internal Medicine Clinic, Suwon, Korea
| | - Ji Su Kim
- Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovation, Ajou University Medical Center, Suwon, Korea
| | - Bumhee Park
- Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovation, Ajou University Medical Center, Suwon, Korea
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Min-Jeong Lee
- Department of Nephrology, Ajou University School of Medicine, Suwon, Korea
| | - Gyu-Tae Shin
- Department of Nephrology, Ajou University School of Medicine, Suwon, Korea
| | - Heungsoo Kim
- Department of Nephrology, Ajou University School of Medicine, Suwon, Korea
| | - Kyongmin Kim
- Department of Microbiology, Ajou University School of Medicine, Suwon, Korea
| | - A-Young Park
- Department of Microbiology, Ajou University School of Medicine, Suwon, Korea
| | - Ho-Joon Shin
- Department of Microbiology, Ajou University School of Medicine, Suwon, Korea
- Department of Molecular Science and Technology, Ajou University School of Medicine, Suwon, Korea
| | - Inwhee Park
- Department of Nephrology, Ajou University School of Medicine, Suwon, Korea
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Jesus LADSD, Pinheiro BV, Lucinda LMF, de Oliveira GBGR, Haddad MFPD, Vidigal ABR, Maciel JM, Watanabe LD, Oliveira CC, Reboredo MM. Factors associated with postural balance in patients with end-stage renal disease on hemodialysis. Clin Biomech (Bristol, Avon) 2023; 107:106033. [PMID: 37352608 DOI: 10.1016/j.clinbiomech.2023.106033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 04/18/2023] [Accepted: 06/16/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Patients with end-stage renal disease on hemodialysis have postural balance impairments due to uremic syndrome and hemodialysis complications. This study evaluated the factors associated with postural balance in patients on hemodialysis. METHODS This cross-sectional study included patients on hemodialysis [n = 93, 62.0 (16.0) years]. Postural balance was evaluated using a force plate in a static position with eyes opened and eyes closed on a firm surface and with eyes opened on a foam surface to register the center of pressure path length. Physical function was assessed by isometric handgrip force, the 5-repetition sit-to-stand test, and gait speed. The level of physical activity and quality of life were evaluated by accelerometry and the 36-Item Short Form Health Survey, respectively. FINDINGS After adjustment for potential confounders, the multiple linear regression analysis showed that the presence of diabetes mellitus and neurological disease and gait speed were significantly associated with the center of pressure path length in the eyes opened test (R2 = 0.263; p < 0.001). The center of pressure path length in the eyes closed test was significantly associated with the presence of neurological disease (R2 = 0.177; p = 0.002). The center of pressure path length in the eyes opened on a foam surface test was significantly associated with the presence of diabetes mellitus (R2 = 0.223; p < 0.001). INTERPRETATION Poor postural balance was associated with the presence of diabetes mellitus and neurological disease and a slower gait speed in patients on hemodialysis.
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Affiliation(s)
| | - Bruno Valle Pinheiro
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Leda Marília Fonseca Lucinda
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; Barbacena School of Medicine, Barbacena, Minas Gerais, Brazil; Department of Morphology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | | | | | | | | | | | - Cristino Carneiro Oliveira
- Department of Physiotherapy, Federal University of Juiz de Fora - Governador Valadares, Governador Valadares, Minas Gerais, Brazil; School of Physical Education, Physical Therapy, and Occupational Therapy. Department of Physical Therapy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maycon Moura Reboredo
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil.
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25
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Hunter-Dickson M, Conway J. Calcinosis cutis of the thumb. Med J Aust 2023. [PMID: 37278167 DOI: 10.5694/mja2.51999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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26
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Gholian K, Hajian-Tilaki K, Akbari R. Modeling Factors Associated with Dialysis Adequacy Using Longitudinal Data Analysis: Generalized Estimating Equation Versus Quadratic Inference Function. J Res Health Sci 2023; 23:e00582. [PMID: 37571953 PMCID: PMC10422138 DOI: 10.34172/jrhs.2023.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/15/2023] [Accepted: 04/09/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND In hemodialysis patients, changes in dialysis adequacy (DA) are examined longitudinally. The aim of this study was to determine factors affecting DA using the generalized estimating equation (GEE) and to compare them with the quadratic inference function (QIF). STUDY DESIGN A longitudinal study. METHODS This longitudinal study examined the records of 153 end-stage renal disease (ESRD) patients. The longitudinal data on the DA and baseline demographic and clinical characteristics were obtained from patients' files. The GEE1, GEE2, and QIF models were fitted with different correlation structures, and then the best correlation structure was selected using the quasi-likelihood information criterion (QIC), Akaike information criterion (AIC), and Bayes information criterion (BIC) fitting criteria. RESULTS The majority of patients (59.5%) had unfavorable DA (KT/V<1.2). Women and patients<60 years had more favorable DA. In the GEE model, the coefficients of female gender (β=0.079, 95% confidence interval [CI]: 0.032, 0.062), age at starting dialysis (β=-0.002, 95% CI: -0.004, -0.0001), hypertension (HTN, β=-0.055, 95% CI: -0.007, -0.103), diabetes (β=-0.088,95% CI: -0.021, -0.155), dialysis duration (β=0.132, 95% CI: 0.085, 0.178), and weight (β=-0.004, 95% CI: -0.006, -0.003) demonstrated a significant relationship with DA. The three models resulted in a similar estimate of regression coefficients. The relative efficiencies of QIF versus GEE1, QIF versus GEE2, and GEE2 versus GEE1 were 1.175, 1.056, and 1.113, respectively. CONCLUSION DA is not optimal in most hemodialysis patients, and gender, age at the start of dialysis, HTN, diabetes, dialysis duration, and weight had a significant association with DA. The three different models yielded quite similar coefficient estimates, but the QIF model resulted more efficient than GEE1 and GEE2.
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Affiliation(s)
- Khadije Gholian
- Student Research Center, Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Karimollah Hajian-Tilaki
- Dept of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran
- Social Determinants Research Center, Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Roghayeh Akbari
- Dept of Internal Medicine, Ayatollah Rohani Hospital, Babol University of Medical Sciences, Babol, Iran
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27
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Kwong VWK, Au CWY, Law MC, Chow KM, Szeto CC, Li PKT. Home haemodialysis with a novel machine in a patient with end-stage kidney disease: first case report from Asia. Hong Kong Med J 2023. [PMID: 37169523 DOI: 10.12809/hkmj2210050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Affiliation(s)
- V W K Kwong
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - C W Y Au
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - M C Law
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - K M Chow
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - C C Szeto
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - P K T Li
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
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28
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Heindel P, Feliz JD, Fitzgibbon JJ, Rouanet E, Belkin M, Hentschel DM, Ozaki CK, Hussain MA. Comparative effectiveness of bovine carotid artery xenograft and polytetrafluoroethylene in hemodialysis access revision. J Vasc Access 2023:11297298231170654. [PMID: 37125779 DOI: 10.1177/11297298231170654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND When hemodialysis arteriovenous accesses fail, autogenous options are often limited. Non-autogenous conduit choices include bovine carotid artery xenografts (BCAG) and expanded polytetrafluoroethylene (PTFE), yet their comparative effectiveness in hemodialysis access revision remains largely unknown. METHODS A cohort study was performed from a prospectively collected institutional database from August 2010 to July 2021. All patients undergoing an arteriovenous access revision with either BCAG or PTFE were followed for up to 3 years from their index access revision. Revision was defined as graft placement to address a specific problem of an existing arteriovenous access while maintaining one or more of the key components of the original access (e.g. inflow, outflow, and cannulation zone). Outcomes were measured starting at the date of the index revision procedure. The primary outcome was loss of secondary patency at 3 years. Secondary outcomes included loss of post-intervention primary patency, rates of recurrent interventions, and 30-day complications. Pooled logistic regression was used to estimate inverse probability weighted marginal structural models for the time-to-event outcomes of interest. RESULTS A total of 159 patients were included in the study, and 58% received access revision with BCAG. Common indications for revision included worn out cannulation zones (32%), thrombosis (18%), outflow augmentation (16%), and inflow augmentation (13%). Estimated risk of secondary patency loss at 3 years was lower in the BCAG group (8.6%, 3.9-15.1) compared to the PTFE group (24.8%, 12.4-38.7). Patients receiving BCAG experienced a 60% decreased relative risk of secondary patency loss at 3 years (risk ratio 0.40, 0.14-0.86). Recurrent interventions occurred at similar rates in the BCAG and PTFE groups, with 1.86 (1.31-2.43) and 1.60 (1.07-2.14) interventions at 1 year, respectively (hazard ratio 1.22, 0.74-1.96). CONCLUSIONS Under the conditions of this contemporary cohort study, use of BCAG in upper extremity hemodialysis access revision decreased access abandonment when compared to PTFE.
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Affiliation(s)
- Patrick Heindel
- Department of Surgery, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - Jessica D Feliz
- Department of Surgery, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - James J Fitzgibbon
- Department of Surgery, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - Eva Rouanet
- Department of Surgery, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - Michael Belkin
- Department of Surgery, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - Dirk M Hentschel
- Department of Medicine, Division of Renal Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - C Keith Ozaki
- Department of Surgery, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - Mohamad A Hussain
- Department of Surgery, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
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Heindel P, Fitzgibbon JJ, Feliz JD, Hentschel DM, Burke SK, Al-Omran M, Bhatt DL, Belkin M, Ozaki CK, Hussain MA. Evaluating national guideline concordance of recurrent interventions after radiocephalic arteriovenous fistula creation. J Vasc Surg 2023; 77:1206-1215.e2. [PMID: 36567000 PMCID: PMC10038866 DOI: 10.1016/j.jvs.2022.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Radiocephalic arteriovenous fistulas have been historically perceived as requiring multiple follow-up procedural interventions to achieve maturation and maintain patency. Recent clinical practice guidelines from the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) emphasize a patient-centered hemodialysis access strategy with new maximum targets for intervention rates, potentially conflicting with concomitant recommendations to prioritize autogenous forearm hemodialysis access creation. The present descriptive study seeks to assess whether radiocephalic fistulas can meet the KDOQI guideline benchmarks for interventions following access creation, and to elucidate clinical and anatomic characteristics associated with the timing and frequency of interventions following radiocephalic arteriovenous fistula creation. METHODS Prospective patient-level data from the multicenter PATENCY-1 and PATENCY-2 randomized trials, which enrolled patients undergoing new radiocephalic arteriovenous fistula creation, was analyzed (ClinicalTrials.govNCT02110901 and NCT02414841). The primary outcome was the rate of interventions at 1 year postoperatively. Incidence rates were calculated, and time to surgical or endovascular intervention following fistula creation was modeled using recurrent event extensions of the Cox proportional hazards model. Confidence intervals at the 95% level were calculated using nonparametric bootstrapping. RESULTS The cohort consisted of 914 patients; mean age was 57 years (standard deviation, 13 years), and 22% were female. Median follow-up was 707 days (interquartile range, 447-1066 days). The incidence of interventions per person-year was 1.04 (95% confidence interval [CI], 0.95-1.13) overall; 1.10 (95% CI, 0.98-1.21) before fistula use, and 0.96 (95% CI, 0.82-1.11) after fistula use. The most common interventions overall were balloon angioplasty (54.9% of all interventions), venous side-branch ligation (16.4%), and open revisions (eg, proximalization from snuffbox to wrist, 16.4%). The locations requiring balloon angioplasty included the juxta-anastomotic segment (51.7% of angioplasties), the outflow vein (29.2%), the inflow artery (14.8%), the central veins (3.8%), and the cephalic arch (0.5%). Common indications were to restore or maintain patency (75.6% of all interventions), assist maturation (14.9%), improve depth (4.4%), or improve augmentation (3.0%). In the multivariable regression analysis, female sex (adjusted hazard ratio [HR], 1.21; 95% CI, 1.05-1.45), diabetes (HR, 1.21; 95% CI, 1.01-1.46), and intraoperative vein diameter <3.0 mm (vs ≥4.0 mm: HR, 1.33; 95% CI, 1.02-1.66) were associated with earlier and more frequent interventions. Patients not on hemodialysis at the time of fistula creation underwent less frequent interventions (HR, 0.69; 95% CI, 0.59-0.81). CONCLUSIONS Patients with radiocephalic arteriovenous fistulas can expect to undergo one intervention, on average, in the first year after creation, which aligns with current KDOQI guidelines. Patients already requiring hemodialysis, female patients, patients with diabetes, and patients with intraoperative vein diameters <3.0 mm were at increased risk for repeated intervention. No subgroup exceeded guideline-suggested maximum thresholds for recurrent interventions. Overall, the results demonstrate that creation of radiocephalic arteriovenous fistula remains a guideline-concordant strategy when part of an end-stage kidney disease life-plan in appropriately selected patients.
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Affiliation(s)
- Patrick Heindel
- Division of Vascular and Endovascular Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - James J Fitzgibbon
- Division of Vascular and Endovascular Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jessica D Feliz
- Division of Vascular and Endovascular Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Dirk M Hentschel
- Department of Medicine, Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Mohammed Al-Omran
- Division of Vascular Surgery and Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, NY
| | - Michael Belkin
- Division of Vascular and Endovascular Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - C Keith Ozaki
- Division of Vascular and Endovascular Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Mohamad A Hussain
- Division of Vascular and Endovascular Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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van Vliet LV, Zonnebeld N, Bouwman LH, Cuypers PW, Huisman LC, Lemson S, Schlösser FJ, de Smet AA, Toorop RJ, Snoeijs MG. Editor's Choice - Interventions to Achieve Functionality in Newly Created Arteriovenous Fistulas in the Shunt Simulation Study Cohort. Eur J Vasc Endovasc Surg 2023; 65:555-562. [PMID: 36646270 DOI: 10.1016/j.ejvs.2023.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/06/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Although observational cohort studies report that interventions to achieve functionality are clinically successful in 85% of patients, the proportion of newly created autologous arteriovenous fistulas that result in functional vascular access typically is only 70 - 80%. To address this discrepancy, the selection and outcomes of interventions to achieve functionality in a multicentre prospective cohort study were analysed. METHODS The Shunt Simulation Study enrolled 222 patients who needed a first arteriovenous fistula in nine dialysis units in The Netherlands from 2015 to 2018 and followed these patients until one year after access creation. In this observational study, the technical and clinical success rates of interventions to achieve functionality based on lesion and intervention characteristics were analysed and the clinical outcomes of arteriovenous fistulas with assisted and unassisted functionality were compared. RESULTS For patients who were on dialysis treatment at the end of the study, unassisted fistula functionality was 54% and overall fistula functionality was 78%. Thirty-four per cent of arteriovenous fistulas required an intervention to achieve functionality, 68% of which eventually became functional. Seventy-five per cent of these interventions were percutaneous balloon angioplasties of vascular access stenoses. Patients with clinically successful interventions to achieve functionality had larger pre-operative vein diameters (2.8 ± 1.0 mm vs. 2.3 ± 0.6 mm, p = .036) and less often presented with thrombosed fistulas than patients with unsuccessful interventions (7% vs. 43%, p = .006). Arteriovenous fistulas with assisted functionality had similar secondary patency as fistulas with unassisted functionality (100% and 98% at six months, p = .44), although they required more interventions to maintain function (2.6 vs. 1.7 per year; rate ratio 1.52, 95% CI 1.04 - 2.18, p = .032). CONCLUSION Interventions to achieve functionality were needed in about a third of newly created arteriovenous fistulas. Most thrombosed fistulas were abandoned, and when selected for thrombectomy rarely reached clinical success. On the other hand, interventions to achieve functionality of patent fistulas had high clinical success rates and therefore can be done repeatedly until the fistula has become functional.
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Affiliation(s)
- Letty V van Vliet
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands; Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands.
| | - Niek Zonnebeld
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands; Department of Surgery, Zuyderland Medical Centre, Heerlen, the Netherlands
| | - Lee H Bouwman
- Department of Surgery, Zuyderland Medical Centre, Heerlen, the Netherlands
| | | | | | - Susan Lemson
- Department of Surgery, Slingeland Hospital, Doetinchem, the Netherlands
| | - Felix J Schlösser
- Department of Surgery, Laurentius Hospital, Roermond, the Netherlands
| | - André A de Smet
- Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | - Raechel J Toorop
- Department of Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Maarten G Snoeijs
- Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
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Le Leu R, Bennett PN, Dansie K, Shanahan L, Chur-Hansen A, Collins KL, Burke ALJ, Donnelly F, Duncanson E, Meade A, McDonald S, Jesudason S. Changes in symptom burden in the first 6 months after dialysis commencement: a prospective longitudinal observational cohort study. J Nephrol 2023:10.1007/s40620-023-01603-1. [PMID: 37000370 DOI: 10.1007/s40620-023-01603-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/12/2023] [Indexed: 04/01/2023]
Affiliation(s)
- Richard Le Leu
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, 1 Port Rd, Adelaide, SA, 5000, Australia.
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, 5000, Australia.
| | - Paul N Bennett
- University of South Australia, Clinical and Health Sciences, Adelaide, SA, Australia
| | - Kathryn Dansie
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia
| | - Lisa Shanahan
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, 1 Port Rd, Adelaide, SA, 5000, Australia
| | - Anna Chur-Hansen
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Kathryn L Collins
- Psychology Department, Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Anne L J Burke
- Psychology Department, Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Fiona Donnelly
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, 1 Port Rd, Adelaide, SA, 5000, Australia
| | - Emily Duncanson
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia
| | - Anthony Meade
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, 1 Port Rd, Adelaide, SA, 5000, Australia
| | - Stephen McDonald
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, 1 Port Rd, Adelaide, SA, 5000, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, 5000, Australia
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia
| | - Shilpanjali Jesudason
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, 1 Port Rd, Adelaide, SA, 5000, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, 5000, Australia
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Park HC, Kim DH, Cho A, Kwon YE, Ryu DR, Kim J, Yang KH, Shin JH, Son EJ, Lee YK. Dialysis specialist care and patient survival in hemodialysis facilities: a Korean nationwide cohort study. Kidney Res Clin Pract 2023:j.krcp.22.103. [PMID: 37098673 DOI: 10.23876/j.krcp.22.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/11/2022] [Indexed: 04/27/2023] Open
Abstract
Background It is important for the dialysis specialist to provide essential and safe care to hemodialysis (HD) patients. However, little is known about the actual effect of dialysis specialist care on the survival of HD patients. We therefore investigated the influence of dialysis specialist care on patient mortality in a nationwide Korean dialysis cohort. Methods We used an HD quality assessment and National Health Insurance Service claims data from October to December 2015. A total of 34,408 patients were divided into two groups according to the proportion of dialysis specialists in their HD unit, as follows: 0%, no dialysis specialist care group, and ≥50%, dialysis specialist care group. We analyzed the mortality risk of these groups using the Cox proportional hazards model after matching propensity scores. Results After propensity score matching, 18,344 patients were enrolled. The ratio of patients from the groups with and without dialysis specialist care was 86.7% to 13.3%. The dialysis specialist care group showed a shorter dialysis vintage, higher levels of hemoglobin, higher single-pool Kt/V values, lower levels of phosphorus, and lower systolic and diastolic blood pressures than the no dialysis specialist care group. After adjusting demographic and clinical parameters, the absence of dialysis specialist care was a significant independent risk factor for all-cause mortality (hazard ratio, 1.10; 95% confidence interval, 1.03-1.18; p = 0.004). Conclusion Dialysis specialist care is an important determinant of overall patient survival among HD patients. Appropriate care given by dialysis specialists may improve clinical outcomes of patients undergoing HD.
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Affiliation(s)
- Hayne Cho Park
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
- Hallym University Kidney Research Institute, Seoul, Republic of Korea
| | - Do Hyoung Kim
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
- Hallym University Kidney Research Institute, Seoul, Republic of Korea
| | - Ajin Cho
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
- Hallym University Kidney Research Institute, Seoul, Republic of Korea
| | - Young Eun Kwon
- Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Dong-Ryeol Ryu
- Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Jinseog Kim
- Department of Bigdata and Applied Statistics, Dongguk University, Gyeongju, Republic of Korea
| | - Ki Hwa Yang
- Healthcare Review and Assessment Committee, Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Ji Hyeon Shin
- Department of Quality Assessment Administration, Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Eun Jung Son
- Department of Quality Assessment, Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Young-Ki Lee
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
- Hallym University Kidney Research Institute, Seoul, Republic of Korea
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Fitzgibbon JJ, Heindel P, Feliz JD, Rouanet E, Wu W, Huynh C, Hentschel DM, Belkin M, Ozaki CK, Hussain MA. Staged autogenous to prosthetic hemodialysis access creation strategy to maximize forearm options. J Vasc Surg 2023; 77:1788-1796. [PMID: 36791894 DOI: 10.1016/j.jvs.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 02/02/2023] [Accepted: 02/04/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVE When an adequate cephalic vein is not available for fistula construction, surgeons often turn to basilic vein or prosthetic constructions. Single-stage forearm prosthetic hemodialysis accesses are associated with poor durability, and upper arm non-autogenous access options are often limited by axillary outflow failure, which inevitably drives transition to the contralateral arm or lower extremity. We hypothesized that initial creation of a modest flow proximal forearm arterial-venous anastomosis to dilate ("develop") inflow and outflow vessels, followed by a planned second-stage procedure to create a cannulation zone with a prosthetic graft in the forearm, would result in reliable and durable hemodialysis access in patients with limited options. METHODS We performed an institutional cohort study from 2017 to 2021 using a prospectively maintained database supplemented with adjudicated chart review. Patients without traditional autogenous hemodialysis access options in the forearm underwent an initial non-wrist arterial-venous anastomosis creation in the forearm as a first stage, followed by a second-stage interposition graft sewn to the existing inflow and venous outflow segments to create a useable cannulation zone in the forearm while leveraging vascular development. Outcomes included time from second-stage access creation to loss of primary and secondary patency, frequency of subsequent interventions, and perioperative complications. RESULTS The cohort included 23 patients; first-stage radial artery-based (74%) configurations were more common than brachial artery-based (26%). Mean age was 63 years (standard deviation, 14 years), and 65% were female. Median follow-up was 340 days (interquartile range [IQR], 169-701 days). Median time to cannulation from second-stage procedure was 28 days (IQR, 18-53 days). Primary, primary assisted, and secondary patency at 1 year was 16.7% (95% confidence interval [CI], 5.3%-45.8%), 34.6% (95% CI, 15.2%-66.2%), and 95.7% (95% CI, 81.3%-99.7%), respectively. Subsequent interventions occurred at a rate of 3.02 (IQR, 1.0-4.97) per person-year, with endovascular thrombectomy with or without angioplasty/stenting (70.9%) being the most common. There were no cases of steal syndrome. Infection occurred in two cases and were managed with antibiotics alone. CONCLUSIONS For patients without adequate distal autogenous access options, staged prosthetic graft placement in the forearm offers few short-term complications and excellent durability with active surveillance while strategically preserving the upper arm for future constructions.
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Affiliation(s)
- James J Fitzgibbon
- Division of Vascular and Endovascular Surgery, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Patrick Heindel
- Division of Vascular and Endovascular Surgery, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Jessica D Feliz
- Division of Vascular and Endovascular Surgery, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Eva Rouanet
- Division of Vascular and Endovascular Surgery, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Winona Wu
- Division of Vascular and Endovascular Surgery at Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA
| | - Cindy Huynh
- Division of Vascular and Endovascular Surgery, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Dirk M Hentschel
- Division of Renal Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Michael Belkin
- Division of Vascular and Endovascular Surgery, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - C Keith Ozaki
- Division of Vascular and Endovascular Surgery, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Mohamad A Hussain
- Division of Vascular and Endovascular Surgery, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA.
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Tebib N, Tebib N, Paredes M, Castro R, Baggio S, Torrico MV, Leon AAF, Zamorano MH, Chappuis F, Getaz L. Prevalence and risk factors of Strongyloides stercoralis in haemodialysis in Cochabamba, Bolivia: a cross-sectional study. BMC Nephrol 2023; 24:27. [PMID: 36750775 PMCID: PMC9903486 DOI: 10.1186/s12882-023-03074-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 01/31/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Strongyloidiasis is an infectious disease that can be fatal in immunocompromised patients. Patients with end-stage renal failure who are on dialysis have a considerably weakened immune system, and organ transplantation is a major risk factor for severe strongyloidiasis. Knowledge of the local epidemiology in tropical and subtropical areas is an essential prerequisite for designing an appropriate strategy to prevent this potentially lethal complication. In this study, we aimed to estimate the prevalence and associated risk factors of S. stercoralis infection in patients on dialysis in Cochabamba, Bolivia. METHODS A cross-sectional study was carried out among patients undergoing haemodialysis in Cochabamba (elevation 2,500 m, temperate climate), collecting information on socio-demographic, lifestyle, and clinical variables, and using one coproparasitological technique (the modified Baermann technique) and one serological (ELISA) test for S.stercoralis diagnosis. RESULTS In total, 149 patients participated in the study (mean age = 51.4 years, 48.3% male). End-stage renal disease was predominantly (59%) of hypertensive and/or diabetic origin. The positive serological prevalence was 18.8% (95% CI: 13.3%-25.9%). Based on the sensitivity and specificity of the ELISA test, the estimate of the actual prevalence was 15.1% (95% CI: 9.4%-20.7%). Stool samples of 105 patients (70.5%) showed a coproparasitological prevalence of 1.9% (95% CI: 0.52%-6.68%). No potential risk factors were significantly associated with S. stercoralis infection. CONCLUSIONS We found a high seroprevalence of S. stercoralis in Bolivian patients undergoing haemodialysis in Cochabamba. We recommend presumptive antiparasitic treatment at regular intervals to avoid the potentially fatal complications of severe strongyloidiasis.
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Affiliation(s)
- Nicolas Tebib
- grid.492936.30000 0001 0144 5368Intensive Care Unit, Centre Hospitalier de Bienne, Bienne, Switzerland
| | - Nathalie Tebib
- grid.492936.30000 0001 0144 5368Division of Internal Medicine, Centre Hospitalier de Bienne, Bienne, Switzerland
| | - Mauricio Paredes
- Centro de Hemodiálisis de La Media Luna Roja de Irán, Cochabamba, Bolivia
| | - Rosario Castro
- Division of Infectious Diseases, Hospital Clınico VIEDMA, Cochabamba, Bolivia
| | - Stéphanie Baggio
- grid.150338.c0000 0001 0721 9812Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland ,grid.5734.50000 0001 0726 5157Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | | | | | | | - Francois Chappuis
- grid.150338.c0000 0001 0721 9812Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Laurent Getaz
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland. .,Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
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Sabouri F, Rambod M, Khademian Z. The effect of positive thinking training on hope and adherence to treatment in hemodialysis patients: a randomized controlled trial. BMC Psychol 2023; 11:6. [PMID: 36624540 PMCID: PMC9830796 DOI: 10.1186/s40359-023-01036-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Patients undergoing hemodialysis are exposed to psychological problems, such as despair, which in turn can be a trigger for them to abandon the treatment process. This study aimed to determine the effect of positive thinking training on hope and adherence to treatment in hemodialysis patients. METHODS This randomized controlled trial was performed on 80 hemodialysis patients referred to two hemodialysis centers in Shiraz, Iran. They were randomly divided into an intervention and a control group. Eight sessions of positive thinking skills training carried out individually on the patients' bedsides. The primary and secondary outcomes were hope and adherence to treatment, respectively. The data were collected using Snyder Hope Questionnaire, End-Stage Renal Disease Adherence Questionnaire, laboratory tests, and weight measurements. Data were analyzed by Chi-square and Paired and Independent T-test using SPSS software version 18. RESULTS After the intervention, the mean score of hope was significantly higher in the intervention group (42.1 ± 6.1) than in the control group (38.7 ± 6.5) (p = 0.024). Moreover, after the intervention, the mean score of adherence to treatment was significantly higher in the intervention group (1070.2 ± 80.1) compared to the control group (1018.4 ± 105.3) (p = 0.019). In addition, blood urea nitrogen, phosphate and inter-dialytic weight gain were lower in the intervention group compared to the control group after the intervention. CONCLUSIONS The findings showed that positive thinking interventions could lead to improvement in hope and adherence to treatment in hemodialysis patients. Positive thinking training could be used in caring of hemodialysis patients to improve their hope and adherence to treatment. Trial registration RCT Registry: Iranian Registry of Clinical Trials; RCT registration number: IRCT20180915041044N1; Registration date: 19/12/2018.
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Affiliation(s)
- Fatemeh Sabouri
- grid.412571.40000 0000 8819 4698Student Research Committee, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoume Rambod
- grid.412571.40000 0000 8819 4698Department of Nursing, Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Khademian
- grid.412571.40000 0000 8819 4698Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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Francisco DDS, Peruzzolo CC, Moecke DP, Yamaguti WP, Kunzler DH, Paulin E. Influence of mild pulmonary congestion on diaphragmatic mobility and activities of daily living in chronic kidney disease: An experimental and clinical study. Nefrologia 2023; 43:81-90. [PMID: 36494284 DOI: 10.1016/j.nefroe.2022.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 12/01/2021] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Pulmonary congestion is a strong predictor of mortality and cardiovascular events in chronic kidney disease (CKD); however, the effects of the mild form on functionality have not yet been investigated. The objective of this study was to assess the influence of mild pulmonary congestion on diaphragmatic mobility (DM) and activities of daily living (ADL) in hemodialysis (HD) subjects, as well as compare ADL behavior on dialysis and non-dialysis days. In parallel, experimentally induce CKD in mice and analyze the resulting pulmonary and functional repercussions. METHODS Thirty subjects in HD underwent thoracic and abdominal ultrasonography, anthropometric assessment, lung and kidney function, respiratory muscle strength assessment and symptoms analysis. To measure ADL a triaxial accelerometer was used over seven consecutive days. Twenty male mice were randomized in Control and CKD group. Thoracic ultrasonography, TNF-α analysis in kidney and lung tissue, exploratory behavior and functionality assessments were performed. RESULTS Mild pulmonary congestion caused a 26.1% decline in DM (R2=.261; P=.004) and 20% reduction in walking time (R2=.200; P=.01), indicating decreases of 2.23mm and 1.54min, respectively, for every unit increase in lung comet-tails. Regarding ADL, subjects exhibited statistically significant differences for standing (P=.002), walking (P=.034) and active time (P=.002), and number of steps taken (P=.01) on days with and without HD. In the experimental model, CKD resulted in increased levels of TNF-α on kidneys (P=.037) and lungs (P=.02), attenuation of exploratory behavior (P=.01) and significant decrease in traveled distance (P=.034). Thoracic ultrasonography of CKD mice showed presence of B-lines. CONCLUSION The mild pulmonary congestion reduced DM and walking time in subjects undergoing HD. Individuals were less active on dialysis days. Furthermore, the experimental model implies that the presence of pulmonary congestion and inflammation may play a decisive role in the low physical and exploratory performance of CKD mice.
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Affiliation(s)
| | | | | | | | | | - Elaine Paulin
- Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil.
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Kaufman HW, Wang C, Wang Y, Han H, Chaudhuri S, Usvyat L, Hahn Contino C, Kossmann R, Kraus MA. Machine Learning Case Study: Patterns of Kidney Function Decline and Their Association With Clinical Outcomes Within 90 Days After the Initiation of Renal Dialysis. Adv Kidney Dis Health 2023; 30:33-39. [PMID: 36723279 DOI: 10.1053/j.akdh.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 10/28/2022] [Accepted: 11/16/2022] [Indexed: 01/20/2023]
Abstract
A case study explores patterns of kidney function decline using unsupervised learning methods first and then associating patterns with clinical outcomes using supervised learning methods. Predicting short-term risk of hospitalization and death prior to renal dialysis initiation may help target high-risk patients for more aggressive management. This study combined clinical data from patients presenting for renal dialysis at Fresenius Medical Care with laboratory data from Quest Diagnostics to identify disease trajectory patterns associated with the 90-day risk of hospitalization and death after beginning renal dialysis. Patients were clustered into 4 groups with varying rates of estimated glomerular filtration rate (eGFR) decline during the 2-year period prior to dialysis. Overall rates of hospitalization and death were 24.9% (582/2341) and 4.6% (108/2341), respectively. Groups with the steepest declines had the highest rates of hospitalization and death within 90 days of dialysis initiation. The rate of eGFR decline is a valuable and readily available tool to stratify short-term (90 days) risk of hospitalization and death after the initiation of renal dialysis. More intense approaches are needed that apply models that identify high risks to potentially avert or reduce short-term hospitalization and death of patients with a severe and rapidly progressive chronic kidney disease.
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Affiliation(s)
| | - Catherine Wang
- Statistics and Data Science, Dietrich College of Humanities and Social Sciences, Carnegie Mellon University, Pittsburgh, PA
| | - Yuedong Wang
- Department of Statistics and Applied Probability, College of Letters and Science, University of California - Santa Barbara, Santa Barbara, CA
| | - Hao Han
- Fresenius Medical Care, Waltham, MA
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Park HC, Choi HY, Kim DH, Cho AJ, Kwon YE, Ryu DR, Yang KH, Won ,EM, Shin JH, Kim J, Lee YK. Hemodialysis facility star rating affects mortality in chronic hemodialysis patients: a longitudinal observational cohort study. Kidney Res Clin Pract 2023; 42:109-116. [PMID: 36328993 PMCID: PMC9902734 DOI: 10.23876/j.krcp.22.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/16/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Many countries have their own hemodialysis (HD) quality assurance programs and star rating systems for HD facilities. However, the effects of HD quality assurance programs on patient mortality are not well understood. Therefore, in the present study, the effects of the Korean HD facility star rating on patient mortality in maintenance HD patients were evaluated. METHODS This longitudinal, observational cohort study included 35,271 patients receiving HD treatment from 741 facilities. The fivestar ratings of HD facilities were determined based on HD quality assessment data from 2015, which includes 12 quality measures in structural, procedural, and outcome domains. The patients were grouped into high (three to five stars) and low (one or two stars) groups based on HD facility star rating. Cox proportional hazards model was used to evaluate the effects of star rating on patient mortality during the mean follow-up duration of 3 years. RESULTS The patient ratio between high and low HD facility star rating groups was 82.0% vs. 18.0%. The patients in the low star rating group showed lower single-pool Kt/V and higher calcium and phosphorus levels compared with subjects in the high star rating group. After adjusting for sociodemographic and clinical parameters, the HD facility star rating independently increased the mortality risk (hazard ratio, 1.11; 95% confidence interval, 1.04-1.18; p = 0.002). CONCLUSION The HD facilities with low star rating showed higher patient mortality.
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Affiliation(s)
- Hayne Cho Park
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea,Kidney Research Institute, Hallym University, Seoul, Republic of Korea
| | | | - Do Hyoung Kim
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea,Kidney Research Institute, Hallym University, Seoul, Republic of Korea
| | - AJin Cho
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea,Kidney Research Institute, Hallym University, Seoul, Republic of Korea
| | - Young Eun Kwon
- Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Dong-Ryeol Ryu
- Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Ki Hwa Yang
- Healthcare Review and Assessment Committee, Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - , Eun Mi Won
- Division of Chronic Disease Assessment, Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Ji Hyeon Shin
- Division of Quality Assessment Management, Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Jinseog Kim
- Department of Big Data and Applied Statistics, College of Science and Technology, Dongguk University, Gyeongju, Republic of Korea
| | - Young-Ki Lee
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea,Kidney Research Institute, Hallym University, Seoul, Republic of Korea,Correspondence: Young-Ki Lee Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea. E-mail:
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Shibata K, Shinzato T, Toma S, Nakai S, Kobayashi Y, Hashimoto T, Tamura K. Novel Capped-Needle Device: A Novel Safety Feature to Eliminate Air Bubbles in Hemodialysis. Blood Purif 2023; 52:54-59. [PMID: 35468597 PMCID: PMC9909616 DOI: 10.1159/000524357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 03/25/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Air bubbles in the dialysis circuit are rarely visible after automatic priming; however, they are often visible after the needles are manually connected to the circuit. To prevent this issue, we thought to prime needles with a circuit at automatic priming by the hemodialysis machine. In order to achieve this idea, we designed and manufactured a novel capped needle to connect the needles to the extracorporeal circuit before the automatic priming of the hemodialysis machine. This study investigated the effectiveness of this novel capped needle and compared it with the conventional method for preventing air bubble contamination. METHODS We tested novel capped needles ten times to evaluate whether the dialysis machine works appropriately and removes air bubbles even with the attached capped needle. Next, we performed 25 trials using the conventional method, in which skilled nurses manually connect the needle. In both methods, we thoroughly counted the air bubbles with our naked eyes. We predicted that the capped needle would leave few bubbles in the circuit. In order to evaluate fewer bubbles, we conducted an additional experiment using a microparticle counter to measure the size and number of the bubbles. RESULTS We thoroughly searched for air bubbles during each of the ten tests but could not find any bubbles visible to the naked eye. In the conventional method, bubbles were visible in 29 out of 50 cases. The bubble count was significantly lower in the capped-needle method than in the conventional method (p < 0.0001, Pearson's χ2 test). In the additional experiments using the microparticle counter, the average remaining air volume in the extracorporeal circuit was 0.0999 ± 0.2438 nL when the priming was performed using the novel capped needles. CONCLUSION The novel capped needle eliminated all visible bubbles efficiently and effectively; therefore, it could be a valuable device for hemodialysis treatment. The reduction of air from the dialysis circuit may improve patient prognosis.
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Affiliation(s)
| | | | | | - Shigeru Nakai
- Faculty of Clinical Engineering Technology, Fujita Health University School of Health Sciences, Toyoake City, Japan
| | - Yusuke Kobayashi
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Hospital, Yokohama City, Japan
| | - Tatsuo Hashimoto
- Graduate School of Dentistry, Kanagawa Dental University, Yokosuka City, Japan
| | - Koichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Hospital, Yokohama City, Japan
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Coscas R, Petrica N, Massy Z, Jayet J, De Launay J. Readmissions Following Arteriovenous Access Creation for Haemodialysis in a French National Database. Eur J Vasc Endovasc Surg 2022; 64:703-710. [PMID: 35988860 DOI: 10.1016/j.ejvs.2022.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/08/2022] [Accepted: 08/08/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE There is a lack of large real world data on arteriovenous (AV) access results. This study aimed to describe the required hospital care during the first year following creation of AV access. METHODS Data from all adult patients who underwent creation of AV access performed in 2017 in a public or private facility were collected through the French national hospitalisation database. Patients were classified into two groups ("de novo" and "secondary") according to their history of prior AV access creation. The primary outcome was the proportion of patients with at least one hospital readmission related to the AV access recorded during the first 12 post-operative months. RESULTS In 2017, 10 476 adult patients underwent AV access creation in France, including 8 690 (83%) de novo creations. An AV fistula was created for 92% of the patients (95% de novo vs. 78% secondary; p < .001). During the first 12 post-operative months, 6 591 (63%) patients recorded at least one related readmission (68% secondary vs. 62% de novo; p < .001). A total of 5 557 (53%) recorded a readmission for surgical/interventional procedure and 2 852 (27%) were observed with a readmission for medical complications. The mean (± standard deviation) number of related readmissions at 12 months was 1.4 ± 1.6 per patient (1.7 ± 1.9 secondary vs. 1.3 ± 1.5 de novo; p < .001). Patients with an AV graft were more frequently readmitted than those with an AV fistula (1.8 ± 2 vs. 1.3 ± 1.5 readmission; p < .001). CONCLUSION This study highlights the high frequency of readmissions during the first 12 months following creation of AV access, particularly in patients who had already undergone creation of a previous AV access or had an AV graft implanted. Further research should focus on tailoring AV access strategies to improve patient quality of life and decrease the healthcare cost burden.
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Affiliation(s)
- Raphael Coscas
- Department of Vascular Surgery, CHU Ambroise Paré, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Centre for Research in Epidemiology and Population Health (CESP), Inserm UMRS 1018, team 5, France; University Versailles-Saint Quentin, University Paris-Saclay, Villejuif, France.
| | | | - Ziad Massy
- Centre for Research in Epidemiology and Population Health (CESP), Inserm UMRS 1018, team 5, France; University Versailles-Saint Quentin, University Paris-Saclay, Villejuif, France; Department of Nephrology, CHU Ambroise Paré, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Jérémie Jayet
- Department of Vascular Surgery, CHU Ambroise Paré, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Centre for Research in Epidemiology and Population Health (CESP), Inserm UMRS 1018, team 5, France; University Versailles-Saint Quentin, University Paris-Saclay, Villejuif, France
| | - Jérôme De Launay
- Becton, Dickinson and Company - BD Interventional, Health Economics Department, Voisins-le-Bretonneux, France
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Greeviroj P, Lertussavavivat T, Thongsricome T, Takkavatakarn K, Phannajit J, Avihingsanon Y, Praditpornsilpa K, Eiam-Ong S, Susantitaphong P. The world prevalence, associated risk factors and mortality of hepatitis C virus infection in hemodialysis patients: a meta-analysis. J Nephrol 2022; 35:2269-82. [PMID: 36383211 DOI: 10.1007/s40620-022-01483-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 10/01/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The worldwide burden of HCV infection among hemodialysis patients has not been systematically examined. METHODS A systematic literature search was conducted in MEDLINE and Scopus to determine the worldwide prevalence of HCV infection, risk factors, and clinical outcomes among hemodialysis patients. Random-effect models and meta-regressions were used to generate pooled estimates and assess heterogeneity. RESULTS Four hundred and seven studies with 1,302,167 participants were analyzed. The pooled prevalence of HCV infection was 21%. The highest prevalence was observed in Africa (28%) and low-income countries (48.5%). A significant prevalence decline was observed following the publication year and was also inversely related to GDP and total population of each country. Factors associated with HCV positivity included younger age, longer dialysis duration, more blood transfusions, and dialyzer reuse. The pooled unadjusted hazard ratio for all-cause mortality was 1.12 (95% CI 1.03-1.22), and the adjusted hazard ratio was 1.21 (95% CI 1.12-1.30) in HCV-infected compared to non-HCV infected patients. CONCLUSIONS HCV infection among hemodialysis patients is a worldwide shared burden and is associated with a higher risk of death. Avoiding unnecessary blood transfusion and dialyzer reuse should be encouraged to prevent HCV transmission in hemodialysis units.
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Park JH, Park I, Han K, Yoon J, Sim Y, Kim SJ, Won JY, Lee S, Kwon JH, Moon S, Kim GM, Kim MD. Feasibility of Deep Learning-Based Analysis of Auscultation for Screening Significant Stenosis of Native Arteriovenous Fistula for Hemodialysis Requiring Angioplasty. Korean J Radiol 2022; 23:949-958. [PMID: 36174999 PMCID: PMC9523235 DOI: 10.3348/kjr.2022.0364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/05/2022] [Accepted: 08/05/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the feasibility of using a deep learning-based analysis of auscultation data to predict significant stenosis of arteriovenous fistulas (AVF) in patients undergoing hemodialysis requiring percutaneous transluminal angioplasty (PTA). MATERIALS AND METHODS Forty patients (24 male and 16 female; median age, 62.5 years) with dysfunctional native AVF were prospectively recruited. Digital sounds from the AVF shunt were recorded using a wireless electronic stethoscope before (pre-PTA) and after PTA (post-PTA), and the audio files were subsequently converted to mel spectrograms, which were used to construct various deep convolutional neural network (DCNN) models (DenseNet201, EfficientNetB5, and ResNet50). The performance of these models for diagnosing ≥ 50% AVF stenosis was assessed and compared. The ground truth for the presence of ≥ 50% AVF stenosis was obtained using digital subtraction angiography. Gradient-weighted class activation mapping (Grad-CAM) was used to produce visual explanations for DCNN model decisions. RESULTS Eighty audio files were obtained from the 40 recruited patients and pooled for the study. Mel spectrograms of "pre-PTA" shunt sounds showed patterns corresponding to abnormal high-pitched bruits with systolic accentuation observed in patients with stenotic AVF. The ResNet50 and EfficientNetB5 models yielded an area under the receiver operating characteristic curve of 0.99 and 0.98, respectively, at optimized epochs for predicting ≥ 50% AVF stenosis. However, Grad-CAM heatmaps revealed that only ResNet50 highlighted areas relevant to AVF stenosis in the mel spectrogram. CONCLUSION Mel spectrogram-based DCNN models, particularly ResNet50, successfully predicted the presence of significant AVF stenosis requiring PTA in this feasibility study and may potentially be used in AVF surveillance.
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Affiliation(s)
- Jae Hyon Park
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Insun Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kichang Han
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea.
| | - Jongjin Yoon
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Yongsik Sim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Jin Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Yun Won
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Shina Lee
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Joon Ho Kwon
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Sungmo Moon
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Gyoung Min Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Man-Deuk Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
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Nogueira GM, Silva NLOR, Moura AF, Duarte Silveira MA, Moura-Neto JA. Acute kidney injury and electrolyte disorders in COVID-19. World J Virol 2022; 11:283-292. [PMID: 36188735 PMCID: PMC9523327 DOI: 10.5501/wjv.v11.i5.283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/30/2022] [Accepted: 08/22/2022] [Indexed: 02/05/2023] Open
Abstract
Acute kidney injury (AKI) and electrolyte disorders are important complications of hospitalized coronavirus disease 2019 (COVID-19) patients. AKI is thought to occur due to multiple pathophysiological mechanisms, such as multiple organ dysfunction (mainly cardiac and respiratory), direct viral entry in the renal tubules, and cytokine release syndrome. AKI is present in approximately one in every ten hospitalized COVID-19 patients. The incidence rates of AKI increase in patients who are admitted to the intensive care unit (ICU), with levels higher than 50%. Additionally, renal replacement therapy (RRT) is used in 7% of all AKI cases, but in nearly 20% of patients admitted to an ICU. COVID-19 patients with AKI are considered moderate-to-severe cases and are managed with multiple interdisciplinary conducts. AKI acts as a risk factor for mortality in severe acute respiratory syndrome coronavirus 2 infection, especially when RRT is needed. Electrolyte disorders are also common manifestations in hospitalized COVID-19 patients, mainly hyponatremia, hypokalemia, and hypocalcemia. Hyponatremia occurs due to a combination of syndrome of inappropriate secretion of antidiuretic hormone and gastrointestinal fluid loss from vomiting and diarrhea. When it comes to hypokalemia, its mechanism is not fully understood but may derive from hyperaldosteronism due to renin angiotensin aldosterone system overstimulation and gastrointestinal fluid loss as well. The clinical features of hypokalemia in COVID-19 are similar to those in other conditions. Hypocalcemia is the most common electrolyte disorder in COVID-19 and seems to occur because of vitamin D deficiency and parathyroid imbalance. It is also highly associated with longer hospital and ICU stay.
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Affiliation(s)
- Gabriel Martins Nogueira
- Department of Medicine, Bahiana School of Medicine and Public Health, Salvador 40290-000, Bahia, Brazil
| | | | - Ana Flávia Moura
- Department of Medicine, Bahiana School of Medicine and Public Health, Salvador 40290-000, Bahia, Brazil
| | | | - José A Moura-Neto
- Department of Medicine, Bahiana School of Medicine and Public Health, Salvador 40290-000, Bahia, Brazil
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Torres R, Toro L, Sanhueza ME, Lorca E, Ortiz M, Pefaur J, Clavero R, Machuca E, Gonzalez F, Herrera P, Mocarquer A, Frias A, Roessler E, Muñoz C, Nuñez M, Aravena C, Quintana E, Lemus J, Lillo M, Reynolds E, Morales A, Pais E, Fiabane A, Parra-Lucares A, Garrido C, Mendez G, Villa E, Mansilla R, Sotomayor G, Gonzalez M, Miranda C, Briones E, Gomez E, Mezzano S, Bernales W, Rocca X, Espinoza O, Zuñiga E, Aragon H, Badilla M, Valenzuela M, Escobar L, Zamora D, Flores I, Tapia B, Borquez T, Herrera P. Clinical efficacy of SARS-CoV-2 vaccination in hemodialysis patients. Kidney Int Rep 2022; 7:2176-2185. [PMID: 35874643 PMCID: PMC9287586 DOI: 10.1016/j.ekir.2022.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 12/31/2022] Open
Abstract
Introduction The COVID-19 pandemic is a global public health problem. Patients with end-stage renal disease on hemodialysis are at a higher risk of infection and mortality than the general population. Worldwide, a vaccination campaign has been developed that has been shown to reduce severe infections and deaths in the general population. However, there are currently limited data on the clinical efficacy of vaccinations in the hemodialysis population. Methods A national multicenter observational cohort was performed in Chile to evaluate the clinical efficacy of anti-SARS-CoV-2 vaccination in end-stage renal disease patients on chronic hemodialysis from February 2021 to August 2021. In addition, the BNT162b2 (Pfizer-BioNTech) and CoronaVac (Sinovac) vaccines were evaluated. The efficacy of vaccination in preventing SARS-CoV-2 infection, hospitalizations, and deaths associated with COVID-19 was determined. Results A total of 12,301 patients were evaluated; 10,615 (86.3%) received a complete vaccination (2 doses), 490 (4.0%) received incomplete vaccination, and 1196 (9.7%) were not vaccinated. During follow-up, 1362 (11.0%) patients developed COVID-19, and 150 died (case fatality rate: 11.0%). The efficacy of the complete vaccination in preventing infection was 18.1% (95% confidence interval [CI]:11.8–23.8%), and prevention of death was 66.0% (95% CI:60.6–70.7%). When comparing both vaccines, BNT162b2 and CoronaVac were effective in reducing infection and deaths associated with COVID-19. Nevertheless, the BNT162b2 vaccine had higher efficacy in preventing infection (42.6% vs. 15.0%) and deaths (90.4% vs. 64.8%) compared to CoronaVac. Conclusion The results of our study suggest that vaccination against SARS-CoV-2 in patients on chronic hemodialysis was effective in preventing infection and death associated with COVID-19.
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Affiliation(s)
- Rubén Torres
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Luis Toro
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago, Chile.,Centro de Investigación Clínica Avanzada, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - María E Sanhueza
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Eduardo Lorca
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital del Salvador, Santiago, Chile
| | - Mireya Ortiz
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Department of Nephrology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jacqueline Pefaur
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital Barros Luco Trudeau, Santiago, Chile
| | - Rene Clavero
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital Dr. Gustavo Fricke, Valparaiso, Chile
| | - Eduardo Machuca
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Fresenius Medical Care Chile, Chile
| | | | - Patricia Herrera
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital del Salvador, Santiago, Chile
| | - Alfredo Mocarquer
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Dialisis Gran Avenida, Santiago, Chile
| | - Alondra Frias
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital Regional de Talca, Talca, Chile
| | - Eric Roessler
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Department of Nephrology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carolina Muñoz
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital Puerto Montt, Puerto Montt, Chile
| | - Miguel Nuñez
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital Puerto Montt, Puerto Montt, Chile
| | - Cesar Aravena
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Dialisis Municipal La Granja, Santiago, Chile
| | - Enrique Quintana
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital Padre Hurtado, Santiago, Chile
| | - Juan Lemus
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Dialisis Antares, Santiago, Chile
| | - Mario Lillo
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Centro Médico y de Diálisis Ltda, Santiago, Chile
| | - Enrique Reynolds
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital del Salvador, Santiago, Chile
| | - Alvaro Morales
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital del Salvador, Santiago, Chile
| | - Edgard Pais
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Complejo Asistencial Sótero del Río, Santiago, Chile
| | - Andrea Fiabane
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital Barros Luco Trudeau, Santiago, Chile
| | - Alfredo Parra-Lucares
- Centro de Investigación Clínica Avanzada, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Cristian Garrido
- Department of Radiology, Hospital Clinico Universidad de Chile, Santiago, Chile
| | - Gabriel Mendez
- Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Eduardo Villa
- Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Rodrigo Mansilla
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Critical Care Medicine, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Germana Sotomayor
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital del Salvador, Santiago, Chile
| | - Marcela Gonzalez
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital Clínico de Magallanes, Punta Arenas, Chile
| | - Cecilia Miranda
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital Militar de Santiago, Santiago, Chile
| | - Eduardo Briones
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,CID Servicio Integral de Salud S.A, Santiago, Chile
| | - Esteban Gomez
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Clinica Indisa, Santiago, Chile
| | - Sergio Mezzano
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital Clinico San Borja Arriaran, Santiago, Chile
| | - Waldo Bernales
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Faculty of Medicine, Universidad Austral de Chile, Valdivia, Santiago
| | - Ximena Rocca
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital del Salvador, Santiago, Chile
| | - Oscar Espinoza
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital del Salvador, Santiago, Chile
| | - Eric Zuñiga
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital Regional de Coyhaique, Coyhaique, Chile
| | - Henry Aragon
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Clinica Bupa Antofagasta, Antofagasta, Chile
| | - Marta Badilla
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital San José, Santiago, Chile
| | - Marcela Valenzuela
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Complejo Asistencial Sótero del Río, Santiago, Chile
| | - Luis Escobar
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Clinica Bupa Antofagasta, Antofagasta, Chile
| | - Daniela Zamora
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital Barros Luco Trudeau, Santiago, Chile
| | - Ivan Flores
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital de Puerto Natales, Puerto Natales, Chile
| | - Beatriz Tapia
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital Dr. Gustavo Fricke, Valparaiso, Chile
| | - Tamara Borquez
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital San Juan de Dios de Curicó, Curicó, Chile
| | - Patricio Herrera
- Fuerza de Trabajo anti-COVID-19 (FUTAC Team), Sociedad Chilena de Nefrología, Chile.,Division of Nephrology, Hospital Clínico del Sur, Concepción, Chile
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45
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Asadzandi M, Mazandarani HA, Saffari M, Khaghanizadeh M. Effect of Spiritual Care Based on the Sound Heart Model on Spiritual Experiences of Hemodialysis Patients. J Relig Health 2022; 61:2056-2071. [PMID: 34427849 DOI: 10.1007/s10943-021-01396-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 06/13/2023]
Abstract
Hemodialysis patients require spiritual care due to their spiritual distress. This study aimed to investigate the effect of spiritual care on spiritual experiences of hemodialysis patients. This randomized controlled trial was conducted in 2017 at hemodialysis departments of Baqiyatallah and Cham ran hospitals in Tehran. The volunteer patients were selected by available sampling according to the inclusion criteria. Participants were randomly assigned to intervention and control groups. Interventions were performed in the educational-supportive nursing system according to the patients' self-care ability. Eight individual counseling sessions, 15-45 min, face-to-face, during dialysis, once a week were implemented for intervention group. Developing the relationship with God, self, people and nature were the main goals of care. Daily spiritual experience questionnaire was completed by patients before and three months after the intervention. There was no significant difference in the spiritual experience score of the intervention (75.20 ± 9.14) and control group (76.63 ± 10.03), before the intervention (P = 0.523). There was a statistically significant difference between the intervention (82.93 ± 5.69) and the control group score (77.24 ± 12.09) three months after the intervention (P < 0.0001). Due to the need for holistic and community-oriented care and the positive effect of this study, the use of the Sound Heart Model is recommended for Muslim patients.
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Affiliation(s)
- Minoo Asadzandi
- Medicine, Quran and Hadith Research Center, Baqiyatallah University of Medical Sciences, Vanak Square, South Sheikh Baha'i, Nosrati Alley, P.O.Box 19575-174, Tehran, Iran.
| | | | - Mohsen Saffari
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Morteza Khaghanizadeh
- Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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46
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Russo DS, Eugenio CS, Balestrin IG, Rodrigues CG, Rosa RG, Teixeira C, Kelly YP, Vieira SRR. Comparison of hemodynamic instability among continuous, intermittent and hybrid renal replacement therapy in acute kidney injury: A systematic review of randomized clinical trials. J Crit Care 2022; 69:153998. [PMID: 35124346 DOI: 10.1016/j.jcrc.2022.153998] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 01/10/2022] [Accepted: 01/19/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE To compare hemodynamic instability during continuous, intermittent and hybrid renal replacement therapy (RRT) in critically ill patients, and its association with renal recovery and mortality. MATERIALS AND METHODS The search was conducted in accordance with the PRISMA guidelines which was registered at the PROSPERO Database (CRD42018086504). Randomized clinical trials (RCTs) involving critically ill patients with acute kidney injury (AKI) treated with continuous, intermittent or hybrid RRT were included. The search was performed using PubMed, Embase and Cochrane databases. RESULTS Out of 3442 citations retrieved, 12 RCTs were included in the systematic analysis, representing 1419 patients. Most studies (n = 8) did not report differences in hemodynamic parameters across different RTT modalities. The incidence of hypotensive episodes varied from 5 to 60% among the studies. Punctual differences on heart rate and blood pressure were observed among studies. However, studies presented high heterogeneity in terms of outcome definitions and measurement, thus making the conduction of meta-analysis impossible. CONCLUSIONS There is very few information available regarding hemodynamic tolerance of renal replacement therapy methods. A better standardization of hemodynamic tolerance and further reports are needed before conclusions can be drawn.
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Affiliation(s)
- Diana Silva Russo
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | | | | | | | | | - Cassiano Teixeira
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.
| | - Yvelynne P Kelly
- Division of Renal Medicine, Brigham and Women's Hospital, United States of America
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47
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Greenham L, Bennett PN, Dansie K, Viecelli AK, Jesudason S, Mister R, Smyth B, Westall P, Herzog S, Brown C, Handke W, Palmer SC, Caskey FJ, Couchoud C, Simes J, McDonald SP, Morton RL. The Symptom Monitoring with Feedback Trial (SWIFT): protocol for a registry-based cluster randomised controlled trial in haemodialysis. Trials 2022; 23:419. [PMID: 35590395 PMCID: PMC9118566 DOI: 10.1186/s13063-022-06355-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Kidney failure prevalence is increasing worldwide. Haemodialysis, peritoneal dialysis or kidney transplantation are undertaken to extend life with kidney failure. People receiving haemodialysis commonly experience fatigue, pain, nausea, cramping, itching, sleeping difficulties, anxiety and depression. This symptom burden contributes to poor health-related quality of life (QOL) and is a major reason for treatment withdrawal and death. The Symptom monitoring WIth Feedback Trial (SWIFT) will test the hypothesis that regular symptom monitoring with feedback to people receiving haemodialysis and their treating clinical team can improve QOL. METHODS We are conducting an Australia and New Zealand Dialysis and Transplant (ANZDATA) registry-based cluster randomised controlled trial to determine the clinical- and cost-effectiveness at 12 months, of 3-monthly symptom monitoring using the Integrated Palliative Outcome Scale-Renal (IPOS-Renal) survey with clinician feedback, compared with usual care among adults treated with haemodialysis. Participants complete symptom scoring using a tablet, which are provided to participants and to clinicians. The trial aims to recruit 143 satellite haemodialysis centres, (up to 2400 participants). The primary outcome is change in health-related QOL, as measured by EuroQol 5-Dimension, 5-Level (EQ-5D-5L) instrument. Secondary outcomes include overall survival, symptom severity (including haemodialysis-associated fatigue), healthcare utilisation and cost-effectiveness. DISCUSSION SWIFT is the first registry-based trial in the Australian haemodialysis population to investigate whether regular symptom monitoring with feedback to participants and clinicians improves QOL. SWIFT is embedded in the ANZDATA Registry facilitating pragmatic recruitment from public and private dialysis clinics, throughout Australia. SWIFT will inform future collection, storage and reporting of patient-reported outcome measures (PROMs) within a clinical quality registry. As the first trial to rigorously estimate the efficacy and cost-effectiveness of routine PROMs collection and reporting in haemodialysis units, SWIFT will provide invaluable information to health services, clinicians and researchers working to improve the lives of those with kidney failure. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12620001061921 . Registered on 16 October 2020.
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Affiliation(s)
- Lavern Greenham
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia
| | - Paul N Bennett
- Satellite Healthcare, San Jose, CA, USA.,University of South Australia, Adelaide, SA, Australia
| | - Kathryn Dansie
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia
| | - Andrea K Viecelli
- Princess Alexandra Hospital, Woolloongabba, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Shilpanjali Jesudason
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, SA, Australia.,University of Adelaide, Adelaide, SA, Australia
| | - Rebecca Mister
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Brendan Smyth
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia.,Department of Renal Medicine, St George Hospital, Kogarah, NSW, Australia
| | - Portia Westall
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Samuel Herzog
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Chris Brown
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | | | | | | | - Cecile Couchoud
- Renal Epidemiology and Information Network (REIN), Agence de la Biomédecine, Saint-Denis, Paris, France
| | - John Simes
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Stephen P McDonald
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia.,Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, SA, Australia.,University of Adelaide, Adelaide, SA, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia.
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48
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Qin L, Gu S, Xiao R, Liu P, Yan F, Yu H, Yang W. Value of native T1 mapping in the prediction of major adverse cardiovascular events in hemodialysis patients. Eur Radiol 2022; 32:6878-6890. [PMID: 35554644 DOI: 10.1007/s00330-022-08839-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/14/2022] [Accepted: 04/25/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This study aimed to evaluate the association of myocardial characterization by native T1 mapping using cardiac MR (CMR) with the incidence of major adverse cardiovascular event (MACE) in end-stage renal dysfunction (ESRD) patients on hemodialysis. METHODS A total of 52 ESRD patients and 52 healthy individuals were prospectively recruited between June 2017 and June 2018. ESRD patients underwent CMR examinations post-hemodialysis for the evaluation of cardiac function and global native T1 mapping. Demographics, serum biomarkers, and coronary artery calcification were collected. MACE including all-caused death, and new onset of myocardial infarction, heart failure leading to hospitalization, fatal arrhythmia, and cardiac arrest was set as the endpoint. RESULTS During a median follow-up of 38.0 months, 13 patients (25.0%) reached the endpoints. Global native T1 mapping in patients on hemodialysis was significantly higher compared with that of healthy individuals (1280.3 ms ± 45.3 vs. 1238.2 ms ± 31.1, p < 0.001). In the univariate Cox regression analysis, global native T1 mapping (HR [hazard ratios]: 1.887, 95% CI [confidence interval]: 1.302-2.736, p = 0.001) was associated with the prediction of MACE. Multivariate Cox regression analysis demonstrated that global native T1 mapping (HR: 1.580, 95% CI: 1.112-2.244, p = 0.011) and age (HR: 1.088, 95% CI: 1.032-1.146, p = 0.002) were associated with the incidence of MACE after adjusting for other conventional risk factors. CONCLUSIONS Global native T1 mapping by CMR can potentially become a novel predictor of MACE in ESRD patients on hemodialysis, providing additional prognostic values over conventional risk factors. However, this conclusion should be validated in a larger sample size of hemodialysis patients. KEY POINTS • Global native T1 mapping was significantly higher in ESRD patients on hemodialysis compared with that of normal controls. • Global native T1 mapping was associated with myocardial enzymes, myocardial hypertrophy, coronary calcification, and cardiac function. • Global native T1 mapping value was independently predictive of MACE in hemodialysis patients, providing additional prognostic values over conventional risk factors.
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Affiliation(s)
- Le Qin
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin 2nd Rd, Shanghai, 200025, China
| | - Shengjia Gu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin 2nd Rd, Shanghai, 200025, China
| | - Ruijie Xiao
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin 2nd Rd, Shanghai, 200025, China
| | - Peng Liu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin 2nd Rd, Shanghai, 200025, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin 2nd Rd, Shanghai, 200025, China
| | - Haijin Yu
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin 2nd Rd, Shanghai, 200025, China.
| | - Wenjie Yang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin 2nd Rd, Shanghai, 200025, China.
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49
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Son HE, Ryu JY, Lee K, Choi YI, Kim MS, Park I, Shin GT, Kim H, Ahn C, Kim S, Chin HJ, Na KY, Chae DW, Ahn S, Hwang SS, Jeong JC. The importance of muscle mass in predicting intradialytic hypotension in patients undergoing maintenance hemodialysis. Kidney Res Clin Pract 2022; 41:611-622. [PMID: 35545221 PMCID: PMC9576459 DOI: 10.23876/j.krcp.21.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 02/08/2022] [Indexed: 11/04/2022] Open
Abstract
Background Patients undergoing hemodialysis are susceptible to sarcopenia. As intracellular reservoirs of water, skeletal muscles are important contributors to intradialytic hypotension. This study was designed to determine the role of skeletal muscle mass in intradialytic hypotension. Methods In a cross-sectional study, the body composition of 177 patients was measured immediately after hemodialysis using bioelectrical impedance analysis. The parameters measured were skeletal muscle mass, intracellular and extracellular water contents, total body water, and cell-membrane functionality (in phase angle at 50 kHz). Data from laboratory tests, chest radiography, measurements of handgrip strength and mid-arm circumference, and questionnaires were collected. The main outcome was intradialytic hypotension, defined as more than two episodes of hypotension (systolic blood pressure of <90 mmHg) with intervention over the 3 months following enrollment. Logistic regression models including each parameter related to sarcopenia were compared with a clinical model. Results Patients with a low ratio of skeletal muscle mass to dry body weight (SMM/WT) had a higher rate of intradialytic hypotension (41%). Most low-SMM/WT patients were female, obese, diabetic, and had a lower handgrip strength compared with the other patients. In the high-SMM/WT group, the risk of intradialytic hypotension was lower, with an odds ratio of 0.08 (95% confidence interval [CI], 0.02-0.28) and adjusted odds ratio of 0.06 (95% CI, 0.01-0.29). Conclusion Measurement and maintenance of skeletal muscle can help prevent intradialytic hypotension in frail patients undergoing hemodialysis.
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Affiliation(s)
- Hyung Eun Son
- Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ji Young Ryu
- Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kyunghoon Lee
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | | | - Myeong Sung Kim
- Gojan Myeong Internal Medicine Clinic, Ansan, Republic of Korea
| | - Inwhee Park
- Division of Nephrology, Department of Internal Medicine, Ajou University Hospital, Suwon, Republic of Korea.,Department of Internal Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Gyu Tae Shin
- Division of Nephrology, Department of Internal Medicine, Ajou University Hospital, Suwon, Republic of Korea.,Department of Internal Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Heungsoo Kim
- Division of Nephrology, Department of Internal Medicine, Ajou University Hospital, Suwon, Republic of Korea.,Department of Internal Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Curie Ahn
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sejoong Kim
- Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho Jun Chin
- Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ki Young Na
- Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong-Wan Chae
- Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Soyeon Ahn
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Seung Sik Hwang
- Department of Public Health Science, School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Jong Cheol Jeong
- Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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50
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Usmani S, Ahmed N, Gnanasegaran G, Marafi F, van den Wyngaert T. Update on imaging in chronic kidney disease-mineral and bone disorder: promising role of functional imaging. Skeletal Radiol 2022; 51:905-922. [PMID: 34524489 DOI: 10.1007/s00256-021-03905-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 02/02/2023]
Abstract
Disorders of mineral metabolism and bone disease are common complications in chronic kidney disease (CKD) patients and are associated with increased morbidity and mortality. Bone biopsies, bone scintigraphy, biochemical markers, and plain films have been used to assess bone disorders and bone turnover. Of these, functional imaging is less invasive than bone/marrow sampling, more specific than serum markers and is therefore ideally placed to assess total skeletal metabolism. 18F-sodium fluoride (NaF) PET/CT is an excellent bone-seeking agent superior to conventional bone scan in CKD patients due to its high bone uptake, rapid single-pass extraction, and minimal binding to serum proteins. Due to these properties, 18F-NaF can better assess the skeletal metabolism on primary diagnosis and following treatment in CKD patients. With the increased accessibility of PET scanners, it is likely that PET scanning with bone-specific tracers such as 18F-NaF will be used more regularly for clinical assessment and quantitation of bone kinetics. This article describes the pattern of scintigraphic/functional appearances secondary to musculoskeletal alterations that might occur in patients with CKD.
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Affiliation(s)
- Sharjeel Usmani
- Department of Nuclear Medicine, Kuwait Cancer Control Centre, Kuwait City, Kuwait.
| | - Najeeb Ahmed
- Jack Brignall PET/CT Centre, Castle Hill Hospital, Cottingham, UK.,Cancer Research Group, Hull York Medical School, University of Hull, York, UK
| | | | - Fahad Marafi
- Jaber Al-Ahmad Molecular Imaging Center, Kuwait City, Kuwait
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