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Zhang Z, Li J, Ding J, Zhang S, Wang M, Xu J. Relationship between effective blood flow rate and clinical outcomes in maintenance hemodialysis patients: a single-center study. Ren Fail 2024; 46:2344655. [PMID: 38685582 PMCID: PMC11062268 DOI: 10.1080/0886022x.2024.2344655] [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: 07/04/2023] [Accepted: 04/11/2024] [Indexed: 05/02/2024] Open
Abstract
The association between blood flow rate (BFR) and clinical outcomes in patients undergoing maintenance hemodialysis (MHD) is inconclusive. This retrospective study included 175 patients undergoing MHD treatment between July 2015 and March 2022, divided into two groups based on time-averaged effective blood flow rate (eBFR) median value. We investigated arteriovenous fistula (AVF) outcomes and the association of eBFR with all-cause mortality and new major adverse cardiovascular events (MACE). Mean ± SD and median time-averaged eBFR values were 276 ± 24 and 275 mL/min, respectively. After adjusting for relevant factors including age, sex, vintage, diabetes, CVD, receiving hemodiafiltration (HDF) treatment and spKt/V, Cox models indicated a low time-averaged eBFR (≤ 275 ml/min) was associated with increased risks of all-cause mortality (hazard ratio [HR] 14.18; 95% confidence interval [CI], 3.14-64.1) and new MACE (HR 3.76; 95% CI, 1.91-7.40) in MHD patients. Continuous Cox models demonstrated each 20 ml/min increase in eBFR linked to a 63% decrease in the risk of all-cause mortality (HR: 0.37, 95% CI: 0.23-0.59) and a 38% decrease in the occurrence of new MACE (HR: 0.62, 95% CI: 0.46-0.84). There was no significant difference in AVF outcomes between the two groups. Our study noted higher eBFR (>275 mL/min) is associated with lower risks of both all-cause mortality and new MACE compared with low eBFR (≤275 mL/min). Increased eBFR is not associated with a higher risk of AVF failure.
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Affiliation(s)
- Zhoucang Zhang
- Department of Nephrology, The Fourth Hospital of Hebei Medical University, Hebei Clinical Research Center for Chronic Kidney Disease, Hebei Key Laboratory of Vascular Calcification in Kidney Disease, Shijiazhuang, P.R. China
- Department of Nephrology, Peking University International Hospital, Beijing, China
| | - Jiarui Li
- Department of Nephrology, Peking University International Hospital, Beijing, China
| | - Jiaxiang Ding
- Department of Nephrology, Peking University International Hospital, Beijing, China
| | - Shenglei Zhang
- Department of Nephrology, The Fourth Hospital of Hebei Medical University, Hebei Clinical Research Center for Chronic Kidney Disease, Hebei Key Laboratory of Vascular Calcification in Kidney Disease, Shijiazhuang, P.R. China
| | - Mei Wang
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
| | - Jinsheng Xu
- Department of Nephrology, The Fourth Hospital of Hebei Medical University, Hebei Clinical Research Center for Chronic Kidney Disease, Hebei Key Laboratory of Vascular Calcification in Kidney Disease, Shijiazhuang, P.R. China
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Zhang C, Yao L, Liu M, Zhou Y. Features of cardiovascular magnetic resonance native T1 mapping in maintenance hemodialysis patients and their related factors. Ren Fail 2024; 46:2310078. [PMID: 38293793 PMCID: PMC10833117 DOI: 10.1080/0886022x.2024.2310078] [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: 07/20/2023] [Accepted: 01/21/2024] [Indexed: 02/01/2024] Open
Abstract
PURPOSE Increased myocardial T1 values on cardiovascular MRI (CMRI) have been shown to be a surrogate marker for myocardial fibrosis. The use of CMRI in patients on hemodialysis (HD) remains limited. This research aimed to explore the characteristics of native T1 values in HD patients and identify factors related to T1 values. METHODS A total of thirty-two patients on HD and fourteen healthy controls were included in this study. All participants underwent CMRI. Using modified Look-Locker inversion recovery (MOLLI) sequence, native T1 mapping was achieved. Native CMRI T1 values were compared between the two groups. In order to analyze the relationship between T1 values and clinical parameters, correlation analysis was performed in patients on HD. RESULTS Patients on HD exhibited elevated global native T1 values compared to control subjects. In the HD group, the global native T1 value correlated positively with intact parathyroid hormone (iPTH) (r = 0.418, p = 0.017) and negatively with triglycerides (r= -0.366, p = 0.039). Moreover, the global native T1 value exhibited a positive correlation with the left ventricular end-diastolic volume indexed to body surface area (BSA; r = 0.528, p = 0.014), left ventricular end-systolic volume indexed to BSA (r = 0.506, p = 0.019), and left ventricular mass indexed to BSA (r = 0.600, p = 0.005). A negative correlation was observed between the global native T1 value and ejection fraction (r = 0.-0.551, p = 0.010). CONCLUSION The global native T1 value was prolonged in HD patients compared with controls. In the HD group, the global T1 value correlated strongly with iPTH, triglycerides, and cardiac structural and functional parameters.
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Affiliation(s)
- Changqin Zhang
- Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lijing Yao
- Department of Nephrology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Min Liu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Yilun Zhou
- Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Cui L, Zhang L, Li J, Li Y, Hao X, Xu Y, Li C. Correlation between ultrafiltration rate and hemoglobin level and erythropoietin response in hemodialysis patients. Ren Fail 2024; 46:2296609. [PMID: 38178573 PMCID: PMC10773628 DOI: 10.1080/0886022x.2023.2296609] [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: 09/19/2023] [Accepted: 12/13/2023] [Indexed: 01/06/2024] Open
Abstract
This study aimed to investigate the correlation between ultrafiltration rate (UFR) and hemoglobin levels and erythropoietin (EPO) response in patients receiving maintenance hemodialysis (MHD). 225 MHD patients were divided into three groups according to the UFR: < 10 ml/h/kg, 10-13 ml/h/kg, and >13 ml/h/kg. Clinical parameters and prognosis were compared among the groups. Multiple linear correlation and regression analyses were conducted. SPSS 26.0 (IBM, Chicago, IL, USA) was used to analyze all statistics. The UFR < 10 ml/h/kg group was older than the other groups (p < 0.05). The UFR > 13 ml/h/kg group had the highest SpKt/V (p < 0.05), monthly EPO dose/weight (p < 0.001), and EPO resistance index (p < 0.001), as well as the lowest dry weight (p < 0.001), BMI (p < 0.001), hemoglobin (p < 0.001), hematocrit (p < 0.05), and red blood cell count (p < 0.05). Multiple linear regression analysis showed that sex, dry weight, UFR, calcium, phosphorus, albumin, and C-reactive protein levels were associated with hemoglobin levels. Multivariate logistic regression analysis revealed that a higher UFR was associated with lower hemoglobin levels, while male sex and higher levels of calcium and albumin were associated with higher hemoglobin levels. High UFR is associated with more severe anemia and EPO resistance in MHD. This study provides new insights into anemia management in patients undergoing hemodialysis.
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Affiliation(s)
- Li Cui
- Department of Nephrology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lili Zhang
- Department of Nutrition, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jing Li
- Department of Nutrition, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yuan Li
- Department of Nephrology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaolei Hao
- Department of Nephrology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yan Xu
- Department of Nephrology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chunmei Li
- Department of Nephrology, The Affiliated Hospital of Qingdao University, Qingdao, China
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Xiang Y, Ma G, Yang Q, Cao M, Xu W, Li L, Yang Q. External validation of the prediction model of intradialytic hypotension: a multicenter prospective cohort study. Ren Fail 2024; 46:2322031. [PMID: 38466674 DOI: 10.1080/0886022x.2024.2322031] [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: 08/31/2023] [Accepted: 02/17/2024] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVE Intradialytic hypotension (IDH) is a common and serious complication in patients with Maintenance Hemodialysis (MHD). The purpose of this study is to externally verify three IDH risk prediction models recently developed by Ma et al. and recalibrate, update and present the optimal model to improve the accuracy and applicability of the model in clinical environment. METHODS A multicenter prospective cohort study of patients from 11 hemodialysis centers in Sichuan Province, China, was conducted using convenience sampling from March 2022 to July 2022, with a follow-up period of 1 month. Model performance was assessed by: (1) Discrimination: Evaluated through the computation of the Area Under Curve (AUC) and its corresponding 95% confidence intervals. (2) Calibration: scrutinized through visual inspection of the calibration plot and utilization of the Brier score. (3) The incremental value of risk prediction and the utility of updating the model were gauged using NRI (Net Reclassification Improvement) and IDI (Integrated Discrimination Improvement). Decision Curve Analysis (DCA) was employed to evaluate the clinical benefit of updating the model. RESULTS The final cohort comprised 2235 individuals undergoing maintenance hemodialysis, exhibiting a 14.6% occurrence rate of IDH. The externally validated Area Under the Curve (AUC) values for the three original prediction models were 0.746 (95% CI: 0.718 to 0.775), 0.709 (95% CI: 0.679 to 0.739), and 0.735 (95% CI: 0.706 to 0.764) respectively. Conversely, the AUC value for the recalibrated and updated columnar plot model reached 0.817 (95% CI: 0.791 to 0.842), accompanied by a Brier score of 0.081. Furthermore, Decision Curve Analysis (DCA) exhibited a net benefit within the threshold probability range of 15.2% to 87.1%. CONCLUSION Externally validated, recalibrated, updated, and presented IDH prediction models may serve as a valuable instrument for evaluating IDH risk in clinical practice. Furthermore, they hold the potential to guide clinical providers in discerning individuals at risk and facilitating judicious clinical intervention decisions.
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Affiliation(s)
- Yuhe Xiang
- School of Nursing, Chengdu Medical College, Chengdu, China
| | - Guoting Ma
- Health Management Center, Sichuan Tai Kang Hospital, Chengdu, China
| | - Qin Yang
- School of Nursing, Chengdu Medical College, Chengdu, China
| | - Min Cao
- Department of Orthopedics, Sichuan second traditional Chinese medicine hospital, Chengdu, China
| | - Wenbin Xu
- School of Nursing, Chengdu Medical College, Chengdu, China
| | - Lin Li
- School of Nursing, Chengdu Medical College, Chengdu, China
| | - Qian Yang
- School of Nursing, Chengdu Medical College, Chengdu, China
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Kang SH, Kim GO, Kim BY, Son EJ, Do JY. Effect of angiotensin-converting enzyme inhibitors versus that of angiotensin receptor blockers on survival in patients undergoing hemodialysis: a nationwide observational cohort study. Ren Fail 2024; 46:2313173. [PMID: 38522955 PMCID: PMC10962295 DOI: 10.1080/0886022x.2024.2313173] [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: 10/20/2023] [Accepted: 01/27/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the patient survival rates based on the use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) in a large cohort of patients undergoing maintenance hemodialysis (HD). METHODS Data from a national HD quality assessment program were used in this retrospective study. The patients were classified into four groups based on the use of renin-angiotensin system blockers (RASBs) as follows: No group, patients without a prescription of any anti-hypertensive drugs including RASBs; Other group, patients with a prescription of anti-hypertensive drugs excluding RASBs; ACEI group, patients with a prescription of an ACEI; and ARB group, patients with a prescription of an ARB. RESULTS The 5-year survival rates in the no, other, ACEI, and ARB groups were 68.6%, 67.8%, 70.6%, and 69.2%, respectively. The ACEI group had the best patient survival trend among the four groups. In multivariable Cox regression analyses, no differences were observed between the ACEI and ARB groups. Among young patients and patients without diabetes or heart disease, the ACEI group had the best patient survival among the four groups. However, among patients with DM or heart disease, the ARB group had the best patient survival. CONCLUSIONS Our study found that patients receiving ACEI and ARB had comparable survival. However, patients receiving ARB had better survival in the subgroups of patients with DM or heart disease, and patients receiving ACEI had better survival in the subgroup of young patients or patients without diabetes or heart disease.
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Affiliation(s)
- Seok Hui Kang
- Department of Internal Medicine, Division of Nephrology, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Gui Ok Kim
- Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Bo Yeon Kim
- Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Eun Jung Son
- Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Jun Young Do
- Department of Internal Medicine, Division of Nephrology, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Fu C, Liu Y, Yang H, Liang Q, Liu W, Guo W. Construction of a miR-15a-based risk prediction model for vascular calcification detection in patients undergoing hemodialysis. Ren Fail 2024; 46:2313175. [PMID: 38419564 PMCID: PMC10906117 DOI: 10.1080/0886022x.2024.2313175] [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: 07/31/2023] [Accepted: 01/27/2024] [Indexed: 03/02/2024] Open
Abstract
Vascular calcification (VC) is highly prevalent in patients undergoing hemodialysis, and is a significant contributor to the mortality rate. Therefore, biomarkers that can accurately predict the onset of VC are urgently required. Our study aimed to investigate serum miR-15a levels in relation to VC and to develop a predictive model for VC in patients undergoing hemodialysis at the Beijing Friendship Hospital hemodialysis center between 1 January 2019 and 31 December 2020. The patients were categorized into two groups: VC and non-VC. Logistic regression (LR) models were used to examine the risk factors associated with VC. Additionally, we developed an miR-15a-based nomogram based on the results of the multivariate LR analysis. A total of 138 patients under hemodialysis were investigated (age: 58.41 ± 13.22 years; 54 males). VC occurred in 79 (57.2%) patients. Multivariate LR analysis indicated that serum miR-15a, age, and WBC count were independent risk factors for VC. A miR-15a-based nomogram was developed by incorporating the following five predictors: age, dialysis vintage, predialysis nitrogen, WBC count, and miR-15a. The receiver operating characteristic (ROC) curve had an area under the curve of 0.921, diagnostic threshold of 0.396, sensitivity of 0.722, and specificity of 0.932, indicating that this model had good discrimination. This study concluded that serum miR-15a levels, age, and white blood cell (WBC) count are independent risk factors for VC. A nomogram constructed by integrating these risk factors can be used to predict the risk of VC in patients undergoing hemodialysis.
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Affiliation(s)
- Chen Fu
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
| | - Yingjie Liu
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
| | - Huayu Yang
- Division of Geriatrics, Medical and Health Care Center, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
| | - Qiaojing Liang
- Division of Geriatrics, Medical and Health Care Center, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
| | - Wenhu Liu
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
| | - Weikang Guo
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
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Mahmoudi Z, Roumi Z, Askarpour SA, Mousavi Z, Shafaei H, Valisoltani N, Shapouri M, Mirshafaei SR, Mirzaee P, Mobarakeh KA, Taghavi Sufiani E, Motiee Bijarpasi Z, Motiei Z, Khosravi M, Doaei S, Gholamalizadeh M. The effects of omega-3 fatty acids supplementation on hemoglobin, hematocrit, and platelet levels of patients with ESRD condition undergoing dialysis. J Transl Autoimmun 2024; 8:100233. [PMID: 38464414 PMCID: PMC10924142 DOI: 10.1016/j.jtauto.2024.100233] [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: 11/08/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 03/12/2024] Open
Abstract
Background Concomitant inflammation may boost the cardiovascular complications in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). Omega-3 fatty acids may have certain health benefits in HD patients. The aim of this study was to investigate the effects of omega-3 fatty acids supplementation on hematocrit (HCT), hemoglobin (HB) level and platelet (PLT) counts of HD patients. Methods A randomized controlled trial was conducted on HD patients at a private dialysis center in Rasht, Iran. Three omega-3 fatty acid supplement capsules (3 g/d) were administered daily for two months to patients in the intervention group (n = 55). The control group (n = 60) were given three placebo capsules containing medium chain triglyceride (MCT) oil, similar to the supplemental dose of the intervention group at the same period. Three parameters of HCT, HB and PLT were measured at baseline and after the intervention. Results The PLT count decreased in the intervention group compared to the control group (173.38 ± 74.76 vs. 227.68 ± 86.58 103/mm3, F = 4.83, P = 0.03). No significant change was found on the levels of HCT and HB parameters between the two groups after the intervention. Conclusion Omega-3 supplementation in HD patients may decrease the risk of forming blood clots in the blood vessels. Further studies are warranted.
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Affiliation(s)
- Zahra Mahmoudi
- Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Zahra Roumi
- Department of Nutrition, Electronic Health and Statistics Surveillance Research Center, Science and Research Branch. Islamic Azad University, Tehran, Iran
| | - Seyed Ali Askarpour
- Division of Food Safety and Hygiene, Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Mousavi
- School of Nursing and Midwifery Shahed University, Tehran, Iran
| | - Hanieh Shafaei
- Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Neda Valisoltani
- Department of Medicine, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Mahsa Shapouri
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Reza Mirshafaei
- Department of applied mathematics, Roudsar and Amlash branch, Islamic Azad University, Roudsar, Iran
| | - Pouya Mirzaee
- Department of Medicine, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Khadijeh Abbasi Mobarakeh
- Department of Community Nutrition, Nutrition and Food Security Research Center, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elahe Taghavi Sufiani
- Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Zeinab Motiee Bijarpasi
- Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Zeynab Motiei
- Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Masoud Khosravi
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Saeid Doaei
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Gholamalizadeh
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Takahashi R, Yabe H, Ishikawa H, Hibino T, Morishita S, Kono K, Moriyama Y, Yamada T. The impact of malnutrition on the effectiveness of intradialytic exercise in hemodialysis patients: amulticenter cohort study. Int Urol Nephrol 2024; 56:2093-2101. [PMID: 38334912 DOI: 10.1007/s11255-024-03952-7] [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: 09/06/2023] [Accepted: 01/06/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE Low physical function can be effectively improved via intradialytic exercise. However, the association between the effects of intradialytic exercise on physical function and malnutrition severity has not been studied extensively. This study aimed to investigate the impact of nutritional status severity on physical function in patients undergoing hemodialysis with low physical function to whom intradialytic exercise was prescribed. METHODS The participants were patients with decreased mobility [walking speed < 1.0 m/s and/or Short Physical Performance Battery (SPPB) < 12] who had been undergoing hemodialysis thrice a week for 6 months and performing intradialytic exercise program. Patients were divided into groups based on the Geriatric Nutritional Risk Index (GNRI) [Non-malnutrition group (GNRI > 98), Gentle/slim malnutrition group (GNRI ≤ 98, GNRI ≥ 92), Mild malnutrition group (GNRI < 92, GNRI ≥ 82), Severe malnutrition group (GNRI < 82)]. The primary outcomes were Grip strength, isometric knee extension strength (IKES), SPPB, and 10-m walking speed measured at baseline and at 6 months. Statistical analyses were performed using a linear mixed-effects model with the intention-to-treat analysis, including within-group analysis and between-group comparison. RESULTS A total of 805 participants were included in the study. Within-group comparisons showed significantly improved IKES, 10-m walking speed, and SPPB improved, except in the Severe malnutrition group. Grip strength significantly improved in the Gentle/slim and mild malnutrition groups. Between-group comparison with controls showed that the improvement in Grip strength was significantly bigger in the Gentle/slim malnutrition group [0.98 (0.15 to 1.82) kg] than in the non-malnutrition group. However, IKES in the Severe malnutrition group [- 5.14 (- 9.18 to - 1.10) %] less significantly improve than that in the non-malnutrition group. No significant differences were found in the other indices. CONCLUSION In patients with severe malnutrition, the changes in IKES scores resulting from Intradialytic exercise were significantly smaller than those observed in non-malnourished patients. Therefore, it is necessary to initiate suitable nutritional and exercise therapy based on the severity of malnutrition.
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Affiliation(s)
- Ren Takahashi
- Department of Rehabilitation, Kaikoukai Josai Hospital, Nagoya, Aichi, Japan.
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu, Shizuoka, Japan.
| | - Hiroki Yabe
- Department of Physical Therapy, School of Rehabilitation Sciences, Seirei Christopher University, Hamamatsu, Shizuka, Japan
| | - Hideaki Ishikawa
- Department of Internal Medicine, Kaikoukai Josai Hospital, Nagoya, Aichi, Japan
| | - Takashi Hibino
- Department of Rehabilitation, Kaikoukai Josai Hospital, Nagoya, Aichi, Japan
| | - Sayumi Morishita
- Department of Rehabilitation, Kaikoukai Josai Hospital, Nagoya, Aichi, Japan
| | - Kenichi Kono
- Department of Physical Therapy, International University of Health and Welfare School of Health Science at Narita, Narita, Chiba, Japan
| | - Yoshifumi Moriyama
- Department of Wellness Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Tetsuya Yamada
- Dialysis Division, Kaikoukai Healthcare Group, Nagoya, Aichi, Japan
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Chia CKA, Tay HT. Endovascular salvage of a chronically thrombosed hemodialysis arteriovenous fistula. J Vasc Surg Cases Innov Tech 2024; 10:101472. [PMID: 38591018 PMCID: PMC11000162 DOI: 10.1016/j.jvscit.2024.101472] [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: 12/30/2023] [Accepted: 02/23/2024] [Indexed: 04/10/2024] Open
Abstract
For hemodialysis-dependent patients, maintaining functional access is a crucial lifeline. Thrombosed access should be salvaged as soon as possible to avoid complications of missed dialysis and to maximize the chance of success. Due to unfortunate circumstances, this patient's thrombosed arteriovenous fistula was not salvaged for 7 months. Despite the chronicity, endovascular salvage was achieved, with subsequent successful cannulation for maintenance dialysis. Contrary to conventional wisdom, chronically thrombosed arteriovenous fistulas can be salvaged through endovascular means with appropriate patient selection.
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Affiliation(s)
| | - Hsien Tsung Tay
- Department of Vascular Surgery, Singapore General Hospital, Singapore, Singapore
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Navalha DDP, Felix N, Nogueira A, Clemente M, Marinho AD, Ferreira ROM, Pasqualotto E, Dagostin CS, Pinto LCS, Fernandes GC. Direct oral anticoagulants versus vitamin K antagonists in patients with atrial fibrillation on chronic hemodialysis: a meta-analysis of randomized controlled trials. Int Urol Nephrol 2024; 56:2001-2010. [PMID: 38153665 DOI: 10.1007/s11255-023-03889-3] [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: 07/21/2023] [Accepted: 11/14/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE Patients with atrial fibrillation (AF) and end-stage renal disease on chronic hemodialysis are at risk for thromboembolic and bleeding events. We aimed to perform a meta-analysis to evaluate the safety and efficacy of direct oral anticoagulants (DOACs) compared with vitamin K antagonists (VKAs) in this population. METHODS We systematically searched PubMed, Excerpta Medica Database (EMBASE) and Cochrane Library for randomized controlled trials (RCTs) comparing DOACs with VKAs in patients with AF on chronic hemodialysis from inception to February 2023 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Outcomes were reported using risk ratios (RRs) with 95% confidence intervals (CIs). Statistical analyses were performed using R version 4.2.2. RESULTS We selected three RCTs including 341 patients, of whom 176 (51.6%) were randomized to DOACs. Follow-up ranged from 174 days to 3.38 years. There was no significant difference between groups in terms of cardiovascular mortality (RR 1.34; 95% CI 0.69-2.60; p = 0.39), all-cause mortality (RR 0.96; 95% CI 0.72-1.27; p = 0.77), ischemic/uncertain type of stroke or transient ischemic attack (RR 0.50; 95% CI 0.19-1.35; p = 0.17), or major or life-threatening bleeding (RR 0.70; 95% CI 0.39-1.25; p = 0.22). CONCLUSION In this meta-analysis of three RCTs, no significant difference was observed between DOACs and VKAs in cardiovascular mortality, all-cause mortality, ischemic/uncertain type of stroke or transient ischemic attack, or major or life-threatening bleeding in patients with AF on chronic hemodialysis.
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Affiliation(s)
| | - Nicole Felix
- Federal University of Campina Grande, Campina Grande, Brazil
| | - Alleh Nogueira
- Bahiana School of Medicine and Public Health, Salvador, Brazil
| | | | - Alice D Marinho
- Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
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Suemitsu K, Iida O, Torii S, Hata Y, Toyoshima T, Izumi M. Pathological evaluation of a fluoropolymer-based drug-eluting stent in an arteriovenous graft outflow venous stenosis. J Vasc Surg Cases Innov Tech 2024; 10:101447. [PMID: 38510091 PMCID: PMC10950806 DOI: 10.1016/j.jvscit.2024.101447] [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: 11/30/2023] [Accepted: 01/25/2024] [Indexed: 03/22/2024] Open
Abstract
A fluoropolymer-based drug-eluting stent was implanted in an arteriovenous graft outflow venous stenosis. Two and a half years later, due to a local infection, the stent was removed surgically, and a pathological evaluation was conducted. The stent struts exhibited partial endothelial cell coverage, with the remaining surface predominantly covered by fibrin. Notably, there was no evidence of restenosis or aneurysmal change.
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Affiliation(s)
- Kotaro Suemitsu
- Division of Kidney and Dialysis, Department of Internal Medicine, Kansai Rosai Hospital, Amagasaki, Japan
| | - Osamu Iida
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | - Sho Torii
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Yosuke Hata
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | - Taku Toyoshima
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | - Masaaki Izumi
- Division of Kidney and Dialysis, Department of Internal Medicine, Kansai Rosai Hospital, Amagasaki, Japan
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Cuervo LG, Villamizar CJ, Osorio L, Ospina MB, Cuervo DE, Cuervo D, Bula MO, Zapata P, Owens NJ, Hatcher-Roberts J, Martín EA, Piquero F, Pinilla LF, Martínez-Herrera E, Jaramillo C. Dynamic measurements of geographical accessibility considering traffic congestion using open data: a cross-sectional assessment for haemodialysis services in Cali, Colombia. Lancet Reg Health Am 2024; 34:100752. [PMID: 38737772 PMCID: PMC11087994 DOI: 10.1016/j.lana.2024.100752] [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] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 03/19/2024] [Accepted: 04/16/2024] [Indexed: 05/14/2024]
Abstract
Background Many cities with traffic congestion lack accessibility assessments accounting for traffic congestion and equity considerations but have disaggregated georeferenced municipal-level open data on health services, populations, and travel times big data. We convened a multistakeholder intersectoral collaborative group that developed a digital, web-based platform integrating open and big data to derive dynamic spatial-temporal accessibility measurements (DSTAM) for haemodialysis services. We worked with stakeholders and data scientists and considered people's places of residence, service locations, and travel time to the service with the shortest travel time. Additionally, we predicted the impacts of strategically introducing haemodialysis services where they optimise accessibility. Methods Cross-sectional analyses of DSTAM, accounting for traffic congestion, were conducted using a web-based platform. This platform integrated traffic analysis zones, public census and health services datasets, and Google Distance Matrix API travel-time data. Predictive and prescriptive analytics identified optimal locations for new haemodialysis services and estimated improvements. Primary outcomes included the percentage of residents within a 20-min car drive of a haemodialysis service during peak and free-flow traffic congestion. Secondary outcomes focused on optimal locations to maximise accessibility with new services and potential improvements. Findings were disaggregated by sociodemographic characteristics, providing an equity perspective. The study in Cali, Colombia, used geographic and disaggregated sociodemographic data from the adjusted 2018 Colombian census. Predicted travel times were obtained for two weeks in 2020. Findings There were substantial traffic variations. Congestion reduced accessibility, especially among marginalised groups. For 6-12 July, free-flow and peak-traffic accessibility rates were 95.2% and 45.0%, respectively. For 23-29 November, free-flow and peak traffic accessibility rates were 89.1% and 69.7%. The locations where new services would optimise accessibility had slight variation and would notably enhance accessibility and health equity. Interpretation Establishing haemodialysis services in targeted areas has significant potential benefits. By increasing accessibility, it would enhance urban health and equity. Funding No external or institutional funding was received.
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Affiliation(s)
| | | | - Lyda Osorio
- School of Public Health, Universidad del Valle, Cali, Colombia
| | | | | | | | | | | | - Nancy J. Owens
- Independent Content and Communications Consultant, Fairfax, VA, USA
| | - Janet Hatcher-Roberts
- School of Epidemiology and Public Health in the Faculty of Medicine, and Bruyère Research Institute, University of Ottawa, Ottawa, ON, Canada
| | | | - Felipe Piquero
- Patient Advocate and Author of an Autopathography, Bogotá, Colombia
| | | | | | - Ciro Jaramillo
- School of Civil and Geomatic Engineering of the Universidad del Valle, Cali, Colombia
| | - The AMORE Project Collaborationp
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- School of Public Health, Universidad del Valle, Cali, Colombia
- Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
- National Disability Board of Colombia, Bogotá, Colombia
- IQuartil SAS, Bogotá, Colombia
- Independent Researcher, Bogotá, Colombia
- Independent Content and Communications Consultant, Fairfax, VA, USA
- School of Epidemiology and Public Health in the Faculty of Medicine, and Bruyère Research Institute, University of Ottawa, Ottawa, ON, Canada
- Colombian Association of Transplanted Athletes, Bogota, Colombia
- Patient Advocate and Author of an Autopathography, Bogotá, Colombia
- Universidad de la Sabana, Campus del Puente del Común, Chía, Cundinamarca, Colombia
- National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia
- School of Civil and Geomatic Engineering of the Universidad del Valle, Cali, Colombia
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13
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Zang W, Fang M, Xiao N, Zhang X, Lin C, Wang S. Quantifying the dose-response relationship between exercise and health-related quality of life in patients undergoing haemodialysis: A meta-analysis. Prev Med Rep 2024; 42:102737. [PMID: 38707251 PMCID: PMC11066687 DOI: 10.1016/j.pmedr.2024.102737] [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: 10/09/2023] [Revised: 04/18/2024] [Accepted: 04/20/2024] [Indexed: 05/07/2024] Open
Abstract
Objective This meta-analysis aims to explore the dose-response relationship of aerobic exercise or aerobic combined resistance exercise on cardiopulmonary function in maintenance hemodialysis(MHD), with the goal of aiding in the formulation of precise exercise prescriptions. Methods A literature search up to August 18, 2023, was conducted in databases including Web of Science, among others, focusing on the effects of exercise interventions on cardiopulmonary function in hemodialysis patients.Two researchers independently conducted literature screening, data extraction, and an assessment of study methodology quality. A dose-response meta-analysis was carried out using a one-stage cubic spline mixed-effects model, followed by stratified analyses based on intervention period, intervention method, and exercise environment. Results A nonlinear dose-response relationship was observed between exercise and 6-minute walk test (6WMT) as well as peak oxygen uptake (VO2Peak) in hemodialysis patients. The optimal exercise dose for the 6WMT across the full exposure range was 922 METs-min/week, with VO2Peak increasing with the dose. The effects were influenced by the type of exercise, intervention period, and exercise environment. An exercise dose of 500 METs-min/week and 619 METs-min/week was found sufficient to achieve the minimal clinically important differences (MCID) for 6WMT and VO2Peak, respectively. Conclusion There is a significant association between the dose of exercise and its effects. With appropriate adjustment of variables, even low-dose exercise can lead to clinically significant improvements in cardiopulmonary function.
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Affiliation(s)
- Wanli Zang
- Postgraduate School, University of Harbin Sport, Harbin, China
| | - Mingqing Fang
- Xiangya Hospital, Central South University, Changsha, China
| | - Ningkun Xiao
- Department of Immunochemistry, Institution of Chemical Engineering, Ural Federal University, Russia
| | - Xianzuo Zhang
- Department of Orthopedics, the First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Changchun Lin
- Xiangya Hospital, Central South University, Changsha, China
| | - Su Wang
- Department of Sports Science, University of Harbin Sport, Harbin, China
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14
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Cetin BM, Guzel FB, Ozturk I, Erken E, Gungor O, Altunoren O. The factors that are associated with itching in chronic kidney patients and evaluation of itching with the 5d itch scale. Int Urol Nephrol 2024; 56:1973-1981. [PMID: 38334911 DOI: 10.1007/s11255-023-03937-y] [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: 09/11/2023] [Accepted: 12/28/2023] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Uremic pruritus is a distressing complication of chronic kidney disease (CKD), associated with mortality, and negatively impacts quality of life. The 5D-Itch Scale (5D-IS) is an easy-to-apply technique that evaluates 5 different dimensions of itching such as duration, severity, course, disability, and prevalence. We aimed to investigate the prevalence of itching in different CKD stages using the 5D-IS and to investigate the factors associated with itching in CKD patients. MATERIALS AND METHODS 5D-IS was used to evaluate itching in chronic hemodialysis (HD) and Stage 3-5 CKD patients. Total itching score and sub-scores consist of duration, severity, course, disability and distribution were obtained. Itching scores and prevalence according to CKD stages were investigated. Also the relationships between itching scores and some laboratory and clinical parameters such as iPTH, Ca, P, CRP levels were examined. RESULTS 158 CKD patients included in the study included (110 Stage 3-5 and 48 HD). The frequency of itching was higher in HD patients than in predialysis patients (62.5% vs 46.4%; p = 0.04). The total itching score increased along with CKD stages 3 to 5 (7.75 ± 3.39, 7.82 ± 4.11 and 9.08 ± 5.12 respectively; p = 0.14). The severity, duration and course scores of itching were similar between the groups, but the distribution scores increased as the CKD stage increased. The laboratory and clinical characteristics of patients with and without itching were not different. Even if a significant positive correlation was detected between the parathyroid hormone levels and both the total 5D-IS scores and all of the sub-scores, Ca and P values were not correlated with itching scores. In the multiple regression analysis, the only parameter that had an effect on the total 5D-IS Score was the parathyroid hormone level. CONCLUSION In CKD, itching affects 40-70% of patients from the early stages. As the CKD stage increases, itching spreads throughout the body. The only parameter that seems to be associated with itching is the PTH level.
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Affiliation(s)
- Barıs Mulla Cetin
- Faculty of Medicine, Department of Nephrology, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Fatma Betul Guzel
- Faculty of Medicine, Department of Nephrology, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Ilyas Ozturk
- Faculty of Medicine, Department of Nephrology, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Ertugrul Erken
- Faculty of Medicine, Department of Nephrology, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Ozkan Gungor
- Faculty of Medicine, Department of Nephrology, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Orcun Altunoren
- Faculty of Medicine, Department of Nephrology, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey.
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15
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Pereira M, Tocino MLS, Mas-Fontao S, Manso P, Burgos M, Carneiro D, Ortiz A, Arenas MD, González-Parra E. Dependency and frailty in the older haemodialysis patient. BMC Geriatr 2024; 24:416. [PMID: 38730386 PMCID: PMC11088105 DOI: 10.1186/s12877-024-04973-8] [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: 08/10/2023] [Accepted: 04/12/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Frailty among older adults undergoing hemodialysis is increasingly prevalent, significantly impacting cognitive function, mobility, and social engagement. This study focuses on the clinical profiles of very older adults in hemodialysis, particularly examining the interplay of dependency and frailty, and their influence on dialysis regimens. METHODS In this observational, descriptive study, 107 patients aged over 75 from four outpatient centers and one hospital unit were examined over a year. Patient data encompassed sociodemographic factors, dialysis specifics, analytical outcomes, lifestyle elements, and self-reported post-treatment fatigue. Malnutrition-inflammation scale was used to measure the Nutritional status; MIS scale for malnutrition-inflammation, Barthel index for dependency, Charlson comorbidity index; FRIED scale for frailty and the SF12 quality of life measure. RESULTS The study unveiled that a substantial number of older adults on hemodialysis faced malnutrition (55%), dependency (21%), frailty (46%), and diminished quality of life (57%). Patients with dependency were distinctively marked by higher comorbidity, severe malnutrition, enhanced frailty, nursing home residency, dependency on ambulance transportation, and significantly limited mobility, with 77% unable to walk. Notably, 56% of participants experienced considerable post-dialysis fatigue, correlating with higher comorbidity, increased dependency, and poorer quality of life. Despite varying clinical conditions, dialysis patterns were consistent across the patient cohort. CONCLUSIONS The older adult cohort, averaging over four years on hemodialysis, exhibited high rates of comorbidity, frailty, and dependency, necessitating substantial support in transport and living arrangements. A third of these patients lacked residual urine output, yet their dialysis regimen mirrored those with preserved output. The study underscores the imperative for tailored therapeutic strategies to mitigate dependency, preserve residual renal function, and alleviate post-dialysis fatigue, ultimately enhancing the physical quality of life for these patients.
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Affiliation(s)
- M Pereira
- Fundación Renal Íñigo Álvarez de Toledo, Madrid, 28003, Spain
| | - M L Sanchez Tocino
- Fundación Renal Íñigo Álvarez de Toledo, Madrid, 28003, Spain
- Facultad de Enfermería, Universidad de Salamanca, Salamanca, Spain
| | - Sebastian Mas-Fontao
- Instituto de Investigación Sanitaria Fundación Jimenez Díaz, Madrid, 28040, Spain.
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain.
- Facultad de Medicina y Biomedicina, Universidad Alfonso X, Villanueva de la Cañada, Spain.
| | - P Manso
- Fundación Renal Íñigo Álvarez de Toledo, Madrid, 28003, Spain
| | - M Burgos
- Fundación Renal Íñigo Álvarez de Toledo, Madrid, 28003, Spain
| | - D Carneiro
- Fundación Renal Íñigo Álvarez de Toledo, Madrid, 28003, Spain
| | - A Ortiz
- Instituto de Investigación Sanitaria Fundación Jimenez Díaz, Madrid, 28040, Spain
- Servicio de Nefrología, Fundación Jiménez Díaz, Madrid, Spain
| | - M D Arenas
- Fundación Renal Íñigo Álvarez de Toledo, Madrid, 28003, Spain
| | - E González-Parra
- Fundación Renal Íñigo Álvarez de Toledo, Madrid, 28003, Spain.
- Instituto de Investigación Sanitaria Fundación Jimenez Díaz, Madrid, 28040, Spain.
- Servicio de Nefrología, Fundación Jiménez Díaz, Madrid, Spain.
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16
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Park YR, Jung JH, Hwang D, Yun WS, Huh S, Kim HK. Outcomes of Surgical and Endovascular Treatment for Cephalic Arch Stenosis in Proximal Arteriovenous Fistula. Vasc Specialist Int 2024; 40:13. [PMID: 38711398 DOI: 10.5758/vsi.240015] [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: 01/26/2024] [Revised: 03/26/2024] [Accepted: 04/05/2024] [Indexed: 05/08/2024] Open
Abstract
Purpose The cephalic arch is a significant site of stenosis in proximal arteriovenous fistulas (AVFs) that contributes to access dysfunction and thrombosis. This study aimed to evaluate the outcomes of surgical treatment (ST) and endovascular treatment (ET) for cephalic arch stenosis (CAS). Materials and Methods A total of 62 patients with proximal AVF who underwent CAS revision using either ST or ET were enrolled between January 2018 and March 2023. In the ET group, only the initial ET following AVF formation was considered, to mitigate bias. In the ST group, central transposition of the native AVF (transposition group) or interposition of the prosthetic graft into the proximal basilic or axillary vein (interposition group) was performed. We evaluated primary and functional patency based on these groups and calculated the number of patency loss events after CAS treatment. Results Of the 62 patients, 38 (61%) were male, with a mean age of 66.4 years. ST was performed in 26 (42%) patients, including transposition in 16 and interposition in 10, whereas ET was administered to 36 patients during the study period. Among the ST recipients, 42% had a history of ET for CAS. The incidence of AVF thrombosis was marginally higher in the ST group than in the ET group (39% vs. 19%, P=0.098). The primary patency rates at 6 months, 1 year, and 3 years were 87%, 87%, and 66% in the transposition group; 45%, 23%, and 11% in the interposition group; and 66%, 49%, and 17% in the ET group, respectively. Notably, the primary patency of the transposition group was significantly higher than that of the interposition (P=0.001) and ET groups (P=0.016). The frequency of patency loss events per person-year after the initial revision was 0.40, 0.52, and 1.42 in the transposition, interposition, and ET groups, respectively. Conclusion Transposition exhibited the most favorable primary patency rate and the lowest number of subsequent patency loss events during follow-up despite the higher rates of AVF thrombosis and previous ET at presentation. Consequently, transposition should be actively considered in eligible patients with CAS.
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Affiliation(s)
- Young Ryul Park
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Ji Hyun Jung
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Deokbi Hwang
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Woo-Sung Yun
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Seung Huh
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Hyung-Kee Kim
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
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Taşkin Duman H, Karadakovan A. The effect of video training on symptom burden, comfort level, and quality of life in hemodialysis patients: Clustered randomized controlled trial. Patient Educ Couns 2024; 126:108314. [PMID: 38761675 DOI: 10.1016/j.pec.2024.108314] [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: 02/06/2024] [Revised: 04/24/2024] [Accepted: 05/02/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE Use of video in patient education is becoming widespread due to its low cost, time management, ease of application, and permanent learning. The study aimed to investigate the effect of video training on the symptom burden, comfort level, and quality of life of patients undergoing hemodialysis treatment. METHODS In this clustered randomized controlled trial, the patients were randomly assigned to groups by lottery method according to hemodialysis treatment days and sessions. Individuals in the intervention group(n = 26) were screened one episode of the training video in each session for three episodes per week for 12 weeks. Individuals in the control group(n = 22) received only conventional hemodialysis without video training. RESULTS At the third and fourth measurement times, in intervention group, mean scores of symptom burden decreased compared to baseline (respectively:40,12 ± 21,63; 22,31 ± 14,08;21,54 ± 16,78), mean scores of comfort level increased (respectively:102,42 ± 13,45; 111,42 ± 8,00;115,04 ± 9,73)(p < 0.05), while there was no significant difference in control group(p > 0.05). This study observed a statistically significant difference between quality of life scale scores individuals in intervention group(p < 0,05). CONCLUSION It was concluded that video training delivered to patients undergoing hemodialysis treatment decreased symptom burden of patients and increased their comfort level, and quality of life. PRACTICE IMPLICATIONS Video training can be utilized in the educational program of hemodialysis patients.
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Affiliation(s)
- Halise Taşkin Duman
- Muğla Sıtkı Koçman University Fethiye Faculty of Health Sciences, Nursing Department, Muğla, Turkey.
| | - Ayfer Karadakovan
- Ege University Faculty of Nursing, Nursing Department, İzmir, Turkey
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18
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Pennetta FF, Millarelli M, De Santis F, Bandiera A, Tozzi M, Chiappa R. Cavoatrial junction stenting in vascular hemodialysis catheter malfunction. J Vasc Access 2024:11297298241250372. [PMID: 38708829 DOI: 10.1177/11297298241250372] [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: 05/07/2024] Open
Abstract
In patients undergoing hemodialytic treatment via intravascular catheters, stenosis or occlusion of central veins is common. Despite an extensive characterization of Superior Vena Cava Syndrome (SVCS) no data is available about CavoAtrial Junction (CAJ) stenosis. We report the case of two patients with a story of multiple catheter failures due to thrombosis or infection. Computed tomography (CT) showed radiological signs of CAJ stenosis confirmed at the following venography. In absence of other feasible options to place a vascular access, the two underwent stenting with Gore Viabahn VBX balloon expandable endoprosthesis (W.L. Gore & Associates, Flagstaff, AZ, USA) of the CAJ stenosis. Completion venography showed complete resolution of the stenosis in both patients. No complications occurred during the procedures. At a mean follow-up of 878 ± 559 days no signs of in-stent restenosis or recoil were found. The present cases emphasize the feasibility and safety of CAJ stenting, underlining the importance of preserving CAJ and upper veins patency in hemodialysis access.
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Affiliation(s)
| | | | | | | | - Matteo Tozzi
- Vascular Surgery Unit, University of Insubria, Varese, Lombardy, Italy
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Abe M, Kikuchi K, Wada A, Nakai S, Kanda E, Hanafusa N. Current dialyzer classification in Japan and mortality risk in patients undergoing hemodialysis. Sci Rep 2024; 14:10272. [PMID: 38704419 PMCID: PMC11069571 DOI: 10.1038/s41598-024-60831-y] [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: 02/04/2024] [Accepted: 04/27/2024] [Indexed: 05/06/2024] Open
Abstract
Dialyzers are classified into five types based on their β2-microglobulin clearance rate and albumin sieving coefficient: Ia, Ib, IIa, and IIb. In addition, a new classification system introduced a type S dialyzer. However, limited information is available regarding the impact of dialyzer type on patient outcomes. A cohort study was conducted using data from the Japanese Society for Dialysis Therapy Renal Data Registry database. Total 181,804 patients on hemodialysis (HD) were included in the study, categorized into four groups (type Ia, IIa, IIb, and S). The associations between each group and two-year all-cause mortality were assessed using Cox proportional hazard models. Furthermore, propensity score-matching analysis was performed. By the end of 2019, 34,185 patients on dialysis had died. After adjusting for all confounders, the risk for all-cause mortality was significantly lower in the type IIa, and S groups than in the type Ia group. These significant findings were consistent after propensity score matching. In conclusion, our findings suggest that super high-flux dialyzers, with a β2-microglobulin clearance of ≥ 70 mL/min, may be beneficial for patients on HD, regardless of their albumin sieving coefficient. In addition, type S dialyzers may be beneficial for elderly and malnourished patients on dialysis.Trial registration number: UMIN000018641.
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Affiliation(s)
- Masanori Abe
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.
- Division of Nephrology, Hypertension, and Endocrinology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
| | - Kan Kikuchi
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
- Division of Nephrology, Shimoochiai Clinic, Tokyo, Japan
| | - Atsushi Wada
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
- Department of Nephrology, Kitasaito Hospital, Asahikawa, Japan
| | - Shigeru Nakai
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
- Department of Clinical Engineering, Fujita Health University, Aichi, Japan
| | - Eiichiro Kanda
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
- Department of Medical Science, Kawasaki Medical School, Kurashiki, Japan
| | - Norio Hanafusa
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
- Department of Blood Purification, Tokyo Women's Medical University, Tokyo, Japan
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20
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Beck NS, Seo Y, Park T, Jun SS, Im JI, Hong SY. Oxidative stress in patients with coronavirus disease and end-stage renal disease: a pilot study. BMC Nephrol 2024; 25:155. [PMID: 38702607 PMCID: PMC11069245 DOI: 10.1186/s12882-024-03584-0] [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: 02/09/2024] [Accepted: 04/23/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Oxidative stress, an imbalance between reactive oxygen species production and antioxidant capacity, increases in patients with coronavirus disease (COVID-19) or renal impairment. We investigated whether combined COVID-19 and end-stage renal disease (ESRD) would increase oxidative stress levels compared to each disease alone. METHODS Oxidative stress was compared among three groups. Two groups comprised patients with COVID-19 referred to the hospital with or without renal impairment (COVID-ESRD group [n = 18]; COVID group [n = 17]). The third group (ESRD group [n = 18]) comprised patients without COVID-19 on maintenance hemodialysis at a hospital. RESULTS The total oxidative stress in the COVID-ESRD group was lower than in the COVID group (p = 0.047). The total antioxidant status was higher in the COVID-ESRD group than in the ESRD (p < 0.001) and COVID (p < 0.001) groups after controlling for covariates. The oxidative stress index was lower in the COVID-ESRD group than in the ESRD (p = 0.001) and COVID (p < 0.001) groups. However, the three oxidative parameters did not differ significantly between the COVID and COVID-ESRD groups. CONCLUSIONS The role of reactive oxygen species in the pathophysiology of COVID-19 among patients withESRD appears to be non-critical. Therefore, the provision of supplemental antioxidants may not confer a therapeutic advantage, particularly in cases of mild COVID-19 in ESRD patients receiving hemodialysis. Nonetheless, this area merits further research.
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Affiliation(s)
- Nam-Seon Beck
- Department of Pediatrics, Chung-Ang Jeil Hospital, Chungbuk, South Korea
| | - Yeonju Seo
- Interdisciplinary Program in Bioinformatics, Seoul National University, Seoul, South Korea
| | - Taesung Park
- Department of Statistics, Seoul National University, Seoul, South Korea
| | - Sang-Sin Jun
- Department of Neurology, Chung-Ang Jeil Hospital, Chungbuk, South Korea
| | - Joung-Il Im
- Department of Orthopedic Surgery, Chung-Ang Jeil Hospital, Chungbuk, South Korea
| | - Sae-Yong Hong
- Department of Nephrology, Chung-Ang Jeil Hospital, Chungbuk, South Korea.
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Shi R, Zhu JX, Zhu L, Zhao WM, Li H, Chen QC, Pan HF, Wang DG. Exploring the nexus between fatigue, body composition, and muscle strength in hemodialysis patients. Eur J Med Res 2024; 29:266. [PMID: 38698469 PMCID: PMC11067273 DOI: 10.1186/s40001-024-01852-1] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/19/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Fatigue is a relatively prevalent condition among hemodialysis patients, resulting in diminished health-related quality of life and decreased survival rates. The purpose of this study was to investigate the relationship between fatigue and body composition in hemodialysis patients. METHODS This cross-sectional study included 92 patients in total. Fatigue was measured by Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F) (cut-off ≤ 34). Body composition was measured based on quantitative computed tomography (QCT), parameters including skeletal muscle index (SMI), intermuscular adipose tissue (IMAT), and bone mineral density (BMD). Handgrip strength was also collected. To explore the relationship between fatigue and body composition parameters, we conducted correlation analyses and binary logistic regression. RESULTS The prevalence of fatigue was 37% (n = 34), abnormal bone density was 43.4% (n = 40). There was a positive correlation between handgrip strength and FACIT-F score (r = 0.448, p < 0.001). Age (r = - 0.411, p < 0.001), IMAT % (r = - 0.424, p < 0.001), negatively associated with FACIT-F score. Multivariate logistic regression analysis shows that older age, lower serum phosphorus, higher IMAT% are associated with a high risk of fatigue. CONCLUSION The significantly increased incidence and degree of fatigue in hemodialysis patients is associated with more intermuscular adipose tissue in paraspinal muscle.
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Affiliation(s)
- Rui Shi
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, China
| | - Jia-Xin Zhu
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, China
| | - Li Zhu
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, China
| | - Wen-Man Zhao
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, China
| | - Huai Li
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, China
| | - Qi-Chun Chen
- Department of Radiology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, China
| | - Hai-Feng Pan
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, China.
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, China.
| | - De-Guang Wang
- Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, China.
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, China.
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22
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Shirai N, Usui N, Abe Y, Tamiya H, Amari T, Kojima S, Mikami K, Nagashima M, Shinozaki N, Shimano Y, Saitoh M. Relationship among Falls, Fear of Falling, and Physical Activity Level in Patients on Hemodialysis. Phys Ther 2024:pzae064. [PMID: 38696344 DOI: 10.1093/ptj/pzae064] [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: 08/05/2023] [Revised: 11/20/2023] [Indexed: 05/04/2024]
Abstract
OBJECTIVE Patients on hemodialysis are highly susceptible to falls and fractures. Amplified apprehension regarding the fear of falling (FOF) constitutes a risk factor that restricts physical activity and escalates the probability of falls among the elderly population. This study aimed to elucidate the association between falls and FOF and physical activity in patients on hemodialysis. METHODS A prospective cohort study was conducted across 9 centers. FOF was assessed using the Falls Efficacy Scale-International (FES-I). Physical activity was assessed using the Japanese version of the International Physical Activity Questionnaire short form. Subsequently, falls were monitored over a duration of 1 year. Logistic regression analysis was performed to evaluate the relationship between falls and FOF and physical activity. In addition, in the receiver operating characteristic analysis, the cutoff value of FES-I that predicts falls was determined using the Youden Index. A restricted cubic spline curve was utilized to analyze the nonlinear association between falls and the FES-I. RESULTS A total of 253 patients on hemodialysis (70.0 [59.0-77.0] years old; 105 female [41.5%]) were included in the analysis. During the 1-year observation period, 90 (35.6%) patients experienced accidental falls. The median FES-I score was 36.0 (24.0-47.0) points, and patients with higher FES-I scores had more falls. Following adjusted logistic regression analysis, FES-I exhibited an independent association with falls (OR = 1.04; 95% CI = 1.01-1.06), but physical activity was not. The area under the receiver operating characteristic curve was 0.70 (95% CI = 0.64-0.77), and the FES-I threshold value for distinguishing fallers from non-fallers was determined as 37.5 points (sensitivity 65.6%, specificity 35.0%). A nonlinear relationship between falls and FES-I was observed. CONCLUSION FOF was associated with the incidence of falls in patients on hemodialysis. IMPACT The evaluation and implementation of interventions targeting the FOF may mitigate the risk of falls.
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Affiliation(s)
- Nobuyuki Shirai
- Department of Rehabilitation, Niigata Rinko Hospital, Niigata, Japan
- Renal Exercise and Physical Activity Network - Virtual Laboratory
| | - Naoto Usui
- Department of Physical Therapy, Kisen Hospital, Tokyo, Japan
- Renal Exercise and Physical Activity Network - Virtual Laboratory
| | - Yoshifumi Abe
- Department of Rehabilitation, Faculty of Health Sciences, Tokyo Kasei University, Saitama, Japan
- Renal Exercise and Physical Activity Network - Virtual Laboratory
| | - Hajime Tamiya
- Department of physical therapy, Niigata University of Health and Welfare, Niigata, Japan
- Renal Exercise and Physical Activity Network - Virtual Laboratory
| | - Takashi Amari
- Department of Physical Therapy, Health Science University, Yamanashi, Japan
- Renal Exercise and Physical Activity Network - Virtual Laboratory
| | - Sho Kojima
- Department of Physical Therapy, Kisen Hospital, Tokyo, Japan
- Renal Exercise and Physical Activity Network - Virtual Laboratory
| | - Kenta Mikami
- Department of Cardiac Rehabilitation, Iwatsuki Minami Hospital, Saitama, Japan
- Renal Exercise and Physical Activity Network - Virtual Laboratory
| | - Mizuki Nagashima
- Department of Cardiac Rehabilitation, Iwatsuki Minami Hospital, Saitama, Japan
- Renal Exercise and Physical Activity Network - Virtual Laboratory
| | - Nobuhito Shinozaki
- Department of Rehabilitation, Tokatsu Clinic Hospital, Chiba, Japan
- Renal Exercise and Physical Activity Network - Virtual Laboratory
| | - Yu Shimano
- Department of Rehabilitation, Saiyu Clinic, Saitama, Japan
- Renal Exercise and Physical Activity Network - Virtual Laboratory
| | - Masakazu Saitoh
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
- Renal Exercise and Physical Activity Network - Virtual Laboratory
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Zhang S, Xu Y, Xia Y. The efficacy and safety of sertraline in maintenance hemodialysis patients with depression: A randomized controlled study. J Affect Disord 2024; 352:60-66. [PMID: 38336164 DOI: 10.1016/j.jad.2024.02.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/23/2024] [Accepted: 02/05/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE To determine the efficacy and safety of sertraline in maintenance hemodialysis (MHD) patients with depression. METHODS A randomized controlled trial was conducted involving 125 MHD patients with depression. The treatment group received sertraline, while the control group did not receive any antidepressant treatment. After 12 weeks, we compared the changes in the Hamilton Depression Rating Scale (HAMD), the Medication Adherence Report Scale-5 (MARS-5), the Mini Nutritional Assessment short-form (MNA-SF), the Kidney Disease Quality of Life-36 (KDQOL-36) scores, selected clinical and laboratory indicators, and the incidence of drug-related adverse reactions between the two groups. RESULTS After 12 weeks of treatment, the HAMD scores of patients in the treatment group significantly decreased compared to before treatment and were lower than those in the control group. The KDQOL-36, MARS-5, and MNA-SF scores in the treatment group also significantly improved compared to before treatment and were superior to those in the control group. Albumin and hemoglobin levels in the treatment group significantly increased, while C-reactive protein significantly decreased. The incidence of nausea was slightly higher in the treatment group, and was mostly relieved after reducing the dosage of sertraline. LIMITATIONS This study is a single-center, small-sample study with a relatively short duration of treatment and follow-up. CONCLUSIONS Sertraline can alleviate depressive symptoms, and improve the quality of life and treatment compliance of MHD patients, while improving chronic inflammation, malnutrition, and anemia. However, starting with a low dose and reducing the maintenance dose is recommended when administering sertraline.
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Affiliation(s)
- Shunjuan Zhang
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing 400016, China.
| | - Ya Xu
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing 400016, China
| | - Yunfeng Xia
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing 400016, China.
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Alhasan K, Alsalmi AA, Almaiman W, Al Herbish AJ, Farhat A, Sandokji I, Aloufi M, Faqeehi HY, Abdulmajeed N, Alanazi A, AlHassan A, Alshathri A, Almalki AM, Bafageeh AA, Aldajani AM, AlMuzain A, Almuteri FS, Nasser HH, Al Alsheikh K, Almokali KM, Maghfuri M, Abukhatwah MW, Ahmed MAM, Fatani N, Al-Harbi N, AlDhaferi RF, Amohaimeed S, AlSannaa ZH, Shalaby MA, Raina R, Broering DC, Kari JA, Temsah MH. Insight into prevalence, etiology, and modalities of pediatric chronic dialysis: a comprehensive nationwide analysis. Pediatr Nephrol 2024; 39:1559-1566. [PMID: 38091245 DOI: 10.1007/s00467-023-06245-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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 03/16/2024]
Abstract
BACKGROUND This study aimed to determine the prevalence and etiology of kidney failure (KF) among children below 15 years of age receiving chronic dialysis in Saudi Arabia and describe their dialysis modalities. METHODS This cross-sectional descriptive study was conducted on 8 August 2022, encompassing all 23 pediatric dialysis centers in Saudi Arabia. Data gathered comprised patient demographics, causes of KF, and the dialysis methods employed. Collected data underwent analysis to determine prevalence of children undergoing chronic dialysis, discern underlying causes of KF, and evaluate distribution of patients across different dialysis modalities. RESULTS The prevalence of children on chronic dialysis is 77.6 per million children living in Saudi Arabia, equating to 419 children. The predominant underlying cause of KF was congenital anomalies of the kidneys and urinary tract (CAKUT), representing a substantial 41% of cases. Following this, others or unknown etiologies accounted for a noteworthy 25% of cases, with focal segmental glomerulosclerosis (FSGS) comprising 13%, glomerulonephritis at 11%, and congenital nephrotic syndrome contributing 10% to etiological distribution. Regarding dialysis modalities employed, 67% of patients were on peritoneal dialysis (PD), while the remaining 33% were on hemodialysis (HD). CONCLUSIONS This first nationwide study of pediatric chronic dialysis in Saudi Arabia sheds light on the prevalence of children undergoing chronic dialysis and underlying causes of their KF, thereby contributing to our understanding of clinical management considerations. This research serves as a stepping stone for the development of national registries.
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Affiliation(s)
- Khalid Alhasan
- Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
- Division of Nephrology, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
| | - Amro Attaf Alsalmi
- Division of Nephrology, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Weiam Almaiman
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Adi J Al Herbish
- Pediatric Nephrology Division, Pediatric Department, King Abdullah Specialized Children Hospital, Ministry of National Guard, Riyadh, Saudi Arabia
| | - Afrah Farhat
- Division of Nephrology, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim Sandokji
- Section of Nephrology, Department of Pediatrics, College of Medicine, Taibah University, Medina, Saudi Arabia
| | - Majed Aloufi
- Pediatric Nephrology Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Hassan Yahya Faqeehi
- Division of Pediatric Nephrology, King Fahad Medical City, Children Specialized Hospital, Riyadh, Saudi Arabia
| | - Naif Abdulmajeed
- Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Division of Nephrology, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Pediatric Nephrology Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdulkarim Alanazi
- Division of Pediatric Nephrology, King Fahad Medical City, Children Specialized Hospital, Riyadh, Saudi Arabia
| | - Abdulaziz AlHassan
- Pediatric Department, Maternity and Children Hospital, Ministry of Health, Al Ahsa, Saudi Arabia
| | - Abdulaziz Alshathri
- Pediatric Nephrology Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Abeer Mohammad Almalki
- Pediatric Nephrology Department, Children's Hospital, Ministry of Health, Taif, Saudi Arabia
| | - Afaf Alawi Bafageeh
- Center of Multi-Organ Transplant, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Ali M Aldajani
- Pediatric Nephrology Department, Maternity Children Hospital, Dammam, Saudi Arabia
| | - Ashraf AlMuzain
- Pediatric Department, King Fahd Hospital of the University, Khobar, Saudi Arabia
| | - Faten Sudan Almuteri
- Pediatric Nephrology Division, Pediatric Department, King Salman Bin Abdulaziz Medical City, Ministry of Health, Madina, Saudi Arabia
| | - Haydar Hassan Nasser
- Division of Nephrology, Pediatric Department, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Khalid Al Alsheikh
- Pediatric Department, Maternity and Children Hospital, Abha, Saudi Arabia
| | - Khamisa Mohamed Almokali
- Pediatric Nephrology Division, Pediatric Department, King Abdullah Specialized Children Hospital, Ministry of National Guard, Riyadh, Saudi Arabia
| | - Magbul Maghfuri
- Pediatric Nephrology Department, King Fahad Central Hospital, Jazan, Saudi Arabia
| | - Mohamed Waleed Abukhatwah
- Pediatric Nephrology Section, Pediatric Department, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | | | - Naeima Fatani
- Pediatric Department, Maternity and Childcare Hospital, Ministry of Health, Makkah, Saudi Arabia
| | - Naffaa Al-Harbi
- Department of Pediatrics, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Rezqah Fajor AlDhaferi
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Sulaiman Amohaimeed
- Pediatric Department, King Fahad Military Medical Complex, Dhahran, Saudi Arabia
| | | | - Mohamed A Shalaby
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Pediatric Nephrology Centre of Excellence, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Rupesh Raina
- Department of Nephrology, Akron Children's Hospital, Akron, OH, USA
| | - Dieter Clemens Broering
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Jameela A Kari
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Pediatric Nephrology Centre of Excellence, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Mohamad-Hani Temsah
- Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
- Evidence-Based Healthcare and Knowledge Translation Research Chair, King Saud University, Riyadh, Saudi Arabia.
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25
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Lin L, Chen L, Lu C, Chen G, Hong FF. Chitosan particles embedded bacterial nanocellulose flat membrane for hemodialysis. Int J Biol Macromol 2024; 266:130646. [PMID: 38460632 DOI: 10.1016/j.ijbiomac.2024.130646] [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: 08/10/2023] [Revised: 02/20/2024] [Accepted: 03/04/2024] [Indexed: 03/11/2024]
Abstract
The development of bio-based hemodialysis membranes continues to be a challenge. Bacterial nanocellulose (BNC) membranes show potential in hemodialysis but can hardly retain beneficial proteins. Here, chitosan particles/bacterial nanocellulose (CSP/BNC) membranes were designed to efficiently remove uremic toxins and retain beneficial proteins. First, CSPs were synthesized in situ within a BNC membrane by ionic gelation following negative pressure impregnation. Subsequently, these membranes were thoroughly characterized. Compared with the BNC membrane, the pore volume and pore size of the 3 % CSP/BNC membrane decreased by 42.2 % and 32.1 %, respectively. The increased 22.2 times of Young's modulus and 88.9 % of tensile strength in the 3 % CSP/BNC membrane confirmed enhanced mechanical property. The sieving coefficient of bovine serum albumin decreased to 0.05 ± 0.03 in the 3 % CSP/BNC membrane. Moreover, the CSP/BNC membrane exhibited good hemocompatibility and cytocompatibility. The simulated dialysis results showed that the 3 % CSP/BNC membrane exhibited high clearance of urea (16.37 %/cm2) and lysozyme (3.54 %/cm2), while efficiently retaining bovine serum albumin (98.04 %/cm2). This is the first demonstration of the construction of a BNC-based hemodialysis membrane with in situ CSP formation to effectively regulate the pore properties of the membrane, making the CSP/BNC membrane a promising candidate for hemodialysis applications.
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Affiliation(s)
- Lulu Lin
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, Donghua University, Shanghai 201620, China; College of Biological Science and Medical Engineering, Donghua University, No. 2999 North Ren Min Road, Shanghai 201620, China
| | - Lin Chen
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, Donghua University, Shanghai 201620, China; National Advanced Functional Fiber Innovation Center, Wu Jiang, Su Zhou, China
| | - Changrui Lu
- College of Biological Science and Medical Engineering, Donghua University, No. 2999 North Ren Min Road, Shanghai 201620, China
| | - Genqiang Chen
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, Donghua University, Shanghai 201620, China; College of Biological Science and Medical Engineering, Donghua University, No. 2999 North Ren Min Road, Shanghai 201620, China.
| | - Feng F Hong
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, Donghua University, Shanghai 201620, China; College of Biological Science and Medical Engineering, Donghua University, No. 2999 North Ren Min Road, Shanghai 201620, China; National Advanced Functional Fiber Innovation Center, Wu Jiang, Su Zhou, China.
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26
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Mourchid R, Yassine A, Bellahcen M, Cherrah Y, Serragui S. Chronic kidney disease in America, Africa, and Asia: Overview of treatment cost and options. Ann Pharm Fr 2024; 82:392-400. [PMID: 38218427 DOI: 10.1016/j.pharma.2024.01.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/02/2024] [Accepted: 01/07/2024] [Indexed: 01/15/2024]
Abstract
Chronic kidney disease (CKD) is one of the non-infectious diseases that threaten patients' lives on a daily basis. Its prevalence is high, but under-reported by patients and those living with the disease, as it is silent and asymptomatic in the early stages. Kidney disease increases the risk of heart and vascular disease. These problems can manifest themselves slowly, over a long period of time. Early detection and treatment can often prevent chronic kidney disease from worsening. As kidney disease progresses, it can lead to kidney failure, requiring dialysis or a kidney transplant to stay alive. In this narrative review, we will mainly discuss different treatment option costs in different countries and how much they cost healthcare systems in countries in three different continents.
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Affiliation(s)
- Rania Mourchid
- Pharmaco-epidemiology and pharmacoeconomics research team, Pharmacology and Toxicology Laboratory, Faculty of Medicine and Pharmacy, Mohammed V University, 10100 Rabat, Morocco.
| | - Amal Yassine
- National health Insurance agency, 10100 Rabat, Morocco.
| | - Mohammed Bellahcen
- Hemodialysis Center Fondation Amal Hay Nahda Rabat, 10210 Rabat, Morocco.
| | - Yahia Cherrah
- Pharmaco-epidemiology and pharmacoeconomics research team, Pharmacology and Toxicology Laboratory, Faculty of Medicine and Pharmacy, Mohammed V University, 10100 Rabat, Morocco.
| | - Samira Serragui
- Pharmaco-epidemiology and pharmacoeconomics research team, Pharmacology and Toxicology Laboratory, Faculty of Medicine and Pharmacy, Mohammed V University, 10100 Rabat, Morocco.
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Chen YT, Lin CC, Huang PH, Li SY. Comparative analysis of hemodialysis and peritoneal dialysis on the risk of new onset diabetes mellitus. J Formos Med Assoc 2024; 123:606-612. [PMID: 38220559 DOI: 10.1016/j.jfma.2024.01.013] [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: 08/28/2023] [Revised: 11/17/2023] [Accepted: 01/05/2024] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Diabetes mellitus is a significant risk factor for cardiovascular events and mortality in dialysis patients. The impact of different dialysis modalities on the risk of new onset diabetes mellitus (NODM) remains a subject of debate. Previous studies did not adequately account for critical confounding factors such as pre-dialysis glycemic status, medication use, and nutritional status, which may influence the association between dialysis modality and NODM risk. METHODS We conducted a retrospective cohort study of 1426 non-diabetic end-stage renal disease (ESRD) patients who underwent either hemodialysis (HD) or peritoneal dialysis (PD) at a single medical center. We used different statistical methods, adjusting for potential confounding factors, and accounted for competing risk of death. RESULTS Over 12 years, 331 patients (23 %) developed NODM. After adjusting for potential confounding factors and mortality, PD patients had a significantly higher risk of NODM compared to HD patients (adjusted HR 1.52, p = 0.001). A propensity-matched cohort sensitivity analysis yielded similar results. Among patients with prediabetes, those receiving PD had a 2.93 times higher risk of developing NODM than those receiving HD (p for interaction <0.001), whereas no significant difference was observed among euglycemic patients. NODM was also associated with a 1.78 times increased risk of major cardiovascular events. CONCLUSION Our study provides evidence that PD treatment may increase the risk of NODM in ESRD patients, particularly among those with preexisting prediabetes. These findings highlight the importance of personalized treatment approaches, and nephrologists should consider prediabetes when choosing the dialysis modality for their patients.
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Affiliation(s)
- Yung-Tai Chen
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Medicine, Taipei City Hospital Heping Fuyou Branch, Taipei, Taiwan; University of Taipei, Taiwan
| | - Chih-Ching Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Depart of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Hsun Huang
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Szu-Yuan Li
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Depart of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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28
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Kanth RK, Agrawal N, Patel P, Arora A, Chaturvedy M, Tiwari S, Aggarwal D, Panda S. Sensory ataxic polyneuropathy unmasking late-onset urea cycle defect. Clin Neurol Neurosurg 2024; 240:108260. [PMID: 38564992 DOI: 10.1016/j.clineuro.2024.108260] [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: 12/12/2023] [Revised: 03/21/2024] [Accepted: 03/23/2024] [Indexed: 04/04/2024]
Abstract
A 63-year-old man with type 2 diabetes mellitus, alcohol consumption in moderation, and three episodes of hepatic encephalopathy presented with symmetrical lower limb distal weakness, sensory ataxia, thickened palpable nerves, mood disturbances for seven years, and a family history of schizophreniform disorders. Nerve conduction studies showed demyelinating sensorimotor polyradiculoneuropathy. CSF analysis showed mild albumino-cytological dissociation. MRI brain and lumbosacral plexus showed thickened fifth cranial nerves and lumbosacral roots. He was treated with steroids for a provisional diagnosis of chronic inflammatory polyneuropathy and became encephalopathic. EEG showed triphasic waves. Serum ammonia was 201 micrograms/dL. Further evaluation suggested ornithine transcarbamylase (OTC) deficiency. The patient underwent hemodialysis with a low protein diet, rifaximin, and sodium benzoate, with subsequent recovery.
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Affiliation(s)
- Ravi Krishna Kanth
- Department of Neurology, All India Institute of Medical Sciences, Jodhpur, India
| | - Naman Agrawal
- Department of Neurology, All India Institute of Medical Sciences, Jodhpur, India
| | - Pratik Patel
- Department of Neurology, All India Institute of Medical Sciences, Jodhpur, India
| | - Anka Arora
- Department of Neurology, All India Institute of Medical Sciences, Jodhpur, India
| | - Manish Chaturvedy
- Departments of Neurology, Nephrology, All India Institute of Medical Sciences, Jodhpur, India
| | - Sarbesh Tiwari
- Departments of Neurology, Nephrology, Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Divya Aggarwal
- Departments of Neurology, Nephrology, Diagnostic and Interventional Radiology, and Pathology, All India Institute of Medical Sciences, Jodhpur, India
| | - Samhita Panda
- Department of Neurology, All India Institute of Medical Sciences, Jodhpur, India.
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Hebah HA, Kamel HM, Bastawy IM, Ahmed FA. Association between serum beclin 1 level and cardiac valvular calcification in hemodialysis patients. Curr Probl Cardiol 2024; 49:102519. [PMID: 38492612 DOI: 10.1016/j.cpcardiol.2024.102519] [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: 03/03/2024] [Accepted: 03/13/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Cardiovascular calcification is a pervasive issue throughout chronic kidney disease (CKD) progression. Autophagy, a fundamental cellular process, exerts significant influence on various cardiac pathologies, including arrhythmias, atherosclerosis, heart failure, and notably, valvular, and vascular calcifications. Beclin-1, a crucial eukaryotic protein, plays a major regulatory role in autophagy as part of the phosphatidylinositol-3-kinase (PI3K) complex. Recent evidence suggests a protective role for Beclin-1-mediated autophagy in CKD vascular calcification, raising its potential as a novel therapeutic target in this context. WE AIMED TO Investigate the association between serum Beclin 1 levels and the presence of cardiovascular valvular calcification in hemodialysis patients. RESULTS This study evaluated a cohort of 102 hemodialysis patients, evenly divided into two groups based on echocardiographic findings. All participants underwent serum Beclin 1 measurement and transthoracic echocardiography. Patients with acute kidney injury, active malignancy, or diabetes were excluded. Our study revealed significant differences between the two groups in terms of: Serum Beclin 1 levels, all parameters of lipid profile, prevalence of ischemic heart disease, serum albumin levels and Total calcium. Echocardiography in Group 1 showed that most cases (60.78%) exhibited mild aortic valve calcification. Additionally, significant relationships were observed between Beclin 1 and: ischemic heart disease (p=0.011) Aortic valve calcification on echocardiography (p < 0.001) Interestingly, lower Beclin 1 levels were associated with more severe valve calcification. A Beclin 1 cutoff value of ≤ 35.5 ng/ml demonstrated the highest sensitivity (98%) and specificity (92%). CONCLUSION Our findings suggest that the serum Beclin 1 level could be incorporated into a predictive model for cardiac valvular calcification in hemodialysis patients.
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Affiliation(s)
- Hayam Ahmed Hebah
- Ain Shams University, Faculty of Medicine, Internal Medicine, And Nephrology Department. Cairo, Egypt
| | - Hadeer Moamen Kamel
- Ain Shams University, Faculty of Medicine, Internal Medicine, And Nephrology Department. Cairo, Egypt
| | | | - Fatma Abdelrahman Ahmed
- Ain Shams University, Faculty of Medicine, Internal Medicine, And Nephrology Department. Cairo, Egypt.
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Takei Y, Saito S, Shibasaki I, Kuwata T, Yamada Y, Fukuda H. Simulation to determine the approach of transcatheter aortic valve implantation in patients undergoing hemodialysis. Surg Today 2024; 54:428-435. [PMID: 37668736 PMCID: PMC11026236 DOI: 10.1007/s00595-023-02743-4] [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: 04/19/2023] [Accepted: 08/13/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE The present study investigated potential access vessels in patients receiving hemodialysis who underwent surgical aortic valve replacement and determined which approaches were most suitable for performing transcatheter aortic valve implantation. METHODS Consecutive patients undergoing hemodialysis with aortic valve stenosis who underwent surgical aortic valve replacement were included. Preoperative computed tomography data were analyzed to assess the vessel diameter and calcification. Simulations were conducted to determine the feasibility of inserting the 14-F eSheath of Sapien 3 via transfemoral, trans-cervical, trans-subclavian, and direct aorta approaches. RESULTS A total of 72 patients were included in this study. The access route was characterized by severe calcification of the common iliac artery. The transfemoral approach was feasible in 77.8% of the cases, but the rate decreased to 33% when the calculations were based on the maximum sheath extension diameter. The trans-cervical, trans-subclavian, and direct aortic approaches were suitable for many patients. Lower extremity artery disease was identified as a risk factor for the unsuitability of the transfemoral approach. CONCLUSIONS Common iliac artery calcification in patients undergoing hemodialysis restricts the use of the transfemoral approach. Therefore, some patients require alternative approaches.
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Affiliation(s)
- Yusuke Takei
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University Graduate School of Medicine, 880 Kitakobayashi, Mibu-Machi, Shimotuga-gun, Tochigi, 321-0293, Japan.
| | - Shunsuke Saito
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University Graduate School of Medicine, 880 Kitakobayashi, Mibu-Machi, Shimotuga-gun, Tochigi, 321-0293, Japan
| | - Ikuko Shibasaki
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University Graduate School of Medicine, 880 Kitakobayashi, Mibu-Machi, Shimotuga-gun, Tochigi, 321-0293, Japan
| | - Toshiyuki Kuwata
- Division of Cardiovascular Surgery, Maebashi Red Cross Hospital, Maebashi, Gunma, Japan
| | - Yasuyuki Yamada
- Division of Cardiovascular Surgery, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Hirotsugu Fukuda
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University Graduate School of Medicine, 880 Kitakobayashi, Mibu-Machi, Shimotuga-gun, Tochigi, 321-0293, Japan
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Sharif-Nia H, Marôco J, Froelicher ES, Barzegari S, Sadeghi N, Fatehi R. The relationship between fatigue, pruritus, and thirst distress with quality of life among patients receiving hemodialysis: a mediator model to test concept of treatment adherence. Sci Rep 2024; 14:9981. [PMID: 38693146 PMCID: PMC11063047 DOI: 10.1038/s41598-024-60679-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/25/2024] [Indexed: 05/03/2024] Open
Abstract
Hemodialysis is a conservative treatment for end-stage renal disease. It has various complications which negatively affect quality of life (QOL). This study aimed to examine the relationship between fatigue, pruritus, and thirst distress (TD) with QOL of patients receiving hemodialysis, while also considering the mediating role of treatment adherence (TA). This cross-sectional study was carried out in 2023 on 411 patients receiving hemodialysis. Participants were consecutively recruited from several dialysis centers in Iran. Data were collected using a demographic information form, the Fatigue Assessment Scale, the Thirst Distress Scale, the Pruritus Severity Scale, the 12-Item Short Form Health Survey, and the modified version of the Greek Simplified Medication Adherence Questionnaire for Hemodialysis Patients. Covariance-based structural equation modeling was used for data analysis. The structural model and hypothesis testing results showed that all hypotheses were supported in this study. QOL had a significant inverse association with fatigue, pruritus, and TD and a significant positive association with TA. TA partially mediated the association of QOL with fatigue, pruritus, and TD, denoting that it helped counteract the negative association of these complications on QOL. This model explained 68.5% of the total variance of QOL. Fatigue, pruritus, and TD have a negative association with QOL among patients receiving hemodialysis, while TA reduces these negative associations. Therefore, TA is greatly important to manage the associations of these complications and improve patient outcomes. Healthcare providers need to assign high priority to TA improvement among these patients to reduce their fatigue, pruritus, and TD and improve their QOL. Further studies are necessary to determine the most effective strategies for improving TA and reducing the burden of complications in this patient population.
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Affiliation(s)
- Hamid Sharif-Nia
- Psychosomatic Research Center, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Nursing, Amol School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - João Marôco
- William James Centre for Research ISPA-Instituto Universitário, Lisbon, Portugal
| | - Erika Sivarajan Froelicher
- Department of Physiological Nursing, School of Nursing, University of California San Francisco, San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Saeed Barzegari
- Department of Paramedicine, Amol School of Paramedical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Niloofar Sadeghi
- Department of Paramedicine, Amol School of Paramedical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Reza Fatehi
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran.
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Furukawa K, Lee KW, Shimata K, Ito T, Toshima T, Akamatsu N, Hibi T, Hong SK, Kim JM, Hatano E, Yoshizumi T, Ikegmi T, Suh KS. Feasible living donor liver transplantation for patients on chronic hemodialysis: a multicenter study in East Asian countries. Surg Today 2024; 54:471-477. [PMID: 37742325 DOI: 10.1007/s00595-023-02751-4] [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: 04/26/2023] [Accepted: 08/22/2023] [Indexed: 09/26/2023]
Abstract
PURPOSES End-stage liver and kidney disease is an indication for simultaneous liver and kidney transplantation. However, in countries where deceased donor transplantation is not well established, living donor liver transplantation (LDLT) is a realistic option for patients on hemodialysis (HD). We investigated the outcomes of LDLT for patients on HD. METHODS We conducted a retrospective multicenter survey of patients on chronic HD who underwent LDLT in East Asian countries. The characteristics of donors and recipients and the short and long-term outcomes were analyzed. RESULTS Between 2001 and 2021, 45 patients on HD underwent LDLT and 11 of these patients also underwent kidney transplantation (KT). The overall survival rate at 5 years of the 34 patients who underwent only LDLT was 44.5%. Multivariate analysis identified a low graft recipient weight ratio (< 1%) (p = 0.048) and long HD duration (≥ 10 years) (p = 0.046) as independent predictors of poor overall survival. The major complication was posttransplant bleeding, which occurred in12 patients (35%). CONCLUSION It is important to establish the indications for LDLT, taking into consideration graft size and HD duration in candidate patients on HD.
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Affiliation(s)
- Kenei Furukawa
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Kwang-Woong Lee
- Division of HBP Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Keita Shimata
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Takashi Ito
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeo Toshima
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nobuhisa Akamatsu
- Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Suk Kyun Hong
- Division of HBP Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Etsuro Hatano
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toru Ikegmi
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kyung-Suk Suh
- Division of HBP Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
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Jahromi LSM, Vejdanpak M, Ghaderpanah R, Sadrian SH, Dabbaghmanesh A, Roshanzamir S, Dabbaghmanesh M. Efficacy of Acupuncture on Pain Severity and Frequency of Calf Cramps in Dialysis Patients: a Randomized Clinical Trial. J Acupunct Meridian Stud 2024; 17:47-54. [PMID: 38686428 DOI: 10.51507/j.jams.2024.17.2.47] [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: 07/14/2023] [Revised: 09/26/2023] [Accepted: 03/24/2024] [Indexed: 05/02/2024] Open
Abstract
Background Patients with chronic kidney disease, as a common disorder, usually necessitate the implementation of hemodialysis. Muscle cramps are one of the most disabling complications affecting their quality of life. Objectives We aimed to investigate the efficacy of acupuncture as a safe alternative to the management of pain severity and frequency of calf cramps in dialysis patients compared to a control group. Methods Fifty dialysis patients experiencing calf cramps who met the eligibility criteria were randomly allocated to two groups. Group A received routine management, including analgesic consumption, stretching exercises, and nine acupuncture sessions, including acupoints BL57, GV26, CV4, CV6, LV3, KI 1, LU7, LU9, and GB34. Group B underwent sham acupuncture therapy at locations other than the primary acupoints in addition to following the specified routine management. The pain severity was measured using the visual analog scale (VAS), and the daily frequency of calf cramps was evaluated at baseline and one month after treatment completion. Results VAS scores and the frequency of calf cramps were improved one month after treatment completion in both groups. However, the improvement was significant in group A (p < 0.001), while it was not statistically significant in group B (p > 0.05). There was also a significant difference between both groups regarding reducing pain and the frequency of calf cramps, which showed the efficacy of acupuncture compared to the control group (p < 0.0001). Conclusion Acupuncture can decrease pain and frequency of calf cramps in dialysis patients.
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Affiliation(s)
| | | | - Rezvan Ghaderpanah
- Students Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Hassan Sadrian
- Students Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Dabbaghmanesh
- Department of Internal Medicine, Shiraz Medical School, Shiraz University of Medical Sciences (SUMS), Shiraz, Iran
| | - Sharareh Roshanzamir
- Physical Medicine and Rehabilitation, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadhossein Dabbaghmanesh
- Shiraz Endocrine and Metabolism Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Pungchompoo W, Parinyachitta S, Pungchompoo S, Udomkhwamsuk W, Suwan P. The feasibility of integrating a home telehealth model for older persons living with hemodialysis. BMC Geriatr 2024; 24:378. [PMID: 38671357 PMCID: PMC11055365 DOI: 10.1186/s12877-024-04981-8] [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: 10/24/2023] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND In Thailand, there is a rapidly increasing population of older persons living with hemodialysis (OPLWH) for whom quality of life and clinical outcomes are their main focus. This study aims to assess the feasibility of an integrated home telehealth model on quality of life and laboratory parameters of OPLWH. METHODS In this study, the second phase of a mixed methods exploratory sequential design was conducted using a repeated measures experimental design. Participants met the inclusion criteria, which included being an OPLWH at a single hemodialysis center of one hospital in Chiang Mai province, Thailand, during the experimental period between 1 April and 30 September 2018, and willing to participate in the study. The 54 participants were purposively selected and randomly assigned to receive either an intervention (n = 24) consisting of health education and health monitoring using a telehealth device (an iPad) and a web application, or usual care (n = 30). The instruments included a demographic data form, which was analyzed using the chi-square test. The health-related quality of life questionnaire (the 9-item Thai Health Status Assessment questionnaire) and blood chemistry (BUN, Cr, Hb, Hct, Alb, K, Kt/V, and nPCR) were compared and measured at baseline, and at 3 and 6 months after enrolment using independent t-test and one-way repeated measures ANOVA. RESULTS The comparison of quality of life between the two groups at the two points of repeated measurement (after 3 months) showed a statistically significant difference in mental health scores at P < 0.05. Six months after the intervention, mean scores for health outcomes and patients' quality of life improved; however, this change did not reach statistical significance. CONCLUSIONS An integrated home telehealth model implemented by a hemodialysis nurse is a feasible holistic care approach for OPLWH. However, the absence of statistical significance may partly be associated with the clinical characteristics of frailty and risk factors such as increased age, hypertension, diabetes, heart disease, longer dialysis time, and inadequacy of Kt/V. Large-scale multi-centre trials are warranted to fully examine the acceptability of the model. The duration and long-term effects of the telehealth model are also recommended for further investigation. PATIENT OR PUBLIC CONTRIBUTION The development of a home telehealth model was a collaborative process between patients, caregivers, healthcare professionals from the hemodialysis unit, and the research team.
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Affiliation(s)
- Wanicha Pungchompoo
- Department of Medical Nursing, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand.
| | - Saowaros Parinyachitta
- Department of Nephrology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sirirat Pungchompoo
- Department of Industrial and Manufacturing Engineering, Faculty of Engineering, Prince of Songkla University, Songkhla, Thailand
| | - Warawan Udomkhwamsuk
- Department of Surgical Nursing, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
| | - Panadda Suwan
- Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Yamazaki O, Shibata S. Another evidence that supports the continued use of RAS inhibitors in end-stage kidney diseases. Hypertens Res 2024:10.1038/s41440-024-01695-7. [PMID: 38658651 DOI: 10.1038/s41440-024-01695-7] [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] [Received: 03/25/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Osamu Yamazaki
- Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan.
| | - Shigeru Shibata
- Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
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Wefer F, Krüger L, Waldréus N, Köpke S. Non-pharmacological interventions to reduce thirst in patients with heart failure or hemodialysis: A systematic review and meta-analysis. Heart Lung 2024; 67:33-45. [PMID: 38653004 DOI: 10.1016/j.hrtlng.2024.04.012] [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: 01/18/2024] [Revised: 04/05/2024] [Accepted: 04/05/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Thirst is a frequent and burdening symptom in many patients, especially in patients with chronic heart failure (CHF) and/or receiving hemodialysis (HD). As drug therapies are not feasible, non-pharmacological strategies are needed to reduce thirst and thirst-related burden. OBJECTIVES To identify non-pharmacological interventions aiming to reduce thirst in patients with CHF and/ or HD, to describe intervention components, and to evaluate the effectiveness of these interventions. METHODS In February 2024, we completed a systematic search in MEDLINE via PubMed, Livivo, CINAHL, Cochrane Library and Web of Science. Two reviewers independently screened titles, abstracts, and full texts, performed critical appraisal and data extraction. We checked risk of bias with the checklists of the Joanna Briggs Institute and the Cochrane Risk of Bias tool and calculated meta-analyses for sufficiently homogeneous studies using fixed-effects models. RESULTS We included 15 intervention studies applying non-pharmacological interventions including chewing gum (n = 8), low-sodium diet (n = 2), acupressure (n = 1), frozen strawberries (n = 1), fluid timetables (n = 1), ice cubes and mouthwash (n = 1), and a psychological intervention (n = 1). Sample sizes varied between 11 and 88 participants. Eleven intervention studies showed a reduction of thirst as intervention effect. Meta-analyses for chewing gum showed no significant effect on thirst using a visual analogue scale (IV: -2,32 [-10.37,5.73]; p = 0.57) or the dialysis thirst inventory (IV: -0.26 [- 1.83, 1.30]; p = 0.74). Quality of studies was moderate to low. CONCLUSION Results indicate that various non-pharmacological interventions could be helpful to reduce thirst in patients with CHF or HD, but important uncertainty remains.
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Affiliation(s)
- Franziska Wefer
- Institute of Nursing Science, University of Cologne, Medical Faculty & University Hospital Cologne, Cologne, Germany; Heart and Diabetes Center NRW, Care Development, Care Directorate, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany.
| | - Lars Krüger
- Heart and Diabetes Center NRW, Care Development, Care Directorate, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Nana Waldréus
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden; Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Sascha Köpke
- Institute of Nursing Science, University of Cologne, Medical Faculty & University Hospital Cologne, Cologne, Germany
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Yang G, Shan H, Wu D, Li S, Lai Z, Zheng F, Xiong Z, Xiong Z, Diao Y, Shan Y, Chen Y, Wang A, Liang W, Yin Y. COVID-19 increases extracorporeal coagulation during hemodialysis associated with upregulation of vWF/FBLN5 signaling in patients with severe/critical symptoms. BMC Infect Dis 2024; 24:427. [PMID: 38649864 PMCID: PMC11036607 DOI: 10.1186/s12879-024-09245-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/22/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND COVID-19 has been shown to increase the risk of extracorporeal coagulation during hemodialysis in patients, but the underlying mechanism remains unclear. This study aimed to investigate the effect and mechanism of COVID-19 on the risk of extracorporeal coagulation in patients with chronic kidney disease undergoing hemodialysis. METHODS A retrospective analysis of the extracorporeal coagulation status of 339 hemodialysis patients at our center before and after COVID-19 infection was performed, including subgroup analyses. Post-infection blood composition was analyzed by protein spectrometry and ELISA. RESULTS Compared to the pre-COVID-19 infection period, COVID-19-induced extracorporeal coagulation predominantly occurred in patients with severe/critical symptoms. Further proteomic analysis demonstrated that in patients with severe/critical symptoms, the coagulation cascade reaction, platelet activation, inflammation, and oxidative stress-related pathways were significantly amplified compared to those in patients with no/mild symptoms. Notably, the vWF/FBLN5 pathway, which is associated with inflammation, vascular injury, and coagulation, was significantly upregulated. CONCLUSIONS Patients with severe/critical COVID-19 symptoms are at a higher risk of extracorporeal coagulation during hemodialysis, which is associated with the upregulation of the vWF/FBLN5 signaling pathway. These findings highlight the importance of early anticoagulant therapy initiation in COVID-19 patients with severe/critical symptoms, particularly those undergoing hemodialysis. Additionally, vWF/FBLN5 upregulation may be a novel mechanism for virus-associated thrombosis/coagulation.
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Affiliation(s)
- Guang Yang
- Division of Renal Medicine, Peking University Shenzhen Hospital, Peking University, Shenzhen, 518036, China.
- Shenzhen Clinical Research Centre for Urology and Nephrology, Shenzhen, 518036, China.
- Institute of Nephrology, Shenzhen Peking University-Hong Kong University of Science and Technology (PKU-HKUST) Medical Center, Shenzhen, 518036, China.
| | - Hui Shan
- Precision Medicine Research Institute, Peking University Shenzhen Hospital, Peking University, Shenzhen, 518036, China
| | - Dibin Wu
- Division of Renal Medicine, Peking University Shenzhen Hospital, Peking University, Shenzhen, 518036, China
| | - Sanmu Li
- Division of Renal Medicine, Peking University Shenzhen Hospital, Peking University, Shenzhen, 518036, China
| | - Zhiwei Lai
- Division of Renal Medicine, Peking University Shenzhen Hospital, Peking University, Shenzhen, 518036, China
| | - Fengping Zheng
- Division of Renal Medicine, Peking University Shenzhen Hospital, Peking University, Shenzhen, 518036, China
| | - Zibo Xiong
- Division of Renal Medicine, Peking University Shenzhen Hospital, Peking University, Shenzhen, 518036, China
- Shenzhen Clinical Research Centre for Urology and Nephrology, Shenzhen, 518036, China
| | - Zuying Xiong
- Division of Renal Medicine, Peking University Shenzhen Hospital, Peking University, Shenzhen, 518036, China
- Shenzhen Clinical Research Centre for Urology and Nephrology, Shenzhen, 518036, China
- Institute of Nephrology, Shenzhen Peking University-Hong Kong University of Science and Technology (PKU-HKUST) Medical Center, Shenzhen, 518036, China
| | - Yuhan Diao
- Department of Medical Records & Statistics, Peking University Shenzhen Hospital, Peking University, Shenzhen, 518036, China
| | - Ying Shan
- Clinical Research Academy, Peking University Shenzhen Hospital, Peking University, Shenzhen, 518036, China
| | - Yun Chen
- Institute of Ultrasound Medicine, Shenzhen Peking University-Hong Kong University of Science and Technology (PKU-HKUST) Medical Center, Shenzhen, 518036, China
| | - Aihong Wang
- Division of Renal Medicine, Peking University Shenzhen Hospital, Peking University, Shenzhen, 518036, China.
| | - Wei Liang
- Division of Renal Medicine, Peking University Shenzhen Hospital, Peking University, Shenzhen, 518036, China.
| | - Yuxin Yin
- Precision Medicine Research Institute, Peking University Shenzhen Hospital, Peking University, Shenzhen, 518036, China.
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朱 金, 赵 亚, 黄 巍, 赵 微, 王 悦, 王 松, 苏 春. [Clinical characteristics of COVID-19 infection in patients undergoing hemodialysis]. Beijing Da Xue Xue Bao Yi Xue Ban 2024; 56:267-272. [PMID: 38595243 PMCID: PMC11004971] [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] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Indexed: 04/11/2024]
Abstract
OBJECTIVE To analyze the clinical characteristics of hemodialysis patients with corona virus disease 2019 (COVID-19) in a single-center from Beijing. METHODS Patients with COVID-19 who received regular hemodialysis at Peking University Third Hospital from November 30, 2022 to January 4, 2023 were selected as the study objects. Clinical symptoms, severity and duration of symptoms during the period of virus positive were investigated in the form of questionnaires, and the basic information of the patients, as well as the results of blood tests (routine blood and blood biochemistry, etc.) before and after infection, dialysis treatment and the outcome of the disease were collected by consulting medical records. RESULTS A total of 203 subjects were included in this study, including 148 mild cases (72.91%), 23 medium cases (11.33%), 32 severe and critical cases (15.76%), and 16 (7.88%) deaths occured during the follow-up. Clinical symptoms mainly included respiratory symptoms (among which 81.77% had cough, 68.97% had expectoration), fever (81.28%) and fatigue (65.52%), and fatigue and weakness had the longest duration [9 (5, 15) days] among all symptoms. Twenty-six patients (12.8%) reduced the dialysis sessions [1 (1, 2) times], 25 patients (12.32%) had the behavior of early finishing dialysis (27 times), reducing the dialysis time by 30.0 (20.0, 30.5) minutes. Univa-riate analysis showed that the hemoglobin, creatinine, urea nitrogen and ultrafiltration decreased signi-ficantly after infection (P < 0.05). There were significant differences in age, albumin, hemoglobin, creatinine levels and vascular access types among the patients with different clinical subtypes, and the changes of dialysis sessions, fever, expectoration and fatigue degree were also different among the patients with different clinical subtypes (P < 0.05). Multivariate Logistic regression analysis showed that age (OR=1.051, 95%CI: 1.017-1.086, P=0.003) and albumin levels (OR=0.905, 95%CI: 0.803-1.019, P=0.098) corrected by fever, expectoration and fatigue levels were still associated with the occurrence of pneumonia. CONCLUSION The morbidity of pneumonia and the proportion of deaths in hemodialysis patients with COVID-19 were higher, and some clinical symptoms lasted for a longer time than the general population. During the infection period, the incidence of dialysis-related complications increased, hemoglobin and nutritional status decreased. Elderly patients and patients with low albumin level had a higher risk of developing pneumonia after infection.
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Affiliation(s)
- 金荣 朱
- />北京大学第三医院肾内科,北京 100191Department of Nephrology, Peking University Third Hospital, Beijing 100191, China
| | - 亚娜 赵
- />北京大学第三医院肾内科,北京 100191Department of Nephrology, Peking University Third Hospital, Beijing 100191, China
| | - 巍 黄
- />北京大学第三医院肾内科,北京 100191Department of Nephrology, Peking University Third Hospital, Beijing 100191, China
| | - 微微 赵
- />北京大学第三医院肾内科,北京 100191Department of Nephrology, Peking University Third Hospital, Beijing 100191, China
| | - 悦 王
- />北京大学第三医院肾内科,北京 100191Department of Nephrology, Peking University Third Hospital, Beijing 100191, China
| | - 松 王
- />北京大学第三医院肾内科,北京 100191Department of Nephrology, Peking University Third Hospital, Beijing 100191, China
| | - 春燕 苏
- />北京大学第三医院肾内科,北京 100191Department of Nephrology, Peking University Third Hospital, Beijing 100191, China
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Bossola M, Picconi B. Uremic toxins and the brain in chronic kidney disease. J Nephrol 2024:10.1007/s40620-024-01929-4. [PMID: 38625502 DOI: 10.1007/s40620-024-01929-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/09/2024] [Indexed: 04/17/2024]
Abstract
Chronic kidney disease (CKD) patients have an increased risk for cognitive impairment compared to the general population. The risk is much higher in CKD patients who progress to end-stage kidney disease (ESKD) and require hemodialysis or peritoneal dialysis. Multiple factors may contribute to cognitive impairment in CKD patients and in patients on chronic dialysis. However, the observation that, after kidney transplantation, there is an improvement in several cognitive performance markers and that some structural and functional brain abnormalities may improve suggests that cognitive deficits in patients on dialysis may be at least partially reversible. Recent evidence supports the hypothesis that uremic toxins may disrupt the blood brain barrier and damage the brain cells. Such brain toxicity should prompt efforts to lower the burden of uremic toxins through dialytic and non-dialytic strategies.
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Affiliation(s)
- Maurizio Bossola
- Hemodialysis Unit, Division of Nephrology, Università Cattolica del Sacro Cuore, 00168, Rome, Italy.
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy.
| | - Barbara Picconi
- Laboratory of Experimental Neurophysiology, IRCCS San Raffaele, 00166, Rome, Italy
- Telematic University San Raffaele, 00166, Rome, Italy
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Thongdee C, Lumkul L, Wongyikul P, Spilles N, Laonapaporn B, Patumanond J, Phinyo P. Optimal volume for the draw-and-return methods to enhance activated partial thromboplastin time ratio accuracy in hemodialysis patients with central venous catheters. Heliyon 2024; 10:e28651. [PMID: 38590898 PMCID: PMC11000023 DOI: 10.1016/j.heliyon.2024.e28651] [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: 08/10/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/10/2024] Open
Abstract
Background Significant errors of activated partial thromboplastin time (aPTT) ratio were frequently observed in blood sampling from central venous dialysis catheter (CVC) of hemodialysis (HD) patients. Following the draw-and-return methods, initial blood withdrawal from the catheter before sampling can reduce the error, but the optimal withdrawal volume remains undetermined. Aim The objective of this study is to determine the optimal blood withdrawal volume for the draw-and-return methods to improve aPTT ratio accuracy in hemodialysis patients with CVC. Methods A prospective study was conducted in patients receiving HD via CVC. Four blood samples were collected from each patient, involving a peripheral venipuncture and three draw-and-return samples (10 ml, 20 ml and 25 ml groups). The aPTT ratio of a peripheral sample was used as a reference to determine the aPTT ratio accuracy for each draw-and-return group. Subsequently, the agreement was illustrated using modified Bland-Altman plot. Results A total of 1,000 samples were obtained from 250 patients. The patients had a mean age of 59.6 ± 15.4 years, with 17.2% using citrate as the CVC's locking agent. The adjusted accuracies of the aPTT ratio varied significantly among the three withdrawal volumes (p-value <0.001). The 25 ml group demonstrated the highest accuracy (43.2%; 95%CI, 38.0-48.4), followed by the 20 ml group (30.0%; 95%CI, 24.9-35.2), and the 10 ml group (18.0%; 95%CI, 12.8-23.2). Additionally, using citrate as a locking agent provided more than 80.0% aPTT ratio accuracy, whereas heparin demonstrated inferior accuracy even in the 25 ml withdrawal group. Conclusion The optimal blood withdraw volume for the draw-and-return methods concluded at 20 ml for citrate locked-CVC and 25 ml for heparin which significantly improved aPTT ratio accuracies. Applying citrate as a locking agent provides clear benefits for aPTT ratio monitoring, while peripheral venipuncture is recommended in cases of heparin-locked CVC.
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Affiliation(s)
- Chitrada Thongdee
- Dialysis Center, Nopparat Rajathanee Hospital, Ministry of Public Health, Bangkok, Thailand
| | - Lalita Lumkul
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Multidisciplinary Technology for Advanced Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pakpoom Wongyikul
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nantana Spilles
- Dialysis Center, Nopparat Rajathanee Hospital, Ministry of Public Health, Bangkok, Thailand
| | - Boonruksa Laonapaporn
- Dialysis Center, Nopparat Rajathanee Hospital, Ministry of Public Health, Bangkok, Thailand
| | - Jayanton Patumanond
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phichayut Phinyo
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Multidisciplinary Technology for Advanced Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Yıldırım Üşenmez T, Demir Dikmen R. The Effect of Religious Attitude on Death Anxiety among Patients Undergoing Hemodialysis Treatment: A Sample from Turkey. J Relig Health 2024:10.1007/s10943-024-02042-3. [PMID: 38619688 DOI: 10.1007/s10943-024-02042-3] [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] [Accepted: 03/25/2024] [Indexed: 04/16/2024]
Abstract
The aim of the current study was to evaluate the effect of religious attitude on death anxiety among patients undergoing hemodialysis treatment. This cross-sectional study included 77 patients undergoing hemodialysis treatment. The religious attitude scale (RAS) and the death anxiety scale (DAS) were used to collect data. The results revealed a moderately strong negative relationship between the mean RAS total score and the mean DAS total score (r = - 0.350, p < 0.05). Additionally, religious attitude accounted for 12% of the variance in death anxiety (R2 = 0.12). Accordingly, the levels of religious attitude exhibited by patients may negatively affect their death anxiety.
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Affiliation(s)
- Tülay Yıldırım Üşenmez
- Department of Nursing, Atatürk Health Sciences Faculty, Dicle University, Diyarbakir, Turkey.
| | - Rukiye Demir Dikmen
- Geriatric Care, Department of Medical Services and Techniques, Vocational Higher School of Health Services, Bingöl University, Bingöl, Turkey
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Yoshikoshi S, Imamura K, Yamamoto S, Suzuki Y, Harada M, Osada S, Matsuzawa R, Matsunaga A. Prevalence and relevance of cachexia as diagnosed by two different definitions in patients undergoing hemodialysis: A retrospective and exploratory study. Arch Gerontol Geriatr 2024; 124:105447. [PMID: 38692154 DOI: 10.1016/j.archger.2024.105447] [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: 03/10/2024] [Revised: 04/08/2024] [Accepted: 04/14/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE Cachexia is present in various chronic diseases and is associated with decreased quality of life and increased risk of morbidity and mortality. However, evidence regarding the association of cachexia with prognosis in patients undergoing hemodialysis is limited. We assessed cachexia using two definitions and compared prevalence, functional impairment, and prognostic impact in patients undergoing hemodialysis. METHODS We enrolled outpatients undergoing hemodialysis at two centers retrospectively. We assessed cachexia using the conventional cachexia (Evans' criteria) and the Asian Working Group for Cachexia (AWGC) criteria. The study examined all-cause mortality and functional status (Clinical Frailty Scale and short physical performance battery). We used Cox proportional hazards model to examine the association with prognosis, and logistic regression analysis to examine the association with functional impairment. RESULTS Among 367 patients (mean age, 67 years; 63 % male), cachexia prevalence, as defined by Evans' criteria and AWGC, was 21.3 % and 35.2 %, respectively. Cachexia as defined by Evans' criteria was associated with an increased risk of all-cause mortality (hazard ratio [HR], 95 % confidence interval [CI]: 1.81, 1.02-3.23). Also, cachexia as defined by AWGC criteria showed suggestive association with increasing mortality (HR, 95 % CI: 1.56, 0.90-2.70). Similar results were seen between cachexia and functional impairment. CONCLUSIONS Among patients on hemodialysis, cachexia was highly prevalent and was associated with poor prognosis and functional impairment. Detecting cachexia in earlier stages may be useful for risk stratification in this population.
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Affiliation(s)
- Shun Yoshikoshi
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan; Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
| | - Keigo Imamura
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
| | - Shohei Yamamoto
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yuta Suzuki
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Saitama, Japan
| | - Manae Harada
- Department of Rehabilitation, Sagami Circulatory Organ Clinic, Kanagawa, Japan
| | - Shiwori Osada
- Department of Nephrology, Tokyo Ayase Kidney Center, Tokyo, Japan
| | - Ryota Matsuzawa
- Department of Physical Therapy, School of Rehabilitation, Hyogo Medical University, Hyogo, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan
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De Luca I, Miliziano D, Guerra G, Colombo R, Morosi C, Sposito C, Fiore M, Venturelli E, Sangalli C, Casali PG, Cavalleri A, Fumagalli E. Hemodialysis and imatinib: Plasma levels, efficacy and tolerability in a patient with metastatic GIST - Case report. Heliyon 2024; 10:e28494. [PMID: 38596050 PMCID: PMC11002597 DOI: 10.1016/j.heliyon.2024.e28494] [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: 11/26/2023] [Revised: 03/13/2024] [Accepted: 03/20/2024] [Indexed: 04/11/2024] Open
Abstract
Purpose To study plasma levels, efficacy and tolerability of imatinib in a patient affected by metastatic GIST treated with oral Imatinib and undergoing hemodialysis. Patients and methods The patient suffered from metastatic GIST to the liver having a mutation of exon 9 of KIT. He was on hemodialysis and received first-line treatment with imatinib 400 mg/day. Results The overall mean plasma level of imatinib was 1875,4 ng/ml pre-dialysis, 1553,0 ng/ml post-dialysis and 1998,1 ng/ml post-24h. In red blood cells the overall mean level of imatinib was 619,5 ng/ml pre-dialysis, 484,9 ng/ml post-dialysis and 663,1 ng/ml post-24h. The plasma level of nor-imatinib/imatinib was 16,2% pre-dialysis, 15,6% post-dialysis and 16,4% post-24h. Comparing our findings regarding levels of imatinib in plasma and RBC, we found a statistically significant difference between pre-dialysis and post-dialysis (respectively p < 0,001 and p = 0,002), post-dialysis and post-24h (both p < 0,001), pre-dialysis and post-24h (respectively p = 0.035 and p = 0,042). Ultimately, regarding nor-imatinib/imatinib in plasma, we did not find any statistically significant difference between pre-dialysis and post-dialysis (p = 0,091), post-dialysis and post-24h (p = 0,091), pre-dialysis and post-24h (p = 0.903). Currently the patient is receiving oral imatinib 400 mg/day with radiological evidence of response. Conclusion In this case, hemodialysis did not affect significantly imatinib plasma levels. The statistically significant difference between pre- and post-dialysis can be explained by the fact that dialysis may likely contribute to a small portion of the normal metabolism of imatinib. The evaluation of imatinib levels in RBC and of its main metabolite in plasma also suggests that hemodialysis did not affect other aspects of the elimination of the drug.
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Affiliation(s)
- Ida De Luca
- Fondazione IRCCS Istituto Nazionale dei Tumori, Oncologia medica 2 Tumori mesenchimali dell'adulto, Milan, Italy
| | - Daniela Miliziano
- Fondazione IRCCS Istituto Nazionale dei Tumori, Oncologia medica 2 Tumori mesenchimali dell'adulto, Milan, Italy
| | - Giulia Guerra
- Fondazione IRCCS Istituto Nazionale dei Tumori, s.c. Epidemiologia e Prevenzione, Milan, Italy
| | | | - Carlo Morosi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Radiologia diagnostica ed interventistica, Milan, Italy
| | - Carlo Sposito
- Fondazione IRCCS Istituto Nazionale dei Tumori, Chirurgia dell'apparato digerente e Trapianto di Fegato, Milan, Italy
| | - Marco Fiore
- Fondazione IRCCS Istituto Nazionale dei Tumori, Dipartimento di Chirurgia, Milan, Italy
| | - Elisabetta Venturelli
- Fondazione IRCCS Istituto Nazionale dei Tumori, s.s.d. Ricerca Nutrizionale e Metabolomica, Milan, Italy
| | - Claudia Sangalli
- Fondazione IRCCS Istituto Nazionale dei Tumori, Radioterapia, Milan, Italy
| | - Paolo G. Casali
- Fondazione IRCCS Istituto Nazionale dei Tumori & University of Milan, Milan, Italy
| | - Adalberto Cavalleri
- Fondazione IRCCS Istituto Nazionale dei Tumori, s.c. Epidemiologia e Prevenzione, Milan, Italy
| | - Elena Fumagalli
- Fondazione IRCCS Istituto Nazionale dei Tumori, Oncologia medica 2 Tumori mesenchimali dell'adulto, Milan, Italy
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Zhang XM, Shen QQ. Application and management of continuous glucose monitoring in diabetic kidney disease. World J Diabetes 2024; 15:591-597. [PMID: 38680699 PMCID: PMC11045421 DOI: 10.4239/wjd.v15.i4.591] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/01/2024] [Accepted: 03/01/2024] [Indexed: 04/11/2024] Open
Abstract
Diabetic kidney disease (DKD) is a common complication of diabetes mellitus that contributes to the risk of end-stage kidney disease (ESKD). Wide glycemic var-iations, such as hypoglycemia and hyperglycemia, are broadly found in diabetic patients with DKD and especially ESKD, as a result of impaired renal metabolism. It is essential to monitor glycemia for effective management of DKD. Hemoglobin A1c (HbA1c) has long been considered as the gold standard for monitoring glycemia for > 3 months. However, assessment of HbA1c has some bias as it is susceptible to factors such as anemia and liver or kidney dysfunction. Continuous glucose monitoring (CGM) has provided new insights on glycemic assessment and management. CGM directly measures glucose level in interstitial fluid, reports real-time or retrospective glucose concentration, and provides multiple glycemic metrics. It avoids the pitfalls of HbA1c in some contexts, and may serve as a precise alternative to estimation of mean glucose and glycemic variability. Emerging studies have demonstrated the merits of CGM for precise monitoring, which allows fine-tuning of glycemic management in diabetic patients. Therefore, CGM technology has the potential for better glycemic monitoring in DKD patients. More research is needed to explore its application and management in different stages of DKD, including hemodialysis, peritoneal dialysis and kidney transplantation.
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Affiliation(s)
- Xin-Miao Zhang
- Geriatric Medicine Center, Department of Endocrinology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou 310014, Zhejiang Province, China
| | - Quan-Quan Shen
- Urology and Nephrology Center, Department of Nephrology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou 310014, Zhejiang Province, China
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Arasnezhad M, Namazinia M, Mazlum SR, Miri K. The effect of ascending- descending ultrafiltration and sodium profiles on blood pressure in hemodialysis patients: a randomized cross-over study. BMC Nephrol 2024; 25:128. [PMID: 38605298 PMCID: PMC11007972 DOI: 10.1186/s12882-024-03554-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 03/20/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Considering no previous research into the utilization of ascending/descending ultrafiltration and linear sodium profiles in improving blood pressure among hemodialysis patients, the present study aimed to explore the effect of the A/D-UF along with linear sodium profiles on HD patients with hypotension. METHODS Applying a crossover design, this clinical trial was fulfilled between December 2022 and June 2023 on 20 patients undergoing HD, randomized into two groups, each one receiving two intervention protocols, viz., (a) an intervention protocol in which the liquid sodium in the dialysis solution was linear and the UF profiling was A/D, and (b) a routine protocol or HD, wherein both liquid sodium and UF in the dialysis solution remained constant. The HD patients' BP was then checked and recorded at six intervals, namely, before HD, one, two, three, and four hours after it, and following its completion, within each session. The data were further statistically analyzed using the IBM SPSS Statistics 20 and the related tests. RESULTS In total, 20 patients, including 12 men (60%) and 8 women (40%), with the mean age of 58.00 ± 14.54 on HD for an average of 54 months, were recruited in this study. No statistically significant difference was observed in the mean systolic and diastolic BP levels in the group receiving the A/D-UF profile all through the desired hours (p > 0.05), indicating that the patients did not face many changes in these two numbers during HD. Our cross-over clinical trial demonstrated a statistically significant reduction in symptomatic IDH episodes from 55 to 15% with the application of the A/D-UF profile (p < 0.05). CONCLUSION The study demonstrated that the A/D-UF profile could contribute to the stability of blood pressure levels among HD patients, with no significant fluctuations observed during treatment sessions. TRIAL REGISTRATION This study was registered in the Iranian Registry of Clinical Trials (no. IRCT20180429039463N5) on 07/01/2023.
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Affiliation(s)
- Morteza Arasnezhad
- 9 Dey Educational Hospital, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Mohammad Namazinia
- Department of Nursing, School of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.
| | - Seyyed Reza Mazlum
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Kheizaran Miri
- Department of Nursing, School of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.
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Moorthi RN, Moe SM, O'Connell T, Dickinson S, Kalim S, Thadhani R, Clish CB, Shafi T, Rhee EP, Avin KG. Plasma metabolites and physical function in patients undergoing hemodialysis. Sci Rep 2024; 14:8427. [PMID: 38600145 PMCID: PMC11006868 DOI: 10.1038/s41598-024-58522-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/31/2024] [Indexed: 04/12/2024] Open
Abstract
Impaired physical function contributes to falls, fractures, and mortality among patients undergoing dialysis. Using a metabolomic approach, we identified metabolite alterations and effect size-based composite scores for constructs of impaired gait speed and grip strength. 108 participants incident to dialysis had targeted plasma metabolomics via liquid chromatography-mass spectrometry and physical function assessed (i.e., 4 m walk, handgrip strength). Physical function measures were categorized as above/ below median, with grip utilizing sex-based medians. To develop composite scores, metabolites were identified via Wilcoxon uncorrected p < 0.05 and effect size > 0.40. Receiver operating characteristic analyses tested whether scores differentiated between above/below function groups. Participants were 54% male, 77% Black and 53 ± 14 y with dialysis vintage of 101 ± 50 days. Median (IQR) grip strength was 35.5 (11.1) kg (males) and 20 (8.4) kg (females); median gait speed was 0.82 (0.34) m/s. Of 246 measured metabolites, composite scores were composed of 22 and 12 metabolites for grip strength and gait speed, respectively. Area under the curve for metabolite composite was 0.88 (gait) and 0.911 (grip). Composite scores of physical function performed better than clinical parameters alone in patients on dialysis. These results provide potential pathways for interventions and needed validation in an independent cohort.
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Affiliation(s)
| | - Sharon M Moe
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | - Sahir Kalim
- Department of Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Ravi Thadhani
- Department of Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Clary B Clish
- Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
| | - Tariq Shafi
- Department of Medicine, University of Mississippi Medical Center, Jackson, MI, 39216, USA
| | - Eugene P Rhee
- Department of Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Keith G Avin
- Indiana University School of Medicine, Indianapolis, IN, USA.
- School of Health and Human Sciences, IUPUI, Indianapolis, IN, USA.
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Chen W, Wang Z, Wang G, Cao C, Hong B, Liu J, Xie F, Wang R. A meta-analysis of risk factors for a Dacron-cuffed catheter related infection in hemodialysis. BMC Nephrol 2024; 25:126. [PMID: 38589798 PMCID: PMC11003140 DOI: 10.1186/s12882-024-03568-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/30/2024] [Indexed: 04/10/2024] Open
Abstract
OBJECTIVE To provide theoretical basis for prevention of a Dacron-cuffed catheter related infection (CRI), the risk factors of CRI in hemodialysis patients were systematically evaluated. METHODS Eight databases, including PubMed, Cochrane library, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Database (CBM), Wanfang Database and Chinese Scientific Journal Database (VIP), were searched to screen out literatures related to the risk factors of long-term indwelling a Dacron-cuffed CRI in hemodialysis. Meta-analysis of risk factors for a Dacron-cuffed CRI in hemodialysis and publication bias test were performed using RevMan 5.4 software. RESULTS After screening, 13 literatures involving a Dacron-cuffed CRI were included, with a total of 625 patients, and the infection rate was 11.7%. The combined OR value and 95% confidence interval (CI) of all factors were: Combined with Diabetes (1.94, 1.51 ~ 2.50), Hb (1.82, 1.35 ~ 2.44), age (2.38, 1.06 ~ 5.34), catheter indwelling time (1.79, 1.21 ~ 2.66), serum albumin (2.26, 1.25 ~ 4.08), catheter indwelling site (3.29, 1.74 ~ 6.23) and the number of tube placement (5.40, 2.65 ~ 11.02). CONCLUSIONS The main risk factors for a Dacron-cuffed CRI in hemodialysis were combined with diabetes, hemoglobin level, age, catheter indwelling time, serum albumin level, femoral vein catheter indwelling and catheterization times. In other words, hemodialysis patients are at higher risk of CRI if they have diabetes, or if they have a lower hemoglobin level, or if they are older, or if they have a longer duration of catheterization, or if they have a lower serum albumin level, or if they have a femoral vein catheter, or if they have more catheters.
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Affiliation(s)
- Wen Chen
- Department of Nephrology, The First Affiliated Hospital, Gannan Medical University, Ganzhou, 341000, Jiangxi, China
| | - Zaoju Wang
- Department of Nephrology, The First Affiliated Hospital, Gannan Medical University, Ganzhou, 341000, Jiangxi, China
| | - Guoping Wang
- Department of Nephrology, The First Affiliated Hospital, Gannan Medical University, Ganzhou, 341000, Jiangxi, China
| | - Chunyu Cao
- Department of Nephrology, The First Affiliated Hospital, Gannan Medical University, Ganzhou, 341000, Jiangxi, China
| | - Bo Hong
- Department of Nephrology, The First Affiliated Hospital, Gannan Medical University, Ganzhou, 341000, Jiangxi, China
| | - Jinying Liu
- School of Basic Medicine, Gannan Medical University, Ganzhou, 341000, Jiangxi, China
| | - Fuhua Xie
- School of Basic Medicine, Gannan Medical University, Ganzhou, 341000, Jiangxi, China.
| | - Runxiu Wang
- Department of Nephrology, The First Affiliated Hospital, Gannan Medical University, Ganzhou, 341000, Jiangxi, China.
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do Nascimento Lima H, Monárrez-Espino J, Nerbass FB, Moura-Neto JA, Sesso R, Lugon JR. Comparison of 1-year survival between patients initiating chronic hemodialysis under public and private health insurance: register-based data analysis from Brazil. Int Urol Nephrol 2024:10.1007/s11255-024-04018-4. [PMID: 38578392 DOI: 10.1007/s11255-024-04018-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/29/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE Brazil has one of the world's highest numbers of patients on hemodialysis (HD). Most dialysis centers are private and perform HD for patients with private and public health insurance. We compared 1-year survival between patients initiating chronic HD with public and private health insurance. METHODS This is an HD register-based retrospective cohort. Adult patients starting HD from January 2011 to December 2021 were included. Survival analysis was stratified according to the period entered in the HD register. Multivariate Cox regression focused on 1-year survival differences between private and public patients. RESULTS In the final sample (n = 5114), 68.5% of participants had public and 31.3% to private health insurance, with overall 1-year survival of 92.8% and 89.9%, respectively (p = 0.002). Crude analysis showed a slightly higher survival rate among patients with public health insurance than those with private health insurance (91 vs. 87%, p = 0.030) in the first period (2019-21). However, the adjusted hazard ratio (HR) did not remain significantly higher for patients with private health insurance compared to those with public health insurance (HR = 1.07; 95% CI 0.80-1.41; p = 0.651), even after propensity score matching of the groups by several baseline features. CONCLUSION Brazilian chronic HD patients funded by either private health plans or the public system have a similar 1-year mortality risk after controlling for several sociodemographic and clinical parameters.
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Affiliation(s)
- Helbert do Nascimento Lima
- Medicine Department, University of the Region of Joinville (Univille), Rua Rio do Sul 270, Joinville, Santa Catarina, 89202-201, Brazil.
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
- Brazilian Society of Nephrology, SBN, Sao Paulo, Brazil.
| | - Joel Monárrez-Espino
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - José A Moura-Neto
- Internal Medicine Division, Bahiana School of Medicine and Public Health, Salvador, Brazil
- Brazilian Society of Nephrology, SBN, Sao Paulo, Brazil
| | - Ricardo Sesso
- Nephrology Division, Federal University of São Paulo, Sao Paulo, Brazil
- Brazilian Society of Nephrology, SBN, Sao Paulo, Brazil
| | - Jocemir Ronaldo Lugon
- Nephrology Division, Universidade Federal Fluminense (UFF), Niterói, Brazil
- Brazilian Society of Nephrology, SBN, Sao Paulo, Brazil
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Rahimi Esbo S, Ghaffari F, Fotokian Z, Nikbakht HA, Saadati K. Development and psychometric evaluation of uncertainty about disease and treatment scale in hemodialysis patients: a sequential-exploratory mixed-method study. BMC Psychol 2024; 12:187. [PMID: 38581066 PMCID: PMC10998385 DOI: 10.1186/s40359-024-01685-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: 11/21/2023] [Accepted: 03/26/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVE The need for long-term treatment and frequent visits to treatment centers for hemodialysis can lead to psychological problems such as Uncertainty about Disease and Treatment (UC about D&T) in patients with chronic kidney failure. In order to understand uncertainty about disease and treatment and to plan for preventive measures and care interventions in various dimensions, there is a need for reliable and valid tools. The present study was conducted to design and psychometrically evaluate the Uncertainty about Disease and Treatment Scale (UC about D&TS) in patients undergoing hemodialysis. METHODS This study is of a methodological type and conducted in two stages. The first stage included a deductive (literature review) and an inductive approach (face-to-face interviews). In the second stage, psychometric indices of the UC about D&TS, including face validity (qualitative-quantitative), content validity (qualitative-quantitative), construct validity (exploratory factor analysis), and reliability (using Cronbach's alpha and McDonald's omega) were examined. RESULTS In the literature review stage, 66 items were extracted, and in the qualitative stage, 48 items were extracted. After merging similar items, 29 items were entered into the psychometric process. No items were removed in the face and content validity stages. In the construct validity stage, five factors were extracted, including self-uncertainty, uncertain situation, uncertain future, uncertainty of treatment outcomes, and information uncertainty, which constituted a total of 82.16% of the total variance. In this stage, five items were removed from the study due to a corrected item-total correlation below 0.32, and four items were removed due to cross-loading. The α and Ω were calculated as 0.828 and 0.818, respectively. The measurement stability and standard error of measurement were estimated at 0.977 and 2.019, respectively. CONCLUSION The results showed that the UC about D&TS is a valid and reliable measure for patients undergoing hemodialysis. This scale is specifically designed to measure UC about D&T in hemodialysis patients, and it is recommended that healthcare providers (Hcps) use this scale in follow-up visits.
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Affiliation(s)
- Sobhan Rahimi Esbo
- Student Research Committee, Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R., Iran
| | - Fatemeh Ghaffari
- Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R., Iran
| | - Zahra Fotokian
- Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R., Iran.
| | - Hossein-Ali Nikbakht
- Social Determinants of Health Research Center, Health Research Institute, Department of Biostatistics & Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, I.R., Iran
| | - Kiana Saadati
- Student Research Committee, Ramsar Campus, Mazandaran University of Medical Sciences, Ramsar, I.R, Iran
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Baye TA, Gebeyehu H, Bekele M, Abdelmenan S, Ashengo TA, Mengistu B. The economic burden of hemodialysis and associated factors of among patients in private and public health facilities: a cross-sectional study in Addis Ababa, Ethiopia. Cost Eff Resour Alloc 2024; 22:25. [PMID: 38575968 PMCID: PMC10996090 DOI: 10.1186/s12962-024-00530-7] [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: 05/31/2023] [Accepted: 03/08/2024] [Indexed: 04/06/2024] Open
Abstract
INTRODUCTION The treatment of kidney disease, including hemodialysis, poses challenges in healthcare and finances. Despite limited data on hemodialysis costs and determinants in Ethiopia, existing literature indicates a paucity of evidence regarding the economic burden of hemodialysis. This study aims to evaluate the direct and indirect costs of hemodialysis among end-stage renal disease (ESRD) patients, alongside associated factors, among selected governmental and private institutions in Addis Ababa, Ethiopia. METHODS An institutional-based cross-sectional study using a simple random sampling technique was conducted from September 10 to November 1, 2021. One hundred twenty-eight patients participated in the study. Data was collected using an interviewer-administered questionnaire. The analysis used proportion and frequency measures of central tendency and linear regression measures. Both simple and multiple linear regression models were used to assess associated factors. The final model used a P value < 0.05 at 95% confidence interval (CI) was used to determine significance. RESULT The mean cost of hemodialysis in a representative sample of selected hospitals in Addis Ababa was 7,739.17 $ ±2,833.51 $, with direct medical cost contributing 72.9% of the total cost. Furthermore, the institution type (private or public) and duration on hemodialysis were associated with an increased cost of hemodialysis. CONCLUSION Our findings underline the necessity for policymakers, program administrators, and healthcare institution executives to prioritize this group, recognizing the substantial load they bear and extending these services in government facilities to a broader patient population.
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Affiliation(s)
| | - Hamelmal Gebeyehu
- Department of Internal Medicine, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mahteme Bekele
- Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | | | - Berhanu Mengistu
- Department of Human Nutrition, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
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