Hemodialysis International最新文献

Associations of vitamin D levels and clinical parameters with COVID-19 infection, severity and mortality in hemodialysis patients: A cohort study 血液透析患者中维生素D水平和临床参数与COVID-19感染、严重程度和死亡率的关系：一项队列研究

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2024-12-22 DOI: 10.1111/hdi.13194

Yanhua You, Chun Xu, Yuqing Hu, Meng Liang, Qi Sun

Introduction

Vitamin D deficiency is prevalent among patients undergoing hemodialysis. This study aimed to investigate the associations between vitamin D levels and clinical parameters with the risk of COVID-19 infection, severity, and mortality in hemodialysis patients with end-stage kidney disease (ESKD).

Methods

This retrospective cohort study included 198 hemodialysis patients from a single center. Vitamin D deficiency was defined by the last measurement of 25-hydroxycholecalciferol less than 20 ng/mL. Vitamin D deficiency and vitamin D supplements were combined to categorize patients into three groups: deficiency, uncertain deficiency, and likely sufficient. COVID-19 infection status, severity, and outcomes were recorded. Statistical analyses were performed to assess the associations between vitamin D levels and COVID-19 severity and mortality.

Findings

Among the 198 patients, 73 patients (37%) were in the deficiency group, 29 patients (15%) had uncertain deficiency, and 96 patients (48%) were likely sufficient. The overall COVID-19 infection rate was 59%. The deficiency group had a similar infection rate (60.3%) compared to those with likely sufficient levels (54.2%). However, the severity and mortality rates of vitamin D deficiency group had a significantly higher rate than those with likely sufficient levels. Multivariate logistic regression analysis showed that vitamin D deficiency and uncertain deficiency group were significantly associated with an increased risk of COVID-19 severity (OR = 22.57, p = 0.01 and OR = 15.8, p = 0.03, respectively). Uncertain deficiency group was significantly associated with an increased risk of COVID-19 mortality (OR = 12.93, p = 0.04), while the deficiency group should similarly trend but did not reach statistical significance.

Discussion

Vitamin D deficiency is associated with an increased risk of COVID-19 severity in hemodialysis patients with ESKD. These findings suggest that monitoring and managing vitamin D levels may be important in reducing the risk of COVID-19 severity in this vulnerable population.

维生素D缺乏症在血液透析患者中普遍存在。本研究旨在探讨终末期肾病（ESKD）血液透析患者的维生素D水平和临床参数与COVID-19感染风险、严重程度和死亡率之间的关系。方法：本回顾性队列研究纳入198例来自单一中心的血液透析患者。最后一次测量25-羟基胆骨化醇低于20 ng/mL时确定维生素D缺乏。维生素D缺乏症和维生素D补充剂将患者分为三组：缺乏、不确定缺乏和可能充足。记录COVID-19感染状况、严重程度和结果。进行统计分析以评估维生素D水平与COVID-19严重程度和死亡率之间的关系。结果：198例患者中，73例患者（37%）属于维生素缺乏组，29例患者（15%）缺乏不确定，96例患者（48%）可能充足。新冠肺炎总感染率为59%。缺乏组的感染率（60.3%）与可能足够水平的组（54.2%）相似。然而，维生素D缺乏组的严重程度和死亡率明显高于维生素D充足组。多因素logistic回归分析显示，维生素D缺乏组和不确定缺乏组与COVID-19严重程度风险增加显著相关（OR = 22.57, p = 0.01; OR = 15.8, p = 0.03）。不确定缺乏组与COVID-19死亡风险增加有显著相关（OR = 12.93, p = 0.04），缺乏组也有类似趋势，但未达到统计学意义。讨论：维生素D缺乏与ESKD血液透析患者COVID-19严重程度风险增加有关。这些发现表明，监测和管理维生素D水平可能对降低这一弱势群体患COVID-19严重程度的风险很重要。

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引用次数: 0

Predictive factors for arteriovenous fistula maturation: A prospective study 动静脉瘘成熟的预测因素：前瞻性研究

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2024-12-17 DOI: 10.1111/hdi.13193

Ana Luisa Correia, Ana Rita Silva, Filipe Mira, Rui Pinto, Emanuel Ferreira, Maria Guedes Marques, Catarina Romãozinho, Rui Alves

Introduction

Arteriovenous fistula (AVF) maturation failure remains common despite preoperative ultrasound mapping. Identifying predictive biomarkers can help anticipate primary failure and reducing invasive procedures. Our study aimed to identify clinical and analytical risk factors for primary AVF failure or delay.

Methods

A prospective study (October 2022–March 2023) included adult patients scheduled for AVF creation. In all patients, a preoperative ultrasound mapping was conducted and AVF maturation assessed at least 6 weeks post-surgery. Clinical, analytical, and demographic data were collected.

Findings

Eighty patients were included, 62.5% male, and mean age 66.3 years. For distal anastomosis, preoperative vein (3.8 ± 1.2 vs. 2.8 ± 0.6 mm; p 0.002) and supply artery (2.5 ± 0.4 vs. 2.0 ± 0.3 mm; p 0.001) diameters were significant factors impacting primary failure. Also, for proximal anastomosis, the artery diameter (2.4 ± 0.4 vs. 2.0 ± 0.4 mm; p 0.01) had an impact on AVF maturation. ROC curves established for distal AVF a vein diameter cutoff of 3.25 mm (AUC 77.2%) and artery cut-off of 2.35 mm (AUC 74.6%) and for proximal AVF an artery cutoff of 2.25 mm (AUC 76.5%). Distal AVF creation correlated with higher primary failure risk (p < 0.001). No correlation was found between the primary failure rate and the presence of central venous catheter or serum results. In a sub analysis, we found that patients with central venous catheter had higher levels of inflammatory markers.

Discussion

Our study highlights the importance of preoperative evaluation, ultrasound mapping, and careful AVF site selection. Recognizing vein and artery diameter thresholds for optimal outcomes is crucial. Avoiding central venous catheters in suitable patients can positively impact AVF results.

导读：尽管术前超声定位，动静脉瘘（AVF）成熟失败仍然很常见。识别预测性生物标志物可以帮助预测原发性衰竭，减少侵入性手术。我们的研究旨在确定原发性AVF衰竭或延迟的临床和分析危险因素。方法：一项前瞻性研究（2022年10月至2023年3月）纳入了计划进行AVF创建的成年患者。对所有患者进行术前超声定位，并在术后至少6周评估AVF成熟度。收集临床、分析和人口统计数据。结果：纳入80例患者，男性62.5%，平均年龄66.3岁。远端吻合，术前静脉（3.8±1.2 vs 2.8±0.6 mm）；P 0.002)和供血动脉（2.5±0.4 vs. 2.0±0.3 mm）；P 0.001)直径是影响初次失效的重要因素。对于近端吻合，动脉直径(2.4±0.4 vs. 2.0±0.4 mm；p 0.01)对AVF成熟有影响。建立了远端AVF的ROC曲线，静脉直径切断3.25 mm (AUC 77.2%)，动脉切断2.35 mm (AUC 74.6%)，近端AVF的动脉切断2.25 mm （AUC 76.5%）。讨论：我们的研究强调了术前评估、超声定位和仔细选择AVF部位的重要性。识别最佳结果的静脉和动脉直径阈值至关重要。在合适的患者中避免中心静脉导管可以积极影响AVF结果。

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引用次数: 0

A rare cause of acute kidney injury due to recurrent rhabdomyolysis: Carnitine palmitoyltransferase 2 deficiency 复发性横纹肌溶解引起急性肾损伤的罕见原因：肉毒碱棕榈酰转移酶2缺乏。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2024-12-13 DOI: 10.1111/hdi.13195

Pervin Ozkan Kurtgoz, Suleyman Karakose, Ibrahim Guney

The most common cause of rhabdomyolysis is trauma. In the presence of rhabdomyolysis attacks triggered by heavy exercise and fever, hereditary causes should be investigated. In our study, a case was presented that developed rhabdomyolysis and acute kidney injury due to carnitine palmitoyltransferase 2 (CPT2) deficiency and then required hemodialysis treatment. We wanted to draw attention to hereditary rhabdomyolysis in this case. A 25-year-old male patient was hospitalized with pneumonia and acute kidney injury. On examination, muscle enzymes, creatinine, and potassium levels were high. The patient, who was evaluated as having rhabdomyolysis and acute kidney injury, underwent three sessions of hemodialysis treatment due to the indication for renal replacement therapy. He had a history of rhabdomyolysis and acute kidney injury 5 years ago. The only trigger for both attacks was febrile infection. There was a history of acute kidney injury in two of his siblings in family history. In the gene analysis requested due to suspicion of hereditary causes, homozygous mutation was detected in CPT2 whole gene sequence analysis. Medium-chain triglycerides, low-fat diet, and L-carnitine capsules were given for treatment. Carnitine palmitoyltransferase 2 deficiency is the most common form of muscle fatty acid metabolism disorder. The phenotype of the patients can vary from severe infantile form to milder muscle form characterized by rhabdomyolysis. Cases requiring hemodialysis are very rare, so we wanted to present this case. Detection of hereditary rhabdomyolysis is important for preventing new attacks and preventive treatments.

横纹肌溶解最常见的原因是外伤。在横纹肌溶解症发作由剧烈运动和发烧引起的情况下，应调查遗传原因。在我们的研究中，报告了一例由于肉碱棕榈酰转移酶2 （CPT2）缺乏而发生横纹肌溶解和急性肾损伤，然后需要血液透析治疗的病例。我们希望在本病例中引起对遗传性横纹肌溶解的注意。一名25岁男性患者因肺炎和急性肾损伤住院。经检查，肌酶、肌酐和钾水平高。该患者被诊断为横纹肌溶解和急性肾损伤，由于肾替代治疗的适应症，接受了三次血液透析治疗。5年前有横纹肌溶解和急性肾损伤史。这两次发作的唯一诱因是发热性感染。家族史上有两名兄弟姐妹有急性肾损伤史。在怀疑遗传原因要求的基因分析中，在CPT2全基因序列分析中检测到纯合突变。给予中链甘油三酯、低脂饮食和左旋肉碱胶囊治疗。肉毒碱棕榈酰基转移酶2缺乏症是肌肉脂肪酸代谢紊乱的最常见形式。患者的表型可以从严重的婴儿型到以横纹肌溶解为特征的轻度肌肉型不等。需要血液透析的病例非常罕见，所以我们想提出这个病例。发现遗传性横纹肌溶解症对预防新的发作和预防性治疗具有重要意义。

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引用次数: 0

Dialysis Jeopardy! 透析冒险!

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2024-12-09 DOI: 10.1111/hdi.13192

Shreepriya Mangalgi, Madhukar Misra

Dialysis Jeopardy! was a fun and innovative dialysis quiz for conference attendees at the Annual Dialysis Conference 2024 held in San Diego. The event saw active participation from nephrology fellows, faculty, and allied health care professionals. The event provided an excellent opportunity for nephrology fellows to interact with faculty in a nonformal setting.

透析冒险!是在圣地亚哥举行的2024年年度透析会议上为与会者提供的一个有趣而创新的透析测试。这次活动看到了来自肾脏病研究员、教师和联合医疗保健专业人员的积极参与。该活动为肾病学研究员提供了一个在非正式环境中与教师互动的绝佳机会。

引用次数: 0

The effects of death anxiety on diet-fluid restriction non-adherence in hemodialysis patients 死亡焦虑对血液透析患者不遵守饮食-液体限制的影响。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2024-11-11 DOI: 10.1111/hdi.13191

Gülcan Bahçecioğlu Turan, Zülfünaz Özer, Seda Başak

Introduction

The study was performed to examine the effects of death anxiety on diet-fluid restriction non-adherence in hemodialysis patients.

Methods

This descriptive, cross-sectional, and correlational study was performed with 118 hemodialysis patients who received treatment in the dialysis unit of a university hospital and a state hospital in Elazığ, eastern Turkey. The study data were obtained with the “Descriptive Data Form”, “Death Anxiety Scale”, and “Dietary and Fluid Restriction Non-Adherence Scale”.

Findings

The average Death Anxiety Scale total score of the patients was 10.00 ± 4.75. The “Duration of non-adherence with diet” mean score was 1.66 ± 1.70, “Degree of non-adherence with diet” mean score was 1.24 ± 1.19, “Duration of non-adherence with fluid restriction” mean score was 1.61 ± 1.71, and “Degree of non-adherence with fluid restriction” mean score was 1.16 ± 1.13. The independent variable Death Anxiety Scale significantly and negatively affected the dependent variable “Duration of non-adherence with diet”, “Degree of non-adherence with diet”, “Duration of non-adherence with fluid restriction”, and “Degree of non-adherence with fluid restriction”.

Discussion

Hemodialysis patients face serious death anxiety, their degree of non-adherence with diet-fluid restriction was low as death anxiety scores increased, and the degree of non-adherence with diet-fluid restriction decreased.

简介：本研究旨在探讨死亡焦虑对血液透析患者不坚持饮食-液体限制的影响：本研究旨在探讨死亡焦虑对血液透析患者不遵守饮食-液体限制的影响：这项描述性、横断面和相关性研究的对象是在土耳其东部埃拉泽的一所大学医院和一所国立医院的透析室接受治疗的118名血液透析患者。研究数据通过 "描述性数据表"、"死亡焦虑量表 "和 "饮食和液体限制不遵守量表 "获得：患者的死亡焦虑量表总分平均为（10.00 ± 4.75）分。饮食不依从持续时间 "平均分为（1.66±1.70）分，"饮食不依从程度 "平均分为（1.24±1.19）分，"液体限制不依从持续时间 "平均分为（1.61±1.71）分，"液体限制不依从程度 "平均分为（1.16±1.13）分。自变量死亡焦虑量表对因变量 "不坚持饮食的持续时间"、"不坚持饮食的程度"、"不坚持限制输液的持续时间 "和 "不坚持限制输液的程度 "有明显的负向影响：讨论：血液透析患者面临严重的死亡焦虑，随着死亡焦虑评分的增加，他们不坚持限制饮食和液体的程度较低，而不坚持限制饮食和液体的程度降低。

{"title":"The effects of death anxiety on diet-fluid restriction non-adherence in hemodialysis patients","authors":"Gülcan Bahçecioğlu Turan, Zülfünaz Özer, Seda Başak","doi":"10.1111/hdi.13191","DOIUrl":"10.1111/hdi.13191","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The study was performed to examine the effects of death anxiety on diet-fluid restriction non-adherence in hemodialysis patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This descriptive, cross-sectional, and correlational study was performed with 118 hemodialysis patients who received treatment in the dialysis unit of a university hospital and a state hospital in Elazığ, eastern Turkey. The study data were obtained with the “Descriptive Data Form”, “Death Anxiety Scale”, and “Dietary and Fluid Restriction Non-Adherence Scale”.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>The average Death Anxiety Scale total score of the patients was 10.00 ± 4.75. The “Duration of non-adherence with diet” mean score was 1.66 ± 1.70, “Degree of non-adherence with diet” mean score was 1.24 ± 1.19, “Duration of non-adherence with fluid restriction” mean score was 1.61 ± 1.71, and “Degree of non-adherence with fluid restriction” mean score was 1.16 ± 1.13. The independent variable Death Anxiety Scale significantly and negatively affected the dependent variable “Duration of non-adherence with diet”, “Degree of non-adherence with diet”, “Duration of non-adherence with fluid restriction”, and “Degree of non-adherence with fluid restriction”.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Hemodialysis patients face serious death anxiety, their degree of non-adherence with diet-fluid restriction was low as death anxiety scores increased, and the degree of non-adherence with diet-fluid restriction decreased.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"29 1","pages":"108-115"},"PeriodicalIF":1.2,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The effect of using a local skin cooling device on arteriovenous fistula cannulation pain and comfort level of patients on hemodialysis: A single-blind randomized controlled study 使用局部皮肤冷却装置对血液透析患者动静脉内瘘插管疼痛和舒适度的影响：单盲随机对照研究。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2024-10-28 DOI: 10.1111/hdi.13190

Hatice Demırağ, Nurşen Kulakaç

Introduction

The study aimed to investigate the impact of the using local skin cooling on arteriovenous fistula cannulation pain and the comfort levels of hemodialysis patients.

Methods

The single-blind randomized controlled trial was formed with 50 patients between June 20, 2023, and July 31, 2023, in the hemodialysis units of two state hospitals in Turkey. Patients were randomly assigned to either the experimental group (n = 25) or the control group (n = 25) using the block randomization method. This data were collected through the use of the CoolSense device, the “Patient Information Form,” the “Verbal Category Scale,” and the “General Comfort Scale.” Patients in the experimental group received the local skin cooling for five seconds during arteriovenous fistula cannulation, while the control group followed the standard hospital protocol. The study was registered on Clinical Trials (NCT06144801).

Findings

The study revealed that the application of the local skin cooling during arteriovenous fistula cannulation significantly reduced pain and increased patients’ comfort levels, demonstrating an anesthetic effect (p < 0.001). Furthermore, it was observed that as pain levels decreased, patient comfort levels increased (p < 0.001).

Discussion

It is concluded that the using lokal skin cooling is an effective tool for reducing pain and enhancing comfort during arteriovenous fistula cannulation in hemodialysis patients.

简介：该研究旨在探讨局部皮肤冷却对动静脉内瘘插管疼痛和血液透析患者舒适度的影响：该研究旨在探讨局部皮肤冷却对动静脉内瘘插管疼痛和血液透析患者舒适度的影响：在 2023 年 6 月 20 日至 7 月 31 日期间，在土耳其两家国立医院的血液透析室对 50 名患者进行了单盲随机对照试验。采用分块随机法将患者随机分配到实验组（25 人）或对照组（25 人）。这些数据是通过使用 CoolSense 设备、"患者信息表"、"口头分类量表 "和 "一般舒适度量表 "收集的。实验组患者在动静脉内瘘插管过程中接受了 5 秒钟的局部皮肤冷却，而对照组则按照医院的标准方案进行。该研究已在临床试验（NCT06144801）上注册：研究结果表明，在动静脉内瘘插管时应用局部皮肤冷却可明显减轻疼痛，提高患者的舒适度，显示出麻醉效果（P 讨论）：结论：在血液透析患者动静脉内瘘插管期间，使用局部皮肤冷却是减轻疼痛和提高舒适度的有效工具。

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引用次数: 0

Prior central venous catheter placement and age are associated with earlier intervention after permanent hemodialysis access creation 在建立永久性血液透析通路后，先前的中心静脉导管置入和年龄与较早进行干预有关。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2024-10-24 DOI: 10.1111/hdi.13180

Ramtin Talebi, Ramin Talebi, Joshua Chen, Angela Yang, Sanath Patil, Paul J. DiMuzio, Babak Abai, Dawn M. Salvatore, Michael J. Nooromid

Introduction

Arteriovenous fistulas (AVFs) and grafts are essential for long-term hemodialysis access in patients with end-stage renal disease. However, complications and access failure often necessitate re-intervention. In this study, we aim to delineate the factors associated with earlier failure of permanent hemodialysis access warranting revision procedures.

Methods

This retrospective study aimed to identify factors associated with increased revision rates in AVFs and arteriovenous grafts, using multivariate survival analysis. A cohort of 136 patients who underwent initial arteriovenous access creation between 2005 and 2022 was analyzed. Patient characteristics, including age, comorbidities, access type, and vascular anatomy, were extracted, and hazard ratios (HR) were calculated to identify independent predictors of needing revision.

Findings

A total of 119 patients were included in the final cohort, with a mean age of 55.2 years. Over 40% of patients had a previous central venous catheter placement, while 15% had a previous AVF. The majority of procedures were performed on the left side (74%), and brachiocephalic fistulas were most commonly created (41%). Univariate and multivariate Cox regression revealed that age (adjusted HR = 1.02, p = 0.01) and prior central venous catheter placement (adjusted HR = 1.77, p = 0.01) were independent predictors of earlier revision, while other variables such as sex, hypertension, and diabetes did not show significant associations. Patients with prior central venous catheter placement had a 77% increased risk of revision, even when adjusted for confounders.

Discussion

Understanding predictors of successful long-term access outcomes can guide decision-making regarding access type and alternative strategies. In our cohort, increased age and prior central venous catheter placement are associated with a shorter time to failure of permanent hemodialysis access and an increased risk of needing revision.

导言：动静脉瘘（AVF）和移植物是终末期肾病患者进行长期血液透析的重要通路。然而，并发症和通路失效往往需要再次介入治疗。在这项研究中，我们旨在明确与永久性血液透析通路早期失败相关的因素，从而为翻修手术提供依据：这项回顾性研究旨在通过多变量生存分析，确定与动静脉滤过和动静脉移植物翻修率增加相关的因素。研究分析了 2005 年至 2022 年间接受初次动静脉通路创建的 136 名患者。研究人员提取了患者的特征，包括年龄、合并症、通路类型和血管解剖结构，并计算了危险比（HR），以确定需要翻修的独立预测因素：共有119名患者被纳入最终队列，平均年龄为55.2岁。超过 40% 的患者曾置入过中心静脉导管，15% 的患者曾置入过 AVF。大部分手术在左侧进行（74%），肱脑瘘最常见（41%）。单变量和多变量 Cox 回归显示，年龄（调整后 HR = 1.02，P = 0.01）和曾置入中心静脉导管（调整后 HR = 1.77，P = 0.01）是提前翻修的独立预测因素，而性别、高血压和糖尿病等其他变量与之无显著关联。即使对混杂因素进行调整，曾置入中心静脉导管的患者翻修风险也增加了77%：讨论：了解成功的长期入路结果的预测因素可为入路类型和替代策略的决策提供指导。在我们的队列中，年龄的增加和曾置入中心静脉导管与永久性血液透析通路失败的时间缩短和需要翻修的风险增加有关。

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引用次数: 0

Association between trace elements and cognitive function among hemodialysis patients in Turkey 土耳其血液透析患者体内微量元素与认知功能之间的关系。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2024-10-21 DOI: 10.1111/hdi.13188

Meric Oruc, Furkan Asan, Selda Mercan, Sennur Kose, Mehmet Murat Kirpinar, Burc Cagri Poyraz, Sinan Trabulus, Feray Karaali Savrun, Mehmet Riza Altiparmak

Introduction

Cognitive impairment is common among patients with hemodialysis. Hemodialysis patients have theoretical risks for both deficiency and accumulation of trace elements. We aimed to investigate the relationship between cognitive dysfunction and whole blood levels of trace elements in hemodialysis patients. We also aimed to examine the effect of baseline trace element status and cognitive dysfunction on mortality.

Methods

Maintenance hemodialysis patients and age-and sex-matched controls were included. The whole blood levels of trace elements were measured by inductively coupled plasma mass spectrometry. Cognitive impairment was defined as a score of ≤24 points on the Montreal Cognitive Assessment test. Executive dysfunction was also defined as Trails A score of more than 75 s and Trails B score of more than 180 s.

Findings

Forty-two patients and 35 controls were included. Cognitive impairment was detected in 69% of the patients and 45.7% of the controls (p = 0.039). Cognitively impaired patients had lower education years (p = 0.003) and higher whole blood levels of manganese (Mn) and lead (Pb) (p = 0.026, p = 0.019, respectively) compared to patients without cognitive impairment. Mn levels were also found statistically higher in patients with executive dysfunction compared to patients without executive dysfunction (p = 0.005). Lower education years and higher Pb levels were independent risk factors for cognitive impairment in hemodialysis patients (odds ratio [OR] 0.589 [95% confidence interval, CI 0.400–0.866, p = 0.007] and OR 1.047 [95% CI 1.001–1.096, p = 0.047, respectively]).

Discussion

Cognitive impairment, especially impaired executive function, is common among patients with hemodialysis patients. Cognitive impairment is not found to be associated in cross-sectional analysis with several modifiable end-stage renal disease- and dialysis-associated factors. The accumulation of trace elements especially Mn and Pb might exacerbate the cognitive dysfunction in hemodialysis patients.

介绍：认知障碍在血液透析患者中很常见。理论上，血液透析患者存在微量元素缺乏和蓄积的风险。我们旨在研究血液透析患者认知功能障碍与全血微量元素水平之间的关系。我们还旨在研究基线微量元素状态和认知功能障碍对死亡率的影响：方法：纳入维持性血液透析患者和年龄与性别匹配的对照组。采用电感耦合等离子体质谱法测量了全血中的微量元素水平。认知障碍的定义是蒙特利尔认知评估测试得分≤24分。执行功能障碍还被定义为 Trails A 评分超过 75 秒，Trails B 评分超过 180 秒：共纳入 42 名患者和 35 名对照组患者。69%的患者和 45.7% 的对照组发现了认知障碍（P = 0.039）。与无认知障碍的患者相比，认知障碍患者受教育年限较低（p = 0.003），全血锰（Mn）和铅（Pb）水平较高（分别为 p = 0.026 和 p = 0.019）。与无执行功能障碍的患者相比，执行功能障碍患者的锰含量在统计学上也更高（p = 0.005）。教育年限较低和铅含量较高是血液透析患者认知障碍的独立风险因素（几率比[OR]分别为0.589[95%置信区间，CI 0.400-0.866，p = 0.007]和OR 1.047 [95% CI 1.001-1.096，p = 0.047]）：讨论：认知障碍，尤其是执行功能受损，在血液透析患者中很常见。在横断面分析中，未发现认知障碍与几种可改变的终末期肾病和透析相关因素有关。微量元素尤其是锰和铅的积累可能会加重血液透析患者的认知功能障碍。

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引用次数: 0

Optimizing use of an electronic medical record system for quality improvement initiatives in hemodialysis: Review of a single center experience 优化使用电子病历系统，提高血液透析质量：回顾单个中心的经验。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2024-10-21 DOI: 10.1111/hdi.13178

Noémie Laurier, Jorane-Tiana Robert, Alexander Tom, Jerrica McKinnon, Nancy Filteau, Laura Horowitz, Murray Vasilevsky, Catherine Weber, Tiina Podymow, Andrey V. Cybulsky, Rita S. Suri, Emilie Trinh

Introduction

The complexity of managing patients with end-stage kidney disease on hemodialysis underscores the importance of implementing quality improvement (QI) initiatives to enhance patient safety and prioritize patient-centered care. To address this, we established a QI committee at our tertiary academic center focusing on evidence-based practices, patient-centered approaches, and cost efficiency. To facilitate the seamless implementation of QI initiatives, we leveraged the capabilities of our electronic medical record (EMR) system.

Methods

This review details effective strategies for optimizing use of an EMR system to successfully implement QI efforts. Drawing from our experience, we provide detailed descriptions and practical insights that can be applied to other EMRs.

Findings

The creation of a secure and accessible dashboard, offering real-time data on quality metrics, stands out as the most notable feature. This dashboard operates through an algorithm that merges data from both our dialysis and hospital EMR systems. Its primary objectives are to streamline the identification of high-priority patients, enhance team communication, and facilitate tracking of quality indicators. Additionally, we integrated clinical pathways, checklists, and standardized protocols into the renal EMR to ensure smooth implementation of QI interventions. Notable examples of these interventions include an incremental hemodialysis protocol, a new hemodialysis start checklist, vaccination care plans, and personalized kidney transplant workups. Programmed electronic automatic reminders have proven invaluable in ensuring timely follow-ups of assigned tasks. The EMR has also contributed to medication optimization and deprescribing by generating patient lists based on specific medication classes. Finally, the EMR's capability to swiftly generate lists of patients with specific features has significantly facilitated targeted QI interventions.

Conclusions

Leveraging the capabilities of an EMR system can be crucial for enhancing care of hemodialysis patients and implementing effective QI initiatives.

导言：血液透析终末期肾病患者管理的复杂性凸显了实施质量改进（QI）计划以提高患者安全和优先考虑以患者为中心的护理的重要性。为此，我们在三级学术中心成立了质量改进委员会，重点关注循证实践、以患者为中心的方法和成本效益。为了促进 QI 计划的顺利实施，我们充分利用了电子病历系统（EMR）的功能：本综述详细介绍了优化使用 EMR 系统以成功实施 QI 的有效策略。根据我们的经验，我们提供了可应用于其他 EMR 的详细描述和实用见解：创建一个安全、可访问的仪表板，提供有关质量指标的实时数据，是最显著的特点。该仪表板通过一种算法，将透析和医院 EMR 系统中的数据合并在一起。它的主要目的是简化高优先级患者的识别，加强团队沟通，促进质量指标的跟踪。此外，我们还将临床路径、核对表和标准化协议整合到肾脏 EMR 中，以确保质量改进干预措施的顺利实施。这些干预措施的显著例子包括增量血液透析方案、新的血液透析启动核对表、疫苗接种护理计划和个性化肾移植工作检查。事实证明，程序化的电子自动提醒在确保及时跟进指定任务方面非常有价值。此外，电子医疗记录仪还能根据特定药物类别生成病人名单，从而有助于优化用药和取消处方。最后，EMR 能够迅速生成具有特定特征的病人名单，这极大地促进了有针对性的 QI 干预：利用电子病历系统的功能对于加强血液透析患者的护理和实施有效的质量改进措施至关重要。

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引用次数: 0

Efficacy and safety of sucroferric oxyhydroxide versus sevelamer carbonate: A systematic review and meta-analysis 蔗糖铁氧氢氧化物与碳酸司维拉姆的疗效和安全性对比：系统回顾和荟萃分析。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2024-10-18 DOI: 10.1111/hdi.13187

Christos Georgopoulos, Anila Duni, Eleni Stamellou, Athanasios Kitsos, Charikleia Gouva, Evangelia Dounousi

Introduction

Phosphate binders are commonly used in patients receiving kidney replacement therapy (KRT), aiming to reduce and maintain serum phosphorus. Chronic kidney disease-mineral and bone disorder has been linked to reduced lifespan and worsened quality of life. This study aims to examine the efficacy and safety of sucroferric oxyhydroxide versus sevelamer carbonate in patients receiving KRT.

Methods

The data sources examined were MEDLINE (PubMed), Scopus, and the Cochrane Central Register of Controlled Clinical Trials with a search deadline of October 2023. We examined randomized controlled trials that compared sucroferric oxyhydroxide versus sevelamer carbonate in the adult population receiving KRT. We performed a meta-analysis combining the data from trials, using R-studio.

Findings

Inclusion criteria were met by five randomized trials. There was no statistically significant difference in the reduction of serum phosphorus between the two groups (MD: −0.07 mmol/L, 95% CI-random effects: −0.15 to 0.02). In the same line, a non-statistically significant difference was observed in serum i-PTH reduction between the two drugs (MD = −1.53 mg/dL, 95% CI = (−4.45, 1.4), p = 0.26, random effects model). No statistically significant difference was observed in all adverse events between the two groups (odds ratio: 1.11, 95% CI: 0.65–1.88, random effects model). Further analysis of gastrointestinal adverse events revealed that sevelamer carbonate increases gastrointestinal adverse events by up to 60% (odds ratio: 1.60, 95% CI: 1.31–1.97, common (fixed) effect model).

Discussion

This meta-analysis of randomized trials showed that both drugs, sucroferric oxyhydroxide and sevelamer equally and effectively controlled serum phosphorus levels, whereas sucroferric oxyhydroxide revealed a better profile in terms of gastrointestinal adverse events. Sucroferric oxyhydroxide is a valuable option for patients receiving KRT when sevelamer carbonate is more difficult to tolerate.

简介：磷酸盐结合剂常用于接受肾脏替代疗法（KRT）的患者，旨在降低和维持血清磷。慢性肾病-矿物质和骨骼紊乱与寿命缩短和生活质量下降有关。本研究旨在探讨蔗糖铁氧氢氧化物与碳酸司维拉姆在接受 KRT 治疗的患者中的疗效和安全性：研究数据来源于 MEDLINE (PubMed)、Scopus 和 Cochrane Central Register of Controlled Clinical Trials，搜索截止日期为 2023 年 10 月。我们研究了在接受 KRT 的成人中比较蔗糖铁氧氢氧化物与碳酸司维拉姆的随机对照试验。我们使用 R-studio.Findings 对试验数据进行了荟萃分析：五项随机试验均符合纳入标准。两组试验在降低血清磷方面无统计学差异（MD：-0.07 mmol/L，95% CI-随机效应：-0.15 至 0.02）。同样，观察到两种药物在降低血清 i-PTH 方面存在无统计学意义的差异（MD = -1.53 mg/dL，95% CI = (-4.45, 1.4)，p = 0.26，随机效应模型）。在所有不良事件中，两组之间未观察到有统计学意义的差异（几率比：1.11，95% CI：0.65-1.88，随机效应模型）。对胃肠道不良事件的进一步分析显示，碳酸司维拉默会使胃肠道不良事件增加多达60%（几率比：1.60，95% CI：1.31-1.97，共同（固定）效应模型）：这项随机试验的荟萃分析表明，蔗糖铁氧氢氧化物和西维拉姆这两种药物都能同样有效地控制血清磷水平，而蔗糖铁氧氢氧化物在胃肠道不良事件方面的表现更好。在碳酸司维拉姆较难耐受的情况下，蔗糖铁氧氢氧化物是接受 KRT 的患者的重要选择。

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引用次数: 0