Hemodialysis International最新文献

Introduction

Erythropoiesis-stimulating agents (ESAs) and iron supplementation are standard treatments for chronic kidney disease (CKD)–related anemia. Targeting higher hemoglobin values in CKD increases cardiovascular risk. Whether the increased risk is from higher ESA doses or higher hemoglobin levels is uncertain, but alternative therapies are sought for patients requiring high ESA doses. Phase 3 INNO₂VATE trials in patients with dialysis-dependent CKD (DD-CKD) demonstrated vadadustat's noninferiority compared with darbepoetin alfa. To determine vadadustat's potential to treat anemia, including in patients requiring high ESA doses, its safety and efficacy were compared with those of darbepoetin alfa across prespecified baseline ESA dose subgroups in the prevalent DD-CKD INNO₂VATE trial.

Methods

We compared the safety and efficacy of vadadustat versus darbepoetin alfa across prespecified baseline ESA dose subgroups (low [≤ 90 U/kg/week], intermediate [> 90 and < 300 U/kg/week], or high [≥ 300 U/kg/week]) in the INNO₂VATE prevalent trial. The primary safety endpoint was time to first adjudicated major adverse cardiovascular event (MACE). Primary and secondary efficacy endpoints were mean hemoglobin level change from baseline at weeks 24–36 and weeks 40–52, respectively.

Findings

Compared with darbepoetin alfa, first MACE hazard ratios for vadadustat were 0.99 (95% CI, 0.81–1.23), 0.93 (95% CI, 0.74–1.18), and 0.62 (95% CI, 0.34–1.14) for low, intermediate, and high baseline ESA dose subgroups, respectively (interaction p = 0.92). Vadadustat was noninferior to darbepoetin alfa in hemoglobin change from baseline to primary evaluation period, with mean differences (vadadustat–darbepoetin alfa) of −0.10 g/dL (95% CI, −0.19 to −0.02), −0.20 g/dL (95% CI, −0.30 to −0.09), and −0.39 g/dL (95% CI, −0.67 to −0.11) for low, intermediate, and high ESA dose subgroups, respectively.

Discussion

Comparing safety and efficacy by baseline ESA dose among patients with CKD on maintenance dialysis, vadadustat was noninferior to darbepoetin alfa for all ESA dose subgroups, including patients with high baseline ESA requirements.

Introduction

Hemodialysis professionals are particularly at risk due to the chronic nature of patient care and the intense emotional burden it entails. The aim of this study is to determine the levels of compassion fatigue and brain fog among healthcare professionals working in these units, to examine the relationship between them, and to identify their predictive factors.

Methods

This study employed a descriptive and analytical design, with data collected between February 16 and June 16, 2024. Reporting followed the STROBE checklist. The study population consisted of healthcare professionals working in private and public hemodialysis centers in Turkey. A non-probability snowball sampling method was used. Data were collected using a Descriptive Information Form, the Compassion Fatigue–Short Scale, and the Brain Fog Scale.

Results

Of the participants, 82.0% were female, and 33.6% were between 36 and 45 years of age. Participants reported moderate levels of compassion fatigue (59.67 ± 21.25) and high levels of brain fog (80.01 ± 26.53). A strong positive correlation was observed between compassion fatigue and brain fog (r = 0.744, p < 0.001). Compassion fatigue levels were significantly predicted by gender, profession, and brain fog (p < 0.005). Conversely, brain fog levels were significantly predicted by the institution of employment, profession, and compassion fatigue (p < 0.005).

Discussion

Healthcare professionals experienced moderate levels of compassion fatigue and high levels of brain fog, both of which can impair well-being and job performance. Early recognition and management of these conditions are crucial. Nursing practice and health policy should emphasize supportive interventions such as mental health programs, resilience training, and workload management to protect staff well-being and sustain quality patient care.

Introduction

People with kidney failure experience severe, often intractable symptoms, which affect quality of life. These symptoms are often unacknowledged and difficult to treat due to few treatment options being available. The use of cannabinoids to treat symptoms of long-term medical conditions is increasing worldwide. However, there is a paucity of data on the experiences of people using cannabis to treat the specific symptoms of kidney disease.

Methods

We conducted a qualitative semistructured interview study involving patients who had used either prescribed or nonprescribed cannabis to manage symptoms of kidney failure. Data were coded inductively to identify themes and a conceptual framework.

Results

Thirteen participants had used nonprescribed cannabis and four prescribed cannabis. Most participants had experience of treatment with hemodialysis. We identified four themes and subthemes: Managing overwhelming symptom burden (using cannabinoids to relieve symptoms, alleviating the mental load, restricted by a lack of options, feeling abandoned managing symptom burden); Barriers to accessing medical cannabis (constrained by finances and avoiding stigma and judgment); Weighing up risks of nonprescribed cannabis (wanting to avoid illegal behavior, avoiding potential harm, concerns of safety with treatment, worried about the safety of nonregulated products, seeking only medicinal benefits); Lack of clinician support (poor provision of information, lack of knowledge of prescribed options, valuing honesty).

Conclusion

People with kidney failure describe frustration at the limited options for symptom management and appreciate the benefits of cannabis. Access to prescribed cannabis is restricted by legal issues and lack of clinician familiarity and confidence, which creates uncertainties and safety issues for patients when managing their symptoms.

Introduction

Hemodialysis water distribution systems represent a critical component of dialysis treatment, requiring meticulous design and material selection to ensure water purity and patient safety. Recent advances in biomaterial science and fluid dynamics have revolutionized our understanding of optimal system design, particularly regarding biofilm mitigation strategies.

Methods

This review examines cutting-edge developments in water distribution loop design, focusing on novel approaches to flow dynamics optimization, next-generation material compatibility, and innovative disinfection protocols specifically tailored for dialysis applications. We present a comprehensive evaluation of both traditional and emerging piping materials.

Results

The analysis incorporates recent clinical data on material performance in actual dialysis centers, including polyvinylchloride (PVC), chlorinated PVC (CPVC), polyvinylidene fluoride (PVDF), cross-linked polyethylene (PEX), and stainless steel. The manuscript introduces a new paradigm for maintaining adequate flow velocities (1.5–6 feet per second [FPS]) through dynamic flow modulation technology. Furthermore, we detail groundbreaking construction techniques that reduce contamination risks and analyze the latest disinfection methods, presenting clinical evidence supporting the superiority of pulsed-thermal disinfection systems (80°C–85°C with variable pressure cycles) for biofilm prevention. The discussion challenges traditional PVC system dogma and presents a compelling case for smart material systems like nano-enhanced PEX and antimicrobial stainless steel, supported by longitudinal studies.

Conclusion

Finally, we address the critical practical considerations of cost, operational logistics, and regulatory compliance that influence the adoption of these advanced technologies in modern dialysis installations.

Introduction

High ultrafiltration rate is a common clinical problem in those undergoing maintenance dialysis and is associated with myocardial injury and increased mortality. The safety of the downward sloping profile of ultrafiltration in those with high ultrafiltration rates is currently unknown. The aim of the present study is to compare mean arterial pressure trends and dialysis-associated high-sensitivity Troponin I changes among patients with high ultrafiltration rates undergoing constant and profiled ultrafiltration.

Methods

The enrolled study participants were patients on maintenance dialysis thrice weekly with ultrafiltration rates > 13 mL/kg/h and without known cardiac disease. During the study month, they received six sessions with constant ultrafiltration and six sessions with downward sloping profiled ultrafiltration. Pre-to-post HD hs TnI change, blood pressures, and intradialytic hypotension episodes were measured during all 12 sessions.

Findings

A total of 42 study participants with 504 dialysis sessions were analyzed. The mean age of study participants was 41.3 (±12.1) years, two-thirds were male, and up to 17% had diabetes mellitus. The mean ultrafiltration volume was 17.4 (±3.2) mL/kg/h. Mean arterial pressures and intradialytic hypotension did not differ significantly between constant and profiled sessions, except for trends toward higher pressures at the post-HD timepoint in profiled UF (p = 0.08). Upon comparing Δ Post-Pre-HD hs Tn I of constant versus profiled ultrafiltration, constant sessions showed a median rise of troponin, ranging from 8 to 21 ng/mL from pre- to post-HD, and profiled sessions showed a median fall, ranging from 11 to 21 ng/mL from pre- to post-HD during profiled UF sessions (p < 0.001). Multivariate logistic regression analysis showed that constant UF type was associated with 27 times greater odds of developing a 10% rise in high-sensitivity troponin.

Conclusion

In maintenance dialysis patients with high ultrafiltration, constant fluid removal is associated with a rise in hs Tn I, and a downward sloping profile may be safer than constant fluid removal.

Trial Registration: Clinical Trials Registry of India (CTRI): CTRI/2023/02/049618.

Purpose

To analyze the effects of aerobic combined resistance exercise in dialysis on restless legs syndrome (RLS), sleep quality, anxiety, depression, and quality of life of maintenance dialysis patients.

Methods

59 patients who underwent maintenance hemodialysis combined with RLS in the blood purification center of Taihe County People's Hospital of Anhui Province from September to December 2024 were selected as the study subjects. The study subjects were divided into 30 cases of the control group and 29 cases of the intervention group using a randomized numerical table. The control group received routine dialysis and health education. In contrast, the intervention group received aerobic combined resistance exercise in dialysis, similar to the control group, with the time controlled at about 40 min, three times a week for 12 weeks. We observed the severity of RLS (IRLS), Pittsburgh Sleep Quality Index (PSQI), self-rating anxiety scale (SAS), self-rating depression scale (SDS), and quality of life (the Kidney Disease Questionnaire, KDQ) in the two groups before and after 12 weeks of intervention.

Results

There was no statistical difference in IRLS, PSQI, SAS, SDS, and KDQ scores between the two groups before the intervention (p > 0.05). After 12 weeks of intervention, IRLS, SAS, and SDS scores of the intervention group were lower than those of the control group (p < 0.05). Notably, the intervention group showed significantly improved PSQI scores (p < 0.05). The KDQ scores were higher than those of the control group, and the differences were all statistically significant (p < 0.05).

Conclusion

Aerobic combined resistance exercise in dialysis can improve the symptoms of RLS in maintenance hemodialysis patients, enhance sleep quality, reduce negative emotions such as anxiety and depression, and improve quality of life.

Objective

The primary objective was to evaluate the impact of the Community-Hospital-Family Interactive Management (CHFIM) Model on social isolation in elderly patients undergoing maintenance hemodialysis. Secondary objectives included assessing its effects on social support, loneliness, depression, and family function.

Methods

A total of 160 elderly maintenance hemodialysis patients from the Blood Purification Center of Taixing People's Hospital between July 2023 and March 2024 were selected as the study subjects. Using a controlled trial design, the patients were divided into a control group (n = 80) and an intervention group (n = 80). The control group received routine care, while the intervention group received Community-Hospital-Family Interactive Management. The social network level, social support level, loneliness, and depression levels of the two groups were compared.

Results

After the intervention, the intervention group showed significant improvements in social network level (primary outcome) and social support, along with significant reductions in loneliness and depression (secondary outcomes) compared to the control group (p < 0.05).

Conclusion

The CHFIM Model effectively reduces social isolation in elderly maintenance hemodialysis patients, promoting their physical and mental health.

Trial Registration

Chinese Clinical Trial Registry, ChiCTR2500107611

Background

T50 is a serum-based measure of calcification propensity and a predictor of cardiovascular risk and mortality in hemodialysis (HD) patients. Cardiovascular disease is in part driven by uremic toxins. Medium cut-off (MCO) dialyzers enhance the clearance of middle molecular weight (MW) uremic toxins compared to conventional dialyzers. However, the long-term impact of MCO dialyzers on pre-dialysis and post-dialysis T50 scores remains unknown.

Methods

The study included maintenance HD patients on low-flux (LF) dialyzers. Pre- and post-dialysis serum samples were collected in mid-week HD sessions: first with LF dialyzers (baseline) and then 6 months after switching to MCO dialyzers. Change in T50 was analyzed for a single HD treatment under LF and MCO dialyzers, and baseline and sixth-month pre-dialysis T50 scores were compared.

Results

Fifteen patients were included. Pre- and post-dialysis percent improvement in T50 for LF and MCO dialyzers were similar (85.2% [45.0, 282.7] and 56.3% [21.1, 238.6], respectively, p = 0.35). Pre-dialysis T50 after 6 months on MCO was comparable to the baseline (p = 0.73). Pre-dialysis T50 at baseline had an inverse association with improvement in T50 after a single HD treatment (β = −0.88; 95% CI: −1.18 to −0.57; p < 0.01), and smoking had a direct association with pre-dialysis T50 after 6 months of MCO treatment (β = −172; 95% CI: −287 to −56.8; p = 0.02).

Conclusion

MCO dialyzers do not confer additional benefits in improving serum calcification propensity, compared to LF dialyzers. Our data do not support a significant contribution of middle MW uremic toxins' removal to T50 scores.

Introduction

Brazil is the third country in the world with the highest number of dialysis patients. The increasing number of dialysis patients may reflect the state of renal care in the country. We analyzed and reported trends in the prevalence and incidence of chronic dialysis in Brazil since 2006, and projected estimates for 2039.

Methods

We compared trends in the prevalence and incidence rates of the Brazilian Dialysis annual Surveys since 2006. Monotonic trends were evaluated using the Mann–Kendall test, and forecasting trends were performed using classical and exponential smoothing techniques until 2039.

Findings

The incidence and prevalence rates of dialysis in Brazil have shown an upward trend over the past 19 years. Prevalence rates have increased across all five regions of the country. Regarding incidence rates, only the northeast region of Brazil did not show a significant upward trend over the period. The projected incidence and prevalence rates for 2039 are 338 patients per million population (95% CI: 306–370) and 1225 per million population (95% CI: 1179–1271), respectively. This represents an increase of 35.8% and 50.9% over 15 years, respectively.

Discussion

The projected rise in the incidence and prevalence of chronic dialysis in Brazil over the next decade is worrisome. It underscores the need for more vigorous measures to manage the burden of chronic kidney disease in the country, aiming to mitigate its impact on health care and associated costs.