Hemodialysis International最新文献

Introduction

Despite being a rare cause of end-stage kidney disease (ESKD), sickle cell disease has broad kidney implications. Patients with both sickle cell disease and ESKD are at a greater risk of adverse events including mortality; while these patients can be managed with hemodialysis (HD), the use of nocturnal HD in sickle cell disease has not been previously described.

Methods

Here, we report a patient with sickle cell disease and ESKD who transitioned from conventional HD to nocturnal home HD.

Findings

Following the initiation of extended HD, we observed a significant improvement in her blood pressure (BP) parameters, serum potassium levels, and volume status. We describe the importance of nitric oxide (NO) in maintaining normal endothelial function, and how NO bioavailability is disrupted in both the sickle cell disease and ESKD populations. We speculated that our patient had significant vasoconstriction secondary to NO depletion causing uncontrolled hypertension and intravascular hemolysis (leading to recurrent hyperkalemia), and theorized that extended HD could have enhanced the bioavailability of NO, restoring the vasodilatory capability of her endothelium.

Discussion

Having a dialysis modality that counters the negative pathophysiologic endothelial changes in sickle cell disease and ESKD could result in fewer complications in this vulnerable population.

Purpose

This study investigated the effect of frailty and avoidance behavior due to fear of falling on the quality of life in older patients receiving hemodialysis treatment.

Methods

This study is cross-sectional and descriptive. The study was conducted between January 2 and 31, 2022, with 154 individuals aged 65 years and over receiving treatment in dialysis centers. The study data were collected using the Patient Information Form, Edmonton Frail Scale, Fear of Falling Avoidance-Behavior Questionnaire, and Quality of Life Scale (SF-12).

Results

The Mean Edmonton Frail Scale score was found to be 8.7 ± 3.36, the mean Fear of Falling Avoidance-Behavior Questionnaire score was found to be 33.17 ± 9.11, the mean SF-12 physical component score was found to be 34.32 ± 8.51, and the mean mental component score was seen as 41.77 ± 8.35. The Fear of Falling Avoidance-Behavior Questionnaire was an associated factor in the effect of the Edmonton Frail Scale on quality of life. It strengthened the negative impact of the Edmonton Frail Scale on quality of life. The predictive effect of these two variables in explaining quality of life was 59.3%.

Conclusion

It was found that the participants had moderate levels of frailty, moderate levels of activity limitation, and participation restriction due to fear of falling, and low levels of physical and mental quality of life. It was determined that frailty had a direct impact on quality of life. Also, the indirect effect of frailty on quality of life was determined through the role of avoidance behavior due to fear of falling.

Background

Endogenous endophthalmitis is an infrequent yet severe complication of hemodialysis catheter-related sepsis. In this report, we present a case of endogenous bacterial endophthalmitis in a patient with hemodialysis catheter-related sepsis.

Case Presentation

A 65-year-old male had a history of hepatitis B-related glomerulonephritis, end-stage renal disease, hepatitis-B-related decompensated cirrhosis, hypertension, diabetes mellitus, and coronary artery disease. He received temporary central venous catheterization and commenced hemodialysis. Subsequent diagnosis of methicillin-resistant Staphylococcus aureus (MRSA) endogenous endophthalmitis originating from catheter-related bloodstream infection (CRBSI) was established. The patient underwent vitrectomy and received intravitreal antibiotic injections. Treatment with systemic and local antibiotics was sustained for a duration of 4 weeks, however, the patient's visual acuity remained poor.

Conclusions

Endogenous endophthalmitis represents a vision-threatening emergency necessitating rapid identification and intervention. Clinicians should maintain a high index of suspicion for endogenous endophthalmitis when ocular symptoms manifest in the context of sepsis. Timely ophthalmological evaluation and management are imperative to optimize patient outcomes.

Endogenous endophthalmitis represents a vision-threatening emergency necessitating rapid identification and intervention. Clinicians should maintain a high index of suspicion for endogenous endophthalmitis when ocular symptoms manifest in the context of sepsis. Timely ophthalmological evaluation and management are imperative to optimize patient outcomes.

Introduction

Nonattendance for prescribed hemodialysis (HD) sessions is a form of nonadherence that compromises the delivery of life-sustaining HD therapy and is associated with severe morbidity and mortality. In this study, we aimed to assess the characteristics and outcomes of HD nonattenders in a single renal center in the North West of England.

Methods

HD patients followed by the renal team at our unit between December 2020 and September 2022 were included in this study. Dialysis nonattendance data were retrieved from the incident reports (DATIX) between December 2020 and November 2022, excluding dialysis nonattendance due to concurrent hospitalization. The cohort was split into group 1: no dialysis nonattendance; group 2: two or fewer dialysis nonattendances; and group 3: more than two dialysis nonattendances for comparative analysis. All patients were followed up for outcomes including all-cause mortality, transplantation, and hospitalizations until the study endpoint date of 12/31/2023. Predictors of dialysis nonattendance were identified using logistic regression.

Results

Of the 464 patients, dialysis nonattendance was noted in 149 (32%) patients, of which 79 (17%) had two dialysis nonattendance episodes and 70 (15%) had more than two dialysis nonattendance episodes. Over a median follow-up of 35 months, patients in group 3 had a higher hospitalization episode (4 vs. 1 day, p < 0.001) and lower kidney transplantation rates (4.3% vs. 13%, p = 0.038) compared to patients in group 1. In multivariate regression analysis, younger age (OR: 0.97; 95% CI: 0.95–0.98; p = 0.001), history of smoking (OR: 2.01; 95% CI: 1.12–3.62; p = 0.019), alcohol excess history (OR: 3.49; 95% CI: 1.87–6.49; p < 0.001) and history of mental health illness (OR: 3.01; 95% CI: 1.61–5.62; p = 0.001) were significant predictors of dialysis nonattendance.

Conclusion

Skipping HD is a common phenomenon associated with mental health issues and is associated with increased morbidity. Further research is required to understand the psychosocial determinants of nonadherence and effective models of intervention developed to improve outcomes.

Background

Previously, two reports proposed a four-stream dialysis fluid delivery system consisting of an acid concentrate, a base concentrate, a sodium chloride concentrate, and product water for correcting dysnatremias and metabolic acid–base disorders separately, by hemodialysis.

Methods

This report describes a new method for the clinical use of the previously reported four-stream dialysis fluid delivery system to treat concurrently dysnatremias and metabolic acid–base disturbances by hemodialysis. Pumps attached to each concentrate are designed to control its flow rate. Formulas were derived to determine the flow rate of each of the pumps controlling the flows of the product water ( W ), the base concentrate ( B ), and the sodium chloride concentrate ( S ) for any prescribed combination of sodium and bicarbonate concentrations is the final dialysis fluid. In this scheme, the flow rate of the acid concentrate ( A ), the concentrations of its contents in the final dialysis fluid remain constant. The flow rate ratio W:S:B:A remains also constant at 45 (i.e., 45X).

Results

The formulas were entered in an EXCEL flow sheet which determines the flow rate ratio W:S:B:A for any desired combination of sodium and bicarbonate concentrations in the dialysis fluid. The upper and lower limits of the concentrations of sodium and bicarbonate in the dialysis fluid were computed. The system has not been applied clinically. Measurements of any electrolyte concentrations have not been made.

Discussion

This system makes the treatment of profound dysnatremias, metabolic acid–base disorders, and combined dysnatremias and metabolic acid–base disorders feasible. The clinical application of the system demands prior in vitro or ex vivo studies plus fastidious and expert attention to ensure safe and dependable application.

Introduction

Home dialysis has been associated with better patient survival compared to in-center hemodialysis. Finland has over 40 years of experience with home dialysis. Despite sustained efforts, the prevalence of home dialysis has decreased in the last decade. We aimed to explore the barriers to expanding home dialysis treatments from healthcare providers' and patients' perspectives.

Methods

This is qualitative research, based on an electronic semi-structured survey directed to nephrologists, nephrology nurses, and patient associations. The survey development contemplated the main barriers shown in a conceptual framework described previously in the literature. An open-ended question was analyzed using the content analysis method.

Findings

All participants agreed that the nurse shortage and patients' several comorbidities are the main barriers. Healthcare teams were perceived as having good qualifications and interest in home dialysis. Intense transplant activity was not perceived as a barrier. Doctors and nurses believed that starting in-center hemodialysis decreases the odds of switching to home dialysis later, and patients have less motivation or reliability in their abilities. From the patient's perspective, the financial burden and the impact of home dialysis on the assistant or relative constitute critical barriers. Also, bringing hospitals home or living in small spaces is an important barrier to accepting home dialysis.

Discussion

Expanding home dialysis modalities requires boosting the home dialysis nursing pool, choosing home dialysis as a first modality, and removing the financial burden on the patients. While the rise in patients with multiple comorbidities remains unchanged, supporting relatives to prevent burnout could be beneficial.

Background

Pain is a prevalent cause of medical consultation among dialysis patients, severely impacting both treatment outcomes and quality of life. This study focuses on a specific yet underexplored type of pain—delayed and progressive perivenous tissue pain in the outflow tract of arteriovenous fistulas (AV fistula) during dialysis. The aim is to summarize its clinical features, investigate its underlying mechanisms, and evaluate the effectiveness of various treatments, ultimately providing new insights into pain management.

Methods

This study included 36 patients who experienced delayed and progressive perivenous tissue pain in the outflow tract of AV fistulas during dialysis. Pain features were systematically summarized, and the AV fistula status was comprehensively evaluated through general observation, physical examination, and imaging. A series of trial interventions were employed to further explore the underlying mechanisms of pain. Based on these findings, appropriate treatment strategies were identified and implemented, with therapeutic outcomes monitored over a 12-month follow-up.

Findings

The specific pain may be closely associated with venous hypertension. Ultrasonography identified high-flow fistulas in 18 patients, while angiography revealed varying degrees of outflow vein stenosis in 23 patients. Five patients with slightly elevated fistula blood flow and no significant stenosis underwent bandage compression therapy. Thirty-one patients with markedly increased blood flow and/or outflow vein stenosis received ultrasound-guided flow restriction surgery, percutaneous transluminal angioplasty, or combined therapies. All patients achieved pain relief, with no recurrence during the follow-up period.

Conclusions

This study systematically investigates perivenous tissue pain in the outflow tract of AV fistula during dialysis. Venous hypertension is likely the primary underlying cause of this condition. Treatment options, including bandage compression, flow restriction surgery, percutaneous transluminal angioplasty, and combined therapies, effectively alleviate the tissue pain.

Introduction

Cat Scratch Disease, caused by the bacterium Bartonella henselae, typically manifests with fever, headache, anorexia, weight loss, tender lymphadenopathy, and other systemic symptoms. Transmission commonly occurs through a cat scratch or bite. The clinical course varies depending on the patient's immune status, notably in individuals with conditions such as renal failure. While generally localized, Cat Scratch Disease can occasionally present as a systemic illness with diverse manifestations. This report aims to elucidate the etiology of fever of unknown origin in hemodialysis patients, focusing on the case of a 30-year-old female.

Methods

A 30-year-old female patient, who routinely undergoes hemodialysis (HD) three times a week for four hours at the hemodialysis unit, was admitted to our service for further evaluation and treatment due to an infectious disease clinic presentation. She is now under close observation and management in our inpatient department.

Findings

The patient's presenting symptoms included fever, arthralgia, night sweats, and weight loss, refractory to empirical antibiotic and broad-spectrum antimicrobial therapy. Physical examination revealed lymphadenopathy and splenomegaly. Laboratory investigations demonstrated elevated C-reactive protein and procalcitonin levels. Ultrasound imaging revealed reactive lymphadenopathy in multiple regions. Following the exclusion of bacterial, viral, and mycobacterial infections, including tuberculosis, a diagnosis of lymphoma was considered. However, a subsequent lymph node biopsy revealed non-caseating granulomatous lymphadenitis, a histopathological finding consistent with Cat Scratch Disease.

Discussion

Although rare, Cat Scratch Disease should be considered in the differential diagnosis of fever of unknown origin in patients with chronic kidney disease undergoing hemodialysis.

Introduction

Under physiological conditions, blood volume and extracellular volume are in a ratio of 1–3, even in hemodialysis patients. The question therefore arises: can blood volume be inferred from the bioimpedance analysis data? The aim of the study was to compare the blood volumes calculated from extracellular volume determined by bioimpedance analysis data to the actually measured blood volumes.

Methods

Immediately before treatment, extracellular volume and volume overload were evaluated by bioimpedance spectroscopy. The actual blood volume was determined by indicator dilution, using an on-line infusate bolus and subsequent calculation with the data from the relative blood volume monitor. Alternatively, blood volume was calculated from extracellular volume divided by 3 and compared to the measured blood volume.

Findings

Overall, there were no significant differences between measured (5.56 ± 1.47 L) and calculated (5.79 ± 1.30 L) blood volumes. However, intra-individually, there were very large discrepancies with a range of −1.409 to 1.450 L. Median absolute deviation was 382 mL corresponding to 6.2 mL/kg. The differences between measured and calculated blood volumes correlated significantly (r = −0.98; p < 0.001) with the blood to extracellular volume ratio.

Discussion

In almost half of patients, blood volume can be inferred from bioimpedance data with sufficient certainty. But the greater the deviation from the physiological blood to extracellular volume ratio of 1–3, the more the calculated blood volumes differ from the measured values. For this reason, bioimpedance data should not be used uncritically to set the ultrafiltration.

Introduction

Infective endocarditis can present with a wide range of cardiac and extra-cardiac symptoms. However, purulent pericarditis as a presenting sign has rarely been documented in the literature.

Case Description

We present a case of a 47-year-old woman on hemodialysis who presented to the emergency department due to dyspnea and edema in her lower extremities. A chest X-ray revealed an enlarged cardiac silhouette, while a computed tomography (CT) scan showed a large pericardial effusion. A transthoracic echocardiogram indicated vegetation on the tricuspid valve and pericardial effusion, with echocardiographic signs of cardiac tamponade. Emergent drainage of the pericardial space was performed, during which purulent material was obtained. Methicillin-resistant Staphylococcus aureus was identified in blood cultures collected upon admission and in the cultures from the pericardial effusion. The patient received intensive antibiotic therapy; however, despite the treatment and after a complicated hospital course, she succumbed to the illness.

Conclusion

Diagnosing purulent pericarditis in hemodialysis patients with infective endocarditis requires a high level of suspicion because typical symptoms of pericarditis are uncommon, and there is a tendency to initially attribute nonspecific constitutional symptoms to the underlying infection itself. Aggressive treatment with pericardial drainage and appropriate antibiotic therapy may prevent catastrophic outcomes.