Hemodialysis International最新文献

Introduction

Patients with end-stage kidney disease (ESKD) face a significantly increased risk of cardiovascular disease (CVD). Effective management of these patients necessitates the early identification and continuous monitoring of cardiovascular complications. This study aimed to evaluate the clinical utility of circulating adropin, salusin-α (Sal-α), and salusin-β (Sal-β) levels in ESKD patients, with and without co-occurring CVD.

Methods

We enrolled 149 participants, categorized into three groups: healthy controls (n = 50), ESKD patients without CVD (n = 50), and ESKD patients with CVD (n = 49). We measured anthropometric parameters, markers of kidney and cardiac function, and circulating levels of adropin, Sal-α, and Sal-β.

Results

Serum adropin and Sal-α levels were significantly lower in ESKD patients with CVD compared to both healthy controls and ESKD patients without CVD. Conversely, ESKD patients with CVD exhibited significantly higher Sal-β levels and a higher Sal-β/Sal-α ratio when compared to controls and ESKD patients without CVD. Furthermore, high circulating adropin levels were associated with a decreased risk of CVD, whereas elevated circulating Sal-β levels and an increased Sal-β/Sal-α ratio were associated with an increased CVD risk. The Sal-β level and Sal-β/Sal-α ratio demonstrated the highest diagnostic efficacy in differentiating ESKD patients with CVD from those without CVD. Combining these parameters further improved diagnostic efficacy.

Conclusion

Adropin insufficiency and an imbalance in salusin levels (specifically an elevated Sal-β/Sal-α ratio) may play a role in the pathogenesis of CVD in ESKD patients. The circulating levels of adropin and Sal-β, along with the Sal-β/Sal-α ratio, appear to be valuable diagnostic biomarkers for CVD in this high-risk population.

Background

Hemodialysis is a common initial treatment for young individuals with end-stage renal disease. Educating these patients is crucial for improving their knowledge and well-being. Lifestyle modifications, promoted through health education, are essential for reducing hemodialysis-related complications. Although traditional face-to-face education is prevalent, video-based education offers a more convenient and cost-effective alternative with numerous benefits.

Objective

This study aimed to evaluate the impact of a video-assisted educational program on the knowledge of adolescents undergoing hemodialysis in Palestine.

Methods

We conducted a quasi-experimental, pretest-posttest intervention study with 68 adolescent patients (Aged 13–18) diagnosed with end-stage kidney disease (ESKD). Patients were divided into two groups based on their treating hospital: an experimental group (n = 34) received video-based education, whereas a control group (n = 34) received traditional face-to-face education. Knowledge in both groups was assessed using the validated Kidney Knowledge Questionnaire.

Results

A Generalized Estimating Equation analysis revealed a statistically significant difference in knowledge scores between the experimental and control groups across pretest, posttest, and follow-up assessments (p = 0.024). Furthermore, within both the experimental and control groups, there were statistically significant improvements in total knowledge scores from pretest to posttest and follow-up assessments (p < 0.001).

Conclusion

Implementing effective educational interventions can enhance the knowledge of individuals undergoing hemodialysis. Therefore, we recommend using video-based instruction as a practical, easy, and engaging approach for educating hemodialysis patients.

Introduction

Virtual reality headsets are increasingly used in medical procedures to help manage pain and anxiety. This study investigated the effect of a video played through a virtual reality headset on pain and anxiety levels during arteriovenous (AV) fistula needle insertion in patients undergoing hemodialysis.

Methods

This randomized controlled trial included 80 patients from a hemodialysis ward, with 40 in the intervention group and 40 in the control group. Data were collected using a Personal Information Form (developed by the researcher based on relevant literature to gather descriptive and medical characteristics), the visual analogue scale (VAS) for pain severity, and the State–Trait Anxiety Inventory to measure anxiety levels. The intervention group utilized a virtual reality headset during the procedure. The intervention was applied during a single dialysis treatment.

Findings

The mean pain score in the intervention (virtual reality headset) group was 6.2 ± 0.8, significantly lower than the control group's mean pain score of 8.3 ± 0.9 (p < 0.001). The mean State Anxiety Inventory score for the intervention (virtual reality headset) group was 41.9 ± 3.6, which was significantly lower than the control group's mean score of 64.6 ± 3.4 (p < 0.001).

Conclusion

The results of this pilot study suggest that using a virtual reality headset significantly reduced both pain and anxiety in patients undergoing AV fistula needle insertion during hemodialysis. Further studies are indicated to evaluate the utility of virtual reality headset use over a prolonged period.

Trial Registration: https://clinicaltrials.gov: NCT06776497

Background

Chronic pain is common in patients with chronic kidney disease (CKD), yet pain management in non-dialysis-dependent CKD (NDD-CKD) is underexplored. Inappropriate analgesic use poses significant risks in this population.

Objective

To evaluate patterns of analgesic use—specifically opioids and NSAIDs—and associated clinical characteristics in patients with NDD-CKD.

Methods

A systematic review was conducted following PRISMA 2020 guidelines. Databases including PubMed and ClinicalTrials.gov were searched in December 2024 using MeSH terms related to CKD, analgesics, opioids, and NSAIDs. Inclusion criteria targeted NDD-CKD patients with reported analgesic use. Data extraction and risk of bias assessments were performed independently by two reviewers.

Results

Nine studies encompassing 3,674,959 patients were included. Opioid use was reported in 324,111 patients (22.8%), while NSAIDs were used in 1,095,052 (77.1%). Opioid use increased with CKD severity and pain intensity, but was associated with higher mortality, especially in frail or comorbid patients. NSAID use was prevalent in early-stage CKD and associated with nephrotoxic risk and may occur without clinician oversight. Regional variation and inconsistent prescribing practices were noted. No study directly compared opioid vs. NSAID outcomes.

Conclusion

Analgesic use in NDD-CKD is widespread and varies by region, CKD stage, and pain severity. Inadequate pain control is common. Standardized guidelines tailored to CKD patients are urgently needed to optimize pain management while minimizing harm.

Case Presentation

We report the case of a 65-year-old Caucasian woman who presented to our emergency department following the ingestion of approximately thirty 2.5 mg bisoprolol tablets. Initially stable, she rapidly developed severe bradycardia and hypotension, culminating in cardiogenic–distributive shock that required intubation, aggressive vasoactive support, and advanced metabolic therapies. Due to concurrent hepatic and renal dysfunction impairing drug elimination, continuous kidney replacement therapy (CKRT) was initiated as a supportive intervention and potential drug elimination pathway. The patient's condition progressively improved, leading to complete recovery.

Conclusion

In addition to describing our clinical experience, we provide a concise literature review on the use of CKRT in beta-blocker poisoning, highlighting current knowledge gaps and the need for cautious interpretation in the absence of direct pharmacokinetic measurements.

Background

Heparin and low-molecular-weight heparin (LMWH) are first-line anticoagulants in hemodialysis but may trigger heparin-induced thrombocytopenia (HIT), a severe immune-mediated complication. Despite its clinical significance, HIT is often misdiagnosed early, increasing thromboembolic risks and mortality.

Case Report

We present a case of a 61-year-old male patient who developed HIT during initial hemodialysis. The patient exhibited recurrent catheter thrombosis, intermuscular venous thrombosis in the lower extremities, and progressive thrombocytopenia following LMWH administration during dialysis. The diagnosis was confirmed by IgG-specific anti-PF4/heparin antibody testing. Shortly after the last dialysis session, the patient developed acute dyspnea and chest pain. Computed tomography angiography of the chest revealed pulmonary embolism. Despite aggressive intervention, the patient's condition deteriorated rapidly, with platelet counts dropping to 5 × 10⁹/L, culminating in a fatal outcome.

Conclusion

The combination of dialysis catheter thrombosis and declining platelet counts constitutes an essential early diagnostic clue for HIT in hemodialysis patients, the recognition of which could prevent fatal thromboembolic complications.

Background

Dialysis patients, often immunocompromised, are highly susceptible to infectious diseases, including oral candidiasis, the most common mycotic infection of the oral mucosa.

Objective

To identify risk factors for oral candidiasis in dialysis patients to improve management strategies.

Methods

A cross-sectional study was conducted in Birjand, Iran, involving 158 dialysis patients. Oral samples were cultured on CHROMagar Candida medium, with Candida species identified using colony color and molecular techniques. Multiple logistic regression analysis was used to determine predictors of oral candidiasis.

Results

Of the 158 patients, 69 (43.7%) tested positive for oral candidiasis, yielding 97 Candida isolates. Candida albicans was the most prevalent species (55.7%), followed by Candida glabrata (22.7%). Significant predictors of oral candidiasis included longer dialysis duration (OR = 7.48; 95% CI = 1.31–2.05; p < 0.001), male gender (OR = 3.07; 95% CI = 1.12–8.39; p = 0.02), and smoking (OR = 7.48; 95% CI = 1.98–28.31; p = 0.003).

Conclusion

Oral candidiasis is a prevalent opportunistic infection in dialysis patients, particularly among men, smokers, and those with extended dialysis duration. Enhanced screening, especially in developing countries, may be useful to address this often-overlooked condition.