Hemodialysis International最新文献_第3页

Using cryotherapy, EMLA (eutectic lidocaine/prilocaine) cream, or lidocaine spray to reduce pain during arteriovenous fistula puncture: A randomized controlled trial 使用冷冻疗法、EMLA（共晶利多卡因/普鲁卡因）乳膏或利多卡因喷雾剂减轻动静脉瘘穿刺时的疼痛：随机对照试验

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2024-04-11 DOI: 10.1111/hdi.13152

Mohammed Baqer Al-Jubouri, Sabah A. Jaafar, Murtadha Khudair Abbas, Ihab Nadhir Gazi, Maitham A. Shawwat, Karrar Faleh Karmoud, Taher Mohsin Al-Faham

Introduction

In hemodialysis patients, pain associated with needle insertion into an arteriovenous fistula is a physical and psychological problem. The aim of this study was to assess the effectiveness of pre-puncture application of an ice pack, EMLA cream, or lidocaine spray to reduce pain associated with access puncture.

Methods

This was a multicenter study done in nine hemodialysis centers in Iraq. The study utilized a randomized, parallel-group design, in which patients being dialyzed using an arteriovenous access were allocated into one of four groups. Access puncture was preceded by nothing (control group), by use of ice pack cooling at the puncture site, by application of EMLA cream, or by application of lidocaine spray. Pain after access puncture was assessed during a single treatment for each patient. Pain was quantified using a Visual Analogue Scale.

Findings

A total of 1548 patients agreed to participate, and 1041 patients were included in the data analysis. Use of an ice pack, EMLA cream, or lidocaine spray each was associated with a lower pain score on access puncture compared with no pretreatment. The mean Visual Analogue Scores in the four groups were: 69.7 ± 15.7 in the controls, 39.8 ± 13.2 in the ice pack group, 45 ± 18.4 in the EMLA group, and 52.9 ± 15.2 in lidocaine group. Ranking of the pain severity scores suggested that ice pack use was associated with the least pain, followed by use of EMLA cream and use of lidocaine spray (severity score ranking, from lowest to highest, being 1.62, 2.18, and 2.63, respectively).

Discussion

Application of an ice pack prior to vascular access puncture is a fast and inexpensive technique to limit pain associated with this procedure.

引言在血液透析患者中，动静脉瘘穿刺针引起的疼痛是一个生理和心理问题。本研究的目的是评估穿刺前使用冰袋、EMLA 霜或利多卡因喷雾剂对减轻入路穿刺疼痛的效果。研究采用随机平行分组设计，使用动静脉通路进行透析的患者被分配到四组中的一组。穿刺前什么都不做（对照组）、在穿刺部位使用冰袋冷却、涂抹 EMLA 霜或喷洒利多卡因。在对每位患者进行单次治疗时，对其进行入路穿刺后的疼痛评估。共有 1548 名患者同意参与，1041 名患者被纳入数据分析。使用冰袋、EMLA 软膏或利多卡因喷雾剂与不进行预处理相比，都能降低入路穿刺时的疼痛评分。四组患者的平均视觉模拟评分分别为对照组为 69.7 ± 15.7，冰袋组为 39.8 ± 13.2，EMLA 组为 45 ± 18.4，利多卡因组为 52.9 ± 15.2。疼痛严重程度评分结果表明，使用冰袋的疼痛程度最低，其次是使用 EMLA 霜和利多卡因喷雾剂（严重程度评分从低到高分别为 1.62、2.18 和 2.63）。

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引用次数: 0

Tc-99m-MIBI SPECT/CT imaging to diagnose secondary hyperparathyroidism after parathyroid forearm transplantation 用 Tc-99m-MIBI SPECT/CT 成像诊断前臂甲状旁腺移植术后继发性甲状旁腺功能亢进症

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2024-04-03 DOI: 10.1111/hdi.13149

Zhenchun Xu, Chenxi Zheng, Maohua Rao, Yalan Xiong, Yan Tian, Gengbiao Yuan

This article report a 40-year-old male patient who underwent total thyroidectomy and forearm auto-transplantation in another hospital for secondary hyperparathyroidism. After 4 years of follow-up, the level of parathyroid hormone continued to increase, and ultrasound showed nodules in the neck and right forearm, which were considered to be of parathyroid origin. Technetium 99m sestamibi single photon emission computed tomography and computed tomography (Tc-99m-MIBI SPECT/CT) imaging showed increased radioactive uptake in the submuscular soft tissue nodule of the right medial forearm, maximum standardized uptake value (SUVmax) is 0.98, which was identified as transplanted functioning parathyroid tissue. No parathyroid imaging activity was found in the neck. The patient then underwent partial removal of ectopic parathyroid tissue from the right forearm. Pathological examination confirmed parathyroid tissue, and removal was followed by a rapid decline in serum parathyroid hormone levels.

本文报告了一名40岁的男性患者，他因继发性甲状旁腺功能亢进症在另一家医院接受了甲状腺全切除术和前臂自体移植术。随访4年后，患者的甲状旁腺激素水平持续上升，超声检查显示其颈部和右前臂有结节，考虑为甲状旁腺源性结节。锝99m姒他米单光子发射计算机断层扫描和计算机断层扫描（Tc-99m-MIBI SPECT/CT）成像显示，右前臂内侧肌下软组织结节的放射性摄取增加，最大标准化摄取值（SUVmax）为0.98，确定为移植的功能性甲状旁腺组织。颈部未发现甲状旁腺成像活动。随后，患者接受了右前臂异位甲状旁腺组织的部分切除术。病理检查证实为甲状旁腺组织，切除后血清甲状旁腺激素水平迅速下降。

引用次数: 0

Evaluation of hepatosteatosis and gallstone disease in patients with chronic kidney disease 评估慢性肾病患者的肝硬化和胆石症。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2024-04-01 DOI: 10.1111/hdi.13151

Doğu Karahan, İdris Şahin

Introduction

The prevalence rates of hepatosteatosis and gallstones are increasing owing to the multifactorial causes of chronic kidney disease, and the prevalence may change with the availability of different forms of renal replacement therapy. We aimed to determine the incidence or prevalence rates of hepatosteatosis, cholelithiasis, and acute cholecystitis in patients with chronic kidney disease and compare them between renal replacement therapy modalities.

Methods

A total of 270 patients (90 with chronic kidney disease stages III–V, 90 undergoing peritoneal dialysis, and 90 undergoing hemodialysis) were included and categorized into the pre-dialysis, hemodialysis, and peritoneal dialysis groups. The patients were questioned about previous gallbladder surgeries and chronic diseases. The results of abdominal ultrasonography, tomography, and magnetic resonance imaging were retrospectively evaluated with respect to the findings on the hepatobiliary system. Hepatosteatosis and cholelithiasis were diagnosed by expert radiologists on the basis of abdominal ultrasonography, tomography, and magnetic resonance imaging findings. The prevalence rates of hepatosteatosis, cholelithiasis, and other liver findings were compared between the groups.

Findings

Hepatosteatosis and cholelithiasis were detected in 16.7% and 21.5% of the 270 cases, respectively. Hepatosteatosis was present in 17.8%, 25.6%, and 6.7% of patients in the pre-dialysis, hemodialysis, and peritoneal dialysis groups, respectively. The prevalence of hepatosteatosis was significantly higher in patients undergoing hemodialysis than in patients undergoing peritoneal dialysis (p = 0.002). However, no statistically significant difference was found between the peritoneal dialysis and pre-dialysis groups or between the hemodialysis and pre-dialysis groups (p >0.05). The prevalence rates of cholelithiasis were 15.6%, 28.9%, and 20.0%, in the pre-dialysis, hemodialysis, and peritoneal dialysis groups, respectively, and there were no statistically significant differences among the groups. The incidence of acute cholecystitis was significantly higher in the hemodialysis group than in the pre-dialysis group (p = 0.006).

Discussion

Our study showed that the hepatobiliary system is frequently affected in chronic kidney disease and that the findings may differ depending on the renal replacement therapy modality.

导言：由于慢性肾脏病的多因素原因，肝硬变和胆结石的患病率正在上升，而且患病率可能会随着不同肾脏替代疗法的出现而发生变化。我们旨在确定慢性肾脏病患者肝硬变、胆石症和急性胆囊炎的发病率或流行率，并对不同肾脏替代疗法进行比较：共纳入 270 名患者（90 名慢性肾脏病 III-V 期患者、90 名腹膜透析患者和 90 名血液透析患者），并将其分为透析前组、血液透析组和腹膜透析组。研究人员询问了患者之前的胆囊手术和慢性疾病情况。回顾性评估了腹部超声波、断层扫描和磁共振成像对肝胆系统的检查结果。放射科专家根据腹部超声波检查、断层扫描和磁共振成像结果诊断出肝软化症和胆石症。两组患者的肝软化症、胆石症和其他肝脏疾病的发病率进行了比较：结果：在 270 个病例中，分别有 16.7% 和 21.5% 的人被查出患有肝软化症和胆石症。在透析前、血液透析和腹膜透析组中，分别有 17.8%、25.6% 和 6.7% 的患者出现肝软化症。接受血液透析的患者的肝软化症发病率明显高于接受腹膜透析的患者（P = 0.002）。然而，腹膜透析组和透析前组之间以及血液透析组和透析前组之间的差异均无统计学意义（P >0.05）。透析前组、血液透析组和腹膜透析组的胆石症发病率分别为 15.6%、28.9% 和 20.0%，组间差异无统计学意义。血液透析组急性胆囊炎的发生率明显高于透析前组（P = 0.006）：讨论：我们的研究表明，慢性肾脏病患者的肝胆系统经常受到影响，不同的肾脏替代疗法可能会有不同的结果。

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引用次数: 0

Incidence of hyperkalemia in anuric hemodialysis patients treated with sacubitril/valsartan 使用沙库比妥/缬沙坦治疗的无尿血液透析患者的高钾血症发生率。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2024-04-01 DOI: 10.1111/hdi.13150

Xiaofan Li, Fei Ma, Yan Wang, Haidan Zhao, Jianjun Gao

Introduction

Sacubitril/valsartan is increasingly used in hemodialysis patients due to its cardioprotective benefits. However, its impact on serum potassium levels in anuric patients undergoing hemodialysis remains controversial.

Methods

We conducted a retrospective data from patients undergoing hemodialysis at two dialysis centers. A total of 71 out of 332 patients receiving hemodialysis treatment were enrolled. Mean serum potassium (mean value of 6–8 determinations), peak serum potassium (maximum K value observed during follow-up observations), and other biochemical parameters were recorded at baseline and during the follow-up period.

Findings

After 6 months of follow-up, mean serum potassium increased from 4.84 ± 0.45 mmol/L at baseline to 5.07 ± 0.46 mmol/L at 3 months and 5.04 ± 0.46 mmol/L at 6 months (p < 0.001). Notably, no significant group differences were found in peak serum potassium concentrations between baseline and 6 months after sacubitril/valsartan therapy (5.69 ± 0.56 vs. 5.75 ± 0.41, p = 0.419). Prior to starting sacubitril/valsartan treatment, none of the patients had severe hyperkalemia; however, after 3 and 6 months of sacubitril/valsartan therapy, two (2.80%) and three (4.20%) patients experienced severe hyperkalemia, respectively; however, this difference was not statistically significant. Additionally, there was a significant reduction in blood pressure; however, serum sodium, bicarbonate, and Kt/V values did not change significantly during either period.

Discussion

Sacubitril/valsartan therapy is associated with an increase in serum potassium levels in anuric hemodialysis patients. Nevertheless, the proportion of patients with severe hyperkalemia did not increase significantly. This suggests that the use of sacubitril/valsartan in anuric patients on hemodialysis is relatively safe.

简介由于萨库比特利/缬沙坦具有保护心脏的作用，因此越来越多地用于血液透析患者。然而，它对接受血液透析的无尿患者血清钾水平的影响仍存在争议：我们对两个透析中心的血液透析患者进行了回顾性数据分析。在接受血液透析治疗的 332 名患者中，共有 71 名患者入选。在基线和随访期间记录了平均血清钾（6-8 次测定的平均值）、峰值血清钾（随访观察期间观察到的最大钾值）和其他生化参数：随访 6 个月后，平均血清钾从基线时的 4.84 ± 0.45 mmol/L 增加到 3 个月时的 5.07 ± 0.46 mmol/L 和 6 个月时的 5.04 ± 0.46 mmol/L（p 讨论）：萨库比特利/缬沙坦治疗与无尿血液透析患者血清钾水平的升高有关。然而，严重高钾血症患者的比例并未显著增加。这表明，在无尿血液透析患者中使用沙库比妥/缬沙坦是相对安全的。

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引用次数: 0

Early access flow rate predicts vascular access patency-related intervention in the first year: A retrospective cohort study 早期通路流速可预测第一年与血管通路通畅相关的干预：一项回顾性队列研究。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2024-03-27 DOI: 10.1111/hdi.13148

Matthias Bergmann, Butros Fakhoury, Tiago Barroso, Scott G. Prushik, Bertrand L. Jaber, Vaidyanathapuram S. Balakrishnan

Introduction

Arteriovenous fistulas and grafts are lifelines for most hemodialysis patients, and a low access flow rate often requires patency-related intervention, such as angioplasty or thrombectomy, to prevent access failure. We examined whether early access flow rate, measured after initial fistula/graft cannulation, predicts vascular access patency-related intervention within 1 year.

Methods

This was a single-center retrospective cohort study. Among 172 patients undergoing surgical creation of a fistula/graft, 52 (30.2%) had documented access flow rates measurement by the Transonic™ ultrasound dilution technique, performed within an average of 48 days from initial access cannulation. The need for a patency-related intervention, defined as undergoing a fistulogram, angioplasty, thrombectomy, or surgical revision, was ascertained within 1 year. A receiver-operating characteristic curve (ROC) was generated to evaluate the diagnostic performance of first and average access flow rates for predicting patency-related intervention within 1 year.

Findings

Twenty-eight (53.8%) of the 52 study subjects required a patency-related intervention within 1 year. Their characteristics were not significantly different from those who did not require patency-related interventions. However, first access flow rates were significantly lower in patients requiring patency-related intervention compared to those who did not (898 vs. 1471 mL/min; p = 0.003), as were average access flow rates (841 vs. 1506 mL/min; p < 0.001). The ROC analyses revealed that first access flow rates and average access flow rates predicted the need for patency-related intervention within 1 year, with an area under-the-ROC curve of 0.743 (95% confidence interval [CI] 0.608, 0.877) and 0.775 (95% CI 0.648, 0.903), respectively, demonstrating acceptable discrimination.

Discussion

In adults undergoing hemodialysis, early access flow rate measurement can predict patency-related intervention within 1 year after initial vascular access cannulation. Additional studies are required to confirm these findings and identify optimal access flow rate cut-off values to predict vascular accesses at higher risk of stenosis.

导言：动静脉内瘘和移植物是大多数血液透析患者的生命线，如果通路流速较低，通常需要进行血管成形术或血栓切除术等与通路通畅相关的干预，以防止通路失效。我们研究了首次瘘管/移植物插管后测量的早期通路流速是否能预测 1 年内与血管通路通畅相关的干预措施：这是一项单中心回顾性队列研究。在 172 名接受瘘管/移植物手术的患者中，有 52 人（30.2%）在首次插入通路插管后平均 48 天内使用 Transonic™ 超声稀释技术测量了有记录的通路流速。在 1 年内确定是否需要进行与通畅相关的干预，即进行瘘管造影、血管成形术、血栓切除术或手术翻修。研究人员绘制了接收者操作特征曲线（ROC），以评估首次和平均通路流速在预测 1 年内通畅相关介入治疗方面的诊断性能：52名研究对象中有28人（53.8%）需要在1年内进行与通畅相关的干预。他们的特征与不需要通畅相关干预的人没有明显差异。但是，与不需要通畅相关干预的患者相比，需要通畅相关干预的患者的首次通畅率明显较低（898 对 1471 毫升/分钟；P = 0.003），平均通畅率也明显较低（841 对 1506 毫升/分钟；P 讨论：在接受血液透析的成人中，早期通路流速测量可预测首次血管通路插管后 1 年内与通畅相关的干预。还需要更多的研究来证实这些发现，并确定最佳通路流速截断值，以预测狭窄风险较高的血管通路。

{"title":"Early access flow rate predicts vascular access patency-related intervention in the first year: A retrospective cohort study","authors":"Matthias Bergmann, Butros Fakhoury, Tiago Barroso, Scott G. Prushik, Bertrand L. Jaber, Vaidyanathapuram S. Balakrishnan","doi":"10.1111/hdi.13148","DOIUrl":"10.1111/hdi.13148","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Arteriovenous fistulas and grafts are lifelines for most hemodialysis patients, and a low access flow rate often requires patency-related intervention, such as angioplasty or thrombectomy, to prevent access failure. We examined whether early access flow rate, measured after initial fistula/graft cannulation, predicts vascular access patency-related intervention within 1 year.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a single-center retrospective cohort study. Among 172 patients undergoing surgical creation of a fistula/graft, 52 (30.2%) had documented access flow rates measurement by the Transonic™ ultrasound dilution technique, performed within an average of 48 days from initial access cannulation. The need for a patency-related intervention, defined as undergoing a fistulogram, angioplasty, thrombectomy, or surgical revision, was ascertained within 1 year. A receiver-operating characteristic curve (ROC) was generated to evaluate the diagnostic performance of <i>first</i> and <i>average</i> access flow rates for predicting patency-related intervention within 1 year.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Twenty-eight (53.8%) of the 52 study subjects required a patency-related intervention within 1 year. Their characteristics were not significantly different from those who did not require patency-related interventions. However, <i>first</i> access flow rates were significantly lower in patients requiring patency-related intervention compared to those who did not (898 vs. 1471 mL/min; <i>p</i> = 0.003), as were <i>average</i> access flow rates (841 vs. 1506 mL/min; <i>p</i> < 0.001). The ROC analyses revealed that <i>first</i> access flow rates and <i>average</i> access flow rates predicted the need for patency-related intervention within 1 year, with an area under-the-ROC curve of 0.743 (95% confidence interval [CI] 0.608, 0.877) and 0.775 (95% CI 0.648, 0.903), respectively, demonstrating acceptable discrimination.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>In adults undergoing hemodialysis, early access flow rate measurement can predict patency-related intervention within 1 year after initial vascular access cannulation. Additional studies are required to confirm these findings and identify optimal access flow rate cut-off values to predict vascular accesses at higher risk of stenosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140295673","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

Prevention of dialysis disequilibrium syndrome in children with advanced uremia with a structured hemodialysis protocol: A quality improvement initiative study 通过结构化血液透析方案预防晚期尿毒症患儿透析失衡综合征：质量改进计划研究。

IF 1.3 4区医学 Q3 Medicine

Hemodialysis International

Pub Date : 2024-03-20 DOI: 10.1111/hdi.13147

Sidharth Kumar Sethi, Valerie Luyckx, Timothy Bunchman, Aishwarya Nair, Shyam Bihari Bansal, Bryce Pember, Kritika Soni, Savita, Dinesh Kumar Yadav, Vivek Sharma, Khalid Alhasan, Rupesh Raina

Background

Dialysis disequilibrium syndrome (DDS) is a rare but significant concern in adult and pediatric patients undergoing dialysis initiation with advanced uremia or if done after an interval. It is imperative to gain insights into the epidemiological patterns, pathophysiological mechanisms, and preventive strategies aimed at averting the onset of this ailment.

Design

Prospective observational quality improvement initiative cohort study.

Setting and Participants

A prospective single-center study involving 50 pediatric patients under 18 years recently diagnosed with chronic kidney disease stage V with blood urea ≥200 mg/dL, admitted to our tertiary care center for dialysis initiation from January 2017 to October 2023.

Quality Improvement Plan

A standardized protocol was developed and followed for hemodialysis in pediatric patients with advanced uremia. This protocol included measures such as lower urea reduction ratios (targeted at 20%–30%) with shorter dialysis sessions and linear dialysate sodium profiling. Prophylactic administration of mannitol and 25% dextrose was also done to prevent the incidence of dialysis disequilibrium syndrome.

Measures

Incidence of dialysis disequilibrium syndrome and severe dialysis disequilibrium syndrome, mortality, urea reduction ratios (URRs), neurological outcome at discharge, and development of complications such as infection and hypotension. Long-term outcomes were assessed at the 1-year follow-up including adherence to dialysis, renal transplantation, death, and loss to follow-up.

Results

The median serum creatinine and urea levels at presentation were 7.93 and 224 mg/dL, respectively. A total of 20% of patients had neurological symptoms attributable to advanced uremia at the time of presentation. The incidence of dialysis disequilibrium syndrome was 4% (n = 2) with severe dialysis disequilibrium syndrome only 2% (n = 1). Overall mortality was 8% (n = 4) but none of the deaths were attributed to dialysis disequilibrium syndrome. The mean urea reduction ratios for the first, second, and third dialysis sessions were 23.45%, 34.56%, and 33.50%, respectively. The patients with dialysis disequilibrium syndrome were discharged with normal neurological status. Long-term outcomes showed 88% adherence t

背景：透析失衡综合征（DDS）在晚期尿毒症或间歇期后开始透析的成人和儿童患者中非常罕见，但却令人担忧。当务之急是深入了解流行病学模式、病理生理机制和预防策略，以避免这种疾病的发生：设计：前瞻性观察质量改进计划队列研究：2017年1月至2023年10月，50名18岁以下儿童患者被诊断为慢性肾脏病V期，血尿素≥200 mg/dL，入住我们的三级医疗中心开始透析：为晚期尿毒症儿科患者的血液透析制定并遵循了标准化方案。该方案包括降低尿素还原率（目标值为 20%-30%）、缩短透析疗程和线性透析液钠谱分析等措施。此外，还预防性服用甘露醇和 25% 葡萄糖，以防止透析失衡综合征的发生：测量指标：透析失衡综合征和严重透析失衡综合征的发生率、死亡率、尿素还原比（URR）、出院时的神经功能预后以及感染和低血压等并发症的发生率。在为期1年的随访中对长期结果进行了评估，包括坚持透析、肾移植、死亡和失去随访：结果：患者发病时血清肌酐和尿素水平的中位数分别为 7.93 和 224 mg/dL。共有20%的患者在发病时出现了可归因于晚期尿毒症的神经症状。透析失衡综合征的发病率为 4%（n = 2），其中严重透析失衡综合征的发病率仅为 2%（n = 1）。总死亡率为 8%（4 例），但没有一例死亡是由透析失衡综合征引起的。第一次、第二次和第三次透析的平均尿素还原率分别为 23.45%、34.56% 和 33.50%。透析失衡综合征患者出院时神经状况正常。长期结果显示，88%的患者坚持透析，38%的患者进行了肾移植：本研究的特点是单中心设计、非随机方法和样本量有限：我们的结构化方案为透析失衡综合征的低发病率提供了标准化程序框架。

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引用次数: 0

Transjugular approach in aspiration thrombectomy and angioplasty of a thrombosed straight arteriovenous graft compared to the direct hemodialysis access approach 经颈静脉方法与直接血液透析通路方法在血栓直动静脉移植抽吸血栓切除术和血管成形术中的比较。

IF 1.3 4区医学 Q3 Medicine

Hemodialysis International

Pub Date : 2024-03-13 DOI: 10.1111/hdi.13142

JungWon Kwak, Sung Bum Cho, Heungman Jun, Hwan Hoon Chung, Sung-Joon Park, Tae-Seok Seo, Woo Jin Yang

Purpose

To evaluate the efficacy and outcome of the transjugular approach in endovascular recanalization of a thrombosed straight arteriovenous graft (AVG) compared to those of the direct hemodialysis access approach (conventional approach).

Materials and Methods

We retrospectively assessed patients who underwent aspiration thrombectomy and percutaneous transluminal angioplasty for thrombosed straight AVG performed at a single institution between October 2006 and October 2021. A total of 138 thrombosed AVGs in 83 patients (39 male and 44 females) were divided into the transjugular approach group (Group A) and the conventional approach group (Group B). Technical and clinical success, postintervention primary patency, cumulative patency, and periprocedural complications were compared.

Results

There was no statistical difference in demographic data between groups A and B. The technical success rate of group A and B was 96.4% (80/83) and 98.2% 54/55, respectively (p > 0.05). The mean procedure time was 61.4 min (Group A) and 70.5 min (Group B) (p > 0.05). There was no statistically significant difference between the two groups in postintervention primary patency. The cumulative patency of Groups A and B was 911.9 days (range 122–6277) and 1062.3 days (range 72–2302 days), respectively (p > 0.05). One patient in Group B experienced a major graft rupture. Pseudoaneurysm formation at the sheath insertion site occurred in two patients in Group B. No cases of stenosis or thrombosis of the IJV or hematoma at the puncture site were observed in Group A.

Conclusion

The transjugular approach is as safe and effective as the conventional approach for aspiration thrombectomy and percutaneous transluminal angioplasty of thrombosed straight AVGs.

目的：评估经颈静脉途径与直接血液透析通路途径（传统途径）相比，对血栓形成的直动静脉移植（AVG）进行血管内再通的疗效和结果：我们回顾性评估了 2006 年 10 月至 2021 年 10 月期间在一家医疗机构接受抽吸式血栓切除术和经皮腔内血管成形术治疗血栓性直动静脉移植的患者。83 名患者（39 名男性和 44 名女性）共 138 例血栓性 AVG 被分为经颈静脉入路组（A 组）和传统入路组（B 组）。比较了技术和临床成功率、介入后一次通畅率、累积通畅率和围术期并发症：A 组和 B 组的技术成功率分别为 96.4%（80/83）和 98.2%（54/55）（P > 0.05）。平均手术时间为 61.4 分钟（A 组）和 70.5 分钟（B 组）（P > 0.05）。两组干预后的主要通畅率差异无统计学意义。A 组和 B 组的累积通畅时间分别为 911.9 天（范围 122-6277）和 1062.3 天（范围 72-2302）（P > 0.05）。B 组的一名患者发生了严重的移植物破裂。A 组未观察到 IJV 狭窄或血栓形成或穿刺部位血肿的病例：结论：经颈静脉方法与传统方法一样，可安全有效地对血栓形成的直行动静脉畸形进行抽吸血栓切除术和经皮腔内血管成形术。

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引用次数: 0

Treatment of severe hyponatremia with continuous renal replacement therapy: A case and review of corrective strategies 用持续肾脏替代疗法治疗严重低钠血症：一个病例和纠正策略回顾。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2024-03-11 DOI: 10.1111/hdi.13146

Paul J. Der Mesropian, Shawn Phillips, Martha Naber, Sunjeev Konduru, Gulvahid Shaikh, Krishnakumar Hongalgi

Treatment of severely hyponatremic patients with continuous renal replacement therapy (CRRT) presents a unique challenge given the lack of commercial options for hypotonic replacement solutions or dialysate. We report the case of a 55-year-old male who presented with profound, symptomatic hyponatremia in the setting of acute kidney injury (AKI). The patient was found to have a serum sodium concentration of 97 mEq/L because of free water retention that occurred during severe AKI from viral gastroenteritis and rhabdomyolysis. Continuous veno-venous hemofiltration (CVVH) was required for AKI complicated by hyperkalemia, metabolic acidosis, and uremia. To prevent overcorrection of serum sodium, replacement fluids customized to natremic status had to be prepared. Conventional replacement fluid was modified on a daily basis to create hypotonic solutions with successively higher sodium concentrations. Over the course of a week, serum sodium successfully improved in a controlled and safe fashion. This case incorporates and reviews the variety of methods that have been used to safely manage severe hyponatremia with CRRT.

由于缺乏低渗替代溶液或透析液的商业选择，使用持续肾脏替代疗法（CRRT）治疗严重低钠血症患者是一项独特的挑战。我们报告了一例 55 岁男性患者的病例，他在急性肾损伤 (AKI) 的情况下出现了严重的、无症状的低钠血症。由于病毒性胃肠炎和横纹肌溶解症导致的严重急性肾损伤期间出现游离水潴留，患者的血清钠浓度为 97 mEq/L。由于 AKI 并发高钾血症、代谢性酸中毒和尿毒症，因此需要进行连续静脉-静脉血液滤过（CVVH）。为防止过度纠正血清钠，必须准备适合尿毒症状态的替代液体。传统的补充液每天都要进行调整，以产生钠浓度逐渐升高的低渗溶液。在一周的时间里，血清钠成功地以可控和安全的方式得到了改善。本病例结合并回顾了使用 CRRT 安全处理严重低钠血症的各种方法。

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引用次数: 0

IF 1.3 4区医学 Q3 Medicine

Hemodialysis International

Pub Date : 2024-03-11 DOI: 10.1111/hdi.13138

Kush Doshi, Rupesh Raina, Kar Hui Ng, Vera Koch, Girish C. Bhatt, Arwa Nada, Brian Foresi, Sibee Sambandam Kamalakkannan, Mignon McCulloch, Sidharth Sethi, Maria Díaz-González de Ferris

Introduction

Health-related quality of life (HRQoL) studies demonstrate the impact of end-stage renal disease (ESRD) on the physical and psychosocial development of children. While several instruments are used to measure HRQoL, few have standardized domains specific to pediatric ESRD. This review examines current evidence on self and proxy-reported HRQoL among pediatric patients with ESRD, based on the Pediatric Quality of Life Inventory (PedsQL) questionnaires.

Methods

Following PRISMA guidelines, we conducted a systematic review and meta-analysis on HRQoL using the PedsQL 4.0 Generic Core Scale (GCS) and the PedsQL 3.0 ESRD Module among 5- to 18-year-old patients. We queried PubMed, Embase, Web of Science, CINAHL, and Cochrane databases. Retrospective, case-controlled, and cross-sectional studies using PedsQL were included.

Findings

Of 435 identified studies, 14 met inclusion criteria administered in several countries. Meta-analysis demonstrated a significantly higher total HRQoL for healthy patients over those with ESRD (SMD:1.44 [95% CI: 0.78–2.09]) across all dimensional scores. In addition, kidney transplant patients reported a significantly higher HRQoL than those on dialysis (PedsQL GCS, SMD: 0.33 [95% CI: 0.14–0.53]) and (PedsQL ESRD, SMD: 0.65 [95% CI: 0.39–0.90]) concordant with parent-proxy reports.

Discussion

Patients with ESRD reported lower HRQoL in physical and psychosocial domains compared with healthy controls, while transplant and peritoneal dialysis patients reported better HRQoL than those on hemodialysis. This analysis demonstrates the need to identify dimensions of impaired functioning and produce congruent clinical interventions. Further research on the impact of individual comorbidities in HRQoL is necessary for developing comprehensive, integrated, and holistic treatment programs.

简介：与健康相关的生活质量（HRQoL）研究表明，终末期肾病（ESRD）对儿童的身体和社会心理发展有很大影响。虽然有多种工具可用于测量 HRQoL，但很少有专门针对小儿 ESRD 的标准化领域。本综述以儿科生活质量量表（PedsQL）问卷为基础，研究了儿科 ESRD 患者自我和代理报告 HRQoL 的现有证据：按照 PRISMA 指南，我们使用 PedsQL 4.0 通用核心量表 (GCS) 和 PedsQL 3.0 ESRD 模块对 5 至 18 岁患者的 HRQoL 进行了系统回顾和荟萃分析。我们查询了 PubMed、Embase、Web of Science、CINAHL 和 Cochrane 数据库。纳入了使用 PedsQL 进行的回顾性、病例对照和横断面研究：在已确定的 435 项研究中，有 14 项符合纳入标准，这些研究在多个国家开展。元分析表明，在所有维度评分中，健康患者的总 HRQoL 明显高于 ESRD 患者（SMD：1.44 [95% CI：0.78-2.09]）。此外，肾移植患者的 HRQoL 明显高于透析患者（PedsQL GCS，SMD：0.33 [95% CI：0.14-0.53]）和（PedsQL ESRD，SMD：0.65 [95% CI：0.39-0.90]），这与家长代理的报告一致：讨论：与健康对照组相比，ESRD 患者在身体和社会心理领域的 HRQoL 较低，而移植和腹膜透析患者的 HRQoL 则优于血液透析患者。这项分析表明，有必要确定功能受损的各个层面，并采取一致的临床干预措施。有必要进一步研究个人合并症对 HRQoL 的影响，以制定全面、综合和整体的治疗方案。

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引用次数: 0

Accelerated neuropathy among chronic kidney disease patients undergoing hemodialysis: Analysis of an institutional cluster 接受血液透析的慢性肾病患者的加速性神经病变：机构群组分析。

IF 1.3 4区医学 Q3 Medicine

Hemodialysis International

Pub Date : 2024-03-06 DOI: 10.1111/hdi.13143

Subrahmanian Sathiavageesan, Subramani Murugan

Background

Accelerated neuropathy is a rare syndrome of rapidly worsening peripheral neuropathy, typically described in end-stage kidney disease (ESKD) patients undergoing dialysis. In our center, we encountered a surge in the occurrence of accelerated neuropathy among ESKD patients undergoing hemodialysis, which prompted systematic research.

Methods

In this case–control study, we present the clinical features, electrophysiologic findings, and outcome of a series of patients who developed accelerated neuropathy after commencing hemodialysis for ESKD. Those who initiated hemodialysis and did not develop accelerated neuropathy were included as controls. We used logistic regression to identify predictors of accelerated neuropathy.

Results

Among 436 ESKD patients who initiated hemodialysis over 4 years, 17 were diagnosed with accelerated neuropathy. The median-time (interquartile range) from hemodialysis initiation to presentation with accelerated neuropathy was 3 weeks (2–6). It typically presented as acute onset of unsteadiness of gait necessitating assistance for ambulation. Electrophysiology revealed length-dependent symmetric sensorimotor axonal neuropathy. Diabetes mellitus (odds ratio [OR] 4.1, 95% CI 1.2–13.9, p = 0.02), pre-existing peripheral neuropathy (OR 9.25, 95% CI 2.79–30.6, p < 0.001), and serum alkaline phosphatase (OR 1.2 for every 10 U increase, 95% CI 1.00–1.52, p = 0.04) significantly predicted accelerated neuropathy. With continued dialysis and supportive care, neurologic status improved, total-neuropathy score (summary score of peripheral nerve dysfunction incorporating clinical and electrophysiological parameters) declined from 26.5 to 18.4 (p < 0.001) and most regained unassisted ambulation.

Conclusion

This study presents the largest series of patients with accelerated neuropathy and has identified predictors. However, in view of the unusually high incidence of accelerated neuropathy we speculate that other unidentified factor(s) could be underlying its pathogenesis.

背景：加速性神经病变是一种外周神经病变迅速恶化的罕见综合征，通常发生在接受透析治疗的终末期肾病（ESKD）患者身上。在我们中心，接受血液透析的 ESKD 患者中加速性神经病变的发生率激增，这促使我们开展了系统性研究：在这项病例对照研究中，我们介绍了一系列因 ESKD 而开始血液透析后发生加速性神经病变的患者的临床特征、电生理检查结果和预后。开始血液透析后未发生加速性神经病变的患者被列为对照组。我们采用逻辑回归法来确定加速性神经病变的预测因素：结果：在 4 年内开始血液透析的 436 名 ESKD 患者中，有 17 人被诊断为加速性神经病变。从开始血液透析到出现加速性神经病变的中位时间为 3 周（2-6 周）。典型表现为急性发病，步态不稳，需要他人协助才能行走。电生理学显示，该病为长度依赖性对称感觉运动轴索神经病变。糖尿病（几率比[OR] 4.1，95% CI 1.2-13.9，P = 0.02）、原有周围神经病变（OR 9.25，95% CI 2.79-30.6，P 结论：本研究展示了最大规模的加速性神经病变患者系列，并确定了预测因素。然而，鉴于加速性神经病变的发病率异常之高，我们推测其发病机制可能还存在其他未确定的因素。

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引用次数: 0

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