Hemodialysis International最新文献_第4页

The effects of mandala coloring on fatigue, psychological well-being, and coping with stress in patients receiving hemodialysis treatment 曼陀罗涂色对血液透析患者疲劳、心理健康和应对压力的影响。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2024-06-19 DOI: 10.1111/hdi.13163

Zülfünaz Özer, Gülcan Bahçecioğlu Turan, Mine Uyman, Mukadder Mollaoğlu

Background

Hemodialysis is an important health problem that negatively affects psychosocial status and support systems. Through practices such as mandala coloring, individuals transfer the unknowns they experience to the outside and make them visible. This study was conducted to examine the effects of mandala coloring on fatigue, psychological well-being, and factors associate with coping with stress in patients receiving hemodialysis treatment.

Methods

The design was a prospective, parallel-group controlled trial. The study was conducted in the dialysis unit of a university hospital in eastern Turkey between April 4 and October 31, 2022, with a total of 60 patients, 30 in the intervention group, and 30 in the control group. The patients in the intervention group colored mandala once a week for 2 h, for a total of 8 weeks. The data were collected face-to-face using a patient information form, a Fatigue Severity Scale, a Psychological Well-Being Scale, and a Ways of Coping Questionnaire.

Results

There were improvements in fatigue severity and psychological well-being over the 8-week study period in both the intervention and control groups. Scores were similar at baseline in the control and intervention groups, but better in the intervention groups compared to controls at 4 and 8 weeks for both metrics (p < 0001). Five factors from the Ways of Coping Questionnaire (self-confident approach, optimistic approach, seeking social support, helpless approach, and submissive approach) each improved during the 8-week period in the intervention group (p < 0.001). Three of these five factors improved in the control group as well. Scores for each of the five coping factors were better in the intervention group compared to controls at 4 and 8 weeks (p < 0.001).

Conclusion

Mandala coloring improved fatigue and psychological well-being and was associated with improved patient coping strategies.

背景：血液透析是一个重要的健康问题，对社会心理状态和支持系统造成负面影响。通过曼陀罗涂色等实践，个人将其经历的未知转移到外部，并使其可见。本研究旨在探讨曼陀罗涂色对接受血液透析治疗的患者的疲劳、心理健康以及应对压力的相关因素的影响：设计为前瞻性平行组对照试验。研究于 2022 年 4 月 4 日至 10 月 31 日在土耳其东部一所大学医院的透析室进行，共有 60 名患者参加，其中干预组和对照组各 30 人。干预组患者每周为曼陀罗上色一次，每次 2 小时，共持续 8 周。通过患者信息表、疲劳严重程度量表、心理健康量表和应对方式问卷面对面收集数据：结果：在为期 8 周的研究期间，干预组和对照组的疲劳严重程度和心理健康都有所改善。对照组和干预组的基线得分相似，但在 4 周和 8 周时，干预组的两项指标均优于对照组（p 结论：曼陀罗涂色改善了疲劳程度和心理健康：曼陀罗涂色改善了疲劳和心理健康，并与患者应对策略的改善有关。

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引用次数: 0

The knowledge, attitudes, and practices of arteriovenous access assessment among hemodialysis nurses: A multicenter cross-sectional survey 血液透析护士对动静脉通路评估的认识、态度和实践：多中心横断面调查。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2024-05-27 DOI: 10.1111/hdi.13160

Jingying Chen, Jinghua Lu, Xia Fu, Hongzhen Zhou

Introduction

Hemodialysis nurses' cannulation technique, monitoring, and management methods can affect patients' vascular access longevity. An arteriovenous access assessment comprises a medical history and vascular assessment through physical examination and surveillance. However, further exploration is needed to fully understand hemodialysis nurses' knowledge, attitudes, and practices (KAP) in this area.

Methods

Between June and July 2023, we recruited hemodialysis nurses from 21 cities in Guangdong Province using a convenience sampling method. Four questionnaires—the General Data Questionnaire, the KAP Scale of Arteriovenous Access Assessment among Hemodialysis Nurses, the Utrecht Work Engagement Scale, and the NASA Task Load Index—were utilized for data collection through the Questionnaire Star platform.

Findings

Of the 530 hemodialysis nurses participating in the study, 458 (86.4%) had a valid response. The participants demonstrated moderate knowledge and practice levels regarding arteriovenous access assessment and exhibited positive attitudes. We identified several factors related to arteriovenous access assessment that predict KAP in hemodialysis nurses. These factors included years of experience as a hemodialysis nurse, whether a nurse's knowledge of physical examination was sufficient to meet clinical needs, whether a nurse had received training in performing physical examination, whether a nurse's department regularly checked the quality of physical examination, and nurses' levels of work engagement and mental workload. All factors explained 32.4% of the variance in participants' KAP regarding arteriovenous access assessment.

Discussion

Improving hemodialysis nurses' assessment of arteriovenous access is crucial to ensure optimal patient care. Dialysis center managers and educators should prioritize understanding hemodialysis nurses' KAP of arteriovenous access assessment and any factors influencing these areas.

导言：血液透析护士的插管技术、监测和管理方法会影响患者血管通路的寿命。动静脉通路评估包括病史以及通过体格检查和监测进行的血管评估。然而，要充分了解血液透析护士在这方面的知识、态度和实践（KAP），还需要进一步的探索：方法：2023 年 6 月至 7 月期间，我们采用便利抽样法招募了广东省 21 个城市的血液透析护士。通过问卷星平台，利用四份问卷--一般数据问卷、血液透析护士动静脉通路评估 KAP 量表、乌得勒支工作参与量表和 NASA 任务负荷指数进行数据收集：在参与研究的 530 名血液透析护士中，458 人（86.4%）做出了有效回答。参与者在动静脉通路评估方面的知识和实践水平适中，并表现出积极的态度。我们发现了几个与动静脉通路评估相关的因素，这些因素可预测血液透析护士的 KAP。这些因素包括血液透析护士的工作年限、护士的体格检查知识是否足以满足临床需要、护士是否接受过体格检查培训、护士所在科室是否定期检查体格检查质量以及护士的工作投入程度和脑力劳动负荷。所有因素解释了参与者在动静脉通路评估方面的 KAP 差异的 32.4%：讨论：改善血液透析护士对动静脉通路的评估对确保最佳患者护理至关重要。透析中心的管理者和教育者应优先了解血液透析护士对动静脉通路评估的 KAP 以及影响这些方面的任何因素。

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引用次数: 0

Hemodynamic effects of low versus high dialysate bicarbonate concentration in hemodialysis patients 血液透析患者透析液碳酸氢盐浓度过低与过高对血液动力学的影响。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2024-05-27 DOI: 10.1111/hdi.13162

Jonas Schandorph Kaalund Jensen, Ina Hunnerup Jørgensen, Niels Henrik Buus, Jens Dam Jensen, Christian Daugaard Peters

Introduction

Hemodialysis treatment using standard dialysate bicarbonate concentrations cause transient metabolic alkalosis possibly associated with hemodynamic instability. The aim of this study was to perform a detailed comparison of high and low dialysate bicarbonate in terms of blood pressure, intradialytic hemodynamic parameters, orthostatic blood pressure, and electrolytes.

Methods

Fifteen hemodialysis patients were examined in a single-blind, randomized, controlled, crossover study. Participants underwent a 4-h hemodialysis session with dialysate bicarbonate concentration of 30 or 38 mmol/L with 1 week between interventions. Blood pressure was monitored throughout hemodialysis, while cardiac output, total peripheral resistance, stroke volume, and central blood volume were assessed with ultrasound dilution technique (Transonic). Orthostatic blood pressure was measured pre- and post-hemodialysis.

Findings

With similar ultrafiltration (UF) volume (2.6 L), systolic blood pressure (SBP) tended to decrease more during high dialysate bicarbonate compared to low dialysate bicarbonate; the mean (95% confidence interval) between treatment differences in SBP were: 8 (−4; 20) mmHg (end of hemodialysis) and 7 (0; 15) mmHg (post-hemodialysis). Stroke volume decreased whereas total peripheral resistance increased significantly more during high dialysate bicarbonate compared to low dialysate bicarbonate with mean between treatment differences: Stroke volume: 12 (1; 23) mL; Total peripheral resistance: −2.9 (−5.3; −0.5) mmHg/(L/min). Cardiac output tended to decrease more with high dialysate bicarbonate compared to low dialysate bicarbonate with mean between treatment difference 0.7 (0.0; 1.4) L/min. High dialysate bicarbonate caused alkalosis, hypocalcemia, and lower plasma potassium, whereas patients remained normocalcemic with normal pH during low dialysate bicarbonate. Orthostatic blood pressure response after dialysis did not differ significantly.

Discussion

The use of high dialysate bicarbonate compared to low dialysate bicarbonate was associated with hypocalcemia, alkalosis, and a more pronounced hypokalemia. During hemodialysis with UF, a better preservation of blood pressure, stroke volume, and cardiac output may be achieved with low dialysate bicarbonate compared to high dialysate bicarbonate.

导言：使用标准透析液碳酸氢盐浓度进行血液透析治疗会导致短暂的代谢性碱中毒，可能与血液动力学不稳定有关。本研究旨在对高浓度和低浓度透析液碳酸氢盐在血压、透析内血液动力学参数、正压和电解质方面进行详细比较：在一项单盲、随机对照、交叉研究中，15 名血液透析患者接受了检查。参与者在透析液碳酸氢盐浓度为 30 或 38 mmol/L 的条件下进行 4 小时血液透析，两次透析间隔一周。血液透析过程中全程监测血压，同时使用超声稀释技术（Transonic）评估心输出量、总外周阻力、每搏量和中心血容量。血液透析前和透析后测量静动脉血压：在超滤量（2.6 升）相似的情况下，与低碳酸氢盐透析液相比，高碳酸氢盐透析液透析时收缩压（SBP）的下降幅度更大；SBP 的平均值（95% 置信区间）在不同治疗间的差异为：8（-4；20）毫米汞柱：8（-4；20）毫米汞柱（血液透析结束时）和7（0；15）毫米汞柱（血液透析后）。与低碳酸氢盐透析相比，在高碳酸氢盐透析期间，卒中量明显减少，而总外周阻力明显增加，治疗间平均差异为平均治疗差异为：卒中量：12 (1; 23) mL；总外周阻力：-2.9 (-5.3; -0.5) mmHg/（L/min）。与低碳酸氢盐透析液相比，高碳酸氢盐透析液的心输出量下降幅度更大，治疗间平均差异为 0.7 (0.0; 1.4) 升/分钟。高浓度透析液碳酸氢盐会导致碱中毒、低钙血症和血浆钾降低，而低浓度透析液碳酸氢盐则会使患者保持正常钙血症和正常 pH 值。讨论：讨论：与低碳酸氢盐透析相比，使用高碳酸氢盐透析与低钙血症、碱中毒和更明显的低钾血症有关。在使用超滤的血液透析过程中，低碳酸氢盐透析液比高碳酸氢盐透析液能更好地保持血压、每搏量和心输出量。

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引用次数: 0

Application of therapeutic ultrasonic waves across the dialyzer membrane: A pilot study on the impact on dialyzer clearance and safety 在透析器膜上应用治疗性超声波：关于透析器清除率和安全性影响的试点研究。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2024-05-24 DOI: 10.1111/hdi.13161

Girish Namagondlu Seetharamaiah, Limesh Marisiddappa, Shashank Dhareshwar, Savitha Rani, Nikhil Das

Introduction

Progressive clogging of the dialyzer membrane during hemodialysis can compromise solute removal efficiency. Existing solutions fall short in addressing intradialytic reduction of dialyzer clearance. This pilot study aims to assess the impact and safety of applying therapeutic ultrasonic waves to dialyzers for mitigating intradialytic clogging.

Methods

In this pilot study, 15 stable maintenance hemodialysis patients (12 males and 3 females) were enrolled. Each patient served as their own control. They underwent one session of hemodialysis with the application of therapeutic ultrasonic waves (Ultrasonic session) and were crossed-over to a second session without the use of ultrasonic waves (Control session). All the study sessions operated at a fixed dialysate flow rate of 500 mL/min and a blood flow rate of 250 or 300 mL/min. The adequacy of dialysis achieved during each session was monitored using Online Clearance Monitoring of the dialysis machines, and clearance K values, varying between 135 and 209 mL/min, were recorded, and plotted. A direct comparison between Control and Ultrasonic sessions was performed to assess the impact and safety of using ultrasonic waves during hemodialysis.

Findings

The mean percentage decline in dialyzer clearance values was 4.41% for Ultrasonic sessions (SD: 5.3) and 12.69% for Control sessions (SD: 6.35) (p-value <0.001). This indicates that the application of ultrasonic waves reduced the decline in clearance values. The mean differences of the blood component parameters were comparable between both Ultrasonic sessions and Control sessions, suggesting the safety of utilizing ultrasonic waves during dialysis. Microscopic membrane analysis corroborated the safety.

Discussion

Intradialytic clogging of dialyzer membranes is a significant problem that can cause dialysis inadequacy. Our study tackles this issue by introducing therapeutic ultrasonic waves to improve dialyzer clearance during hemodialysis sessions in patients.

简介血液透析过程中透析器膜的逐渐堵塞会影响溶质清除效率。现有的解决方案无法解决透析器内清除率降低的问题。本试验研究旨在评估在透析器上应用治疗性超声波以减轻透析器内堵塞的影响和安全性：在这项试验性研究中，共招募了 15 名稳定的维持性血液透析患者（12 名男性和 3 名女性）。每位患者都是自己的对照组。他们接受了一次应用治疗性超声波的血液透析治疗（超声波治疗），并交叉接受了第二次不使用超声波的血液透析治疗（对照治疗）。所有研究时段的透析液流速固定为 500 毫升/分钟，血流量为 250 或 300 毫升/分钟。利用透析机的在线清除率监测系统对每次透析过程中的透析充分性进行监测，记录并绘制清除率 K 值（介于 135 至 209 毫升/分钟之间）。对对照组和超声波组进行直接比较，以评估在血液透析过程中使用超声波的影响和安全性：结果：超声波透析的透析器清除率平均下降了 4.41%（SD：5.3），而对照组下降了 12.69%（SD：6.35）（P 值讨论）：透析膜的椎管内堵塞是导致透析不足的一个重要问题。我们的研究通过引入治疗性超声波来改善患者血液透析过程中透析器的清除率，从而解决了这一问题。

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引用次数: 0

Relationship between altered taste and smell with malnutrition among hemodialysis patients 血液透析患者的味觉和嗅觉改变与营养不良之间的关系。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2024-05-23 DOI: 10.1111/hdi.13158

İlknur Özkan, Seçil Taylan, Yücel Kurt

Introduction

Alterations in taste and smell are among the most distressing symptoms experienced by haemodialysis patients. There is limited research on the relationship between these two symptoms and malnutrition in haemodialysis patients. This study aimed to investigate alterations in taste and smell in hemodialysis patients and their relationship with malnutrition.

Methods

This cross-sectional study was carried out with 149 hemodialysis patients at the dialysis centers of three state hospitals. The Taste and Smell Dysfunction Questionnaire was used to assess the changes in patients' taste and smell, and the Prognostic Nutritional Index (PNI), as well as the Controlling Nutritional Status (CONUT) tool, were utilized to evaluate their nutritional status.

Findings

A substantial percentage (45.6%) of patients reported an altered sense of smell, and 40.2% reported an altered sense of taste. The aspect of taste that was most abnormal was bitterness (46.7%); 53.0% of the patients were at moderate risk of malnutrition by PNI score, and 14.8% were categorized as malnourished by CONUT score. Malnutrition was related to dialysis vintage: a 1-year increase in vintage was associated with an increased risk of malnutrition (OR: 1.17, 95% CI 1.02–1.32, p < 0.001). Altered taste was associated with malnutrition: one-unit increase in the standard deviation of the taste subdimension score was associated with a relative risk of malnutrition (OR: 6.89, 95% CI 1.67–28.39, p < 0.001). A one-unit increase in the standard deviation of the smell subdimension was associated with relative risk of malnutrition (OR: 1.35, 95% CI 1.10–1.64, p < 0.001).

Discussion

Malnutrition was found in a significantpercentage of hemodialysis patients. Altered taste and smell and the durationof dialysis treatment were significantly associated with malnutrition scores It isrecommended that healthcare professionals regularly assess alterations in tasteand smell in hemodialysis patients, as these alterations may be associated withmalnutrition, and manage these alterations accordingly.

介绍：味觉和嗅觉的改变是血液透析患者最痛苦的症状之一。有关这两种症状与血液透析患者营养不良之间关系的研究十分有限。本研究旨在调查血液透析患者味觉和嗅觉的改变及其与营养不良的关系：这项横断面研究在三家国立医院的透析中心对 149 名血液透析患者进行了调查。采用味觉和嗅觉功能障碍问卷评估患者的味觉和嗅觉变化，并采用预后营养指数（PNI）和控制营养状况（CONUT）工具评估患者的营养状况：相当大比例（45.6%）的患者报告嗅觉发生了改变，40.2%的患者报告味觉发生了改变。根据 PNI 评分，53.0% 的患者面临中度营养不良风险，根据 CONUT 评分，14.8% 的患者被归类为营养不良。营养不良与透析年份有关：透析年份每增加一年，营养不良的风险就会增加（OR：1.17，95% CI 1.02-1.32，p 讨论）：相当比例的血液透析患者存在营养不良。建议医护人员定期评估血液透析患者的味觉和嗅觉变化，因为这些变化可能与营养不良有关，并对这些变化进行相应的处理。

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引用次数: 0

Prevention and resolution of headaches occurring during hemodialysis treatment by supplemental oxygen 通过补充氧气预防和解决血液透析治疗期间出现的头痛。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2024-05-22 DOI: 10.1111/hdi.13159

Garrett B. Gianneschi, Jennine M. Michaud

A patient with end-stage renal disease experienced severe headaches exclusively during dialysis that were bilateral and throbbing with photophobia, weakness, and lightheadedness. The patient had no history of headaches, and dialysis was determined to be the cause of the severe headaches. More than 10 treatments were attempted without success. Headaches were successfully treated and prevented by addition of 100% oxygen (2 L via nasal cannula) for over 12 months without recurrence at time of publication. This case study indicates that oxygen therapy may be a valuable intervention for headaches during dialysis.

一名患有终末期肾病的患者在透析期间出现严重头痛，这种头痛是双侧性的，并伴有搏动性畏光、乏力和头晕。患者没有头痛病史，透析被确定为导致剧烈头痛的原因。患者尝试了十多种治疗方法，均未奏效。在发表本研究报告时，患者已使用 100% 氧气（通过鼻插管吸入 2 升）治疗头痛超过 12 个月，并且没有复发，从而成功地治疗和预防了头痛。本病例研究表明，氧疗可能是治疗透析期间头痛的一种有价值的干预措施。

引用次数: 0

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