The present study was conducted to investigate the effect of nursing care structured according to Kolcaba's comfort theory and given to hemodialysis patients on their symptom severity and comfort.
Design
This quasi-experimental study was conducted with 46 patients; 22 were in the intervention group and 24 were in the control group, who received treatment in the hemodialysis unit of a training and research hospital in Türkiye between November 2021 and May 2022.
Methods
The Patient Information Form (PIF), Dialysis Symptom Index (DSI) and Hemodialysis Comfort Scale-Version II (HDCS-II) were used to collect data.
Results
While the mean DSI scores decreased in the intervention group over time, they increased in the control group. The mean score obtained from the overall HDCS-II increased over time in three follow-ups performed at different times in the intervention group. The mean score obtained from the overall HDCS-II decreased over time in three follow-ups performed at different times in the control group.
Conclusions
In the present study, nursing care structured according to Kolcaba's Comfort Theory given to hemodialysis patients reduced the severity of the symptoms in the participants and increased their comfort levels.
{"title":"The Effect of Nursing Care Based on Kolcaba's Comfort Theory on Symptom Severity and Comfort of Hemodialysis Patients","authors":"Gamze Goke Arslan, Sebnem Cinar Yucel","doi":"10.1111/hdi.70009","DOIUrl":"10.1111/hdi.70009","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The present study was conducted to investigate the effect of nursing care structured according to Kolcaba's comfort theory and given to hemodialysis patients on their symptom severity and comfort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>This quasi-experimental study was conducted with 46 patients; 22 were in the intervention group and 24 were in the control group, who received treatment in the hemodialysis unit of a training and research hospital in Türkiye between November 2021 and May 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The Patient Information Form (PIF), Dialysis Symptom Index (DSI) and Hemodialysis Comfort Scale-Version II (HDCS-II) were used to collect data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>While the mean DSI scores decreased in the intervention group over time, they increased in the control group. The mean score obtained from the overall HDCS-II increased over time in three follow-ups performed at different times in the intervention group. The mean score obtained from the overall HDCS-II decreased over time in three follow-ups performed at different times in the control group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In the present study, nursing care structured according to Kolcaba's Comfort Theory given to hemodialysis patients reduced the severity of the symptoms in the participants and increased their comfort levels.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 1","pages":"194-206"},"PeriodicalIF":1.2,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651656","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}
Sebastian Mussnig, Simon Krenn, David Keane, Manfred Hecking, Daniel Schneditz
In a follow-up to a previous study [1], Kron et al. recently [2] examined whether blood volume (BV) in hemodialysis patients could be estimated from extracellular volume (ECV) derived from bioimpedance spectroscopy, assuming a constant physiological 1-over-3 relationship between these volumes, described previously [1, 3]. The authors compared BV estimated from bioimpedance (ECV/3) to their experimental BV, measured using their dialysate dilution method [4]. The overall bias was 0.2 L and small, but the 95% confidence limits were ±1.2 L and large. The authors attributed all error to bioimpedance and to deviations from the population-derived 1-over-3 relationship, and it ultimately remained unclear how estimated BV information should be used.
Kron et al. asked “Can Bioimpedance Analysis Be Used to Estimate Absolute Blood Volume in Hemodialysis Patients?” and answered that this estimation is only possible in patients without severe fluid overload. This interpretation hinges on data that the authors were not able to provide because they excluded patients with “severe volume expansion” and selected “stable patients without recorded intradialytic morbid events in the previous 3 weeks”. We reproduced the analysis by Kron et al. [2] in a larger population [5] without exclusions, with longitudinal measurements over multiple months. We found (a) that the margin of error might even be larger and showed (b) that BV is overestimated by ECV/3 in those patients who are increasingly fluid overloaded (Figure 1). In a separate cohort with repeated measurements covering 5 weeks, we found that ECV and fluid overload followed an expected weekly cycle, decreasing during the week and increasing during the long treatment interval, whereas pre-dialysis BV remained more or less unchanged and independent of fluid overload, without any clear weekly pattern [6]. Similar to previous findings [7], our data suggest that variable fluid overload is predominantly located in the extravascular space and that the BV/ECV ratio may not be constant.
While Kron et al. are to be congratulated for their contributions to volume estimation in dialysis patients, the present analysis [2] does not seem appropriate to answer the question they posed not only because data were obtained at a single time point, but more importantly because they excluded fluid overload as the condition of interest. Direct measurement of blood volume is required to uncover pathological imbalances between the intravascular and interstitial spaces. BV should not be estimated by ECV/3 assuming a constant factor in patients who suffer from fluid disequilibrium.
The authors declare no conflicts of interest.
The data that support the findings of this study are available from the corresponding author upon reasonable request.
{"title":"Is Anything Gained From Estimating Blood Volume in Hemodialysis From Extracellular Volume Divided by a Constant Factor?","authors":"Sebastian Mussnig, Simon Krenn, David Keane, Manfred Hecking, Daniel Schneditz","doi":"10.1111/hdi.70008","DOIUrl":"10.1111/hdi.70008","url":null,"abstract":"<p>In a follow-up to a previous study [<span>1</span>], Kron et al. recently [<span>2</span>] examined whether blood volume (BV) in hemodialysis patients could be estimated from extracellular volume (ECV) derived from bioimpedance spectroscopy, assuming a constant physiological 1-over-3 relationship between these volumes, described previously [<span>1, 3</span>]. The authors compared BV estimated from bioimpedance (ECV/3) to their experimental BV, measured using their dialysate dilution method [<span>4</span>]. The overall bias was 0.2 L and small, but the 95% confidence limits were ±1.2 L and large. The authors attributed all error to bioimpedance and to deviations from the population-derived 1-over-3 relationship, and it ultimately remained unclear how estimated BV information should be used.</p><p>Kron et al. asked “Can Bioimpedance Analysis Be Used to Estimate Absolute Blood Volume in Hemodialysis Patients?” and answered that this estimation is only possible in patients without severe fluid overload. This interpretation hinges on data that the authors were not able to provide because they excluded patients with “severe volume expansion” and selected “stable patients without recorded intradialytic morbid events in the previous 3 weeks”. We reproduced the analysis by Kron et al. [<span>2</span>] in a larger population [<span>5</span>] without exclusions, with longitudinal measurements over multiple months. We found (a) that the margin of error might even be larger and showed (b) that BV is overestimated by ECV/3 in those patients who are increasingly fluid overloaded (Figure 1). In a separate cohort with repeated measurements covering 5 weeks, we found that ECV and fluid overload followed an expected weekly cycle, decreasing during the week and increasing during the long treatment interval, whereas pre-dialysis BV remained more or less unchanged and independent of fluid overload, without any clear weekly pattern [<span>6</span>]. Similar to previous findings [<span>7</span>], our data suggest that variable fluid overload is predominantly located in the extravascular space and that the BV/ECV ratio may not be constant.</p><p>While Kron et al. are to be congratulated for their contributions to volume estimation in dialysis patients, the present analysis [<span>2</span>] does not seem appropriate to answer the question they posed not only because data were obtained at a single time point, but more importantly because they excluded fluid overload as the condition of interest. Direct measurement of blood volume is required to uncover pathological imbalances between the intravascular and interstitial spaces. BV should not be estimated by ECV/3 assuming a constant factor in patients who suffer from fluid disequilibrium.</p><p>The authors declare no conflicts of interest.</p><p>The data that support the findings of this study are available from the corresponding author upon reasonable request.</p>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 1","pages":"277-278"},"PeriodicalIF":1.2,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hdi.70008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hemodialysis treatment presents physical, emotional, and social challenges for patients, impacting their overall well-being and daily life. Successful management requires adherence to fluid restrictions, dietary guidelines, and regular medication intake. This study explored the associations between self-efficacy, dietary adherence, and fluid control in patients undergoing hemodialysis.
Methods
This cross-sectional, descriptive study was conducted from 15 April 2024 to 15 June 2024, involving 197 patients receiving hemodialysis at a public hospital and a private dialysis center in Erzurum, eastern Turkey. Data were collected using a Personal Information Form, the General Self-Efficacy Scale, the Fluid Control in Hemodialysis Patients Scale, and the Attitude Scale for Dietary Therapy of Hemodialysis Patients. Descriptive statistics and structural equation modeling were used for analysis. A Bayesian estimator assessed direct and indirect relationships between variables. The model's reliability and validity were assessed using various statistical tests.
Results
Participants had an average age of 53.3 years and an average duration on dialysis of 6.7 years. Of the participants, 91.4% regularly monitored their weight, and 65% regularly monitored edema. The average scores were 28.35 (5.92, SD) on the General Self-Efficacy Scale, 45.8 (8.12) on the Attitude Scale for Dietary Therapy, and 49.0 (9.05) on the Fluid Control Scale. Self-efficacy had a significant positive indirect association with fluid control through dietary adherence (β = 0.126, 95% confidence interval [0.008, 0.277]). The total association between self-efficacy and fluid control was also significant (β = 0.624, 95% confidence interval [0.483, 0.755]), with dietary adherence partially mediating this relationship. Self-efficacy accounted for 31% of the variance in dietary adherence, and the overall model explained 41% of the variance in fluid control.
Conclusion
Higher self-efficacy was associated with better dietary adherence and improved fluid control. Dietary adherence partially mediated the association between self-efficacy and fluid control. Healthcare providers may consider strategies to enhance self-efficacy in hemodialysis patients to support dietary adherence and fluid control, potentially improving treatment outcomes, and quality of life.
{"title":"Analysis of the Relationship Between Self-Efficacy, Adherence With Diet Therapy and Fluid Control in Patients Receiving Hemodialysis Treatment: A Structural Equation Analysis","authors":"Gülcan Bahçecioğlu Turan, Ceren Karabulutlu, Zülfünaz Özer","doi":"10.1111/hdi.70004","DOIUrl":"10.1111/hdi.70004","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Hemodialysis treatment presents physical, emotional, and social challenges for patients, impacting their overall well-being and daily life. Successful management requires adherence to fluid restrictions, dietary guidelines, and regular medication intake. This study explored the associations between self-efficacy, dietary adherence, and fluid control in patients undergoing hemodialysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional, descriptive study was conducted from 15 April 2024 to 15 June 2024, involving 197 patients receiving hemodialysis at a public hospital and a private dialysis center in Erzurum, eastern Turkey. Data were collected using a Personal Information Form, the General Self-Efficacy Scale, the Fluid Control in Hemodialysis Patients Scale, and the Attitude Scale for Dietary Therapy of Hemodialysis Patients. Descriptive statistics and structural equation modeling were used for analysis. A Bayesian estimator assessed direct and indirect relationships between variables. The model's reliability and validity were assessed using various statistical tests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Participants had an average age of 53.3 years and an average duration on dialysis of 6.7 years. Of the participants, 91.4% regularly monitored their weight, and 65% regularly monitored edema. The average scores were 28.35 (5.92, SD) on the General Self-Efficacy Scale, 45.8 (8.12) on the Attitude Scale for Dietary Therapy, and 49.0 (9.05) on the Fluid Control Scale. Self-efficacy had a significant positive indirect association with fluid control through dietary adherence (β = 0.126, 95% confidence interval [0.008, 0.277]). The total association between self-efficacy and fluid control was also significant (β = 0.624, 95% confidence interval [0.483, 0.755]), with dietary adherence partially mediating this relationship. Self-efficacy accounted for 31% of the variance in dietary adherence, and the overall model explained 41% of the variance in fluid control.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Higher self-efficacy was associated with better dietary adherence and improved fluid control. Dietary adherence partially mediated the association between self-efficacy and fluid control. Healthcare providers may consider strategies to enhance self-efficacy in hemodialysis patients to support dietary adherence and fluid control, potentially improving treatment outcomes, and quality of life.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 1","pages":"234-241"},"PeriodicalIF":1.2,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577356","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}
Uremic pruritus is a common and distressing symptom among patients undergoing hemodialysis, frequently accompanied by fatigue and poor sleep quality. These symptoms collectively impair quality of life (QoL), yet their interrelationships remain unclear. To examine whether fatigue and sleep quality mediate the relationship between uremic pruritus and QoL in hemodialysis patients.
Methods
A cross-sectional study using quantitative mediation analysis. A total of 175 hemodialysis patients from three hospital-affiliated dialysis centers in South Korea completed validated self-report measures assessing uremic pruritus, fatigue, sleep quality, and QoL. Mediation analysis was conducted using Baron and Kenny's framework, Sobel test, and bootstrapping.
Findings
Uremic pruritus was significantly correlated with fatigue (r = 0.30, p < 0.001) and sleep quality (r = 0.53, p < 0.001), and negatively correlated with QoL (r = −0.29, p < 0.001). Fatigue (B = −0.3, 95% CI: −0.5 to −0.1) and sleep quality (B = −0.2, 95% CI: −0.4 to −0.1) were significantly associated with both uremic pruritus and QoL. The final model accounted for 40% of the variance in QoL.
Conclusions
Uremic pruritus indirectly affects QoL through its impact on fatigue and sleep quality. This suggests that its influence operates via interconnected symptoms rather than directly. The findings support the need for integrated symptom management approaches in dialysis care. Interventions targeting fatigue and sleep quality may be effective in reducing the burden of pruritus and improving daily functioning and well-being in patients undergoing hemodialysis.
Preprint Statement
This manuscript has not been previously published and is not under consideration elsewhere. If the manuscript is posted on a preprint server, the authors will update it with a link to the final published version.
Statistical Compliance Statement
The statistics were checked prior to submission by an expert statistician, Ilhyun Lee, Email: [email protected].
{"title":"Mediating Effects of Fatigue and Sleep Quality on Uremic Pruritus and Quality of Life Among Hemodialysis Patients: A Cross-Sectional Study","authors":"Yongjun Ji, Hye-Ja Park, Sunki Kim","doi":"10.1111/hdi.70003","DOIUrl":"10.1111/hdi.70003","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Uremic pruritus is a common and distressing symptom among patients undergoing hemodialysis, frequently accompanied by fatigue and poor sleep quality. These symptoms collectively impair quality of life (QoL), yet their interrelationships remain unclear. To examine whether fatigue and sleep quality mediate the relationship between uremic pruritus and QoL in hemodialysis patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional study using quantitative mediation analysis. A total of 175 hemodialysis patients from three hospital-affiliated dialysis centers in South Korea completed validated self-report measures assessing uremic pruritus, fatigue, sleep quality, and QoL. Mediation analysis was conducted using Baron and Kenny's framework, Sobel test, and bootstrapping.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Uremic pruritus was significantly correlated with fatigue (<i>r</i> = 0.30, <i>p</i> < 0.001) and sleep quality (<i>r</i> = 0.53, <i>p</i> < 0.001), and negatively correlated with QoL (r = −0.29, <i>p</i> < 0.001). Fatigue (<i>B</i> = −0.3, 95% CI: −0.5 to −0.1) and sleep quality (<i>B</i> = −0.2, 95% CI: −0.4 to −0.1) were significantly associated with both uremic pruritus and QoL. The final model accounted for 40% of the variance in QoL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Uremic pruritus indirectly affects QoL through its impact on fatigue and sleep quality. This suggests that its influence operates via interconnected symptoms rather than directly. The findings support the need for integrated symptom management approaches in dialysis care. Interventions targeting fatigue and sleep quality may be effective in reducing the burden of pruritus and improving daily functioning and well-being in patients undergoing hemodialysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Preprint Statement</h3>\u0000 \u0000 <p>This manuscript has not been previously published and is not under consideration elsewhere. If the manuscript is posted on a preprint server, the authors will update it with a link to the final published version.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Statistical Compliance Statement</h3>\u0000 \u0000 <p>The statistics were checked prior to submission by an expert statistician, Ilhyun Lee, Email: <span>[email protected]</span>.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 1","pages":"224-233"},"PeriodicalIF":1.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531967","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}
Hemodialysis (HD) patients are at high risk for infection owing to the necessity of vascular access to the bloodstream for treatments. Despite widespread efforts to promote early establishment of arteriovenous fistula or graft (AVF/G) for HD, 70%–80% of patients initiate dialysis with a central venous catheter (CVC). Catheter-related bloodstream infections (CRBSIs) are a known risk of central venous catheter use, accounting for 70% of HD access-related bloodstream infections. Given the significant morbidity, mortality, and cost associated with central venous catheter use, prevention of CRBSIs is a major priority for nephrologists, dialysis facilities, and kidney care organizations attempting to improve quality and deliver safe care to dialysis patients. Recent strategies for prevention of CRBSI in HD have broadened focus to pre-dialysis education and planning and a growing armamentarium of evidence-based interventions to avoid or mitigate the consequences of central venous catheter use. New commercially available products containing chlorhexidine and taurolidine promise to augment core interventions to prevent CRBSI in dialysis facilities. This manuscript reviews selected topics and recent advances in knowledge related to preventing CRBSI in HD, with emphasis on dialysis care in United States.
{"title":"Practical Strategies for Prevention of Catheter-Related Bloodstream Infections (CRBSI) in United States Hemodialysis Facilities","authors":"Leslie P. Wong","doi":"10.1111/hdi.70005","DOIUrl":"10.1111/hdi.70005","url":null,"abstract":"<div>\u0000 \u0000 <p>Hemodialysis (HD) patients are at high risk for infection owing to the necessity of vascular access to the bloodstream for treatments. Despite widespread efforts to promote early establishment of arteriovenous fistula or graft (AVF/G) for HD, 70%–80% of patients initiate dialysis with a central venous catheter (CVC). Catheter-related bloodstream infections (CRBSIs) are a known risk of central venous catheter use, accounting for 70% of HD access-related bloodstream infections. Given the significant morbidity, mortality, and cost associated with central venous catheter use, prevention of CRBSIs is a major priority for nephrologists, dialysis facilities, and kidney care organizations attempting to improve quality and deliver safe care to dialysis patients. Recent strategies for prevention of CRBSI in HD have broadened focus to pre-dialysis education and planning and a growing armamentarium of evidence-based interventions to avoid or mitigate the consequences of central venous catheter use. New commercially available products containing chlorhexidine and taurolidine promise to augment core interventions to prevent CRBSI in dialysis facilities. This manuscript reviews selected topics and recent advances in knowledge related to preventing CRBSI in HD, with emphasis on dialysis care in United States.</p>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 1","pages":"10-17"},"PeriodicalIF":1.2,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531968","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}
Reflecting on recent reports suggesting the efficacy of extracorporeal blood purification, including hemodialysis, for severe caffeine poisoning, we conducted a retrospective 5-year follow-up study on acute caffeine poisoning in Japan particularly focusing on extracorporeal blood purification.
Methods
Patients transported to emergency facilities between April 2016 and March 2021 after consuming large or excessive amounts of over-the-counter drugs and energy drinks containing caffeine as a primary ingredient were included. We collected information on demographic characteristics, medical history, the caffeine-containing products consumed, clinical and laboratory findings, treatments, and outcomes using a questionnaire. We compared the data of patients who were treated with and without extracorporeal blood purification (blood purification vs. nonblood purification group). We also compared our findings with those of a previous related study.
Findings
Seventy-six patients were included. Patients in the blood purification group (n = 22) were significantly older (p = 0.02), ingested higher estimated doses of caffeine (p < 0.01), demonstrated higher pulse rates (p = 0.01), respiratory rates (p = 0.03), and serum glucose levels (p = 0.05) on admission, resulting in longer hospital stays (p < 0.01) than those in the nonblood purification group (n = 54). However, their backgrounds, clinical features on arrival, and clinical signs and symptoms during the clinical course were similar between this and the previous study. Compared to the previous study, this study had a higher percentage of patients who underwent extracorporeal blood purification (16.8% vs. 28.9%; p = 0.07), including hemodialysis (10.9% vs. 22.4%; p = 0.06); nevertheless, no statistically significant differences were observed in the prognoses between the studies.
Conclusions
Currently, the use of extracorporeal blood purification including hemodialysis for the treatment of caffeine poisoning is being promoted in Japan; however, the decision to administer it mostly depends on the patients' ingested doses or vital signs, and not on the serum caffeine levels. Further studies are warranted to confirm whether extracorporeal blood purification improves the prognoses of patients with severe caffeine poisoning.
{"title":"Use of Extracorporeal Therapies to Treat Severe Caffeine Poisoning","authors":"Saeko Kohara, Yoshito Kamijo, Michiko Takai, Ryoko Kyan, Eiju Hasegawa, Takuya Shimane","doi":"10.1111/hdi.70002","DOIUrl":"10.1111/hdi.70002","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Reflecting on recent reports suggesting the efficacy of extracorporeal blood purification, including hemodialysis, for severe caffeine poisoning, we conducted a retrospective 5-year follow-up study on acute caffeine poisoning in Japan particularly focusing on extracorporeal blood purification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients transported to emergency facilities between April 2016 and March 2021 after consuming large or excessive amounts of over-the-counter drugs and energy drinks containing caffeine as a primary ingredient were included. We collected information on demographic characteristics, medical history, the caffeine-containing products consumed, clinical and laboratory findings, treatments, and outcomes using a questionnaire. We compared the data of patients who were treated with and without extracorporeal blood purification (blood purification vs. nonblood purification group). We also compared our findings with those of a previous related study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Seventy-six patients were included. Patients in the blood purification group (<i>n</i> = 22) were significantly older (<i>p</i> = 0.02), ingested higher estimated doses of caffeine (<i>p</i> < 0.01), demonstrated higher pulse rates (<i>p</i> = 0.01), respiratory rates (<i>p</i> = 0.03), and serum glucose levels (<i>p</i> = 0.05) on admission, resulting in longer hospital stays (<i>p</i> < 0.01) than those in the nonblood purification group (<i>n</i> = 54). However, their backgrounds, clinical features on arrival, and clinical signs and symptoms during the clinical course were similar between this and the previous study. Compared to the previous study, this study had a higher percentage of patients who underwent extracorporeal blood purification (16.8% vs. 28.9%; <i>p</i> = 0.07), including hemodialysis (10.9% vs. 22.4%; <i>p</i> = 0.06); nevertheless, no statistically significant differences were observed in the prognoses between the studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Currently, the use of extracorporeal blood purification including hemodialysis for the treatment of caffeine poisoning is being promoted in Japan; however, the decision to administer it mostly depends on the patients' ingested doses or vital signs, and not on the serum caffeine levels. Further studies are warranted to confirm whether extracorporeal blood purification improves the prognoses of patients with severe caffeine poisoning.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 1","pages":"73-79"},"PeriodicalIF":1.2,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hdi.70002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Arteriovenous (AV) fistulas are widely used in hemodialysis patients, but their most common complication is stenosis. Stiffness at the arterial site of the AV fistula is believed to contribute to stenosis. This study examines whether arterial stiffness can predict the development of AV fistula stenosis.
Methods
Arterial stiffness was assessed using brachial-ankle pulse wave velocity (PWV). Chart reviews and laboratory records were analyzed. The diagnosis and intervention for AV fistula stenosis were performed using fistulography and percutaneous transluminal angioplasty.
Findings
A total of 80 patients were enrolled in the study. Over the 7-year follow-up period, 40 patients developed AV fistula stenosis. Univariate logistic regression analysis revealed that AV fistula stenosis was significantly associated with diabetes (OR: 4.68, 95% CI: 1.19–18.34, p = 0.03), average monthly cholesterol level (OR: 1.02, 95% CI: 1.00–1.04, p = 0.03), average monthly triglyceride level (OR: 1.01, 95% CI: 1.00–1.01, p = 0.02), and brachial-ankle PWV (OR: 1.61, 95% CI: 1.32–1.97, p < 0.01). In multivariate logistic regression analysis, only brachial-ankle PWV remained significantly associated with AV fistula stenosis (OR: 1.72, 95% CI: 1.34–2.22, p < 0.01). Receiver-operating characteristic curve analysis identified 16.75 m/s as the optimal cutoff value of brachial-ankle PWV for predicting the development of AV fistula stenosis. Patients with PWV > 16.75 m/s had a significantly higher risk of developing AV fistula stenosis compared with those with a PWV ≤ 16.75 m/s (HR: 4.71, 95% CI: 2.22–9.97, p < 0.01).
Discussion
Assessment of brachial-ankle PWV can improve the prediction efficacy of AV fistula stenosis development in hemodialysis patients.
动静脉（AV）瘘广泛应用于血液透析患者，但其最常见的并发症是狭窄。房内瘘动脉部位的僵硬被认为是导致狭窄的原因。本研究探讨动脉硬度是否可以预测房室瘘狭窄的发展。方法：采用肱-踝脉波速度（PWV）评价动脉僵硬度。对图表回顾和实验室记录进行分析。采用瘘道造影术和经皮腔内血管成形术对房瘘狭窄进行诊断和干预。结果：共有80名患者入组研究。在7年的随访期间，40例患者发生房室瘘狭窄。单因素logistic回归分析显示，房内瘘狭窄与糖尿病（OR: 4.68, 95% CI: 1.19-18.34, p = 0.03）、月平均胆固醇水平（OR: 1.02, 95% CI: 1.00-1.04, p = 0.03）、月平均甘油三酯水平（OR: 1.01, 95% CI: 1.00-1.01, p = 0.02）、臂踝PWV （OR: 1.61, 95% CI: 1.32-1.97, p = 16.75 m/s）发生房内瘘狭窄的风险显著高于PWV≤16.75 m/s的患者(HR：4.71, 95% CI: 2.22-9.97， p讨论：评估肱-踝PWV可提高对血液透析患者房室瘘狭窄发展的预测效果。
{"title":"Association Between Pulse Wave Velocity and Arteriovenous Fistula Stenosis in Hemodialysis Patients","authors":"Kai-Ni Lee, Chien-An Chen, Li-Yu Yang","doi":"10.1111/hdi.70001","DOIUrl":"10.1111/hdi.70001","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Arteriovenous (AV) fistulas are widely used in hemodialysis patients, but their most common complication is stenosis. Stiffness at the arterial site of the AV fistula is believed to contribute to stenosis. This study examines whether arterial stiffness can predict the development of AV fistula stenosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Arterial stiffness was assessed using brachial-ankle pulse wave velocity (PWV). Chart reviews and laboratory records were analyzed. The diagnosis and intervention for AV fistula stenosis were performed using fistulography and percutaneous transluminal angioplasty.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>A total of 80 patients were enrolled in the study. Over the 7-year follow-up period, 40 patients developed AV fistula stenosis. Univariate logistic regression analysis revealed that AV fistula stenosis was significantly associated with diabetes (OR: 4.68, 95% CI: 1.19–18.34, <i>p</i> = 0.03), average monthly cholesterol level (OR: 1.02, 95% CI: 1.00–1.04, <i>p</i> = 0.03), average monthly triglyceride level (OR: 1.01, 95% CI: 1.00–1.01, <i>p</i> = 0.02), and brachial-ankle PWV (OR: 1.61, 95% CI: 1.32–1.97, <i>p</i> < 0.01). In multivariate logistic regression analysis, only brachial-ankle PWV remained significantly associated with AV fistula stenosis (OR: 1.72, 95% CI: 1.34–2.22, <i>p</i> < 0.01). Receiver-operating characteristic curve analysis identified 16.75 m/s as the optimal cutoff value of brachial-ankle PWV for predicting the development of AV fistula stenosis. Patients with PWV > 16.75 m/s had a significantly higher risk of developing AV fistula stenosis compared with those with a PWV ≤ 16.75 m/s (HR: 4.71, 95% CI: 2.22–9.97, <i>p</i> < 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Assessment of brachial-ankle PWV can improve the prediction efficacy of AV fistula stenosis development in hemodialysis patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 1","pages":"66-72"},"PeriodicalIF":1.2,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369880","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}
Fang Xu, Jun Qiu, Shanshan Huo, Haitao Bai, Xia Wang, Peng Shu
Objective
This study aims to evaluate the impact of multiple single cannulation technique (MuST) on complications associated with arteriovenous fistulas (AV fistulas) in hemodialysis patients.
Methods
Patients who initiated hemodialysis using AV fistulas at our hospital between August 2023 and December 2023 were selected using convenience sampling. Participants were randomly assigned to either the control group or the experimental group using a random number table, with odd-numbered patients placed in the control group and even-numbered patients in the experimental group. The experimental group received MuST, while the control group received the rope ladder cannulation technique. After 12 months of follow-up, we assessed the incidence of aneurysms, thrombosis, infiltration, and stenosis, along with the cannulation success rate. Pain levels were evaluated using the Visual Analogue Scale (VAS) for pain, and cannulation difficulty was rated using Likert's five-point scale.
Results
The experimental group exhibited significantly lower incidences of aneurysms (3.44% vs. 15.3%), thrombus (1.72% vs. 13.6%), and stenosis (1.72% vs. 11.7%) compared to the control group (p < 0.05). The cannulation success rate was also significantly higher in the experimental group (99.5% vs. 99.0%) (p < 0.05). Moreover, the experimental group reported significantly lower cannulation difficulty scores (1.41 ± 0.54 vs. 2.24 ± 1.04) and pain scores (1.82 ± 0.93 vs. 3.29 ± 0.77) (p < 0.05). However, the incidence of infiltration was significantly higher in the experimental group (19.0% vs. 6.78%).
Conclusions
MuST was associated with reduced pain and higher success rate of cannulation, and fewer complications compared to the standard rope ladder method. However, it was linked with a higher rate of infiltration. These findings suggest that MuST may be a promising alternative and warrants further investigation and broader clinical adoption.
{"title":"Multiple Single Cannulaton Technique for Puncturing Arteriovenous Fistulas: Randomized Comparison With Rope Ladder Technique Cannulation","authors":"Fang Xu, Jun Qiu, Shanshan Huo, Haitao Bai, Xia Wang, Peng Shu","doi":"10.1111/hdi.70000","DOIUrl":"10.1111/hdi.70000","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aims to evaluate the impact of multiple single cannulation technique (MuST) on complications associated with arteriovenous fistulas (AV fistulas) in hemodialysis patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients who initiated hemodialysis using AV fistulas at our hospital between August 2023 and December 2023 were selected using convenience sampling. Participants were randomly assigned to either the control group or the experimental group using a random number table, with odd-numbered patients placed in the control group and even-numbered patients in the experimental group. The experimental group received MuST, while the control group received the rope ladder cannulation technique. After 12 months of follow-up, we assessed the incidence of aneurysms, thrombosis, infiltration, and stenosis, along with the cannulation success rate. Pain levels were evaluated using the Visual Analogue Scale (VAS) for pain, and cannulation difficulty was rated using Likert's five-point scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The experimental group exhibited significantly lower incidences of aneurysms (3.44% vs. 15.3%), thrombus (1.72% vs. 13.6%), and stenosis (1.72% vs. 11.7%) compared to the control group (<i>p</i> < 0.05). The cannulation success rate was also significantly higher in the experimental group (99.5% vs. 99.0%) (<i>p</i> < 0.05). Moreover, the experimental group reported significantly lower cannulation difficulty scores (1.41 ± 0.54 vs. 2.24 ± 1.04) and pain scores (1.82 ± 0.93 vs. 3.29 ± 0.77) (<i>p</i> < 0.05). However, the incidence of infiltration was significantly higher in the experimental group (19.0% vs. 6.78%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>MuST was associated with reduced pain and higher success rate of cannulation, and fewer complications compared to the standard rope ladder method. However, it was linked with a higher rate of infiltration. These findings suggest that MuST may be a promising alternative and warrants further investigation and broader clinical adoption.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"30 1","pages":"58-65"},"PeriodicalIF":1.2,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319058","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}
Serap Yadigar, Gülümser Sevgin Halil, Pınar Özdemir, Erman Özdemir, Ezgi Gültekin Güner, Abdurrahman Engin Demir, Sukru Hakan Gunduz, Banu Şahin Yıldız, Mustafa Yıldız
Background
It has been suggested that ventricular strain measurements may be impaired in chronic hemodialysis patients despite having no history of heart disease. The aim of this study is to investigate whether ventricular strain parameters can be used to detect subclinical cardiac dysfunction in hemodialysis patients.
Methods
In our study, 47 patients under the age of 65 years with no known history of cardiac or valvular disease and receiving chronic hemodialysis treatment for at least 1 year were compared with an age- and sex-matched control group of 29 healthy individuals. Transthoracic echocardiography was used to evaluate parameters such as global longitudinal strain, right ventricular global longitudinal strain, and left ventricular diastolic diameter. Differences between groups were analyzed by Student's t-test and Mann–Whitney U test.
Results
The global longitudinal strain values of the hemodialysis group were significantly lower than those of the control group (−13.2 ± 3.91 vs. −22.1 ± 1.59, p < 0.001). Right ventricular global longitudinal strain (RV GLS) and left ventricular diastolic diameter were also significantly impaired in the hemodialysis group (p < 0.05). These results indicate the presence of subclinical cardiac dysfunction in hemodialysis patients.
Conclusions
Ventricular strain measurements may be impaired in chronic hemodialysis patients without a history of cardiovascular disease. Therefore, it is considered that ventricular strain measurements can be a useful method for the early detection of cardiac dysfunction in hemodialysis patients.
背景：有研究表明，尽管没有心脏病史，但慢性血液透析患者的心室应变测量可能会受损。本研究的目的是探讨心室应变参数是否可以用于检测血液透析患者的亚临床心功能障碍。方法：在我们的研究中，47例65岁以下、无心脏或瓣膜疾病病史且接受慢性血液透析治疗至少1年的患者与29例年龄和性别匹配的健康对照组进行比较。经胸超声心动图评价总纵应变、右心室总纵应变、左心室舒张直径等参数。组间差异采用Student’st检验和Mann-Whitney U检验。结果：血液透析组的整体纵向应变值明显低于对照组（-13.2±3.91 vs -22.1±1.59,p）。结论：无心血管病史的慢性血液透析患者的心室应变测量可能受损。因此，心室应变测量可作为血液透析患者心功能障碍早期检测的有效方法。
{"title":"Three Dimensional Speckle Tracking Echocardiography in Hemodialysis Patients","authors":"Serap Yadigar, Gülümser Sevgin Halil, Pınar Özdemir, Erman Özdemir, Ezgi Gültekin Güner, Abdurrahman Engin Demir, Sukru Hakan Gunduz, Banu Şahin Yıldız, Mustafa Yıldız","doi":"10.1111/hdi.13272","DOIUrl":"10.1111/hdi.13272","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>It has been suggested that ventricular strain measurements may be impaired in chronic hemodialysis patients despite having no history of heart disease. The aim of this study is to investigate whether ventricular strain parameters can be used to detect subclinical cardiac dysfunction in hemodialysis patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In our study, 47 patients under the age of 65 years with no known history of cardiac or valvular disease and receiving chronic hemodialysis treatment for at least 1 year were compared with an age- and sex-matched control group of 29 healthy individuals. Transthoracic echocardiography was used to evaluate parameters such as global longitudinal strain, right ventricular global longitudinal strain, and left ventricular diastolic diameter. Differences between groups were analyzed by Student's <i>t</i>-test and Mann–Whitney <i>U</i> test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The global longitudinal strain values of the hemodialysis group were significantly lower than those of the control group (−13.2 ± 3.91 vs. −22.1 ± 1.59, <i>p</i> < 0.001). Right ventricular global longitudinal strain (RV GLS) and left ventricular diastolic diameter were also significantly impaired in the hemodialysis group (<i>p</i> < 0.05). These results indicate the presence of subclinical cardiac dysfunction in hemodialysis patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Ventricular strain measurements may be impaired in chronic hemodialysis patients without a history of cardiovascular disease. Therefore, it is considered that ventricular strain measurements can be a useful method for the early detection of cardiac dysfunction in hemodialysis patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"29 4","pages":"588-598"},"PeriodicalIF":1.2,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311079","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}
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