Hemodialysis International最新文献_第5页

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。

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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 UROLOGY & NEPHROLOGY

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

<div> <section> <h3> Background</h3> <p>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.</p> </section> <section> <h3> Design</h3> <p>Prospective observational quality improvement initiative cohort study.</p> </section> <section> <h3> Setting and Participants</h3> <p>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.</p> </section> <section> <h3> Quality Improvement Plan</h3> <p>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.</p> </section> <section> <h3> Measures</h3> <p>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.</p> </section> <section> <h3> Results</h3> <p>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% (<i>n</i> = 2) with severe dialysis disequilibrium syndrome only 2% (<i>n</i> = 1). Overall mortality was 8% (<i>n</i> = 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 UROLOGY & NEPHROLOGY

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 UROLOGY & NEPHROLOGY

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 UROLOGY & NEPHROLOGY

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

Dosing lutetium Lu 177-dotatate for a hemodialysis patient 血液透析患者的镥Lu 177-dotatate剂量。

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2024-03-06 DOI: 10.1111/hdi.13144

Lindsay Taylor, Richard Meades, Ann-Marie Quigley, Christos Toumpanakis, Catriona Goodlad, Andrew Davenport

Lu177-dotatate (Lutathera™) is a radioactive drug approved for the treatment of adults with gastro-entero-pancreatic neuroendocrine tumors and is predominantly renally excreted. Currently all patients receive 7400 MBq (200 mCi), and there are no guidelines for treating hemodialysis patients. We measured radioactivity prior to and post administration of two cycles of Lu177-dotatate in a hemodialysis patient, and radiation exposure to staff. We reduced the standard 7400 MBq by 33% for the first cycle and patient radioactivity fell by 40% following postdilution hemodiafiltration started 6 h post dosing, and by 45% for the second cycle and radioactivity fell by 47% with postdilution hemodiafiltration started 5 h post administration. By reducing the initial administered radioactivity, coupled with early dialysis, and choosing postdilution hemodiafiltration we were able to achieve radioactivity retention curves similar to those from patients with normal renal function receiving the standard administration of 7400 MBq.

Lu177-dotatate（Lutathera™）是一种放射性药物，已被批准用于治疗成人胃肠胰神经内分泌肿瘤，主要通过肾脏排泄。目前，所有患者都接受了 7400 MBq（200 mCi）的治疗，但没有针对血液透析患者的治疗指南。我们测量了一名血液透析患者接受两个周期的 Lu177-dotatate 治疗前后的放射性，以及工作人员受到的辐射量。在第一个周期中，我们将 7400 MBq 的标准剂量降低了 33%，在用药后 6 小时开始进行稀释后血液过滤后，患者的放射性降低了 40%；在第二个周期中，我们将标准剂量降低了 45%，在用药后 5 小时开始进行稀释后血液过滤后，患者的放射性降低了 47%。通过降低初始给药放射性，加上早期透析和选择稀释后血液过滤，我们能够获得与接受 7400 MBq 标准给药的正常肾功能患者相似的放射性保留曲线。

引用次数: 0

The risk factors for arteriovenous fistula dysfunction in maintenance hemodialysis patients: A cross-sectional study 维持性血液透析患者动静脉瘘功能障碍的风险因素：一项横断面研究。

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2024-03-06 DOI: 10.1111/hdi.13145

Fan Zhang, Jie Yu, Guoli Li, Shuangshuang Fu, Hailang Xiao, Yiya Yang, Yumei Liang, Yinyin Chen, Xun Luo

Introduction

Arteriovenous fistula (AVF) dysfunction is a prevalent complication among maintenance hemodialysis patients. However, the factors influencing AVF patency remain unclear. To address this, we conducted a study aimed at identifying factors contributing to AVF dysfunction in this patient population.

Methods

The study compared clinical data, vascular calcification score, and laboratory data focusing on blood cell composition and coagulation in 100 maintenance hemodialysis patients in whom an AVF had been inserted from January through September of 2022. The patients were divided into a group in which the AVF functioned without issues and a group in which the AVF was dysfunctional, defined as not able to provide a blood flow of greater than 200 mL/min.

Findings

Patients in the 2 groups (56 in the dysfunctional AVF group and 44 in the group with satisfactory AVF function) were similar demographically. Compared with the normally functioning AVF group, the AVF dysfunction group exhibited significantly higher Agatston calcium scores (20.5 [1.28, 298] median [Q1, Q3] vs. 1.14 [0.00, 11.6]; p = 0.01), elevated triglyceride levels (1.1 [0.6, 1.2] mmol/L vs. 0.5 [0.3, 0.8]; p < 0.01), increased prothrombin activity (113 ± 22.1% vs. 99.4 ± 23.1; p < 0.01), lower prothrombin time (10.4 [9.8, 10.8] s vs. 11.0 [10.3, 11.5]; p < 0.01), higher red blood cell (RBC) counts (3.5 ± 0.7 · 10¹²/L vs. 3.0 ± 0.7; p < 0.01), and elevated hemoglobin levels (98.0 ± 21.8 g/L vs. 84.9 ± 24.2; p < 0.01). Higher C-reactive protein (20.2 [3.3, 20.2] mg/L vs. 17.8 [6.2, 17.8]; p = 0.01) and procalcitonin levels (0.9 [0.4, 0.9] ng/mL vs. 0.5 [0.2, 0.7]; p < 0.01) were also noted. Logistic regression analysis indicated that platelet/lymphocyte ratio, monocyte/lymphocyte ratio, and RBC count were factors associated with AVF dysfunction. Increased monocyte/lymphocyte ratio and RBC count correlated with higher risk, while a higher platelet/lymphocyte ratio was associated with lower risk.

Discussion

Arteriovenous fistula dysfunction in maintenance hemodialysis patients is associated with higher proportions of specific hematological parameters, particularly elevated RBC count, and altered platelet/lymphocyte and monocyte/lymphocyte ratios.

导言：动静脉瘘（AVF）功能障碍是维持性血液透析患者中普遍存在的并发症。然而，影响动静脉瘘通畅的因素仍不明确。为了解决这个问题，我们进行了一项研究，旨在确定导致这一患者群体动静脉瘘功能障碍的因素：该研究比较了 2022 年 1 月至 9 月期间 100 名插入了 AVF 的维持性血液透析患者的临床数据、血管钙化评分以及以血细胞成分和凝血功能为重点的实验室数据。这些患者被分为两组，一组的动静脉瓣膜功能正常，另一组的动静脉瓣膜功能失调，即不能提供大于 200 毫升/分钟的血流量：两组患者（动静脉瓣膜功能障碍组 56 人，动静脉瓣膜功能正常组 44 人）的人口统计学特征相似。与功能正常的动静脉瘘组相比，动静脉瘘功能障碍组的 Agatston 钙评分明显更高（20.5 [1.28, 298] 中位数 [Q1, Q3] vs. 1.14 [0.00, 11.6]; p = 0.01），甘油三酯水平升高（1.1 [0.6, 1.2] mmol/L vs. 0.5 [0.3, 0.8]; p 12 /L vs. 3.0 ± 0.7; p 讨论：维持性血液透析患者的动静脉内瘘功能障碍与特定血液参数比例较高有关，尤其是红细胞计数升高，以及血小板/淋巴细胞和单核细胞/淋巴细胞比率改变。

{"title":"The risk factors for arteriovenous fistula dysfunction in maintenance hemodialysis patients: A cross-sectional study","authors":"Fan Zhang, Jie Yu, Guoli Li, Shuangshuang Fu, Hailang Xiao, Yiya Yang, Yumei Liang, Yinyin Chen, Xun Luo","doi":"10.1111/hdi.13145","DOIUrl":"10.1111/hdi.13145","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Arteriovenous fistula (AVF) dysfunction is a prevalent complication among maintenance hemodialysis patients. However, the factors influencing AVF patency remain unclear. To address this, we conducted a study aimed at identifying factors contributing to AVF dysfunction in this patient population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study compared clinical data, vascular calcification score, and laboratory data focusing on blood cell composition and coagulation in 100 maintenance hemodialysis patients in whom an AVF had been inserted from January through September of 2022. The patients were divided into a group in which the AVF functioned without issues and a group in which the AVF was dysfunctional, defined as not able to provide a blood flow of greater than 200 mL/min.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Patients in the 2 groups (56 in the dysfunctional AVF group and 44 in the group with satisfactory AVF function) were similar demographically. Compared with the normally functioning AVF group, the AVF dysfunction group exhibited significantly higher Agatston calcium scores (20.5 [1.28, 298] median [<i>Q</i>1, <i>Q</i>3] vs. 1.14 [0.00, 11.6]; <i>p</i> = 0.01), elevated triglyceride levels (1.1 [0.6, 1.2] mmol/L vs. 0.5 [0.3, 0.8]; <i>p</i> < 0.01), increased prothrombin activity (113 ± 22.1% vs. 99.4 ± 23.1; <i>p</i> < 0.01), lower prothrombin time (10.4 [9.8, 10.8] s vs. 11.0 [10.3, 11.5]; <i>p</i> < 0.01), higher red blood cell (RBC) counts (3.5 ± 0.7 · 10<sup>12</sup>/L vs. 3.0 ± 0.7; <i>p</i> < 0.01), and elevated hemoglobin levels (98.0 ± 21.8 g/L vs. 84.9 ± 24.2; <i>p</i> < 0.01). Higher C-reactive protein (20.2 [3.3, 20.2] mg/L vs. 17.8 [6.2, 17.8]; <i>p</i> = 0.01) and procalcitonin levels (0.9 [0.4, 0.9] ng/mL vs. 0.5 [0.2, 0.7]; <i>p</i> < 0.01) were also noted. Logistic regression analysis indicated that platelet/lymphocyte ratio, monocyte/lymphocyte ratio, and RBC count were factors associated with AVF dysfunction. Increased monocyte/lymphocyte ratio and RBC count correlated with higher risk, while a higher platelet/lymphocyte ratio was associated with lower risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Arteriovenous fistula dysfunction in maintenance hemodialysis patients is associated with higher proportions of specific hematological parameters, particularly elevated RBC count, and altered platelet/lymphocyte and monocyte/lymphocyte ratios.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"28 2","pages":"170-177"},"PeriodicalIF":1.3,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140051323","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

In memoriam: Todd S. Ing, MD 悼念Todd S. Ing, MD, FACP.

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2024-02-28 DOI: 10.1111/hdi.13137

John T. Daugirdas, Philip Kam-Tao Li, Michela Wrong

This special article describes the achievements and impact of Dr. Todd Siu-Toa Ing, MBBS, (1933–2023) on the field of nephrology as recounted by a colleague from Hong Kong, a U.S. nephrologist ex-trainee, and the daughter of an important mentor. Dr. Ing was a founding member of the International Society for Hemodialysis. He made important discoveries regarding the diagnosis of renal tubular acidosis and electrolyte transport in the gastrointestinal tract and published many innovative findings relating to peritoneal and hemodialysis. He was especially interested in nephrology and dialysis education and was co-editor of a Handbook of Dialysis that has been in publication in five editions since 1988 with translation into many foreign languages. Dr. Ing was very supportive of nephrology in China as well as Chinese nephrologists practicing in the United States, and was a founding member of the Chinese American Society of Nephrology.

这篇特稿介绍了一位来自香港的同事、一位曾在美国接受过培训的肾脏病学家以及一位重要导师的女儿所讲述的托德-小多-英医生（Todd Siu-Toa Ing，MBBS，1933-2023 年）在肾脏病学领域的成就和影响。Ing 博士是国际血液透析学会的创始成员之一。他在肾小管酸中毒诊断和胃肠道电解质转运方面有重要发现，并发表了许多与腹膜透析和血液透析有关的创新研究成果。他对肾脏病学和透析教育特别感兴趣，是《透析手册》的共同编辑，该手册自 1988 年以来已出版了五版，并被翻译成多种外语。英医生非常支持中国的肾脏病学以及在美国执业的中国肾脏病学家，他还是美国华人肾脏病学会的创始成员之一。

引用次数: 0

The use of lung ultrasound in evaluation of extravascular lung water in hemodialysis patients: Systematic review and meta-analysis 使用肺部超声评估血液透析患者的血管外肺水：系统回顾和荟萃分析。

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2024-02-27 DOI: 10.1111/hdi.13141

Anas Elgenidy, Mostafa Atef Amin, Ahmed K. Awad, Abdullah Emad, Abdelrahman Nassar, Omar Alomari, Radwa Ibrahim, Faeq Husain-Syed, Mostafa G. Aly

Rationale and Objectives

Determining dry weight is crucial for optimizing hemodialysis, influencing efficacy, cardiovascular outcomes, and overall survival. Traditional clinical assessment methods for dry weight, relying on factors such as blood pressure and edema, frequently lack reliability. Lung ultrasound stands out as a promising tool for assessing volume status, given its non-invasiveness and reproducibility. This study aims to explore the role of Lung ultrasound in evaluating the impact of hemodialysis and ultrafiltration on extravascular lung water, with a specific focus on changes in B-lines post-hemodialysis compared to pre-hemodialysis.

Materials and Methods

The research encompassed searches across PubMed, WOS, and Scopus databases for studies related to lung ultrasound and hemodialysis. A meta-analysis was then performed to determine the mean differences in various parameters before compared to after, hemodialysis, including the number of B-lines, indexed end-inspiratory and end-expiratory inferior vena cava diameters, inferior vena cava collapsibility index, weight, blood pressure, and serum levels of NT-pro-BNP.

Results

Our meta-analysis, included 33 studies with 2301 hemodialysis patients, revealed a significant decrease in the number of B-lines post-hemodialysis (mean difference = 8.30, 95% CI [3.55 to 13.05]). Furthermore, there was a noteworthy reduction in inspiratory and expiratory inferior vena cava diameters post-hemodialysis (mean difference = 2.32, 95% CI [0.31 to 4.33]; mean difference = 4.05, 95% CI [2.44 to 5.65], respectively). Additionally, a significant positive correlation was observed between B-lines and the maximum inferior vena cava diameter both pre- and post-hemodialysis (correlation coefficient = 0.39; correlation coefficient = 0.32, respectively).

Conclusion

These findings indicate the effectiveness of lung ultrasound in detection of volume overload and assessment of response to ultrafiltration in hemodialysis patients.

理由和目标：确定干体重对于优化血液透析至关重要，会影响疗效、心血管预后和总体存活率。传统的干体重临床评估方法依赖于血压和水肿等因素，往往缺乏可靠性。肺部超声因其无创性和可重复性而成为评估肺容量状态的理想工具。本研究旨在探讨肺部超声在评估血液透析和超滤对血管外肺水影响方面的作用，重点关注血液透析后与透析前相比 B 线的变化：研究包括在 PubMed、WOS 和 Scopus 数据库中搜索与肺部超声和血液透析相关的研究。然后进行了一项荟萃分析，以确定血液透析前与血液透析后各种参数的平均差异，包括 B 线数量、吸气末和呼气末下腔静脉直径指数、下腔静脉塌陷指数、体重、血压和血清 NT-pro-BNP 水平：我们的荟萃分析包括 33 项研究，涉及 2301 名血液透析患者，结果显示血液透析后 B 线数量显著减少（平均差异 = 8.30，95% CI [3.55 至 13.05]）。此外，血液透析后吸气和呼气下腔静脉直径明显缩小（平均差=2.32，95% CI [0.31至4.33]；平均差=4.05，95% CI [2.44至5.65]）。此外，在血液透析前和血液透析后，B线与下腔静脉最大直径之间均存在明显的正相关性（相关系数=0.39；相关系数=0.32）：这些研究结果表明，肺部超声在检测血液透析患者容量超负荷和评估超滤反应方面非常有效。

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引用次数: 0