Hemodialysis International最新文献

Background

Hemodialysis is a lifesaving therapy but imposes a significant environmental burden due to its excessive consumption of water and energy and the generation of non-recyclable medical waste. The emerging Green Dialysis movement aims to mitigate these environmental impacts by promoting sustainable practices in nephrology. We summarize current knowledge on the environmental challenges associated with hemodialysis and highlight innovative strategies for reducing its ecological footprint through the Green Dialysis framework.

Methods

This review synthesized recent literature on water use, energy consumption, and waste generation in dialysis, evaluating practical and technological innovations, including water recycling, reduced dialysate flow, renewable energy integration, and sorbent-based systems, that aim to improve sustainability in nephrology care.

Results

Key environmental challenges of hemodialysis include excessive water and energy consumption and substantial waste generation. Hemodialysis facilities consume vast quantities of water, with up to 60 percent of treated water being discarded, while energy demands produce considerable carbon emissions. Waste production, particularly plastic waste, poses additional environmental challenges, as much of it is non-recyclable and poorly managed. Through the Green Dialysis movement, there is a concerted effort to promote sustainable practices in nephrology. Innovative solutions such as water recycling, reduced dialysate flow rates, adoption of renewable energy sources, and advanced hemodialysis machine designs may minimize resource use and waste.

Conclusion

The Green Dialysis movement offers a comprehensive and actionable approach to improving the environmental sustainability of dialysis care. By integrating these strategies, the Green Dialysis movement aims to mitigate the environmental footprint of hemodialysis, fostering a sustainable and resilient future for nephrology care.

Background

Acute hemorrhagic rectal ulcer (AHU) is a rare but severe cause of painless lower GI bleeding, mainly in elderly patients with comorbidities. Uremia increases bleeding risk due to platelet dysfunction and hemodialysis anticoagulation, but AHU in dialysis patients is underreported.

Aims

To report a case of AHU in a uremic hemodialysis patient and analyze management challenges.

Materials and Methods

A 78-year-old female with ESRD presented with rectal bleeding. Colonoscopy showed a 3 × 4 cm ulcer, managed with clips, injections, and adhesives.

Results

The patient experienced recurrent bleeding, requiring multiple endoscopic interventions (titanium clip placement, methylene blue-polydocanol injection, tissue adhesive). Despite initial hemostasis, she developed worsening heart failure and multi-organ failure, dying at home after ICU admission.

Discussion

Uremia, anticoagulation, and comorbidities fueled bleeding. Endoscopic therapy was key, but systemic decline dominated. Multidisciplinary care is vital for high-risk patients.

Conclusion

This case instills awareness of the exigency regarding continuous observation and tailored management in this population of patients with high risk.

Background

Depression and anxiety in individuals undergoing hemodialysis (HD) significantly impair daily functioning and hinder renal rehabilitation efforts. Various factors, including negative life events, illness perceptions, and difficulty processing emotions (alexithymia), have been associated with these psychological challenges; however, their specific impact on HD-related psychological distress remains unclear.

Methods

In this cross-sectional study, 246 individuals receiving HD were assessed using self-administered questionnaires, including the Life Events Scale (LES), Illness Perceptions Questionnaire (IPQ-R), Toronto Alexithymia Scale (TAS-20), and the Hospital Anxiety and Depression Scale (HADS).

Results

The study found that 32.5% and 41.5% of HD patients exhibited symptoms of depression and anxiety, respectively. Logistic regression analyses revealed significant correlations between negative life events, illness perceptions, and alexithymia with both depression and anxiety. Specifically, higher scores on the “Negative Emotional Representation about Illness” subscale were associated with an increased risk of depression (adjusted odds ratio [OR], 1.302; 95% confidence interval [CI], 1.118–1.544; p < 0.001). Conversely, lower scores on “Personal Control” were linked to a heightened risk of depression (adjusted OR, 0.796; 95% CI, 0.683–0.927; p = 0.003). For anxiety, elevated scores in “Negative Emotional Representation about Illness” (adjusted OR, 1.185; 95% CI, 1.014–1.261; p = 0.015) and “difficulty identifying feelings” (adjusted OR, 1.210; 95% CI, 1.031–1.411; p = 0.016) indicated increased risk, while lower scores in “Personal Control” were similarly associated with heightened anxiety risk (adjusted OR, 0.852; 95% CI, 0.734–0.983; p = 0.042).

Conclusion

This study suggests that negative life events, specific illness perceptions, and alexithymia are significant predictors of depression and anxiety among HD patients. Addressing maladaptive illness perceptions and emotional regulation deficits could offer novel strategies to enhance mental health outcomes in this population, highlighting the need for further investigation.

Introduction

Thirst distress is a common yet underexplored symptom among hemodialysis (HD) patients, with limited understanding of its impact on quality of life. This study aims to evaluate thirst perception, identify factors associated with its intensity, and examine its relationship with quality of life in a multicenter cohort of HD patients.

Methods

This cross-sectional analysis utilized baseline data from the Hemodiafiltration on Physical Activity and Self-Reported Outcomes: A Randomized Controlled Trial (HDFit). Participants were over 18 years old from 13 dialysis units across Brazil. Thirst perception was assessed using the Dialysis Thirst Inventory (DTI) questionnaire, and health-related quality of life (HRQoL) was measured with the SF-36 questionnaire. We compared participants with low versus high thirst perception based on the median DTI score and conducted multiple regression analysis to identify independent determinants of physical and mental HRQoL components.

Findings

The study sample comprised 195 patients (male: 71%; median age: 54 [41–66] years; 29% with diabetes) from 13 dialysis centers, with chronic HD duration up to 24 months. The median DTI score was 17 (14–22). Participants with higher thirst perception (DTI > 17) were younger, had a higher prevalence of lower income and educational levels, and a lower prevalence of fluid overload. Multiple regression analysis, adjusted for demographic, clinical, and nutritional variables, revealed that increased thirst perception was independently associated with poorer physical and mental HRQoL.

Conclusion

In a multicenter HD population, higher thirst perception was an independent determinant of diminished health-related quality of life.

Background

Patients with end-stage kidney disease (ESKD) undergoing hemodialysis frequently exhibit thyroid dysfunction or morphological abnormalities such as thyroid nodules. Although prior studies indicate a high prevalence of thyroid abnormalities in ESKD patients, few have explored the specific incidence, types, and anatomical distribution of thyroid nodules in this population.

Purpose

This study aimed to determine the prevalence, types, and anatomical distribution of thyroid nodules in ESKD patients on hemodialysis and to evaluate the relationship between hemodialysis duration and nodule occurrence.

Methods

A cross-sectional study was conducted at Beit Jala Hospital, Palestine, involving 200 ESKD patients receiving hemodialysis. Thyroid ultrasound was used to assess nodule presence, morphology, and distribution. Patient demographics, medical history, and dialysis duration were analyzed using statistical methods.

Results

Thyroid nodules were identified in 41.0% (n = 82) of participants, with no significant gender differences (p = 0.839). Solid nodules (58.5%) were more prevalent than cystic nodules (41.4%), and unilateral multinodular goiter (60.5%) was more common than bilateral multinodular goiter (39.5%), though these differences were not statistically significant. A significant correlation was observed between hemodialysis duration and nodule prevalence, with a higher incidence in patients on dialysis for ≥ 5 years (p = 0.003), suggesting prolonged dialysis may contribute to nodule formation.

Conclusion

This study confirms a high prevalence of thyroid nodules in ESKD patients on hemodialysis, predominantly solid nodules, and unilateral multinodular goiter. The significant association between longer dialysis duration and increased nodule prevalence highlights the need for routine thyroid monitoring in this population. Further research is needed to elucidate underlying mechanisms and optimize clinical management of thyroid abnormalities in ESKD patients.

Background

This systematic review evaluated physical function tests used to assess postural balance in patients on dialysis and described their measurement properties.

Methods

The study was registered in PROSPERO (#CRD42020186578). Seven databases were searched from inception to August 2023. Observational and experimental studies including at least one physical function test for postural balance in patients on hemodialysis or peritoneal dialysis were eligible. Two independent researchers selected studies, assessed methodological quality using the Critical Review Form-Quantitative Studies, and extracted data.

Results

Of the 21 studies analyzed, 42.9% were cross-sectional, and 38.1% demonstrated good methodological quality. The one-leg standing Test was the most common physical function test (used in 47.6% of studies), with variations in protocol, such as eyes open or closed and durations ranging from 5 to 60 s or unspecified. Other tests included the Berg balance scale, balance evaluation systems test, brief-balance evaluation systems test, mini-balance evaluation systems test, stork balance test, standing balance test, functional reach test, and frailty and injuries cooperative studies of intervention technique-4. Reliability, standard error of measurement, and minimal detectable change were reported for only the one-leg standing test, balance evaluation systems test, brief-balance evaluation systems test, and mini-balance evaluation systems test.

Conclusions

The one-leg standing test was the most frequently used physical function test for assessing postural balance in patients on dialysis. Additionally, the measurement properties of these tests remain understudied in this population.

Introduction

This study aimed to assess the impact of audiobooks on anxiety, depression, and quality of life in patients undergoing hemodialysis.

Methods

We conducted a randomized controlled trial involving 60 patients receiving hemodialysis. The intervention group listened to audiobooks for 4 weeks. Data on anxiety and depression levels were collected using the Hospital Anxiety and Depression Scale, and quality of life was assessed using the SF-36 Quality of Life Scale.

Results

Statistically significant reductions in anxiety and depression scores were observed in the intervention group following the 4-week audiobook intervention. Furthermore, the intervention group demonstrated significant improvements in quality of life parameters, specifically in energy, social functioning, physical role limitations, and mental health. The control group showed a significant improvement only in social functioning.

Conclusions

The findings suggest that audiobook interventions can effectively reduce anxiety and depression and enhance certain aspects of quality of life in patients receiving hemodialysis.

Trial Registration: Registration number: NCT05272891

Background

Despite extensive research on peritoneal dialysis (PD) and hemodialysis (HD), understanding long-term outcomes between these modalities remains limited. We conducted a retrospective cohort study to assess the clinical outcomes of PD and HD in a real-world context.

Methods

Utilizing the National Health Insurance Research Database in Taiwan, we studied patients who underwent dialysis from January 2006 to December 2017. Patients with a history of cancer, renal transplantation, age < 20 or > 84 years, or patients on PD who switched to HD within 3 months of starting the modality were excluded. They were categorized into three groups: HD-only (n = 59,751), PD-only (n = 3969), and PD-to-HD transition (n = 3196). Propensity score matching based on sex, age, and the Charlson comorbidity index was used to create comparable groups. Hazard ratios (HR) for clinical outcomes were calculated using the Cox regression model, comparing HD-only versus PD-only and the transition group outcomes. Follow-up continued until December 31, 2020. Finally, external validation was performed using the global TriNetX dataset.

Results

After 1:1 propensity score matching and multivariable adjustment, the HD-only group (n = 3969) exhibited significantly lower all-cause mortality and infection-related admissions compared to the PD-only group (n = 3969) (HRs 0.77 and 0.75, 95% CI: 0.72–0.83 and 0.70–0.80, respectively), with a survival advantage across most subgroups. Conversely, the PD-to-HD transition group (n = 2014) had worse hospitalization and major adverse cardiovascular event outcomes than those on PD-only (n = 2014) (HRs 1.83 and 1.22, 95% CIs: 1.71–1.97 and 1.10–1.36, respectively) but showed neutral mortality rates. A survival benefit emerged 2 years post-transition from PD to HD, with an HR of 0.62 (95% CI: 0.54–0.74). These findings were corroborated by the TriNetX data.

Conclusion

Our study indicates that HD patients tend to have better clinical outcomes, including greater longevity, compared to PD patients. Thus, the choice of dialysis modality should be tailored to individual patient needs for optimal outcomes.