Hemodialysis International最新文献_第7页

Age-associated effects of intradialytic exercise on physical function and nutritional status in patients receiving ambulatory hemodialysis: A multicenter cohort study 透析内运动对接受动态血液透析患者身体功能和营养状况的年龄相关性影响：一项多中心队列研究。

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2023-11-07 DOI: 10.1111/hdi.13128

Ren Takahashi, Hiroki Yabe, Hideaki Ishikawa, Takashi Hibino, Tomoya Yamaguchi, Sayumi Morishita, Kenichi Kono, Yoshifumi Moriyama, Tetsuya Yamada

Introduction

Intradialytic exercise is essential for improving physical function for older patients. This study aimed to examine the relationship between the effects of exercise therapy and aging.

Methods

This multicenter cohort study included 1176 patients aged 40–89 years, who participated in an intradialytic exercise program, comprising stretching and resistance training, three times per week for 12 months. Isometric knee extension strength (IKES), 10-m walking speed, Short Physical Performance Battery (SPPB), and Geriatric Nutritional Risk Index (GNRI) were measured at baseline and after 12 months. The patients were divided according to age as follows: 40–59, 60–69, 70–79, and 80–89 years. A linear mixed-effects model examined the improvement within-group and between-control differences, as the 40–59 age group was the control group.

Findings

The 40–59, 60–69, 70–79, and 80–89 age groups comprised 180, 317, 466, and 213 participants, respectively. Within-group differences, all the age groups significantly improved IKES and SPPB. The 10-m walking speed [0.02 (0.02) m/s] and GNRI [0.38 (0.33)] did not improved only in the 80–89 age group despite other age groups significantly improved. Between-control differences, IKES of the 70–79 age group [−0.24 (−0.42 to −0.06) %] was significantly lower improvement than control. GNRI of all the older groups were significantly smaller improvement than control (p < 0.05).

Discussion

The older group demonstrated difficulty in improving walking ability and nutritional status compared with the younger groups. Clinicians need to consider the difference in effectiveness due to age and prescribe intradialytic exercises accordingly.

引言：透析内运动对改善老年患者的身体功能至关重要。本研究旨在探讨运动治疗效果与衰老之间的关系。方法：这项多中心队列研究包括1176名40-89岁的患者年，参加了一项透析内锻炼计划，包括拉伸和阻力训练，每周三次，共12次月。在基线和术后12天测量等长伸膝力量（IKES）、10米步行速度、短期体能测试（SPPB）和老年营养风险指数（GNRI）月。根据年龄将患者分为：40-59岁、60-69岁、70-79岁和80-89岁年。线性混合效应模型检查了组内和对照组之间的改善差异，因为40-59岁年龄组是对照组。研究结果：40-59岁、60-69岁、70-79岁和80-89岁年龄组分别由180名、317名、466名和213名参与者组成。在组内差异中，所有年龄组的IKES和SPPB均有显著改善。10米步行速度[0.02（0.02）m/s]和GNRI[0.38（0.33）]不仅在80-89岁年龄组有改善，尽管其他年龄组有显著改善。在对照组差异之间，70-79岁年龄组的IKES改善率【-0.24（-0.42至-0.06）%】明显低于对照组。所有老年组的GNRI改善均明显小于对照组（p 讨论：与年轻组相比，老年组在提高行走能力和营养状况方面表现出困难。临床医生需要考虑因年龄而产生的有效性差异，并相应地开具透析内运动处方。

{"title":"Age-associated effects of intradialytic exercise on physical function and nutritional status in patients receiving ambulatory hemodialysis: A multicenter cohort study","authors":"Ren Takahashi, Hiroki Yabe, Hideaki Ishikawa, Takashi Hibino, Tomoya Yamaguchi, Sayumi Morishita, Kenichi Kono, Yoshifumi Moriyama, Tetsuya Yamada","doi":"10.1111/hdi.13128","DOIUrl":"10.1111/hdi.13128","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Intradialytic exercise is essential for improving physical function for older patients. This study aimed to examine the relationship between the effects of exercise therapy and aging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter cohort study included 1176 patients aged 40–89 years, who participated in an intradialytic exercise program, comprising stretching and resistance training, three times per week for 12 months. Isometric knee extension strength (IKES), 10-m walking speed, Short Physical Performance Battery (SPPB), and Geriatric Nutritional Risk Index (GNRI) were measured at baseline and after 12 months. The patients were divided according to age as follows: 40–59, 60–69, 70–79, and 80–89 years. A linear mixed-effects model examined the improvement within-group and between-control differences, as the 40–59 age group was the control group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>The 40–59, 60–69, 70–79, and 80–89 age groups comprised 180, 317, 466, and 213 participants, respectively. Within-group differences, all the age groups significantly improved IKES and SPPB. The 10-m walking speed [0.02 (0.02) m/s] and GNRI [0.38 (0.33)] did not improved only in the 80–89 age group despite other age groups significantly improved. Between-control differences, IKES of the 70–79 age group [−0.24 (−0.42 to −0.06) %] was significantly lower improvement than control. GNRI of all the older groups were significantly smaller improvement than control (<i>p</i> < 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The older group demonstrated difficulty in improving walking ability and nutritional status compared with the younger groups. Clinicians need to consider the difference in effectiveness due to age and prescribe intradialytic exercises accordingly.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"28 1","pages":"117-124"},"PeriodicalIF":1.3,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71490382","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

Dr. Andreas Pierratos, MD, FRCPC 安德烈亚斯·皮尔拉托斯博士，医学博士，FRCPC。

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2023-10-24 DOI: 10.1111/hdi.13119

Christopher T. Chan

引用次数: 0

Higher NT-proBNP levels and the risk of intradialytic hypotension at hemodialysis initiation 血液透析开始时较高的NT-proBNP水平和透析内低血压的风险。

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2023-10-24 DOI: 10.1111/hdi.13125

Katherine A. Curtis, Sushrut S. Waikar, Finnian R. Mc Causland

Introduction

Elevated N-terminal pro B-type natriuretic peptide (NT-proBNP) is a potent predictor of adverse outcomes in hemodialysis initiation. These patients often experience intradialytic hypotension, which may partially reflect cardiac dysfunction, but the association of NT-proBNP with intradialytic hypotension is not clear.

Methods

We performed a post hoc analysis of a randomized trial that tested mannitol versus placebo in 52 patients initiating hemodialysis (NCT01520207). NT-proBNP was measured prior to the first and third sessions (n = 87). Mixed-effects models (adjusting for randomized treatment, sex, race, age, diabetes, heart failure, catheter use, pre-dialysis systolic blood pressure, pre-dialysis weight, ultrafiltration volume, serum sodium, bicarbonate, urea nitrogen, phosphate, albumin, hemoglobin, and session length) were fit to examine the association of NT-proBNP with systolic blood pressure decline (pre-dialysis minus nadir systolic blood pressure). Additionally, mixed-effects Poisson models were fit to examine the association with intradialytic hypotension (≥20 mmHg decline in systolic blood pressure).

Findings

Mean age was 55 ± 16 years; 33% had baseline heart failure. The median NT-proBNP was 5498 [25th-75th percentile 2011, 14,790] pg/mL; 26 sessions (30%) were complicated by intradialytic hypotension. In adjusted models, each unit higher log-NT-proBNP was associated with 6.0 mmHg less decline in systolic blood pressure (95%CI −9.2 to −2.8). Higher pre-dialysis NT-proBNP, per log-unit, was associated with a 52% lower risk of intradialytic hypotension (IRR 0.48, 95%CI 0.23–0.97), without evidence for effect modification by randomized treatment (P-interaction = 0.17).

Discussion

In patients initiating hemodialysis, higher NT-proBNP is associated with less decline in intradialytic systolic blood pressure and lower risk of intradialytic hypotension. Future studies should investigate if higher pre-dialysis NT-proBNP levels may identify patients who might tolerate more aggressive ultrafiltration.

引言：升高的N-末端B型利钠肽原（NT-proBNP）是血液透析开始时不良结果的有力预测因子。这些患者经常出现透析内低血压，这可能部分反映了心脏功能障碍，但NT-proBNP与透析内低血压的关系尚不清楚。方法：我们对一项随机试验进行了事后分析，该试验在52名开始血液透析的患者中测试了甘露醇与安慰剂（NCT01520207）。在第一次和第三次治疗前测量NT-proBNP（n = 87）。混合效应模型（调整随机治疗、性别、种族、年龄、糖尿病、心力衰竭、导管使用、透析前收缩压、透析前体重、超滤量、血清钠、碳酸氢盐、尿素氮、磷酸盐、白蛋白、血红蛋白和疗程时长）适用于检查NT-proBNP与收缩压下降的关系（透析前减去最低点收缩压）。此外，混合效应泊松模型适用于检查与透析内低血压（≥20 收缩压下降mmHg）。结果：平均年龄为55岁 ± 16 年；33%的患者有基线心力衰竭。NT-proBNP中位数为5498[25-75百分位201114790]pg/mL；26个疗程（30%）并发透析内低血压。在调整后的模型中，每单位高log NT-proBNP与6.0相关收缩压下降幅度小于mmHg（95%CI-9.2至-2.8）。透析前NT-proBNP升高，每对数单位，与透析内低血压风险降低52%相关（IRR 0.48，95%CI 0.23-0.97），没有证据表明随机治疗（P-相互作用 = 0.17）。讨论：在开始血液透析的患者中，较高的NT-proBNP与透析内收缩压下降较少和透析内低血压风险较低有关。未来的研究应该调查透析前较高的NT-proBNP水平是否可以识别出可能耐受更积极超滤的患者。

{"title":"Higher NT-proBNP levels and the risk of intradialytic hypotension at hemodialysis initiation","authors":"Katherine A. Curtis, Sushrut S. Waikar, Finnian R. Mc Causland","doi":"10.1111/hdi.13125","DOIUrl":"10.1111/hdi.13125","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Elevated N-terminal pro B-type natriuretic peptide (NT-proBNP) is a potent predictor of adverse outcomes in hemodialysis initiation. These patients often experience intradialytic hypotension, which may partially reflect cardiac dysfunction, but the association of NT-proBNP with intradialytic hypotension is not clear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a post hoc analysis of a randomized trial that tested mannitol versus placebo in 52 patients initiating hemodialysis (NCT01520207). NT-proBNP was measured prior to the first and third sessions (<i>n</i> = 87). Mixed-effects models (adjusting for randomized treatment, sex, race, age, diabetes, heart failure, catheter use, pre-dialysis systolic blood pressure, pre-dialysis weight, ultrafiltration volume, serum sodium, bicarbonate, urea nitrogen, phosphate, albumin, hemoglobin, and session length) were fit to examine the association of NT-proBNP with systolic blood pressure decline (pre-dialysis minus nadir systolic blood pressure). Additionally, mixed-effects Poisson models were fit to examine the association with intradialytic hypotension (≥20 mmHg decline in systolic blood pressure).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Mean age was 55 ± 16 years; 33% had baseline heart failure. The median NT-proBNP was 5498 [25th-75th percentile 2011, 14,790] pg/mL; 26 sessions (30%) were complicated by intradialytic hypotension. In adjusted models, each unit higher log-NT-proBNP was associated with 6.0 mmHg less decline in systolic blood pressure (95%CI −9.2 to −2.8). Higher pre-dialysis NT-proBNP, per log-unit, was associated with a 52% lower risk of intradialytic hypotension (IRR 0.48, 95%CI 0.23–0.97), without evidence for effect modification by randomized treatment (<i>P</i>-interaction = 0.17).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>In patients initiating hemodialysis, higher NT-proBNP is associated with less decline in intradialytic systolic blood pressure and lower risk of intradialytic hypotension. Future studies should investigate if higher pre-dialysis NT-proBNP levels may identify patients who might tolerate more aggressive ultrafiltration.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"28 1","pages":"77-84"},"PeriodicalIF":1.3,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50159578","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

A phase 3b, multicenter, open-label, single-arm study of roxadustat within a US dialysis organization: The DENALI study 在美国透析组织中进行的一项多中心、开放标签、单臂的3b期罗沙司他研究:DENALI研究。

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2023-10-24 DOI: 10.1111/hdi.13122

John Larkin, Jeffrey Hymes, Marcus L. Britton, Yemmie Oluwatosin, Jacqueline Nolen, Lixia Zhu, Arnold Silva

Introduction

Roxadustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor approved in several regions for the treatment of anemia of chronic kidney disease (CKD). DENALI, a phase 3b study, evaluated the efficacy, safety, and feasibility of roxadustat in patients with anemia of CKD receiving in-center or home dialysis.

Methods

Eligible patients received open-label roxadustat, dosed three times weekly for 24 weeks, with an optional extension of ≤1 year. Initial dosing depended on erythropoiesis-stimulating agent (ESA) dose at screening for patients receiving ESAs (≥6 weeks) and weight-based for those not (total <6 weeks). Primary efficacy endpoints were proportion of patients with mean hemoglobin (Hb) ≥10.0 g/dL averaged over Weeks 16–24, and mean Hb change from baseline to the average during Weeks 16–24. Treatment-emergent adverse events (TEAEs) and treatment-emergent serious adverse events (TESAEs) were assessed.

Findings

Of 281 patients screened, 203 were treated and 201 included in the full analysis set. Overall, 166 patients completed the 24-week treatment period and 126 continued into the extension period. Mean baseline Hb was 10.4 g/dL and 82.6% received in-center hemodialysis. Overall, 84.6% of patients achieved a mean Hb ≥ 10.0 g/dL averaged Weeks 16–24. Mean (standard deviation) Hb change from baseline averaged Weeks 16–24 was 0.5 (1.0) g/dL. Prespecified subgroup analyses were consistent with primary analyses. Dosing adherence was 94%. Overall, 3.0% of patients received a red blood cell transfusion at up to Week 24. TEAEs and TESAEs were reported by 71.4% and 25.6% of patients, respectively. The most frequently reported TESAEs were COVID-19 (n = 5; 2.5%), and acute myocardial infarction, pneumonia, and sepsis (each n = 4; 2.0%).

Discussion

Roxadustat effectively achieved and/or maintained mean Hb levels ≥10.0 g/dL in patients receiving dialysis. The feasibility of incorporating oral roxadustat into dialysis organizations was successfully demonstrated with high dosing adherence. No new safety signals were identified.

简介：罗沙司他是一种口服缺氧诱导因子脯氨酰羟化酶抑制剂，已在多个地区获得批准，用于治疗慢性肾脏疾病（CKD）贫血。DENALI是一项3b期研究，评估了罗沙司他在接受中心或家庭透析的CKD贫血患者中的疗效、安全性和可行性。方法：符合条件的患者接受开放标签罗沙司他，每周给药3次，共24次周，可选择延长≤1 年首次给药取决于接受ESA（≥6）的患者筛查时的红细胞生成刺激剂（ESA）剂量周）和基于体重的未筛查患者（总发现：在281名筛查患者中，203人接受了治疗，201人被纳入完整的分析集。总体而言，166名患者完成了24周的治疗期，126人继续进入延长期。平均基线Hb为10.4 g/dL，82.6%接受中心血液透析。总体而言，84.6%的患者平均Hb ≥ 10 g/dL平均16-24周。16-24周平均Hb变化平均值为0.5（1.0） g/dL。预先指定的亚组分析与主要分析一致。给药依从性为94%。总体而言，3.0%的患者在第24周之前接受了红细胞输注。TEAE和TESAE分别有71.4%和25.6%的患者报告。最常报告的TESAE是新冠肺炎（n = 5.2.5%），以及急性心肌梗死、肺炎和败血症（每个n = 4.2.0%）。讨论：Roxadustat有效地达到和/或保持了平均Hb水平≥10.0 g/dL。将口服罗沙司他纳入透析组织的可行性已通过高剂量依从性成功证明。没有发现新的安全信号。

{"title":"A phase 3b, multicenter, open-label, single-arm study of roxadustat within a US dialysis organization: The DENALI study","authors":"John Larkin, Jeffrey Hymes, Marcus L. Britton, Yemmie Oluwatosin, Jacqueline Nolen, Lixia Zhu, Arnold Silva","doi":"10.1111/hdi.13122","DOIUrl":"10.1111/hdi.13122","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Roxadustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor approved in several regions for the treatment of anemia of chronic kidney disease (CKD). DENALI, a phase 3b study, evaluated the efficacy, safety, and feasibility of roxadustat in patients with anemia of CKD receiving in-center or home dialysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Eligible patients received open-label roxadustat, dosed three times weekly for 24 weeks, with an optional extension of ≤1 year. Initial dosing depended on erythropoiesis-stimulating agent (ESA) dose at screening for patients receiving ESAs (≥6 weeks) and weight-based for those not (total <6 weeks). Primary efficacy endpoints were proportion of patients with mean hemoglobin (Hb) ≥10.0 g/dL averaged over Weeks 16–24, and mean Hb change from baseline to the average during Weeks 16–24. Treatment-emergent adverse events (TEAEs) and treatment-emergent serious adverse events (TESAEs) were assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Of 281 patients screened, 203 were treated and 201 included in the full analysis set. Overall, 166 patients completed the 24-week treatment period and 126 continued into the extension period. Mean baseline Hb was 10.4 g/dL and 82.6% received in-center hemodialysis. Overall, 84.6% of patients achieved a mean Hb ≥ 10.0 g/dL averaged Weeks 16–24. Mean (standard deviation) Hb change from baseline averaged Weeks 16–24 was 0.5 (1.0) g/dL. Prespecified subgroup analyses were consistent with primary analyses. Dosing adherence was 94%. Overall, 3.0% of patients received a red blood cell transfusion at up to Week 24. TEAEs and TESAEs were reported by 71.4% and 25.6% of patients, respectively. The most frequently reported TESAEs were COVID-19 (<i>n</i> = 5; 2.5%), and acute myocardial infarction, pneumonia, and sepsis (each <i>n</i> = 4; 2.0%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Roxadustat effectively achieved and/or maintained mean Hb levels ≥10.0 g/dL in patients receiving dialysis. The feasibility of incorporating oral roxadustat into dialysis organizations was successfully demonstrated with high dosing adherence. No new safety signals were identified.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"28 1","pages":"59-71"},"PeriodicalIF":1.3,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hdi.13122","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50159576","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}

引用次数: 0

Myocardial markers are highly altered by higher rates of fluid removal during hemodialysis 在血液透析期间，较高的液体排出率会使心肌标志物发生高度改变。

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2023-10-24 DOI: 10.1111/hdi.13124

Junko Goto, Michael Ott, Bernd Stegmayr

Introduction

Although hemodialysis is lifesaving in patients with kidney failure extensive interdialytic weight gain (IDWG) between dialyses worsens the prognosis. We recently showed a strong correlation between IDWG and predialytic values of cardiac markers. The aim of the present study was to evaluate if the cardiac markers N-terminal pro-B-type natriuretic peptide (proBNP) and troponin T were influenced by IDWG and speed of fluid removal (ultrafiltration-rate).

Methods

Twenty hemodialysis patients performed in total 60 hemodialysis (three each). Predialytic values of proBNP and troponin T and changes from predialysis to 180 min hemodialysis (180–0 min) were compared with the IDWG calculated in percent of body weight. The ultrafiltration-rate was adjusted (UF-rate_adj) to IDWG: (100 × weight gain between dialysis [kg])/(estimated body dry weight [kg] × length of hemodialysis session [hours]).

Results

UF-rate_adj correlated (Spearman) with (1) predialytic values of IDWG (r = 0.983, p < 0.001), proBNP (r = 0.443, p < 0.001), and troponin T (r = 0.296, p = 0.025); and (2) differences in proBNP_180–0min (r = 0.572, p < 0.001) and troponin T_180–0min (r = 0.400, p = 0.002). UF-rates_adj above a breakpoint of 0.60 caused more release of proBNP_180–0min (p = 0.027). Remaining variables in multiple regression analysis with ProBNP_180–0min as dependent factor were predialytic proBNP (p < 0.001) and the ultrafiltration-rate (p < 0.001).

Conclusion

Higher UF-rate_adj during dialysis was correlated to increased levels of cardiac markers. Data support a UF-rate_adj lower than 0.6 to limit such increase. Further studies may confirm if limited fluid intake and a lower UF-rate_adj should be recommended to prevent cardiac injury during dialysis.

引言：尽管血液透析可以挽救肾衰竭患者的生命，但透析之间的大量分析间体重增加（IDWG）会恶化预后。我们最近发现IDWG和心脏标志物的分析前值之间有很强的相关性。本研究的目的是评估心脏标志物N-末端B型钠尿肽原（proBNP）和肌钙蛋白T是否受到IDWG和排液速度（超滤率）的影响。方法：20名血液透析患者共进行了60次血液透析（各3次）。BNP和肌钙蛋白T的透析前值及从透析前到180的变化最低血液透析（180-0 min）与以体重百分比计算的IDWG进行比较。将超滤速率（UF rateadj）调整为IDWG:（100 × 透析之间的体重增加[kg]）/（估计身体干重[kg] × 结果：UF比率adj（Spearman）与（1）IDWG的分析前值（r = 0.983，p 180-0分钟（r = 0.572，p 180-0分钟（r = 0.400，p = 0.002）。高于0.60断点的UF速率sadj导致proBNP180-0min的更多释放（p = 0.027）。以ProBNP180-0min为因变量的多元回归分析中的剩余变量为分析前的proBNP（p 结论：透析过程中UF率升高与心脏标志物水平升高有关。数据支持UF比率adj低于0.6以限制这种增长。进一步的研究可能会证实，是否应该建议限制液体摄入和降低UF率，以防止透析过程中的心脏损伤。

{"title":"Myocardial markers are highly altered by higher rates of fluid removal during hemodialysis","authors":"Junko Goto, Michael Ott, Bernd Stegmayr","doi":"10.1111/hdi.13124","DOIUrl":"10.1111/hdi.13124","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Although hemodialysis is lifesaving in patients with kidney failure extensive interdialytic weight gain (IDWG) between dialyses worsens the prognosis. We recently showed a strong correlation between IDWG and predialytic values of cardiac markers. The aim of the present study was to evaluate if the cardiac markers N-terminal pro-B-type natriuretic peptide (proBNP) and troponin T were influenced by IDWG and speed of fluid removal (ultrafiltration-rate).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty hemodialysis patients performed in total 60 hemodialysis (three each). Predialytic values of proBNP and troponin T and changes from predialysis to 180 min hemodialysis (180–0 min) were compared with the IDWG calculated in percent of body weight. The ultrafiltration-rate was adjusted (UF-rate<sub>adj</sub>) to IDWG: (100 × weight gain between dialysis [kg])/(estimated body dry weight [kg] × length of hemodialysis session [hours]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>UF-rate<sub>adj</sub> correlated (Spearman) with (1) predialytic values of IDWG (<i>r</i> = 0.983, <i>p</i> < 0.001), proBNP (<i>r</i> = 0.443, <i>p</i> < 0.001), and troponin T (<i>r</i> = 0.296, <i>p</i> = 0.025); and (2) differences in proBNP<sub>180–0min</sub> (<i>r =</i> 0.572, <i>p</i> < 0.001) and troponin T<sub>180–0min</sub> (<i>r</i> = 0.400, <i>p</i> = 0.002). UF-rates<sub>adj</sub> above a breakpoint of 0.60 caused more release of proBNP<sub>180–0min</sub> (<i>p</i> = 0.027). Remaining variables in multiple regression analysis with ProBNP<sub>180–0min</sub> as dependent factor were predialytic proBNP (<i>p</i> < 0.001) and the ultrafiltration-rate (<i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Higher UF-rate<sub>adj</sub> during dialysis was correlated to increased levels of cardiac markers. Data support a UF-rate<sub>adj</sub> lower than 0.6 to limit such increase. Further studies may confirm if limited fluid intake and a lower UF-rate<sub>adj</sub> should be recommended to prevent cardiac injury during dialysis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"28 1","pages":"17-23"},"PeriodicalIF":1.3,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hdi.13124","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50159579","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}

引用次数: 0

Elevated intraneural vascularization of the median nerve proximal to the arteriovenous fistula in hemodialysis patients suspected of carpal tunnel syndrome: A case series 怀疑腕管综合征的血液透析患者动静脉瘘附近正中神经的神经内血管形成升高：一系列病例。

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2023-10-23 DOI: 10.1111/hdi.13123

Carina N. Bagge, Kristine Lindhard, Ylian S. Liem, Janus Kaufmann Lindquist, Eszter Balazs-Becsi, Nils Wolfram

Patients with end-stage kidney disease may require creation of an arteriovenous fistula in order to receive hemodialysis treatment. The creation may result in several complications, including carpal tunnel syndrome. Early diagnosis and treatment are essential to relieve symptoms, prevent permanent nerve damage, and improve quality of life. However, the sensory and motor disturbances resembling carpal tunnel syndrome could be related to other etiologies than external compression of the median nerve underneath the transverse ligament. This case report presents eight patients with a radiocephalic arteriovenous fistula, who all had symptoms of carpal tunnel syndrome. Ultrasonographic examination showed a segmental intraneural hypervascularization of a large vessel inside the median nerve proximal to the wrist and arteriovenous fistula anastomosis with garland-like course as well as multiple flow velocities. The neurophysiological findings showed a significant decreased velocity in the ipsilateral forearm to the arteriovenous fistula.

患有终末期肾病的患者可能需要建立动静脉瘘才能接受血液透析治疗。这种创造可能会导致几种并发症，包括腕管综合征。早期诊断和治疗对于缓解症状、预防永久性神经损伤和提高生活质量至关重要。然而，类似腕管综合征的感觉和运动障碍可能与其他病因有关，而不是横向韧带下正中神经的外部压迫。本病例报告介绍了8例放射性脑动静脉瘘患者，他们都有腕管综合征的症状。超声检查显示，手腕附近正中神经内的一条大血管出现节段性神经内血管过多，动静脉瘘与花环状路线吻合，流速多。神经生理学结果显示动静脉瘘同侧前臂的流速显著降低。

{"title":"Elevated intraneural vascularization of the median nerve proximal to the arteriovenous fistula in hemodialysis patients suspected of carpal tunnel syndrome: A case series","authors":"Carina N. Bagge, Kristine Lindhard, Ylian S. Liem, Janus Kaufmann Lindquist, Eszter Balazs-Becsi, Nils Wolfram","doi":"10.1111/hdi.13123","DOIUrl":"10.1111/hdi.13123","url":null,"abstract":"<p>Patients with end-stage kidney disease may require creation of an arteriovenous fistula in order to receive hemodialysis treatment. The creation may result in several complications, including carpal tunnel syndrome. Early diagnosis and treatment are essential to relieve symptoms, prevent permanent nerve damage, and improve quality of life. However, the sensory and motor disturbances resembling carpal tunnel syndrome could be related to other etiologies than external compression of the median nerve underneath the transverse ligament. This case report presents eight patients with a radiocephalic arteriovenous fistula, who all had symptoms of carpal tunnel syndrome. Ultrasonographic examination showed a segmental intraneural hypervascularization of a large vessel inside the median nerve proximal to the wrist and arteriovenous fistula anastomosis with garland-like course as well as multiple flow velocities. The neurophysiological findings showed a significant decreased velocity in the ipsilateral forearm to the arteriovenous fistula.</p>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"28 1","pages":"125-129"},"PeriodicalIF":1.3,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49695371","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

Effect of vitamin D supplementation on management of anemia in hemodialysis patients with vitamin D deficiency: A double-blind, randomized, controlled trial 补充维生素D对维生素D缺乏血液透析患者贫血治疗的影响：一项双盲、随机、对照试验。

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2023-10-18 DOI: 10.1111/hdi.13121

Sameh Mohamed Emarah, Mohamed Abd El Rahman Ahmed, Ghada Mohamed El Kannishy, Ahmed Elsaeed Abdulgalil

Introduction

Anemia and vitamin D deficiency are common problems among hemodialysis (HD) patients. This study aimed to assess the impact of correction of vitamin D deficiency with vitamin D supplementation on the improvement of anemia in patients with end-stage renal disease (ESRD) on maintenance HD.

Methods

This double-blind, randomized, controlled study included 100 anemic HD patients with vitamin D deficiency who were randomly divided using the closed envelop method into two groups (1:1). The first group received vitamin D (50,000 IU) monthly for 6 months, and the other group received a placebo for the same period. 25-Hydroxyvitamin D (25(OH)D) levels were measured for both groups at the beginning of the study and after 6 months at the end of the study. Hemoglobin (Hb) concentrations were recorded monthly.

Findings

Vitamin D supplementation during the period of the study increased 25(OH)D levels in the vitamin D group more than the placebo group (p > 0.001). Serum ferritin, serum iron, and transferrin saturation did not differ significantly between both groups during the period of the study. Hb concentration in the vitamin D group increased more than that in the other group over the period of the study, and there was a statistically significant difference between the two groups in all durations of follow-up. Erythropoietin (EPO) dosage requirements were found to be lower in the vitamin D group than in the placebo group, and this was statistically significant (p > 0.001).

Discussion

Vitamin D supplementation in anemic ESRD patients on HD with vitamin D deficiency or insufficiency is safe and effective in improving anemia and decreasing EPO dosage.

简介：贫血和维生素D缺乏是血液透析（HD）患者的常见问题。本研究旨在评估补充维生素D纠正维生素D缺乏对终末期肾病（ESRD）患者贫血改善的影响。第一组接受了维生素D（50000 IU）每月6次月，另一组在同一时期接受安慰剂治疗。在研究开始时和6 研究结束时的几个月。每月记录血红蛋白（Hb）浓度。研究结果：在研究期间补充维生素D使维生素D组的25（OH）D水平比安慰剂组增加更多（p > 0.001）。在研究期间，两组之间的血清铁蛋白、血清铁和转铁蛋白饱和度没有显著差异。在研究期间，维生素D组的Hb浓度比另一组增加得更多，在所有随访时间内，两组之间存在统计学显著差异。维生素D组对促红细胞生成素（EPO）的剂量要求低于安慰剂组，这具有统计学意义（p > 0.001）。讨论：在患有维生素D缺乏或不足的HD的贫血ESRD患者中补充维生素D在改善贫血和减少EPO剂量方面是安全有效的。

{"title":"Effect of vitamin D supplementation on management of anemia in hemodialysis patients with vitamin D deficiency: A double-blind, randomized, controlled trial","authors":"Sameh Mohamed Emarah, Mohamed Abd El Rahman Ahmed, Ghada Mohamed El Kannishy, Ahmed Elsaeed Abdulgalil","doi":"10.1111/hdi.13121","DOIUrl":"10.1111/hdi.13121","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Anemia and vitamin D deficiency are common problems among hemodialysis (HD) patients. This study aimed to assess the impact of correction of vitamin D deficiency with vitamin D supplementation on the improvement of anemia in patients with end-stage renal disease (ESRD) on maintenance HD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This double-blind, randomized, controlled study included 100 anemic HD patients with vitamin D deficiency who were randomly divided using the closed envelop method into two groups (1:1). The first group received vitamin D (50,000 IU) monthly for 6 months, and the other group received a placebo for the same period. 25-Hydroxyvitamin D (25(OH)D) levels were measured for both groups at the beginning of the study and after 6 months at the end of the study. Hemoglobin (Hb) concentrations were recorded monthly.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Vitamin D supplementation during the period of the study increased 25(OH)D levels in the vitamin D group more than the placebo group (<i>p</i> > 0.001). Serum ferritin, serum iron, and transferrin saturation did not differ significantly between both groups during the period of the study. Hb concentration in the vitamin D group increased more than that in the other group over the period of the study, and there was a statistically significant difference between the two groups in all durations of follow-up. Erythropoietin (EPO) dosage requirements were found to be lower in the vitamin D group than in the placebo group, and this was statistically significant (<i>p</i> > 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Vitamin D supplementation in anemic ESRD patients on HD with vitamin D deficiency or insufficiency is safe and effective in improving anemia and decreasing EPO dosage.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"28 1","pages":"51-58"},"PeriodicalIF":1.3,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49686622","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

The role of calcitonin gene-related peptide and substance P in the pathogenesis of dialysis headache 降钙素基因相关肽和P物质在透析性头痛发病机制中的作用。

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2023-10-18 DOI: 10.1111/hdi.13120

Gizem Gürsoy, Serhat Karadağ, Şennur Köse, Tamer Şakacı, Sibel Yücel Koçak, Yasemin Erdoğan Döventaş, Ayla Çulha Oktar, Muhammet Duran Bayar

Aim

The present study aims to establish the role of serum CGRP and SP levels in the disease pathophysiology in patients with dialysis headache not accompanied by primary or secondary headaches, and also whether there is a correlation between these vasoactive peptides and the severity of headache.

Method

This study was designed as prospective and multicenter. A total of 30 dialysis headache patients and 30 patients without headache as the control group in the Nephrology outpatient clinics which implement similar dialysis procedures were included in the study. Blood samples were taken from all the patients before hemodialysis, and post-hemodialysis samples were collected. CGRP and SP contents in serum samples were measured using the ELISA method with detection kits.

Results

A total of 60 patients were included in the study with 17 female and 13 male patients in the dialysis headache group and 18 female and 12 male patients in the control group, and there were no significant differences in sex and age between the groups. CGRP levels in the headache group were found to be significantly higher compared with the control group both before and after hemodialysis. Furthermore, pre-hemodialysis CGRP levels were significantly higher than post-hemodialysis CGRP levels in both the headache and control groups. Serum SP levels in the headache group were found to be higher compared with the control group both before and after hemodialysis, there was no significant difference between the groups. Even though SP levels in both groups decreased after hemodialysis, there was again no significant difference between the groups. No correlation was found between the patients' severity of headache and serum CGRP and SP levels.

Conclusion

This study concludes that CGRP and SP, even though the latter is not statistically significant, play a role in the pathophysiology of the dialysis headache, and further studies with a larger and more specific patient population may reveal the relationship between the neuropeptides and dialysis headache more clearly.

目的：本研究旨在确定血清CGRP和SP水平在不伴有原发性或继发性头痛的透析性头痛患者的疾病病理生理学中的作用，以及这些血管活性肽与头痛的严重程度之间是否存在相关性。方法：本研究为前瞻性多中心研究。在实施类似透析程序的肾病门诊，共有30名透析头痛患者和30名无头痛患者作为对照组纳入研究。血液透析前采集所有患者的血样，血液透析后采集血样。用ELISA法和检测试剂盒测定血清中CGRP和SP的含量。结果：共有60名患者被纳入研究，透析头痛组17名女性和13名男性患者，对照组18名女性和12名男性患者。两组之间的性别和年龄没有显著差异。在血液透析前后，头痛组的CGRP水平均显著高于对照组。此外，头痛组和对照组血液透析前CGRP水平均显著高于血液透析后CGRP水平。头痛组血液透析前后血清SP水平均高于对照组，两组间无显著差异。尽管血液透析后两组的SP水平都有所下降，但两组之间再次没有显著差异。患者头痛的严重程度与血清CGRP和SP水平之间没有相关性。结论：本研究得出结论，CGRP和SP在透析性头痛的病理生理学中发挥作用，尽管后者没有统计学意义，但对更大、更具体的患者群体进行进一步研究可能会更清楚地揭示神经肽与透析性头痛之间的关系。

{"title":"The role of calcitonin gene-related peptide and substance P in the pathogenesis of dialysis headache","authors":"Gizem Gürsoy, Serhat Karadağ, Şennur Köse, Tamer Şakacı, Sibel Yücel Koçak, Yasemin Erdoğan Döventaş, Ayla Çulha Oktar, Muhammet Duran Bayar","doi":"10.1111/hdi.13120","DOIUrl":"10.1111/hdi.13120","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The present study aims to establish the role of serum CGRP and SP levels in the disease pathophysiology in patients with dialysis headache not accompanied by primary or secondary headaches, and also whether there is a correlation between these vasoactive peptides and the severity of headache.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>This study was designed as prospective and multicenter. A total of 30 dialysis headache patients and 30 patients without headache as the control group in the Nephrology outpatient clinics which implement similar dialysis procedures were included in the study. Blood samples were taken from all the patients before hemodialysis, and post-hemodialysis samples were collected. CGRP and SP contents in serum samples were measured using the ELISA method with detection kits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 60 patients were included in the study with 17 female and 13 male patients in the dialysis headache group and 18 female and 12 male patients in the control group, and there were no significant differences in sex and age between the groups. CGRP levels in the headache group were found to be significantly higher compared with the control group both before and after hemodialysis. Furthermore, pre-hemodialysis CGRP levels were significantly higher than post-hemodialysis CGRP levels in both the headache and control groups. Serum SP levels in the headache group were found to be higher compared with the control group both before and after hemodialysis, there was no significant difference between the groups. Even though SP levels in both groups decreased after hemodialysis, there was again no significant difference between the groups. No correlation was found between the patients' severity of headache and serum CGRP and SP levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study concludes that CGRP and SP, even though the latter is not statistically significant, play a role in the pathophysiology of the dialysis headache, and further studies with a larger and more specific patient population may reveal the relationship between the neuropeptides and dialysis headache more clearly.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"28 1","pages":"85-91"},"PeriodicalIF":1.3,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49686623","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

Intravascular volumes and the influence on anemia assessed by a carbon monoxide rebreathing method in patients undergoing maintenance hemodialysis 一氧化碳再呼吸法评估维持性血液透析患者的血管内容量和对贫血的影响。

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2023-10-12 DOI: 10.1111/hdi.13118

Vårin Vinje, Tobias Bomholt, Carsten Lundby, Peter Oturai, Marianne Rix, Kristine Lindhard, Mads Hornum

Introduction

Fluid overload is a major challenge in hemodialysis patients and might cause hypervolemia. We speculated that hemodialysis patients reaching dry weight could have undetected hypervolemia and low hemoglobin (Hb) concentration (g/dL) due to hemodilution.

Methods

The study included hemodialysis patients (n = 22) and matched healthy controls (n = 22). Blood volume, plasma volume, red blood cell volume, and total Hb mass were determined using a carbon monoxide (CO)-rebreathing method in hemodialysis patients reaching dry weight and controls. Blood volume measurements were also obtained by a dual-isotope labeling technique in a subgroup for validation purposes.

Findings

In the hemodialysis group, the median specific blood volume was 89.3 mL/kg (interquartile range [IQR]: 76.7–95.4 mL/kg) and was higher than in the control group (79.9 mL/kg [IQR: 70.4–88.0 mL/kg]; p < 0.037). The median specific plasma volume was 54.7 mL/kg (IQR: 47.1–61.0 mL/kg) and 44.0 mL/kg (IQR: 38.7–49.5 mL/kg) in the hemodialysis and control groups, respectively (p < 0.001). Hb concentration was lower in hemodialysis patients (p < 0.001), whereas no difference in total Hb mass was observed between groups (p = 0.11). A correlation was found between blood volume measured by the CO-rebreathing test and the dual-isotope labeling technique in the control group (r = 0.83, p = 0.015), but not the hemodialysis group (r = 0.25, p = 0.60).

Discussion

The hemodialysis group had increased specific blood volume at dry weight due to high plasma volume, suggesting a hypervolemic state. However, correlation was not established against the dual-isotope labeling technique underlining that the precision of the CO-rebreathing test should be further validated. The total Hb mass was similar between hemodialysis patients and controls, unlike Hb concentration, which emphasizes that Hb concentration is an inaccurate marker of anemia among hemodialysis patients.

引言：血液透析患者的主要挑战是液体过载，可能导致高容量血症。我们推测，达到干重的血液透析患者可能由于血液稀释而出现未被检测到的高容量血症和低血红蛋白（Hb）浓度（g/dL）。方法：纳入血液透析患者（n = 22）和匹配的健康对照组（n = 22）。在达到干重的血液透析患者和对照组中，使用一氧化碳（CO）再呼吸法测定血容量、血浆容量、红细胞容量和总Hb质量。为了验证目的，还通过亚组中的双同位素标记技术获得了血容量测量值。结果：血液透析组的中位比血容量为89.3 mL/kg（四分位间距[IQR]：76.7-95.4 mL/kg），并且高于对照组（79.9 mL/kg【IQR:70.4-88.0 mL/kg]；p 讨论：血液透析组由于血浆容量高，在干重时比血容量增加，表明处于高容量状态。然而，没有建立与双同位素标记技术的相关性，这强调了CO再呼吸测试的准确性应该进一步验证。血液透析患者和对照组的总Hb质量相似，不同于Hb浓度，后者强调Hb浓度是血液透析患者贫血的不准确标志。

{"title":"Intravascular volumes and the influence on anemia assessed by a carbon monoxide rebreathing method in patients undergoing maintenance hemodialysis","authors":"Vårin Vinje, Tobias Bomholt, Carsten Lundby, Peter Oturai, Marianne Rix, Kristine Lindhard, Mads Hornum","doi":"10.1111/hdi.13118","DOIUrl":"10.1111/hdi.13118","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Fluid overload is a major challenge in hemodialysis patients and might cause hypervolemia. We speculated that hemodialysis patients reaching dry weight could have undetected hypervolemia and low hemoglobin (Hb) concentration (g/dL) due to hemodilution.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study included hemodialysis patients (<i>n</i> = 22) and matched healthy controls (<i>n</i> = 22). Blood volume, plasma volume, red blood cell volume, and total Hb mass were determined using a carbon monoxide (CO)-rebreathing method in hemodialysis patients reaching dry weight and controls. Blood volume measurements were also obtained by a dual-isotope labeling technique in a subgroup for validation purposes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>In the hemodialysis group, the median specific blood volume was 89.3 mL/kg (interquartile range [IQR]: 76.7–95.4 mL/kg) and was higher than in the control group (79.9 mL/kg [IQR: 70.4–88.0 mL/kg]; <i>p</i> < 0.037). The median specific plasma volume was 54.7 mL/kg (IQR: 47.1–61.0 mL/kg) and 44.0 mL/kg (IQR: 38.7–49.5 mL/kg) in the hemodialysis and control groups, respectively (<i>p</i> < 0.001). Hb concentration was lower in hemodialysis patients (<i>p</i> < 0.001), whereas no difference in total Hb mass was observed between groups (<i>p</i> = 0.11). A correlation was found between blood volume measured by the CO-rebreathing test and the dual-isotope labeling technique in the control group (<i>r</i> = 0.83, <i>p</i> = 0.015), but not the hemodialysis group (<i>r</i> = 0.25, <i>p</i> = 0.60).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The hemodialysis group had increased specific blood volume at dry weight due to high plasma volume, suggesting a hypervolemic state. However, correlation was not established against the dual-isotope labeling technique underlining that the precision of the CO-rebreathing test should be further validated. The total Hb mass was similar between hemodialysis patients and controls, unlike Hb concentration, which emphasizes that Hb concentration is an inaccurate marker of anemia among hemodialysis patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"28 1","pages":"40-50"},"PeriodicalIF":1.3,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41223977","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

The relationship between skeletal muscle mass and exercise capacity in patients undergoing hemodialysis: An exploratory secondary-analysis 血液透析患者骨骼肌质量与运动能力的关系：探索性二次分析。

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2023-10-10 DOI: 10.1111/hdi.13115

Xuanrui Zhang, Yan Zhuang, Wen Qin, Lun Yang, Yan Song

Background

Protein-energy wasting is commonly observed in patients undergoing hemodialysis, leading to reduced muscle mass and, in severe cases, sarcopenia, which significantly impacts the patients' quality of life and clinical outcomes. Exercise interventions are frequently employed to address muscle loss in these patients. However, the relationship between exercise capacity and skeletal muscle mass in this context remains uncertain. In this study, researchers conducted a series of body composition analysis and exercise capacity test to explore the relationship between exercise capacity and skeletal muscle mass.

Methods

This study recruited 32 patients undergoing hemodialysis and analyzed their demographic and clinical parameters. To assess aerobic exercise capacity, the incremental shuttle walking test (ISWT) was conducted, while the handgrip strength test was used to evaluate muscle strength. The patients' body compositions were assessed using the Fresenius Body Composition Monitor, and the appendicular skeletal muscle was scanned using a GE Healthcare Lunar iDXA scanner. Three sequential linear models were employed to model the relationship between ISWT and skeletal muscle mass. Model 1 regressed ISWT against gender and age; Model 2 added handgrip strength, fat tissue index, and Davies comorbidity scores as additional predictors; and Model 3 further included the appendicular skeletal muscle index (appendicular skeletal muscle/height).

Findings

After controlling for age and gender (Model 1: R² = 0.373), and subsequently including handgrip strength, fat tissue index, and Davies comorbidity score effects (Model 2: R² = 0.581), the impact of appendicular skeletal muscle on ISWT was found to be non-significant (Model 3: R² = 0.600).

Conclusion

There was no significant correlation observed between exercise capacity and skeletal muscle mass in patients undergoing hemodialysis, indicating the factors influencing exercise capacity in this patient population are complex and that increasing skeletal muscle mass may not necessarily involve solely addressing the improvement of exercise capacity.

背景：在接受血液透析的患者中，通常会观察到蛋白质能量消耗，导致肌肉质量减少，在严重情况下，还会出现少肌症，这会严重影响患者的生活质量和临床结果。经常采用运动干预来解决这些患者的肌肉损失问题。然而，在这种情况下，运动能力和骨骼肌质量之间的关系仍然不确定。在这项研究中，研究人员进行了一系列的身体成分分析和运动能力测试，以探索运动能力与骨骼肌质量之间的关系。方法：本研究招募了32名接受血液透析的患者，并分析了他们的人口统计学和临床参数。为了评估有氧运动能力，进行了增量穿梭步行测试（ISWT），而握力测试用于评估肌肉力量。使用费森尤斯身体成分监测仪评估患者的身体成分，并使用GE Healthcare Lunar iDXA扫描仪扫描阑尾骨骼肌。采用三个连续线性模型对ISWT与骨骼肌质量之间的关系进行建模。模型1根据性别和年龄对ISWT进行回归；模型2增加了握力、脂肪组织指数和Davies共病评分作为额外的预测因素；模型3进一步包括阑尾骨骼肌指数（阑尾骨骼肌/身高）。研究结果：在控制了年龄和性别后（模型1:R2 = 0.373），随后包括握力、脂肪组织指数和Davies共病评分效应（模型2:R2 = 0.581），发现阑尾骨骼肌对ISWT的影响不显著（模型3:R2 = 0.600）。结论：在接受血液透析的患者中，运动能力和骨骼肌质量之间没有观察到显著的相关性，这表明影响该患者群体运动能力的因素是复杂的，增加骨骼肌质量可能不一定只涉及运动能力的提高。

{"title":"The relationship between skeletal muscle mass and exercise capacity in patients undergoing hemodialysis: An exploratory secondary-analysis","authors":"Xuanrui Zhang, Yan Zhuang, Wen Qin, Lun Yang, Yan Song","doi":"10.1111/hdi.13115","DOIUrl":"10.1111/hdi.13115","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Protein-energy wasting is commonly observed in patients undergoing hemodialysis, leading to reduced muscle mass and, in severe cases, sarcopenia, which significantly impacts the patients' quality of life and clinical outcomes. Exercise interventions are frequently employed to address muscle loss in these patients. However, the relationship between exercise capacity and skeletal muscle mass in this context remains uncertain. In this study, researchers conducted a series of body composition analysis and exercise capacity test to explore the relationship between exercise capacity and skeletal muscle mass.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study recruited 32 patients undergoing hemodialysis and analyzed their demographic and clinical parameters. To assess aerobic exercise capacity, the incremental shuttle walking test (ISWT) was conducted, while the handgrip strength test was used to evaluate muscle strength. The patients' body compositions were assessed using the Fresenius Body Composition Monitor, and the appendicular skeletal muscle was scanned using a GE Healthcare Lunar iDXA scanner. Three sequential linear models were employed to model the relationship between ISWT and skeletal muscle mass. Model 1 regressed ISWT against gender and age; Model 2 added handgrip strength, fat tissue index, and Davies comorbidity scores as additional predictors; and Model 3 further included the appendicular skeletal muscle index (appendicular skeletal muscle/height).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>After controlling for age and gender (Model 1: <i>R</i><sup>2</sup> = 0.373), and subsequently including handgrip strength, fat tissue index, and Davies comorbidity score effects (Model 2: <i>R</i><sup>2</sup> = 0.581), the impact of appendicular skeletal muscle on ISWT was found to be non-significant (Model 3: <i>R</i><sup>2</sup> = 0.600).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>There was no significant correlation observed between exercise capacity and skeletal muscle mass in patients undergoing hemodialysis, indicating the factors influencing exercise capacity in this patient population are complex and that increasing skeletal muscle mass may not necessarily involve solely addressing the improvement of exercise capacity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"28 1","pages":"98-106"},"PeriodicalIF":1.3,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41223978","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