Hemodialysis International最新文献_第8页

Relationship Between Illness Adaptation and Type D Personality in Hemodialysis Patients 血液透析患者疾病适应与D型人格的关系

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2025-04-10 DOI: 10.1111/hdi.13243

Berna Akay, Canan Bozkurt, Nurdan Sahin

Introduction

Although the impact of Type D personality on individuals with various chronic health conditions has been widely studied, its role in hemodialysis patients remains unclear. This study aimed to explore the relationship between illness adaptation and Type D personality in hemodialysis patients and to examine the sociodemographic and clinical characteristics that influence illness adaptation.

Methods

This cross-sectional study was conducted in hemodialysis units in western Turkey from November 2021 to November 2022. Data were collected using a Personal Information Form, the Adaptation to Chronic Illness Scale, and the Type D Personality Scale. Descriptive statistics, t-tests, ANOVA, Pearson's correlation, and multivariate linear regression analysis were applied to analyze the data.

Results

A total of 138 hemodialysis patients participated in the study. The mean score for adaptation to chronic illness was 80.6 ± 13.6. Among these patients, 38.4% had Type D personality. A negative correlation was found between illness adaptation and Type D personality (r = −0.683, p < 0.001). Regression analysis revealed that Type D personality (β = −0.255), gender (β = −0.087), age (β = 0.137), education level (β = 0.152), economic status (β = 0.177), and hemodialysis duration (β = 0.307) were significant predictors of illness adaptation.

Conclusion

Healthcare providers should offer individualized psychosocial care and counseling services to enhance illness adaptation in hemodialysis patients. In particular, strategies to improve adaptation should be tailored for patients with Type D personality traits.

虽然D型人格对各种慢性健康状况个体的影响已被广泛研究，但其在血液透析患者中的作用尚不清楚。本研究旨在探讨血液透析患者疾病适应与D型人格的关系，并探讨影响疾病适应的社会人口学和临床特征。方法：这项横断面研究于2021年11月至2022年11月在土耳其西部的血液透析单位进行。数据采用个人信息表、慢性疾病适应量表和D型人格量表收集。采用描述性统计、t检验、方差分析、Pearson相关及多元线性回归分析对数据进行分析。结果：共138例血液透析患者参与研究。慢性疾病适应的平均得分为80.6±13.6。其中38.4%为D型人格。疾病适应与D型人格呈负相关（r = -0.683, p）。结论：医疗服务提供者应提供个性化的心理社会护理和咨询服务，以提高血液透析患者的疾病适应。特别是，提高适应能力的策略应该针对D型人格特征的患者量身定制。

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引用次数: 0

Pharmacokinetics of Metronidazole During Prolonged Intermittent Kidney Replacement Therapy 甲硝唑在长期间歇肾替代治疗中的药代动力学。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2025-04-04 DOI: 10.1111/hdi.13242

Jessica H. Xu, Vesa Cheng, Matthew Rawlins, David Morgan, Hayoung Won, Xiaolin Wu, John Dyer, Jason A. Roberts

Acute kidney injury is a common complication present in critically ill patients and is often managed by kidney replacement therapy. Prolonged intermittent kidney replacement therapy (PIKRT) is a modality of kidney replacement therapy often utilized in intensive care settings, but dosing recommendations and pharmacokinetic data for antimicrobial removal during PIKRT are limited. Metronidazole, a 5-nitroimidazole agent, is commonly prescribed for anaerobic and protozoal infections. Although generally well tolerated, adverse effects including severe neurotoxicity have been reported in association with prolonged or high cumulative dosing, particularly in the setting of kidney or hepatic impairment. In this case study, we describe and discuss the pharmacokinetics of metronidazole and the hydroxy-metabolite (hydroxy-metronidazole) concentrations in a critically ill patient undergoing PIKRT.

急性肾损伤是危重患者常见的并发症，通常采用肾脏替代治疗。延长间歇性肾脏替代疗法（PIKRT）是一种肾脏替代疗法，通常用于重症监护环境，但在PIKRT期间抗生素去除的剂量建议和药代动力学数据有限。甲硝唑是一种5-硝基咪唑类药物，通常用于治疗厌氧和原生动物感染。虽然一般耐受性良好，但有报道称，长期或高累积剂量的不良反应，包括严重的神经毒性，特别是在肾脏或肝脏损害的情况下。在这个案例研究中，我们描述并讨论了甲硝唑的药代动力学和羟基代谢物（羟基甲硝唑）浓度在一个危重病人接受PIKRT。

引用次数: 0

Evaluation of Long-Term Effects of Parathyroidectomy in Patients With Refractory Secondary Hyperparathyroidism 难治性继发性甲状旁腺功能亢进患者行甲状旁腺切除术的远期疗效评价。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2025-04-04 DOI: 10.1111/hdi.13222

Liu Yang, Nian-rong Zhang, Hai-feng Wang, Jing-ning Chen, Meng Yang, Xiao-liang Sun, Yong Lv, Yao Lu, Wan-ning Jia, Wen-wen He, Ling Zhang

<div> <section> <h3> Objective</h3> <p>Parathyroidectomy is an effective intervention for patients with end-stage renal disease and refractory secondary hyperparathyroidism. This study aimed to assess the long-term clinical outcomes and overall quality of life of patients following parathyroidectomy in real-world clinical practice.</p> </section> <section> <h3> Methods</h3> <p>The study included 103 patients with refractory secondary hyperparathyroidism treated with parathyroidectomy in a real-world setting (51 males, age 58 ± 10 years). Intact parathyroid hormone (iPTH), serum calcium, and serum phosphorus indices were compared preoperatively and at 6 months, 12 months, and 1 year postoperatively. The proportion of patients with a > 30% decrease in iPTH was evaluated to assess the long-term treatment effect of parathyroidectomy. The EQ-5D-5L scale was utilized to evaluate the long-term postoperative quality of life.</p> </section> <section> <h3> Results</h3> <p>Fifty percent of the patients included in the study had a follow-up time of more than 19 months (19.0 [12.0, 24.0]). The median pretreatment iPTH level was 1796.2 (905.5, 2909.8) pg/mL, with 43.7% of patients exceeding 2000 pg/mL and 19.4% exceeding 3000 pg/mL; 19 (18%) patients had an iPTH level of ≤ 800 pg/mL. The preoperative mean serum calcium level was 2.54 (0.22), 95% CI (2.44, 2.68), and the mean serum phosphorus level was 2.09 (0.48), 95% CI (1.81, 2.19). Approximately 50% of patients underwent total parathyroidectomy. The iPTH levels decreased significantly after surgery (<i>p</i> < 0.001). At 6 months postoperatively, 96.7% of the patients had a decrease in iPTH of more than 30% compared to the preoperative levels, and this percentage was 94.9% at 12 months postoperatively. Mean serum calcium and phosphorus levels decreased significantly after surgery (<i>p</i> < 0.01). More than 60% of patients achieved target serum calcium levels, and more than 40% achieved target serum phosphorus levels at 6 months postoperatively, demonstrating a statistically significant increase compared to preoperative levels (<i>p</i> < 0.001). No significant difference in surgical outcomes was observed between the groups with preoperative iPTH levels > 800 and < 800 pg/mL. The utilization of secondary hyperparathyroidism-related medications decreased following surgical intervention. The median health utility value, as measured using the EQ-5D-5L scale, was 0.897 (0.739, 1.0), with a median VAS score of 80 (60, 90).</p> </section> <section> <h3> Conclusions</h3> <p>In clinical practice, parathyroidectomy demonstrates efficacy in reducing iPTH levels and facilitating the

目的：甲状旁腺切除术是终末期肾病合并难治性继发性甲状旁腺功能亢进患者的有效干预手段。本研究旨在评估现实世界临床实践中甲状旁腺切除术后患者的长期临床结果和整体生活质量。方法：研究纳入103例在现实环境中接受甲状旁腺切除术治疗的难治性继发性甲状旁腺功能亢进患者（51例男性，年龄58±10岁）。术前、术后6个月、12个月、1年比较完整甲状旁腺激素（iPTH）、血钙、血磷指标。评估iPTH下降bbb30 %的患者比例，以评估甲状旁腺切除术的长期治疗效果。采用EQ-5D-5L量表评价术后长期生活质量。结果：50%纳入研究的患者随访时间超过19个月（19.0[12.0,24.0]）。预处理iPTH水平中位数为1796.2 (905.5,2909.8)pg/mL，其中43.7%的患者超过2000 pg/mL， 19.4%超过3000 pg/mL；19例（18%）患者iPTH水平≤800 pg/mL。术前平均血钙水平为2.54 (0.22),95% CI(2.44, 2.68)，平均血磷水平为2.09 (0.48),95% CI（1.81, 2.19）。大约50%的患者接受了甲状旁腺全切除术。结论：在临床实践中，甲状旁腺切除术对降低甲状旁腺激素水平和促进血清钙、磷水平的管理有明显的疗效。此外，这种手术干预显著减少了药物需求，提高了患者术后的长期生活质量。有证据表明，手术干预可能会给难治性继发性甲状旁腺功能亢进患者带来长期的益处。

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引用次数: 0

Hemodialysis and Water Management in a Dialysis Unit in Morocco, an Approach to Dealing With Water Scarcity 摩洛哥透析单位的血液透析和水管理，解决缺水问题的方法。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2025-04-01 DOI: 10.1111/hdi.13241

I. Haddiya, I. Melhaoui, A. El Khalifi, S. Ramdani, Y. Bentata, F. Z. Berkchi

Introduction

Chronic kidney disease is a global public health issue, affecting approximately 10% of the world's population, and more than 3 million people living with kidney failure who are estimated to be on maintenance dialysis programs, with the majority receiving hemodialysis (HD). This treatment is particularly water-intensive, posing a considerable challenge in regions experiencing water scarcity, such as Morocco.

Methods

Our HD center in Oujda, Eastern Morocco, has implemented several key strategies to address water scarcity and ensure uninterrupted HD procedures during periods of hydric stress.

Results

These strategies include expanding water storage capacities to safeguard against shortages, upgrading infrastructure to enhance water efficiency, and employing innovative technology for real-time monitoring and management of water resources. Additionally, we collaborate closely with local water authorities to secure reliable water supplies and explore possibilities for water regeneration and recycling.

Discussion

The rising demand for clean water, coupled with its increasing scarcity, presents a significant challenge for healthcare systems, particularly in the context of HD. Therefore, innovative approaches are essential to mitigate this issue. The concept of green dialysis, which focuses on reducing water usage and minimizing environmental impact, is emerging as a promising solution with measurable benefits. Implementing water-efficient reverse osmosis systems has resulted in significant reductions in water waste, while real-time monitoring and early warning systems have enhanced water security and operational efficiency. Additionally, initiatives exploring the reuse of reject water hold potential for further conservation. These tangible outcomes demonstrate how green dialysis practices can contribute to sustainable HD treatment, ensuring uninterrupted patient care, reduced resource consumption, and improved environmental stewardship in water-scarce regions.

慢性肾脏疾病是一个全球性的公共卫生问题，影响着世界上大约10%的人口，据估计有300多万肾衰竭患者正在接受维护性透析计划，其中大多数接受血液透析（HD）。这种处理特别耗水，对摩洛哥等缺水地区构成相当大的挑战。方法：我们在摩洛哥东部Oujda的HD中心实施了几项关键战略，以解决水资源短缺问题，并确保在水力压力期间HD程序不间断。结果：这些战略包括扩大储水能力以防止短缺，升级基础设施以提高用水效率，以及采用创新技术对水资源进行实时监测和管理。此外，我们与当地水务部门密切合作，以确保可靠的供水，并探索水再生和循环利用的可能性。讨论：对清洁水的需求不断增加，加上其日益稀缺，对卫生保健系统提出了重大挑战，特别是在HD背景下。因此，创新的方法对于缓解这一问题至关重要。绿色透析的概念侧重于减少用水量和最大限度地减少对环境的影响，这是一种有前景的解决方案，具有可衡量的效益。实施节水的反渗透系统大大减少了水的浪费，而实时监测和预警系统则提高了水安全和运营效率。此外，探索废弃水再利用的举措具有进一步节约用水的潜力。这些切实的成果表明，绿色透析实践可以促进HD的可持续治疗，确保患者不间断护理，减少资源消耗，改善缺水地区的环境管理。

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引用次数: 0

Attitude of Healthcare Professionals and Patients With End-Stage Kidney Disease Towards Home Hemodialysis: A Survey in China 医护人员和终末期肾病患者对家庭血液透析的态度：中国调查。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2025-03-30 DOI: 10.1111/hdi.13197

Junqing Liang, Ying Wang, Hongjie Yang, Yongju Jin, Li Zuo

Introduction

Home hemodialysis is still in its early stages in mainland China. This survey aimed to assess the perceptions of healthcare professionals and patients towards home hemodialysis and to identify the barriers hindering its uptake.

Methods

A cross-sectional observational survey was conducted using convenience sampling. Healthcare professionals specializing in nephrology and patients with end-stage kidney disease (ESKD) across mainland China were included. A self-reported questionnaire was administered to gather data on participants' demographics, attitudes, perceived barriers, and facilitating factors related to home hemodialysis. Chi-square tests were used to analyze the association between categorical variables.

Findings

A significant majority (80.1%) of healthcare professionals recognized the need for home hemodialysis. However, there was a statistically significant difference in willingness to undertake or receive home hemodialysis between healthcare professionals (53.6%) and patients (63.2%), respectively. Healthcare professionals identified the following as top facilitating factors: patients' needs (6.9 points), higher patient benefits (5.7 points), and shortage of dialysis resources (5.1 points). The primary barriers cited were the absence of relevant policies and regulations (7.5 points), lack of guidelines and management standards (7.0 points), and inadequate treatment technology and knowledge (6.6 points). Patients' willingness to accept home hemodialysis was primarily driven by the potential to save time and travel expenses (70.7%) and reduce infection risk (49.0%). The main barriers identified by patients were the inability to manage acute complications (77.8%), increased risk of vascular access infection (66.1%), and uncertainty about self-cannulation (60.7%).

Conclusion

There is a clear demand for home hemodialysis in China among both healthcare professionals and patients with ESKD. However, the lack of a supportive system, including policies, standards, and management frameworks, remains a significant obstacle to its widespread adoption.

导读：家庭血液透析在中国大陆仍处于起步阶段。本调查旨在评估医疗保健专业人员和患者对家庭血液透析的看法，并确定阻碍其吸收的障碍。方法：采用方便抽样的横断面观察调查方法。研究对象包括中国大陆的肾病专业医护人员和终末期肾病（ESKD）患者。通过自我报告问卷收集参与者的人口统计数据、态度、感知障碍以及与家庭血液透析相关的促进因素。使用卡方检验分析分类变量之间的相关性。结果：绝大多数（80.1%）的卫生保健专业人员认识到家庭血液透析的必要性。然而，医疗保健专业人员（53.6%）和患者（63.2%）在进行或接受家庭血液透析的意愿方面存在统计学差异。医疗保健专业人员确定了以下最重要的促进因素：患者需求（6.9分）、更高的患者福利（5.7分）和透析资源短缺（5.1分）。主要障碍依次为：缺乏相关政策法规（7.5分）、缺乏指导方针和管理标准（7.0分）、缺乏治疗技术和知识（6.6分）。患者愿意接受家庭血液透析的主要原因是节省时间和差旅费（70.7%）和降低感染风险（49.0%）。患者确定的主要障碍是无法控制急性并发症（77.8%）、血管通路感染风险增加（66.1%）和自我插管不确定（60.7%）。结论：中国的医护人员和ESKD患者对家庭血液透析有明显的需求。然而，缺乏支持系统，包括政策、标准和管理框架，仍然是其广泛采用的重大障碍。

{"title":"Attitude of Healthcare Professionals and Patients With End-Stage Kidney Disease Towards Home Hemodialysis: A Survey in China","authors":"Junqing Liang, Ying Wang, Hongjie Yang, Yongju Jin, Li Zuo","doi":"10.1111/hdi.13197","DOIUrl":"10.1111/hdi.13197","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Home hemodialysis is still in its early stages in mainland China. This survey aimed to assess the perceptions of healthcare professionals and patients towards home hemodialysis and to identify the barriers hindering its uptake.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional observational survey was conducted using convenience sampling. Healthcare professionals specializing in nephrology and patients with end-stage kidney disease (ESKD) across mainland China were included. A self-reported questionnaire was administered to gather data on participants' demographics, attitudes, perceived barriers, and facilitating factors related to home hemodialysis. Chi-square tests were used to analyze the association between categorical variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>A significant majority (80.1%) of healthcare professionals recognized the need for home hemodialysis. However, there was a statistically significant difference in willingness to undertake or receive home hemodialysis between healthcare professionals (53.6%) and patients (63.2%), respectively. Healthcare professionals identified the following as top facilitating factors: patients' needs (6.9 points), higher patient benefits (5.7 points), and shortage of dialysis resources (5.1 points). The primary barriers cited were the absence of relevant policies and regulations (7.5 points), lack of guidelines and management standards (7.0 points), and inadequate treatment technology and knowledge (6.6 points). Patients' willingness to accept home hemodialysis was primarily driven by the potential to save time and travel expenses (70.7%) and reduce infection risk (49.0%). The main barriers identified by patients were the inability to manage acute complications (77.8%), increased risk of vascular access infection (66.1%), and uncertainty about self-cannulation (60.7%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>There is a clear demand for home hemodialysis in China among both healthcare professionals and patients with ESKD. However, the lack of a supportive system, including policies, standards, and management frameworks, remains a significant obstacle to its widespread adoption.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"29 3","pages":"284-293"},"PeriodicalIF":1.2,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756543","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

Cerebrovascular Reactivity and Cerebral Ischemia During Chronic Hemodialysis 慢性血液透析期间脑血管反应性与脑缺血。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2025-03-28 DOI: 10.1111/hdi.13233

Dawn F. Wolfgram, Isabelle Grassl, Claire Seigworth, Michael E. Widlansky, Yan Gao

Background

Cerebral hypo-perfusion during hemodialysis (HD) may contribute to cerebral ischemic lesions and atrophy in HD patients. Vascular disease and stiffness can impair cerebrovascular reactivity (CVR) in HD patients, placing them at higher risk for cerebral hypo-perfusion during the hemodynamic stress of HD. We evaluated the relationship between CVR and change in cerebral perfusion during HD.

Methods

In a cohort of in-center HD patients, we used hypercapnia to induce a change in cerebral blood flow velocity measured with transcranial Doppler to assess CVR. We used continuous cerebral oximetry during HD to measure a change in cerebral oxygen saturation (ScO₂), calculating overall decline and the largest drop as markers of cerebral perfusion. We used multiple linear regression to assess the relationship between CVR and the ScO₂-associated endpoints.

Findings

We measured CVR in 42 HD patients and of those, 41 had the ScO₂ measurements completed. The mean age was 58.5 (11.0) years, and most were male (90.5%, N = 38) with diabetes (59.5%, N = 25) and hypertension (87.5%, N = 36). The average CVR was 2.7 (1.6)%/mmHg. The average overall decline in ScO₂ during HD was 2.2 (2.5)% and the average largest drop in ScO₂ was 5.9 (2.8)%. CVR was negatively associated with both the largest drop in ScO₂ (β = −0.67 95% CI [−1.20, −0.15], p = 0.01) and the overall decline in ScO₂ (β = −0.62 95% CI [−1.09, −0.15], p = 0.01). Vascular disease was a risk factor for lower CVR (β = −1.21, 95% CI [−2.16, −0.26] p = 0.01).

Conclusions

A lower CVR increases the risk for cerebral hypo-perfusion during HD. Impaired CVR may be an important part of the pathophysiology of ischemic brain injury and cognitive impairment in HD patients.

背景：血液透析（HD）期间大脑低灌注可能导致HD患者脑缺血病变和脑萎缩。血管疾病和僵硬可损害HD患者的脑血管反应性（CVR），使他们在HD血流动力学应激期间面临更高的脑低灌注风险。我们评估了CVR与HD期间脑灌注变化的关系。方法：在一组中心内HD患者中，我们使用高碳酸血症诱导经颅多普勒测量的脑血流速度变化来评估CVR。我们在HD期间使用连续脑血氧仪来测量脑氧饱和度（ScO2）的变化，计算总体下降和最大下降作为脑灌注的标志。我们使用多元线性回归来评估CVR与sco2相关终点之间的关系。结果：我们测量了42例HD患者的CVR，其中41例完成了ScO2测量。平均年龄58.5（11.0）岁，以男性居多（90.5%,N = 38），合并糖尿病（59.5%,N = 25）和高血压（87.5%,N = 36）。平均CVR为2.7 (1.6)%/mmHg。在HD期间，ScO2的平均总体下降为2.2 (2.5)%，ScO2的平均最大下降为5.9(2.8)%。CVR与最大ScO2下降（β = -0.67 95% CI [-1.20, -0.15], p = 0.01）和总体ScO2下降（β = -0.62 95% CI [-1.09, -0.15], p = 0.01）呈负相关。血管疾病是降低CVR的危险因素（β = -1.21, 95% CI [-2.16, -0.26] p = 0.01）。结论：较低的CVR增加了HD期间大脑低灌注的风险。CVR受损可能是HD患者缺血性脑损伤和认知功能障碍病理生理的重要组成部分。

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引用次数: 0

Adverse Events in Hemodialysis Patients With Venous Catheters Locked With 30% Trisodium Citrate Versus Alternative Locking Solutions 血液透析患者静脉导管使用 30% 枸橼酸三钠溶液锁定与使用其他锁定溶液时发生的不良事件。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2025-03-28 DOI: 10.1111/hdi.13239

George Miller, Astrid Feuersenger, Kingsley Ogujiofor, Hans-Juergens Arens, Marina Blanco, Rukhaiya Fatima, Emma Albrecht, Isabella Zabaleta

Introduction

Catheter locking solutions—including trisodium citrate—are crucial for maintaining central venous catheter patency in end-stage renal disease patients. Despite widespread usage, discrepancies remain regarding the safety profile of trisodium citrate. This study evaluates the safety of 30% trisodium citrate relative to alternative solutions in a large, heterogenous population.

Methods

We conducted a retrospective cohort study of 83,306 catheters from 51,243 patients at Fresenius Medical Care clinics across Europe, the Middle East, Africa, and Latin America from October 15, 2011 to 31 August 31, 2021. The 30% trisodium citrate group (10,689 patients) comprised all catheters routinely locked with 30% trisodium citrate. The control group (40,554 patients) included catheters locked with various non-trisodium citrate solutions, most commonly heparin, along with saline, gentamicin, and, less frequently, alteplase, antimicrobial caps (isopropyl alcohol or chlorhexidine), or taurolidine. Mean follow-up was 116 days.

Findings

Chi-square testing identified significant differences in three of four adverse event categories between the 30% trisodium citrate and control groups. The 30% trisodium citrate showed a favorable risk profile for Catheter and Procedure Issues (RR = 0.27, 95% CI: 0.25–0.28), Systemic Reactions and Symptoms (RR = 0.10, 95% CI: 0.09–0.11), and Thrombotic or Coagulation Complications (RR = 0.60, 95% CI: 0.58–0.61). No significant difference emerged for Infection-Related Events (RR = 1.02, 95% CI: 0.98–1.07).

Discussion

These results support the relative safety of 30% trisodium citrate as a locking solution in a large, diverse patient cohort. Further research should further explore how patient-level, catheter-level, and facility-level factors influence the comparative safety of locking solutions.

导读：包括柠檬酸三钠在内的导管锁定溶液对于维持终末期肾病患者中心静脉导管通畅至关重要。尽管广泛使用，但关于枸橼酸三钠的安全性仍然存在差异。本研究评估了30%柠檬酸三钠相对于其他溶液在大型异质人群中的安全性。方法：从2011年10月15日至2021年8月31日，我们在欧洲、中东、非洲和拉丁美洲的费森尤斯医疗保健诊所进行了一项回顾性队列研究，从51,243名患者中获得83,306根导管。30%柠檬酸三钠组（10689例）包括所有导管常规用30%柠檬酸三钠锁住。对照组（40,554例患者）包括用各种非柠檬酸三钠溶液锁住的导管，最常见的是肝素，以及生理盐水、庆大霉素，少数情况下使用阿替普酶、抗菌帽（异丙醇或氯己定）或牛磺酸。平均随访116天。结果：卡方检验发现，30%柠檬酸三钠组和对照组在四种不良事件类别中有三种有显著差异。30%柠檬酸三钠在导管和手术问题（RR = 0.27, 95% CI: 0.25-0.28）、全身反应和症状（RR = 0.10, 95% CI: 0.09-0.11）以及血栓或凝血并发症（RR = 0.60, 95% CI: 0.58-0.61）方面具有良好的风险。感染相关事件无显著性差异（RR = 1.02, 95% CI: 0.98-1.07）。讨论：这些结果支持30%柠檬酸三钠作为锁定溶液在大型、多样化患者队列中的相对安全性。进一步的研究应进一步探讨患者水平、导管水平和设施水平的因素如何影响锁定方案的相对安全性。

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引用次数: 0

Exploring Mortality and Associated Risks Among Assisted Home Hemodialysis Patients in Qatar 探究卡塔尔辅助家庭血液透析患者的死亡率及相关风险。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2025-03-28 DOI: 10.1111/hdi.13236

Abdullah I. Hamad, Amani Z. Zidan, Mostafa F. Elshirbeny, Fadwa S. Al-Ali, Tarek A. Ghonimi, Mohamed Y. Abdelhadi, Mossab Filali, Ahmed Awaisu, Rania A. Ibrahim, Mohamad M. Alkadi, Hassan A. Al-Malki

Background

Home hemodialysis (HD) is a well-established modality that promotes patient independence but poses significant challenges, particularly in regions like the Gulf Cooperation Council (GCC) countries. Assisted home HD has gained momentum in the GCC over the past few years. Qatar's assisted home HD program has expanded substantially in the past 2 years. This study examines the demographics, mortality rates, and associated risk factors within Qatar's assisted home HD patient population.

Methods

This was a retrospective cohort study to review national data for all assisted home HD patients in Qatar between July 2021 and December 2023. Patients had to be > 60 years old and have limited mobility to be eligible for the assisted home HD program and included in the study.

Results

We had 114 assisted home HD patients with a median age of 71.5; 54 (47.4%) were males. During the study period, 20 patients (17.5%) died, and 8 (7%) stopped receiving the service for traveling abroad, personal preference for in-center HD, or changing dialysis modality. Most deaths occurred due to infectious causes. The deceased patients had significantly less HD vintage, more severe immobility, and more hospitalizations compared to the alive participants. On multivariate analysis, patients with severe immobility had 3.8 (CI: 1.1–12.8, 95% p < 0.05) times higher odds of mortality than patients with mild to moderate immobility.

Conclusion

Our study found that mortality in the assisted home HD program is significant and mostly related to mobility status. Patients with severely reduced mobility had almost four times the risk of mortality compared to more mobile patients. Further, larger studies are needed to confirm these findings.

背景：家庭血液透析（HD）是一种行之有效的方式，可促进患者的独立性，但也带来了巨大的挑战，尤其是在海湾合作委员会（GCC）国家等地区。过去几年，辅助家庭血液透析在海湾合作委员会国家的发展势头良好。卡塔尔的辅助家庭 HD 项目在过去两年中大幅扩展。本研究探讨了卡塔尔家庭辅助血液透析患者的人口统计学、死亡率和相关风险因素：这是一项回顾性队列研究，旨在回顾 2021 年 7 月至 2023 年 12 月期间卡塔尔所有居家辅助血液透析患者的全国数据。患者年龄必须大于 60 岁，且行动不便，才有资格参加家庭辅助血液透析项目并被纳入研究：共有 114 名居家辅助型 HD 患者，中位年龄为 71.5 岁；男性 54 名（占 47.4%）。在研究期间，20 名患者（17.5%）死亡，8 名患者（7%）因出国旅行、个人偏好中心内 HD 或更换透析方式而停止接受服务。大多数死亡原因是感染。与存活的参与者相比，死亡患者的血液透析次数明显较少，行动不便程度更严重，住院次数也更多。在多变量分析中，行动不便的患者死亡率为 3.8（CI：1.1-12.8，95% p）：我们的研究发现，居家辅助性 HD 计划中的死亡率非常高，而且主要与行动能力状况有关。与行动能力较强的患者相比，行动能力严重下降的患者的死亡风险几乎是后者的四倍。还需要更大规模的研究来证实这些发现。

{"title":"Exploring Mortality and Associated Risks Among Assisted Home Hemodialysis Patients in Qatar","authors":"Abdullah I. Hamad, Amani Z. Zidan, Mostafa F. Elshirbeny, Fadwa S. Al-Ali, Tarek A. Ghonimi, Mohamed Y. Abdelhadi, Mossab Filali, Ahmed Awaisu, Rania A. Ibrahim, Mohamad M. Alkadi, Hassan A. Al-Malki","doi":"10.1111/hdi.13236","DOIUrl":"10.1111/hdi.13236","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Home hemodialysis (HD) is a well-established modality that promotes patient independence but poses significant challenges, particularly in regions like the Gulf Cooperation Council (GCC) countries. Assisted home HD has gained momentum in the GCC over the past few years. Qatar's assisted home HD program has expanded substantially in the past 2 years. This study examines the demographics, mortality rates, and associated risk factors within Qatar's assisted home HD patient population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective cohort study to review national data for all assisted home HD patients in Qatar between July 2021 and December 2023. Patients had to be > 60 years old and have limited mobility to be eligible for the assisted home HD program and included in the study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We had 114 assisted home HD patients with a median age of 71.5; 54 (47.4%) were males. During the study period, 20 patients (17.5%) died, and 8 (7%) stopped receiving the service for traveling abroad, personal preference for in-center HD, or changing dialysis modality. Most deaths occurred due to infectious causes. The deceased patients had significantly less HD vintage, more severe immobility, and more hospitalizations compared to the alive participants. On multivariate analysis, patients with severe immobility had 3.8 (CI: 1.1–12.8, 95% <i>p</i> < 0.05) times higher odds of mortality than patients with mild to moderate immobility.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study found that mortality in the assisted home HD program is significant and mostly related to mobility status. Patients with severely reduced mobility had almost four times the risk of mortality compared to more mobile patients. Further, larger studies are needed to confirm these findings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":"29 4","pages":"487-495"},"PeriodicalIF":1.2,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hdi.13236","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733756","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

Use of Biologic Therapy in AA Amyloidosis Patients Undergoing Dialysis—A Systematic Literature Review 在接受透析的 AA 淀粉样变性患者中使用生物疗法--系统性文献综述。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2025-03-28 DOI: 10.1111/hdi.13238

Ege Sinan Torun, Gülay Kadıoğlu

Background

The advent of biological agents has provided significant therapeutic opportunities for patients with AA amyloidosis. However, when these patients reach end-stage renal disease and begin dialysis, some clinicians may discontinue biological treatments due to the heightened risk of infections. Given that AA amyloidosis is a progressive condition, there is a potential for the disease to affect additional organs in these patients. Consequently, we aimed to evaluate the benefits and risks associated with biological agents in AA amyloidosis patients receiving dialysis.

Method

We performed a systematic literature review in Cochrane Database and MEDLINE about the use of biologic agents in AA amyloidosis patients undergoing dialysis.

Results

We identified fifty-five patients across twenty-two studies. Familial Mediterranean fever was the etiology in 21 patients (71.4% anakinra and 28.6% canakinumab), rheumatoid arthritis in 17 patients (52.9% etanercept and 47.1% tocilizumab), unknown etiology in 8 patients (62.5% anakinra and 37.5% tocilizumab), ankylosing spondylitis in 5 patients (40% etanercept, 40% adalimumab, and 20% infliximab), hidradenitis suppurativa in 3 patients and tumor necrosis factor receptor-associated periodic syndrome (TRAPS) in 1 patient. Biologic agents were effective or partially effective for primary disease control in 52 patients (94.5%). Two patients were able to discontinue dialysis. Most frequent side effects were infections (8 episodes in 7 patients). Eight patients died (5 due to infections, one due to cardiac causes and two due to pulmonary hemorrhage).

Conclusion

Biologic agents are effective in AA amyloidosis patients that are treated with dialysis and seem to have an acceptable safety profile.

背景：生物制剂的出现为 AA 淀粉样变性患者提供了重要的治疗机会。然而，当这些患者进入肾病晚期并开始透析时，一些临床医生可能会因感染风险增加而停止生物治疗。鉴于 AA 淀粉样变性是一种进展性疾病，该病有可能影响这些患者的其他器官。因此，我们旨在评估生物制剂对接受透析的 AA 淀粉样变性患者的益处和风险：我们在 Cochrane 数据库和 MEDLINE 中对接受透析的 AA 淀粉样变性患者使用生物制剂的情况进行了系统性文献回顾：结果：我们在22项研究中发现了55名患者。21例患者的病因是家族性地中海热（71.4%为阿纳金拉，28.6%为卡那珠单抗），17例患者的病因是类风湿性关节炎（52.9%为依那西普，47.1%为托西珠单抗），8例患者的病因不明（62.5%为阿纳金拉，37.5名患者为强直性脊柱炎（依那西普占40%、阿达木单抗占40%、英夫利昔单抗占20%），3名患者为化脓性扁桃体炎，1名患者为肿瘤坏死因子受体相关周期性综合征（TRAPS）。生物制剂对 52 名患者（94.5%）的原发性疾病控制有效或部分有效。两名患者能够停止透析。最常见的副作用是感染（7 名患者出现 8 次）。8名患者死亡（5人死于感染，1人死于心脏病，2人死于肺出血）：结论：生物制剂对接受透析治疗的 AA 淀粉样变性患者有效，而且似乎具有可接受的安全性。

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引用次数: 0

Enhancing Postoperative Pain Management: Assessing the Influence of Ultrasound-Guided Stellate Ganglion Block on Arteriovenous Fistula Surgery 加强术后疼痛管理：评估超声引导星状神经节阻滞对动静脉瘘手术的影响。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2025-03-25 DOI: 10.1111/hdi.13220

Hashemian Morteza, Bahaadini Azadeh, Aflatoonian Behnaz, Vehedian Mehrdad, Nozarinia Mostafa, Shahdadi Hamed, Abolhasani Zadeh Firoozeh

Introduction

The effectiveness of stellate ganglion block in managing acute postoperative pain remains uncertain due to limited high-quality evidence. This study evaluates the impact of stellate ganglion block on acute pain following arteriovenous fistula surgery.

Methods

A randomized controlled clinical trial was conducted in the Surgery Department of Bahonar and Shafa Hospitals at Kerman University of Medical Sciences, Iran. Patients undergoing arteriovenous fistula surgery were randomly assigned to either the intervention group, which received an ultrasound-guided stellate ganglion block with 5 mL of 5% lidocaine, or the control group, which received no intervention. A total of 60 patients were selected based on age and gender similarity. Pain levels were assessed using the visual analog scale immediately after surgery and at 6 and 12 h postoperatively.

Findings

Pain scores differed significantly between the two groups at all time points (p ≤ 0.05). The intervention group reported lower pain levels at 6 and 12 h postoperatively compared to the control group. Repeated measures analysis confirmed a significant reduction in pain over time in both groups (p ≤ 0.05), with a more pronounced decrease in the intervention group (p ≤ 0.05).

Conclusion

Preoperative stellate ganglion block effectively reduces acute postoperative pain following arteriovenous fistula surgery. However, its effects beyond the 12-h postoperative period remain unknown. Further research is needed to evaluate its long-term impact.

导语：由于有限的高质量证据，星状神经节阻滞治疗急性术后疼痛的有效性仍然不确定。本研究评估星状神经节阻滞对动静脉瘘术后急性疼痛的影响。方法：在伊朗克尔曼医科大学Bahonar和Shafa医院外科进行随机对照临床试验。行动静脉瘘手术的患者被随机分为干预组和对照组，干预组接受5 mL 5%利多卡因超声引导下的星状神经节阻滞，对照组不接受干预。根据年龄和性别相似性，共选择60例患者。术后即刻及术后6、12小时采用视觉模拟量表评估疼痛水平。结果：两组患者各时间点疼痛评分差异均有统计学意义（p≤0.05）。与对照组相比，干预组术后6和12小时的疼痛水平较低。重复测量分析证实两组疼痛随时间的推移均有显著减轻（p≤0.05），干预组疼痛减轻更为明显（p≤0.05）。结论：术前星状神经节阻滞可有效减轻动静脉瘘术后急性疼痛。然而，其在术后12小时后的效果尚不清楚。需要进一步的研究来评估其长期影响。

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引用次数: 0