Hemodialysis International最新文献_第9页

A phase 3b, multicenter, open-label, single-arm study of roxadustat (ASPEN): Operational learnings within United States dialysis organizations 罗沙司他3b期、多中心、开放标签、单臂研究（ASPEN）：美国透析组织的操作经验。

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2023-06-28 DOI: 10.1111/hdi.13100

Steven Fishbane, Mark Vishnepolsky, Yemmie Oluwatosin, Jacqueline Nolen, Lixia Zhu, Kerry Cooper, Amy Young

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). ASPEN evaluated the efficacy, safety, and feasibility of roxadustat in patients with anemia of CKD in US dialysis organizations.

Methods

This open-label, single-arm study (NCT04484857) comprised a 6-week screening period, followed by 24 weeks of treatment (with optional extension ≤1 year) and a 4-week follow-up. Patients aged ≥18 years, receiving chronic dialysis, with hemoglobin (Hb) 9.0–12.0 g/dL if converting from erythropoiesis-stimulating agents (ESAs), or <10.0 g/dL if receiving ESAs for <6 weeks, received oral roxadustat three times weekly in-center. Primary efficacy endpoints included proportion of patients with mean Hb ≥10 g/dL, averaged over weeks 16–24, and mean Hb change from baseline to the average over weeks 16–24. Safety was also assessed.

Findings

Overall, 283 patients were enrolled and treated, 282 (99.6%) were included in the full analysis set, and 216 (76.3%) continued into the extension period. Most patients enrolled were from DaVita sites (71%), with the rest from US Renal Care sites (29%). Mean (standard deviation [SD]) baseline Hb was 10.6 (0.7) g/dL. Nearly all patients were prior ESA users (n = 274; 97.2%). The proportion of patients with mean Hb ≥10 g/dL during weeks 16–24 was 83.7% (95% confidence interval 78.9–88.6). Mean (SD) Hb increase from baseline to the average over weeks 16–24 was 0.2 (1.0) g/dL. During the treatment period, 82 (29.0%) patients reported treatment-emergent serious adverse events (TESAEs). The most common TESAEs were COVID-19 pneumonia (n = 10; 3.5%), acute respiratory failure (n = 9; 3.2%), COVID-19 (n = 7; 2.5%), acute myocardial infarction (n = 7; 2.5%), and fluid overload (n = 6, 2.1%).

Discussion

Roxadustat was effective in maintaining Hb in patients with anemia of CKD on dialysis in large, community-based dialysis organizations.

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。ASPEN在美国透析机构评估了罗沙司他治疗CKD贫血患者的疗效、安全性和可行性。方法：这项开放标签的单臂研究（NCT04484857）包括6周的筛选期，随后24周治疗周数（可选延长≤1 一年）和4周的随访。年龄≥18岁的患者年，接受慢性透析，血红蛋白（Hb）9.0-12.0 g/dL，如果从红细胞生成刺激剂（ESA）转化而来，或结果：总的来说，283名患者被纳入并接受治疗，282名（99.6%）被纳入完整的分析集，216名（76.3%）继续进入延长期。大多数入选患者来自DaVita站点（71%），其余来自美国肾脏护理站点（29%）。平均值（标准差[SD]）基线Hb为10.6（0.7） g/dL。几乎所有患者都曾使用ESA（n = 274；97.2%）。平均Hb≥10的患者比例 16-24周的g/dL为83.7%（95%置信区间78.9-88.6）。16-24周从基线到平均值的平均（SD）Hb增加为0.2（1.0） g/dL。在治疗期间，82名（29.0%）患者报告了治疗引发的严重不良事件（TESAE）。最常见的TESAE是新冠肺炎肺炎（n = 10；3.5%）、急性呼吸衰竭（n = 9；3.2%）、新冠肺炎（n = 7.2.5%）、急性心肌梗死（n = 7.2.5%）和流体过载（n = 6，2.1%）。讨论：在大型社区透析组织中，Roxadustat在维持CKD贫血患者的Hb方面是有效的。

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引用次数: 0

Evaluation of partial pressure CO2 change in the dialyzer blood inlet during hemodialysis as a measure of vascular access recirculation 血液透析过程中透析器血液入口分压CO2变化作为血管通路再循环测量的评估

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2023-06-28 DOI: 10.1111/hdi.13109

Silverio Rotondi, Adolfo Perrotta, Giovanni Pintus, Laura Capasso, Marzia Pasquali, Alessio Farcomeni, Emanuela Paoloni, Sandro Mazzaferro, Lida Tartaglione

Introduction

Vascular access recirculation during hemodialysis is associated with reduced effectiveness and worse survival outcomes. To evaluate recirculation, an increase in pCO₂ in the blood of the arterial line during hemodialysis (threshold of 4.5 mmHg) was proposed. The blood returning from the dialyzer in the venous line has significantly higher pCO₂, so in the presence of recirculation, pCO2 in the arterial blood line may increase (ΔpCO₂) during hemodialysis sessions. The aim of our study was to evaluate ΔpCO₂ as a diagnostic tool for vascular access recirculation in chronic hemodialysis patients.

Methods

We evaluated vascular access recirculation with ΔpCO₂ and compared it with the results of a urea recirculation test, which is the gold standard. ΔpCO₂ was obtained from the difference in pCO₂ in the arterial line at baseline (pCO₂T1) and after 5 min of hemodialysis (pCO₂T2). ∆pCO₂ = pCO₂T2–pCO₂T1.

Findings

In 70 hemodialysis patients (mean age: 70.52 ± 13.97 years; hemodialysis vintage of 41.36 ± 34.54, KT/V 1.4 ± 0.3), ∆pCO₂ was 4 ± 4 mmHg, and urea recirculation was 7% ± 9%. Vascular access recirculation was identified using both methods in 17 of 70 patients, who showed a ∆pCO₂ of 10 ± 5 mmHg and urea recirculation of 20% ± 9%; time in months of hemodialysis was the only difference between vascular access recirculation and non-vascular access recirculation patients (22 ± 19 vs. 46 ± 36, p: 0.05). In the non-vascular access recirculation group, the average ΔpCO₂ was 1.9 ± 2 (p: 0.001), and the urea recirculation % was 2.8 ± 3 (p: 0.001). The ΔpCO₂ correlated with the urea recirculation % (R: 0.728; p < 0.001).

Discussion

ΔpCO₂ in the arterial blood line during hemodialysis is an effective and reliable diagnostic tool for identifying recirculation of the vascular access but not its magnitude. The ΔpCO₂ test application is simple and economical and does not require special equipment.

引言血液透析期间的血管通路再循环与疗效降低和生存结果恶化有关。为了评估再循环，血液透析期间动脉线血液中pCO2的增加（阈值4.5 mmHg）。从静脉线路中的透析器返回的血液具有显著更高的pCO2，因此在存在再循环的情况下，动脉血液线路中的pCO2可能在血液透析期间增加（ΔpCO2）。我们研究的目的是评估ΔpCO2作为慢性血液透析患者血管通路再循环的诊断工具。方法我们用ΔpCO2评价血管通路再循环，并将其与金标准尿素再循环试验的结果进行比较。ΔpCO2是从基线（pCO2T1）和5 血液透析分钟数（pCO2T2）。∆pCO2 = pCO2T2–pCO2T1。70名血液透析患者（平均年龄：70.52 ± 13.97 年；血液透析年份41.36 ± 34.54，KT/V 1.4 ± 0.3），∆pCO2为4 ± 4. mmHg，尿素再循环为7% ± 9%。在70名患者中的17名患者中，使用这两种方法确定了血管通路再循环，这些患者的∆pCO2为10 ± 5. mmHg和尿素再循环20% ± 9%；血液透析的月数是血管通路再循环和非血管通路再循环患者之间的唯一差异（22 ± 19对46 ± 36，p：0.05）。在非血管通路再循环组中，平均ΔpCO2为1.9 ± 2（p：0.001），尿素再循环率为2.8 ± ΔpCO2与尿素再循环百分比相关（R:0.728；p <； 0.001）。讨论血液透析期间动脉血线中的ΔpCO2是一种有效和可靠的诊断工具，用于识别血管通路的再循环，但不是其大小。ΔpCO2测试应用简单经济，不需要特殊设备。

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引用次数: 0

Necessity of adjusting the blood hemoglobin target owing to interdialytic weight gain in patients on maintenance hemodialysis 由于维持性血液透析患者的分析间体重增加，调整血红蛋白目标的必要性。

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2023-06-26 DOI: 10.1111/hdi.13108

Masayuki Tanemoto

To the Editor: Anemia is a common complication in patients on maintenance hemodialysis, and its correction with erythropoiesis-stimulating agents is an established therapy. Current guidelines indicate the target blood hemoglobin levels for administering erythropoiesisstimulating agents but do not specify the hemoglobin measurement conditions, which reportedly affect hemoglobin in maintenance hemodialysis patients. Notably, hemoglobin decreases in case of hemodilution, such as that caused by interdialytic weight gain, and a difference in the gain would generally result in pre-dialysis hemoglobin measured early in the week (early-week-preHb) being lower than that measured midweek (midweekpre-Hb). However, studies examining this hemoglobin difference are scarce and have reported varying results; the difference was only 0.9% in one study but 4.3% in another. Thus, we aimed to examine this difference. This study was performed at a dialysis center in accordance with the Declaration of Helsinki. Pre-dialysis hemoglobin was measured during consecutive earlyweek and midweek maintenance hemodialysis sessions in 12 patients who were undergoing three maintenance hemodialysis sessions per week and were not on the therapy with erythropoiesis-stimulating agents. Comparisons were performed using Student’s paired t-test. Table 1 summarizes the measurements. The mean and median of the early-week-pre-Hb to midweek-pre-Hb ratio were 96.1% and 96.8%, respectively. Therefore, early-week-pre-Hb was lower than midweek-pre-Hb by approximately 4%. In the present analysis, interdialytic weight gain relative to dry weight—the target weight after a dialysis session (IDWG/DW)—was approximately 5.5% and 4.2% in the early-week and midweek sessions, respectively. This increase reduced early-week-pre-Hb by approximately 4% compared with midweek-pre-Hb. Thus, hemoglobin decreased by approximately 3% per additional 1% increase in IDWG/DW. As the daily IDWG/DW is typically 1.5%, the present findings support the previous finding that early-week-pre-Hb was lower than midweekpre-Hb by approximately 4.5%. Interdialytic weight gain is primarily attributed to increased extracellular fluid. As extracellular fluid accounts for approximately one-third of the total body fluid, which in turn accounts for approximately

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引用次数: 0

Pharmacotherapy considerations in pregnant patients on hemodialysis 妊娠血液透析患者的药物治疗考虑

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2023-06-21 DOI: 10.1111/hdi.13107

Beatrice Drambarean, Justyna Mastalerz, Lisa Wendt, Stephanie Toth-Manikowski

Purpose

Successful pregnancy rates on dialysis are increasing with the advent of intensive hemodialysis and advances in medical management.

Summary

Data support the use of intensive hemodialysis in pregnant women with end-stage kidney disease (ESKD). This paper provides an overview of common pharmacotherapeutic changes in management when caring for a pregnant woman receiving intensive hemodialysis. Pregnant patients on peritoneal dialysis were excluded from this analysis due to insufficient data. Topics covered include those related to anemia (iron and erythropoietin stimulating agents), blood pressure agents, monitoring of phosphorus, as well as nutrition and anticoagulation.

Conclusion

When patients on hemodialysis become pregnant, medication adjustments are needed regarding antihypertensives, anemia management, and mineral-bone disease management as many agents require dose adjustment, switching agents due to teratogenicity, or cessation due to fetal complications. There are minimal data in this population; however, successful and healthy infants have been delivered in this patient population with the medication changes discussed.

目的随着强化血液透析的出现和医学管理的进步，透析成功妊娠率不断提高。数据支持在终末期肾病(ESKD)孕妇中使用强化血液透析。这篇论文提供了一个共同的药物治疗的变化管理的概述，当照顾孕妇接受强化血液透析。由于资料不足，腹膜透析的孕妇被排除在本分析之外。所涵盖的主题包括与贫血(铁和促红细胞生成素刺激剂)、血压剂、磷监测以及营养和抗凝有关的内容。结论当血液透析患者怀孕时，需要调整降压药、贫血治疗和骨矿病治疗的药物，因为许多药物需要调整剂量，由于致畸而切换药物，或由于胎儿并发症而停止使用。这个群体的数据很少;然而，成功和健康的婴儿已经在这些患者群体中分娩，并讨论了药物变化。

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引用次数: 0

Comparing the Fried frailty phenotype versus the Veterans Affairs frailty index among dialysis dependent patients 比较透析依赖患者的弗里德虚弱表型与退伍军人事务部虚弱指数。

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2023-06-15 DOI: 10.1111/hdi.13101

Anum Hamiduzzaman, Ruoxue Wu, Victoria Murray, Kamyar Kalantar-Zadeh, Elani Streja, John Sy

Introduction

Frailty in dialysis patients is a modifiable disease state which can increase mortality if left untreated but remains underdiagnosed as frailty evaluations can be arduous or time consuming. We evaluate the agreement between a clinical frailty construct (Fried frailty phenotype, FFP) against and an electronic health record-based Veterans Affairs Frailty Index (VAFI) and their association with mortality.

Methods

A retrospective cohort analysis of 764 participants from the ACTIVE/ADIPOSE study was performed. Frailty as measured by VAFI and FFP was obtained and Kappa statistic estimating concordance between the two scores were calculated. Differences in mortality risk were analyzed according to presence or absence of frailty.

Findings

When assessing agreement between the VAFI and FFP, the kappa statistic was 0.09 (95% confidence interval [CI] 0.02–0.16) suggesting a low level of agreement. Frailty was independently associated with higher mortality risk (hazards ratio [HR] 1.40–1.42 in fully adjusted models depending upon frailty construct). Discordantly frail patients by construct had a higher risk of mortality though this was not statistically significant after adjustment. However, concordantly frail patients had much higher mortality risk compared to concordantly nonfrail (adjusted HR 2.08, 95% CI 1.44–3.01).

Discussion

Poor agreement between constructs is likely reflective of the multifactorial definition of frailty. While further longitudinal studies are needed to determine if the VAFI would be beneficial in the reassessment of frailty, it may be beneficial as a cue for further frailty testing (e.g., with FFP) with the combination of multiple frail constructs providing improved prognostic information.

引言：透析患者的虚弱是一种可改变的疾病状态，如果不进行治疗，可能会增加死亡率，但由于虚弱评估可能很困难或很耗时，因此诊断仍然不足。我们评估了临床虚弱构建体（Fried虚弱表型，FFP）与基于电子健康记录的退伍军人事务虚弱指数（VAFI）之间的一致性及其与死亡率的关系。方法：对来自ACTIVE/ADIPOSE研究的764名参与者进行回顾性队列分析。获得通过VAFI和FFP测量的脆弱性，并计算Kappa统计估计两个得分之间的一致性。根据虚弱与否分析死亡风险的差异。结果：当评估VAFI和FFP之间的一致性时，kappa统计量为0.09（95%置信区间[CI]0.02-0.16），表明一致性水平较低。虚弱与较高的死亡率风险独立相关（根据虚弱结构，完全调整模型中的危险比[HR]1.40-1.42）。结构不协调虚弱的患者有更高的死亡风险，尽管调整后这在统计学上并不显著。然而，与一致性非疲劳患者相比，一致性虚弱患者的死亡率要高得多（调整后的HR 2.08，95%CI 1.44-3.01）。讨论：结构之间的不一致可能反映了虚弱的多因素定义。虽然需要进一步的纵向研究来确定VAFI是否有利于虚弱的重新评估，但它可能有助于进一步的虚弱测试（例如，使用FFP），多种虚弱结构的组合提供了改善的预后信息。

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引用次数: 0

Effects of using a stress ball on anxiety and depression in patients undergoing hemodialysis: A prospective, balanced, single-blind, crossover study 使用压力球对血液透析患者焦虑和抑郁的影响：一项前瞻性、平衡性、单盲、交叉研究。

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2023-06-15 DOI: 10.1111/hdi.13102

Nurten Ozen, Soner Berse, Betul Tosun

Introduction

Use of a stress ball is a known t non-pharmacological method to distract attention and to relieve stress and anxiety. The goal of our study was to evaluate the effect of stress ball use on anxiety and depression in hemodialysis patients.

Methods

The study utilized a single-blind, balanced crossover design. There were two sequential 4-week intervention periods separated by a 4-day washout period. During one intervention period stress ball use at home was encouraged while the other 4-week “intervention” period served as a control. The order in which the two evaluation periods were applied was randomized for a given patient. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale before and after each 4-week intervention period.

Findings

A total of 65 patients participated in this study. There were statistically significant reductions in both anxiety (p < 0.001) and depression (p < 0.001) during the stress ball intervention periods vs. no change during the control interventions. A delayed follow-up evaluation showed that the anxiety level of patients remained reduced after 1 month of no longer using a stress ball.

Discussion

The use of a stress ball at home for 4 weeks significantly decreased anxiety and depression levels in our group of hemodialysis patients.

引言：使用压力球是一种已知的分散注意力、缓解压力和焦虑的非药物方法。我们研究的目的是评估压力球的使用对血液透析患者焦虑和抑郁的影响。方法：本研究采用单盲平衡交叉设计。有两个连续的4周干预期，间隔4天的冲洗期。在一个干预期内，鼓励在家使用压力球，而另一个4周的“干预”期则作为对照。对于给定的患者，两个评估期的应用顺序是随机的。在每个4周干预期前后，使用医院焦虑和抑郁量表评估焦虑和抑郁。研究结果：共有65名患者参与了这项研究。两组患者的焦虑程度均有统计学意义的降低（p 讨论：在家使用压力球4 在我们的血液透析患者组中，数周显著降低了焦虑和抑郁水平。

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引用次数: 0

Discrepancy in responses to the surprise question between hemodialysis nurses and physicians, with focus on patient clinical characteristics: A comparative study 血液透析护士和医生对意外问题的回答存在差异，重点关注患者的临床特征：一项比较研究。

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2023-06-15 DOI: 10.1111/hdi.13103

Jeanette M. Wallin, Stefan H. Jacobson, Lena Axelsson, Jenny Lindberg, Carina I. Persson, Jenny Stenberg, Agneta Wennman-Larsen

Introduction

The surprise question (SQ) “Would I be surprised if this patient died within the next xx months” can be used by different professions to foresee the need of serious illness conversations in patients approaching end of life. However, little is known about the different perspectives of nurses and physicians in responses to the SQ and factors influencing their appraisals. The aim was to explore nurses' and physicians' responses to the SQ regarding patients on hemodialysis, and to investigate how these answers were associated with patient clinical characteristics.

Methods

This comparative cross-sectional study included 361 patients for whom 112 nurses and 15 physicians responded to the SQ regarding 6 and 12 months. Patient characteristics, performance status, and comorbidities were obtained. Cohen's kappa was used to analyze the interrater agreement between nurses and physicians in their responses to the SQ and multivariable logistic regression was applied to reveal the independent association to patient clinical characteristics.

Findings

Proportions of nurses and physicians responding to the SQ with “no, not surprised” was similar regarding 6 and 12 months. However, there was a substantial difference concerning which specific patient the nurses and physicians responded “no, not surprised”, within 6 (κ = 0.366, p < 0.001, 95% CI = 0.288–0.474) and 12 months (κ = 0.379, p < 0.001, 95% CI = 0.281–0.477). There were also differences in the patient clinical characteristics associated with nurses' and physicians' responses to the SQ.

Discussion

Nurses and physicians have different perspectives in their appraisal when responding to the SQ for patients on hemodialysis. This may reinforce the need for communication and discussion between nurses and physicians to identify the need of serious illness conversations in patients approaching the end of life, in order to adapt hemodialysis care to patient preferences and needs.

引言：“如果这个病人在未来xx个月内死亡，我会感到惊讶吗？”这个令人惊讶的问题（SQ）可以被不同的职业用来预测即将结束生命的病人需要进行严重疾病对话。然而，人们对护士和医生对SQ的不同看法以及影响他们评估的因素知之甚少。目的是探讨护士和医生对血液透析患者的SQ的反应，并调查这些回答如何与患者的临床特征相关。方法：这项横断面比较研究包括361名患者，其中112名护士和15名医生对6名和12名患者的SQ做出了回应月。获得患者特征、表现状态和合并症。Cohen’s kappa用于分析护士和医生对SQ的反应中的参与者间一致性，并应用多变量逻辑回归来揭示与患者临床特征的独立相关性。调查结果：护士和医生对SQ回答“不，不惊讶”的比例在6岁和12岁时相似月。然而，对于哪一位特定的患者，护士和医生的回答是“不，不惊讶”，在6（κ = 0.366，p 讨论：护士和医生在对血液透析患者的SQ做出反应时，有不同的评价角度。这可能会加强护士和医生之间的沟通和讨论需求，以确定即将结束生命的患者对严重疾病对话的需求，从而使血液透析护理适应患者的偏好和需求。

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引用次数: 0

Remission of refractory Crohn's disease with anti-IL-12/23 therapy in a patient undergoing hemodialysis: A case report 抗il -12/23治疗难治性克罗恩病在血液透析患者中的缓解:1例报告

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2023-06-14 DOI: 10.1111/hdi.13106

Michail Spathakis, Eirini Filidou, George Kolios, Dimitrios Papazoglou, Stergios Vradelis

Crohn's disease is a relapsing chronic inflammatory condition of the intestine with increasing prevalence around the world. Biologic therapies are currently widely used and have proved safe and effective in treating moderate to severe Crohn's disease. However, contemporary bibliography contains little information about the use of these drugs in patients with end-stage renal disease undergoing hemodialysis. Here we present a case of a 47-year-old female patient with treatment-refractory Crohn's disease on hemodialysis. In this patient, treatment with the anti-IL-12/23 receptor antibody ustekinumab was effective in inducing and maintaining remission while being safe in administering throughout hemodialysis.

克罗恩病是一种反复发作的慢性肠道炎症性疾病，在世界各地的患病率越来越高。生物疗法目前广泛使用，并已被证明安全有效地治疗中重度克罗恩病。然而，当代文献中关于这些药物在接受血液透析的终末期肾病患者中的应用的信息很少。在这里我们提出一个47岁的女性患者治疗难治性克罗恩病的血液透析。在该患者中，使用抗il -12/23受体抗体ustekinumab治疗在诱导和维持缓解方面是有效的，同时在整个血液透析过程中是安全的。

引用次数: 1

Interactions between intradialytic central venous oxygen saturation, relative blood volume, and all-cause mortality in maintenance hemodialysis patients 维持性血液透析患者溶内中心静脉氧饱和度、相对血容量和全因死亡率之间的相互作用

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2023-06-12 DOI: 10.1111/hdi.13104

Priscila Preciado, Laura Rosales Merlo, Hanjie Zhang, Jeroen P. Kooman, Frank M. van der Sande, Peter Kotanko

Introduction

In maintenance hemodialysis (HD) patients, low central venous oxygen saturation (ScvO₂) and small decline in relative blood volume (RBV) have been associated with adverse outcomes. Here we explore the joint association between ScvO₂ and RBV change in relation to all-cause mortality.

Methods

We conducted a retrospective study in maintenance HD patients with central venous catheters as vascular access. During a 6-month baseline period, Crit-Line (Fresenius Medical Care, Waltham, MA) was used to measure continuously intradialytic ScvO₂ and hematocrit-based RBV. We defined four groups per median change of RBV and median ScvO₂. Patients with ScvO₂ above median and RBV change below median were defined as reference. Follow-up period was 3 years. We constructed Cox proportional hazards model with adjustment for age, diabetes, and dialysis vintage to assess the association between ScvO₂ and RBV and all-cause mortality during follow-up.

Findings

Baseline comprised 5231 dialysis sessions in 216 patients. The median RBV change was −5.5% and median ScvO₂ was 58.8%. During follow-up, 44 patients (20.4%) died. In the adjusted model, all-cause mortality was highest in patients with ScvO₂ below median and RBV change above median (HR 6.32; 95% confidence interval [CI] 1.37–29.06), followed by patients with ScvO₂ below median and RBV change below median (HR 5.04; 95% CI 1.14–22.35), and ScvO₂ above median and RBV change above median (HR 4.52; 95% CI 0.95–21.36).

Discussion

Concurrent combined monitoring of intradialytic ScvO₂ and RBV change may provide additional insights into a patient's circulatory status. Patients with low ScvO₂ and small changes in RBV may represent a specifically vulnerable group of patients at particularly high risk for adverse outcomes, possibly related to poor cardiac reserve and fluid overload.

在维持性血液透析(HD)患者中，低中心静脉氧饱和度(ScvO2)和相对血容量(RBV)的小幅下降与不良结局相关。在这里，我们探讨了ScvO2和RBV变化与全因死亡率之间的联合关系。方法回顾性研究中心静脉导管作为血管通路的维持性HD患者。在6个月的基线期间，使用Crit-Line (Fresenius Medical Care, Waltham, MA)连续测量透析内ScvO2和基于血细胞比容的RBV。我们根据RBV和ScvO2的中位数变化定义了四组。将ScvO2高于中位数，RBV低于中位数的患者作为参考。随访期3年。我们构建了Cox比例风险模型，调整了年龄、糖尿病和透析时间，以评估随访期间ScvO2和RBV与全因死亡率之间的关系。基线包括216例患者5231次透析。中位RBV变化为- 5.5%，中位ScvO2为58.8%。随访期间死亡44例(20.4%)。在调整后的模型中，ScvO2低于中位数、RBV变化高于中位数的患者全因死亡率最高(HR 6.32;95%可信区间[CI] 1.37-29.06)，其次是ScvO2低于中位数和RBV变化低于中位数的患者(HR 5.04;95% CI 1.14-22.35)， ScvO2高于中位数，RBV高于中位数(HR 4.52;95% ci 0.95-21.36)。同时联合监测分析内ScvO2和RBV的变化可以为患者的循环状态提供额外的见解。低ScvO2和小RBV变化的患者可能是一个特别脆弱的患者群体，具有特别高的不良结局风险，可能与心脏储备不良和液体过载有关。

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引用次数: 0

Obesity and survival in a national cohort of incident hemodialysis patients: An analysis of the Brazilian Dialysis Registry 国家血液透析患者队列中的肥胖与生存率：巴西透析登记处的分析。

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2023-06-01 DOI: 10.1111/hdi.13099

Angélica Peçanha, Fabiana B. Nerbass, Ricardo C. Sesso, Jocemir R. Lugon

Introduction

A phenomenon called the “obesity paradox” has consistently been reported in several cohorts of patients on chronic hemodialysis. In this setting, a higher body mass index (BMI) is paradoxically associated with better survival. This study aimed to evaluate the effect of BMI on mortality in patients undergoing chronic hemodialysis using the Brazilian Dialysis Registry.

Methods

This was a retrospective national cohort study with data on incident hemodialysis patients collected between January 2011 to December 2018. Those aged <18 or > 80 years were excluded from the study. The variables studied were the clinical and laboratory data regularly collected at the dialysis units. The variable of primary interest was BMI, represented as the median of the entire dialysis treatment and stratified into four ranges according to the World Health Organization (WHO) classification. The primary outcome was death within 4 years. Cox proportional hazards regression analysis was used to test associations with mortality.

Findings

The analyzed sample consisted of 5489 patients from 73 centers in five regions of the country. Of these, 5.9% were underweight, 48.3% were of normal weight, 31.0% were overweight, and 14.7% were obese. The 4-year survival rates in these BMI ranges were 58%, 70%, 75%, and 80%, respectively. The probability of survival for each BMI extract was significantly different from that in the normal-weight range (p < 0.05). In the fully adjusted Cox proportional hazard regression model, BMI > 24.9 kg/m² remained an independent protective factor for mortality (HR: 0.76, 95% CI: 0.62–0.95, p = 0.016).

Discussion

In Brazil, being overweight and obese are protective factors for survival in the chronic hemodialysis population.

引言：一种被称为“肥胖悖论”的现象一直被报道在几个慢性血液透析患者队列中。在这种情况下，更高的体重指数（BMI）与更好的生存率有着矛盾的联系。本研究旨在使用巴西透析注册中心评估BMI对接受慢性血液透析患者死亡率的影响。方法：这是一项回顾性全国队列研究，收集了2011年1月至2018年12月期间发生的血液透析患者的数据。老年人 80 年被排除在研究之外。研究的变量是在透析单位定期收集的临床和实验室数据。主要感兴趣的变量是BMI，以整个透析治疗的中位数表示，并根据世界卫生组织（世界卫生组织）分类分为四个范围。主要结果是4天内死亡年。Cox比例风险回归分析用于检验与死亡率的相关性。研究结果：分析样本包括来自全国五个地区73个中心的5489名患者。其中，5.9%体重不足，48.3%体重正常，31.0%超重，14.7%肥胖。在这些BMI范围内的4年生存率分别为58%、70%、75%和80%。每种BMI提取物的存活概率与正常体重范围内的存活概率显著不同（p 24.9 kg/m2仍然是死亡率的独立保护因素（HR:0.76，95%CI:0.62-0.95，p = 0.016）。讨论：在巴西，超重和肥胖是慢性血液透析人群生存的保护因素。

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引用次数: 0