Hemodialysis International最新文献_第9页

Dialysis education and options for late presenters—An ongoing dilemma 透析教育和选择迟到的演讲者-一个持续的困境

IF 1.3 4区医学 Q3 Medicine

Hemodialysis International

Pub Date : 2023-04-03 DOI: 10.1111/hdi.13082

Yimeng Zhang, Jyoti Baharani

Pre-dialysis education forms a crucial part of dialysis preparation. Acute start dialysis patients often commence and remain on in-center hemodialysis (ICHD) without the benefit of an informed decision making process for kidney replacement therapy options. The aim of this review is to evaluate the evidence surrounding methods of education provision to the acute dialysis start population and their associated outcomes. Publications have described a holistic education pathway with multimedia provision of information and interactive experiences. One or more trained specialist nurses provided information over 3–5 sessions. Formal education was mostly initiated as an inpatient. 86%–100% of acute start dialysis patients are initiated and remain on ICHD. Following formal education, 21%–58% of patients chose peritoneal dialysis (PD), 10%–24% home hemodialysis, 33%–58% ICHD. This brings the number of patients maintained on an independent form of dialysis similar to the planned dialysis start population. Patients commenced on PD without needing temporary hemodialysis, hence avoided complications associated with such. Patients aged under 75 (p < 0.0001) and males (p = 0.006) were more likely to be influenced by education to select PD. The adjusted 5 year survival rates among discharged patients were similar between home and ICHD groups (73% vs. 71% respectively), with a comparable age of death. A targeted education program in the acute dialysis start population has proven to be feasible. Adaptations are likely required for each center; however, various methods have been shown to be effective, with an increased number of patients choosing an independent dialysis modality when given the choice.

透析前教育是透析准备的重要组成部分。急性开始透析患者经常开始并继续进行中心血液透析(ICHD)，而没有对肾脏替代治疗方案进行知情决策。本综述的目的是评估对急性透析开始人群提供教育的方法及其相关结果的证据。出版物描述了以多媒体提供信息和互动体验的全人教育途径。一名或多名训练有素的专业护士在3-5次会议上提供信息。正规教育大多是在住院期间开始的。86%-100%的急性开始透析患者开始并保持ICHD。接受正规教育后，21%-58%的患者选择腹膜透析(PD)， 10%-24%的患者选择家庭血液透析，33%-58%的患者选择ICHD。这使得维持独立透析形式的患者数量与计划的透析开始人数相似。患者开始PD治疗时不需要临时血液透析，因此避免了与之相关的并发症。75岁以下的患者(p < 0.0001)和男性(p = 0.006)更容易受到教育程度的影响而选择PD。家庭组和ICHD组出院患者的调整后5年生存率相似(分别为73%和71%)，死亡年龄相似。在急性透析开始人群中有针对性的教育计划已被证明是可行的。每个中心可能都需要适应;然而，各种方法已被证明是有效的，当给予选择时，越来越多的患者选择独立的透析方式。

{"title":"Dialysis education and options for late presenters—An ongoing dilemma","authors":"Yimeng Zhang, Jyoti Baharani","doi":"10.1111/hdi.13082","DOIUrl":"10.1111/hdi.13082","url":null,"abstract":"<p>Pre-dialysis education forms a crucial part of dialysis preparation. Acute start dialysis patients often commence and remain on in-center hemodialysis (ICHD) without the benefit of an informed decision making process for kidney replacement therapy options. The aim of this review is to evaluate the evidence surrounding methods of education provision to the acute dialysis start population and their associated outcomes. Publications have described a holistic education pathway with multimedia provision of information and interactive experiences. One or more trained specialist nurses provided information over 3–5 sessions. Formal education was mostly initiated as an inpatient. 86%–100% of acute start dialysis patients are initiated and remain on ICHD. Following formal education, 21%–58% of patients chose peritoneal dialysis (PD), 10%–24% home hemodialysis, 33%–58% ICHD. This brings the number of patients maintained on an independent form of dialysis similar to the planned dialysis start population. Patients commenced on PD without needing temporary hemodialysis, hence avoided complications associated with such. Patients aged under 75 (<i>p</i> < 0.0001) and males (<i>p</i> = 0.006) were more likely to be influenced by education to select PD. The adjusted 5 year survival rates among discharged patients were similar between home and ICHD groups (73% vs. 71% respectively), with a comparable age of death. A targeted education program in the acute dialysis start population has proven to be feasible. Adaptations are likely required for each center; however, various methods have been shown to be effective, with an increased number of patients choosing an independent dialysis modality when given the choice.</p>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9884893","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

Hemosiderosis in chronic dialysis patients: Monitoring the response to deferasirox by quantitative hepatic magnetic resonance imaging 慢性透析患者的含铁血黄素沉着:定量肝磁共振成像监测对去铁铁的反应

IF 1.3 4区医学 Q3 Medicine

Hemodialysis International

Pub Date : 2023-03-30 DOI: 10.1111/hdi.13081

Wafae Bekhechi, Hakim Chiali, Latifa Khelil, Rawda Sari-Hamidou, Mustapha Benmansour

Introduction

Hemosiderosis of chronic dialysis has always been a frequent phenomenon in dialysis; formerly related to blood transfusions before the advent of Erythropoiesis Stimulating Agents (ESA), it is currently in connection with the use of massive doses of injectable iron, to ensure the full therapeutic efficacy of ESA. Few studies have looked at the therapeutic aspect of iron chelators in the dialysis population.

Methods

We followed 31 dialysis patients treated for secondary hemosiderosis with deferasirox (DFX) at the dose 10 mg/kg/day, by hepatic MRI from September 2017 to September 2021, in order to evaluate the efficacy of iron chelators on the reduction of liver iron concentration (LIC). The diagnosis of hemosiderosis was carried for a value of the LIC > 50 μmol/g of dry liver.

Results

Chelation resulted in a significant reduction in liver iron burden as measured by liver MRI: (201.4 ± 179.9 vs. 122.6 ± 154.3 μmol/g liver) (p = 0.000) and in mean ferritin level: (2058.8 ± 2004.9 vs. 644.2 ± 456.6 ng/mL) (p = 0.002). A gain of 1.1 g/dL in mean hemoglobin level: (10.5 ± 1.6 vs. 11.6 ± 2.0 g/dL) (p = 0.006). A significant increase in mean albumin level: (43 ± 5.5 to 46.2 ± 6.1 g/L) (p = 0.04). The therapeutic response was clearly influenced by the cause of overload, longer in polytransfused patients (p = 0.023) and the degree of overload assessed by MRI (p = 0.003) and ferritin level (p = 0.04).

Conclusion

DFX, prescribed at a dose of 10 mg/kg/day, resulted in a significant reduction in hepatic iron burden as measured by liver MRI and ferritin. The therapeutic response was clearly influenced by blood transfusions and the degree of iron overload.

慢性透析含铁血黄素沉着一直是透析中的常见现象;在促红细胞生成剂(ESA)出现之前，它以前与输血有关，目前与使用大剂量注射铁有关，以确保促红细胞生成剂的充分治疗效果。很少有研究着眼于铁螯合剂在透析人群中的治疗方面。方法从2017年9月至2021年9月，通过肝脏MRI对31例接受去铁铁素(DFX)治疗的继发性含铁血黄素缺铁性透析患者进行随访，评估铁螯合剂降低肝铁浓度(LIC)的效果。肝干的LIC值为50 μmol/g时，诊断为含铁血黄素沉着。结果肝MRI显示，螯合可显著降低肝铁负荷(201.4±179.9比122.6±154.3 μmol/g肝脏)(p = 0.000)，平均铁蛋白水平(2058.8±2004.9比644.2±456.6 ng/mL) (p = 0.002)。平均血红蛋白水平增加1.1 g/dL:(10.5±1.6 vs. 11.6±2.0 g/dL) (p = 0.006)。平均白蛋白水平显著升高(43±5.5 ~ 46.2±6.1 g/L) (p = 0.04)。多次输血患者负荷时间较长(p = 0.023)、MRI评估负荷程度(p = 0.003)和铁蛋白水平(p = 0.04)对治疗反应有明显影响。结论DFX给药剂量为10mg /kg/d，通过肝脏MRI和铁蛋白检测可显著降低肝脏铁负荷。治疗效果明显受输血量和铁超载程度的影响。

{"title":"Hemosiderosis in chronic dialysis patients: Monitoring the response to deferasirox by quantitative hepatic magnetic resonance imaging","authors":"Wafae Bekhechi, Hakim Chiali, Latifa Khelil, Rawda Sari-Hamidou, Mustapha Benmansour","doi":"10.1111/hdi.13081","DOIUrl":"10.1111/hdi.13081","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Hemosiderosis of chronic dialysis has always been a frequent phenomenon in dialysis; formerly related to blood transfusions before the advent of Erythropoiesis Stimulating Agents (ESA), it is currently in connection with the use of massive doses of injectable iron, to ensure the full therapeutic efficacy of ESA. Few studies have looked at the therapeutic aspect of iron chelators in the dialysis population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We followed 31 dialysis patients treated for secondary hemosiderosis with deferasirox (DFX) at the dose 10 mg/kg/day, by hepatic MRI from September 2017 to September 2021, in order to evaluate the efficacy of iron chelators on the reduction of liver iron concentration (LIC). The diagnosis of hemosiderosis was carried for a value of the LIC > 50 μmol/g of dry liver.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Chelation resulted in a significant reduction in liver iron burden as measured by liver MRI: (201.4 ± 179.9 vs. 122.6 ± 154.3 μmol/g liver) (<i>p</i> = 0.000) and in mean ferritin level: (2058.8 ± 2004.9 vs. 644.2 ± 456.6 ng/mL) (<i>p</i> = 0.002). A gain of 1.1 g/dL in mean hemoglobin level: (10.5 ± 1.6 vs. 11.6 ± 2.0 g/dL) (<i>p</i> = 0.006). A significant increase in mean albumin level: (43 ± 5.5 to 46.2 ± 6.1 g/L) (<i>p</i> = 0.04). The therapeutic response was clearly influenced by the cause of overload, longer in polytransfused patients (<i>p</i> = 0.023) and the degree of overload assessed by MRI (<i>p</i> = 0.003) and ferritin level (<i>p</i> = 0.04).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>DFX, prescribed at a dose of 10 mg/kg/day, resulted in a significant reduction in hepatic iron burden as measured by liver MRI and ferritin. The therapeutic response was clearly influenced by blood transfusions and the degree of iron overload.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9875779","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: 1

Initiative to improve the quality of patient care for chronic dialysis patients in the inpatient setting 主动提高住院慢性透析患者的护理质量

IF 1.3 4区医学 Q3 Medicine

Hemodialysis International

Pub Date : 2023-03-26 DOI: 10.1111/hdi.13078

Sai Sudha Mannemuddhu, Manzar Hussain, Liezyl Liao, Mark Segal, Rupam Ruchi

To the Editor Proper inter and intrahospital transfers remain a crucial part of the safe delivery of medical care. The most critical but often missed part of the transfer is documentation. The University of Florida (UF), Shands hospital is a large academic medical center with over 1000 beds and over 300 ICU beds that care for many patients with kidney failure on hemodialysis. We recognized that the chronic hemodialysis treatment plan was not documented in adult patients’ charts when admitted to the inpatient facility (medical wards and ICU). Chronic hemodialysis treatments were provided at various outpatient facilities (privately owned or hospital-based). The dialysis center nephrologists managed the outpatient dialysis unit, and the on-call nephrologists managed inpatient treatments. We observed that patients without appropriate documentation received different hemodialysis treatments or medication dosages (erythropoietin, vitamin D analogs, antibiotics, etc.) during hospitalization. To mitigate the situation and improve the quality of medical care and patient safety, we implemented a quality improvement (QI) project to identify the cause(s) of the inaccessibility of medical records and enact a plan to rectify the situation. The SMART aim (specific, measurable, achievable, realistic, time-bound) of this QI project is to increase the availability of complete outside medical records to consulting nephrologists by >95% in 9 months. Our QI project focuses on increasing value with zero harm.

{"title":"Initiative to improve the quality of patient care for chronic dialysis patients in the inpatient setting","authors":"Sai Sudha Mannemuddhu, Manzar Hussain, Liezyl Liao, Mark Segal, Rupam Ruchi","doi":"10.1111/hdi.13078","DOIUrl":"10.1111/hdi.13078","url":null,"abstract":"To the Editor Proper inter and intrahospital transfers remain a crucial part of the safe delivery of medical care. The most critical but often missed part of the transfer is documentation. The University of Florida (UF), Shands hospital is a large academic medical center with over 1000 beds and over 300 ICU beds that care for many patients with kidney failure on hemodialysis. We recognized that the chronic hemodialysis treatment plan was not documented in adult patients’ charts when admitted to the inpatient facility (medical wards and ICU). Chronic hemodialysis treatments were provided at various outpatient facilities (privately owned or hospital-based). The dialysis center nephrologists managed the outpatient dialysis unit, and the on-call nephrologists managed inpatient treatments. We observed that patients without appropriate documentation received different hemodialysis treatments or medication dosages (erythropoietin, vitamin D analogs, antibiotics, etc.) during hospitalization. To mitigate the situation and improve the quality of medical care and patient safety, we implemented a quality improvement (QI) project to identify the cause(s) of the inaccessibility of medical records and enact a plan to rectify the situation. The SMART aim (specific, measurable, achievable, realistic, time-bound) of this QI project is to increase the availability of complete outside medical records to consulting nephrologists by >95% in 9 months. Our QI project focuses on increasing value with zero harm.","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9849014","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

Evaluation of outcomes with permanent vascular access in an elderly Korean population based on the National Health Insurance Service database 基于国民健康保险服务数据库的韩国老年人永久性血管通路的结果评估

IF 1.3 4区医学 Q3 Medicine

Hemodialysis International

Pub Date : 2023-03-21 DOI: 10.1111/hdi.13077

Hyangkyoung Kim, Hoon Suk Park, Tae Hyun Ban, Seung Boo Yang, Young joo Kwon, the vascular access working group of the Korean Society of Dialysis Access

Introduction

As nearly half of patients with end-stage kidney disease (ESKD) who initiate hemodialysis (HD) are over 65 years old (commonly defined as elderly), the fistula first strategy is controversial even in HD patients ≥65 years.

Methods

In Korea's National Health Insurance Service database from 2008 to 2019, 41,989 elderly (≥ 65 years) HD patients were retrospectively reviewed to identify their clinical characteristics and outcomes. Vascular access (VA) patencies, risk factors associated with patencies and patient survival between arteriovenous fistula (AVF) and arteriovenous graft (AVG) were compared.

Results

Elderly AVF group (n = 28,467) had superior primary, primary assisted, and secondary patencies than elderly AVG group (n = 13,522) (all p values are <0.001). Patient survival was also better in the elderly AVF group than in the elderly AVG (p < 0.001). In multivariate Cox regression analyses for diverse outcomes, AVG (vs. AVF) was identified as a risk factor for all-cause mortality (adjusted hazard ratio [HR]: 1.307; 95% confidence interval [CI]: 1.272–1.343; p < 0.001), primary patency (adjusted HR: 1.745; 95% CI: 1.701–1.790; p < 0.001), primary-assisted patency (adjusted HR: 2.163; 95% CI: 2.095–2.233; p < 0.001), and secondary patency (adjusted HR: 3.718; 95% CI: 3.533–3.913; p < 0.001).

Conclusion

Our study demonstrated that as a permanent VA for HD, AVF should be strongly considered in elderly (≥ 65 years) ESKD Korean patients. The age limit for AVF creation in ESKD patients should be adjusted more upward.

由于近一半开始进行血液透析(HD)的终末期肾病(ESKD)患者年龄超过65岁(通常定义为老年人)，因此即使在≥65岁的HD患者中，瘘管优先策略也存在争议。方法对2008年至2019年韩国国民健康保险服务数据库中41989例老年(≥65岁)HD患者进行回顾性分析，以确定其临床特征和结局。比较动静脉瘘(AVF)和动静脉移植物(AVG)的血管通路(VA)通畅度、相关危险因素及患者生存率。结果老年AVF组(n = 28,467)的原发性、原发性辅助和继发性通畅率均高于老年AVG组(n = 13,522) (p值均为<0.001)。老年AVF组患者生存率也高于老年AVG组(p < 0.001)。在多种结局的多变量Cox回归分析中，AVG (vs. AVF)被确定为全因死亡的危险因素(校正危险比[HR]: 1.307;95%置信区间[CI]: 1.272-1.343;p < 0.001)，原发性通畅(调整后HR: 1.745;95% ci: 1.701-1.790;p < 0.001)，原发性辅助通畅(调整后风险比:2.163;95% ci: 2.095-2.233;p < 0.001)和继发性通畅(调整后HR: 3.718;95% ci: 3.533-3.913;p < 0.001)。结论:我们的研究表明，对于老年(≥65岁)韩国ESKD患者，应强烈考虑AVF作为HD的永久性VA。ESKD患者产生AVF的年龄限制应该向上调整。

{"title":"Evaluation of outcomes with permanent vascular access in an elderly Korean population based on the National Health Insurance Service database","authors":"Hyangkyoung Kim, Hoon Suk Park, Tae Hyun Ban, Seung Boo Yang, Young joo Kwon, the vascular access working group of the Korean Society of Dialysis Access","doi":"10.1111/hdi.13077","DOIUrl":"10.1111/hdi.13077","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>As nearly half of patients with end-stage kidney disease (ESKD) who initiate hemodialysis (HD) are over 65 years old (commonly defined as elderly), the fistula first strategy is controversial even in HD patients ≥65 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In Korea's National Health Insurance Service database from 2008 to 2019, 41,989 elderly (≥ 65 years) HD patients were retrospectively reviewed to identify their clinical characteristics and outcomes. Vascular access (VA) patencies, risk factors associated with patencies and patient survival between arteriovenous fistula (AVF) and arteriovenous graft (AVG) were compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Elderly AVF group (n = 28,467) had superior primary, primary assisted, and secondary patencies than elderly AVG group (n = 13,522) (all <i>p</i> values are <0.001). Patient survival was also better in the elderly AVF group than in the elderly AVG (<i>p</i> < 0.001). In multivariate Cox regression analyses for diverse outcomes, AVG (vs. AVF) was identified as a risk factor for all-cause mortality (adjusted hazard ratio [HR]: 1.307; 95% confidence interval [CI]: 1.272–1.343; <i>p</i> < 0.001), primary patency (adjusted HR: 1.745; 95% CI: 1.701–1.790; <i>p</i> < 0.001), primary-assisted patency (adjusted HR: 2.163; 95% CI: 2.095–2.233; <i>p</i> < 0.001), and secondary patency (adjusted HR: 3.718; 95% CI: 3.533–3.913; <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study demonstrated that as a permanent VA for HD, AVF should be strongly considered in elderly (≥ 65 years) ESKD Korean patients. The age limit for AVF creation in ESKD patients should be adjusted more upward.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10243625","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

Advanced Nuclear Reactors - International Issues 先进核反应堆-国际问题

IF 1.3 4区医学 Q3 Medicine

Hemodialysis International

Pub Date : 2023-03-16 DOI: 10.2172/1961172

Sanjoy Mukhopadhyay

引用次数: 0

Pregnancy in end-stage kidney disease: Great news that needs to be handled carefully 终末期肾病怀孕:需要小心处理的好消息

IF 1.3 4区医学 Q3 Medicine

Hemodialysis International

Pub Date : 2023-03-16 DOI: 10.1111/hdi.13079

Amir Kazory

Compared to women with normal kidney function, women with end-stage kidney disease (ESKD) are much less likely to become pregnant, but more likely to have a complicated pregnancy. While renal transplantation remains the best option for women who desire to have a child, pregnancy on dialysis should be considered an option for those who may not receive a transplant during their reproductive years. Many physicians do not encounter a pregnant patient with ESKD during their nephrology training, and may not feel prepared to provide care for such patients in a busy practice. In this paper, we briefly provide an overview of the most significant practical points related to management of a pregnant patient with ESKD through a real-life case with twin pregnancy. The two key elements in management of these patients would be an intensified hemodialysis regimen and a multidisciplinary team that can provide frequent, regular, and multifaceted assessments.

与肾功能正常的女性相比，患有终末期肾病(ESKD)的女性怀孕的可能性要小得多，但更有可能出现复杂的妊娠。虽然肾移植仍然是想要孩子的妇女的最佳选择，但对于那些在生育年龄可能没有接受移植的妇女来说，透析妊娠应该被考虑为一种选择。许多医生在他们的肾脏病学培训中没有遇到妊娠ESKD患者，并且可能没有准备好在繁忙的实践中为这些患者提供护理。在本文中，我们简要概述了通过现实生活中的双胎妊娠病例与ESKD妊娠患者管理相关的最重要的实践要点。管理这些患者的两个关键因素是强化血液透析方案和多学科团队，可以提供频繁，定期和多方面的评估。

引用次数: 0

Chronic kidney disease-associated pruritus in patients undergoing hemodialysis: Xerosis and topical therapy 血液透析患者的慢性肾病相关性瘙痒:干燥和局部治疗

IF 1.3 4区医学 Q3 Medicine

Hemodialysis International

Pub Date : 2023-02-22 DOI: 10.1111/hdi.13071

Arum Krismi, Retno Danarti, Ida I. Dewa Putu Pramantara Setiabudi, Yohanes W. Wirohadidjojo

Chronic kidney disease-associated pruritus (CKD-aP) is a common and distressing symptom for patients with CKD and a difficult challenge for nephrologists and dermatologists. Recent results showed the multifactorial nature of the pathophysiology, and therapeutic trials were only successful in certain subsets of patients. The clinical manifestations are varied, with xerosis being the most common dermatological manifestation and correlated with the intensity of CKD-aP. A better understanding of the pathophysiology of xerosis in CKD-aP and appropriate topical treatment could correct xerosis to reduce the intensity of CKD-aP and improve the patient's quality of life.

慢性肾脏疾病相关性瘙痒(CKD- ap)是慢性肾脏疾病患者常见且令人痛苦的症状，也是肾病学家和皮肤科医生面临的一个难题。最近的结果显示病理生理学的多因素性质，治疗试验仅在某些亚组患者中成功。临床表现多种多样，干燥是最常见的皮肤病表现，与CKD-aP的强度相关。更好地了解CKD-aP干枯的病理生理，适当的局部治疗可以纠正干枯，降低CKD-aP的强度，提高患者的生活质量。

引用次数: 0

Effects of warm or cold compresses applied to the legs during hemodialysis on cramps, fatigue, and patient comfort: A placebo-controlled randomized trial 血液透析期间腿部热敷或冷敷对抽筋、疲劳和患者舒适度的影响:一项安慰剂对照的随机试验

IF 1.3 4区医学 Q3 Medicine

Hemodialysis International

Pub Date : 2023-02-14 DOI: 10.1111/hdi.13070

Gülşah Kesik, Leyla Ozdemir, Tolga Yıldırım, Jabrayil Jabrayilov, Gülseren Çeliksöz

Introduction

Muscle cramps and fatigue are common complications in hemodialysis patients and have been associated with reduced patient comfort. Among the complementary therapies advocated for the management of these complications have been the application of warm or cold compresses to the extremities during a hemodialysis treatment. In this study, we compared the effects of warm or cold compresses application on cramping, fatigue, and patient comfort.

Methods

This placebo-controlled randomized trial was done in 69 patients, who were stratified and randomly allocated to three treatment arms. Two of the three groups included an intervention; application of either warm (n = 23) or cold (n = 23) compresses to the extremities during dialysis. The third group served as a placebo control (n = 23). The study period comprised 12 hemodialysis sessions. One week after the completion of the intervention, a follow-up dialysis session was also evaluated. Data were collected at baseline (t₀), during each of 12 intervention sessions (t₁—t₁₂), and at the follow-up session t₁₃. Cramps, fatigue, and patient comfort were evaluated using the Cramp Episode Follow-up Chart, Piper's Fatigue Scale, and the Hemodialysis Comfort Scale, respectively.

Results

In both the intervention and follow-up sessions, cramping and fatigue were lower, and comfort was higher in each of the intervention groups compared to placebo controls Application of warm compresses was superior to use of cold compresses.

Discussion

Both warm and cold compress administration reduced muscle cramps, fatigue, and hemodialysis comfort in hemodialysis patients.

肌肉痉挛和疲劳是血液透析患者常见的并发症，并与患者舒适度降低有关。在这些并发症的管理中提倡的补充疗法是在血液透析治疗期间对四肢进行热敷或冷敷。在这项研究中，我们比较了热敷和冷敷对痉挛、疲劳和患者舒适度的影响。方法采用安慰剂对照随机试验，69例患者分层随机分为3个治疗组。三组中的两组包括干预;在透析期间对四肢进行温敷(n = 23)或冷敷(n = 23)。第三组作为安慰剂对照组(n = 23)。研究期间包括12次血液透析。干预结束一周后，随访透析期也进行了评估。在基线(t0)、12个干预阶段(t1-t12)中的每一个阶段以及随访阶段(t13)收集数据。分别使用痉挛发作随访表、Piper疲劳量表和血液透析舒适量表评估痉挛、疲劳和患者舒适度。结果在干预和随访阶段，与安慰剂对照组相比，每个干预组的痉挛和疲劳程度较低，舒适度较高。冷敷和热敷均可减轻血液透析患者的肌肉痉挛、疲劳和血液透析舒适度。

{"title":"Effects of warm or cold compresses applied to the legs during hemodialysis on cramps, fatigue, and patient comfort: A placebo-controlled randomized trial","authors":"Gülşah Kesik, Leyla Ozdemir, Tolga Yıldırım, Jabrayil Jabrayilov, Gülseren Çeliksöz","doi":"10.1111/hdi.13070","DOIUrl":"10.1111/hdi.13070","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Muscle cramps and fatigue are common complications in hemodialysis patients and have been associated with reduced patient comfort. Among the complementary therapies advocated for the management of these complications have been the application of warm or cold compresses to the extremities during a hemodialysis treatment. In this study, we compared the effects of warm or cold compresses application on cramping, fatigue, and patient comfort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This placebo-controlled randomized trial was done in 69 patients, who were stratified and randomly allocated to three treatment arms. Two of the three groups included an intervention; application of either warm (<i>n</i> = 23) or cold (<i>n</i> = 23) compresses to the extremities during dialysis. The third group served as a placebo control (<i>n</i> = 23). The study period comprised 12 hemodialysis sessions. One week after the completion of the intervention, a follow-up dialysis session was also evaluated. Data were collected at baseline (<i>t</i><sub>0</sub>), during each of 12 intervention sessions (<i>t</i><sub>1</sub>—<i>t</i><sub>12</sub>), and at the follow-up session <i>t</i><sub>13</sub>. Cramps, fatigue, and patient comfort were evaluated using the Cramp Episode Follow-up Chart, Piper's Fatigue Scale, and the Hemodialysis Comfort Scale, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In both the intervention and follow-up sessions, cramping and fatigue were lower, and comfort was higher in each of the intervention groups compared to placebo controls Application of warm compresses was superior to use of cold compresses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Both warm and cold compress administration reduced muscle cramps, fatigue, and hemodialysis comfort in hemodialysis patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9411981","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

Effects of pre-analytical sample care and analysis methodology on measures of metabolic acidosis in hemodialysis patients 分析前样品护理和分析方法对血液透析患者代谢性酸中毒测量的影响

IF 1.3 4区医学 Q3 Medicine

Hemodialysis International

Pub Date : 2023-02-14 DOI: 10.1111/hdi.13069

Camilla C. Correa, Mariana M. B. Figueiredo, Analucia R. Xavier, Salim Kanaan, Jocemir R. Lugon

Introduction

We evaluated the effects of pre-analytical care on total carbon dioxide (tCO₂) in hemodialysis patients, as calculated by blood gas analysis (ctCO₂) or measured by an enzymatic assay (mtCO₂).

Methods

Blood samples were collected via vascular access before dialysis sessions. For blood gas analysis, eight aliquots were collected, refrigerated or non-refrigerated, and analyzed at 0, 4, 8, and 24 h after collection. A blood sample was then collected for the enzymatic method and distributed into 14 aliquots. Half of the aliquots were refrigerated. The samples analyzed at time point 0 were centrifuged immediately. The remaining aliquots of both the refrigerated and non-refrigerated clusters were centrifuged before storage. Samples were analyzed at 4, 8, and 24 h post-collection.

Findings

By blood gas analysis, no significant change was found in bicarbonate values over time, either in the non-refrigerated or refrigerated samples. ctCO₂ values during the experiment showed a minor but statistically significant increase of questionable clinical relevance in both non-refrigerated and refrigerated aliquots. In the enzymatic assay, the reduction in mtCO₂ levels during the experiment was negligible. The median absolute reductions at the end of the experiment were 1.77, 1.21, 1.04, and 1.12 mmol/L for the non-centrifuged/non-refrigerated, centrifuged/non-refrigerated, non-centrifuged/refrigerated, and centrifuged/refrigerated aliquots, respectively.

Discussion

Our results suggest that measured or calculated tCO₂ levels of capped and cooled samples are adequate for analyzing the acid–base status of hemodialysis patients, even when such determination is not performed immediately after collection.

我们评估了分析前护理对血液透析患者总二氧化碳(tCO2)的影响，通过血气分析(ctCO2)计算或酶分析(mtCO2)测量。方法透析前经血管通道采血。血气分析，收集8个等分，冷藏或不冷藏，并在收集后0、4、8和24小时进行分析。然后收集血液样本用于酶法，并将其分成14份。一半的等分水被冷藏。在时间点0分析的样品立即离心。冷冻和非冷冻的剩余等分在储存前进行离心。在采集后4、8和24 h对样品进行分析。通过血气分析，无论是在非冷藏还是冷藏样品中，碳酸氢盐值都没有随着时间的推移而发生显著变化。实验期间的ctCO2值显示，在非冷藏和冷藏等分中，可疑的临床相关性有轻微但统计学上显著的增加。在酶促分析中，实验期间mtCO2水平的降低可以忽略不计。实验结束时，非离心/非冷藏、离心/非冷藏、非离心/冷藏、离心/冷藏和离心/冷藏等分的绝对降低中值分别为1.77、1.21、1.04和1.12 mmol/L。我们的研究结果表明，封顶和冷却样品的测量或计算的tCO2水平足以分析血液透析患者的酸碱状态，即使在收集后没有立即进行这种测定。

{"title":"Effects of pre-analytical sample care and analysis methodology on measures of metabolic acidosis in hemodialysis patients","authors":"Camilla C. Correa, Mariana M. B. Figueiredo, Analucia R. Xavier, Salim Kanaan, Jocemir R. Lugon","doi":"10.1111/hdi.13069","DOIUrl":"10.1111/hdi.13069","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>We evaluated the effects of pre-analytical care on total carbon dioxide (tCO<sub>2</sub>) in hemodialysis patients, as calculated by blood gas analysis (ctCO<sub>2</sub>) or measured by an enzymatic assay (mtCO<sub>2</sub>).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Blood samples were collected via vascular access before dialysis sessions. For blood gas analysis, eight aliquots were collected, refrigerated or non-refrigerated, and analyzed at 0, 4, 8, and 24 h after collection. A blood sample was then collected for the enzymatic method and distributed into 14 aliquots. Half of the aliquots were refrigerated. The samples analyzed at time point 0 were centrifuged immediately. The remaining aliquots of both the refrigerated and non-refrigerated clusters were centrifuged before storage. Samples were analyzed at 4, 8, and 24 h post-collection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>By blood gas analysis, no significant change was found in bicarbonate values over time, either in the non-refrigerated or refrigerated samples. ctCO<sub>2</sub> values during the experiment showed a minor but statistically significant increase of questionable clinical relevance in both non-refrigerated and refrigerated aliquots. In the enzymatic assay, the reduction in mtCO<sub>2</sub> levels during the experiment was negligible. The median absolute reductions at the end of the experiment were 1.77, 1.21, 1.04, and 1.12 mmol/L for the non-centrifuged/non-refrigerated, centrifuged/non-refrigerated, non-centrifuged/refrigerated, and centrifuged/refrigerated aliquots, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Our results suggest that measured or calculated tCO<sub>2</sub> levels of capped and cooled samples are adequate for analyzing the acid–base status of hemodialysis patients, even when such determination is not performed immediately after collection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9411982","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

Individually adjusted absolute blood volume feedback control: A promising solution for intradialytic hypotension 单独调节绝对血容量反馈控制:一个有希望的解决方案，为透析性低血压

IF 1.3 4区医学 Q3 Medicine

Hemodialysis International

Pub Date : 2023-02-14 DOI: 10.1111/hdi.13074

Marta Álvarez Nadal, Nuria Rodríguez Mendiola, Martha Elizabeth Díaz Domínguez, Milagros Fernández Lucas

Introduction

Intradialytic hypotension (IDH) remains one of the most frequent complications associated to hemodialysis (HD), frequently triggered by a reduction in absolute blood volume (ABV) not compensated by vascular refilling. A recently developed dilutional method allows routinary measurement of ABV and, by a simple algorithm, may turn blood volume monitor (BVM) guided UF (ultrafiltration) biofeedback into an ABV control, automatically adjusting UF rate to maintain ABV above a preset threshold. The aim of this study is to identify an individual critical ABV threshold and test the ability of an ABV feedback control to avoid IDH.

Methods

We studied 24 patients throughout three consecutive midweek HD treatments. ABV and blood pressure (BP) were measured every 30 min and anytime the patient referred any symptoms to identify each patient's critical ABV (ABV at the time of hypotension). A fixed bolus dilution approach at the start of HD was used to calculate ABV. Then, patients were followed through three additional HD treatments and IDH development was analyzed.

Findings

Seventy-one treatments performed in 24 patients. ABV monitoring showed a constant decrease as HD treatment progressed. Thirteen IDH events were observed in eight different patients, with a mean systolic BP drop in IDH treatments of 37.38 ± 4.31 mmHg and a mean adjusted ABV at hypotension of 71.07 ± 14.88 mL/kg. Critical ABV was individually set in patients prone to IDH. As expected, ABV feedback control successfully maintained ABV over preset critical ABV. IDH events were avoided in 21 out of 22 treatments performed. ABV drop was successfully reduced, as well as SBP drop (despite similar UF than prior to ABV feedback control implementation).

Discussion

ABV feedback control avoided IDH in 21 out of 22 treatments performed by maintaining blood volume above critical ABV, significantly reducing ABV variations without compromising prescribed UF.

分析性低血压(IDH)仍然是与血液透析(HD)相关的最常见的并发症之一，通常由绝对血容量(ABV)的减少引起，而不是由血管再充盈补偿。最近开发的一种稀释方法允许常规测量ABV，并且通过简单的算法，可以将血容量监视器(BVM)引导的UF(超滤)生物反馈转变为ABV控制，自动调节UF速率以保持ABV高于预设阈值。本研究的目的是确定个体临界ABV阈值，并测试ABV反馈控制避免IDH的能力。方法对24例患者进行连续三次周中HD治疗。每30分钟及患者提及任何症状时测量ABV和血压(BP)，以确定每位患者的临界ABV(低血压时的ABV)。HD开始时采用固定体积稀释法计算ABV。然后，对患者进行三次额外的HD治疗，并分析IDH的发展情况。结果24例患者共进行71次治疗。ABV监测显示，随着HD治疗的进展，ABV持续下降。在8例不同的患者中观察到13例IDH事件，IDH治疗时平均收缩压下降37.38±4.31 mmHg，低血压时平均调整ABV为71.07±14.88 mL/kg。对易发生IDH的患者单独设定临界ABV。正如预期的那样，ABV反馈控制成功地在预设的临界ABV上维持了ABV。22例治疗中有21例避免了IDH事件。ABV下降成功降低，SBP下降(尽管UF与ABV反馈控制实施前相似)。ABV反馈控制在22例治疗中有21例通过维持血容量高于临界ABV来避免IDH，显著减少ABV变化而不影响规定的UF。

{"title":"Individually adjusted absolute blood volume feedback control: A promising solution for intradialytic hypotension","authors":"Marta Álvarez Nadal, Nuria Rodríguez Mendiola, Martha Elizabeth Díaz Domínguez, Milagros Fernández Lucas","doi":"10.1111/hdi.13074","DOIUrl":"10.1111/hdi.13074","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Intradialytic hypotension (IDH) remains one of the most frequent complications associated to hemodialysis (HD), frequently triggered by a reduction in absolute blood volume (ABV) not compensated by vascular refilling. A recently developed dilutional method allows routinary measurement of ABV and, by a simple algorithm, may turn blood volume monitor (BVM) guided UF (ultrafiltration) biofeedback into an ABV control, automatically adjusting UF rate to maintain ABV above a preset threshold. The aim of this study is to identify an individual critical ABV threshold and test the ability of an ABV feedback control to avoid IDH.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We studied 24 patients throughout three consecutive midweek HD treatments. ABV and blood pressure (BP) were measured every 30 min and anytime the patient referred any symptoms to identify each patient's critical ABV (ABV at the time of hypotension). A fixed bolus dilution approach at the start of HD was used to calculate ABV. Then, patients were followed through three additional HD treatments and IDH development was analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Seventy-one treatments performed in 24 patients. ABV monitoring showed a constant decrease as HD treatment progressed. Thirteen IDH events were observed in eight different patients, with a mean systolic BP drop in IDH treatments of 37.38 ± 4.31 mmHg and a mean adjusted ABV at hypotension of 71.07 ± 14.88 mL/kg. Critical ABV was individually set in patients prone to IDH. As expected, ABV feedback control successfully maintained ABV over preset critical ABV. IDH events were avoided in 21 out of 22 treatments performed. ABV drop was successfully reduced, as well as SBP drop (despite similar UF than prior to ABV feedback control implementation).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>ABV feedback control avoided IDH in 21 out of 22 treatments performed by maintaining blood volume above critical ABV, significantly reducing ABV variations without compromising prescribed UF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12815,"journal":{"name":"Hemodialysis International","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9411980","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: 2