Hemodialysis International最新文献_第9页

The Relationship Between Uric Acid and Mortality in Hemodialysis Patients 血液透析患者尿酸与死亡率的关系。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2025-03-25 DOI: 10.1111/hdi.13237

Can Hüzmeli, Ayşe Şeker, Hatice Ortaç, Ali Borazan, Serhan Pişkinpaşa, Ferhan Candan

Introduction

Uric acid, the end product of purine metabolism, is an antioxidant molecule. Both low and high serum uric acid levels are associated with increased mortality. The aim is to investigate the relationship between serum uric acid levels and mortality in hemodialysis patients.

Methods

This retrospective study was conducted on hemodialysis patients in Hatay, Turkey, between 2010 and 2023. Records were reviewed, and serum uric acid levels, other laboratory tests, and hemodialysis duration were noted. Patients on hemodialysis for at least 3 months were included. A p-value of less than 0.05 was considered statistically significant.

Findings

A total of 3443 hemodialysis patients were included. The average age was 64.39 ± 13.57 years (minimum: 18 years, maximum: 90 years), and 58% were male. The mean serum uric acid level was 6.23 ± 1.43 mg/dL (range: 0.1–16). The prevalence of hyperuricemia was 39.3%, and hypouricemia was 0.2%. The median parathyroid hormone (PTH) value was lower in the group with a serum uric acid level ≤ 4 mg/dL (p < 0.001) and higher in the group with a serum uric acid level > 7 mg/dL (p < 0.001). There were significant differences in mortality among the study groups (p < 0.001). Subgroup analyses revealed that the mortality rate was higher in the patient group with serum uric acid levels ≤ 4 mg/dL and lower in the group with serum uric acid levels > 7 mg/dL (p < 0.001).

Discussion

Low serum uric acid levels have been associated with increased mortality; this may be because serum uric acid is an indicator of nutritional status. Higher serum uric acid levels were associated with higher PTH levels; further studies are needed to elucidate the causal relationship. Low serum uric acid levels were associated with an increased risk of cerebrovascular disease.

尿酸是嘌呤代谢的最终产物，是一种抗氧化分子。低和高血清尿酸水平都与死亡率增加有关。目的是探讨血液透析患者血清尿酸水平与死亡率之间的关系。方法：对2010 - 2023年土耳其哈塔伊地区血液透析患者进行回顾性研究。审查了记录，并记录了血清尿酸水平、其他实验室检查和血液透析持续时间。接受血液透析至少3个月的患者被纳入研究。p值小于0.05被认为具有统计学意义。结果：共纳入血液透析患者3443例。平均年龄64.39±13.57岁（最小18岁，最大90岁），男性占58%。平均血清尿酸水平为6.23±1.43 mg/dL（范围：0.1 ~ 16）。高尿酸血症患病率为39.3%，低尿酸血症患病率为0.2%。血清尿酸水平≤4mg /dL （p7mg /dL）组甲状旁腺激素（PTH）中位值较低讨论：低血清尿酸水平与死亡率增加有关；这可能是因为血清尿酸是营养状况的一个指标。较高的血清尿酸水平与较高的甲状旁腺激素水平相关；需要进一步的研究来阐明因果关系。低血清尿酸水平与脑血管疾病的风险增加有关。

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引用次数: 0

The Relationship Between Fluid Control and Health Literacy in Patients Receiving Hemodialysis Treatment 血液透析患者体液控制与健康素养的关系

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2025-03-25 DOI: 10.1111/hdi.13240

Havva Doğankaya, Ezgi Mutluay Yayla

Background

Failure to adhere to fluid restrictions negatively affects the quality of life and increases the risk of complications among hemodialysis patients. In chronic diseases, including chronic kidney disease, health literacy plays a crucial role in mitigating disease complications. The level of health literacy in chronic diseases such as chronic kidney disease can play a significant role in reducing the complications of the disease. This study aimed to assess the relationship between fluid control and health literacy in hemodialysis patients, representing the first such research in Turkey.

Methods

This descriptive, cross-sectional, and correlational study was conducted in all dialysis centers in Bolu province, Turkey, from September 2022 to August 2023. The study included 144 hemodialysis outpatients meeting the inclusion criteria. Patient fluid control and health literacy were assessed using the “Fluid Restriction Scale in Patients Receiving Hemodialysis Treatment” and the “Turkey Health Literacy Scale-32”. Statistical analysis was performed using SPSS version 25.0.

Results

The mean total score on the Health Literacy Scale was 22.6 ± 10.2, indicating a relatively low level of health literacy among the hemodialysis patients. 54.2% of patients receiving hemodialysis treatment exhibited inadequate health literacy. The mean score on the Fluid Restriction Scale was 50.4 ± 8.63, suggesting moderate fluid control adherence among the study population. 56.3% of hemodialysis patients had moderate levels of fluid control. A statistically significant moderate positive correlation was found between fluid control and health literacy levels (r = 0.456, p < 0.001). Health literacy scores accounted for 20.2% of the variance in fluid restriction scores (R ² = 0.20), indicating a moderate contribution of health literacy to fluid control adherence.

Conclusion

This study revealed a positive correlation between health literacy and fluid control adherence. Therefore, it is recommended that hemodialysis nurses concurrently assess patients' health literacy and fluid control and develop tailored educational programs based on these assessments.

背景：未能坚持液体限制会对血液透析患者的生活质量产生负面影响，并增加并发症的风险。对于慢性疾病，包括慢性肾病，卫生知识在减轻疾病并发症方面发挥着至关重要的作用。慢性肾病等慢性疾病的卫生知识水平可以在减少疾病并发症方面发挥重要作用。本研究旨在评估血液透析患者体液控制与健康素养之间的关系，这是土耳其首次开展此类研究。方法：这项描述性、横断面和相关性研究于2022年9月至2023年8月在土耳其Bolu省的所有透析中心进行。本研究纳入144例符合纳入标准的血液透析门诊患者。采用“接受血液透析治疗的患者液体限制量表”和“土耳其健康素养量表-32”对患者的液体控制和健康素养进行评估。采用SPSS 25.0版本进行统计分析。结果：血透患者健康素养量表平均总分为22.6±10.2分，血透患者健康素养水平较低。接受血液透析治疗的患者中有54.2%表现出健康素养不足。液体限制量表的平均得分为50.4±8.63，表明研究人群的液体控制依从性中等。56.3%的血液透析患者有中等水平的体液控制。液体控制与健康素养水平之间存在统计学上显著的中度正相关（r = 0.456, p 2 = 0.20），表明健康素养对液体控制依从性有中度贡献。结论：本研究显示健康素养与液体控制依从性呈正相关。因此，建议血液透析护士同时评估患者的健康素养和流体控制，并根据这些评估制定量身定制的教育计划。

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引用次数: 0

The Impact of Socioeconomic Factors on the Prevalence of Hemodialysis in Mainland China 社会经济因素对中国大陆血液透析流行的影响。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2025-03-25 DOI: 10.1111/hdi.13218

Zenghui Xing, Sichen Li, Delong Zhao, Chao Liu, Guangyan Cai, Xiangmei Chen, Xuefeng Sun

Objective

The prevalence of hemodialysis varies significantly across countries and regions with different levels of socioeconomic development. This paper aims to analyze the socioeconomic factors influencing hemodialysis in mainland China, providing a basis for formulating reasonable hemodialysis strategies.

Methods

All the hemodialysis prevalence data and socioeconomic data were obtained from the National Medical Service and Quality Safety Report and the China Statistical Yearbook. The 31 regions were categorized into low, medium, and high groups based on the per capita gross domestic product, and the changes in hemodialysis prevalence rates and their growth rates were compared. Linear regression analysis was conducted to identify the independent risk factors affecting hemodialysis prevalence rates.

Results

Significant differences in hemodialysis prevalence rates were observed across different years and per capita gross domestic product groups (p < 0.001). The prevalence of hemodialysis in the low and medium per capita gross domestic product groups significantly increased from 2011 to 2020 (p < 0.001), while an increase in the high per capita gross domestic product group was not statistically significant (p > 0.05). The growth in hemodialysis prevalence rates over the 10-year period decreased with increasing per capita gross domestic product levels in 2011 (325.2% ± 98.6%, 209.3% ± 61.9%, and 52.6% ± 73.7% for the low, medium, and high per capita gross domestic product groups, respectively). The incidence of hemodialysis, per capita gross domestic product, the proportion of rural–urban population, highway mileage per square kilometer, and the number of beds in medical facilities per 1000 population were identified as independent factors of hemodialysis prevalence rates (p < 0.05).

Conclusions

With the development of the social economy and the enhancement of medical service capabilities, the prevalence of hemodialysis in Mainland China has increased. Compared to economically less developed and moderately developed regions, the increase in hemodialysis prevalence in economically developed areas has been attenuated.

目的：不同社会经济发展水平的国家和地区血液透析患病率差异显著。本文旨在分析影响中国大陆血液透析的社会经济因素，为制定合理的血液透析策略提供依据。方法：所有血液透析流行数据和社会经济数据来源于《国家医疗服务和质量安全报告》和《中国统计年鉴》。将31个地区按人均国内生产总值分为低、中、高三组，比较各地区血液透析患病率及增长率的变化情况。采用线性回归分析确定影响血液透析患病率的独立危险因素。结果：血液透析患病率在不同年份和人均国内生产总值组之间存在显著差异（p < 0.05）。2011年，随着人均国内生产总值（gdp）水平的提高，10年间血液透析患病率的增幅有所下降（人均gdp低、中、高组分别为325.2%±98.6%、209.3%±61.9%、52.6%±73.7%）。血液透析发病率、人均国内生产总值、城乡人口比例、每平方公里公路里程、每千人口医疗机构床位数是影响血液透析患病率的独立因素(p)。结论：随着社会经济的发展和医疗服务能力的提高，中国大陆地区血液透析患病率有所上升。与经济欠发达和中等发达地区相比，经济发达地区血液透析患病率的增长有所减弱。

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引用次数: 0

Serum Nickel Concentrations in Patients Receiving Chronic Hemodialysis 慢性血液透析患者血清镍浓度。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2025-03-24 DOI: 10.1111/hdi.13235

Wen-Yu Ho, Ju-Ching Yen, Cheng-Hao Weng, Wen-Hung Huang, Li-Chung Chiu, Po-Yen Kuo, Kai-Fan Tsai, I-Kuan Wang, Tzung-Hai Yen, Ching-Wei Hsu

Introduction

Chronic nickel accumulation is harmful to multiple organ systems, and nickel is classified as a human carcinogen. Nevertheless, few studies have examined serum nickel concentrations in end-stage kidney disease (ESKD) patients receiving chronic hemodialysis, and the relationship of serum nickel with clinical outcomes remains unclear.

Methods

This prospective observational study recruited 409 hemodialysis patients in 2019 and followed them for 18 months. The patients were stratified into four quartiles, that is, < 2.9 μg/L (n = 92), 2.9 μg/L to < 3.4 g/L (n = 104), 3.4 μg/L to < 3.9 μg/L (n = 104), and ≥ 3.9 μg/L (n = 109), according to their serum nickel concentrations. Baseline demographic, hematologic, biochemical, dialysis-related, and mortality data were obtained for analysis.

Findings

The mean age of the patients was 62.9 ± 11.7 years. A total of 401 (98.04%) patients had elevated serum nickel concentrations, with an average level of 3.6 ± 1.3 μg/L. Higher quartiles of serum nickel were associated with longer dialysis vintage (p < 0.001), higher Kt/V values (p < 0.001), and higher urea removal rates (p < 0.001). Multivariate analysis identified albumin level and dialysis vintage as independent factors positively correlated with serum nickel concentrations (R = 0.163, p = 0.001; R = 0.212, p < 0.001, respectively). Nevertheless, no association was found between serum nickel levels and all-cause mortality.

Conclusion

ESKD patients on hemodialysis commonly exhibit elevated serum nickel concentrations, possibly linked to serum albumin levels and dialysis vintage. Further studies are warranted.

简介：慢性镍积累对多器官系统有害，镍被列为人类致癌物。然而，很少有研究检测接受慢性血液透析的终末期肾病（ESKD）患者的血清镍浓度，血清镍与临床结局的关系尚不清楚。方法：本前瞻性观察性研究于2019年招募409例血液透析患者，随访18个月。结果：患者平均年龄为62.9±11.7岁。401例（98.04%）患者血清镍浓度升高，平均为3.6±1.3 μg/L。结论：接受血液透析的ESKD患者通常表现出血清镍浓度升高，可能与血清白蛋白水平和透析时间有关。进一步的研究是必要的。

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引用次数: 0

Associations Between Type of Hemodialysis Access and Pulmonary Hypertension: A Single-Center Retrospective Cohort 血液透析途径类型与肺动脉高压的关系：一项单中心回顾性队列研究

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2025-03-23 DOI: 10.1111/hdi.13231

Muhammad Umair Jahngir, Christine De Antonis, Rizwan Rabbani, Amir Ashiq, Ajiya Fatima, Rabia Ahmed, Avrum Gillespie

<div> <section> <h3> Background</h3> <p>Pulmonary hypertension affects patients with hemodialysis-dependent end-stage kidney failure; however, the estimated prevalence varies greatly due to the underutilization of right heart catheterization and the evolving diagnostic criteria of pulmonary hypertension. Pulmonary hypertension in end-stage kidney failure is often attributed to arteriovenous (AV) access; therefore, we hypothesized that patients with AV fistula/graft would have a greater prevalence of pulmonary hypertension on right heart catheterization compared to those with central venous (CV) catheter accesses.</p> </section> <section> <h3> Methods</h3> <p>In this retrospective single-center cohort study, we identified and randomly sampled patients from July 2012 to August 2022 receiving hemodialysis for ≥ 3 months and who underwent right heart catheterization, using Current Procedural Terminology codes. Pulmonary hypertension was defined as mean pulmonary arterial pressure (mPAP) > 20 mmHg. Our primary outcome was the prevalence of pulmonary hypertension among patients with AV fistula/graft versus CV hemodialysis access, tested with descriptive statistics. We evaluated survival as a secondary outcome using a Cox proportional hazards model.</p> </section> <section> <h3> Results</h3> <p>A total of 3834 patient charts were extracted. Overall, 444 charts were randomly sampled, resulting in 137 subjects meeting the inclusion criteria. The mean age was 63.8 ± 10.5 years, and 62% were male. The most common etiology of end-stage kidney failure was diabetic kidney disease (57.7%). Eighty percent of end-stage kidney failure patients had pulmonary hypertension; however, the type of hemodialysis access was not associated with pulmonary hypertension (85% CV catheter vs. 79.5% AV access, <i>p</i> = 0.59). Patients with pulmonary hypertension had lower hemoglobin (9.6 ± 0.8 vs. 11.2 ± 1.3 g/dL, <i>p</i> < 0.0001) and serum albumin (2.3 ± 0.9 vs. 3.4 ± 0.6 g/dL, <i>p</i> < 0.0001) than those without pulmonary hypertension. Those with pulmonary hypertension had an increased risk of mortality (hazard ratio: 2.2, 95% confidence interval: 1.04–4.61; <i>p</i> = 0.04).</p> </section> <section> <h3> Conclusion</h3> <p>Our findings show a high burden of pulmonary hypertension among this heterogeneous cohort of end-stage kidney failure patients, with no association between pulmonary hypertension and the type of hemodialysis access. This study highlights the need for prospective investigations incorporating current strategies for pulmonary hypertension diagnosis and treatment among the dialysis-dependent population.</p> </section>

背景：肺动脉高压影响着依赖血液透析的终末期肾衰竭患者；然而，由于右心导管检查的利用率不足以及肺动脉高压诊断标准的不断变化，估计的患病率差异很大。终末期肾衰竭患者的肺动脉高压通常归因于动静脉（AV）通路；因此，我们假设，与中心静脉（CV）导管通路的患者相比，动静脉瘘/移植物患者在右心导管检查中的肺动脉高压发病率更高：在这项回顾性单中心队列研究中，我们使用当前程序术语代码，识别并随机抽取了 2012 年 7 月至 2022 年 8 月期间接受血液透析≥ 3 个月并接受右心导管检查的患者。肺动脉高压的定义是平均肺动脉压 (mPAP) > 20 mmHg。我们的主要研究结果是房室瘘/移植物与 CV 血液透析通路患者的肺动脉高压患病率，并通过描述性统计进行检验。作为次要结果，我们使用 Cox 比例危险模型评估了存活率：共提取了 3834 份患者病历。结果：我们共提取了 3834 份患者病历，随机抽样 444 份，符合纳入标准的受试者为 137 人。平均年龄为（63.8 ± 10.5）岁，62%为男性。终末期肾衰竭最常见的病因是糖尿病肾病（57.7%）。80%的终末期肾衰竭患者患有肺动脉高压；然而，血液透析通路的类型与肺动脉高压无关（85%的CV导管与79.5%的AV通路相比，P = 0.59）。肺动脉高压患者的血红蛋白较低（9.6 ± 0.8 vs. 11.2 ± 1.3 g/dL，P 结论：我们的研究结果表明，肺动脉高压患者的负担较重：我们的研究结果表明，在这个异质性的终末期肾衰竭患者群体中，肺动脉高压的负担很重，而肺动脉高压与血液透析通路类型之间没有关联。这项研究强调，有必要在透析依赖人群中开展前瞻性调查，并结合当前的肺动脉高压诊断和治疗策略。

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引用次数: 0

Carbon Dioxide Digital Subtraction Angiography for Central Venous Recanalization in a Kidney Transplant Patient: A Case Report 二氧化碳数字减影血管造影用于肾移植患者中心静脉再通：1例报告。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2025-03-22 DOI: 10.1111/hdi.13234

Limei Chen, Ruining Liu, Tianlei Cui

Background

We present the case of a kidney transplant recipient with elevated serum creatinine who developed left upper limb swelling due to left subclavian vein thrombosis. Concerned about potential hemodialysis resumption, the patient prioritized preserving their arteriovenous fistula.

Methods

To address the swelling and maintain fistula function, central venous recanalization was necessary. Given the risk of iodine contrast-induced acute kidney injury, particularly with elevated creatinine, the patient opted for carbon dioxide (CO₂) angiography. Following forearm fistula puncture, a catheter was inserted, and 50 mL of CO₂ was injected. Angiography revealed a left subclavian vein filling defect and stenosis, preventing guidewire passage. The stenosis was dilated using an 8 mm × 20 mm balloon, followed by implantation of a 6 mm × 10 mm vascular stent. Postintervention CO₂ angiography confirmed successful vein opening. Oral rivaroxaban was prescribed for anticoagulation.

Results

The patient's limb swelling gradually resolved, and serum creatinine remained stable.

Conclusion

CO₂-DSA represents a potentially viable alternative imaging modality for patients requiring vascular interventions who are at elevated risk of iodinated contrast-induced nephropathy.

背景：我们报告一例肾移植受者血清肌酐升高，由于左锁骨下静脉血栓形成而发展为左上肢肿胀。考虑到可能的血液透析恢复，患者优先考虑保留其动静脉瘘。方法：通过中心静脉再通治疗瘘口肿胀，维持瘘口功能。考虑到碘造影剂引起急性肾损伤的风险，特别是肌酐升高，患者选择了二氧化碳血管造影。前臂瘘穿刺后，插入导管，注射CO2 50 mL。血管造影显示左锁骨下静脉充盈缺损和狭窄，阻止导丝通过。使用8mm × 20mm球囊扩张狭窄，然后植入6mm × 10mm血管支架。干预后CO2血管造影证实静脉打开成功。口服利伐沙班用于抗凝。结果：患者肢体肿胀逐渐消退，血清肌酐保持稳定。结论：CO2-DSA对于需要血管介入治疗且碘化造影剂肾病风险高的患者是一种潜在可行的替代成像方式。

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引用次数: 0

Treatment Strategies for Refractory Catheter-Related Central Venous Occlusive Disorders: Review 难治性导管相关中心静脉闭塞性疾病的治疗策略：综述。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2025-03-14 DOI: 10.1111/hdi.13229

Xiao Ma, Jiehao Chen, Tianqiao Yang, Lan Gao, Yaoxiong Xia

Background

Catheter-related central vein occlusive disease (CVOD) is a frequent complication in hemodialysis patients and significantly affects their prognosis. Current treatment options for catheter-related CVOD include standard guidewire and catheter techniques, radiofrequency ablation, and sharp recanalization. However, large-scale clinical trials evaluating these techniques are lacking, making CVOD management challenging. This article reviews current treatment strategies for catheter-related CVOD.

Methods

A comprehensive literature review was conducted via PubMed, focusing on studies evaluating the effectiveness and safety of various treatment modalities for CVOD. The following keywords were used in PubMed: “hemodialysis”, “central vein occlusion”, “central vein stenosis”, and “catheter”.

Results

The treatment methods for refractory CVOD in hemodialysis patients are diverse, including sharp recanalization, radiofrequency ablation, and percutaneous superior vena cava puncture. Complications and success rates vary widely across treatments, and evidence is generally limited to small studies or case series. However, a standardized treatment protocol is still lacking.

Conclusions

While several techniques show promise in treating catheter-related CVOD, high-quality clinical studies are necessary to identify the more effective and safe procedure. The choice of treatment should be based on individual patient characteristics, extent of the occlusion, and available resources. Percutaneous SVC puncture may be a feasible alternative after failed sharp recanalization for refractory CVOD.

背景：导管相关性中央静脉闭塞性疾病（CVOD）是血液透析患者的常见并发症，严重影响其预后。目前导管相关CVOD的治疗方案包括标准导丝和导管技术、射频消融和尖锐再通术。然而，缺乏评估这些技术的大规模临床试验，这使得CVOD管理具有挑战性。本文综述了目前导管相关CVOD的治疗策略。方法：通过PubMed进行文献综述，重点评价各种治疗方式治疗慢性阻塞性肺病的有效性和安全性。PubMed中使用的关键词有：“血液透析”、“中央静脉闭塞”、“中央静脉狭窄”、“导管”。结果：血液透析患者难治性CVOD的治疗方法多种多样，包括尖锐再通、射频消融、经皮上腔静脉穿刺等。不同治疗的并发症和成功率差异很大，证据通常仅限于小型研究或病例系列。然而，目前仍缺乏标准化的治疗方案。结论：虽然有几种技术在治疗导管相关CVOD方面显示出希望，但需要高质量的临床研究来确定更有效和安全的治疗方法。治疗的选择应基于个体患者的特点，闭塞的程度和可用的资源。经皮SVC穿刺可能是难治性CVOD尖锐再通失败后可行的替代方法。

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引用次数: 0

Oral Sodium Bicarbonate vs. Use of Higher Dialysate Bicarbonate in Hemodialysis Patients With Metabolic Acidosis: A Randomized Controlled Trial 口服碳酸氢钠与使用高透析液碳酸氢钠治疗血透患者代谢性酸中毒：一项随机对照试验

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2025-03-14 DOI: 10.1111/hdi.13230

Hoda M. M. Abdulaziz, Alaa Sabry, Marwa Saleh, Ghada El-Said

Introduction

The optimal strategy for correcting metabolic acidosis and maintaining acid–base balance in hemodialysis patients remains unclear. This study aimed to evaluate and compare the effects of oral bicarbonate administration vs. increased dialysate bicarbonate concentration on predialysis serum bicarbonate levels in hemodialysis patients with metabolic acidosis.

Methods

This was a single-center, open-label, randomized controlled trial. Adult hemodialysis patients with metabolic acidosis (serum bicarbonate < 22 mmol/L) were randomly assigned in a 1:1:1 ratio to one of three treatment groups for 16 weeks: (1) standard dialysate (32 mM bicarbonate plus 3 mM acetate), (2) increased dialysate bicarbonate (34 mM bicarbonate plus 3 mM acetate), or (3) standard dialysate with daily oral sodium bicarbonate supplementation (0.3–0.5 mmol/kg). Of the 75 eligible participants, 66 completed the study. The primary outcome was the difference in predialysis serum bicarbonate levels between the groups at 16 weeks.

Results

Baseline predialysis serum bicarbonate levels averaged approximately 19.5 mmol/L across all three groups. At 16 weeks, there was no statistically significant difference in predialysis serum bicarbonate levels among the groups (p = 0.701). The mean levels were 20.1 (SD 2.16) mmol/L in the standard dialysate group, 20.5 (SD 2.04) mmol/L in the increased dialysate bicarbonate group, and 20.8 (SD 2.61) mmol/L in the oral supplementation group. Compared to baseline, predialysis bicarbonate levels significantly increased within the increased dialysate bicarbonate group (p = 0.010) and the oral supplementation group (p = 0.021), but not in the control (standard dialysate, no oral supplementation) group.

Conclusion

Oral or dialytic bicarbonate supplementation at the doses used in this study demonstrated equivalent effects on predialysis serum bicarbonate concentrations in acidotic hemodialysis patients. However, the amount of supplemental bicarbonate administered via either route was insufficient to achieve the target correction of acidosis (e.g., predialysis serum bicarbonate ≥ 22 mmol/L).

导言：血液透析患者纠正代谢性酸中毒和维持酸碱平衡的最佳策略尚不清楚。本研究旨在评估和比较口服碳酸氢盐与增加透析液碳酸氢盐浓度对代谢性酸中毒血液透析患者透析前血清碳酸氢盐水平的影响。方法：这是一项单中心、开放标签、随机对照试验。结果：三组透析前血清碳酸氢盐基线水平平均约为19.5 mmol/L。16周时，两组透析前血清碳酸氢盐水平差异无统计学意义（p = 0.701）。标准透析液组的平均水平为20.1 (SD 2.16) mmol/L，增加碳酸氢盐透析液组的平均水平为20.5 (SD 2.04) mmol/L，口服补充组的平均水平为20.8 (SD 2.61) mmol/L。与基线相比，透析前碳酸氢盐水平在增加碳酸氢盐透析液组（p = 0.010）和口服补充组（p = 0.021）中显著增加，但在对照组（标准透析液，无口服补充）组中没有显著增加。结论：本研究中使用的剂量口服或透析补充碳酸氢盐对酸中毒血液透析患者透析前血清碳酸氢盐浓度有相同的影响。然而，通过任何一种途径补充碳酸氢盐的量都不足以达到酸中毒的目标矫正（例如，透析前血清碳酸氢盐≥22 mmol/L）。

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引用次数: 0

Frequent In-Center Hemodialysis: Who Can Benefit From a Frequent Dialysis Approach? 频繁中心血液透析：谁能从频繁透析方法中受益？

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2025-03-13 DOI: 10.1111/hdi.13225

Steven G. Achinger, Juan Carlos Ayus

Frequent (a.k.a daily hemodialysis) has continued to spark interest in the nephrology community as a way to possibly improve outcomes for the end-stage renal disease population. This is a patient population with a very high disease burden and mortality rate. The concept of dialysis adequacy in its current form has consolidated mainly around three times weekly dialysis, which has become the worldwide accepted standard. The current drive to encourage more home hemodialysis (which is a frequent dialysis regimen) has made the lessons from daily in-center hemodialysis more relevant. Frequent hemodialysis has been shown in both observational and randomized controlled studies to have some cardiovascular, mineral metabolism, and quality of life benefits. Some of what is learned from this body of literature is applicable today with increasing emphasis on home hemodialysis. This review will focus on the benefits and potential harms of daily hemodialysis to assist the practitioner in shared decision making with patients about the expected benefits and drawbacks of frequent in-center dialysis and what the expected goals should be for a frequent dialysis regimen.

频繁（又名每日血液透析）作为一种可能改善终末期肾脏疾病人群预后的方法，一直引起肾脏病学界的兴趣。这是一个疾病负担和死亡率都很高的患者群体。目前形式的透析充分性概念主要集中在每周透析三次左右，这已成为世界公认的标准。目前鼓励更多的家庭血液透析（这是一种常见的透析方案）使得每天在中心进行血液透析的经验教训更加相关。观察性和随机对照研究均显示，频繁的血液透析对心血管、矿物质代谢和生活质量有一定的益处。从这一文献中所学到的一些知识在今天越来越强调家庭血液透析的情况下是适用的。本综述将关注每日血液透析的益处和潜在危害，以帮助医生与患者共同决策频繁中心透析的预期益处和缺点，以及频繁透析方案的预期目标。

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引用次数: 0

Association Between Work Status and Quality of Life in End-Stage Renal Disease Patients During the First Year of Hemodialysis 终末期肾病患者血液透析第一年工作状态与生活质量的关系

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International

Pub Date : 2025-03-11 DOI: 10.1111/hdi.13221

Saule B. Bodesova, Nazym S. Sagandykova, Kurmet Danebek, Bagdat G. Sultanova, Madina B. Baurzhan, Yerbol S. Onalbekov

Introduction

End-stage renal disease patients have impaired health-related quality of life as compared to the general population due to the combined effects of the disease and hemodialysis (HD) therapy. As a result, poor quality of life increases their risk of mortality and hospitalization and affects their general well-being. While existing rehabilitation programs aim to improve physical activity in HD patients, the link between work status, particularly within the first year of treatment, and their quality of life remains unclear.

Objectives

This study aimed to compare the quality of life of working and nonworking end-stage renal disease patients during their first year of HD.

Materials and Methods

The comparative cross-sectional study involved 120 patients (60 working, 60 non- working) with end-stage renal disease at the hemodialysis (HD) centers during their first year of HD. Patients were administered the SF-36 survey to determine their physical and mental health levels. Statistical analyses, including Mann–Whitney U tests, Spearman's correlation, and multiple regression, were performed using SPSS 22.

Results

Employed patients demonstrated significantly higher physical functioning (MR = 82.37, Me = 41.27) and mental health (MR = 74.33, Me = 47.22) scores compared to non-employed (MR = 38,63, Me = 29.07 and MR = 46.67, Me = 38,14, respectively) (p < 0.001). Employment is a significant predictor of high quality of life (B = 11.6 for PF, B = 6.5 for MH). Despite older age and increased prevalence of comorbidities, employed patients demonstrate better quality of life results.

Conclusion

Employment has a positive effect on the quality of life of patients with chronic renal failure receiving HD, indicating that their regimen may be improved by incorporating work into the treatment program. Employment opportunities for patients with chronic renal failure receiving dialysis should be explored in the future.

与一般人群相比，由于疾病和血液透析（HD）治疗的联合作用，终末期肾病患者的健康相关生活质量受损。因此，生活质量差增加了他们死亡和住院的风险，并影响到他们的总体福祉。虽然现有的康复计划旨在改善HD患者的身体活动，但工作状态，特别是在治疗的第一年，与他们的生活质量之间的联系尚不清楚。目的：本研究旨在比较工作和非工作终末期肾病患者在HD第一年的生活质量。材料和方法：比较横断面研究涉及120例终末期肾病患者（60例工作，60例非工作），在血液透析（HD）中心接受HD治疗的第一年。对患者进行SF-36调查，以确定他们的身心健康水平。采用SPSS 22进行统计分析，包括Mann-Whitney U检验、Spearman相关和多元回归。结果：有工作患者的身体功能评分（MR = 82.37, Me = 41.27）和心理健康评分（MR = 74.33, Me = 47.22）均显著高于无工作患者（MR = 38,63, Me = 29.07, MR = 46.67, Me = 38,14） (p)。结论：就业对慢性肾功能衰竭合并HD患者的生活质量有积极影响，将工作纳入治疗方案可改善其生活方式。对于接受透析治疗的慢性肾功能衰竭患者，未来应探索其就业机会。

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引用次数: 0