Seminars in Dialysis最新文献

Objective: We investigated the clinical characteristics and treatment outcomes of heparin-induced thrombocytopenia (HIT) following therapeutic plasma exchange (TPE) with heparin anticoagulation in patients with neurological autoimmune diseases.

Methods: Clinical data were prospectively collected from 158 patients (79 males, 79 females; mean age 37.49 ± 16.95 years) with neurological autoimmune diseases who underwent TPE in the neuro-intensive care unit between January 2016 and June 2024. For patients with continuous platelet decline after TPE, the 4Ts score was determined, and platelet factor 4 (PF4) antibody tests were performed. Their platelet counts, clinical complications (thrombosis and bleeding), treatment plans, outcomes, and prognoses before and after TPE were analyzed.

Results: One hundred thirty-nine patients experienced at least one significant decrease in platelet count during TPE (average decrease 36.75 ± 19.63%), and the average 4Ts score was 3.55 ± 1.87 points. PF4 antibody testing was conducted on 23 patients with continuous platelet decline and 4Ts scores ≥ 4. Four PF4-positive patients were diagnosed with type II HIT and developed deep vein thrombosis. After heparin withdrawal, the platelet count gradually normalized after intravenous immunoglobulin (IVIG), nonheparin TPE, or argatroban/fondaparinux anticoagulant therapy (mean recovery time 8.17 ± 3.54 days). The platelet counts spontaneously recovered for the remaining 116 patients (mean recovery time 3.88 ± 2.66 days).

Conclusion: Platelet counts should be dynamically monitored throughout TPE with heparin anticoagulation. Patients with continually decreasing platelet counts and an intermediate to high 4Ts score should be monitored for HIT. Heparin should be discontinued immediately for patients with type II HIT, and nonheparin anticoagulants, IVIG, or nonheparin TPE may be administered.

The aim of this review is to summarize the literature on the pathophysiology, diagnosis, and etiology of adrenal insufficiency (AI) in dialysis patients. The prevalence of AI in dialysis patients is unknown, and AI appears to be an uncommon complication associated with dialysis. Data in the literature on the impact of chronic kidney disease and dialysis on adrenal function give conflicting results. Patients with end-stage renal disease are at risk of hypercortisolism due to loss of the nychthemeral cortisol cycle. Dialysis itself may lead to a rebound in cortisol synthesis at the end of dialysis session. Nevertheless, it has recently been suggested that dialysis vintage was associated with loss of adrenal function and with the onset of AI, and that among chronically hypotensive dialysis patients, the prevalence of AI may be as high as 20%. In dialysis patients, adrenal function is preserved, and AI is rare. AI is difficult to diagnose and often goes unnoticed, as symptoms are nonspecific and diminish with dialysis, which partially corrects them. Diagnosis is therefore delayed and often occurs during an adrenal crisis. For hemodialysis patients, diagnosis is based on blood cortisol measurements before and after an ACTH stimulation test, which are performed at the start of dialysis, regardless of the dialysis session schedule. Salivary cortisol measurements can be used instead of blood cortisol measurements for peritoneal dialysis patients to avoid venipunctures. Situations suggestive of AI in dialysis patients include history or current low-dose corticosteroid therapy, unexplained chronic arterial hypotension, recurrent hypoglycemia, and unexplained hypercalcemia.

For patients with end-stage renal failure, hemodialysis is a crucial renal replacement therapy, which is meaningful to alleviate patients' symptoms and prolong survival. The principle of hemodialysis is to exchange the substances in the blood and dialysis solution through a semipermeable membrane and to discharge the excess water, metabolic waste, and electrolytes into the dialysis solution, which can balance the water, electrolytes, and acid-base. However, patients on maintenance hemodialysis are at high risk of developing cardiovascular and cerebrovascular diseases. Therefore, the composition of dialysis fluid has been widely studied, and the use of sugar-containing dialysis fluid can reduce the incidence of hypoglycemia, hypotension, and cardiovascular and cerebrovascular complications in hemodialysis patients. This article reviews the effects of current glucose-containing dialysate on cardiovascular and cerebrovascular outcome events in hemodialysis patients.

Objective: Multiple in vitro and in vivo studies indicate that there is a significant amount of dialysis catheter lock leak with tunneled and nontunneled dual lumen hemodialysis (HD) catheters. The impact of heparin 1000 unit/mL HD catheter lock on outcomes in patients on therapeutic heparin has not been previously reported.

Methods: Twenty-nine patients with 42 patient events on HD or continuous renal replacement therapy (CRRT) via double lumen catheters were retrospectively analyzed. Study patients received heparin 1000 unit/mL HD catheter lock while on therapeutic intravenous heparin. All patients had stable activated partial thromboplastin times (PTT) prior to catheter locking and had a PTT drawn within 6 h after administration of the heparin HD catheter lock.

Results: The average prelock PTT was 56 s and postlock PTTs increased on average to 85 s (p < 0.0001). PTTs were significantly higher when drawn closer to the administration time of the heparin catheter lock. Major bleeding occurred in many surgical patients after heparin HD catheter lock administration.

Conclusion: Citrate or saline HD catheter lock may be preferable to heparin HD catheter lock in patients on intravenous heparin infusions, especially in high-bleed-risk surgical patients.

Objectives: Arteriovenous fistula (AVF) is the most ideal vascular access for hemodialysis. People with AVF have a longer vascular access survival rate and a lower complication rate. Thrombosis and stenosis are the most common complications of AVF. The annual thrombosis event rate is 10%-50%. Appropriate identification of AVF stenosis and management could reduce the risk of thrombosis and access loss. Guidelines recommended physical examinations as the first line of AVF stenosis monitoring. However, even for health professionals, the diagnosis rate by hearing the bruit varied. The sound waves of AVF can be recorded by electronic stethoscopes and the analysis of the digitalized signal may help predict stenosis of AVF and trigger the next step of management.

Methods: From January 1, 2019, to December 31, 2019, all dialysis patients with AVF referred to our angiography laboratory for AVF angiography were enrolled. Significant stenosis was defined as stenosis severity > 70% on angiography. The stenosis severities were measured before and after the angioplasty. Before and after the angioplasty/angiography, the sounds of AVF were digitally recorded by an electrical stethoscope. Two sections longer than 10 s were obtained at different sites for each recording. Seventy percent of all the data was used to train the machine learning algorithm. The other 30% was used for testing. For the output of the algorithm, the AVF stenosis severity was classified into significant stenosis or non-significant stenosis.

Results: One hundred ninety-nine patients were enrolled. Ninety-six patients were with significant stenotic AVF and the other 103 patients were with insignificant stenosis. One hundred eighty-nine recording sections for significant stenosis and 511 recording sections for insignificant stenosis were obtained. The machine learning artificial intelligence can classify the input sound waves as significant or insignificant stenosis with a 94.1% sensitivity rate and an 81.7% specificity rate.

Conclusions: Artificial intelligence can help predict AVF stenosis by analyzing the digitalized sound waves of AVF. This analysis is convenient and non-invasive. Moreover, this technique can help the development of a remote monitor of AVF stenosis, which is especially important in the era of the COVID-19 pandemic.

PD catheter breaks are rare and can occur spontaneously or traumatically. Breaks may cause peritonitis due to wet contamination. We describe the management of three unique cases of catheter breaks without interruption of treatment. We salvaged two PD catheters with breaks that were proximal to the exit site with minimally invasive procedures. Even though one patient required removal of the catheter, a new catheter was exchanged over a guidewire and used immediately. PD therapy was continued without any complications. Out of the box thinking and repair of PD catheter breaks prevents removal and extends its life.

A systematic assessment was conducted to evaluate the effectiveness of digital health technology interventions on anxiety, depression, and treatment adherence in maintenance hemodialysis patients. A computerized search of 10 databases of randomized controlled trials of digital health technologies on anxiety, depression, and treatment adherence in maintenance hemodialysis patients was conducted for the period from database construction to December 5, 2024, and a meta-analysis of the included literature was performed using RevMan 5.4 and Stata 15.0 software to evaluate the level of evidence-based on GRADE. A total of 13 papers were included with 1063 maintenance hemodialysis patients. Meta-analysis results showed that digital health technology could reduce anxiety and depression and improve treatment adherence of maintenance hemodialysis patients. Digital health technology has a positive effect on anxiety, depression, and treatment adherence in maintenance hemodialysis patients. However, due to the limitations of the quality and quantity of included studies, as well as the heterogeneity of the findings, further validation of the results is necessary through the inclusion of more high-quality studies.

Aim: This study aimed to investigate the effect of fatigue levels of patients undergoing hemodialysis on their sleep quality after dialysis treatment.

Materials and methods: This descriptive study was conducted with 100 patients who received treatment in a private dialysis center. The data were collected through face-to-face interviews between March and May 2024 using the Patient Diagnostic Form, Fatigue Severity Scale, and Pittsburgh Sleep Quality Index.

Findings: The FSS and PSQI mean scores of the participants were 5.17 ± 2.62 and 7.70 ± 3.57, respectively. 70% of the patients felt tired after dialysis treatment. Results of the study also revealed that the scores of the participants who were female, had a low educational level, were unemployed, had diabetes and hypertension as the primary causes of kidney disease, needed rest after dialysis treatment, could not sleep well at night, had difficulty sleeping at night on the days of dialysis treatment, and felt restless when they woke up in the morning had significantly higher FSS scores. As a result of regression analysis, the model showed that having difficulty sleeping at night on the days of dialysis treatment, reasons that made it difficult to sleep, taking pills to sleep, and feeling rested when waking up in the morning had significant effects.

Conclusion: This study revealed that fatigue levels of hemodialysis patients after dialysis treatment affected their sleep quality; sleeping problems were common in dialysis patients, and sleep quality was correlated with fatigue.

Background: People receiving dialysis treatment are at higher risk of sarcopenia. This review aimed to determine the global prevalence of sarcopenia in people on peritoneal dialysis and hemodialysis. We investigated whether the prevalence of sarcopenia differs based on assessment criteria, timing of assessment, and measurement tools used and explored the risk factors for sarcopenia in people on dialysis.

Methods: This review followed JBI and PRISMA guidelines and included studies assessing sarcopenia in adults aged 18 and older with chronic kidney disease undergoing dialysis. Five databases were searched from inception to November 2022. The JBI SUMARI software was used to perform the meta-analysis. Publication bias and risk factor analysis were performed using STATA (Version 18).

Results: A meta-analysis of 62 studies (15,382 participants) found the global prevalence of sarcopenia to be 30.1% (95% CI: 25.6%-39.9%) for hemodialysis and 20.5% (95% CI: 15.1%-26.4%) for peritoneal dialysis. Sarcopenia prevalence ranged between 23.1% and 30.3% in HD and between 6.1% and 26.9% in PD, based on the assessment criteria. Post-dialysis sarcopenia prevalence was higher (33%) than pre-dialysis (24.2%) in hemodialysis patients. Measuring muscle mass after dialysis using dual-energy X-ray assessment yielded a lower prevalence of sarcopenia (22.5%) than bioimpedance analysis or spectroscopy (33%). Risk factors in the HD population included age, sex, diabetes, inflammation markers, nutritional indices, and dialysis vintage, although heterogeneity between studies was high.

Conclusion: This study showed a high prevalence of sarcopenia among the dialysis population and identified many risk factors, emphasizing the need for early identification and intervention and standardized assessments.

Background: Anemia is a common occurrence in people with chronic kidney disease and end-stage kidney disease. Intravenous administration of iron is standard treatment for people undergoing maintenance hemodialysis. However, until the recent PIVOTAL randomized control trial, there was uncertainty around clinically effective regimens. This study found that among incident, people receiving hemodialysis in the first year, a proactive high-dose intravenous iron regimen was superior to reactive low-dose regimen, leading to reduced mortality and cardiac events. Our study investigated whether the research and guidelines have been successfully implemented into clinical care across the United Kingdom, identified barriers experienced, and explored our local hemodialysis population's awareness of the treatment they are receiving.

Methods: We conducted a cross-sectional survey using a convenient sample of UK-based kidney physicians working in the NHS and local people receiving hemodialysis. Two preconceived, standardized questionnaires were designed.

Results: Forty physicians responded. Of these, 40% had implemented a proactive iron protocol, whereas 37.5% had not. Respondents acknowledged concerns about doses of iron and the need for local protocols. Thirty-seven patients responded to the patient questionnaire within our own hemodialysis unit. Fifty-one percent of patients reported to be receiving iron supplementation, of which 84% stated it was intravenous through their dialysis machine.

Conclusions: We have not observed a paradigm shift in clinical practice and identified poor patient understanding of their treatment. Strategies to overcome barriers are necessary to introduce treatments that offer both clinical advantages and cost savings. Eliminating futile practice is challenging due to departmental prioritization and economic considerations. Traditionally, efforts to improve care are targeted towards newer therapies; however, there is an opportunity to improve implementation of current evidence.