Pub Date : 2023-09-01Epub Date: 2023-07-09DOI: 10.1111/sdi.13168
Hadar Mudrik-Zohar, Danny Alon, Naomi Nacasch, Aviad Sternschuss, Meidad Greenberg, Sydney Benchetrit, Ronit Gavrieli, Tali Zitman-Gal, Keren Cohen-Hagai
Introduction: Patients with end stage kidney disease undergoing maintenance hemodialysis (MHD) are prone to malnutrition and infections.
Objective: The objective of this study was to evaluate the effect of polymorphonuclear (PMN) cell dysfunction on clinical outcomes of MHD patients, in association with nutritional status.
Methods: This prospective study investigated 39 MHD patients by evaluating the oxidative activity of their PMN cells using Phorbol 12-Myristate-13-Acetate (PMA) stimulation. Blood samples were taken from each participant at dialysis initiation. Demographics, laboratory data, and clinical outcomes during a 24-month follow-up period were obtained from electronic medical records.
Results: Phagocytic activity was described in percentiles of mean fluorescence intensity (MFI) of PMA levels. There were no differences in comorbidities between patients with low or high MFI-PMA percentiles. Patients in the lowest (25th) MFI-PMA percentile (N = 10) had poorer nutritional status and more frequent severe infections compared to the other 29 patients (4.3 ± 3.4 events versus 2 ± 2.2 events, p = 0.017). Furthermore, they had more frequent hospitalizations (>3) due to infections (70% versus 41%, p = 0.073) and their mortality rate was higher (80% versus 31%, p = 0.007). The odds ratio for all-cause mortality was 8.85. In multivariate analysis, the MFI-PMA percentile and ischemic heart disease were the strongest predictors of all-cause mortality (p = 0.02 and p = 0.005, respectively).
Conclusions: Low MFI-PMA levels were associated with poor nutritional status and adverse clinical outcomes and might serve as a prognostic biomarker, predicting severe infections and mortality among malnourished MHD patients.
{"title":"Neutrophil reactive oxygen formation, bacterial infections and mortality in malnourished hemodialysis patients: Evaluation of clinical outcomes.","authors":"Hadar Mudrik-Zohar, Danny Alon, Naomi Nacasch, Aviad Sternschuss, Meidad Greenberg, Sydney Benchetrit, Ronit Gavrieli, Tali Zitman-Gal, Keren Cohen-Hagai","doi":"10.1111/sdi.13168","DOIUrl":"10.1111/sdi.13168","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with end stage kidney disease undergoing maintenance hemodialysis (MHD) are prone to malnutrition and infections.</p><p><strong>Objective: </strong>The objective of this study was to evaluate the effect of polymorphonuclear (PMN) cell dysfunction on clinical outcomes of MHD patients, in association with nutritional status.</p><p><strong>Methods: </strong>This prospective study investigated 39 MHD patients by evaluating the oxidative activity of their PMN cells using Phorbol 12-Myristate-13-Acetate (PMA) stimulation. Blood samples were taken from each participant at dialysis initiation. Demographics, laboratory data, and clinical outcomes during a 24-month follow-up period were obtained from electronic medical records.</p><p><strong>Results: </strong>Phagocytic activity was described in percentiles of mean fluorescence intensity (MFI) of PMA levels. There were no differences in comorbidities between patients with low or high MFI-PMA percentiles. Patients in the lowest (25th) MFI-PMA percentile (N = 10) had poorer nutritional status and more frequent severe infections compared to the other 29 patients (4.3 ± 3.4 events versus 2 ± 2.2 events, p = 0.017). Furthermore, they had more frequent hospitalizations (>3) due to infections (70% versus 41%, p = 0.073) and their mortality rate was higher (80% versus 31%, p = 0.007). The odds ratio for all-cause mortality was 8.85. In multivariate analysis, the MFI-PMA percentile and ischemic heart disease were the strongest predictors of all-cause mortality (p = 0.02 and p = 0.005, respectively).</p><p><strong>Conclusions: </strong>Low MFI-PMA levels were associated with poor nutritional status and adverse clinical outcomes and might serve as a prognostic biomarker, predicting severe infections and mortality among malnourished MHD patients.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10512468","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}
Pub Date : 2023-09-01Epub Date: 2023-08-17DOI: 10.1111/sdi.13171
Jun Liu, Kehong Chen, Jia Chen, Lili Fu, Weiwei Zhang, Jing Lin, Jingfang Wan
Background: The study aims to explore the incidence and risk factors of cognitive dysfunction in hemodialysis patients.
Methods: PubMed, Embase, Cochrane Library, and Web of Science databases were searched for clinical studies on the association between hemodialysis and cognitive dysfunction from the database's inception to 1 December 2022. Two researchers independently completed data extraction and risk of bias assessments for the included studies. All statistical analyses were performed using STATA15.0 software.
Results: Ten studies were included in this meta-analysis, with a total of 5535 hemodialysis patients, that is, 2033 patients with cognitive dysfunction and 3502 patients with normal cognitive function. The Newcastle-Ottawa Scale scores of the included studies were greater than 5. Meta-analysis results suggested that the incidence of cognitive dysfunction in hemodialysis patients was (effect size = 51%, 95% confidence interval [CI] [0.33, 0.69]), and hemodialysis patients with cognitive dysfunction were often older than those with normal cognition (standard mean difference [SMD] = 0.49, 95% CI [0.31, 0.68]). Female gender was a risk factor for cognitive dysfunction in hemodialysis patients (relative risk [RR] = 1.21, 95% CI [1.04, 1.41]); diabetes (RR = 1.33, 95% CI [1.04, 1.71]) and stroke (RR = 1.66, 95% CI [1.08, 2.55]) increased the incidence of cognitive dysfunction in hemodialysis patients.
Conclusions: The most important risk factors for cognitive dysfunction associated with hemodialysis might be female gender, old age, diabetes, and stroke. Close attention should be paid to such patients for early prevention.
{"title":"Incidence and risk factors of cognitive dysfunction in hemodialysis patients: A systematic review and meta-analysis.","authors":"Jun Liu, Kehong Chen, Jia Chen, Lili Fu, Weiwei Zhang, Jing Lin, Jingfang Wan","doi":"10.1111/sdi.13171","DOIUrl":"10.1111/sdi.13171","url":null,"abstract":"<p><strong>Background: </strong>The study aims to explore the incidence and risk factors of cognitive dysfunction in hemodialysis patients.</p><p><strong>Methods: </strong>PubMed, Embase, Cochrane Library, and Web of Science databases were searched for clinical studies on the association between hemodialysis and cognitive dysfunction from the database's inception to 1 December 2022. Two researchers independently completed data extraction and risk of bias assessments for the included studies. All statistical analyses were performed using STATA15.0 software.</p><p><strong>Results: </strong>Ten studies were included in this meta-analysis, with a total of 5535 hemodialysis patients, that is, 2033 patients with cognitive dysfunction and 3502 patients with normal cognitive function. The Newcastle-Ottawa Scale scores of the included studies were greater than 5. Meta-analysis results suggested that the incidence of cognitive dysfunction in hemodialysis patients was (effect size = 51%, 95% confidence interval [CI] [0.33, 0.69]), and hemodialysis patients with cognitive dysfunction were often older than those with normal cognition (standard mean difference [SMD] = 0.49, 95% CI [0.31, 0.68]). Female gender was a risk factor for cognitive dysfunction in hemodialysis patients (relative risk [RR] = 1.21, 95% CI [1.04, 1.41]); diabetes (RR = 1.33, 95% CI [1.04, 1.71]) and stroke (RR = 1.66, 95% CI [1.08, 2.55]) increased the incidence of cognitive dysfunction in hemodialysis patients.</p><p><strong>Conclusions: </strong>The most important risk factors for cognitive dysfunction associated with hemodialysis might be female gender, old age, diabetes, and stroke. Close attention should be paid to such patients for early prevention.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10215670","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}
Objective: Endovascular intervention for thrombosed aneurysmal arteriovenous fistula (AVF) is still a challenge. Manual compression technique (MCT)-assisted angioplasty may be helpful, but there is no evidence or data to support it.
Methods: From January 2018 to May 2021, patients with thrombosed aneurysmal AVFs were retrospectively enrolled. The patients were separated into the MCT group or the traditional group according to the procedure received. Technical failure, clinical failure, 90-day patency, and safety were analyzed.
Results: A total of 159 cases (64 ± 12 years old, 60% male) were enrolled, of which 87 cases received MCT and 72 underwent traditional angioplasty. No technical failure was observed in the MCT group, while five technical failures were observed in the traditional group (0% vs. 7%, p = 0.02). There were no differences in the clinical failure rate (3% vs. 7%, p = 0.30), 90-day patency rate, or procedure time between the MCT group and the traditional group. There was no symptomatic pulmonary embolism or other complication in the two groups.
Conclusion: MCT is a low-cost, less invasive, and safe procedure for thrombosed aneurysmal AVF, and it achieves a higher technical success rate than traditional angioplasty.
目的:血栓性动脉瘤动静脉瘘(AVF)的血管内介入治疗仍是一个挑战。手动加压技术(MCT)辅助血管成形术可能有帮助,但没有证据或数据支持。方法:从2018年1月至2021年5月,回顾性纳入血栓性动脉瘤性avf患者。根据所接受的治疗方法将患者分为MCT组和传统组。分析技术失败、临床失败、90天通畅及安全性。结果:共入组159例(64±12岁,男性占60%),其中行MCT 87例,行传统血管成形术72例。MCT组无技术失败,而传统组有5例技术失败(0% vs. 7%, p = 0.02)。MCT组与传统组在临床失败率(3% vs. 7%, p = 0.30)、90天通畅率或手术时间方面均无差异。两组患者均未出现症状性肺栓塞及其他并发症。结论:MCT是一种低成本、微创、安全的治疗血栓性动脉瘤性AVF的方法,其技术成功率高于传统的血管成形术。
{"title":"Manual compression technique improves the success rate in the treatment of thrombosed aneurysmal arteriovenous fistula: A single-center experience.","authors":"Cheng-Yu Ko, Li-Ying Yu, Po-Wei Chen, Chih-Chang Ko, Tian-Xi Lin, Cheng-Han Lee, Ping-Yen Liu, Hsien-Yuan Chang","doi":"10.1111/sdi.13127","DOIUrl":"https://doi.org/10.1111/sdi.13127","url":null,"abstract":"<p><strong>Objective: </strong>Endovascular intervention for thrombosed aneurysmal arteriovenous fistula (AVF) is still a challenge. Manual compression technique (MCT)-assisted angioplasty may be helpful, but there is no evidence or data to support it.</p><p><strong>Methods: </strong>From January 2018 to May 2021, patients with thrombosed aneurysmal AVFs were retrospectively enrolled. The patients were separated into the MCT group or the traditional group according to the procedure received. Technical failure, clinical failure, 90-day patency, and safety were analyzed.</p><p><strong>Results: </strong>A total of 159 cases (64 ± 12 years old, 60% male) were enrolled, of which 87 cases received MCT and 72 underwent traditional angioplasty. No technical failure was observed in the MCT group, while five technical failures were observed in the traditional group (0% vs. 7%, p = 0.02). There were no differences in the clinical failure rate (3% vs. 7%, p = 0.30), 90-day patency rate, or procedure time between the MCT group and the traditional group. There was no symptomatic pulmonary embolism or other complication in the two groups.</p><p><strong>Conclusion: </strong>MCT is a low-cost, less invasive, and safe procedure for thrombosed aneurysmal AVF, and it achieves a higher technical success rate than traditional angioplasty.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10510419","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}
Pub Date : 2023-07-01Epub Date: 2023-06-14DOI: 10.1111/sdi.13162
Yixiu Liu, Xiju Luo, Siyan Deng, Jing Chen, Lu Zhang, Ying Huang, Huagang Hu
Exercise brings many benefits to patients undergoing maintenance hemodialysis (MHD), but the effect of combined aerobic and resistance exercise remains unclear. English and Chinese databases (PubMed, Cochrane Library, Embase, Web of Science, CNKI, VIP, Wan Fang, and CBM) were searched from inception to January 2023 to retrieve qualified randomized controlled trials. The literature selection, data extraction, and risk of bias assessment of included studies were conducted independently by two reviewers. Meta-analysis was performed using RevMan 5.3 software. A total of 23 studies with 1214 participants were included, and 17 of the interventions were conducted during dialysis. Results showed that combined aerobic and resistance exercise (CARE) improved the peak oxygen uptake, six-minute walking test, 60 s sit-to-stand test (STS), 30 s STS, dialysis adequacy, five (out of eight) domains and physical component summary of health-related quality of life (HRQOL) measured by the Medical Outcomes Study Short Form-36, blood pressure, and hemoglobin for MHD patients compared with usual care. No significant changes were found in the mental component summary of HRQOL, C-reactive protein, creatinine, potassium, sodium, calcium, and phosphate. Subgroup analysis showed that intradialytic CARE ameliorated more outcomes, except for handgrip strength and hemoglobin, than non-intradialytic ones. CARE is an effective way to improve physical function, aerobic capacity, dialysis adequacy, and HRQOL for MHD patients. Strategies should be implemented by clinicians and policymakers to motivate patients to do more exercise. Well-designed clinical trials are warranted to explore the effectiveness of non-intradialytic CARE.
运动给接受维持性血液透析(MHD)的患者带来了许多好处,但有氧运动和阻力运动的联合效果尚不清楚。从开始到2023年1月,检索英文和中文数据库(PubMed、Cochrane Library、Embase、Web of Science、CNKI、VIP、Wan Fang和CBM),检索合格的随机对照试验。纳入研究的文献选择、数据提取和偏倚风险评估由两名评审员独立进行。使用RevMan 5.3软件进行荟萃分析。共纳入23项研究,共有1214名参与者,其中17项干预措施是在透析期间进行的。结果表明,有氧和阻力运动(CARE)相结合可以提高峰值摄氧量、6分钟步行测试、60 s坐立式测试(STS),30 与常规护理相比,MHD患者的STS、透析充分性、五个(八个)领域和健康相关生活质量(HRQOL)的物理成分总结(通过医疗结果研究简表36测量)、血压和血红蛋白。HRQOL、C反应蛋白、肌酸酐、钾、钠、钙和磷酸盐的心理成分汇总没有发现显著变化。亚组分析显示,除握力和血红蛋白外,透析内CARE比非透析外改善了更多的结果。CARE是改善MHD患者身体功能、有氧能力、透析充分性和HRQOL的有效方法。临床医生和决策者应该实施策略,激励患者进行更多的锻炼。精心设计的临床试验有助于探索非透析CARE的有效性。
{"title":"Combined aerobic and resistance exercise in maintenance hemodialysis patients: A meta-analysis.","authors":"Yixiu Liu, Xiju Luo, Siyan Deng, Jing Chen, Lu Zhang, Ying Huang, Huagang Hu","doi":"10.1111/sdi.13162","DOIUrl":"10.1111/sdi.13162","url":null,"abstract":"<p><p>Exercise brings many benefits to patients undergoing maintenance hemodialysis (MHD), but the effect of combined aerobic and resistance exercise remains unclear. English and Chinese databases (PubMed, Cochrane Library, Embase, Web of Science, CNKI, VIP, Wan Fang, and CBM) were searched from inception to January 2023 to retrieve qualified randomized controlled trials. The literature selection, data extraction, and risk of bias assessment of included studies were conducted independently by two reviewers. Meta-analysis was performed using RevMan 5.3 software. A total of 23 studies with 1214 participants were included, and 17 of the interventions were conducted during dialysis. Results showed that combined aerobic and resistance exercise (CARE) improved the peak oxygen uptake, six-minute walking test, 60 s sit-to-stand test (STS), 30 s STS, dialysis adequacy, five (out of eight) domains and physical component summary of health-related quality of life (HRQOL) measured by the Medical Outcomes Study Short Form-36, blood pressure, and hemoglobin for MHD patients compared with usual care. No significant changes were found in the mental component summary of HRQOL, C-reactive protein, creatinine, potassium, sodium, calcium, and phosphate. Subgroup analysis showed that intradialytic CARE ameliorated more outcomes, except for handgrip strength and hemoglobin, than non-intradialytic ones. CARE is an effective way to improve physical function, aerobic capacity, dialysis adequacy, and HRQOL for MHD patients. Strategies should be implemented by clinicians and policymakers to motivate patients to do more exercise. Well-designed clinical trials are warranted to explore the effectiveness of non-intradialytic CARE.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9835303","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}
Pub Date : 2023-07-01Epub Date: 2023-04-23DOI: 10.1111/sdi.13157
Gustavo Laham, Gervasio Soler Pujol, Jenny Guzman, Natalia Boccia, Anabel Abib, Carlos H Diaz
Introduction: Deciding when and how to initiate hemodialysis (HD) is still controversial. An early start (ES) seems to show a lack of benefit. "Lead time bias" and comorbidities have been associated with different outcomes in ES groups. On the other hand, it is well accepted that the impact the type of vascular access (VA) has on patient survival. Our aim was to evaluate survival with early start (ES) versus late start (LS) on HD, taking into account the vascular access (VA) used.
Methods: Between 01/1995 and 06/2018, 503 incidental patients initiated HD at our Dialysis Unit. eGFR was estimated by the CKD-EPI equation. Diabetes mellitus (DM), coronary disease (CD), and peripheral vascular disease (PVD) were considered comorbid conditions. According to eGFR and VA, patients were divided into four groups: G1: ES (eGFR > 7 mL/min) with catheter (ES + C), G2: ES with fistula or graft (F/G) (ES + F/G), G3: LS (eGFR< 7 mL/min) with catheter (LS + C), and G4: LS with F/G (LS + F/G). The cut-off value to define ES or LS was based on median eGFR for these 503 patients. We compared patient's survival rates by Kaplan-Meier and log-rank test. The four groups were compared before and after matching with propensity scores (PS). Cox analysis was performed to determine the impact of predictors of mortality.
Results: Median eGFR was 7 (5.3-9.5) mL/min/1.73 m2 , median follow-up time was 30.9 (13-50) months, 52.1% had F/G access at entry, and 46.9% died during the observation period. Among the four groups, the ES + C were significantly older, and there were more diabetics and comorbid conditions, while phosphatemia, iPTH, albumin, and hemoglobin were significantly higher in the LS groups. Before propensity score (PS) matching, the ES + C group had a poor survival rate (p < 0.0001), while LS + F/G access had the best survival. After PS, a total of 180 patients were selected in the same four groups and ES + C kept showing a statistically significant poorer survival. Multivariate analysis revealed that ES + C was an independent predictor of mortality.
Conclusion: In this retrospective study, ES + C on HD was associated with a higher mortality rate than LS. This association persisted after PS matching.
{"title":"Early start hemodialysis with a catheter may be associated with greater mortality: A propensity score analysis.","authors":"Gustavo Laham, Gervasio Soler Pujol, Jenny Guzman, Natalia Boccia, Anabel Abib, Carlos H Diaz","doi":"10.1111/sdi.13157","DOIUrl":"10.1111/sdi.13157","url":null,"abstract":"<p><strong>Introduction: </strong>Deciding when and how to initiate hemodialysis (HD) is still controversial. An early start (ES) seems to show a lack of benefit. \"Lead time bias\" and comorbidities have been associated with different outcomes in ES groups. On the other hand, it is well accepted that the impact the type of vascular access (VA) has on patient survival. Our aim was to evaluate survival with early start (ES) versus late start (LS) on HD, taking into account the vascular access (VA) used.</p><p><strong>Methods: </strong>Between 01/1995 and 06/2018, 503 incidental patients initiated HD at our Dialysis Unit. eGFR was estimated by the CKD-EPI equation. Diabetes mellitus (DM), coronary disease (CD), and peripheral vascular disease (PVD) were considered comorbid conditions. According to eGFR and VA, patients were divided into four groups: G1: ES (eGFR > 7 mL/min) with catheter (ES + C), G2: ES with fistula or graft (F/G) (ES + F/G), G3: LS (eGFR< 7 mL/min) with catheter (LS + C), and G4: LS with F/G (LS + F/G). The cut-off value to define ES or LS was based on median eGFR for these 503 patients. We compared patient's survival rates by Kaplan-Meier and log-rank test. The four groups were compared before and after matching with propensity scores (PS). Cox analysis was performed to determine the impact of predictors of mortality.</p><p><strong>Results: </strong>Median eGFR was 7 (5.3-9.5) mL/min/1.73 m<sup>2</sup> , median follow-up time was 30.9 (13-50) months, 52.1% had F/G access at entry, and 46.9% died during the observation period. Among the four groups, the ES + C were significantly older, and there were more diabetics and comorbid conditions, while phosphatemia, iPTH, albumin, and hemoglobin were significantly higher in the LS groups. Before propensity score (PS) matching, the ES + C group had a poor survival rate (p < 0.0001), while LS + F/G access had the best survival. After PS, a total of 180 patients were selected in the same four groups and ES + C kept showing a statistically significant poorer survival. Multivariate analysis revealed that ES + C was an independent predictor of mortality.</p><p><strong>Conclusion: </strong>In this retrospective study, ES + C on HD was associated with a higher mortality rate than LS. This association persisted after PS matching.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9837050","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}
Introduction: In recent years, consciousness impairment in patients with end-stage renal disease (ESRD) has been paid more and more attention, but the cause and mechanism of consciousness state change is not clear.
Methods: As the hippocampus played a crucial role in consciousness, we explored the pathological and electrophysiological changes in chronic kidney disease (CKD) mouse hippocampus.
Results: Whole-cell recordings in hippocampal neurons showed that miniature excitatory postsynaptic current (mEPSC) frequency decreased, but the amplitude was unaltered in CKD_8w mice. In addition, α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid receptor-mediated EPSCs (AMPAR-EPSCs) and N-methyl-D-aspartic acid receptor-mediated EPSCs (NMDAR-EPSCs) in hippocampal Schaffer collateral-CA1 synapses displayed a significant decline in CKD_8w mice. Although the ratio of AMPAR-/NMDAR-EPSCs did not change, the paired-pulse ratio (PPR) in CKD_8w mice increased. Intriguingly, the mEPSC frequency and AMPAR-/NMDAR-EPSCs amplitudes were positively associated with body weight, and the mEPSC frequency was negatively correlated with serum creatinine in CKD_8w mice, indicating a potential correlation between cognition and nutritional status in patients with CKD. To confirm the above hypothesis, we collected the clinical data from multiple hemodialysis centers to analyze the correlation between cognition and nutritional status.
Conclusion: Our analysis indicated that protein energy wasting (PEW) was a possible independent risk factor for consciousness dysfunction in maintenance hemodialysis (MHD) patients. Our results provided a more detailed mechanism underlying the cognitive impairment (CI) in ESRD patients at the synaptic level. Last but not least, our results showed that PEW was a probable new independent risk factor for CI in cases with ESRD.
{"title":"The association of cognition with protein energy wasting and synaptic transmission in chronic kidney disease.","authors":"Xia Yang, Yujun Quan, Erzhong Wu, Yuecheng Jiang, Qian Song, Yue Li, Qian Li, Zhaolin Sun, Jing Yuan, Yan Zha, Xiaoli Cui","doi":"10.1111/sdi.13146","DOIUrl":"10.1111/sdi.13146","url":null,"abstract":"<p><strong>Introduction: </strong>In recent years, consciousness impairment in patients with end-stage renal disease (ESRD) has been paid more and more attention, but the cause and mechanism of consciousness state change is not clear.</p><p><strong>Methods: </strong>As the hippocampus played a crucial role in consciousness, we explored the pathological and electrophysiological changes in chronic kidney disease (CKD) mouse hippocampus.</p><p><strong>Results: </strong>Whole-cell recordings in hippocampal neurons showed that miniature excitatory postsynaptic current (mEPSC) frequency decreased, but the amplitude was unaltered in CKD_8w mice. In addition, α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid receptor-mediated EPSCs (AMPAR-EPSCs) and N-methyl-D-aspartic acid receptor-mediated EPSCs (NMDAR-EPSCs) in hippocampal Schaffer collateral-CA1 synapses displayed a significant decline in CKD_8w mice. Although the ratio of AMPAR-/NMDAR-EPSCs did not change, the paired-pulse ratio (PPR) in CKD_8w mice increased. Intriguingly, the mEPSC frequency and AMPAR-/NMDAR-EPSCs amplitudes were positively associated with body weight, and the mEPSC frequency was negatively correlated with serum creatinine in CKD_8w mice, indicating a potential correlation between cognition and nutritional status in patients with CKD. To confirm the above hypothesis, we collected the clinical data from multiple hemodialysis centers to analyze the correlation between cognition and nutritional status.</p><p><strong>Conclusion: </strong>Our analysis indicated that protein energy wasting (PEW) was a possible independent risk factor for consciousness dysfunction in maintenance hemodialysis (MHD) patients. Our results provided a more detailed mechanism underlying the cognitive impairment (CI) in ESRD patients at the synaptic level. Last but not least, our results showed that PEW was a probable new independent risk factor for CI in cases with ESRD.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10210041","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}
Pub Date : 2023-07-01Epub Date: 2023-03-16DOI: 10.1111/sdi.13140
Takamasa Miyauchi, Hiroki Nishiwaki, Aya Mizukami, Masahiko Yazawa
Introduction: This systematic review and meta-analysis examined the relationship between hyponatremia and worse outcomes in patients undergoing maintenance hemodialysis.
Methods: The MEDLINE, EMBASE, CENTRAL, and Web of Science databases were used to search for relevant articles. The target population was patients on maintenance hemodialysis (those undergoing hemodialysis for ≥60 days). The defined outcomes were death, cardiovascular disease, cognitive decline, and falls. Meta-analysis was performed with a random-effects model of pairwise comparisons of normonatremia and hyponatremia defined for each study, 1-mmol/L increment of sodium analysis, and dose-response analysis using the sodium concentration defined for each study. This study was registered with PROSPERO (registration number CRD42018087667).
Results: Thirteen articles were included. The pairwise analysis revealed that the hazard ratio for all-cause mortality was 1.45 (95% confidence interval, 1.31-1.61). The analysis of 1-mmol/L increment of sodium included six studies with a hazard ratio for all-cause mortality of 0.94 (95% confidence interval, 0.91-0.97) for each 1-mmol/L increase in the serum sodium concentration. In the dose-response analysis, assuming a linear relationship, a sodium increment of 1 mmol/L revealed a hazard ratio for all-cause mortality of 0.97 (95% confidence interval, 0.96-0.98). Other outcomes could not be integrated.
Conclusions: Hyponatremia is associated with all-cause mortality in patients undergoing maintenance hemodialysis. Healthcare providers should pay special attention to even the slightest indication of hyponatremia.
引言:本系统综述和荟萃分析研究了维持性血液透析患者低钠血症与不良预后之间的关系。方法:使用MEDLINE、EMBASE、CENTRAL和Web of Science数据库检索相关文章。目标人群是接受维持性血液透析的患者(那些接受血液透析≥60 天)。定义的结果是死亡、心血管疾病、认知能力下降和跌倒。荟萃分析采用随机效应模型进行,该模型对每项研究中定义的正常钠血症和低钠血症进行成对比较,钠增量为1mol/L,并使用每项研究定义的钠浓度进行剂量反应分析。本研究已在PROSPERO注册(注册号CRD42018087667)。结果:共收录13篇文章。成对分析显示,全因死亡率的危险比为1.45(95%置信区间,1.31-1.61)。钠浓度增加1mmol/L的分析包括6项研究,血清钠浓度每增加1mmol/L,全因死亡的危险比均为0.94(95%置信间隔,0.91-0.97)。在剂量反应分析中,假设呈线性关系,钠增量为1 mmol/L时,全因死亡率的危险比为0.97(95%置信区间,0.96-0.98)。其他结果无法整合。结论:维持性血液透析患者的低钠血症与全因死亡率相关。医疗保健提供者应特别注意哪怕是最轻微的低钠血症迹象。
{"title":"Hyponatremia and mortality in patients undergoing maintenance hemodialysis: Systematic review and meta-analysis.","authors":"Takamasa Miyauchi, Hiroki Nishiwaki, Aya Mizukami, Masahiko Yazawa","doi":"10.1111/sdi.13140","DOIUrl":"10.1111/sdi.13140","url":null,"abstract":"<p><strong>Introduction: </strong>This systematic review and meta-analysis examined the relationship between hyponatremia and worse outcomes in patients undergoing maintenance hemodialysis.</p><p><strong>Methods: </strong>The MEDLINE, EMBASE, CENTRAL, and Web of Science databases were used to search for relevant articles. The target population was patients on maintenance hemodialysis (those undergoing hemodialysis for ≥60 days). The defined outcomes were death, cardiovascular disease, cognitive decline, and falls. Meta-analysis was performed with a random-effects model of pairwise comparisons of normonatremia and hyponatremia defined for each study, 1-mmol/L increment of sodium analysis, and dose-response analysis using the sodium concentration defined for each study. This study was registered with PROSPERO (registration number CRD42018087667).</p><p><strong>Results: </strong>Thirteen articles were included. The pairwise analysis revealed that the hazard ratio for all-cause mortality was 1.45 (95% confidence interval, 1.31-1.61). The analysis of 1-mmol/L increment of sodium included six studies with a hazard ratio for all-cause mortality of 0.94 (95% confidence interval, 0.91-0.97) for each 1-mmol/L increase in the serum sodium concentration. In the dose-response analysis, assuming a linear relationship, a sodium increment of 1 mmol/L revealed a hazard ratio for all-cause mortality of 0.97 (95% confidence interval, 0.96-0.98). Other outcomes could not be integrated.</p><p><strong>Conclusions: </strong>Hyponatremia is associated with all-cause mortality in patients undergoing maintenance hemodialysis. Healthcare providers should pay special attention to even the slightest indication of hyponatremia.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9824146","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}
Pub Date : 2023-07-01Epub Date: 2023-05-28DOI: 10.1111/sdi.13158
Daniel Mendes, Paulo Almeida, Andreia Pinelo, João Castro, António Norton-de-Matos
Stent-grafts have been increasingly used in hemodialysis arteriovenous accesses, particularly in recurrent stenosis or in cases of vein rupture after percutaneous transluminal angioplasty (PTA). Although they limit neointimal hyperplasia, stenosis development at stent edges remains a concern. Despite their advantages, they are seldom used on the forearm veins due to fracture risk associated with elbow motion and the potential to limit cannulation sites. This report presents a novel application of stent-grafts in salvaging a radio-cephalic arteriovenous fistula in an 84-year-old male to treat a single outflow path at the elbow through a stenosed antecubital perforating vein, after failed PTA. The vascular access remained patent 18 months after the procedure, with no need for additional treatments at this target lesion, even though a PTA was required for juxta-anastomotic stenosis. This report highlights a possible further use of covered stents in arteriovenous vascular accesses.
{"title":"Antecubital perforating vein stent-grafting for radiocephalic arteriovenous fistula recovery: A case report.","authors":"Daniel Mendes, Paulo Almeida, Andreia Pinelo, João Castro, António Norton-de-Matos","doi":"10.1111/sdi.13158","DOIUrl":"10.1111/sdi.13158","url":null,"abstract":"<p><p>Stent-grafts have been increasingly used in hemodialysis arteriovenous accesses, particularly in recurrent stenosis or in cases of vein rupture after percutaneous transluminal angioplasty (PTA). Although they limit neointimal hyperplasia, stenosis development at stent edges remains a concern. Despite their advantages, they are seldom used on the forearm veins due to fracture risk associated with elbow motion and the potential to limit cannulation sites. This report presents a novel application of stent-grafts in salvaging a radio-cephalic arteriovenous fistula in an 84-year-old male to treat a single outflow path at the elbow through a stenosed antecubital perforating vein, after failed PTA. The vascular access remained patent 18 months after the procedure, with no need for additional treatments at this target lesion, even though a PTA was required for juxta-anastomotic stenosis. This report highlights a possible further use of covered stents in arteriovenous vascular accesses.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9834829","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}
Néstor Toapanta, Jordi Comas, Juan León Román, Natalia Ramos, María Azancot, Oriol Bestard, Jaume Tort, María José Soler
Background: The incidence of older patients over 80 years old with chronic kidney disease who start hemodialysis (HD) program has been increasing in the last decade.
Methods: We aimed to identify risk factors for morbidity and mortality in patients older than 80 years with end-stage renal disease who started HD. We conducted a retrospective observational study of the Catalan Renal registry (RMRC).
Results: A total of 2833 patients equal or older than 80 years (of 15,137) who started HD between 2002 and 2019 from the RMRC were included in the study. In this group, the first dialysis was performed through an arteriovenous fistula in 44%, percutaneous catheter in 28.2%, and tunneled catheter in 26.6%. Conventional dialysis was used in 65.7% and online HD in 34.3%. The most frequent cause of death was cardiac disease (21.8%), followed by social problems (20.4%) and infections (15.9%). Overall survival in older HD during the first year was 84% versus 91% in younger than 80 years (p < 0.001). Cox regression analysis identified the start of HD in the period 2002-2010, chronic obstructive pulmonary disease (COPD), and the onset of HD through vascular graft depicted as risk factors for first-year mortality after dialysis initiation in patients older than 80 years with end-stage renal disease who started HD.
Conclusions: In conclusion, patients older than 80 years who started HD program had higher mortality, especially those who presented exacerbation of kidney disease, those with COPD, and those who started with a vascular graft.
{"title":"Mortality in elderly patients starting hemodialysis program.","authors":"Néstor Toapanta, Jordi Comas, Juan León Román, Natalia Ramos, María Azancot, Oriol Bestard, Jaume Tort, María José Soler","doi":"10.1111/sdi.13114","DOIUrl":"https://doi.org/10.1111/sdi.13114","url":null,"abstract":"<p><strong>Background: </strong>The incidence of older patients over 80 years old with chronic kidney disease who start hemodialysis (HD) program has been increasing in the last decade.</p><p><strong>Methods: </strong>We aimed to identify risk factors for morbidity and mortality in patients older than 80 years with end-stage renal disease who started HD. We conducted a retrospective observational study of the Catalan Renal registry (RMRC).</p><p><strong>Results: </strong>A total of 2833 patients equal or older than 80 years (of 15,137) who started HD between 2002 and 2019 from the RMRC were included in the study. In this group, the first dialysis was performed through an arteriovenous fistula in 44%, percutaneous catheter in 28.2%, and tunneled catheter in 26.6%. Conventional dialysis was used in 65.7% and online HD in 34.3%. The most frequent cause of death was cardiac disease (21.8%), followed by social problems (20.4%) and infections (15.9%). Overall survival in older HD during the first year was 84% versus 91% in younger than 80 years (p < 0.001). Cox regression analysis identified the start of HD in the period 2002-2010, chronic obstructive pulmonary disease (COPD), and the onset of HD through vascular graft depicted as risk factors for first-year mortality after dialysis initiation in patients older than 80 years with end-stage renal disease who started HD.</p><p><strong>Conclusions: </strong>In conclusion, patients older than 80 years who started HD program had higher mortality, especially those who presented exacerbation of kidney disease, those with COPD, and those who started with a vascular graft.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9832501","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}
Pub Date : 2023-07-01Epub Date: 2023-03-05DOI: 10.1111/sdi.13152
Gulen Sezer Alptekın
A 59 year-old man was admitted as his left antecubital arterio-venous fistula was thrombosed, and hemodialysis could not be succeeded for the last two sessions. It was a brachio-basilic fistula without transposition, which also required thrombectomy 8 months ago, and had been created 18 months before. He had multiple catheter insertions during the period of 6 years. Following the failed catheter insertions from both jugular and femoral veins, an ultrasound-guided venography via the left popliteal vein demonstrated the intact left popliteal and femoral vein with well-developed collaterals at the level of occluded left iliac vein. A temporary hemodialysis catheter was placed through the popliteal vein with an antegrade manner under ultrasound guidance in prone position, which effectively worked during hemodialysis sessions afterwards. Transposition of basilic vein was performed. Following the wound recovery, arterialized basilic vein has started to be used effectively for hemodialysis, and the popliteal catheter was displaced.
A 59 一名年仅岁的男子因其左侧肘前动静脉瘘形成血栓而入院,在过去的两次治疗中未能成功进行血液透析。这是一个没有移位的肱-罗勒瘘,8个月前也需要血栓切除术,已经形成18 几个月前。在6年的时间里,他多次插入导管。颈静脉和股静脉导管插入失败后,经左腘静脉进行的超声引导静脉造影显示,左腘和股静脉完好无损,在左髂静脉闭塞的水平上有发育良好的侧支。在超声引导下,俯卧位将临时血液透析导管顺行穿过腘静脉,在随后的血液透析过程中有效发挥作用。进行了基底静脉移位术。伤口恢复后,动脉化的基底静脉开始有效地用于血液透析,腘导管移位。
{"title":"Renal replacement therapy via popliteal vein for exhausted vascular access in emergency: A case report.","authors":"Gulen Sezer Alptekın","doi":"10.1111/sdi.13152","DOIUrl":"10.1111/sdi.13152","url":null,"abstract":"<p><p>A 59 year-old man was admitted as his left antecubital arterio-venous fistula was thrombosed, and hemodialysis could not be succeeded for the last two sessions. It was a brachio-basilic fistula without transposition, which also required thrombectomy 8 months ago, and had been created 18 months before. He had multiple catheter insertions during the period of 6 years. Following the failed catheter insertions from both jugular and femoral veins, an ultrasound-guided venography via the left popliteal vein demonstrated the intact left popliteal and femoral vein with well-developed collaterals at the level of occluded left iliac vein. A temporary hemodialysis catheter was placed through the popliteal vein with an antegrade manner under ultrasound guidance in prone position, which effectively worked during hemodialysis sessions afterwards. Transposition of basilic vein was performed. Following the wound recovery, arterialized basilic vein has started to be used effectively for hemodialysis, and the popliteal catheter was displaced.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9888523","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}