Pub Date : 2023-11-01Epub Date: 2023-01-29DOI: 10.1111/sdi.13141
Yi Li, Kevin Qi, Jiahua Li, Andrew Siedlecki
A 54-year-old underwent brachiocephalic arteriovenous fistula placement. Following maturation of the access, consistent cannulation for routine hemodialysis was challenging for clinical specialists. A three-dimensional intraluminal access model was generated, but clinical specialists adept at cannulation had difficulty orienting the model to the patient's anatomy without repeat supervision. When provided the model prima facie, 50% (4/8) clinical specialists were not able to spatially orient the model appropriately in the x-axis with respect to the coronal plane (2/8) or in the z-axis with respect to the transverse plane (2/8). Spatial renderings of the subcutaneous volume available for cannulation were then printed and physically applied to the vascular access model resulting in appropriate spatial orientation among all clinical specialists (n = 12) that were presented the models for the first time. Mean Kt/V increased during the 3-month period directly following model introduction. This case demonstrates the potential utility of 3D-modeling to readily visualize the subcutaneous volume of a hemodialysis vascular access and reduce cannulation error.
{"title":"3D printed hemodialysis access and subcutaneous volume model as a guide for cannulation: A proof of concept training tool.","authors":"Yi Li, Kevin Qi, Jiahua Li, Andrew Siedlecki","doi":"10.1111/sdi.13141","DOIUrl":"10.1111/sdi.13141","url":null,"abstract":"<p><p>A 54-year-old underwent brachiocephalic arteriovenous fistula placement. Following maturation of the access, consistent cannulation for routine hemodialysis was challenging for clinical specialists. A three-dimensional intraluminal access model was generated, but clinical specialists adept at cannulation had difficulty orienting the model to the patient's anatomy without repeat supervision. When provided the model prima facie, 50% (4/8) clinical specialists were not able to spatially orient the model appropriately in the x-axis with respect to the coronal plane (2/8) or in the z-axis with respect to the transverse plane (2/8). Spatial renderings of the subcutaneous volume available for cannulation were then printed and physically applied to the vascular access model resulting in appropriate spatial orientation among all clinical specialists (n = 12) that were presented the models for the first time. Mean Kt/V increased during the 3-month period directly following model introduction. This case demonstrates the potential utility of 3D-modeling to readily visualize the subcutaneous volume of a hemodialysis vascular access and reduce cannulation error.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"486-488"},"PeriodicalIF":1.6,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10688215","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: To determine appropriate dosing of piperacillin-tazobactam in critically ill patients receiving continuous renal replacement therapy (CRRT).
Methods: The databases of PubMed, Embase, and ScienceDirect were searched. We used the Medical Subject Headings of "piperacillin-tazobactam," "CRRT," and "pharmacokinetics" or related terms or synonym to identify the studies for reviews. A one-compartment pharmacokinetic model was conducted to predict piperacillin levels for the initial 48 h of therapy. The pharmacodynamic target was 50% of free drug level above the minimum inhibitory concentration (MIC) and 4 times of the MIC. The dose that achieved at least 90% of the probability of target attainment was defined as an optimal dose.
Results: Our simulation study reveals that the dosing regimen of piperacillin-tazobactam 12 g/day is appropriate for treating Pseudomonal infection with KDIGO recommended effluent rate of 25-35 mL/kg/h. The MIC values of each setting were an important factor to design piperacillin-tazobactam dosing regimens.
Conclusion: The Monte Carlo simulation can be a useful tool to evaluate drug dosing in critically ill acute kidney injury patients receiving CRRT when limited pharmacokinetic data are a concern. Clinical validation of these results is needed.
{"title":"Piperacillin-tazobactam dosing in anuric acute kidney injury patients receiving continuous renal replacement therapy.","authors":"Dhakrit Rungkitwattanakul, Taniya Charoensareerat, Ekanong Chaichoke, Thanakorn Rakamthong, Pitchaya Srisang, Sutthiporn Pattharachayakul, Nattachai Srisawat, Weerachai Chaijamorn","doi":"10.1111/sdi.13148","DOIUrl":"10.1111/sdi.13148","url":null,"abstract":"<p><strong>Introduction: </strong>To determine appropriate dosing of piperacillin-tazobactam in critically ill patients receiving continuous renal replacement therapy (CRRT).</p><p><strong>Methods: </strong>The databases of PubMed, Embase, and ScienceDirect were searched. We used the Medical Subject Headings of \"piperacillin-tazobactam,\" \"CRRT,\" and \"pharmacokinetics\" or related terms or synonym to identify the studies for reviews. A one-compartment pharmacokinetic model was conducted to predict piperacillin levels for the initial 48 h of therapy. The pharmacodynamic target was 50% of free drug level above the minimum inhibitory concentration (MIC) and 4 times of the MIC. The dose that achieved at least 90% of the probability of target attainment was defined as an optimal dose.</p><p><strong>Results: </strong>Our simulation study reveals that the dosing regimen of piperacillin-tazobactam 12 g/day is appropriate for treating Pseudomonal infection with KDIGO recommended effluent rate of 25-35 mL/kg/h. The MIC values of each setting were an important factor to design piperacillin-tazobactam dosing regimens.</p><p><strong>Conclusion: </strong>The Monte Carlo simulation can be a useful tool to evaluate drug dosing in critically ill acute kidney injury patients receiving CRRT when limited pharmacokinetic data are a concern. Clinical validation of these results is needed.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"468-476"},"PeriodicalIF":1.6,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10758337","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: People on renal replacement therapy (RRT) have a high risk of COVID-19 infection and subsequent death. COVID-19 vaccination is strongly recommended for those on RRT. Data are limited on the immune response of the ChAdOx1 nCoV-19/AZD1222 (Covishield®) vaccine in patients on RRT.
Methods: A prospective cohort of adult (age > 18 years), on RRT in the form of hemodialysis were included and received two intramuscular doses of Covishield®. A blood specimen of 5.0 mL was collected at two time points, within a few days before administering the first dose of the vaccine and at 4-16 weeks after the second dose. According to their prior COVID-19 infection status, the participants were grouped as (i) prior symptomatic COVID-19 infection, (ii) prior asymptomatic COVID-19 infection, and (iii) no prior COVID-19 infection.
Results: A large proportion (81%) of participants had anti-spike antibodies (ASAb) before vaccination, and a reasonable proportion (30%) also had neutralizing antibodies (NAb). The titer of ASAb was relatively low (207 U/mL) before vaccination. The ASAb titer (9405 [1635-25,000] U/mL) and percentage of NAb (96.4% [59.6-98.1%]) were markedly increased following the administration of two doses of the vaccine. The participants' prior COVID-19 exposure status did not influence the rise in ASAb titer and NAb percentage. Further, administering two doses of the Covishield vaccine helps them achieve a high ASAb titer.
Conclusion: Two doses of ChAdOx1 nCoV-19/AZD1222 (Covishield®) vaccine, given 12 weeks apart, achieve a high titer of ASAb and a high percentage of NAb in people on hemodialysis.
{"title":"Antibody response to ChAdOx1 nCoV-19 (Covishield®) vaccine in people on maintenance hemodialysis.","authors":"Dharmendra Singh Bhadauria, Prachi Tiwari, Amit Goel, Harshita Katiyar, Anupma Kaul, Mayank, Amita Aggarwal, Alka Verma, Dhiraj Khetan, Monika Yachha, Manas Ranjan Behera, Brijesh Yadav, Kartik Agarwal, Narayan Prasad","doi":"10.1111/sdi.13149","DOIUrl":"10.1111/sdi.13149","url":null,"abstract":"<p><strong>Introduction: </strong>People on renal replacement therapy (RRT) have a high risk of COVID-19 infection and subsequent death. COVID-19 vaccination is strongly recommended for those on RRT. Data are limited on the immune response of the ChAdOx1 nCoV-19/AZD1222 (Covishield®) vaccine in patients on RRT.</p><p><strong>Methods: </strong>A prospective cohort of adult (age > 18 years), on RRT in the form of hemodialysis were included and received two intramuscular doses of Covishield®. A blood specimen of 5.0 mL was collected at two time points, within a few days before administering the first dose of the vaccine and at 4-16 weeks after the second dose. According to their prior COVID-19 infection status, the participants were grouped as (i) prior symptomatic COVID-19 infection, (ii) prior asymptomatic COVID-19 infection, and (iii) no prior COVID-19 infection.</p><p><strong>Results: </strong>A large proportion (81%) of participants had anti-spike antibodies (ASAb) before vaccination, and a reasonable proportion (30%) also had neutralizing antibodies (NAb). The titer of ASAb was relatively low (207 U/mL) before vaccination. The ASAb titer (9405 [1635-25,000] U/mL) and percentage of NAb (96.4% [59.6-98.1%]) were markedly increased following the administration of two doses of the vaccine. The participants' prior COVID-19 exposure status did not influence the rise in ASAb titer and NAb percentage. Further, administering two doses of the Covishield vaccine helps them achieve a high ASAb titer.</p><p><strong>Conclusion: </strong>Two doses of ChAdOx1 nCoV-19/AZD1222 (Covishield®) vaccine, given 12 weeks apart, achieve a high titer of ASAb and a high percentage of NAb in people on hemodialysis.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"477-482"},"PeriodicalIF":1.6,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10768905","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 : 2023-11-01Epub Date: 2023-05-12DOI: 10.1111/sdi.13145
Keng-Hee Koh, Durga Arinandini Arimuthu
<p><strong>Introduction: </strong>Spontaneous tendon rupture (STR) is one of the complications related to hyperparathyroidism. This study aims to verify this and to elucidate the feasibility of combined incidence rate of STR and bony fracture to assess clinical management of renal bone disease in dialysis cohort.</p><p><strong>Method: </strong>This is a clinical audit of cases of STR and fracture with 5504 patient-year dialysis vintage over 10 years. In order to verify the risk factor, comparison of cases of tendon rupture, the gender, and dialysis vintage matched patients without tendon rupture were done, followed by comparison with post-parathyroidectomy patients.</p><p><strong>Result: </strong>Six cases of STR involving eight tendons were identified, including a case of concurrent tendon rupture and bony fracture. These include two cases of double tendons ruptures. During this time, there were 15 cases of bony fracture without tendon rupture. The overall incidence rate for STR and fracture was of 0.0011 and 0.0029 incidence per year of dialysis vintage or one case per 917 and 344 patient-year dialysis vintage, respectively. For patients with PTH ≥ 600 pg/mL, the incidence rate of tendon rupture and fracture was 0.0199 and 0.0430 incidence per person-years or one case per 50 and 23 person-years, respectively. For patients with PTH < 600 pg/mL, the respective rate was 0 and 0.0006 incidence per person-years or one case per >5202 and 1734 person-years. There was significant difference for incidence rates of tendon rupture and fracture between these two groups, with six incidences of tendon rupture per 302 patient-dialysis-years of PTH ≥ 600 pg/mL versus 0 incidence per 5202 patient-year dialysis vintage of PTH < 600 pg/mL (p < 0.001). In similar comparison, there was also significant difference for incidence rate of fracture with 13/302 versus 2/5202 (p < 0.001). In the 5 yearly audit over 10 years, the incidence rates of tendon rupture and fracture have dropped from 0.0052 to 0.0028 or one incidence per 192 to 356 person-years. Among 35 patients post-parathyroidectomy, there was an incidence of tendon rupture in a patient with recurrence of hyperparathyroidism, 5 years after surgery. Comparing six survived patients with tendon rupture versus 12 age-gender-dialysis vintage matched patients, hyperparathyroidism has been shown to be most important risk factor. And subsequently, comparing them with six post-parathyroidectomy patients, reduction of alkaline phosphatase (ALP) has been shown to be associated with lower risk of tendon rupture. Median survival in patients with history of tendon rupture and those with history of fracture was 5.9 and 2.2 years, respectively (p = 0.192).</p><p><strong>Conclusion: </strong>Although rare, end-stage renal failure patients on dialysis with PTH > 600 pg/mL had high risk of tendon rupture and bony fracture. Parathyroidectomy might reduce the risk of tendon rupture and fracture with lowering ALP signifying reducti
{"title":"Association of incidence rate of spontaneous tendon rupture and renal bone disease in end-stage renal disease patients' cohort.","authors":"Keng-Hee Koh, Durga Arinandini Arimuthu","doi":"10.1111/sdi.13145","DOIUrl":"10.1111/sdi.13145","url":null,"abstract":"<p><strong>Introduction: </strong>Spontaneous tendon rupture (STR) is one of the complications related to hyperparathyroidism. This study aims to verify this and to elucidate the feasibility of combined incidence rate of STR and bony fracture to assess clinical management of renal bone disease in dialysis cohort.</p><p><strong>Method: </strong>This is a clinical audit of cases of STR and fracture with 5504 patient-year dialysis vintage over 10 years. In order to verify the risk factor, comparison of cases of tendon rupture, the gender, and dialysis vintage matched patients without tendon rupture were done, followed by comparison with post-parathyroidectomy patients.</p><p><strong>Result: </strong>Six cases of STR involving eight tendons were identified, including a case of concurrent tendon rupture and bony fracture. These include two cases of double tendons ruptures. During this time, there were 15 cases of bony fracture without tendon rupture. The overall incidence rate for STR and fracture was of 0.0011 and 0.0029 incidence per year of dialysis vintage or one case per 917 and 344 patient-year dialysis vintage, respectively. For patients with PTH ≥ 600 pg/mL, the incidence rate of tendon rupture and fracture was 0.0199 and 0.0430 incidence per person-years or one case per 50 and 23 person-years, respectively. For patients with PTH < 600 pg/mL, the respective rate was 0 and 0.0006 incidence per person-years or one case per >5202 and 1734 person-years. There was significant difference for incidence rates of tendon rupture and fracture between these two groups, with six incidences of tendon rupture per 302 patient-dialysis-years of PTH ≥ 600 pg/mL versus 0 incidence per 5202 patient-year dialysis vintage of PTH < 600 pg/mL (p < 0.001). In similar comparison, there was also significant difference for incidence rate of fracture with 13/302 versus 2/5202 (p < 0.001). In the 5 yearly audit over 10 years, the incidence rates of tendon rupture and fracture have dropped from 0.0052 to 0.0028 or one incidence per 192 to 356 person-years. Among 35 patients post-parathyroidectomy, there was an incidence of tendon rupture in a patient with recurrence of hyperparathyroidism, 5 years after surgery. Comparing six survived patients with tendon rupture versus 12 age-gender-dialysis vintage matched patients, hyperparathyroidism has been shown to be most important risk factor. And subsequently, comparing them with six post-parathyroidectomy patients, reduction of alkaline phosphatase (ALP) has been shown to be associated with lower risk of tendon rupture. Median survival in patients with history of tendon rupture and those with history of fracture was 5.9 and 2.2 years, respectively (p = 0.192).</p><p><strong>Conclusion: </strong>Although rare, end-stage renal failure patients on dialysis with PTH > 600 pg/mL had high risk of tendon rupture and bony fracture. Parathyroidectomy might reduce the risk of tendon rupture and fracture with lowering ALP signifying reducti","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"462-467"},"PeriodicalIF":1.6,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9447004","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}
Acute kidney injury (AKI) is a heterogeneous syndrome with multiple etiologies. It occurs frequently in the neurocritical intensive care unit and is associated with greater morbidity and mortality. In this scenario, AKI alters the kidney-brain axis, exposing patients who receive habitual dialytic management to greater injury. Various therapies have been designed to mitigate this risk. Priority has been placed by KDIGO guidelines on the use of continuous over intermittent acute kidney replacement therapies (AKRT). On this background, continuous therapies have a pathophysiological rationale in patients with acute brain injury. A low-efficiency therapy such as PD and CRRT could achieve optimal clearance control and potentially reduce the risk of secondary brain injury. Therefore, this work will review the evidence on peritoneal dialysis as a continuous AKRT in neurocritical patients, describing its benefits and risks so it may be considered as an option when deciding among available therapeutic options.
{"title":"Peritoneal dialysis and acute kidney injury in acute brain injury patients.","authors":"Gonzalo Ramírez-Guerrero, Faeq Husain-Syed, Daniela Ponce, Vicente Torres-Cifuentes, Claudio Ronco","doi":"10.1111/sdi.13151","DOIUrl":"10.1111/sdi.13151","url":null,"abstract":"<p><p>Acute kidney injury (AKI) is a heterogeneous syndrome with multiple etiologies. It occurs frequently in the neurocritical intensive care unit and is associated with greater morbidity and mortality. In this scenario, AKI alters the kidney-brain axis, exposing patients who receive habitual dialytic management to greater injury. Various therapies have been designed to mitigate this risk. Priority has been placed by KDIGO guidelines on the use of continuous over intermittent acute kidney replacement therapies (AKRT). On this background, continuous therapies have a pathophysiological rationale in patients with acute brain injury. A low-efficiency therapy such as PD and CRRT could achieve optimal clearance control and potentially reduce the risk of secondary brain injury. Therefore, this work will review the evidence on peritoneal dialysis as a continuous AKRT in neurocritical patients, describing its benefits and risks so it may be considered as an option when deciding among available therapeutic options.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"448-453"},"PeriodicalIF":1.6,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9097470","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 : 2023-11-01Epub Date: 2023-10-24DOI: 10.1111/sdi.13184
Melissa Rau, Esther Alba, Joana Valcarcel, Jaid Landa, Diego Sandoval
Vascular access (VA) for hemodialysis (HD) continues to be the keystone of the technique's success. The first option should be an arteriovenous fistula (AVF) or arteriovenous graft (AVG), although in some scenarios the only possibility available is a central venous catheter, which could lead to an increase in vascular complications such as thoracic central vein occlusion (TCVO), becoming a challenge for physicians. If conventional therapies cannot be performed, a new device called the Surfacer® Inside-Out® Access Catheter System (IOA) (Bluegrass Vascular Technologies, San Antonio, TX, USA) arises as a promising alternative. Here we describe the case of a patient in which we performed a combination of two techniques: sharp recanalization plus Surfacer® Inside-Out® Access Catheter System.
{"title":"A new hope for vascular access, modifying a new technique: The Surfacer® Inside-Out Access Catheter System and sharp recanalization.","authors":"Melissa Rau, Esther Alba, Joana Valcarcel, Jaid Landa, Diego Sandoval","doi":"10.1111/sdi.13184","DOIUrl":"10.1111/sdi.13184","url":null,"abstract":"<p><p>Vascular access (VA) for hemodialysis (HD) continues to be the keystone of the technique's success. The first option should be an arteriovenous fistula (AVF) or arteriovenous graft (AVG), although in some scenarios the only possibility available is a central venous catheter, which could lead to an increase in vascular complications such as thoracic central vein occlusion (TCVO), becoming a challenge for physicians. If conventional therapies cannot be performed, a new device called the Surfacer® Inside-Out® Access Catheter System (IOA) (Bluegrass Vascular Technologies, San Antonio, TX, USA) arises as a promising alternative. Here we describe the case of a patient in which we performed a combination of two techniques: sharp recanalization plus Surfacer® Inside-Out® Access Catheter System.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":" ","pages":"483-485"},"PeriodicalIF":1.6,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49692281","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: Sarcopenia is associated with significant cardiovascular risk, and death in patients undergoing peritoneal dialysis (PD). Three tools are used for diagnosing sarcopenia. The evaluation of muscle mass requires dual energy X-ray absorptiometry (DXA) or computed tomography (CT), which is labor-intensive and relatively expensive. This study aimed to use simple clinical information to develop a machine learning (ML)-based prediction model of PD sarcopenia.
Methods: According to the newly revised Asian Working Group for Sarcopenia (AWGS2019), patients were subjected to complete sarcopenia screening, including appendicular skeletal muscle mass, grip strength, and five-time chair stand time test. Simple clinical information such as general information, dialysis-related indices, irisin and other laboratory indices, and bioelectrical impedance analysis (BIA) data were collected. All data were randomly split into training (70%) and testing (30%) sets. Difference, correlation, univariate, and multivariate analyses were used to identify core features significantly associated with PD sarcopenia.
Result: 12 core features (C), namely, grip strength, body mass index (BMI), total body water value, irisin, extracellular water/total body water, fat-free mass index, phase angle, albumin/globulin, blood phosphorus, total cholesterol, triglyceride, and prealbumin were excavated for model construction. Two ML models, the neural network (NN), and support vector machine (SVM) were selected with tenfold cross-validation to determine the optimal parameter. The C-SVM model showed a higher area under the curve (AUC) of 0.82 (95% confidence interval [CI]: 0.67-1.00), with a highest specificity of 0.96, sensitivity of 0.91, positive predictive value (PPV) of 0.96, and negative predictive value (NPV) of 0.91.
Conclusion: The ML model effectively predicted PD sarcopenia and has clinical potential to be used as a convenient sarcopenia screening tool.
{"title":"Prediction of the sarcopenia in peritoneal dialysis using simple clinical information: A machine learning-based model.","authors":"Jiaying Wu, Shuangxiang Lin, Jichao Guan, Xiujuan Wu, Miaojia Ding, Shuijuan Shen","doi":"10.1111/sdi.13131","DOIUrl":"10.1111/sdi.13131","url":null,"abstract":"<p><strong>Introduction: </strong>Sarcopenia is associated with significant cardiovascular risk, and death in patients undergoing peritoneal dialysis (PD). Three tools are used for diagnosing sarcopenia. The evaluation of muscle mass requires dual energy X-ray absorptiometry (DXA) or computed tomography (CT), which is labor-intensive and relatively expensive. This study aimed to use simple clinical information to develop a machine learning (ML)-based prediction model of PD sarcopenia.</p><p><strong>Methods: </strong>According to the newly revised Asian Working Group for Sarcopenia (AWGS2019), patients were subjected to complete sarcopenia screening, including appendicular skeletal muscle mass, grip strength, and five-time chair stand time test. Simple clinical information such as general information, dialysis-related indices, irisin and other laboratory indices, and bioelectrical impedance analysis (BIA) data were collected. All data were randomly split into training (70%) and testing (30%) sets. Difference, correlation, univariate, and multivariate analyses were used to identify core features significantly associated with PD sarcopenia.</p><p><strong>Result: </strong>12 core features (C), namely, grip strength, body mass index (BMI), total body water value, irisin, extracellular water/total body water, fat-free mass index, phase angle, albumin/globulin, blood phosphorus, total cholesterol, triglyceride, and prealbumin were excavated for model construction. Two ML models, the neural network (NN), and support vector machine (SVM) were selected with tenfold cross-validation to determine the optimal parameter. The C-SVM model showed a higher area under the curve (AUC) of 0.82 (95% confidence interval [CI]: 0.67-1.00), with a highest specificity of 0.96, sensitivity of 0.91, positive predictive value (PPV) of 0.96, and negative predictive value (NPV) of 0.91.</p><p><strong>Conclusion: </strong>The ML model effectively predicted PD sarcopenia and has clinical potential to be used as a convenient sarcopenia screening tool.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":"36 5","pages":"390-398"},"PeriodicalIF":1.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10148202","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}
Background: In the United Kingdom, over 80% of end-stage kidney disease patients receive in-center hemodialysis. We conducted a survey of UK renal healthcare workers on their preferred dialysis modality if they needed dialysis themselves.
Methods: An anonymized online survey was disseminated to all renal healthcare workers in the United Kingdom. We asked "Assume you are an otherwise well 40-year-old (and, separately, 75-year-old) person approaching end stage kidney disease, you have no living kidney donor options at present. There are no contraindications to any dialysis options. Which dialysis therapy would you choose?" We also asked about factors influencing their choice.
Results: 858 individuals with a median age of 44.3 years responded. 70.2% were female, 37.4% doctors, and 31.1% were senior nurses. There was a preference for peritoneal dialysis over in-center hemodialysis (50.47% v. 6.18%; p < 0.001 for 40-year-old and 49.18% v. 17.83%; p < 0.001 for 75-year-old assumption) and home hemodialysis (50.47% v. 39.28%; p < 0.001 for 40-year-old and 49.18% v. 18.41% for 75-year-old assumption). There was a preference for home hemodialysis over in-center hemodialysis for 40-year-old (39.28% v. 6.18%; p < 0.001) but not for 75-year-old. On logistic regression, senior doctors were more likely to opt for PD when compared to nurses. Nurses, allied healthcare professionals, and those of Asian/British Asian ethnicity were more likely to choose in-center hemodialysis.
Conclusions: Most healthcare workers in renal medicine would choose home-based treatment for themselves although the majority of end-stage kidney disease patients receive in-center hemodialysis in the United Kingdom; the reasons for the discrepancy need to be explored.
{"title":"Do we practice what we preach? Dialysis modality choice among healthcare workers in the United Kingdom.","authors":"Rizwan Hamer, Awais Hameed, Sarah Damery, Karen Jenkins, Indranil Dasgupta, Jyoti Baharani","doi":"10.1111/sdi.13160","DOIUrl":"10.1111/sdi.13160","url":null,"abstract":"<p><strong>Background: </strong>In the United Kingdom, over 80% of end-stage kidney disease patients receive in-center hemodialysis. We conducted a survey of UK renal healthcare workers on their preferred dialysis modality if they needed dialysis themselves.</p><p><strong>Methods: </strong>An anonymized online survey was disseminated to all renal healthcare workers in the United Kingdom. We asked \"Assume you are an otherwise well 40-year-old (and, separately, 75-year-old) person approaching end stage kidney disease, you have no living kidney donor options at present. There are no contraindications to any dialysis options. Which dialysis therapy would you choose?\" We also asked about factors influencing their choice.</p><p><strong>Results: </strong>858 individuals with a median age of 44.3 years responded. 70.2% were female, 37.4% doctors, and 31.1% were senior nurses. There was a preference for peritoneal dialysis over in-center hemodialysis (50.47% v. 6.18%; p < 0.001 for 40-year-old and 49.18% v. 17.83%; p < 0.001 for 75-year-old assumption) and home hemodialysis (50.47% v. 39.28%; p < 0.001 for 40-year-old and 49.18% v. 18.41% for 75-year-old assumption). There was a preference for home hemodialysis over in-center hemodialysis for 40-year-old (39.28% v. 6.18%; p < 0.001) but not for 75-year-old. On logistic regression, senior doctors were more likely to opt for PD when compared to nurses. Nurses, allied healthcare professionals, and those of Asian/British Asian ethnicity were more likely to choose in-center hemodialysis.</p><p><strong>Conclusions: </strong>Most healthcare workers in renal medicine would choose home-based treatment for themselves although the majority of end-stage kidney disease patients receive in-center hemodialysis in the United Kingdom; the reasons for the discrepancy need to be explored.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":"36 5","pages":"407-413"},"PeriodicalIF":1.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10213975","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: 2023-07-22DOI: 10.1111/sdi.13169
Saad Khan, Kavita Babu, Rohan Sidhu, Matthew Niemi
Introduction: Caffeine overdose, while uncommon, can be life threatening with hemodynamic and neurological complications and often requires intensive monitoring and critical management.
Case report: We report a case of a 23-year-old male who ingested approximately 24 g of caffeine in a suicidal attempt and developed cardiopulmonary complications. He was resuscitated, and hemodialysis was performed with successful recovery.
Conclusion: Hemodialysis appears to effectively remove caffeine from the blood system and can be lifesaving in severe caffeine overdose.
{"title":"Caffeine intoxication treated with hemodialysis.","authors":"Saad Khan, Kavita Babu, Rohan Sidhu, Matthew Niemi","doi":"10.1111/sdi.13169","DOIUrl":"10.1111/sdi.13169","url":null,"abstract":"<p><strong>Introduction: </strong>Caffeine overdose, while uncommon, can be life threatening with hemodynamic and neurological complications and often requires intensive monitoring and critical management.</p><p><strong>Case report: </strong>We report a case of a 23-year-old male who ingested approximately 24 g of caffeine in a suicidal attempt and developed cardiopulmonary complications. He was resuscitated, and hemodialysis was performed with successful recovery.</p><p><strong>Conclusion: </strong>Hemodialysis appears to effectively remove caffeine from the blood system and can be lifesaving in severe caffeine overdose.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":"36 5","pages":"414-418"},"PeriodicalIF":1.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10156241","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: 2023-01-03DOI: 10.1111/sdi.13138
Mei Huang, Aili Lv, Feng Yang, Yuning Tang, Yang Li, Yan Hua, Julin Gao, Chunping Ni
Introduction: Physical inactivity is a strong predictor of mortality in hemodialysis patients. Although regular physical activity reduces mortality, patients remain inactive. Comparing the cognition of exercise in hemodialysis patients with different physical activity status could highlight domains where inactive people experience heightened barriers to physical activity. We therefore assessed patients' perceived benefits and barriers to exercise using a standardized way, thereby informing future exercise interventions to address these barriers experienced by inactive patients.
Methods: ESRD patients undergoing hemodialysis were recruited and asked to complete a human activity profile, wear a pedometer for seven consecutive days, and complete the Dialysis Patient-perceived Exercise Benefits and Barriers Scale (DPEBBS). Binominal Logistic regression analysis was conducted to determine which benefits and barriers are associated with physical activity. This cross-sectional observational study was registered as NCT05189795.
Results: A total of 505 patients completed the survey, most of whom were male (67.1%), with an average age of 49.69 ± 13.96 years. And 52.67-76.63% patients on HAP questionnaire were inactive. The co-benefits in active patients were improving mood and prevention of muscle wasting but did not reach significance in physical activity level. Tiredness, muscle fatigue, and lack of knowledge of exercise were common barriers to patients, and all have a significant impact on a patient's physical activity level.
Conclusions: For inactive patients, exercise during hemodialysis can not only improve physical activity but also reduce family burden. And improving physical activity is a long-term project that cannot be separated from the support of hemodialysis medical staff.
{"title":"Impacts of cognition of exercise on physical activity participation in hemodialysis patients.","authors":"Mei Huang, Aili Lv, Feng Yang, Yuning Tang, Yang Li, Yan Hua, Julin Gao, Chunping Ni","doi":"10.1111/sdi.13138","DOIUrl":"10.1111/sdi.13138","url":null,"abstract":"<p><strong>Introduction: </strong>Physical inactivity is a strong predictor of mortality in hemodialysis patients. Although regular physical activity reduces mortality, patients remain inactive. Comparing the cognition of exercise in hemodialysis patients with different physical activity status could highlight domains where inactive people experience heightened barriers to physical activity. We therefore assessed patients' perceived benefits and barriers to exercise using a standardized way, thereby informing future exercise interventions to address these barriers experienced by inactive patients.</p><p><strong>Methods: </strong>ESRD patients undergoing hemodialysis were recruited and asked to complete a human activity profile, wear a pedometer for seven consecutive days, and complete the Dialysis Patient-perceived Exercise Benefits and Barriers Scale (DPEBBS). Binominal Logistic regression analysis was conducted to determine which benefits and barriers are associated with physical activity. This cross-sectional observational study was registered as NCT05189795.</p><p><strong>Results: </strong>A total of 505 patients completed the survey, most of whom were male (67.1%), with an average age of 49.69 ± 13.96 years. And 52.67-76.63% patients on HAP questionnaire were inactive. The co-benefits in active patients were improving mood and prevention of muscle wasting but did not reach significance in physical activity level. Tiredness, muscle fatigue, and lack of knowledge of exercise were common barriers to patients, and all have a significant impact on a patient's physical activity level.</p><p><strong>Conclusions: </strong>For inactive patients, exercise during hemodialysis can not only improve physical activity but also reduce family burden. And improving physical activity is a long-term project that cannot be separated from the support of hemodialysis medical staff.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":"36 5","pages":"366-373"},"PeriodicalIF":1.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10159276","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}