BMC Nephrology最新文献

Background: The management of depression in patients undergoing hemodialysis remains challenging and affects quality of life; however, there is a possibility that breathing exercises may be effective in this context. Thus, the purpose of this study was to evaluate the effectiveness of a breathing training program on quality of life and depression among patients on hemodialysis.

Methods: A one-group pretest-posttest quasi-experimental design was used. Data were collected from hemodialysis patients at three dialysis centers. Initial baseline data were collected, and a breathing training program was implemented. The program included three types of breathing exercises. A total of 41 participants completed the study. The participants were asked to perform the breathing training program three times a day for 30 days. The impact of the intervention on patients' quality of life and depression was measured using both the Kidney Disease Quality of Life Short Version and the Beck Depression Inventory-Second Edition.

Results: A significant decrease in the overall depression score was observed after implementing the breathing training program (BDI-II mean difference =-3.9, 95% CI:0.35-7.45, p = 0.03). The intervention has also had significant improvements on overall quality of life (KDQOL mean difference = 6.09, 95% CI: 0.48-11.70, p = 0.03) and a reduction in the symptoms and problems domain (domain mean difference = 6.71, 95% CI: 0.01-13.40, p = 0.05). There were some improvements on other quality of life domains but did not reach the statistical differences after program implementation.

Conclusions: Breathing exercises are associated with improved quality of life and reduced depression among HD patients, providing a simple and cost-effective intervention.

Background: Cardiac surgery is a major contributor to acute kidney injury (AKI); approximately 22% of patients who undergo cardiac surgery develop AKI, and among them, 2% will require renal replacement therapy (RRT). AKI is also associated with heightened risks of mortality and morbidity, longer intensive care stays, and increased treatment costs. Due to the challenges of treating AKI, prevention through the use of care bundles is suggested as an effective approach. This review aimed to assess the impact of care bundles on kidney outcomes, mortality, and hospital stay for cardiac patients in critical care.

Methods: PubMed, Scopus, Web of Science, and EMBASE were searched up to November 2024. Inclusion criteria were studies on individuals with cardiac diseases receiving critical care, that used AKI care bundle as the intervention, and reported outcomes related to AKI, mortality, and other kidney-related events. We used the Cochrane Collaboration's risk of bias tool 2 and the Newcastle-Ottawa scale for quality assessment. Pooled odds ratios (ORs) or risk ratios (RRs) with 95% confidence intervals (CIs) were calculated.

Results: Seven studies on total 5045 subjects, including five observational and two randomized controlled trials (RCTs) were included. The implementation of care bundles significantly reduced the incidence of all-stage AKI (OR: 0.78; 95%CI: 0.61-0.99) and moderate-severe AKI (OR: 0.56; 95%CI: 0.43-0.72). Also, the implementation of care bundle increased the incidence of persistent renal dysfunction after 30 days by 2.39 times. However, there were no significant changes in RRT, major adverse kidney events, or mortality between the groups. The mean quality assessment score for observational studies was 7.2 out of ten, while there were noted concerns in the risk of bias assessment of the RCTs.

Conclusions: The application of care bundles in patients, including those undergoing cardiac surgeries as well as non-cardiac critical illness, appears to be effective in reducing AKI, particularly in moderate and severe stages. However, given the inclusion of non-cardiac patients in some studies, the observed effect may not be solely attributable to cardiac surgery cases. Future large-scale RCTs focusing specifically on cardiac surgery patients are recommended to clarify the impact of care bundles within this subgroup.

Registration id in prospero: CRD42024498972.

Background: Managing acute myocardial infarction (AMI) in patients with chronic kidney disease (CKD) or end-stage renal disease on dialysis (renal replacement therapy, RRT) presents challenges due to elevated complication risks. Concerns about contrast-related kidney damage may lead to the omission of guideline-directed therapies like percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in this population.

Methods: We analysed German-DRG data of 2016 provided by the German Federal Bureau of Statistics (DESTATIS). We included cases with a primary diagnosis of AMI (ST-Elevation Myocardial Infarction (STEMI) or Non-ST-Elevation Myocardial Infarction (NSTEMI) ICD-10: I21 or I22) with and without CKD or RRT. We calculated crude- and age-standardized hospitalization rates (ASR, per 100,000 person years). Furthermore, we calculated log-binominal regression models adjusting for sex, CKD, RRT, comorbidities, and place of residence to estimate adjusted relative-risks (aRR) for receiving treatments of interest in AMI, such as PCI or CABG.

Results: We identified 217,514 AMI-cases (69,728 STEMI-cases and 147,786 NSTEMI-cases). AMI-cases without CKD had percutaneous coronary intervention (PCI) in 60.8%. In contrast, AMI-cases with CKD or RRT had PCI in 46.6% and 54.5%, respectively. The ASR for AMI-cases amounted to 184.7 (95%CI 183.5-185.8) per 100,000 person years. In regression analysis AMI-cases with CKD were less likely treated with PCI (aRR: 0.89 (95%CI 0.88-0.90)), compared to cases without CKD. AMI-Cases with RRT showed no difference in PCI rates (aRR: 1.0 (95%CI 0.97-1.03)) but were more frequently treated with CABG (aRR: 2.20 (95%CI 2.03-2.39)). Conversely, CKD was negatively associated with CABG (aRR: 0.71, 95%CI 0.67-0.75) when non-CKD cases were used as the reference group.

Conclusion: We show that AMI-cases with CKD underwent PCI less frequently, while RRT has no discernible impact on PCI utilization in AMI. Furthermore, AMI-cases with RRT exhibited a higher CABG rate.

Background: Accurate assessment of fluid volume and hydration status is essential in many disease states, including patients with chronic kidney disease. The aim of this study was to investigate the ability of a wearable continuous bioimpedance sensor to detect changes in fluid volume in patients undergoing regular hemodialysis (HD).

Methods: 31 patients with end-stage renal disease were enrolled and monitored with a sensor patch (Re:Balans^®) on the upper back through two consecutive HD sessions and the interdialytic period between. The extracellular resistance R_E was calculated from multi-frequency bioimpedance measurements and was hypothesized to correlate with the amount of extracted fluid during dialysis.

Results: Only HD sessions with a positive net fluid extraction were included in the primary analysis. Participants had an increase of 7.5 ± 4.3 Ω (Ohm) in R_E during the first HD and 6.2 ± 2.3 Ω during the second HD, and a fluid extraction (ultrafiltration (UF) volume) of 1.5 ± 0.8 L and 1.2 ± 0.6 L, respectively. The relative change in R_E during HD correlated strongly with UF volume (r = 0.82, p < 0.001). During the interdialytic period, the patients had a mean decrease in R_E of 6.0 ± 3.5 Ω. Longitudinal changes in R_E (%) and body weight (kg) over the entire study period was negatively correlated (r = -0.61 p < 0.001). Longitudinal changes in blood samples and cardiovascular changes were also in agreement with changes in weight and R_E.

Conclusions: The results of this clinical investigation indicate that the investigational device is capable of tracking both rapid and gradual changes in hydration status in patients undergoing regular HD.

Background: Dialysis recovery time (DRT) refers to the period during which fatigue and weakness subside following hemodialysis treatment, allowing patients to resume their daily routines. This study aimed to identify the factors influencing DRT in hemodialysis patients in Turkey and Portugal, where the prevalence of chronic kidney disease is notably high.

Methods: A cross-sectional observational study was conducted in a private dialysis center in Turkey and three dialysis centers in Portugal. The study included hemodialysis patients aged 18 years or older who had been undergoing four-hour hemodialysis sessions three times a week for at least six months. Participants had no communication barriers and voluntarily agreed to take part in the study. Data were collected using a semi-structured questionnaire to gather descriptive characteristics and the Hospital Anxiety and Depression Scale. Logistic regression analysis was employed to identify independent variables influencing DRT.

Results: A total of 294 patients participated in the study, including 187 from Turkey and 107 from Portugal. In Turkey, increased interdialytic weight gain (P = 0.043) was associated with prolonged recovery time, while the use of high-flux dialyzers (P = 0.026) was linked to shorter recovery times. In Portugal, older age (P = 0.020) was found to extend recovery time.

Conclusion: Recovery time after dialysis is influenced by varying factors across different countries. Further research with larger sample sizes is needed to deepen understanding of these factors and their implications.

Clinical trial number: NCT04667741.

Background: Urinalysis is a commonly performed test for the diagnosis and prognosis of kidney disease in hospitalized patients. It involves examining the chemical composition of the urine and microscopy to examine the cells and casts. In clinical settings, urinalysis is frequently delayed by several hours after sample collection and held at room temperature. The purpose of this study is to investigate the changes in urine composition over set time intervals to confirm the reliability of urinalysis when there are delays in performing the tests.

Methods: We obtained 15 mL of urine from the Foley catheters of five patients in the intensive care unit. We utilized the state-of-the-art IDEXX SediVue Dx ® machine to perform urine microscopy and the Siemens CLINITEK Status + Urine Analyzer to perform the dipstick tests. We performed microscopy and dipstick tests at 0, 1, 2, 4, and 6 h. Between the two testing methods, 30 individual components were tested in the urine. We calculated the %CV for each component by taking four repeated measurements at one time period for multiple samples.

Results: After calculating the %CV for each component, we analyzed the trend for each constituent over the 6 h. If the percent change over the six-hour interval was ± twofold than the %CV, we determined time to influence the results. Significant changes were seen in bacteria as the levels increased, red blood cells and pathological casts where the level decreased, and crystal levels were determined inconclusive due to fluctuations in the results. All other components were found to remain unchanged.

Conclusions: Timely urine analysis is necessary for accurate results as delayed analysis can considerably change the makeup of urine, which can affect clinical decisions and patient management.

Background: The effects of acute kidney injury (AKI) on liver-related outcomes in patients with hepatitis B virus (HBV) infection remain unclear. The study aimed to evaluate the association between AKI with liver-related mortality and complications in patients with HBV infection.

Methods: The multicenter, retrospective cohort study included Chinese adults with HBV infection from 24 regional central hospitals between January 2000 and December 2022. AKI was defined as a ≥ 26.5 μmol/l increase in serum creatinine concentration within 48 h, or a ≥ 50% increase over the baseline within 7 days. The primary outcome was post-discharge liver-related mortality, while the secondary outcome was a composite of new-onset liver cirrhosis and hepatocellular carcinoma. Cox proportional hazard model was employed for analyses.

Results: Of the 86,204 inpatients with HBV infection and without liver cancer or cirrhosis at baseline, 4407(5.1%) patients experienced AKI. During a mean follow-up of 4.6 ± 2.4 years, 334 (0.4%) patients died of liver-related events. After adjustment, AKI during hospitalization was significantly associated with a higher risk of liver-related mortality after discharge (adjusted hazard ratio (HR), 1.78; 95% confidence intervals (CI), 1.26-2.51, P = 0.001), especially in those with severe AKI. Similarly, AKI was associated with a higher risk of cirrhosis or new-onset hepatocellular carcinoma (adjusted HR, 1.33; 95%CI, 1.10-1.60, P = 0.004). The association between AKI and liver-related outcomes remained consistent across different subgroups.

Conclusions: AKI during hospitalization was associated with substantial increased risk of liver-related mortality and incident liver-related complication. Our findings highlight the importance of monitoring AKI in patients with HBV infection for tailoring personalized treatments.

Background: To evaluate the epidemiological data on the prevalence of frailty and prefrailty in individuals aged 60 years or older on MHD patients.

Methods: PubMed, Web of Science, Embase, CNKI, WanFang, CBM, and VIP were searched from inception to February 2023 using combinations of subject words and free words. The methodological quality of all the selected studies was assessed using the Joanna Briggs Institute Critical Appraisal of Epidemiological Studies Checklist and Newcastle‒Ottawa Cohort Quality Assessment Scale. Random effects meta-analysis was used to pool estimates from different studies. Subgroup analysis and meta-regression were performed to explore potential sources of heterogeneity.

Results: Of the 4,190 documents retrieved, 16 observational studies involving 2,446 participants from 8 countries were included in this systematic review. Among older adults receiving MHD, the overall prevalence of frailty and prefrailty was 41% (95% CI = 34-49%) and 37% (95% CI = 26-48%), respectively, with considerable heterogeneity. The pooled prevalence of frailty was greater among individuals aged > 70 years (45%) than among those aged ≤ 70 years (37%). However, subgroup analyses indicated that the confidence intervals for the age group overlap substantially.

Conclusion: Our research showed that the prevalence of frailty and prefrailty in older patients with MHD are high.

Trial registration: The PROSPERO registration number for this study was CRD42023442569.

Background: Results from the CONVINCE clinical trial suggest a 23% mortality risk reduction among patients receiving high-volume (> 23 L) hemodiafiltration. We assessed the real-world effectiveness of blood-based kidney replacement therapy (KRT) with hemodiafiltration vs. hemodialysis in a large, unselected patient population treated prior to and during the COVID-19 pandemic.

Methods: In this retrospective cohort study, we analyzed pseudonymized data from 85,117 adults receiving in-center care across NephroCare clinics in Europe, the Middle East, and Africa during 2019-2022. Cox regression models with KRT modality and coronavirus disease 2019 (COVID-19) status as time-varying covariates, and adjusted for multiple confounders, were used to estimate all-cause (primary) and cardiovascular (secondary) mortality. Subgroup analyses were performed for age, dialysis vintage, COVID-19 status, diabetes, and cardiovascular disease.

Results: At baseline, 55% of patients were receiving hemodialysis and 45% of patients were receiving hemodiafiltration. Baseline characteristics were similar between baseline modalities, except that hemodiafiltration patients were a median of 2 years younger, had higher percentage of fistula access (66% vs. 47%), and had longer mean dialysis vintages (4.4 years vs. 2.6 years). Compared with hemodialysis, hemodiafiltration was associated with an adjusted hazard ratio (HR) for all-cause mortality of 0.78 (95% confidence interval [Cl], 0.76-0.80), irrespective of COVID-19 infection. The pattern of a beneficial effect of hemodiafiltration was consistently observed among all analyzed subgroups. Among patients receiving high-volume hemodiafiltration (mean convection volume ≥ 23 L), the risk of death was reduced by 30% (HR, 0.70 [95% CI, 0.68-0.72]). Hemodiafiltration was also associated with a 31% reduced risk of cardiovascular death.

Conclusions: Our results suggest that hemodiafiltration has a beneficial effect on all-cause and cardiovascular mortality in a large, unselected patient population and across patient subgroups in real-world settings. Our study complements evidence from the CONVINCE trial and adds to the growing body of real-world evidence on hemodiafiltration.

Background: Chronic kidney disease (CKD) is a global health problem, affecting over 840 million individuals. CKD is linked to higher mortality and morbidity, partially mediated by higher cardiovascular risk and worsening kidney function. This study aimed to identify risk factors and develop risk prediction models for selected cardiorenal clinical outcomes in patients with non-diabetic CKD.

Methods: The study included adults with non-diabetic CKD (stages 3 or 4) from the Optum® Clinformatics® Data Mart US healthcare claims database. Three outcomes were investigated: composite outcome of kidney failure/need for dialysis, hospitalization for heart failure, and worsening of CKD from baseline. Multivariable time-to-first-event risk prediction models were developed for each outcome using swarm intelligence methods. Model discrimination was demonstrated by stratifying cohorts into five risk groups and presenting the separation between Kaplan-Meier curves for these groups.

Results: The prediction model for kidney failure/need for dialysis revealed stage 4 CKD (hazard ratio [HR] = 2.05, 95% confidence interval [CI] = 2.01-2.08), severely increased albuminuria-A3 (HR = 1.58, 95% CI = 1.45-1.72), metastatic solid tumor (HR = 1.58, 95% CI = 1.52-1.64), anemia (HR = 1.42, 95% CI = 1.41-1.44), and proteinuria (HR = 1.40, 95% CI = 1.36-1.43) as the strongest risk factors. History of heart failure (HR = 2.42, 95% CI = 2.37-2.48), use of loop diuretics (HR = 1.65, 95% CI = 1.62-1.69), severely increased albuminuria-A3 (HR = 1.55, 95% CI = 1.33-1.80), atrial fibrillation or flutter (HR = 1.53, 95% CI = 1.50-1.56), and stage 4 CKD (HR = 1.48, 95% CI = 1.44-1.52) were the greatest risk factors for hospitalization for heart failure. Stage 4 CKD (HR = 2.90, 95% CI = 2.83-2.97), severely increased albuminuria-A3 (HR = 2.30, 95% CI = 2.09-2.53), stage 3 CKD (HR = 1.74, 95% CI = 1.71-1.77), polycystic kidney disease (HR = 1.68, 95% CI = 1.60-1.76), and proteinuria (HR = 1.55, 95% CI = 1.50-1.60) were the main risk factors for worsening of CKD stage from baseline. Female gender and normal-to-mildly increased albuminuria-A1 were found to be associated with lower risk in all prediction models for patients with non-diabetic CKD stage 3 or 4.

Conclusions: Risk prediction models to identify individuals with non-diabetic CKD at high risk of adverse cardiorenal outcomes have been developed using routinely collected data from a US healthcare claims database. The models may have potential for broad clinical applications in patient care.