Hemodialysis international. International Symposium on Home Hemodialysis最新文献

Purpose: To investigate the association between postdialysis fatigue (PDF) and physical and emotional symptoms in patients receiving maintenance hemodialysis.

Methods: All prevalent patients undergoing maintenance hemodialysis at our Hemodialysis Service between June 2022 and September 2024 were considered eligible. The Dialysis Symptom Index questionnaire was administered during dialysis sessions. PDF was assessed using the approach recommended by Sklar et al. Patients were classified as having PDF if they spontaneously reported feeling fatigued after dialysis in response to the question: "Do you feel fatigued after dialysis?"

Results: A total of 269 patients were studied: 220 with PDF and 49 without. Patients with PDF were significantly older and had a higher Charlson comorbidity index. The median [95% CI] number of symptoms was 13 [12-14] in patients with PDF versus 7 [6-8.8] in those without (p < 0.0001). In multivariable logistic regression, PDF was independently associated with the Charlson comorbidity index (odds ratio [95% CI]: 1.41 [1.08-1.85], p = 0.010) and the total number of symptoms (1.27 [1.16-1.40], p < 0.0001). The prevalence of 15 out of 29 symptoms was significantly higher in patients with PDF. After adjustment, PDF remained independently associated with swelling in the legs (OR [95% CI]: 12.8 [1.43-113.9], p = 0.022), restless legs (3.41 [0.98-11.8], p = 0.052), difficulty concentrating (8.24 [2.12-32.1], p = 0.002), difficulty becoming sexually aroused (6.00 [2.58-13.9], p < 0.0001), and feeling sad (6.06 [2.31-15.9], p = 0.0003). The severity of itching, bone or joint pain, worrying, feeling nervous, feeling anxious, and decreased interest in sex was also significantly greater in patients with PDF.

Conclusion: PDF is independently associated with a higher burden of comorbidities and a greater number of physical and emotional symptoms. It is also specifically linked to the prevalence of leg swelling, restless legs, difficulty concentrating, difficulty becoming sexually aroused, and sadness.

Introduction: Hemodialysis, the primary treatment for chronic kidney disease, prolongs life but is frequently accompanied by physical and psychological symptoms that impair quality of life. Progressive muscle relaxation exercises offer a novel non-pharmacological approach to symptom management. This study aimed to evaluate progressive muscle relaxation exercises on dialysis-related symptoms (primary outcome) and quality of life (secondary outcome) in patients undergoing hemodialysis.

Methods: A randomized controlled pre-test-post-test study was conducted between May and September 2025 in two dialysis units in eastern Türkiye. Ninety-two hemodialysis patients were randomly assigned to either an intervention group (n = 46) or a control group (n = 46). The intervention group received 24 sessions of progressive muscle relaxation exercises over 8 weeks, while the control group received routine care. Data were collected at baseline and after the intervention using the dialysis symptom index and the Short Form-36 quality-of-life scale.

Findings: The groups were similar in baseline. After the intervention, the progressive muscle relaxation exercises group demonstrated a significant reduction in symptom burden, with mean dialysis symptom index scores decreasing from 29.4 ± 13.3 to 16.3 ± 6.77 (t = 7.21, p < 0.001). Short-Form-36 quality-of-life scores increased from 51.4 ± 9.83 to 65.8 ± 10.1 (t = 4.67, p < 0.001), with significant improvements in physical functioning, vitality, pain, general health, and mental well-being (p < 0.05).

Discussion: Progressive muscle relaxation exercises reduced dialysis-related symptoms and improved quality of life in hemodialysis patients. Given its simplicity, non-invasive nature, and low cost, it may be used as a complementary intervention in routine hemodialysis care. Further research should examine long-term effects and broader clinical applicability.

Introduction: Vascular access is critical for hemodialysis in patients with end-stage renal disease. Autogenous arteriovenous fistula is the first-line option, while arteriovenous grafts are an alternative for patients with poor native vascular conditions. Over the past decade, early cannulation arteriovenous grafts with a multi-layered structure have emerged, allowing cannulation within 24-72 h after implantation to meet urgent dialysis needs. However, this specific structure renders them susceptible to dissection, a unique complication. To date, no systematic review has summarized the characteristics and management of this complication, and this paper aims to address this gap.

Methods: The search was conducted in the PubMed database. Finally, seven case reports and one cohort study were included.

Findings: The diagnosis of dissection in early cannulation arteriovenous grafts mainly relies on Doppler ultrasound examination. Most reported cases involve Acuseal grafts, with dissections predominantly located between the middle and outer layers, and mostly on the anterior wall. It may be associated with balloon dilation, vascular sheath insertion, inappropriate puncture angle, and repeated joint movement. There is no standard treatment protocol. Available options include PTA, stent implantation, graft replacement, and conservative observation. Graft replacement yields the best primary patency rate. Stent implantation or graft replacement is recommended as the first-line treatment.

Discussion: Reports on dissection in early cannulation arteriovenous grafts remain scarce. The true incidence across different graft types, optimal treatment strategies, and long-term outcomes following various interventions have not been fully clarified, and further research should be conducted in the future.

Background: Synthetic dialysis membranes, particularly those composed of polysulfone blended with polyvinylpyrrolidone, are commonly used in hemodialysis due to their efficiency. However, hypersensitivity reactions-often atypical and not fitting traditional type A and B classifications-have increasingly been reported. Symptoms include chest tightness, bronchospasm, oxygen desaturation, and hypotension, often without clear etiology. The need for safer alternatives has led to interest in newer dialyzer technologies, such as the hydrophilic helixone membrane which incorporates tocopherol to enhance biocompatibility.

Methods: We conducted a multicenter, retrospective observational study in four hemodialysis units in Catalonia (Spain). Thirty-one stable patients previously diagnosed with hypersensitivity to synthetic membranes and dialyzing with cellulose triacetate were switched to hydrophilic helixone (CorAL) dialyzers. Clinical data, including symptoms before and after the switch, were extracted from medical records. The primary outcome was the occurrence of adverse reactions after the transition.

Results: Of the 31 patients (mean age 70.1 ± 13.9 years), the most common symptoms at initial reaction included cutaneous (21, 67.7%), respiratory (13, 41.9%), and cardiovascular (9, 29.0%) manifestations. After switching to hydrophilic helixone, 28 patients (90.3%) had no further hypersensitivity symptoms over a mean follow-up of 5.8 ± 4.3 months. Three patients experienced mild reactions (two with pruritus, one with hypotension) and reverted to cellulose triacetate. No significant associations were found between relapse and the type of membrane or symptom profile.

Conclusions: The hydrophilic helixone membranes appear to be a safe and well-tolerated alternative for patients with a history of hypersensitivity to synthetic membranes. These findings suggest that hydrophilic helixone dialyzers may allow more patients to continue treatment with synthetic membranes without severe reactions, potentially improving biocompatibility and treatment flexibility in routine clinical practice. While the findings are promising, larger prospective studies are necessary to confirm the safety and long-term clinical benefits.

Objective: The traditional treatment for venous air embolism has been mainly conservative, with very few reports advocating the use of manual aspiration. The objective of this report is to describe a novel procedure that employed a practical combination of positional maneuvers and direct catheter-based aspiration for air embolism encountered during tunneled hemodialysis catheter insertion.

Methods: A retrospective review of three cases of venous air embolism encountered during a 3-year period (September 2022-July 2025) was conducted, in which the patient repositioning combined with manual aspiration of intravascular air was employed.

Results: Venous air embolism characteristically occurred during removal of the dilator-guidewire assembly from the vascular sheath during the procedure, especially in long-term tunneled catheters, owing to the larger caliber of the peel-apart sheath. The embolized air has the potential to lodge in the right ventricular outflow tract, thereby reducing pulmonary venous return and cardiac output. Immediate patient repositioning combined with rapid central venous catheter insertion and targeted manual aspiration of intravascular air achieved prompt clinical stabilization in all three cases.

Conclusion: Venous air embolism is a rare but life-threatening complication of image-guided central venous catheter insertions. For symptomatic air embolism involving the right ventricular outflow tract, prompt catheter insertion, proper positioning, and manual aspiration of air through the inserted catheter, in conjunction with oxygen supplementation, may assist in managing this acute condition promptly.

Introduction: Loss of skeletal muscle mass in chronic kidney disease is strongly associated with reduced physical function and increased mortality. Although well recognized, the impact of volume overload, on physical function and muscle strength, remains understudied. This study aimed to assess the association between volume overload, physical function, and muscle strength in individuals on hemodialysis.

Methods: Fifty-two individuals on hemodialysis were included. Muscle strength was assessed using hand dynamometry, defining dynapenia as muscle strength < 20 kg in women and < 30 kg in men. Physical function was measured using the short physical performance battery, with "low physical function" defined as a score ≤ 8.0. Bioelectrical impedance vector analysis z-score graph was plotted according to physical function and muscle strength classification as normal or reduced. Resistance and reactance data, normalized to height, were converted into z-scores and plotted on a z-score graph. The comparison of bioelectrical impedance vector analysis between groups was performed using Hotelling's T² test. In addition, multivariate logistic regression was used to explore the association between volume overload with muscle strength and physical function.

Findings: Bioelectrical impedance vector analysis z-score graphs showed that individuals with reduced physical function were outside the 95th percentile of the major axis, indicating volume overload, while those with normal physical function had adequate hydration status (p < 0.0001). In Model 1 of the multivariate logistic regression, volume overload was associated with low physical function. In Model 2, none of the independent variables were associated with muscle strength.

Discussion: Individuals on hemodialysis with reduced physical function exhibited higher volume overload. Although volume overload is associated with worse physical function, no association was observed with muscle strength.

Animal exhibits can be a source of E. coli O157:h7 transmission and may lead to hemolytic uremic syndrome. The E. coli O157:h7 outbreak in Tennessee affected over 64 children. Five children, 15 months to 7 years of age, developed acute renal failure due to HUS, requiring renal replacement therapy. They were admitted to the hospital with acute renal failure between 7 and 12 days after exposure to animals. All children presented with vomiting, diarrhea, abdominal pain, and oligo-anuria and had laboratory confirmation of E. coli O157:h7 in the stool sample. They all required renal replacement therapy, and one child required therapeutic plasma exchange due to thrombotic microangiopathy vasculitis-associated encephalopathy. These children experienced dialysis catheter malfunction (n = 1), encephalopathy (n = 1), and thrombosis of the right jugular vein (n = 1). All children developed hypertension, and three out of five required anti-hypertensives at discharge. At the 1-year follow-up, the GFR ranged from 54 to 92 mL/min. Hypertension was noted in two. Hemolytic uremic syndrome can cause long-term sequelae like cerebral atrophy, hypertension, and chronic kidney disease. Hygiene measures can potentially prevent hemolytic uremic syndrome.