Hemodialysis international. International Symposium on Home Hemodialysis最新文献

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.

Background: In pediatric hemodialysis patients with exhausted vascular access, managing rare pathogens like Ochrobactrum intermedium is challenging, often posing a dilemma between catheter removal and salvage attempts. There are few reports on the supported viability of meropenem-heparin lock therapy for this purpose in pediatric patients.

Case presentation: We present the case of a 12-year-old male with chronic kidney disease on hemodialysis who was admitted with sepsis attributed to her long-term hemodialysis catheter. Ochrobactrum intermedium was isolated from all catheter lumens and blood cultures. Due to a documented history of vascular access failure, catheter salvage was the primary goal. A combined systemic antibiotic and lock therapy with meropenem and unfractionated heparin was initiated. Critically, bacteremia relapsed promptly after a planned temporary suspension of the lock therapy, while systemic antibiotics were continued. Definitive microbiological eradication was only achieved after the re-initiation and completion of a 14-day course of the lock therapy, resulting in full clinical recovery and long-term catheter preservation. This case report suggests the potential efficacy of meropenem lock therapy as a salvage strategy for O. intermedium CRBSI when catheter removal is not a viable option. The relapse upon its suspension highlights that the lock therapy itself was the critical component for eradicating the O. intermedium biofilm, a feat the systemic antibiotic alone could not achieve. This approach is a viable alternative when catheter removal is not feasible.

Introduction: Patients undergoing maintenance hemodialysis frequently encounter a substantial psychosocial burden, yet conventional care frequently lacks the capacity to deliver comprehensive, sustained psychosocial support due to limitations in resources. Nurse-led peer support, which integrates professional expertise with the lived experience of peers, presents a promising complementary model; however, its consolidated efficacy in this population lacks rigorous synthesis.

Objective: This systematic review and meta-analysis aimed to evaluate the effects of nurse-led peer support on self-management, psychological status, and quality of life in patients receiving maintenance hemodialysis.

Methods: This review systematically searched ten databases (PubMed, Web of Science, Embase, CINAHL, Cochrane Library, Scopus, CNKI, WanFang, VIP, and SinoMed) from their inception to 20 January 2025 for randomized controlled trials and quasi-experimental studies. A meta-analysis was performed using random-effects models to pool standardized mean difference (SMD). The quality assessment and meta-analysis were conducted utilizing the Cochrane RevMan 5.4 software, with the evidence quality being evaluated employing the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system. The present study is registered in PROSPERO with the registration number CRD42025639997.

Results: A total of 292 literature records were retrieved, among which 27 studies met the inclusion criteria, and 11 provided data suitable for analysis (n = 1074). The overall risk of bias was thus determined to be low to moderate. Peer support demonstrated significant benefits for self-management (SMD = 0.77, 95% CI: 0.60-0.94; I² = 35%), quality of life (SMD = 0.91, 95% CI: 0.50-1.32; I² = 77%), and depression (SMD = -0.87, 95% CI: -1.39-0.36; I² = 70%). Evidence from two studies suggests that anxiety may be alleviated. The certainty of evidence was moderate for most outcomes.

Conclusions: This systematic review and meta-analysis indicates that nurse-guided peer support improves self-management capabilities and quality of life among maintenance hemodialysis patients while alleviating depressive and anxiety symptoms. Due to the limited number of included studies and heterogeneity in intervention protocols, implementation formats, and supporter criteria, the certainty of evidence is mostly moderate. However, consistent results support the positive clinical benefits of this intervention. Therefore, integrating structured peer support into routine care systems represents an effective complementary strategy. Future research should focus on identifying key factors influencing its efficacy, developing standardized intervention protocols, and validating the effectiveness and sustainability of blended online-offline delivery models.

Objectives: This study evaluated the effects of an interactive handgrip game on vascular maturation and grip strength in patients undergoing arteriovenous fistula (AVF) surgery.

Methods: This was a preliminary randomized controlled trial. Thirty patients who underwent AVF surgery were randomly assigned to either an interactive handgrip game group or a soft ball group, with 15 participants in each. Both groups began their respective interventions on the first day after returning home; they engaged in either the interactive handgrip game or soft ball exercises for 30 min per session, twice daily (morning and afternoon) for 2 months. Data were obtained using a self-designed structured questionnaire, a Noblus ultrasound machine, and a Jamar hand dynamometer. Assessments were conducted the day before AVF surgery, at the fourth week, and at the eighth week.

Results: A total of 30 participants with mean age of 56 years adhered fully to the prescribed training sessions. Compared with the soft ball group, the interactive handgrip game group demonstrated greater improvements in blood flow rate at 8 weeks (1230 vs. 930 mL/min; p < 0.001) and in handgrip strength at both 4 weeks (14 vs. 12 kg; p < 0.001) and 8 weeks (18 vs. 14 kg; p < 0.001). No significant time-by-group interactions were observed for vein diameter or fistula depth. Participants also reported high satisfaction (scores 4.6-5) and strong agreement on the feasibility of the interactive handgrip game (mean = 5).

Conclusion: A 2-month regimen of an interactive handgrip game yielded significantly greater vascular maturation and grip strength relative to soft ball exercises. In addition, the game resulted in high patient satisfaction and was feasible to implement, supporting its potential as an effective intervention for AVF maturation.

Trial registration: ClinicalTrials.gov: NCT05493046.

Background: The research aimed to establish sarcopenia occurrence rates among patients beginning hemodialysis treatment and assess muscle mass and function changes and sarcopenia status after six months of dialysis.

Methods: The prospective observational study included 110 patients who were new to hemodialysis (maximum 1 month). Patients were grouped as sarcopenic (n = 33) and non-sarcopenic (n = 77) according to EWGSOP2 criteria. Demographic characteristics, body composition by bioelectrical impedance analysis, hand grip strength, walking speed tests, and laboratory parameters were evaluated at baseline and at 6 months.

Results: At baseline, 30% of the patients were considered sarcopenic. After six months of hemodialysis, only 2 of 33 patients (6.1%) who were sarcopenic at baseline remained sarcopenic (p = 0.76). Skeletal Muscle Index (SMI) increased from 6.4 ± 1.0 kg/m² to 6.9 ± 0.9 kg/m² in the sarcopenic group (p = 0.65), but this difference was not significant when compared with the non-sarcopenic group (p = 0.32). Walking speed time improved from 10.5 ± 3.8 s to 8.7 ± 3.3 s in the sarcopenic group and the difference between the groups was statistically significant (p = 0.03). Right hand grip strength increased from 20.8 ± 9.2 kg to 31.2 ± 7.8 kg (p = 0.68). In multivariate analysis, SMI (OR: 0.38, p < 0.001) was significantly associated with sarcopenia, while age (p = 0.37), gender (p = 0.15), albumin (p = 0.62), and CRP (p = 0.82) were not significantly associated.

Conclusions: Patients who start hemodialysis have high rates of sarcopenia but have significant muscle mass and functional improvements during the first six months of effective hemodialysis treatment. The removal of uremic toxins produces beneficial effects on muscle metabolism according to these results.

Introduction: Erythropoiesis-stimulating agents (ESAs) and iron supplementation are standard treatments for chronic kidney disease (CKD)-related anemia. Targeting higher hemoglobin values in CKD increases cardiovascular risk. Whether the increased risk is from higher ESA doses or higher hemoglobin levels is uncertain, but alternative therapies are sought for patients requiring high ESA doses. Phase 3 INNO₂VATE trials in patients with dialysis-dependent CKD (DD-CKD) demonstrated vadadustat's noninferiority compared with darbepoetin alfa. To determine vadadustat's potential to treat anemia, including in patients requiring high ESA doses, its safety and efficacy were compared with those of darbepoetin alfa across prespecified baseline ESA dose subgroups in the prevalent DD-CKD INNO₂VATE trial.

Methods: We compared the safety and efficacy of vadadustat versus darbepoetin alfa across prespecified baseline ESA dose subgroups (low [≤ 90 U/kg/week], intermediate [> 90 and < 300 U/kg/week], or high [≥ 300 U/kg/week]) in the INNO₂VATE prevalent trial. The primary safety endpoint was time to first adjudicated major adverse cardiovascular event (MACE). Primary and secondary efficacy endpoints were mean hemoglobin level change from baseline at weeks 24-36 and weeks 40-52, respectively.

Findings: Compared with darbepoetin alfa, first MACE hazard ratios for vadadustat were 0.99 (95% CI, 0.81-1.23), 0.93 (95% CI, 0.74-1.18), and 0.62 (95% CI, 0.34-1.14) for low, intermediate, and high baseline ESA dose subgroups, respectively (interaction p = 0.92). Vadadustat was noninferior to darbepoetin alfa in hemoglobin change from baseline to primary evaluation period, with mean differences (vadadustat-darbepoetin alfa) of -0.10 g/dL (95% CI, -0.19 to -0.02), -0.20 g/dL (95% CI, -0.30 to -0.09), and -0.39 g/dL (95% CI, -0.67 to -0.11) for low, intermediate, and high ESA dose subgroups, respectively.

Discussion: Comparing safety and efficacy by baseline ESA dose among patients with CKD on maintenance dialysis, vadadustat was noninferior to darbepoetin alfa for all ESA dose subgroups, including patients with high baseline ESA requirements.