Hemodialysis international. International Symposium on Home Hemodialysis最新文献

Acute kidney injury is a common complication present in critically ill patients and is often managed by kidney replacement therapy. Prolonged intermittent kidney replacement therapy (PIKRT) is a modality of kidney replacement therapy often utilized in intensive care settings, but dosing recommendations and pharmacokinetic data for antimicrobial removal during PIKRT are limited. Metronidazole, a 5-nitroimidazole agent, is commonly prescribed for anaerobic and protozoal infections. Although generally well tolerated, adverse effects including severe neurotoxicity have been reported in association with prolonged or high cumulative dosing, particularly in the setting of kidney or hepatic impairment. In this case study, we describe and discuss the pharmacokinetics of metronidazole and the hydroxy-metabolite (hydroxy-metronidazole) concentrations in a critically ill patient undergoing PIKRT.

Objective: Parathyroidectomy is an effective intervention for patients with end-stage renal disease and refractory secondary hyperparathyroidism. This study aimed to assess the long-term clinical outcomes and overall quality of life of patients following parathyroidectomy in real-world clinical practice.

Methods: The study included 103 patients with refractory secondary hyperparathyroidism treated with parathyroidectomy in a real-world setting (51 males, age 58 ± 10 years). Intact parathyroid hormone (iPTH), serum calcium, and serum phosphorus indices were compared preoperatively and at 6 months, 12 months, and 1 year postoperatively. The proportion of patients with a > 30% decrease in iPTH was evaluated to assess the long-term treatment effect of parathyroidectomy. The EQ-5D-5L scale was utilized to evaluate the long-term postoperative quality of life.

Results: Fifty percent of the patients included in the study had a follow-up time of more than 19 months (19.0 [12.0, 24.0]). The median pretreatment iPTH level was 1796.2 (905.5, 2909.8) pg/mL, with 43.7% of patients exceeding 2000 pg/mL and 19.4% exceeding 3000 pg/mL; 19 (18%) patients had an iPTH level of ≤ 800 pg/mL. The preoperative mean serum calcium level was 2.54 (0.22), 95% CI (2.44, 2.68), and the mean serum phosphorus level was 2.09 (0.48), 95% CI (1.81, 2.19). Approximately 50% of patients underwent total parathyroidectomy. The iPTH levels decreased significantly after surgery (p < 0.001). At 6 months postoperatively, 96.7% of the patients had a decrease in iPTH of more than 30% compared to the preoperative levels, and this percentage was 94.9% at 12 months postoperatively. Mean serum calcium and phosphorus levels decreased significantly after surgery (p < 0.01). More than 60% of patients achieved target serum calcium levels, and more than 40% achieved target serum phosphorus levels at 6 months postoperatively, demonstrating a statistically significant increase compared to preoperative levels (p < 0.001). No significant difference in surgical outcomes was observed between the groups with preoperative iPTH levels > 800 and < 800 pg/mL. The utilization of secondary hyperparathyroidism-related medications decreased following surgical intervention. The median health utility value, as measured using the EQ-5D-5L scale, was 0.897 (0.739, 1.0), with a median VAS score of 80 (60, 90).

Conclusions: In clinical practice, parathyroidectomy demonstrates efficacy in reducing iPTH levels and facilitating the management of serum calcium and phosphorus levels. Moreover, this surgical intervention significantly decreases medication requirements and enhances the long-term quality of life for patients postoperatively. The evidence suggests that surgical intervention may confer long-term benefits to patients with refractory secondary hyperparathyroidism.

Introduction: Chronic kidney disease is a global public health issue, affecting approximately 10% of the world's population, and more than 3 million people living with kidney failure who are estimated to be on maintenance dialysis programs, with the majority receiving hemodialysis (HD). This treatment is particularly water-intensive, posing a considerable challenge in regions experiencing water scarcity, such as Morocco.

Methods: Our HD center in Oujda, Eastern Morocco, has implemented several key strategies to address water scarcity and ensure uninterrupted HD procedures during periods of hydric stress.

Results: These strategies include expanding water storage capacities to safeguard against shortages, upgrading infrastructure to enhance water efficiency, and employing innovative technology for real-time monitoring and management of water resources. Additionally, we collaborate closely with local water authorities to secure reliable water supplies and explore possibilities for water regeneration and recycling.

Discussion: The rising demand for clean water, coupled with its increasing scarcity, presents a significant challenge for healthcare systems, particularly in the context of HD. Therefore, innovative approaches are essential to mitigate this issue. The concept of green dialysis, which focuses on reducing water usage and minimizing environmental impact, is emerging as a promising solution with measurable benefits. Implementing water-efficient reverse osmosis systems has resulted in significant reductions in water waste, while real-time monitoring and early warning systems have enhanced water security and operational efficiency. Additionally, initiatives exploring the reuse of reject water hold potential for further conservation. These tangible outcomes demonstrate how green dialysis practices can contribute to sustainable HD treatment, ensuring uninterrupted patient care, reduced resource consumption, and improved environmental stewardship in water-scarce regions.

Introduction: Home hemodialysis is still in its early stages in mainland China. This survey aimed to assess the perceptions of healthcare professionals and patients towards home hemodialysis and to identify the barriers hindering its uptake.

Methods: A cross-sectional observational survey was conducted using convenience sampling. Healthcare professionals specializing in nephrology and patients with end-stage kidney disease (ESKD) across mainland China were included. A self-reported questionnaire was administered to gather data on participants' demographics, attitudes, perceived barriers, and facilitating factors related to home hemodialysis. Chi-square tests were used to analyze the association between categorical variables.

Findings: A significant majority (80.1%) of healthcare professionals recognized the need for home hemodialysis. However, there was a statistically significant difference in willingness to undertake or receive home hemodialysis between healthcare professionals (53.6%) and patients (63.2%), respectively. Healthcare professionals identified the following as top facilitating factors: patients' needs (6.9 points), higher patient benefits (5.7 points), and shortage of dialysis resources (5.1 points). The primary barriers cited were the absence of relevant policies and regulations (7.5 points), lack of guidelines and management standards (7.0 points), and inadequate treatment technology and knowledge (6.6 points). Patients' willingness to accept home hemodialysis was primarily driven by the potential to save time and travel expenses (70.7%) and reduce infection risk (49.0%). The main barriers identified by patients were the inability to manage acute complications (77.8%), increased risk of vascular access infection (66.1%), and uncertainty about self-cannulation (60.7%).

Conclusion: There is a clear demand for home hemodialysis in China among both healthcare professionals and patients with ESKD. However, the lack of a supportive system, including policies, standards, and management frameworks, remains a significant obstacle to its widespread adoption.

Background: Cerebral hypo-perfusion during hemodialysis (HD) may contribute to cerebral ischemic lesions and atrophy in HD patients. Vascular disease and stiffness can impair cerebrovascular reactivity (CVR) in HD patients, placing them at higher risk for cerebral hypo-perfusion during the hemodynamic stress of HD. We evaluated the relationship between CVR and change in cerebral perfusion during HD.

Methods: In a cohort of in-center HD patients, we used hypercapnia to induce a change in cerebral blood flow velocity measured with transcranial Doppler to assess CVR. We used continuous cerebral oximetry during HD to measure a change in cerebral oxygen saturation (ScO₂), calculating overall decline and the largest drop as markers of cerebral perfusion. We used multiple linear regression to assess the relationship between CVR and the ScO₂-associated endpoints.

Findings: We measured CVR in 42 HD patients and of those, 41 had the ScO₂ measurements completed. The mean age was 58.5 (11.0) years, and most were male (90.5%, N = 38) with diabetes (59.5%, N = 25) and hypertension (87.5%, N = 36). The average CVR was 2.7 (1.6)%/mmHg. The average overall decline in ScO₂ during HD was 2.2 (2.5)% and the average largest drop in ScO₂ was 5.9 (2.8)%. CVR was negatively associated with both the largest drop in ScO₂ (β = -0.67 95% CI [-1.20, -0.15], p = 0.01) and the overall decline in ScO₂ (β = -0.62 95% CI [-1.09, -0.15], p = 0.01). Vascular disease was a risk factor for lower CVR (β = -1.21, 95% CI [-2.16, -0.26] p = 0.01).

Conclusions: A lower CVR increases the risk for cerebral hypo-perfusion during HD. Impaired CVR may be an important part of the pathophysiology of ischemic brain injury and cognitive impairment in HD patients.

Introduction: Catheter locking solutions-including trisodium citrate-are crucial for maintaining central venous catheter patency in end-stage renal disease patients. Despite widespread usage, discrepancies remain regarding the safety profile of trisodium citrate. This study evaluates the safety of 30% trisodium citrate relative to alternative solutions in a large, heterogenous population.

Methods: We conducted a retrospective cohort study of 83,306 catheters from 51,243 patients at Fresenius Medical Care clinics across Europe, the Middle East, Africa, and Latin America from October 15, 2011 to 31 August 31, 2021. The 30% trisodium citrate group (10,689 patients) comprised all catheters routinely locked with 30% trisodium citrate. The control group (40,554 patients) included catheters locked with various non-trisodium citrate solutions, most commonly heparin, along with saline, gentamicin, and, less frequently, alteplase, antimicrobial caps (isopropyl alcohol or chlorhexidine), or taurolidine. Mean follow-up was 116 days.

Findings: Chi-square testing identified significant differences in three of four adverse event categories between the 30% trisodium citrate and control groups. The 30% trisodium citrate showed a favorable risk profile for Catheter and Procedure Issues (RR = 0.27, 95% CI: 0.25-0.28), Systemic Reactions and Symptoms (RR = 0.10, 95% CI: 0.09-0.11), and Thrombotic or Coagulation Complications (RR = 0.60, 95% CI: 0.58-0.61). No significant difference emerged for Infection-Related Events (RR = 1.02, 95% CI: 0.98-1.07).

Discussion: These results support the relative safety of 30% trisodium citrate as a locking solution in a large, diverse patient cohort. Further research should further explore how patient-level, catheter-level, and facility-level factors influence the comparative safety of locking solutions.

Background: Home hemodialysis (HD) is a well-established modality that promotes patient independence but poses significant challenges, particularly in regions like the Gulf Cooperation Council (GCC) countries. Assisted home HD has gained momentum in the GCC over the past few years. Qatar's assisted home HD program has expanded substantially in the past 2 years. This study examines the demographics, mortality rates, and associated risk factors within Qatar's assisted home HD patient population.

Methods: This was a retrospective cohort study to review national data for all assisted home HD patients in Qatar between July 2021 and December 2023. Patients had to be > 60 years old and have limited mobility to be eligible for the assisted home HD program and included in the study.

Results: We had 114 assisted home HD patients with a median age of 71.5; 54 (47.4%) were males. During the study period, 20 patients (17.5%) died, and 8 (7%) stopped receiving the service for traveling abroad, personal preference for in-center HD, or changing dialysis modality. Most deaths occurred due to infectious causes. The deceased patients had significantly less HD vintage, more severe immobility, and more hospitalizations compared to the alive participants. On multivariate analysis, patients with severe immobility had 3.8 (CI: 1.1-12.8, 95% p < 0.05) times higher odds of mortality than patients with mild to moderate immobility.

Conclusion: Our study found that mortality in the assisted home HD program is significant and mostly related to mobility status. Patients with severely reduced mobility had almost four times the risk of mortality compared to more mobile patients. Further, larger studies are needed to confirm these findings.

Background: The advent of biological agents has provided significant therapeutic opportunities for patients with AA amyloidosis. However, when these patients reach end-stage renal disease and begin dialysis, some clinicians may discontinue biological treatments due to the heightened risk of infections. Given that AA amyloidosis is a progressive condition, there is a potential for the disease to affect additional organs in these patients. Consequently, we aimed to evaluate the benefits and risks associated with biological agents in AA amyloidosis patients receiving dialysis.

Method: We performed a systematic literature review in Cochrane Database and MEDLINE about the use of biologic agents in AA amyloidosis patients undergoing dialysis.

Results: We identified fifty-five patients across twenty-two studies. Familial Mediterranean fever was the etiology in 21 patients (71.4% anakinra and 28.6% canakinumab), rheumatoid arthritis in 17 patients (52.9% etanercept and 47.1% tocilizumab), unknown etiology in 8 patients (62.5% anakinra and 37.5% tocilizumab), ankylosing spondylitis in 5 patients (40% etanercept, 40% adalimumab, and 20% infliximab), hidradenitis suppurativa in 3 patients and tumor necrosis factor receptor-associated periodic syndrome (TRAPS) in 1 patient. Biologic agents were effective or partially effective for primary disease control in 52 patients (94.5%). Two patients were able to discontinue dialysis. Most frequent side effects were infections (8 episodes in 7 patients). Eight patients died (5 due to infections, one due to cardiac causes and two due to pulmonary hemorrhage).

Conclusion: Biologic agents are effective in AA amyloidosis patients that are treated with dialysis and seem to have an acceptable safety profile.

Introduction: The effectiveness of stellate ganglion block in managing acute postoperative pain remains uncertain due to limited high-quality evidence. This study evaluates the impact of stellate ganglion block on acute pain following arteriovenous fistula surgery.

Methods: A randomized controlled clinical trial was conducted in the Surgery Department of Bahonar and Shafa Hospitals at Kerman University of Medical Sciences, Iran. Patients undergoing arteriovenous fistula surgery were randomly assigned to either the intervention group, which received an ultrasound-guided stellate ganglion block with 5 mL of 5% lidocaine, or the control group, which received no intervention. A total of 60 patients were selected based on age and gender similarity. Pain levels were assessed using the visual analog scale immediately after surgery and at 6 and 12 h postoperatively.

Findings: Pain scores differed significantly between the two groups at all time points (p ≤ 0.05). The intervention group reported lower pain levels at 6 and 12 h postoperatively compared to the control group. Repeated measures analysis confirmed a significant reduction in pain over time in both groups (p ≤ 0.05), with a more pronounced decrease in the intervention group (p ≤ 0.05).

Conclusion: Preoperative stellate ganglion block effectively reduces acute postoperative pain following arteriovenous fistula surgery. However, its effects beyond the 12-h postoperative period remain unknown. Further research is needed to evaluate its long-term impact.

Background: Failure to adhere to fluid restrictions negatively affects the quality of life and increases the risk of complications among hemodialysis patients. In chronic diseases, including chronic kidney disease, health literacy plays a crucial role in mitigating disease complications. The level of health literacy in chronic diseases such as chronic kidney disease can play a significant role in reducing the complications of the disease. This study aimed to assess the relationship between fluid control and health literacy in hemodialysis patients, representing the first such research in Turkey.

Methods: This descriptive, cross-sectional, and correlational study was conducted in all dialysis centers in Bolu province, Turkey, from September 2022 to August 2023. The study included 144 hemodialysis outpatients meeting the inclusion criteria. Patient fluid control and health literacy were assessed using the "Fluid Restriction Scale in Patients Receiving Hemodialysis Treatment" and the "Turkey Health Literacy Scale-32". Statistical analysis was performed using SPSS version 25.0.

Results: The mean total score on the Health Literacy Scale was 22.6 ± 10.2, indicating a relatively low level of health literacy among the hemodialysis patients. 54.2% of patients receiving hemodialysis treatment exhibited inadequate health literacy. The mean score on the Fluid Restriction Scale was 50.4 ± 8.63, suggesting moderate fluid control adherence among the study population. 56.3% of hemodialysis patients had moderate levels of fluid control. A statistically significant moderate positive correlation was found between fluid control and health literacy levels (r = 0.456, p < 0.001). Health literacy scores accounted for 20.2% of the variance in fluid restriction scores (R² = 0.20), indicating a moderate contribution of health literacy to fluid control adherence.

Conclusion: This study revealed a positive correlation between health literacy and fluid control adherence. Therefore, it is recommended that hemodialysis nurses concurrently assess patients' health literacy and fluid control and develop tailored educational programs based on these assessments.