Hemodialysis international. International Symposium on Home Hemodialysis最新文献

Introduction: Nonattendance for prescribed hemodialysis (HD) sessions is a form of nonadherence that compromises the delivery of life-sustaining HD therapy and is associated with severe morbidity and mortality. In this study, we aimed to assess the characteristics and outcomes of HD nonattenders in a single renal center in the North West of England.

Methods: HD patients followed by the renal team at our unit between December 2020 and September 2022 were included in this study. Dialysis nonattendance data were retrieved from the incident reports (DATIX) between December 2020 and November 2022, excluding dialysis nonattendance due to concurrent hospitalization. The cohort was split into group 1: no dialysis nonattendance; group 2: two or fewer dialysis nonattendances; and group 3: more than two dialysis nonattendances for comparative analysis. All patients were followed up for outcomes including all-cause mortality, transplantation, and hospitalizations until the study endpoint date of 12/31/2023. Predictors of dialysis nonattendance were identified using logistic regression.

Results: Of the 464 patients, dialysis nonattendance was noted in 149 (32%) patients, of which 79 (17%) had two dialysis nonattendance episodes and 70 (15%) had more than two dialysis nonattendance episodes. Over a median follow-up of 35 months, patients in group 3 had a higher hospitalization episode (4 vs. 1 day, p < 0.001) and lower kidney transplantation rates (4.3% vs. 13%, p = 0.038) compared to patients in group 1. In multivariate regression analysis, younger age (OR: 0.97; 95% CI: 0.95-0.98; p = 0.001), history of smoking (OR: 2.01; 95% CI: 1.12-3.62; p = 0.019), alcohol excess history (OR: 3.49; 95% CI: 1.87-6.49; p < 0.001) and history of mental health illness (OR: 3.01; 95% CI: 1.61-5.62; p = 0.001) were significant predictors of dialysis nonattendance.

Conclusion: Skipping HD is a common phenomenon associated with mental health issues and is associated with increased morbidity. Further research is required to understand the psychosocial determinants of nonadherence and effective models of intervention developed to improve outcomes.

Background: Previously, two reports proposed a four-stream dialysis fluid delivery system consisting of an acid concentrate, a base concentrate, a sodium chloride concentrate, and product water for correcting dysnatremias and metabolic acid-base disorders separately, by hemodialysis.

Methods: This report describes a new method for the clinical use of the previously reported four-stream dialysis fluid delivery system to treat concurrently dysnatremias and metabolic acid-base disturbances by hemodialysis. Pumps attached to each concentrate are designed to control its flow rate. Formulas were derived to determine the flow rate of each of the pumps controlling the flows of the product water (W), the base concentrate (B), and the sodium chloride concentrate (S) for any prescribed combination of sodium and bicarbonate concentrations is the final dialysis fluid. In this scheme, the flow rate of the acid concentrate (A), the concentrations of its contents in the final dialysis fluid remain constant. The flow rate ratio W:S:B:A remains also constant at 45 (i.e., 45X).

Results: The formulas were entered in an EXCEL flow sheet which determines the flow rate ratio W:S:B:A for any desired combination of sodium and bicarbonate concentrations in the dialysis fluid. The upper and lower limits of the concentrations of sodium and bicarbonate in the dialysis fluid were computed. The system has not been applied clinically. Measurements of any electrolyte concentrations have not been made.

Discussion: This system makes the treatment of profound dysnatremias, metabolic acid-base disorders, and combined dysnatremias and metabolic acid-base disorders feasible. The clinical application of the system demands prior in vitro or ex vivo studies plus fastidious and expert attention to ensure safe and dependable application.

Introduction: Home dialysis has been associated with better patient survival compared to in-center hemodialysis. Finland has over 40 years of experience with home dialysis. Despite sustained efforts, the prevalence of home dialysis has decreased in the last decade. We aimed to explore the barriers to expanding home dialysis treatments from healthcare providers' and patients' perspectives.

Methods: This is qualitative research, based on an electronic semi-structured survey directed to nephrologists, nephrology nurses, and patient associations. The survey development contemplated the main barriers shown in a conceptual framework described previously in the literature. An open-ended question was analyzed using the content analysis method.

Findings: All participants agreed that the nurse shortage and patients' several comorbidities are the main barriers. Healthcare teams were perceived as having good qualifications and interest in home dialysis. Intense transplant activity was not perceived as a barrier. Doctors and nurses believed that starting in-center hemodialysis decreases the odds of switching to home dialysis later, and patients have less motivation or reliability in their abilities. From the patient's perspective, the financial burden and the impact of home dialysis on the assistant or relative constitute critical barriers. Also, bringing hospitals home or living in small spaces is an important barrier to accepting home dialysis.

Discussion: Expanding home dialysis modalities requires boosting the home dialysis nursing pool, choosing home dialysis as a first modality, and removing the financial burden on the patients. While the rise in patients with multiple comorbidities remains unchanged, supporting relatives to prevent burnout could be beneficial.

Background: Pain is a prevalent cause of medical consultation among dialysis patients, severely impacting both treatment outcomes and quality of life. This study focuses on a specific yet underexplored type of pain-delayed and progressive perivenous tissue pain in the outflow tract of arteriovenous fistulas (AV fistula) during dialysis. The aim is to summarize its clinical features, investigate its underlying mechanisms, and evaluate the effectiveness of various treatments, ultimately providing new insights into pain management.

Methods: This study included 36 patients who experienced delayed and progressive perivenous tissue pain in the outflow tract of AV fistulas during dialysis. Pain features were systematically summarized, and the AV fistula status was comprehensively evaluated through general observation, physical examination, and imaging. A series of trial interventions were employed to further explore the underlying mechanisms of pain. Based on these findings, appropriate treatment strategies were identified and implemented, with therapeutic outcomes monitored over a 12-month follow-up.

Findings: The specific pain may be closely associated with venous hypertension. Ultrasonography identified high-flow fistulas in 18 patients, while angiography revealed varying degrees of outflow vein stenosis in 23 patients. Five patients with slightly elevated fistula blood flow and no significant stenosis underwent bandage compression therapy. Thirty-one patients with markedly increased blood flow and/or outflow vein stenosis received ultrasound-guided flow restriction surgery, percutaneous transluminal angioplasty, or combined therapies. All patients achieved pain relief, with no recurrence during the follow-up period.

Conclusions: This study systematically investigates perivenous tissue pain in the outflow tract of AV fistula during dialysis. Venous hypertension is likely the primary underlying cause of this condition. Treatment options, including bandage compression, flow restriction surgery, percutaneous transluminal angioplasty, and combined therapies, effectively alleviate the tissue pain.

Introduction: Cat Scratch Disease, caused by the bacterium Bartonella henselae, typically manifests with fever, headache, anorexia, weight loss, tender lymphadenopathy, and other systemic symptoms. Transmission commonly occurs through a cat scratch or bite. The clinical course varies depending on the patient's immune status, notably in individuals with conditions such as renal failure. While generally localized, Cat Scratch Disease can occasionally present as a systemic illness with diverse manifestations. This report aims to elucidate the etiology of fever of unknown origin in hemodialysis patients, focusing on the case of a 30-year-old female.

Methods: A 30-year-old female patient, who routinely undergoes hemodialysis (HD) three times a week for four hours at the hemodialysis unit, was admitted to our service for further evaluation and treatment due to an infectious disease clinic presentation. She is now under close observation and management in our inpatient department.

Findings: The patient's presenting symptoms included fever, arthralgia, night sweats, and weight loss, refractory to empirical antibiotic and broad-spectrum antimicrobial therapy. Physical examination revealed lymphadenopathy and splenomegaly. Laboratory investigations demonstrated elevated C-reactive protein and procalcitonin levels. Ultrasound imaging revealed reactive lymphadenopathy in multiple regions. Following the exclusion of bacterial, viral, and mycobacterial infections, including tuberculosis, a diagnosis of lymphoma was considered. However, a subsequent lymph node biopsy revealed non-caseating granulomatous lymphadenitis, a histopathological finding consistent with Cat Scratch Disease.

Discussion: Although rare, Cat Scratch Disease should be considered in the differential diagnosis of fever of unknown origin in patients with chronic kidney disease undergoing hemodialysis.

Introduction: Under physiological conditions, blood volume and extracellular volume are in a ratio of 1-3, even in hemodialysis patients. The question therefore arises: can blood volume be inferred from the bioimpedance analysis data? The aim of the study was to compare the blood volumes calculated from extracellular volume determined by bioimpedance analysis data to the actually measured blood volumes.

Methods: Immediately before treatment, extracellular volume and volume overload were evaluated by bioimpedance spectroscopy. The actual blood volume was determined by indicator dilution, using an on-line infusate bolus and subsequent calculation with the data from the relative blood volume monitor. Alternatively, blood volume was calculated from extracellular volume divided by 3 and compared to the measured blood volume.

Findings: Overall, there were no significant differences between measured (5.56 ± 1.47 L) and calculated (5.79 ± 1.30 L) blood volumes. However, intra-individually, there were very large discrepancies with a range of -1.409 to 1.450 L. Median absolute deviation was 382 mL corresponding to 6.2 mL/kg. The differences between measured and calculated blood volumes correlated significantly (r = -0.98; p < 0.001) with the blood to extracellular volume ratio.

Discussion: In almost half of patients, blood volume can be inferred from bioimpedance data with sufficient certainty. But the greater the deviation from the physiological blood to extracellular volume ratio of 1-3, the more the calculated blood volumes differ from the measured values. For this reason, bioimpedance data should not be used uncritically to set the ultrafiltration.

Introduction: Infective endocarditis can present with a wide range of cardiac and extra-cardiac symptoms. However, purulent pericarditis as a presenting sign has rarely been documented in the literature.

Case description: We present a case of a 47-year-old woman on hemodialysis who presented to the emergency department due to dyspnea and edema in her lower extremities. A chest X-ray revealed an enlarged cardiac silhouette, while a computed tomography (CT) scan showed a large pericardial effusion. A transthoracic echocardiogram indicated vegetation on the tricuspid valve and pericardial effusion, with echocardiographic signs of cardiac tamponade. Emergent drainage of the pericardial space was performed, during which purulent material was obtained. Methicillin-resistant Staphylococcus aureus was identified in blood cultures collected upon admission and in the cultures from the pericardial effusion. The patient received intensive antibiotic therapy; however, despite the treatment and after a complicated hospital course, she succumbed to the illness.

Conclusion: Diagnosing purulent pericarditis in hemodialysis patients with infective endocarditis requires a high level of suspicion because typical symptoms of pericarditis are uncommon, and there is a tendency to initially attribute nonspecific constitutional symptoms to the underlying infection itself. Aggressive treatment with pericardial drainage and appropriate antibiotic therapy may prevent catastrophic outcomes.

Background: Urolithiasis is a common malady afflicting 8.8% of the general population. Its occurrence is also not uncommon in patients undergoing renal replacement therapy. Despite the leaping scientific advancement achieved in managing and preventing urolithiasis in the general population, there remains limited data regarding its prevention in patients undergoing renal replacement therapy.

Case presentation: We present a case of recurrent urolithiasis in a patient with end-stage renal disease on renal replacement therapy.

Conclusion: We performed a literature review on urolithiasis in patients with ESKD undergoing renal replacement therapy, emphasizing evidence-based available preventative strategies.

Focal segmental glomerulosclerosis (FSGS) has become one the leading causes of kidney disease in the United States. With the incidence of FSGS rising over the past decade, capable treatment options have been a large focus in research. One therapy that shows promise is low density lipoprotein apheresis (LDL-A). This procedure removes lipoproteins containing apolipoprotein-B from the blood, thus reducing the lipid load on the renal system. LDL-A also improves responsiveness to the standard FSGS therapy of corticosteroids and cyclosporine. This paper describes the current LDL-A techniques, offers insight to existing clinical studies employing this therapy, and ultimately highlights LDL-A as a treatment option for FSGS, post-renal transplant, and nephrotic syndrome.

Nephrogenic ascites, or ascites associated with renal failure, is most commonly observed in patients with end-stage renal disease undergoing hemodialysis, though it can occur less frequently in earlier stages of renal failure. While its exact cause is likely multifactorial, several contributing mechanisms are commonly recognized. These include delayed diagnosis of chronic kidney disease, reduced peritoneal lymphatic reabsorption, malnutrition, increased permeability of the peritoneal membrane, and the effects of dialysis and ultrafiltration in uremia. Nephrogenic ascites typically affects cachectic, under-dialyzed, and malnourished patients and carries a poor long-term prognosis. This paper presents a series of eight cases involving patients with refractory ascites subsequently diagnosed as being of renal origin and provides a review of this condition.