Hemodialysis international. International Symposium on Home Hemodialysis最新文献

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.

Introduction: Cardiac arrest is a common cause of death among patients undergoing maintenance hemodialysis; however, the prevalence and risk factors for cardiac arrest in the setting of acute kidney injury (AKI) are not studied in detail.

Methods: Patients who received hemodialysis for AKI between 2014 and 2024 were classified as those who experienced cardiac arrest during hemodialysis (group A) and patients who had cardiac arrest during hospitalization outside the hemodialysis session (group B). Logistic regression analysis was performed to determine the odds of cardiac arrest during the hemodialysis session versus outside the session.

Findings: Among the 1702 patients who received hemodialysis for AKI, 33 (0.02%) experienced cardiac arrest at the time of hemodialysis (group A), and 100 (0.06%) had cardiac arrest outside the session (group B). Previous history of atrial fibrillation was more common in group A (39% vs. 19%, p = 0.017). Groups were comparable in terms of oxygen or vasopressor requirement and baseline mean serum creatinine. Metabolic acidosis was more severe, and serum blood urea nitrogen and calcium levels were higher in group B (p < 0.05). Ultrafiltration rates were higher in group A than in group B (mean 10.6 mL/h/kg vs. 6.2 mL/h/kg, p < 0.001). There were more deaths in group A within the first 24 h following cardiac arrest (79% vs. 48%, p < 0.05); however, spontaneous recirculation and overall in-hospital mortality were comparable. In the multivariate regression model, atrial fibrillation (OR = 4.91, 95% CI 1.35-17.8, p = 0.016), lower pre-dialysis serum calcium levels (OR = 2.66, 95% CI 1.25-5.65, p = 0.011), and higher ultrafiltration volume (OR = 10.9, 95% CI 3.90-30.5, p < 0.001) were independently associated with an increased risk of cardiac arrest during hemodialysis sessions.

Discussion: History of atrial fibrillation, lower pre-dialysis serum calcium levels, and higher ultrafiltration volumes are associated with an increased risk of cardiac arrest during hemodialysis than cardiac arrest outside the hemodialysis session in the AKI setting.

Introduction: Spiritual well-being was a critical component of quality of life for hemodialysis patients. However, existing research primarily concentrates on the overall level of spiritual well-being and associated factors, often neglecting the heterogeneity within the hemodialysis patients regarding their patterns of spiritual well-being. In addition, the effect of spiritual well-being on hope levels in hemodialysis patients remains unclear. This study aimed to examine the latent profiles of spiritual well-being among hemodialysis patients and to explore their effect on hope.

Methods: A convenience sampling method was employed between July 2023 and March 2024 to recruit hemodialysis patients from three teaching hospitals in Sichuan Province as study participants. All participants complied with a demographic questionnaire, the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being, and the Herth Hope Index. A latent profile analysis was adopted to identify the latent profiles of spiritual well-being among hemodialysis patients, and hierarchical linear regression was conducted to examine their role in hope.

Findings: Two latent profiles of spiritual well-being were identified based on the participants' responses, designated as "Spiritual burnout group"(n = 246, 74.4%) and "Spiritual fulfillment group" (n = 51, 25.6%). Different latent profiles of spiritual well-being among hemodialysis patients have a significant positive effect on the level of hope (ΔR² = 0.224, p < 0.001).

Discussion: The spiritual well-being of hemodialysis patients was identified as suboptimal and demonstrated a significant positive association with their level of hope. Healthcare providers could identify the different profiles of spiritual well-being in HD patients and deliver targeted interventions to guide them to positively live in harmony with themselves, others, and the environment to improve their level of hope.

Introduction: There is limited data on medication regimen complexity on outcomes in patients with kidney failure receiving hemodialysis (HD) in different settings. This study aims to quantify medication regimen complexity and assess its impact on patient-related and clinical outcomes in facility-based and home-based HD-treated patients.

Methods: This study targeted patients undergoing HD at a large metropolitan dialysis center in Australia. Baseline data and hospitalizations were recorded through a retrospective audit of electronic medical records, while other outcome data were collected prospectively. Medication regimen complexity was assessed using the 65-item Medication Regimen Complexity Index (MRCI). Medication adherence was evaluated with the 4-item Morisky-Green-Levine Scale (MGLS), whereby participants were deemed not adherent if they responded "yes" to any of the questions. EQ-5D-5L and EQ VAS scores were used to assess health-related quality of life (HRQoL) with higher scores indicating better health.

Findings: Of 174 eligible adults, 145 (80 facility-based and 65 home HDs) patients participated. Participants of both facility-based and home HD were predominantly men (65% and 75.4%, respectively) with a mean age of 62 ± 13 years and 56 ± 12 years, respectively. Home HD participants had a higher median MRCI than those on facility-based HD [26.0 (IQR 20.6-33.0) vs. 20.8 (IQR 13.6-28.4), respectively; p = 0.005]. While there was no significant difference in the non-adherence rate, home HD participants had higher scores for both EQ-5D-5L [0.917 (IQR 0.745-0.984) vs. 0.798 (IQR 0.302-0.956), respectively; p = 0.006] and EQ VAS [60 (IQR 50-75) vs. 50 (IQR 40-70), respectively; p = 0.034]. Home HD participants also had a fewer number of hospitalizations in the prior (1 year 0 (IQR 0-1) vs. 1 (IQR 0-1), respectively; p = 0.042).

Discussion: The higher complexity of the medication regimen for home HD compared to facility-based HD participants may be due to the shift in dose administration responsibility of several parenteral medications. Despite the higher complexity, home HD patients had better outcomes, including HRQoL and hospitalizations compared to facility-based HD patients.

Introduction: This study explored the relationship between post dialysis fatigue (PDF) and dialysis recovery time (DRT) with perceived stress and depression.

Methods: A cross-sectional study was conducted on 223 patients on hemodialysis (HD). We collected demographic, laboratory and clinical variables [including depression and perceived stress levels measured with the Perceived Stress Scale (PSS) and Beck Depression Inventory (BDI-II)] to explore their association with PDF and DRT.

Findings: Of the total, 120 patients suffered PDF and 103 did not. Groups differed in Charlson comorbidity index, dialysate sodium concentration, dialysate temperature, and BDI score, but had similar perceived stress levels. Logistic regression identified BDI and Charlson scores as independently associated with PDF. Of 130 patients, DRT was ≤ 120 min, and in 73, it was > 120 min, with higher BDI scores in the latter. Stratifying by perceived stress levels showed no significant differences in PDF or DRT. However, PDF and DRT were higher in patients with BDI > 17, and perceived stress levels strongly correlated with BDI.

Conclusion: While PDF and DRT are not significantly linked to perceived stress, they are strongly associated with depression levels in HD patients.

Objective: Data regarding the efficacy of cefepime in treating patients with Pseudomonas aeruginosa infections undergoing renal replacement therapy (RRT) are limited. Therefore, we conducted a study to investigate the outcomes of recommended cefepime dosing in this population.

Methods: A retrospective descriptive cohort study was conducted between May 2015 and December 2022 on patients diagnosed with active sepsis secondary to P. aeruginosa infection, requiring cefepime treatment and undergoing RRT. The primary endpoint was 30-day all-cause mortality, with secondary endpoints including clinical cure, microbiologic cure, infection recurrence rate, and incidence of adverse events.

Results: A total of 132 patients met the inclusion criteria. Of these, 81 (62.4%) were male, with a median age of 69 years and a median BMI of 27 kg/m². The most common diagnoses were pneumonia (58.3%), followed by bacteremia (18.9%). The median minimum inhibitory concentration (MIC) of cefepime for P. aeruginosa was 2 mcg/mL. The median dose of cefepime was 2000 mg every 12 h in those undergoing continuous venovenous hemofiltration and 1000 mg every 24 h in those undergoing intermittent hemodialysis, with a median duration of therapy of 8 days. The median Charlson Comorbidity index for survivors was 9 (8-11), while it was 7.5 (5.25-9.75) for non-survivors (p = 0.754). The 30-day survival rate was achieved in 96 patients (72.7%), the clinical cure was achieved in 58.3% of subjects, and a microbiologic cure rate of 31%. The 30-day reinfection rate was 9.1%, with no documented adverse events associated with the doses used. Multivariable logistic regression analysis identified the use of vasopressors (Odds Ratio 4.6, 95% CI 1.3-17.1) and white blood cell count at the end of therapy (Odds Ratio 1.1, 95% CI 1.01-1.4) as the main predictors of all-cause mortality in this population.

Conclusion: Our results suggest that the utilized doses of cefepime in patients with P. aeruginosa infections undergoing RRT were effective. Larger study is needed to confirm our findings.

Low molecular weight heparin (LMWH), a common anticoagulant in hemodialysis, can cause the dangerous condition of heparin-induced thrombocytopenia (HIT) in rare cases. The present study reviews five cases of HIT diagnosed in our center, which treats more than 400 maintenance hemodialysis patients annually over a 30-year period. All five cases occurred in incident patients who were being exposed to LMWH for the first time. Treatment involved stopping LMWH and using alternative anticoagulants. Both the 4Ts score and antibody tests were used to confirm the diagnosis of HIT. Following diagnosis, close monitoring was performed for 10-15 days in typical cases or 30 days in severe cases until blood platelet levels recovered to near normal values. Our results suggest that while uncommon, HIT associated with use of LMWH can occur in hemodialysis patients, especially when patients are being exposed to this anticoagulant for the first time.

Background: Although case reports exist on vascular access intervention through the distal radial artery approach, there is a dearth of clinical studies reporting its safety and clinical outcomes. This study aimed to investigate the safety and long-term outcomes of vascular access intervention utilizing the distal radial artery approach.

Methods: Patients who underwent forearm arteriovenous fistula vascular access intervention at our hospital were divided into two groups: The distal radial artery approach (DRA group, N = 46) and the outflow vein approach (Vein group, N = 122). Patient characteristics, procedure results (procedure success rate, contrast medium dose, fluoroscopy dose), and one-year primary patency rates were compared between the two groups.

Findings: The procedure success rate was 100% in both groups. The DRA group demonstrated significantly lower contrast medium dose, fluoroscopy dose, and fluoroscopy time compared to the Vein group. No bleeding complications, arterial occlusion, or steal syndrome occurred in the DRA group. There was no significant difference in the one-year primary patency rate between the two groups.

Discussion: Vascular access intervention utilizing the distal radial artery approach offers benefits in reducing contrast medium and fluoroscopy dose compared to the outflow vein approach. Moreover, it demonstrates acceptable safety and patency rates.

Introduction: The management of symptoms associated with hemodialysis, which adversely affect patients, increases their quality of life. Complementary integrative therapies such as Reiki are used in symptom management. This study aimed to investigate the effects of Reiki on pain, fatigue, and itching in hemodialysis patients.

Methods: The study had a randomized controlled design and was conducted in three dialysis centers with a total of 74 hemodialysis patients, 37 in the intervention group, and 37 in the control group. A total of 10 sessions of Reiki were administered to the patients in the intervention group twice a week for 5 weeks, while the patients in the control group received routine hemodialysis treatment. The data of the study were collected using the Patient Identification Form, the Patient Clinical Parameters Form, the Visual Analog Scale, the McGill Pain Questionnaire, the Piper Fatigue Scale, and the 5-D Itch Scale.

Findings: It was determined that there was a statistically significant decrease in the pain, fatigue, and itching levels of the patients in favor of the intervention group in the second and third measurements (p < 0.05). Although there was no change in the pain and fatigue levels of the patients in the control group, the levels of itching increased statistically and significantly (p < 0.05).

Discussion: The findings suggest that Reiki has an effect on pain, fatigue, and itching in hemodialysis patients.

Trial registration: ClinicalTrials.gov: NCT05531175.