Hemodialysis international. International Symposium on Home Hemodialysis最新文献

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 Infection in our immunocompromised patients is the second leading cause of death, according to the Centers for Disease Control and Prevention (CDC). In an effort to improve quality of care, engage patients in their own care, and reduce morbidity and mortality secondary to infection, the Network designed a joint quality improvement/patient engagement activity to decrease bloodstream infection (BSI) rates. Methods Dialysis facilities were ranked utilizing 2014 National Healthcare Safety Network (NHSN) data. Selection included 20% of Network 13 facilities (n = 58) with the highest BSI rates, which captured 31% of the patient population. Findings Statistically significant (P < 0.001) improvement was reached in the reduction of BSIs; increasing patient engagement in the infection control process; and, correct completion of hand hygiene audits. Significant (P < 0.01) improvement was reached in correct completion of cannulation audits. There was also improvement in the catheter audits, but results were not significant. Discussion Involving patients in the infection control process contributed to our successful outcomes and could be replicated to meet the needs of the end stage renal disease community as a whole.