Hemodialysis international. International Symposium on Home Hemodialysis最新文献

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.

Introduction: Latent profile analysis is a statistical method for identifying potential groups or profiles and categorizing individuals accordingly. In psychology and social sciences, it is frequently employed to explore the latent group structure in data, aiding researchers in comprehending disparities and similarities among different groups. This study utilized latent profile analysis to explore the potential categories of sleep quality in patients on hemodialysis and analyze the factors associated with each category.

Methods: Convenience sampling was used to select 268 patients who received maintenance hemodialysis treatment at China-Japan Friendship Hospital from July 2023 to June 2024. This study was a cross-sectional survey, and data were collected using a general information survey, the Pittsburgh Sleep Quality Index, Frailty Screening Scale, and Fatigue Scale-14. Different sleep types were identified in patients on hemodialysis using latent profile analysis, and the factors affecting sleep quality in each type were analyzed.

Findings: The study included 154 males and 114 females, with a mean age of 61.07 ± 13.72 years and a median dialysis duration of 4.00 (2.00, 9.00) years. Latent profile analysis identified four sleep quality categories among patients on hemodialysis: good sleep quality (35.30%), insufficient sleep time with high medication use (13.80%), good sleep time with high medication use (4.50%), and insufficient sleep time with low medication use (46.40%). Sex, age, employment status, ultrafiltration volume, frailty screening scale, and fatigue rate-14 were compared among the different categories, revealing significant differences (p < 0.05).

Discussion: Latent profile analysis identified four sleep quality categories among patients undergoing hemodialysis, with factors, such as age, dialysis duration, and the presence of frailty influencing sleep quality differently. Future efforts should focus on this population by providing targeted health counseling and psychological support tailored to the characteristics of each sleep category to address their sleep issues and improve their quality of life.

Background: The GNRI (Geriatric Nutritional Risk Index1) is an index used in geriatrics to predict the risk of complications and mortality associated with malnutrition. It considers serum albumin levels and the ratio of current weight or BMI to the ideal theoretical weight/BMI.

Aim: The aim of this study was to evaluate this index in a population of metabolically stable chronic hemodialysis patients aged > 60 years and associate it with other nutritional markers.

Methods: The studied patient cohort was divided into two groups based on their Geriatric Nutritional Risk Index (GNRI) scores: Gr 1 with GNRI score < 97 and Gr 2 with GNRI ≥ 97. We registered the anthropometric, clinical, and biological data of the study population.

Results: One hundred seventy-seven patients (102 M-75F) undergoing chronic hemodialysis were included. There were no differences in age, muscle mass estimated by bioimpedance analysis, potassium levels, phosphorus levels, and nPCR between the groups. However, there were significant differences between the two groups concerning the primary disease. Gr 1 presented with a higher prevalence of diabetes and cardiovascular comorbidities. Additionally, Gr 1 presented with lower handgrip strength (Mean ± standard deviation in kg, 19.79 ± 9.37 vs. 26.83 ± 11.63, p = 0.05), lower fat mass index estimated by bioimpedance analysis (Mean ± standard deviation in kg/m2, 7.31 ± 4.55 vs. 15.24 ± 6.47, p < 0.001), and higher CRP levels (Mean ± standard deviation in mg/l, 22.27 ± 23.49 vs. 8.13 ± 10.14, p < 0.001).

Conclusion: In conclusion, the GNRI, an easy calculation tool for nutrition assessment, is associated with important nutritional status parameters in chronic hemodialysis patients.

Introduction: Chronic kidney disease-mineral and bone disorder (CKD-MBD), is a common syndrome in end stage kidney disease (ESKD) patients, is marked by dysregulation of electrolytes and hormones, including calcium, phosphorus and parathyroid hormone (PTH). Calcimemetics are a cornerstone of PTH lowering therapy; cinacalcet, an oral calcimemetic, is the most used and typically prescribed as a daily administration, thus contributing to the high total pill burden of this population. Recent clinical trials have provided evidence that administration of cinacalcet at the dialysis unit three times a week might be a safe and effective treatment option. In this study we sought to evaluate the comparative effectiveness of cinacalcet delivered daily at-home versus three times weekly in-center.

Methods: This was a retrospective matched cohort study of 2894 adult in-center hemodialysis patients a between January 01, 2008 and September 30, 2022 who were started on cinacalcet for the first time (group 1: at-home use or group 2: in-center administration). Patients were matched (1:1) on: age, body mass index, cinacalcet dose, and baseline phosphorous, calcium, and PTH. Patients were followed until censoring (i.e., lost to follow up) or 12 months after baseline, whichever occurred first. The primary outcome was achieving triple control of PTH, phosphorous, and calcium.

Results: Overall, the patients had a median patient age of 63 (IQR: 55, 71) years, were predominately Black (41.6%) and male (56.5%), and well matched on other baseline clinical and demographic characteristics, including etiology of ESKD. Fitted proportion model results show no statistical difference between the intermittent in-center or daily at home cinacalcet use group in achieving the primary outcome (triple control). The secondary outcomes of control of phosphorous or PTH, showed similar results. Calcium control was the same for 9 of 12 months, and better controlled in the in-center group during the remaining months.

Conclusion: In a well-matched cohort, no clinical difference exists between administering cinacalcet thrice weekly in-center and prescribing cinacalcet daily at-home.

Calciphylaxis is a rare and serious disorder characterized by vascular calcification and occlusion of the microvessels in the dermis, subcutaneous adipose tissue, visceral organs, and musculature. Studies have suggested that the major risk factors for developing calciphylaxis are chronic kidney disease and secondary hyperparathyroidism. Its diagnosis is clinical, and the treatment includes a multidisciplinary approach, although there are no clinical protocols based on randomized clinical trials. Therefore, the management and treatment are informed by specialist opinion. Sodium thiosulfate is frequently utilized for its vasodilatory and antioxidant properties, as well as its ability to chelate calcium. However, there are no guidelines regarding the duration of its use. The present report describes a chronic kidney disease patient on hemodialysis with calciphylaxis, who underwent sodium thiosulfate treatment for 2 years associated with debridement and reconstructive plastic surgery with a good response and control of the disease.

Objectives: To assess the efficacy and safety of locally manufactured generic sofosbuvir-based direct-acting antivirals in the treatment of Hepatitis C virus (HCV) infected patients on maintenance hemodialysis.

Patients and methods: We have conducted a retrospective multicenter study including patients on maintenance hemodialysis, treated with sofosbuvir-based regimens between 01/01/2017 and 09/30/2021. Patients were treated for 12 or 24 weeks, with sofosbuvir 400 mg + ledipasvir 90 mg 3 times/week, or sofosbuvir 3 times/week + daclatasvir 60 mg/d, or sofosbuvir + daclatasvir in coformulation, 3 times/week. Sustained virological response was defined as a negative HCV RNA test 12 weeks after treatment. The occurrence of serious adverse events during treatment defines intolerance to treatment. Statistical analysis was performed using SPSS software (version 25).

Results: A total of 120 patients were treated; the mean age was 50 ± 14.17 years [18-78], 50% were men. Twenty-two patients (n = 22; 18.3%) were previously treated with pegylated Interferon. Genotype 1 was predominant (n = 68; 82%). Most of the patients (n = 53; 44.2%) had no significant fibrosis, and 24 (20%) had cirrhosis. The SVR rate was 93.3% (CI 95% [88.8; 97.8]) (n = 112), the serious adverse events rate was 10.8% (CI 95% [0.054-0.166]) (n = 13), including 2 deaths unrelated to direct-acting antivirals. Early treatment discontinuation occurred in 5.8% (n = 7), and a relapse in 0.8% (n = 1). On multivariate analysis, risk factors for serious adverse events included advanced liver fibrosis, thrombocytopenia, hypoalbuminemia, high bilirubin level, and pre-treatment status.

Conclusion: Locally manufactured generic sofosbuvir-based regimens are safe and effective in maintenance hemodialysis patients. However, they should be closely monitored to manage comorbidities and complications during treatment.