Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy最新文献

Introduction: Given that social frailty is closely associated with adverse health outcomes among older maintenance hemodialysis (MHD) patients, this study aimed to investigate the prevalence of social frailty among older MHD patients, with an emphasis on its correlation with factors such as family functioning, self-care ability, depression, and physical frailty.

Methods: A multi-center cross-sectional investigation was conducted to recruit older patients with MHD between September and December 2024 from four hemodialysis centers in four tertiary hospitals in Sichuan Province, China. Self-report scales were employed to collect general information and assess the participants' social frailty, family functioning, depression, and physical frailty. Univariate analysis and binary logistic regression analysis were adopted to determine the predictors of social frailty.

Results: A total of 386 older MHD patients were included in the analysis. Of the participants, 205 (53.1%) were diagnosed with social frailty. Binary logistic regression analyses demonstrated that family functioning (OR = 0.863, 95% CI: 0.776-0.960, p = 0.007), self-care ability (OR = 3.527, 95% CI: 1.958-6.352, p < 0.001), depression (OR = 2.007, 95% CI: 1.180-3.415, p = 0.010), and physical frailty (OR = 2.261, 95% CI: 1.237-4.133, p = 0.008) were significantly associated with social frailty among older MHD patients.

Conclusions: Social frailty is highly prevalent among older patients with MHD. In addition, family function, self-care ability, depression, and physical frailty were detected to be independently associated with social frailty. These findings could facilitate the refinement of daily care strategies for older patients with MHD to reduce or mitigate the negative effects of social frailty.

Introduction: Accurate patient self-assessment of catheter exit-site conditions is vital to prevent catheter-related infections (CRI) and ensure effective treatment in patients with peritoneal dialysis (PD). This study aimed to evaluate the concordance between PD patients' self-assessment of their catheter exit-site conditions and that of healthcare professionals and to analyze the trend in concordance.

Methods: A prospective observational study was conducted on 44 patients who started PD. The patients were assessed monthly using an exit-site scoring system. Questionnaires were used for patients' self-assessments. The concordance between both evaluations was analyzed over 12 months.

Results: The mean concordance rate between patient self-assessments and healthcare professional evaluations was 88%. The concordance rate was higher when no abnormalities were detected (93.8%) and lower when abnormalities were detected (63.2%), decreasing over time in both cases.

Conclusions: Overall, a high concordance was observed between patient and healthcare professional assessments of PD catheter exit sites. However, the concordance was lower when abnormalities were present and tended to decrease over time, highlighting the potential need for continuous patient education to maintain accurate self-assessment.

Trial registration: UMIN000037871 and 000039224.

Introduction: Altitude may influence the requirement for erythropoiesis-stimulating agent (ESA) therapy in patients undergoing hemodialysis (HD). This study aimed to compare anemia-related parameters, ESA utilization, and intravenous (IV) iron supplementation among HD patients residing at different altitudes.

Methods: This retrospective-multicenter study was conducted in three provinces of Türkiye, each located at a distinct altitude: Balikesir (139 m; low-altitude-group [LA]), Malatya (964 m; moderate-altitude-group [MA]), and Hakkari (1728 m; high-altitude-group[HA]).

Results: Two hundred and twenty nine HD patients were included in the study: 99 in the LA group, 77 in the MA group, and 53 in the HA group. The mean age was 59 ± 13 years. ESA use was observed in 92 (93%) patients in the LA group, 61 (73%) in the MA group, and 43 (81%) in the HA group (p = 0.021). Age (OR: 1.102, 95% CI: 1.035-1.174, p = 0.003), female gender (OR: 6.068, 95% CI: 1.080-34.111, p = 0.041), residing at LA (OR: 12.845, 95% CI: 1.833-90.118, p = 0.010), IV iron use (OR: 21.015, 95% CI: 3.397-130.009, p = 0.001), hematocrit (OR: 0.364, 95% CI: 0.229-0.578, p < 0.001), and ferritin (OR: 1.003, 95% CI: 1.001-1.005, p = 0.007) were identified as independent predictors of ESA use.

Conclusion: Residing at LA was associated with increased ESA requirements in HD patients, suggesting that altitude may be a relevant factor in anemia management.

Introduction: Little is known about the effect of cardiac rehabilitation (CR) on cardiovascular events in patients with advanced chronic kidney disease (CKD).

Methods: We performed a retrospective cohort study in 189 patients with an estimated glomerular filtration rate of less than 30 mL/min/1.73 m² who were referred to our outpatient CR center. They were divided into two groups according to whether they participated in CR or not, and compared for major adverse cardiovascular events (MACEs) incidences.

Results: There were 143 that participated in CR and 46 that did not. The cumulative MACE rates in the participation group were lower than in the non-participation group (48% vs. 61%, p = 0.015). The hazard ratio for all-cardiovascular events in the participation group as compared to the non-participation group after adjusting for confounders was 0.56 (95% CI, 0.35-0.89, p = 0.014).

Conclusion: CR might reduce MACEs in patients with advanced CKD.

Introduction: High-dose online HDF compared with hemodialysis reduces all-cause mortality, but increases water consumption. We postulate that the conundrum could be solved by individualizing dialysate flow.

Methods: Thirty CKD5D patients undergoing online HDF post-dilution were changed from fixed dialysate flow (500 mL/min) to individualized dialysate flow, resulting in a dialysate flow that was always 20% higher than the blood flow. Kt/V _urea, K⁺, Phos, and pill burden in one quater pre as well as four quarters after the change were evaluated.

Results: The practice change resulted in a reduction of the fixed dialysate flow from 500 to 360 (240-383) mL/min. Parameters of dialysis adequacy did not change; neither did the medication.

Conclusion: An individualization of the dialysate flow saved about 36 L dialysate per session; hence, even in light of 23 L used for online HDF, the net burden on the environment could be reduced. Neither dialysis adequacy nor pill burden was negatively affected.

Introduction: Although continuous kidney replacement therapy (CKRT) for acute kidney injury (AKI) management is common, its effect on the outcomes of patients treated with extracorporeal membrane oxygenation (ECMO) for severe coronavirus disease 2019 (COVID-19) remains unclear. Therefore, we aimed to investigate the impact of CKRT on the outcomes of these patients.

Methods: Using a database of patients with severe COVID-19 who required venovenous ECMO across three centers in Japan, we assessed demographics, clinical parameters, and in-hospital mortality rates from January 2020 to December 2021.

Results: Data of 122 patients treated with ECMO for COVID-19 were analyzed. Forty-five patients required CKRT; the in-hospital mortality rate was 28.7%. Multivariate analysis showed age and CKRT were independent risk factors for in-hospital mortality. The in-hospital mortality rate was significantly higher in the CKRT group.

Conclusion: CKRT was associated with significantly high in-hospital mortality in patients treated with ECMO for severe COVID-19.