Beginning Of Dialysis Treatment Research Articles

Fragility Fractures in End-Stage Chronic Kidney Disease (CKD) Population: Patient-Related and CKD-Related Factor Analysis-A Single-Center Experience.

Background: Chronic kidney disease (CKD) stands as a prevalent global health concern, and mineral and bone disease are among the most impactful consequences. A severe complication arising from mineral and bone disease is the occurrence of fragility fractures, which disproportionately affect individuals with CKD compared to the general population. The prevalence of these fractures impacts both survival rates and quality of life. The aims of this study are analyzing and identifying (i) patient-related risk factors and (ii) CKD-related risk factors to contribute to the development of preventive measures for fragility fractures for this population. Methods: A retrospective, single-center observational study was conducted, encompassing patient data from the years 2021 to 2023. Registry data were recorded, including patient-related and CKD-related data. Patients were interviewed about traumatological history, and their answers were recorded. Logistic regression analysis was employed to investigate the association between independent variables and dependent variables. Results: Eighty-four patients, with a mean age of 64.3 ± 15.2 years and a male percentage of 58.3%, were included in this study. Among them, 19.5% exhibited smoking habits. The mean Charlson Comorbidity Index was 3.06 ± 1.21. All patients were diagnosed with end-stage chronic kidney disease, with mean durations of 208 months from the diagnosis and 84.5 months from the beginning of dialysis. The logistic regression analysis, adjusted for age, sex, and CCI, revealed that smoking habits play a significant role as a risk factor for fragility fractures in lower limbs (p: 0.011 *). The incidence of fragility fractures increases directly proportionally to the time since diagnosis (p-value: 0.021 *) and the beginning of dialysis treatment (p-value: 0.001 *). Conclusions: Among patient-related factors, smoking habits seem to significantly affect lower-limb fracture rates (p < 0.05), whereas among CKD-related factors, time since CKD diagnosis and time since the beginning of dialysis treatment are directly related to higher risks of fragility fractures. No relevant correlations emerged in the studied treatments, except for a reduction in proximal femur fracture occurrence when patients underwent a combined treatment of a calcimimetic and a vitamin D analog.

혈액투석환자의 사전연명의료의향서 작성 영향요인*

The purpose of this study was to identify the factors that influence Hemodialysis patients’ intentions to write Advanced Directives (ADs). A questionnaire was used to collect data from 165 chronic renal failure patients receiving hemodialysis treatment at two general hospitals in South Korea. The variables that were found to have a significant influence on the intention to write an AD were education level, knowledge of Ads, and attitudes toward ADs. Patients with a university degree or high school education were significantly more likely (3.35 times and 3.62 times, respectively) to write an AD than were those without a high school education. In terms of knowledge of ADs, as the score increased by 1 point out of 21, the intention to write an AD increased by 1.12 times. Regarding attitudes toward ADs, as the score increased by 1 point, the intention to write an AD increased by 1.13 times. Patients that would choose to continue dialysis treatment during the end-of-life period were less willing to write an AD than those who would stop the dialysis treatment. However, 18.5% of those willing to write an AD indicated that they would continue hemodialysis treatment during the end-of-life period. The results of this study suggest that discussions between patients, family members, and healthcare providers are required from the beginning of dialysis treatment so that these patients have the right knowledge and attitudes about ADs and can confirm their values and beliefs about end-of-life care.

Improving Depression, Hope, and Quality of Life in Dialysis Patients Using Health Promotion Education Groups

Taiwan has the highest incidence and prevalence of dialysis in the world. The literature suggests that severity of depression at the beginning of dialysis treatment is an independent predictor of survival. Depression significantly worsens the condition of chronic renal disease patients, with the adverse consequences of depression including increased mortality and hospitalization rates as well as poor compliance and quality of life. Given the importance of this problem, providing safe and effective information and good nursing care to dialysis patients is urgently needed. The purpose of this study was to explore the effects of implementing health promotion education groups on self-perceived depression, hope, and quality of life in dialysis patients. Dialysis patients who met the study criteria and had provided consent to participate in the health promotion education group were randomly assigned to either the treatment group (20 persons) or the control group (20 persons). In the control group, routine dialysis treatment and nursing care were maintained. In addition to receiving routine dialysis treatment and nursing care, the experimental group participated in health promotion education group activities for 90 minutes, twice a week for a total of 8 sessions. The quantitative data from both groups and the qualitative data analysis of the experimental group were used to assess the effects of the intervention. The results showed that the intervention had significantly improved self-perceived depression, hope, and quality of life in the experimental group. The participants indicated that the health promotion education group had helped them learn to adapt to their physical conditions, change their mindset, learn to regard happiness as the purpose of life, and maintain hope and increase mutual support in the face of difficulties. This study demonstrated that the cross-disciplinary integrated care provided through health promotion education groups is able to significantly improve depression, hope, and quality of life in dialysis patients. Thus, health promotion education groups arranged by the case management nurses for dialysis patients have the potential to promote mental health and quality of life in these patients. Therefore, continuing education is recommended to strengthen the awareness and knowledge of dialysis case management nurses with regard to applying integrated cross-disciplinary care in health promotion education groups and to promoting the implementation of these groups in the holistic care of dialysis patients.

Assessment of depression among patients undergoing haemodialysis: a cross-sectional study

Background: Depression is the most important neuropsychiatric complication in chronic kidney disease because it reduces quality of life and increases mortality. The beginning of dialysis treatment causes subtle changes in the life of CKD patients, mainly in the physical and social spheres. It affects the self-care of these patients which lead to poor adherence to dialysis. Hence, the present study was conducted to screen for depression.Methods: This was an observational study among 100 patients undergoing haemodialysis at HIMS, HASSAN. After taking informed consent, subjects were requested to complete Beck, depression Inventory, a 21-question multiple-choice self-report inventory for measuring the severity of depression. Descriptive statistics was applied to infer the findings.Results: The study population showed depression of mild (31%), borderline (10%), moderate (17%), severe (7%) and extreme (3%) grade and the remaining subjects did not show depressive symptoms (32%).Conclusions: Majority of patients undergoing hemodialysis were depressed. Major risk factors for depression were marital status of the patients, low literacy rate, gender and those started on dialysis recently.

Reduction in the presence of cryoglobulins over time in the hemodialysis treatment

Background: The presence of cryoglobulins in patients with chronic kidney disease (CKD) on hemodialysis is well described. However, the generation of cryoglobulins during the dialysis treatment has yet to be established. The aim of the present study was to determine the presence of serum cryoglobulins over time in the dialysis treatment in patients with CKD not infected with hepatitis C virus (HCV).Method: Peripheral blood samples were collected at the beginning of dialysis treatment and at 30, 60, 90 and 120 days afterwards. Cryoglobulins were defined by the presence of immunocomplexes that precipitated in vitro with exposure to cold and resolubilized when rewarmed. The components of the cryoprecipitate were analyzed by radial immunodiffusion.Results: In this study, 14 patients were included: 11 male and three female, aged 28–88 years, with mean time on hemodialysis of 57 ± 36 days at baseline. The presence of cryoglobulin, constituted by IgM, IgA, IgG and the C3 and C4 components of the complement, was observed in the serum of all patients at the beginning of hemodialysis. Sequence analyses showed that the amount of cryoprecipitate decreased during the dialysis treatment.Conclusion: There was a high prevalence of mixed cryoglobulins in CKD patients at the beginning of hemodialysis, and the amount of cryoprecipitate decreased during the treatment.

The Peritoneum: From Histological Studies to Mesothelial Transplant through Animal Experimentation

Normal peritoneal anatomy is dramatically altered by several stimuli, one of which is the presence of peritoneal dialysis solutions (PDS) in the abdomen (1‐3). The distress induced by these commercial dialysis solutions manifests as rapid mesothelial changes, vascular alterations, and peritoneal sclerosis (PS) (4,5). These alterations start with the beginning of dialysis treatment and are accelerated by episodes of peritonitis, leading to gradual replacement of peritoneum by fibrous tissue (6,7). Efforts have been made to understand the role of commercial PDS and to prepare more biocompatible dialysis solutions (8‐10). Mesothelial cell cultures allow us to study the behavior of these cells in normal conditions and during peritoneal dialysis (PD), but to explore the submesothelial layer it is necessary to experiment

Renal Replacement in End-Stage Renal Disease Patients over 75 Years Old

Background: Over the last decade, the age of dialysis patients has been increasing steadily in several units in Canada. Our main objective was to assess prevalence, co-morbidity and outcome of ESRD patients over 75 years old at the beginning of dialysis treatment in our center. As a group, they were compared to younger dialysis patients treated simultaneously. Methods: In the last 5 years, all cases beginning dialysis in our institution who were above 75 years of age were reviewed, as well as cases aged between 50 and 60 years who started dialysis during the same period. Between January 1996 and December 2000, among a total of 429 new chronic dialysis patients, 67 ESRD patients over 75 years (15.6%) and 66 patients between 50 and 60 years (15.4%) began dialysis treatment. Results – Primary and Secondary: Diabetes was present in 37% of elderly and in 56% of the younger patients. Younger patients had been referred earlier to our nephrologists than the older ones (42 vs. 27%). Elderly were more frequently treated by hemodialysis than peritoneal dialysis (81 vs. 19%) when compared to their younger counterparts (65 vs. 35%). Long-term catheters for hemodialysis were used more often in elderly patients. No renal transplantation were performed in older patients while 7 younger patients received a renal graft. Survival rates after 1 and 3 years were, respectively, 93 and 74% for patients between 50 and 60 years, whereas it decreased to 80 and 45% for those over 75 years (p = 0.002). More than 50% of patients older than 75 years died within 2 years after starting dialysis; their mean survival was 31 months; patients starting dialysis between 50 and 60 years survived on the average 44 months during the study period. According to the multivariate logistic regression model, risk factors for increased mortality in the older group were: number of hospitalization days during the past 3 months (OR 34.8, 95% CI 8.3–145.7, p < 0.001) and lower weight (OR 16.6, 95% CI 2.0–139.0, p = 0.001). Conclusion: We may conclude that, in our hands, life expectancy of patients who began dialysis above 75 years is significantly shorter than for patients for whom dialysis is initiated between age 50 and 60 years, especially if they have a low weight, lose weight and/or require hospitalization.

Impact of socioeconomic status on the quality of life of ESRD patients

Background: Socioeconomic status (SES) has been associated with the incidence of end-stage renal disease (ESRD); however, the impact of SES on the quality of life (QOL) of these patients has not been clearly defined. Methods: One hundred eighteen patients were prospectively evaluated at the beginning of dialysis treatment and reassessed (n = 90) after an average of 7 months. QOL was measured by means of the Medical Outcomes Survey 36-Item Short Form (SF-36). Classification of SES was according to validated criteria of the Brazilian Association of Research Institutes. Results: Mean scores for SF-36 dimensions were decreased in patients with low compared with high SES, with greater differences noted during follow-up. At this time, mean scores for SF-36 scales for the low- and high-SES groups were as follows: Functional Capacity, 43 ± 31 versus 68 ± 26 (P < 0.01); Physical Aspect, 34 ± 36 versus 56 ± 38; Pain, 55 ± 31 versus 80 ± 28 (P < 0.01); General Health Status, 60 ± 21 versus 67 ± 19; Vitality, 42 ± 25 versus 59 ± 16 (P < 0.05); Social Aspect, 53 ± 32 versus 81 ± 21 (P < 0.01); Emotional Aspect, 49 ± 44 versus 70 ± 41; and Mental Health, 51 ± 27 versus 70 ± 22 (P < 0.05), respectively. These differences were more pronounced than expected for an age- and sex-matched sample of the Brazilian general population. Multivariate analysis showed that SES continued to significantly affect all QOL dimensions, explaining 5.5% to 14.1% of variation in scales. Conclusion: SES is an important factor associated with QOL in patients with ESRD. Further studies to determine optimum interventions and measures in groups with lower SES may be important to improve QOL outcomes and reduce their morbidity. Am J Kidney Dis 41:186-195. © 2003 by the National Kidney Foundation, Inc.

Effect of dialysis on serum/plasma levels of free immunoglobulin light chains in end-stage renal disease patients.

Free immunoglobulin light chains (FLCs) have previously been shown to be uraemic toxins. In this work we investigated the effect of haemodialysis and haemodiafiltration on the level of FLCs in serum/plasma of uraemic patients. Serum/plasma proteins were separated by non-reducing SDS-PAGE and transferred to a nitro-cellulose membrane. FLCs were detected by specific antibodies and an enhanced chemiluminescence detection system. The FLC concentrations were calculated. We studied 15 healthy subjects, 10 patients with chronic renal failure, 71 patients undergoing haemodialysis treatment and 33 patients treated with haemodiafiltration. Different membranes were compared: low- and high-flux polysulfone membranes, low- and high-flux cellulose triacetate membranes, high-flux polymethylmethacrylate and polyacrylonitrile membranes. Chronic renal failure patients showed elevated FLC concentrations as compared with controls. In haemodialysis or haemodiafiltration patients these values were even higher. This was mainly due to an increased concentration of FLC of the lambda-type. The treatment modality per se did not influence the FLC concentrations. Only haemodialysis or haemodiafiltration with the polymethylmethacrylate membrane lead to a significant reduction in FLC concentrations; however, these did not reach control levels. We did not observe differences in FLC levels between patients with different underlying diseases, nor did we find a correlation between age or the duration of the dialysis treatment and FLC concentrations. We found a positive correlation between FLC concentrations at the beginning of dialysis treatment and the amount of IgLCs removed during treatment. However, the average FLC level after treatment did not reach control values. Currently available haemodialysis or haemodiafiltration treatments are unable to normalize the elevated serum/plasma levels of FLCs in end-stage renal disease patients.

High mortality and poor quality of life during predialysis period in type II diabetic patients with diabetic nephropathy.

We investigated the rate of decline in GFR and the changing prevalences of micro- and macrovascular complications in 20 type II diabetic patients [mean age 58 (46-71) years, female:male = 7:13, duration of diabetes 16 (12-30) years] from the stage of macroproteinuria with GFRs which were still normal until the beginning of dialysis or the time of death. Controls of renal function, proteinuria, HbAlc, serum lipids, and blood pressure were performed every 6 months at the beginning of the study and later on at 3-month intervals. Fundoscopy, electrocardiogram at rest and in case of need a symptom-limited treadmill ECG, a Duplex ultrasound examination of the carotid vessels, and a Doppler sonographic examination of the femoral arteries were repeated each year. The creatinine clearance (mean +/- SD) of the patients was 81 +/- 6 mL/min/1.73 m2 at the beginning of the study. The rate of decline in creatinine clearance was 1.01 +/- 0.38 mL/min/month during the whole period of observation. Twelve patients (group A) required dialysis after a mean time of 74 (40-119) months; their creatinine clearance was 7 +/- 2 mL/min/month at the beginning of renal replacement therapy. Eight patients (group B) died a short time before the beginning of dialysis treatment; their creatinine clearance was 13 +/- 5 mL/min/1.73 m2. The causes of death were sudden death (n = 4), cardiac failure (n = 1), and stroke (n = 2); in one case it was unknown. The two patient groups did not differ in respect to the mean age, duration of diabetes, HbAlc values, serum cholesterol levels, and blood pressure. The decline in the creatinine clearance was also similar in both patient groups, with 1.07 +/- 0.35 versus 0.98 +/- 0.41 mL/min/month. Only the mean serum triglyceride concentration was significantly higher in the patients who died before dialysis. At the start of the study, cerebrovascular disturbances (including plaques in the carotid vessels) were found in 30%, cardiovascular disturbances (including pathologic ECG findings) in 45%, a peripheral vascular disease in 15%, and diabetic retinopathy (grade I and II) in 75%. At the beginning of dialysis treatment or the time of death, respectively, the prevalence of cerebrovascular diseases was increased to 70% and the prevalence of cardiovascular diseases to 90%; peripheral vascular disease was present in 50% and diabetic retinopathy in all of the cases. We conclude that type II diabetic patients show high mortality (40%) and poor quality of life, not only when they require dialysis treatment, but also in the predialysis phase.

Hämodialyse bei Diabetikern mit terminaler Niereninsuffizienz*

Long-term dialysis treatment of diabetics with terminal renal failure is beset with severe complications. In 19 unselected diabetics in terminal renal failure (13 juvenile diabetics and 6 maturity-onset diabetics) the clinical course during long-term dialysis was observed. A total of 1377 dialyses during 167 months of treatment were performed. Diabetic angiopathy, hypertension, and hyperhydration were the most prominent complications. The interval between the onset of diabetes and the beginning of dialysis treatment was 21,5 years in the juvenile diabetics and 5,2 years in maturity-onset diabetes. The survival time during dialysis was on average 13,2 months for the juvenile diabetics and 0,6 months for maturity-onset diabetics. The patients died chiefly from cardiovascular complications.