Chronic Maintenance Hemodialysis Research Articles

Application SF 36 And EQ 5D To Assess Quality Of Life In Musculo-Skeletal Health Of Elderly Patiens To Determine Intervention: Systematic Review

Background: Elderly Patients which chronic Kidney Diseases on Haemodialysis (HD) experience impaired muscle strength related quality of life (QoL). We analysed HD relationship with physical performance, body composition, and muscle strength; Purpose: To asses QoL in muscle-skeletal health and functional Capacity on elderly Chronic Kidney Diseases maintenance Haemodialysis. Methods: Using systematic literature review with data base EBSCO, ELSIVIER, Pup Med, Science Direct, Walley, start search year 2020-2023, 13 articles Randomize control trial and cross sectional. Groups underwent the following assessments physical QoL using application of the SF-36 questionnaire , and the Euro QoL five item psychologic-questionnaire (EQ-5D) are two of the most popular. Observed 6-minute walk test (6MWT) and handgrip strength, one-repetition maximum of knee flexors and extensors. Result: Main approaches, namely generic and disease-specific instruments, can be applied to measure health-related quality of life, the short form 36 questionnaire (SF-36) and the Euro QoL five item questionnaire (EQ-5D) are two of the most popular. One of the main goals of any interventions to prevent and cure musculoskeletal problems in the ageing population with should be to improve quality of life. Conclusion: To measure health-related quality of life, two basic methods can be used: The EQ-5D and the short form 36 questionnaire. Overview surveys are used to measure the quality of life related to health in individuals suffering from musculoskeletal illnesses. The validation of therapeutic and preventive interventions in this field should be aided by the recent development of specific instruments.

Combined right and left sided endocarditis in a hemodialysis patient: A cautionary tale

IntroductionInfective endocarditis is a potentially life-threatening condition, more prevalent among chronic maintenance hemodialysis patients, as opposed to the general population.AimCombined involvement of both the right and left heart chambers is exceptionally rare.Case studyHerein, we present the case of a patient on long-term maintenance hemodialysis with right and left sided infective endocarditis.Results and discussionWe discuss potential risk factors leading to the widespread infection and emphasize the importance of an early diagnosis and prompt treatment in yielding better outcomes.ConclusionsThe patient was treated successfully by a multidisciplinary team.

Upper extremity functions and physical activity in chronic maintenance hemodialysis patients: A case-control study.

Continuous hemodialysis (HD) treatment causes many complications in patients. The aim of this study is to evaluate the upper extremity functional capacity, physical activity level, and physical functions of patients receiving continuous HD treatment. Fifty HD patients and fifty healthy subjects were included in the study. Hand grip strength with Dynamometer, range of motion of upper extremity with Digital Goniometer, functional level of the upper extremity with the Turkish version of the Shoulder, Arm, and Hand Problems Questionnaire (The DASH-T), physical activity levels with international physical activity questionnaire short form and physical functions with the human activity profile (HAP) were evaluated. The mean grip strength of the subjects in the control group was 23.3 ± 1.44 kg, while the mean grip strength of the HD patients with fistula was 15.75 ± 3.08 kg (P < .05). In all joint range of motion measurements; the values of HD patients were significantly lower than the control group (P < .05). The DASH symptom scores of the individuals in the HD group (mean 19.19 ± 1.41) were significantly higher than the control group (mean 5.75 ± 1.41) (P < .05). The number of individuals with low-level activity in the HD group (72%) was higher than the control group (34%) (P < .01). The maximum activity score score of the HAP (mean 68.7 ± 1.4) and the adjusted activity score of the HAP (mean 42.54 ± 3.02) were lower in the HD group (P < .0001). HD treatment adversely affects hand grip strength, the range of motion, upper extremity functions, physical activity, and physical function levels of the patients.

Can a Kidney Failure Patient Survive with One to Two Hemodialysis Sessions per Month for More than 5 Years?

Background: Kidney failure known as renal failure or Stage 5 CKD or End Stage Renal Diseases is a major problem among kidney diseases worldwide, its incidence and prevalence are rising yearly. The management requires renal replacement therapy, hemodialysis, 3 sessions per week or peritoneal dialysis until the time of renal transplantation. The cost is high in low income countries and is not covered by major medical insurances. Few renal patients are able to afford dialysis and renal transplantation. Case Presentation: A 45-year-old man Butcher, living in rural Rwanda presented with renal failure and Hypertension with history of native medication intake. He remained on chronic maintenance hemodialysis since October 2017, at one to two hemodialysis sessions per month. He preserved quality of life and cognitive function. He is reporting to have more than 1000 cc of urine volume per day. Conclusion: This case demonstrates that suboptimal hemodialysis sessions can help the renal patients to survive when they preserve residual renal functions.

Hierarchical multiple regression investigating factors associated with depressive symptoms in the middle-aged and elderly undergoing haemodialysis

BackgroundDepressive moods are commonly seen in patients who receive haemodialysis. This can cause a lack of compliance in their treatment procedures and increase the rate of hospitalization. This study aimed to investigate the relationship between social support and degree of depression in middle-aged and elderly patients undergoing haemodialysis and the predictors of depressive symptoms.MethodsA cross-sectional correlational study was designed with a structured questionnaire survey. Patients over 40 years of age were included from five haemodialysis centres. Measures embraced a demographic and clinical characteristics questionnaire, the Centre for Epidemiologic Studies Depression Scale, and the Personal Resource Questionnaire 2000. Statistical analysis was performed using hierarchical multiple regression analysis.ResultsA total of 179 patients over 40 years of age were included from five haemodialysis centres in the analysis. The mean CES-D score was 19.0(12.3); the majority of participants (60.3%) had a CES-D score ≥ 15, indicating likely depressive status. The mean PRQ2000 score was 75.7(15.9). The proportional mean of the PRQ2000 was 72.11%, indicating moderate social support for participants in this study. Data disclosed that marital status, number of comorbidities, exercise behaviour, and social support could significantly predict depressive symptoms; total explanatory variance was 31.3%.ConclusionHealth care professionals should identify those at high risk of depressive symptoms when they provide care to the middle-aged and elderly patients undergoing haemodialysis. These findings may lead to greater insights into the nursing and rehabilitative care of patients treated by chronic maintenance haemodialysis.

Porphyria Cutanea Tarda

Patients with chronic kidney disease can have many dermatological manifestations. One of the very rare conditions is porphyria cutanea tarda (PCT), which manifests with hyperpigmentation of skin and photosensitivity along with painful bullae in sun-exposed areas. It is due to deficiency of uroporphyrinogen III decarboxylase enzyme which takes part in heme synthesis. The deficiency could be genetic or sporadic. Iron therapy and hepatitis C infection are known to precipitate these lesions. We report a case of PCT in a woman undergoing chronic maintenance hemodialysis, review the literature, and discuss the problems with management specific to the dialysis population.

The neutrophil-to-lymphocyte ratio may indicate when to start hemodialysis

We evaluated whether the neutrophil-to-lymphocyte ratio (NLR) could aid dialysis decision-making in combination with the clinical presentation and biochemical findings. We retrospectively evaluated the medical records of 279 patients who commenced chronic maintenance hemodialysis. We compared the laboratory findings at 6 months before dialysis to those at dialysis initiation. NLR cutoffs and risk factors for each of six uremic symptoms were determined. Mean age was 60.7 years and mean estimated glomerular filtration rate (eGFR) was 5.7 ± 2.5 mL/min/1.73 m2 at the time of hemodialysis and 7.7 ± 3.8 mL/min/1.73 m2 6 months earlier (p < 0.001). The mean NLR increased significantly from 2.5 ± 1.0 to 4.9 ± 2.8 (p < 0.001). The NLR was positively correlated with the C-reactive protein level (r = 0.202, p = 0.009) and negatively correlated with those of albumin (r = −0.192, p = 0.001) and total CO2 (r = −0.134, p = 0.023). The NLR cutoffs for neurological and gastrointestinal symptoms as determined using receiver operator curve analysis were 2.4 (area under the curve [AUC] 0.976; 95% confidence interval [CI] 0.960–0.993; sensitivity 92.2%; specificity 94.7%) and 3.6 (AUC 0.671; 95% CI 0.588–0.755; sensitivity 68.1%; specificity 63.5%), respectively. On multiple linear regression analysis of neurological symptoms, the NLR was a significant predictor (β = −0.218, p = 0.017), as was age (β = 0.314, p = 0.037). In conclusion, the NLR may serve as a supplementary marker predicting uremic symptoms and a need for hemodialysis in stage 5 CKD patients.

Factors associated with elevated blood lactate levels in patients undergoing maintenance hemodialysis.

Factors associated with chronic elevation of the blood lactate levels in patients undergoing chronic maintenance hemodialysis (hereinafter, hemodialysis patients) have not yet been thoroughly investigated. The purpose of the present study was to clarify factors associated with elevated blood lactate levels in hemodialysis patients. We divided the hemodialysis patients into two groups according the blood lactate levels (the high blood lactate group [> 2mmol/L] and normal blood lactate group), and conducted a retrospective comparison of the following items between the two groups: (1) the creatinine generation rate (%CGR) and the geriatric nutrition risk index (GNRI) as indices of the nutritional status; (2) the left ventricular ejection fraction (LVEF) and E/A, an indicator of diastolic function; (3) the ankle-brachial index (ABI) and transcutaneous partial pressure of oxygen as indices of the adequacy of circulation in the peripheral blood vessels of the lower extremities; (4) the white blood cell count and serum level of C-reactive protein (CRP) before dialysis as markers of an inflammatory state. The mean age and serum CRP level were significantly higher in the high blood lactate group than in the normal blood lactate group. There were no significant differences in the markers of the nutritional status, cardiac function, or adequacy of circulation in the peripheral blood vessels of the lower extremities between the two groups. Advanced age and a state of chronic inflammation appear to be associated with elevated blood lactate levels in patients undergoing chronic maintenance hemodialysis.

Optimal Sampling Strategy and Threshold of Serum Vancomycin Concentration in Elderly Japanese Patients Undergoing High-Flux Hemodialysis.

The optimal sampling points and thresholds for initial serum vancomycin (VCM) concentrations have not been determined in hemodialysis (HD) patients. To clarify this, multiple blood tests were performed, and the correlations between VCM concentrations at several sampling points and the area under the concentration-time curve for 24 hours (AUC24h) were analyzed. A single-center, prospective observational study was conducted. Patients with end-stage renal failure who received VCM treatment while undergoing chronic maintenance HD were enrolled in this study. HD was performed using a high-flux membrane as the dialyzer. After VCM administration, 7 points were sampled between the first and second HD. The AUC24h after the end of the first HD (AUC0-24) and that before the end of the second HD (AUC24-48) were calculated using the linear trapezoidal method. Correlation analysis and simple regression analysis between AUC24h and serum concentrations were performed at each sampling point. Nine patients were evaluated. Strong correlations were found between AUC24-48 and serum concentrations at 24 hours after the initiation of VCM treatment following the first HD (C24h, R = 0.983 and P < 0.001), between AUC0-24 and C24h (R = 0.967 and P < 0.001), and between AUC24-48 and serum concentration just before the second HD (Cpre(HD2), R = 0.965 and P < 0.001). Regression equations with high coefficients of determination (R2 > 0.9) were obtained, and a C24h of ≥18.0 mg/L and a Cpre(HD2) of ≥16.5 mg/L were required to achieve an AUC24-48 value of ≥400 mg·h/L. In addition, a C24h of ≤23.3 mg/L was estimated to satisfy the AUC0-24 range of ≤600 mg·h/L. C24h and Cpre(HD2) are optimal sampling points for predicting VCM-AUC24h in HD patients.

A study to predict fracture risk using bone mineral density and FRAX score in patients on chronic maintenance haemodialysis.

Introduction:Disturbances in mineral and bone metabolism are prevalent in chronic kidney disease (CKD) and are important causes of morbidity also their diagnosis often delayed and require a spectrum of investigations. The current study attempts to predict and correlate, the fracture risk using simple tools like BMD and FRAX (Fracture Risk Assessment Tool) score in CKD patients.Methods:A cross-sectional study among 50 CKD patients age more that 40 years attending OPD (Out Patient Department) at a tertiary care Hospital in north India.Results:There is a negative correlation between BMD (NOF) and FRAX score for hip fracture risk and major osteoporotic fracture risk.Conclusion:The 10-year fracture risk in these patients, as predicted by FRAX score using FRAX (Indian) calculator, was significantly higher in CKD patients.Recommendation:FRAX can be useful tool for early screening of fracture risk in such situations for timely interventions.

Muscle strength in chronic maintenance haemodialysis patients

Rationale: End-stage kidney damage causes toxic metabolic wastes to build up in the body; with associated malnutrition muscles get damage and leading to poor function of muscles.

Patients on Chronic Maintenance Hemodialysis with and Without COVID-19 Infection: Comparison of Baseline Characteristics and Mortality

Patients on Chronic Maintenance Hemodialysis with and Without COVID-19 Infection: Comparison of Baseline Characteristics and Mortality

MO656CORRELATION BETWEEN CHANGES IN THE BODY FLUID VOLUME CALCULATED BY THE URIC ACID KINETIC MODEL AND CHANGES IN THE BODY WEIGHT*

Abstract Background and Aims Uric acid (UA) is a solute unable to cross the cell membranes in general tissues by any of simple diffusion, facilitated diffusion or active transport. These facts imply that UA distribution volume (UDiV) equals to the extracellular fluid volume (ECFV). We have developed a method for calculating UDiV from serum uric acid levels before and after hemodialysis based on a uric acid kinetic model (Shinzato T, Int J Artif Organs 2020). Urea is evenly distributed throughout the body fluids. Therefore, the total body fluid volume (TBFV) can be calculated by using the same method as the calculation of UDiV for the serum urea level. The remaining body fluid volume, which is TBFV minus UDiV, is considered to reflect the intracellular fluid volume (ICFV). In this study, we clarified the relationship between the amount of change over time in UDiV and ICFV calculated by the uric acid kinetic model and the amount of change over time in the actual body weight of hemodialysis patients. Method Subjects were 1,101 patients with chronic maintenance hemodialysis. UDiV and ICFV before and after dialysis were calculated for two time points, December 2019 and June 2020. Results The amount of change in UDiV per body during the dialysis session showed a very good correlation with the amount of body weight change during the same dialysis (UDiV change = 0.950 x body weight change - 0.158, R-square 0.90, p &amp;lt; 0.0001). The amount of change in ICFV during the 6 months from December 2019 to June 2020 showed a good correlation with the amount of change in post-dialysis body weight during the same period (ICFV change = 0.270 x post-dialysis body weight change + 0. 240, R-square 0.21, p &amp;lt;0.0001). Conclusion These results suggest that the body fluid volume calculated by the uric acid kinetic model has high accuracy.

An Integrative Approach to Detect Protein–Energy Wasting Among Chronic Kidney Disease Maintenance Hemodialysis Patients

Background: Malnutrition is a major predictor of overall outcome in patients on hemodialysis. Regular and frequent evaluation of the nutritional status of these patients is advisable. Aims and Objectives: This study aimed to look at nutritional status of a hemodialysis cohort and to evaluate whether multiple assessment tools improve the detection of malnutrition in this cohort. Materials and Methods: A prospective study in two outpatient hemodialysis centers was conducted over 6 months. Stable patients without any irreversible organ damage and preserved cognitive function were included in the study. Data collected included demographics, comorbid conditions, and baseline laboratory investigations. The nutritional assessment tools included body mass index (BMI), 7-point Subjective Global Assessment, Global Leadership In Malnutrition (GLIM), handgrip strength, and body composition analysis. Results: A total of 121 subjects (77 males, 44 females) participated in the study. Based on BMI, only 14% were underweight. 7-point SGA detected 77 malnourished subjects, whereas according to GLIM criteria, all patients had some degree of malnutrition. Body composition analysis showed depleted total body protein mass in majority of patients. There was a correlation between total body protein mass and handgrip strength. The assessment tools showed some degree of correlation in patients who were malnourished. Conclusions: Use of a single assessment tool often underdiagnoses malnutrition in hemodialysis patients. An integrative approach using multiple evaluation tools may be beneficial in these groups of patients.

POS-559 EVALUATION OF MINERAL AND BONE DISORDERS IN PATIENTS WHO HAVE SURVIVED FOR MORE THAN 2 YEARS ON MAINTENANCE HEMODIALYSIS IN INDIA

Government initiatives and increasing social support have increased hemodialysis facilities in India. But there is a dearth of outcome data of patients on long-term chronic maintenance hemodialysis (MHD). Our study aims to assess the types of mineral and bone disorders (MBD) in patients who have been more than 2 years on MHD. We also aim to study the correlation of MBD with vascular calcification leading to cardiovascular events and bone fractures.

Retrospective analysis of nontraumatic subdural hematoma incidence and outcomes in Egyptian patients with end-stage renal disease on hemodialysis

Background The incidence of subdural hematoma (SDH) in chronic maintenance hemodialysis (CMH) patients may change over time, along with the evolving characteristics of the underlying populations. Methods We conducted a retrospective, single-center study at Cairo University hospitals, assessing the incidence, associated risk factors, and outcomes of nontraumatic SDH in CMH patients between January 2006 and January 2019. Results Out of 1217 CMH patients, nontraumatic SDH was diagnosed in 41 (3.37%) during the study, increasing with the enrollees’ age but stable over the observation period and translating into an annual incidence rate of 28 per 1000 patients per year. SDH patients were likely to use central venous catheters, reported pruritis and history of bone fractures, and had higher phosphorus, parathyroid hormone, and alkaline phosphatase values (p < 0.001); however, there was no association with atrial fibrillation or use of anticoagulants. In the SDH cohort (n = 41), six patients did not need surgical intervention and 13 patients died before becoming surgically fit for intervention; mortality correlated with ischemic heart disease (p = 0.033) and the presence of atrial fibrillation or chronic anticoagulation with warfarin (p < 0.0001 for both), among others. Twenty-two patients received surgical operations and of these 2 died postoperatively; overall patient mortality was 12/41 (29.27%) at 30 days and 15/41 (36.59%) at 1 year. Conclusion Our study demonstrated a striking enrichment for underlying comorbidities in those patients developing SDH and a high risk of immediate mortality. The benefit of chronic anticoagulation therapy should be carefully weighed against the risk of CNS bleed in MHD patients.

A Qualitative Analysis of the Accessibility and Connection to Traditional Food for Aboriginal Chronic Maintenance Hemodialysis Patients.

ABSTRACTBackgroundDue to the lack of resources in remote Aboriginal communities within the Northern Territory of Australia, Aboriginal people requiring chronic maintenance hemodialysis often must relocate from their home communities to Darwin city permanently to receive ongoing care. This phenomenon can cause distressing isolation from important traditional food, land, and family.ObjectiveThe aim was to identify the relation to traditional food from an Aboriginal perspective and the enablers and barriers to accessing traditional food post-relocation from remote regions of the Northern Territory, Australia, to the urban city of Darwin.MethodsThis was a qualitative study design with a total of 12 Aboriginal participants (4 males, 8 females) receiving ongoing hemodialysis at the Nightcliff Renal Unit. Participants had all relocated from a remote region to Darwin. Interviews were conducted between July and September 2018 in Darwin, Australia. Data interpretation was conducted by an Aboriginal researcher and co-authors with a combined 30 y of experience conducting research with Aboriginal people in a health context. Data analysis comprised an inductive thematic analysis approach with an indigenist knowledge interpretation lens to construct, reaffirm, and protect Indigenous views.ResultsTraditional food was an important part of participants’ identity and strongly connected to social, emotional, spiritual and physical health, and well-being. Access to traditional food post-relocation is associated with enablers and barriers including mobility, local knowledge, social support networks, commercial access, and economics.ConclusionsDialysis patients who are dislocated from remote Aboriginal communities to Darwin experience clear disruption to traditional food access, consumption, availability, and knowledge dissemination to the younger generations.

SUN-507 Parathyroid Carcinoma and Incidental Finding of Hashimoto's Thyroiditis in a Patient with End-Stage Renal Disease: A Case Report

Background: Parathyroid carcinoma is a very rare endocrine neoplasia. The incidence reported is less than 1% in primary hyperparathyroidisim (1). The presence of this rare carcinoma is even less likely in the setting of chronic kidney disease. Unfortunately, parathyroid carcinoma is difficult to differentiate clinically with parathyroid adenoma and hyperplasia pre-operatively. Clinical Case: A case of a 48-year-old male, diagnosed with end-stage renal disease secondary to IgA Nephropathy and maintained on chronic hemodialysis for 8 years, presented with progressive decreasing height and occasional bone pain. Despite compliance to hemodialysis, calcimimetics, phosphate binders, calcium and vitamin D supplementation to suppress the high PTH levels, patient remained persistently hyperparathyroid with intact PTH of 4793pg/ml (NV: 15-65 pg/ml). Other laboratory findings showed vitamin D sufficiency (Vitamin D 87 nmol/L (NV: >75 nmol/L), hypocalcemia (ionized calcium 1.08 mmol/L (NV: 1.10-1.35) and hyperphosphatemia (inorganic phosphate 2.15 mmol/L (NV: 0.01-1.45 mmol/L). With the failure of medications to suppress the high PTH levels, surgical removal of the parathyroid glands was then the next possible option. A dual phase sestamibi scan of the parathyroid revealed a single focal activity at the mid aspect of the right thyroid bed on the wash-out phase. Patient underwent total parathyroidectomy and total thyroidectomy. Intraoperative findings revealed enlarged bilateral parathyroid glands with largest measuring 2x2 cm and incidental findings of multiple nodules in bilateral thyroid glands. Final histopathology revealed parathyroid carcinoma in 3 out of 4 glands and Hashimoto’s thyroiditis with multi-nodular adenomatous goiter. Conclusion: It is a challenge to clinically differentiate parathyroid carcinoma and other causes of hyperparathyroidism among patients undergoing chronic maintenance hemodialysis due to the effect of renal insufficiency on calcium metabolism. This case highlights an unusual case of parathyroid carcinoma in a patient with ESRD and incidental finding of hashimoto’s thyroiditis, who presented with extremely elevated intact parathyroid hormone accompanied with hypocalcemia. Reference: (1) Ronald A. De Lellis, Ricardo V. Lloyd, Philipp U. Heitz, CharisEng: World Health Organization Classification of Tumors. Pathology and Genetics, Tumors of Endocrine Organs.77, 2004

A rare case of paraneoplastic opsoclonus myoclonus syndrome that developed during chronic maintenance hemodialysis

A rare case of paraneoplastic opsoclonus myoclonus syndrome that developed during chronic maintenance hemodialysis

Pressure Ulcers due to a Tunneled Central Venous Catheter in a Patient on Chronic Maintenance Hemodialysis

Pressure Ulcers due to a Tunneled Central Venous Catheter in a Patient on Chronic Maintenance Hemodialysis