Control In Hemodialysis Patients Research Articles

The effect of different dialysate sodium concentrations on ambulatory blood pressure in hemodialysis patients: a prospective interventional study.

Hypertension is associated with increased morbidity and mortality in hemodialysis patients. Existing recommendations suggest reduction of sodium load, but the effect of dialysate sodium on blood pressure (BP) is not fully elucidated. The aim of the present study is to investigate the effect of different dialysate sodium concentrations on 72-h ambulatory BP in hemodialysis patients. This prospective study included patients on standard thrice-weekly hemodialysis. All patients initially underwent six sessions with dialysate sodium concentration of 137meq/L, followed consecutively by another six sessions with dialysate sodium of 139meq/L and, finally, six sessions with dialysate sodium of 141meq/L. At the start of the sixth hemodialysis session on each sodium concentration, 72-h ABPM was performed over the long interdialytic interval to evaluate ambulatory systolic and diastolic BP (SBP and DBP) during the overall 72-h, different 24-h, daytime and night-time periods. Twenty-five patients were included in the final analysis. A significant increase in the mean 72-h SBP was observed with higher dialysate sodium concentrations (124.8±16.6mmHg with 137meq/L vs 126.3±17.5mmHg with 139meq/L vs 132.3±19.31mmHg with 141meq/L, P=0.002). Similar differences were noted for DBP; 72-h DBP was significantly higher with increasing dialysate sodium concentrations (75.1±11.3mmHg with 137meq/L vs 76.3±13.7mmHg with 139meq/L vs 79.5±13.9mmHg with 141meq/L dialysate sodium, P=0.01). Ambulatory BP during the different 24-h intervals, daytime and night-time periods was also progressively increasing with increasing dialysate sodium concentration. This pilot study showed a progressive increase in ambulatory BP with higher dialysate sodium concentrations. These findings support that lower dialysate sodium concentration may help towards better BP control in hemodialysis patients.

Extremity Joint Range of Motion Exercise on Intradialytic Blood Pressure Control in Hemodialysis Patients

Changes in blood pressure during hemodialysis is an important point that must be a concern. The occurrence of hypotension and intradialytic hypertension can have an impact on reducing the adequacy of dialysis, decreasing kidney function, and can even affect the patient's quality of life. Among the non-pharmacological interventions that are considered safe and effective in the management of intradialytic blood pressure control are intradialytic exercises, one of which is range of motion exercises for the extremities. To determine the effect of extremity joint range of motion exercises on intradialytic blood pressure control in hemodialysis patients. This research used a quasi-experimental pre-test and post-test control group design using cluster sampling with a purposive sampling technique with a sample size of 46 respondents (23 intervention and 23 control group respondents) with Wilcoxon test data analysis. in the intervention group the average systolic blood pressure before and after intradialytic exercise was -6.42mmHg, the diastolic blood pressure difference was -2.38mmHg with p value of systolic and diastolic blood pressure p=<0.05, In the control group systolic blood pressure p= 0.024 with a difference of 2.4, independent t test results mean systolic blood pressure 2.88mmHg and diastolic blood pressure mean 1.12mmHg with p value both P>0.05. Extremity joint range of motion exercises can affect blood pressure in the intervention group.

Short-term biochemical and anthropometric effects of nutritional education for serum phosphorus control in hemodialysis patients

Background Hyperphosphatemia is a frequently encountered and difficult-to-manage problem in hemodialysis (HD) patients and is an important risk factor for cardiovascular diseases. This study was carried out to explore the effect of nutritional education on the serum phosphorus level in HD patients. Patients and methods This open-label, single-center randomized controlled trial involved 100 HD patients. Patients were randomly assigned to one of two groups: the education group underwent a 12-week nutritional education program, whereas the control group received standard treatment. Nutritional education was provided by a trained renal dietitian in the form of educational sessions, brochures, audiovisual teaching aids, and patient-tailored dietary recommendations. Detailed nutritional and laboratory tests were done before randomization and 3 weeks after the end of the study. Results Serum phosphorus level and calcium–phosphorus product were significantly lower among the education group (P=0.02 and 0.04, respectively) with a percent reduction of serum phosphorus of -13.8 ± 21.41 after nutritional education. Nutritional education (B: -0.57, 95% confidence interval: -1.13 to -0.01, P=0.04) and the dietary protein intake (B: -0.47, 95% confidence interval: -0.94 to -0.003, P=0.04) were the predictors of serum phosphorus level at the end of the study. Three weeks after termination, BMI, waist circumference, and malnutrition inflammation score were lower (P=0.04, 0.04 and 0.02, respectively), whereas midarm muscle circumference was higher (P=0.004) among the education group. Conclusion Nutritional education can help in controlling the serum phosphorus level in HD patients without causing derangements in the nutritional status and should be provided in each HD unit.

Correction of hyperphosphatemia in hemodialysis patients: 12-month findings from a randomized study

Abstract. The aim of our study was to compare the safety and effectiveness of the use of sevelamer with calcium acetate for hyperphosphatemia control in hemodialysis patients.
 Materials and methods. An open-label, randomized, parallel study was conducted to compare the safety and effectiveness of the use of sevelamer with calcium acetate for hyperphosphatemia control in hemodialysis patients. 198 patients treated with hemodialysis at the Kyiv City Center of Nephrology and Dialysis in the period from 2019 to 2021 were included. The duration of the study was 12 months. with a 2-week washout period before starting the study. Before the start of the study, any phosphate binders were withdrawn. After a 2-week washout period, patients were randomized to receive sevelamer or calcium acetate. The primary endpoint of the study was death from any cause, the surrogates were death from cardiovascular events, and the incidence of fractures.
 Results. At the end of the follow-up period, 86 (93%) of the 92 patients who remained alive (main group) had the target serum phosphorus level. At the end of treatment, the level of phosphorus in the main group was 1.62 (1.4, 1.67) mmol/l (p<0.001). The dose of sevelamer carbonate was 4800 mg/day.
 The target serum phosphorus level was achieved in 72 (94%) of the 77 patients who remained alive after 12 months of follow-up period. At the end of the treatment, the phosphorus level in the comparison group was 1.62 (1.44, 1.66) mmol/l (p<0.001). The dose of calcium acetate was 3000 (1500; 3000) mg/day.
 24 (24%) patients in the main group and 22 (23%) in the comparison group reported at least one adverse event (AE) related to phosphate binder intake. In most cases, the established AEs had a mild degree of severity and did not require discontinuation of the drug.
 During the observation period, the overall mortality rate in the comparison group was more than 2.3 times higher than in the main group, and this difference was statistically significant (RR 0.43, 95% CI: 0.207 - 0.902). At the same time, cardiovascular mortality in the comparison group was more than 2.8 times higher than in the main group, and this difference was also statistically significant (RR 0.34, 95% CI: 0.128 - 0.916). Survival analysis showed a statistically significant difference in survival in patients of the studied groups. During the observation period (12 months), 6 cases of fractures (6%) were recorded in the main group. In the comparison group, the frequency of fractures was 7%, and the difference in frequency was not statistically significant (RR 0.82, 95% CI: 0.287 - 2.362).
 Conclusions. The obtained data showed the high efficiency and safety of sevelamer for hyperphosphatemia correction in hemodialysis patients, as well as a beneficial effect on important clinical outcomes.

Effectiveness of Self-Regulation Fluid Program on Patients with Hemodialysis Self-Efficacy for Fluid Adherence in Al-Diwaniyah Teaching Hospital

Objectives: to evaluate patient knowledge with hemodialysis and to determine the effectiveness of Self-regulation Fluid Program on Patients with hemodialysis self-efficacy for fluid adherence in Al-Diwaniyah Teaching Hospital.
 Methodology: A quasi-experimental design (two group design: pre-test and post-test) was used. This study was conducted in Al-Diwaniya Teaching Hospital for the period from (15th of October 2018 to 20th of May 2019) on a non-probability (purposive) sample consisting of (60 patients) treatment in hemodialysis units. A questionnaire was built as a data collection tool and consisted of four parts:
 First part: Demographic characteristics of the patient that consisted of (7) items, second part: Clinical information of the patient that consisted of (8) items, third part: the self-efficacy scale of fluid control in hemodialysis patients that consisted of (22) items and fourth part: patients’ knowledge in two axis that consisted of (20) items.
 The validity of the questionnaire and the educational program were verified by presenting it to (18) experts. The sample has received a pre-test, educational program, and post-test. Descriptive and inferential statistics were used to analyze the results of the study using the Statistical Package of Social Sciences (SPSS) version 22 and Microsoft Excel (2010).
 Results: The study finding shows, that all the study sample responses at the pre-test were fair knowledge with a statistical mean of scores (1.35). Other than the post-test, shows (100%) of the study sample have high knowledge at the mean of scores (2.66). Also, the maturity of the patients in both groups (control and study) is female and age group (more than 48) years, most of them not read and write, the maturity of the sample of study marred, regarding to the monthly income is not sufficient and urban residency. The study also confirms that the effectiveness of an instructional program on patients with hemodialysis to enhance self-efficacy fluid control is positive.
 Conclusion: Program helps patients in increasing self-confidence, knowledge of Chronic Kidney Disease patient care including controlling fluid overload.
 Recommendations: The study recommended the necessity of activating the role of instructional program correctly in order to give about end stage renal disease, and conduct future research programs to improve the patient's knowledge about end stage renal disease, fluid adherence and provide small booklist for caring.

Predictive value of the glycated albumin versus glycosylated hemoglobin in follow-up of glucose homeostasis in hemodialysis-maintained type-2 diabetic patients.

Objectives. Markers for glucose control in hemodialysis patients (HDP) are debated. Glycosylated hemoglobin (HbA1c%) relies on the stable red blood cell survival. Albumin turnover is faster than hemoglobin. Glycated albumin (GA%) may be used as an index of short-term glycemic control. The predictive value of GA% versus HbA1c% in monitoring the glucose homeostasis in type-2 diabetic HDP is studied. Methods. Forty type-2 diabetic HDP and 20 healthy non diabetic subjects matched age and sex as a control group were included. Calculation of body mass index and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and urea reduction ratio were done. Glycosylated hemoglobin, glycated albumin, fasting blood glucose, insulin, total lipid, kidney and liver functions tests, hepatitis markers, electrolytes, complete blood count, and international normalized ratio were performed. Patients were followed up after 6 months. Results. The study showed that GA% is more sensitive than HbA1c%, but less specific in the follow-up of the glucose homeostasis in type-2 diabetic HDP. Diagnostic accuracy is higher in HbA1c% than in GA%. HOMA-IR is superior regarding the sensitivity and the diagnostic accuracy. Conclusion. The present data show that GA% is more sensitive than HbA1c% and has more diagnostic accuracy in the follow-up of the glucose homeostasis in type-2 diabetic HDP.

Biomarkers of Glyco-Metabolic Control in Hemodialysis Patients: Glycated Hemoglobin vs. Glycated Albumin.

Background and Objectives: Glycated hemoglobin (HbA1c) dosage is considered the gold standard in glycol-metabolic monitoring, but it presents limits, which can underestimate the glycemia trend. In this regard, it was introduced the glycated albumin (GA). The aim of the study is to verify the predictivity of the GA compared to HbA1c in identifying glyco-metabolic alterations in non-diabetic and diabetic hemodialysis (HD) patients. Materials and Methods: For this purpose, we conducted a multicenter study involving one analysis laboratory and six dialysis centers in the Lazio region (Rome, Italy). Both diabetic and non-diabetic HD patients represent the study population, and the protocol included five time points. Results: The analyzed data highlighted the ability of GA to predict changes in glycemic metabolism in HD patients, and GA values are not significantly influenced, like HbA1c, by dialysis therapy itself and by comorbidities of the uremic state, such as normochromic and normocytic anemia. Thus, GA seems to reflect early glyco-metabolic alterations, both in patients with a previous diagnosis of diabetes and in subjects without diabetes mellitus. As part of this study, we analyzed two HD patients (one diabetic and one non-diabetic) in which GA was more predictive of glycol-metabolic alterations compared to HbA1c. Our study confirms the need to compare classical biomarkers used for the monitoring of glyco-metabolic alterations with new ones, likely more reliable and effective in specific subgroups of patients in which the classic biomarkers can be influenced by the preexisting pathological conditions. Conclusions: In conclusion, our evidence highlights that in uremic patients, GA shows a better ability to predict glyco-metabolic alterations allowing both an earlier diagnosis of DM and a prompt modulation of the hypoglycemic therapy, thus improving the clinical management of these patients.

Endothelin-1 and Parameters of Systolic Blood Pressure in Hemodialysis.

Hypertension is common in hemodialysis (HD) patients. Increased blood pressure (BP) variability, particularly higher and lower extremes, is associated with adverse outcomes. We explored the association of endothelin-1 (ET-1), a potent vasoconstrictor, with different BP parameters (pre-HD, intra-HD, and post-HD) during HD in a contemporary patient cohort. This study uses the DaVita Biorepository, a longitudinal prospective cohort study with quarterly collection of clinical data and biospecimens. Unadjusted and adjusted linear mixed effects regression models were fit to determine association of pre-HD ET-1 (log-transformed and quartiles) with HD-related systolic BP (SBP) parameters (pre-HD, nadir intra-HD, and post-HD). As ET-1 was measured at baseline, analyses were restricted to 1 year of follow-up. Among 769 participants, mean age was 52 years, 42% were females, and 41% were Black. Mean pre-HD SBP was 152 (±28) mm Hg and mean ET-1 concentration was 2.3 (±1.2) ng/ml. In fully adjusted models, each unit increase in SD of log-transformed ET-1 was associated with a 2.7 (95% confidence interval [CI] 1.5, 4.0) mm Hg higher pre-SBP; 1.6 (95% CI 0.9, 2.3) mm Hg higher nadir SBP; and 2.0 (95% CI 1.1, 2.9) mm Hg higher post-SBP. Each SD increase in log-transformed ET-1 was associated with 21% higher odds of experiencing intradialytic hypertension (odds ratio 1.21; 95% CI 1.10-1.34). Higher baseline ET-1 levels are independently associated with higher SBP and higher odds of intradialytic hypertension. These results highlight a potential role for ET-1 in BP control in HD patients and raise the possibility of ET-1 antagonism as a therapeutic target.

Using of Glycated Albumin Rather than Glycated Hemoglobin for assessing Glycaemic Control in Hemodialysis Patients with Type II Diabetes Mellitus

Diabetes mellitus (DM) is a global epidemic that is correlated with long-term damage and causes dysfunctionof many organs like the kidney leading to diabetic nephropathy (DN) which need for heamodialysis (HD) toprotect progressive renal decline. This study was designed to evaluate the significance of glycated albumin(GA), compared with fasting blood sugar (FBS) and glycated hemoglobin (HbA1c), were evaluated as anindicator of glycemic control, also determinant of insulin. This study was conducted on 95 patients at agerang (30-70) years, and patients include (35) HD patients with diabetes, (35) HD patients without diabetesand (25) Type 2 diabetes mellitus, who attended atRamadi General Hospital and (25) samples as controlincluded in this study. This study showed that HbA1c% was significantly lower than simultaneous FBS andGA% in HD patients in comparison with in diabetic patients and control, as illustrated in significantly shallowslope of regression line between FBS with HbA1c and FBS with GA. Also, GA% was nearly correspondingbetween before and after one hemodialysis in HD patients compared with HbA1c.In conclusion, GA providesa better measure to estimate glycemic control in HD patients with diabetes compared with HbA1c.

Efficacy and Safety of a Novel Nicotinamide Modified-Release Formulation in the Treatment of Refractory Hyperphosphatemia in Patients Receiving Hemodialysis—A Randomized Clinical Trial

IntroductionDespite widespread use of phosphate binders (PBs), phosphate control is insufficient in many hemodialysis patients. Preliminary clinical observations suggest that nicotinamide may act synergistically with PBs to improve phosphate control.MethodsThis multinational, randomized, double-blind, placebo-controlled study evaluated the efficacy and safety of nicotinamide modified release (NAMR) in combination with oral PB in a large cohort of hemodialysis patients with abnormal serum phosphate concentration (>4.5 mg/dl) despite treatment with PB. Patients entered a proof-of-efficacy phase (12 weeks [W12]) in which adjustments of relevant comedication were not permitted, followed by a safety extension phase for up to 52 weeks. Here, we report the results of the first phase.ResultsThe intention-to-treat (ITT) population consisted of 539 patients in the NAMR and 183 patients in the placebo group. NAMR and placebo were orally administered once daily (250–1500 mg/d). Mean age of patients was 61.8 years, and 63.0% were men. In the confirmatory analysis that estimated the difference in serum phosphate concentration after 12 weeks, NAMR proved superior over placebo with a significant difference of –0.51 mg/dl (95% confidence interval [CI] –0.72, –0.29; P < 0.0001). This effect was associated with significantly lower intact parathyroid hormone (iPTH) values (NAMR: 292.4±300.4 pg/ml vs. placebo: 337.0±302.7 pg/ml; P = 0.04) and an improved calcification propensity (T50 time; NAMR: 23.8±97.1 minutes vs. placebo: 2.3±100.7 minutes; P = 0.02). Diarrhea and pruritus were more frequent in the NAMR group.ConclusionNAMR combined with oral PB significantly improved phosphate control in hemodialysis patients.

Evaluation of management and factors associated with hypertension control in hemodialysis patients at a tertiary-care hospital in Pakistan

Hypertension is highly prevalent and poorly controlled among hemodialysis patients. However, published information regarding the management and control of hypertension among Pakistani hemodialysis patients is scarce. Our objective was to evaluate the pharmacotherapeutic management and control of hypertension and associated factors in hemodialysis patients at a tertiary-care hospital. Eligible hypertensive hemodialysis patients enrolled at the Balochistan Institute of Nephrology-Urology Quetta, Pakistan, between 1 July 2017 and 30 November 2019 were retrospectively followed for 6 months after the baseline hemodialysis session. Collected data were analyzed using SPSS version 20, and odds ratios (ORs) were calculated. Patients with mean pre-dialysis blood pressure (BP) < 140/90 and post-dialysis BP < 130/80 mmHg in the final month of study were classified as being at target BP. A total of 237 hypertensive hemodialysis patients were included in the analysis. The mean age of patients was 42.8 ± 13.2 years, and most (78.9%) had at least one comorbidity. In the final month of the study, only 68 patients (28.7%) were at target BP. Patients were treated with a median of two antihypertensive drugs (range 1–5). Calcium-channel blockers (CCBs) were the most commonly prescribed antihypertensive (54.4%), followed by angiotensin-receptor blockers (53.2%) and diuretics (42.2%). In multivariate binary logistic regression analysis, the use of diuretics (OR 0.50; 95% CI 0.27–0.95), CCBs (OR 2.90; 95% CI 1.35–6.20), β-blockers (OR 2.9; 95% CI 1.30–6.73), and α/β-blockers (OR 2.75; 95% CI 1.26–5.98) was significantly associated with hypertension control. Hypertension control was suboptimal at the study site. A notable proportion of patients were receiving diuretics despite guidelines discouraging their use. The use of β-blockers, α-β-blockers, and CCBs was associated with hypertension control.

Efficacy of Saxagliptin for Blood Glucose Control in Hemodialysis Patients with Diabetes

Studies on the drug saxagliptin (marketed in Japan since 2013) suggest favorable efficacy in hemodialysis patients, but included small sample sizes. Noting that some hemodialysis patients at our medical institution had been switched to saxagliptin 2.5 mg from treatment with other dipeptidyl peptidase-4 inhibitors, we decided to evaluate the effects of switching to saxagliptin on blood glucose control in these patients. The study included 11 patients. Before switching drugs, six of the patients used teneligliptin 20 mg and five used linagliptin 5 mg. Mean glycated albumin (GA) from before to 4 months after switching tended to increase in the previous users of teneligliptin 20 mg (18.4±3.0% to 19.5±2.7%) and tended to decrease in the previous users of linagliptin 5 mg (18.8±3.3% to 17.7±1.4%). Lack of a substantial change in GA when the previous users of teneligliptin 20 mg and linagliptin 5 mg were switched to saxagliptin 2.5 mg indicates that these three agents might have comparable antihyperglycemic profiles when used in patients on hemodialysis. Future research following from this pilot study must evaluate the risk of cardiac failure and incidences of adverse events in a larger population, to investigate the long-term efficacy and safety of switching to saxagliptin.

Peripheral nerve block combined with general anesthesia for lower extremity amputation in hemodialysis patients: case series

BackgroundAnesthetic management of lower extremity amputation in chronic hemodialysis (HD) patients can be challenging because of their poor cardiovascular status. As previously reported, peripheral nerve block (PNB) may be beneficial in these complicated cases. We report the effects of PNB combined with general anesthesia on hemodynamic stability in HD patients undergoing elective lower extremity amputation.MethodsWe retrospectively analyzed 13 HD patients who underwent lower extremity amputation. Patients received general anesthesia (GA group, n = 7) or general anesthesia combined with PNB (GA with PNB group, n = 6), as decided by the anesthesiologists. Mean blood pressure (MBP), systolic blood pressure (SBP), lowest BP, heart rate (HR), blood loss, fluid and blood infusion volumes, and doses of vasopressors required were compared for hemodynamic assessment. The coefficient of variation ( mathrm{CV}=upsigma /overline{mathcal{X}} ) of MBP (CVMBP) and SBP (CVSBP) was calculated to compare hemodynamic stability. Intraoperative opioid use and postoperative pain scores at rest using a numerical rating scale (NRS) on postoperative days 0 and 1 were compared for pain assessment. We also assessed 30-day mortality.ResultsCVMBP in the GA group was significantly higher than that in the GA with PNB group (0.15 ± 0.05 and 0.08 ± 0.04, respectively, p = 0.03). The CVSBP in the GA group was also significantly higher than that in the GA with PNB group (0.16 ± 0.02 and 0.09 ± 0.01, respectively, p = 0.03). No significant differences in other hemodynamic parameters were observed. Intraoperative fentanyl doses were significantly lower in the GA with PNB group (GA 210.7 ± 99.9 μg vs. GA with PNB 113.0 ± 75.6 μg, p = 0.04). There were no significant differences in other pain parameters and 30-day mortality between the groups.ConclusionOur results suggest that PNB combined with general anesthesia contributes to intraoperative hemodynamic stability through better pain control in HD patients undergoing lower extremity amputation.

Mineral and bone disorder management in hemodialysis patients: comparing PTH control practices in Japan with Europe and North America: the Dialysis Outcomes and Practice Patterns Study (DOPPS)

BackgroundHigh-circulating level of parathyroid hormone (PTH) is associated with elevated mortality in dialysis patients. The Japanese Society for Dialysis Therapy guideline suggests a lower PTH target than other international guidelines; thus, PTH control may differ in Japan compared with other regions, and be associated with mortality.MethodsWe analyzed data from hemodialysis patients with ≥3 measurements of PTH during the first 9 months after enrollment in the Dialysis Outcomes and Practice Patterns Study (DOPPS) phases 4–5 (2009–2015). PTH control was assessed by the mean, slope, and mean squared error (MSE) of all PTH measurements over the 9-month run-in period. Distribution of each PTH control was assessed by regions (Europe/Australia/New Zealand [Eur/ANZ], Japan and North America) and dialysis vintage. Mortality rates were compared across PTH control categories using Cox regression models.ResultsMean PTH was lower in Japan than in other regions across dialysis vintage categories. In patients with dialysis vintage < 90 days, PTH level was more likely to decline > 5% per month in Japan (48% of patients) versus Eur/ANZ (35%) and North America (35%). In patients with dialysis vintage > 1 year, Japanese patients maintained steady PTH, while patients in Eur/ANZ and North America were more likely to experience a PTH increase. Mean PTH was associated with mortality in the overall samples (highest mortality rate for PTH > 600 pg/mL, hazard ratio, 1.35; 95% confidence interval, 1.20 to 1.52 vs PTH 200–399 pg/mL), and the association was obvious in the prevalent patients (hazard ratio, 1.44; 95% confidence interval, 1.26 to 1.65). PTH slope and MSE did not show significant association with mortality in the overall sample as well as in subjects stratified both by region and dialysis vintage.ConclusionPTH control in hemodialysis patients, as measured by keeping a stable PTH level over 9 months, was observed in Japan contrasted with other regions. High PTH mean, but not increased PTH slope and MSE, was associated with mortality especially in prevalent patients.

Nutrient intake assessed with Diet History Questionnaire II, in relation to long-term calcium-phosphate control in hemodialysis patients with end-stage renal failure.

Diet is a key factor that determines proper alignment of calcium-phosphate and nutritional status among hemodialysis (HD) patients. To assess the nutrient intake in relation to long-term calcium-phosphate control in HD patients with end-stage renal failure. The study included 107 patients (66 men, 41 women) from 10 dialysis centers in the Upper Silesia region of Poland. To analyze the diet composition during the previous year, a portion-sized version of the Diet History Questionnaire II (DHQ-II) from National Institutes of Health was used. The nutrient intake was assessed in accordance with the most complex recommendations on HD patients' nutrition - K/DOQI Clinical Practice Guidelines for nutrition in chronic renal failure. Poor long-term alignment of calcium-phosphate homeostasis was defined as the presence of over 50% monthly phosphorus concentrations exceeding 5 mg/dL, and for calcium 10.2 mg/dL, during the last 6-month period. Lower than recommended protein intake was found in 63% of HD patients (average consumption: 0.9 ±0.5 g/kg/day). Most of the patients consumed too much fat (33.5 ±6.7% of daily energy intake) and sodium (2912 ±1542 mg/day). In 42% of patients, dietary phosphorus intake was consistent with the recommendations (13.3 ±7.5 mg/kg/day). Protein intake over 1.2 g/kg/day resulted in an increased consumption of phosphorous, but did not increase the risk of misalignment of phosphorus concentrations (OR = 1.15 [0.40-3.27]); p = 0.8). Poor control of serum phosphorus concentrations was observed in 69% of patients (they were on average 8 years younger). The average intake of protein and phosphate in the groups with good or not satisfactory serum phosphorus alignment did not differ significantly. Adequate control of protein intake is not sufficient to obtain phosphorus alignment, especially in younger HD patients.

Xanthine oxidoreductase activity is associated with serum uric acid and glycemic control in hemodialysis patients

Xanthine oxidoreductase activity (XOR-a) plays an important role as a pivotal source of reactive oxygen species. In the present study, we investigated factors associated with plasma XOR-a in 163 hemodialysis patients (age 67.3 ± 10.9 years; 89 males and 74 females), using a newly established, highly-sensitive assay based on [13C2,15N2] xanthine and liquid chromatography/triple quadrupole mass spectrometry. Plasma glucose and serum uric acid levels correlated significantly and positively with plasma XOR-a. In multiple regression analyses, the presence of type 2 diabetes mellitus (T2DM) and plasma glucose were associated significantly, independently, and positively with plasma XOR-a. While serum uric acid correlated significantly and positively with plasma XOR-a in hemodialysis patients without T2DM, plasma glucose and serum glycated albumin, a new marker of glycemic control in diabetic hemodialysis patients, correlated significantly and positively with plasma XOR-a in those with T2DM. Multivariate analyses in those with T2DM revealed that plasma glucose and serum glycated albumin were associated significantly and independently with plasma XOR-a, and that serum uric acid was associated significantly and independently with XOR-a in those without T2DM. Our results suggested that glycemic control in hemodialysis patients may be important in regard to a decrease in ROS induced by XOR.

Effectiveness of teaching cognitive-behavioral techniques on locus of control in hemodialysis patients.

BackgroundMany of the cognitive behavioral models and therapeutic protocols developed so far for psychological disorders and chronic diseases have proved effective through clinical research.ObjectiveThis study aimed to determine the effectiveness of teaching cognitive-behavioral techniques on locus of control in hemodialysis patients.MethodsThis controlled clinical trial study was conducted in 2015 with 76 patients selected by census and treated with a hemodialysis machine in the dialysis department of Vali-Asr Hospital in the city of Meshkinshahr. A total of four patients were excluded because of their critical conditions while the rest, who were recruited, were randomly divided into two equal groups of 36 patients as the intervention and control groups. First, the locus of control was measured in both groups through a pretest, and cognitive-behavioral techniques were then taught to the intervention group during eight 45 to 90-minute sessions. The locus of control in patients of both groups was finally re-measured through a posttest. Data were collected using Rotter’s Locus of Control Inventory. The Wilcoxon test and Mann–Whitney U test were respectively used in SPSS18 for data analysis.ResultsIn the pretest and posttest stages respectively, 4.8% and 14.3% of samples in the control group as well as 14.3% and 33.3% of samples in the intervention group enjoyed internal locus of control. The difference between the pretest and posttest scores of internal locus of control in the intervention group was significant (p=0.004), which indicates the positive effect of cognitive-behavioral psychotherapeutic intervention on internalization of locus of control in this group.ConclusionsGiven the external locus of control in most of the study patients and also the positive significant effect of cognitive-behavioral psychotherapy on internalization of locus of control in this group of patients, it appears necessary to have a psychology resident present in the hemodialysis department to teach the necessary cognitive-behavioral techniques to internalize the locus of control.Trial registrationThe trial was registered at the Thai Clinical Trial Registry (http://www.clinicaltrials.in.th) with the TCTID: TCTR20170707003.FundingThe authors received no financial support for the research, authorship, and/or publication of this article.

Analisis Perilaku Pasien Hemodialisis dalam Pengontrolan Cairan Tubuh

behavior of the fluid control in hemodialysis patients can determine the success of hemodialysis therapy. Hemodialysis patients who do not abide by controlling the fluid can develop complications such as congestive heart failure. This study aimed to identify the behavior of hemodialysis patients in the control of body fluids in the Hemodialysis Dr. Harjono Ponorogo General Hospitals. design used is descriptive with a population of 250 hemodialysis patients in Dr. Harjono Ponorogo General Hospitals. Total sample of 38 respondents to the sampling technique used was purposive sampling. Data Collection using questionnaires. Data were analyzed using T-Score categories of good and bad behavior. From study, of 38 respondents we obtained 20 respondents (52.63%) had a bad behavior and 18 respondents (47.36%) had good behavior. behavior of the fluid control in hemodialysis patients can be improved by providing better support from health professionals and families of patients during hemodialysis and self-efficacy training. Recommendations for further research conduct research on The Relationship Behavior In Hemodialysis Patients With Body Fluids Controls Risk of Complications.

Analisis Perilaku Pasien Hemodialisis dalam Pengontrolan Cairan Tubuh

The behavior of the fluid control in hemodialysis patients can determine the success of hemodialysis therapy. Hemodialysis patients who do not abide by controlling the fluid can develop complications such as congestive heart failure. This study aimed to identify the behavior of hemodialysis patients in the control of body fluids in the Hemodialysis Dr. Harjono Ponorogo General Hospitals. The design used is descriptive with a population of 250 hemodialysis patients in Dr. Harjono Ponorogo General Hospitals. Total sample of 38 respondents to the sampling technique used was purposive sampling. Data Collection using questionnaires. Data were analyzed using T-Score categories of good and bad behavior. From The study, of 38 respondents we obtained 20 respondents (52.63%) had a bad behavior and 18 respondents (47.36%) had good behavior. The behavior of the fluid control in hemodialysis patients can be improved by providing better support from health professionals and families of patients during hemodialysis and self-efficacy training. Recommendations for further research conduct research on "The Relationship Behavior In Hemodialysis Patients With Body Fluids Controls Risk of Complications.

Role of clinical pharmacist in the management of blood pressure in dialysis patients.

Background Hypertension is highly prevalent yet undertreated condition in hemodialysis patients. Objective The objective of this study was to evaluate clinical pharmacist's role in the management of blood pressure in hemodialysis patients guided by home blood pressure monitoring. Setting Outpatient hemodialysis units of Jordan University Hospital and Isra'a Hospital. Method This was a randomized controlled study. It lasted 6months (September 2011 till the end of March 2012). All hypertensive patients receiving hemodialysis were invited to participate in the study. Out of 60 patients approached, 56 were actually included. Patients were randomly allocated to an intervention (29) or control group (27). In the intervention arm, patients received physician-pharmacist collaborative care. While in the control arm patients received standard medical care. Main outcome measure Percentage of patients achieving weekly average home blood pressure below or equal 135/85 mmHg. Other secondary measures that were assessed include absolute reduction in peridialysis blood pressure, interdialytic weight gain, adherence to medications and dialysis sessions. Results A total of 52 patients completed the study. Forty-six percent of patients in the intervention arm achieved BP target (mean home blood pressure ≤135/85mmHg) compared to only 14.3% of patients in the control arm (p=0.02). Average decline in weekly mean home systolic blood pressure was 10.9±17.7mmHg in the intervention arm (p=0.004), while weekly mean home systolic blood pressure increased by 3.5±18.4mmHg in the control arm (p=0.396). No significant reduction was achieved in weekly home diastolic blood pressure, dialysis blood pressure readings, or interdialytic weight gain in either arm. Conclusions Clinical pharmacist-physicians' collaboration improved rate of blood pressure control in hemodialysis patients. Using home blood pressure monitoring was found to be an efficient way to guide blood pressure therapy.