Dialysis Adequacy In Hemodialysis Patients Research Articles

#4588 EFFECT OF TRISODIUM CITRATE 30% VERSUS HEPARIN AS A CATHETER LOCK SOLUTION ON INFLAMMATORY RESPONSE AND DIALYSIS ADEQUACY IN HEMODIALYSIS PATIENTS

Abstract Background and Aims In hemodialysis (HD) patients, the majority of bloodstream infections are caused by infection of vascular access catheters. Commonly, Central venous catheters (CVCs) are the only option when HD is needed for patients without definitive vascular access. However, in addition to infection, CVCs are associated with other complications, such as thrombosis, and dysfunction, leading to higher mortality and expenditures. In Egypt, recent data show that 6.6% of HD patients use catheters as a vascular access, of which short term catheters represent 59.6% and 40.4% with long-term catheters. Many data show that the use of HD catheter-locking solutions could contribute to reduction of catheter-related complications, especially infections. Aim; to assess the possible effect of using Trisodium citrate 30% (TSC 30%) in comparison to unfractionated heparin, as a lock solution for HD catheters, on inflammatory status, incidence of catheter related Bacteremia (CRB) and dialysis adequacy in HD patients. Method This was a randomized controlled clinical trial, conducted on 70 prevalent HD patients on regular dialysis using HD catheters as a vascular access, recruited from hemodialysis unit in Nasser Institute Hospital in Cairo government at the time of catheter insertion. Patients were divided into two groups: Citrate Group; 35 patients received trisodium citrate 30% as a catheter lock after HD session, Heparin Group; 35 patients received unfractionated heparin (5000i.u) as a catheter lock solution after HD session. Both groups were followed up for 3 months period and monitored for signs of CRB. Also, Urea reduction ratio (URR) were measured monthly. Highly sensitive CRP were measured at baseline and 3 months after start using the lock solutions. Blood cultures were withdrawn in patients who developed signs of CRB. Results In our study, the catheter-related bacteremia (CRB) episodes were significantly lower in the Citrate group when compared to Heparin group. Only 2 patients (5.7%) in Citrate group had CRB, whereas in Heparin group, 8 patients (22.9%) had CRB (P = 0.04) (Fig. 1). Also, Bacteremia-free time was longer in the Citrate group. The mean bacteremia free time in Citrate group was 10.97 ± 2.36 weeks, while in Heparin group it was 9.43 ± 3.91 weeks (P = 0.032) (Fig. 2). At base line, there was no significant difference between both groups regarding hsCRP (P = 0.596) and WBCs (P = 0.528). While after 3 months of using TSC 30% as a lock solution, there was a significant difference as regards levels of hsCRP (P = 0.030) (Fig. 3) and WBCs (P = 0.036), with the higher levels of inflammatory markers showed in Heparin group. There was no difference between the two studied groups regarding thrombosis events. However, dialysis adequacy and catheter performance, assessed by URR, were higher in citrate group compared to heparin group after 3 months (P = 0.005) compared to baseline (P = 0.108) (Fig. 4). Conclusion we may conclude that, using Trisodium citrate 30% as lock solution for HD catheters was associated with reduction in the inflammatory markers and CRB incidence compared to the standard heparin lock. Also, its use was associated with better catheter performance and dialysis adequacy. We therefore believe that TSC 30% may be a potential alternative to standard heparin as a catheter lock solution for HD patients.

Dialysis Adequacy among Haemodialysis Patients in Eastern Mediterranean Region: A Systematic Review and Meta-Analysis

Introduction: Dialysis adequacy is one of the most important indicators for measuring the quality of care provided in hemodialysis (HD) wards. Despite individual studies, there is still no comprehensive study about dialysis adequacy in the Eastern Mediterranean Region (EMRO). This study was conducted to evaluate the dialysis adequacy in HD patients in the EMRO. Methods: In the present systematic review and meta-analysis international (EMBASE, Scopus, PubMed, Web of Science) and national (SID, MAGIRAN) databases were searched for related articles using keywords “dialysis adequacy” and “EMRO” from 1 January 2000 to April 30, 2020. The quality of studies was studied using Hoy et al instrument. Results: Out of 966 retrieved studies, 63 studies conducted on 15462 HD patients were included. The pooled mean of KT/V and URR were 1.24 (95% CI: 1.19, 1.30) and 63.03% (95% CI: 61.31, 64.75), respectively. The pooled prevalence of Kt/V>1.2 and URR>65.0% were 42.73% (95% CI: 31.58, 53.88) and 42.52% (95% CI: 25.3, 59.7), respectively. Conclusion: The results of the present study indicate the poor dialysis adequacy in the EMRO region and the need to improve the physical infrastructure, workforce, and pieces of equipment in hemodialysis wards.

Relationship Between Depression and Its Severity with Dialysis Adequacy in Hemodialysis Patients in Ahvaz Teaching Hospitals

Background: Depression is a prevalent psychological disorder among hemodialysis patients and is associated with a variety of adverse outcomes. Dialysis adequacy also affects hemodialysis patients' survival rates. Objectives: This study aimed to investigate the prevalence of depression in hemodialysis patients and its association with dialysis adequacy. Methods: In this cross-sectional study, 205 individuals undergoing hemodialysis at Ahvaz teaching hospitals in 2019 were included. The depression level was determined using the Beck Depression Inventory (BDI-II) for the participants aged below 65 years and Geriatric Depression Scale (GDS) for the patients aged above 65 years. Dialysis adequacy measures, including the Kt/V and urea reduction rate (URR), were calculated using standard formulas. Results: In this study, 60.5% of the participants suffered from depression, and the overall prevalence of depression was 54.6% in individuals aged below 65 and 67% in those aged above 65 years. Among the patients with age below 65 years, 19 persons (17.6%) were suffering from mild depression, 22 individuals (20.4%) were suffering from moderate depression, and 18 individuals (16.7%) had severe depression. Among the patients aged above 65 years, moderate depression was found to affect 45 persons (46.4%), and 20 individuals (20.6%) had severe depression. The mean values of Kt/V and URR were not significantly correlated with depression scores (P > 0.05). Conclusions: Depression is a common disorder among hemodialysis patients in Iran; however, it is not significantly associated with dialysis adequacy. However, the results of studies on the relationship between depression and dialysis adequacy cannot be analyzed simply.

The Relationship between Serum Procalcitonin and Dialysis Adequacy in Hemodialysis Patients

Introduction:In hemodialysis (HD) patients procalcitonin (PCT) considered as an early predictor of acute infection. It represents a new and potential marker of inflammation and may correlate with dialysis adequacy. This makes procalcitonin a potential biomarker for obesity-related low-grade inflammation. Objective: The aim of the work was to assess procalcitonin level in obese prevalent hemodialysis patients and its relation to hemodialysis adequacy. Patients and Methods: A cross sectional study was conducted on 90 patients divided into 3 groups, 40 obese (BMI ≥ 30 Kg/m2) ESRD patients on regular hemodialysis (group A), 40 non obese (BMI < 25Kg/m2) ESRD patients on regular hemodialysis (group B) attending at Dialysis Unit, El-Sahel Teaching Hospital and 10 healthy individuals with BMI < 25Kg/m2 as a control group (group C). All patients were subjected to detailed history taking and general examination. All patients were laboratory investigated for CBC, serum urea, creatinine, CRP, urea reduction ratio (URR), equilibrated Kt/v. All controls were subjected to written informed consent, full history, examination and CRP level. Procalcitonin level was done by ELISA technique for all patients and controls. Results: In our study, we found that there was a higher level of procalcitonin (PCT) in obese hemodialysis patient than non-obese. We also found that there was no correlation between PCT and hemodialysis adequacy in our study population. Conclusion: It could be concluded that procalcitonin is a potential biomarker for obesity-related low-grade inflammation, but not related to hemodialysis adequacy.

Characterization of the cylindrical electrospun nanofibrous polysulfone membrane for hemodialysis with modelling approach.

Electrospun nanofibrous membrane (ENM) is a membrane fabricated using electrospinning technique which has considerable characteristics such as high porosity, nanometer pore size, and simple process. Although ENMs are being evaluated in various medical applications, the effectiveness for hemodialysis (HD) has not been evaluated carefully. Thus, in this study, the cylindrical electrospun nanofibrous polysulfone (CENP) membrane was fabricated and its performance in the dialysis adequacy in HD patients was evaluated.The CENP membrane was fabricated in a tabular shape. The physical characteristics of the membrane are examined using scanning electron microscope (SEM) images and the permporometry technique. Then, its efficiency in urea and creatinine removal from the blood serum of 21 HD patients was evaluated at a low blood flow rate (BFR) of 200 ml min-1 and dialysate fluid rate (DFR) of 300 ml min-1. Afterwards, the results were modeled and optimized using artificial neural network (ANN) and genetic algorithm (GA), respectively. Finally, sensitive analysis was performed via Spearman's rank correlation coefficient. The highest dialysis adequacy was observed in membranes with an inner diameter of 3 mm. The CENP membrane belongs to the super high-flux membrane and it could be replaced with existing commercial hollow fiber membranes.

Relationship between the filter type and blood flow rate and, dialysis adequacy in hemodialysis patients

Context: One of the main factors associated with the death of chronic renal failure patients is dialysis adequacy. Aims: The present study aimed to investigate the relationship between filter type and blood flow rate with dialysis adequacy in hemodialysis patients referring to educational hospitals of Mazandaran University of Medical Sciences in 2016. Setting and Design: This correlational study was performed in 2016 in educational hospitals of Mazandaran University of Medical Sciences. Materials and Methods: This study was performed on 185 hemodialysis patients. Sampling was done using simple random sampling. The inclusion criteria included at least 6 months of hemodialysis history and two sessions of dialysis per week. Demographic data, as well as information on the filter type and blood flow rate, were collected using a questionnaire. Dialysis adequacy is generally measurable by two methods of urea reduction ratio (URR) and K or urea clearance, T or time of dialysis, and V, or volume of urea distribution in the body (KT/V) (K or urea clearance). Statistical Analysis Used: Data were described with mean, standard deviation, and frequency and analyzed using Chi-square and Fisher's exact tests. Results: Out of a total of 185 patients, 101 patients were male and 84 were female, with a mean age of 57.2 ± 0.7 years. The dialysis adequacy in high-flux and low-flux filters was, respectively, 79% and 1.5% based on the KT/V index and 70.6% and 0% according to the URR index. A statistically significant relationship was found between the filter type and blood flow rate with both KT/V and URR criteria (P Conclusion: It is recommended to use high-flux filters with high blood flow rate to improve dialysis adequacy in patients with hemodialysis. However, other factors affecting dialysis adequacy should be considered.

Erratum: Relationship between the filter type and blood flow rate and, dialysis adequacy in hemodialysis patients

Erratum: Relationship between the filter type and blood flow rate and, dialysis adequacy in hemodialysis patients

Evaluation of Dialysis Adequacy in Hemodialysis Patients in Shahid Ayatollah Ashrafi Esfahani Hospital in Tehran in 2016

Evaluation of Dialysis Adequacy in Hemodialysis Patients in Shahid Ayatollah Ashrafi Esfahani Hospital in Tehran in 2016

Evaluating the Effect of Combined Education on Blood Pressure and Dialysis Adequacy of Hemodialysis Patients Admitted to Special Diseases Center of Imam Khomeini Hospital in Zabol city, 2017

Introduction: Inadequate dialysis is one of the factors determining the survival rate of patients. Increasing the adequacy of dialysis is effective in improving dialysis patients. Blood pressure is one of the factors affecting the adequacy of dialysis. Thus, this research was conducted to evaluate the effect of combined education on blood pressure and dialysis adequacy in hemodialysis patients admitted to special diseases center of Imam Khomeini Hospital in Zabol city in 2017. Methods: This is a quasi-experimental research, in which 34 hemodialysis patients were examined in two groups (each group included 17 patients). The intervention group received four routine educations for 4 sessions and the control group received only routine education during this period. At the start and at the end of the research, blood pressure and dialysis adequacy were checked by the KT / V formula and analyzed by t-test. Results: The research results revealed that the mean of blood pressure decreased significantly in the intervention group two months after the implementation of combined education (P=0.001). In addition, the mean of dialysis adequacy in this group increased from 1.13 (0.35) to 1.27 (0.36) (P=0.007) after intervention. Conclusion: Based on the research results, it can be concluded that combined education improves blood pressure and improves the dialysis adequacy of patients undergoing hemodialysis.

The Effect of Muscle Relaxation on Dialysis Adequacy in Hemodialysis Patients

The Effect of Muscle Relaxation on Dialysis Adequacy in Hemodialysis Patients

Evaluation of dialysis adequacy in hemodialysis patients: A systematic review.

Hemodialysis is the common kidney replacement therapy in Iran. Doing an adequate and effective dialysis can improve patients' quality of life and reduce kidney failure complications. Additionally, dialysis quality is an important factor in reducing mortality in patients with chronic kidney failure. This systematic review has investigated the adequacy of dialysis in studies done on hemodialysis patients of Iran. All articles related to the dialysis adequacy in hemodialysis patients in English and Farsi (contemporary Persian) were identified by searching the related keywords in various electronic databases. According to the inclusion criteria 21 studies were identified. The results were analyzed using Stata software version 11. A number of 6677 patients had been enrolled in 21 studies that were chosen for this systematic review. Based on the random effects model, the overall dialysis adequacy (KT/V) (K: clearance of urea, T: duration of dialysis, V: distribution of urea) more than 1.2 and confidence interval were 36.3% and 46.2-26.4, respectively. Also, based on random effects model more than 65% urea reduction ratio in all studies was 28.8% and the confidence interval was 43.3-14.4. KT/V and urea reduction ratio were much less desirable in hemodialysis patients and the dialysis quality was also undesirable. It seems that inadequate dialysis prescription, use of inappropriate filters, low pump speed (blood flow speed), and the short duration and few times of dialysis are the major causes of this inadequacy.&nbsp.

Clinical effects of buttonhole cannulation method on hemodialysis patients

Although the buttonhole cannulation method is now widely used as an alternative to the rope-ladder method in most countries, only the latter method is used in Korea. This study was performed to investigate clinical benefit of the buttonhole technique for arteriovenous fistula (AVF) cannulation in maintenance hemodialysis (HD) patients. Thirty-two patients receiving HD via mature AVF were included and AVF cannulation was performed by 20 experienced nurses. During the 8 weeks, AVFs were cannulated by the rope-ladder method with 15-gauge sharp needles. After creating of 2 pairs of tunnel tracks by sharp needles for 7 weeks, AVFs were cannulated by the buttonhole method using 15-gauge blunt needles during the 16 weeks. Vascular access blood flow rate (BFR), dialysis venous pressure (DVP), and dialysis adequacy (Kt/V) were measured within the first week of the two cannulation methods. Cannulation pain, hemostasis time, and nurse's stress were evaluated at the end of the two methods. There were no statistical differences in vascular access BFR (P = 0.139), DVP (P = 0.152), and dialysis adequacy (P = 0.343) between the two methods. However, the buttonhole method shortened hemostasis time (P = 0.001) and decreased cannulation pain (P = 0.001) as well as nurse's stress (P = 0.001) compared with the rope-ladder method. In conclusion, the buttonhole cannulation method improves hemostasis time, cannulation pain, and nurse's stress without a change in vascular access BFR and dialysis adequacy in HD patients.

Do We Know the Correct Hemoglobin Target for Anemic Patients with Chronic Kidney Disease?

The major objectives of this article are to review hemoglobin outcome studies, focusing on the utility of purely observational approaches; the design limitations of hemoglobin target randomized trials; what is known from the trials that have been performed to date; and whether confident recommendations for target ranges can be made. The commonly observed association among lower hemoglobin levels, left ventricular hypertrophy, and higher mortality also has been seen within randomized trials when assigned hemoglobin targets were ignored; critically, however, corresponding relationships were absent when intention-to-treat principles were used, strongly suggesting noncausal associations and the need for randomized designs. This being said, hemoglobin typical target trials often have undesirable features, including inadequate blinding and the use of imbalanced, nonstandardized, nonblinded co-interventions. The trials published to date, spanning hemoglobin levels of approximately 7 to 13 g/dl, suggest that higher treatment targets enhance quality of life but at the price of higher BP, thrombotic events, and reduced dialysis adequacy in hemodialysis patients. To date, there is no convincing evidence that targets that approach the physiologic range (versus intermediate targets) have an effect on left ventricular size or survival. Therefore, depending on the outcome examined, higher hemoglobin levels may have beneficial effects, harmful effects, or no effect, leading to the unsatisfactory situation of having to make opinion-based tradeoff decisions. Whereas the available evidence suggests that 11 g/dl is a reasonable lower bound for the hemoglobin target range, the upper bound remains to be defined and targets above 13 g/dl cannot be routinely recommended.

The effect of dialysis needle size on hemodialysis adequacy

Objective: Dialysis adequacy indexed by Kt/V in hemodialysis (HD) patients is recommended as a single pool Kt/V at least 1.2 per session thrice weekly. But many patients cannot achieve this adequacy target. Although dialysis time is the most important factor influencing Kt/V, it is difficult to prolong dialysis time in practice because of its economic impact and poor patient compliance. This study was performed to investigate the effect of increasing dialysis needle size on dialysis adequacy in HD patients. Methods: This study enrolled 73 patients receiving HD thrice weekly for more than 3 months with arteriovenous fistula (AVF) or graft in a single center. Dialysis blood flow rate was 200 ml/min in 12 patients, 250 ml/min in 32 patients, and 300 ml/min in 29 patients. Surface area of dialyzer was 1.2 m2 in 56 patients and 1.6 m2 in 17 patients. We first performed HD using a 16‐gauge needle. Then we increased needle size up to 15‐gauge without change of any other dialysis conditions such as blood and dialysate flow rates, dialysis time, or distance between needle insertion sites. We compared compression time after removing the needles, venous dialysis pressure (VDP), Kt/V, and urea reduction ratio (URR) between these two methods. Results: The mean age was 54 ± 13 years and the number of patients with diabetes mellitus was 27 (37%). Fifty‐eight patients (79.5%) have native AVF. Mean Kt/V at HD method using a 15‐gauge needle was higher than at HD method using a 16‐gauge needle (1.30 ± 0.18 vs. 1.23 ± 0.18, p &lt; 0.001). URR at HD method using a 15‐gauge needle was also higher than at HD method using a 16‐gauge needle. In contrast, VDP at HD method using a 15‐gauge needle was lower than at HD method using a 16‐gauge needle (88 ± 22 mmHg vs. 118 ± 28 mmHg, p &lt; 0.001). There was no difference in compression time between the two methods. Conclusion: This study suggests that increasing dialysis needle size is a safe and effective method in improving dialysis adequacy without increasing blood flow rate or dialysis time.

The Effect of Increasing Blood Flow Rate on Dialysis Adequacy in Hemodialysis Patients with Low Kt/V

Dialysis adequacy indexed by Kt/V in hemodialysis (HD) patients is recommended as a single‐pool Kt/V of at least 1.2 per session thrice weekly. But many patients cannot achieve this adequacy target. Although dialysis time is the most important as a factor influencing Kt/V, it is difficult to prolong dialysis time in practice because of its economic impact and poor patient compliance.Objective: The aim of this study is to investigate the effect of increasing blood flow rate on dialysis adequacy in HD patients with low Kt/V.Methods: This study enrolled 36 HD patients with single‐pool Kt/V &lt;1.2 per session thrice weekly, which was measured in dialyzer blood flow rate of 230 mL/min. We increased 15% of blood flow rate in patients &lt;65 kg of body weight and 20% in patients &gt;65 kg. And then we compared Kt/V and urea reduction ratio (URR) between before and after increasing blood flow rate.Results: The mean age was 48 ± 11 years (23–73 years), and the number of males was 25. Of the total patients, 24 patients had dry weight &lt;65 kg. Mean dialysis duration was 52 ± 50 months (3–216 months). Mean Kt/V before increasing blood flow rate was 1.02 ± 0.09. It increased to 1.14 ± 0.12 after increasing blood flow rate (p &lt; 0.001). Of the total 36 patients, 13 patients (36.1%) achieved adequacy target (Kt/V ≤ 1.2). Mean URR before increasing blood flow rate was 56.9 ± 4.0%. It also increased to 60.8 ± 4.1% (p &lt; 0.001).Conclusion: Our data suggest that increasing blood flow rate by 15–20% of previous flow rate is effective in achieving dialysis adequacy in HD patients with low Kt/V.

Outcome data on pediatric dialysis patients from the end-stage renal disease Clinical Indicators Project

Network 1 (New England) initiated the Clinical Indicator Project to survey dialysis adequacy (Kt/V), nutrition (serum albumin level), and anemia management in patients maintained on chronic dialysis. Because little information is available in children, data were specifically recorded covering these variables in patients (age, 1 to 18 years) maintained on either hemodialysis (HD) or peritoneal dialysis (PD). During the 18 months of data collection, 29 observations were recorded on 23 HD patients (age, 14.3 ± 3.6 years), and 43 observations were made on 30 PD patients (age,10.6 ± 4.7 years). Kt/V correlated inversely with the age of the patient (HD, P < 0.004; PD, P < 0.0007). Although serum albumin level was not associated with dialysis adequacy in HD patients, there was a strong inverse relationship between albumin level and Kt/V in PD patients (P < 0.002). Hematocrit values were not significantly different in the two groups (HD, 31.0% ± 5.5% versus PD, 32.9% ± 4.8%) and could not be correlated with weekly erythropoietin dose. Weekly erythropoietin dose was directly related to patient age in both groups (HD, P < 0.05; PD, P < 0.02). The weekly erythropoietin dosage needed to maintain the hematocrit was greater in HD patients (HD, 11,211 ± 7,484 U versus PD, 3,790 ± 1,968 U; P < 0.0001). We conclude that (1) smaller children in both groups tend to have a greater Kt/V, (2) Kt/V greater than 2.75 in PD patients may not improve nutrition per se and could result in increased albumin losses, and (3) erythropoietin dosing appears to correlate best with patient size (age) rather than degree of anemia.