Dialysis Centers Research Articles

Peritoneal dialysis in patients with severe obesity: A successful single center experience.

There is growing emphasis on increasing utilization of peritoneal dialysis (PD) in patients with end stage kidney disease (ESKD); however, use in patients with severe obesity has still been fraught for various reasons. We aim to assess the viability of PD in patients with severe obesity (BMI > 40 Kg/m2). We conducted a retrospective chart review of patients admitted at the home dialysis center of an academic center between 2014 and 2020 (n = 99). Patients with a BMI>40 kg/m2 at the time of PD initiation (n = 9) were selected. We extracted and examined the data for these nine patients till March 2023. The mean age at baseline was 47.8 ± 12.6 year, 56% were males, 67% were Hispanic, 33% were white, and mean BMI was 43.3 ± 3.4 kg/m2. By the end of the follow-up of this report, five (56%) patients were still active on PD (mean duration 27.8 ± 4.5 months). PD therapy was terminated in 3 (33%) patients (17.7 ± 6.8 months) due to refractory peritonitis, burnout, transfer to rehabilitation facility, respectively. One patient transferred out to another facility after 10.6 months. Rates of access and mechanical complications as well as peritonitis in these nine patients were similar to center's overall rates. All the patients had elimination of uremic symptoms using incremental prescription and met weekly Kt/V targets of >1.7 using adjusted weight. Overall, patients' weight and glycemic control remained stable. In conclusion, PD can be an effective long-term high-quality dialysis option for patients with ESKD and severe obesity. Further studies in a larger population are required to confirm our findings.

Recommendations to Advance Social Connectedness in End Stage Kidney Disease Care in a Post-COVID-19 Era.

Social connectedness, defined as a sense of belonging and inclusion among individuals and groups, is crucial for the well-being of end-stage kidney disease (ESKD) patients. This perspective employs a hypothetical case study to highlight the risks of social isolation and loneliness faced by ESKD patients. It offers guidance on how the ESKD community can effectively address these challenges. Although in-center hemodialysis provides an inherent environment for fostering social connections, the COVID-19 pandemic has intensified the risk of social disconnection. This paper delineates five key recommendations to mitigate this risk: 1) improve detection of loneliness and social isolation; 2) implement evidence-based social support interventions; 3) revitalize the in-center experience; 4) engage family caregivers; and 5) leverage technology for social connectedness. Neglecting opportunities to bolster social connections among ESKD patients would represent a significant interdisciplinary lapse. The proposed recommendations are feasible due to the integral role of interdisciplinary care within dialysis centers.

Treatment of depression and poor quality of life through breathing training in hemodialysis patients

BackgroundThe management of depression in patients undergoing hemodialysis remains challenging and affects quality of life; however, there is a possibility that breathing exercises may be effective in this context. Thus, the purpose of this study was to evaluate the effectiveness of a breathing training program on quality of life and depression among patients on hemodialysis.MethodsA one-group pretest-posttest quasi-experimental design was used. Data were collected from hemodialysis patients at three dialysis centers. Initial baseline data were collected, and a breathing training program was implemented. The program included three types of breathing exercises. A total of 41 participants completed the study. The participants were asked to perform the breathing training program three times a day for 30 days. The impact of the intervention on patients’ quality of life and depression was measured using both the Kidney Disease Quality of Life Short Version and the Beck Depression Inventory-Second Edition.ResultsA significant decrease in the overall depression score was observed after implementing the breathing training program (BDI-II mean difference =-3.9, 95% CI:0.35–7.45, p = 0.03). The intervention has also had significant improvements on overall quality of life (KDQOL mean difference = 6.09, 95% CI: 0.48–11.70, p = 0.03) and a reduction in the symptoms and problems domain (domain mean difference = 6.71, 95% CI: 0.01–13.40, p = 0.05). There were some improvements on other quality of life domains but did not reach the statistical differences after program implementation.ConclusionsBreathing exercises are associated with improved quality of life and reduced depression among HD patients, providing a simple and cost-effective intervention.

Psychological wellbeing and treatment adherence among cardio-renal syndrome patients in Yemen: a cross section study.

Anxiety and depression are associated with adverse outcomes in cardiorenal syndrome patients undergoing hemodialysis, including decreased quality of life, poorer clinical parameters, and lower treatment adherence. This study aimed to examine the level of psychological wellbeing and its relationship with treatment adherence among dialysis patients with cardiorenal syndrome. This cross-sectional descriptive study was conducted between February and May 2021 on convenience sampling of 100 patients in two dialysis centers in Hadhramout, Yemen. Patients' depression and anxiety levels were assessed using the Hospital Anxiety and Depression Scale (HADS)-Arabic version, and patient treatment adherence was assessed using the Treatment Adherence Questionnaire (TAQ). Descriptive statistics, Pearson's correlation analysis, and multiple linear regression analyzes were performed to analyze data with a significance level set at p < 0.05. The mean age ± standard deviation of participants was 53.46 ± 14.24 years. Most (90%) of patients had moderate to high levels of anxiety and depression. Most of the patients (87%) had a low level of treatment adherence. The findings revealed that psychological wellbeing is significantly association with treatment adherence t = 2.577 (95% CI 0.029, 0.225), p = 0.011. Anxiety and depression symptoms occurred more frequently among dialysis patients with cardiorenal syndrome, and there was a significant association between psychological wellbeing and treatment adherence. Our findings suggest that nurse managers should take into account that adding psychotherapies into the present cardiorenal syndrome treatment programs would improve patients' clinical and psychological parameters and, consequently, their clinical outcomes while taking patient heterogeneity and resource limitations into consideration.

The relationship between frailty levels and quality of life in patients over 65 years of age receiving regular hemodialysis treatment.

This study was conducted to investigate the relationship between frailty levels and quality of life in patients over 65 years of age receiving regular haemodialysis treatment. The study was designed as a descriptive and correlational study. Data were collected from patients in a university hospital and two private dialysis centres in Konya between August and September 2023. The study sample consisted of 171 patients. The data collection tools included the Descriptive Characteristics Information Form, the Edmonton Frail Scale (EFS), and the EQ-5D-5L Quality of Life Questionnaire. Data analysis was performed using the SPSS software program. Frequency and percentage calculations were obtained for the measurements in the personal information form. Since the data in the personal information form and EFS did not show normal distribution, non-parametric tests, specifically the Mann-Whitney U-test and the Kruskal-Wallis H-test, were used. The results obtained in the present study showed a significant, moderate, negative correlation between the quality of life and frailty levels of patients over 65 years of age receiving dialysis treatment. This study demonstrated that as quality of life increased, frailty levels decreased. Improvements in patients' quality of life could potentially lead to a reduction in frailty levels.

Higher atherogenic index of plasma is associated with intradialytic hypotension: a multicenter cross-sectional study

Background Patients receiving maintenance hemodialysis (MHD) frequently encounter a drop in blood pressure during dialysis, known as intradialytic hypotension (IDH). The AIP is associated with diseases such as diabetes and cardiovascular events. It remains unclear whether the AIP is associated with IDH. The present study aimed to explore the association between AIP and IDH in MHD patients. Methods In this multi-center cross-sectional study, we included 1946 adult hemodialysis patients from twenty dialysis centers. Patients were divided into four groups based on the AIP quartiles. Linear regression and multiple logistic regression models were used to analyze the relationship between AIP and IDH. Subgroup analyses were further conducted to assess the robustness of the association between the AIP and IDH. Results After adjusting for potential confounding variables, each 1-unit increase in AIP was associated with a 21% increase in the odds of IDH. The odds ratios (ORs) of IDH increased gradually with higher quartiles of AIP compared with the Q1 reference group (Q2: OR, 1.41, 95% CI: 0.91-2.18; Q3: OR, 1.63, 95% CI: 1.07-2.49; Q4: OR, 1.57, 95% CI: 1.01-2.42). No interaction was observed in the subgroup analysis stratified by age, sex, history of diabetes, heart failure, and myocardial infarction. Conclusion Elevated AIP levels are associated with a heightened risk of IDH in MHD patients.

Association of plasma microRNA-16-5p and abdominal aortic calcification in maintenance hemodialysis patients

Recent studies have shown that microRNA-16-5p (miR-16-5p) plays a crucial role in the pathological mechanism of vascular calcification. Nevertheless, the expression profile of miR-16-5p in maintenance hemodialysis (MHD) patients who are predisposed to vascular calcification remains unknown. This study aims to investigate the potential associations between calcification risk and serum miR-16-5p expression among MHD patients. This cross-sectional study involved 132 MHD patients from the Dialysis Center of Beijing Friendship Hospital between 1 January 2019 and 31 December 2020. The degree of calcification in MHD patients was assessed using the Abdominal aortic calcification (AAC) score, and miR-16-5p expression was quantified using quantitative real-time polymerase chain reaction (qRT-PCR) with the 2–ΔΔCT method. Statistical analyses, including spearman correlation, linear regression and logistic regression analysis were used to explore the associations between laboratory parameters and AAC score. Calcifications were observed in 79(59.80%) patients. The linear regression showed a one-quartile decrease in miR-16-5p expression led to a significant increase in the AAC score by 5.336 (95% CI: 2.670–10.662, p = 0.000). Multivariate logistic regression analyses revealed that decreased miR-16-5p expression, reduced serum urea nitrogen, elevated white blood cell count, and longer dialysis vintage were significantly associated with an increased incidence of vascular calcification. The Area Under the Curve (AUC) of the Receiver Operating Characteristic (ROC) of the miR-16-5p-based logistic regression model was 0.842 (95% CI: 0.771–0.913, p = 0.000). There was an independent association between miR-16-5p expression and calcification degree. Lower miR-16-5p expression levels seem to be a potential risk factor of vascular calcification in MHD patients.

The association Malnutrition-Inflammation Score with chronic kidney disease-associated pruritus and quality of life in hemodialysis patients: a multicenter cross-sectional study

Malnutrition is prevalent among hemodialysis patients, negatively impacting their quality of life (QoL) and chronic kidney disease-associated pruritus (CKD-aP). This study investigates the association between the Malnutrition-Inflammation Score (MIS) and CKD-aP, as well as QoL, in hemodialysis patients. This cross-sectional study was conducted on 479 HD patients (279 males and 200 females) referred to eight dialysis centers. A food frequency questionnaire (FFQ), Kidney Disease Quality of Life Short Form (KDQOL-SF™), and Yosipovitch Itch Questionnaire (YIQ) were used to assess nutritional status, QoL, and CKD-aP, respectively. Anthropometric indices, body mass index (BMI), biochemical parameters, and adequacy of dialysis (Kt/V) were also measured in all patients. Significant differences were observed across MIS quartiles in terms of age, dialysis vintage, dialysis time, and urine volume (p < 0.05 for all). QoL scores showed significant differences, with the physical component score and symptoms/problems score being lower in higher MIS quartiles (p < 0.05 for all). Multivariate analyses revealed that higher MIS quartiles were significantly associated with worse QoL scores, including symptoms/problems and physical component scores, even after adjusting for confounders (p < 0.05 for all). Moreover, the pruritus VAS score, as well as the burden of kidney disease and mental component, had a significant negative association with MIS after adjusting for confounders (p < 0.05 for all). This study demonstrates that higher MIS, indicating poorer nutritional status, is associated with impaired QoL, particularly in the symptoms/problems, physical, and mental components among hemodialysis patients. However, no significant association was found between MIS and CKD-aP.

Fluid overload trajectories and mortality in hemodialysis patients.

Fluid overload remains critical in managing patients with end-stage kidney disease. However, there is limited empirical understanding of fluid overload's impact on mortality. This study analyzes fluid overload trajectories and their association with mortality in hemodialysis patients. This longitudinal study included 9332 incident hemodialysis patients from the EuCliD database, treated in Fresenius Medical Care NephroCare dialysis centers across seven countries between January 2016 and December 2019, with follow-up until May 2023. Fluid overload was assessed using bioimpedance spectroscopy, and patients were grouped based on fluid overload trajectories using group-based trajectory modeling. Cox regression models, adjusted for potential confounders, were used to investigate the relationship between trajectory groups and mortality. Four distinct fluid overload trajectories were identified. Patients in the highest trajectory group (8.5% of the cohort) had more frequent background cardiovascular complications, lower BMI and serum albumin, and their adjusted mortality risk was 2.20 times higher than the lowest trajectory. There was a dose-response relationship between trajectories and mortality. The incidence rate of death increased with the degree of fluid overload, from 8.6 deaths per 100 person-years in the lowest trajectory to 18.6 in the highest. This longitudinal study highlights the significant risk of chronic fluid overload in hemodialysis patients. Latent trajectory analysis provides novel information into the dynamic nature of fluid overload and its impact on mortality in the hemodialysis population.

Assessment Of Psychiatric Morbidity Among Patients With Chronic Kidney Disease On Dialysis Attending Tertiary Care Hospital: A Cross-Sectional Single Centre Study

Background: Chronic Kidney Disease (CKD) poses a growing public health concern, affecting up to 10% of adults worldwide. Aim &amp; Objective: This study aims to assess psychiatric morbidities and associated risk factors among chronic kidney disease patients undergoing hemodialysis. Methodology: An observational cross-sectional study was conducted among 100 cases, both male and female patients diagnosed with Chronic kidney disease attending Dialysis Center of the General Medicine Department in a tertiary care hospital within the age group of 18 to 60 years. A systemic randomized technique was employed for patient selection, involving every second CKD patient. After obtaining permission from the Institutional Ethical Committee and Informed written consent from participants, a pretested questionnaire was administered. Data was entered in MS Excel and analyzed using SPSS software. Results: In this study 24% of participants found with mild depression, 25% had moderate, 17% had severe depression and 13% had very severe depression. Additionally, 14% with mild anxiety, 23% had mild to moderate anxiety, and 20% had moderate to severe anxiety. Conclusion: The overall prevalence of depression and anxiety among CKD patients undergoing dialysis was found to be 79% and 57% respectively.

Acceptance of Illness and Health Behaviours of Patients with End-Stage Renal Disease Treated with Haemodialysis: A Single-Centre Study.

Patients with end-stage renal disease undergoing haemodialysis experience numerous life changes often requiring significant sacrifices. Adaptation to the limitations associated with the disease and dialysis treatments may influence their health behaviour. The aim of the study was to analyse the relationship between the level of illness acceptance and the intensity of health behaviours in patients treated with haemodialysis. The study used a diagnostic survey method using the Acceptance of Illness Scale and Health Behaviour Inventory questionnaires, adapted to Polish conditions by Z. Juczyński. The study was conducted from December 2022 to March 2023 among 105 patients in one dialysis centre in Poland. The patients showed an average level of disease acceptance (22.64 ± 6.52) and presented a low level of health behaviour intensity (79.11 ± 12.46). The disease acceptance index and the intensity of health behaviours showed positive correlations with age, disease duration, and the duration of haemodialysis treatment. Statistically significant positive correlations were identified between illness acceptance and the intensity of health-related behaviours. The acceptance of illness may influence adherence to health behaviours, which highlights the importance of introducing integrated and early therapeutic support to assist in the acceptance process.

Hand Grip Strength Index, a Novel Tool in Risk-Assessing Multi-Ethnic End-Stage Kidney Disease Patients Treated by Haemodialysis.

Increasing numbers of elderly co-morbid patients with end-stage kidney disease (ESKD) are now offered haemodialysis. Simple, rapid screening tools are required to risk-assess patients, highlighting those requiring nutritional or other support and advising on prognosis. As such, we assessed a newly introduced tool, the hand grip strength index (HGS index), a comparison of measured to predicted HGS. We reviewed ESKD dialysis patients dialysing under the care of an inner-city tertiary dialysis centre who had contemporaneous HGS measurements, and body composition measured by multifrequency bioelectrical impedance analysis, followed for ≤ 9 years, censoring for transplantation. Results from 1023 patients, 63.2% male, 48.2% White and 46.5% diabetic, with a dialysis vintage of 21.2 (7.2-61.0) months, were analysed. Mortality was significantly greater for those in the lowest HGS index quartile using Kaplan-Meier analysis (p < 0.001). On multivariable step-backward Cox regression analysis, mortality was independently significantly associated (p < 0.001) with increasing age (hazard ratio [HR] 1.04 95% confidence interval (CI) [1.029-1.045]), higher co-morbidity score (HR 1.24 [1.142-1.347]) and post-dialysis extracellular water/total body water ratio (HR 1.15 [1.089-1.219]) and lower HGS index (HR -0.76 [0.991-0.998]), whereas sarcopenia and frailty were not retained in the model. Increasing numbers of elderly co-morbid patients are being treated with dialysis, so simple screening tools are required to advise on prognosis and highlight patients who may need additional support, including nutrition. We found the HGS index to have prognostic value, along with the traditional risk factors of patient age and co-morbidity.

Assessment of IL-8, RANTES, MIG, MCP-1, IP-10, and IL-12p70 and Their Association with Anxiety and Quality of Life in Patients with Chronic Kidney Disease or After Kidney Transplantation.

Anxiety is a subjective feeling of fear in response to stressful or threatening situations. Chronic diseases (such as chronic kidney disease) or the state after kidney transplantation are such situations and they may result in a decreased quality of life. The main aim of this research was to evaluate if the proteins IL-8, RANTES, MIG, MCP-1, IP-10, and IL-12p70 could be indicators of higher levels of anxiety or decreased quality of life in chronically ill women. The assessment was conducted using the STAI and SF-36 questionnaires and with the measurement of listed proteins from the patient's blood sample. The study group consisted of 107 women-101 patients from the Nephrological Clinic and 6 from the Dialysis Center. Both of the facilities are part of University Clinical Hospital No. 2 in Szczecin. Statistical analysis was performed using JASP software (JASP 0.18.3 version). Anxiety levels and quality of life correlations between STAI and SF-36 scores and individual variables were assessed. Logistic regression models were performed for both questionnaire outcomes: SF-36 and STAI. Lower quality of life was found in the group with a higher IL-8 concentration compared to the group of women with a lower IL-8 concentration. A positive weak correlation was found between a decreased quality of life and IL-8 and RANTES. A higher RANTES level increases the odds of a lower quality of life. This study shows that special care should be provided for chronically ill women (especially with CKD or after KTx) with a higher RANTES or IL-8 concentration. They would highly benefit from close monitoring of their mental health.

The Socioeconomic Impact of Transport Costs for Adult Patients Requiring Haemodialysis: A Mixed Methods Study.

Patients requiring haemodialysis often perceive the cost of their travels to the dialysis centres as a significant burden. The study aimed to collect a first Swiss national data set on transport costs and assess their impact on patients and their relatives. In addition to interviews with patients, a quantitative survey was developed and distributed online using a voluntary sampling strategy. Data were analysed by means of descriptive statistics. A Sounding Board of patients, relatives, and healthcare professionals accompanied all steps of the project. A total of 6 dialysis patients were interviewed; 437 respondents of the national survey met the inclusion criteria. Patients travel a median distance of 7.5 km to their dialysis centres. For 78% of them, the journey takes up to 30 min, and nearly half use their private car as their main mode of transport. The median annual transport costs are CHF 2925 (mean = CHF 5041). Approximately half of the patients perceive transport costs as a burden or limitation, yet only about 30% receive financial support, for which there is no standard process. Patients requiring financial support reported difficulties navigating the system. This study highlighted that many dialysis patients are burdened by transport costs and receive limited financial support and counselling services. Implementation of a standardised process for financial support should be explored.

Bioimpedance analysis (extracellular mass to body cell mass ratio) as complementary assessment for malnutrition in hemodialysis patients

Background: Protein energy wasting (PEW) is a frequent condition in haemodialysis patients but often goes missed. The diagnosis of PEW is complex even though composite nutritional indices seem to show strong correlations with mortality and cardiovascular events. Bioimpedance analysis in dialysis centres is used to study patient's degree of water load but not to assess nutritional status. Recently, the extracellular mass/body cell mass ratio (ECM/BCM) ≥ 1.2 has also been considered as a parameter of malnutrition in the haemodialysis patients. Objective: To assess the nutritional reliability of ECM/BCM ≥ 1.2 in patients referred to the Dialysis Centre of the “S. Spirito Hospital” Rome. Methods: 16 Patients were enrolled and than evaluated anthropometrically, for nutritional and inflammatory parameters, subjected to the Malnutrition Inflammation Score (MIS) and monitored with impedance measurements before, after and 30 min after the haemodialysis session. Results: ECM/BCM ≥ 1.2 demonstrates a statistically significant direct correlation ( p &lt; 0.001) with MIS. Albumin and pre-albumin were inversely correlated with ECM/BCM ≥ 1.2, cholesterolaemia was directly correlated. Conclusions: ECM/BCM ≥ 1.2 appears to be a simple and reliable indicator for the diagnosis of malnutrition in the chronic haemodialysis patient. Given the small sample size, further studies are needed to support this thesis.

How dialysis frequency and duration impact uremic toxin and fluid removal: a pediatric perspective.

Three-weekly 4-h hemodialysis/hemodiafiltration (HD/HDF) per week has become the "standard HD/HDF" regimen in children across the globe, although increasingly criticized, since crucial determinants such as residual kidney function and patient preferences are not considered. As a consequence, several children fail to achieve adequate dialysis while on a "standard HD/HDF." In these circumstances, an extended dialysis prescription such as short daily (2-3h/session, 5-7days a week) or nocturnal HD/HDF (6-9h/session, 3-5days a week), either at home or in a dialysis center, may be considered. The purpose of this educational review is to summarize the impact of dialysis duration and frequency on uremic toxin and fluid removal. Moreover, we aim to summarize the existing literature on HD/HDF strategies with extended dialysis duration and/or increased frequency (> 12h dialysis time per week) in pediatrics. Dialysis duration and frequency plays a crucial role in uremic toxin removal, in particular for uremic toxins with retarded transport in patients, such as phosphate, β2-microglobulin (β2m), and protein-bound uremic toxins. Also, increasing dialysis duration and/or frequency decreases the gap between plasma refilling and ultrafiltration volume), thereby decreasing the need for a high ultrafiltration rate. Observational studies in children demonstrate a beneficial effect of extended dialysis regimens (i.e., more frequent or longer duration) on blood pressure control, left ventricular hypertrophy, growth, and quality of life. PTH levels tend to decrease in the majority of studies, while hypocalcemia or suppressed PTH levels were also reported. Dietary restrictions were decreased or stopped, along with tapering of phosphate binders and potassium chelators. Extended HD/HDF regimens are beneficial in a particular group of children. Pediatric-specific international guidelines are needed to support pediatric nephrologists in determining for which children extended HD regimens are beneficial, along with increasing efforts to decrease the financial, organizational, and psychosocial barriers that are present in extended HD/HDF.

Effect of Electronic Moxibustion in Patients with IDH: A Randomized Crossover Pilot Study.

Intradialytic hypotension (IDH), a common complication of hemodialysis (HD), is associated with increased cardiovascular risk, morbidity, and mortality. Fatigue is one of the most frequent symptoms of IDH, and deteriorates the quality of life of patients. This study aimed to evaluate the efficacy and safety of electronic moxibustion for improving IDH and its associated symptoms. We prospectively recruited 32 end-stage renal disease patients with IDH who underwent regular HD at our hospital's dialysis center between April 2019 and April 2020. A randomized, controlled, two-arm crossover trial was performed to evaluate the efficacy of adding one-hour electronic moxibustion during HD. The outcome measurements included patients' subjective assessment of the degree of fatigue, recovery time of fatigue from HD, cold intolerance before and after each intervention, frequency of IDH episodes and nursing interventions needed during HD, and blood pressure changes during HD. Thirty (94%) patients completed the study. Intervention with electronic moxibustion improved the degree of fatigue (95% CI, -2.95 to -0.18, p = 0.027), specifically in patients prescribed with midodrine (95% CI, -4.20 to -0.53, p = 0.013). The short-term use of electronic moxibustion during HD did not significantly alter the frequency of IDH or reduce the degree of decrease in blood pressure. Serious adverse effects were not observed. One patient complained of heat, whereas two patients had local transient erythema and pruritus. Electronic moxibustion appears to be safe and efficacious for improving IDH-related fatigue, thus acting as an adjuvant therapy in HD units to enhance patient comfort and treatment adherence. Further studies with larger sample sizes are required to confirm the benefits of this novel technique.

Benefits of Continuous Outpatient Orthopedic Consultations for Both Upper and Lower Body on the Mortality Rates of Hemodialysis Patients.

The purpose of the present observational study was to examine whether there is a difference in prognosis for hemodialysis patients with or without continued orthopedic outpatient visits over five years. Methods: One hundred and thirteen hemodialysis patients who visited the dialysis center of Takagi Hospital, Okawa, Japan, as of December 2017 were included in this study. Data were collected from the medical records until December 2022. All 113 patients were divided into two groups: patients who continuously visited the orthopedic outpatient department (n = 59) and those who did not (n = 54). Patients who had orthopedic consultation were divided into three semi-groups: patients who consulted for the upper body (n = 11), the lower body (n = 22), and both the upper and lower bodies (n = 26). During the five-year follow-up period, 13 out of 59 patients (22.0%) who had orthopedic consultation died, and this ratio tended to be lower compared to the mortality rate of patients without orthopedic consultation (37.0%) but not significant (P < 0.08). Duration of hemodialysis was significantly longer in patients with orthopedic consultation (P = 0.009). The mortality rate was significantly lower in patients who consulted for both upper and lower bodies than those without orthopedic consultation (P < 0.05, respectively). These differences were not observed in patients who consulted for only upper or lower bodies. The mortality of hemodialysis patients was significantly lower in the group which was undertaking continuous outpatient orthopedic consultations for both upper and lower bodies, which suggested that periodical consultation with orthopedics might be critical for hemodialysis patients.

Caregiver burden and quality of life among family caregivers of hemodialysis patients from South India.

Hemodialysis (HD) patients require assistance from family caregivers in performing daily activities. This additional responsibility may cause caregivers to feel burdened, resulting in a poor quality of life. The current study envisaged assessing the degree of caregiver burden (CB) and quality of life among the primary caregivers of HD patients. A cross-sectional study was conducted among conveniently sampled, consenting family caregivers (N = 200) of HD patients in tertiary care dialysis centers in Thiruvananthapuram, Kerala, India, from March 2022 to May 2022. A structured interview schedule was used to collect sociodemographic data from participants. The caregiver burden and quality of life were assessed using the Zarit Burden Interview and the World Health Organization (WHO) Quality of Life (QoL) BREF scale. Univariate and multivariate analyses were performed to determine the association between the variables. Fifty-eight percent of the caregivers reported CB. Caregivers with no leisure time (ORadj = 3.29 [95% CI: 1.73-6.41]), perceived financial stress (ORadj = 2.27 [95% CI: 1.16-4.49]), and having comorbidities (ORadj = 2.92 [95% CI: 1.43-6.12]) had an increased odds of experiencing caregiver burden. The CB score was inversely correlated with all domains of QoL. Moreover, the QoL score was lower among family caregivers with CB than those without CB. The present study highlights a high prevalence of caregiver burden, which negatively impacts the QoL of family caregivers of HD patients. This study opens up new directions for possible policy-making to reduce caregiver burden and improve the QoL of family caregivers.

The effectiveness of a cognitive behavioral counseling program to alleviate future anxiety among patients with diabetes Kidney failure at Al-Kamelin Hospital

This scientific paper based on scientific research to investigate a cognitive behavioral counseling program to reduce the cognitive distortions and future anxiety of kidney failure patients at Dr. Dalal Kidney Dialysis Center, Al Kamline Hospital, the researcher used the experimental method single group design including a sample size of (30) patients who were selected on purposeful method. The two researchers implemented the future anxiety scale, prepared by Dr. Zainab Shugair, and the data has been processed using the Statistical Package for Social Sciences (SPSS) program using: Pearson's correlation coefficient, Cronbach's alpha coefficient, one-sample ttest, one-way variance (ANOVA). The researcher concluded the following results: The anxiety of the future of kidney failure patients at Al-Kamline Hospital, Dr. Dalal Center for Kidney Dialysis is high. There are also statistically significant differences in the effectiveness of the behavioral guidance program among the members of the experimental group between the pre-measurement and the post-measurement in favor of the post-measurement. There are also no statistically significant differences between the members of the experimental group, attributed to the age variable. There are no statistically significant differences between the members of the experimental group attributed to the educational level variable, and there are no statistically significant differences between the members of the experimental group attributed to the social status variable. At the end of the research, the researcher presented a number of recommendations, the most important of which is the need to prepare psychological treatment programs to treat cognitive distortions for psychiatric patients in general and kidney patients in particular.