Dialysis-related Factors Research Articles

Social Support and Quality of Life in Hemodialysis Patients: A Comparative Study with Healthy Controls

Background and Objectives: Hemodialysis patients face significant physical and psychological challenges, including diminished quality of life and reduced social support. This study aimed to assess the levels of social support and quality of life in hemodialysis patients and identify the sociodemographic and dialysis-related factors influencing these outcomes. Materials and Methods: This study included 115 hemodialysis patients and 107 healthy controls. Social support was measured using the Modified Social Support Survey (MSSS) and its abbreviated version (MSSS-5). Quality of life was assessed using the WHOQOL-BREF questionnaire. Demographic variables (age, sex, education, marital status) and dialysis-related factors (session duration, Kt/V, vascular access type, and urea reduction ratio) were analyzed to determine their effects on social support and quality of life. Results: Hemodialysis patients reported significantly lower scores in the Physical Health and Psychological Health domains of the WHOQOL-BREF compared to healthy controls. Males on hemodialysis scored lower than the controls in the Physical Health, Psychological Health, and Environment domains of the WHOQOL-BREF and the Affectionate Support and Positive Social Interaction subscales of MSSS. Conversely, hemodialysis females reported higher scores for Tangible Support, Emotional/Informational Support, and Affectionate Support. Longer dialysis sessions negatively impacted the Social Relationships domain. Married hemodialysis patients had higher Emotional/Informational Support and Affectionate Support scores. Conclusions: Hemodialysis patients experience diminished physical and psychological quality of life, particularly males. Social support, especially emotional and informational support, is crucial for hemodialysis patients, with marital status playing a key role. Addressing these psychosocial factors may improve outcomes for hemodialysis patients.

Supplementation of Antioxidants in Chronic Kidney Disease: Clinical Necessity or Wishful Thinking? A Bench to Bedside Translational Research.

Chronic Kidney Disease (CKD) patients are at increased risk for atherosclerosis, cardiovascular disease (CVD) and progression to end stage kidney disease (ESKD). This heavy CVD risk cannot be solely at-tributed to traditional Framingham risk factors. Oxidative stress (OS), defined as the disruption of balance between prooxidants and antioxidants in favor of the former, has emerged as a novel risk factor for CVD and CKD progression. Specifically, lipid peroxidation has been identified as a trigger for endothelial dys-function, the first step towards atherogenesis and protein oxidation has been associated with CKD progres-sion. The oxidation of proteins and lipids starts early in CKD, increases gradually with disease progression and is further exacerbated in ESKD, due to dialysis related factors. In order to counteract the deleterious effects of free radicals and thereby ameliorate, or delay, CV disease and progression of CKD, exogenous administration of antioxidants has been proposed. Here, we attempt to summarize existing data from ex-perimental and clinical studies that test antioxidants for their possible beneficial effects against CVD and CKD progression such as vitamins E and C, statins, omega-3 fatty acids, trace elements, polyphenols and N-acetylcysteine. </p>.

#52 Pulmonary hypertension in hemodialysis patients: prevalence and risk factors: a single center study

Abstract Background and Aims Pulmonary hypertension (PH) is an underestimated cardiovascular trouble in patients on hemodialysis (HD). Therefore, we studied its prevalence, risk factors, association with inflammation, and cardiac changes in HD patients. Method This was a single-center cross-sectional observational study conducted at Sfax CNSS polyclinic hemodialysis center during October 2023. Patients on hemodialysis for at least three months were included and divided into those with and without PH; patients with secondary causes for PH were excluded. Clinical characteristics, HD-related factors, lab parameters, and echocardiography details were compared. PH was defined as a mean pulmonary artery pressure (PAP) of &amp;gt; 25 mmHg at rest, and it was further divided as mild (26–39 mmHg), moderate (40–60mmHg), and severe (&amp;gt; 60 mmHg). Mean levels of PAP were compared in different groups according to the main clinical parameters. Results Of 30 patients, 21 patients had PH (mild:15, moderate:4, and two had severe PH) with a prevalence of 70%, and a mean age of 58 years old. No difference was found in clinical characteristics, dialysis-related factors, and biochemical parameters. Inflammation seemed to be more important in the PH group but the difference was not statistically significant (mean C-reactive protein in the PH group vs. 5,69 in the non-PH group; p=0,34). Otherwise, according to echocardiography findings, PAP was significantly higher in patients with left ventricular failure(HF) (mean PAP in HF group vs. 31,12 in the non-HF group; p=0,011), in patients with right ventricular dilation(RVD)(mean PAP in RVD patients=47,83mmHg vs 28,88mmHg in the non-RVD group; p=0,05) and in patients with mitral regurgitation(MR) (mean PAP in MR group=40,18mmHg Vs 28,32mmHg in the non-MR group; p=0,04). Conclusion Haemodialysis patients have a high prevalence of PH, especially in patients with heart failure and ventricular dilation. PH was significantly associated with the presence of mitral regurgitation on echocardiography. Inflammation was slightly higher in PH but our study did not find significant differences in traditional risk factors, and HD-related factors between the groups with and without PH.

#1588 Modifiable factors associated with fatigue and prolonged recovery time in hemodialysis patients: a French multicenter observational study

Abstract Background and Aims Fatigue and dialysis recovery time (DRT) are two important patient-reported outcomes that highly affect the well-being of patients on hemodialysis. The DOPPS working group showed that prolonged DRT increases mortality. Therefore, this study aims to assess all modifiable dialysis-related factors, associated with DRT and fatigue, that could be addressed in future clinical trials. Method This is a French multicenter observational study that included all patients ≥ 18 years, on chronic hemodialysis for &amp;gt;3 months, who consented to participate during December 2023. Patients with cognitive problems, active cancer and admitted to hospital were excluded. The study got the approval of the local ethics committee. DRT was assessed six times by asking at each session for two non-consecutive weeks: "How long did it take you to recover from your last dialysis session?" Fatigue was assessed by using the French validated SONG-HD fatigue scale that includes three questions: in the last week, "did you feel tired?", "did you lack energy?", "did fatigue limit your usual activities?". Logistic regression analysis assessed the association between DRT&amp;gt;12 hours and fatigue score ≥4 with all demographic and dialysis-related factors. A sub-analysis of DRT-related factors was performed for very elderly ≥ 85 years. Results A total of 536 patients and 2967 sessions were analyzed. Mean age was 68.1 ± 14.3 years with 10.4% above 85 years; 60.9% were males, median dialysis vintage was 41 (22.5, 80) months, 33.2% had diabetes, 46.3% had cardiovascular (CV) disease, 5.2% were on nocturnal hemodialysis, 14.4% had a catheter and 63.3% were on HDF. Median dialysate sodium was 138 (136, 140) with a minimum of 130 to a maximum of 142. Median DRT was 140 (45, 440) minutes with 42.7% of patients recovering in &amp;lt;2 hours, 16.2% in 120-360 minutes, 26.1% in 361-720 minutes and 14.9% &amp;gt;12 hours. The mean SONG-HD fatigue score was 3.1 ± 2.3 with 18% having no fatigue and 37.7% having a score ≥4. DRT and fatigue score were significantly associated (P &amp;lt; 0.001). Factors significantly associated with DRT&amp;gt;12 hours are summarized in Table 1: sex, diabetes, CV disease, BMI, ultrafiltration rate/Kg/hour, duration of session, blood flow, Kt/V, blood pressure, membrane type and all routine blood tests were not associated with DRT whereas intradialytic change in natremia was significantly associated with recovery time (Fig. 1). In multivariable regression analysis, factors associated with a fatigue score ≥4 included females (OR = 1.74; 95% CI: 1.21, 2.51; P = 0.003), and lower hemoglobin (OR = 0.83; 95% CI: 0.71, 0.99; P = 0.003). In the subgroup of patients ≥85 years, HDF was associated with prolonged DRT (OR = 4.2; 95% CI: 1.04, 17.03; P = 0.045) and lower hemoglobin was associated with fatigue (OR = 0.51; 95% CI :0.28, 0.93; P = 0.029). Conclusion DRT and fatigue are significantly associated however modifiable factors associated with prolonged DRT are not exactly similar to those associated with fatigue. A negative intra-dialytic change in natremia and low frequency of dialysis are two major factors associated with longer DRT, with HDF significantly associated with longer recovery in very elderly patients, whereas the modifiable independent factor associated with fatigue is the hemoglobin level.

Multidisciplinary management of penile calciphylaxis in a patient undergoing hemodialysis

Penile necrosis in end-stage chronic kidney disease patients on hemodialysis presents complex pathophysiology involving vascular, metabolic, and dialysis-related factors. This clinical case emphasizes the significance of prompt multidisciplinary management. Surgical interventions like penectomy with scrotal pedicled flaps offer effective reconstruction, preventing complications. Long-term success mandates diligent oversight of metabolic and vascular issues. A comprehensive approach integrating urology, vascular surgery, and nephrology specialists is essential for optimal patient outcomes and quality of life.

Prognostication After Dialysis Withdrawal

IntroductionDialysis withdrawal represents an increasingly common cause of death in patients receiving kidney replacement therapy internationally. Prognostic information around stopping dialysis guides clinicians counselling patients and families regarding end-of-life care. However, few studies examine prognostication after withdrawal.We aimed to determine median survival time after withdrawal of dialysis, and to determine what patient and dialysis-related factors are significantly associated with prognosis. MethodsThis retrospective cohort study used registry data. We included all adult patients from the Western Renal Services who were receiving peritoneal dialysis or haemodialysis prior to death, whose cause of death was documented as “Withdrawal from dialysis” and whose date of death was between 1 January 2016 and 30 June 2022. Demographic, clinical and biochemical data was extracted. The primary outcome was time to death, defined as days from last dialysis session to date of death. ResultsMedian survival time from last dialysis to death for the peritoneal dialysis group (n=53) was 4 days (IQR 3-10 days), not significantly different from the haemodialysis group which was 6 days (IQR 2-11 days, p=0.72). For peritoneal dialysis, the only variable significantly associated with survival time was reason for withdrawing (p=0.01). Median survival time was significantly longer for patients withdrawing for psychosocial reasons compared to those withdrawing for other reasons (p=0.002). For haemodialysis (n=186), variables significantly associated with survival time from last dialysis to death was reason for withdrawing (p=0.001), urine production at time of withdrawal (p=0.005), serum sodium (p=0.02) and smoking status (p=0.009). ConclusionMedian survival time was longer for withdrawals for psychosocial reasons compared to medical reasons. The data presented could inform withdrawal discussions regarding prognostication and end-of-life planning with patients and family.

Factors Affecting Adherence to Hemodialysis Therapy Among Patients With End-Stage Renal Disease Attending In-Center Hemodialysis in Al-Ahsa Region, Saudi Arabia.

Background Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are global health concerns, with ESRD requiring renal replacement therapy (RRT). Hemodialysis is a prevalent modality for RRT. However, access to hemodialysis is challenging for rural patients due to geographical barriers and limited nephrology services. This research aims to identify factors influencing adherence to hemodialysis sessions among rural ESRD patients, addressing travel, healthcare infrastructure, and socioeconomic factors. Materials and methods A cross-sectional study of 154 participants was conducted from July 06to September 10, 2023 at Al-Jaber Dialysis Center in Al-Ahsa, Saudi Arabia. It included adult CKD patients on hemodialysis who were interviewed to assess factors influencing hemodialysis adherence using a structured questionnaire. Results Our study assessed hemodialysis adherence in 154 patients in Al-Ahsa, Saudi Arabia. Gender distribution was nearly equal (male = 54.5%), with the majority aged 41-60, married, and residing in downtown areas. Hypertension (43.9%) and diabetes (32.3%) were the prevalent comorbidities. Most patients received thrice-weekly dialysis (96.15%), with family cars as the primary transportation mode (55.2%). Hypertension (43.3%) and diabetic nephropathy (40.9%) were the leading causes of CKD. Approximately 26% missed dialysis, with health issues and transportation difficulties being common reasons. Notably, adherence correlated with female gender, lower education, and family car transportation mode. Social support significantly influenced adherence, highlighting its importance in maintaining hemodialysis adherence. Conclusion Our study identified various sociodemographic and dialysis-related factors influencing adherence among hemodialysis patients in the Al-Ahsa region, Saudi Arabia. Notably, factors such as gender, education level, and transportation means significantly influenced adherence. Adequate family and social support were associated with better adherence. These findings highlight the importance of tailored interventions addressing these factors to enhance hemodialysis adherence and ultimately improve patient outcomes in this population.

Apparently Resistant Hypertension in Polish Hemodialyzed Population: Prevalence and Risk Factors.

The aim of this study was to assess the prevalence, characteristics, and determinants of apparent treatment-resistant hypertension (aTRH) in an unselected large population of patients with end-stage kidney disease (ESKD) treated with hemodialysis (HD) throughout the country. A database of 5879 patients (mean age 65.2 ± 14.2 years, 60% of males receiving hemodialysis) was obtained from the biggest provider of hemodialysis in the country. Hypertension and aTRH were defined using pre- or/and post-dialysis BP values. Patients with and without aTRH (non-aTRH) were compared. Using pre- and post-dialysis criteria, hypertension was diagnosed in 90.7% and 89.1% of subjects, respectively. According to pre- and post-dialysis blood pressure criteria, aTRH incidences were 40.9% and 38.4%, respectively. The hypertensive patients with aTRH versus non-aTRH were younger, had a higher rate of cardiovascular disease, lower dialysis vintage, shorter time on dialysis, higher eKt/V, higher ultrafiltration, higher pre- and post-dialysis BP and HR, and higher use of antihypertensive drugs. Factors that increase the risk of aTRH according to both pre- and post-dialysis BP criteria were age-OR 0.99 [0.98-0.99] and 0.99 [0.98-0.99], the history of CVD 1.26 [1.08-1.46] and 1.30 [1.12-1.51], and diabetes 1.26 [1.08-1.47] and 1.28 [1.09-1.49], adjusted OR with 95% CI. In the real-life world, as much as 40% of HD patients may have aTRH. In ESKD HD patients, aTRH seems to be multifactorial, influenced by patient-related rather than dialysis-related factors. Various definitions of aTRH preclude easy comparisons between studies.

Risk factors and prevalence of cognitive impairment in maintenance haemodialysis patients: A systematic review and meta-analysis of observational studies.

To systematically identify the risk factors for cognitive impairment in maintenance haemodialysis patients and to assess its prevalence in included studies. Systematic review and meta-analysis about observational studies. Systematic search of seven databases, including PubMed, Web of Science, Scope, Wanfang Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database and Weipu Chinese Science and Technology Journal Database, from inception until October 2021. Observational studies reporting the risk factors for cognitive impairment in maintenance haemodialysis patients in English and Chinese language were included. Meta-analysis was performed to identify risk factors and prevalence of cognitive impairment in maintenance haemodialysis patients with STATA 15.0 software. Overall, 37 eligible studies encompassing 129,849 cases were included. The risk factors with statistical significance after meta-analysis were older age, female sex, fewer years of education, hypertension, diabetes, cerebrovascular accident, multiple comorbid conditions, systolic blood pressure variability, arterial stiffness and low haemoglobin and albumin level. The overall prevalence of cognitive impairment in maintenance haemodialysis patients was 49.1%. The current analysis indicated a high prevalence of cognitive impairment in maintenance haemodialysis patients. Eleven risk factors for cognitive impairment in maintenance haemodialysis patients were identified, among which more attention should be paid to modifiable factors such as cardiovascular disease risk factors and specific kidney and dialysis-related factors. This paper provides an updated estimate of the pooled prevalence of cognitive impairment in maintenance haemodialysis patients. Identification of risk factors associated with cognitive impairment may assist in developing targeted prevention strategies for maintenance haemodialysis patients at high risk. This study was a systematic review completed by the authors in accordance with relevant guidelines and processes and did not include the participation of patients, service users, caregivers or the general public.

#4268 RELATIONSHIP BETWEEN MEASURED SLEEP QUALITY AND CLINICAL PARAMETERS IN DIALYSIS PATIENTS

Abstract Background and Aims Poor sleep quality in dialysis patients has been well reported and has deleterious effects on quality of life. Factors affecting the sleep quality in these patients have not been very well explored. Actigraphy using wearable devices with 3D accelerometers is a well-recognised method of analysing the sleep quality. We set out to determine the relationship of sleep quality parameters measured using actigraphy with dialysis related factors in patients on dialysis. Method We conducted a prospective analysis of 95 patients, involving 75 In Centre Haemodialysis (ICHD), 15 Home Haemodialysis (HHD) and 8 Peritoneal dialysis (PD) patients. Sleep data was collected using Actigraph wrist device. Participants were instructed to wear the device 24 hours a day for consecutive 7 days. Sleep data analysis was conducted with Actilife software using Cole-Kripke sleep-wake algorithm. Sleep quality parameters used for assessment included Sleep Efficiency, Average Total sleep time (TST), Wake after sleep onset (WASO), Number of Awakenings, Sleep Fragmentation index. All of these are well recognised sleep quality parameters. Demographic and clinical information was collected prospectively from medical records. Results Our study cohort was well representative of general dialysis population. Median Age was 65 years, with 65.6% Males and 34.4% Females. All sleep quality parameters were considerably poor compared to age matched general population. Mean Sleep Efficiency was 77.5% (Normal for age matched general population is 83.2%), Mean TST was 318 minutes (Normal 372 minutes), Mean WASO was 83 minutes (Normal 64 minutes), Mean Sleep Fragmentation index was 43. None of the sleep quality parameters had significant difference in different dialysis modalities in our study. Amongst the predictors of sleep quality, serum phosphate had significant association with increased WASO (p = 0.002). Mean WASO was 99 minutes for patients with serum Phosphate &amp;gt; 1.8 mmol/L compared to 74 minutes for those with serum phosphate of &amp;lt; 1.8 mmol/L. Serum phosphate had a borderline significant positive correlation with Number of Awakenings (p = 0.06) and borderline significant negative correlation with Sleep Efficiency (p = 0.06). Renal urea clearance (KRU) had statistically significant positive correlation with sleep efficiency (p = 0.013) but didn’t reach statistical significance in relation to the other sleep quality parameters. Urine volume also had positive correlation with sleep efficiency nearly reaching statistical significance (p = 0.055). Other factors analysed during the study didn’t appear to have any significant associations with sleep quality. Conclusion Actigraphy is non-invasive, less cumbersome, and reliable method of sleep assessment in dialysis patients. Compared to the age matched general population, dialysis patients have objectively measured poor sleep quality. Serum phosphate has significant negative impact on sleep quality possibly secondary to hyperphosphatemia-related side effects. Residual kidney function has positive association with sleep efficiency. This study highlights the potential importance of preserving residual kidney functions and treating hyperphosphatemia in dialysis patients which warrants further research.

Uremic pruritus: prevalence, determinants, and its impact on health-related quality of life and sleep in Indian patients undergoing hemodialysis

BackgroundUremic pruritus has an impact on the quality of life and sleep of hemodialysis patients, but the majority of cases go unreported and untreated unless severe, due to a lack of awareness. The purpose of this study is to determine the prevalence, associated factors, and impact on health-related quality of life (HR-QOL) and sleep in hemodialysis patients.MethodologyA single-center observational study of 3 months wherein 120 adults on maintenance hemodialysis were included. Baseline characteristics, dialysis-related factors, and lab parameters influencing uremic pruritus were recorded. Those with uremic pruritus completed “12-item pruritus severity scale (12-PSS)”, “SKINDEX10”, and “Itch-MOS” questionnaires to evaluate severity, impact on HR-QOL, and sleep respectively.ResultsSixty seven over one hundred twenty (55.83%) patients had pruritus and majority were mild (40.83%) as per 12-PSS. Those with pruritus (n=67) had a mean age of 56.5±11.3 years, most were males (82%), chronic glomerulonephritis (29.1%) was the commonest cause of end-stage kidney disease, 3 active smokers, and 4 seropositive. 65(97%) patients were on twice-weekly dialysis, 36/67 had <5 years’ dialysis vintage and acceptable adequacy. There was no significant association between uremic pruritus and dialysis-related/laboratory parameters. Patients with uremic pruritus demonstrated significantly worse “HR-QOL” (p<0.001) on the “SKINDEX-10”, and patients' “Itch-MOS” scores demonstrated a significant decline in sleep quality with increasing pruritus severity (p<0.001).ConclusionThe majority of patients on maintenance hemodialysis experience uremic pruritus. None of the clinical characteristics, dialysis-related factors, and laboratory parameters affected uremic pruritus. Uremic pruritus patients had the worst HR-QOL & their sleep quality significantly declined as pruritus severity escalated.Trial registration number and date of registrationStudy approval was obtained from Institutional Research Committee and Institutional Ethical Committee (IEC 642/2021). Clinical Trial Registry of India (CTRI) registration (CTRI/2022/01/039143) was also obtained.

Quality of Life of Patients on Peritoneal Dialysis and Contributing Factors

In recent years, interest in Health-Related Quality of Life (HRQoL) as a major indicator of clinical efficacy and treatment outcome in patients of End-Stage Renal Disease (ESRD) has grown significantly. This study aimed to determine the contributing factors affecting the quality of life (QoL) of ESRD patients undergoing peritoneal dialysis (PD). A cross-sectional study was conducted on PD patients presented at PD centres of Al-Zahra and Noor hospitals in Isfahan, Iran, from May to August 2019. A total of 173 patients having peritoneal dialysis for more than 3 months filled the validated 36-item short-form health survey questionnaire (SF-36). Baseline demographic details and dialysis-related factors were collected from patients’ medical records. The overall QoL score of patients was 50.28 ± 20.87. Male patients had a higher QoL score than female patients (58.18 in males, compared to 48.18 in females; P = 0.04). A significant association between frequency of dialysis and quality of life was observed, where three sessions of dialysis per day yielded the highest quality of life (QoL score = 59.62; P = 0.047). A significant positive correlation was discovered between QoL score and residual renal function (P = 0.013). In addition, a higher QoL score was observed in self-employed patients (60.95), compared to housewives (46.49) (P = 0.001). QoL assessment should be included as an integral part of patient follow-up to evaluate treatment outcomes and implement possible interventions to improve patient’s quality of life.

Epidemiology of End-Stage Renal Disease in Mogadishu, Somalia: First Report at a Tertiary Care Hospital.

BackgroundEnd-stage renal disease (ESRD) in Somalia remains unexamined due to a lack of a national registry system, and the impact of the disease in the country is not estimated yet. The present study is the first report that aims to evaluate the epidemiological characteristics, causes, and dialysis-related factors associated with readmissions in ESRD patients who were going to routine hemodialysis.Patients and methodsThis cross-sectional observational study enrolled 208 patients with ESRD. Also, this study investigated patients readmitted to the hospital (n=135) after they enrolled in hemodialysis. The sociodemographic characteristics, risk factors, and comorbidities associated with these patients were reviewed. Admission site, length of hospital stay, outcome, and dialysis-related factors associated with readmissions in the first six months after being on a regular hemodialysis program were also assessed.ResultsThe mean age of the patients was 52.7±15.0 years, 43.3% were >60 years, and 61.5% were male. The most common cause was diabetes at 39.4%, followed by hypertension (35.6%) and 12.5% for postrenal obstruction. The prevalence of 6-month hospital readmissions was 65%. The most common dialysis-related factor associated with readmissions was uremic complications due to missed hemodialysis sessions (40%), vascular access/catheter infection (20%), and anemia (17.8%) (95% CI: 0.825–5.357, OR: 3.017, p<0.04). Female cases were more vulnerable to vascular catheter site infection, anemia, and hyponatremia (p<0.001). 27.5% of the patients were admitted to the intensive care unit (ICU), and the most common reason for ICU admissions was pulmonary edema (53.8%), sepsis (42.8%), and uremia due to hemodialysis skip (26.4%) (95% CI: 1.507–13.632, OR: 2.08, p=0.01). The mortality rate was 5.2%.ConclusionThe prevalence of unplanned hospital readmissions within six months was very high, and a missed hemodialysis session was identified as the leading cause. Inadequate knowledge, wrong social beliefs about the concept of dialysis and a lack of a health insurance system that covers the higher costs of each dialysis session are believed to be the causes of missed dialysis occasions.

Risk Factors of Pulmonary Hypertension in Patients on Hemodialysis: A Single Center Study.

IntroductionPulmonary hypertension (PH) is an underestimated cardiovascular consequence and a mortality predictor in patients on hemodialysis (HD). Thus, we studied its prevalence, risk factors, association with inflammation/oxidative stress, and cardiac changes in HD patients.MethodsThis was a single-center cross-sectional observational study conducted at a tertiary care hospital. Patients aged >18 years on hemodialysis for at least three months were included and divided into those with and without PH; patients with secondary causes for PH were excluded. Clinical characteristics, HD-related factors, lab parameters (C-reactive protein and malondialdehyde with thiol assay were used as markers of inflammation and oxidative stress, respectively), and echocardiography details were compared. PH was defined as a mean pulmonary artery pressure of >25 mmHg at rest, and it was further divided as mild (25–40 mmHg), moderate (40–60 mmHg), and severe (>60 mmHg).ResultsOf 52 patients, 28 patients had PH (mild 24, moderate 4, and none had severe PH) with prevalence of 54%. No difference was found in clinical characteristics, dialysis-related factors, biochemical parameters including inflammation (C-reactive protein; p=0.76), or oxidative stress (thiol; p=0.36 and MDA; p=0.46) between the groups. When compared to individuals without PH, HD patients with PH exhibited significantly more mitral regurgitation (p=0.002).ConclusionHemodialysis patients have a high prevalence of PH. PH was significantly associated with the presence of mitral regurgitation on echocardiography. Our study did not find differences in traditional risk factors, HD-related factors, and inflammation/oxidative markers between the groups with and without PH.

Effects of uremic toxins on hippocampal synaptic transmission: implication for neurodegeneration in chronic kidney disease

Patients affected by chronic kidney disease (CKD) have an increased risk of developing cognitive impairment. The cause of mental health disorders in CKD and in chronic hemodialysis patients is multifactorial, due to the interaction of classical cardiovascular disease risk factors, kidney- and dialysis-related risk factors with depression, and multiple drugs overuse. A large number of compounds, defined as uremic toxins that normally are excreted by healthy kidneys, accumulate in the circulations, in the tissues, and in the organs of CKD patients. Among the candidate uremic toxins are several guanidino compounds, such as Guanidine. Uremic toxins may also accumulate in the brain and may have detrimental effects on cerebral resident cells (neurons, astrocytes, microglia) and microcirculation. The present study aims to analyze the effect of Guanidine on hippocampal excitatory postsynaptic field potentials (fEPSPs) and in CA1 pyramidal neurons recorded intracellularly. Moreover, we compared these effects with the alterations induced in vitro by CKD patients derived serum samples. Our results show an increased, dose-dependent, synaptic activity in the CA1 area in response to both synthetic Guanidine and patient’s serum, through a mechanism involving glutamatergic transmission. In particular, the concomitant increase of both NMDA and AMPA component of the excitatory postsynaptic currents (EPSCs) suggests a presynaptic mechanism. Interestingly, in presence of the lower dose of guanidine, we measure a significant reduction of EPSCs, in fact the compound does not inhibit GABA receptors allowing their inhibitory effect of glutamate release. These findings suggest that cognitive symptoms induced by the increase of uremic compounds in the serum of CKD patients are caused, at least in part, by an increased glutamatergic transmission in the hippocampus.

Super high-flux membrane dialyzers improve mortality in patients on hemodialysis: a 3-year nationwide cohort study.

ABSTRACTIntroductionIn Japan, dialyzers are classified based on β2-microglobulin clearance. Type I dialyzers are classified as low-flux dialyzers (<10 mL/min clearance), type II and III as high-flux dialyzers (≥10 to <30 mL/min and ≥30 to <50 mL/min clearance, respectively), and type IV and V as super high-flux dialyzers (≥50 to <70 mL/min and ≥70 mL/min clearance, respectively). Super high-flux dialyzers are commonly used, but their superiority over low-flux dialyzers is controversial.MethodsIn this nationwide prospective cohort study, we analyzed Japanese Society for Dialysis Therapy Renal Data Registry data collected at the end of 2008 and 2011. We enrolled 242,467 patients on maintenance hemodialysis and divided them into five groups by dialyzer type. We assessed the associations of each dialyzer type with 3-year all-cause mortality using Cox proportional hazards models and performed propensity score matching analysis, adjusting for potential confounders.ResultsBy the end of 2011, 53,172 (21.9%) prevalent dialysis patients had died. Mortality significantly decreased according to dialyzer type. Hazard ratios (HRs) were significantly higher for type I, II and III compared with type IV (reference) after adjustment for basic factors and further adjustment for dialysis-related factors. HR was significantly higher for type I, but significantly lower for type V, after further adjustment for nutrition- and inflammation-related factors. These significant findings were also evident after propensity score matching.ConclusionsHemodialysis using super high-flux dialyzers might reduce mortality. Randomized controlled trials are warranted to clarify whether these type V dialyzers can improve prognosis.

Frailty, Age, and Postdialysis Recovery Time in a Population New to Hemodialysis.

Frailty, a phenotype characterized by decreased physiologic reserve and the inability to recover following confrontation with a stressor like hemodialysis, may help identify which patients on incident hemodialysis will experience longer postdialysis recovery times. Recovery time is associated with downstream outcomes, including quality of life and mortality. We characterized postdialysis recovery times among patients new to hemodialysis and quantified the association between frailty and hemodialysis recovery time. Among 285 patients on hemodialysis enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease (PACE) study, frailty was measured using the Fried phenotype. Self-reported recovery time was obtained by telephone interview. We estimated the association of frailty (intermediately frail and frail versus nonfrail) and postdialysis recovery time using adjusted negative binomial regression. Median time between dialysis initiation and study enrollment was 3.4 months (IQR, 2.7-4.9), and that between initiation and recovery time assessment was 11 months (IQR, 9.3-15). Mean age was 55 years, 24% were >65 years, and 73% were Black; 72% of individuals recovered in ≤1 hour, 20% recovered in 1-6 hours, 5% required 6-12 hours to recover, and <5% required >12 hours to recover. Those with intermediate frailty, frailty, and age ≤65 years had 2.56-fold (95% CI, 1.45 to 4.52), 1.72-fold (95% CI, 1.03 to 2.89), and 2.35-fold (95% CI, 1.44 to 3.85) risks, respectively, of longer recovery time independent of demographic characteristics, comorbidity, and dialysis-related factors. In adults new to hemodialysis, frailty was independently associated with prolonged postdialysis recovery. Future studies should assess the effect of frailty-targeted interventions on recovery time to improve clinical outcomes.

Dialysis-Related Factors Affecting Activities of Daily Living among Hemo-dialysis Patients in Erbil City

Background and objectives: Hemodialysis procedure is one of the important replacement therapies for patients with renal failure. Maintenance hemodialysis is associated with many complications that play a significant role in the activities of daily living. The present study aimed to find out the factors affecting activities of daily living among patients with maintenance hemodialysis in Erbil City in the Kurdistan Region of Iraq. Methods: The cross-sectional study was conducted on 268 patients undergoing mainte-nance hemodialysis for more than two months, and at least two times per a week at two dialysis centres in Erbil City from December 2019 to April 2020. The activities of daily living and complications from the hemodialysis procedure questionnaire to collect research da-ta. The data analysis was conducted using descriptive statistical approach including fre-quency, percentages, and inferential statistical analysis consisting chi-square test. Results: According to the findings of the study, the majority of participants were above 51 years of age, able to read and write, with middle income, and from an urban area. Almost half of the study sample were males, and most were on hemodialysis between one and three years. The majority of them had hypertension and complications associated with he-modialysis such as headache and hypotension, and more than half had back pain. A highly significant association was found between dependency in activities of daily living and some socio-economic and clinical variables. Furthermore, a significant association was found be-tween dependency in activities of daily living and some hemodialysis complications with P&lt;0.001. Conclusion: According to the result of the study, the researchers concluded that partici-pants suffered from chronic diseases, hemodialysis complications and low level of activities of daily living. The complications of hemodialysis treatment were significantly affecting the activities of daily living. Haemodialysis patients need more education and nursing care to reduce treatment complications and to increase their activities.

Intradialytic hypotension definitions with mortality prediction capacity in a cohort of haemodialysis patients

IntroductionIntradialytic hypotension (IDH) is a common complication and is associated with higher morbidity and mortality in patients on haemodialysis (HD). However, there is a lack of uniformity in definitions of IDH. The main objective of this study is to analyse clinical and dialysis related factors with several IDH definitions, and its relationship with morbidity and mortality in a cohort of HD patients. MethodsObservational study with a 30-month follow-up period that includes 68 prevalent patients on HD with at least six months of treatment. We analysed 18 non-consecutive dialysis sessions (first three of each month of a six-month period), and different definitions of IDH were recorded. A positive event of IDH was defined if any definition occurred in more than 25% of the sessions studied. Using survival analysis, we analysed the prediction capacity of each IDH definition (Nadir90, Nadir100, Fall20, Fall30, Fall20Nadir90, Fall30Nadir90, KDOQI, HEMO). The relationship with non-fatal cardiovascular disease (CVD) and global mortality was estimated using different Cox proportional models. ResultsWe found IDH definitions that occurred significantly more frequently (Nadir100: 339.8/1000 sessions, Nadir90: 172.3/1000 sessions) than others (KDOQI: 98/1000 sessions, HEMO 129.9/1000 sessions). We registered 13 fatal events with a mean follow-up of 27.12 ± 6.84 months. A greater number of sessions with IDH according to the Nadir90 definition was a predictive factor of mortality (Log rank 5.02, p 0.025), independent according to adjusted models (HR: 3.23 [95% CI: 1.08–9.6], p 0.035). The definitions Nadir100 (HR: 4.54 [95% CI: 1.25−16.4], p 0.02) and Fall30Nadir90 (HR: 3.08 [95% CI: 1.07–8.8], p 0.03) were independent predictors of non-fatal CVD in adjusted models. ConclusionIntradialytic hypotension, even asymptomatic, is a predictor of mortality and non-fatal cardiovascular disease in prevalent patients on haemodialysis.

Definiciones de hipotensión intradiálisis con poder predictivo de mortalidad en una cohorte de hemodiálisis

IntroductionIntradialytic hypotension (IDH) is a common complication and is associated with higher morbidity and mortality in patients on haemodialysis. However, there is a lack of uniformity in definitions of IDH. The main objective of this study is to analyse clinical and dialysis related factors with several IDH definitions, and its relationship with morbidity and mortality in a cohort of haemodialysis patients. MethodologyObservational study with a 30-month follow-up period that includes 68 prevalent patients on haemodialysis with at least six months of treatment. We analysed 18 non-consecutive dialysis sessions (first three of each month of a six-month period), and different definitions of IDH were recorded. A positive event of IDH was defined if any definition occurred in more than 25% of the sessions studied. Using survival analysis, we analysed the prediction capacity of each IDH definition (Nadir90, Nadir100, Fall20, Fall30, Fall20Nadir90, Fall30Nadir90, KDOQI, HEMO). The relationship with non-fatal cardiovascular disease and global mortality was estimated using different Cox proportional models. ResultsWe found IDH definitions that occurred significantly more frequently (Nadir100: 339.8/1,000 sessions, Nadir90: 172.3/1,000 sessions) than others (KDOQI: 98/1,000 sessions, HEMO 129.9/1,000 sessions). We registered 13 fatal events with a mean follow-up of 27.12±6.84 months. A greater number of sessions with IDH according to the Nadir90 definition was a predictive factor of mortality (Log rank 5.02, p=0.025), independent according to adjusted models (HR: 3.23 [95% CI: 1.08-9.6], p=0.035). The definitions Nadir100 (HR: 4.54 [95% CI: 1.25-16.4], p=0.02) and Fall30Nadir90 (HR: 3.08 [95% CI: 1.07-8.8], p=0.03) were independent predictors of non-fatal cardiovascular disease in adjusted models. ConclusionsIntradialytic hypotension, even asymptomatic, is a predictor of mortality and non-fatal cardiovascular disease in prevalent patients on haemodialysis.