Duration Of Hemodialysis Treatment Research Articles

#1062 Effect of intradialytic resistance exercise on patient survival: a multicenter non-randomized cohort study

Abstract Background and Aims Intradialytic exercise significantly benefits the physical function of patients undergoing hemodialysis. Prior research into its impact on patient longevity has been constrained by small participant numbers and the lack of a control group. This study investigates the influence of exercise therapy during hemodialysis on patient lifespan in a broad multicenter cohort. Method This forward-looking, multicenter, non-randomized clinical investigation included 17 outpatient clinics from the Kaikoukai Medical Group, recruited between April and December 2018. Participants were voluntarily enlisted in an exercise regimen during their dialysis sessions and segregated into exercising and non-exercising cohorts. The trial was not blinded. The intradialytic regimen comprised stretching and four types of resistance exercises utilizing elastic tubes, conducted thrice weekly. Baseline data encompassing age, gender, stature, baseline weight, duration of hemodialysis treatment, and concurrent diabetic conditions were collected. Additional data regarding hemodialysis, including Kt/V ratio, hemodialysis blood flow rate (QB), dialysate volume (QD), and duration of dialysis, were recorded. Laboratory parameters such as albumin (Alb), calcium (Ca), potassium (K), hemoglobin (Hb), C-reactive protein (CRP), and creatinine (Cr) levels were extracted from medical records. Patient outcomes were monitored until either the occurrence of death or the study's culmination in December 2021. In statistical analyses, missing values were addressed using multiple imputation techniques, and baseline characteristics between groups were compared using an unpaired t-test. Cox proportional hazards regression analysis was employed to examine the relationship between the exercise intervention and survival, adjusting for multiple confounding variables. Three models were constructed for analysis: Model 1 incorporated basic patient data, Model 2 included hemodialysis parameters, and Model 3 involved laboratory data. The study was approved by the Ethical Committee of Nagoya Kyoritsu Hospital. Results The study encompassed 2006 subjects (average age 70.1±0.3 years), with 512 (25.5%) in the exercise group and 1494 (74.5%) in the control group. Initial comparisons indicated that the exercise group had significantly lower average height (160.9±0.3 vs. 159.7±0.4 cm, p=0.03), baseline weight (57.2±0.3 vs. 55.9±0.5 kg, p=0.04), Kt/V ratio (1.59±0 vs. 1.64±0, p=0.01), and QD (494±0.9 vs. 486.8±1.9 ml, p<0.01). Over the median observation period of 25 months, 338 (16.9%) patients, comprising 58 (11.3%) from the exercise group and 280 (18.7%) from the control group, succumbed. Survival analysis revealed a significant association between exercise intervention and mortality reduction, adjusted for confounders in Model 1 (HR 0.6, 95%CI 0.4-0.9, p=0.01), Model 2 (HR 0.55, 95%CI 0.37-0.8, p=0.02), and Model 3 (HR 0.57, 95%CI 0.38-0.87, p=0.01). Conclusion This research is the first to demonstrate a significant association between intradialytic resistance training and improved survival in hemodialysis patients within a multicenter, non-randomized cohort. This relationship remained significant after adjusting for multiple confounding factors, suggesting that incorporating resistance training into standard hemodialysis care could markedly enhance patient survival outcomes.

#570 A study of QTc time trends and factors affecting QTc changes during dialysis

Abstract Background and Aims Several studies have revealed the relationship between an abnormal QTc interval and mortality with sudden death in patients undergoing haemodialysis (HD). The QTc interval in HD is regulated by several factors, such as electrolytes, pH, and drugs. However, few studies have investigated the changes in the QTc interval during HD sessions and the determining factors. Therefore, we investigated the relationship between changes in electrolytes and QTc interval during HD. Method In this cross-sectional study, 53 patients undergoing maintenance HD were enrolled. Electrocardiogram and blood samples were obtained two days after dialysis. QTc was measured every hour from the start of the HD session, and blood samples were collected at the start, 2 h after, and at the end of the HD session. At the start of the HD session, we measured the blood levels of urea nitrogen, creatinine, β2-microglobulin (β2MG), HCO3-, albumin, intact-parathyroid hormone, phosphorus, Ca, Mg, and K. Blood Ca, Mg, K, and HCO3- levels were evaluated at the start, 2 h after, and at the end of the HD session. The relationship between changes in the QTc interval and various parameters was analysed by Spearman correlation analysis and multiple regression analysis. Results The patients were aged 37–91 (median; 71.5) years, and the duration of dialysis was 1–402 months (median; 2 months). Of the patients, 40.4% were diagnosed as the prolonged QTc interval (≥460 ms) at the start of HD (median; 455 ms). Conversely, 15.9% of patients at 2 h after the start of HD (median; 444 ms) and 8.4% of patients at end of HD (447 ms) were normalized in QTc interval. The peak change in the QTc interval occurred 2 h after start of HD. Thus, we estimated the factors that affected the change in QTc 2 h after the start of dialysis (ΔQTc2h). The duration of HD treatment (r = 0.312, P = 0.025) and serum levels of β2MG (r = 0.324, P = 0.019) were positively correlated with ΔQTc2h. The 2-h change in corrected Ca (ΔcCa2h) (r = −0. 31, P = 0.03) and intact-PTH (r = −0.30, P = 0.035) were negatively correlated with ΔQTc2h. We found no significant correlation between ΔQTc2h and changes in K and Mg. According to the multiple regression analysis, ΔcCa2h (β = −0.293, P = 0.033) and β2MG (β = 0.271, P = 0.042) were significant predictors of ΔQTc2h. Conclusion We anticipated that QTc interval might be prolonged due to the decreased serum K and Mg levels via HD treatments. However, QTc levels during HD were shortened according to increased serum Ca levels. Among the electrolyte levels, the change in blood Ca was significantly correlated with the change in the QTc interval but not with the change in Mg and K. The study results suggest the importance of optimal dialysate electrolytes composition to prevent adverse events and premature death caused by abnormalities in the QTc interval.

The Impact of Medium Cut-Off Dialyzers on Malnutrition-Inflammation Scores in Maintenance Hemodialysis Patients

Introduction: Medium cut-off (MCO) membranes may be able to remove middle-large uremic toxins that are retained in the body, which has been linked to various risk factors including malnutrition-inflammation score (MIS). The effect of MCO dialyzers on MIS has been studied. Methods: This single-center exploratory prospective observational study enrolled maintenance hemodialysis patients who underwent dialysis using either MCO (Theranova 400) or high-flux (FX80) membranes as part of their regular care. Measurements of MIS, body weight, height, body mass index, and various biochemical markers were taken at the beginning and conclusion of the study. Results: This study included 50 patients who were treated with either the Theranova 400 (n = 25) or the FX80 (n = 25) for a period of 6 months. The two groups were similar in terms of demographics, duration of hemodialysis treatment, and baseline biochemical test results. Theranova 400 had no significant impact on the median MIS (6 [6–10] vs. 7 [5-10], p 0.575) and serum albumin levels (4.07 [3.92–4.22] vs. 4.04 [3.85–4.30], p 0.689), while the FX80 resulted in a significant increase in MIS (6 [5–8] vs. 8 [6–10], p 0.033) and a significant decrease in serum albumin levels (4.23 [4.03–4.36] vs. 3.98 [3.77–4.12], p 0.027) at the end of the study. Discussion/Conclusion: After 6 months of treatment, the MCO dialyzer did not demonstrate a statistically significant difference in the MIS when compared to the high-flux dialyzer. However, MIS worsening was significantly less in the MCO group, indicating the potential benefits of MCO membranes in maintaining nutritional status. Further research is required to validate these results.

The Duration of Hemodialysis Treatment and comorbidity with Adherence to Fluid Restristion in patient Undergoing Hemodialysis: A Correlational Study

Background: To achieve successful hemodialysis, patients with End Stage Renal Disease (ESRD) must follow comprehensive treatment including: diet, medication use, fluid restriction and presence of hemodialysis. Previous research has identified that fluid restriction is the most difficult regimen to adherence.Limiting fluid intake is very important done For avoid complications excess fluid Which can cause interdialytic weight gain (IDWG) and has an impact on cardiovascular complications such as congestive heart failure, pulmonary edema and even death. Apart from complications due to excess fluid, patients are also at risk of experiencing complications from hypertension, anemia, decreased immunity and nervous disorders . This can influence patient perceptions and impact behavior on compliance with hemodialysis therapy regimens . Another thing that can affect compliance is ongoing psychosocial stress due to having to undergoing hemodialysis therapy for a long time, causing a negative impression or attitude towards fluid restriction management. Apart from that, other research stated that the duration of hemodialysis was correlated with non-compliance with fluid restrictions . Based on this phenomena, researchers are interested in analyzing the relationship between length of time undergoing hemodialysis and comorbidities with fluid restrictions in hemodialysis patients.Purpose : This study aims to determine the relationship between duration of hemodialysis treatment and comorbidity with adherence to fluid restrictions in patients hemodialysis.Methods: This study used a cross sectional design with consecutive sampling on 121 respondents. Data collection with demographic sheets and fluid compliance questionnaires. Next, a bivariate analysis was carried out using Chi-Square .Results : The majority of respondents were in the age range 41-60 years namely 82 respondents , the majority of respondents were men As many as 75 respondents , the education level of the respondents showed that most were at the high school level, around 59 respondent , The majority of respondents had undergoing hemodialysis within a period of 1-5 years. Characteristics respondents other is comorbidity where majority own comorbidity <3 as much as many as 100 respondents. bivariate analysis showed that there was a significant relationship between duration of hemodialysis treatment and adherence to fluid restrictions (p=0.033), however there was no significant relationship between comorbidities and adherence to fluid restrictions (p= 0.560 ) .Conclusion: there is a significant relationship between duration of hemodialysis treatment and adherence to fluid restrictions, but there is no significant relationship between comorbidities and adherence to fluid restrictions. Keywords : End Stage Renal Disease, Hemodialysis , Fluid adherence, comorbidity, Duration of Hemodialysis Treatment

Evaluation of Ocular Perfusion in Patients with End-Stage Renal Disease Receiving Hemodialysis Using Optical Coherence Tomography Angiography.

Hemodialysis (HD) is known to affect ocular blood flow. This case-control study aims to evaluate macular and peripapillary vasculature in patients with end-stage renal disease (ESRD) receiving HD in comparison to matched controls. A total of 24 eyes of 24 ESRD patients receiving HD and 24 eyes of 24 healthy, age- and gender-matched control subjects were prospectively included in this study. Optical coherence tomography angiography was used to image the superficial (SCP), deep (DCP), and choriocapillary (CC) macular vascular plexus, as well as the radial peripapillary capillaries (RPC) of the optic disc. In addition, retinal thickness (RT) and retinal volume (RV) were compared between both groups. Flow density (FD) values of each retinal layer and data of parameters related to the foveal avascular zone (FAZ), as well as RT and RV, were analyzed using Mann-Whitney U tests. There was no significant difference in FAZ parameters between the two groups. Whole en face FD of the SCP and CC was noticeably reduced in the HD group in comparison to the control group. FD was negatively correlated with the duration of HD treatment. RT and RV were significantly smaller in the study group than in controls. Retinal microcirculation appears altered in patients with ESRD undergoing HD. Concurrently, the DCP appears more resilient towards hemodynamic changes in comparison to the other microvascular retinal layers. OCTA is a useful, non-invasive tool to investigate retinal microcirculation in ESRD patients.

Comparison of use of central venous catheter and arteriovenous fistula as initial vascular access in 735 patıents with end-stage renal disease

Aim: Although arteriovenous fistula (AVF) has been shown as the first choice for hemodialysis (HD), its superiority over central venous catheter (CVC) is still controversial considering the risk factors. Aim was to compare AVF and CVC, which should be is used as the first vascular access in HD.
 Material and Methods: Patients were divided into two groups according to the use of AVF and CVC. The groups were compared in terms of age, gender, body mass index (BMI), comorbidities, use of antiplatelet and anticoagulant agents, HD sessions per week, end stage renal disease (ESRD) duration, HD treatment duration, patency of vascular acces and number of changes. 
 Results: When patients were grouped, 499 patients were in the CVC group and 235 patients were in the AVF group. The mean age of patients in the AVF group was higher than that of the CVC group (p=0.010). The difference between the median ESRD duration of the patients in the CVC and AVF groups was statistically significant (5 vs 6 months) (p=0.004). The duration of HD treatment was significantly longer in the AVF group (p=0.031). The median patency of their CVC was 3 months, while the median patency of their AVF was 48 months (p

Features of erythrocyte electrophoretic mobility in programmed hemodialysis patients

Objective: to analyze the electrophoretic properties of erythrocytes in patients receiving programmed hemodialysis treatment. Materials and Methods. The study included 100 patients with an established diagnosis of stage 5D chronic kidney disease, receiving programmed hemodialysis treatment. The control group included 17 healthy blood donors. The following indicators of erythrocyte electrophoretic activity were evaluated: oscillation amplitude, percentage of motile cells, ellipticity, and aggregation index. Results. Compared with the control group, we revealed significant changes in the amplitude of oscillations and the percentage of motile cells (p<0.001). No significant gender-dependent differences were observed (p>0.05). Statistically significant differences between young and senile age groups (p=0.048) were observed in the average oscillation amplitude, whereas ellipticity differed significantly in middle-aged vs. senile patients (p=0.040) and elderly vs. senile subjects (p=0.035). As for the effect of hemodialysis treatment duration, a reduction in the oscillation amplitude was observed when comparing maximum with minimum duration: less than 1 year (p=0.029) and 1 year (p=0.035). Aggregation index values were the highest in the groups with the minimum (p=0.044) and maximum (p=0.035) dialysis duration. Conclusion. In hemodialysis patients, the oscillation amplitude of erythrocytes was significantly reduced, with assumed tendency for further decrease associated with duration of hemodialysis treatment.

Клиническая оценка нарушений мелатонинобразующей функции эпифиза и анемии у больных с хронической болезнью почек 5-й стадии, которые лечатся гемодиализом

Актуальность. Результаты ряда исследований доказали наличие взаимосвязи между функциональным состоянием эпифиза и функцией почек. Однако нарушение мелатонинобразующей функции эпифиза (МФЭ) у больных хронической болезнью почек (ХБП), находящихся на гемодиализе (ГД), и его связь с развитием анемии у данной популяции пациентов являются малоизученным вопросом. Цель: провести клиническую оценку анемии у больных ХБП 5-й стадии, которые лечатся ГД, в зависимости от клинико-демографических показателей и определить ее связь с нарушением МФЭ. Материалы и методы. Обследованы 130 пациентов (50 % мужчин) с ХБП 5-й стадии, находящихся на лечении гемодиализом. С учетом уровня мелатонина (МТ) в слюне больных, которые лечатся ГД, разделили на две группы: группа I — 110 больных с нарушенной МФЭ, группа II — 20 пациентов с нормальной МФЭ. Контрольную группу составили 20 здоровых лиц, сопоставимых по возрасту и полу. Всем больным проведены клинико-лабораторные исследования: общий и биохимический анализы крови с определением всех показателей обмена железа крови, липидного профиля, измерение артериального давления, расчет индекса массы тела, определение концентрации мелатонина в слюне в разные периоды суток и паратгормона. Результаты. Обнаружена значительная распространенность нарушения МФЭ у больных ХБП 5-й стадии, которые лечатся ГД, и его связь с развитием анемии. Анализ циркадных уровней МТ в зависимости от степени тяжести анемии продемонстрировал глубокие их нарушения у пациентов со средней степенью тяжести анемии, при котором достоверная разница определялась по уровню МТ в ночное время (р = 0,004). Анализ корреляционных связей показал слабую отрицательную корреляционною связь между уровнем гемоглобина (Нb) и продолжительностью лечения ГД (r = –0,217; р < 0,05), что может свидетельствовать о прогрессировании анемии при увеличении стажа почечно-заместительной терапии (ПЗТ). Установлены положительные корреляции между Нb и уровнем дневного МТ (r = 0,193; р < 0,05) и более тесные — с уровнем ночного МТ (r = 0,278; р < 0,05), что отражает взаимосвязь между нарушением МФЭ и синтезом Нb. Продемонстрирована отрицательная корреляционная связь ферритина с Нb (r = –0,31; р < 0,05), с уровнем сывороточного железа (r = –0,202; р < 0,05) и уровнем трансферрина (r = –0,234 р < 0,05). Отрицательная корреляционная связь определяется между уровнем ферритина и дневным уровнем МТ в слюне (r = –0,202; р < 0,05), связь средней силы — с ночным уровнем МТ (r = –0,396; р < 0,05). При анализе уровня трансферрина определялись положительные корреляционные связи последнего с дневным уровнем МТ (r = –0,332; р < 0,05) и средние корреляционные связи — с ночным (r = 0,447; р < 0,05). Определялась обратная слабая корреляционная связь трансферрина со стажем ГД (r = –0,191; р < 0,05). Выводы. Продемонстрирована высокая частота нарушения МФЭ (84,6 %), что ассоциируется со значительной распространенностью анемии и дефицита железа у больных ХБП 5-й стадии, находящихся на лечении ГД. У больных на ПЗТ установлена взаимосвязь между степенью дисфункции эпифиза и тяжестью анемии, при этом она усиливается с увеличением срока лечения ГД, продолжительности АГ. У больных на ГД концентрация ферритина отражает активность воспаления, возрастает при нарушении МФЭ. Дисфункция эпифиза и анемия имеют возрастзависимый характер: наиболее выражены в пожилом возрасте.

Factors Affecting The Satisfaction Of Hemodialysis Patients From The Nursing Care Received

Introduction: In the field of hemodialysis care, the issue of patient satisfaction is of particular importance. These patients are users of health care, usually for a long time. Most of them are particularly sensitive to the attitude of the health care system towards them. This requires special attention, especially when it comes to their opinion about the quality of the service they receive. Objective: To study and analyze the factors influencing the satisfaction with the received nursing care in patients on hemodialysis treatment. Material and methods: Documentary, sociological and statistical methods were used in the study. An anonymous survey surveyed the opinion of 575 patients on hemodialysis treatment in dialysis structures located in 8 cities (Varna, Ruse, Dobrich, Burgas, Shumen, Razgrad, Targovishte and Silistra). The data was processed using SPSS Statistics. Results: Examining patient satisfaction as users of hemodialysis nurses, we found that almost all were satisfied (90%). 8.52% of the respondents cannot assess their degree of satisfaction, and 1.74% of the respondents are completely dissatisfied. It is noteworthy that those who expressed dissatisfaction with nursing care are only males. As the age of the patients increases, so does the satisfaction with the care provided by the dialysis nurse. As the time spent on hemodialysis treatment increases, so does the satisfaction of patients with the nursing care provided. Patients with lower levels of satisfaction are more adamant that the nurse can contribute to the quality of dialysis care. Conclusions: Patients on hemocial treatment were satisfied with the care they received during treatment (p<0.001). Among the factors influencing their satisfaction are: gender (p <0.05), age (p<0.001), duration of hemodialysis treatment (p<0.05). Our study found that patients who felt that the nurse could influence the quality of care provided had a lower level of satisfaction.

The Duration of Hemodialysis Treatment and the Adherence of Chronic Kidney Disease Patients in Fluid Intake Limitation: a Relationship

Hemodialysis is a routine medical intervention for a patient with chronic kidney disease. The duration of hemodialysis treatment makes the patient's behavior change to be not adherence to the recommended diet, including restrictions on fluid intake. The objective of this research is to determine the Relationship duration of hemodialysis treatment with Adherence to fluid restriction of Chronic Kidney Disease Patients. This cross-sectional study involving 44 respondents, taken by consecutive sampling techniques. Research has been conducted in the hemodialysis room at the Reksodiwiryo hospital in Padang from May-June 2019. Data collection was carried out by looking at medical records and questionnaires regarding fluid intake compliance in patients with chronic kidney disease. The data obtained were analyzed univariate with frequency distribution and bivariate with the Kendall Tau test. The results showed that there were 26 (59.1%) non-adherence patients, and 18 (40.9%) patients were adherence to limiting fluid intake. Old patients were 17 people (38.6%) and new patients were 27 (61.4%). The Kendall Tau bivariate test showed that the length of hemodialysis has a significant correlation with adherence fluid restriction (p = 0.014), with a negative correlation (r -0.375), it's meaning that the longer the hemodialysis, the lower the fluid restriction compliance. It is expected that hemodialysis nurses regularly evaluate the compliance of hemodialysis patients and routinely carry out educational and motivational programs as well as fluid diet counseling at each hemodialysis session. Keywords: compliance, fluid, hemodialysis, restriction

Characteristics of melatonin-forming disorders of the epiphysis in hemodialysis patients depending on clinical and demographic parameters

Current scientific studies’ results have shown the relationship between the epiphysis functional state and the kidneys function. However, the impaired of the epiphysis melatonin-forming function (MFE) in patients with chronic kidney disease (CKD) undergoing hemodialysis (HD) is a poorly understood issue.
 Methods. 130 HD patients (50% of men) were examined in this study. Based on the melatonin level, the patients were allocated into 2 groups: group I included 110 HD patients with impaired MFE and group II consisted of 20 HD patients with preserved MFE. 20 healthy individuals were included in the control group.
 Results. The melatonin level was significantly lower in HD patients compared to the control group at daytime and night (p <0.001). MFE disorder were diagnosed in 84.6% HD patients. The group I patients had significantly higher BMI (p = 0.01), waist volume (p = 0.04), duration of HD treatment (p = 0.01) and arterial pressure (p <0.001) compared with the second group. Moreover, the increased level of C-reactive protein (p <0.001), total cholesterol (p < 0.05), triglycerides (p <0.05) and a lower serum albumin level (p <0.01) were observed in the patients of group I compared with the second one. The melatonin levels at daytime and night were significantly correlated with the patients’ age (r = -0.42; p <0.001 and r = -0.40; p <0.001), HD treatment duration (r = -0.64; p <0.001 and r = -0.65; p <0.001), BMI (r = -0.22; p = 0.006 and r = -0.33; p <0.001) and arterial pressure (r = -0.66; p <0.001 and r = -0.84; p <0.001). In addition, albumin, hemoglobin and serum uric acid concentration were associated with the melatonin level.
 Conclusions. The violation of MFE was diagnosed in 84.6% of HD patients and determined by the duration of the dialysis treatment, the blood pressure, body weight, hemoglobin level, the degree of impaired protein and purine metabolism.

Determination of genotoxic effects in hemodialysis patients with chronic kidney disease and the role of diabetes mellitus and other biochemical parameters

Chronic kidney disease (CKD) is a common health problem. The primary etiology of CKD is diabetes mellitus (DM). The aim of our study is to determine the possible role of DM and also effects of other factors such as hypertension, duration of hemodialysis (HD), age, sex, body mass index (BMI), and levels of hemoglobin (HB), intact parathormone (iPTH), and ferritin on genetic alterations in maintenance HD patients using chromosomal aberrations (CAs), sister chromatid exchanges (SCEs), and micronucleus (MN) tests. According to the results, the frequency of CAs (p = 0.001), SCEs (p < 0.001) and MN (p < 0.001) statistically increased in HD patients compared to controls. However, there was no significant effect of diabetes as well as other factors on CA, SCE (except at factor of age), and MN in HD patients compared to controls. The mitotic (MI), replication (RI) and nuclear division indices (NDI) significantly decreased in HD patients compared to controls (p < 0.001). In addition, RI (p < 0.001) and NDI (p = 0.047) were significantly decreased in diabetic HD patients than the non-diabetic HD patients. There was no relation between the frequency of CA, SCE and MN and duration of HD treatment with correlation analysis. According to univariate regression analyses, only having CKD was significantly associated with the values of CA, SCE and MN. However, in multivariate analyses, only having CKD remained as significantly associated with CA, SCE and MN values. Consequently, the clastogenic and mutagenic effects increased in HD patients compared to controls; unlike DM in which cell proliferation decreased.

PAIN SYNDROMES DEVELOPING IN PATIENTS DURING LONG-TERM HEMODIALYSIS

Objective. To assess the frequency and intensity of painful muscle spasms (cramps) in patients with end-stage CKD during hemodialysis; to determine the impact of potentially modifiable risk factors on their development. Materials and Methods. The study involved 111 male and female patients receiving treatment on hemodialysis program. Crumps intensity was assessed using a brief pain questionnaire two hours after hemodialysis initiation, during three consecutive procedures. The HADS questionnaire was used to detect anxiety and depression. Blood pressure, interdialysis weight gain were evaluated during three consecutive dialysis procedures. Phosphate binders were taken into account for all patients in the sample. Serum concentrations of phosphorus (P), total calcium (Ca) and parathyroid hormone (iPTG) were determined in all patients. Results. The mean age of patients was 51.8 ± 2.3 years, the mean duration of hemodialysis treatment was 7.7 ± 0.9 years, the mean procedure duration was 12 ± 0.24 hours per week, the mean level of KT/V was 1.4 ± 0.03. The frequency of crumps was 55%, the mean intensity was 5.2±1.8 points by the numerical rating scale (NRS). Compared with the group of patients without crumps, the risk of pain muscle spasms increased with increasing age of patients, hemodialysis experience, interdialysis weight gain. An important modifiable risk factor was intradialysis hypotension (or 10.9 (95%CI 3,0; 38.9) p = 0.0002). Statistically significant differences between the groups with or without cramps not obtained on any of the three indicators of mineral metabolism (PTH (p = 0,87); P (p = 0,25); overall Ca (p = 0,70)). Conclusion. Painful muscle spasms (cramps) occur in every second patient on hemodialysis program. The impact on potentially modifiable risk factors for muscle spasms, such as interdialysis weight gain, hypotension during hemodialysis, and phosphorus level correction, can reduce the frequency and intensity of this type of pain syndrome.

Hemodialysis Water Parameters as Predisposing Factors for Anemia in Patients in Dialytic Treatment: Application of Mixed Regression Models.

Contamination by metals and microbiological agents in hemodialysis water can cause clinical intercurrences in hemodialysis patients. Evaluating and assuring minimum levels of contamination from metals and microorganisms in hemodialysis water can improve patient safety. The objective of this study was to assess hemodialysis water quality in a major tertiary hospital in Brazil and investigate the relationship between hemodialysis water quality and clinical intercurrences in hemodialysis patients. A prospective-observational cohort study for evaluation of water quality parameters and clinical intercurrences present by patients (n = 52) were performed from May 2014 to April 2015. Mixed linear regression models and binary regression models were fitted for water quality parameters and patients' clinical parameters. The increase in the levels of copper and nitrate in hemodialysis water was significant (p < 0.05) to explain anemia. Bone pain was related to age, sex (female), and hemodialysis treatment duration (years). Hypotensive episodes were related to serum sodium decrease. Aluminum in hemodialysis water was present in an average concentration higher than the permitted threshold (15.35 ± 14.53μg/L). Cadmium, total coliforms, Escherichia coli, and endotoxins in hemodialysis water were not detected and the heterotrophic bacteria count was below the reference limit. These parameters' concentrations varied during the study, evidencing the need for continuous monitoring.

AGE AND GENDER-SPECIFICS OF CARDIOVASCULAR MORTALITY IN HEMODIALYSIS PATIENTS

Cardiovascular diseases are the leading causes of death in hemodialysis (HD) patients. An analysis of the epidemiological evidence is the basis for the development of the measures and recommendations directed on reducing prevalence of fatal events, including cardiovascular.&#x0D; Aim. The study of cardiovascular mortality in patients who received treatment for renal replacement therapy, based on the demographic and gender characteristics, type of kidney damage and duration of HD treatment.&#x0D; Methods. Cardiovascular mortality causes in 89 patients who received programmed hemodialysis from January 1, 2007 to December 31, 2011 in Kyiv City Scientific and Practical Center of Nephrology and Dialysis were analyzed.&#x0D; Results. Cardiovascular disease was the primary cause of death in the study population (64, 96 %). The annual cardiovascular mortality rate has a significant positive trend in the HD patients. It was ascertained its declining from 10,26% in 2007 to 6,69% in 2011.&#x0D; About 40% of cardiovascular causes of death occurred during the first 90 days of HD treatment, 73,53% of them were among males.&#x0D; The number of fatality authentically is higher for younger women with non- diabetic renal glomerular lesions and middle-aged patients with diabetes mellitus. CVD, as the cause of death, was significantly more often for males of middle age with the glomerular (diabetic and non-diabetic) diseases and of the elderly - with nonglomerular and non-diabetic glomerular origin.&#x0D; Conclusion. According to the study the series of the regularities of the structure of cardiovascular mortality has been established. The significant association between the sex of the patient and the type of renal disease was identified in each age group.

Risk Factors Associated with Pain on Chronic Intermittent Hemodialysis: A Systematic Review.

The aim of the study was to define risk factors related to pain in adult end-stage renal disease (ESRD) patients on chronic intermittent hemodialysis (HD) by developing a systematic review of published data. The search was conducted from MEDLINE, Scopus, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). Manuscripts in all languages were considered. Two authors performed each step independently, and all disagreements were resolved after discussion with the third author. Quality of studies was analyzed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist and Cochrane risk of bias tool. A total of 67 studies with 7,818 participants were included (median number of participants=60). Most of the studies reported common factors such as age, gender, body mass index, race/ethnicity, marital status, duration of HD treatment since initiation of HD, different comorbidities, and biochemical parameters. Other studies reported more specific factors such as type, regimen or place of hemodialysis, type of dialyzer, dialysis phase, type of dialyzer membrane, administration site, type of preparation, and dose of erythropoiesis-stimulating agent (ESA). The studies indicate that these factors may contribute to increased pain in general and also promote development of different pain modalities of various locations and causes in HD patients (eg, pain in general, pain related to arteriovenous access, headache, musculoskeletal pain, ESA application pain). Multiple factors for various types of pain in very heterogeneous populations and heterogeneous settings were analyzed in the literature. The results turned out to be inconsistent between the studies. Future large-scale studies are required, taking into the account limitations of the current evidence base.

Factors that Influence Graft Function at 1-Year Posttransplantation and Correlation with Baseline Donated Kidney Function Measured with Radioisotopes

Abstract Introduction. Assessment of renal function is a crucial component of donor evaluation. The higher measured donor GFR is independently associated with a better allograft outcomes in living donor kidney transplantation (LDKT). Monitoring graft function and estimation of GFR is a recommended method for patients’ follow-up in posttransplantation period. The aim of our study was to investigate the correlation of directly measured GFR of donated kidney with estimated GFR through creatininebased formulas and to detect impact factors on the graft function at 12 months posttransplantation. Methods. Fifty LDKT patients (related and nonrelated donors) with stable renal function in a period of 12 months after transplantation were included in our study. The mean recipient age was 30.7±9.6 years, and donor age 55.45±9.41 years. The mean directly measured donated kidney GFR was 47.61±5.72 ml/min. Graft function was estimated at 3, 6 and 12 months by 3 formulas: Cockcroft- Gault (C-G), MDRD 6 variables and Nankivell. Direct correlation of estimated with measured radiolabeled 99mTc DTPA GFR was performed. Various impact factors such as donor age, dialysis vintage and different calcineurin inhibitors as a part of immunosupression were evaluated. Results. Estimated GFR at 12 months with MDRD, Cockroft Gault, and Nankivell formulas was 72.65±22.6, 94.25±36.42, and 81.78±17.89 ml/min, respectively. The highest estimated GFR was obtained with C-G formula at all three time points. The estimated allograft GFR did not correlate with directly measured GFR of donated kidney. Donor age well correlated with the graft function at 12 months. Allografts from standard criteria donors-SCD (&lt;60 years) had better function than allografts form expanded criteria donors-ECD (&gt;60 years). The highest GFR was estimated with C-G equation (106.08±39.26 ml/min), while GFR estimated with Nankivell was 86.86±15.30 ml/min, and with MDRD 79.67±20.28 ml/min, presenting patients in stage 2 of chronic kidney disease. Duration of hemodialysis treatment under 24 months showed better graft function estimated by C-G at 12 months (102.23±38.86 ml/min), compared to that above 24 months of HD (77.84±18.11 ml/ min). Different type of calcineurin inhibitors did not influence on the graft function at any time point. Conclusion. Creatinine-based formulas for estimation of the graft function did not correlate with directly measured function of the donated kidney with radiolabeled isotopes, nor between each other. Hence, the monitoring of the graft function should be done by a single formula in the posttransplantation period. Expectedly, a better graft function was observed in young donors (standard criteria) and in patients with shorter hemodialysis treatment.

Association Between Hypertension and Residual Renal Function in Hemodialysis Patients

AbstractIntroduction.Cardiovascular diseases are the leading cause of death in hemodialysis patients. The decline of residual renal function increases the prevalence and severity of risk factors of cardiovascular morbidity and mortality in these patients. Hypertension is common in dialysis patients and represents an important independent factor of survival in these patients.Methods.The study included 77 patients who are on chronic HD for longer than 3 months. Depending on the measured residual diuresis patients were divided into two groups. The study group consisted of patients with residual diuresis &gt;250 ml/day, while patients from control group had residual diuresis &lt;250 ml/day. All patients had their blood pressure measured before 10 consecutive hemodialysis treatments. Collected data were statistically analyzed using SPSS 16.0.Results.The study included 77 hemodialysis patients, mean age of 56.56±14.6 years and mean duration of hemodialysis treatment of 24.0 months. Of the total number of patients, 39(50.6%) had preserved residual renal function. Hypertension was more common in the group of patients who did not have preserved residual renal function (68.4% vs 25.6%). There was statistically significant negative linear correlation between the volume of residual urine output and the residual clearance of urea and values of systolic blood pressure [(rho=−0.388; p&lt;0.0001); (rho=−0.392; p&lt;0.0005)], values of mean arterial pressure [(rho =−0.272; p&lt;0.05); (rho=−0.261; p=0.023; p&lt;0.05)] and values of pulse pressure in hemodialysis patients [(rho =−0.387; p&lt;0.001); (rho=−0.400; p&lt;0.0005)].Conclusions.Residual renal function plays an important role in controlling blood pressure in patients on hemodialysis. More attention should be directed to preserve residual renal function, and after the start of hemodialysis by avoiding intensive ultrafiltration with optimal antihypertensive therapy.

PP.11.25

Objective: Despite advances in the technology of dialysis, cardiovascular morbidity and mortality in patients with end-stage renal disease (ESRD) who are on hemodialysis therapy are still very high. Recent clinical studies have demonstrated a significant correlation between leptin levels and hypertension, hyperlipidemia, perturbed fibrinolysis and chronic inflammation. The aim of this study was to investigate the significance of changes in serum leptin concentrations and relationship of leptin and traditional cardiovascular risk factors in patients with varying duration of hemodialysis therapy. Design and method: The cross sectional study included 60 patients with end stage renal disease, of both sexes, divided into two equal groups (n = 30) based on the duration of hemodialysis treatment: A group of subjects who are on hemodialysis therapy between three months and five years, and group of subjects who are on hemodialysis therapy five and more than five years. The control group (n = 30) consisted of apparently healthy subjects, with no subjective and objective indicators of chronic renal disease. The serum leptin concentration was determined by enzyme-linked immunosorbent assay (ELISA). Results: Serum leptin levels in patients in Group under 5 years was significantly higher from leptin concentrations in serum of patients in Group eqally and more then 5 years and of serum leptin concentrations in the control group. Statistically significant positive correlation was found between serum leptin levels and body mass index (BMI) in subjects of Group eqally and more then 5 years and in the control group. There was no significant correlation between serum leptin levels and C – reactive protein (CRP) in any of the groups of patients. Results showed that the serum leptin value had a poor diagnostic accuracy in distinguish hemodialysis patients from healthy control, as well as, hemodialysis patients at different length of dialysis therapy. Conclusions: In this population of stable HD patients, obtained results do not support the hypothesis that serum leptin and relationship between leptin and traditional cardiovascular risk factors can be used as an independent marker to distinguish between hemodialysis patients than healthy subjects, nor in differentiating hemodialysis patients at different length of dialysis therapy.

Compliance with guidelines and predictors of mortality in hemodialysis. Learning from Serbia patients

ObjectivesThe aims of the study were to determine the percentage of patients on regular hemodialysis (HD) in Serbia failing to meet KDOQI guidelines targets and find out factors associated with the risk of time to death and the association between guidelines adherence and patient outcome. MethodsA cohort of 2153 patients on regular HD in 24 centers (55.7% of overall HD population) in Serbia were followed from January 2010 to December 2012. The percentage of patients failing to meet KDOQI guidelines targets of dialysis dose (Kt/V>1.2), hemoglobin (>110g/L), serum phosphorus (1.1–1.8mmol/L), calcium (2.1–2.4mmol/L) and iPTH (150–300pg/mL) was determined. Cox proportional hazards analysis was used to select variables significantly associated with the risk of time to death. ResultsThe patients were on regular HD for 5.3±5.3 years, dialyzed 11.8±1.9h/week. Kt/V<1.2 had 42.4% of patients, hemoglobin <110g/L had 66.1%, s-phosphorus <1.1mmol/L had 21.7% and >1.8mmol/L 28.6%, s-calcium <2.1mmol/L had 11.7% and >2.4mmol/L 25.3%, iPTH <150pg/mL had 40% and >300pg/mL 39.7% of patients. Using Cox model (adjustment for patient age, gender, duration of HD treatment) age, duration of HD treatment, hemoglobin, iPTH and diabetic nephropathy were selected as significant independent predictors of time to death. When targets of five examined parameters were included in Cox model, target for KtV, hemoglobin and iPTH were found to be significant independent predictors of time to death. ConclusionSubstantial proportion of patients examined failed to meet KDOQI guidelines targets. The relative risk of time to death was associated with being outside the targets for Kt/V, hemoglobin and iPTH.