Factors In Hemodialysis Patients Research Articles

Investigation of temporomandibular joint diseases and related factors in hemodialysis patients: a cross-sectional study

Aims: This study aimed to investigate the prevalence of temporomandibular joint diseases (TMD) among hemodialysis (hd) patients and to explore the association between sociodemographic and laboratory parameters and the occurrence of TMD. Methods: A cross-sectional study was conducted involving 81 hd patients. Sociodemographic characteristics and laboratory parameters of the participants were collected. TMD was assessed using the fonseca anamnestic test. Statistical analysis was performed using spss-22. Results: Among the 81 participants, 39 (48.1%) were female and 42 (51.9%) were male, with a mean age of 58.2±15.27 years. TMD was detected in 50 patients (61.7%). Significant associations were found between TMD and the presence of comorbid diseases (p=0.002), low hemoglobin levels (p=0.001), and low albumin levels (p=0.002). Conclusion: the study identified comorbid diseases, low hemoglobin, and low albumin as significant factors associated with TMD in hd patients. These findings suggest that heightened awareness and targeted management of these risk factors may improve clinical outcomes for hd patients with TMD. Enhanced understanding among clinicians regarding the high incidence and related factors of TMD in this patient population could lead to more effective treatment strategies.

Pain Assessment and Affecting Factors in Hemodialysis Patients

Pain Assessment and Affecting Factors in Hemodialysis Patients

#477 Risk factors for the mortality among hemodialysis patients with COVID-19 infection in 28 hemodialysis centers, South Korea

Abstract Background and Aims Understanding mortality risk factors in hemodialysis patients with COVID-19 is critical for effective management. This study aimed to identify the factors influencing mortality risk and to evaluate the efficacy of COVID-19 vaccines in this specific population. Method This retrospective study analyzed clinical data from patients with COVID-19 who underwent hemodialysis at 28 affiliated centers of the Yeolin Medical Foundation between January 2020 and December 2022. Risk factors contributing to mortality were assessed through comparative analysis between survivors and deceased patients using R statistics. Results Of the 1,983 (ive study analyzed clinical data from patients with COVID-19 who underwent hemodialysis at 28 affiliated centers of the Yeolin analysis comparing survivors and deceased individuals revealed significant associations between mortality risk and several factors such as the omicron dominance period, age om patients with COVID-19 who underwent hemodialysis at 28 affiliated centers of tation, except for one dose, showed a decreasing trend in mortality risk with increasing doses. In the multivariable analysis, age ≥65 years(OR 1.04;95% CI[1.00 - 1.09],p=0.028), dyspnea(OR1.13;95% CI [1.07 - 1.19],p<0.001), and multiple doses of COVID-19 vaccination{2 doses(OR 0.91;CI[0.86 - 0.96],p=0.001), 3 doses(OR 0.88;CI[0.84- 0.92],p<0.001), 4 doses(OR 0.88;CI [0.84 - 0.93],p<0.001), 5 doses(OR 0.87;CI[0.81 - 0.93],p<0.001)} retained significance. Mortality did not appear to be significantly affected by sex, duration of ESRD, BMI, pneumococcal vaccination status, type and total number of comorbidities, or use of immunosuppressants. Conclusion Hemodialysis patients with COVID-19 infection have a high mortality rate per se, and comorbidity had no effect on mortality. Age(>65) and dyspnea were associated with higher mortality rates, and the lower ORs with increasing number of vaccines suggest that vaccination is a crucial protective factor in dialysis patients.

Nutritional Strategies to Mitigate Complications and Improve Long-Term Functionality of Autologous Arteriovenous Fistula Post Ultrasound and DSA Guided Balloon Dilation

This prospective cohort study evaluated the efficacy of omega-3 fatty acid supplementation on arteriovenous fistula patency and systemic inflammation in 220 hemodialysis patients undergoing ultrasound and digital subtraction angiography-guided balloon dilation. The participants were randomized into an intervention group receiving 2,000 mg of omega-3 fatty acids daily and a placebo group. The primary outcome measures were arteriovenous fistula patency at 12- and 24-months post-dilation, while secondary outcomes included thrombosis incidence, changes in inflammatory markers (c-reactive protein and interleukin-6), lipid profiles, and health-related quality of life (HRQoL). Results indicated a significant improvement in arteriovenous fistula patency in the omega-3 group at 24 months (80.9 vs. 68.2%, P < 0.05). Additionally, there was a significant reduction in thrombosis rates (7.3 vs. 16.4%, P < 0.05) and inflammatory markers (c-reactive protein and interleukin-6) in the omega-3 group compared to the placebo. Lipid profile analysis showed a decrease in total cholesterol and low-density lipoprotein levels with omega-3 supplementation, with significant changes at 12 months (P < 0.05). HRQoL scores also improved significantly in the omega-3 group at both 12 and 24 months (P < 0.05). These findings suggest that omega-3 fatty acids can enhance arteriovenous fistula functionality and reduce cardiovascular risk factors in hemodialysis patients. And its integration into standard care protocols for patients with arteriovenous fistulas would improve long-term outcomes.

Immune Response after Anti-SARS-CoV-2 mRNA Vaccination in Relation to Cellular Immunity, Vitamin D and Comorbidities in Hemodialysis Patients.

In the global threat of SARS-CoV-2, individuals undergoing maintenance dialysis represent a vulnerable population with an increased risk of severe COVID-19 outcomes. Therefore, immunization against SARS-CoV-2 is an essential component of healthcare strategy for these patients. Existing data indicate that they tend to exhibit a reduced immune response to vaccines compared to the general population. Our study aimed to assess both humoral and cellular immune responses following two doses of an anti-SARS-CoV-2 mRNA vaccine, an ability to maintain adequate antibody titers over time, and potential relations with vitamin D, comorbidities and other factors in hemodialysis patients based on a single center experience. A total of 41/45 patients (91.1%) responded to the second dose of the anti-SARS-CoV-2 mRNA vaccine. The titer of anti-SARS-CoV-2 IgG class antibodies and levels of T cells three to four weeks after vaccination were lower in dialysis patients than in healthy controls. Antibodies titer in dialysis patients had a positive correlation with B lymphocytes and was related to cardiovascular diseases. The level of CD4+ cells had a negative correlation with hemodialysis vintage, as did the vitamin D level with post-vaccination seroconversion and decline in anti-SARS-CoV-2 antibodies titer during six months after vaccination. Hemodialysis patients had decreased amounts of CD4+ and CD8+ cells and lower levels of anti-SARS-CoV-2 antibodies than healthy controls. Therefore, chronic hemodialysis could lead to diminished cellular immunity and humoral immune response to the anti-SARS-CoV-2 mRNA vaccination and reduced protection from COVID-19. Comorbidity in cardiovascular diseases was associated with a lower level of specific anti-SARS-CoV-2 antibody titer. Vitamin D may be important in maintaining stable levels of anti-SARS-CoV-2 antibodies, while the duration of dialysis treatment could be one of the factors decreasing anti-SARS-CoV-2 antibody titer and determining lower CD4+ cell counts.

Aloe vera supplementation improves cardiovascular risk factors in hemodialysis patients: A randomized, double-blind, placebo-controlled trial.

This study assessed the effects of Aloe vera supplementation on serum inflammatory factors, blood sugar and lipid profiles in hemodialysis patients. Totally, 50 hemodialysis patients were allocated randomly to either Aloe vera or placebo groups. The Aloe vera group received 2 Aloe vera capsules daily for 8 weeks (500 mg/day). Serum C-reactive protein (hs- CRP), Fasting blood glucose (FBS), and lipid profiles levels were evaluated at the baseline and the end of the eighth week. Aloe vera supplementation for 8 weeks was associated with a significant reduction of serum hs- CRP (p=0.004), total cholesterol (p=0.01), low density lipoprotein (LDL) (p=0.02) leves and increased high density lipoprotein (HDL) (p=0.002) concentration in the hemodialysis patients. Aloe vera supplementation is beneficial in improvement of cardiovascular risk factors in hemodialysis patients.

The Characteristics of Myocardial Fibrosis and Analysis on Related Influencing Factors in Hemodialysis Patients

The Characteristics of Myocardial Fibrosis and Analysis on Related Influencing Factors in Hemodialysis Patients

The Prevalence and Risk Factors of Metabolic Syndrome in Patients with Hemodialysis.

Metabolic syndrome is a common disorder that puts patients at high risk for cardiovascular disease (CVD) and mortality. To our knowledge, there is no published study in Pub Med which evaluated both lifestyle and metabolic syndrome in hemodialysis patients. This study aimed to estimate the prevalence of metabolic syndrome and investigate the potential risk factors in hemodialysis patients. This was a cross-sectional study conducted on 204 patients enrolled conveniently. National Cholesterol Education Program Adult Treatment Panel III criteria considered for Metabolic Syndrome. Demographics, lifestyle, and disease characteristics were gathered. The relationship between metabolic syndrome and its severity with independent variables was investigated through multivariable multivariate logistic and linear regressions. The mean (SD) age was 55 (14) years and 42% were women. 42.6% had metabolic syndrome. Low high-density lipoprotein (HDL), high fasting blood sugar, high blood pressure (BP), increased waist circumference (WC), and high triglyceride were observed in decreasing order of frequency in 54.4%, 44.1%, 38.7%, 33.3% 28.9% of patients, respectively. The logistic regression model revealed significant associations between metabolic syndrome and physical activity (OR=0.85, 95% CI : 0.74-0.97), mood (OR=1.04, 95% CI : 1.002-1.078), age (OR=1.023, 95% CI : 1.001-1.046), and missed work (OR=0.86, 95% CI : 0.76-0.97). The linear regression model revealed significant associations between metabolic syndrome severity score and physical activity (B=-0.12, 95% CI : -0.21-0.02) and sleep quality (B=0.017, 95% CI : 0.001-0.033). Poorer sleep quality, lower physical activity, lower mood status, and older age were associated with higher odds of metabolic syndrome/metabolic syndrome severity score in hemodialysis patients.

Time-Dependent Factors Influencing Cardiocerebral Vascular Events in Chronic Hemodialysis Patients: Insights from a Longitudinal Study.

BACKGROUND Cardiocerebral vascular events (CVCs) are significant complications in patients undergoing hemodialysis (HD). Given the increased morbidity and mortality associated with CVCs in this population, understanding the factors influencing CVC occurrence over time is crucial. This study aimed to investigate these time-dependent factors in HD patients. MATERIAL AND METHODS A total of 228 HD patients from 2 dialysis centers, with at least 3 months of treatment between 2017 and 2021, were included. Annual clinical data were collected, and patients were monitored until CVC development. Kaplan-Meier analysis and a time-dependent Cox regression model were used for data analysis. RESULTS The mean age of 228 patients was 55.0±15.0 years, and 64.76% were male. For 5 years of monitoring, the mean follow-up interval was 3.1±1.0 years for patients to develop CVCs. The 1-year, 3-year, and 5-year CVC-free rates were 97.47%, 81.31%, and 70.71%, respectively. Time-dependent Cox regression revealed that C-reactive protein was an independent time-dependent risk factor in HD patients and blood flow rate was an independent time-dependent protective factor. The male subgroup and non-diabetic subgroup had these same results. The following were was the independent time-dependent risk factors: white blood cell count for the female subgroup; blood flow rate for the non-elderly subgroup; and C-reactive protein for the diabetic subgroup. None were risk factors for the elderly subgroup. CONCLUSIONS It took an average of 3.1±1.0 years for patients with HD to develop CVCs. C-reactive protein and blood flow rate emerged as key time-dependent influencing factors for CVCs in this population.

Irritable bowel syndrome frequency and related factors in hemodialysis patients

Irritable bowel syndrome frequency and related factors in hemodialysis patients

Klotho and lean mass as novel cardiovascular risk factors in hemodialysis patients.

Patients with chronic kidney disease (CKD) present a higher risk of cardiovascular (CV) morbidity and mortality compared with the general population. While there are several well-established traditional CV risk factors, few studies have addressed novel potential risk factors such as α-Klotho, asymmetric dimethylarginine (ADMA) and lean mass. This was an observational, prospective, single-center, cohort study that included prevalent hemodialysis (online hemodiafiltration) adult patients. By univariate logistic regression models, univariate and multivariate Cox proportional hazards models, and Kaplan-Meier analysis, we evaluated the association between the levels of α-Klotho, ADMA and lean mass, with the risk of peripheral vascular disease (PVD), CV events and all-cause mortality in these patients. A total of 200 HD patients was included. We found that increased levels of log-α-Klotho were significantly associated with decreased odds of both PVD [odds ratio (OR) 0.521, 95% confidence interval (CI) 0.270-0.954, P=.034] and CV events (OR 0.415, 95% CI 0.203-0.790, P=.01), whereas increased levels of log-ADMA were only significantly associated with increased odds of PVD (OR 13.482, 95% CI 5.055-41.606, P<.001). We also found that the levels of log-α-Klotho (HR 0.357, 95% CI 0.140-0.906, P<.05) and lean mass (HR 0.187, 95% CI 0.042-0.829, P<.05), but not log-ADMA, were significantly associated with the risk of all-cause mortality, even after adjusting for possible confounding variables. Novel long-term clinical associations were generated that support α-Klotho and lean mass as novel CV risk factors in hemodialysis patients.

The Relationship Between Patient Survival and ECG aVR T Wave Positivity in Hemodialysis Patients

Introduction: Evidence suggests a relationship between electrocardiography (ECG) aVR (augmented voltage right) T wave and cardiovascular mortality in hemodialysis patients. The aim of our study was to investigate the relationship between ECG T aVR positivity and overall mortality together with other known risk factors in hemodialysis patients.&#x0D; &#x0D; Materials and methods: One hundred and one hemodialysis patients were retrospectively screened for ECG T aVR wave positivity. In parallel, the relationship between T aVR positivity and age, gender, calcium phosphorus index, heart rate, ECG and echocardiographic parameters, mortality, smoking, presence of diabetes mellitus, hypertension, myocardial infarction were investigated.&#x0D; &#x0D; RESULTS: Univariate analyzes revealed that patients with positive T aVR (16%) had a statistically lower dialysis time and ejection fraction compared to patient with negative T aVR (p=0.041 and p=0.046, respectively). Survival analysis revealed statistically significantly better prognosis for T aVR-negative patients compared to T aVR-positive patients (5-year survival 70.9%, and 45.5%, respectively; p=0.027). Among tested parameters, independent risk factors affecting survival in hemodialysis patients were found to be age (hazard ratio, HR: 1.03), high heart rate (HR: 1.03), smoking (HR: 3.37) and presence of diabetes mellitus (HR: 2.91).&#x0D; &#x0D; CONCLUSIONS: Our results indicate that routine monitorization of T wave in aVR derivation together with evaluation of other risk factors may provide information about the cardiovascular risk profile, mortality and life habits of hemodialysis patients.

Prevalence of Recirculation and Related Factors in Hemodialysis Patients in Golestan Province, Iran

Prevalence of Recirculation and Related Factors in Hemodialysis Patients in Golestan Province, Iran

Libération du canal carpien sous WALANT chez les patients hémodialysés avec shunt artério-veineux

IntroductionLong-term hemodialysis patients experience many hand diseases caused by dialysis-related amyloidosis (DRA), with carpal tunnel syndrome (CTS) being the most common. For the patients with arteriovenous (AV) shunt, surgical decompression remains challenging because of the contraindications of a tourniquet. A technique called wide-awake local anesthesia with no tourniquet (WALANT), in which epinephrine provides hemostasis instead of the tourniquet, can be a good option for hemodialysis patients. The purpose of this study was to assess the prevalence of CTS and related factors in hemodialysis patients and to establish the efficacy and safety of WALANT on hemodialysis patients with AV shunt. Materials and methodsThis prospective study included 275 hemodialysis patients between March 2013 and July 2019. Forty-three patients were diagnosed with CTS, involving surgical treatment on 70 wrists. We performed mini-open carpal tunnel release using WALANT on the AV shunt arm (defined as the WALANT group), while using lidocaine and a tourniquet on the arm without an AV shunt (defined as the tourniquet group). The operative time, surgical field bleeding (blood loss and hemostasis score), surgical pain (injection pain and tourniquet pain), outcomes, complications, and satisfaction were compared between the two groups. ResultsThe incidence of CTS in hemodialysis patients was 15.6%. Longer dialysis durations were related to higher proportions of patients with CTS. There was no significant difference in blood loss (p=0.184) and hemostasis score (p=0.165) between the two groups. Clinical symptoms improved in all patients and there were no severe complications. The WALANT group had a significantly longer preparation time of approximately 20minutes, but they had low injection pain and no tourniquet pain. There was also no significant difference in terms of satisfaction levels (p=0.212). DiscussionCTS is a very common disease among hemodialysis patients. WALANT provided sufficient hemostasis without a tourniquet, despite the patients’ high bleeding tendency. The technique also had the advantages of low injection pain, no tourniquet pain, and no major complications. In this respect, WALANT can be a good choice for hemodialysis patients with AV shunt. Level of evidenceII.

Evaluation of hemodialysis adequacy using urea reduction rate and related factors in Iranian patients’ undergoing hemodialysis in Guilan, Iran

Introduction: Dialysis quality is an important factor in reducing inability and mortality in chronic kidney failure patients and can enhance their life quality and social activity. Objectives: The aim of this investigation was to examine the efficacy of dialysis based on urea reduction rate (URR) and the associated factors in hemodialysis patients due to the lack of clarity on the adequacy of dialysis. Patients and Methods: This multicenter cross-sectional study was conducted on 344 hemodialysis patients over 18 years and referred to seven dialysis centers in Guilan, Iran. The adequacy of dialysis was obtained using URR (&gt;65%) criteria. Results: The mean URR of studied patients was 63 ±10.4%. The desirable dialysis adequacy was reached in 45.9% of the patients. There was a significant negative association between URR and BMI (r= -0.155, P =0.005). Patients who had normal calcium levels had significantly higher URR adequacy than patients with abnormal calcium levels ( P &lt;0.001). The URR criterion was contrariwise associated to blood pressure before and after dialysis ( P &lt;0.05). There was a significant association between the length of the time, patients underwent dialysis (in year) and URR (R=125, P =0.023). Conclusion: This study indicated that URR is a desirable criterion for dialysis adequacy, which was associated with blood pressure, serum calcium level and body mass index (BMI). These findings suggest providing treatment strategies based on these findings to enhance the effect of dialysis adequacy.

Kidney stones incidence and related factors in hemodialysis patients: a multi-center study of Iran southeast population

Introduction: In previous studies, kidney stones was reported as a common complication in general populations. Objectives: This study aimed to evaluate kidney stone incidence and related factors in hemodialysis patients. Patients and Methods: This descriptive-analytical study was conducted on 284 hemodialysis patients in the Zahedan. Demographic and clinical data were collected. The incidence rate of kidney stone was calculated. The correlation between kidney stone incidence with predicting factors was explored by multivariate logistic regression. Results: Results demonstrated that most patients were male, with a mean age of 48.81 ± 16.84 years. The correlation between kidney stone incidence with gender, race, smoking, and blood group was not significant (P &gt; 0.05); however, its correlation with diabetes mellitus, urinary tract infection, age, and body mass index (BMI) was significant (P &lt; 0.05). The kidney stone incidence rate was 23.24%, while diabetes mellitus, urinary tract infection, older age, and higher BMI were the most common predictors. Conclusion: Diabetes mellitus, urinary tract infection, older age, and higher BMI were the common predictors for kidney stone incidence in hemodialysis patients. Identifying kidney stone incidence predictors in patients with hemodialysis can be helping in lower complications.

Oxidative Stress and Hemodialysis: The Role of Aerobic Exercise Training on the Various Laboratory Parameters

Background: Oxidative stress (OS) and inflammation are common factors in patients with chronic kidney disease and increase the risk of cardiovascular disease (CVD) and death in these patients, particularly in hemodialysis (HD) cases. Exercise training is a therapeutic approach to reduce morbidity and mortality in these patients. The purpose of this study was to determine the effect of aerobic exercise training on OS factors in HD patients. Methods: This case-control study was performed over one year (From March 2019 to February 2020) at Kerman (south of Iran). Nineteen outpatient HD patients participated in an aerobic exercise training program during HD. Cycling was performed by mini-cycle in the first hour of HD, pedaling was started with the least tolerable time by the patients, and increased up to three-quarters of an hour based on the patient’s tolerance, three times a week for eight weeks. Also control group, 18 outpatient HD patients were selected and did not enter the exercise training program. Blood samples were collected before and after the intervention in both groups. Inflammatory factors such as albumin (Alb), C-reactive protein (CRP), ferritin, white blood cell (WBC) as well as, oxidative and nitrogenous factors such as malondialdehyde (MDA), carbonyl groups, uric acid, and ionic regenerating capacity were measured. Chi-square and independent t test were used to analyze the data and compare the two groups. Results: There were no significant differences in CRP, Alb, and uric acid between the two groups. In the test group, variables such as total antioxidant capacity (TAC), glutathione (GSH), protein carbonyl (PC), lipid peroxidation (LPO) products, ferric reducing ability of plasma (FRAP), and thiobarbituric acid reactive substances (TBARST) showed a significant difference after the intervention. The values of TAC, GSH, and FRAP in the case group were significantly higher than the same values in the control group (P≤0.0001 for all), but PC (P≤0.006) and TBARS (P≤0.026) values were higher in the control group after the intervention. The intervention had no effect on Alb and ferritin. But, uric acid levels decreased significantly in both groups after the intervention. In the case group, TAC, GSH, and FRAP increased (P=0.0001 for all), but PC, LPO, and TBARST decreased (P=0.0001, P≤0.03, and P≤0.02 respectively). Conclusion: The results of the present study showed that aerobic exercise training had no effect on inflammatory factors such as CRP, ferritin, and Alb.

Comparisons of patient mortality and mortality-related factors in hemodialysis patients with and without systemic lupus erythematosus

Comparisons of patient mortality and mortality-related factors in hemodialysis patients with and without systemic lupus erythematosus

Comparisons of patient mortality and mortality-related factors in hemodialysis patients with and without systemic lupus erythematosus

Comparisons of patient mortality and mortality-related factors in hemodialysis patients with and without systemic lupus erythematosus

Carpal tunnel release under wide awake local anesthesia with no tourniquet in hemodialysis patients with arteriovenous shunt

IntroductionLong-term hemodialysis patients experience many hand diseases caused by dialysis-related amyloidosis (DRA), with carpal tunnel syndrome (CTS) being the most common. For the patients with arteriovenous (AV) shunt, surgical decompression remains challenging because of the contraindications of a tourniquet. A technique called wide-awake local anesthesia with no tourniquet (WALANT), in which epinephrine provides hemostasis instead of the tourniquet, can be a good option for hemodialysis patients. The purpose of this study was to assess the prevalence of CTS and related factors in hemodialysis patients, and to establish the efficacy and safety of WALANT on hemodialysis patients with AV shunt. Materials and methodsThis prospective study included 275 hemodialysis patients between March 2013 and July 2019. 43 patients were diagnosed with CTS, involving surgical treatment on 70 wrists. We performed mini-open carpal tunnel release using WALANT on the AV shunt arm (defined as the WALANT group), while using lidocaine and a tourniquet on the arm without an AV shunt (defined as the tourniquet group). The operative time, surgical field bleeding (blood loss and hemostasis score), surgical pain (injection pain and tourniquet pain), outcomes, complications, and satisfaction were compared between the two groups. ResultsThe incidence of CTS in hemodialysis patients was 15.6%. Longer dialysis durations were related to higher proportions of patients with CTS. There was no significant difference in blood loss (p=0.184) and hemostasis score (p=0.165) between the two groups. Clinical symptoms improved in all patients, and there were no severe complications. The WALANT group had a significantly longer preparation time of approximately 20minutes, but they had low injection pain and no tourniquet pain. There was also no significant difference in terms of satisfaction levels (p=0.212). DiscussionCTS is a very common disease among hemodialysis patients. WALANT provided sufficient hemostasis without a tourniquet, despite the patients’ high bleeding tendency. The technique also had the advantages of low injection pain, no tourniquet pain, and no major complications. In this respect, WALANT can be a good choice for hemodialysis patients with AV shunt. Level of evidenceII.