Hemodialysis Facilities Research Articles

Depression and Anxiety in Chronic Kidney Disease Patients Undergoing Hemodialysis Therapy at Hemodialysis Installations General Hospital Dr. Moewardi Surakarta

<p><em>This study is an analytical descriptive study with a cross-sectional design that aims to determine the proportion and level of depression and anxiety of patients, as well as the relationship between the length of hemodialysis therapy with depression and anxiety of patients with Chronic Kidney Disease undergoing hemodialysis therapy at the Hemodialysis Installation of Dr. Moewardi Surakarta Regional General Hospital. Samples in this study were taken by purposive sampling. The sample in this study amounted to 31 research subjects. The specified data analysis is a Chi-square test analysis to test the relationship between variables. The percentage of anxiety among Chronic Kidney Disease patients receiving hemodialysis treatment at Dr. Moewardi Surakarta Regional General Hospital's Hemodialysis Facility is 29%, while the percentage of depressed patients with Chronic Kidney Disease undergoing hemodialysis therapy at the same facility is 41.9%. It has been determined that there is no discernible correlation between the duration of hemodialysis therapy and the emergence of anxiety and depression in patients with Chronic Kidney Disease at this specific healthcare center. To gain a more comprehensive understanding, additional research is warranted to investigate other factors linked to anxiety and depression in patients with chronic kidney disease undergoing hemodialysis therapy. Furthermore, there is a pressing need for the implementation of a screening program for Chronic Kidney Disease patients undergoing hemodialysis therapy at hospitals, with a potential referral to the Department of Psychiatry for the assessment and management of any mental symptoms that may arise. </em></p><p> </p><p><strong><em>Keyword: Anxiety, Chronic kidney disease, Depression</em></strong></p>

Utility of the low physical activity questionnaire for hemodialysis patients with frailty: a cross-sectional study

BackgroundThe low physical activity questionnaire (LoPAQ), which has been developed to assess the low levels of physical activity in patients on dialysis, is so far available only in English. Moreover, no study has examined whether the LoPAQ can be used to screen for frailty in patients on hemodialysis. The purpose of this study was to translate the original LoPAQ into Japanese and evaluate its utility in screening for frailty among patients on hemodialysis.MethodsFor this cross-sectional study, we enrolled patients from two hemodialysis facilities in Japan between April 2018 and June 2019. We used the LoPAQ to calculate physical activity for one week, with pedometer steps (steps/week) as the standard reference. We used Spearman’s rank test and two multiple linear regression models to assess the relationship between the Japanese LoPAQ results and pedometer step counts. Finally, we examined whether the LoPAQ had the ability to screen for frailty (Fried scale ≥ 3) using area under the curves.ResultsIn total, 220 patients on hemodialysis completed the LoPAQ and wore a pedometer for one week. Their mean age was 67.8 ± 11.6 years, and 59.1% were men. The LoPAQ showed a total physical activity of 825.0 kilocalories/week and walking activity of 315.0 kilocalories/week. The LoPAQ total physical activity and walking activity were significantly correlated with pedometer step counts (r = 0.37–0.53, P < 0.01). Furthermore, LoPAQ total physical activity and walking activity were associated with pedometer step counts despite adjusting for covariates (β: 3.33–5.45, P < 0.001, β: 8.63–16.80, P < 0.001, respectively). In addition, the LoPAQ total physical activity and walking activity showed good values in the area under the curves to identify frailty (0.72 and 0.73, respectively).ConclusionsPhysical activity assessed using the LoPAQ significantly correlated with pedometer step counts in Japanese patients on hemodialysis. Furthermore, the LoPAQ total physical activity and walking activity had a moderate screening ability for frailty. The results indicate that the LoPAQ questionnaire is useful as a physical activity assessment tool and as a screening tool for frailty in patients on hemodialysis.

Patient Care Technician Staffing in US Hemodialysis Facilities: An Ecological Study

Technicians caring for patients receiving dialysis play a critical, frontline role in the care of patients receiving dialysis in the United States. We sought to provide a comprehensive description and identify correlates of US in-center hemodialysis facility patient care technician staffing patterns. This was an ecological study. US facilities providing hemodialysis and reporting patient care technician staffing, identified using the US Renal Data System. Geography, year, and facility characteristics, including aggregated patient characteristics. The study outcome was facility-reported patient-to-patient care technician ratio. We examined patient-to-patient care technician ratios by US state and over time and also estimated the differences in patient-to-patient care technician ratios associated with facility characteristics, using robust regression with adjustment for facility-level covariates. The median patient-to-patient care technician ratio among 6,862 US facilities in 2019 was 9.9 (25th-75th percentiles, 8.2-12.0). Median 2019 patient-to-patient care technician ratios varied substantially by US state and region. There was an overall decline (from 10.6 to 9.9) in median patient-to-patient care technician ratios from 2004 to 2019, whereas the percentage of positions that were unfilled increased (from 2.8% to 3.5%). After adjustment, large dialysis organization status (β,-0.42; 95% CI,-0.61 to-0.23) and larger facility size (β,-0.51; 95% CI,-0.68 to-0.33) were associated with lower patient-to-patient care technician ratios. Higher patient-to-registered nurse (β, 0.80; 95% CI, 0.65-0.94) and patient-to-social worker (β, 0.53; 95% CI, 0.37-0.70) ratios, presence of licensed vocational nurses or licensed practical nurses at the clinic (β, 0.83; 95% CI, 0.53-1.12), and location in a poverty area (β, 0.29; 95% CI, 0.13-0.44) were all associated with higher patient-to-patient care technician ratios. Aggregated patient characteristics of patients treated at the facilities were generally not associated with patient-to-patient care technician ratio after adjustment. Limited causal inference and potential shifts in staffing after2019. US dialysis facilities vary considerably in their patient care technician staffing by geography, over time, and by various facility characteristics. Further investigation of US patient care technician staffing is warranted and could lead to better, more stable dialysis staffing, improved staff and patient satisfaction, and higher quality of care.

Feasibility of Symptom monitoring WIth Feedback Trial (SWIFT) for adults on hemodialysis: a registry-based cluster randomized pilot trial

BackgroundPatients with kidney failure on hemodialysis (HD) experience considerable symptom burden and poor health-related quality of life (HRQoL). There is limited use of patient reported outcome measures (PROMs) in facility HD units to direct immediate care, with response rates in other studies between 36 to 70%. The aim of this pilot study was to evaluate feasibility of electronic PROMs (e-PROMs) in HD participants, with feedback 3-monthly to the participants’ treating team, for severe or worsening symptoms as identified by the Integrated Palliative Outcome Scale (IPOS-Renal), with linkage to the Australian and New Zealand Dialysis and Transplant (ANZDATA) registry, compared with usual care.MethodsThis is a registry-based cluster-randomized controlled pilot trial involving all adults receiving HD in 4 satellite units in Australia over a 6-month period. HD units were cluster randomized 1:1 to the control (HRQoL data collection only) or intervention arm (symptom monitoring with feedback to treating team every 3 months). Feasibility was assessed by participant response rate (percentage of eligible HD participants, including new incident participants, who completed the questionnaire at each time point); retention rate (percentage of participants who completed the baseline questionnaire and all subsequent measures); and completion time. HRQoL and symptom burden scores are described.ResultsThere were 226 unique participants who completed the e-PROMs (mean age 62 years, 69% males, 78% White-European, median dialysis vintage 1.62 years). At 6 months, response rate and retention rate for the intervention arm were 54% and 68%, respectively, and 89% and 97% in the control arm. Median time to complete IPOS-Renal was 6.6 min (5.3, 10.1) at 3 months, and when combined with the outcome measure (EQ-5D-5L), the median time was 9.4 min (6.9, 13.6) at 6 months.ConclusionsElectronic symptom monitoring among HD participants with feedback to clinicians is feasible. Variations in response and retention rates could be potentially explained by the lengthier questionnaire, and higher frequency of data collection time points for participants in the intervention arm. A definitive national RCT is underway.Trial registrationACTRN12618001976279 (07/12/2018).

Use of Cell/Smartphone Technology in an Urban Free-Standing Hemodialysis Facility in the United States: A Single Center Study

Use of Cell/Smartphone Technology in an Urban Free-Standing Hemodialysis Facility in the United States: A Single Center Study

Primary Caregiver Burden in a Mexican Hemodialysis Facility: Prevalence and Risk Factors

Primary Caregiver Burden in a Mexican Hemodialysis Facility: Prevalence and Risk Factors

Integrating Care Coordination and Mental Health Research Into Dialysis Practice: Stakeholder Perspectives, Methods, and Outcomes

Despite many studies suggesting beneficial innovations for patients, few make it into clinical practice. This study aims to enhance patient care by facilitating effective dissemination of patient-centered outcomes research to health care workers in outpatient dialysis facilities, aided by the Patient-Centered Outcomes Research Institute's (PCORI) dissemination and implementation framework. Dissemination and implementation project. Outpatient hemodialysis facilities in the United States. We brought together panels of key stakeholders, which included researchers, patient subject matter experts, and dialysis personnel. Their role was to provide guidance on the content and methods for disseminating research findings. With a focus on 2 critical patient safety areas-care coordination or care transitions and mental or behavioral health-we developed virtual education modules. These modules were then made available to outpatient dialysis facilities by the national 5-Diamond Patient Safety Program. In 2022, the training was used by more than 2,500 dialysis facilities and approximately 40,000 dialysis staff in the care coordination module, and by more than 300 dialysis facilities and 5,000 staff for the mental health module. Cumulatively, the modules affected more than 179,000 patients. Evidence of efficacy was the significant increase in trainee knowledge of research findings and implementation considerations (P≤0.05). Potential selection bias because dialysis facilities that did not participate in the program may differ significantly from those that did, which may affect generalizability. In addition, variable timing in release of the different modules may have influenced uptake by facilities. By using key stakeholder guidance and accessible virtual education modules, the implementation framework shows promise in effectively disseminating research findings within outpatient dialysis settings. This method potentially carries implications for broader health care settings as well. Our study addresses a common health care challenge-many promising ideas for improving patient care never actually reach the patients. We aimed to bridge the dissemination gap by sharing research with health care workers in outpatient dialysis, promoting evidence-based practice. We collaborated with experts, patients, and dialysis personnel to develop easy-to-understand educational materials focused on 2 critical topics: care coordination and mental health. In 2022, our training benefited more than 2,500 facilities and 40,000 staff for care coordination, and 300 facilities with 5,000 staff for mental health, positively affecting more than 179,000 patients. We found that the training significantly increased knowledge among staff. Our approach shows promise for sharing research effectively in dialysis centers and potentially in other health care settings.

Effects of iron-based phosphate binders on mortality and cardiovascular events in patients receiving maintenance dialysis

Phosphate binders are the main treatment for hyperphosphatemia in patients with chronic kidney disease, and iron-based phosphate binders have been used with increasing frequency in recent years. This study examined the association of the use of iron-based, rather than non-iron-based, phosphate binders with the incidence of cardiovascular events, in a real-world setting. We used data from a cohort comprising representative adult patients on maintenance hemodialysis in Japan. The exposure of interest was the time-varying use of phosphate binders, classified into “iron-based”, “only non-iron-based”, and “no use”. The primary outcome was a composite of cardiovascular events and all-cause deaths. A marginal structural Cox regression model was used to deal with possible time-dependent confounding. Of the 2247 patients from 58 hemodialysis facilities, iron-based and only non-iron-based phosphate binders were used in 328 (15%) and 1360 (61%), respectively, at baseline. Hazard ratios (95% confidence intervals) for iron-based and non-iron-based phosphate binders versus no use of phosphate binders were 0.35 (0.24, 0.52) and 0.44 (0.33, 0.58), respectively. The hazard ratio for iron-based relative to non-iron-based phosphate binders was 0.81 (0.58, 1.13), which was not statistically significant. Further studies are warranted to elucidate whether the use of iron-based phosphate binders reduces the event rate.

Multicentre, observational, retrospective cohort of hyperkalaemia burden at haemodialysis facility-level in China: the Visualize-HD study protocol

ObjectivesHyperkalaemia is a potentially life-threatening disorder in patients undergoing haemodialysis (HD). Excess mortality and hospitalisation have been associated with hyperkalaemia (HK) after the long (2-day) interdialytic interval (LIDI) in patients...

Depression and death anxiety among patients undergoing hemodialysis during the COVID-19 pandemic in Palestine: a cross sectional study.

Hemodialysis patients are vulnerable to serious complications such as prolonged hospital stay and psychosocial issues like depression and death anxiety. Studies on psychosocial factors on end-stage renal disease patients' outcomes during COVID-19 pandemic are limited. We aimed to determine the prevalence of depression and death anxiety among Palestinian hemodialysis patients and the evaluate the relationship between their sociodemographic and clinical characteristics during COVID-19 Pandemic. A cross-sectional study was conducted using a convenience sampling technique. We recruited 308 hemodialysis patients from five hemodialysis units located in government hospitals in Palestine. Beck Depression Inventory and the Templers Death Anxiety Scale were used to collect data, which were then analyzed using SPSS version 20. Descriptive statistics (frequencies and means), t-test, ANOVA and multiple linear regression models were used for data analysis. Nearly 66.2% of the sample had depression symptoms, 61.4% met the diagnostic threshold for depression, and 69.8% had death anxiety. Furthermore, the multivariate analysis revealed that having a female identity, residing in a city or refugee camp, and patients who reported not experiencing depression had a significant relationship with death anxiety, while having a higher educational level than 12 years, having one or more chronic co-morbidities, and patients who reported experiencing death anxiety had a significant correlation with depression. Patients receiving hemodialysis frequently experience depression and death anxiety. These patients should receive a psychiatric evaluation in the early stages of their illness so that timely and appropriate psychological interventions can be given in hemodialysis facilities in Palestine during and after future pandemics.

Adaptive Nutrition Intervention Stabilizes Serum Phosphorus Levels in Hemodialysis Patients: A Multicenter Decentralized Clinical Trial Using Real-World Data

This study aims to evaluate the effect of an adaptive nutritional and educational intervention for patients on hemodialysis (HD) in a routine care setting, using real-world data from electronic health records. Decentralized clinical trial of seven HD facilities recruited patients who have been on HD for over 3months (N=153) for an 8-week adaptive intervention protocol. Patients were divided into four groups: (1) control (2) education intervention (3) meal intervention (4) education and meal interventions. Educational contents were digitally delivered via mobile phones and premade meals tailored on laboratory findings were home-delivered. Changes in serum electrolytes and malnutrition inflammation score (MIS) were analyzed. Meal intervention statistically significantly stabilized serum phosphorus level (β=-0.81mg/dL, 95% confidence interval=[-1.40, -0.22]) at week 8, with increased likelihood of being within target serum value range (odds ratio=1.21, 95% confidence interval=[1.04, 1.40]). Meal group showed better nutritional status (MIS=3.65) than the education group (MIS=5.10) at week 8 (adjusted p<.05). No significant changes were observed in serum potassium level, depression, and self-efficacy. It was demonstrated that an adaptive meal intervention in a real-world care setting may benefit serum phosphorus control and nutritional status of patients on HD, without negative effect on depression levels or self-efficacy. More work is needed to develop an effective educational intervention.

Valorization of Hemodialysis Wastewater: An Emerging Reality

The reutilization and valorization of wastewater contributes to water saving and improve the energetic efficiency of hemodialysis facilities. Moreover, it has the added benefit of reducing environmental impact and providing economically interesting added value products. This review discusses the most recent approaches for the valorization of this type of wastewater.

#4098 PATIENT ACUITY AND CARDIOVASCULAR OUTCOME IN HEMODIALYSIS PATIENTS: A KOREAN NATIONWIDE COHORT STUDY

Abstract Background and Aims Patients acuity has been reported to be associated with poor outcome in hospitals. However, the effect of the patient acuity of hemodialysis center on the prognosis of individual patients is not well known. In this study, the association between the severity of illness in hemodialysis facility and major adverse cardiac and cerebrovascular event (MACCE) in patients undergoing hemodialysis was investigated. Method 15,633 participants receiving hemodialysis in the primary health care center who participated in the Periodic Hemodialysis Quality Assessment by Health Insurance Review &amp; Assessment Service (HIRA) were examined. The main predictor was severity-to-nurse ratio, defined as a sum of Charlson comorbidity index of all patients divided by the number of nurses in each hemodialysis facility. The primary and secondary outcome were MACCE, and all-cause mortality, respectively. Results During a median follow-up of 5.5 years, MACCE and all-cause mortality occurred in 7,966 (51.0%) and 6,536 (41.8%) participants. Participants with higher severity-to-nurse ratio tended to have higher incidence rate of MACCE. The hazard ratios (HRs) of MACCE for the second, third, and highest quartiles compared with the lowest quartile of severity-to-nurse ratio were 1.05 (95% confidence intervals [CI], 0.98-1.11; P = 0.151), 1.07 (95% CI, 1.00-1.14; P = 0.053), and 1.08 (95% CI, 1.00-1.16; P = 0.040). When treating severity-to-nurse ratio as a continuous variable, MACCE risk increased by 1% per 1 increase in severity-to-nurse ratio (HR, 1.01; 95% CI, 1.00 - 1.02; P = 0.003). Compared to the lowest quartile group, the HRs of all-cause mortality for second, third and fourth quartile were 1.12 (95% CI, 1.04-1.19; P = 0.002), 1.11 (95% CI, 1.03-1.19; P = 0.005), and 1.16 (95% CI, 1.07-1.25; P&amp;lt;0.001), respectively. Conclusion As the part of the Joint Project on Quality Assessment Research by HIRA, the present study showed that the patient acuity was strongly associated with an increased risk of poor outcomes in hemodialysis patients.

Comparison of residual kidney function assessment between the hemodialysis two- and three-day interdialytic interval.

Background Residual kidney function (RKF) is a dynamic marker having been shown to demonstrate fluctuations over successive days of the interdialytic interval. This study compares measured RKF between the long (LIDP) and short interdialytic intervals (SIDP). Methods This was a prospective cohort study. Thirty-four clinically stable, ambulatory facility hemodialysis patients were recruited. Urine samples collected in the last twelve hours of each interdialytic interval were paired with a blood test at the conclusion of each twelve-hour interval to evaluate measured RKF through a mean of urinary urea and creatinine clearances. The paired Student's t-test and the Wilcoxon matched-pairs signed-ranks were used respectively to compare differences in assessed mean and median RKF. Results Although average serum creatinine (607 +/- 219 µmol/L vs. 547 +/- 192 µmol/L, p = <0.01) and serum urea concentrations (25 +/- 15 mmol/L vs. 19 +/- 5 mmol/L, p = 0.01) were higher in the LIDP compared to SIDP, there was no statistically significant difference in urine volume (630 +/- 460 mL vs. 520 +/- 470 mL, p = 0.06), urine urea (116 +/- 49mmol/L vs. 118 +/ 90, p = 0.87), or urine creatinine (7816 +/- 3943 µmol/L vs. 8926 +/- 5752 µmol/L, p = 0.06) concentrations. On the whole, there was no significant difference in assessed RKF between the long and short interdialytic intervals (mean 8 +/- 6 mL/min vs 6 +/- 4 mL/min, p = 0.24; median 6.3 [3.2 - 10.4] vs 5.8 [3.8 - 8.9], p = 0.13). Conclusions There was no statistically significant difference observed in assessed RKF between the LIDP and SIDP. Measured RKF through samples collected from the LDIP and SIDP are comparable.

Intravenous Antimicrobial Starts among Hemodialysis Patients in the National Healthcare Safety Network Dialysis Component, 2016-2020.

Key Points NHSN total IV antimicrobial start rates for patients on hemodialysis decreased from 2016 to 2020, but rates unsupported by NHSN surveillance documentation did not.There were 80% of reporting hemodialysis facilities that had ≥1 unsupported IV antimicrobial start, and the fraction of facilities with unsupported starts increased yearly.Accurate reporting and timely review of antimicrobial data is critical to understanding prescribing trends and practices in hemodialysis facilities.

Current elimination status of hepatitis C virus-infected maintenance hemodialysis patients in Iwate Prefecture, Japan.

The aim is to clarify the hepatitis C virus (HCV) status of hemodialysis (HD) patients and patient management after HCV elimination. Questionnaire survey was conducted in Iwate prefecture, Japan from 2016 to 2021. Patients underwent HD was 2944, including 132 anti-HCV antibody-positive patients, with 91 HCV RNA-positive patients. Of the 91 HCV RNA-positive patients, 51 received antiviral treatment. Sustained virological response (SVR) rate was 94%. The patients treated with direct antiviral agents had significantly lower mortality rate than the untreated patients, and no liver-related deaths occurred in patients who achieved SVR or in HCV RNA-negative patients. The HCV RNA-positive prevalence was finally 0.79%. Approximately 40% of the facilities had dedicated beds and dialysis-related items for patients who achieved an SVR. To eliminate HCV in HD facilities, it is necessary to promote HCV RNA testing for anti-HCV antibody-positive patients and to provide antiviral treatment for HCV RNA-positive patients. Additionally, collaboration among hepatologists and HD specialists are essential.

Prevalence of hepatitis C virus among hemodialysis facilities: national screening study in Tunisia, 2021-2022

Prevalence of hepatitis C virus among hemodialysis facilities: national screening study in Tunisia, 2021-2022

Estimating the effect of dialysis staffing ratio regulations on mortality and hospitalizations for Medicare hemodialysis patients.

Eight states and Washington, DC have implemented regulations mandating a minimum ratio between treatment staff and patients receiving hemodialysis in a facility in an effort to improve the quality of hemodialysis treatment. Our investigation examines the association between minimum staffing regulations and patient mortality for four states and hospitalizations for two states that implemented these rules during our sample period. We utilized a synthetic difference in differences estimation to analyze the effect of minimum staffing ratios on hemodialysis treatment quality, measured by deaths and hospitalizations for end-stage renal disease patients. We used data gathered by the US Renal Data System and aggregated at the state level. We are unable to find evidence that mandated dialysis staffing ratios area associated with a reduction in mortality or hospitalizations. We estimate a slight reduction in deaths per 1000 patient hours and a slight increase in hospitalizations, but neither are statistically significant. We were unable to find evidence that minimum staffing ratios for hemodialysis facilities are associated with improved patient outcomes. Our findings highlight the need for future work, studying the impact of these regulations at the facility level.

Dialysis specialist care and patient survival in hemodialysis facilities: a Korean nationwide cohort study.

It is important for the dialysis specialist to provide essential and safe care to hemodialysis (HD) patients. However, little is known about the actual effect of dialysis specialist care on the survival of HD patients. We therefore investigated the influence of dialysis specialist care on patient mortality in a nationwide Korean dialysis cohort. We used an HD quality assessment and National Health Insurance Service claims data from October to December 2015. A total of 34,408 patients were divided into two groups according to the proportion of dialysis specialists in their HD unit, as follows: 0%, no dialysis specialist care group, and ≥50%, dialysis specialist care group. We analyzed the mortality risk of these groups using the Cox proportional hazards model after matching propensity scores. After propensity score matching, 18,344 patients were enrolled. The ratio of patients from the groups with and without dialysis specialist care was 86.7% to 13.3%. The dialysis specialist care group showed a shorter dialysis vintage, higher levels of hemoglobin, higher single-pool Kt/V values, lower levels of phosphorus, and lower systolic and diastolic blood pressures than the no dialysis specialist care group. After adjusting demographic and clinical parameters, the absence of dialysis specialist care was a significant independent risk factor for all-cause mortality (hazard ratio, 1.10; 95% confidence interval, 1.03-1.18; p = 0.004). Dialysis specialist care is an important determinant of overall patient survival among HD patients. Appropriate care given by dialysis specialists may improve clinical outcomes of patients undergoing HD.

Hepatitis C Virus Prevalence in Hemodialysis Patients in Karbala Province

Purpose: The study aimed to evaluate HCV infection rates are widespread in hemodialysis patients and identify any potential HCV infection risk factors in this cohort. Methods: Hepatitis C virus statistical information was collected from the publicly accessible Karbala province/ Iraq. Results: All told, 236 dialysis patients, 150 (63.6%) male and 86 (36.4%) female, they are between the ages of 15 and 78 (44.39 + 15.06 S.D.) years. Sampling lasted from May to October 2019-2021. Each HD treatment required three to four hours, and depending on their haemodialysis facility, patients were divided into two shifts for each of their two or three weekly dialyses. Dialysis membranes were single-use, disposable devices. Conclusions: The information in this study indicated that HCV is prevalent in hemodialysis centers are comparatively high and also demonstrated that the greatest risk factor for developing HCV seems to be the duration of time undergoing hemodialysis therapy, which raises the possibility of nosocomial transmission.