Hemodialysis Patients Research Articles

Knowledge, attitude, and practice regarding Sarcopenia in maintenance hemodialysis patients in Northeastern China.

Sarcopenia is a severe complication affecting patients receiving hemodialysis (HD) treatment over an extended period of time. This cross-sectional study assessed knowledge, attitude, and practice (KAP) towards sarcopenia among maintenance HD patients in Northeastern China between 13 December 2023 and 13 January 2024. A total of 752 questionnaires were collected. Multivariate logistic regression showed that completed high school or vocational secondary school, college or bachelor's degree, and maintenance HD lasting ≥ 11 years were independently associated with proactive practice. The Structural equation modeling (SEM) showed that knowledge directly affected attitude and practice. Moreover, attitude directly affects practice. Maintenance HD patients showed inadequate knowledge, positive attitude, and proactive practice towards sarcopenia. Healthcare providers should focus on educational campaigns to increase patient awareness of sarcopenia, its risk factors, and preventive measures.

Optimizing use of an electronic medical record system for quality improvement initiatives in hemodialysis: Review of a single center experience.

The complexity of managing patients with end-stage kidney disease on hemodialysis underscores the importance of implementing quality improvement (QI) initiatives to enhance patient safety and prioritize patient-centered care. To address this, we established a QI committee at our tertiary academic center focusing on evidence-based practices, patient-centered approaches, and cost efficiency. To facilitate the seamless implementation of QI initiatives, we leveraged the capabilities of our electronic medical record (EMR) system. This review details effective strategies for optimizing use of an EMR system to successfully implement QI efforts. Drawing from our experience, we provide detailed descriptions and practical insights that can be applied to other EMRs. The creation of a secure and accessible dashboard, offering real-time data on quality metrics, stands out as the most notable feature. This dashboard operates through an algorithm that merges data from both our dialysis and hospital EMR systems. Its primary objectives are to streamline the identification of high-priority patients, enhance team communication, and facilitate tracking of quality indicators. Additionally, we integrated clinical pathways, checklists, and standardized protocols into the renal EMR to ensure smooth implementation of QI interventions. Notable examples of these interventions include an incremental hemodialysis protocol, a new hemodialysis start checklist, vaccination care plans, and personalized kidney transplant workups. Programmed electronic automatic reminders have proven invaluable in ensuring timely follow-ups of assigned tasks. The EMR has also contributed to medication optimization and deprescribing by generating patient lists based on specific medication classes. Finally, the EMR's capability to swiftly generate lists of patients with specific features has significantly facilitated targeted QI interventions. Leveraging the capabilities of an EMR system can be crucial for enhancing care of hemodialysis patients and implementing effective QI initiatives.

The effect of recreational therapy application on fatigue in hemodialysis patients: a randomized clinical trial

BackgroundChronic Kidney Disease (CKD) is a progressive disorder that often leads to End-Stage Renal Disease (ESRD), necessitating hemodialysis (HD) treatment. Fatigue is a prevalent and debilitating symptom among HD patients, significantly affecting their quality of life. Recreational Therapy (RT) is a therapeutic recreational service designed to maintain and restore a person’s level of performance and independence in daily activities. This study aimed to evaluate the effect of a smartphone-based recreational therapy intervention on fatigue in hemodialysis patients.MethodsThis randomized controlled trial was conducted on HD patients at a hospital in Mashhad, Iran. The intervention group received a custom-designed recreational therapy mobile application, including music, comedy, exercise, and educational content. The control group received standard care. Fatigue was assessed using the Multidimensional Fatigue Inventory (MFI-20) before and after the 30-day intervention.ResultsA total of 72 patients (36 per group) participated in the study. The intervention group demonstrated a significant reduction in overall fatigue scores and improvements across various fatigue dimensions, including general fatigue, physical fatigue, mental fatigue, reduced activity, and reduced motivation, compared to the control group (p < 0.001).ConclusionThe smartphone-based recreational therapy intervention effectively reduced fatigue in hemodialysis patients. This approach could be a valuable complementary strategy for managing fatigue in this population. Further research is needed to explore the long-term sustainability of these benefits and the intervention’s impact on other patient-reported outcomes.Trial registrationThis study was registered in the Iranian Registry of Clinical Trials (no. IRCT20220803055608N1) on 29/08/2022.

Pulmonary Congestion and Anemia in Hemodialysis: The Potential Link to Inflammation

Pulmonary congestion (PC) is common in hemodialysis (HD) patients. We explored the association of anemia and pulmonary congestion in HD patients. A prospective pilot observational study included 18 patients on maintenance HD. Individual B-lines scores (BLS; 8-sites method) were obtained by lung ultrasound, before and after the first two consecutive HD sessions of the week (HD1-HD2), with different inter-dialytic intervals (68 vs. 44 h). Bioimpedance spectroscopy body composition (BIS) was performed before each HD session. Hemoglobin (Hb) levels, in addition to circulating markers of chronic inflammation (soluble urokinase Plasminogen Activator Receptor [suPAR], soluble Suppression of Tumorigenicity 2 [sST2]) were obtained. Mean (±SD) BLS values were quite elevated at all time points: Pre-HD1 (16 ± 5.53), post-HD1 (15.3 ± 6.63), pre-HD2 (16.3 ± 5.26) and post-HD2 (13.6 ± 5.83), respectively. No direct significant correlation was found between inflammation markers levels and BLS. However, mean levels (±SD, ng/mL) of suPAR pre-HD1 (7.88 ± 3.07) and pre-HD2 (7.78 ± 3.02) remained significantly above the normal range (&lt;4 ng/mL), and sST2 levels reached 2-fold the upper normal value in most patients (27.4 ± 17.8). Pulmonary congestion reflected by BLS was negatively correlated to Hb levels pre-HD1 (R² = 0.439, p = 0.003), and pre-HD2 (R² = 0.301, p = 0.018). In addition, Hb levels were negatively correlated to global volume status estimated by BIS (R² = 0.351, p = 0.009). Hemoglobin levels were negatively correlated to pulmonary congestion and to the global volume status evaluated by BIS. Chronic inflammation markers were increased in HD patients, suggesting a complex volume- and non-volume-dependent pathophysiology of pulmonary congestion in HD patients.

The German Epidemiological Hemodialysis Itch Study (GEHIS) - 10-year follow-up of pruritus and health-related quality of life in hemodialysis patients.

Chronic pruritus (CP) in hemodialysis (HD) patients is a difficult to control phenomenon. While some drugs like difelikefalin showed promising results in a reduction of CP, others failed. GEHIS (German Epidemiological Hemodialysis Itch Study) is a representative, prospective cross-sectional observational cohort study of 860 HD patients started in 2013. It addresses prevalence and associated factors of CP in HD patients such as health-related quality of life (HRQOL).

Prediction of gastrointestinal bleeding hospitalization risk in hemodialysis using machine learning

BackgroundGastrointestinal bleeding (GIB) is a clinical challenge in kidney failure. INSPIRE group assessed if machine learning could determine a hemodialysis (HD) patient’s 180-day GIB hospitalization risk.MethodsAn eXtreme Gradient Boosting (XGBoost) and logistic regression model were developed using an HD dataset in United States (2017–2020). Patient data was randomly split (50% training, 30% validation, and 20% testing). HD treatments ≤ 180 days before GIB hospitalization were classified as positive observations; others were negative. Models considered 1,303 exposures/covariates. Performance was measured using unseen testing data.ResultsIncidence of 180-day GIB hospitalization was 1.18% in HD population (n = 451,579), and 1.12% in testing dataset (n = 38,853). XGBoost showed area under the receiver operating curve (AUROC) = 0.74 (95% confidence interval (CI) 0.72, 0.76) versus logistic regression showed AUROC = 0.68 (95% CI 0.66, 0.71). Sensitivity and specificity were 65.3% (60.9, 69.7) and 68.0% (67.6, 68.5) for XGBoost versus 68.9% (64.7, 73.0) and 57.0% (56.5, 57.5) for logistic regression, respectively. Associations in exposures were consistent for many factors. Both models showed GIB hospitalization risk was associated with older age, disturbances in anemia/iron indices, recent all-cause hospitalizations, and bone mineral metabolism markers. XGBoost showed high importance on outcome prediction for serum 25 hydroxy (25OH) vitamin D levels, while logistic regression showed high importance for parathyroid hormone (PTH) levels.ConclusionsMachine learning can be considered for early detection of GIB event risk in HD. XGBoost outperforms logistic regression, yet both appear suitable. External and prospective validation of these models is needed. Association between bone mineral metabolism markers and GIB events was unexpected and warrants investigation.Trial registrationThis retrospective analysis of real-world data was not a prospective clinical trial and registration is not applicable.Graphical

Quality of life among patients with end-stage renal disease undergoing haemodialysis in Africa: a systematic review

ABSTRACT Chronic kidney disease affects every aspect of patients’ lives, particularly burdening those in 44low- and middle-income countries. This systematic review aims to explore the quality of life of haemodialysis patients in Africa. Following the PRISMA guidelines, inclusion and exclusion criteria were pre-established for this systematic review, leading to the selection of eight articles on life quality of haemodialysis patients in Africa. This review reveals, on the one hand, that studies carried out in Africa on the quality of life of haemodialysis patients are rare and, on the other hand, that the different domain scores of the Kidney Disease Quality of Life (KDQOL) questionnaire show a deterioration in the quality of life of haemodialysis patients in Africa. According to the results of this review, African healthcare systems need to pay more attention to haemodialysis patients, especially in countries where resources are limited.

Epidemiological characteristics, complications of haemodialysis patients with end-stage diabetic nephropathy in a tertiary hospital in Guizhou, China: a cross-sectional survey

Epidemiological characteristics, complications of haemodialysis patients with end-stage diabetic nephropathy in a tertiary hospital in Guizhou, China: a cross-sectional survey

Cost Analysis of End-Stage Renal Disease in Pediatric Patients in Greece.

The cost resulting from peritoneal dialysis (PD), conventional hemodialysis (HD) and online hemodiafiltration (OL-HDF) in pediatric patients with end-stage renal disease (ESRD) has not been estimated to date in Greece. The present single-center retrospective study aimed to estimate the mean annual cost of the above methods, as well as the individual components of this cost. Twenty pediatric patients undergoing the three different methods of renal replacement therapy were included in this study. Their mean total annual cost was estimated by the method of micro-costing and the bottom-up approach. The mean total annual cost for PD patients (n = 7) was estimated at EUR 56,676.04; for conventional HD patients (n = 9), it was EUR 39,786.86; and for OL-HDF patients (n = 4), it was EUR 43,894.73. The PD method was found to be more expensive than the other two methods (p < 0.001 vs. conventional HD and p = 0.024 vs. OL-HDF). PD consumables used for daily application had the greatest contribution to the total annual cost. The total mean annual cost in the groups of patients undergoing HD and OL-HDF did not differ significantly (p = 0.175). The total operating cost of the renal dialysis unit had the greatest contribution to the total mean annual costs of both the conventional HD and OL-HDF techniques. This cost analysis provides useful information to healthcare policymakers who make decisions about the treatment of children with ESRD.

Toxoplasma Gondii In Association with TLR4 Among Regular Hemodialysis Patients

Background: Hemodialysis patients can be considered immunocompromised as they have an increased risk of infections. The activity of Toll -like receptors in defense against infections was observed particularly for Toll like receptor4 molecule. Several single-nucleotide polymorphisms (SNPs) residing in genes encoding Toll -like receptors were reported as significant genetic modifications associated with infections. Aim: To determine the association between Toll- like receptors 4 polymorphisms and the susceptibility to infection with Toxoplasma gondii in hemodialysis patients. Materials and Methods: This case- control study was conducted on 150 patients with hemodialysis and 150 apparently healthy blood donors as control group, the samples were collected in the period from march 2021 to November 2021 from Al-Karama hospital and Al-Yarmouk Teaching Hospital. All patients were investigated for the presence of Toxoplasma gondii and Abs (IgG, IgM) by using ELISA technique and conformation by molecular technique (Real time-PCR). The selected SNPs in Toll- like receptors 4 were amplified by using conventional polymerase chain reaction PCR and then sequencing there polymorphism. Results: In the current study the comparison of median age between patients and controls was with no significant difference, while the laboratory tests revealed significant difference in median level of urea, creatinin , calcium , potassium ,albumin and hemoglobin, and insignificant difference for body mass index and sodium between studied groups. The ratio of females infected with Toxoplasma gondii was higher than infected males. The seropositive result in patients for Toxoplasma gondii - IgG and IgM was 15 and 6 respectively while 19 patients were positive by PCR. However in control group there were 8 patients seropositive for IgG and positive in PCR results while the results of IgM and PCR were negative for all control group. The Polymerase chain reaction (PCR) products of Toll- like receptors 4 genes were subjected for direct sequencing by using Bio edit software. And the resultant sequences were compared with reference sequences in NCBI. The analysis of TLR-4 rs4986790 genotypes were 24(80%) AA and 6(20%) AG in patients while 6 (60%) AA and 4(40%) AG in controls with insignificant difference, while the analysis of TLR-4 rs4986791 genotypes were 24(80%) CC and 6 (20%) CT in patients while 6 (60%) CC and 4(40%) CT in controls with insignificant difference. Conclusion: There was no significant association of Toxoplasma gondii with TLR4 genotypes of rs4986790 and rs4986791 SNPs in hemodialysis patients.

HED-Start: A Brief Positive Psychology Cluster-Randomized Controlled Trial to Improve Psychological Adjustment in Patients New on Hemodialysis.

Initiation onto hemodialysis marks a critical transition with intense psychosocial demands. Interventions using cognitive-behavioral therapy to improve distress have been variably effective but require trained staff and are typically delivered only to those who screen positive for clinically significant distress. Interventions guided by positive psychology are lacking. To investigate the effectiveness of a brief positive-skills RCT in improving psychological adjustment in new hemodialysis patients. Using a parallel (2:1) design, blinded cluster-randomized controlled trial (cRCT) design, incident patients (<6 months at NKF dialysis centers) undergoing hemodialysis were randomized to intervention or usual care (UC). HED-Start intervention comprised four group sessions delivered by healthcare staff on positive emotions, acceptance, and life-orientated goal setting. Measures were taken at baseline (pre-randomization) and at 12 weeks: distress/mood (HADS; SPANE); quality of life (KDQOL-SF, WHOQOL-BREF); benefit-finding (BFS, BIPQ); life-oriented skills (HEIQ, CD-RISC-2); self-efficacy (CD-SES). A total of 147 participants enrolled in the trial (response rate, 51.0%; retention [assessment], 90.5%). Study arms were comparable on all baseline and outcome variables except for age, diabetic nephropathy, and hypertensive nephrosclerosis which were subsequently controlled for. Repeated measures ANCOVAs (intention to treat) were used. HED-Start yielded significant reductions over time in depression, and increased quality of life, self-efficacy, benefit finding, and skills relative to UC (moderate effect sizes). Rates of clinically significant depression significantly decreased in HED-Start (p < .001) and increased in UC (p = .002). The significant positive effects of HED-Start, a low-intensity and cost intervention, on several adjustment indices, suggest that programs focusing on positive life skills can value add to existing renal care services.

Objectively measured levels of moderate to vigorous intensity physical activity are associated with cognitive impairment in diabetic hemodialysis patients: a cross-sectional study.

The purpose of this study was to observe the relationship between objectively measured levels of physical activity and cognitive impairment (CI) in the presence or absence of diabetes in middle-aged and elderly hemodialysis patients. In this multicenter cross-sectional study, 339 clinically stable hemodialysis patients (210 males; mean age: 67.38 ± 8.07 years) aged ≥55 years were included from 7 dialysis units in Shanghai, China. The Chinese version of the Modified Mini-Mental State Examination (MMSE) was used to assess the CI. The duration of physical activity at different intensities, including moderate to vigorous physical activity (MVPA) as well as light physical activity (LPA), was measured using a triaxial accelerometer (ActiGraph GT3X+, Pensacola, FL, USA). Logistic regression and multiple linear regression were used for analyses. The prevalence of CI was higher in hemodialysis patients with comorbid diabetes (24.3%). In diabetic patients, MVPA (increase per 10 min/day) was negatively associated with CI after adjusting for covariates [(OR = 0.89, 95%CI = 0.79-0.99), p = 0.042]. However, no significant association between physical activity and CI was found in non-diabetic hemodialysis patients. Further analyses revealed that MVPA was positively associated with temporal orientation, attention and calculation and recall in diabetic hemodialysis patients. Physical activity was associated with CI in diabetic hemodialysis patients rather than the non-diabetes group. This study is important for early differential diagnosis of CI and improvement of cognitive status in hemodialysis patients.

Comparisons of Intradialytic Exercise Versus Home-Based Exercise in Hemodialysis Patients: A Narrative Review.

With the increasing prevalence of end-stage kidney disease, the number of patients requiring hemodialysis (HD) continues to rise. While life-sustaining, HD is often associated with adverse effects such as muscle loss, physical deconditioning, fatigue, and compromised health-related quality of life (HRQoL). Recent research suggests that intradialytic exercise (IDE) and home-based exercise (HBE) may mitigate these adverse effects and improve patient outcomes. However, the existing literature mainly focuses on the outcomes of both exercises, whereas the comparison of types is often omitted. Hence, this review consolidates findings from studies investigating the effectiveness, implementation, safety, feasibility, and adherence of different types of IDE and HBE in HD patients. Overall, the current literature bolsters the significance of IDE and HBE for improving health in HD patients. IDE and HBE enhance physical function, cardiopulmonary capacity, HRQoL, and cognitive well-being. Some research proposed an indirect link between IDE and survival rates. Despite these benefits, challenges remain in implementing these exercise modalities, including patient adherence and the feasibility of routine exercise during HD sessions. Integrating these exercises into routine care allows healthcare providers to enhance outcomes for HD patients. Further research is suggested to optimize exercise protocols and explore long-term effects and cost-effectiveness.

Investigating the complex relationship and influencing factors of frailty on nutritional status in maintenance hemodialysis patients.

Given the high prevalence and significant challenges of frailty, a state of increased vulnerability to adverse health outcomes, among maintenance hemodialysis (MHD) patients, this cross-sectional study aimed to investigate its prevalence and explore its association with nutritional status and other relevant factors. The study involved 290 MHD patients with an average age of 52.98 ± 13.65 years. Frailty assessments, nutritional evaluations, and medical status measurements were performed. Data analysis involved descriptive statistics, correlation analyses, and multivariate logistic regression. Among the patients, 70.3% were identified with frailty (16.9% frail, 53.4% pre-frail). Frailty was more prevalent in female patients compared to males and correlated positively with age, marital status, caregiving needs, comorbidities, dialysis duration, and higher nutritional risk scores. Negative correlations were observed with serum albumin, hemoglobin, body weight, and height. A significant prevalence of frailty was found in MHD patients, with notable associations to various demographic, clinical, and nutritional factors.

Bioelectrical impedance analysis–derived phase angle predicts possible Sarcopenia in patients on maintenance hemodialysis: a retrospective study

BackgroundThe prevalence of possible sarcopenia is notably high among maintenance hemodialysis (MHD) patients. Possible sarcopenia, defined as a decrease in muscle strength and/or somatic function, is an early and reversible condition between non-sarcopenic and sarcopenia, and early recognition and intervention for possible sarcopenia is important for preventing adverse outcomes and improving the quality of life of these patients. This study aimed to establish a simple and effective model for screening and identifying MHD patients at high risk of possible sarcopenia by using 50 kHz-Whole Body Phase Angle (PhA), with a specific focus on gender differences.MethodsThis prospective cross-sectional study was conducted from September to December 2023 at the Wenjiang Hemodialysis Center in the Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China. A total of 244 MHD patients, including 130 males and 114 females, were enrolled. Data were collected prospectively, including demographic information and physical measurements. All participants provided informed consent before enrollment. Measurements were taken post-dialysis to ensure consistency. The whole-body phase angle was measured using the InBody S10 device, grip strength was measured using an electronic grip strength tester, and physical function was assessed by the Short Physical Performance Battery (SPPB). The Skeletal Muscle Index (SMI) was also calculated.ResultsA total of 244 patients receiving hemodialysis were enrolled in this study. Among these, 109 patients were categorized as non-sarcopenic, 111 as having possible sarcopenia, and 24 as sarcopenic. The prevalence of sarcopenia among MHD patients is 9.8%, while the prevalence of possible sarcopenia is 45.5%. The receiver operating characteristic (ROC) curve analysis showed that for male patients, the AUC of PhA for predicting possible sarcopenia was 0.798, with a sensitivity of 80.36%, specificity of 69.70%, and a cutoff value of 6.20°. For female patients, the AUC of PhA was 0.701, with a sensitivity of 70.91% and specificity of 62.79%, and a cutoff value of 5.70°.ConclusionsPhA may be a useful and simple predictor of the risk of possible sarcopenia in MHD patients, and more research is needed to further promote the use of PhA in possible sarcopenia.

African American Patients' Perspectives on Determinants of Hemodialysis Adherence and Use of Motivational Interviewing to Improve Hemodialysis Adherence.

Compared to White patients, African American (AA) patients have a four-fold higher prevalence of kidney failure and higher hemodialysis non-adherence. Adherence behaviors are influenced by psychosocial factors, including personal meaning of a behavior and self-confidence to enact it. We assessed perspectives of AA hemodialysis patients on unique factors impacting dialysis adherence, and use of motivational interviewing, an evidence-based intervention, to improve these factors, dialysis adherence, and outcomes in AAs. Self-identified AA hemodialysis patients (N=22) watched a brief video describing motivational interviewing and then completed a semi-structured interview or focus group session. Interview questions explored unique barriers and facilitators of hemodialysis adherence in AAs, and perceived utility of motivational interviewing to address these obstacles. Verbatim transcripts and an iterative inductive/deductive approach were used to develop a hierarchical coding system. Three experienced coders independently coded the same two transcripts. Coding was compared and discrepancies were reconciled by a fourth coder or consensus. Transcripts, quotations, and codes were managed using Microsoft Excel 2016 and SPSS version 28.0. Themes and sub-themes emerged and culminated in a novel conceptual model informed by three theoretical models of behavior change: Theory of Self-Care Management for Vulnerable Populations; Social Cognitive Theory; and Self Determination Theory. This conceptual model will inform the design of a culturally tailored, motivational interviewing-based intervention to improve dialysis adherence in AAs. Integrating AA hemodialysis patient perspectives is critical for enhancing dialysis care delivery and the design of effective interventions such as motivational interviewing to improve dialysis adherence in AA and promote kidney health equity. AA hemodialysis patients view motivational interviewing as a tool to clarify patient priorities, build trust, and promote patient-provider therapeutic alliance. Cultural tailoring of motivational interviewing to address unique barriers of AAs with kidney failure will improve adherence and health outcomes in these vulnerable patients.

Antiphospholipid antibody positivity is associated with maturation failure and thrombosis of native arteriovenous fistula: a retrospective study in HD patients.

The prevalence of antiphospholipid antibody (aPL) is high among hemodialysis (HD) patients compared to the general population and is inconsistently associated with arteriovenous fistula (AVF) thrombosis or stenosis. The association with maturation failure has never been investigated. This study aims to evaluate native AVF complications (thrombosis, stenosis, and maturation failure) and primary patency in aPL positive HD patients. We retrospectively identified 116 HD patients with native AVF. We collected the aPL profiles, the clinical and biological data potentially involved in AVF maturation failure, thrombosis, and stenosis, and investigated the association of these complications and aPL positivity. Kaplan-Meier survival analysis was performed. In our cohort, the prevalence of aPL persistent positivity was 32.7% and this was strongly associated with AVF maturation failure defined by ultrasound. aPL persistent positivity was a strong predictor in multivariate analysis and this association was independent of AVF stenosis or thrombosis during maturation process. There was no association with primary and functional primary patency, and stenosis. However, aPL persistent positivity according to ACR/EULAR classification criteria was associated with thrombosis when compared to strictly negative aPL patients. In our cohort, aPL persistent positivity was significantly associated with AVF maturation failure and thrombosis but not with AVF stenosis. To our knowledge, we report for the first time, a statistically significant association between aPL positivity and delay or absence of native AVF maturation.

Association between dietary fatty acids and depressive symptoms in Chinese haemodialysis patients: a cross-sectional study.

Depression is highly prevalent in haemodialysis patients, and diet might play an important role. Therefore, we conducted this cross-sectional study to determine the association between dietary fatty acids (FA) consumption and the prevalence of depression in maintenance haemodialysis (MHD) patients. Dietary intake was assessed using a validated FFQ between December 2021 and January 2022. The daily intake of dietary FA was categorised into three groups, and the lowest tertile was used as the reference category. Depression was assessed using the Patient Health Questionnaire-9. Logistic regression and restricted cubic spline (RCS) models were applied to assess the relationship between dietary FA intake and the prevalence of depression. As a result, after adjustment for potential confounders, a higher intake of total FA [odds ratio (OR)T3 vs. T1 = 1·59, 95 % confidence interval (CI) = 1·04, 2·46] and saturated fatty acids (SFA)(ORT3 vs. T1 = 1·83, 95 % CI = 1·19, 2·84) was associated with a higher prevalence of depressive symptoms. Significant positive linear trends were also observed (P < 0·05) except for SFA intake. Similarly, the prevalence of depression in MHD patients increasedby 20% (OR = 1.20, 95% CI = 1.01-1.43)foreach standard deviation increment in SFA intake. RCS analysis indicated an inverse U-shaped correlation between SFA and depression (P nonlinear > 0·05). Additionally, the sensitivity analysis produced similar results. Furthermore, no statistically significant association was observed in the subgroup analysis with significant interaction. In conclusion, higher total dietary FA and SFA were positively associated with depressive symptoms among MHD patients. These findings inform future research exploring potential mechanism underlying the association between dietary FA and depressive symptoms in MHD patients.

Phase angle variability on bleeding risks in hemodialysis patients.

This study investigated the association between Phase Angle (PhA), measured by bioelectrical impedance analysis, and bleeding risk in hemodialysis patients to evaluate PhA as a predictive marker for bleeding events. This retrospective cohort study included 102 hemodialysis patients who underwent PhA measurements between July 2019 and April 2024. Demographic data, medical histories, dialysis parameters, and bleeding events were collected. Patients were stratified by PhA values and followed for a median of 832days (IQR: 516-1304days). Multivariate Cox proportional hazards regression and Kaplan-Meier analysis were performed. The cohort had an average age of 74.0years and a median dialysis vintage of 6.7years. During follow-up, 19 patients (18.6%) experienced major bleeding events. Lower PhA was an independent risk factor for bleeding (HR: 0.24, 95% CI 0.11-0.52, p < 0.001). Kaplan-Meier analysis showed that patients with PhA ≥ 4.00 had a higher probability of remaining free from major bleeding at 2years (94.3%) compared to those with PhA < 4.00 (75.0%) (p < 0.001). In 82 patients with repeat PhA measurements, bleeding event-free rates at 2years were 97.5%, 75%, 100%, and 78.3% for the High to High, High to Low, Low to High, and Low to Low groups, respectively (p < 0.001). PhA is a predictive marker for bleeding risk in hemodialysis patients. Routine PhA monitoring could help stratify bleeding risk and optimize clinical management.

Profiling oxidative stress markers and cardiovascular complications in chronic kidney disease patients supplemented with vitamin E

IntroductionCardiovascular diseases are common complications in chronic kidney disease (CKD). Oxidative stress associated with renal and metabolic dysfunctions is one of the cardiovascular complications (CVC) in haemodialysis patients. The aim of the present study is to analyse the oxidative stress markers in CDK patients supplemented with antioxidants and vitamin E, with monitoring of CVC.Material and methodsThis was a cross-sectional study conducted on 99 subjects. CKD patients received oral supplementation of vitamin E (300 mg/day) for 2 years. Oxidative stress markers, nitric oxide (NO); myeloperoxidase (MPO); oxidized low-density lipoprotein (LDLox); malondialdehyde (MDA) and glutathione were measured before and after the vitamin treatment.ResultsNO (62.62 ±2.80 µmol/l), LDLox (10.55 ±4.62 µmol/l), MDA (6.11 ±2.83 µmol/l) and MPO (53.35 ±3.82 UI/ml) were overconcentrated, while glutathione (62.09 ±4.15 UI/ml) was less concentrated in CKD patients with cardiovascular complications, compared to those without cardiovascular complications (67.08 ±1.90 µmol/l, 31.18 ±5.25 µmol/l, 16 ±6.47 µmol/l, 57.00 ±7.24 UI/ml, 43.09 ±3.33 UI/ml, respectively). After 2 years of vitamin E treatment, the overall cardiovascular complications were not significantly decreased.ConclusionsThese results showed that oral complementation with vitamin E did not affect the occurrence of cardiovascular complications associated with CKD. These findings may pave the way for future innovative strategies for antioxidant supplementation in CKD patients.