Health In Hemodialysis Patients Research Articles

Patterns of oral disease in adults with chronic kidney disease treated with hemodialysis.

Oral disease is a potentially treatable determinant of mortality and quality of life. No comprehensive multinational study to quantify oral disease burden and to identify candidate preventative strategies has been performed in the dialysis setting. The ORAL disease in hemoDialysis (ORALD) study was a prospective study in adults treated with hemodialysis in Europe (France, Hungary, Italy, Poland, Portugal and Spain) and Argentina. Oral disease was assessed using standardized WHO methods. Participants self-reported oral health practices and symptoms. Sociodemographic and clinical factors associated with oral diseases were determined and assessed within nation states. Of 4726 eligible adults, 4205 (88.9%) participated. Overall, 20.6% were edentulous [95% confidence interval (CI), 19.4-21.8]. Participants had on average 22 (95% CI 21.7-22.2) decayed, missing or filled teeth, while moderate to severe periodontitis affected 40.6% (95% CI 38.9-42.3). Oral disease patterns varied markedly across countries, independent of participant demographics, comorbidity and health practices. Participants in Spain, Poland, Italy and Hungary had the highest mean adjusted odds of edentulousness (2.31, 1.90, 1.90 and 1.54, respectively), while those in Poland, Hungary, Spain and Argentina had the highest odds of ≥14 decayed, missing or filled teeth (23.2, 12.5, 8.14and 5.23, respectively). Compared with Argentina, adjusted odds ratios for periodontitis were 58.8, 58.3, 27.7, 12.1 and 6.30 for Portugal, Italy, Hungary, France and Poland, respectively. National levels of tobacco consumption, diabetes and child poverty were associated with edentulousness within countries. Oral disease in adults on hemodialysis is very common, frequently severe and highly variable among countries, with much of the variability unexplained by participant characteristics or healthcare. Given the national variation and high burden of disease, strategies to improve oral health in hemodialysis patients will require implementation at a country level rather than at the level of individuals.

혈액투석환자의 건강 관련 삶의 질과 영향 요인

본 연구는 혈액투석환자의 증상경험 정도, 건강관련 삶의 질과 영향요인을 파악하기 위한 서술적 조사연구이다. 연구대상자는 D광역시에 소재한 1개의 대학병원과 2개의 투석전문병원에 등록되어 혈액투석을 받고 있는 환자 102명이었다. 자료수집 기간은 2014년 4월부터 5월까지이었고, 자료분석은 SPSS/WIN 18.0을 활용하...

Ego strength and health: An empiric study in hemodialysis patients

Introduction: Ego strength represents an important variable that could be predictable about health and compliance in chronic diseases. In this study we propose a new questionnaire, E.F.E. “Ego Functioning Experience”, able to reveal the psychological functioning profile in Hemodialysis patients. The aim of this work, is to underline the existing relations between emotional profile and compliance, whit E.F.E., that may be predictive of a state of psychologycal health in hemodialysis patients. Methods: Study population included 90 hemodialysis patients. The study protocol was made by three psychological tests: the E.F.E. Questionnaire, the DMI, the Self-Liking and Self-Competence Scale. Results: Factor analysis extracts three factors: 1) “Need of Ego support”; 2) “Ego activity oriented to treatment”; 3) “Ego strength”. The correlation coefficients between the E.F.E. Questionnaire factors (three factors) and other measures, showed a direct correlation with the first factor and “turning against object” TAO of the DMI test (correlation is significant at the 0.001 level) and an inverse relation with set mechanisms of “Principalization”, PRN of the DMI (correlation is significant at the 0.005 level). The correlations of the second and the third factors with other measures, were not statistically significant. No relations were found about other variables. Conclusions: The E.F.E. questionnaire is a simple evaluation to detect hemo-dialysis patients who may need greater attention to the psychological health and therefore the need for treatment such as psychological support. In fact, lower presence of ego strength is indicative of poor compliance to clinical treatment in hemodialysis, but also of worsening of psychiatric symptoms such as demoralization and depressed mood. In conclusion, an increased social support is needed in hemodialysis patient in order to achieve better compliance and achieve a better state of psychological health in chronic hemodialysis patients.

Abstract LB-423: A first in class novel cell therapy (PVS-30200) for the treatment and prevention of metastatic cancer by regulating the tumor microenvironment

Abstract Cancer metastases have been difficult to treat and to control. The nature of tumor growth and metastases depends on many elements including the tumor microenvironment and cellular and vascular components to sustain viability and dissemination of cancer cells. Tumors themselves release signals that can alter resident endothelial cells (ECs) to form aberrant vessels to sustain tumor growth. Here we report the use of a novel, endothelial cell therapy (PVS-30200) that is delivered locally and able to control tumor growth and inhibit metastases. It promotes homeostasis and acts as a paracrine regulator of the tumor and its microenvironment to prevent growth and limit cancer invasion and metastasis. PVS-30200 comprises allogeneic ECs cultured on a gelatin substrate; this unique setting maintains the quiescent nature of the ECs and resists tumor alteration of the quiescent endothelial phenotype. A similar local EC therapy is entering a Phase 3 clinical trial for enhancing blood vessel repair and promoting vascular health in hemodialysis patients and has demonstrated a safe and tolerant profile.In vitro proliferation assays that cultured MDA-MB-231 breast and A549 lung carcinoma cells with EC-conditioned media reduced growth by approximately 40% (p < 0.001 for both cell lines). Migration and invasion were measured in a dual chamber culture system. Culture in EC-conditioned media significantly reduced in vitro invasiveness of both cancer lines. Analysis of the conditioned media showed the presence of anti-inflammatory, and anti-tumorigenic factors, such as TGF-β1, heparan sulfate proteoglycan and tissue inhibitors of matrix metalloproteinases. In vivo studies were performed to confirm the anti-proliferative and invasiveness activity. A spontaneously metastasizing orthotopic prostate (PC-3M-Luc) tumor model was utilized to determine the therapeutic potential of this treatment. Progression of the tumor and distant metastases were monitored using bioluminescent in vivo imaging (BLI). These studies demonstrated that a single injection of 500 μL PVS-30200 to the area surrounding the tumor prevented distant chest metastases and inhibited primary tumor growth. Twenty-nine days after tumor inoculation and 15 days post PVS-30200 treatment, the metastatic BLI measurements were 2.1-, 8.8-, and 11.8-fold greater than the initial day 0 BLI measurements for PVS-30200, vehicle, and untreated groups, respectively. Statistical significance was observed using a Kruskal-Wallis comparison of the group median BLI measurements for primary tumor growth (p=0.0386) and distant chest metastases (p=0.0387). This safe and novel cell therapy has demonstrated promising utility in the treatment of local cancers and in the reduction of metastases. This therapy is being explored in other in vivo solid tumor models to further assess the effects on tumor growth and metastases. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr LB-423. doi:10.1158/1538-7445.AM2011-LB-423

Nephrology Literature Watch

Nephrology Literature Watch

Improving Psychosocial Health in Hemodialysis Patients After a Disaster

Twenty-two social workers implemented a cognitive-behavioral intervention with 69 patients in 22 dialysis units in Louisiana to improve psychosocial health following Hurricanes Katrina and Rita. Pre- and post-intervention questionnaires measured psychosocial status domains (general health status, social functioning, burden of kidney disease, depressed mood, anxiety, and mastery). Participants rated their general health status (p < .05) and social functioning (p < .05) significantly higher after the intervention. Participants who listened to the class Managing stress through communication and problem solving and discussed it with their social worker, had significant improvement in depressed mood score (p < .05) after completing the program, compared to participants who did not discuss this material with their social worker. Sixty-five percent had scores indicating depressed mood before the program, compared with 56% following. The more positive participants' program evaluation, the higher their quality of life (lower perceived burden of kidney disease [p = .05]).

Lower Prevalence of Depression in Hemodialysis Patients Who Use Polysulfone Dialyzers

Background: Depression is common in dialysis patients and is also associated with the presence of chronic inflammation. Dialysis patients who use polysulfone dialyzers are less likely to have inflammation. It is unknown whether the use of polysulfone dialyzers is associated with lower prevalence of depression. Method: The aim of this cross-sectional study is to examine the association between the use of polysulfone dialyzers and depression in dialysis patients. This association was examined by use of univariate and multivariate analysis. Results: Depression affected 35% of our hemodialysis patients. Compared with nondepressed patients, depressed patients were more likely to be male, thinner (lower body mass index), and have more comorbidities. Depression was also associated with the use of cellulose derivative dialyzers (p = 0.008). In multivariate analysis with stepwise regression, gender, albumin, number of comorbidities, and BMI lost their significance. However, the use of polysulfone dialyzers remained correlated with a lower prevalence of depression (odds ratio 0.063, 95% confidence interval 0.01–0.43; p = 0.005). This indicates that the type of dialyzer is independently associated with depression in these hemodialysis patients. Conclusion: The prevalence of depression was lower in patients using polysulfone dialyzers than cellulose derivative dialyzers. Using more biocompatible dialyzers appears to be associated with better mental health in hemodialysis patients.

Relationship between cognitive family functioning and mental health in hemodialysis patients

Relationship between cognitive family functioning and mental health in hemodialysis patients

Japanese study links hypercalcemia to poor mental health in hemodialysis patients

Japanese study links hypercalcemia to poor mental health in hemodialysis patients

Comparison Of Supervised And Home Based Exercise Training Programs In Hemodialysis Patients

PURPOSE: To compare the effects of supervised and home based exercise training on functional capacity, physical functioning, pulse wave velocity, self-reported health and physical activity in hemodialysis patients. METHODS: Forty maintenance hemodialysis patients were randomized to receive either supervised cycle training during dialysis (S), a home based walking program (H) or usual care (C). The goals of the training programs were to complete three sessions per week and eventually be exercising for 45 minutes per session at an RPE of 13. RESULTS: After three months, twenty seven patients (males=16, mean±SD, age=52±12yrs, BMI=29±9) remained in the study (S=8, H=9, C=10). Training compliance over the three months was S=90% and H=80% in the remaining patients. There were no significant (P>0.05) time or group differences in pre to post changes in six minute walk time (S=[up arrow]13%, H= S=[up arrow]5%, C= [up arrow]12%), get-up-and-go time (S= [down arrow]l%, H= [up arrow] 2%, C=s [down arrow]9%), pulse wave velocity (S= [up arrow]8%, H=> [up arrow]l2%, C=s [up arrow]3%), self reported mental (S= [down arrow]6%, H= [up arrow]6, C=[up arrow]4%) and physical health (S=> [down arrow]l4%, H= [up arrow]7%, C=[up arrow] [down arrow]1%). Of interest was the finding that increases in health enhancing physical activity levels (including time spent training) were not different between groups (S=[up arrow]400%, H=[up arrow]500%, C=[up arrow]200%). CONCLUSIONS: After three months, there were no differences in functional capacity, physical functioning, pulse wave velocity and self-reported health in hemodialysis patients randomized to supervised cycle training, home based walking or usual care. An increase in physical activity levels in the usual care patients may explain the unexpected lack of differences between these and the exercising patients.