Hemodialysis Centers Research Articles

Muscle Fatigue Experienced by Healthcare Workers in Hemodialysis Centers: A Survey

Muscle Fatigue Experienced by Healthcare Workers in Hemodialysis Centers: A Survey

Short-physical performance battery: complete mediator of cognitive depressive symptoms and diabetes mellitus in hemodialysis patients

ObjectiveThis study aimed to examine the relationship between different dimensions of depressive symptoms and the presence of diabetes mellitus in hemodialysis patients. Additionally, the study sought to elucidate the mediating effect of physical performance on this association.MethodsThis was a cross-sectional multicenter study conducted between July 2020 and March 2023, involving 1024 patients from eight hemodialysis centers in Shanghai. Diabetes mellitus was based on a documented physician diagnosis and blood glucose tests. Physical performance and depressive symptoms were assessed using short-physical performance battery (SPPB) and the patient health questionnaire-9, respectively. Regression and mediation analysis were applied to statistical analysis.ResultsAmong the 1024 participants, 39.26% (n = 402) were found to have coexisting diabetes mellitus. Diminished SPPB scores (OR = 0.843, 95% CI = 0.792–0.897) and cognitive depressive symptoms (OR = 1.068, 95% CI = 1.011–1.129) exhibited significant associations with diabetes mellitus, while somatic depressive symptoms did not show a significant correlation. Notably, SPPB emerged as a complete mediator in the relationship between cognitive depressive symptoms and diabetes mellitus. The observed indirect effect of SPPB on this relationship was estimated at 0.038 (95% CI: 0.021–0.057).ConclusionThis study showed an association between diabetes mellitus and cognitive depressive symptoms in patients undergoing hemodialysis, with physical performance appearing to mediate the relationship between diabetes mellitus and depressive symptoms.

Urate lowering therapy in patients starting hemodialysis limit gout flares occurrence: ten years retrospective study

BackgroundUncontrolled gout can cause articular impairment but is also associated with a global and cardiovascular excess mortality, especially in dialysis population.Data documented within existing research is not conclusive regarding gout flares evolution during hemodialysis and their control by urate lowering therapy (ULT).Without clear guidelines concerning hemodialysis patients management with chronic gout, this study proposes to investigate whether gout flare incidence reduction could be observed on this population treated by urate lowering therapy versus patients without treatment.MethodsWe performed a retrospective cohort study in two hemodialysis centers in France. Were selected patients over 18 years old with a gout history who started hemodialysis between January 2005 and September 2015.Demographics and clinicals data were recorded at hemodialysis start and throughout 5 years of follow up. Gout flare was defined as presence of uric acid crystal in joint punction or clinically diagnosed as such with a colchicine prescription.All statistical analysis were performed in SAS® version 9.4 (SAS Institute Inc., Cary, NC).ResultsOne hundred eighty-one patients have been included, mean age at dialysis initiation was 68.6 years (± 12.4) with 72% of men, 54% were treated by ULT: 89.7% by allopurinol and 9.3% by febuxostat. One patient received both treatments successively. After hemodialysis initiation, 35.36% patients had experienced at least one gout flare. The appearance of at least one gout flare concerned 50% of patients in no ULT group and 22.68% patients in ULT group (p = 0.0002).Dialysis efficiency was measured at regular interval during follow-up and was similar in both groups.To study the association strength between clinical factors and gout flares occurrences, a Cox model was performed; ULT is a protector factor of gout flare (HR:0,42, CI 95: 0,25-0,71).The proportion of serum urate values within the target (median 53% vs 29.3%, p < 0.0001) was significantly higher in ULT group versus no ULT group (median 53% vs 29.3%, p < 0.0001).ConclusionUrate lowering therapy limit new gout flares occurrence in hemodialysis patients with gout historyCollaboration between rheumatologists and nephrologists may help to update guidelines for urate-lowering therapies in patients on dialysis.

Relationship between carotid-femoral pulse wave velocity and prognosis in maintenance hemodialysis patients.

Carotid-femoral pulse wave velocity (Cf-PWV) can well predict the prognosis of the general population. However, whether Cf-PWV can be used as a prognostic indicator in maintenance hemodialysis (MHD) patients remains mysterious. The present study endeavored to explore the prognostic value of Cf-PWV among the MHD population. Patients who received MHD and underwent Cf-PWV examination at the hemodialysis center of Zhejiang Provincial People's Hospital between March 1, 2017 and October 15, 2019 were enrolled. Relevant clinical data were collected from these patients, who were subsequently followed up for a minimum of 1 year. During the follow-up period, the occurrence of all-cause death was recorded as a prognostic indicator. Based on the predetermined inclusion and exclusion criteria 178 patients were included in the final analysis. These patients were categorized into 2 groups based on Cf-PWV values: group 1 (Cf-PWV < 13.8 m/s), and group 2 (Cf-PWV ≥ 13.8 m/s). Thirty-four patients succumbed to their conditions within a median follow-up period of 23.3 months. Kaplan-Meier survival analysis revealed that the median survival time of group 2 was significantly shorter than group 1 (log-rank test, χ2 = 12.413, P < .001). After adjusting for various factors, including age, cardiovascular disease, peripheral arterial diastolic pressure, central arterial diastolic pressure, albumin, blood urea nitrogen, serum creatinine, left ventricular ejection fraction, 25 hydroxyvitamin D3, C-reactive protein and serum phosphorus, it was found that Cf-PWV ≥ 13.8m/s was an independent risk factor for all-cause mortality in MHD patients (relative risk = 3.04, 95% confidence interval [CI] = 1.22-7.57; P = .017). A high level of Cf-PWV (≥13.8 m/s) is an independent risk factor for all-cause death in MHD patients.

Evaluation of Fall Risk in Hemodialysis Patients within the Scope of Quality Improvements: A Comparison of Two Assessment Scales

Introduction: Patient falls are one of the most important quality indicators in healthcare. Aim: It was aimed to compare two tools used to evaluate fall risk in hemodialysis patients. Method: The mean age of the patients was 58.72 ± 14.49 years and 62% were male. The mean duration of treatment was 4.98 ± 4.71 years. Within the last year, 33% of the patients had a history of falling. The patients' fall risk was assessed using the Itaki Fall Risk Scale and Dialysis Fall Risk Index. The relationship between patients' age, gender, duration of hemodialysis treatment, and the status of having a chronic disease and falls were examined. Results: According to the Itaki Scale, 57% were in the ''high-risk'' group. According to the Dialysis Fall Risk Index, 64% were in the "very high risk" group. The mean Itaki Fall Risk Scale score was 4.75 ± 3.92, and the mean of the Dialysis Fall Risk Index was 7.59 ± 1.92. According to the cut-of score, the sensitivity and specifiity of the Itaki Fall Risk Scale were 97% and 99.6%, and the Dialysis Fall Risk Index was 93.9% and 99.6%. The positive and negative predictive value were 56.1% and 97.7%, respectively for the Itaki Fall Risk Scale. These points were 51.6% and 100% for the Dialysis Fall Risk Index. Conclusion: Both scales were effctive in improving care quality in hemodialysis centers. Itaki Scale may be preferred due to its ease of use and patient compliance.

Lower extremity function and cardiovascular disease risk in hemodialysis patients: A multicenter cross-sectional study.

Physical performance in hemodialysis patients declines and serves as a cardiovascular disease (CVD) incidence and mortality predictor. However, lower extremity function's role remains unclear. This study aimed to quantify the association between lower extremity function and CVD risk in hemodialysis patients. This was a multicenter cross-sectional study enrolling 868 participants (532 males, 336 females) from seven hemodialysis centers in Shanghai, China. Patients were divided into three groups per lower extremity function, evaluated by short physical performance battery (SPPB) scores: 0-6, 7-9, and 10-12. Upper extremity function was quantified through grip strength assessment. CVD risk was assessed using the Framingham Risk Score. Approximately 35% of hemodialysis patients had impaired lower extremity function (SPPB score < 10). Participants with high SPPB scores had stronger handgrip and lower Framingham CVD risk scores than those with low and moderate SPPB scores (p < 0.05). After adjusting clinical confounders, SPPB was independently associated with CVD risk, as a categorized variable (odds ratio: 0.577, 95% confidence interval [CI]: 0.388-0.857, p = 0.006) and as a continuous variable (odds ratio: 0.858, 95% CI: 0.772-0.953, p = 0.004). An SPPB score < 10 predicted an increased CVD risk (area under curve: 0.649, 95% CI: 0.599-0.699, p < 0.001). Causality between physical performance and CVD risk was not considered. Some upper limb results may not be generalizable to peritoneal dialysis and kidney transplant patients. Lower extremity function was significantly associated with CVD risk in hemodialysis patients. Further studies are needed to explore the long-term relationship between lower extremity function and CVD risk.

Construction of Risk-Prediction Models for Autogenous Arteriovenous Fistula Thrombosis in Patients on Maintenance Hemodialysis

Introduction: Autogenous arteriovenous fistula (AVF) is the preferred vascular access in patients undergoing maintenance hemodialysis (MHD). However, complications such as thrombosis may occur. This study aimed to construct and validate a machine learning-based risk-prediction model for AVF thrombosis, hypothesizing that such a model can effectively predict occurrences, providing a foundation for early clinical intervention. Methods: The retrospective longitudinal study included a total of 270 patients who underwent MHD at the Hemodialysis Center of the Second Affiliated Hospital of Harbin Medical University between March 2021 and December 2022. During this study, baseline data and scale information of patients between March 2020 and December 2021 were collected. We recorded outcome indicators between March 2021 and December 2022 for subsequent analyses. Five machine learning models were developed (artificial neural network, logistic regression, ridge classification, random forest, and adaptive boosting). The sensitivity (recall), specificity, accuracy, and precision of each model were evaluated. The effect size of each variable was analyzed and ranked. Models were assessed using the area under the receiver-operating characteristic (AUROC) curve. Results: Among the 270 included patients, 105 had AVF thrombosis (55 male and 50 female patients; age range, 29–79 years; mean age, 56.72 years; standard deviation [SDs], ±13.10 years). Conversely, 165 patients did not have AVF thrombosis (99 male and 66 female patients; age range, 23–79 years; mean age, 53.58 years; SD, ± 13.33 years). During the observation period, approximately 52.6% of patients with AVF experienced long-term complications. The most common complications associated with AVF were thrombosis (105; 38.9%), aneurysm formation (27; 10%), and excessively high output flow (10; 3.7%). Fifty-four (20%) patients with AVF required intervention because of complications associated with vascular access. The AUROC curve of the testing set was between 0.858 and 0.903. Conclusion: In this study, we developed five machine learning models to predict the risk of AVF thrombosis, providing a reference for early clinical intervention.

Screening hemodialysis patients for tuberculosis in Sudan

ObjectivesTo estimate the prevalence of latent tuberculosis infection (LTBI) and the need for TB preventive treatment (TPT) among hemodialysis (HD) patients in Sudan. MethodsWe screened patients in a single HD center by two-step tuberculin skin test (TST), symptom survey, physical examination and chest radiography (CXR). ResultsThe survey included 204 patients, five of whom (2.5%) had history of previously treated TB. The proportion of TST positive patients was 12.3% after the first test and increased to 21.1% after the second test. Patients previously treated for TB were more likely to have positive TST (80 vs 20.1%, p = 0.01). We screened 184 patients for TB disease; 16.3% were symptomatic, 15.8% had CXR abnormality and 6.5% were symptomatic with CXR abnormality. Additionally, 13.6% of patients had physical signs consistent with extra-pulmonary TB without symptoms or CXR abnormality. Based on these findings, high probability of pulmonary and extra-pulmonary TB was found in 38.6% and 13.6% of patients respectively and they were referred for bacteriological confirmation. We diagnosed LTBI and prescribed TPT to 9.2% of screened patients. ConclusionIn this cohort of Sudanese HD patients, 21.1% were positive after two-step TST and 52.2% were considered to have high probability of TB disease.

Service Delivery of Hemodialysis Centers among Public Hospitals in Region III: An Evaluation

The affordability and accessibility of hemodialysis treatment in public hospitals have increased unlike decades before. While there is significant progress, constraining factors and problems exist in hemodialysis service delivery hindering this progress and health outcomes. This study aimed to evaluate the level and identify the problems of service delivery of hemodialysis centres to create evidence-based proposed measures and recommendations. The study used a descriptive quantitative research design wherein data was collected by surveying 93 hemodialysis staff in three tertiary hospitals using a Likert scale survey and multiple-choice questionnaire. The study determined that overall level of service delivery has a very satisfactory rating of 3.71. Therefore, the hospitals have sufficient knowledgeable staff, necessary materials and equipment that can deliver quality care and service to an increasing volume of patients while ensuring the patient’s satisfaction; however, the hospitals can further improve the availability, the quality, and the maintenance of the materials and equipment. Moreover, respondents identified these seven service delivery indicators to be the common service delivery problems they encountered. These findings indicate the need for better resource allocation and interagency collaboration to further assess the identified problems, undertake possible interventions, and strengthen local and public healthcare system policymaking.

The lived experiences of fatigue among patients receiving haemodialysis in Oman: a qualitative exploration

BackgroundFatigue among patients with end-stage kidney disease (ESKD) receiving haemodialysis imposes a substantial burden on patients’ quality of life and expected treatment outcomes. This study explores the perspective on ESKD-related fatigue and contributing factors among Omani patients receiving haemodialysis.MethodsAn exploratory qualitative design was used. Participants (N = 25) were recruited from two Omani haemodialysis centres, and data were collected through semi-structured interviews, which were transcribed and analysed using a thematic analysis approach. NVivo 11 is used to manage qualitative data and create memos, nodes, and codes.ResultsFindings highlighted three themes: (i)“Inevitability of fatigue,” (ii)“Contributors to physical fatigue,” and (iii)“Contributors to mental fatigue.” Theme one alluded to the inevitability of fatigue and the unique experience encountered by patients. Theme two addressed the physical fatigue associated with ESKD-related factors, such as chronically low haemoglobin levels, and the exhausting impact caused by the frequency and travelling distance for treatment sessions. Theme three, mental fatigue, was notably driven by heightened emotional disturbance, encompassing frustration, guilt, anxiety, and distress, that in turn impacted family interactions, frequently triggering anger and remorse. Moreover, mental fatigue is a result of disturbances in expressing physical sexuality in marriage, as physical fatigue was found to be a significant contributor to unsatisfactory sexual experiences and, thus, straining the relationships between couples.ConclusionsThis study offers an explanation of fatigue among Omani patients with ESKD who are receiving haemodialysis. The study emphasises close links between physiological change, the haemodialysis process, and mental tiredness, together with their contribution to supporting the need for a holistic approach and care strategies in managing these patients and promoting patient and family well-being.

Bioelectrical impedance phase angle combined with physical function predicts pre-frailty in maintenance hemodialysis patients: a prospective study

BackgroundThe prevalence of pre-frailty is notably high among maintenance hemodialysis (MHD) patients. Pre-frailty, an early and reversible condition between non-frailty and frailty, can lead to adverse outcomes such as increased unplanned hospital admissions and a higher risk of other chronic diseases. Early identification and intervention of pre-frailty in MHD patients are crucial. This study aimed to establish a simple and effective model for screening and identifying MHD patients at high risk of pre-frailty by using 50 kHz-Whole Body Phase Angle (PhA) measured by bioelectrical impedance analysis (BIA), hand grip strength (HGS), the Five-Times-Sit-to-Stand Test (FTSST), and laboratory parameters, 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, comprising 128 non-frail and 116 pre-frail individuals. Data were collected prospectively, including demographic information, physical measurements, and laboratory test results. All participants provided informed consent before enrollment. The FRAIL scale (FS) was used to assess pre-frailty in MHD patients. Grip strength was measured using an electronic grip strength tester, physical function was assessed using the Five-Times-Sit-to-Stand Test, and whole-body phase angle was measured using the InBody S10 device.ResultsA total of 244 MHD patients with a mean age of 53.75 ± 0.90 years were enrolled, including 130 males with a mean age of 54.12 ± 1.26 years and 114 females with a mean age of 53.32 ± 1.29 years. ROC curve analysis showed that in male patients, the AUC of PhA for predicting pre-frailty was 0.919, with a sensitivity of 94.5% and specificity of 91.3%, and a cutoff value of 6.05°; in female patients, the AUC of PhA was 0.870, with a sensitivity of 70.5% and specificity of 90.6%, and a cutoff value of 5.25°. The AUC of FTSST for screening pre-frailty in male patients was 0.827, with a sensitivity of 62.3% and specificity of 96.2%, and a cutoff value of 12.95 s; in female patients, the AUC of FTSST was 0.784, with a sensitivity of 67.3% and specificity of 84.0%, and a cutoff value of 12.95 s. Additionally, in male patients, the combination of PhA and FTSST resulted in an AUC of 0.930, with a sensitivity of 96.4% and specificity of 81.3%; in female patients, the AUC was 0.911, with a sensitivity of 78.7% and specificity of 92.5%.ConclusionPhA measured by BIA, in combination with the Five-Times-Sit-to-Stand Test, serves as an effective screening tool and predictor of pre-frailty in MHD patients. The combination of PhA and FTSST shows enhanced diagnostic value in female patients, while PhA alone is sufficient for predicting pre-frailty in male patients.Trial registrationChinese Clinical Trial Registry (ChiCTR2100051111), registered on 2021–09-13.

Analysis of the Current Situation and Influencing Factors of Psychosocial Adaptation of Hemodialysis Patients

Objective: To investigate the current status and influencing factors of psychosocial adaptation of hemodialysis patients, and to provide a reference basis for the development of nursing interventions. Methods: 435 hemodialysis patients from the hemodialysis centers of three tertiary A hospitals in Xi’an City were conveniently selected from April to August 2023, and were investigated using the General Information Questionnaire, the Psychosocial Adaptation to Disease Scale, the Fear of Disease Progression Simplification Scale, and the Personal Sense of Control Scale. Results: The psychosocial adaptation score of hemodialysis patients was (56.68 ± 18.32); the results of multiple linear regression analysis showed that marital status, the form of payment for medical expenses, work status, degree of self-care in daily life, number of co-morbid chronic illnesses, fear of disease progression, and sense of personal mastery were the main influencing factors of psychosocial adaptation of hemodialysis patients. Conclusion: The psychosocial adaptation of hemodialysis patients is at the level of severe maladaptation, and healthcare professionals should formulate scientific and reasonable nursing intervention programs according to their influencing factors to enhance their psychosocial adaptation.

Intervention control of aerobic exercise in maintaining quality of life and pulmonary hypertension in hemodialysis patients.

Pulmonary hypertension is a serious complication in the treatment of maintenance hemodialysis patients, which seriously affects the quality of life of patients and threatens their life safety. Prevention, treatment and improvement of pulmonary hypertension are of great significance to improve the quality of life of patients. To investigate the intervention and control of pedal-powered bicycle in maintaining quality of life and pulmonary hypertension in hemodialysis patients. 73 patients with maintenance hemadialysis combined with pulmonary arterial hypertension at a hemodialysis center in a certain hospital from May 2021 to May 2022 are selected. Patients are divided into two groups, 37 cases in the control group (group C) and 36 cases in the intervention group (group I). Patients are divided into two groups, group C is treated with oral administration of betaglandin sodium combined with routine nursing care. Based on group C, group I conducts power cycling exercises. After treatment, group I patients had higher muscle strength, 36-Item Short Form Health Survey scores, and Kidney Disease Targets Areas scores; The 6-minute walk distance test index level was higher and the Borg score was lower; The group I had lower systolic blood pressure, greater vital capacity, higher positive emotion, lower systolic pulmonary artery pressure index level, higher arterial partial oxygen pressure level, lower pulmonary vascular resistance index level, and higher blood oxygen saturation level [158.91 ± 11.89 vs 152.56 ± 12.81, 1795.01 ± 603.18 vs 1907.20 ± 574.15, 24.00 (22.00, 29.00) vs 24.00 (22.00, 28.00), P < 0.001]. Aerobic exercise combined with Western medicine treatment can effectively improve patients' pulmonary hypertension, alleviate their negative emotions, and enable them to achieve a higher level of quality of life.

Determinants of moderate-to-high physical activity levels in hemodialysis patients: A multicenter cross-sectional study.

Moderate physical activity is related to reduced mortality in hemodialysis patients. However, most hemodialysis patients have low physical activity levels for complex reasons. This study investigated the determinants of moderate-to-high physical activity levels and whether psychosocial correlates are associated with engagement in moderate-to-high physical activity among hemodialysis patients. A cross-sectional survey was conducted with 134 hemodialysis outpatients, aged 64.7 years, in three hemodialysis centers in Taiwan. Data on sociodemographics, comorbidities, lifestyles, and psychosocial correlates, including perceived benefits, barriers, and self-efficacy of physical activity, were collected. Multiple logistic regression analyses were performed. Results showed that patients with moderate-to-high physical activity levels constituted a significantly lower proportion of current smokers and had fewer perceived physical activity barriers and higher self-efficacy of physical activity compared with those with low levels. After adjusting for potential sociodemographic covariates, current employment, nonsmoking status, and high self-efficacy of physical activity were significantly associated with moderate-to-high physical activity levels. Developing strategies to improve the self-efficacy of physical activity, support employment, and enhance anti-smoking campaigns in hemodialysis patients can help them engage in moderate-to-high levels of physical activity.

Culturally responsive care in haemodialysis: A scoping review.

To describe how clinicians provide culturally responsive care to culturally diverse people with kidney failure in haemodialysis centres. Culturally diverse individuals receiving in-centre maintenance haemodialysis have unique cultural needs. Unmet cultural needs can impair and profoundly affect their experiences. Given culturally responsive care has the potential to enhance the experiences of culturally diverse people, it is vital to understand how clinicians provide culturally responsive care. A scoping review was undertaken using Arksey and OMalleys framework. Five databases: Medline and CINAHL Complete (EBSCO), PsycINFO, Embase (OVID) and ProQuest Theses and Dissertation databases were searched for research literature published in English between 1990 and 2023. Narrative synthesis was used to synthesise the data. From the 17,271 records screened, 17 papers reporting 14 studies met the inclusion criteria. Narrative synthesis revealed two themes: (i) communication enablers and barriers including linguistic differences, professional and lay interpreter use; and (ii) the importance of culture, which encompassed acknowledging cultural priorities, accommodating cultural food preferences and access to cultural training. While competing priorities associated with haemodialysis may be a challenge for clinicians, recognising the significance of cultural care needs and accommodating them in care is important. Demonstrating respect towards cultural diversity and providing person-centred care by facilitating the unique cultural needs of people with kidney failure in haemodialysis is imperative. Culturally responsive care is complex and multidimensional. Individuals' cultural care needs should be acknowledged, respected, and accommodated in care. No patient or public contribution. The study protocol was registered in the Open Science Framework. https://osf.io/uv8g3.

The Relationship Between Anemia and Parathyroid Hormone Levels in Patients With Kidney Failure Undergoing Hemodialysis Treatment in Georgia.

Chronic kidney disease (CKD) and its associated complications, such as anemia and secondary hyperparathyroidism (SHPT), pose significant challenges to global healthcare systems. This study explores the demographic and clinical characteristics of 284 kidney failure (KF) patients undergoing hemodialysis, in an effort to shed light on the possible association between anemia and SHPT. A proven connection between the two could theoretically influence the management plans for CKD patients, with the hopes of achieving lower morbidity and/or mortality in this patient group. A retrospective, cross-sectional, real-world data analytical study was conducted at a hemodialysis center in Tbilisi, Georgia, encompassing a sample size of n = 284 patients on maintenance hemodialysis. The data analyzed was extracted from patients' medical records. According to our results, the prevalence of anemia was strikingly high at 82.04%, underlining its substantial burden within this patient population.Our analysis revealed a notable systemic association between anemia and SHPT, particularly when considering hemodialysis vintage. However, our final analysis model revealed no statistically significant association between anemia and intact parathyroid hormone (iPTH) levels. Conclusion:Our study revealed a significant systemic relationship between anemia and SHPTwhen hemodialysis duration was considered, despite initial analyses showing no direct association. Future research should focus on longitudinal and multi-center studies to better understand this relationship, aiming to enhance the care and management of CKD patients on hemodialysis.

Toward acid- and heparin-free dialysis: the regional anticoagulation approach.

In chronic intermittent hemodialysis, heparin is the standard anticoagulant as is the use of acid-containing dialysate. Regional anticoagulation (RA) with a calcium-free, citrate-containing dialysate has been developed. We compared RA using a calcium-free, citrate-free dialysate, routinely used in our center, versus systemic heparinization. In a retrospective, observational, single-center, crossover study, we examined 15 patients undergoing chronic hemodialysis who were at high risk of bleeding and temporarily unable to use heparin. These patients received temporary treatment with RA involving calcium-free and citrate-free dialysate. We compared the dialysis session success rates during two distinct periods: standard heparinization and RA procedure with a calcium-free and citrate-free dialysate. In our study of 15 patients on chronic hemodialysis which compared 30 RA sessions versus 28 heparin-based anticoagulation session, we observed a 100% success rate with a median session duration of 240 min in both RA and heparin groups. No early extracorporeal circulation (ECC) loss was reported. However, we noted significant differences in the post-dialysis ECC thrombosis scores, with higher Global Thrombosis Index (GTI) and higher membrane coagulation scores in the RA group (P<.007 and P<.02, respectively). No hypocalcaemia or hypercalcemia symptoms occurred. Median post-filter ionized calcium levels were 0.32 (0.29-0.39) mmol/L at 30 min and median patient ionized calcium levels was 1.19 (1.135-1.28) mmol/L at 60 min. No significant difference in per-dialysis arterial blood pressure was observed between groups. Our study evaluated the RA approach using a calcium-free, citrate-free acetate dialysate in a chronic hemodialysis center and found it effective. Although an acid-free dialysate was not used in this study, our findings suggest it could be the next frontier in the evolution of advanced dialysis techniques.

Nurses' knowledge, attitude, and practice toward chronic kidney disease in hemodialysis centers at Hail City, Saudi Arabia

Chronic kidney disease (CKD) is a significant global issue with clinical, social, and economic impacts. It negatively affects quality of life and is linked to higher rates of illness and death. Nurses are crucial in the early detection and management of CKD. This study aimed to evaluate the knowledge, attitudes, and practices of nurses regarding CKD, and the factors influencing these aspects in hemodialysis centers in Hail City, Saudi Arabia. A cross-sectional study was conducted from July to October 2022 using a self-administered questionnaire. This questionnaire assessed nurses’ knowledge of CKD, their attitudes toward it, and their CKD care practices. A significance level of p&lt;0.05 was used for all tests. Approximately 63.06% of the nurses provided correct answers related to CKD knowledge. Most nurses (84.52%) had positive attitudes towards caring for CKD patients, and more than half (53.06%) had positive CKD care practices. There was a significant relationship between nurses’ knowledge scores and both “years of experience” and “received information regarding CKD care” (p=0.033 and p&lt;0.001, respectively). Nurses with more experience and previous information had higher knowledge scores than those with less experience and no prior information. Additionally, nurses with more experience and previous information also had more positive attitudes toward CKD patients than those with less experience and no prior information (p=0.004 and p=0.008, respectively). Therefore, nurses with more experience and prior information about CKD care were more knowledgeable and had more positive attitudes towards CKD patients compared to those with less experience and no prior information.

The Mediating Effect of Symptom Burden in the Depression and Quality of Life in Patients with Maintenance Hemodialysis.

To investigate current status of quality of life and the association between depression and symptom burden in a sample of Chinese maintenance hemodialysis (MHD) patients. A self-designed patient general information questionnaire, disease-related information questionnaire, dialysis patient symptom burden scale, depression scale, and quality of survival scale were used to investigate 380 maintenance haemodialysis patients in haemodialysis centres. A regression model of the factors affecting the quality of survival was established using structural equation modelling. The regression model data had a high goodness of fit: c2/df = 4.736, RMSEA = 0.099, GFI = 0.918, CFI = 0.972, TLI = 0.962, SRMR = 0.0469. Structural equation model analysis showed that depression had a positive predictive effect on symptom burden, β = 0.398, P < 0.001; Symptom burden had a negative predictive effect on the quality of life, β =-0.851, P < 0.001; and Depression had a negative predictive effect on the quality of life, β =-0.151, P < 0.001. Depression indirectly affects the quality of life through symptom burdens. Depression and symptom burden directly or indirectly affect the quality of life in patients with maintenance hemodialysis. Symptom burden moderates the relationship between depression and quality of life as a mediating variable.

Personalized prediction of intradialytic hypotension in clinical practice: Development and evaluation of a novel AI dashboard incorporating risk factors from previous and current dialysis sessions

BackgroundIntradialytic hypotension (IDH) is one of the most common and critical complications of hemodialysis. Despite many proven factors associated with IDH, accurately predicting it before it occurs for individual patients during dialysis sessions remains a challenge. PurposeTo establish artificial intelligence (AI) predictive models for IDH, which consider risk factors from previous and ongoing dialysis to optimize model performance. We then implement a novel digital dashboard with the best model for continuous monitoring of patients’ status undergoing hemodialysis. The AI dashboard can display the real-time probability of IDH for each patient in the hemodialysis center providing an objective reference for care members for monitoring IDH and treating it in advance. MethodsEight machine learning (ML) algorithms, including Logistic Regression (LR), Random Forest (RF), Support Vector Machine (SVM), K Nearest Neighbor (KNN), Light Gradient Boosting Machine (LightGBM), Multilayer Perception (MLP), eXtreme Gradient Boosting (XGBoost), and NaiveBayes, were used to establish the predictive model of IDH to determine if the patient will acquire IDH within 60 min. In addition to real-time features, we incorporated several features sourced from previous dialysis sessions to improve the model’s performance. The electronic medical records of patients who had undergone hemodialysis at Chi Mei Medical Center between September 1, 2020 and December 31, 2020 were included in this research. Impact evaluation of AI assistance was conducted by IDH rate. ResultsThe results showed that the XGBoost model had the best performance (accuracy: 0.858, sensitivity: 0.858, specificity: 0.858, area under the curve: 0.936) and was chosen for AI dashboard implementation. The care members were delighted with the dashboard providing real-time scientific probabilities for IDH risk and historic predictive records in a graphic style. Other valuable functions were appended in the dashboard as well. Impact evaluation indicated a significant decrease in IDH rate after the application of AI assistance. ConclusionThis AI dashboard provides high-quality results in IDH risk prediction during hemodialysis. High-risk patients for IDH will be recognized 60 min earlier, promoting individualized preventive interventions as part of the treatment plan. Our approachis believed to promise an excellent way for IDH management.