Treatment Of Hemodialysis Patients Research Articles

Self-adaptive epidermal blood flow sensor for high-flux vascular access monitoring of hemodialysis patients

Well-functioning vascular access (VA) is essential for hemodialysis treatment in patients with end-stage renal disease (ESRD). However, continuous and accurate monitoring of blood flow to assess high-flux VA during hospitalization or at home is not feasible for either clinical instruments or wearable sensors. Here, we report the design and preclinical validation of a high-precision, long-term, epidermal blood flow sensor that self-adapts to unavoidable sensor-mounting deviations on the skin and is compatible with individual tissue differences. Specifically, the technology is based on thermal dissipation of the skin, and improves the signal-to-error ratio surpassing 4 times when measuring high-flux blood (100–600 mL/min). In preclinical validation, the sensor is compared with the Doppler ultrasound and demonstrate a blood flow resolution of 10–50 mL/min. Furthermore, it is highly-integrated and wearable, measuring 36 × 50 mm2. The sensor paves the way for accurate, convenient, high-flux blood monitoring, offering significant potential to extend the lives of patients with ESRD.

TH1 Cell Frequency and Neutrophil-to-Lymphocyte Ratio in Hemodialysis: Potential Contributions to Patient Monitoring.

Introduction: Patients undergoing hemodialysis (HD) often exhibit an impaired cellular immune response, which may contribute to an increased susceptibility to infections and other complications. Th1 cells, a subset of T-helper cells, play a crucial role in cellular immunity. However, the modulation of Th1 cells by HD treatment remains unclear. Objective: This study aims to investigate the levels of circulating T cells, especially Th1 cells, and the neutrophil-to-lymphocyte ratio (NLR) in HD patients. Methods: We recruited 26 HD patients and 10 healthy volunteers. Demographical data were collected, and peripheral blood samples were analyzed. Absolute blood cell counts were determined, and T-cell populations were identified using flow cytometry. Th1 cells were defined as IFN-γ-producing CD4+ T cells after in vitro activation, and NLR was calculated through the ratio between the neutrophil and lymphocyte counts measured in peripheral blood. Results: We have observed a significant decrease in Th1 subpopulation frequency in HD patients, as well as significant correlations between immunological and demographic parameters, among which are the NLR values and the absolute values of T-cell subsets. Conclusions: These results seem to clarify the role of Th1 cells in modulating the immune responses of hemodialysis-treated patients, potentially considering its frequency as an indicator for CKD development.

Chronic kidney disease–associated pruritus: a comparison of instruments and associations with patient-reported outcomes using an electronic patient-reported outcome survey in Europe

ABSTRACT Background The associations between self-reported chronic kidney disease–associated pruritus (CKD-aP) and patient-reported outcomes (PROs) have been reported using various instruments to assess itch. Data collection via multiple CKD-aP instruments allows the evaluation of different domains and measurements of CKD-aP burden and may help tailor data capture for future research or clinical care. Methods An electronic PRO (ePRO) survey was distributed to European hemodialysis (HD) patients enrolled in the Dialysis Outcomes and Practice Patterns Study (DOPPS) in 2021–23. The DOPPS is an international cohort study that aims to investigate practice patterns and outcomes in HD patients. The ePRO survey included multiple CKD-aP instruments: Average Itch and Worst Itching Intensity Numerical Rating Scales (AI-NRS, WI-NRS) and a Kidney Disease Quality of Life (KDQOL)-36 single question. Linear and logistic regression were used to estimate adjusted associations between CKD-aP instruments and various PROs. Results This analysis included 769 patients who completed the WI-NRS from HD facilities in France, Germany, Italy, Spain, Sweden and the UK. The correlation between WI-NRS and the KDQOL-36 itch question was 0.88 overall and 0.46 among patients at least somewhat bothered by itch. Mean WI-NRS scores stratified by response to the KDQOL-36 itch question were 8.1, 6.4, 4.1 and 3.1 for extremely, very much, moderately and somewhat bothered, respectively. Patients with worse WI-NRS scores reported worse sleep quality, greater fatigue, more depressive symptoms, and lower mental and physical quality of life; these associations were similar to those observed for the KDQOL-36 itch question. Conclusion Correlation between CKD-aP instruments was high overall, but moderate among the subgroup of patients bothered by itch; differences can be partially attributed to the recall period for the KDQOL-36 (4 weeks) vs the AI- and WI-NRS (24 h). The consistent associations of these instruments with poor outcomes underscores the importance to identify and effectively treat HD patients suffering from pruritus.

Long-term efficacy and safety of difelikefalin in moderate-to-severe pruritus in Japanese hemodialysis patients: a 52-week open-label extension period of a phase 3 trial

BackgroundDifelikefalin, a potent and highly selective agonist of kappa opioid receptors, is used to treat moderate-to-severe pruritus in hemodialysis patients.MethodsThis was a 52-week, open-label phase 3 trial following a 6-week randomized double-blind placebo-controlled treatment period to investigate the efficacy and safety of difelikefalin in Japanese hemodialysis patients. Having completed the 6-week double-blind period, patients received difelikefalin 0.5 μg/kg three times per week intravenously for 52 weeks. Efficacies were assessed using numerical rating scale (NRS) scores, proportion of patients whose NRS score improved by ≥ 3 points and ≥ 4 points, Shiratori severity score, proportion of patients with a nighttime Shiratori severity score of ≤ 2, the Skindex-16 score, 5-D itch scale score, and patient global impression of change (PGIC). Safety was assessed on the basis of adverse events, clinical laboratory tests, vital signs, body weight, 12-lead electrocardiography, and dependency.ResultsThe number of patients who entered the extension treatment period from the difelikefalin (MR–MR) and placebo (P-MR) groups was 85 and 83, respectively. The weekly mean NRS scores (mean ± SD) in the MR–MR group at baseline, week 6, and week 58 were 6.57 ± 1.32, 4.04 ± 2.24, and 2.36 ± 1.86, respectively. The weekly mean scores in the P-MR group, at baseline, week 6, and week 58 were 6.42 ± 1.29, 4.85 ± 1.90, and 2.73 ± 2.14, respectively. In patients receiving difelikefalin, there was a decline in the score from treatment initiation, and this decline continued until week 58. Similarly, improvements were seen until week 58 in the proportion of responders, Shiratori severity score, proportion of responders based on the Shiratori severity score, the Skindex-16 score, 5-D itch scale score, and PGIC. A correlation was seen between the change in NRS and itch-related quality of life (QOL), including the Shiratori severity score, Skindex-16 score, 5-D itch scale score, and PGIC. Difelikefalin was well tolerated and safe even when used long term.ConclusionsDifelikefalin improved itching and itch-related quality of life during long-term treatment in hemodialysis patients with moderate-to-severe pruritus whose response to conventional medications had been inadequate. It also demonstrated excellent safety and tolerability.Trial registration: ClinicalTrials.gov; NCT04711603. Registered 15 January 2021, https://www.clinicaltrials.gov/study/NCT04711603?term=NCT04711603&rank=1.

Pharmacokinetics of Sofosbuvir/Velpatasvir and efficacy of an alternate-day treatment in hemodialysis patients with chronic hepatitis C infection.

Sofosbuvir/Velpatasvir (SOF/VEL) is a combination drug used for chronic hepatitis C (HCV) infection. However, limited information exists regarding the pharmacokinetics of SOF/VEL and its metabolites in hemodialysis patients. We conducted a prospective investigation of the pharmacokinetic parameters of SOF/VEL after a single dose of SOF/VEL (400/100 mg) on days with and without dialysis in 12 Thai hemodialysis patients with chronic HCV infection, who had been undergoing hemodialysis for a duration of 0.5-20 years. Blood samples were collected before dose (0) and 0.5, 1.0, 2.0, 2.5, 3.0, 3.5, 4.0, 5.0, 6.0, 8.0, and 12.0 h after dose. Dialysate samples were also collected before dose (0) and 1.0, 2.0, 3.0, and 4.0 h after dose. Plasma and dialysate samples were quantified for SOF and its metabolite, GS-331007, and VEL concentrations using a fully validated LCMS technique. In addition, a preliminary efficacy study was conducted using the proposed SOF/VEL dose reduction regimen in all patients. No differences in SOF/VEL PK parameters between on- and off-dialysis studies. On the contrary, GS-331007 exhibited a 30% reduction in the area under the plasma concentration-time curve from time 0 to 24 h (AUC0-24h) on dialysis days compared with non-dialysis days (AUC0-24h ratio 0.68 vs. 1.04, respectively). The dialysis clearance of SOF and GS-331007 was 9.35 (8.72-15.11) and 8.89 (8.52-14.07) mL/min, respectively. Subsequently, an alternate-day regimen of SOF/VEL (400/100 mg) was administered for 12 weeks, resulting in an undetectable plasma HCV viral load without side effects. Further clinical studies are warranted to validate the efficacy and safety of our proposed dose reduction regimen.

Predictive Role of Resilience and Hope on Adherence to Treatment in Hemodialysis Patients.

To determine the predictive role of resilience and hope on adherence to treatment in hemodialysis patients hospitalized in two hospitals affiliated to Shiraz University of Medical Sciences (Shiraz, Iran). This is a descriptive-analytical study that was conducted in 2021-2022 on 120 patients treated in hemodialysis sections in Namazi and Shahid Faqihi teaching hospitals. Sampling was conducted using a stratified random method. Demographic information questionnaires, Connor and Davidson's resilience, Snyder's hope and adherence to kidney patients' treatment questionnaires were used to collect the data. The finds showed that the levels of resilience, hope, and adherence to treatment had hight level. More specifically, it was indicated that the mean and standard deviation for the total resilience score, the hope variable, and adherence to total treatment was 75.45±14.34, 40.43±3.66, and 80.12±18.20, respectively; which have maximum possible scores of 100, 48 and 100. Thus, it can be said that no correlation was observed between resilience and adherence to treatment variables (p>0.05); hope variable and adherence to treatment (p>0.05), and adherence to treatment with hope and resilience variables (p>0.05). However, hope and resilience variables showed a direct and weak correlation with each other (r=0.36, p<0.05); that is, patients who had more hope indicated better resilience as well. Although in this study we found that the resilience and hope variables were not able to predict the treatment adherence, hope and resilience indicated a direct and weak correlation. It is recommended that nurses should pay more attention to hope and resilience of hemodialysis patients in order to promote their health.

Hemodialysis bilayer bionic blood vessels developed by the mechanical stimulation of hepatitis B viral X(HBX) gene- transfected hepatic stellate cells.

Artificial vascular graft (AVG) fistula is widely used for hemodialysis treatment in patients with renal failure. However, it has poor elasticity and compliance, leading to stenosis and thrombosis. The ideal artificial blood vessel for dialysis should replicate the structure and components of a real artery, which is primarily maintained by collagen in the extracellular matrix (ECM) of arterial cells. Studies have revealed that in hepatitis B virus (HBV)-induced liver fibrosis, hepatic stellate cells (HSCs) become hyperactive and produce excessive ECM fibers. Furthermore, mechanical stimulation can encourage ECM secretion and remodeling of a fiber structure. Based on the above factors, we transfected HSCs with the hepatitis B viral X (HBX) gene for simulating the process of HBV infection. Subsequently, these HBX-HSCs were implanted into a polycaprolactone-polyurethane (PCL-PU) bilayer scaffold in which the inner layer is dense and the outer layer consists of pores, which was mechanically stimulated to promote the secretion of collagen nanofiber from the HBX-HSCs and to facilitate crosslinking with the scaffold. We obtained an ECM-PCL-PU composite bionic blood vessel that could act as access for dialysis after decellularization. Then, the vessel scaffold was implanted into a rabbit's neck arteriovenous fistula model. It exhibited strong tensile strength and smooth blood flow and formed autologous blood vessels in the rabbit's body. Our study demonstrates the use of human cells to create biomimetic dialysis blood vessels, providing a novel approach for creating clinical vascular access for dialysis.

#492 Ten-year experience treating osteoporosis with bisphosphonate in hemodialysis patients

Abstract Background and Aims The treatment of osteoporosis in patients undergoing hemodialysis (HD) has not been established, as there is insufficient evidence regarding the treatment of osteoporosis. The Kidney Disease: Improving Global Outcomes (KDIGO) 2017 guidelines suggest that determining the bone marrow density (BMD) of HD patients is useful. In 2011, we began treating HD patients' osteoporosis with alendronate. Herein, we describe the effects of the treatment based on our 10-year experience. Method This was a single-center prospective observational study of 85 HD patients (age 67.8 ± 11.0 yrs; 47 females, 38 males) treated for osteoporosis with alendronate at our hospital during the 10 years 2011–2021. The average observational period was 3.9 ± 2.9 years. The patients' BMD values including those at the lumbar spine, femoral neck, and total hip were determined by dual-energy X-ray absorptiometry. The patients whose first T-score was ≤ −2.5 were treated with alendronate. We evaluated the patients' yearly BMD measurements and their yearly values of bone metabolism markers, i.e., parathyroid hormone (PTH), bone alkaline phosphatase (BAP), and tartrate-resistant acid phosphatase 5b (TRACP-5b). Results We compared the data before and after the start of alendronate treatment by dividing the patients into a responder group (the patients whose T-score had improved at 1 year after treatment started; n=44) and a non-responder group (the patients whose T-score had not improved; n=32). The mean observational period of the responder group was significantly longer than that of the non-responder group (p&amp;lt;0.01). In a multiple regression analysis, a longer observational period was significantly associated with the improvement of T-scores (p=0.02). Only the mean T-score of the lumbar spine gradually improved during the study period; those of the femoral neck and total hip did not. Conclusion A long-term use of alendronate for the treatment of osteoporosis may be effective in hemodialysis patients, especially for the lumbar spine. Decisions regarding the effect of alendronate treatment for osteoporosis patients undergoing HD should not be made within only a year after the treatment initiation; rather, a longer observation period is necessary.

#2035 Use of ETElcalcetidefor pReserving vitamiN K-dependent proteInactivitYITAlian Study (ETERNITY-ITA Study)

Abstract Background and Aims Vascular calcifications (VCs) are prevalent in chronic kidney disease (CKD) and mineral disorders, associated with aortic calcification and increased bone fracture risk. The complex pathogenesis involves factors like calcium overload, phosphate imbalance, and secondary hyperparathyroidism. Key inhibitors, vitamin K-dependent proteins (VKDPs) like matrix Gla protein (MGP) and osteocalcin (BGP), play pivotal roles in VC development. Traditional VC risk reduction focuses on lowering parathyroid hormone, calcium and phosphorus levels. Etelcalcetide, a synthetic peptide activating the calcium-sensing receptor, demonstrates promise in clinical trials. Studies on Vitamin K Italian (VIKI) show that calcimimetic treated hemodialysis patients exhibit higher levels of total BGP and MGP, suggesting a protective effect. These findings underscore the multifactorial nature of VC in CKD, informing refined treatment strategies and targeted pathways for improved outcomes. The proposed study will investigate real world evidence of the effect of Etelcalcetide in preserving active forms of VKDPs among total MGP and total BGP with a resulting reduction of those inactive such as dephosphorylated-undercarboxylated MGP or dp-uc MGP, undercarboxylated BGP or uc-BGP, thus contributing to bone and vascular health in hemodialysis patients (Table 1). Method This is a multi-center comparative effectiveness observational longitudinal study with no predefined interference on drug dosing on the part of the investigators. The study will enroll 160 hemodialysis patients: 80 patients considered in the exposed group (treated with Etelcalcetide) and 80 age and sex matched patients considered in the unexposed group (treated with Calcitriol or vitamin D analogs). The treating nephrologist will base their target dose of Etelcalcetide on an individual-level patient basis in order to achieve the KDIGO PTH target level. In the Etelcalcetide-treated group, the addition of calcitriol is allowed when required by normal clinical practice (for correction of hypocalcemia) (Fig. 1). The primary endpoint is the comparison of the levels of active and non-active forms of VKDP between patients treated with Etelcalcetide and those treated with vitamin D or vitamin D analogues. The two groups will be compared for longitudinal changes in the following biomarkers, measured at baseline and after 3, 9, and 18 months of treatment: total MGP, dephosphorylated-undercarboxylated MGP, total BGP, and undercarboxylated BGP. As secondary outcomes will be evaluated bone vascular markers levels, serum calcification propensity T50 test, anemia markers levels, dialysis routine biomarkers, changes from baseline prevalence VCs (Aorta and Iliac arteries) and vertebral fractures by lateral Dorsal Lumbar spine x-Ray and Bone Mass Density (BMD) by Dual-energy X-ray absorptiometry (DEXA). Results Conclusion

Comparison of the effect of heparin, reteplase, and taurolock in the prevention of thrombosis in hemodialysis catheters.

One of the complications of using catheters is the occurrence of thrombosis, which can be dangerous for patients. The main objective of this study is to compare the effect of heparin, reteplase, and taurolock in the prevention of thrombosis in hemodialysis catheters. The present study is a clinical trial, in which the effect of three drugs, heparin, reteplase, and taurolock, in the prevention of thrombosis in hemodialysis catheters, has been investigated. The research units were studied in two intervention and control groups. The stratified random allocation method was used to assign patients to five groups (control, Heparin 50, Heparin 1000, reteplase, and taurolock), with strata based on the patient's age (20-70 years), gender, and duration of dialysis. Within each stratum, patients were also assigned to groups using the randomized block permutation method and a random number table tool. To prevent bias, this study is triple-blinded. This means that the patient, the thrombosis assessor, and the statistical analyst are unaware of the type of intervention received by the patient. Gender (p < 0.999), age distribution (p = 0.774), and duration of dialysis (p = 0.875) showed no statistically significant relationship with thrombosis. However, significant differences were observed among the five groups regarding thrombosis incidence. The relative risk of thrombosis in the Heparin 50, Heparin 1000, reteplase, and taurolock groups compared to the control group was 92.5%, 92.2%, 98.2%, and 89% lower, respectively. Our study underscores the efficacy of heparin, reteplase, and taurolock in preventing thrombosis in hemodialysis catheters. While all three drugs demonstrated efficacy, the Heparin 50 group exhibited the highest relative risk reduction. These findings suggest that heparin, particularly at a low dose, should be considered a standard prophylactic treatment in hemodialysis patients.

Influences of Nursing Professionalism, Empathy, and Clinical Decision-Making Ability on Shared Decision-Making Awareness among Hemodialysis Nurses

Aim. To examine the relationships among nursing professionalism, empathy, and clinical decision-making ability and the factors influencing shared decision-making awareness in hemodialysis nurses. Background. Self-management and treatment for hemodialysis patients are essential for maintaining health and life in daily life. In this process, shared decision-making in which patients, nurses, and medical teams participate and make decisions together has a greater impact on the health recovery and improvement of quality of life for hemodialysis patients than for any other chronic disease patients. Methods. A cross-sectional descriptive design was employed. Participants were 145 nurses working in the hemodialysis centers at hospitals in Seoul and Gyeonggi-do. Measures included the general characteristics of study participants, nursing professionalism, empathy, clinical decision-making ability, and shared decision-making awareness. Data were collected from May to July, 2022, and multiple linear regression analysis was used to examine the predictive factors of shared decision-making awareness. Results. The strongest predictor was empathy, followed by clinical decision-making ability and the level of education. The explanatory power of the final regression model was 23%. Conclusions. Empathy towards hemodialysis patients was an important factor influencing the shared decision-making awareness in hemodialysis nurses. Implications for Nursing Management. In nursing management, nursing managers or nurses should pay attention to influencing factors to improve the shared decision-making awareness of hemodialysis nurses. Empathy towards hemodialysis patients need to be reinforced to improve the shared decision-making awareness of hemodialysis nurses.

Association between serum 25-hydroxyvitamin D level and inflammatory markers in hemodialysis-treated patients.

To investigate the relationship between serum 25-hydroxyvitamin D (25(OH)D) level with novel inflammatory markers in hemodialysis-treated patients. A total of 167 maintenance hemodialysis-treated patients were enrolled in this cross-sectional study. The patients were divided into vitamin D deficiency (a serum 25(OH)D level <20 ng/mL) and nondeficiency (a serum 25(OH)D level ≥20 ng/mL) groups. The neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and monocyte to lymphocyte ratio (MLR) were calculated by the complete blood cell count. The relationship between 25(OH)D level with other parameters was assessed by bivariate correlation analysis and linear regression analysis. There were significant differences between the two groups in terms of age, diabetes, levels of albumin, creatinine, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) as well as NLR and MLR (p = .004, p = .031, p < .001, p = .043, p = .008, p = .006, p = .002, and p < .001, respectively). There exist negative correlations between serum 25(OH)D level with age, diabetes, alkaline phosphatase level, NLR, PLR, and MLR (p = .002, p = .002, p = .037, p = .001, p = .041, and p < .001, respectively) and positive correlations between serum 25(OH)D level with albumin level, creatinine level, phosphorus level, HDL-C, and LDL-C (p < .001, p < .001, p = .013, p = .02, p = .002, respectively). Multiple analysis results showed that sex, diabetes, albumin level and NLR were independently associated with serum 25(OH)D level (p = .021, p = .015, p = .033, and p = .041, respectively). High values of NLR and MLR were associated with patients with serum 25(OH)D deficiency. There were negative interplays between serum 25(OH) D level with NLR, PLR, and MLR and also an independent association between serum 25(OH) D level with NLR. Collectively, serum 25(OH)D level has a negative correlation with inflammatory markers.

Effect of Educational Intervention on Adherence of Treatment in Hemodialysis Patients

Background: Adherence to treatment plans and prescribed drugs is considered an important challenge in chronic patients, and non-adherence to the treatment plan in these patients causes worsening of the condition of the disease and a decrease in their quality of life. Therefore, this study was conducted with the aim of determining the effect of self-care program training on treatment compliance in hemodialysis patients. Methods: The present study was a Quasi-experiment study in which all eligible patients of the hemodialysis department of Sanandaj were selected by census method in two intervention and control groups. In two groups, before and one month after the intervention, a demographic questionnaire and a questionnaire of adherence to the treatment of kidney patients were completed. The intervention included three training sessions as well as a training booklet for the ward. But in the control group, the patients received the necessary care according to routine. Data were analyzed using spss-16 software and descriptive tests and Wilcoxon and Mann-Whitney non-parametric tests. Results: The results of the study showed that the average age and standard deviation of the participants was 51.71±15.85 years and the participants were homogenous in both groups. The average total score of treatment adherence in the intervention group increased from 93.03±12.77 before the intervention to 105.23±24.39 after the intervention (P&lt;0.05); However, in the control group before and after the intervention, the results of the Wilcoxon test did not show a significant difference. Conclusion: The program training and training for patients has led to an increase in patients’ awareness, improved patient care, and comprehensively and accurately points out all the information related to the patient’s condition, and provides them with the opportunity to ask and answer questions with nurses.

Efficacy and safety of difelikefalin in the treatment of hemodialysis patients with pruritus: A meta-analysis and systematic review.

The incidence of pruritus associated with hemodialysis (HD) patients can be as high as 70%, and ~40% of patients suffer from moderate to severe systemic pruritus. Difelikefalin (CR845), a peripheral restrictor κ-opioid receptor agonist, activates opioid receptors on peripheral neurons and immune cells to relieve pruritus in patients. However, the clinical effect of difelikefalin on HD-related pruritus is unclear. Therefore, the purpose of this meta-analysis and systematic review was to investigate the safety and efficacy of difelikefalin in the treatment of HD-associated pruritus. This study explored the efficacy and safety of difelikefalin in the treatment of pruritus in HD patients by systematic review and meta-analysis. Randomized controlled trials on difelikefalin in the treatment of pruritus in HD patients were retrieved from PubMed, Embase, Cochrane Library, and Web of Science electronic databases. The retrieval deadline was January 1, 2023. Stata 15.0 software was used for data analysis of the included studies. A total of 4 randomized controlled trials were included, totaling 1,268 patients (736 patients in the experimental group and 532 patients in the control group). Results of the meta-analysis showed that, compared with the control group, difelikefalin could significantly improve the Worst Itch Numeric Rating Scale score (improvement &gt; 3; risk ratio (RR)=1.28, 95% confidence interval (CI) (1.07, 1.53)), decrease the 5-D itch score (standardized mean difference=-0.43, 95% CI (-0.55, -0.30)), and significantly improve adverse events (RR=1.33, 95% CI (1.13, 1.56)). Although difelikefalin can improve itching symptoms in HD patients, it can also increase adverse reactions based on the current literature. Therefore, more studies are needed to further explore the safety and efficacy of difelikefalin treatment.

The Impact of Physical Exercise on microRNAs in Hemodialysis Patients: A Review and a Protocol for an Ancillary Study.

Physical inactivity is considered a significant risk factor for mortality and morbidity among chronic hemodialysis (HD) patients. Therefore, physical exercise is recommended in the treatment of HD patients. Although the beneficial effects of physical exercise in HD patients are well-described in the literature, the underlying physiological mechanisms still need to be fully understood. Recently, microRNAs (miRNAs) have emerged as potential mediators of the therapeutic effects of physical exercise in healthy individuals. miRNAs are short, single-stranded, noncoding RNAs involved in gene expression regulation. Specifically, upon forming the RNA-induced silencing complex, miRNAs selectively bind to specific miRNAs within cells, reducing gene expression. miRNAs can be secreted by cells in an accessible form or enclosed within exosomes or extracellular vesicles. They can be detected in various body fluids, including serum (circulating miRNAs), facilitating the study of their diverse expression. Currently, there is no available data regarding the impact of physical exercise on the expression of miRNAs involved in osteogenic differentiation, a fundamental mechanism in the development of vascular calcification, for HD patients. Therefore, we have designed an observational and longitudinal case-control study to evaluate the expression of miR-9 and miR-30b in HD patients participating in a 3-month interdialytic physical exercise program. This paper aims to present the study protocol and review the expression of circulating miRNAs in HD patients and their modulation through physical exercise.

The Effect of Hope Therapy on the Management of Hemodialysis Outcomes: A Review Article.

Hemodialysis can have specific adverse effects, so it's critical to minimize them by employing non-pharmacological techniques. This review's primary goal was to assess how hope therapy affected the treatment of hemodialysis patients.This review was conducted by analyzing the results of previous studies published between1996and 2023. We chose sixteen studies in consideration of the inclusion and exclusion criteria and by employing Medical Subject Headings (MeSH) terms to the literature discussed in international databases. The findings of the current study revealed that hope therapy can significantly reduce anxiety, stress, and depression and also considerably increase happiness, quality of life, and adherence to treatment in hemodialysis patients. In addition, effective interventions for improving hope in hemodialysis patients included spiritual counseling, spiritual therapy, stress management training, intervention based on disease perception, positive thinking training, and other similar methods.Based on the findings, we concluded that the caregivers of hemodialysis patients and their families must use other non-pharmacological methods, especially hope therapy, to reduce the adverse outcomes of hemodialysis.

Comparative efficacy of sodium thiosulfate, bisphosphonates, and cinacalcet for the treatment of vascular calcification in patients with haemodialysis: a systematic review and network meta-analysis

BackgroundUp to now, there is no unequivocal intervention to mitigate vascular calcification (VC) in patients with hemodialysis. This network meta-analysis aimed to systematically evaluate the clinical efficacy of sodium thiosulfate, bisphosphonates, and cinacalcet in treating vascular calcification.MethodsA comprehensive study search was performed using PubMed, Web of Science, the Cochrane Library, EMBASE and China National Knowledge Internet (CNKI) to collect randomized controlled trials (RCTs) of sodium thiosulfate, bisphosphonates, and cinacalcet for vascular calcification among hemodialysis patients. Then, network meta-analysis was conducted using Stata 17.0 software.ResultsIn total, eleven RCTs including 1083 patients were qualified for this meta-analysis. We found that cinacalcet (SMD − 0.59; 95% CI [–0.95, -0.24]) had significant benefit on vascular calcification compared with conventional therapy, while sodium thiosulfate or bisphosphonates did not show such efficiency. Furthermore, as for ranking the efficacy assessment, cinacalcet possessed the highest surface under the cumulative ranking curve (SUCRA) value (88.5%) of lessening vascular calcification and was superior to sodium thiosulfate (50.4%) and bisphosphonates (55.4%). Thus, above results suggested that cinacalcet might be the most promising drug for vascular calcification treatment in hemodialysis patients. Mechanistically, our findings illustrated that cinacalcet reduced serum calcium (SMD − 1.20; 95% CI [–2.08, − 0.33]) and showed the tendency in maintaining the balance of intact Parathyroid Hormone (iPTH) level.ConclusionsThis network meta-analysis indicated that cinacalcet appear to be more effective than sodium thiosulfate and bisphosphonates in mitigating vascular calcification through decreasing serum calcium and iPTH. And cinacalcet might be a reasonable option for hemodialysis patients with VC in clinical practice.Systematic Review Registration[http://www.crd.york.ac.uk/PROSPERO], identifier [CRD42022379965].

Use of sertraline and agomelatine in hemodialysis patients: A case series report.

Major depressive disorder (MDD) is one of the most common psychiatric issues in hemodialysis population. However, the research on proper diagnostic tools and its treatment is still insufficient. The study was performed to investigate the safety and effectiveness of sertraline and agomelatine in a group of hemodialysis patients. 78 adult patients from one dialysis centre in Poland were included into the study. The Beck Depression Inventory II (BDI-II) was used to screen for depressive symptoms and was followed by the clinical interview with the psychiatrist. Nine patients diagnosed with major depressive disorder received antidepressant treatment with sertraline or agomelatine, according to the best clinical practice. The additional treatment with vortioxetine was used if the initial one was not effective. The time of observation was 24 weeks. The psychiatric follow up as well as the laboratory data were obtained during the course of observation. All patients receiving sertraline achieved remission of depressive symptoms. In patients receiving agomelatine no remission was observed despite dose augmentation. The side effects of antidepressants were mild and did not result in treatment discontinuation. No abnormalities in liver enzymes levels were observed. In five cases the significant decrease of haemoglobin level was noticed, with no cases of bleeding reported. In patients receiving sertraline the antidepressant effect was satisfactory. No remission of depressive symptoms was observed in patients taking agomelatine. The side effects of antidepressants were mild and transient. Further research on depression treatment in hemodialysis patients is needed, including newer medications.

Evaluation of the Effect of Group Hope Therapy on Reducing Anxiety and Adherence to Treatment in Hemodialysis Patients

Background: Anxiety and non-compliance with treatment endanger the health of hemodialysis patients. Hope therapy focuses on human abilities and capabilities instead of weaknesses using a positive psychology approach. Objectives: This study aimed to evaluate the effect of group hope therapy (GHT) on reducing anxiety and adherence to treatment (ATT) in hemodialysis patients. Methods: This semi-experimental study was conducted with a pre-test and post-test on 40 patients undergoing hemodialysis as consecutive non-probability sampling from among the clients of two hemodialysis centers in Khorram Abad, Iran, in 2017. Primary data of the study was collected using the Spielberger State-Trait Anxiety Inventory (STAI) and End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ) in four stages, including before the intervention, immediately after the intervention, one and three months after the intervention. Hope therapy intervention was implemented in groups of five people for eight sessions (one session per week and each session for 60 minutes) by the researcher and with the supervision and approval of a psychiatrist and a clinical psychologist. The data were analyzed in the SPSS software version 21 at the significance level (α = 0.05). In addition, Cronbach’s alpha test was used to measure the reliability of the questionnaires. Results: There was a significant difference in the mean scores of anxiety and ATT between the two stages “before the intervention" and “immediately after the intervention" (P &lt; 0.05). In addition, there was no significant compliance with the treatment between the two stages “immediately after the intervention" and “three months after the intervention" (P &lt; 0.05), while the average scores of Overt and covert anxiety were significant (P &lt; 0.05). Conclusions: Based on the results, GHT effectively reduces overt and hidden anxiety and increases ATT in hemodialysis patients. Therefore, these results can help plan care for hemodialysis patients. Counseling sessions related to GHT should be offered for consecutive periods in educational and treatment centers by people with experience and training in working with hemodialysis patients.

Impact of Using Natural Herbal Materials for Acupoint Application Combined with an Evidence-Based Supervision Method on Improving Renal Function and Lifestyle Treatment in Hemodialysis Patients

Natural herbal materials are commonly derived from plants, minerals, and animals, and compared to synthetic drugs, are closer to natural resources. Here, we analyzed the impact of using evidence-based supervision in combination with natural herbal materials for acupoint application on renal function and lifestyle treatment in hemodialysis patients, with the aim to provide evidence for clinical practice. We selected 80 patients who underwent hemodialysis treatment in our hospital between September 2021 and December 2022 as the research subjects. All of the research subjects were randomly divided into observation and control groups, with 40 cases in each group. The control group received conventional nursing interventions, while the observation group received interventions using acupuncture point application of natural Traditional Chinese medicine herbal materials combined with evidence-based supervision. The main endpoints were to compare the nursing intervention effects between the two groups, including patients’ renal function indicators and quality of life. The natural Chinese medicinal herb Atractylodes macrocephala contains eucalyptol-type sesquiterpene lactones, which exhibit various activities, especially in anti-inflammatory aspects, with a definite effect on the prevention and treatment of renal fibrosis in hemodialysis patients. Clinical studies have shown that the levels of serum creatinine (SCr) and blood urea nitrogen (BUN) in the observation group were lower than those in the control group, while the GQOLI-74 scores of the observation group were higher than those of the control group (all P &gt;0.05). Natural Chinese medicines are natural biobased materials that are often described as compound drugs in practical clinical applications, containing multiple components that can work synergistically to produce comprehensive therapeutic effects. Among them, Atractylodes macrocephala has a definite effect on the prevention and treatment of renal fibrosis in hemodialysis patients. The use of natural Chinese medicinal materials in acupoint application combined with evidence-based supervisory methods has shown precise clinical effects in hemodialysis patients, not only by improving renal function but also significantly enhancing their quality of life.