Hemodialysis Unit Research Articles

Risk factors associated with COVID-19 severity among patients on maintenance haemodialysis: a retrospective multicentre cross-sectional study in the UK

ObjectivesTo assess the applicability of risk factors for severe COVID-19 defined in the general population for patients on haemodialysis.SettingA retrospective cross-sectional study performed across thirty four haemodialysis units in midlands...

Benson Relaxation Technique Combined With Music Therapy for Fatigue, Anxiety, and Depression in Hemodialysis Patients: A Randomized Controlled Trial.

This study aimed to investigate the effects of the Benson relaxation technique combined with music therapy on fatigue, anxiety, and depression levels of patients undergoing hemodialysis. This randomized controlled study was conducted with 61 patients (30 patients in the intervention group, 31 patients in the control group) in a province located in Turkey. This 8-week, randomized, clinical trial was carried out in 2 hemodialysis units. After the patients in both groups were informed about the study, the Piper Fatigue Scale and the Hospital Anxiety and Depression Scale were administered to the patients. All subdomain scores of the Piper Fatigue Scale in the intervention group were significantly lower at weeks 4, 8, and 10 than those of the control group (P < .05). The intervention group had significantly lower Anxiety subscale scores than those of the control group at week 10 (P < .05). Similarly, Depression subscale scores were significantly lower in the intervention group at weeks 8 and 10 than those in the control group (P < .05). The findings suggest that Benson relaxation technique combined with music therapy is an effective approach to manage fatigue, anxiety, and depression symptoms related to hemodialysis.

Serological and molecular characterization of hepatitis B virus infection in chronic kidney disease patients from Rio de Janeiro, Brazil

Chronic kidney disease (CKD) patients undergoing hemodialysis (HD) are more vulnerable to blood-borne viral infections due to frequent invasive procedures. Hepatitis B virus (HBV) infection in this cohort of patients has been a matter of concern worldwide. The objective of this cross-sectional study was to evaluate the frequency of serological markers for hepatitis B, and the occurrence of overt and occult HBV infection (OBI) and its molecular characterization in serum samples from 644 CKD patients in HD units located in Rio de Janeiro, Brazil, from 2013 to 2017. HBV DNA was investigated in HBsAg reactive and “anti-HBc alone” samples to determine infecting genotypes and genetic relatedness between sequences. The prevalence of serological markers HBsAg+, anti-HBc alone, anti-HBc+/anti-HBs+, anti-HBs+, anti-HBc/anti-HBs/HBsAg were 5.9%, 2.8%, 30.7%, 26.6%, 34.0%, respectively. HBV DNA was detected in 39.5% (15/38) of the HBsAg+ and in 5/18 (27.8%) of the “anti-HBc alone” individuals, indicating a high prevalence of OBI within this group. We found a higher prevalence of HBV/A1 (65%), followed by HBV/D3 (20%), and HBV/A2 (15%). Bayesian MCC tree with a highly supported clade, genetic distance comparison, and identical nucleotide sequences suggested a nosocomial spread of HBV in some units. The high prevalence of HBV infection and low number of individuals immune to infection reinforces the need for vaccination in this group. The presence of closely related strains in the same HD unit reinforces the importance of continuous improvement of safety control measures and laboratory surveillance of serological markers to prevent the risk of infection and transmission of HBV.

Accumulation of Advanced Glycation End Products Independently Increases the Risk of Hospitalization Among Hemodialysis Patients

Objective: To determine the association between AGE accumulation detected by skin-autofluorescence (SAF) and hospitalization among ESKD patients.Materials and Methods: 196 ESKD patients from two hemodialysis (HD) units in Bangkok were enrolled in this retrospective study from November 2015 to March 2016. Before HD treatment, AGEs were measured with the SAF device on the area with intact skin on the volar surface of the non-fistula arm. The study concluded in December 2020, and the number of and causes of hospitalization were reviewed. A logistic regression model was used to determine the association between SAF level and patient hospitalization.Results: Of the 196 patients enrolled in the study, SAF was measured in 165 patients with a mean (SD) age of 69.2 (13.0) years. Most of the participants were non-smokers who had hypertension and diabetes and were on high-flux dialyzers. The average weekly spKt/V was 2.1, and the mean (SD) SAF was 3.05 (0.81) AU. The group with high SAF consisted of older patients and had a higher proportion of diabetics and smokers, but this was not statistically significant when compared to the low SAF group. In the multivariable analysis model, SAF greater or equal to 3.05 AU (OR = 2.28; 95% CI, 1.05–4.94; P &lt; 0.05) and increased age (OR = 1.05; 95% CI, 1.01–1.09; P &lt; 0.05) were associated with an increased risk of hospitalization.Conclusion: Higher values of age and SAF were independently associated with increased risk of hospitalization among ESKD patients.

Echocardiographic Abnormalities in Children with Chronic Kidney Disease on Maintenance Hemodialysis

Objective: To identify the echocardiographic abnormalities in children with chronic kidney disease on maintenance hemodialysis.&#x0D; Study Design: Prospective longitudinal study.&#x0D; Place and Duration of Study: Hemodialysis unit of Department of Pediatric Nephrology, The Children’s Hospital and Institute of Child Health, Lahore from Jun to Nov 2020.&#x0D; Methodology: A total of 75 children of chronic kidney disease on hemodialysis were included. Blood and urine tests, chest x-ray and transthoracic echo cardio-grapy were performed to assess the cardiac morphological and functional abnormalities. &#x0D; Results: The mean age of patients was 12.14 ± 2.18 years with 54 (72%) males and 21 (28%) females. The mean duration of hemodialysis was 22.54 ± 17.01 months with mean urea reduction ratio (URR) (%) 65.58 ± 4.31 and mean Kt/v 1.3 ± 0.1. Hypertension was noted in 70 (93.3%) patients with mean systolic and diastolic blood pressure 134.07 ± 10.64 and 89.13 ± 6.78 mmHg, respectively. The echocardiography revealed the mean ejection fraction of 58.02 ± 12.40 with mild systolic and diastolic dysfunction noted in 48 (64%) patients, pericardial effusion in 23 (30.7%) cases and left ventricular hypertrophy (LVH) in 52 (69.3%) cases.&#x0D; Conclusion: As the frequency of left ventricular hypertrophy (LVH) was noted to be high in our chronic kidney disease patients on hemodialysis, there is a need to implement echocardiographic screening of these patients at regular intervals to identify and rectify cardiac complications early.

End Stage Renal Disease among Patients Undergoing Haemodialysis at a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Chronic kidney disease is defined as structural or functional damage of the kidney persisting for three or more months. Studies have shown hypertension and diabetes as the leading causes of chronic kidney disease. The aim of this study is to find out the prevalence of end-stage renal disease patients undergoing haemodialysis in a tertiary care hospital. This was a descriptive cross-sectional study conducted among 96 patients undergoing haemodialysis from February 13, 2021 to April 4, 2021 in the hemodialysis unit of a tertiary care centre after receiving ethical clearance from the Institutional Review Committee (Reference number: 354). Convenience sampling was done and all patients older than 18 years who were on maintenance haemodialysis on an outpatient basis were included in the study. Data were collected using a self-administered questionnaire. Data were analysed using the Statistical Package for the Social Science version 22.0. Point estimate at 95% Confidence Interval was calculated along with frequency and percentages for binary data and mean with standard deviation for continuous data. Among 96 patients undergoing haemodialysis, the prevalence of end-stage renal disease was 83 (86.45%) (79.60-93.30 at 95% Confidence Interval). The most common underlying condition was hypertensive nephropathy in 34 (40.96%) patients, followed by both hypertensive and diabetic nephropathy in 26 (31.33%) patients. The prevalence of end-stage renal disease in our study was higher when compared to similar studies conducted in similar settings. Early diagnosis and adequate treatment of hypertension and diabetes could be crucial to reducing the prevalence of the end-stage renal disease. chronic kidney failure; chronic renal insufficiency; end stage renal disease; hemodialysis; Nepal.

2 DRY WEIGHT GAIN AND INCIDENCE OF INTRADIALYTIC HYPERTENSION: A CROSS-SECTIONAL STUDY IN RURAL HOSPITAL

Background: Intradialytic hypertension (HID) is defined as an increase in post-dialysis systolic blood pressure with a post-dialysis and pre-dialysis difference of Systolic Blood Pressure (SBP) ≥ 10 mmHg. HID affects up to 15% of hemodialysis patients and occurs more frequently in older patients, have a lower dry weight, take antihypertensive drugs, and have lower serum creatinine values. It was known to be related to increased morbidity and mortality. To prevent HID, the identification of other risk factors was crucial. Current study aims to determine the relationship between dry weight gain and the incidence of intradialytic hypertension. Methods: This research method was a cross-sectional study. The study was taken on December 2021 at Hemodialysis Unit of Arga Makmur Regional Hospital, North Bengkulu Regency, Bengkulu. Result: There was 27.7% subject having intradialytic hypertension among 54 subjects. The variables consist of gender, age, and etiology did not show any statistically significant relationship toward increased dry weight and the incidence of intradialytic hypertension. Chi-Square test results was p&gt;0.005. The paired t-test showed a significant difference among dry weight, systolic and diastolic blood pressure before and after hemodialysis, with p-value = 0.000 (p &lt;0.005). Increased dry weight gain more than 1 kg was related to 1.7 (95%CI 1.3-2.1) times increased risk of intradialytic hypertension among patients undergoing hemodialysis. Conclusion: The dry weight gain had a statistically significant relationship to the incidence of intradialytic hypertension.

Severe Anemia and Six-Month All-Cause Mortality in Chronic Kidney Disease Patients Undergoing Hemodialysis

Anemia is often found in patients with Chronic Kidney Diseases (CKD). Anemia can affect poor outcomes in hemodialysis patients. However, no publications examined the role of severe anemia as a predictor factor in six-month all-cause mortality in hemodialysis patients. Therefore, further study was needed to answer these questions. This study aimed to determine the role of severe anemia and six-month all-cause mortality in hemodialysis patients. The cohort design study was carried out from October 2019 to March 2020 at the Hemodialysis Unit of Roemani Muhammadiyah Hospital Semarang. The dependent variable was severe anemia, defined as hemoglobin levels &lt;8.0 g/dL. The mortality rate was investigated over six months after the baseline measurements. Among 85 respondents, 35 (41.2%) respondents were categorized into severe anemia, and 50 (58.8%) respondents were categorized into non-severe anemia groups. The respondents consisted of 54 (63.5%) males and 31 (36.5%) females. The hemoglobin level in the severe and non-severe anemia groups was 7.2 ± 0.6 and 9.5 ± 1.2 (mean ± standard deviation). The Kaplan Meier survival curve showed that the non-severe anemia group had a higher survival rate than the severe anemia group (98.0% vs. 82.9%, p = 0.011). The Cox regression analysis found a significant relationship between anemia severity and 6-month all-cause mortality in hemodialysis patients (p = 0.027; Hazard ratio: 9.3). Severe anemia plays a role as a predictor factor in six-month all-cause mortality among hemodialysis patients.

The reliability and validity of the Turkish version of the Shortened Xerostomia Inventory in hemodialysis patients.

The aim of this study was to translate, linguistically validate, and evaluate the psychometric properties of the Shortened Xerostomia Inventory (SXI) among Turkish patients undergoing hemodialysis (HD). The study was conducted with 81 chronic HD patients in the HD units of two state hospitals between June and August 2020. Explanatory factor analysis was implemented to test the construct validity. In addition, the test-retest method was performed to test the reliability and consistency of the scale over time. A total of 81 patients participated in the study. The Cronbach's alpha coefficient of SXI was 0.788. The mean values for the test were 12.84 ± 6.78 and re-test scores was 11.03 ± 6.88. Intraclass correlation coefficient value calculated as 0.992 and accordingly a statistically significant relationship between the test and retest scores (p < 0.001). Our study showed that the SXI is a valid and reliable measurement tool for Turkish HD patients.

Physical behavior and interpersonal relationship among patients undergoing hemodialysis

This study aimed to evaluate the effectiveness of an interventional program on patients' knowledge toward physical behavior and interpersonal relationship as health-protective behaviors. A quasi-experimental (tow-group pretest-posttest) design was used to conduct this study at the hemodialysis unit in Al-Hussain Teaching Hospital for the period from (18th of Dec 2021, to the 5th of May 2022). A non-probability (purposive) sampling was used to select (80 patients) undergoing hemodialysis. To measure the effectiveness of the interventional program on patients' knowledge, the researcher used a knowledge form which included (40) questions. The validity of the questionnaire and the interventional program were verified by presenting it to (18) experts. The reliability was determined using the test-retest approach for the knowledge questionnaire. The study findings showed that there are highly statistically significant differences between the scores of patients' knowledge in two levels of measurements (pre-test and post-test) at a p-value (0.000), where the statistical mean of the overall knowledge at a p-value of patients in the pre-test was (0.896), while it becomes (0.000) in post-test.

Pain, Anxiety, and Depression in Patients Undergoing Chronic Hemodialysis Treatment: A Multicentre Cohort Study

BackgroundPain is a considerable health concern that interferes with hemodialysis treatment outcomes and can lead to a patient developing anxiety and depression. AimsTo examine the perception of pain in patients on chronic hemodialysis therapy, and to analyze the relationship between their pain, anxiety, depression, and sociodemographic data. MethodThe research was conducted using a quantitative, observational, cross-sectional design. The study recruited 138 patients from multicentered hemodialysis units. A battery of questionnaires, including the visual analog scale (VaS) as pain intensity scale, the Hospital Anxiety and Depression Scale (HADS), and an ad hoc sociodemographic data questionnaire, were given to patients to answer during their hemodialysis sessions. A linear regression analysis was conducted to obtain the results. ResultsThe mean of pain to all participants was generally low, as per AVS scale (0-10) it was 3.6 (stanard deviation [SD] = 3.07). Women manifested lower levels of pain than men (p = .015). One in five participants in both sexes suffered from clinical anxiety and one in six participants in both sexes suffered from clinical depression. Women scored higher on both the anxiety (4.8 versus 4.2) and depression scale (6.8 versus 6.5). Those participants who manifested clinical anxiety were younger compared with those who did not (aged 56.8 versus 66.8 years). Finally, older patients (aged 68.5 years) manifested higher levels of depression. ConclusionsThe level of pain perceived by patients undergoing chronic hemodialysis therapy was generally low, especially in women. The study also demonstrated a positive association between levels of pain and anxiety and depression.

Nurse Caseload and Patient Survival in Hemodialysis Units: A Korean Nationwide Cohort Study

Introduction: The patient-to-nurse ratio is highly variable among dialysis facilities. However, there is little known about the association between nurse caseload and hemodialysis (HD) patient outcomes. We evaluated the association between patient-to-nurse ratio and mortality in the Korean patients undergoing HD. Methods: We used HD quality assessment data and National Health Insurance Service claim data from the year of 2013 for collecting demographic and clinical data. Altogether, 21,817 patients who participated in the HD quality assessment in 2013 were included in the study. Nurse caseload was defined as the number of HD sessions performed by a nurse per working day. The patients were divided into two groups according to the nurse caseload as follows: low nurse caseload group (≤6.0) and high nurse caseload group (>6.0). We analyzed mortality risk based on nurse caseload using the Cox proportional hazard model. Results: The mean age was 59.1 years, and males accounted for 58.5%. The mean hemoglobin was 10.6 g/dL and albumin was 3.99 g/dL. At the mean follow-up duration of 51.7 (20.6) months, the ratio between low and high groups was 69.6% (15,184 patients) versus 30.4% (6,633 patients). The patients in the high nurse caseload group were older and showed lower levels of hemoglobin, albumin, calcium, and iron saturation and higher levels of phosphorus than those in the low nurse caseload group. A high nurse caseload was associated with a lower survival rate. In the adjusted Cox analysis, a high nurse caseload was an independent risk factor for all-cause mortality (hazard ratio 1.08; 95% confidence interval, 1.02–1.14; p = 0.01). Conclusion: High nurse caseload was associated with an increased mortality risk among the patients undergoing HD. Further prospective studies are needed to determine whether a caseload of nursing staff can improve the prognosis of HD patients.

Impact of the COVID pandemic on vascular access creation for haemodialysis in 16 Spanish haemodialysis centres.

ABSTRACTBackgroundThe coronavirus disease (COVID) pandemic has resulted in a major disruption in healthcare that has affected several medical and surgical specialties. European and American Vascular Societies have proposed deferring the creation of an elective vascular access (VA) [autologous or prosthetic arteriovenous fistula (AVF) or arteriovenous graft (AVG)] in incident patients on haemodialysis (HD) in the era of the COVID pandemic. The aim of this study is to examine the impact of the COVID pandemic on VA creation and the central venous catheter (CVC)-related hospitalizations and complications in HD patients dialyzed in 16 Spanish HD units of three different regions.MethodsWe compared retrospectively two periods of time: the pre-COVID (1 January 2019–11 March 2020) and the COVID era (12 March 2020–30 June 2021) in all HD patients (prevalent and incident) dialyzed in our 16 HD centres. The variables analysed were type of VA (CVC, AVF and AVG) created, percentage of CVC in incident and prevalent HD patients, CVC-related hospitalizations and complications (infection, extrusion, disfunction, catheter removal) and percentage of CVC HD sessions that did not reach the goal of Kt (>45) as a marker of HD adequacy.ResultsA total of 1791 VAs for HD were created and 905 patients started HD during the study period. Patients who underwent vascular access surgery during the COVID period compared with pre-COVID period were significantly younger, with a significant decrease in surgical activity to create AVFs and AVGs in older HD patients (>75 and >85 years of age). There was a significant increase in CVC placement (from 59.7% to 69.5%; P < 0.001) from the pre-COVID to the COVID period. During the COVID pandemic, a significantly higher number of patients started HD through a CVC (80.3% versus 69.1%; P < 0.001). The percentage of CVC in prevalent HD patients has not decreased in the 19 months since the start of the pandemic [414 CVC/1058 prevalent patients (39.4%)]. No significant changes were detected in CVC-related hospitalizations between the pre-COVID and COVID periods. In the COVID period, a significant increase in catheter replacement and the percentage of HD session that did not reach the HD dose objective (Kt > 45) was observed.ConclusionsCOVID has presented a public health system crisis that has influenced VA for HD, with an increase in CVCs relative to AVFs. A decrease in HD sessions that did not reach the HD dose objective was observed in the COVID period compared with a pre-COVID period.

Nurse-Driven Advance Care Planning in a Hemodialysis Unit in a Veteran Population (S509)

Nurse-Driven Advance Care Planning in a Hemodialysis Unit in a Veteran Population (S509)

Effect of kidney transplantation activity on arteriovenous fistula use in prevalent haemodialysis patients: A registry-based study.

Kidney transplantation (KT) is considered to be the best kidney replacement therapy (KRT) option for most end-stage kidney disease (ESKD) patients. Arteriovenous fistula (AVF) is considered to be the best vascular access (VA) for most haemodialysis (HD) patients. In this study, we investigated the effect of KT activity on AVF use in prevalent HD patients. The probability of receiving a kidney graft (KTx) over time, depending on the first VA used to start the HD program, was also evaluated. Data from the Catalan Registry of prevalent patients on KRT by either KT or HD were examined over a 20-year period (1997-2017). The percentage of prevalent ESKD patients with a functioning KTx increased from 40.5% in 1997 to 57.0% in 2017 and, conversely, the percentage of AVF utilisation in HD patients decreased from 86.0% to 63.2% during the same period (for both comparisons, p < 0.001). This inverse relationship was also demonstrated in other countries and regions worldwide by performing a simple linear regression analysis (R2 = 0.4974, p = 0.002). The probability of prevalent patients dialysed through an AVF in Catalonia was independently associated with the percentage of functioning KTx among KRT population, after adjusting by age, gender, primary kidney disease, time on KRT, cardiovascular disease and type of HD Unit. Incident patients starting HD through an AVF had a significantly higher probability of receiving a KTx over time in comparison to patients who initiated HD through a catheter (hazard ratio 1.68 [95% confidence interval: 1.41-2.00], p < 0.001). In addition to some demographical and clinical characteristics of patients and type of HD Unit, KT activity can be a determining factor in AVF use in prevalent HD patients. Starting an HD programme through an AVF is independently associated with a greater probability of receiving a KTx as compared to starting HD through a catheter.

Point-of-Care Ultrasound (POCUS) for Dialysis Patients: A Step Forward

Point-of-care ultrasound (POCUS) refers to the use of portable ultrasound systems by clinicians at a patient’s bedside for diagnostic and therapeutic purposes. It is not a substitute but rather a complement to clinical examination, and contrary to the classic ultrasound examination performed by radiologists, POCUS is not a detailed morphologic examination but focuses on answering specific clinical questions in an effort to reduce time to diagnosis and treatment, improve patient safety and decrease complication rates. In this article, we present the POCUS in hemodialysis units for and beyond vascular-access purposes, arguing that its implementation will help the practicing nephrologist who is treating hemodialysis patients on a daily basis to rapidly and efficiently answer several clinical questions that are common to dialysis patients, such as vascular-access assessment and cannulation, and assessment of volume status. POCUS aims to answer specific clinical questions, so a question-answer format is used. This review is divided in two parts. In the first part we will answer specific clinical questions exclusively concerning vascular access. The second part is dedicated to the use of POCUS for the assessment of volume status and dry-weight determination.

Assessment of Pain and Anxiety During Arteriovenous Fistula Cannulation Among Hemodialysis Patients: A Cross-Sectional Study in Saudi Arabia.

BackgroundThe number of hemodialysis patients has dramatically increased over the years. The cost of healthcare provision to those patients has been rising as well. In addition, pain management during arteriovenous fistula (AVF) cannulation is an important aspect of nursing care. Patients’ outcomes and appropriate pain control are one of the most critical issues in healthcare.PurposeTo measure the level of pain and anxiety associated with arteriovenous fistula cannulation among hemodialysis patients.MethodsA correlational cross-sectional research design was used in this study at the Hemodialysis Unit at King Fahad Hospital of the university, Al-Khobar, in the Eastern region of the Kingdom of Saudi Arabia using a self-administered questionnaire. Ethical approval was obtained. A convenience sample of 117 HD patients from the previous mentioned setting were included in the study. The data were collected using three tools: sociodemographic characteristics, Numerical Analogue Scale (NAS), and Hospital Anxiety and Depression Scale (HADS). Using IBM SPSS software package version 25.0, statistical significance of the obtained results was judged at the 5% level.ResultsAccording to the results, most of the participants experienced a mild to moderate level of pain and anxiety during arteriovenous fistula cannulation. Furthermore, there was a positive association between the level of pain and anxiety, with statistical significance (p<0.001).ConclusionBased on the results of the study, most of the study participants’ level of pain and anxiety during AVF cannulation ranged between mild and moderate.

Nutritional Behavior and Medication Adherence among Patients Undergoing Hemodialysis

Background: Chronic kidney disease is a progressive disease with five phases based on the glomerular filtration rate. In each of these stages, the patient continues to suffer from the condition and must take responsibility for his health, such as changing his diet and lifestyle and taking significant doses of medication. If not treated effectively, Chronic kidney disease can lead to a high rate of morbidity and mortality, lowering the quality of life and hastening death. Objectives: This study aimed to evaluate the effectiveness of an interventional program on patients' knowledge toward nutritional behavior and medication adherence as health-protective behaviors. Methodology: A quasi-experimental (tow-group pretest-posttest) design was used to conduct this study at the hemodialysis unit in Al-Hussain Teaching Hospital. A non-probability (purposive) sampling was used to select (80 patients) undergoing hemodialysis. To measure the effectiveness of the interventional program on patients' knowledge, the researcher used a knowledge form which included (40) questions. The validity of the questionnaire and the interventional program were verified by presenting it to (17) experts. The reliability was determined using the test-retest approach for the knowledge questionnaire. Results: The study findings showed that there are highly statistically significant differences between the scores of patients knowledge in two levels of measurements (pre-test and post-test) at p-value (0.000), where the statistical mean of the overall knowledge at p-value of patients in the pre-test was (0.896), while it becomes (0.000) in post-test. Conclusion: The study concluded that the interventional program positively affects the patients' knowledge concerning nutritional behaviors and medication adherence as health-protective behaviors. Keywords: Nutritional behavior, Medication adherence, Hemodialysis, Health promotion.

Differences in Malnutrition Inflammation Score of Hemodialysis Patients Associated With Hemodialysis Factors. A Spanish Multicenter Epidemiologic Study

The aims of this study are to analyze the prevalence of malnutrition in hemodialysis (HD) patients in Spain, and to assess the association of malnutrition in these patients with sociodemographic characteristics, comorbidity, and parameters related to HD. A multicenter, retrospective, cross-sectional study in HD patients from centers all over Spain was conducted. Nutritional status of patients was assessed using Malnutrition Inflammation Score (MIS), and was stratified according to MIS values into 5 categories: ≤2, normal nutrition; >2 to ≤5, mild malnutrition or risk of malnutrition; >5 to ≤7, moderate malnutrition; >7 to ≤10, severe malnutrition, and >10, extreme malnutrition. A total of 52 Spanish HD Units participated in the study enrolling 2,748 patients. Mean age of patients was 68.20±14.24years, 1,811 (65.9%) were men. Mean time on HD was 55.63±63.25months. Using an MIS cut-off point of 2 for malnutrition, 89% of patients were malnourished (MIS > 2). However, with a cut-off point of 5, more commonly described in the literature, the percentage of patients with malnutrition was reduced to 51.7%. Using this cut-off, we observed significant differences between patients with malnutrition and normo-nourished patients in biochemical parameters, age, Charlson Index, HD residual renal function, scheme, and vascular access (permanent catheter vs arteriovenous fistula). A multivariate regression analysis showed that age, sex, HD scheme, vascular access, residual renal function, and comorbidity index were predictive factors for malnutrition. We found that a high percentage of HD patients with malnutrition did not receive oral supplementation. The prevalence of malnutrition in HD patients in Spain, assessed using the MIS scale, was high. Higher malnutrition was associated with the use of catheter versus fistula, and standard HD versus online hemodiafiltration, and with the absence of residual renal function, older age, greater comorbidity, and male sex. Malnourished patients had a low rate of oral supplementation.

Incidence of Polyneuropathy among Uremic Patients Undergoing Hemodialysis: Cross-Sectional Study among Iraqis

Background: Peripheral neuropathy (PNP) is among the commonest neurological disorders. NP is a disorder of sensory or motor neurons. Peripheral NP impacts around 60-100% of cases admitted for dialysis units due to chronic kidney disease (CKD). In dialysis-dependent patients, a progressive uremic sensorimotor axonal NP is a well-known complication. Nevertheless, the precise polyneuropathy (PNP) among CKD patients has to be further investigated especially in our country. Objectives: This cross-sectional study aimed to evaluate the incidence of polyneuropathy among Iraqi uremic patients undergoing hemodialysis. Materials and Methods: This cross-sectional study was performed on patients 215 patients (99 women and 116 men). All participants were suffering from ESRD were assessed by expert specialists, aging 17-80 years, attending hemodialysis unit, receiving standardized maintenance hemodialysis. All patients had completed neurophysiological assessment in the same hospital, for sensory and motor nerves including median, ulnar, tibial, peroneal, and sural nerves, regardless of whether they had clinical findings of NP or not. SPSS (V-25) software was used for statistical analysis. A confidence level of 95% had considered significant. Results: Mean age and weight of patients was (48.16 ±13.4 years and 66.9 ± 12.9 kg), respectively, and the mean duration of dialysis was 4.7 ± 1.4 years. The majority of patients (85.1%) had a frequency of dialysis three times/week. The prevalence of UNP was 63.7% among the studied candidates. More than half of patients (51.8%) presented with moderate UPN, (29.2%) with mild UPN, and (19. 0%) with severe UPN (P&lt;0.05). There were significant differences between means of age and frequency of dialysis with the incidence of UPN. Conclusion: Polyneuropathy is a very common complication in patients with uremia undergoing dialysis. Polyneuropathy is not associated with the frequency of dialysis, but with a duration of uremia.