In-center Hemodialysis Patients Research Articles

SARS-CoV-2 Seropositivity Rates in Patients and Clinical Staff in New York City Dialysis Facilities: Association With the General Population

There are concerns that in-center maintenance hemodialysis (HD) patients may have higher risk for infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) because they take 3 or more round-trips a week to dialysis centers and spend several hours during dialysis close to fellow patients and clinic staff. This concern is supported by data from dialysis facilities in London, United Kingdom.1

A Comparative Study of Treatment Adherence Among In-Center Hemodialysis Patients Based on Years on Dialysis and Demographic Factors

Shortened or missed dialysis treatments are directly associated with increased hospitalization and mortality rates among end-stage renal disease (ESRD) patients. The purpose of this study was to investigate the differences in treatment adherence according to the number of years on dialysis and demographic factors such as age, annual income, living status, and sex, with respect to the numbers of dialysis treatments shortened by ≥10 min and missed dialysis treatments among patients undergoing in-center hemodialysis. This study used a quantitative and nonexperimental research design to investigate the differences in adherence. Data were collected from 412 in-center hemodialysis patients through patient surveys and from the participants’ medical records. Dialysis patients aged ≥60 years were found to be more adherent than those aged 18–59 years, with a statistically significant difference between the groups (p = .01, each for shortened and missed treatments). Patients whose annual income was >200% of the federal poverty level were also more adherent than those who reported less income, with a statistically significant difference between the groups (p = .01, each for shortened and missed treatments). Future studies should focus on addressing adherence by incorporating more adherence factors and different treatment modalities for ESRD.

POS-526 UNDERSTANDING THE PATIENT EXPERIENCE AND CLINICAL COURSE DURING THE INCIDENT DIALYSIS PERIOD: DESIGN AND IMPLEMENTATION OF A DOPPS CHINA STUDY

Initiation of chronic dialysis for patients with kidney failure broadly affects all aspects of health-related quality of life (HRQoL). The transition to chronic dialysis is particularly challenging, with marked life disruption and exceptionally high mortality rates. Longitudinal trajectories of patient-reported outcomes (PROs) in incident dialysis populations are scarce and poorly understood, especially in China. The Dialysis Outcomes and Practice Patterns Study in China (DOPPS China, launched in 2011) provides a platform to gain in-depth real-world understanding of the complexities of care and outcomes for in-center hemodialysis (ICHD) patients. Leveraging the recently launched DOPPS China 7 (1488 prevalent ICHD patients enrolled to date), we aim to collect longitudinal clinical and PRO data from newly enrolled incident ICHD patients to: (1) characterize trajectory of laboratory variables; (2) assess change in PROs and (3) describe outcomes such as hospitalization and mortality rates during the transition period and first year of ICHD. We enrolled 43 sites in Beijing, Guangzhou, and Shanghai metropolitan areas (14, 15, and 14 sites respectively) in DOPPS China 7, using stratified random sampling by clinic characteristics. We plan to include >650 incident ICHD patients (median accrual/facility/year is 16) at these sites with longitudinal follow-up to characterize clinical course and optimally capture the complete patient experience. Eligible patients, ≥18 years old, will be approached sequentially for enrolment within one month of starting ICHD. Where available, clinical data will be collected retrospectively for up to 6 months prior to and during ICHD initiation. Clinical data will be submitted monthly via secure, web-based software. In parallel, we will deploy an electronic patient questionnaire (ePQ) into which patients report information directly via mobile device over the first year of enrollment. The ePQ encompasses a short version administered monthly and a longer version quarterly. Instruments were chosen based on previous validation in dialysis patients to minimize patient burden and content overlap (Table). To date, the DOPPS 7 China study has enrolled 184 incident patients. With approximately 1 year of follow-up, less than 10% have died or left ICHD. Twenty-eight have been hospitalized, mostly for HD access-related reasons. Initial results from the enriched selection of incident ICHD patients with clinical and PRO data are anticipated in 2021. We expect this innovative study to contribute meaningful new insights on the interplay among complications of kidney failure, treatment, clinical conditions, and the patient experience during the incident dialysis period in China.

POS-602 TETRASODIUM EDTA REDUCES ALTEPLASE USE IN PATIENTS WITH DYSFUNCTIONAL HEMODIALYSIS CATHETERS

Catheter dysfunction is a frequent complication of hemodialysis which impacts treatment adequacy and patients’ quality of life. Standard lock solutions for hemodialysis catheters such as heparin or sodium citrate often fail to prevent access dysfunction, and alteplase has to be used to restore or maintain catheter patency. EDTA tetrasodium 4% is a new lock solution with antimicrobial and anticoagulant properties. The goal of this retrospective study is to evaluate the impact of tetrasodium EDTA 4% on alteplase use and catheter function. Chronic in-center hemodialysis patients with a dysfuctional hemodialysis catheter who were switched from sodium citrate 4% to tetrasodium EDTA 4% were included. Data regarding alteplase use, blood flow, arterial and venous pressure, line reversal, weekly kt/V and serum electrolytes were compared before and after the change of lock solution. Twenty-two patients were studied. Alteplase use decreased from 3.88 ± 1.41 sessions/month while using sodium citrate to 1.59 ± 1,25 sessions/month after changing to tetrasodium EDTA (paired t-test, 3 months pre- vs post-intervention, p < 0,0001). Mixed effect model analysis showed a mean reduction of alteplase use of 1.68 95%CI [-2.32, -1.04] after changing the lock solution, and a continued reduction over time of -0,25/month, 95%CI [-0.37, -0.14]. A slight reduction in blood flow was observed 329±21 mL/min vs 320±26 ml/min (p<0,05). There was no statistical difference for line reversal, venous pressure, arterial pressure, kt/V, serum sodium, potassium, calcium and magnesium. In a group of chronic in-center hemodialysis patients with a dysfunctional catheter, the conversion from a citrate sodium 4% to a tetrasodium EDTA 4% lock solution led to a significant reduction in the use of alteplase.

161 Clinical Outcomes of In-Center Hemodialysis Patients During the COVID-19 Pandemic

161 Clinical Outcomes of In-Center Hemodialysis Patients During the COVID-19 Pandemic

Identifying prognostic risk factors for poor outcome following COVID-19 disease among in-centre haemodialysis patients: role of inflammation and frailty.

IntroductionThe pandemic of coronavirus disease (COVID-19) has highly affected patients with comorbidities and frailty who cannot self-isolate, such as individuals undergoing haemodialysis. The aim of the study was to identify risk factors for mortality and hospitalisation, which may be useful in future disease spikes.MethodsWe collected data retrospectively from the electronic medical records of all patients receiving a diagnosis of COVID-19 between 11th March and 10th May 2020 undergoing maintenance haemodialysis at four satellite dialysis units from the Royal Free London NHS Foundation Trust, London, UK. Mortality was the primary outcome, and the need for hospitalization was the secondary one.ResultsOut of 746 patients undergoing regular haemodialysis, 148 symptomatic patients tested positive for SARS-CoV-2 by RT-PCR and were included in the analysis. The overall mortality rate was 24.3%. By univariate analysis, older age, ischaemic heart disease, lower systolic blood pressure, lower body mass index (BMI) and higher frailty scores were associated with higher rates of mortality (all p value < 0.05). The laboratory factors associated with mortality were higher values of WBC, neutrophil counts, neutrophil to lymphocyte ratios (NLR), C-reactive protein (CRP), bilirubin, ferritin, troponin, and lower serum albumin level (all p value < 0.05). In the logistic regression, mortality was associated with older age and higher CRP, while high levels of NLR and CRP were associated with the need for hospitalization.DiscussionHaemodialysis patients are susceptible to COVID-19 and have a high mortality rate. Our study identifies prognostic risk factors associated with poor outcome including age, frailty and markers of inflammation, which may support more informed clinical decision-making.Graphic abstract

Home Dialysis: A Majority Chooses It, a Minority Gets It

Introduction: When choosing a modality for outpatient renal replacement therapy, patients and medical providers have 3 options to choose from in-center hemodialysis (HD), home HD (HHD), and peritoneal dialysis (PD). In 2017, just over 10% of incident ESKD patients were on a home dialysis modality. We set out to determine outcomes of dialysis modality education in both pre-dialysis and dialysis patients. Moreover, we examined barriers that preclude patients from choosing home dialysis. Methods: This was a single-center, retrospective study looking at patients who were referred to the CKD educator for dialysis modality education between January 1, 2019, and March 31, 2020. Patient demographics, preferred language of communication, stage of renal disease, and reasons for patients’ refusal to undertake a home dialysis modality were recorded. Patients’ average household income and driving distance to our home dialysis unit were calculated using their home zip code. Results: 167 patients were referred for CKD education. Mean age was 60 years, and 59% male, 42% African American, 22% White, 7% Asian, and 28% were Hispanic or Latino. Only 23% of the total cohort chose in-center HD, while 74% chose a home dialysis modality (59% PD and 15% HHD), and the remaining patients remained undecided. 56% of in-center HD patients chose a home dialysis modality. The most commonly cited barriers to home dialysis were lack of a care partner, lack of home space, and patient preference. Limitations: Over 90% of our patients reside in NY City where home space is limited. We require in our home HD program that patients have a trained care partner present during their treatments. We cannot assume that all CKD stage-4 patients or higher were either referred for CKD education or followed through on the referral. Conclusions: A large discrepancy between informed patients’ choices and the reality of the current dialysis landscape. Absence of a care partner, lack of home space, and patients not deemed appropriate surgical candidates were the main driving forces in their not opting for a home modality.

Nephrologists' Attitudes Regarding Psychosocial Care in Hemodialysis Units.

Background:There is a high prevalence of psychosocial issues affecting patients with kidney failure.Objective:We sought to examine Canadian nephrologists’ attitudes and opinions regarding the importance of renal patient psychosocial care, nephrologists’ roles, and experience with psychosocial care in addition to what barriers, if any, prevent these physicians from providing psychosocial care to their patients.Design:A self-administered, survey questionnaire.Setting:Online.Sample:Canadian Society of Nephrology members who predominantly work in clinical care with adult, in-center hemodialysis patients.Measurements:Measurements of the survey include demographics, training, and nephrologists’ opinions regarding their role in administering psychosocial care, potential administrative and patient time constraints, accessibility of other health care workers for this activity, and factors that influence or impede physicians’ ability to address their patients’ psychosocial needs.Methods:A self-administered survey was sent to almost 500 members of the Canadian Society of Nephrology between November 2018 and December 2018. The survey questionnaire was designed to gather opinions and attitudes on psychosocial care delivery as well as potential influencing factors on nephrologists’ ability to provide this care. A univariate statistical analysis was used to analyze survey responses.Results:A total of 30 nephrologists responded to the survey, generating a 6% response rate. Respondents varied across provinces, with the majority being staff nephrologists (80%). While over 94% of respondents either agreed or strongly agreed that focus on psychosocial care improves patient outcomes, only 43% felt that staff nephrologists were suited to provide this care to patients; 97% of respondents believed social workers to be the most suited to provide this. Lack of additional supporting health care members, the need for additional training, too many administrative duties, and empathy fatigue were some of the predominant barriers respondents felt prevented them from addressing the psychosocial care of their patients.Limitations:A low response rate for the survey was obtained, roughly 6%, limiting our ability to draw definitive conclusions. Survey answers by respondents may be different from those by nonrespondents. Answers may be subject to social desirability and/or selection bias.Conclusion:Nephrologists believe that the current psychosocial care of patients in hemodialysis units is inadequate. However, further research is necessary to elucidate the barriers nephrologists face in providing psychosocial care and the changes required to most effectively implement optimal psychosocial care for patients with kidney failure in hemodialysis units.

Effect of COVID-19 on Kidney Disease Incidence and Management.

The COVID-19 outbreak has had substantial effects on the incidence and management of kidney diseases, including AKI, ESKD, GN, and kidney transplantation. Initial reports from China suggested a lower AKI incidence in patients with COVID-19, but more recent studies from North America reveal a much higher incidence, likely due to the higher prevalence of comorbid conditions, such as hypertension, diabetes, and CKD. AKI in this setting is associated with worse outcomes, including the requirement for vasopressors or mechanical ventilation and death. Performing RRT in those with AKI poses challenges, such as limiting exposure of staff, preserving PPE, coagulopathy, and hypoxemia due to acute respiratory distress syndrome. Continuous RRT is the preferred modality, with sustained low-efficiency dialysis also an option, both managed without 1:1 hemodialysis nursing support. Regional citrate is the preferred anticoagulation, but systemic unfractionated heparin may be used in patients with coagulopathy. The ultrafiltration rate has to be set carefully, taking into consideration hypotension, hypoxemia, and responsiveness to presser and ventilatory support. The chance of transmission puts in-center chronic hemodialysis and other immunosuppressed patients at particularly increased risk. Limited data show that patients with CKD are also at increased risk for more severe disease, if infected. Little is known about the virus's effects on immunocompromised patients with glomerular diseases and kidney transplants, which introduces challenges for management of immunosuppressant regimens. Although there are no standardized guidelines regarding the management of immunosuppression, several groups recommend stopping the antimetabolite in hospitalized transplant patients and continuing a reduced dose of calcineurin inhibitors. This comprehensive review critically appraises the best available evidence regarding the effect of COVID-19 on the incidence and management of kidney diseases. Where evidence is lacking, current expert opinion and clinical guidelines are reviewed, and knowledge gaps worth investigation are identified.

Province-Wide Prevalence Testing for SARS-CoV-2 of In-Center Hemodialysis Patients and Staff in Ontario, Canada: A Cross-Sectional Study.

Background:People receiving in-center hemodialysis face a high risk for contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and experience poor outcomes. During the first wave of the coronavirus disease 2019 (COVID-19) pandemic in Ontario (between March and June 2020), it was unclear whether asymptomatic or presymptomatic cases were common and whether widespread testing of all dialysis patients and staff would identify cases earlier and prevent transmission. Ontario has a population of about 14.5 million. Approximately 8900 people receive dialysis across 102 in-center dialysis units.Objective:The objective of this study was to determine participation rates for patients and staff in point prevalence testing in dialysis units across the province and to determine the prevalence of asymptomatic or presymptomatic infection.Design:Cross-sectional study design.Setting:In-center hemodialysis units at 27 renal programs across Ontario.Participants:Patients and staff in in-center dialysis units in Ontario.Measurements:Participation rates, demographic data, SARS-CoV-2 positivity rates, and COVID-19-related symptom data.Methods:From June 8 to 30, 2020, all in-center dialysis patients and staff in the Province of Ontario were requested to undergo a symptom screening assessment and nasopharyngeal swab. Testing was done using polymerase chain reaction to detect SARS-CoV-2. A standardized questionnaire of atypical and typical COVID-19-related symptoms was administered to patients, to assess for new or worsening COVID-19-related symptoms.Results:Patient participation was 83% (7155 of 8612) of which 15 tests were positive: less than 5 (<0.07%) were new positive cases, 7 were false positive, and the remaining were recovered positives. Half of the new positive cases had symptoms. Common symptoms reported included fatigue (4%), falls (4%), runny nose (3%), dyspnea (3%), and cough (3%). Staff participation was 49% (2109 of 4325), and less than 5 (<0.24%) were asymptomatic positive.Limitations:As point prevalence testing was voluntary, not all patients and staff participated. Lower participation rate may be due to decreasing new cases in Ontario, and testing or pandemic fatigue, among other factors. This study did not use serology to identify prior infections because it was not widely available in Ontario. With respect to the standardized symptom questionnaire, it was only available in English and French and could not be tested due to the urgency of the initiative.Conclusions:Participation among patients in point prevalence testing was good, but participation among staff was relatively low. Asymptomatic positivity in the dialysis patient and staff population was rare during the first wave of the COVID-19 pandemic in Ontario.

Estimating hospital inpatient cost-savings with sucroferric oxyhydroxide in patients on chronic hemodialysis in five European countries: a cost analysis

Aims Hyperphosphatemia is common among patients with advanced chronic kidney disease (CKD) undergoing dialysis. The iron-based phosphate binder (PB), sucroferric oxyhydroxide (SO), has a low daily pill burden and is indicated for the control of serum phosphorus in these patients. In a retrospective database study, hemodialysis patients switched to long-term SO therapy had fewer hospitalizations compared with patients switched to other PB therapies. This economic analysis aimed to quantify potential cost-savings of reduced hospitalizations associated with SO for healthcare systems in five European countries. Materials and methods All-cause hospital admissions incidence data were sourced from a real-world retrospective database study comparing adult, in-center hemodialysis patients maintained on 2 years of SO therapy (mSO) versus patients who discontinued SO (dSO) within 90 days of their first prescription and switched to other PBs. A literature search was conducted to determine the cost per hospital admission for dialysis patients in the healthcare setting of each European country. A cost-model combined the incidence rate of all-cause hospital admissions and the cost per admission to estimate the country-specific inpatient costs for the mSO and dSO groups. Results Annual inpatient cost-savings per patient in the mSO group versus the dSO group were €1,201, €2,097, €2,059, €1,512, and €3,068 in France, Germany, Italy, Spain, and the UK, respectively. When annual PB drug costs per patient were considered, the net annual economic cost-savings per patient were €327, €1,585, €1,022, €1,100, and €2,204, respectively. Limitations Hospital admissions data used in the analysis were observational in nature and derived from a US hemodialysis patient population; the effect of SO therapy on hospitalization rates for US and European hemodialysis patients may differ. The analysis did not consider indirect healthcare costs associated with hospitalizations. Conclusion SO therapy may offer substantial inpatient cost-savings by reducing all-cause hospital admissions attributable to uncontrolled hyperphosphatemia.

Survival on four compared with three times per week haemodialysis in high ultrafiltration patients: an observational study.

BackgroundThe harm caused by the long interdialytic interval in three-times-per-week haemodialysis regimens (3×WHD) may relate to fluid accumulation and associated high ultrafiltration rate (UFR). Four-times-per-week haemodialysis (4×WHD) may offer a solution, but its impact on mortality, hospitalization and vascular access complications is unknown.MethodsFrom the AROii cohort of incident in-centre haemodialysis patients, 3×WHD patients with a UFR >10 mL/kg/h were identified. The hazard for the outcomes of mortality, hospitalization and vascular access complications in those who switched to 4×WHD compared with staying on 3×WHD was estimated using a marginal structural Cox proportional hazards model. Adjustment included baseline patient and treatment characteristics with inverse probability weighting used to adjust for time-varying UFR and cardiovascular comorbidities.ResultsFrom 10 637 European 3×WHD patients, 3842 (36%) exceeded a UFR >10 mL/kg/h. Of these, 288 (7.5%) started 4×WHD and at baseline were more comorbid. Event rates while receiving 4×WHD compared with 3×WHD were 12.6 compared with 10.8 per 100 patient years for mortality, 0.96 compared with 0.65 per year for hospitalization and 14.7 compared with 8.0 per 100 patient years for vascular access complications. Compared with 3×WHD, the unadjusted hazard ratio (HR) for mortality on 4×WHD was 1.05 [95% confidence interval (CI) 0.78–1.42]. Following adjustment for baseline demographics, time-varying treatment probability and censoring risks, this HR was 0.73 (95% CI 0.50–1.05; P = 0.095). Despite these adjustments on 4×WHD, the HR for hospitalization remained elevated and vascular access complications were similar to 3×WHD.ConclusionsThis observational study was not able to demonstrate a mortality benefit in patients switched to 4×WHD. To demonstrate the true benefits of 4×WHD requires a large, well-designed clinical trial. Our data may help in the design of such a study.

Comparison of physical activity and quality of life in home haemodialysis (HHD) patients versus conventional in-centre haemodialysis (ICHD) patients: the observational, longitudinal, prospective, international, multicentric SeCoIA study protocol

BackgroundHome haemodialysis (HHD), has shown improved clinical outcomes, as well as a better quality of life, compared to conventional in-centre haemodialysis (ICHD) but still has a global low prevalence among end-stage renal disease patients. Haemodialysis (HD) patients tend to be sedentary but only few studies, mainly in North American ICHD patients, have evaluated the level of activity in HD patients.MethodsSeCoIA is an observational, longitudinal, prospective, international, multicentric, study, conducted in metropolitan France and Belgium. The main objective of the study is to quantify the physical activity measured by the total daily number of steps, in HHD patients compared to ICHD patients. The SeCoIA study will include 80 HHD patients and 80 ICHD patients,. Secondary objectives will be to characterize the HHD population and to confirm HHD efficiency on clinical parameters, as well as quality of life (QoL), in current practice. Physical activity will be measured by a 3-axis accelerometer. Accelerometers have been shown to provide accurate information, on both physical activity and sedentary behaviour. Patients will be instructed to wear the device and complete a patient diary 7 consecutive days after inclusion and the first week of each month for 12 months. Decision to undergo HDD or ICHD is independent of the study and follow-up frequency remains at the discretion of the physician/centre. QoL and quality of sleep will be respectively assessed by the Kidney Disease Quality of Life 1.2 (KDQOL™) and the Pittsburg Sleep Quality index (PSQI) questionnaires at inclusion, 6- and 12-month visits. Patients presenting a restless leg syndrome (RLS) will also complete the International Restless Legs Syndrome rating scale (IRLS) questionnaire.DiscussionThe SeCoIA study will be the first large cohort study (160 patients) evaluating physical activity, objectively measured with a 3-axis accelerometer, in HHD versus ICHD patients. The present study will also include a comparison of QoL with a focus on RLS between HHD and ICHD. It is anticipated that HHD patients will have an improved physical activity and QoL which should encourage physicians to further promote HHD.Trial registrationClinical trial NCT03737578 study registered on November 9, 2018 (Retrospectively registered).

Sociodemographic features and mortality of individuals on haemodialysis treatment who test positive for SARS-CoV-2: A UK Renal Registry data analysis.

Kidney disease is a recognised risk factor for poor COVID-19 outcomes. Up to 30 June 2020, the UK Renal Registry (UKRR) collected data for 2,385 in-centre haemodialysis (ICHD) patients with COVID-19 in England and Wales. Overall unadjusted survival at 1 week after date of positive COVID-19 test was 87.5% (95% CI 86.1-88.8%); mortality increased with age, treatment vintage and there was borderline evidence of Asian ethnicity (HR 1.16, 95% CI 0.94-1.44) being associated with higher mortality. Compared to the general population, the relative risk of mortality for ICHD patients with COVID-19 was 45.4 and highest in younger adults. This retrospective cohort study based on UKRR data supports efforts to protect this vulnerable patient group.

Hepatitis B and C Viruses Infections Among Dialysis Patients in Saudi Arabia

Background: Viral Hepatitis is a global disease, affecting millions of patients around the world. Dialysis dependent patients used as an artificial kidney (hemodialyzer) to remove waste product from the blood in severe renal impairment patients. Hence they are more vulnerable to viral hepatitis. Aims:The aim of this study is to investigate the prevalence of hepatitis B and C infections among dialysis patients in the Qassim province, Saudi Arabia. We further examine their epidemiological profile, risk factors, prognostic factors, treatment course, and characterization of their liver disease stage. Methods: This study is a cross-sectional study. Hepatitis B and C positive patients receiving dialysis in Qassim Province were included in this study. We reviewed the data registry of dialysis centers where medical records of hepatitis B surface antigen (HBsAg) and hepatitis C virus (HCV) serology are reported from 18 affiliated dialysis centers across Al Qassim Region. The prevalence was calculated by dividing the number of patients with positive HBsAg or HCV serology to the total number of patients. Results: The prevalence of Hepatitis B Surfaces Antigen (HBsAg) positive cases among in-center hemodialysis patients was 20 (03.2%) with 12 (01.9%) of cases converting from HBsAg negative to positive during the previous 12 months. While the prevalence of Hepatitis C antibody positive cases was 40 (06.4%) with 2 cases converting from negative to positive during the previous 12 months. Conclusion: This study finds low intermediate prevalence HBV and high prevalence for HCV according to CDC classification. Funding Statement: The authors received no financial support for the research, authorship, and/or publication of this article. Declaration of Interests: The authors declare that they have no conflicts of interest. Ethics Approval Statement: This paper is approved by Qassim Research Ethics Committee.

Changes in Cerebral Volume and White Matter Integrity in Adults on Hemodialysis and Relationship to Cognitive Function

Introduction: Patients on hemodialysis (HD) have a significant burden of cognitive impairment. Characterizing the cerebral structural changes in HD patients compared to healthy controls and evaluating the relationship of cerebral structural integrity with cognitive performance in HD patients can help clarify the pathophysiology of the cognitive impairment in HD patients. Methods: In this cross-sectional study, in-center HD patients ≥50 years of age underwent brain structural and diffusion MRIs and cognitive assessment using the NIH Toolbox cognition battery. The cerebral imaging measures of the HD participants were compared to imaging from age-matched controls. Gray matter volume, white matter volume, and white matter integrity determined by diffusion tensor imaging parameters (including fractional anisotropy [FA]) were measured in both cohorts to determine differences in the cerebral structure between HD participants and healthy controls. The association between cognitive performance on the NIH Toolbox cognition battery and cerebral structural integrity was evaluated using multiple linear regression models. Results: We compared imaging measures form 23 HD participants and 15 age-matched controls. The HD participants had decreased gray matter volumes (526.8 vs. 589.5 cm³, p < 0.01) and worsened white matter integrity overall (FA values of 0.2864 vs. 0.3441, p < 0.01) within major white matter tracts compared to healthy controls. Decreases in white matter integrity in the left superior longitudinal fasciculus was associated with lower executive function scores (r² = 0.24, p = 0.02) and inferior longitudinal fasciculus with lower memory scores (r = 0.25 and p = 0.03 for left and r² = 0.21 and p = 0.03 for right). Conclusions: HD patients have a pattern of decreased white matter integrity and gray matter atrophy compared to controls. Decreases in white matter integrity were associated with decreased cognitive performance in the HD population.

Fluid overload is an independent predictor of atrial fibrillation in end-stage renal disease: A prospective study using insertable cardiac and body composition monitors

Fluid overload and atrial fibrillation (AF) are frequently encountered in patients with end-stage renal disease (ESRD). We used subcutaneously insertable cardiac monitors (ICM) to detect AF and associated it with the hydration status, determined with a body composition monitor (BCM) in dialysis patients. 69 patients were recruited. Fluid overload was defined based on BCM measurements as a ratio of overhydration (OH) and extracellular water (OH/ECW) of > 15% at baseline. AF episodes lasting ≥ 2 minutes were collected. 45 in-center hemodialysis patients, 11 on peritoneal dialysis, 12 on home hemodialysis, and 1 predialysis-stage patient were followed up for a median of 2.9 years (25th - 75th percentile 1.9 - 3.1). 29% were overhydrated at baseline, and the percentage remained similar throughout the study. Overhydrated patients had a lower body mass index, a higher prevalence of type 1 diabetes mellitus (DM) and diabetic nephropathy, higher systolic blood pressure, greater ultrafiltration (UF) during dialysis, and a smaller lean tissue index than normohydrated patients. Chronic or paroxysmal AF was known to occur in 20.3% at entry, and a further 33.3% developed AF during the study, with an overall prevalence 53.6%. In univariable logistic regression, OH/ECW > 15% was strongly associated with AF prevalence (OR 6.8, 95% CI 1.7 - 26.5, p = 0.006), as were UF, age, coronary heart disease (CHD), DM, and the echocardiogram-derived ejection fraction and left atrial diameter. In multivariable analyses, OH/ECW > 15% remained an independent predictor of AF alongside age and CHD. The occurrence of AF is independently associated with BCM-measured fluid overload, which is common among ESRD patients.

Examining patient distress and unmet need for support across UK renal units with varying models of psychosocial care delivery: a cross-sectional survey study

ObjectiveTo examine in-centre haemodialysis patients’ emotional distress and need for support across UK renal units with varying models of psychosocial service provision.DesignThe study used a cross-sectional survey design. Logistic regression...

Factors affecting uptake of home hemodialysis among self-care dialysis unit patients.

Superior outcomes have been reported among hemodialysis (HD) patients who take active control over their dialysis treatment either at self-care satellite dialysis units or home compared to the regular in-center hemodialysis patient. Although the differences between the home hemodialysis (HHD) and self-care in-center HD (SCHD) are not well described, the growing literature on the superior outcomes of HHD suggests that HHD is the better option. We performed a cross-sectional study in a stand-alone self-care unit to examine the differences in patients that are keen to consider HHD and those who are not. A cross-sectional sample of 44 patients completed a structured interview and the distress thermometer score used to assess psychological stress. Only 68% of patients reported to have heard about the benefits of HHD despite the long-established history and availability of the modality in the unit. One of the more critical findings in our study was that the cohort of patients who were keen to consider HHD believed that self-care and HHD would improve their quality of life (P < 0.05). Specifically, the perceived benefits stated by those willing to consider HHD were the lack of need to travel, association with better outcomes and the possibility of having the treatment in the comfort of home (P < 0.05). We surmise that the answers expressed in this survey likely reflect a difference in perceptions of self-care and beliefs about HHD; hence, the importance of introducing HHD education earlier in the course of their chronic kidney disease journey.

Assessment of literacy and numeracy skills related to medication labels in patients on chronic in-center hemodialysis

ObjectivesPatients on hemodialysis have complicated medication regimens requiring the ability to accurately interpret medication information. Literacy and numeracy skills have been shown to differ by the types of materials provided to patients. The aims of this study were to determine prescription and over-the-counter medication label understanding and to assess the prevalence of low health literacy regarding medication labeling among in-center hemodialysis patients. Design, setting and participantsThe Medication Literacy and Numeracy in Dialysis (MedLitD) tool is an assessment of a person’s ability to read and understand medication labels. A comparison with the Rapid Estimate of Adult Literacy in Medicine Short Form (REALM-SF), an established literacy tool, was conducted to determine if there were differences in the literacy results from the 2 tools that could be leveraged to target education initiatives for this specialized population. ResultsA total of 110 patients receiving hemodialysis from 3 dialysis facilities in the Capital Region of upstate New York were enrolled in the study. Most patients (77%) achieved a maximum REALM-SF score, indicating a high level of literacy proficiency; however, their MedLitD scores varied. Patients who were 65 years and older had lower scores on the MedLitD tool compared with younger patients. Gender, education, and the number of medications did not influence the MedLitD scores. Only 16% of all participants correctly answered the question asking for an indication of the phosphate binder (PB), although the most patients were currently taking PBs. ConclusionA continuum of medication literacy levels exists among patients on hemodialysis. Appropriate evaluation of medication literacy should be done to better inform individualized education and counseling.