Interdialytic Weight Gain Research Articles

Adherence to Pharmacotherapy and Lifestyle Recommendations Among Hemodialyzed Patients and Kidney Transplant Recipients

Success in treatment with hemodialysis (HD) and kidney transplantation (KTx) requires good adherence. The objective of this study was to evaluate adherence to pharmacotherapy and health recommendations among HD and KTx patients using subjective and objective measures. Two hundred thirty-nine enrolled patients, with 132 KTx (39F, 93M) and 107 HD (48F, 59M) completed a questionnaire regarding over-the-counter (OTC) medications and dietary supplements (DS), adherence to pharmacotherapy, lifestyle recommendations, and self-evaluation of knowledge on them. The surveys were supplemented with objective data from patients' medical records, including interdialytic weight gain and laboratory parameters. About 42.1% HD and 39.4% KTx patients reported using OTC medications without medical consultation (P=.677); 43.9% HD and 31.1% KTx used DS (P=.040); more HD than KTx failed to notify a doctor about it (52.2% vs. 21.4%; P<.001). More HD patients skipped medication doses (33.6% vs. 9.7%; P<.001). About 40.2% HD and 20.5% KTx patients drank alcohol (P<.001), 22.4% HD and 10.5% KTx smoked (P=.013). About 46.7% HD and 66.4% KTx patients limited their caloric intake (P=.002), 73.8% HD and 84.9% KTx limited their salt intake (P=.030). HD patients drank 1.17±0.57L of fluids daily and KTx drank 2.51±0.67L (P<.001). In HD patients, interdialytic weight gains positively correlated with dialysis vintage (R=0.26, P=.02) and fluid (R=0.28, P=.011) but not salt intake (P=.307). The variability of trough levels of calcineurin inhibitors was unrelated to use of DS or OTC medications. KTx rated their knowledge on recommendations higher compared with HD (mean score 4.0±1.0 vs. 3.7±1.0, P=.040). KTx recipients exhibit better adherence and rate their knowledge on recommendations higher than HD patients.

Hemodiafiltration maintains a sustained improvement in blood pressure compared to conventional hemodialysis in children-the HDF, heart and height (3H) study.

Hypertension is prevalent in children on dialysis and associated with cardiovascular disease. We studied the blood pressure (BP) trends and the evolution of BP over 1year in children on conventional hemodialysis (HD) vs. hemodiafiltration (HDF). This is a post hoc analysis of the "3H - HDF-Hearts-Height" dataset, a multicenter, parallel-arm observational study. Seventy-eight children on HD and 55 on HDF who had three 24-h ambulatory BP monitoring (ABPM) measures over 1year were included. Mean arterial pressure (MAP) was calculated and hypertension defined as 24-h MAP standard deviation score (SDS) ≥95th percentile. Poor agreement between pre-dialysis systolic BP-SDS and 24-h MAP was found (mean difference - 0.6; 95% limits of agreement -4.9-3.8). At baseline, 82% on HD and 44% on HDF were hypertensive, with uncontrolled hypertension in 88% vs. 25% respectively; p < 0.001. At 12months, children on HDF had consistently lower MAP-SDS compared to those on HD (p < 0.001). Over 1-year follow-up, the HD group had mean MAP-SDS increase of +0.98 (95%CI 0.77-1.20; p < 0.0001), whereas the HDF group had a non-significant increase of +0.15 (95%CI -0.10-0.40; p = 0.23). Significant predictors of MAP-SDS were dialysis modality (β = +0.83 [95%CI +0.51 - +1.15] HD vs. HDF, p < 0.0001) and higher inter-dialytic-weight-gain (IDWG)% (β = 0.13 [95%CI 0.06-0.19]; p = 0.0003). Children on HD had a significant and sustained increase in BP over 1year compared to a stable BP in those on HDF, despite an equivalent dialysis dose. Higher IDWG% was associated with higher 24-h MAP-SDS in both groups.

Prévalence et facteurs de risque associés à l’hypotension intradialytique en Afrique subsaharienne : cas du Burkina Faso

AimThe aim of our study was to determine the prevalence and factors associated with intradialytic hypotension in our cohort of chronic hemodialysis patients. MethodsThis was a prospective monocentric study over a six-month period. Intradialytic hypotension was defined as a decrease in systolic blood pressure ≥ 20mmHg or a decrease in mean arterial pressure of 10mmHg associated with clinical events and the need for nursing interventions. The groups were compared using univariate analysis of variance. ResultsWe included 48 patients and counted 3014 hemodialysis sessions. The mean age was 44.7±15 years. The prevalence of intradialytic hypotension was 12.4%, with cramps 20 (41.7%) as the main symptom. Factors associated with frequent intradialytic hypotension compared to the groups without intradialytic hypotension and with infrequent intradialytic hypotension were age (61±13 years, p=0.018), diabetes (33.3%, p=0.019), high body mass index (27, 3±7.8kg/m2, p=0.002), interdialytic weight gain ≥ 5% of baseline weight (66.7%, p=0.033), hourly ultrafiltration (800±275ml/h, p=0.037) and perdialytic feeding (33.3%, p=0.016). Low pre-dialysis diastolic blood pressure (72±13mmHg, p=0.012) and high baseline weight (73.9±17.5kg, p=0.028) were associated with frequent versus infrequent intradialytic hypotension. ConclusionIntradialytic hypotension is common in our context. Its prevention in at-risk patients is critical to reducing morbidity and mortality and improving quality of life.

Follow-Up Study on the Effect of Cognitive Behaviour Therapy on Haemodialysis Adherence

ObjectivesPatients with chronic kidney disease (CKD) undergoing haemodialysis often experience a myriad of psychosocial problems, resulting in poor adherence to their therapeutic regimen. This study aimed to examine the effect of cognitive behaviour therapy (CBT) on dialysis, fluid, drug and diet adherence among a previously reported sample of CKD patients undergoing haemodialysis.MethodsA randomised controlled trial was conducted between January 2013 to Febrary 2014 on a random selection of 67 CKD patients attending a tertiary multispecialty hospital in India. The experimental group (n = 33) was exposed to CBT, whereas the control group (n = 34) received non-directive counselling. A haemodialysis adherence scale was developed and used to assess adherence to the treatment regimen. The effect size was calculated using Cohen’s d statistics.ResultsAt six months, mean reductions from baseline were observed in the experimental group in terms of interdialytic weight gain (−1.23 kg; effect size: 0.57), systolic blood pressure (−22.18 mmHg; effect size: 0.71) and diastolic blood pressure (−10.06 mmHg; effect size: 0.72), whereas mean increases were noted in haemoglobin (+0.75 g/dL; effect size: 0.31) and adherence to dialysis (+0.94; effect size: 0.51), fluids (+16.34; effect size: 2.30), diet (+61.19; effect size: 4.75) and drugs (+10.73; effect size: 1.3). Differences from baseline were significantly higher in the experimental group compared to the control group (P = 0.001 each).ConclusionThese results show that CBT is more effective than non-directive counselling for improving therapeutic adherence and physiological, clinical parameters among CKD patients undergoing haemodialysis.

Prevalence of xerostomia in patients on haemodialysis: A systematic review and meta-analysis.

Haemodialysis is the most popular procedure of treating end-stage renal disease. But patients on haemodialysis report various symptoms including xerostomia that add to the physical as well as the psychological stress. Xerostomia is also considered to be one of the factors for interdialytic weight gain. This systematic review aims to find out the prevalence of xerostomia in patients on haemodialysis. The results would help the nephrologists to consider xerostomia, treat it appropriately and minimise the risks during haemodialysis. The search strategy was in line with the PRISMA guidelines. An online literature search of databases like PUBMED, SCOPUS, Wiley Online Library and the Cochrane library along with journal hand searches and scanning of references was done. The relevant articles were identified based on the inclusion and exclusion criteria. Full-text articles were obtained and scrutinised. Risk of bias assessment was carried out for the included articles. Four articles satisfying the inclusion criteria were finalised. The pooled prevalence of xerostomia in patients on haemodialysis was 52.3%. The assessment of risk bias placed the articles at low risk. With the limited number and variations of studies, the prevalence of xerostomia in haemodialysis patients was high. Ideal management approaches could be proposed if many more accurate estimates of prevalence of xerostomia in patients on haemodialysis are recorded in future.

A Text Messaging Intervention for Dietary Behaviors for People Receiving Maintenance Hemodialysis: A Feasibility Study of KIDNEYTEXT

An important component of hemodialysis management involves delivery of complex dietary recommendations. The aim of this study was to determine the feasibility of a mobile phone text-message intervention to improve dietary behavior in people undergoing hemodialysis. Six-month randomized feasibility study. Patients receiving maintenance hemodialysis across 2 health districts in Sydney, Australia. Participants randomized to the intervention received 3 text messages per week in addition to standard dietary care for 6 months. The usual care group received standard dietary care. The primary outcomes were feasibility measured using recruitment and retention rates, acceptability of the intervention, and adherence to dietary recommendations. Secondary exploratory outcomes included information on certain clinical parameters related to dietary management of patients receiving maintenance hemodialysis. 130 people were recruited; 48% of eligible patients (130 of 272) consented to participate, and 88% (115 of 130) completed the study. Semistructured interviews evaluating acceptability identified 5 themes: clear and comprehensive, engaging with consistent and relevant content, maintaining attention with timely reminders, sustaining interest through ongoing care, and generic messages inadequate to prompt dietary change. There was no difference in adherence to dietary recommendations across treatment groups (odds ratio, 1.21 [95% CI, 0.55-2.72]; P= 0.6). Secondary exploratory analyses suggested reductions in dietary intake of single nutrients (potassium, phosphorus, sodium, protein), interdialytic weight gain, and phosphate binder use among intervention participants compared with participants assigned to standard care. Our feasibility study was of short duration. Adherence was based on self-reported data. Generalizability to populations receiving maintenance hemodialysis outside of an urban, Australian setting is unknown. A simple mobile phone text-messaging intervention was feasible and acceptable to patients. Further investigation of the impact on patient-reported and clinical outcomes is warranted. Funding for the study was provided by a Sydney Medical School Foundation Grant and the Centre for Transplant and Renal Research at Westmead Hospital. Registered at Australian New Zealand Clinical Trials Registry with study number ACTRN12617001084370.

Incremental Versus Conventional Hemodialysis for Preservation of Residual Kidney Function in Patients on Regular Hemodialysis

Incremental hemodialysis has many potential benefits to patients clinicians and health systems.The aim of this work was to evaluate incremental hemodialysis twice/week compared with conventional dialysis thrice/week for preservation of the residual kidney function among patients initiating regular hemodialysis.Study design Prospective, comparative study.Setting Nephrology department Military Hospitals AL-maadi kobry AL-koba and air force military hospital.Subjects We assigned 40 patients with chronic kidney disease stage V D who early started hemodialysis into2 groups Group1:20 patients underwent incremental hemodialysis twice/week and Group2:20 patients underwent conventional hemodialysis thrice/week.Methods: All patients followed for laboratory findings of complete blood picture creatinine urea calcium albumin phosphorus parathyroid hormone alkaline phosphatase glomerular filtration rate. Also Kt/v at start and every month was done.Clinical outcome measures included mortality cardiovascular outcome hospital admission and dialysis complications.Results: In the studied population,the mean age was45.95±2.97 years.Regarding sex 60% were males and 40% were females. Regarding outcome data20%of patients had hypotension15%had hospital admission,while nobody suffered mortality.Comparative study betwee the 2 groups revealed; significant decrease in hypotension incidence in incremental group 40%compared to conventional group 10% p=0.03.Conclusion: To conclude, our study examines associations between HD treatment frequency and patient survival. In agreement with recent literature,30,31 our findings suggest that in an incident HD population, certain selected patients with adequate RKF, adequate control of interdialytic weight gain,and low or moderate comorbid disease burden CCI <5 an incremental HD approach

ADHERENCE OF SELF-CARE MANAGEMENT AMONG HEMODIALYSIS PATIENTS

Chronic kidney disease (CKD) has a high prevalence and incidence so that it is a frequent global problem. CKD causes kidney tissue damage which is marked by the accumulation of metabolic waste in the blood so it is necessary to do kidney replacement therapy, one of which is hemodialysis. CKD has 5 stages based on the glomerular filtration rate, wherein each stage the patient must be responsible for managing his health such as diet and lifestyle modification, administering large amounts of medication, and complying with doctor's rules. Therefore, patients must increase their adherence to self-care management so that they can prevent the worsening of the disease. This study aims to determine adherence of self-care management among hemodialysis patients. The research design used a quantitative descriptive with a cross-sectional approach. The sample in this study was 84 patients who underwent hemodialysis at the Majalaya Hospital, and they were taken by consecutive sampling technique from a population of 145 people. The instrument used in this study was Morisky questionnaire, Body Mass Index, Hemodialysis Self-Management Instrument (HDSMI), IDWG (Interdialytic Weight Gain). Data analysis was done using statistical software to obtain frequency distribution. The results showed that the compliance of hemodialysis patients in taking medication was still low, 50% (42 respondents), 72.6% (61 respondents) did not comply with the diet, 61.9% (52 respondents) did not comply with fluid intake, 53.6% (45 respondents) were not obedient in caring for AV fistula. This result can be influenced by several factors, namely education, gender, marital status, age, length of HD. Adherence to self-care management it is very important because it greatly influences the management of complications, controlling symptoms, minimizing negative effects, and delaying disease progression.

Paradoxical Association Between Intradialytic Blood Pressure Change and Long-Term Mortality with Different Levels of Interdialytic Weight Gain.

BackgroundA greater interdialytic weight gain (IDWG) implies a greater ultrafiltration rate, which might lead to hemodynamic instability and intradialytic blood pressure (BP) change in hemodialysis patients. However, current studies have not explicated the impact of IDWG on the association between intradialytic BP changes and prognosis, especially in patients without cardiac dysfunction and diabetes. In this study, we aimed to explore the relationship between absolute intradialytic BP changes and mortality with different IDWG levels.MethodsA total of 204 hemodialysis patients (without cardiac dysfunction and diabetes) were included in this prospective observation study, with a mean follow-up of 55.32±20.99 months. Initially, we collected IDWG, IDWG% (percentages according to dry weight), and pre-/post-BPs of 36 consecutive dialysis sessions during three months enrollment. And the average value of them was defined as baseline value. Patients were divided into 3 cohorts according to IDWG% tertiles (<3.3%, 3.3%–4.6%, ≥4.6%). Comparisons between different tertiles were analyzed.ResultsCompared to the low IDWG% group (tertile 1, T1), patients of high IDWG% group (tertile 3, T3) were younger, had higher ultrafiltration rate, less residual kidney function, lower BMI and dry weight, longer dialysis vintage and higher N terminal pro B type natriuretic peptide levels (P<0.05). Correlations were found between IDWG% and intradialytic BP changes. Kaplan–Meier analysis and multivariate Cox regression model adjusted for demographic data, dialysis information and predialysis BPs indicated that greater absolute intradialytic BP changes were associated with worse prognosis in T1 group (P<0.05). While in T3 group, less absolute intradialytic BP changes were associated with higher mortality (P<0.05).ConclusionThere is a paradoxical association between absolute intradialytic BP changes and long-term mortality with different IDWG levels. Both BP stability and volume balance are crucial to patients’ prognosis.

The Effect of Interdialytic Weight Gain on Blood Pressure in a Population of Chronic Hemodialysis Patients

Introduction: Hypertension, often associated with hypervolemia, is common in chronic hemodialysis patients. However, the relationship between interdialytic weight gain (IDWG) and blood pressure (BP) is incompletely characterized. Our study seeks to appreciate the relationship between IDWG and BP in a cohort of chronic hemodialysis patients. Patients and Methods: It is a prospective study involving 52 chronic hemodialysis patients and 528 dialysis sessions following a hemodialysis program of 3 times a week, where BP and IDWG were measured before the session. The dialysis sessions occurred over a period of 30 days from January 02 to 30, 2019 in the Hemodialysis unit of Mohammed V Military Training Hospital. Demographic data and dialytic parameters were collected over a 30-day period then analyzed using the following statistical tools: correlation coefficient r, simple linear regression (univariate analysis) and multiple linear regression (multivariate analysis). Results: Mean age was 55 ± 12 years, 48% were men, 32.7% were diabetic and 61.5% were on antihypertensive therapy. In univariate analysis, each 1 kg increase in IDWG was associated with an increase of 3.3 mmHg in systolic BP (p = 0.01) and 2.7 mmHg in diastolic BP (p = 0.006). In multivariate analysis, after adjusting for confounding factors, an increase of 1 kg of IDWG was associated with an increase of 1.7 mmHg of systolic BP (p = 0.05) and 1.8 mmHg of diastolic BP (p = 0.05). Conclusion: Our results show that there is a significant association between IDWG and BP, however, its modest magnitude can’t explain alone the variations of BP in the chronic hemodialysis patients.

Interdialytic Weight Gain in Hemodialysis Patients: Worse Hospital Admissions and Intradialytic Hypotension

Introduction: Interdialytic weight-gain (IDWG) has been linked to various complications in hemodialysis (HD) patients. Method: Prospective clinical-observational study to evaluate the effect of IDWG in HD patients on the rate of hospital admissions over a 12-month period, and the impact of high IDWG on the frequency of IDH. Results: Of the 240 patients, those who had IDWG ≥ 4%, 81% had at least one hospital admission due to volume-overload or the need for extra HD-session(s). On the other hand, only 19% of those having IDWG 4% in our patients), the same stands for the frequency of IDH. Thus, control of IDWG in HD patients is of great importance, keeping in mind the importance of the nutrition status of HD patients that may also impact IDWG.

A study of Factors Affecting Dialysis Recovery Time in Haemodialysis Patients in India.

Background:Patients on maintenance haemodialysis (MHD) often complain of fatigue and tiredness following haemodialysis sessions leading to poor compliance with the dialysis schedule. There is limited Indian data on dialysis recovery time (DRT). The present study was designed to assess the factors affecting DRT in our haemodialysis population.Methods:We recorded self-reported patient recovery times of 120 patients who satisfied the inclusion criteria, over three consecutive dialysis sessions by asking the question, 'How long does it take to recover from a dialysis session'? Data recorded included patient factors like age, sex, co-morbidities, Charlson comorbidity index score (CCI), dialysis vintage, duration of kidney disease, interdialytic weight gain (IDWG), treatment factors like ultrafiltration rate (UFR), SpKt/V, blood pump speed, dialysate sodium, session length, pre and post HD blood pressure and laboratory parameters. Health-related quality of life (HRQoL) was assessed with the KDQOL-SF v. 1.3 questionnaire. Results from the SF-36 score were summarised into the physical composite score (PCS), mental composite score (MCS) and kidney disease composite score (KDCS).Results:The mean age of the study population was 50.6 ± 12.6 years. Among the 120 patients, 77 (64.2%) were males. Thirty-nine patients (32.5%) were diabetic and 95 (79.1%) patients were hypertensive. The mean dialysis vintage of the study population was 26.1 ± 18.6 months, 41 (34.2%) patients reported DRT <2 h; 48 (40%) reported DRT between 2–6 h and 31 (25.8%) reported DRT >6 h. On multivariate regression analysis, higher IDWG, CCI score and UFR were associated with prolonged DRT. Reported DRT also inversely correlated with PCS (r = - 0.66), MCS (r = - 0.65) and KDCS (r = - 0.59) scores which was statistically significant.Conclusion:The present study showed that higher CCI scores, IDWG and UFR were associated with prolonged DRT in Indian haemodialysis patients and patients with longer recovery time had poor HRQoL. Interventions to reduce DRT need to be assessed in further trials in Indian MHD patients.

The Nitty-Gritties of Kt/Vurea Calculations in Hemodialysis and Peritoneal Dialysis.

In advanced Chronic Kidney Disease, patients require renal replacement therapy (dialysis or transplantation) for clearance of toxins, electrolyte and acid-base balance and removal of excess fluid. Dialysis adequacy should be taken into consideration in the adjustment of the dialysis prescription. Kt/Vurea is one method of measuring dialysis adequacy that is commonly used in clinical practice. Different formulae for calculating Kt/V are available. The appropriate Kt/V formula to be used depends on the clinical scenario, as well as parameters such as gender and size of patient, frequency of dialysis, mode of dialysis (ie hemodialysis vs, peritoneal dialysis), inter-dialysis weight gain, clinical symptoms, complications (fluid overload, hyperkalemia, intolerance to dialysis, etc), and residual kidney function. Nutrition parameters including serum protein and albumin levels, vitamin B12 and β2-microglobulin levels should be factored into the assessment of dialysis adequacy. In this review, we have described how Kt/Vurea is calculated in hemodialysis and peritoneal dialysis with examples. We reviewed the available literature by searching for papers related to calculating Kt/Vurea, single pool Kt/V, double pool Kt/V, weekly Kt/V, standard Kt/V, surface area normalized Kt/V, and various equations commonly practiced in clinical practice. We found several original articles, some review articles along with detailed information from manufacturers of different dialyzers published on their websites or as package inserts. Understanding the different equations available for calculating Kt/Vurea and the application of these results in the clinical setting is important for refining patient care and for designing clinical studies.

Severity of frailty as a significant predictor of mortality for hemodialysis patients: a prospective study in China.

Background: Frailty is known to be highly prevalent in older hemodialysis (HD) patients. We studied the prevalence of frailty and its associated factors in Chinese HD patients. We further studied if frailty could predict survival in HD patients.Methods: This is a prospective study involving patients receiving maintenance HD in the dialysis center of Xuanwu Hospital, Beijing. Study subjects were enrolled from October to December, 2017 and followed up for two years. Demographic data, comorbidities and biological parameters were collected. Frailty was assessed using the Fried frailty phenotype at baseline. Cox regression analysis was performed to identify the relationship between frailty and mortality in HD patients. Kaplan-Meier was plotted using the cutoff value obtained by ROC curve to evaluate survival rates in different frailty status.Results: Total of 208 HD patients were enrolled with a mean age of 60.5±12.7 years. According to the frailty criteria, at baseline the prevalence of robust, pre-frail and frail in HD patients was 28.7%, 45.9%, and 25.4%, respectively. The two-year all-cause mortality was 18.8% (39/207) and underlying causes of death included coronary artery disease (CAD), cerebrovascular disease (CVD), hyperkalemia, severe infection, malignant tumor and others. Survival curve showed the patients with frailty score ≥4 to have significantly shorter survival time as compared to patients with frailty score ≤ 3. Frailty predicted two-year mortality when frailty score ≥4 with a sensitivity of 70% and a specificity of 83.67% with an AUC of 0.819. Frailty score was positively associated with age and ratio of ultrafiltration volume to dry weight, while negatively associated with levels of serum albumin, uric acid and diastolic blood pressure after HD.Conclusions: Our results confirm frailty to be very common among HD patients and severity of frailty was a significant predictor of mortality for HD patients. Factors such as age, malnutrition and low blood pressure are the factors to be associated with frailty. Interdialytic weight gain inducing excessive ultrafiltration volume is an important risk factor.

Structural and functional condition of the myocardium and the relationship of metabolic disorders in patients with chronic kidney disease

Purpose. Study of the structural and functional characteristics of the heart in patients receiving long term hemodialysis (HD) treatment, and the identification of links with bone mineral, lipid disorders and anemia.Material and methods. A total of 160 patients with chronic kidney disease (CKD) of the 5th dialysis (5D) stage (70 men, 90 women) who were treated in the hemodialysis departments of Izhevsk were examined. The average age of patients is 52.9 ± 2.0 years old (31 to 78 years old). The procedures were performed 3 times a week for 4–4.5 hours. The inclusion criteria were the duration of dialysis therapy for at least one year and the availability of informed consent. The adequacy index Kt / V amounted to1.56 ± 0.2. Echocardiographic examination assessed the structural and functional parameters, calculated Left Ventricular Mass, LVM index, relative thickness index, “inner membrane”, fractional-shortening of the middle fibers. A study of general clinical indicators of mineral-bone disorders, Lipemic index, erythrocytes was carried out.Results. Violation of left ventricular (LV) geometry was found in 140 (87.5%) patients with 5D CKD stage. Concentric and eccentric hypertrophy prevailed. No significant dependence on patient’s sex was revealed. Patients with eccentric hypertrophy showed high rates of inter-dialysis weight gain (p &lt; 0.05) and ultrafiltration (p &lt; 0.05). In patients with concentric hypertrophy, high indicators of calcium-phosphorus metabolism (p &lt; 0.05), pre-dialysis systolic pressure (p &lt; 0.05) and pulsatility (p &lt; 0.05) were obtained. They also tended to have higher triglyceride indices and more pronounced anemia. The correlation of the structural and functional state of the myocardium with the level of phosphorus, calcium, calcium-phosphorus ratio and pulsatility was established.Conclusions. In most patients with stage 5D CKD, LV remodeling with the prevalence of concentric and eccentric hypertrophy is observed. No significant gender differences were found. In patients with hypervolemia requiring more intense ultrafiltration during dialysis, eccentric LV hypertrophy was detected. High values of pre-dialysis and pulsatility, as well as levels of calcium and phosphorus, are observed with the concentric remodeling type. Correlations of structural changes in the myocardium with calcium-phosphorus metabolism were revealed. The data obtained may open new ways of influencing the regression of LV hypertrophy and improve the cardiovascular prognosis in patients receiving programmed hemodialysis treatment.

Análisis de la influencia del cuidador principal en el estado nutricional del paciente en hemodiálisis

Introducción: La población que se encuentra en tratamiento renal sustitutivo con hemodiálisis sufre frecuentemente cierto grado de desnutrición calórico-proteica debido a las restricciones dietéticas y la mala elección de alimentos. Esta desnutrición unida a la inflamación repercute en su calidad de vida e incrementa su mortalidad. Objetivos: Determinar el estado nutricional de los pacientes en tratamiento con hemodiálisis y su relación con quién elabora su comida. Comprobar la relación entre el grado de cumplimiento de las recomendaciones terapéuticas y su estado nutricional. Material y Método: estudio transversal y descriptivo en una población de pacientes en hemodiálisis hospitalaria. Se recogieron datos sociodemográficos, antecedentes clínicos, resultados analíticos y antropométricos. El estado nutricional se valoró mediante la escala MIS. Se realizó un análisis descriptivo e inferencial de las variables a estudio. Resultados: El grado de desnutrición se situó en el 32,4%(n=34). No se encontró ninguna significación estadística entre el estado nutricional y el cuidador principal. Pese a que el 76,5% refirió seguir las recomendaciones dietéticas, tan solo un 44% tenía unos valores séricos de potasio adecuados y el 34,7% cumplía con la ganancia de peso interdialítica recomendada. Conclusiones: La desnutrición sigue siendo un problema frecuente en las unidades de hemodiálisis. Se deben tomar medidas para reducirla, ya sea con acciones educacionales sobre alimentación o incluso valorar el uso de suplementos dietéticos. Enfermería debe seguir reforzando las recomendaciones dietéticas para que ese cumplimiento referido por nuestros pacientes pueda objetivarse y verse reflejado en sus resultados analíticos.

Interdialytic weight gain of less than 2.5% seems to limit cardiac damage during hemodialysis.

Aims:To investigate if a single low-flux HD induces a rise in cardiac biomarkers and if a change in clinical approach may limit such mechanism.Material and methods:A total of 20 chronic HD patients each underwent three different study-dialyses. Dialyzers (low-flux polysulfone, 1.8 sqm) had been stored either dry or wet (Wet) and the blood level in the venous chamber kept low or high. Laboratory results were measured at baseline, 30 and 180 min, adjusted for the effect of fluid shift. Ultrasound measured microemboli signals (MES) within the return line.Results:Hemodialysis raised cardiac biomarkers (p < 0.001): Pentraxin 3 (PTX) at 30 min (by 22%) and at 180 min PTX (53%), Pro-BNP (15%), and TnT (5%), similarly for all three HD modes. Baseline values of Pro-BNP correlated with TnT (rho = 0.38, p = 0.004) and PTX (rho = 0.52, p < 0.001). The changes from pre- to 180 min of HD (delta-) were related to baseline values (Pro-BNP: rho = 0.91, p < 0.001; TnT: rho = 0.41, p = 0.001; PTX: rho = 0.29, p = 0.027). Delta Pro-BNP (rho = 0.67, p < 0.001) and TnT (rho = 0.38, p = 0.004) correlated with inter-dialytic-weight-gain (IDWG). Biomarkers behaved similarly between the HD modes. The least negative impact was with an IDWG ⩽ 2.5%. Multiple regression analyses of the Wet-High mode does not exclude a relation between increased exposure of MES and factors such as release of Pro-BNP.Conclusion:Hemodialysis, independent of type of dialyzer storage, was associated with raised cardiac biomarkers, more profoundly in patients with higher pre-dialysis values and IDWG. A limitation in IDWG to <2.5% and prolonged ultrafiltration time may limit cardiac strain during HD, especially in patients with cardiovascular risk.

Impact and Efficacy of Topical Dry Mouth Products in Haemodialysis Patients with Xerostomia: A Pilot Study.

Purpose: Previous studies have shown that haemodialysis (HD) patients frequently suffer from xerostomia. This problem is associated with difficulties in oral functions, increased risk of oral diseases and interdialytic weight gain (IDWG). The aims of this preliminary study are to evaluate the efficacy and safety of topical dry mouth products in treating xerostomia in HD patients and their impact in reducing IDWG. Materials and Methods: We included 25 HD patients that suffered from xerostomia and complied with inclusion criteria. Subjects received toothpaste, mouthwash and mouth gel for dry mouth. The duration of treatment was 4 weeks. Patients filled out a visual analogue scale (VAS) for xerostomia and Oral Heath Impact Profile (OHIP)-14 questionnaires. Clinical data and IDWG were collected of the medical history of HD patients. Questionnaires and IDWG were collected at baseline, 2 and 4 weeks post-treatment. Results: Twenty-five patients completed the study (56% male and 44% female). The mean age was 63.52 ± 12.50 years. The topical treatment statistically significantly (p = 0.0001) alleviated the symptoms of xerostomia and improved their quality of life (OHIP-14 scores) (p = 0.0001). We observed a statistically significantly IDWG (kg) and IDWG% reduction (p = 0.03) after the use of topical treatment for xerostomia. None of the patients reported side effects. Conclusions: Xerostomia might affect the quality of life and increase the IDWG of these patients. The daily use of topical treatment for xerostomia could decrease thirst and IDWG, improving the quality of life of HD patients. Future randomised studies are needed to confirm these results.

NT-pro-BNP as marker for cardiac strain that may be caused by high-output arteriovenous shunting in a haemodialysis patient. A case report

BackgroundAn arteriovenous fistula (AVF) is the first choice when considering access for haemodialysis (HD). When a forearm AVF fails an upper arm AVF is a frequent subsequent dialysis access option. The latter may cause cardiac strain. NT-pro-B-type natriuretic peptide (NT-NT-proBNP) is a marker used to estimate volume overload and cardiac strain.This case report shows the benefit of using longitudinal individual follow-up of pre-dialysis NT-proBNP in clinical practice to detect changes in cardiac condition that may be due to high-output AVF.Case presentationAn 18 years old patient performed HD via an upper arm AVF before he was admitted to our unit. NT-proBNP was above the upper detection level of 70,000 ng/L. Echocardiography revealed a left-ventricular cardiac insufficiency. Interdialytic weight gain (IDWG) was above 5%. He was instructed to lower fluid intake and IDWG towards 2%. Four months later NT-proBNP surpassed 70,000 ng/L again. Flow in the brachial artery was at 3034 ml/min. Reconstructive surgery of the AVF did not reduce flow and NT-proBNP in the long run. Clinically, he worsened to NYHA class III-IV. It was decided to close the upper arm AVF and to replace it with a lower arm AVF leading to a reduced artery flow of 1344 mL/min. The clinical condition successively recovered and NT-proBNP decreased to 7000 ng/L.ConclusionsPre-dialysis NT-proBNP should be considered as a suitable routine marker for cardiac strain such as caused by high-output AVF besides variables such as IDWG. Brachial artery flow besides AVF flow measurement is helpful.

Association between pill burden and interdialytic weight gain in patients with hemodialysis: A multi-center cross-sectional study.

High daily pill burden affects quality of life and mortality. High interdialytic weight gain (IDWG) is associated with increased mortality. We examined the association between pill burden and IDWG in hemodialysis patients. This cross-sectional study was conducted in six dialysis centers in Japan in June 2017. The exposure was the number of daily tablets, and outcome was defined as 1 day of relative IDWG divided by post-dialysis weight from the previous session. Among 188 outpatients (mean age, 68.7 [SD, 10.3] years; men, 67.0%; median dialysis vintage, 76.0 [interquartile range, 36.5, 131.5] months), the mean number of daily tablets was 19.7 ± 9.9, and mean relative weight gain was 3.5 ± 1.2%. Multiple linear regression analysis showed a regression coefficient of 0.021 (95% confidence interval: 0.004-0.039), indicating that one additional tablet prescription increased the IDWG by 0.021%. In hemodialysis patients, the daily pill burden was a significant, independent risk for increased relative IDWG.