Intervention In Hemodialysis Patients Research Articles

Amino Acids Supplementation and Exercise Intervention in Hemodialysis Patients: Effects on Muscle and Fatigue, A Randomized Controlled Trial

Amino Acids Supplementation and Exercise Intervention in Hemodialysis Patients: Effects on Muscle and Fatigue, A Randomized Controlled Trial

#3102 LIMITED PHARMACEUTICAL LITERACY IN PATIENTS ON HEMODIALYSIS IN THE NETHERLANDS AS ASSESSED WITH THE RALPH INTERVIEW GUIDE

Abstract Background and Aims Patients with advanced chronic kidney disease typically use 15 or more different drugs. Proper use of these drugs requires sufficient pharmaceutical literacy, which is defined as health literacy in the context of medication use. Until now, no data are available on the prevalence of limited pharmaceutical literacy in patients with CKD or on hemodialysis. Recently, the RALPH (Recognizing and Addressing Limited Pharmaceutical Literacy) interview guide was developed in the Netherlands to assess pharmaceutical literacy skills. The current study aims to provide data on the prevalence of limited pharmaceutical literacy, associated problems, and the domains in which these problems occur, in hemodialysis patients using phosphate-binding drugs in the Netherlands. Method This study was part of a prospective observational study in a teaching hospital in Rotterdam, investigating a complex adherence-improving intervention in hemodialysis patients using phosphate-binding drugs. One of the aims of the original study was to explore pharmaceutical literacy at baseline, using the RALPH interview guide. The RALPH consists of eleven multiple-choice questions and several open-ended questions in three health literacy domains. The functional domain assesses the basic skills of reading, writing, and calculating. The communicative domain assesses more advanced skills, namely finding and understanding information and applying this information to the own situation. The critical domain assesses the even more advanced skills of critically analyzing information and applying this information to different situations. Limited pharmaceutical literacy was defined as the presence of at least one problem in one or more of the domains of the RALPH. The primary outcome was the prevalence of limited pharmaceutical literacy. Secondary outcomes were the prevalence of one or more problems in the domains. Data were analyzed using descriptive statistics (SPSS version 28.0). Results A total of 63 patients were included in the study. Mean age was 66 years, 65% were male. The main primary renal diagnoses were hypertensive nephropathy (31%) and diabetic nephropathy (19.1%). Seventy-three percent of patients received their drugs in a weekly drug dispensing system. The prevalence of limited pharmaceutical literacy was 79%. Fifty-two percent of patients had at least one problem in the communicative domain, 46% in the functional domain, and 78% in the critical domain. Around 90% of patients could correctly reproduce user instructions for phosphate-binding drugs. The most prevalent problems were lack of knowledge about the indication (40%) in the functional domain and finding understandable information (51%) in the communicative domain. In the critical domain, the most frequently encountered problems were a lack of adequate judgment of both reliability and applicability of information (62% and 65%, respectively). Almost half of the patients did not search for information. Furthermore, 32% of patients did not engage in shared-decision making or found this difficult to do. Reasons for this were a profound trust in the nephrologist and the patient's conviction that the nephrologist knew what was best. Conclusion Limited pharmaceutical literacy is frequent in patients on hemodialysis: the majority of patients have problems with finding understandable information and judging its applicability and reliability. The results of this study are in line with earlier findings studying pharmaceutical literacy in Dutch community pharmacies in the Netherlands. However, the current study found slightly higher percentages for problems with finding understandable information and judging the applicability of information. This was expected, as our population generally uses more drugs and has a more vulnerable health status. Recent data show that limited health literacy in general negatively affects certain aspects of self-management, such as adherence, communication, and knowledge. This is also apparent in our study. These data together underline the need for dialysis healthcare providers to individualize their communication and support to meet their patients’ needs.

Patient-specific hemodynamic feature of central venous disease intervened by stent: A numerical study.

Central venous disease (CVD) with stenosis or occlusion is a severe and prevalent complication for chronic hemodialysis (HD) patients, resulting in dialysis access dysfunction. Percutaneous transluminal angioplasty with stent placement (PTS) has become one of the first-line treatments for CVD. In clinical practice, the extra stents would be used if the curative efficacy of a single stent were unsatisfactory. Aiming to evaluate the therapeutic effect of different PTS schemes, computational fluid dynamics (CFD) simulations on four patients were performed to compare the hemodynamic characteristics of real-life HD patients after stent placement. The three-dimensional central vein's models of each patient were built using computational tomography angiography (CTA) images, and idealized models were constructed as contrast. Two inlet velocity modes were imposed to imitate the blood flow rate of healthy and HD patients. The hemodynamic parameters for different patients were investigated, including wall shear stress (WSS), velocity, and helicity. The results showed that the implantation of double stents is able to improve flexibility. When subjected to external force, the double stents have better radial stiffness. This paper evaluated the therapeutic efficacy of stent placement and provided a theoretical basis for CVD intervention in hemodialysis patients.

Neutrophil extracellular trap is an important connection between hemodialysis and acute myocardial infarction

The incidence of acute myocardial infarction (AMI) in hemodialysis (HD) patients is high and the prognosis is extremely poor. However, the potential connection between HD and AMI, and its regulatory mechanisms remain unclear. In this study, the gene expression profiles of HD (GSE15072) and AMI (GSE66360) were downloaded from the Gene Expression Omnibus database, common differentially expressed genes (DEGs) were obtained using the limma R package, the biological functions were analyzed according to Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses, machine learning was conducted to identify hub genes. Receiver operating characteristic curves and gene set enrichment analyses were used to explore the characters and biological function of hub genes, networks were used for candidate identification of transcription factor (TF), microRNA (miRNA), and drug. After a total of 255 common DEGs were selected, GO and KEGG analyses indicated that neutrophil extracellular trap (NET) may be a potential connection between HD and AMI, LILRB2, S100A12, CYBB, ITGAM, and PPIF were finally identified as hub genes. The area under curve of LILRB2, S100A12, and PPIF was higher than 0.8 in both datasets. Networks show the relationship between hub genes, TF, and miRNA, also the relationship between potential drugs and protein. In conclusion, NETs may be the potential connection between AMI and HD. The potential hub gene, signaling pathways, and drugs provided by this study may contribute to future AMI prevention and intervention in HD patients.

A collaborative model between dialysis clinics and a hospital center improves the quality of vascular access care and intervention for hemodialysis patients.

This study reports the outcomes of a collaborative program between dialysis clinics and a referral hospital, which consisted of clinical monitoring and supplementary routine surveillance, for improving the quality of vascular access care. This retrospective observational study was performed at five dialysis clinics as part of a 2-year collaborative program (2019-2020) in conjunction with a hospital-based dialysis access management center. A total of 392 hemodialysis patients (arteriovenous fistula [AVF], n = 339 and arteriovenous graft [AVG], n = 53) were included. Outcome measures included the prognosis of vascular access, clinic satisfaction, and referral rate to the hospital. Increased vascular access flow was observed and critical flow events decreased from the first to the second year (AVF: 18.3% vs. 12.7%, p < 0.001; AVG: 26.2% vs. 20.1%, p = 0.30). There were fewer percutaneous transluminal angioplasty events in the AVG group (0.77 per person-year vs. 0.51 per person-year, p = 0.005). New AVF or AVG creation events also remained low. All dialysis clinics were satisfied with the program. The overall referral rate from the participating clinics increased (65.7% vs. 72.0%) during the study period independently of the physical distance between the dialysis clinic and the hospital. The collaboration between dialysis clinics and a referral hospital for improving the quality of vascular access care was successful in this study, and the model can be used by other clinics and hospitals looking to improve care coordination in dialysis patients.

The Effectiveness of Slimber Ice Against Thirst Intensity In Hemodialysis Patients With Chronic Kidney Disease

Chronic Kidney Disease (CKD) is a progressive & irreversible impairment of kidney function. The replacement therapy in CKD that is widely chosen is hemodialysis. CKD patients undergoing hemodialysis should limit fluid intake during dialysis so that excess fluid does not occur, but the result of fluid restriction will trigger the onset of thirst so patients are less likely to adhere to the fluid intake diet. Slimber ice is an intervention of choice in the management of thirst. This study aims to analyze the effect slimber-ice against thirst intensity in hemodialysis patients with CKD at Stella Maris Hospital Makassar. The type of research used is Pre-Experimental with One Group Pre-Post Test Design. Sampling using the Non-Probability Sampling method with the Consecutive Sampling technique with a total sample of 40 respondents. This study provided intervention in hemodialysis patients with CKD in the form of slimber-ice. The implementation of the intervention begins with a Pre-Test (measurement of thirst intensity) using the Visual Analogue Scale (VAS) instrument, then giving slimber-ice for 5 weeks (2x a week) then a Post-Test is carried out. The results of the study described the majority of respondents aged 56-65 years, namely 15 respondents (37,5%), male gender 29 respondents (72,5%), high school last education 28 respondents (70%), & employment status was not working 22 respondents (55%), then the intensity of thirst before the intervention of the majority of moderate thirst was 29 respondents (72,5%) & after the majority of mild thirst 33 respondents (82,5%). Wilcoxon test analysis was obtained p = 0.000 ˂ α = 0.05 so that there was a significant effect slimber-ice agains thirst intensity in hemodialysis patients with CKD. Researchers recommend slimber-ice as one of the self-interventions in restraining thirst to prevent an imbalance of body fluids due to overhydration.

Application of evidence based practice: Interdialytic weight gain (IDWG) management intervention in hemodialysis patients at Arifin Hospital, Riau

The physical problem that is often experienced by hemodialysis (HD) patients and is difficult to overcome is the problem of excess fluid. This can be seen from the patient's weight gain between dialysis times or called interdialytic weight gain (IDWG). A high IDWG is associated with a higher risk of cardiovascular causes of death and increased morbidity. The application of evidence based practice in the form of IDWG management interventions has been proven to be able to overcome excessive weight gain between the two HD or IDWG times. The purpose of this community service is to increase the knowledge and skills of HD patients regarding evidence based practice in the form of IDWG management interventions. The method of implementing community service activities is in the form of training packaged with HD patients on IDWG management with lectures, questions and answers, and demonstrations. The resulting impact is an increase in the knowledge and skills of HD patients regarding IDWG management with a standard percentage of IDWG weight gain of 22% and IDWG weight loss >3.5% of 14% after implementing IDWG management. In addition, the patient has been able to apply techniques to overcome thirst and xerosemia. Nurses and the patient's family must take part in providing support for patient compliance in implementing IDWG management so that patients can avoid complications from excess fluid problems which can ultimately improve the patient's quality of life.

Lavender Aromatherapy to Treat the Symptoms of Restless Leg Syndrome in Patients Undergoing Hemodialization

Hemodialysis is one of the renal replacement therapy for patients with chronic kidney failure which could give some complications including Restless Leg Syndrome. Non-pharmacological therapies such as lavender can be used to reduce the symptoms caused by RLS. The purpose of this study was to examine several literature, articles and research documents that identified the effectiveness of lavender aromatherapy in overcoming the symptoms caused by RLS in patients undergoing hemodialysis. The method used in this study is a literature review conducted with reference to searches through online database sites, namely Google Scholar, ScienceDirect, Pubmed and ResearchGate. The results of the study from 7 reviewed articles showed that lavender therapy given through various interventions could reduce reduction, reduce fatigue and reduce RLS scores. The conclusion obtained in this study is that the intervention with lavender aromatherapy has been shown to reduce the symptoms caused in hemodialysis patients who experience RLS so nurses need to consider lavender aromatherapy as an intervention in hemodialysis patients who experience RLS.

Effect of Intradialytic Supine Ergometer Exercise on Hemodialysis Patients with Different Nutritional Status.

It is important for hemodialysis patients to exercise while their nutritional status is being monitored. This study aimed to examine the difference in physical exercise function and the effect of exercise intervention in hemodialysis patients who were divided into two groups (high-nutrition and low-nutrition groups) based on the serum albumin levels. A total of 26 outpatients (18 men and 8 women) undergoing hemodialysis (age: 66 ± 10 years) were included in this study. The patients' body composition data (weight, body mass index, percentage of body fat, fat-free mass, and total body water) and physical functions (grip strength, knee extensor strength, open-eyed one-legged standing time, long sitting trunk anteflexion, and 6-minute walking distance [6MWD] test) were measured. The intervention was supine ergometer exercise during hemodialysis, and the patients exercised for 30 minutes during hemodialysis thrice a week. The intervention period was three months. Compared to the high-nutrition group, the low-nutrition group showed a significant decrease in muscle strength. Furthermore, long sitting trunk anteflexion in the high-nutrition group and 6MWD in the low-nutrition group improved significantly after the intervention. The result of this study may indicate that 6MD can be improved by exercise during dialysis, regardless of nutritional status. It is said that low nutritional status has a negative impact on survival rate; thus, considering the impact on survival rate, it is hemodialysis patients with a low nutritional status that should be considered to introduce more active exercise during dialysis.

Effects of an additional resistance training intervention in hemodialysis patients performing long-term ergometer exercise during dialysis.

[Purpose] To verify the effect of a 12-week additional resistance training intervention in patients on hemodialysis who had been performing supine ergometer exercises alone during dialysis. [Participants and Methods] Overall, 18 patients undergoing hemodialysis were included. A 12-week intervention with additional resistance training was conducted in hemodialysis patients who had been performing supine ergometer exercise for 30 min during dialysis for over >3 months. Physical function before and after the period of bicycle ergometer exercise alone and before and during the additional intervention was compared. Resistance training consisted of 1–3 sets per day of five different exercises for the large muscle groups of the upper and lower limbs. [Results] The results of the 6-min walk test improved significantly after the additional intervention. The average driving distance in the supine ergometer exercise during the additional intervention was identified as an associated factor. [Conclusion] The addition of the resistance training to long-term supine ergometer exercisers improved walking endurance. When supine ergometer exercise alone does not change physical function, the additional use of resistance training subsequently may have a positive effect on walking endurance.

Abstract 11038: One Year Prognosis After Coronary Intervention in Hemodialysis Patients Accompanied with Triglyceride Deposit Cardiomyovasculopathy, a Novel Type Atherosclerosis with Triglyceride Deposition

Introduction: Triglyceride deposit cardiomyovasculopathy (TGCV) patients presents the massive accumulation of triglyceride in smooth muscle cells characterized by a novel diffuse narrowing atherosclerosis. There are reported prognostic data on hemodialysis cases accompanied with TGCV, however, little prognostic data after coronary intervention are known. Hypothesis: There might be poor prognosis after coronary intervention in hemodialysis patients accompanied with TGCV. Methods: This retrospective single-center observational study included data from the cardiac catheter database at the study institution between April 2011 and March 2017. Among 654 consecutive patients on hemodialysis, the data for 36 patients implanted DES who could be collated the diagnostic criteria for TGCV using both 123I-β-methyl-iodophenyl- pentadecanoic acid scintigraphy and coronary angiography were analysed. Patients were divided into two groups (TGCV or non-TGCV control group). One-year prognosis after coronary intervention in patients accompanied with and without TGCV were studied. Results: The cohort included 13 and 23 patients accompanied with and without TGCV, respectively. Figure showed one-year prognosis, composite of cardiovascular death or non-fatal myocardial infarction or urgent revascularization, between two groups. Incidence of composite events after coronary intervention was higher in the TGCV group than in the control group (log-rank p=0.036). TGCV was a significantly and independently associated with one-year prognosis after coronary intervention even after adjusted confounding factors. Conclusions: These results demonstrated that TGCV comorbidity is associated with poor prognosis after coronary intervention in hemodialysis patients, and contributes to the novel risk factor for coronary intervention.

Predictors of clinical outcome after rotational atherectomy-facilitated percutaneous coronary intervention in hemodialysis patients.

Percutaneous coronary intervention (PCI) in hemodialysis patients with severely calcified and diffused lesions is associated with extremely high rates of major adverse cardiovascular events (MACE), even when facilitated by rotational atherectomy (ROTA). Potential risk factors for MACE with ROTA-facilitated PCI in hemodialysis patients should be identified. We retrospectively analyzed a consecutive cohort of patients from the Sapporo Cardiovascular Clinic database, who were on maintenance hemodialysis with severe calcified lesions and treated with ROTA-facilitated PCI. Clinical and interventional procedure characteristics were collected and compared between patients with and without MACE, defined as all-cause death, hospitalization due to heart failure, definite stent thrombosis, or target lesion revascularization (TLR) at 1-year follow-up. The individual outcomes of MACE and TLR in the cohort were presented as Kaplan-Meier percentages. Cox regression analyses were performed to identify independent predictors of MACE. A total of 138 patients undergoing hemodialysis and followed up for 362.50 (243.75, 382.25) days. Sixty-one patients in the cohort had MACE, most of which were TLR (47.5%, 29/61). Cumulative all-cause death at 30-day and 1-year follow-up were 6.52% and 18.8%, respectively. Patients with right coronary artery (RCA) lesions, in-stent restenosis (ISR) lesions, and were more likely to have MACE, even with larger reference vessel diameter and greater acute gain after PCI. Cox regression analysis demonstrated that ISR lesion was positively associated with both MACE (HR 3.21, 95% CI: 1.59-6.48) and TLR (HR 5.08, 95% CI: 1.78-14.47), latter of which was also proved to be significantly related to greater acute gain (HR 1.95, 95% CI: 1.12-3.39). In subgroup analysis, RCA was found to be positively associated with MACE in de novo lesion (HR 2.83, 95% CI: 1.28-6.28). We found that the overall prognosis of ROTA-facilitated PCI in hemodialysis patients was poor. ISR was a significant risk factor for MACE, especially TLR.

15. Pilot Study: Mindful Drinking/Eating Intervention for Hemodialysis Patients With Fluid Restrictions

15. Pilot Study: Mindful Drinking/Eating Intervention for Hemodialysis Patients With Fluid Restrictions

Fully Immersive Virtual Reality-Based Mindfulness Intervention in Hemodialysis Patients: A Pilot Study Assessing Safety and Utility

Fully Immersive Virtual Reality-Based Mindfulness Intervention in Hemodialysis Patients: A Pilot Study Assessing Safety and Utility

P1390METHOD FOR AN EFFECTIVE INTRAOPERATIVE IDENTIFICATION OF PARATHYROID GLANDS IN HEMODIALYSIS PATIENTS WITH SEVERE HYPERPARATHYROIDISM FOR ADEQUATE PARATHYROIDECTOMY

Abstract Background and Aims Secondary and tertiary hyperparathyroidism (HPT) in patients undergoing chronic hemodialysis is one of the most important problems of clinical nephrology. The removal of altered parathyroid glands has a number of difficulties: the detection and accurate allocation of the entire volume of the parathyroid glands due to their small size, similar structure to the surrounding tissues (thyroid gland, lymph nodes and adipose tissue) and complex anatomical location. Usually parathyroid glands are located directly on the posterior surface of the thyroid lobes, but in some cases they can be located atypically. In addition, the parathyroid glands are often “immersed” in the tissue of the thyroid gland, which also makes their visualization difficult. Isolation and differentiated intraoperative visualization of the parathyroid glands is extremely important for an adequate amount of surgical intervention. Method Seven dialysis patients with severe hyperparathyroidism were operated on using oral administration of 5-aminolevolenic acid for intraoperative imaging of the parathyroid glands. Secondary and tertiary hyperparathyroidism ware diagnosed in patients with C5D stage CKD by a significant increase in the level of intact parathyroid hormone (iPTH) and increased parathyroid glands detected by ultrasound. In all patients, the level of iPTH before surgery was more than 1500 pg / ml. At the prehospital stage, in all patients, according to the results of ultrasound, enlarged parathyroid glands were revealed (the number of parathyroid glands in one patient was 4 +/- 2). For intraoperative identification of changed parathyroid glands in these patients, the oral administration of a solution of 5-aminolevulinic acid was used (given in 180 minutes before the start of surgery at a dose of 10 -15 mg / kg body weight). Then the surgical field was irradiated with polarized blue light with a wavelength of 395–405 nm to record fluorescence. If fluorescent formations were detected in the area of irradiated tissues, they were removed with subsequent reimplantation of a less altered part of the hyperplastic parathyroid gland into the forearm region. Results Specific bright red fluorescence and luminescence of the parathyroid glands caused by special external sources of polarizing blue light during the operation were observed in all 7 patients. In each patient from 3 to 6 light portions of parathyroid glands were detected. These lightning portions were isolated, removed, and in 3 patients the most unchanged areas of the parathyroid glands were autotransplanted into the forearm. In the postoperative period, all patients showed the decrease in the level of iPTH less than 300 pg/ml, a syndrome of "hungry" bone, which was corrected by the administration of calcium and vitamin D preparations. Histologically all the found tissues were characterized as tissue of the parathyroid glands. The duration of operations was 48 +/- 12 minutes. Patients did not have any side effects indicated in the annotation to the drug. Conclusion Intraoperative fluorescence diagnostics of the parathyroid glands with preoperative oral use of 5-aminolevolenic acid is a simple and effective method of their visualization. This method promotes adequate parathyroidectomy and allows to reduce the time of surgical intervention in hemodialysis patients.

The Effect of Occupational Therapy Intervention in Hemodialysis Patients

The Effect of Occupational Therapy Intervention in Hemodialysis Patients

A Brief Mindful Drinking/Eating Intervention for Hemodialysis Patients With Fluid Restrictions

A Brief Mindful Drinking/Eating Intervention for Hemodialysis Patients With Fluid Restrictions

Feasibility of an Internet-based positive psychological intervention for hemodialysis patients with symptoms of depression

ABSTRACTBackground: Depression is a pervasive psychological issue facing hemodialysis (HD) patients. Novel technology-based treatment strategies that deploy psychology-based interventions have not been the focus for therapy and few published studies exist. The aim of the current trial is to determine the feasibility and acceptability of an Internet-based positive psychological intervention in HD patients with comorbid depressive symptoms. Methods: HD patients (n = 14) with elevated symptoms of depression were enrolled in a single-arm pre-post trial with clinical assessments at baseline and immediately post intervention. Chairside during regularly scheduled HD treatment, patients utilized a web browser to complete online modules promoting skills for increasing positive emotion over a 5-week period using Apple IPads. Targeted skills included noting of daily positive events, gratitude, positive reappraisal, acts of kindness, and mindfulness/meditation. Results: Twelve of 14 patients completed the program for an 85.7% retention rate. Participants felt satisfied with each session and offered consistently positive feedback. On average, participants visited the website 3.5 times per week. Significant improvements were evident for depressive symptoms (15.3 vs. 10.9; p = 0.04), as per the Center for Epidemiological Studies Depression Scale. Conclusions: An innovative Internet-based positive psychological intervention represents a feasible and useful therapeutic option for HD patients with depressive symptoms.

Treatment of intradialytic hypotension with an herbal acupoint therapy in hemodialysis patients: A randomized pilot study

ObjectiveHypotension during hemodialysis (HD) is the most common complication that negatively affects the quality of life of patients. The objective of the current study was to evaluate the preliminary efficacy and safety of herbal acupoint therapy (HAT) for intradialytic hypotension (IDH). MethodsA randomized, placebo-controlled trial was performed in 32 HD patients to determine whether HAT was more effective than a sham treatment for the treatment of IDH. The outcomes were frequency of IDH episodes and number of nursing interventions during HD sessions, pre- and post-dialysis BP, subjective change in fatigue as measured by the Visual Analogue Scale (VAS), and recovery time from fatigue after dialysis at the 0th and 4th week. Data analyses were performed using per-protocol population. ResultsIn all, 27 patients (84%) completed the entire study. At the end of the intervention, the patients in the HAT group were found to have a significantly lower frequency of IDH episodes, fewer nursing interventions, a lower intervention failure rate, and earlier discontinuation of dialysis than those in the sham group (p < .05). The improvement in degree of fatigue (p = .001) was greater and recovery time from fatigue after dialysis (p = .03) was shorter in the group treated with HAT than in the sham group. HAT was safe, with 2 withdrawal cases due to local erythema caused by the patch. ConclusionsHAT appears to be safe and efficacious for improving IDH-related symptoms and intervention in HD patients. Larger studies are needed to confirm the benefit of this technique for IDH.

血液透析患者的中医药治疗及中医护理现状

This paper aims to present situation of traditional Chinese medicine therapy and nursing of hemodialysis patients, to review relevant literature on hemodialysis and to analyze and understand the hemodialysis patients with traditional Chinese medicine therapy and nursing. It is put forward that the future research should focus on specification of hemodialysis lateral comparative evaluation development, etc., in order to standardize and form evidence-based prevention intervention in hemodialysis patients with complications, better improve the quality of survival in hemodialysis patients.