Levels In Hemodialysis Patients Research Articles

Home-based tele-exercise training and physical activity during the COVID-19 pandemic in chronic kidney disease patients.

The coronavirus disease 2019 (COVID-19) pandemic and lockdown reduced physical activity levels in hemodialysis (HD) patients and kidney transplant recipients (KTRs). This study aimed to describe physical activity levels during lockdown and assess the effects of an online home-based exercise training program on physical activity levels in HD patients and KTRs. Forty-five HD patients and thirty-five KTRs were divided into four groups: exercise groups 1 (ΕΧ-HD) and 2 (EX-KTR) followed a 4-month tele-exercise training program, while control groups received usual care. All participants at baseline and at the end of the study completed the International Physical Activity Questionnaire (IPAQ), while their daily physical activity levels were recorded via a step counting application. At the end of the study, the repeated measures analysis revealed a significant effect of time, group, and time-by-group interaction in the average steps per day, walking, and moderate activity for the exercise-HD group (p < 0.05). Similarly, the analysis revealed a notable effect of time, group, and time-by-group interaction in the exercise-KTR group in average daily steps, vigorous and walking activity (p < 0.05). Multiple regression analysis showed that the level of physical activity at the end of the study was related to the urban place of residence and theparticipation in the 4-month exercise program of both HD patients and KTRs. Participation in a tele-exercise training program led to favorable effects on physical activity levels both in HD patients and KTRsduring lockdown.

#406 High ferritin is not needed in hemodialysis patients: a retrospective study of total body iron and oral iron replacement therapy

Abstract Background and Aims In vivo iron levels can be adjusted through intestinal iron absorption to be maintained at a suitable level; however, optimal iron levels in hemodialysis (HD) patients are unclear. Although serum ferritin is useful as an indicator of iron stores, it does not necessarily reflect body iron levels in HD patients with unstable hematopoiesis since iron metabolism is a semi-closed system in vivo. In this study, we investigated total body iron (TBI), new index calculated as the sum of red blood cell (RBC) iron and iron stores, during courses of low-dose oral iron replacement therapy, and evaluated in vivo iron sufficiency and its indicators in HD patients. Method We analyzed data on 105 courses of low-dose iron replacement therapy (50–120 mg of iron daily) administered to 83 patients with serum ferritin &amp;lt;60 ng/mL and Hb &amp;lt;12 g/dL undergoing maintenance hemodialysis at our institution. Low-dose oral iron replacement therapy was initiated between August 2016 and June 2023 and continued for at least seven months. All blood samples were collected at the start of hemodialysis at the beginning of the week. Blood examinations were performed twice a month, and patients were given darbepoetin alfa (DA), long-acting ESAs to maintain Hb at the target level of 10–12 g/dL, in accordance with the guidelines of the Japanese Society for Dialysis Therapy. Iron-related parameters were determined based on blood samples collected once a month, with TSAT calculated from serum iron (Fe) and total iron-binding capacity (TIBC), using the following equation. TSAT=Fe/TIBC × 100. We evaluated changes in TBI, RBC iron, and iron stores from the initiation of treatment to month 7, in two groups of patients, namely, iron-therapy responders and non-responders. Furthermore, we investigated factors associated with steady-state TBI. TBI was regarded as achieving a steady state during the course of therapy when the trend shifted from an increase and the difference from the value at one month was less than or equal to zero. TBI was calculated using the formula proposed by Cable et al (Transfusion. 2016, 56, 2005). Results Mean age was 68.1±12.6 years and median time on hemodialysis was 6.6 years. Of the 105 courses of therapy, 75 were delivered to men and 30 to women, and 66.7% of the patients had diabetic nephropathy. The patients had a mean Hb level of 10.4±0.7 g/dL, a mean serum ferritin level of 27.3±12.5 ng/mL, mean transferrin saturation (TSAT) of 18.1%±5.9%, and a median C-reactive protein level of 0.1 mg/dL at the start of each course. TBI showed significant increases until month 4 and plateaued thereafter in iron-therapy responders, and tended to increase and then reached a similar plateau in non-responders (month 7: 1900±447 vs. 1900±408 mg, Fig. 1). As for RBC iron, iron-therapy responders showed significant monthly increases up to month 3, whereas non-responders showed constant values. Regarding iron stores, iron-therapy responders showed significant monthly increases up to month 5, while non-responders showed a significant increase only at month 1. DA per body weight showed a significant decrease at month 3 and 4 in the effective group, but a slight increase in the non-responder group. Steady-state TBI did not correlate with Hb or serum ferritin, but was strongly correlated with body surface area (BSA) using the Du Bois formula [TBI=−791.914 + 1628.606 × BSA (m2); R2=0.88, p&amp;lt;0.001, Fig. 2]. Conclusion This study showed that hemodialysis patients can increase their body iron levels during oral iron replacement therapy and maintain them at the same level after sufficiency has been achieved, suggesting activation of a “mucosal block.” Furthermore, this result also suggests that determining iron sufficiency based on serum ferritin alone is difficult in HD patients with fluctuations in Hb. However, regression equations using steady-state TBI and BSA showed a high degree of fit. Therefore, BSA might potentially be used in estimations of TBI sufficiency, which may be useful for avoiding excessive iron dosage.

#1336 Serotonin levels in hemodialysis patients with Long COVID-associated cognitive impairment

Abstract Background and Aims Long COVID comprises a broad range of persistent symptoms that emerge after COVID-19 and can last for months or years and have a direct impact on daily life. Cognitive impairment and loss of short-term memory are examples of symptoms associated with long COVID. To date, there are neither generally agreed-upon diagnostic criteria nor effective treatments available. A recent study found an association of serotonin deficiency and long COVID in the general population [1], leading to vagal dysfunction and impaired cognition. In this study, we aimed to evaluate longitudinal serotonin levels in hemodialysis (HD) patients with or without cognitive symptoms associated with long COVID. Method We analyzed routinely collected serum samples (n = 102) from 16 HD patients collected between 60 days before and 60 days after a positive SARS-CoV-2 RT-PCR. Metabolites were extracted using cold methanol and subjected to reverse phase liquid chromatography/mass spectrometry (LC/MS). Serotonin was identified by matching retention time, accurate mass, and fragmentation data against an in-house LC/MS library. Log2 of serotonin signal intensity was used for quantification. The COVID-19 Yorkshire Rehabilitation Scale (C19-YRS) was administered shortly after positive RT-PCR test, as well as 1- and 6-months post-COVID. Patients were classified as having cognitive symptoms if they reported short-term memory loss or difficulties with concentration or communication problems as per C19-YRS. Unpaired t-test or Fisher's exact tests were performed to compare characteristics of patients with and without cognitive symptoms. We defined three study periods relative to the date of COVID-19 diagnosis: –60 to –15 days (baseline); –14 to +14 days (acute COVID); and +15 to +60 days (post-COVID). Differences in serotonin signal intensity (log2) between patients with and without cognitive symptoms were evaluated with unpaired t-tests. Linear mixed effects models with random intercepts were constructed to determine changes in serotonin levels over time with the baseline period as the comparator. This research was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK130067). Results Demographic data are presented in Table 1a. Of the 16 patients, 7 (44%) were classified with cognitive symptoms associated with long COVID. There were no differences in age, sex, race, ethnicity, vintage, diabetes, and hypertension between patients with and without cognitive symptoms. Serotonin levels in patients with vs. without cognitive symptoms did not significantly differ at baseline and during acute COVID (Fig. 1). Of note, in the post-COVID phase, serotonin levels were significantly lower in the group with impaired cognition (p = 0.012) compared to symptoms-free patients (Fig. 1). Within each group, serotonin levels remained unchanged at acute-COVID or post-COVID periods compared to baseline (Table 1b). Conclusion We show that HD patients with impaired cognition have lower serotonin in the post-COVID phase compared to patients without cognitive symptoms. These results corroborate findings in the general population. Further investigation in a larger cohort is warranted to evaluate the potential of serotonin as a target for the prevention or as a marker of neurocognitive symptoms associated with long COVID.

#2560 Intradialytic serum phosphate variations are associated with low PTH levels

Abstract Background and Aims Secondary hyperparathyroidism (SHPT) is one of the most common complications in patients with chronic kidney disease (CKD). The prevalence of SHPT progressively increases with the severity of CKD, affecting approximately 50-70% of patients on hemodialysis (HD). SHPT significantly impacts morbidity, mortality, hospitalization risks, healthcare costs, and the quality of life of CKD patients, making its management of paramount importance in this population. A positive serum phosphorus (P) balance is one of the critical determinants of SHPT, and the management of P levels in HD patients revolves around nutritional therapy, medications, and optimal kidney replacement therapy (KRT). Numerous studies have explored the role of KRT in P control among prevalent HD patients. However, whether the reduction of P achieved during KRT affects parathyroid hormone (PTH) levels is still a matter of debate. Currently, a direct evaluation of the relationship between intra-HD P reduction and PTH levels is lacking. Method We conducted a retrospective observational study on the prevalent HD population at the Division of Nephrology, University Hospital of Verona, from January to December 2022. We Included clinically stable adult patients undergoing HD for over 6 months, with multiple recorded visits during the follow-up. Demographic, clinical, laboratory, and medication data were collected. Time-varying variables were updated at each study visit. Food intake was assessed through a 3-day food record (HD day, non-HD day, and weekend day). Patients were instructed to maintain their usual ideally low-phosphate diet and to meticulously record and weigh all foods and preparations consumed. This assessment was conducted every 4 months during the observation period. From the 3-day food records, the dietary phosphorus intake was calculated using a national database and reported as mg of P per day. A dietitian evaluated dietary questionnaires. The primary outcome of interest was PTH levels. The absolute intra-HD change in P (intra-HD ∆P), defined as the difference between pre- and post-HD P levels, served as the main exposure. Multivariable adjusted linear mixed models were used to investigate the relationship between intra-HD ∆P and PTH levels. Potential confounders were included in the following three models of hierarchical adjustment: (i) Model 1, unadjusted; (ii) Model 2, adjusted for age and sex; (iii) Model 3, adjusted for all covariates in Model 2 plus URR, HD modality, active vitamin D, phosphate binders, calcimimetics, comorbidities. Since the relationship between intra-HD ∆P and PTH is influenced by the pre-HD P, all models were adjusted for pre-HD P. The association between PTH and intra-HD ∆P was also assessed in a subgroup of patients who provided a valid dietary diary. A multivariable linear mixed model adjusted for all covariates in Model 3 plus dietary phosphorus intake was used to assess this association. Results A total of 211 patients contributed to 904 study visits. A significant and positive relationship was observed between intra-HD ∆P and pre-HD P (β = 0.76, 95% CI 0.75, 0.78, p &amp;lt; 0.001) and urea reduction ratio (β = 0.38, 95% CI 0.35, 0.41; p &amp;lt; 0.001) (Figure). An increase in intra-HD ∆P was significantly and independently associated with low PTH levels (β = −0.17, 95% CI −0.30, −0.03; p = 0.016; Table). Overall, 86 out of 211 patients provided valid dietary data. The relationship between intra-HD ∆P and PTH levels was confirmed after additional adjustment for dietary P intake (p = 0.041). Conclusion The extent of intra-HD P reduction significantly correlates with low PTH levels. Strategies focused on optimizing or enhancing depurative efficiency in KRT can exert a substantial impact on managing positive phosphorus balance and secondary hyperparathyroidism (SHPT). The assessment of intra-HD P reduction may play a pivotal role in the management and follow-up of SHPT in HD patients.

#1451 Calcimimetics reduce the progression of high-phosphate diet-induced tubular damage

Abstract Background and Aims During chronic kidney disease (CKD) progresses, there is an increased phosphate load and the concentration of the phosphaturic hormones PTH and FGF23 rises. In patients, phosphate and FGF23 are discussed as risk factors for CKD progression. We have recently shown that mice with high phosphate, PTH and FGF23 levels develop Stat3/Kim-1-mediated proximal tubule damage and tubulointerstitial fibrosis associated with increased MCP-1 expression and accumulation of macrophages. Calcimimetics lower PTH and FGF23 levels in hemodialysis patients and are thought to have both cardio- and nephroprotective effects. In a preclinical study, cinacalcet was shown to stabilize podocyte function in proteinuric mice. Therefore, we postulate that calcimimetics also have a positive effect on the progression of tubular damage in mice with high phosphate, PTH and FGF23 levels. Method For the induction of phosphaturic hormones with concomitant tubule damage, male C57BL/6 mice were fed a 2.0% high phosphate diet (HPD) and compared to animals on a 0.8% control phosphate diet (CPD). After four months, one HPD group was additionally treated with 1 mg/kg body weight/day etelcalcetide (KP-2326). Six months after the start of the trial, blood and urine samples as well as kidneys were taken for biochemical, histological and molecular biological examinations. Results KP-2326 treatment reduced HPD-induced PTH and FGF23 levels, but had no effect on increased phosphate excretion or elevated serum phosphate levels. Histologically, tubular damage was not as pronounced in the KP-2326-treated HPD animals as in the HPD group without therapy. The increased BUN levels caused by HPD and the albuminuria were significantly reduced by KP-2326. KP-2326 reduced HPD-mediated activation of Stat3 in proximal tubule cells and decreased Kim-1 synthesis at both mRNA and protein levels. Moreover, KP-2326 significantly reduced the mRNA expression of Ccl2 and the macrophage-specific marker Adgre1 compared to the untreated HPD group, which was histologically reflected in a lower accumulation of F4/80+ macrophages around the damaged tubules. Conclusion Treatment with KP-2326 was able to reduce the progression of HPD-induced tubule damage, at least in part due to the reduction in PTH and FGF23 levels.

#372 Cross-sectional association between serum magnesium with cognition in patients undergoing hemodialysis: the Osaka Dialysis Complication Study

Abstract Background and Aims Impaired cognitive performance is common in patients with chronic kidney disease including those undergoing haemodialysis, although the mechanisms are not well understood by which chronic kidney disease affects cognitive function. Phosphate plays an important role in the development of aging phenotypes particularly in patients with chronic kidney disease. Phosphate toxicity is thought to be mediated by calciprotein particles, and a shorter T50 reflects a higher propensity of transformation of primary to secondary calciprotein particles. T50 is known to be affected by phosphate, fetuin-A, magnesium, and others. We examined possible relationship between cognitive function and CKD-MBD-related factors in patients undergoing haemodialysis. Method This was a cross-sectional study in 1207 patients on maintenance haemodialysis selected from the participants of Osaka Dialysis Complication Study (ODCS). Cognitive function was assessed by Modified Mini-Mental State examination (3MS). Associations of serum calcium, phosphate, intact PTH, magnesium, fetuin-A, and T50 with 3MS was examined by multiple regression models adjusted for age, sex, dialysis vintage, diabetic kidney disease, prior stroke, prior non-stroke cardiovascular disease, education level, SBP, DBP, Hb, BMI, serum albumin, and CRP. Results Serum magnesium and phosphate levels were significantly and positively associated with 3MS level independent of the potential confounders, whereas other factors were not. Conclusion We found positive associations of cognitive performance with serum magnesium and phosphate levels in haemodialysis patients, suggesting the roles of CKD-MBD-related factors in impaired cognition in this population.

The relationship between satisfaction with life, dietary attitude, and comfort level in hemodialysis patients: Analysis with machine learning approach.

Hemodialysis (HD) patients have become a serious public health problem, the number of which is increasing every year worldwide. This study aimed to determine the relationship between satisfaction with life, dietary attitude, and comfort level in patients receiving HD treatment. This research was conducted in a relational cross-sectional descriptive design. The research was conducted with 174 patients (85% of the population) receiving HD treatment between March 20 and September 30, 2023. In the study, hierarchical regression analysis was performed with SPSS 25.0. Machine learning analysis and prediction were performed using R programming language, version 4.1.3. The model used to determine the factors affecting satisfaction with life was significant and usable (F(2,171) = 25.855, p = 0.001). Attitudes of HD patients toward dietary therapy and their HD comfort levels together explained 22.3% of the total variance of satisfaction with life. In the regression model, according to the results of the t-test regarding the significance of the regression coefficient, the increase in the HD comfort levels of the participants (t = 2.668, p = 0.008) and the increase in the attitude of the HD patients toward dietary therapy (t = 5.897, p = 0.001) caused a statistical increase in "satisfaction with life." According to Shapley values, the most important variable in the prediction of satisfaction with life variable is attitude for the dietary attitude. It was determined that the increase in the comfort levels of HD patients and their positive dietary attitudes increased satisfaction with life. It is recommended to provide education to increase patients' diet attitudes and comfort levels.

Impact of Effectiveness of Physical Activity in a Virtual Environment on the Regulation of Sclerostin and Interleukin 6 Levels in Haemodialysis Patients.

Background: Chronic kidney disease is a significant public health issue associated with reduced physical activity. This can lead to mineral and bone disorders and increased levels of inflammatory markers. One innovative solution that can significantly contribute to increasing patient motivation is the combination of physical training with virtual reality technology during haemodialysis sessions. The aim of this study is to comprehensively assess the impact of regular virtual reality-based physical activity on plasma sclerostin and interleukin 6 levels, as well as on physical performance and the level of physical activity in patients undergoing renal replacement therapy through haemodialysis. Methods: This study is a prospective cohort study. Patients included in the study were randomly assigned to two groups: the study group and the control group. The study group consisted of patients who were entrusted with the task of conducting training using the prototype of the NefroVR system. The duration of the study period for both the study and control groups was 3 months. Results: One hundred and two (102) patients with stage 5 chronic kidney disease who underwent haemodialysis as a renal replacement therapy participated in the study. Patients from the study group were characterized by higher physical activity compared to the control group. There was a significant difference in the level of IL-6 and SOST between the study and control groups in the second measurement. Conclusions: Regular physical activity, especially using approaches such as virtual reality, contributes to improving physical fitness and overall activity levels in patients undergoing haemodialysis. The study demonstrated that regular exercise may be associated with a reduction in inflammatory parameters and positive effects on bone metabolism in patients undergoing haemodialysis.

Evaluating the Effectiveness of a Generative Pretrained Transformer-Based Dietary Recommendation System in Managing Potassium Intake for Hemodialysis Patients

ObjectiveDespite adequate dialysis, the prevalence of hyperkalemia in Chinese hemodialysis(HD) patients remains elevated. This study aims to evaluate the effectiveness of a dietary recommendation system driven by Generative Pre-trained Transformers (GPTs) in managing potassium levels in HD patients. MethodsWe implemented a bespoke dietary guidance tool utilizing GPTs technology. Patients undergoing HD at our center were enrolled for the study from October 2023 to November 2023. The intervention comprised two distinct phases. Initially, patients were provided with conventional dietary education focused on potassium management in HD. Subsequently, in the second phase, they were introduced to a novel GPT-based dietary guidance tool. This AI-powered tool offered real-time insights into the potassium content of various foods and personalized dietary suggestions. The effectiveness of the AI tool was evaluated by assessing the precision of its dietary recommendations. Additionally, we compared pre-dialysis serum potassium levels and the proportion of patients with hyperkalemia among patients before and after the implementation of the GPT-based dietary guidance system. ResultsIn our analysis of 324 food photographs uploaded by 88 HD patients, the GPTs system evaluated potassium content with an overall accuracy of 65%. Notably, the accuracy was higher for high-potassium foods at 85%, while it stood at 48% for low-potassium foods. Furthermore, the study examined the effect of GPTs-based dietary advice on patients' serum potassium levels, revealing a significant reduction in those adhering to GPTs recommendations compared to recipients of traditional dietary guidance (4.57±0.76 mmol/L vs. 4.84±0.94 mmol/L, p = 0.004). Importantly, Compared to traditional dietary education, dietary education based on the GPTs tool reduced the proportion of hyperkalemia in HD patients from 39.8% to 25%(p=0.036). ConclusionThese results underscore the promising role of AI in improving dietary management for HD patients. Nonetheless, the study also points out the need for enhanced accuracy in identifying low potassium foods. It paves the way for future research, suggesting the incorporation of extensive nutritional databases and the assessment of long-term outcomes. This could potentially lead to more refined and effective dietary management strategies in HD care.

WCN24-2088 Increased eryptosis and inflammatory cytokines are associated with low hemoglobin levels in hemodialysis patients

WCN24-2088 Increased eryptosis and inflammatory cytokines are associated with low hemoglobin levels in hemodialysis patients

YKL-40 (chitinase-3-like protein 1) serum levels are associated with abdominal aortic calcification in hemodialysis patients.

Vascular calcification (VC) is highly prevalent and predicts cardiovascular mortality in dialysis patients. The mechanisms are still unclear. Inflammation is a well-known inducer of VC. YKL-40 has been suggested as a novel biomarker of inflammation and has been demonstrated to be associated with cardiovascular mortality in hemodialysis patients. This study aims to evaluate the relationship between serum YKL-40 and VC in hemodialysis (HD) patients. A total of 109 HD patients and 31 healthy controls were enrolled in the study from September 2014 to December 2014. We evaluated the abdominal aortic calcification (AAC) score by plain X-ray films of the abdomen and measured serum YKL-40 concentrations using enzyme-linked immunosorbent assay. We also examined the relationship between YKL-40 levels and AAC scores in HD patients. Serum YKL-40 levels in HD patients were significantly higher than those in healthy controls [199.8 (144.8, 288.7) vs. 71.9 (52.8, 89.3)ng/ml; P < 0.001]. There was a tendency that YKL-40 levels in diabetic hemodialysis patients were higher than those in nondiabetic patients [217.8 (155.3, 335.8) vs. 192.9 (135.9, 274.4)ng/ml; P = 0.093]. A significant positive correlation was found between serum YKL-40 level and AAC score in these patients (r = 0.410, P = 0.003). Multiple regression analysis showed that Ln(YKL-40) was independently associated with AAC score in HD patients (P = 0.044). This study showed high serum YKL-40 concentrations in chronic HD patients and that YKL-40 was independently associated with increased AAC in hemodialysis patients.

Study of Osteopontin as a Marker of Arteriovenous Shunt Stenosis in Hemodialysis Patients.

Although arteriovenous fistula (AVF) is the recommended access for hemodialysis (HD), it carries a high risk for stenosis. Since osteopontin (OPN) is implicated in the process of vascular calcification in HD patients, OPN may be a marker for AVF stenosis. The present study evaluated OPN as a potential marker of AVF stenosis in HD patients. Diagnosing a stenotic lesion was made by combining B mode with color and pulse wave Doppler imaging. Criteria for diagnosis of stenotic AVF included 50% reduction in diameter in B mode in combination with a 2-3-fold increase of peak systolic velocity compared with the unaffected segment. The present study included 60 HD patients with stenotic AVF and 60 patients with functional AVF. Comparison between the two groups revealed that patients in the former group had significantly higher serum OPN levels [median (IQR): 17.1 (12.1-30.4) vs 5.8 (5.0-10.0) ng/mL, p<0.001]. All patients were classified into those with low (< median) and with high (≥ median) OPN levels. Comparison between these groups revealed that the former group had a significantly lower frequency of stenotic AVF (31.7 vs 68.3%, p<0.001) and a longer time to AVF stenosis [mean (95% CI): 68.4 (54.7-82.1) vs 46.5 (39.6-53.4) months, p=0.001]. OPN levels in HD patients may be useful markers for predicting and detecting AVF stenosis.

Relationship between atherogenic index of plasma, asprosin, and metrnl levels in hemodialysis patients

Relationship between atherogenic index of plasma, asprosin, and metrnl levels in hemodialysis patients

Study the effect of urokinase-type plasminogen activator (UPA) and some biochemical parameters in Iraqi hemodialysis patients with type 2 diabetes

Abstract The most common cause of end-stage renal disease (ESRD) and leading ultimately to hemodialysis (HD) is type 2 diabetes mellitus (T2DM). The current study aims to assess the role of serum urokinase plasminogen activator (UPA) levels among Iraqi hemodialysis patients with ESRD with type 2 diabetes. The study encompassed 50 patients aged 40–74 years (35 males and 15 females), admitted to the Iraqi dialysis center at Baghdad Teaching Hospital, Al-Hayat Center at Al-Karama Teaching Hospital, and Hamida Al-Misfah Dialysis Center in Imam Al-Kadhimin Medical City for the period from October 2022 to February 2023. Were diagnosed based on previous medical reports, and laboratory tests by a consultant nephrologist. UPA, Blood. Urea, Creatinine, fasting serum glucose (FSG), HbA1c, Insulin, HOMA-IR, and lipid profile levels were determined. The present study showed a significant increase in serum UPA levels in HD patients in ESRD with T2DM compared to control. In addition, there was an important negative correlation between UPA and Hb1AC, FSG, and a positive correlation with VLDL-C and TG in HD patients in ESRD with T2DM patients. This study demonstrates increased UPA serum levels in HD in ESRD with T2DM patients and associated with FSG, Hb1AC, TG, and VLDL this shows that it can be considered a good marker for the development of diabetes complications, the most important of which is diabetic kidney disease (DKD).

Animal protein intake is directly associated with serum level of pentraxin 3 in hemodialysis patients

Inflammation plays an important role in Cardiovascular disease (CVD) pathogenesis as the main cause of mortality in hemodialysis (HD) patients. Despite the relevance of nutrition and dietary intakes for inflammation status, the role of dietary protein sources remains unclear. The aim of this study was to evaluate the association between the different types of dietary protein and pentraxin 3 (PTX3) levels in HD patients. In this multi-center cross-sectional study, 227 adult patients undergoing HD for a minimum 90 days were recruited. A validated 168-item food frequency questionnaire was used to assess dietary intakes. Also, 5 ml blood samples were collected from each patient to measure the concentration of serum PTX3. Overall, 227 patients, including 63 women and 164 men, with a mean age of 58 years, participated in this study. There was a greater intake of animal protein per kilogram dry weight among patients with higher levels of PTX3 (0.46 vs. 0.54 g/kg; P = 0.035). In contrast, consumption of total protein and plant protein per kilogram dry weight was not different across PTX3 levels. Moreover, the chance of increased PTX3 concentration was directly associated with a one-unit increase in animal protein intake per kilogram dry weight, after adjusting for confounders. We did not observe any association between one-unit increases in plant protein intake per kilogram dry weight and chance of increased PTX3. In conclusion, animal protein intake was directly associated with circulating PTX3.

Glycerol-3-Phosphate Is an Independent Predictor of FGF23 Levels in Hemodialysis Patients

Glycerol-3-Phosphate Is an Independent Predictor of FGF23 Levels in Hemodialysis Patients

Interactive Simulator for Model-Based Predictions of Parathyroid Hormone (PTH) Levels in Hemodialysis Patients

Interactive Simulator for Model-Based Predictions of Parathyroid Hormone (PTH) Levels in Hemodialysis Patients

Post-Traumatic Growth and Self-Compassion Level in Hemodialysis Patients

The hemodialysis process can lead to positive psychological changes in patients as they cope with physical and psychosocial stress factors. Understanding post-traumatic growth and factors that may be associated is essential to increasing the likelihood of achieving positive changes in hemodialysis patients. The aim of this study was to investigate the correlation between post-traumatic growth and self-compassion levels in hemodialysis patients. The study was conducted with 83 hemodialysis patients. Data were collected using “Demographic and Clinical Characteristics Form,” “Post-Traumatic Growth Inventory,” “Self-Compassion Scale.” Post-traumatic growth levels of hemodialysis patients were found to be moderate. The self-compassion levels of hemodialysis patients were found to be high. A statistically significant difference was found between gender, educational status, economic status, and self-compassion mean scores ( p &lt; .05). However, no statistically significant correlation was found between post-traumatic growth and self-compassion ( p &gt; .05). Further research is needed to explore the potential correlation between self-compassion and post-traumatic growth in hemodialysis patients.

Association Between Hemoglobin Levels and Quality of Life in Patients Undergoing Chronic Hemodialysis

Introduction: Anemia is a global problem that can be found almost all over the world. Anemia is the most common complication in patients undergoing chronic hemodialysis which can affect quality of life. Health-related quality of life is a factor that correlates with morbidity, mortality, and patient care costs. This study aimed to assess the correlation between hemoglobin levels and quality of life in patients undergoing chronic hemodialysis. Methods: This study was a cross-sectional study with consecutive sampling of 92 research subjects conducted in November-December 2022 at the hemodialysis installation at Dr. Soetomo General Academic Hospital. This study used the SF-36 questionnaire instrument which was divided into 8 quality of life domains.Results: Of the 92 samples that have been collected, 54 were male patients (58.7%) while 42 were female (41.3%). The average age of the subjects in this study was 47.55 years old. The highest level of education was senior high school graduates with a total of 40 people (43.5%). Hemoglobin levels in 92 research subjects were in the range of 7–3.9 g/dl with an average of 9.70±1.63. Fifty subjects (54.4%) had a poor quality of life and 42 subjects (45.6%) had a good quality of life. The range of total quality of life values was 22.98–89.75 with an average of 59.87±14.16. Conclusion: There was a significant relationship between hemoglobin levels with quality of life of the patients at Dr. Soetomo General Academic Hospital. The higher the hemoglobin level, the higher the total quality of life of the patients. It is recommended to the hemodialysis unit at Dr. Soetomo General Academic Hospital to increase hemoglobin level in hemodialysis patients.

The Association of Neutrophil Lymphocyte Ratio and Glycemic Markers in Hemodialysis Patients

Background/aims: Neutrophil lymphocyte ratio was found to be as an inflammation marker in the preceding decade and recently related with glycemic indices in patients with diabetes mellitus. The target of this research was to explore the association of neutrophil lymphocyte ratio and glycemic indices in hemodialysis population. Methods: 177 hemodialysis patients (98 diabetic and 79 non-diabetic) aged 56.08±16.06 years were enrolled in this research. Neutrophil lymphocyte ratio was calculated and its association with predialysis glucose and HbA1c was studied. Results: NLR was positively correlated with predialysis glucose (p=0.000, r=0.338), body mass index (p=0.029, r=0.220), white blood cell (p=0.000, r=0.430), platelet (p=0.034, r=0.159), neutrophil (p=0.000, r=0.656) and C-reactive protein (p=0.00, r=0.377) levels. In non-diabetic hemodialysis group, predialysis glucose was still correlated with neutrophil lymphocyte ratio (p=0.047, r=0.224). Diabetics had higher predialysis glucose (185.94±81.11 vs 111.24±25.59, p=0.000) and neutrophil lymphocyte ratio (4.99±4.17 vs 2.82±1.23, p=0.000) compared to non-diabetics. Conclusion: This study revealed that predialysis glucose levels in hemodialysis patients are correlated with neutrophil lymphocyte ratio and hemodialysis patients with diabetes have higher neutrophil lymphocyte ratio levels. Neutrophil lymphocyte ratio should be recognized as a glycemic control marker along with traditional glycemic indices in HD patients.