Life In Dialysis Patients Research Articles

Safety and efficacy of sertraline in depression among adults undergoing dialysis: A systematic review and meta-analysis

Background: Depression is prevalent among patients with end-stage renal disease (ESRD) undergoing dialysis, with significant implications for their quality of life and treatment compliance. Traditional treatments for depression, including various therapies and pharmacological interventions, have limitations due to their adverse effects. Sertraline, a selective serotonin re-uptake inhibitor (SSRI), offers a promising alternative, but its efficacy and safety in this population require thorough evaluation. Objective: This meta-analysis aims to assess the effectiveness and adverse effects of sertraline in treating depressive episodes in dialysis patients compared to placebo. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a comprehensive search of databases, including PubMed, Cochrane Library, and Science Direct, up to June 20, 2024. We included randomized controlled trials (RCTs) that compared sertraline with placebo in dialysis patients with depression. Two researchers independently performed data extraction and risk of bias assessment. Statistical analysis was conducted using ReviewManager 5.4.1, employing a random effects model. Results: Four RCTs involving 468 participants were included. Sertraline significantly reduced depressive symptoms, as measured by the Quick Inventory of Depressive Symptomatology (QIDS) and Beck Depression Inventory-II (BDI-II) scores, at 6 and 12 weeks compared to placebo. Improvements in kidney disease-specific quality of life (KDQOL-36) scores were also noted. However, sertraline was associated with a higher risk of adverse events compared to placebo. Conclusions: Sertraline effectively reduces depressive symptoms and improves the quality of life in dialysis patients with ESRD. Despite the increased risk of adverse events, the overall benefits make sertraline a viable treatment option for this population. Larger, more comprehensive studies are needed to confirm these findings and optimize sertraline use in clinical practice.

Impact of Changes in Hemoglobin on Health-Related Quality of Life in Dialysis Patients

Impact of Changes in Hemoglobin on Health-Related Quality of Life in Dialysis Patients

Ethical and legal aspects of end of life in dialysispatients: an Italian point of view.

In the Western world, thanks to continuous progress in the medical field, and to changes in society,the concept of death seems to be increasingly replaced by that of "keeping alive at all costs". Thus also dialysis, a life-sustainingtreatment for patients suffering from kidney failure, in some cases can no longer be seen as a treatment aimed at prolonging life, but as a treatmentto temporarily avert death. In fact, the literature highlights that dialysis is not always associated with greater lifeexpectancy and better quality of life for fragile patients with kidney failure. This point-of-viewpaperdiscusses legal and ethical principles of respect for patient autonomy (beneficence, non-maleficence, justice and professional integrity) inherent in the choice to suspend or tonot start dialysis treatment, while following apathway ofconservative and/or palliative therapy.

Does The Serum Zinc Level Affect the Quality of Life in Dialysis Patients? A Report from Iran

Background: Zinc deficiency is a common finding among ESRD and dialysis patients and may affect their quality of life. Objectives: This study aimed to evaluate the serum level of zinc and its correlation with the quality-of-life score in dialysis patients. Methods: A cross-sectional study was conducted in 2018 on dialysis patients. Patients’ information and clinical data, their serum zinc levels, and quality of life assessed by the SF-36 questionnaire were collected. The Spearman correlation test was used to assess the correlation between serum zinc levels and the Physical (PCS) and Mental (MCS) Component Summary scores of the SF-36 questionnaire in general and in different subgroups. P-values less than 0.05 were considered significant. Results: In the HD group, PCS and MCS scores were significantly correlated (P = 0.0001), while this correlation was not observed in the PD group. Additionally, there was a positive correlation between zinc levels and PCS and MCS scores in the HD group but not in the PD group (P = 0.0001). In the PD group, only age negatively correlated with the PCS score (P = 0.03), without any other significant correlations with other study variables. Multivariate analysis revealed that zinc level was an independent predictor of PCS and MCS scores in the HD group (P < 0.001). In the PD group, age (P = 0.02) and zinc level (P = 0.03) were independent predictors of PCS score but not MCS score. Conclusions: There is a positive correlation between serum zinc levels and both the physical and mental aspects of quality of life in dialysis patients.

Impact of Deep Breathing Exercises and Isometric Handgrip Exercises to Improve Chest Expansion, Handgrip Strength, and Quality of Life in Chronic Renal Failure Patients on Dialysis

Background: Chronic kidney disease (CKD) and its terminal stage, end-stage renal disease (ESRD), significantly impair patients' quality of life, necessitating lifelong dialysis or kidney transplantation. Physical exercises have been posited as beneficial adjunct therapies to improve physical functions and overall well-being in this patient population. Objective: This study aimed to assess the effects of deep breathing and isometric handgrip exercises on chest expansion, handgrip strength, and quality of life among patients with chronic renal failure on dialysis. Methods: In a quasi-experimental study design, 22 participants undergoing dialysis at both governmental and private facilities in Faisalabad, Pakistan, were recruited through purposive sampling. Participants engaged in an 8-week program of deep breathing and isometric handgrip exercises. Assessments of chest expansion, handgrip strength, and quality of life were conducted using measuring tapes, hand-held dynamometers, and the WHOQOL questionnaire, respectively. Data were analyzed using the SPSS software version 25, employing paired sample t-tests to compare pre- and post-intervention measurements. Results: Significant improvements were noted post-intervention, with chest expansion increasing from a mean of 1.36 ± 0.49 cm to 1.58 ± 0.10 cm (t=12.990, p<0.001), right-hand grip strength from 1.00 ± 0.53 kg to 1.24 ± 0.11 kg (t=8.775, p<0.001), and left-hand grip strength from 0.82 ± 0.50 kg to 1.04 ± 0.11 kg (t=7.659, p<0.001). Quality of life metrics also showed significant improvements across various dimensions, including overall quality of life, health satisfaction, and physical mobility. Conclusion: The study concluded that deep breathing and isometric handgrip exercises significantly enhance chest expansion, handgrip strength, and the quality of life in dialysis patients, suggesting that incorporating such exercises into routine care could be beneficial. Keywords: Chronic kidney disease, end-stage renal disease, dialysis, deep breathing exercises, isometric handgrip exercises, quality of life, physical therapy.

Sustainable Impact of Intradialytic Exercise and Cognitive Behavior Therapy on the Quality of Life of Patients with Chronic Kidney Disease: A Non-Pharmacological Approach

Chronic kidney disease (CKD) affects a person's psychological and physical health, which lowers their quality of life. Hemodialysis is a common kind of replacement treatment for patients with chronic renal disease. The data on symptoms is expanding as the need to manage symptoms in advanced chronic kidney disease (CKD) patients receiving hemodialysis (HD) becomes more widely recognized. Finding non-pharmacological ways to improve CKD patients' quality of life was the goal of this study. A brief overview of the existing research on non-pharmacologic therapies aimed at improving symptoms and enhancing quality of life in dialysis patients with advanced chronic kidney disease is provided in this study. Not only are there no clinical practice guidelines available to treat those frequent symptoms, but there is also a dearth of research about the best ways to integrate symptom intervention techniques into clinical care. According to the present review research, this combination of physical and cognitive behavioral intervention may be employed as a non-pharmacological technique to limit physical and cognitive decline and improve quality of life in the HD population. This suggests a promising direction for further research and application in HD care.

Does Online Hemodiafiltration Improve Clinical Outcomes and Quality of Life in Dialysis Patients Compared to Conventional Hemodialysis?

Does Online Hemodiafiltration Improve Clinical Outcomes and Quality of Life in Dialysis Patients Compared to Conventional Hemodialysis?

Psychological burden and disease-related quality of life in dialysis patients during the first wave of the COVID-19 pandemic - a cross-sectional observational study.

Since the first reports of the spread of the new SARS-CoV-2 virus, experts have pointed to the possible psychological consequences of the pandemic. In this study, we tried to answer the question of whether the level of perceived stress related to the pandemic affects the quality of life related to the disease and the functioning of patients on peritoneal and hemodialysis. Out of 106 patients from the dialysis center of the University Clinical Hospital in Wrocław during the first wave of the pandemic, 73 patients were enrolled, including 61 hemodialysis (HD) and 12 peritoneal dialysis (PD). The study used The Perceived Stress Scale (PSS), The General Health Questionnaire (GHQ-28), The Impact of Events Scale-Revised (IES-R), and The Kidney Disease and Quality of Life (KDQOL-SF™). Nearly half of the respondents (48%) experienced psychological distress and 5.6% of the respondents showed clinically significant psychopathological symptoms (GHQ). Half of the study group declared a significant occurrence of post-traumatic stress symptoms (IES-R). A high score of subjectively perceived stress related to the pandemic was observed in both study groups. Numerous significant negative correlations were found between the results of the KDQOL subscales and psychopathological symptoms (IES-R and GHQ) without significant differences between the two groups (HD vs. PD). Almost all KDQOL subscales were significantly moderately or strongly correlated with the level of perceived stress related to the pandemic. The level of subjectively assessed stress related to the pandemic and the severity of psychopathological symptoms, including post-traumatic stress, were significant in the entire group of patients undergoing renal replacement therapy, regardless of the dialysis type. Numerous confirmed relationships between the domains of the quality of life related to the disease and the level of perceived stress and psychopathological symptoms indicate an urgent need to provide effective psychological support to this group of patients and to develop preventive programs in the field of mental health of people undergoing renal replacement therapy.

Impact of phosphate binders on quality of life in dialysis patients: Results from the prospective Dutch nOcturnal and hoME dialysis Study To Improve Clinical Outcomes study.

Phosphate binders cause high pill burden for dialysis patients, complicate medication regimens, and have unpleasant taste and large size which may affect patients' quality of life. This study explores the association between phosphate binder pill burden and health-related quality of life (HRQoL) in dialysis patients. We conducted a cross-sectional multi-centre cohort study in 21 Dutch dialysis centres. Phosphate binder pill burden was extracted from electronic patient records. Primary outcome was HRQoL measured with the Short Form 12 physical and mental component summary scores (PCS and MCS). Secondary endpoints were severity of gastro-intestinal symptoms, itching, dry mouth, and mental health symptoms, measured with the Dialysis Symptom Index. Of 388 included patients, aged 62 ± 16 years, 77% underwent haemodialysis. PCS scores were comparable for patients with and without phosphate binders. Patients using 1-3 pills reported lower scores for decreased appetite (β -0.5; 95%CI -0.9 to -0.2), implying better appetite, than patients without phosphate binders. Patients using 4-6 pills also reported lower scores for decreased appetite (β -0.5; 95%CI -0.8 to -0.1) and for itching (β -0.5; 95%CI -0.9 to -0.1). Patients using >6 pills reported lower MCS (β -2.9; 95%CI -6.2-0.4) and higher scores for feeling nervous (β 0.6; 95%CI 0.1-1.1) and feeling sad (β 0.4; 95%CI 0.0-0.9). Phosphate binder pill burden is not associated with physical quality of life. A higher pill burden is associated with better appetite and less itching. Patients using >6 pills per day report lower mental quality of life and felt nervous and sad more often.

Effect of 4 weeks inspiratory muscle training on inspiratory muscle strength and quality of life in dialysis patients. A pilot study

ABSTRACT:Background: Dialysis is the most preferred way to treat chronic kidney disease (CKD). Thecommonest complication associated with dialysis is uremic myopathy. Inspiratory muscletraining (IMT) improves the strength of respiratory muscles.Methods: 11 patients with Stage 4 and 5 of chronic kidney disease with more than 3 months of dialysis underwent Inspiratory muscle training using self-made inspiratory trainer by taking pre and post intervention values of Maximum inspiratory pressure (MIP) and QOL.Result: Paired t test was used and the MIP and QOL values are statistically significant with a p-value of < 0.0001 and 0.0124 respectively.Conclusion: Inspiratory muscle strength and QOL is reduced in dialysis patients and a 4-week inspiratory muscle training using a self-made inspiratory muscle trainer is effective to reverse the adverse effects of dialysis.Keywords: Kidney disease, complications, respiratory muscles, maximum respiratory pressure, muscle weakness, exercise.

Comparison of Pregabalin and Ketotifen in treatment of uremic pruritus in hemodialysis patients.

This study aims to compare the efficiency of Pregabalin and Ketotifen in treatment of uremic pruritus in hemodialysis (HD) patients. Thirty HD patients were randomly divided into two groups: A (Pregabalin 50 mg three times a day) and B (Ketotifen 1mg twice a day). Efficacy of treatment and quality of life were weekly evaluated by visual analogue scale (VAS) and Itchy Quality of life, respectively. There was no significant difference between the two groups regarding demographic features, laboratory data, quality of life, and VAS before treatment. In the second week of treatment, the pruritus intensity was significantly lower in the Pregabalin group than the Ketotifen group (p= 0.026). The mean of life quality was significantly lower in Ketotifen than Pregabalin group in weeks 1, 2, and 4 (p= 0.001, p= 0.001, and p= 0.036, respectively). There was no significant difference between the two groups regarding the side effects of drugs. This study showed that a higher dose of Pregabalin could be a more effective treatment than Ketotifen without additive side effects in improving the quality of life in dialysis patients.

Impact of Polypharmacy on Health-Related Quality of Life in Dialysis Patients

Introduction: Dialysis patients are often prescribed a large number of medications to improve metabolic control and manage coexisting comorbidities. However, some studies suggest that a large number of medications could also detrimentally affect patients’ health-related quality of life (HRQoL). Therefore, this study aims to provide insight in the association between the number of types of medications and HRQoL in dialysis patients. Methods: A multicentre cohort study was conducted among dialysis patients from Dutch dialysis centres 3 months after initiation of dialysis as part of the ongoing prospective DOMESTICO study. The number of types of medications, defined as the number of concomitantly prescribed types of drugs, was obtained from electronic patient records. Primary outcome was HRQoL measured with the Physical Component Summary (PCS) score and Mental Component Summary (MCS) score (range 0–100) of the Short Form 12. Secondary outcomes were number of symptoms (range 0–30) measured with the Dialysis Symptoms Index and self-rated health (range 0–100) measured with the EuroQol-5D-5L. Data were analysed using linear regression and adjusted for possible confounders, including comorbidity. Analyses for MCS and number of symptoms were performed after categorizing patients in tertiles according to their number of medications because assumptions of linearity were violated for these outcomes. Results: A total of 162 patients were included. Mean age of patients was 58 ± 17 years, 35% were female, and 80% underwent haemodialysis. The mean number of medications was 12.2 ± 4.5. Mean PCS and MCS were 36.6 ± 10.2 and 46.8 ± 10.0, respectively. The mean number of symptoms was 12.3 ± 6.9 and the mean self-rated health 60.1 ± 20.6. In adjusted analyses, PCS was 0.6 point lower for each additional medication (95% confidence interval [95% CI]: −0.9 to –0.2; p = 0.002). MCS was 4.9 point lower (95% CI: −8.8 to –1.0; p = 0.01) and 1.0 point lower (95% CI: −5.1–3.1; p = 0.63) for the highest and middle tertiles of medications, respectively, than for the lowest tertile. Patients in the highest tertile of medications reported 4.1 more symptoms than in the lowest tertile (95% CI: 1.5–6.6; p = 0.002), but no significant difference in the number of symptoms was observed between the middle and lowest tertiles. Self-rated health was 1.5 point lower for each medication (95% CI: −2.2 to –0.7; p < 0.001). Discussion/Conclusion: After adjustment for comorbidity and other confounders, a higher number of medications were associated with a lower PCS, MCS, and self-rated health in dialysis patients and with more symptoms.

Renal Rehabilitation: Exercise Intervention and Nutritional Support in Dialysis Patients.

With the growing number of dialysis patients with frailty, the concept of renal rehabilitation, including exercise intervention and nutrition programs for patients with chronic kidney disease (CKD), has become popular recently. Renal rehabilitation is a comprehensive multidisciplinary program for CKD patients that is led by doctors, rehabilitation therapists, diet nutritionists, nursing specialists, social workers, pharmacists, and therapists. Many observational studies have observed better outcomes in CKD patients with more physical activity. Furthermore, recent systematic reviews have shown the beneficial effects of exercise intervention on exercise tolerance, physical ability, and quality of life in dialysis patients, though the beneficial effect on overall mortality remains unclear. Nutritional support is also fundamental to renal rehabilitation. There are various causes of skeletal muscle loss in CKD patients. To prevent muscle protein catabolism, in addition to exercise, a sufficient supply of energy, including carbohydrates, protein, iron, and vitamins, is needed. Because of decreased digestive function and energy loss due to dialysis treatment, dialysis patients are recommended to ingest 1.2-fold more protein than the regular population. Motivating patients to join in activities is also an important part of renal rehabilitation. It is essential for us to recognize the importance of renal rehabilitation to maximize patient satisfaction.

Predicting health-related quality of life in dialysis patients: Factors related to negative outcome expectancies and social support

ObjectivesDialysis patients report a low health-related quality of life (HRQOL) due to high disease burden and far-reaching consequences of dialysis treatment. This study examined several cognitive-behavioral and social factors, with a focus on negative outcome expectancies, that might be relevant for HRQOL in end-stage kidney disease (ESKD) patients treated with dialysis. MethodsPatients treated with hemodialysis or peritoneal dialysis were recruited from Dutch hospitals and dialysis centers. Patients completed self-report questionnaires at baseline (n = 175) and six months follow-up (n = 130). Multiple regression analyses were performed. ResultsHigher scores on factors related to negative outcome expectancies at baseline, especially helplessness and worrying, and less perceived social support were significantly related to worse HRQOL six months later. When controlling for baseline HRQOL, besides sex and comorbidity, helplessness remained significantly predictive of worse HRQOL six months later, indicating that helplessness is associated with changes in HRQOL over time. ConclusionsNegative outcome expectancies and social support are relevant markers for HRQOL and/or changes in HRQOL over time. Practice implicationsNegative outcome expectancies could be prevented or diminished by enhanced treatment information, an improved patient-clinician relationship, and interventions that promote adaptive and realistic expectations. Additionally, increasing supportive social relationships could be a relevant treatment focus.

Rate of decline in residual kidney function pre and post peritoneal dialysis initiation: A post hoc analysis of the IDEAL study.

BackgroundResidual kidney function (RKF) is associated with improved survival and quality of life in dialysis patients. Previous studies have suggested that initiation of peritoneal dialysis (PD) may slow RKF decline compared to the pre-dialysis period. We sought to evaluate the association between PD initiation and RKF decline in the Initiating Dialysis Early And Late (IDEAL) trial.MethodsIn this post hoc analysis of the IDEAL randomized controlled trial, PD participants were included if results from 24-hour urine collections had been recorded within 30 days of dialysis initiation, and at least one value pre- and one value post-dialysis commencement were available. The primary outcome was slope of RKF decline, calculated as mean of urinary creatinine and urea clearances. Secondary outcomes included slope of urine volume decline and time from PD initiation to anuria.ResultsThe study included 151 participants (79 early start, 72 late start). The slope of RKF decline was slower after PD initiation (-2.69±0.18mL/min/1.73m2/yr) compared to before PD (-4.09±0.33mL/min/1.73m2/yr; change in slope +1.19 mL/min/1.73m2/yr, 95%CI 0.48–1.90, p<0.001). In contrast, urine volume decline was faster after PD commencement (-0.74±0.05 L/yr) compared to beforehand (-0.57±0.06L/yr; change in slope -0.18L/yr, 95%CI -0.34—-0.01, p = 0.04). No differences were observed between the early- and late-start groups with respect to RKF decline, urine volume decline or time to anuria.ConclusionsInitiation of PD was associated with a slower decline of RKF compared to the pre-dialysis period.

Uremic pruritus and long-term morbidities in the dialysis population.

Uremic pruritus (UP) is a multifactorial problem that contributes to low quality of life in dialysis patients. The long-term influences of UP on dialysis patients are still poorly understood. This study aims to elucidate the contribution of UP to long-term outcomes. We used the Taiwan National Health Insurance Research Database to conduct this study. Patients on chronic dialysis were included and divided into UP and non-UP groups according to the long-term prescription of antihistamine in the absence of other indications. The outcomes include infection-related hospitalization, catheter-related infection, major adverse cardiac and cerebrovascular events (MACCE) and parathyroidectomy. After propensity score matching, 14,760 patients with UP and 29,520 patients without UP were eligible for analysis. After a mean follow-up of 5 years, we found that infection-related hospitalization, MACCE, catheter-related infection, heart failure and parathyroidectomy were all slightly higher in the UP than non-UP group (hazard ratio: 1.18 [1.16-1.21], 1.05 [1.01-1.09], 1.16 [1.12-1.21], 1.08 [1.01-1.16] and 1.10 [1.01-1.20], respectively). Subgroup analysis revealed that the increased risk of adverse events by UP was generally more apparent in younger patients and patients who underwent peritoneal dialysis. UP may be significantly associated with an increased risk of long-term morbidities.

P1109HDX: IS IT A BETTER WAY TO DIALYSE?

Abstract Background and Aims Inadequate dialysis has been linked to reduced quality of life, increased symptom burden and increased risk of cardiovascular illness in patients with chronic kidney disease. This is especially significant in long-term haemodialysis patients who have little to no residual urine output and are thus almost entirely dependent on good quality dialysis to remove toxins and fluid. In most conventional haemodialysis modes middle molecule clearance is inadequate. This in turn plays an important part in causing multiple complications. HDx is a new type of haemodialysis being introduced using Theranova® dialyzer. This claims to have medium cut-off membranes, functioning similar to a kidney, hence providing better clearance of middle molecules, whilst selectively preventing loss of proteins from the body. In order to test the safety and efficacy of HDx using Theranova® we tried it in a cohort of our patients in the form of an audit. Our primary objective was to find out the effect of HDx on quality of life. Secondary objective was to determine whether HDx improves blood biochemistry, with a reduction in medication &amp; transfusion needs. Method Thirty seven Haemodialysis patients were switched from hemodiafiltration to HDx, out of these 3 patients were transplanted, 2 patients died, 1 patient switched back and 7 patients were transferred to satellite units. Audit was continued with the remaining 24 patients. All patients completed an Integrated Palliative Care Outcome Score (IPOS) prior to commencing on HDx and then at six months. Blood parameters including phosphorous, calcium, haemoglobin, Ferritin and CRP were measured monthly and mean values of 6 months before and after HDx initiation were compared. Comparison of erythropoietin, intravenous iron and packed red blood cell transfusion requirements pre and post HDx commencement were also undertaken. Results No obvious adverse effects were noted with use of HDx dialysis. All patients had an improvement in overall IPOS scores after being on HDx for 6 months. Shorter post dialysis symptom recovery times were also noted. 13 patients had a decrease in their erythropoietin requirements, in 2 patients requirement remained the same, 9 patients had increase in their requirement however 3 of these patients had been requiring packed red blood cell transfusion prior to HDx commencement, no longer required transfusion. We found an overall improvement in patients iron infusion need. 11 patients had a dose reduction, with 4 of these patients no longer requiring iron. 9 patients continued to have the same requirements. 4 patients had an increase in iron dose, but 3 of these patients previously being transfusion dependant no longer required regular transfusions. We also noted that with use of HDx clotting risk was reduced and patients who were switched from Evodial (heparin coated dialyzer membranes) to HDx did not have increased circuit clotting. With regards to inflammation we noted no significant changes in CRP, ferritin levels and other blood parameters. Conclusion Looking at our cohort of patients we concluded that HDx is safe to use with no obvious adverse effects. It seems that use of HDx is particularly helpful in improving quality of life in dialysis patients as indicated by improvement in IPOS scores. IPOS is a validated questionnaire to measure symptoms and concerns in patients with advanced illnesses. As life quality is a major concern in dialysis patients, this outcome is of particular significance. HDx was also helpful in reducing the overall burden of transfusions, iron and erythropoietin requirements. This is beneficial in overall patient health and cost burden. Based on the above we found out that HDX was safe and effective in our patient cohort, however large-scale studies will be required for more conclusive evidence.

Symptom dimensions of anxiety and their association with mortality, hospitalization and quality of life in dialysis patients

ObjectiveSymptoms of anxiety are highly prevalent in dialysis patients and are associated with adverse clinical outcomes. Identifying symptom dimensions may help to understand the pathophysiology, improve screening and guide treatment. Currently, there are no data on symptom dimensions of anxiety in dialysis patients. This study aimed to identify the best fitting dimensional model for anxiety in dialysis patients and assess the association between symptom dimensions of anxiety and adverse clinical outcomes. MethodsThis study is a prospective observational cohort study including patients from 10 urban dialysis centers between 2012 and 2017. Anxiety symptoms were measured using the self-reported questionnaire Beck Anxiety Inventory. Confirmatory factor analysis was used to identify symptom dimensions. The association between dimensions and mortality, hospitalization and quality of life was investigated using stepwise cox, poisson and lineair regression models. Multivariable models included demographic, social, laboratory and clinical variables to adjust for possible confounding. ResultsIn total 687 chronic dialysis patients were included. A Somatic and Subjective anxiety dimension were identified. Only Somatic anxiety symptoms showed an association with increased risk of hospitalization and mortality (Rate Ratio 1.73 (1.45–2.06) p = .007 and Hazard Ratio 1.65 (1.15–2.37) p = .007 respectively). These associations were independent from somatic comorbidity. All symptom dimensions of anxiety showed an association with Quality of Life. ConclusionThis study shows that anxiety is common in chronic dialysis patients and comprises of a somatic, subjective, and a total score. The discrimination between anxiety dimensions can be useful for clinical practice, as they are related to different clinical outcomes.

Expanded hemodialysis: new opportunities and hopes

In the field of hemodialysis technologies, as in other fields of medicine, evolutionary changes are constantly taking place. The innovations are driven by unachieved clinical outcomes and desire to improve the quality of care of patients with CKD 5D. Recent advances in dialysis techniques resulted in the possibility to expand the permeability of dialysis membranes for a wider spectrum of uremic toxins that lead to the enhancement of long-term outcomes improving quality of life and reducing the mortality rate of dialysis patients. The inadequacy of existent dialysis techniques, at least in part, is due to the chronic accumulation of organic retention solutes of middle and large molecules, which are poorly or even not removed during dialysis.&#x0D; A gradual improvement in the elimination of uremic toxins is observed as a result of the development of new alternative approaches of hemodialysis therapy, such as high-flux hemodialysis, hemodiafiltration, expanded hemodialysis (HDx). However, some techniques have had limited success due to a host number of organizational, technological, financial and human factors. Expanded hemodialysis offers a novel blood purification technology in removal of the large spectrum of uremic toxins, in particular large medium molecules, due to the new structure of the dialysis membrane. There are a number of studies that prove the potential benefits of a new method of dialysis therapy over the previous ones, suggesting a reduction in cardiovascular mortality, vascular calcification and inflammation. In addition, there is evidence of a positive effect of HDx on the quality of life in dialysis patients. In particular, to minimize the manifestations of skin itching, restless legs syndrome, asthenic syndrome.

The Effect of Progressive Relaxation Exercises on Pain, Fatigue, and Quality of Life in Dialysis Patients.

Patients receiving hemodialysis treatment may experience several symptoms at the same time, such as fatigue and pain. Progressive relaxation exercises (PRE) have been reported to have positive effect on the control of these symptoms. In this study, a randomized, controlled, and experimental study was conducted to examine the effect of PRE on pain, fatigue, and quality of life in hemodialysis patients; the study was carried out with 48 intervention and 48 control patients receiving treatment in the hemodialysis units of 2 hospitals. Data were collected by a questionnaire prepared by the researcher, which included questions about sociodemographic variables and the disease; Piper Fatigue Scale; Visual Analog Scale that measures pain severity; and SF-36 Quality of Life Scale. The results of study revealed that mean total fatigue score and mean pain score decreased in the intervention group after the application of PRE; whereas no change was observed in the control group (P < .05). It was also found that quality of life physical component mean score and mental component mean score increased in the intervention group after the application of PRE (P < .05).