Long-term Hemodialysis Research Articles

Efficacy of Psychological Interventions in Reducing the Prevalence and Intensity of Depression in Patients with Long-Term Hemodialysis

Efficacy of Psychological Interventions in Reducing the Prevalence and Intensity of Depression in Patients with Long-Term Hemodialysis

Outcomes of operative intervention for ulcers over hemodialysis arteriovenous access.

The native arteriovenous fistula (AVF) is the gold standard for long-term hemodialysis access. When native vein options are exhausted, arteriovenous graft (AVG) becomes the next choice. An ulcer over an AVF or AVG is a serious condition with the potential for life-threatening hemorrhage. This study aims to present our experience with surgical management of ulcers over AVFs or AVGs. Electronic records of 26 patients who underwent 27 consecutive surgical procedures for ulcers over AVFs or AVGs from December 31, 2016 to December 31, 2021 at the Royal Liverpool University Hospital were retrospectively analyzed. The majority were males (14/26, 53.8%) and the median age was 64.5 years. Operative repair was required for 25 ulcers over 24 AVFs and 2 ulcers over 2 AVGs. Ten patients (37%) presented with bleeding. Seventeen (63%) had impending bleeding suggested by a thin soft tissue covering or a false aneurysm at the site of the ulcer. Previous endovascular intervention for fistula outflow stenosis was a significant predictor for presenting with bleeding (p=0.031). All ulcers (27/27, 100%) underwent excision and primary skin closure. Fistula wall defects were directly repaired in 18/27 (66.7%). Four/26 (14.8%) fistulas had to be ligated and 2 (7.4%) had end-to-end re-anastomosis after excision of damaged segments. Three/26 (11.53%) fistulas thrombosed immediately after the intervention. The overall fistula salvage rate was 73.08% (19/26). There was 1 (3.7%) patient mortality due to bleeding from wound breakdown after surgery. An acceptable fistula salvage rate can be expected following surgical repair of ulcers over AVFs and AVGs. A history of previous endovascular interventions for fistula outflow stenosis was a predictor of bleeding from these ulcers.

The Effect of Music Therapy on Anxiety in Hemodialysis Patients with Kidney Failure : A case report

Chronic kidney failure is a health problem as a result of damaged kidney function. Newly diagnosed patients who have to undergo long-term hemodialysis often feel worried about survival, the amount of dialysis time to the body’s reaction when undergoing hemodialysis. This can create inner conflict, frustration, guilt to severe anxiety. The purpose of this case study is to determine whether there is an effect of music therapy on anxiety in patients undergoing hemodialysis with chronic kidney failure. The research method used in this study is a case study with a total number of respondents as many as 7 patients. The results of the case study showed anxiety in patients undergoing hemodialysis at the hospital after being given music therapy from a total of 7 respondents there were 3 respondents experienced normal anxiety, 2 respondents experienced mild anxiety and 2 respondents experienced moderate anxiety. These results were obtained from the administration of an anxiety the last meeting using DASS 42. The conclusion in this study showed that there was an effect of giving music therapy to patients undergoing hemodialysis with chronic kidney failure.

Case of the Month from the Peter MacCallum Cancer Centre, Melbourne, Australia: combination of stereotactic ablative body radiotherapy and radical nephrectomy for synchronous bilateral primary renal cell carcinoma.

Case of the Month from the Peter MacCallum Cancer Centre, Melbourne, Australia: combination of stereotactic ablative body radiotherapy and radical nephrectomy for synchronous bilateral primary renal cell carcinoma.

Does the balloon-assisted maturation procedure offer comparable results for AVF created with a smaller vein?

Traditionally, a venous diameter of less than 3 mm was not considered for creation of AVF. Some studies have reported smaller venous size could be used for operation. AVF created with a smaller vein may have a lower maturation rate. Currently, percutaneous angioplasty is also used to enhance the maturation of AVF. This study aimed to establish whether the BAM procedure could offer comparable results for AVF created with a smaller vein. From January 2016 to July 2021, 290 patients who received native AVF operation were enrolled in this study. All of the preoperative venous sizes were measured by Duplex ultrasonography under tourniquet enhancement. The study cohort was categorized into two groups based on the pre-operative venous diameter: smaller vein group (SVG, 2.5 < size < 3 mm, 53.1%) and normal vein group (NVG, size ⩾ 3 mm, 46.9%). The mean age was 64 ± 12.9 years, and 58.6% of patients were male. Hypertension and DM were the most common comorbidities. Most patients underwent operation of radio-cephalic fistula (71.4%). The overall primary maturation rate was 79%. The primary maturation rate was significantly higher in the NVG (86% vs 72.7%, p = 0.009). However, after the BAM procedure, the secondary maturation rate was similar in both groups (94.1% vs 90.3%, p = 0.319). According to our study, the BAM procedure can significantly increase the maturation rate, and the secondary maturation rate was similar in both groups. Thus, more patients can be given the opportunity to undergo creation of an AVF for long-term hemodialysis.

Role of short-dwell daily ethanol-lock therapy in the management of hemodialysis tunneled cuffed catheter-related bloodstream infection.

Catheter-Related Blood Stream Infection (CRBSI) is the major limitation of using Tunneled cuffed catheter (TCC) for long-term Hemodialysis. The standard therapy of CRBSI involves systemic antibiotics with catheter replacement/removal. As antibiotic alone is rarely effective therapy for CRBSI, biofilm eradication using antimicrobial locking solutions is a promising modality for CRBSI treatment, hence catheter salvage. The present study evaluated the efficacy and safety of Ethanol-lock therapy (ELT) in combination with systemic antibiotics for the management of CRBSI associated with hemodialysis TCC. 56 patients with CRBSI were treated with 70% ELT (1 h daily for 5 days) along with systemic antibiotics. Seventeen patients with CRBSI who didn't consent to ELT were treated with antibiotics alone. The effect of ELT was evaluated as clinical cure (fever resolution and negative surveillance cultures), infection-free TCC survival duration and adverse events of ELT among patients with CRBSI. The parameters were compared with 17 patients treated with antibiotics alone. ELT was successful in 50 out of 56 patients (89.28%); compared to 41.17% (seven out of 17) with antibiotics alone (p < 0.001). Mean TCC survival was also significantly higher with ELT combined with systemic antibiotics (126.23 ± 18.67 days) compared to antibiotics alone (38.76 ± 9.91) (p = 0.006). No systemic adverse effects were noted with ELT; two patients receiving ELT had catheter breakage during the study period. We conclude that short-dwell daily ELT with systemic antibiotics is an effective therapy for CRBSI in hemodialysis patients with TCC.

Development and Validation of a Predictive Risk Algorithm for Bleeding in Individuals on Long-term Hemodialysis: An International Prospective Cohort Study (BLEED-HD).

Individuals with kidney disease are at a high risk of bleeding and as such tools that identify those at highest risk may aid mitigation strategies. We set out to develop and validate a prediction equation (BLEED-HD) to identify patients on maintenance hemodialysis at high risk of bleeding. International prospective cohort study (development); retrospective cohort study (validation). Development: 15 countries (Dialysis Outcomes and Practice Patterns Study [DOPPS] phase 2-6 from 2002 to 2018); Validation: Ontario, Canada. Development: 53 147 patients; Validation: 19 318 patients. Hospitalization for a bleeding event. Cox proportional hazards models. Among the DOPPS cohort (mean age, 63.7 years; female, 39.7%), a bleeding event occurred in 2773 patients (5.2%, event rate 32 per 1000 person-years), with a median follow-up of 1.6 (interquartile range [IQR], 0.9-2.1) years. BLEED-HD included 6 variables: age, sex, country, previous gastrointestinal bleeding, prosthetic heart valve, and vitamin K antagonist use. The observed 3-year probability of bleeding by deciles of risk ranged from 2.2% to 10.8%. Model discrimination was low to moderate (c-statistic = 0.65) with excellent calibration (Brier score range = 0.036-0.095). Discrimination and calibration of BLEED-HD were similar in an external validation of 19 318 patients from Ontario, Canada. Compared to existing bleeding scores, BLEED-HD demonstrated better discrimination and calibration (c-statistic: HEMORRHAGE = 0.59, HAS-BLED = 0.59, and ATRIA = 0.57, c-stat difference, net reclassification index [NRI], and integrated discrimination index [IDI] all P value <.0001). Dialysis procedure anticoagulation was not available; validation cohort was considerably older than the development cohort. In patients on maintenance hemodialysis, BLEED-HD is a simple risk equation that may be more applicable than existing risk tools in predicting the risk of bleeding in this high-risk population.

S-41-1: PAST, PRESENT AND FUTURE OF CKD IN JAPAN

CKD is increasing in many countries around the world, especially in Asian countries. It is expected that the number will more than double in Asia by the end of 2030 compared to 2010. In North and East Asian countries, the prevalence of CKD is generally above 10%. In Japan, 12% of adults are regarded as CKD. As a result, the number of patients who are treated with chronic hemodialysis is increasing in Japan, and currently 340,000 patients are receiving dialysis treatment. Approximately 40,000 patients are newly introduced to dialysis treatment every year, and the medical expenses required for dialysis treatment exceed 1.5 trillion yen annually. 42% of kidney failure is caused by diabetic kidney disease. At the same time, aging is also a cause of increment of kidney failure. More than half of the patients are 65 years or older at the time of introduction of dialysis. Thus, Japan has the second highest prevalence of patients with long-term hemodialysis after Taiwan.

Gait and Balance in People Undergoing Long-Term Hemodialysis.

Gait and Balance in People Undergoing Long-Term Hemodialysis.

Role of Color Doppler Ultrasonography in evaluation of hemodialysis AV fistula

Background: A significant percentage of the Egyptian population is affected by end-stage kidney disease, which requires long-term hemodialysis. For patients receiving regular hemodialysis, the arteriovenous fistula is now the method most frequently employed to provide vascular access. Objective: The current study's objective was to assess the role and utility of CDUS in assessing vascular access and identifying shunt complications for hemodialysis. Patients and methods: This prospective, randomized controlled trial investigation has been carried out at the Health Insurance Hospital Nasr City's radio-diagnosis department. We included a sample size of thirty patients who needed an arteriovenous fistula in the upper limb for hemodialysis. Patients ranged in age from 8 to 70 and were both male and female. Results: The majority of patients had normal vessel diameters. 6 patients (20%) have a BB fistula, 8 patients (26.7%) have an RC fistula, and 15 patients (50%) have a BC fistula. The study showed a mean age of AVF maturation occurs 2.17 ± 0.379 weeks after its 1st creation. 3 patients had an uncomplicated 10% and 27 patients had shunt complications of 90%. The investigation revealed a significant percentage of venous thrombosis (12 patients, 40%), stenosis (9 patients, 30%), aneurysmal dilatation (6 patients, 20%), pseudoaneurysmal formation (3 patients, 10%), and finally steal syndrome (3.3%, 1 patient). Conclusion: Early identification and repair of a failing hemodialysis fistula can improve the quality of hemodialysis treatment. For patients having AV dysfunction, the CDUS results from this series were useful in determining further treatment care.

Changes in Cerebral Blood Flow in Patients Who Receive Different Durations of Hemodialysis: An Arterial Spin Labeling MRI Study.

This study aimed to determine the changes in cerebral blood flow (CBF) in patients who received different durations of hemodialysis (HD) using arterial spin labeling magnetic resonance imaging. The study included 46 patients who received HD and 24 demographically similar healthy controls (HCs). Patients who received HD were divided into three subgroups based on its duration: HD-1 (n=15, dialysis duration ≤24 months), HD-2 (n=16, dialysis duration >24 and ≤72 months), and HD-3 (n=15, dialysis duration ≥73 months). All subjects completed the Mini Mental State Examination and Montreal Cognitive Assessment tests, and the patients who received HD underwent laboratory tests. Group-level differences in the global and regional CBFs between patients who received HD and HCs were assessed. Correlation analysis was performed to evaluate the associations among CBF, clinical variables, and cognitive function. Compared with HCs, global and regional CBFs were significantly increased in the HD-1 and HD-2 groups (p<0.05), but there was no significant difference in the HD-3 group (p>0.05). However, compared with the HD-1 group, the HD-3 group had significantly decreased global and regional CBFs (p<0.05). The cognitive function was worse in patients who received long-term HD than in HCs. Increased dialysis duration and hemoglobin level were predictive risk factors for decreased CBF in patients who received long-term HD. Patients who received long-term HD with normal CBF had worse cognitive function, which may be related to increased dialysis duration.

Development and Validation of a Nomogram for Predicting All-Cause Mortality in Patients with Hemodialysis Having Pulmonary Hypertension

Introduction: Patients with end-stage renal disease receiving hemodialysis (HD) have a high morbidity and mortality rate associated with pulmonary hypertension (PH). A nomogram was developed to predict all-cause mortality in HD patients with PH. In this study, we aimed to validate the usefulness of this nomogram. Methods: A total of 274 HD patients with PH were hospitalized at the Affiliated Hospital of Xuzhou Medical University between January 2014 and June 2019 and followed up for 3 years. Echocardiography detected PH when the peak tricuspid regurgitation velocity (TRV) was more than 2.8 m/s. To evaluate the all-cause mortality for long-term HD patients with PH, Cox regression analysis was performed to determine the factors of mortality that were included in the prediction model. Next, the area under the receiver-operating characteristic curve (AUC-ROC) was used to assess the predictive power of the model. Calibration plots and decision curve analysis (DCA) were used to assess the accuracy of the prediction results and the clinical utility of the model. Results: The all-cause mortality rate was 29.20% throughout the follow-up period. The nomogram comprised six commonly available predictors: age, diabetes mellitus, cardiovascular disease, hemoglobin, left ventricular ejection fraction, and TRV. The 1-year, 2-year, and 3-year AUC-ROC values were 0.842, 0.800, and 0.781, respectively. The calibration curves revealed excellent agreement with the nomogram, while the DCA demonstrated favorable clinical practicability. Conclusion: The first developed nomogram for predicting all-cause mortality in HD patients with PH could guide clinical decision-making and intervention planning.

Drastic improvement of cardiac function after living-donor renal transplantation in a long-term hemodialysis patient with severe mitral regurgitation.

Although there are reports of recovery of cardiac function after renal transplantation, the feasibility of renal transplantation in patients with low cardiac function remains controversial. A 59-year-old Japanese male was scheduled to undergo living-donor renal transplantation (LDRT) under general anesthesia. Preoperative transthoracic echocardiography revealed severe mitral regurgitation (MR) and a left ventricular ejection fraction (LVEF) at 30%. LDRT was conducted prior to cardiac surgery with restrictive fluid management and close monitoring of cardiac function. The patient's renal function improved promptly after the LDRT, and his hemodynamics were stable throughout the perioperative period. Along with improvements in the patient's renal function and anemia, the patient's cardiac function improved to LVEF 50% and achieved drastically improved MR as well as cardiac function, without intervention. This case indicates that LDRT has the potential to improve cardiac function in patients who have been on hemodialysis for more than 20 years.

Splenic Vessels as a Rescue for Pediatric Kidney Retransplantation in Children With Iliac-caval Agenesis or Thrombosis.

Unavailability of the iliac-caval system due to thrombosis or aberrant anatomy may preclude kidney transplantation (KT) in small infants, exposing them to the complications of long-term dialysis. A tailored approach may enable KT also in these difficult patients. We report the cases of 2 pediatric patients with a history of long-term hemodialysis, a previously failed KT, pending exhaustion of vascular accesses for dialysis, and unsuitability of the iliac-caval axis as a site for KT. Both patients were successfully managed by using splenic vessels as a source of arterial inflow or venous drainage during KT. Notably, one patient also had a previous liver transplant. Both kidney grafts showed primary function. Posttransplant courses were uneventful, and no rejection episode was observed. At 64- and 10-mo follow-ups, both children had optimal renal function and excellent quality of life. When the iliac-caval system is unavailable, kidney graft implantation on splenic vessels represents a safe and effective option for pediatric KT.

Effects of vitamin C supplementation on oxidative stress and serum paraoxonase/arylesterase activities in patients on long-term hemodialysis

BackgroundOxidative stress increases oxidizability of apolipoprotein-B containing lipoproteins and decreases paraoxonase (PON) activity in hemodialysis (HD) patients and plays an important part in the development of atherosclerotic cardiovascular diseases. In HD patients, plasma ascorbic acid (AA) levels are decreased either due to the loss by hemodialysis membranes or due to malnutrition and contribute to the imbalance of antioxidant defense mechanisms. We hypothesized that long-term ascorbic acid (AA) supplementation recovers oxidizability of lipoproteins in HD patients by reinforcing PON activity. MethodsTwenty-nine adult patients were treated with 100mg and 500mg AA at the end of each HD session thrice a week for two consecutive 16 weeks-periods, respectively. Blood samples were obtained before the first HD session and prior to the first HD sessions following the 100mg AA-supplemented and the 500mg AA-supplemented periods. ResultsPON activities were significantly increased after 100mg (p<0.05) and 500mg AA (p<0.001) supplementation periods compared to the basal level. Apo-B lipoprotein oxidizability (Δ-MDA) was significantly decreased after 500mg AA supplementation compared to both basal (p<0.05) and 100mg AA supplementation periods (p<0.05). Plasma AA concentrations were negatively correlated with Δ-MDA levels (R=−0.327; p<0.01). ConclusionOur results suggest that long-term parenteral 500mg AA supplementation improves PON activity alleviating apo B-containing lipoproteins oxidizability in HD patients.

Comparison of catheter patency between surgical inside-out technique and conventional femoral approach for tunneled cuffed catheter placement in patients with thoracic central venous occlusion.

Femoral tunneled cuffed catheters (TCCs) can provide long-term hemodialysis access for patients with exhausted upper extremity access sites due to thoracic central venous occlusion. However, the use of femoral vein catheters (FVCs) has reportedly been associated with the risk of infection, malfunction, and discomfort. An inside-out technique will facilitate chest TCC placement by intentional retrograde extravascularization of the proximal occluded venous stump into the mediastinum. Next, the wire and small catheter are exteriorized to the skin at the base of the neck with a small skin incision. Then, the hemodialysis catheter is railed back down to the right atrium. With this technique, we placed the tip of the catheter into intrathoracic superior vena cava or brachiocephalic vein. In the present study, we compared the catheter patency of the inside-out technique vs a standard approach for FVC placement. The present randomized controlled trial was conducted from May to December 2020. We included 22 patients requiring long-term hemodialysis with failed recanalization of thoracic central venous occlusion. The patients were randomized into the surgical inside-out (S-inside-out) group and FVC group. The S-inside-out and FVC groups included 10 and 12 patients, respectively. All 22 patients had undergone successful catheter placement. Catheter survival function was significantly higher for the S-inside-out group than for the FVC group (100% vs 50%, respectively; P= .017). In addition, the EQ-5D utility score was significantly better for the S-inside-out group (P= .008). Four cases of catheter infection occurred in the FVC group, but no catheter infection was found in the S-inside-out group. Procedural-related complications occurred in two patients; one case each of hemothorax and stroke in the S-inside-out group. Use of the S-inside-out technique facilitated upper chest TCC placement for hemodialysis patients with exhausted access sites. This technique provided better catheter survival function, a better quality of life, and a lower infection rate, which outweighed the procedure risk.

Suitability of the left internal jugular vein for CRT-D placement in the setting of extensive venous occlusion: Case report and review of the literature.

Placement of coronary sinus (CS) leads is predominantly accomplished via the left cephalic-axillary-subclavian venous system. However, vein stenosis or occlusion from long-term chronic hemodialysis (HD) in patients with end-stage renal failure can pose a challenge. Cannulation of the CS via the left internal jugular vein (IJV) is technically difficult but often feasible. We report a case in which a patient with end-stage renal disease (ESRD) had extensive left venous system occlusion from prior in dwelling HD catheters, and an AV fistula contralaterally, who underwent biventricular implantable cardioverter defibrillator placement with lead insertion through the left IJV.

A case of diffuse idiopathic hyperostosis of bone (DISH) in a patient on hemodialysis.

Diffuse idiopathic skeletal hyperostosis (DISH) is a noninflammatory progressive disease resulting in ossification of the anterior longitudinal ligament of the spine and tendons. Herein, we describe a case of DISH in a patient on long-term hemodialysis. The patient was a 79-year-old man undergoing hemodialysis for chronic kidney disease due to diabetic nephropathy. He presented to the emergency department complaining of back pain after a slip and fall. Radiographs revealed bamboo spine-like findings, extending from the cervical to the lumbar spine. Computed tomography and magnetic resonance imaging revealed a compression fracture of thoracic vertebra 12, with abnormal ossification of the anterior longitudinal ligament. Inter-vertebral vertical osseous bridges were also observed at the cervical 7 and lumbar 2 vertebrae. There was no obvious spinal cord compression. Leukocytosis and C-reactive protein levels were not elevated and the human leukocyte type antigen HLA-B27 test was negative. Based on this finding, a diagnosis of DISH was made. In the absence of neurological findings, the patient was treated conservatively. Our findings show an overlap between the clinical features of DISH and those of hemodialysis patients, including older age, male sex, and diabetes.

Comment on: Long-term hemodialysis improved and stabilized diabetic macular edema: two case reports.

Comment on: Long-term hemodialysis improved and stabilized diabetic macular edema: two case reports.

Utilization of bictegravir/emtricitabine/tenofovir alafenamide in patients with end-stage renal disease on hemodialysis.

The combination antiretroviral bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) is a single-tablet, once-daily regimen used in individuals living with HIV; however, its use in the context of renal impairment is uncertain. We report 6 patient cases of BIC/FTC/TAF utilization in individuals with HIV with end-stage renal disease (ESRD) requiring long-term hemodialysis (HD). These case reports describe the utilization of BIC/FTC/TAF in individuals with HIV who require chronic HD, the laboratory parameters measured, and patient-reported quality of life and adverse events. Utilization of BIC/FTC/TAF appears to be an option for individuals with HIV who have ESRD and require long-term HD. This regimen allows for once-daily dosing, elimination of potential serious drug interactions, and simplified patient ART regimens in our patient subset.