Maintained Hemodialysis Patients Research Articles

The association between vascular access satisfaction and quality of life and depression in maintained hemodialysis patients.

Vascular access (VA) is known to be critical for the survival of patients on maintained hemodialysis (MHD) treatment. However, the association between VA satisfaction and psychiatric state in MHD patients is still not fully elucidated. Thus, the aim of this study is to evaluate the relationship among VA satisfaction, health-related quality of life (HRQOL) and depression in MHD patients with different VA types. This cross-sectional study was conducted at two dialysis centers with MHD-dependent patients. The Short Form Vascular Access Questionnaire (VAQ) was administered to estimate the level of MHD patients' satisfaction with their VA. HRQOL was assessed using the Short Form 36 (SF-36) questionnaire. Depression was assessed using the Zung's self-rating depression scale (SDS). Of the total 252 patients, AVF was used by 84.13%, AVG was used by 2.78%, and TCC was used by 13.09%. There was no significant difference in satisfaction and SDS scores by access type in patients with AVF, AVG, and TCC. However, HRQOL was worst in patients with TCC, and highest in the AVF group. Further analysis showed that VAQ scores in the domains of overall and dialysis-related complications exhibited a negative correlation with HRQOL. And SF-36 HRQOL scores, including the total score, PCS and MCS, were all negatively correlated with SDS scores (p < 0.05). The results of multivariable analyses found that VAQ scores in the domains of overall score and physical symptom, and total score of HRQOL influenced the depression. In the present study, no significant difference in satisfaction scores by access type was found in patients with AVF, AVG, and TCC. The HRQOL score was higher in patients with AVF than in those with AVG or TCC. And the result suggested a negative association between HRQOL and depression. Vascular access satisfaction and HRQOL might be risk factors for the presence of depression in MHD patients.

Immunity persistence of 60 μg high dose hepatitis B vaccine and influencing factors in maintained hemodialysis patients

Objective: To compare the anti-HBs level in maintained hemodialysis patients one year after receiving 20 μg and 60 μg hepatitis B vaccination at 0, 1 and 6 months, and explore the influence factors for the immunity persistence and their interactions. Methods: Based on a randomized controlled trial of 20 μg and 60 μg hepatitis B vaccine immunization in maintained hemodialysis patients at 0, 1, and 6 months, follow up was conducted for the patients for one year after the completion of the vaccination for the quantitative detection of anti-HBs, and χ2 test, t test, unconditional logistic regression and interaction analyses were used for statistical analysis. Results: One year after the vaccination, 125 and 124 patients in the 20 μg and 60 μg groups were tested for anti-HBs, respectively. The positive rate of anti-HBs in the 60 μg group (77.42%, 96/124) was significantly higher than that in the 20 μg group (65.60%, 82/125) (P<0.05). After adjusting for the confounding factors, the positive probability of anti-HBs in the 60 μg group was 1.925 times higher than that in the 20 μg group (95%CI: 1.068-3.468). Patients with hemodialysis duration ≥5 years (OR=0.523, 95%CI: 0.293-0.935) and diabetes mellitus (OR=0.376, 95%CI: 0.173-0.818) had lower positive probability of anti-HBs. Moreover, there were additive and multiplicative interactions between hemodialysis duration ≥5 years and diabetes mellitus. Conclusions: The immunity persistence after one year in 60 μg hepatitis B vaccination group was longer than that in 20 μg hepatitis B vaccination group in maintained hemodialysis patients, vaccine dose, hemodialysis duration and diabetes mellitus were the influencing factors for the immunity persistence, there were additive and multiplicative interactions between hemodialysis duration ≥5 years and diabetes mellitus.

Current status of COVID‐19 among hemodialysis patients in the East Azerbaijan Province of Iran

IntroductionManagement of vulnerable patients during the COVID‐19 pandemic requires careful precautions. Hemodialysis patients constitute a large group of at‐risk patients that not only suffer from a compromised immune system but also are at a higher risk due to frequent admission to healthcare units. Therefore, a better understanding on the pathogenesis and possible risk factors of COVID‐19 in hemodialysis patients is of high importance.MethodsA total of 670 maintained hemodialysis patients from all dialysis units of the East Azerbaijan Province of Iran, including 44 COVID‐19 patients were included in the present study. Possible associations between the backgrounds of patients and the incidence of COVID‐19 were assessed. Also, hemodialysis patients with COVID‐19 were compared to 211 nonhemodialysis COVID‐19 patients.FindingsChronic glomerulonephritis patients and those with blood group A demonstrated a higher incidence of COVID‐19. On the other hand, patients with blood group AB+ and those with hypertension etiology of kidney failure demonstrated a lower incidence of COVID‐19. Hemodialysis patients with COVID‐19 had higher counts of polymorphonuclears (PMNs) in their peripheral blood compared to other COVID‐19 patients.DiscussionA better comprehension on the risk factors associated with COVID‐19 in hemodialysis patients can improve our understanding on the pathogenesis of COVID‐19 in different situations and help the enhancement of current therapeutics for COVID‐19 in hemodialysis patients.

Long-term outcome of posterior approach insertion of tunneled cuffed catheter: A single clinic retrospective analysis.

For patients who rely on a tunneled cuffed catheter, the internal jugular vein is the preferred site of insertion. A few studies have suggested that the posterior approach for central lines is equivalent or better in comparison to the conventional central approach. However, there have been fewer studies examining tunneled cuffed catheter insertion using the posterior approach. We have performed many posterior insertions of tunneled cuffed catheters in our practice, and because the technique has not yet been comprehensively studied for long-term use, we performed a retrospective study to evaluate the safety and efficacy of posterior approach for tunneled cuffed catheter in maintained hemodialysis patients. A retrospective review was conducted of 200 hemodialysis patients who were treated with tunneled cuffed catheters over a period of 3 years. There were 104 patients in the study group, as well as a 96-patient control group, who underwent catheter insertion by central approach. The clinical follow-up data were collected and analyzed. All catheters were successfully placed. The mean primary patency days per catheter were 712 catheter days for the study group and 585 catheter days for the control group. The episode of catheter infection was similar in both groups (p = 0.874), but the case of total catheter dysfunction was significantly lower in the study group compared to the control group (p = 0.006). The cumulative patency of catheters was higher in the study group than that in the control group (p = 0.02), while patient survival was the same in the two groups (p = 0.325). The posterior approach is safe, and similar infection rates were observed with lower dysfunction rates compared to tunneled catheter insertion by the conventional central approach.

Effects of High Flux versus Low Flux on Serum C-Reactive Protein a as an Inflammatory Biomarker in Hemodialysis Patients

Background: Traditional low-flux dialysis cannot improve micro-inflammatory status, while new high-flux dialysis can improve the micro-inflammation and lipid metabolism, it helps to improve the quality of life and survival rate of patients, so how to improve the micro-inflammatory status are a focus for researchers. Objective: was to observe the effect of high flux hemodialysis (HFHD) with Gambro polyflux 170H dialyser and low flux hemodialysis (LFPD) with polyflux 17L dialyser on high-sensitivity C-reactive protein in patients with maintenance hemodialysis. Methods: 60 patients with maintenance hemodialysis were randomly divided into HFHD group and LFHD group. Another 20 cases for physical examinations served as normal control group. The maintenance hemodialysis patients were treated with HFHD using 170H dialyser dliahyser and LFHD using 17L dialyser, three times per week, 4 hours once. After 6 months of the treatment, high-sensitive C-reactive protein was determined in patients as well as normal controls before and after treatment. Results and Conclusion: in two groups, the levels of high-sensitive C-reactive protein before the treatment were higher than normal control (P <0.001). In HFHD group, serum high-sensitive C-reactive protein markedly decreased (P <0.01). In LFHD group, these indices remained unchanged after the dialysis for 6 months. HFHD with 170H polysulfone dialyser is effective in improving micro-inflammation in maintained hemodialysis patients.

Factors associated with the elevated percentage of CD4CD69 T cells in maintained hemodialysis patients

Background: CD4 T-cell abnormality, influencing the outcome of the maintained hemodialysis (MHD), is common in patients on dialysis. We try to find out factors associated with the activated CD4 T cells, CD4CD69 T cells, to improve the dialysis quality.Methods: A cross-sectional study was conducted to evaluate the change of CD4CD69 in MHD patients and healthy controls in our hospital from September 2015 to May 2016. A total of 164 MHD patients and 24 healthy controls were included according to the criteria. Univariate and multivariate logistic regression models after correlation analysis were executed to discover the related factors of CD4CD69 T-cell posterior to the division of the CD4CD69 T cell according to its median.Results: The lymphocytes were lower, but the percentage of CD4CD69 T cells was higher in MHD patients compared with healthy controls, even after the propensity score matching based on age and sex. The percentage of CD4 T cells showed no significant difference between the two groups. Further multivariate logistic regression models revealed that CD4CD69 T cell was independently associated with serum total protein (OR 95%CI: 0.830[0.696, 0.990], p = .038), transferrin (OR 95%CI: 3.072[1.131, 8.342], p = .028) and magnesium (OR 95%CI: 16.960[1.030, 279.275], p = .048).Conclusion: The percentage of CD4CD69 T cells, activated CD4 T cells, elevated in hemodialysis patients despite the decrease in lymphocytes. The elevated CD4CD69 T cells were independently associated with serum total protein negatively, but transferrin and magnesium positively. Strengthening nutrition, reducing the concentration of transferrin and magnesium might be beneficial to reduce the activation of CD4 T cells and improve the outcome of MHD patients.

Low employment and low willingness of being reemployed in Chinese working-age maintained hemodialysis patients

Aim: Returning to society plays an important role in improving the quality of life in maintenance hemodialysis (MHD) patients, and retention of employment is one of the core enablers. The study is to assess the employment status and to determine the variables for unemployment in Chinese MHD patients.Methods: Prevalent MHD patients from four dialysis centers in Shanghai China were enrolled. We assessed patients’ employment status, current social functioning, hemodialysis modality, annual income and general health condition. Among current unemployed working-age patients, the reasons of quitting jobs and willingness of being reemployed were evaluated.Results: A total of 231 patients were studied, among which 114 patients were unemployed 1 year before hemodialysis. Among 117 employed patients, 16 patients quitted jobs before dialysis inception, while 49 patients quitted jobs at the initiation of HD, and 26 patients followed after a few months’ HD. The main reasons for ceasing employment were physical insufficiency, conflict between dialysis and work schedules, lack of support from employers and resistance from family members. Among the 166 patients who were in their working age, 26 patients were employed. The unemployed patients had the characters of elder age, lower education level, higher annual family income, higher female ratio, lower blood flow, lower physical functioning, and social functioning and lower frequency of weekend hemodialysis and HDF/HF. Among the 140 unemployed patients, only 47 patients had the willingness of being reemployed. Their unemployment status was positively associated with elder age ((OR) 3.13, 95% CI, 1.08–9.1), lower education level ((OR) 1.97, 95% CI, 1.05–5.92), and higher family income ((OR) 7.75, 95% CI, 2.49–24.14).Conclusion: Ratio of employment and willingness of being reemployed was low in MHD working-age patients. Lack of social and family’s support also hampered patient’s returning to society except for the HD treatment quality.

Combined Brainwave Synchronizer with Progressive Muscle Relaxation on the Maintained Hemodialysis Patients: A Randomly Controlled Study

Mental problems have profound influence on the development and transfer of illness of the maintained hemodialysis (MHD) patients in the past study. The goal of this pilot study was to explore the effects of psychological intervention which combined brainwave synchronizer with progressive muscle relaxation (PMR) on the mental health, physiological function and quality-of-life (QOL) of MHD patients. Seventy-seven MHD patients were randomly assigned to the intervention group (ITG, 39 patients) or the control group (CTG, 38 patients). The CTG received the conventional therapy which included hemodialysis (HD) 3 times/week and recombinant human erythropoietin (rHuEPO) at dosages of 100 units/(kg·week-1) to 150 unites/(kg·week-1) by i.v or subcutaneous injection. The ITG received the conventional therapy combined with psychological intervention, which included brainwave synchronizer and PMR. Psychological and QOL outcomes in both groups were assessed with The Symptom Checklist 90 (SCL-90) and the Short Form 36 Health survey Questionnaire (SF-36) three days before and after the intervention, respectively. And blood routing and kidney functions indexes were tested with hematic parameter at the same time. Two-tailed independent samplettest andχ2test were performed. Thirty-six patients of the ITG and 34 patients of the CTG completed the study. The patients in the ITG showed better mental state, higher global QOL and higher values of heamoglobin (HB), accounting of red blood cells (RBC), hematocrit (HCT) and serum calcium, lower values of serum phosphor, serum kalium, blood urea nitrogen (BUN) before HD and the ratio of interdialytic weight gain to dry weight (IWGR) than those in the CTG. There is no significant difference in serum creatinine (Scr) before HD between both groups. Psychological intervention seems effective in improving MHD patients’ mental state, increasing their compliance to treatment, and mending their physiological function and QOL.

Effect of progressive muscle relaxation combined with health education on the psychological state of the maintained hemodialysis patients

Objective To evaluate the effect of progressive muscle relaxation combined with health education on the psychological state of the maintained hemodialysis patients and provide basis for the psychological intervention for them. Methods Forty-two MHD patients were randomly assigned to the intervention group and control group. Patients in the control group received the conventional nursing, and patients in the intervention group received the conventional therapy combined with nursing intervention for two times. Results After the first intervention, the various psychological testing indicators of intervention group were obviously lower than those of control group and there was statistically significant difference between two groups(P ＜ 0. 05 ). The differences of index of physiological chemistry between two groups had no statistical significance (P ＞ 0. 05 ). After the second intervention, the various psychological testing indicators of intervention group were further lower than those of control group and there was statistical significant difference ( P ＜ 0. 01 or P ＜ 0. 05 ). The Hb and Ca2 + of the intervention group were remarkably higher than control group,while PO43+ and K+ of intervention group were significantly lower than control group. Both differences had statistical significance(P ＜ 0. 05 ). Conclusions Progressive muscle relaxation combined with health education can greatly improve the psychological and physiological status of MHD patients. Key words: Maintenance hemodialysis; Progressive muscle relaxation; Health education

Influence of cognitive behavioral therapy in reducing emergent hemodialysis for maintained hemodialysis patients

Objective To explore the influence of cognitive behavioral therapy (CBT) in reducing the incidence of emergent hemodialysis for maintained hemodialysis (MHD) patients. Methods 230 patients (64 325 times)with MHD between 2004 and 2005(control group) were received daily hemodialysis nursing routine. 230 patients (65 157 times)with M HD between 2006 and 2007 have undergone CBT (experiment group). The reasons, incidence of emergent dialysis happened in these patients, the status of mastering knowledge and weight-control were analysed. Results The incidence of emergent dialysis at irregular HD time in experiment group group was 0.08% compared with O.16% in control group. 100% patients in experiment group mastered the knowledge from health education comparing to 43.3% in control group. The rate of controlling body weight showed higher in ezperiment group(99%) than in control group(45%). The result showed that there were significant differences in these three aspects between control group and trial group. Conclusions CBT can, reduce the inducing factors of emergent dialysis, relieve patients' economic burden, and improve patients' life quality. Key words: Hemodialysis; Emergent; Behavior therapy; Cognitive