Maintenance Hemodialysis Patients Research Articles

Effect of Different Blood Purification Methods on Residual Renal Function in Maintenance Hemodialysis Patients

Objective: This study aims to evaluate the efficacy of different blood purification methods in protecting residual renal function (RRF) in patients with maintenance hemodialysis (MHD). Methods: The study selected 50 patients receiving MHD between September 2023 and September 2024. Using the random number table method, patients were divided into the control group and the study group, each with 25 participants. The control group received hemodiafiltration, while the study group was treated with hemodialysis plus hemoperfusion. The RRF measures of the two groups were compared. Results: There were significant differences in the RRF measures (P < 0.05). Conclusion: Combined hemodialysis and hemoperfusion therapy can effectively improve the RRF index of MHD patients with a significant curative effect.

Stent Placement After Percutaneous Recanalization of Superior Vena Cava Stenosis in Maintenance Hemodialysis Patients.

This study aimed to evaluate the efficacy and safety of stent placement after percutaneous recanalization of superior vena cava (SVC) stenosis in maintenance hemodialysis patients. Adult maintenance hemodialysis patients hospitalized at a university-affiliated tertiary hospital due to SVC stenosis from January 2016 to June 2023 were prospectively included. The efficacy and safety of percutaneous blunt/sharp SVC recanalization combined with SVC stent placement were observed. The patients' demographic information and laboratory examination data, stent placement success rate, surgery-related complications, and long-term vascular access patency rate were also recorded and analyzed. The study was approved by the institutional ethics committee (2015-201) and registered at http://www.chictr.org.cn (registry number: ChiCTR-ONN-16007790). A total of 58 patients were included in the study with an average age of 54.79±13.42 years. Percutaneous SVC recanalization was successful in 53 cases, with a success rate of 91.38%, including 37 cases of traditional recanalization and 16 cases of sharp recanalization. Among 53 hemodialysis patients who underwent SVC recanalization, 14 patients successfully received covered stents and 38 patients received bare metal stents, achieving a stent placement success rate of 98.1%. One patient encountered stent displacement into the heart immediately after implantation, causing intra-operative cardiac tamponade, who was successfully rescued by thoracotomy. Fifty-two patients were followed-up for median period of 26 months (cuffed catheter: 25 patients, arteriovenous fistula [AVF]: 27 patients). The overall 2-year vascular access patency rate was 33.2% (cuffed catheter: 22.2%, AVF: 41.7%, p=0.414). There was no statistically significant difference in the 2-year vascular access patency rate between the traditional recanalization group and the sharp recanalization group (34.1% vs 31.1%, p=0.731) and between bare metal stent group and covered stent group (38.1% vs 21.4%, p=0.248). Percutaneous SVC recanalization with stent placement is an effective treatment strategy that can provide viable vascular access for maintenance hemodialysis patients with SVC stenosis. Cautions should be paid to potential life-threatening complications such as stent displacement and cardiac tamponade. Superior vena cava (SVC) stenosis is a common central venous occlusive lesion in maintenance hemodialysis patients. Whether stent should be implanted simultaneously following SVC recanalization is still lacking research. This pilot cohort study suggested that percutaneous SVC recanalization with stent placement was an effective treatment strategy which provides satisfactory vascular access for hemodialysis. We further found that SVC sharp recanalization with subsequent stent implantation was a feasible treatment, with the 2-year vascular access patency comparable to the traditional SVC recanalization group. This study also highlighted endovascular SVC recanalization should be performed with caution, and appropriate balloon sizes should be selected to avoid SVC rupture or stent displacement.

Association between Serum Zinc and All-Cause Mortality in Patients Undergoing Maintenance Hemodialysis: The Osaka Dialysis Complication Study (ODCS).

Zinc is an essential microelement, and its deficiency is common in patients undergoing hemodialysis. However, the association between serum zinc and mortality in these patients remains unclear. The aim of this study was to explore the possible association between serum zinc levels and all-cause mortality in prevalent patients with kidney failure on maintenance hemodialysis. This was a prospective cohort study of maintenance hemodialysis patients followed up for 5 years. The key exposure was serum zinc level measured at baseline, and the outcome was all-cause mortality. Their association was analyzed using Cox proportional hazard models. Among 1662 eligible patients selected for this analysis, 468 (28%) died. Lower serum zinc levels were associated with a higher risk for mortality, independent of the major demographic factors and factors including mineral and bone disorder and renal anemia. However, this association was no longer significant when adjusted for serum albumin. Because there was a close correlation between serum zinc and albumin levels, we performed further analyses in which participants were categorized into four groups by median serum zinc (68 µg/dL) and albumin (3.7 g/dL) levels. In the lower serum albumin groups, risk of death was significantly higher in those with lower zinc than those with higher zinc levels, whereas such a difference was not significant in the high serum albumin groups. In patients undergoing maintenance hemodialysis with lower serum albumin levels, a lower serum zinc level was associated with a higher risk of mortality.

Pneumonia caused by Enterococcus faecalis and tropical Candida in a maintenance hemodialysis patient concomitant with COVID-19: A case report and literature review: Retraction

Pneumonia caused by Enterococcus faecalis and tropical Candida in a maintenance hemodialysis patient concomitant with COVID-19: A case report and literature review: Retraction

Nutritional and psychological sequelae of COVID-19 infection in maintenance hemodialysis patients.

The risk of infection with COVID-19 in hemodialysis (HD) patients is higher compared to the general population. Additionally, HD patients are at higher risk of developing post-COVID-19 infection sequelae. However, this has not been thoroughly investigated. Therefore, we aimed to study the impact of COVID-19 on nutritional status and psychological health in HD patients 6 months following recovery. We recruited HD patients who were proven to be infected with COVID-19 and received treatment at two HD units in two institutions between April 2022 and December 2022. Additionally, we enrolled a group of age- and sex-matched HD patients who had not previously been infected with COVID-19 or received vaccination. Nutritional status was assessed using malnutrition inflammation score (MIS), while psychological health was assessed using online questionnaires. The Patient Health Questionnaire 9 (PHQ 9) was employed to assess symptoms of depression, the Generalized Anxiety Disorder 7 (GAD 7) was used to identify anxiety disorders, the Patient Health Questionnaire 15 (PHQ 15) was utilized to measure somatic symptoms, and the Insomnia Severity Index (ISI) was used to measure insomnia. A total of 60 subjects (30 patients and 30 controls) were assessed in the study. We found statistically significant differences between patients and controls regarding the MIS (median score (interquartile range (IQR)); 11 (9-12) and 5.5 (5-7), respectively), PHQ 15 (median score (IQR); 17.5 (15-19) and 9 (6-11), respectively), PHQ 9 (median score (IQR); 17 (13-19) and 5 (7-8), respectively), GAD 7 (median score (IQR); 14 (11-16) and 6 (4-8), respectively), and ISI (median score (IQR); 20 (15-22) and 8 (7-11), respectively), with p<0.001 for all scores. COVID-19 has long-term effects on the psychosocial health of HD patients and may lead to a higher incidence of malnutrition 6 months post recovery.

Phase angle as an indicator of depression in maintenance hemodialysis patients

Introduction: Depression is a common psychiatric problem in maintenance hemodialysis (MHD) patients. Recent studies have begun to explore the relationship between body composition and depression. Phase angle (PhA), a core parameter for assessing body composition, has been observed to be associated with frailty and cognitive dysfunction. The aim of this study was to investigate the association between PhA and depression in MHD patients. Methods: This multicenter, cross-sectional study included 843 MHD patients from seven dialysis centers in Shanghai, China. Depressive symptoms were evaluated using the Patient Health Questionnaire (PHQ-9), with a score of ≥10 indicating depression. PhA was measured by bioelectrical impedance analysis. Nutritional status was assessed by Malnutrition inflammation score (MIS) . Multivariable logistic regression models were used to investigate the association between PhA and depression. Restricted cubic spline (RCS) analysis was utilized to examine the association. Receiver operating characteristic (ROC) curve was used to identify the cut-off value of PhA for depression. Results: 15.2% of patients (62.8% male, median age 66 years) had depression. Median PhA level (interquartile range, IQR) of depressed patients was 4.4° (3.9-4.9°) for males and 3.9° (3.2-4.7°) for females. There was a significant decrease in the prevalence of depression with increasing quartiles of PhA levels. In multivariable logistic regression analyses, after adjusting for age, sex, education level, spkt/v, dialysis vintage, Charlson comorbidity index, hemoglobin and serum albumin, lower PhA levels (lowest quartile group) were significantly associated with depressive symptoms (adjusted odds ratio, 2.19; 95% confidence interval, 1.07 to 4.48), compared to higher PhA levels (highest quartile group). RCS analysis showed a relatively inverse linear association between PhA and depression. The optimal cut-off value of PhA for depression was 4.9° for males and 3.5° for females. Subgroup analyses validated the findings across patient characteristics, including age, sex, diabetes, education and malnutrition. Conclusion: Our findings indicated an inverse association between PhA and depressive symptoms in Chinese MHD patients, suggesting that PhA could serve as a valuable indicator for assessing the risk of depression in this population. Further studies are needed to explore the potential of PhA as a prognostic tool and its implications for intervention strategies.

Construction and Explanation Analysis of a Hypotension Risk Prediction Model in Hemodialysis Based on Machine Learning

Objective. To establish a risk prediction model for intradialytic hypotension (IDH) in maintenance hemodialysis (MHD) patients and to analyze the explainability of the risk prediction model. Methods. A total of 2,228,650 hemodialysis records of 1075 MHD patients were selected as the research objects. Thirteen important clinical features including demographic features and clinical features were screened, the blood pressure measured before hemodialysis was collected, then an IDH risk prediction model during hemodialysis was established based on a machine learning algorithm. The contribution of each feature to the risk prediction of IDH was measured based on the Gini evaluation index. The TreeSHAP method was used to provide global and individual explanations for the IDH risk prediction model. Results. Hemodialysis duration, pre-dialysis mean arterial pressure, and pre-dialysis systolic blood pressure were the most important predictive variables for the occurrence of IDH during hemodialysis in MHD patients. The best IDH risk prediction model based on machine learning had an accuracy of 0.92 (95% CI 0.90–0.94) and an AUC of 0.95 (95% CI 0.94–0.96), indicating that machine learning has a good effect on the prediction of IDH during hemodialysis treatment. Our research innovatively achieved IDH risk prediction during the entire hemodialysis period based on blood pressure before the start of hemodialysis and other clinical features, thus enabling the medical team to quickly adjust hemodialysis prescriptions or initiate treatment for timely management and prevention of IDH. Global and individual explanations of the IDH risk prediction model can help hemodialysis medical staff understand the overall prediction mechanism of the model, discover prediction outliers, and identify potential biases or errors in the model. Conclusions. The IDH risk prediction model has definite clinical value in actual hemodialysis treatment.

Risk prediction models for autogenous arteriovenous fistula failure in maintenance hemodialysis patients: A systematic review and meta-analysis.

The aim of this study was to systematically retrieve and evaluate published risk prediction models for autogenous arteriovenous fistula (AVF) failure post-formation in maintenance hemodialysis (MHD) patients, with the goal of assisting healthcare providers in selecting or developing appropriate risk assessment tools and providing a reference for future research. A systematic search of relevant studies was conducted in PubMed, Web of Science, Cochrane Library, CINAHL, Embase, CNKI, Wanfang Database, VIP Database, and CBM Database up to February 1, 2024. Two researchers independently performed literature screening, data extraction, and methodological quality assessment using the Prediction Model Risk of bias (ROB) Assessment Tool. A total of 4869 studies were identified, from which 25 studies with 28 prediction models were ultimately included. The incidence of autogenous AVF failure in MHD patients ranged from 3.9% to 39%. The most commonly used predictors were age, vein diameter, history of diabetes, AVF blood flow, and sex. The reported area under the curve (AUC) ranged from 0.61 to 0.911. All studies were found to have a high ROB, primarily due to inappropriate data sources and a lack of rigorous reporting in the analysis domain. The pooled AUC of five validation models was 0.80 (95% confidence interval: 0.79-0.81), indicating good predictive accuracy. The included studies indicatedthat the predictive models for AVF failure post-formation in MHD patients are biased to some extent. Future research should focus on developing new models with larger sample sizes, strict adherence to reporting procedures, and external validation across multiple centers.

Additive-free preparation of hemodialysis membranes from silibinin-modified polysulfone polymer with enhanced performance in anti-oxidative stress and hemocompatibility

Oxidative stress is highly prevalent in maintenance hemodialysis patients and increases the risk of cardiovascular morbidity and mortality. Silibinin (SLB) is a plant extract with excellent antioxidant effects. The polymer of polysulfone (PSF) grafted SLB (PSF-g-SLB) was synthesized using a two-step approach, and the PSF-g-SLB membrane, a porogen-additive-free blood purification membranes made up of simply the polymer and solvent, was fabricated via the nonsolvent induced phase separation method. The results showed that, with increasing the grafting rate of PSF-g-SLB, the hydrophilicity, antioxidant properties, and the stability of free radical scavenging rate of the PSF-g-SLB membranes were improved. Furthermore, platelet-erythrocyte adhesion and hemolysis rate were decreased, and coagulation time was prolonged. The PSF-g-SLB membrane exhibits significant potential for being compatible with hemocompatibility, biocompatibility, and antioxidant properties. Therefore, the application of PSF-g-SLB membranes could alleviate oxidative stress in patients during hemodialysis.

Fear of falling and associated influencing factors in patients on maintenance hemodialysis.

This cross-sectional study analyzed the fear of falling (FOF) and associated influencing factors in patients undergoing maintenance hemodialysis (MHD). Patients on MHD (n = 131) were assessed using the short Falls Efficacy Scale International, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Perceived Social Support Scale, and Barthel Index questionnaires. The total FOF score was positively correlated with total anxiety and depression scores but negatively correlated with the total score of activities of daily living. There were significant differences in FOF among different age groups, employment status, the use of walkers, living arrangements (living alone), and having a history of falling in the past year. Age, employment status, history of falls in the past year, and anxiety score were significant risk factors for FOF in MHD patients. FOF in MHD patients is strongly associated with age, employment status, history of falls in the past year, and anxiety level.

The Role of Zinc Supplementation in Alleviating Inflammatory Biomarkers in Patients Undergoing Hemodialysis: A Randomized Placebo Controlled, Crossover Trial

Background: Chronic kidney disease (CKD), which progresses to end-stage renal disease (ESRD) and requires maintenance hemodialysis (MHD), is a global health issue. Inflammation in MHD patients is associated with increased mortality and cardiovascular events. Zinc, essential for immune function and possessing anti-inflammatory properties, is frequently deficient in these patients and could potentially help mitigate inflammation. Objectives: This study aims to assess the impact of zinc supplementation on inflammatory biomarkers, specifically (CRP) and the neutrophil-to-lymphocyte ratio (NLR), in MHD patients. Methods: In a double-blind, randomized controlled crossover trial conducted at Labafinejad Hospital, Tehran, MHD patients with zinc deficiency were initially allocated to either a zinc supplementation group or a placebo group. After 30 days, the groups were crossed over, with patients initially receiving zinc now receiving a placebo and vice versa. The primary outcome was changes in serum zinc levels, while secondary outcomes focused on CRP and NLR levels. Results: Significant changes in serum zinc levels were observed in both groups from baseline to Month 2 (drug-placebo group: Mean change -15.9±10.33 µg/dL, P &lt; 0.05; placebo-drug group: Mean change -14.70 ± 12.58 µg/dL, P &lt; 0.05). A significant initial reduction in CRP levels at Month 1 (P = 0.045) was not sustained at Month 2 (P = 0.812). No statistically significant changes in NLR were noted. Improvements in quality of life, including reductions in muscle pain and skin dryness, were significant in the drug-placebo group (P &lt; 0.05). Conclusions: Zinc supplementation in MHD patients significantly improved serum zinc levels and initially reduced CRP levels, highlighting its potential role in managing inflammation. Although the impact on NLR was not significant, overall patient outcomes and quality of life showed promising improvements.

HEPATITIS C VIRUS AND LEUKEMIA PATIENTS: PREVALENCE AND RISK FACTORS ASSOCIATED WITH INFECTION AMONG LEUKEMIA PATIENTS WHO ACHIEVE LONG-TERM REMISSION AFTER CHEMOTHERAPY

Aim and objective: Leukemia patients are at elevated risk of hepatitis C virus infections, with anti-HCV prevalence ranging from 4.3% to 70% post-chemotherapy remission. Long-term leukemia survivors' natural histories are unclear. We measured anti-HCV antibodies to investigate the frequency of HCV infections and the associated odds factors of contracting HCV among leukemia patients who achieved long-term remissions after chemotherapy. Methods: This study is a cross-sectional study, comprising leukemia patients at the oncology center at Kuwait Hospital in Sana'a, Yemen. It included people with leukemia of different ages and genders. Data was collected through a standard questionnaire prepared for this study, which includes clinical symptoms, risk factors, demographic data, and the results of diagnostic tests. Antibody tests for the hepatitis C virus (HCV) were done by ELISA. Results: The majority of patients with HCV are male, with a mean age of 12.8 years. The prevalence is 5.5%, with males having a higher prevalence. Most patients receive blood transfusions more than twice, with major blood banks, Al-Kuwait hospitals, and private hospitals being the primary sources. AML and ALL are the two most common leukemias. Male patients have a higher risk, and those over 15 years old have a higher risk. Conclusions: This study is the first in Yemen to investigate the prevalence of HCV infections in patients with leukemia. According to our research, leukemia patients had a greater prevalence of HCV than the general population's national prevalence. However, health care workers (HCWs) and patients receiving maintenance hemodialysis (HD) patients have prevalence's of HCV that are comparable. Peer Review History: Received 14 May 2024; Reviewed 13 July 2024; Accepted 22 August; Available online 15 September 2024 Academic Editor: Dr. DANIYAN Oluwatoyin Michael, Obafemi Awolowo University, ILE-IFE, Nigeria, toyinpharm@gmail.com Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. Tamer Elhabibi, Suez Canal University, Egypt, tamer_hassan@pharm.suez.edu.eg Dr. George Zhu, Tehran University of Medical Sciences, Tehran, Iran, sansan4240732@163.com

The current status and influencing factors of oral frailty in elderly maintenance hemodialysis patients based on the Andersen Oral Health Outcome Model

ObjectivesTo analyse the elements that influence oral frailty in elderly maintenance hemodialysis patients and to comprehend the present state of this condition.MethodsA survey of 325 elderly maintenance hemodialysis patients from three hospitals in Huzhou City was conducted using a general information questionnaire, the Oral Health Assessment Tool, the Knowledge, Attitude, and Practice of Oral Health Questionnaire, the Social Frailty, the Frail Scale, and the Oral Frailty Index.ResultsIn elderly maintenance hemodialysis patients, the prevalence of oral frailty was 45.2%. Factors influencing it include the Oral Health Knowledge Score (OR = 0.84, 95% CI 0.72–0.98), Oral Health Behavior Score (OR = 0.95, 95% CI 0.92–0.98), insufficient dialysis (OR = 0.30, 95% CI 0.14–0.63), social frailty (OR = 3.72, 95% CI 1.57–8.83), physical frailty (OR = 3.12, 95% CI 1.55–6.30), number of missing teeth (OR = 1.09, 95% CI 1.03–1.15), swallowing abnormalities (OR = 2.84, 95% CI 1.26–6.38), and oral health scores (OR = 1.34, 95% CI 1.14–1.57) (P < 0.05).ConclusionPatients on elderly maintenance hemodialysis are more susceptible to oral frailty. Nursing staff should develop scientifically sound, effective, and targeted oral management strategies for these patients.

Association of the panimmune-inflammatory value (PIV) with all-cause and cardiovascular mortality in maintenance hemodialysis patients: a propensity score matching retrospective study.

The panimmune-inflammatory value (PIV) is a novel inflammatory indicator. However, its role in maintenance hemodialysis (MHD) remains unclear. Our goal was to explore the predictive value of PIV for cardiovascular and all-cause mortality in MHD patients. In this retrospective cohort study, 507 patients receiving MHD between November 2017 and December 2022 were enrolled. The PIV value was calculated as follows: neutrophil count × monocyte count × platelet count/lymphocyte count. Patients were divided into two groups on the basis of the median PIV. Propensity score matching (PSM) was used to adjust for imbalances in baseline information between groups. Kaplan‒Meier curves, Cox regression, the Fine‒Gray competing risk model, and restricted cubic spline (RCS) curves were used to analyze the relationship between PIV and mortality. By the end of follow-up, 126 deaths had occurred, 91 of which were due to cardiovascular disease. The Kaplan‒Meier curves demonstrated that MHD patients with higher PIV levels had a poorer prognosis for all-cause death (p = 0.019). PIV levels were linked to all-cause death in multivariate Cox proportional risk regression (HR = 1.76; 95% CI 1.14, 2.72; p = 0.011). The Fine‒Gray model revealed a greater cumulative incidence of cardiovascular death in the higher PIV group (p = 0.035). PIV levels were linked to cardiovascular mortality in the Fine‒Gray competing risk model (HR = 2.06; 95% CI 1.25, 3.42; p = 0.005). The RCS revealed a nonlinear relationship between PIV and mortality risk (p < 0.05). Using 63years of age as the threshold, we observed a multiplicative interaction effect between age and PIV for all-cause mortality (p = 0.006). In MHD patients, PIV is an independent hazard factor for cardiovascular-related mortality and all-cause mortality.

Sarcopenia is associated with increased major adverse cardiovascular event incidence in maintenance hemodialysis patients: a prospective cohort study and mediation analysis.

Few studies have investigated the relationship between sarcopenia and the incidence of major adverse cardiovascular events (MACE), which are common complications in maintenance hemodialysis (MHD) patients. This study thus explored the association between sarcopenia and MACE in a prospective cohort with mediation analysis. Adult MHD patients in Jiangdu People's Hospital in December 2019 were screened. The exposure was sarcopenia, as defined by the 2019 Asian Working Group. The primary endpoint was the occurrence of MACE, defined as the composite of all-cause mortality or hospital admission with a primary diagnosis of acute myocardial infarction, stroke, or heart failure during a 3-year follow-up period. Multivariate Cox regression analyses were used to test the association between sarcopenia and subsequent MACE incidence. Mediation analyses were used to investigate whether potential mediators influenced the association between sarcopenia and MACE. Of the 230 patients enrolled, 57% were male, with a median age of 57 years (interquartile range [IQR]: 50 to 66), and a median dialysis vintage of 67 months (IQR: 32 to 119). The prevalence of sarcopenia was 45.2%. The presence of sarcopenia was significantly correlated with age (Spearman's r = 0.47, p < 0.001), C-reactive protein (Spearman's r = 0.13, p = 0.044), serum albumin (Spearman's r = -0.22, p < 0.001), 25(OH) vitamin D (Spearman's r = -0.26, p < 0.001), and coronary artery calcification score (Spearman's r = 0.20, p = 0.002). Over the 3-year follow-up period, MACE were observed in 59/104 (56.7%) patients with sarcopenia and 38/126 (30.2%) patients without sarcopenia (log-rank p < 0.001). After accounting for potential confounders, patients with sarcopenia presented a 66% (4-168%, p = 0.035) increase in their risk of MACE incidence as compared to non-sarcopenic individuals. However, adjusted mediation analyses did not detect any indication of a causal mediation pathway linking the effects of sarcopenic status on coronary artery calcification score, C-reactive protein, serum albumin, or 25(OH) vitamin D levels to MACE outcomes. Conversely, sarcopenia exhibited a potential direct effect (average direct effect range: -1.52 to -1.37, all p < 0.05) on MACE incidence. These results revealed that the presence of sarcopenia was associated with a higher incidence of MACE in MHD patients. The putative effects of sarcopenia on this cardiovascular endpoint are possibly not mediated by any causal pathways that include vascular calcification, inflammation, hypoalbuminemia, or vitamin D.

Prevalence and risk factors of long COVID among maintenance hemodialysis patients post SARS‐CoV‐2 infection: A one‐year follow‐up study in China

AbstractPatients undergoing maintenance hemodialysis (MHD) are a high‐risk group susceptible to SARS‐CoV‐2 infection and long‐COVID syndrome appearance. However, there is limited and unclear evidence for long COVID in MHD patients. We collected the general information, symptoms, signs and laboratory indices of 366 MHD patients infected with COVID‐19 and conducted 12 months follow‐up with a series of questionnaires. As a result, 285 MHD patients had long COVID, with the most common symptoms were fatigue (84.69%) and muscle weakness (72.45%). Mobility problem (p &lt; 0.001), anxiety/depression (p = 0.002) and breathlessness (p &lt; 0.001) were more prevalent in long COVID patients than in non‐long COVID patients. Persistent long COVID people were more likely to report all domains problems of the EQ‐5D‐5L. Age, female, inadequate dialysis (Kt/V &lt; 1.2), coagulation abnormalities (d‐dimer &gt; 1 mg/L) and more comorbidities were risk factors for the development of long COVID. In addition to these factors, elevated inflammatory markers (CRP &gt; 10 mg/L) represent an extra risk factor for the persistence of long COVID symptoms in MHD patients. And more than 80% of long COVID symptoms would resolve after 1 year in MHD patients, of which the sixth month after COVID‐19 infection is a critical turning point. In conclusion, more than 68% of MHD patients have long COVID, which has a poor impact on their health status and quality of life. These risk factors for the development and persistence of long COVID deserve the attention of clinicians.

Development and Validation of a Nomogram Model for Accurately Predicting Depression in Maintenance Hemodialysis Patients: A Multicenter Cross-Sectional Study in China.

Depression is a major concern in maintenance hemodialysis. However, given the elusive nature of its risk factors and the redundant nature of existing assessment forms for judging depression, further research is necessary. Therefore, this study was devoted to exploring the risk factors for depression in maintenance hemodialysis patients and to developing and validating a predictive model for assessing depression in maintenance hemodialysis patients. This cross-sectional study was conducted from May 2022 to December 2022, and we recruited maintenance hemodialysis patients from a multicentre hemodialysis centre. Risk factors were identified by Lasso regression analysis and a Nomogram model was developed to predict depressed patients on maintenance hemodialysis. The predictive accuracy of the model was assessed by ROC curves, area under the ROC (AUC), consistency index (C-index), and calibration curves, and its applicability in clinical practice was evaluated using decision curves (DCA). A total of 175 maintenance hemodialysis patients were included in this study, and cases were randomised into a training set of 148 and a validation set of 27 (split ratio 8.5:1.5), with a depression prevalence of 29.1%. Based on age, employment, albumin, and blood uric acid, a predictive map of depression was created, and in the training set, the nomogram had an AUC of 0.7918, a sensitivity of 61.9%, and a specificity of 89.2%. In the validation set, the nomogram had an AUC of 0.810, a sensitivity of 100%, and a specificity of 61.1%. The bootstrap-based internal validation showed a c-index of 0.792, while the calibration curve showed a strong correlation between actual and predicted depression risk. Decision curve analysis (DCA) results indicated that the predictive model was clinically useful. The nomogram constructed in this study can be used to identify depression conditions in vulnerable groups quickly, practically and reliably.

Trajectories and influencing factors of psychological resilience among Chinese patients with maintenance hemodialysis

ObjectiveTo identify distinct trajectories of psychological resilience among Chinese patients with maintenance hemodialysis, explore influencing factors and inform the formulation of corresponding interventions. MethodsThis was a multi-center longitudinal study with a 6-month follow-up. With convenience sampling, a total of 231 patients with maintenance hemodialysis were recruited between September 2020 and July 2021. Patients’ characteristics, including sociodemographic information, social support and family resilience was collected through structured questionnaires as potential baseline influencing factors of psychological resilience trajectories. Psychological resilience was evaluated using the 25-item Chinese version of the Conner and Davidson resilience scale. Latent class growth modeling was conducted to identify homogeneous subgroups with distinct trajectories of psychological resilience. Univariable and multinomial logistic regression analysis were used to examine whether baseline influencing factors were associated with trajectories in patients with maintenance hemodialysis. ResultsFive distinct psychological resilience trajectory groups were identified: declining group (n = 20, 8.7 %), rising group (n = 17, 7.4 %), moderate-stable group (n = 128, 55.4 %), high-stable group (n = 7, 3.0 %) and low-stable group (n = 59, 25.5 %). High-stable group and moderate-stable group were combined into the well-psychological resilience group for multinomial logistic regression analysis. The multinomial logistic regression analysis showed that influencing factors associated with trajectories of psychological resilience were age, religion, monthly household income per capita, and baseline family resilience. ConclusionsThe results highlight the heterogeneity in the development of psychological resilience among Chinese patients with maintenance hemodialysis. There is a need for healthcare professionals to screen for trajectories of psychological resilience in Chinese maintenance hemodialysis patients and prepare individual mental healthcare interventions.

Accuracy of Continuous Glucose Monitoring in Hemodialysis Patients With Diabetes.

In the general population, continuous glucose monitoring (CGM) provides convenient and less-invasive glucose measurements than conventional self-monitored blood glucose and results in reduced hypoglycemia and hyperglycemia and increased time in target glucose range. However, accuracy of CGM versus blood glucose is not well established in hemodialysis patients. Among 31 maintenance hemodialysis patients with diabetes hospitalized from October 2020 to May 2021, we conducted protocolized glucose measurements using Dexcom G6 CGM versus blood glucose, with the latter measured before each meal and at night, plus every 30-min during hemodialysis. We examined CGM-blood glucose correlations and agreement between CGM versus blood glucose using Bland-Altman plots, percentage of agreement, mean and median absolute relative differences (ARDs), and consensus error grids. Pearson and Spearman correlations for averaged CGM versus blood glucose levels were 0.84 and 0.79, respectively; Bland-Altman showed the mean difference between CGM and blood glucose was ∼+15 mg/dL. Agreement rates using %20/20 criteria were 48.7%, 47.2%, and 50.2% during the overall, hemodialysis, and nonhemodialysis periods, respectively. Mean ARD (MARD) was ∼20% across all time periods; median ARD was 19.4% during the overall period and was slightly lower during nonhemodialysis (18.2%) versus hemodialysis periods (22.0%). Consensus error grids showed nearly all CGM values were in clinically acceptable zones A (no harm) and B (unlikely to cause significant harm). In hemodialysis patients with diabetes, although MARD values were higher than traditional optimal analytic performance thresholds, error grids showed nearly all CGM values were in clinically acceptable zones. Further studies are needed to determine whether CGM improves outcomes in hemodialysis patients.

Factors affecting the oral health of patients on maintenance hemodialysis and recommendations for standardized nursing care: a multicenter study.

To determine the oral health status of patients on maintenance hemodialysis and to identify the factors influencing their oral health. This observational study included 1,186 patients with chronic kidney disease who received maintenance hemodialysis across 33 hospitals in China. The patients were recruited for a questionnaire survey between April and August 2023 at Beijing Chaoyang Hospital using stratified sampling. Data collection tools included the General Information Questionnaire for Maintenance Hemodialysis Patients, the Oral Health Assessment Tool, the Pittsburgh Sleep Quality Index, and the Hospital Anxiety and Depression Scale. Spearman rank correlation coefficients were used to assess the relationships between the oral health of patients on maintenance hemodialysis and continuous variables such as sleep quality and emotional status. Multiple linear regression analysis was employed to explore the relationship between oral health and various variables. The oral health scores of the patients ranged from 8 to 22, with a mean score of 12.54 ± 2.63. The final model of the multiple linear regression analysis indicated a goodness of fit of 22.19%. Independent factors affecting the oral health of patients included smoking, the proportion of medical expenses, water consumption, sleep quality, and anxiety scores (all P .05). High levels of smoking, substantial medical expenses, poor sleep quality, and elevated anxiety scores were risk factors for poor oral health (all P .05). Adequate daily water intake served as a protective factor for oral health (P .05). This study proposes targeted interventions to enhance the management and improvement of oral health in patients on hemodialysis, aiming to provide highly personalized and effective oral health care. These interventions are expected to improve oral health outcomes in future clinical practice.