Maintenance Hemodialysis Research Articles

The correlation between protein energy wasting and the incidence of main adverse cardiovascular events in adult maintenance hemodialysis patients: a single-center retrospective cohort study

Background Protein energy wasting (PEW) is prevalent in adult maintenance hemodialysis (MHD) patients. Concurrently, cardiovascular diseases (CVD) remain a leading cause of mortality in MHD patients. However, the relationship between PEW and CVD in MHD patients remains unclear. Methods We conducted a retrospective cohort study at Shanghai East Hospital. According to the inclusion and exclusion criteria, a total of 210 adult MHD patients were finally enrolled. Patients were categorized into two groups based on PEW diagnostic criteria, including 122 patients (58.1%) with PEW and 88 patients (41.9%) without PEW. We further analyzed the incidence of major adverse cardiovascular events (MACE) and all-cause mortality in one year, along with their risk factors. Results MACE incidence was significantly higher in the PEW group compared with the non-PEW group (p = 0.015). Multivariate Cox regression showed PEW, CVD, high N-terminal pro-B-type natriuretic peptide (NT-proBNP) and low Kt/V urea were the risk factors of MACE. Age ≥ 65 years and high NT-proBNP were the risk factors of all-cause death. Among patients aged ≥ 65 years, PEW was associated with a higher risk of all-cause death (p = 0.043). Total cholesterol < 3.4 mmol/L, albumin < 38 g/L and prealbumin < 280 mg/L were the thresholds for MACE incidence in MHD patients with PEW. Conclusion Adult MHD patients with PEW had an increased risk of MACE and all-cause mortality. Strategies aimed at optimizing total cholesterol, albumin, and prealbumin levels may improve cardiovascular outcomes in adult MHD patients with PEW.

Hyperkalaemia among hospital admissions: prevalence, risk factors, treatment and impact on length of stay

BackgroundHyperkalaemia is one of the common electrolyte disorders among hospital patients, affected by many risk factors including medications and medical conditions. Prompt treatment is important given its impact on patient mortality and morbidity, which can lead to negative patient outcomes and healthcare resource utilisation. This study aims to describe the prevalence, characteristics, and treatment of patients admitted to hospitals with hyperkalaemia and compare findings between patients with kidney failure on maintenance haemodialysis therapy and patients without kidney failure. It also aims to identify associations between hyperkalaemia and hospital length of stay.MethodsWe undertook a retrospective cohort study on adult patients admitted to Townsville University Hospital between 1st January 2018 and 31st December 2022 (n = 99,047). Patients were included if they had a serum potassium result of 5.1 mmol/L and above during their admission/s. Statistical analysis was conducted using several methods. A Welch’s t test and Chi-square test were employed to assess differences between groups of patients with kidney failure on maintenance haemodialysis therapy and those without kidney failure. For comparison among multiple groups with varying severities of hyperkalaemia, the Kruskal-Wallis test with Mann-Whitney U test and logistic regression were used.Results8,775 hyperkalaemic patients were included in the study, with a mean age of 64.7 years. The prevalence of hyperkalaemia was 8.9% of patients. Risk factors for hyperkalaemia were highly prevalent among those who had the condition during their admissions. Patients with kidney failure on haemodialysis who had hyperkalaemia were, on average, 6 years younger, more often Indigenous, and experienced more severe hyperkalaemia compared to other patients without kidney failure. There was a notable difference in hyperkalaemia treatment between groups with varying degrees of hyperkalaemia severity. Hyperkalaemia was not found to be associated with prolonged hospital stay.ConclusionHyperkalaemia is common among hospital admissions. Patients with kidney failure on haemodialysis are at higher risk of developing severe hyperkalaemia. Treatment for hyperkalaemia was variable and likely insufficient. Timely detection and treatment of hyperkalaemia is recommended.

Skeletal Muscle Measurements Based on Abdominal Computerized Tomography (CT) Predict Risk of Osteoporosis in Incident Hemodialysis Patients

Objective: Osteoporosis is prevalent in patients with chronic kidney disease (CKD), with risk increasing as CKD progresses, subsequently elevating fracture risk. While previous studies have shown a link between low skeletal muscle mass and osteoporosis in the general population, there is limited research exploring this relationship in patients with advanced CKD (stages 3-5D). This study aimed to evaluate whether skeletal muscle area (SMA), as measured by abdominal CT, is correlated with bone mineral density (BMD) in advanced CKD patients beginning hemodialysis. Methods: This single-center, retrospective cohort study included patients who started maintenance hemodialysis at Daejeon St. Mary’s Hospital from January 2018 to September 2021. Patients who underwent abdominal CT and BMD assessments within three months of dialysis initiation were enrolled, resulting in a sample of 87 individuals. Baseline characteristics were analyzed, with patients stratified by sex and SMA quartiles. Pearson’s correlation and multivariate regression analyses were conducted to the relationship between SMA and BMD T-scores. Results: The study cohort had an average age of 65.4 years, with 52.9% of participants being male. Male patients exhibited significantly higher SMA and BMD T-scores in both the lumbar spine and femur compared to female patients. SMA showed the strongest positive correlation with BMD at both sites (lumbar spine, r = 0.424; femur, r = 0.514; p &lt; 0.001). Multivariate analysis identified SMA as an independent positive predictor of BMD, while alkaline phosphatase (ALP) was independently associated with lower femur BMD. In the SMA-based subgroup analysis, patients with lower SMA had significantly lower BMD T-scores and a higher risk of osteoporosis. Logistic regression indicated that patients in the lowest SMA quartile had substantially increased odds of osteoporosis compared to those in the highest quartile, with an adjusted odds ratio of 30.59 (p = 0.008). Conclusions: Lower skeletal muscle mass is significantly associated with lower bone density and a higher risk of osteoporosis in advanced CKD patients initiating hemodialysis. SMA, as measured by abdominal CT, may serve as a useful marker for identifying patients at elevated osteoporosis risk in this population.

Adequacy of Hemodialysis Assessed in CKD-ESRD Patients using Urea Reduction Rate and Single-Pool Kt/V.

Introduction: Chronic kidney disease and end stage renal disease (ESRD) are major cause of morbidity and mortality. Renal replacement treatment in the form of hemodialysis, peritoneal dialysis or renal transplantation are the treatment of choice to ESRD. Hemodialysis has been the most preferred modality of treatment for sustaining the life of patients with end-stage kidney disease. Achieving adequacy in hemodialysis is a major challenge in treating these patients. Inadequate dialysis will result in high mortality. This study aimed to find out the mean value of the urea reduction ratio and Kt/V in fifty session of hemodialysis in 4 patients undergoing hemodialysis at a tertiary care centre. Methods: This was a prospective open labelled, controlled study design conducted over 3 month. Patients aged &gt;18 years, undergoing maintenance hemodialysis were included in the study. Urea reduction rate and single-pool Kt/V were estimated. Statistical analysis: All data pertinent to the patients are obtained and the analysis of efficacy in terms of dialysis dose, urea reduction ratio (URR) and Kt/V were analysed using the Student’s paired T test, with a p &lt;= 0.05 will be considered statistically significant. Results: Among fifty session of hemodialysis done for four hours through AV fistula the mean urea reduction ratio and standard deviation in the study was 62.49% and 9.7 respectively. Single pool Kt/V mean and standard deviation was 1.22 and 0.2 respectively Conclusions: URR was little lower and Kt/V was optimal as per standard guidelines. Hence estimating URR and Kt/V gives the evidence of adequacy of hemodialysis in addition to clinical assessment and thus helps in reducing morbidity and mortality in these patients. Keywords: chronic kidney disease (CKD), End stage renal disease (ESRD), hemodialysis, urea reduction ratio (URR) and Kt/V.

Elevated HIF-1α levels in maintenance hemodialysis patients: a potential link to increased cognitive impairment risk

IntroductionIn China, an increasing number of patients with end-stage renal disease are undergoing hemodialysis treatment. While this treatment yields relatively positive outcomes, the prevalence of cognitive impairment in patients receiving maintenance hemodialysis ranges from 24 to 80%, which is significantly higher than the general population.MethodIn this retrospective study, a total of 120 patients with kidney disease undergoing maintenance hemodialysis (MHD) were enrolled. The cognitive status of these patients was assessed using the C-MoCA score, which allowed categorization into two groups: the no cognitive impairment (NCI) group and the cognitive impairment (CI) group. Relevant clinical data, laboratory test results, as well as HIF-1α levels, were collected and analyzed to determine their relationship with the cognitive status of the patients.ResultsIn this study, a total of 45 patients (37.5%) developed CI, and their C-MoCA scores were significantly lower (21.6 ± 2.43) compared to patients in the NCI group (27.56 ± 1.48) (P &amp;lt; 0.001). The CI group was characterized by older age, lower levels of education, as well as lower levels of serum total bilirubin, serum total protein (TP), albumin, serum creatinine, and serum phosphorus in comparison to the NCI group. Additionally, CI patients exhibited higher levels of HIF-1α, received fewer monthly hemodiafiltration or hemoperfusion treatments, and had a lower rate of rosacastat treatment. Furthermore, univariate and multivariate logistic regression analyses demonstrated that older age (OR = 11.266 [95% CI: 2.775–45.747], P = 0.001) and higher HIF-1α (OR = 20.654 [4.831–88.298], P &amp;lt; 0.001) increased the risk of developing CI, while higher educational attainment reduced the risk of developing CI (&amp;gt; 12 years, OR = 0.004 [95% CI: 0.016–0.619], P≤0.001; 6–12 years, OR = 0.099 [95% CI: 0.000–0.049], P = 0.013).DiscussionCognitive impairment in patients undergoing maintenance hemodialysis (MHD) was found to be associated with older age, lower level of education, and higher HIF-1α levels. These factors should be taken into consideration by clinicians to monitor the cognitive status of MHD patients.

Endovascular intravascular intervention for central venous stenosis in maintenance hemodialysis patients: a retrospective observational study

BackgroundThe number of people undergoing maintenance hemodialysis is increasing rapidly worldwide. Central vein stenosis (CVS) is a common vascular complication in undergoing hemodialysis, especially those with a history of catheterization. This study aimed to investigate the characteristics of CVS and the clinical effectiveness of percutaneous transluminal angioplasty (PTA) alone and sequential percutaneous transluminal stenting (PTS) in hemodialysis patients with CVS.MethodsA retrospective analysis of 26 cases of endovascular intervention for CVS using PTA alone or sequential PTS was performed. The characteristics of CVS and the clinical effectiveness of these procedures were evaluated.ResultsThis study included 26 hemodialysis patients who presented with symptomatic CVS. Of these 26 patients, 53.85% were male, and their mean age was approximately 54.96 years. All the patients had a history of catheter placement or pacemaker implantation. The incidence of brachiocephalic vein stenosis was significantly higher than that of subclavian vein stenosis (46.16% vs. 26.92%). Based on the degree of stenosis and elastic retraction, these patients were administered PTA alone or sequential PTS. There was no difference in patient age, hemodialysis time, catheter retention time, or stenosis length between the PTA alone and sequential PTS groups. However, the degree of venous stenosis in the PTS group was more severe than that in the PTA alone group. The primary patency rates in the sequential PTS and PTA alone groups were 94.12% and 100% at 3 months; 88.24% and 88.89% at 6 months; 75.00% and 85.71% at 9 months; and 66.67% and 71.43% at 12 months, respectively. It is worth noting that for 7 patients with complete occlusion of the brachiocephalic vein, we used sharp recanalization technology and stenting placement, with patency rates of 85.71% and 71.43% at 6 and 12 months, respectively.ConclusionsPTA alone is recommended for patients with less than 50% central venous elastic retraction, while sequential PTS is recommended for patients with ≥ 50% central venous elastic retraction. PTA and PTS are safe and effective methods for the treatment of CVS in patients undergoing hemodialysis.

Anemia, iron metabolism, and anemia medication habits in patients undergoing maintenance hemodialysis and peritoneal dialysis are different: a multicenter investigation.

This study aimed to investigate anemia, iron metabolism status, and treatment in patients undergoing maintenance hemodialysis (HD) and peritoneal dialysis (PD). Patients aged ≥ 18years undergoing HD and PD were surveyed using a case report form to collect information. Data were collected from 1071 patients undergoing HD and 630 undergoing PD at eight centers. Anemia was observed in 96.2% of the patients (96.7% for HD vs. 95.2% for PD, P = 0.121). Of these, 38.3% had hemoglobin (Hb) levels between 110 and 130g/L (41.2% for HD vs. 33.3% for PD, P < 0.001), 22.8% had absolute iron deficiency (ID) (31.2% for HD vs. 8.4% for PD, P < 0.001), and 5.8% had functional ID (4.7% for HD vs. 7.6% for PD, P = 0.012). Among patients with Hb < 110g/L, 13.0% received no treatment with erythropoiesis-stimulating agents (ESAs, all recombinant human erythropoietin) or hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHI, all roxadustat) (12.6% for HD vs. 13.6% for PD, P = 0.667), while 64.6% had no iron treatment (69.4% for HD vs. 57.4% for PD, P < 0.001). Logistic regression was used to explore the relationship between dialysis mode and hemoglobin target achievement, suggesting that the attainment of hemoglobin targets may be associated with the use of ESAs or HIF-PHI. Anemia, iron metabolism, and medication habits have distinct characteristics in patients undergoing HD and PD. Iron deficiency is prevalent, and achieving hemoglobin targets is suboptimal, possibly influenced by the administration of ESAs or HIF-PHI. Therefore, timely adjustments of medication habits are necessary to prevent anemia exacerbation.

Surgical vs. conservative treatment for hip osteoporotic fracture in maintenance hemodialysis patients: a retrospective analysis.

HSip Osteoporotic fractures are common complications with high mortality in patients undergoing maintenance hemodialysis (MHD). It remains unclear whether surgical or conservative should be adopted for hip fractures in MHD patients. A retrospective analysis was conducted in Tianjin Hospital of Tianjin University from August 2019 to August 2023. A total of 43 MHD patients with hip fracture were included, with 30 cases in the surgical group and 13 cases in the conservative group. The differences in cumulative survival rates, time to first ambulation, Harris score, Barthel index, and incidence of complications were compared. The surgical group had remarkable lower mortality rates as compared with the conservative group at 1, 2, 3, 6, 12, 24 months (13.33 VS. 38.46%, 26.67 VS. 53.85%, 26.67 VS. 53.85%, 26.67 VS. 61.54%, 26.67 VS. 61.54%, and 26.67 VS. 69.23%). In the surgical treatment group, the first ambulation time was reduced to 28 (26) days, which was superior to the conservative group (134.17 ± 43.18 days, P < 0.001). The Harris score at 1 month (61.50 ± 4.10) and the Barthel index at 3 months (95, 11.25) were also significantly higher (P < 0.001). Furthermore, the surgical group had a significantly lower overall incidence of complications (60.00 vs. 92.31%, P = 0.034). The risk of death and complications of surgical treatment was only 23.0 and 32.4% of conservative treatment in MHD patients with hip fracture. Surgical treatment is effective and safe and should be the first choice for hip fracture in MHD patients.

Adverse Outcomes After Tunneled Dialysis Catheter-Related Bloodstream Infections-Too Dark at the End of This Tunnel?

Tunneled dialysis catheters (TDCs) are preferred over temporary noncuffed catheters for access in patients on maintenance hemodialysis. The removal of TDC after catheter-related blood stream infections (CRBSIs) is often not practiced even when indicated, and the adverse outcomes after such salvage are presently unclear. The study aimed to evaluate adverse outcomes after the first episode of definite or probable CRBSI. The composite adverse outcome was recorded as the presence of at least one of three adverse outcomes-death in the index hospital admission, occurrence of recurrent bacteremia, and death within 3 months. During the study period, the TDC CRBSI incidence rate was 6.9/1000 catheter days. Of the 110 study participants, majority were male (63%), with a median age of 35 years, belonging to rural (56%) and agrarian (39%) communities, and 66% were getting dialyzed at stand-alone dialysis units. Gram-negative infections predominated (64%), with 37% of isolates showing resistance to carbapenems. Catheter salvage was practiced in 80%, and immediate catheter removal was done only in the sickest of patients (in seven of eight with in-hospital mortality). Predictors of composite adverse outcomes included sites other than right internal jugular vein (OR 3.6) and resistance to β lactam-β lactamase inhibitors (OR 16.2). At a median follow-up of 7 months, all survivors at 3 months were alive and 46% had recurrent TDC CRBSIs. Up to one-half of patients with end-stage kidney disease experienced composite adverse outcomes after the first episode of TDC CRBSI, with infection-related 3-month mortality of 15%. Clinical trial number: CTRI/2023/10/058556.

Adapting a pain coping skills training intervention for people with chronic pain receiving maintenance hemodialysis for end stage Kidney disease.

Pain Coping Skills Training (PCST) is a first-line cognitive-behavioral, non-pharmacological treatment for chronic pain and comorbid symptoms. PCST has been shown to be effective in racially and ethnically diverse cohorts across several chronic medical conditions. However, PCST has not been evaluated in those with end stage kidney disease (ESKD) receiving in-center maintenance hemodialysis. Due to the high rates of morbidity associated with ESKD, and time-intensive treatment, an adaptation of PCST was warranted to address the unique challenges experienced by people living with ESKD. Using current guidelines developed by Card and colleagues for intervention adaptation, PCST was adapted so that it could be implemented among people living with ESKD in a national multisite trial. The objective of this paper was to describe the adaption process outlined by Card and colleagues including how the team selected an effective intervention to adapt, developed a program model, identified mismatches in the original intervention and study population, and then adapted the intervention for those with ESKD treated with in-center maintenance hemodialysis. Finally, we briefly describe future directions for clinical practice and research with the adapted PCST intervention for those with ESKD.Trial registration: ClinicalTrials.gov #NCT04571619.

Handgrip strength is independently associated with physical quality of life in patients undergoing maintenance hemodialysis: a cross-sectional study.

We aimed to identify the association between Health-related quality of life (HRQoL) and muscle strength in patients undergoing maintenance hemodialysis (MHD). In this cross-sectional study from March 2021 to December 2021, 110 MHD patients with a mean age of 63.9 ± 13.0 years and a median dialysis vintage of 25.5 (12.0-52.3) months, were enrolled at a hemodialysis center in Guangzhou city, China. HRQoL was assessed using the Short Form 36 Health Survey (SF-36) and converted into the Physical Component Summary (PCS) and the Mental Component Summary (MCS). The groups were assigned according to the mean score of PCS and MCS, and those with higher PCS/MCS scores (high-PCS/MCS) were compared with those with lower PCS/MCS scores (low-PCS/MCS). Independent factors were evaluated using multivariate analysis. Muscle strength was estimated by handgrip strength (HGS). The mean HGS was 23.7 ± 9.60 kg in men and 14.3 ± 5.30 kg in women. Compared to the high-PCS group, the low-PCS group had older age, higher levels of creatinine, total cholesterol, high-sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6), and had lower HGS (all p < 0.05). After adjusting for confounding factors in different models, the five-model multivariate binary logistic regression analyses revealed that HGS was the only independent factor in PCS domain, but not in MCS. HGS may be an independent factor of poor HRQoL in MHD patients, particularly in relation to physical health. The management of muscle strength may improve the HRQoL in MHD patients. The study was registered at https://www.chictr.org.cn/ as ChiCTR2100053790.

Mediating Role of Psychological Resilience Between Depression and Quality of Life in Maintenance Hemodialysis Patients in Baoding City, China: A Cross-Sectional Study.

Patients with end-stage renal disease (ESRD) are at an increased risk for emotional issues, with depression being the most prevalent psychological concern, significantly impacting their quality of life. This study aimed to explore the mediating effect of psychological resilience on the relationship between depression and quality of life in maintenance hemodialysis (MHD) patients. This cross-sectional study aimed to explore the mediating effect of psychological resilience on the relationship between depression and quality of life in MHD patients in Baoding, China. Conducted from January 2024 to July 2024, the study involved a questionnaire survey of 215 MHD patients across five hospitals in Baoding. Data were collected using General information questionnaire, Hemodialysis Patient Depression Scale, Psychological Resilience Scale, and Quality of Life Scale, and structural equation modeling using AMOS 21.0 was employed to analyze the mediating effect. The scores for depression, psychological resilience, and quality of life in these MHD patients were 9.37±4.6, 30.58±6.1, and 59.48±9.3, respectively. Depression had a negative correlation with quality of life, while psychological resilience had a positive correlation with quality of life (with correlation coefficients of -0.453 and 0.578, respectively, all P<0.01). Psychological resilience played a mediating role in the relationship between depression and quality of life (β=-0.13, P<0.05), with the mediating effect analysis showing a significant indirect effect of depression on quality of life. The direct and indirect effects of depression on quality of life were -0.34 and -0.13, respectively, with a total effect of -0.47. The mediating effect accounted for 27.7% of the total effect. Interpretation: PHQ-9 scores range from 0 to 27, with higher scores indicating more severe depressive symptoms. CD-RISC scores range from 0 to 100, with higher scores reflecting greater psychological resilience. SF-12 scores range from 0 to 100, with higher scores indicating a better quality of life. Depression, psychological resilience, and quality of life in MHD patients were at a moderately low level. Depression in MHD patients can indirectly affect their quality of life through psychological resilience, suggesting that healthcare professionals should take measures to reduce depression levels, enhance psychological resilience, and ultimately improve the quality of life for these patients. Psychological resilience was identified as a significant mediator in this relationship, highlighting its potential as a target for interventions aimed at improving the mental well-being and quality of life of MHD patients. These results underscore the importance of integrating psychological support into the care of MHD patients.

The expression profile analysis and functional prediction of lncRNAs in peripheral blood mononuclear cells in maintenance hemodialysis patients developing heart failure

Heart failure (HF) is the leading cause of death in patients with maintenance hemodialysis (MHD). Biomarkers has an important guiding role in the early diagnosis, risk stratification, and prognostic assessment of HF. Increasing studies have indicated that long non-coding RNAs (lncRNAs) have played an indispensable role in the regulatory network of HF. This study was aiming to explore the expression profiles of lncRNAs in patients treated with MHD developing heart failure. Peripheral blood mononuclear cells were isolated from 4 hemodialysis patients with reduced ejection fraction (HFrEF) and 4 hemodialysis patients with preserved ejection fraction (HFpEF), respectively. The expression profile analysis of lncRNAs was performed by using Illumina Novaseq 6000 sequencer. Quantitative real time polymerase chain reaction (qRT-PCR) was used to verify the expression of representative differentially expressed lncRNAs. Based on lncRNA-miRNA-mRNA-KEGG network analysis, the potential role of candidate lncRNAs and their association with the severity of HF were further evaluated. In total, 1,429 differentially expressed lncRNAs were found between patients with HFrEF and patients with HFpEF, of which 613 were up-regulated and 816 were down-regulated (P < 0.05). Five candidate lncRNAs were screened out by a series of bioinformatic analyses. After being compared with miRBase, ENST00000561762, one of the 5 candidates, was considered the most likely lncRNA to be serving as a precursor for miRNA. Nine predicted target genes were found by further lncRNA-miRNA-mRNA-KEGG network analysis, and among which ITGB5 was enriched in the actin dynamics signaling pathway. In another cohort of hemodialysis patients, the expression of lncRNA ENST00000561762 was verified by qRT-PCR. Further analysis revealed that there was a strong correlation between left ventricular ejection fraction and ENST00000561762, proBNP, and 6-minute walk distance, respectively. LncRNAs expression profile was remarkably different in hemodialysis patients with HFrEF compared to those with HFpEF. Among which, lncRNA ENST00000561762 was considered as a promising biomarker for patients with HFrEF as it was predicted to be a miRNA precursor to regulate the actin dynamics signaling pathway.

A 32-Year-Old Man C-ANCA Vasculitis Having Sudden Onset Blindness Due To Non-Proliferative Retinopathy and Exudative Maculopathy Treated Successfully with Intravitreal Injection of Bevacizumab: A Rare Case Report

The patient was a 32-year-old doctor known case of c-ANCA positive vasculitis developed sudden onset blurring vision on his left eye. Visual acuity was 6/12 right eye and 6/18 on left eye. Ophthalmic examination revealed exudative maculopathy with non-proliferative retinopathy on both eye; severe on left side. He was treated successfully with three dose of monthly intravitreal bevacizumab injections. He was on corticosteroids for pauci-immune glomerulonephritis and maintenance hemodialysis as a renal replacement therapy.

Association of Secondary Hyperparathyroidism and Hyperkalemia in Hemodialysis-dependent Chronic Kidney Disease Patients

Abstract Introduction: Hyperparathyroidism secondary to chronic renal failure is a condition characterized by increased secretion of parathyroid hormone (PTH), secondary to hyperphosphatemia and hypocalcemia. In dialysis patients’ hyperkalemia is a frequent electrolyte disturbance that may result in various complications. Objectives: The study aimed to determine the association of secondary hyperparathyroidism (SHPTH) with hyperkalemia in hemodialysis patients. There is very little literature on the direct relationship of hyperparathyroidism with hyperkalemia. Materials and Methods: This is an observational study of hemodialysis patients visiting a university hospital for maintenance hemodialysis. Patients were randomly selected for the study who were visiting the Department of Nephrology for their regular maintenance hemodialysis program. Serum PTH analysis was done by chemiluminescence method. Serum potassium &gt;5.5 mEq/L was considered hyperkalemia, and serum intact PTH (iPTH) &gt;300 pg/mL was considered as SHPTH. Results: The study included 59 participants from dialysis-dependent chronic kidney disease patients. In this study, 64.4% of the participants were male and 35.6% were female. The mean age of the study group was 47.64 ± 13.042 years. 44.1% of the participants had hyperkalemia, and 43.1% of the participants had SHPTH. 89.7% of the patients with SHPTH had hyperkalemia. The mean serum potassium in the iPTH ≤300 pg/mL group was 4.50 mEq/L. The mean serum potassium in the iPTH &gt;300 pg/mL group was 6.33 mEq/L. 90.9% of the participants in the group iPTH: ≤300 pg/mL had serum potassium: ≤5.5 mEq/L while 88.0% of the participants in the group iPTH: &gt;300 pg/mL had serum potassium: &gt;5.5 mEq/L. There was a strong positive correlation between iPTH and serum potassium, and this correlation was statistically significant (rho = 0.72, P ≤ 0.001). Conclusion: The present study shows a statistically significant association of iPTH (SHPTH) and serum potassium (hyperkalemia), and high iPTH is positively associated with hyperkalemia.

Intradialytic Hypertension in Maintenance Hemodialysis.

To summarize the current evidence regarding epidemiology, clinical pathophysiology, and latest therapeutic approaches for the management of intradialytic hypertension (IDH). IDH is a rather common complication of dialysis, affecting 10-15% of the patient population and significantly increasing the cardiovascular risk. Its pathophysiology involves multiple mechanisms, including volume and sodium overload, sympathetic nervous system (SNS) and renin-angiotensin-aldosterone system (RAAS) overactivity, endothelial dysfunction, and arterial stiffness. IDH management requires a combination of nonpharmacological and pharmacological interventions. The first mainly focus on volume control through dry weight optimization and modification of dialysate sodium, as studies show that strict volume control or low dialysate sodium can significantly reduce intradialytic and ambulatory blood pressure (BP). Pharmacological interventions have also been examined in research studies. Beta-blockers, particularly those with vasodilatory properties, can effectively target mechanisms such as SNS overactivity and endothelial dysfunction, and have shown some promising results reducing both intradialytic and ambulatory BP. Other drugs classes have also been explored as potential therapeutic options for IDH management, though further research is needed to clarify the efficacy of these interventions. A tailored approach addressing both the underlying pathophysiological mechanisms and individualized patient is warranted for improving BP control and cardiovascular outcomes in this high-risk population.

Cephalic to jugular vein bypass surgery of subclavian vein stenosis for arteriovenous fistula salvage in maintenance hemodialysis patients.

Ipsilateral subclavian vein stenosis in a well-functioning upper extremity arteriovenous fistula (AVF) is a significant factor contributing to AVF failure and sometimes swelling of ipsilateral upper extremity. Graft bypass surgery can alleviate outflow tract stenosis in upper extremity AVF, restore function, and efficiently relieve arm swelling. The present study aimed to evaluate patency and postoperative complications after cephalic to jugular graft bypass surgery in patients with upper extremity AVF failure or upper extremity swelling on the same side of the AVF resulting from ipsilateral subclavian vein stenosis. Five patients with upper extremity AVF and ipsilateral subclavian vein stenosis undergoing maintenance hemodialysis were included. Three patients had AVF dysfunction, while two experienced swelling of the arm due to high venous pressure in the AVF. The surgical procedure involved creating a subcutaneous tunnel in the shoulder to connect a 6 mm polytetrafluorethylene (PTFE) graft, from either near the fistula site (n = 3) or at the mid-upper arm cephalic vein (n = 2), to the jugular vein. Graft bypass surgery was successful, and all patients were able to resume hemodialysis postoperatively. Upper extremity edema improved, without any postoperative wound infections, non-healing wounds, steal syndrome, or high-flow AVF leading to heart failure as a complication. Five to 19 months after surgery, the bypass grafts exhibited a primary patency rate of 100%, and vascular access fulfilled the requirements for hemodialysis. Cephalic to jugular vein bypass surgery for upper extremity AVF with ipsilateral subclavian vein stenosis effectively preserved function of the original fistula, and was associated with few postoperative complications.

Self-compassion in patients undergoing haemodialysis: A qualitative study.

Patients undergoing haemodialysis require long-term treatment and suffer from physical limitations and emotional distress due to restrictions in daily life, such as food and fluid restrictions, which can lead to self-criticism and depression. To address these issues, the concept of self-compassion, which is important for patients undergoing haemodialysis, has gained attention. This study aimed to identify self-compassion in patients undergoing haemodialysis. This is an interview-based qualitative study. Participants were recruited from a regional general hospital in Japan between August and September 2022. They were ≥18-year-old patients with diabetes and chronic kidney disease and visited the hospital for maintenance haemodialysis. Fifteen patients who agreed to participate in the study were interviewed. Semistructured interviews were conducted, and each interview was recorded and transcribed verbatim. Data analysis was conducted using reflecxive thematic analysis (TA). Thematic analysis generated three themes-acceptance, affirmation, and reinvention-from the seven subthemes. A different concept, "reinvention", has been generated in this study. Regarding the sequential nature of the themes, it was predicted that they would proceed in the order of acceptance, affirmation, and reinvention, moving back and forth through these stages. It can be said that nurses can support patients undergoing haemodialysis by providing feedback to them about their thoughts and feelings, which were captured based on the themes and subthemes of this study, to promote the patients' awareness and increase their self-compassion.

Protein-Energy Malnutrition and Its Progression in Dialysis Patients in West Delhi Centre: A Prospective Study

Background: There is a high prevalence of protein-energy malnutrition in patients with chronic renal failure who are undergoing maintenance hemodialysis. Apart from this the pathogenic mechanisms of malnutrition are complex and involve an interplay of multiple pathophysiologic alterations including decreased appetite, decreased nutrient intake and dialysis related abnormalities. Methods: The study subjects were patients of CKD 5 (MHD) of age 18 to 60 years enrolled from Anjuman Medical centre in West Delhi. Total 30 subjects (15 males and 15 females) were enrolled from Dialysis centre and their basic demographic profile socio economic status, dietary habits and physical activity details were recorded. Dietary nutrient (calories, protein, fats, carbohydrates, sodium, potassium, phosphorus and fluid) was calculated by Diet Cal version 10.0 software using a 3-day dietary recall and analysed was done using SPSS software version 21.0. Nutritional status were measured at baseline , 2 months and 3 months. Knowledge, Attitude, practice and Quality of life also recorded at 1 month and at 3 months after nutritional counselling. Results: The average BMI, weight, and height of males were (24.2 kg/m2, 67.6 kg, and 166 cm) and females were (22.2 kg/m2, 54.8 kg, and 158 cm) respectively. Blood pressure was 129±13 systolic and 79±10 mmHg diastolic. 23.3% had pallor, and 60% of patients were moderate and 33.3% were severely malnutrition. Handgrip was 21.7±6.9 kg. Protein intake changed from 52±15.9 to 73.2±11.4 in males and 47.8±50.4 to 57.0±13.7g in females after three months of the study. And energy improved from 1477±333 to 2253±494 in males and 1201±255 to 2106±346 kcal in females. Similarly, fat and phosphorus intake improved from 49.2±37.9 to 56.5±17.9 (p&gt;0.080) and 728.9±287.7 to 1160.0±290.1 (p&gt;0.000) respectively. While KAP was (8.5±2.0, 75.3±10.6 and 25.8±2.3) respectively and QoL also improved from 27.0±4.0 to 30.9±2.7 after 3 months of the study. Conclusion: After 3 months of study, QoL and KAP significantly improved. Further, there were significant changes in intake of energy, protein and phosphorus in all dialysis patients. In nutritional status weight, MUAC and handgrip showed significant increase result. Blood pressure, pallor and MIS score also improved.

Relationships between dyadic coping, marital adjustment, and post-traumatic growth in patients with maintenance hemodialysis patients and their spouses.

To measure the relationships between dyadic coping, marital adjustment, and post-traumatic growth in patients with maintenance hemodialysis and their spouses. Post-traumatic growth is common in patients facing maintenance hemodialysis. However, studies tend to focus on these patients as individuals rather than as part of a couple. Dyadic coping in a couple is important for their marital adjustment; however, little is known about how a couple's dyadic coping influences their marital adjustment and impacts their posttraumatic growth. Cross-sectional study. A questionnaire survey was conducted among patients receiving maintenance hemodialysis and their spouses. Patients were recruited between December 2021 and October 2022 using convenience sampling from the blood purification centers of two first-class tertiary hospitals. A total of 230 couples (460 individuals) of patients receiving maintenance hemodialysis and their spouses were enrolled. A general condition questionnaire, the dyadic coping scale, and the Locke-Wallace marital adjustment scale were used for assessments and data entry and analysis were performed using EpiData 3.1, SPSS 25.0, and Mplus 8.4. The dyadic coping of patients receiving maintenance hemodialysis was positively correlated with both marital adjustment and posttraumatic growth, as was the dyadic coping of their spouses. The marital adjustment of both patients and their spouses was found to partially mediate the association between dyadic coping and posttraumatic growth. Subject-mediated effects between the levels of dyadic coping, marital adjustment, and posttraumatic growth were established for both patients receiving maintenance hemodialysis and their spouses, and it was found that the marital adjustment in both showed varying degrees of mediation in the relationship between their dyadic coping and posttraumatic growth. The findings of the study suggest that attention should be given to promoting dyadic coping behaviors in patients receiving maintenance hemodialysis and their spouses. It is recommended that nurses offer both education and support to couples to promote dyadic coping.