Maintenance Hemodialysis Patients Research Articles

C-Reactive Protein-to-Serum Chloride Ratio: A Novel Marker of All-Cause Mortality in Maintenance Haemodialysis Patients

Background and Objectives: hypochloremia is an emerging risk factor for mortality in patients with chronic kidney disease. The pathophysiological mechanisms of this finding are not very clear. Some studies suggest the influence of inflammation as a synergistic factor, so we set out to analyse the association of a novel C-reactive protein-to-serum chloride ratio (CRP/Cl−) with the prognosis of maintenance haemodialysis patients and to assess its relationship with fluid status and body composition measured by bioimpedance. Materials and Methods: the present work is a retrospective cohort study of maintenance haemodialysis patients from our chronic outpatient haemodialysis programme between 1 January 2022 and 31 December 2022. (n = 281). Survival time was collected for all patients and analysed using the Kaplan–Meier method. A Cox proportional hazards regression model was used to evaluate survival probabilities. Variables included in the model were selected using a stepwise selection procedure based on the corrected Akaike information criterion (AICc), which balances model fit and complexity. Results: during a median follow-up of 306 days, 34 patients died. Patients in the fourth quartile of the CRP/Cl− (>0.118 mg/mEq) had higher overall mortality (log-rank test, p = 0.0011). In the Cox multivariate analysis, the variables significantly associated with higher mortality were higher modified Charlson index (MCI), lower body surface area (BSA), lower interdialytic weight gain (IDWG), and higher CRP/Cl− ratio. The latter variable was independently associated with higher overall mortality (adjusted hazard ratio = 1.027; 95% confidence interval [CI], 1.000–1.055 p = 0.0469). Conclusions: Higher CRP/Cl− ratio values were associated with higher all-cause mortality in our maintenance haemodialysis patients.

The Effect of Seated Baduanjin Exercise on Psychological State, Fatigue Symptoms, and Quality of Life in Maintenance Hemodialysis Patients

Objective: To evaluate the intervention effects of seated Baduanjin exercise on patients undergoing maintenance hemodialysis (MHD). Methods: A total of 108 MHD patients admitted between July 2022 and July 2023 were selected. They were randomly assigned into two groups: the experimental group, with 55 patients, who received seated Baduanjin exercise combined with leg exercises during dialysis; and the control group, with 53 patients, who only performed leg exercises during dialysis. The psychological state, fatigue symptoms, quality of life, and sleep quality scores were compared between the two groups, and exercise endurance was recorded. Results: After the intervention, the psychological state scores in the experimental group were lower than those in the control group, the fatigue symptom scores were lower, the quality of life scores were higher, the sleep quality scores were lower, and the exercise endurance was higher (P < 0.05). Conclusion: Seated Baduanjin exercise can improve the negative psychological state and fatigue symptoms of MHD patients, enhance their quality of life and sleep quality, and effectively increase their exercise endurance.

Inflammation response index (SIRI) is associated with all-cause and cardiovascular mortality in maintenance hemodialysis patients

IntroductionThe aim of this study was to investigate the association between inflammation response index (SIRI) on all-cause and cardiovascular (CVD) mortality in maintenance hemodialysis (MHD) patients.Material and methods371 MHD patients were included in this retrospective study. Time-dependent receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of SIRI. Patients were categorized into two groups based on the median value of SIRI. Kaplan-Meier survival analysis was used to compare the difference in survival rate. Cox regression analysis was used to analyze all-cause and CVD mortality risk factors, and nomograms were established.ResultsThe average age of the patients was (60.71±15.34), and the median follow-up was 42 months. 157 patients died. SIRI had a predictive value for all-cause and CVD mortality. The AUC of the SIRI to predict the all-cause mortality was 0.698, 0.664, 0.713, and 0.900 at 1, 3, 5, and 10 years, respectively. For CVD mortality, the AUC of the SIRI was 0.678, 0.667, 0.717, and 0.906 at 1, 3, 5, and 10 years, respectively. Kaplan-Meier survival analysis showed that patients with high SIRI levels show a significantly lower survival rate. Multivariate Cox regression analysis showed that SIRI > 1.88 was an independent risk factor for all-cause and CVD mortality.ConclusionsSIRI can independently predict all-cause and CVD mortality in MHD patients, which has important value for prognosis.

Correlation Between Symptom Clusters and Self-Management Among Maintenance Haemodialysis Patients: A Cross-Sectional Study.

The purpose of this study was to explore the relationship between symptom clusters and self-management among maintenance haemodialysis (MHD) patients. MHD patients experience disease progression and multiple symptom burdens that severely impact quality of life, and self-management of symptoms may significantly improve patient-reported outcomes. A cross-sectional study. This cross-sectional descriptive study included 194 patients undergoing MHD. The patients were assessed using the Dialysis Symptom Index (DSI) and the Haemodialysis Self-Management Instrument (HD-SMI). We used descriptive analysis, exploratory factor analysis, Pearson's correlation analysis and linear regression analysis to examine (1) the level of individual self-management, (2) the presence of symptom clusters by symptom severity and (3) the correlation between symptom clusters and self-management behaviours. This study was conducted in accordance with the STROBE checklist. The top five most severe symptoms among the patients were itching, feeling tired or lack of energy, difficulty sleeping, dry mouth and dry skin. We identified five groups of symptoms: (1) poor sleep, (2) neuromuscular, (3) gastrointestinal, (4) skin irritation and (5) psychological. In the present study, MHD patients reported low to moderate levels of self-management behaviours (50.84 ± 10.56), and low self-management ability was correlated with greater severity of the five symptom clusters (p < 0.01). Linear regression analysis revealed that all five symptom clusters were included in the regression equation, explaining 30% of the total variance in self-management skills among MHD patients. Enhanced awareness of symptom clusters and comprehensive symptom management are necessary to improve patients' quality of life. Nursing practices should incorporate comprehensive symptom assessments to help patients develop effective self-management strategies to improve quality of life.

Maintenance hemodialysis patients participate in a virtual reality rehabilitation training experience: a qualitative study

Maintenance hemodialysis patients’ psychology and physiology will have negative effects. Adherence to exercise can effectively enhance the physical function of maintenance hemodialysis patients and reduce the negative psychological emotions. In recent years, virtual reality technology has been gradually applied to the hemodialysis group, providing a new way for the rehabilitation training and healthy life of maintenance hemodialysis patients. Objectives To understand the real experience of maintenance hemodialysis patients participating in virtual reality rehabilitation training, and to make reference for the future clinical development of a more perfect virtual reality rehabilitation training program. Metchods Phenomenological research method was used to conduct semi-structured interviews with 10 maintenance hemodialysis patients, and the interview data were compiled and analyzed using Colaizzi’s seven-step analysis. Results Four themes were distilled: (1) Maintenance hemodialysis patients’ overall perceptual experience of the virtual reality rehabilitation system; (2) Physical and psychological improvement of maintenance hemodialysis patients with virtual reality rehabilitation system; (3) Individualized needs of maintenance hemodialysis patients during virtual reality rehabilitation training; (4) Future improvements and recommendations for the virtual reality rehabilitation system. Conclusion The results of the study suggest that virtual reality improves patients’ motivation to recover and shows positive results and potential benefits in improving physical functioning and negative emotions in maintenance hemodialysis patients.

Effect of hemodiafiltration and hemodialysis on mortality of patients with end-stage kidney disease: a meta-analysis

IntroductionPrevious randomized controlled trials (RCTs) and meta-analyses comparing Hemodiafiltration (HDF) with conventional hemodialysis (HD) on the effectiveness of HDF for mortality in end-stage renal disease (ESRD) patients have yielded contrasting results. Importantly, we sought to compile the available information to provide the most up-to-date and reliable evidence.MethodsWe systematically searched PubMed, Embase and Cochrane Library for RCTs up to January 14, 2024. Review Manager 5.3 software was used to analyze relevant data and evaluate the quality of evidence.ResultsOur study involved 10 randomized controlled trials with 4654 chronic dialysis patients. Compared to hemodialysis, hemodiafiltration demonstrated a reduction in all-cause mortality (relative risk [RR] 0.84, 95% confidence intervals [CI] 0.72–0.99, P = 0.04) and cardiovascular mortality (RR 0.74, 95% CI 0.61–0.90, P = 0.002). However, it did not reduce the rate of sudden death (RR 0.92, 95% CI 0.64–1.34, P = 0.68) and infection-related mortality (RR 0.70, 95% CI 0.47–1.03, P = 0.07). A subgroup analysis revealed that HDF demonstrated superiority over high-flux hemodialysis in terms of all-cause mortality, while not over low-flux hemodialysis (RR 0.81, 95% CI 0.69–0.96, P = 0.01; RR 0.93, 95% CI 0.77–1.12, P = 0.44, respectively). Furthermore, a subgroup analysis for convection volume found that hemodiafiltration with a convection volume of 22 L or more reduced all-cause and cardiovascular mortality (RR 0.76, 95% CI 0.65–0.88, P = 0.0002, RR 0.73, 95% CI 0.54–0.94, P = 0.01, respectively).ConclusionIn maintenance hemodialysis patients, hemodiafiltration can reduce mortality compared to conventional hemodialysis. Furthermore, this effect is more pronounced in HDF with high convection volume.

Knowledge, attitude, and practice regarding Sarcopenia in maintenance hemodialysis patients in Northeastern China.

Sarcopenia is a severe complication affecting patients receiving hemodialysis (HD) treatment over an extended period of time. This cross-sectional study assessed knowledge, attitude, and practice (KAP) towards sarcopenia among maintenance HD patients in Northeastern China between 13 December 2023 and 13 January 2024. A total of 752 questionnaires were collected. Multivariate logistic regression showed that completed high school or vocational secondary school, college or bachelor's degree, and maintenance HD lasting ≥ 11 years were independently associated with proactive practice. The Structural equation modeling (SEM) showed that knowledge directly affected attitude and practice. Moreover, attitude directly affects practice. Maintenance HD patients showed inadequate knowledge, positive attitude, and proactive practice towards sarcopenia. Healthcare providers should focus on educational campaigns to increase patient awareness of sarcopenia, its risk factors, and preventive measures.

Association between trace elements and cognitive function among hemodialysis patients in Turkey.

Cognitive impairment is common among patients with hemodialysis. Hemodialysis patients have theoretical risks for both deficiency and accumulation of trace elements. We aimed to investigate the relationship between cognitive dysfunction and whole blood levels of trace elements in hemodialysis patients. We also aimed to examine the effect of baseline trace element status and cognitive dysfunction on mortality. Maintenance hemodialysis patients and age-and sex-matched controls were included. The whole blood levels of trace elements were measured by inductively coupled plasma mass spectrometry. Cognitive impairment was defined as a score of ≤24 points on the Montreal Cognitive Assessment test. Executive dysfunction was also defined as Trails A score of more than 75 s and Trails B score of more than 180 s. Forty-two patients and 35 controls were included. Cognitive impairment was detected in 69% of the patients and 45.7% of the controls (p = 0.039). Cognitively impaired patients had lower education years (p = 0.003) and higher whole blood levels of manganese (Mn) and lead (Pb) (p = 0.026, p = 0.019, respectively) compared to patients without cognitive impairment. Mn levels were also found statistically higher in patients with executive dysfunction compared to patients without executive dysfunction (p = 0.005). Lower education years and higher Pb levels were independent risk factors for cognitive impairment in hemodialysis patients (odds ratio [OR] 0.589 [95% confidence interval, CI 0.400-0.866, p = 0.007] and OR 1.047 [95% CI 1.001-1.096, p = 0.047, respectively]). Cognitive impairment, especially impaired executive function, is common among patients with hemodialysis patients. Cognitive impairment is not found to be associated in cross-sectional analysis with several modifiable end-stage renal disease- and dialysis-associated factors. The accumulation of trace elements especially Mn and Pb might exacerbate the cognitive dysfunction in hemodialysis patients.

Bioelectrical impedance analysis–derived phase angle predicts possible Sarcopenia in patients on maintenance hemodialysis: a retrospective study

BackgroundThe prevalence of possible sarcopenia is notably high among maintenance hemodialysis (MHD) patients. Possible sarcopenia, defined as a decrease in muscle strength and/or somatic function, is an early and reversible condition between non-sarcopenic and sarcopenia, and early recognition and intervention for possible sarcopenia is important for preventing adverse outcomes and improving the quality of life of these patients. This study aimed to establish a simple and effective model for screening and identifying MHD patients at high risk of possible sarcopenia by using 50 kHz-Whole Body Phase Angle (PhA), with a specific focus on gender differences.MethodsThis prospective cross-sectional study was conducted from September to December 2023 at the Wenjiang Hemodialysis Center in the Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China. A total of 244 MHD patients, including 130 males and 114 females, were enrolled. Data were collected prospectively, including demographic information and physical measurements. All participants provided informed consent before enrollment. Measurements were taken post-dialysis to ensure consistency. The whole-body phase angle was measured using the InBody S10 device, grip strength was measured using an electronic grip strength tester, and physical function was assessed by the Short Physical Performance Battery (SPPB). The Skeletal Muscle Index (SMI) was also calculated.ResultsA total of 244 patients receiving hemodialysis were enrolled in this study. Among these, 109 patients were categorized as non-sarcopenic, 111 as having possible sarcopenia, and 24 as sarcopenic. The prevalence of sarcopenia among MHD patients is 9.8%, while the prevalence of possible sarcopenia is 45.5%. The receiver operating characteristic (ROC) curve analysis showed that for male patients, the AUC of PhA for predicting possible sarcopenia was 0.798, with a sensitivity of 80.36%, specificity of 69.70%, and a cutoff value of 6.20°. For female patients, the AUC of PhA was 0.701, with a sensitivity of 70.91% and specificity of 62.79%, and a cutoff value of 5.70°.ConclusionsPhA may be a useful and simple predictor of the risk of possible sarcopenia in MHD patients, and more research is needed to further promote the use of PhA in possible sarcopenia.

Investigating the complex relationship and influencing factors of frailty on nutritional status in maintenance hemodialysis patients.

Given the high prevalence and significant challenges of frailty, a state of increased vulnerability to adverse health outcomes, among maintenance hemodialysis (MHD) patients, this cross-sectional study aimed to investigate its prevalence and explore its association with nutritional status and other relevant factors. The study involved 290 MHD patients with an average age of 52.98 ± 13.65 years. Frailty assessments, nutritional evaluations, and medical status measurements were performed. Data analysis involved descriptive statistics, correlation analyses, and multivariate logistic regression. Among the patients, 70.3% were identified with frailty (16.9% frail, 53.4% pre-frail). Frailty was more prevalent in female patients compared to males and correlated positively with age, marital status, caregiving needs, comorbidities, dialysis duration, and higher nutritional risk scores. Negative correlations were observed with serum albumin, hemoglobin, body weight, and height. A significant prevalence of frailty was found in MHD patients, with notable associations to various demographic, clinical, and nutritional factors.

Association between dietary fatty acids and depressive symptoms in Chinese haemodialysis patients: a cross-sectional study.

Depression is highly prevalent in haemodialysis patients, and diet might play an important role. Therefore, we conducted this cross-sectional study to determine the association between dietary fatty acids (FA) consumption and the prevalence of depression in maintenance haemodialysis (MHD) patients. Dietary intake was assessed using a validated FFQ between December 2021 and January 2022. The daily intake of dietary FA was categorised into three groups, and the lowest tertile was used as the reference category. Depression was assessed using the Patient Health Questionnaire-9. Logistic regression and restricted cubic spline (RCS) models were applied to assess the relationship between dietary FA intake and the prevalence of depression. As a result, after adjustment for potential confounders, a higher intake of total FA [odds ratio (OR)T3 vs. T1 = 1·59, 95 % confidence interval (CI) = 1·04, 2·46] and saturated fatty acids (SFA)(ORT3 vs. T1 = 1·83, 95 % CI = 1·19, 2·84) was associated with a higher prevalence of depressive symptoms. Significant positive linear trends were also observed (P < 0·05) except for SFA intake. Similarly, the prevalence of depression in MHD patients increasedby 20% (OR = 1.20, 95% CI = 1.01-1.43)foreach standard deviation increment in SFA intake. RCS analysis indicated an inverse U-shaped correlation between SFA and depression (P nonlinear > 0·05). Additionally, the sensitivity analysis produced similar results. Furthermore, no statistically significant association was observed in the subgroup analysis with significant interaction. In conclusion, higher total dietary FA and SFA were positively associated with depressive symptoms among MHD patients. These findings inform future research exploring potential mechanism underlying the association between dietary FA and depressive symptoms in MHD patients.

Microarray analysis of microRNA profiles for assessing the therapeutic effects of sodium thiosulfate on end-stage renal disease combined with coronary artery calcification.

Coronary artery calcification (CAC) is a common complication in patients with end-stage renal disease (ESRD), which causes of increased cardiovascular mortality in maintenance hemodialysis patients. This study examined how sodium thiosulfate (STS) treatment affects the microRNA (miRNA) expression profiles of ESRD patients combined with CAC. A total of 18 patients with ESRD complicated with CAC were assigned to a control group that received conservative treatment or a test group that received STS treatment. The 2 groups were then sub-divided into a CGBT group (control group before treatment), TGBT group (test group before treatment), CGAT group (control group after treatment), and TGAT group (test group after treatment). Samples of peripheral venous blood were collected for analysis of biochemical indexes (hs-CRP, ALB, CHO, TG, Ca, P, BUN, Cr, bALP, iPTH, and FGF23) and used to screen for differentially expressed miRNAs that were displayed by hierarchical clustering and in a volcano plot. The functional roles of miRNA target genes were analyzed by Gene Ontology and Kyoto Encycolopedia of Genes and Genomes pathway analyses. Several miRNAs in serum samples were identified using quantitative real time PCR. STS treatment did not significantly change the biochemical indexes. A microarray analysis identified 67 miRNAs that were differentially expressed in the TGAT group vs. the TGBT group, and 28 -miRNAs that were differentially expressed in the CGAT group vs. the CGBT group. The miRNA target genes were associated with signal transduction, transcriptional regulation, cytoplasm and protein binding processes, the MAPK signaling pathway, PI3K-Akt signaling pathway, and various pathways in cancer. Validation experiments confirmed the suppressive effect of STS treatment on miR-337-5p/miR-409-5p expression and the promotive effect of STS on miR-376a-3p expression. MiR-337-5p/miR-409-5p/miR-376a-3p might be key regulators involved with the therapeutic effects of STS treatment in ESRD patients associated with arterial calcification.

Construction of frailty and risk prediction models in maintenance hemodialysis patients: a cross-sectional study.

As the prevalence of diabetic nephropathy and hypertensive nephropathy increases with age in mainland China, the number of patients with end-stage renal disease is increasing, leading to an increase in the number of patients receiving maintenance hemodialysis. Considering the harmful effects of frailty on the health of maintenance hemodialysis patients, this study aims to identify hemodialysis patients at risk for frailty at an early stage, in order to prevent or delay the progression of frailty in the early stage, so as to prevent the adverse consequences of frailty. A total of 479 patients admitted to the blood purification centers of two grade tertiary hospitals in Anhui Province, China, using convenient sampling. The Frailty Scale, the SARC-F questionnaire, the Simplified Food Appetite Questionnaire (SNAQ) and the mini nutritional assessment short-form (MNA-SF) were used in the study. Pearson correlation analysis was used to explore the correlation among the frailty influencing factors. The incidence of frailty was 24.0% among 479 Chinese hemodialysis patients. Gender (p < 0.05), Malnutrition (p < 0.001), sarcopenia (p < 0.001), and feel tired after dialysis (p < 0.001) were highly correlated with frailty in Chinese hemodialysis patients. Serum albumin concentration (p < 0.05) was a protective factor of frailty. This survey shows that frailty was highly prevalent among Chinese hemodialysis patients. Medical staff and their families should make early judgments and carry out interventions on the risk of frailty.

Association between uric acid and cognitive function in maintenance hemodialysis patient

Background: Chronic kidney disease (CKD) is an independent risk factor for cognitive dysfunction. Hyperuricemia is prevalent in CKD patients and has been associated with cognitive dysfunction. Hyperuricemia has been associated with an increased risk for cerebral microvascular disease. Aims and Objectives: The study aimed to evaluate the association between uric acid level and cognitive function in maintenance hemodialysis patients. Materials and Methods: The study was conducted on 90 maintenance hemodialysis patients. Serum uric acid (sUA) level was measured in patients on maintenance hemodialysis and cognitive performance was assessed by the Standardized Mini-Mental State Examination score. Results: There was a significant association between sUA level and cognitive function in hemodialysis patients. Patient with higher sUA levels was found to have poor cognitive function (P&lt;0.05). There was a significant negative correlation between sUA and cognitive function which revealed an increase in sUA will decrease the cognitive function (P&lt;0.05). In our study, there was a significant association between sUA and cognitive function in hemodialysis patients. Patients with hyperuricemia had poor cognitive function. Conclusion: In our study, there was a significant association between sUA and cognitive function in hemodialysis patients. Patients with hyperuricemia had poor cognitive function.

Combinatorial lipidomics and proteomics underscore erythrocyte lipid membrane aberrations in the development of adverse cardio-cerebrovascular complications in maintenance hemodialysis patients.

Patients on maintenance hemodialysis exhibit a notably higher risk of cardio-cerebrovascular complications that constitute the major cause of death. Preceding studies have reported conflicting associations between traditional lipid measures and clinical outcome in dialysis patients. In this prospective longitudinal study, we utilized quantitative lipidomics to elucidate, at molecular resolution, changes in lipidome profiles of erythrocyte and plasma samples collected from maintenance hemodialysis patients followed up for 86 months (≈ 7 years). Primary outcome was defined as cardiovascular-related deaths or new-onset cardio-cerebrovascular events. Cox regression model uncovered plasma/erythrocyte lipids associated with incident cardio-cerebrovascular events in the erythrocyte cohort (n=117 patients, 37 events) and plasma cohort (n= 45 patients, 11 events), respectively. Both the erythrocyte lipid panel [PA 40:5, PI 34:2, PC 42:6, AUC= 0.83] and plasma lipid panel [PC O-34:1, GM3 18:1;O2/25:0, TG 44:1(16:1_28:0), AUC = 0.94] significantly improved the prediction of cardio-cerebrovascular-related outcome compared to the base model comprising age, sex and dialysis vintage alone. Our findings underscore the pathophysiological significance of anionic phospholipid accretion in erythrocytes in the development of cardio-cerebrovascular complications in dialysis patients. In particular, distorted membrane lipid asymmetry leads to compromised membrane deformability, aberrant cell-cell interactions and altered glutathione metabolism in the erythrocytes of high-risk individuals even at relatively early stage of hemodialysis. Our findings thus underscore the importance of maintaining the RBC pool to lower the risk of cardio-cerebrovascular complications in dialysis patients.

The effect of reduced L-glutathione supplementation on TNF-α, hs-CRP, and neutrophil-lymphocyte ratio in maintenance hemodialysis patients.

Cardiovascular disease is the main cause of mortality in patients with chronic kidney disease stage 5 on dialysis (CKD-5D). High sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), and neutrophil-lymphocyte ratio (NLR) are several inflammatory parameters associated with high cardiovascular events in CKD-5D. The main aim of this study was to evaluate the effect of reduced L-glutathione supplementation on serum hs-CRP, TNF-α, and NLR in patients with CKD-5D. This study is a quasi-experimental research with one group pretest-posttest design. Subjects included were patients with CKD-5D who routinely underwent hemodialysis therapy two times a week in Hasan Sadikin General Hospital. Serum hs-CRP, TNF-α, and NLR levels were obtained before and after the intervention of reduced L-glutathione supplementation dosing of one thousand milligrams a day for four weeks. Statistical analysis was then conducted using the Wilcoxon test. There were 26 hemodialysis patients included in the study, with a median age of 43 years and a male predominance. There was a significant decrease in serum TNF-α level after reduced L-glutathione supplementation for 4 weeks, 5.40 (-10.80-0.00) pg/mL, p = 0.002. However, there was no statistically significant decrease in either serum hs-CRP level, 0.40 (-0.70-0.80) mg/L (p = 0.656), or NLR with a difference of 0.55 (0.30-1.00) p = 0.055. Exogenous oral reduced glutathione supplementation for four weeks significantly reduced TNF-α level, but no significant decrease in hs-CRP level and NLR in patients with CKD-5D.

Inflammatory Markers in Patients with ESKD on Maintenance Hemodialysis, Hemodiafiltration (HDF), and Early Postkidney Transplant Patients and Their Relation to Quality of Life (SGA Score)

Inflammatory Markers in Patients with ESKD on Maintenance Hemodialysis, Hemodiafiltration (HDF), and Early Postkidney Transplant Patients and Their Relation to Quality of Life (SGA Score)

Hemoperfusion Is Associated with Reduced Mortality in Outpatient Maintenance Hemodialysis Patients with COVID-19

Hemoperfusion Is Associated with Reduced Mortality in Outpatient Maintenance Hemodialysis Patients with COVID-19

Association of the modified creatinine index with quality of life in haemodialysis patients.

Aims/Background The evaluation of health-related quality of life in patients undergoing maintenance haemodialysis has garnered increasing attention. The modified creatinine index, a surrogate marker for muscle mass, has been linked to various clinical outcomes. However, the relationship between modified creatinine index and health-related quality of life in maintenance haemodialysis patients remains unclear. This study aims to elucidate the association between modified creatinine index and health-related quality of life in individuals receiving maintenance haemodialysis. Methods This cross-sectional study included 217 maintenance haemodialysis patients. Health-related quality of life was assessed using the Kidney Disease Quality of Life Instrument. Collected data included general patient information, laboratory results, and haemodialysis-related parameters. The modified creatinine index was calculated based on gender, age, single-pool Kt/V (spKt/V), and pre-dialysis serum creatinine levels. Multiple linear regression models and smooth curve fitting were used to investigate the relationship between modified creatinine index and health-related quality of life. Subgroup analyses and interaction tests were performed to identify potential effect modifiers. Results The 217 maintenance haemodialysis patients had a mean age of 53.66±13.15 years and a median dialysis vintage of 39 (25-84) months; 120 (55.30%) were male. The mean health-related quality of life score was 55.76±10.33, and the mean modified creatinine index was 22.72±2.95 mg/kg/day. After adjusting for confounding factors, an increase in modified creatinine index was associated with an improvement in health-related quality of life (β=0.55, 95% CI: 0.04, 1.06, p = 0.033). No nonlinear relationship was identified between modified creatinine index and health-related quality of life by smooth curve fitting. Subgroup and interaction analyses indicated that the relationship between modified creatinine index and health-related quality of life was stable and not significantly influenced by age, gender, dialysis vintage, diabetes status, or body mass index (p > 0.05). Conclusion Modified creatinine index is positively correlated with health-related quality of life in maintenance haemodialysis patients, suggesting its potential utility in evaluating patient quality of life. Modified creatinine index could be clinically useful to improve the predictability of health-related quality of life in maintenance haemodialysis patients.

Effect of a Multicomponent Intervention on Pre-Frailty Status Changes in Patients Undergoing Maintenance Hemodialysis: A Randomized Controlled Study.

Aims/Background Pre-frailty is common in patients undergoing maintenance hemodialysis (MHD). Without proper management, it can quickly worsen and progress into frailty, leading to various adverse clinical outcomes. Therefore, timely interventions for pre-frail MHD patients are crucial. However, the response of pre-frail MHD patients to such interventions is currently unclear. This study evaluated the effect of a multicomponent intervention on changes in pre-frailty status, risk factors for frailty, quality of life, and clinical outcomes in pre-frail patients undergoing MHD. Methods Sixty MHD patients were randomly assigned to intervention (received a 12-week multicomponent intervention) and control (received standard care) groups, with 30 participants per group, between February and May 2018. Data were collected at baseline and at 3 and 9 months thereafter. Analyzed outcomes included changes in pre-frailty status, frailty risk factors (such as albumin level, pain, and anxiety), quality of life, and clinical outcomes during the follow-up period. Results Data from a total of 58 MHD patients were collected at three time points. At week 12, frailty scores were 0.9 points lower in the intervention group compared to the control group (p = 0.007). The intervention group showed a 26.2% higher proportion of patients who improved from pre-frailty to non-frailty compared to the control group (p = 0.029), and a 25.9% lower proportion of patients who progressed from pre-frailty to frailty (p = 0.021). Additionally, improvements in albumin levels, pain, anxiety, and quality of life were more significant in the intervention group (all p < 0.05). Although there were fewer incidents of falls and rehospitalizations in the intervention group during follow-up, these differences did not reach statistical significance (all p > 0.05). Conclusion This study validates the effectiveness and practicality of a multicomponent intervention in improving pre-frailty status, frailty risk factors, and quality of life in patients undergoing MHD. Clinical Trial Registration Chinese Clinical Trial Registry (ChiCTR-IOR-17012176).