Maintenance Hemodialysis Therapy Research Articles

Frailty in Hemodialysis Patient

Abstract Background Frailty has been defined as a state of increased vulnerability to stressors as a consequence of degeneration in multiple systems. There remain two schools of thought with regard to frailty: one which sees frailty as a physical phenotype characterized by sarcopenia and another that views frailty as an accumulation of deficits across a variety of domains. Aim of the Work The aim of this study was to assess the prevalence of frailty among dialysis population. Patients and Methods This cross section study carried out in Hemodialysis Unit of the Nasr City Health Insurance Hospital between October 2020 and July 2021. The total number of the study was 325 hemodialysis patients, 25 were excluded from the study, thus the enrolled final number became 300 hemodialysis patients on maintenance hemodialysis therapy for at least 6 months. Results The mean age of the patients was 45.57±11.79 years (range 25-65 years) 50% of them were under 45 years of age. 258 (86%) of patients were males and 42 (14%) females, with male to female ratio about 6.14:1. 37 patients (12.3%) has positive HCV, while the results also show that none of the HBV and HIV of the study group. 10 patients (3.3%) of vulnerable, 89 (29.7%) patients at mild frailty, table also clarified that, 126 (42.0%) patients at moderat4e frailty, furthermore, 75 (25%) patients at severe frailty in Edmonton frail scale. There was significant positive association between frailty and age with p-value <0.001. Males more affected by frailty than females. Conclusion The differences in the frailty prevalence among CKD patients could be caused by the different definitions of frailty that each study adopted. It is important to prevent early-onset disability in end-stage renal disease, which may be accelerated by frailty in this patient population, which includes individuals who already carry a high risk of morbidity and mortality. We adopted the Edmonton Frail Scale (EFS) based on self-report, it is very simple to administer and can be carried out by hemodialysis nursing staff after minimal training, without the need for specialist medical staff, in less than 15 min. Its association with poor short-term outcome highlights its utility in detecting frail patients, but because it is a multi-domain test, it also gives health professionals information about which areas of frailty are affected. This would allow specialists to administer specific, more complex scales to detect deficits in independence for basic and instrumental activities of daily life, cognition, emotional status, and social support. Our findings allow us to recommend the inclusion of the frailty comprehensive assessment of patients starting the dialysis program to timely identification of frailty syndrome.

Potential Association of Serum Hepcidin, hs-CRP and Iron Status Levels in Hemodialytic Patients

Patients on hemodialysis (HD) are usually anemic because of defective erythropoiesis. Hepcidin is a polypeptide that regulates iron homeostasis and could indicate functional iron deficiency in patients with end-stage renal disease (ESRD); this may also aid in assessing a patient's response to erythropoietin (EPO). The present study was directed to investigate serum levels of hepcidin, iron status, and inflammation markers such as C-reactive protein (CRP) in patients with ESRD on maintenance HD and to observe the correlation of serum hepcidin with conventional iron and inflammatory markers. Forty-two patients of both sexes on maintenance HD and EPO therapy were enrolled; 42 age and sex-matched healthy subjects were included as controls. Laboratory tests were performed, including complete blood count, serum hepcidin, total iron binding capacity (TIBC), serum ferritin, serum iron, and CRP. Serum hepcidin levels were significantly higher in patients with ESRD than in the control group (18.2 \(\pm\) 2.8 ng/mL and 8.5 \(\pm\) 2.3 ng/mL, respectively P = 0.000). The hemoglobin, hematocrit, serum iron, TIBC, and transferrin saturation levels in the patient group were significantly lower than in the control group. Higher hepcidin levels were found in EPO non-responders (19.6 (\pm) 2.4 ng/mL), while lower levels (16.9 \(\pm\) 2.5 ng/mL) were seen in responders (P = 0.001). A positive and significant correlation was observed between the values of serum hepcidin and CRP. Our study indicates that higher hepcidin levels are found in ESRD patients on HD and in those not responding to EPO. Our findings suggest that hepcidin might play a role in the pathophysiology of anemia associated with chronic diseases and EPO resistance.

Predialysis education program and early vascular access: a single center experience

Aims: The main objective of this study is to investigate the impact of a pre-dialysis education program on the selection of vascular access during the initiation of maintenance hemodialysis therapy and the short-term impact of this education on patient outcomes.
 Methods: The data were collected from two different times in the past from patients under maintenance hemodialysis: the first group consisted of a group of patients who received a predialysis education program (intervention group) from a dedicated nephrologist, and the second group included those who did not undergo a control program (control group). Predialysis education program involved six modules addressing understanding kidney disease, diet, and nutrition, treatment options for end-stage kidney disease, dialysis procedures, medication management, and self-care/independence. Patients aged ≥18 years were enrolled in the study. The patients were compared according to their clinical status during the onset of maintenance hemodialysis, including vascular access type, serum potassium level, previous hospitalization, and urgent hemodialysis need. Additionally, the hospitalization and infection rates within 6 months following the onset of maintenance hemodialysis were compared. P

Dietary intake, body composition and micronutrient profile of patients on maintenance hemodialysis attending Kiruddu National Referral Hospital, Uganda: A cross sectional study.

Patients on maintenance hemodialysis are at a great risk for altered nutritional status, characterized by protein energy wasting and micronutrient deficiency due to medication interactions and dietary restrictions. This study determined the dietary intake, micronutrient profile and body composition of patients on maintenance hemodialysis at Kiruddu National referral hospital (KNRH), Uganda. A cross sectional study was done among adult CKD patients on maintenance hemodialysis therapy at KNRH. Data concerning patients' demographics, clinical history and dietary intake was obtained using interactive and quantitative food frequency questionnaires. Body composition was obtained using the TANITA BC-351, Japan weighing Bathroom scale and anthropometric measurements using standard methods and procedures. Serum micronutrient profile assessment was done using the COBAS Auto analyzer. Data analysis was done using the SPSS software version 20. T-test was used to make comparisons and logistic regression analysis was done to check for any correlations. A P-value of < 0.05 was considered statistically significant. Among the 63 hemodialysis patients, 38% were female, with a median duration of hemodialysis of 12 months and the overall age range of patients was 31-40 years. Majority (92.1%) of the patients had hypertension. Carbohydrates like maize flour were highly consumed, in addition to eggs among the proteins on the daily basis. Fruits and vegetables were not highly consumed. Regarding body composition; 75% of the study participants had normal Body mass Index (BMI), the mean muscle mass was 51.94±8.68, body fat was 15.25±7.35, bone mass was 2.77±0.46 and body water was 62.04±9.06. Patients had deranged micronutrient levels especially for Vitamin D, Potassium and phosphorus. In conclusion, hemodialysis patients at KNRH, have altered nutritional status as evidenced by altered body weight for some patients and deranged micronutrient levels. We recommend that hemodialysis patients should be regularly assessed for nutritional status, appropriately treated and educated about their nutritional status.

#3246 THE ASSOCIATION OF THE CO-OCCURRENCE OF MALNUTRITION AND SARCOPENIA WITH MORTALITY IN HEMODIALYSIS PATIENTS: A MULTICENTER PROSPECTIVE COHORT STUDY

Abstract Background and Aims Frailty is widely acknowledged as an age-related fragile state characterized by physiological vulnerability to stress, and it is prevalent among patients undergoing maintenance hemodialysis therapy. Various factors are interconnected and can be theoretically consolidated into a cycle of frailty, with malnutrition and sarcopenia at the core. These can result in numerous negative health outcomes in patients on hemodialysis and prompt identification and treatment are necessary. However, limited research has investigated the impact of the overlap between malnutrition and sarcopenia on mortality in this patient population. In this study, we examined the association of the overlap between malnutrition and sarcopenia with all-cause mortality in patients undergoing maintenance hemodialysis. Method The present prospective cohort study recruited outpatients on hemodialysis from three facilities in Japan. At the study baseline, data on patients' characteristics including age, gender, body mass index, duration of dialysis, primary kidney diseases, 11 comorbid conditions, and laboratory parameters (including serum albumin level) were collected from medical records. In addition, muscle mass (skeletal muscle index [SMI]), muscle strength (handgrip strength), and physical performance (short physical performance battery [SPPB]) were measured by physical therapists. A comorbidity index was used to quantify the severity of comorbid illnesses, which was calculated based on primary kidney diseases and the 11 comorbidities. Malnutrition was identified based on geriatric nutritional risk index &amp;lt;98, which was calculated using the serum albumin level and body weight. Sarcopenia was diagnosed when patients had low muscle mass (SMI &amp;lt;7.0 kg/m2 for males and &amp;lt;5.7 kg/m2 for females) and low muscle strength (handgrip strength &amp;lt;28.0kg for males and &amp;lt;18 kg for females) or low physical performance (SPPB ≤9), in accordance with the Asian Working Group for Sarcopenia 2019 criteria. After classifying the study participants into four groups based on the absence or presence of malnutrition and sarcopenia, the mortality risk was evaluated using the Kaplan-Meier method and Cox proportional hazard analysis. This study was approved by the Research Ethics Committee and conducted in accordance with the principles of the Declaration of Helsinki. Results A total of 379 patients on hemodialysis were included in the analysis. The mean age of the patients was 69.5±12.6 years, and 40.2% of the cohort being female. The mean duration of dialysis was 7.9±4.5 years. The most prevalent underlying kidney disease was diabetes mellitus. At baseline, the prevalence rates of malnutrition and sarcopenia were 32.7% and 28.2%, respectively. Over a mean follow-up period of 4.3 years, 23 patients died. The Kaplan-Meier analysis demonstrated a lower cumulative survival rate in patients with malnutrition and/or sarcopenia. After adjustment for the effect of age, gender, duration of dialysis, and comorbidity index, the hazard ratio in patients with both malnutrition and sarcopenia was significantly higher than in patients without both (hazard ratio [HR] 5.78, 95% confidence interval [CI] 1.86-17.94). However, the hazard ratios in patients suffering from either malnutrition or sarcopenia alone were not significantly different (Table 1). Conclusion The present study has demonstrated the strong association of a state of co-occurrence between malnutrition and sarcopenia, which implies starvation and muscle wasting, with a poor prognosis in patients undergoing hemodialysis. The findings of this study have accentuated the significance of addressing both malnutrition and sarcopenia in routine clinical practice for patients undergoing maintenance hemodialysis.

Health-related quality of life of patients undergoing haemodialysis therapy in Dar es Salaam, Tanzania

Background: Patients with kidney failure on maintenance haemodialysis therapy have a lower health-related quality of life (HRQOL) than matched controls without kidney failure. HRQOL is an important predictor of clinical outcomes among patients with kidney failure, yet there is a paucity of such data in Tanzania. We determined HRQOL among Tanzanian patients with kidney failure receiving maintenance haemodialysis therapy. Keywords: health-related quality of life, chronic kidney disease, kidney failure, Tanzania

Malnutrition-Inflammation complex syndrome in Libyan patients with end-Stage renal disease at Hun-Aljufrah

Malnutrition and inflammation complex syndrome in ESRD Patients on maintenance Hemodialysis therapy remains the most common cause of morbidity and mortality characterized by alteration in the structural and functional ability of plasma proteins. The aim of this study was to assess the serum level of albumin, BMI and hs-CRP as a marker of Malnutrition-Inflammation Complex Syndrome. This is a case-control study conducted at Alafia Hospital Hun-Aljufrah from December 2014 to December 2015. Libyan patients with ESRD who routinely attend to dialysis center at the above-mentioned hospital during the period of the study were randomly recruited for this study. The study included one hundred ESRD and one hundred age and sexmatched healthy controls. The patients’ information such as age, sex, height, weight, and clinical history were recorded. Blood samples (6 ml) were collected from patients in plain and EDTA containers from which EDTA and Serum samples were separated. The results of our study showed that there were significant decrease in the mean serum level of albumin (3.12±0.39) (p. value=0.000) and BMI (20.3±5.5) (p. value=0.000) as well as significant increase in the mean serum level of serum C-reactive protein (20.13±5.704) (p. value=0.000) in case group when compared to the control group. The DOT Blot Correlation test showed that there was a significant negative correlation between hs-CRP with albumin (r= -0.812, p=0.02). In conclusion, the significant decreased in the mean level of serum albumin and BMI, as well as the significant increase in the mean level of serum C-reactive protein among hemodialysis ESRD patients, might place them at risk of developing Malnutrition-Inflammation Complex Syndrome in the future. The significant negative correlation between serum albumin with hsCRP support the facts systemic inflammation is the main cause of malnutrition and cardiovascular disease in ESRD patient.

The Relationship between Sleep Quality and Hemodialysis and Nursing Intervention in Uremia Patients Based on Intelligent Data.

Uremia is a manifestation of end-stage renal failure and is a clinical syndrome shared by various advanced renal diseases. In recent years, the prevalence of uremia has been increasing. Maintenance hemodialysis therapy is used as the treatment of choice for uremia and is widely used. For uremia, the day-to-day treatment has a serious impact on the patient's symptoms, causing a lot of unnecessary burdens to life. While imposing a severe symptom burden on patients, excessive sleep deprivation repair time can cause various risk injuries and further increase the probability of patient mortality. The resulting sleep deprivation can lead to the functional damage of multiple organs and systems such as the cardiovascular system and the immune system. Therefore, improving sleep quality can increase the survival rate of patients to a certain extent. There is less domestic attention to its related research, and there are not many discussions on the pathogenesis. Based on this, this paper proposes to explore the effect of hemodialysis on the sleep quality of patients with uremia under the support of intelligent data. In this study, it was found that MHD patients had various sleep quality problems, and the incidence of sleep disturbance was 61.78%. The experimental results in this paper show that the incidence of sleep disturbance in diabetic nephropathy is 89.7%. This may be combined with a series of complications in patients with diabetes, which in turn affects the quality of sleep in patients. It may increase patient mortality and affect patient quality of life and survival. Therefore, we should pay close attention to the prevention of various complications in diabetic dialysis patients, which will help to improve sleep quality.

Prevalence and Predictors of Heart Failure among Patients on Maintenance Hemodialysis Therapy at Tertiary Care Hospitals

Background and Aim: The incidence of heart failure among hemodialysis patients predicts poor outcomes. Hypertension, aging, and diabetes mellitus are traditional risk factors for heart failure which may not predict heart failure accurately. Heart failure might be caused by other factors. The present study aims to determine the prevalence and predictors of heart failure among patients on maintenance hemodialysis. Methodology: This cross-sectional study was carried out on 142 hemodialysis patients in the department of Cardiology, PNS Shifa Hospital Karachi and King Abdullah Teaching hospital Mansehra for duration of six months from 5th March 2021 to 4th September 2021. All the patients having age above 16 years and who underwent at least three months of dialysis therapy were enrolled. Patients with severe respiratory distress and mentally incapacitated were excluded. Questionnaire-based Pro-forma was used for collecting patient’s demographic details, clinical details such as human immunodeficiency virus (HIV) disease, heart failure symptoms, hyperlipidemia, angina, and presence of diabetes, etc., and dialysis-related clinical information. Stadiometer and standard weight scale were used for height and post-dialysis weight also known as dry weight respectively. A monthly dose of erythropoietin (EPO) was taken from medical records. Based on the blood sample, albumin, ferritin, urea, complete blood count, C-reactive protein (CRP), and total cholesterol were measured. SPSS version 21 was used for data analysis. Results:Out of 142 hemodialysis patients, 105 (73.9%) were male and 37 (26.1%) were females. Overall mean age was 46.74 ± 11.62 years. Of the total 142 patients, the prevalence of hypertension and diabetes mellitus was 138 (97.2%) and 73 (51.4%) respectively. The incidence of heart failure was 21 (14.8%). The incidence of hypertension, anemia, and angina were heart failure autonomousprognosticators on multivariate analysis. A higher score of malnutrition inflammation and resistance index for erythropoietin was found in heart failure patients. Conclusion: Our study found that heart failure is significantly associated with anemia, angina, and hypertension in hemodialysis patients. Malnutrition–inflammation complex and erythropoietin resistance were more prevalent in patients with heart failure. These conditions necessitate a thorough cardiac evaluation and appropriate treatment. Keywords: Heart Failure, Hemodialysis, Hypertension. Angina

Assessment of Feasibility of Robot-assisted Radical Cystectomy in Patients With Advanced Bladder Cancer Treated With Maintenance Hemodialysis Therapy.

To clarify the perioperative and oncological outcomes of robot-assisted radical cystectomy (RARC) in advanced bladder cancer (BC) patients treated with maintenance hemodialysis (HD) therapy. We retrospectively evaluated patients receiving HD therapy who had undergone RARC or open radical cystectomy (ORC) for BC between April 1988 and December 2021 at two affiliated institutions. We compared the surgical outcomes and survival after radical cystectomy between patients treated with RARC and those treated with ORC. Thirty-six patients were evaluated, and eight (22%) and 28 (78%) received RARC and ORC, respectively. RARC was more frequently conducted than ORC in elderly patients (median: 75.5 vs. 68.2 years, p<0.05). Regarding postoperative surgical outcomes, the estimated blood loss volume (median: 75 ml vs. 627 ml, p<0.05) was significantly lower in the RARC group than that in the ORC group. A lower blood transfusion rate (25% vs. 67%, p=0.170) was observed. Moreover, there were no differences in operative time (median: 255 vs. 294 min, p=0.232) or complication rate (Clavien-Dindo grade, any grade: 50% vs. 46%, p=0.858; grade 3 or more: 13% vs. 14%, p=0.897). The 11-year overall survival rate did not differ between the two groups (88% vs. 74%, p=0.365). The perioperative outcomes of RARC in patients undergoing HD therapy were comparable to those of ORC. RARC is a potentially feasible surgical option even in patients with high comorbidities.

Perimortem changes in clinical parameters in patients undergoing maintenance hemodialysis

BackgroundEnd-of-life medical care for patients receiving maintenance hemodialysis (HD) therapy has become an increasingly important issue worldwide. Thus far, no clear indicators and/or biomarkers exist regarding the timing of HD therapy withdrawal.MethodsTo clarify the perimortem circumstances, we examined temporal changes in multiple clinical parameters during the last 10 serial HD sessions of 65 terminal patients with end-stage renal disease who had undergone maintenance HD and died in our hospital.ResultsThe results showed that, while most of the laboratory data were unaltered, the physical parameters, such as systolic blood pressure and consciousness levels, gradually and significantly deteriorated toward the last HD session prior to death. The frequency of the use of vasopressors and O2 inhalation tended to increase. The accumulation of such severe conditions was observed at the last HD session. Of interest, the accumulation of severe conditions at the last HD session in patients with malignancies was significantly less than those with cardiovascular diseases or infectious diseases. The accumulation of severe conditions at the last HD session did not differ between patients who withdrew HD versus those who continued HD.ConclusionThe results of the present study suggest that predicting the timing of maintenance HD therapy withdrawal is likely to be difficult and that the timing of maintenance HD therapy termination may differ among patient groups with distinct comorbid conditions.

Prevalence and predictors of heart failure among patients on maintenance hemodialysis therapy at Muhimbili National Hospital in Tanzania: a cross-sectional study

BackgroundHeart failure among patients on hemodialysis therapy portends poor outcomes. Traditional risk factors like aging, hypertension and diabetes mellitus are relatively common in these patients and may not accurately predict the occurrence of heart failure. Such patients may have other factors that contribute to heart failure. This study aimed to investigate the prevalence and predictors of heart failure among patients on maintenance hemodialysis at Muhimbili National Hospital in Dar es Salaam, Tanzania.ResultsAmong 160 patients on maintenance hemodialysis, 49 (30.6%) were female. The mean age of patients was 52.2 ± 13.3 years. Almost all patients had hypertension and 69 (43.1%) had diabetes mellitus. Heart failure was prevalent in 17 (10.6%) patients. On multivariate analysis, presence of angina, intradialytic hypertension, and anemia were independent predictors of heart failure. Patients with heart failure had significantly higher malnutrition inflammation scores and erythropoietin resistance indexes.ConclusionsHeart failure among hemodialysis patients correlates with the presence of angina, intradialytic hypertension, and anemia. Patients with heart failure had a greater degree of malnutrition–inflammation complex, and erythropoietin resistance. Patients with these conditions require a thorough cardiac evaluation and appropriate treatment.

Hemodialysis vascular access in children – A retrospective study in a pediatric dialysis unit

Objective: Permanent access in the form of a fistula is the preferred form of vascular access for most pediatric patients on maintenance hemodialysis (HD) therapy; however, the technical aspects of the procedure that are unique to the pediatric population, the expectation of a short waiting time for kidney transplantation and the need to cannulate every other day (with the pain and fear associated with it) limit its use. Our objective was to analyze the long-term outcomes of pediatric arteriovenous fistulas in our institution. Methods: A retrospective review was performed of all arteriovenous fistula (AVF) created in a HD population aged 0 to 18 years at a single institution from 2007 to 2019. Data abstracted included age, weight, etiology of renal failure, time on dialysis, central venous catheter history and transplantation history. Data were analyzed to determine the primary and secondary patency. Results: During the study period, 19 AVFs were performed in 16 patients, of whom 9 patients (56.3%) were male. Mean patient age was 12.3 years (range 5-17 years), and mean weight was 38.3kg (range 12-83kg). At the time of AVF creation, 9 patients were on dialysis and 7 patients had a central venous catheter (CVC), with a median length of CVC dependence of 10 months. Procedures performed included 4 radiocephalic fistulas, 11 brachiocephalic fistulas and 4 brachiobasilic. Five accesses failed to mature (26.3%). Mean follow-up was 6 years. The 2-year primary and secondary patency rates were 92.3% and 100%, respectively. The 4-year primary and secondary patency rates were 76.9% and 100%, respectively. No thrombosis was documented during follow-up. During the postoperative period, 10 patients (62.5%) received a kidney transplant, in a mean time of 23 months. Conclusions: AVFs demonstrate excellent long-term patency in pediatric HD patients. No significant complications were reported and no thrombosis occurred.

THE EFFECT OF INTRADIALYTIC AEROBIC TRAINING ON PHYSICAL PERFORMANCE AND QUALITY OF LIFE AMONGHEMODIALYSIS PATIENTS

Chronic kidney disease (CKD) and end stage renal disease (ESRD) are worldwide public health problems.(1)The prevalence of CKD (stages 1-5) in the general United States adult population was 14.8% in 2013-2016, CKD and ESRD patients have increased risk of functional impairment, regardless of their age, gender, associated co-morbidities, and cardiovascular events.(3) This high level of functional limitations in patients with CKD and ESRD is not necessarily improved by dialysis. Rehabilitationprinciples need to be integrated into the routine management of patients. (5)Rehabilitation of CKD and ESRD patients involves many aspects as psychological, nutritional, and exercise training.(6)Various exercise programs, such as aerobic exercise, resistance exercise, combined aerobic and resistance exercise, and passive exercise including electrical stimulation have been developed for hemodialysis patientsThe aim of the current study was to assess the effect of intradialytic aerobic training on physical performance and quality of life in patients maintained on haemodialysis therapy.The study included thirty patients on maintenance hemodialysis therapy for more than three months in Alexandria University Hospitals.Patients were divided into two groups: Group (A): Fifteen patients performed exercise during hemodialysis session.Group (B): Fifteen patients were not assigned to any exercise program (as a control group).Mentally or physically unfit patients,patients with overt ischemic heart disease or cardiac decompensation, severe anaemic patients (Hb ≤ 8 g/dl),patients with advanced chronic kidney disease-mineral and bone disorder (CKD-MBD), patients with advanced lower limbs joints disease or amputation of lower limb were excluded.

MO769COMPARISON OF HEMODIALYSIS CONNECTORS CAPS VS ANTIMICROIAL BARRIER CAPS IN CENTERAL LINE-ASSOICATED BLOOSTREAM INFECTION RATES FOR HEMODIALYSIS PATIENTS

Abstract Background and Aims Central line-associated bloodstream infections (CLABSI) lead to increased morbidity and mortality in hemodialysis-dependent patients and are costly to treat. Devices such as hemodialysis connector caps (Tego) and antimicrobial barrier caps (ClearGuardHD) represent promising interventions to reduce CLABSIs. The aim of this study was to assess the efficacy of these devices in reducing CLABSIs in hemodialysis patients who use tunneled dialysis catheters at outpatient dialysis units in a healthcare system. Method In a retrospective review of a quality improvement project, we compared cumulative 6-month CLABSI infection rates before and after transition from Tego connectors to ClearGuardHD caps. CLABSI events, reported to National Healthcare Safety Network (NHSN), were expressed as CLABSI events per 100 patient-months. All adult patients (age &amp;gt;18 years) receiving hemodialysis via a tunneled central catheter were included in the study from February 2018-August 2020. The study cohort was comprised of 13 outpatient dialysis units in a healthcare system with locations throughout the Northern Midwest and Southeastern United States. The date of change from Tego to ClearGuardHD was phased throughout the different units over the study period with events recorded 6 months pre- and post-intervention. Patients receiving home dialysis therapies were excluded from the study. Results The cumulative 6-month CLABSI event rate decreased by 75.7%; Tego (0.465/100 patient-months) vs. ClearGuardHD caps (0.113/100 patient-months). A total of 17 CLABSI occurrences were reported within 3,654 patient-months with Tego use. However, only 4 CLABSI occurrences were reported within 3,527 patient-months during ClearGuardHD use. Conclusion ClearGuardHD caps reduced the rate of CLABSI among hemodialysis patients and are superior to Tego connectors. These findings support prior studies. Implementation of ClearGuardHD caps may help eliminate CLABSI-associated morbidity among individuals requiring maintenance hemodialysis therapy.

Nutritional Status of Patients on Maintenance Hemodialysis at Muhimbili National Hospital in Dar es Salaam, Tanzania: A Cross-Sectional Study.

Background Patients on hemodialysis therapy are at high risk of malnutrition which is attributed to multiple factors. Protein-energy malnutrition in these patients confers poor clinical outcomes. This study investigated the nutritional status of patients on maintenance hemodialysis at Muhimbili National Hospital in Dar es Salaam, Tanzania. Methods A cross-sectional descriptive study was done among 160 adult patients on maintenance hemodialysis therapy. Data concerning patients' personal, medical, dietary, and hemodialysis-related information were collected. Patients' anthropometric and laboratory tests (complete blood count, albumin, total cholesterol, creatinine, and urea) were measured. The quantitative Subjective Global Assessment (SGA) dialysis malnutrition score (DMS) was used to assess their nutritional status. Data analysis was done using the SPSS software version 20. Results Among the 160 hemodialysis patients, 49 (30.6%) were female. Patients' mean age was 52.2 ± 13.3 years. The median duration on hemodialysis was 18 (8.25–29.75) months. Malnutrition was present in 98 (61.2%) of the patients. Severe malnutrition was found in only 3 (1.9%) patients and 16.9% were underweight. The longer duration on hemodialysis, having diabetes mellitus, and being single were associated with increased risk for malnutrition in multivariate logistic regression. Malnourished patients had significantly lower dry weight, body mass index, mid-upper arm circumference, waist circumference, albumin, total cholesterol, and creatinine levels. Conclusion Malnutrition is very common among hemodialysis patients at Muhimbili National Hospital, especially those on longer duration of hemodialysis, and diabetic patients. We recommend that hemodialysis patients should be regularly assessed for malnutrition and appropriately treated which if left unattended heralds worse outcomes.

Impact of serum magnesium and bone mineral density on systemic fractures in chronic hemodialysis patients.

IntroductionBone mineral density (BMD) measured with dual-energy X-ray absorptiometry (DXA) can be used to predict fractures, but its clinical utility has not been fully established in chronic kidney disease (CKD) patients. Magnesium is an essential trace element. Although magnesium is associated with the risk of fractures in non-CKD populations, the relationship is unknown in CKD patients.MethodsBMD and serum magnesium levels were measured in 358 stable outpatients undergoing maintenance hemodialysis therapy. The primary outcome was fragility fracture. Patients were divided into groups according to the median level of magnesium and the normal threshold value of lumbar spine BMD.ResultsDuring the median follow-up period of 36 months, 36 (10.0%) fractures occurred. The cumulative incidence rates of fractures were 17.6% and 5.2% [adjusted hazard ratio (aHR) 2.31, 95% confidence interval (CI) 1.03–5.17, P = 0.030] in the lower (<2.6 mg/dL) and higher (≥2.6 mg/dL) magnesium (Mg) groups, respectively, and 21.2% and 7.3% (aHR 2.59, 95% CI 1.09–6.16, P = 0.027) in the low- and high-BMD groups, respectively. The lower-Mg and low-BMD group had a 9.21-fold higher risk of fractures (95% CI; 2.35–47.00; P = 0.0010) than the higher-Mg and high-BMD group. Furthermore, adding both magnesium levels and lumbar spine BMD levels to the established risk factors significantly improved the prediction of fractures (C-index: 0.784 to 0.830, p = 0.041).Discussion/ConclusionsThe combination of serum magnesium and lumbar spine BMD can be used for fracture risk stratification and synergistically improves the prediction of fractures in CKD patients.

Brain-derived neurotrophic factor is associated with sarcopenia and frailty in Japanese hemodialysis patients.

We evaluated several sarcopenia-related hormones, cytokines and uremic toxins to identify the humoral factors associated with sarcopenia and frailty in Japanese hemodialysis patients. Twenty Japanese patients aged ≥65 years who underwent maintenance hemodialysis therapy at Uonuma Kikan Hospital for more than 6 months were included in this retrospective cross-sectional study. Clinical data, including physical function and mental state, were obtained from the clinical records collected during the regular evaluation at the beginning of each hemodialysis therapy session, 3 days after the previous hemodialysis therapy. The diagnosis of sarcopenia and frailty was based on the Asian Working Group for Sarcopenia 2019 and the Japanese version of the Cardiovascular Health Study, respectively. The mental state of patients was evaluated using the Japanese version of the Patient Health Questionnaire 9 (J-PHQ-9). In univariate analyses, plasma brain-derived neurotrophic factor (BDNF) levels were significantly lower in patients with severe sarcopenia and frailty. The plasma BDNF concentration was correlated with muscle strength and physical performances, such as the 6-m walk test, Short Physical Performance Battery and 5-time chair stand test. BDNF was also correlated with body weight, hemodialysis vintage, and serum levels of total protein and indoxyl sulfate but not with body mass index, appendicular skeletal muscle mass, serum interleukin 6 levels, or J-PHQ-9 scores. The odds ratio per 100 pg/mL of BDNF for the prevalence of frailty was 0.353. BDNF is associated with decreased physical performance and the prevalence of severe sarcopenia and frailty in Japanese maintenance hemodialysis patients. Geriatr Gerontol Int 2021; 21: 27-33.

Pilot study to reduce interdialytic weight gain by provision of low-sodium, home-delivered meals in hemodialysis patients.

Patients with kidney failure undergoing maintenance hemodialysis (HD) therapy are routinely counseled to reduce dietary sodium intake to ameliorate sodium retention, volume overload, and hypertension. However, low-sodium diet trials in HD are sparse and indicate that dietary education and behavioral counseling are ineffective in reducing sodium intake. This study aimed to determine whether 4 weeks of low-sodium, home-delivered meals in HD patients reduces interdialytic weight gain (IDWG). Secondary outcomes included changes in dietary sodium intake, thirst, xerostomia, blood pressure, volume overload, and muscle sodium concentration. Twenty HD patients (55 ± 12 years, body mass index [BMI] 40.7 ± 16.6 kg/m2 ) were enrolled in this study. Participants followed a usual (control) diet for the first 4 weeks followed by 4 weeks of three low-sodium, home-delivered meals per day. We measured IDWG, hydration status (bioimpedance), standardized blood pressure (BP), food intake (3-day dietary recall), and muscle sodium (magnetic resonance imaging) at baseline (0 M), after the 4-week period of usual diet (1 M), and after the meal intervention (2 M). The low-sodium meal intervention significantly reduced IDWG when compared to the control period (-0.82 ± 0.14 kg; 95% confidence interval, -0.55 to -1.08 kg; P < 0.001). There were also 1 month (1 M) to 2 month (2 M) reductions in dietary sodium intake (-1687 ± 297 mg; P < 0.001); thirst score (-4.4 ± 1.3; P = 0.003), xerostomia score (-6.7 ± 1.9; P = 0.002), SBP (-18.0 ± 3.6 mmHg; P < 0.001), DBP (-5.9 ± 2.0 mmHg; P = 0.008), and plasma phosphorus -1.55 ± 0.21 mg/dL; P = 0.005), as well as a 0 M to 2 M reduction in absolute volume overload (-1.08 ± 0.33 L; P = 0.025). However, there were no significant changes in serum or tissue sodium (all P > 0.05). Low-sodium, home-meal delivery appears to be an effective method for improving volume control and blood pressure in HD patients. Future studies with larger sample sizes are needed to examine the long-term effects of home-delivered meals on these outcomes and to assess cost-effectiveness.

The PrEscription of intraDialytic exercise to improve quAlity of Life in patients with chronic kidney disease trial: study design and baseline data for a multicentre randomized controlled trial.

BackgroundExercise interventions designed to improve physical function and reduce sedentary behaviour in haemodialysis (HD) patients might improve exercise capacity, reduce fatigue and lead to improved quality of life (QOL). The PrEscription of intraDialytic exercise to improve quAlity of Life study aimed to evaluate the effectiveness of a 6-month intradialytic exercise programme on QOL and physical function, compared with usual care for patients on HD in the UK.MethodsWe conducted a prospective, pragmatic multicentre randomized controlled trial in 335 HD patients and randomly (1:1) assigned them to either (i) intradialytic exercise training plus usual care maintenance HD or (ii) usual care maintenance HD. The primary outcome of the study was the change in Kidney Disease Quality of Life Short Form (KDQOL-SF 1.3) Physical Component Score between baseline and 6 months. Additional secondary outcomes included changes in peak aerobic capacity, physical fitness, habitual physical activity levels and falls (International Physical Activity Questionnaire, Duke’s Activity Status Index and Tinetti Falls Efficacy Scale), QOL and symptom burden assessments (EQ5D), arterial stiffness (pulse wave velocity), anthropometric measures, resting blood pressure, clinical chemistry, safety and harms associated with the intervention, hospitalizations and cost-effectiveness. A nested qualitative study investigated the experience and acceptability of the intervention for both participants and members of the renal health care team.ResultsAt baseline assessment, 62.4% of the randomized cohort were male, the median age was 59.3 years and 50.4% were white. Prior cerebrovascular events and myocardial infarction were present in 8 and 12% of the cohort, respectively, 77.9% of patients had hypertension and 39.4% had diabetes. Baseline clinical characteristics and laboratory data for the randomized cohort were generally concordant with data from the UK Renal Registry.ConclusionThe results from this study will address a significant knowledge gap in the prescription of exercise interventions for patients receiving maintenance HD therapy and inform the development of intradialytic exercise programmes both nationally and internationally.Trial RegistrationISRCTN N83508514; registered on 17 December 2014.