Maintenance Hemodialysis Treatment Research Articles

Evaluation of the relationship between dietary energy and protein intakes and anthropometric measurements in hemodialysis patients.

This study evaluated the relationship between dietary energy, and protein (animal and plant based) intakes and anthropometric measurements in maintenance hemodialysis (MHD) patients. Individuals between the ages of 19 to 65 who received MHD treatment for more than 3 months from October 2021 to February 2022 in the state hospitals were included in the study. Body mass index (BMI) (kg/m2) was calculated for each patient, and anthropometric measurements including upper middle arm circumference, triceps skinfold thickness (TST) and hand grip strength (HGS) were carried out. 3-day food records and Subjective Global Assessment (SGA) were used to assess nutritional status of the patients. Of the 51 MHD patients included in the study, 33 (64.7%) were male and 18 (35.3%) were female. The mean age of the patients was 50.37 ± 11.55 years, and length of time on MHD was 39.49 ± 51.68 months. The mean energy intake of female and male MHD patients was 20.01 ± 6.94 and 17.26 ± 6.24 kcal/kg/d, respectively. The mean dietary protein intake of female and male MHD patients were 0.84 ± 0.35 and 0.78 ± 0.30 g/kg/d, respectively. Dry weight (P = .048), BMI (P = .020), TST (P = .013), and HGS (P = .026) of well-nourished and moderately malnourished female MHD patients according to SGA results were found to be lower than in male patients. While the majority of the patients receiving MHD treatment appeared to be well-nourished according to the SGA results, energy and protein intakes obtained from the food records were below the recommended daily dietary intake. These evaluations affected the anthropometric measurements including HGS, BMI, and TST. Therefore, there is a need for more comprehensive clinical studies in which anthropometric measurements, food consumption, biochemical findings and nutritional screening tools are used all together to evaluate nutritional status in MHD patients.

Clinical significance and correlation of compliance to thirst in maintenance hemodialysis patients.

The main treatment method for end-stage renal disease (ESRD) is maintenance hemodialysis (MHD). With the continuous improvement of dialysis technology, the survival period of MHD patients has been effectively prolonged, but dialysis technology still cannot completely replace renal function. To study the dietary compliance and its correlation with thirst in MHD patients and to provide guidance for clinical development of corresponding intervention countermeasures. A total of 90 patients who received MHD treatment from March 2021 to March 2022 were selected as objects. The Renal Adherence Attitudes Questionnaire (RAAQ) and the Renal Adherence Behaviour Questionnaire (RABQ) were used to analyze the dietary compliance and thirst status of patients. Pearson correlation analysis was used to analyze the correlation between diet compliance and thirst. Positive correlations were found between VAS and DTI, SXI and TDS (P< 0.05). Social restrictive attitude was positively correlated with VAS, DTI, SXI, TDS, acceptance attitude and compliance in facing difficulties (P< 0.05), and negatively correlated with self-care compliance (r=-0.35, P< 0.05). Health attitude was positively correlated with VAS, DTI and SXI (P< 0.05). Acceptance attitude was positively correlated with DTI, SXI and TDS (P< 0.05). High RAAQ was associated with high VAS (b= 0.11, 95% CI: 0.05, 0.18), DTI (b= 0.28, 95% CI: 0.17, 0.38), SXI (b= 0.24, 95% CI: 0.14, 0.34) and TDS (b= 0.26, 95% CI: 0.13, 0.4). The overall performance of dietary compliance in patients with MHD is at a moderate level, and dietary compliance is negatively correlated with disease perception.

Relationship between effective blood flow rate and clinical outcomes in maintenance hemodialysis patients: a single-center study

The association between blood flow rate (BFR) and clinical outcomes in patients undergoing maintenance hemodialysis (MHD) is inconclusive. This retrospective study included 175 patients undergoing MHD treatment between July 2015 and March 2022, divided into two groups based on time-averaged effective blood flow rate (eBFR) median value. We investigated arteriovenous fistula (AVF) outcomes and the association of eBFR with all-cause mortality and new major adverse cardiovascular events (MACE). Mean ± SD and median time-averaged eBFR values were 276 ± 24 and 275 mL/min, respectively. After adjusting for relevant factors including age, sex, vintage, diabetes, CVD, receiving hemodiafiltration (HDF) treatment and spKt/V, Cox models indicated a low time-averaged eBFR (≤ 275 ml/min) was associated with increased risks of all-cause mortality (hazard ratio [HR] 14.18; 95% confidence interval [CI], 3.14–64.1) and new MACE (HR 3.76; 95% CI, 1.91–7.40) in MHD patients. Continuous Cox models demonstrated each 20 ml/min increase in eBFR linked to a 63% decrease in the risk of all-cause mortality (HR: 0.37, 95% CI: 0.23–0.59) and a 38% decrease in the occurrence of new MACE (HR: 0.62, 95% CI: 0.46–0.84). There was no significant difference in AVF outcomes between the two groups. Our study noted higher eBFR (>275 mL/min) is associated with lower risks of both all-cause mortality and new MACE compared with low eBFR (≤275 mL/min). Increased eBFR is not associated with a higher risk of AVF failure.

The association between vascular access satisfaction and all-cause mortality in maintenance hemodialysis patients.

The mortality is significantly higher in patients undergoing maintenance hemodialysis (MHD) than in the general population. It is well-known that vascular access (VA) is critical for MHD patients. But the association between VA satisfaction and all-cause mortality in MHD patients is still not clear. The aim of this study was to explore the relationship between VA satisfaction and all-cause mortality in MHD patients with a 30-month follow-up. Two hundred twenty-nine MHD patients in two dialysis centers were enrolled in this observational prospective study. VA satisfaction was assessed using the Short Form Vascular Access Questionnaire (VAQ). Health-related quality of life (HRQoL) score was calculated with Short Form 36 (SF-36) questionnaire. Multiple logistic regression analysis was used to evaluate the influencing factors of all-cause mortality. During the 30-month follow-up period, 35 patients dropped out of the study. Among them, 31 patients died, and 4 patients stopped MHD treatment after renal transplantation. Multivariable analyses showed that the age, VAQ total score, social functioning score and dialysis-related complication score of the VAQ, the total score and MCS of the SF-36 were factors influencing all-cause mortality in MHD patients. The Kaplan-Meier curve further showed that the cumulative survival probability was significantly higher in the MHD patients with VAQ scores <7 at baseline than in patients with VAQ scores ⩾7 (p = 0.031). The present study showed that VA satisfaction was significantly associated with all-cause mortality in MHD patients. These findings suggest that a holistic approach is required for VA choice.

Predicting immunogenicity of COVID-19 vaccines in hemodialysis patients with renal disease

Individuals who are diagnosed with chronic kidney disease, particularly those receiving maintenance hemodialysis treatment, face a greater likelihood of suffering from severe symptoms and fatality due to COVID-19. This study aimed to explore the optimal vaccination approach for these individuals. The study used data analysis tasks such as data preprocessing, cleaning, and exploration, and machine learning models including linear regression, random forest, XGBoost, gradient boosting, AdaBoost, decision trees, Lasso, and ridge regression were used to construct the predictive model. The study found that the Lasso model performed the best overall in predicting anti-S IgG antibodies levels in response to COVID-19 vaccines for people with kidney failure with MAE of 8.81, RMSE of 19.59, and R2 value of 0.93. The adjusted R2 value for the Lasso model was also 0.93, indicating that the model's ability to explain the variance in the data was not affected by the number of predictors in the model. The Random Forest model best predicted the duration of immunogenicity, with R2 and adjusted R2 values of 0.71 and 0.69, respectively. The ensemble model that includes all eight models, i.e., Ridge, Lasso, Linear Regression, Random Forest, AdaBoost, Gradient Boosting, XGBoost, and Decision Tree, has the best performance with the lowest MAE, the lowest RMSE, the highest R2, and the highest adjusted R2 values of 3.91, 5.00, 0.73, and 0.72, respectively. However, further research is required to validate these models and extend their application to different populations and vaccine types, as well as considering other factors that may affect immune response to COVID-19 vaccines. These findings can be helpful in improving vaccination strategies and promoting public health.

Risk Factors of Cardiovascular and Cerebrovascular Events in Patients With Uraemia Complicated With Hypertension During Maintenance Haemodialysis Treatment.

This study aimed to investigate the risk factors associated with major adverse cardiovascular (group of events that affect heart and blood vessels) and cerebrovascular (events affecting blood vessels supplying the brain) events (MACCE) in patients with uraemia complicated with hypertension who required maintenance haemodialysis (MHD) treatment. Clinical dataand laboratory indicators of 156 uraemia patients complicated with hypertension were collected and retrospectively analysed. The patients were admitted to a tertiary care hospital (Abbas Institute of Medical Sciences AIMS) in Muzaffarabad, Pakistan, from February 2018 to February 2022. The data was collected through consecutive sampling and patients were recruited after following the inclusion and exclusion criteria. Eighty-one out of 156 patients were not complicated with MACCE, and 75 patients were complicated with MACCE during the MHD treatment cycle, with an incidence of 48.08%. Compared to the non-MACCE group, the MACCE group's diabetes, body mass growth rate, triglyceride (TG), NT-proBNP, standard deviation and coefficient of variance for systolic and diastolic blood pressure (SBP-SD, SBP-CV, DBP-SD, and DBP-CV) showed significant differences (P<0.05) between the groups. Diabetes, body mass growth rate, TG, NT-proBNP, SBP-SD, SBP-CV, DBP-SD, and DBP-CV with odds ratios of 3.074, 3.202, 2.188, 2.512, 2.357, 2.431, 2.299, and 2.062 respectivelywere risk factors for MACCE in uraemia patients with hypertension. From the results of this study, we inferred that patients with uraemia and hypertension complicated by MACCE in the treatment cycle of MHD were related to diabetes, body mass growth rate, TG, NT-proBNP, SBP-SD, SBP-CV, DBP-SD, and DBP-CV.

Effect of Exercise on Fatigue in Patients Receiving Maintenance Hemodialysis Treatment: A Systematic Review and Network Meta-analysis.

This study aimed to evaluate the effect of different exercises for improving fatigue in maintenance hemodialysis patients. PubMed, Embase, Web of Science, Cochrane, PEDro, CNKI, VIP, Wanfang data, CBM, and CINAHL were conducted from the establishment of the database to July 2023. We independently screened the literature, evaluated the quality, analyzed the data using Stata 15.0, and performed subgroup analysis on intervention time and exercise intervention adherence. Twenty-three studies were analyzed, with 1867 patients and nine interventions. Based on the surface under cumulative ranking curves and pairwise comparisons effects, overall long-term, short-term, and exercise intervention adherence >90% effects have all presented that during dialysis aerobic-resistance combined exercise was ranked as the most effective compared with routine care (surface under cumulative ranking curves = 83.9%, standardized mean difference = -1.45, 95% CI = -2.23 to -0.67; surface under cumulative ranking curves = 85.9%, standardized mean difference = -1.38, 95% CI = -2.24 to -0.52; surface under cumulative ranking curves = 86.6%, standardized mean difference = -1.54, 95% CI = -2.58 to -0.49; surface under cumulative ranking curves = 83.6%, standardized mean difference = -1.45, 95% CI = -2.25 to -0.66, respectively), followed by interdialytic period muscle relaxation exercise, interdialytic period aerobic-resistance combined exercise, interdialytic period aerobic exercise, and interdialytic period Baduanjin. Dialysis aerobic-resistance combined exercise may be considered in practice when resources allow. However, high-quality, multicenter, and large-sample randomized control trials must further verify this conclusion.

Investigation of dermatological manifestations in maintenance hemodialysis patients

Aims: Skin findings are common in patients with both chronic kidney disease and undergoing hemodialysis. These findings are observed as nonspecific and specific dermatological manifestations. Our study aimed to describe the characteristics of dermatologic findings of patients with end-stage renal disease undergoing maintenance hemodialysis treatment and to investigate the relationship between these findings and the demographic and clinical features of those patients.&#x0D; Methods: Patients who were admitted to a private hemodialysis clinic in August 2023 were prospectively analyzed. Age, gender, type of vascular access, hemodialysis duration, etiology of end-stage renal disease, duration and frequency of hemodialysis sessions, dermatological findings, and the most recent complete blood count, parathyroid hormone, calcium, phosphorus, urea, and creatinine levels were examined and the findings were documented. Calcium x phosphorus levels were calculated. Statistical significance was accepted as p

Structural and Psychosocial Challenges Among Underserved Patients Receiving Hemodialysis During and Beyond the COVID-19 Pandemic: A Qualitative Study

Racial and ethnic minority groups in the United States are disproportionately affected by chronic kidney disease and progressive kidney failure and face significantly more socioeconomic and psychosocial challenges. However, how such patients' social environment and stigmatization shape their illness experiences and abilities to cope before and during the coronavirus disease 2019 (COVID-19) pandemic has not been well documented, even as social scientific research predicts these groups' exponential vulnerability. Qualitative study using semistructured interviews to elicit individual patient narratives about their personal illness experiences before and during the COVID-19 pandemic, any challenges they faced, and their sources of support. Using purposive sampling, we recruited 20 adult patients receiving maintenance hemodialysis from centers affiliated with a safety-net hospital in Boston, Massachusetts. Interviews were audiotaped, transcribed, and analyzed using thematic content analysis to identify patients' challenges and supports before and during the pandemic. Of the 20 patients in the study, 9 were women, and 18 self-identified as Black or African American. Three main themes emerged, whereby most patients described: (1) stigma and stigmatization as a central element of their life experience; (2) the pandemic as a difficult experience but not a complete rupture from their prepandemic life; and (3) social networks, particularly family, friends, and religious communities, as sources of support crucial to coping with their debilitating illness. Whether the findings apply to other settings is unknown, as participants were recruited from centers in a single safety-net urban hospital setting. Psychosocial and environmental factors, including institutional racism and stigmatization, play significant roles in amplifying the burdens shouldered by racial and ethnic minority individuals with kidney disease who now also face the COVID-19 pandemic that has since turned endemic. The results of this study can inform the development of policy interventions aimed at alleviating tensions and structural conditions that impinge on kidney disease patients' wellbeing and health outcomes. Members of racial and ethnic minority groups in the United States experience the highest rates of progressive kidney failure and face significantly more socioeconomic and psychosocial challenges. We interviewed 20 patients who receive maintenance hemodialysis treatment from centers affiliated with a safety-net hospital. Patients described stigmatization as a central element of their life experience and the pandemic as a difficult challenge (but not a complete rupture) that added to their struggles with illness-related, race-related, and class-related stigmas. Social networks, particularly family, friends, and religious communities, are key sources of support crucial to coping with illness. Findings from this study can inform health care providers and community workers and guide the development of policy interventions to provide better support for these patients.

Impact of the COVID-19 Pandemic on the Provision of Dialysis Service and Mortality in Veterans Receiving Maintenance Hemodialysis in the VA: An Interrupted Time-Series Analysis

Introduction: According to the US Renal Data System (USRDS), patients with end-stage kidney disease (ESKD) on maintenance dialysis had higher mortality during early COVID-19 pandemic. Less is known about the effect of the pandemic on the delivery of outpatient maintenance hemodialysis and its impact on death. We examined the effect of pandemic-related disruption on the delivery of dialysis treatment and mortality in patients with ESKD receiving maintenance hemodialysis in the Veterans Health Administration (VHA) facilities, the largest integrated national healthcare system in the USA. Methods: Using national VHA electronic health records data, we identified 7,302 Veterans with ESKD who received outpatient maintenance hemodialysis in VHA healthcare facilities during the COVID-19 pandemic (February 1, 2020, to December 31, 2021). We estimated the average change in the number of hemodialysis treatments received and deaths per 1,000 patients per month during the pandemic by conducting interrupted time-series analyses. We used seasonal autoregressive moving average (SARMA) models, in which February 2020 was used as the conditional intercept and months thereafter as conditional slope. The models were adjusted for seasonal variations and trends in rates during the pre-pandemic period (January 1, 2007, to January 31, 2020). Results: The number (95% CI) of hemodialysis treatments received per 1,000 patients per month during the pre-pandemic and pandemic periods were 12,670 (12,525–12,796) and 12,865 (12,729–13,002), respectively. Respective all-cause mortality rates (95% CI) were 17.1 (16.7–17.5) and 19.6 (18.5–20.7) per 1,000 patients per month. Findings from SARMA models demonstrate that there was no reduction in the dialysis treatments delivered during the pandemic (rate ratio: 0.999; 95% CI: 0.998–1.001), but there was a 2.3% (95% CI: 1.5–3.1%) increase in mortality. During the pandemic, the non-COVID hospitalization rate was 146 (95% CI: 143–149) per 1,000 patients per month, which was lower than the pre-pandemic rate of 175 (95% CI: 173–176). In contrast, there was evidence of higher use of telephone encounters during the pandemic (3,023; 95% CI: 2,957–3,089), compared with the pre-pandemic rate (1,282; 95% CI: 1,241–1,324). Conclusions: We found no evidence that there was a disruption in the delivery of outpatient maintenance hemodialysis treatment in VHA facilities during the COVID-19 pandemic and that the modest rise in deaths during the pandemic is unlikely to be due to missed dialysis.

Mediation effect of self-neglect in family resilience and medication adherence in older patients undergoing maintenance hemodialysis.

Chronic kidney disease (CKD) patients with regular dialysis treatment for more than 3 months are called maintenance hemodialysis (MHD). The degree of patients' adherence with the doctor's advice to take medicine on time is called medication adherence, which is very important for the control of the disease and the improvement of the quality of life for MHD patients. Living alone, lack of communication with children and self-neglect are risk factors for medication adherence in the older adults. Inappropriate substance use behaviors are common among older adults with self-neglect. Family resilience denotes the ability of a family to retain the stability of its structure by relying on its internal and external resources when facing a difficult situation. Family resilience entails the combination of family beliefs, interaction styles, problem-solving skills, and emotional communication which reflect supportive and positive psychological adjustment effects to benefit older persons. This study aims to provide a theoretical basis for clinical intervention level to improve medication adherence of older patients on MHD through examineing the correlation among family resilience, self-neglect, and medication adherence based on the self-reports. A random sampling method was used to gather information from 632 older patients receiving MHD treatment in Hemodialysis Center of Hunan Province between July to December 2021. For this purpose, a self-designed demographic questionnaire, the Family Resilience Questionnaire (FRQ), the Scale of the Elderly Self-Neglect (SESN), and the Morisky Medication Adherence Scale-4 (MMAS-4) were used to investigate the questionnaire data of the participants. Pearson correlation was used to examine the relationship between family resilience, self-neglect, and medication adherence in older patients and gain insight into their current status. AMOS 24.0 was used for mediation modeling. Bootstrap mediation effect test was used to evaluate the mediation effect among the 3 variables. The questionnaires survey showed that the scores of FRQ, SESN, and MMAS-4 were 78.60±12.49, 7.99±5.60, and 5.93±1.40, respectively; and the medication adherence rate was 18.8%. Pearson correlation analysis showed that family resilience was negatively correlated with self-neglect (r=-0.432, P<0.001), and was positively correlated with medication adherence (r=0.169, P<0.001). Self-neglect was negatively correlated with medication adherence (r=-0.217, P<0.001). Mediating effect analysis showed that the total effect of family resilience on medication adherence was significant (β=0.214, 95% CI 0.121 to 0.313, P<0.001), and the direct effect was not significant (β=0.058, 95% CI -0.073 to 0.187, P>0.05). Self-neglect played a major mediating effect between family resilience and medication adherence (β=0.156, 95% CI 0.088 to 0.240, P<0.001). Family resilience, self-neglect, and medication adherence among older patients on MHD are significantly related, with family resilience primarily influencing medication adherence indirectly through self-neglect.

Effect of Resistance Exercise with Moderate and Low Intensity on Quality of Life and Mental Health in Maintenance Hemodialysis Patients

It was to explore the effects of resistance exercise with moderate and low intensity on quality of life (QoL) and mental health of patients with maintenance hemodialysis (MHD). From June 2022 to December 2022, 90 patients receiving MHD treatment in Blood Purification Center of XXX Hospital were randomly divided into observation group and controls, with 45 patients in each group. The controls received routine hemodialysis care, and observation group received resistance exercise with moderate and low inte in addition to routine hemodialysis care. QoL measurement tool adopted 36-Item Short Form Health Survey (SF-36), Hamilton Rating Scale for Depression (HAMD), and Hamilton Anxiety Scale (HAMA) to evaluate patients. The physical function was 67.64±25.62 and mental health was 71.68±28.55 in controls, and those was 71.11±25.42 and 73.48±13.59 in observation group; in terms of physical function and mental health in QoL, observation group was obviously higher; and HAMD and HAMA scores in observation group were clearly lower as against controls (P &lt; 0.05). The effect of resistance exercise with moderate and low inte was obvious on the physical function and mental state of QoL in MHD patients, but not obvious on other aspects. Resistance exercise with moderate and low inteis beneficial to improve patients’ mental health.

Lower serum insulin-like growth factor-1 levels are independently associated with anemia in patients undergoing maintenance hemodialysis

The relationship between serum insulin-like growth factor-1 (IGF-1) levels and anemia in patients undergoing maintenance hemodialysis (MHD) remains unclear. This cross-sectional study included patients who underwent MHD treatment for >3 months at our dialysis center in March 2021. Demographic and clinical data were recorded. Blood samples were collected before the hemodialysis sessions, and general serum biochemical parameters, routine blood markers, and serum IGF-1 levels were measured. Patients were divided into a group without anemia (hemoglobin ≥110 g/L) and a group with anemia (hemoglobin <110 g/L), and multivariable linear and binary logistic regression analyses were performed to study the relationship between the levels of serum IGF-1 and anemia. A total of 165 patients (male/female = 99:66) with MHD were enrolled in the study, with a median age of 66.0 (58.0, 75.0) years and a median dialysis vintage of 27.0 (12.0, 55.0) months. The mean hemoglobin level was 96.38 ± 16.72 g/L, and 126 patients had anemia (76.4%). Compared to patients without anemia, patients with anemia had lower serum IGF-1 and triglyceride levels and higher intravenous iron supplementation on dialysis (all p < 0.05). After adjusting for confounding factors in different models, the nine-model multivariate binary logistic regression analyses also confirmed that lower serum IGF-1 levels and serum IGF-1 < 197.03 ng/ml were both independently associated with anemia in patients undergoing MHD. However, further multicenter studies with larger sample sizes are required to confirm these findings.

#6658 ORAL HEALTH STATUS IN DIABETIC AND NON-DIABETIC PATIENTS ON MAINTENANCE HEMODIALYSIS TREATMENT

Abstract Background and Aims Uremic toxins and inflammation influence the oral health in patients on maintenance hemodialysis treatment. The presence of diabetes additionally aggravates the oral status. Aims: To compare the oral health status in diabetic and non-diabetic patients on different dialysis modality treatment. Method Observational, cross-section, monocentric study was conducted in 72 hemodialysis (HD) patients divided into two groups regarding the presence of Diabetes mellitus (DM). Patients were routinely designed to hemodialysis or hemodiafiltration (HDF) during the previous year of HD treatment. Demographic characteristics as patients age, dialysis vintage, laboratory inflammatory markers as C-reactive protein (CRP), albumin and Interleukin 6 (IL-6) were measured at the start of the study. Also, uremic small and middle molecules as blood urea nitrogen (BUN), creatinine, β2-microglobilin (β2M), myoglobin, albumin, free light chains kappa (FLC-k), and free light chains lambda (FLC-λ) were analyzed. Patients were examined by a dentist specialist scoring the oral hygiene index (OHI) by Greene Vermillion as good, fair and poor. Presence of tooth fillings and extractions, caries, hyperkeratosis, periodontal disease, erosions, ulceration, erythema, pigmentations, saburral tonque and uremic fetor were notified. Gingival hyperplasia (GH) was scored (1-3) with 3 for worst score and the tooth color was scored 1-3, signing 1-yellow, 2-gray, 3-white. Data was presented as mean and standard deviation for continuous and percentages for nominal values. X squared Fisher exact and Mann-Whitney test were used for statistical analysis. P&amp;lt;0.05 was considered as significant. Results The patients from group 1 - with DM (N=26) didn't differ from the non-diabetic group (N= 46) in respect of gender, age and dialysis modality but had significantly shorter dialysis vintage (48.68 ± 37.45 vs. 88.13 ± 63.29, P = .02, respectively). From the inflammatory markers only Il-6 was significantly higher in diabetics (P = .03). All the analyzed uremic toxins – small and middle molecules also didn't differ between the two groups. Diabetic patients were at 3 fold risk for manifestation of fissure, 4 fold risk for pigmentations and 7 fold risk for erythema (OR 3.58; CI:1.017-12.380, p= 0.003; OR 4.12; CI:0.684-22.870; p= 0.02, OR 4.84; CI:1.343-17.498, p= 0.000), (OR 7.25; CI:1.123-46.880, p= 0.000), respectively. GH was more likely to be present in diabetic patients (35%, 54%, 11% vs 83%, 15, 0%, p= 0.000, respectively). The presence of hyperkeratosis, periodontal disease erosions, caries, extractions, tooth fillings and the tooth colour didn't differ between the groups. Diabetics were found with higher percentage of bad oral hygiene index (38% vs 20%), but the overall comparison of OHI showed no significant difference. Conclusion Oral health is significantly deteriorated in dialysis patients, especially in those with inflammation. Diabetic patients are at higher risk of developing changes in the oral health status.

#2774 ASSOCIATION BETWEEN MODIFIED CREATININE INDEX AND MORTALITY IN PATIENTS UNDERGOING HEMODIALYSIS: A STRATIFIED ANALYSIS IN DIABETES MELLITUS

Abstract Background and Aims Protein-energy wasting, including muscle atrophy, is one of the most frequently reported problems in patients undergoing hemodialysis. A decline in muscle mass leads to limitation and worsening of physical function and is associated with frailty, disability, and decreased survival. Modified creatinine index was used as a marker of lean body mass. Additionally, a longitudinal study revealed that a decrease in the modified creatinine index over time was independently associated with an increased risk of death in patients undergoing hemodialysis. Moreover, the prevalence of diabetes is high among patients undergoing hemodialysis. Diabetes not only leads to reduced skeletal muscle mass but is also a risk factor for cardiovascular events and death among patients undergoing hemodialysis. The relationship between modified creatinine index and mortality can be altered by the presence of diabetes; however, the effect of diabetes on this relationship among patients undergoing hemodialysis is unclear. This study aimed to examine the association between muscle mass and all-cause mortality in the presence or absence of diabetes, which is highly prevalent in hemodialysis patients. Method We included 361 outpatients undergoing maintenance hemodialysis treatment in 2013–2021 (mean age, 66.3±12.0 years; 61.0% males). Baseline was defined as the date of the first laboratory data and the modified creatinine index measurements, and participants were followed up from baseline to the date of the event (all-cause death, transfer, or end date of study follow-up [May 2021]). Modified creatinine index was calculated using age, sex, predialysis serum creatinine level, and single-pool Kt/V for urea. The primary outcome was death due to any cause. A Cox proportional hazards regression model was used to examine the association between the modified creatinine index and all-cause mortality. The dose–response association between the modified creatinine index and all-cause death was modeled using a restricted cubic spline model. Results A significant interaction was found between the presence of diabetes and modified creatinine index (p = 0.04). In the non-diabetic group, a lower modified creatinine index was associated with a higher risk of all-cause death (hazard ratio [HR], 1.33; 95% confidence interval [95% CI], 1.09–1.63), whereas no significant association between modified creatinine index and all-cause death was observed in the diabetic group (HR, 1.00; 95% CI, 0.83–1.20). Conclusion The modified creatinine index was more strongly associated with all-cause mortality in the nondiabetic group than in the diabetic group. The modified creatinine index is a useful tool for the nondiabetic group, and these results may provide useful information for examining the relationship between skeletal muscle mass and prognosis in patients undergoing hemodialysis.

#6837 ASSOCIATION BETWEEN SELF-REPORTED FATIGUE AND THE NEED FOR RECOVERY TIME AFTER THE MAINTENANCE HEMODIALYSIS SESSION: PROHEMO

Abstract Background and Aims Fatigue and the need for recovery time after a hemodialysis session are frequent complaints in patients with chronic kidney disease treated with maintenance hemodialysis (MHD). In the present study, we investigated whether there is an association between self-reported fatigue and the need for recovery time after HDM sessions. Method This is a cross-sectional study with data from 239 adult patients participating in the prospective cohort study “Prognostic Study of Patients on Chronic Hemodialysis” (PROHEMO), developed in Salvador, BA, Brazil. We used “The Chalder Fatigue” questionnaire (CFQ-11) to calculate fatigue scores. CFQ-11 scores can range from 0 to 33; Higher scores mean more intense fatigue. Fatigue was categorized as: absent or mild if the score was &amp;lt;4 and moderate to severe if the score was ≥4. To assess the need for recovery time from hemodialysis, participants answered a question: After finishing dialysis, do you usually need some time to recover? with two answer options (yes or no). We used logistic regression to estimate the odds ratio (OR) of the association between fatigue and need for recovery after hemodialysis, with adjustments for age, sex, diabetes, and heart failure. Results The mean age was 52.5 ± 12.5 years, 57.7% were men, 94.5% were non-white. Self-reported fatigue as absent or mild was 28.4% (68/233) and moderate to severe fatigue was 71.5% (171/233). The prevalence of need for recovery time after hemodialysis was 2.5 times higher in patients with moderate to severe fatigue (prevalence: 51.5%) than in patients with no or mild fatigue (prevalence: 20.6%); prevalence ratio: 2.50 (95% confidence interval: 1.53; 4.08). In logistic regression, an association between moderate to severe fatigue and need for recovery was observed even after adjusting for the effects of age, sex, diabetes, and heart failure (OR = 4.36; 95% CI: 2.21; 8.59). Conclusion The results suggest that patients who report a more intense degree of fatigue, more often have a greater need for time to recover after the end of the hemodialysis session. It is interesting to investigate whether interventions that reduce fatigue in patients undergoing MHD treatment result in a reduction in the need for recovery time after the hemodialysis session.

Frailty as a dynamic process in a diverse cohort of older persons with dialysis-dependent CKD.

This study examines frailty status evolution observed in a two-year follow-up of a cohort of older persons (age ≥65) with chronic kidney disease (CKD) undergoing maintenance hemodialysis (HD) treatment. Frailty, a geriatric syndrome that connotes a state of low physiologic reserve and vulnerability to stressors, is associated with increased risk for multiple adverse health outcomes in studies of persons with CKD as well as older persons in the general population. The Fried frailty index defines frailty as the presence of 3 or more of 5 indicators-recent unintentional weight loss, slowed gait speed, decreased muscle strength, self-reported exhaustion, and low physical activity. In the seminal work by Fried and colleagues, persons who were characterized by 1-2 of the Fried index criteria were termed "pre-frail" and considered at risk for subsequently becoming frail, potentially providing insight regarding intervention targets that might slow or prevent individuals' transition from pre-frail to frail status. Other less frequently studied types of transitions may also be informative, including "recovery or reversion" (improvement) by people whose longitudinal assessments indicate movement from frailty to prefrailty or robust, or from prefrailty to robust. These status changes are also a potential source of insights relevant for prevention or remediation of frailty, but research focusing on the various ways that individuals may transition between frailty states over time remains limited, and no previous research has examined varying patterns of frailty status evolution in an older cohort of persons with dialysis-dependent CKD. In a study cohort of dialysis-dependent older persons, we characterized patterns of frailty status evolution by age, sex, race/ethnicity, and treatment vintage; by longitudinal profiles of non-sedentary behavior; and by self-report indicators relevant for dimensions emphasized in the Age-Friendly 4Ms Health System (What Matters, Mobility, Mentation). Our study suggests that strategies to promote resiliency among older persons with dialysis-dependent CKD can be informed not only by frailty status transition that indicates improvement over time but also by older adults' maintenance of (stable) robust status over time, and we concur that inclusion of both frailty and resilience measures is needed in future longitudinal studies and clinical trials.

Importance of Bio-electrical Impedance for Measurement of Body Fluid Status in Chronic Kidney Disease Patients on Maintenance Haemodialysis: A Narrative Review

Assessing the precise body water status in patients with renal disorders is crucial for their health. It has been reported that chronic fluid overload is present even in the early stages of renal insufficiency. If volume overload in a patient with chronic renal failure is not controlled, serious problems such as pulmonary oedema, cardiac remodelling, and diastolic heart failure can develop. Bioelectrical Impedance Analysis (BIA) has emerged as one of the most useful tools, although randomised clinical studies are lacking to support its universal use. Early management of hydration may improve clinical outcomes, as it allows for personalised dialysis prescriptions and nutritional support. BIA practice is utilised as non invasive health monitoring for Body Composition (BC). BIA is a practical and inexpensive method. Moreover, BIA parameters estimated for disease prognosis analysis have been found to be reasonably predictable for both patient status and healthcare. Additionally, BIA is a simple, accurate, portable, quick, easy, and low-cost method. In patients with End-stage Renal Disease (ESRD) undergoing maintenance Haemodialysis (HD) treatment, excessive fluid volume is considered a risk factor for death. Furthermore, fluid elimination to achieve Dry Weight (DW) is a crucial component of HD treatment for ESRD patients. DW is an important concept related to patients undergoing HD. Conventional methods seem to be time-consuming and operator-dependent. BIA is a new and simple method that has been reported to accurately estimate DW. Estimating the dry weight of HD patients is a challenging task. Many tools are available, but not every HD centre has access to them. Several strategies have been used to develop a more standardised method of assessing dry weight in HD patients. The Bio-impedance Spectroscopy (BIS) device has been validated against gold standard methods of volume assessment. Body composition monitoring appears to be a helpful diagnostic tool that reasonably complements existing clinical methods in assessing the DW of HD patients. BIS identifies Fluid Overload (FO) as a virtual "Over Hydration (OH)" compartment, which is calculated from the difference between the measured extracellular volume and the predicted values based on a fixed hydration of lean and adipose tissue mass.

Research on the relationship between serum indoxyl sulfate concentration and iron dynamics index in patients with end-stage kidney disease: a cross-sectional study

BackgroundChronic kidney disease (CKD) is frequently associated with renal anemia. Erythropoiesis-stimulating agent-hyporesponsive anemia is often caused by iron deficiency in patients with CKD. We hypothesized that high accumulation of indoxyl sulfate, a uremic toxin, accelerates iron deficiency in patients with CKD. The aim of this study was to clarify whether the accumulation of indoxyl sulfate is a cause of iron deficiency in patients with CKD. Therefore, we investigated the association between serum indoxyl sulfate concentration and iron dynamics in patients with end-stage kidney disease (ESKD).MethodsWe performed a cross-sectional study on 37 non-dialyzed patients with ESKD, who were hospitalized to undergo maintenance hemodialysis treatment at Shirasagi Hospital. Serum indoxyl sulfate concentration, iron dynamics parameters and other laboratory data were measured immediately before the initiation of hemodialysis treatment. Clinical characteristics were obtained from electronic medical records.ResultsThe estimated glomerular filtration rate (eGFR) of 37 patients with ESKD was 5.08 (3.78–7.97) mL/min/1.73 m2 (median [range]). Serum ferritin and transferrin saturation (TSAT) were 90 (10–419) ng/mL and 20 (8–59)% (median [range]), respectively. Serum indoxyl sulfate concentration was 62 (11–182) μM (median [range]). Serum indoxyl sulfate concentration was inversely correlated with serum ferritin level (ρ = − 0.422, p = 0.011), but not with TSAT, age, gender, eGFR and c-reactive protein (CRP) in 37 patients. In eight patients taking iron-containing agents, serum indoxyl sulfate concentration was strongly correlated with serum ferritin level (ρ = − 0.796, p = 0.037); however, in 29 patients not taking an iron-containing agent, this correlation was not observed (ρ = − 0.336, p = 0.076). In the multivariate analysis including age, gender, eGFR and CRP, the correlation between serum indoxyl sulfate concentration tended to be, but not significantly correlated with serum ferritin level in 37 patients (regression coefficient = − 54.343, p = 0.137).ConclusionOur study suggests that serum accumulation of indoxyl sulfate is one of causes not to increase serum ferritin level in patients with ESKD taking an iron-containing agent. Further clinical study is needed to reveal the appreciable relationship between serum ferritin and serum indoxyl sulfate.

The occurrence and influencing factors of fatigue and sleep disturbance in maintenance hemodialysis patients

Objective: To investigate the occurrence and influencing factors of fatigue and sleep disturbance in Maintenance Hemodialysis (MHD) patients. Methods: A total of 170 patients with end-stage renal disease who underwent MHD treatment in the hemodialysis room of Shaanxi Provincial Hospital of Traditional Chinese Medicine from October 2021 to March 2022 were selected as the research subjects. The basic information and laboratory indicators of the patients were collected by cross-sectional survey. The survey methods were evaluated by the revised Piper Fatigue Scale and the Pittsburgh Sleep Quality Rating Scale and the incidence and influencing factors of fatigue and sleep disturbance in MHD patients were analyzed. Results: Fatigue occurred in 135 cases, the incidence rate was 79.41%; sleep disturbance occurred in 124 cases and the incidence rate was 72.94%. After one-way analysis of variance, factors such as exercise, Albumin (ALB, serum Creatinine(CRE), Phosphorus(P) and Hemoglobin(HGB) in MHD patients can affect fatigue; while age, gender, exercise, primary disease, dialysis frequency, Phosphorus(P), Hemoglobin(HGB) and high-sensitivity C-Reactive Protein (hs-CRP) factors can affect sleep. A multiple linear regression model was constructed for the factors affecting fatigue (F = 81.110, p &lt; 0.001), and it showed that 70.3% of fatigue (adjusted R2 = 0.703) was related to albumin (ALB), serum creatinine(CRE), and hemoglobin(HGB) (all p &lt; 0.05); A multiple linear regression model was constructed based on the factors of 58% (F = 26.933, p &lt; 0.001), which showed that 58% of sleep disorders (adjusted R2 = 0.580) were significantly related to age, gender, exercise or not, phosphorus(P), high-sensitivity C-reactive protein(hs-CRP) (all p &lt; 0.05) related. Pearson correlation analysis was used to analyze sleep disturbance and fatigue in MHD patients and the results showed that there was a positive correlation between the two (r = 0.478, p &lt; 0.001). Conclusion: The proportion of fatigue and sleep disturbance in MHD patients is relatively high, mainly mild to moderate and the two influence each other. Exercise intervention and nutritional support can effectively improve the occurrence of fatigue and sleep disturbance in MHD patients.