Number Of Hemodialysis Patients Research Articles

Gambaran Kepatuhan Pasien dengan Penyakit Ginjal Kronis dalam Menjalani Hemodialisis di RSUD Prof.Dr.W.Z. Johanes

Hemodialysis is a tool that patients with chronic kidney disease (CKD) need to replace damaged kidney function. Compliance with hemodialysis plays an important role in the patient's health condition. Since 2021, the number of hemodialysis patients at RSUD Prof.DR.W.Z. Johanes, from 108 patients to around 85 patients remaining in 2022. This study aims to provide an overview of CKD patients' compliance in undergoing hemodialysis at RSUD Prof.DR.W.Z. John. This type of research is qualitative with a case study approach. Eight key informants and two supporting informants using purposive sampling. The research results showed that generally, hemodialysis compliance among informants was good. Predisposing factors, knowledge about hemodialysis and its risks, motivation to comply with hemodialysis such as the hope of health, not wanting to give up, want to work, and also the desire to still live with the family as well as belief in the benefits of hemodialysis encouraging informants to be more compliant. Supporting factors such as completeness of facilities and affordability of access to services encourage more optimal hemodialysis. Reinforcing factors such as emotional, instrumental, and information support provided by family and health workers increase informants' compliance with hemodialysis. Hemodialysis units can improve and maintain the quality of hemodialysis facilities and services. Existing health workers can increase patient knowledge and motivation by maintaining positive communication during the hemodialysis process. The family can be a positive companion for the fulfillment of hemodialysis patients. Hemodialysis patients must maintain and improve their physical and mental condition.

Physiotherapy in Chronic Haemodialysis Patients. Recommendations of the Expert Committee of the Rehabilitation Section at the Polish Society of Nephrology

Background: The introduction of renal replacement therapy and its dynamic development contributes to the constant increase in the number of haemodialysis patients. Extending the life of patients with chronic kidney disease (CKD) is no longer the only objective of the medical community. Recently, measures have been initiated to improve quality of life among patients, which is largely influenced by physical functioning, the ability to undertake physical activity and functional independence. Despite the initiatives carried out for many years in the implementation of various regular physical activity forms among people with CKD in Poland, rehabilitation is still not an element of standard care for nephrological patients. In practice, it is mainly based on periodically implemented research projects, as well as scientific meetings devoted to this subject in groups comprising nephrologists and physiotherapists. Despite numerous scientific reports on the safety and effectiveness of undertaking physical activity by end-stage renal disease (ESRD) patients, there are still beliefs in the medical community perceiving this disease as a contraindication to physical training.

Scheduled screening of patency of permanent central venous dialysis catheters

Background: The number of hemodialysis patients is being increased year by year throughout the world, due to the increase in the life expectancy of the population, as well as the increase in incidences of hypertension and diabetes among them, but also due to the fact that many of the patients with heart and renal failure are now being dialyzed. Hemodialysis requires vascular access. But diabetics, hypertensives, as well as the elderly patients, usually have no vessels (arteries and veins) capable enough to give a satisfactory blood flow via a fistula, so the catheter is the only choice. Objective-Design: A well-functioning catheter is a prerequisite for the quality of the clearance provided. In the present study, control of the catheter patency was performed in a monthly basis. If the blood supply remained high (at least >300 ml/min) the catheter was considered to function satisfactorily. Participants-Results: The study examined the patency of permanent dialysis catheters in 34 patients (19F, 15M). The catheter survival was found to be good in all cases (100%) with a blood supply of at least >300 ml/min for 17 months. Furthermore, 75% of the catheters had a good blood supply for 20 months, while 6 catheters survived with good function for 25 months and continue to operate satisfactorily even now. Conclusion: The study found out that the method of controlling the patency of permanent dialysis catheters was easy and efficient for the timely detection of those that were malfunctioning and that the results from their use were satisfactory, compared to those of other researchers in the literature.

Assessment of Pain and Anxiety During Arteriovenous Fistula Cannulation Among Hemodialysis Patients: A Cross-Sectional Study in Saudi Arabia.

BackgroundThe number of hemodialysis patients has dramatically increased over the years. The cost of healthcare provision to those patients has been rising as well. In addition, pain management during arteriovenous fistula (AVF) cannulation is an important aspect of nursing care. Patients’ outcomes and appropriate pain control are one of the most critical issues in healthcare.PurposeTo measure the level of pain and anxiety associated with arteriovenous fistula cannulation among hemodialysis patients.MethodsA correlational cross-sectional research design was used in this study at the Hemodialysis Unit at King Fahad Hospital of the university, Al-Khobar, in the Eastern region of the Kingdom of Saudi Arabia using a self-administered questionnaire. Ethical approval was obtained. A convenience sample of 117 HD patients from the previous mentioned setting were included in the study. The data were collected using three tools: sociodemographic characteristics, Numerical Analogue Scale (NAS), and Hospital Anxiety and Depression Scale (HADS). Using IBM SPSS software package version 25.0, statistical significance of the obtained results was judged at the 5% level.ResultsAccording to the results, most of the participants experienced a mild to moderate level of pain and anxiety during arteriovenous fistula cannulation. Furthermore, there was a positive association between the level of pain and anxiety, with statistical significance (p<0.001).ConclusionBased on the results of the study, most of the study participants’ level of pain and anxiety during AVF cannulation ranged between mild and moderate.

The impact of muscle mass loss and deteriorating physical function on prognosis in patients receiving hemodialysis

Muscle mass loss and worsening physical function are crucial issues in patients receiving hemodialysis (HD). However, few studies have investigated the association between temporal changes in muscle mass and physical function in a large number of HD patients. We examined 286 patients receiving HD (males, 58%; age, 66.8 ± 13.0 years) at a single center, and calculated the percent changes in psoas muscle mass index (%PMI) using computed tomography over two screenings, once per year (July 2011–June 2013). Physical function was evaluated using the Eastern Cooperative Oncology Group Performance Status (ECOG-PS) (range 0–4). The observation period was from July 2012 to June 2021. The median %PMI was -9.5%, and those with the lowest quartile of %PMI (< −20.5%) showed a significantly poor prognosis compared with other patients (p < 0.001). Multivariable logistic regression analysis revealed that these patients tended to have decreased physical function (ECOG-PS 2–4) [odds ratio (OR): 2.46, p < 0.001] and albumin levels (OR: 0.22, p = 0.007). Multiple-factor-adjusted Cox regression analyses showed that %PMI (hazard ratio: 0.99, p = 0.004) and each ECOG-PS stage (1–4 vs. 0) (p < 0.01) were associated with mortality. Augmenting physical activities in daily life and serum albumin levels should be considered to maintain muscle mass and improve the prognosis of patients receiving HD.

Prediction model for cardiovascular disease risk in hemodialysis patients.

To derive and validate a prediction score for cardiovascular disease (CVD) risk in hemodialysis patients in China. Three hundred and eighty-eight patients with regular hemodialysis for more than 3months were recruited from January 1, 2015 to September 30, 2019 and followed up till May 31, 2020. We derived a prediction score using all participants as a training data set and validated using a bootstrap validation data set. Discriminatory ability of the prediction score was assessed by the area under the receiver operating characteristic curve (AUC). Of 388 patients without CVD at baseline, 132 developed first CVD events during an average follow-up of 3.27 (inter-quartile range = 3.08) years. Of 26 clinical parameters, age, hypertension, diabetes and abnormal white blood cell (WBC) count were identified as significant predictors and included in the prediction model. Compared to those without any of these risk factors, those with one, two, and three to four points showed increased risks of CVD, with the adjusted hazards ratio and 95% confidence interval (CI) being 3.29 (1.17-9.26), 7.42 (2.68-20.51) and 15.43 (5.44-43.75), respectively. The score showed satisfactory discriminatory ability in both training and validation data set (AUC = 0.7025, 95% CI 0.6520-0.7530, and 0.6876, 95% CI 0.6553-0.7200, respectively). We derived and validated a prediction score for CVD risk in hemodialysis patients in China. Given there is a rapid increase in the number of hemodialysis patients, this simple point score can be used to identify high-risk individuals in clinical practice for more precise and efficient personalized treatment.

Trends in the incidence and prevalence of end-stage renal disease with hemodialysis in entire Korean population: A nationwide population-based study.

Data on the overall epidemiology and temporal trends of end-stage renal disease (ESRD) requiring hemodialysis in Korea are scarce. We aimed to estimate the prevalence and incidence of ESRD requiring hemodialysis in Korea between 2002 and 2017.Using the National Health Insurance Service database, we analyzed data from the entire Korean population between 2002 and 2017. Hemodialysis patients were identified using rare incurable disease codes (V001) or prescription of medical fee codes of hemodialysis (O7020 and O7021). We only included patients who had been maintained on hemodialysis for more than 90 days from the date of dialysis initiation, to exclude patients who required short-term dialysis for acute kidney injury, conversion to peritoneal dialysis, or kidney transplantation.During the 16-year follow-up, the number of hemodialysis patients in Korea has steadily increased from 11,215 in 2002 to 67,486 in 2017. The mean age of these patients has gradually increased from 55.57 ± 13.31 years in 2002 to 62.13 ± 13.23 years in 2017. In 2017, the crude prevalence rate of hemodialysis was 1303.4 per million population. Overall, the number of men tended to be somewhat higher than that of women, and the proportion of men increased slightly from 55.56% in 2002 to 58.45% in 2017. The proportion of diabetic patients increased rapidly from 23.84% to 47.84%, and the percentage of dyslipidemic patients rose from 18.9% to 86.7%. The number of incident hemodialysis patients increased significantly from 4406 in 2003 to 12,134 in 2014, and then decreased to 8090 in 2017. In the incident cases of hemodialysis, the observed increase in the proportion of male patients and in diabetes and dyslipidemia were similar to that of prevalent patients. The more recent era of hemodialysis initiation, the better 5-year survival rates were observed.The prevalence and incidence of hemodialysis in Korea gradually increased between 2002 and 2017. The proportion of men, and patients with diabetes and dyslipidemia requiring hemodialysis also increased continuously. The survival rate of hemodialysis patients was gradually improving. These findings may serve as a reference for future epidemiological studies on hemodialysis in Korea.

Gender-Related Differences and Mortality Predictors among Egyptian Hemodialysis Patients: A Multi-Center Prospective Observational Study

Background: End-stage renal disease (ESRD) is an important cause of global morbidity and mortality affecting both sexes. Both genders may present with different symptoms and signs, respond differently to therapy and may exhibit different degrees of tolerance towards their disease. In Egypt, hemodialysis (HD) constitutes the most common modality of renal replacement therapy and the number of hemodialysis patients is increasing. The objective of the present study was to investigate gender-related differences in clinical and biochemical characteristics in HD patients. Mortality events in both genders were also recorded and predictors of mortality in the included HD population were explored.&#x0D; Methods: This multicenter study adopted essentially a cross-sectional design and included 2158 patients (1241 males and 917 females) undergoing HD in 25 hemodialysis units in six governorates in Egypt. The study started at June 2016 till May 2017. Data were extracted from the patients' records. One year mortality events in the included HD patients were prospectively observed and recorded.&#x0D; Results: Males on HD had a significantly lower body mass index (BMI) values and were less efficiently dialyzed. Their blood pressure measurements were significantly higher. In addition, males had significantly higher serum albumin with a significantly lower serum potassium level. The overall mortality rate was 6.9% (149 deaths) during the one year follow up period with a significant male predominance (7.9% in males vs. 5.6% in females p=0.03). The mortality rate was highest within the first 14 months after starting hemodialysis therapy. Mortality was statistically significantly higher in patients with diabetes, ischemic heart disease (IHD), anemia with low hemoglobin, and low serum albumin. The mortality risk is nearly duplicated in HD patients with IHD, while low serum albumin was associated with about 3 times an increase in mortality risk in the studied HD patients. &#x0D; Conclusion: Gender differences in clinical and laboratory characteristics and mortality do exist in Egyptian HD patients and should be considered when management guidelines are developed to suit the gender-related variations.

P1496TRENDS IN THE INCIDENCE AND PREVALENCE OF END-STAGE RENAL DISEASE PATIENTS WITH HEMODIALYSIS IN ENTIRE KOREAN POPULATION: A NATIONWIDE POPULATION-BASED STUDY

Abstract Background and Aims Data on the epidemiology and temporal trends of end-stage renal disease (ESRD) with hemodialysis are not well established in the entire Korean population. We aimed to estimate the incidence and prevalence of ESRD with hemodialysis in Korea between 2002 and 2017. Method Using the National Health Insurance Service database, we analyzed entire Korean population from 2002 to 2017. Hemodialysis patients was identified by using rare incurable disease codes (V001) or prescription of medical fee code of hemodialysis (O7020, O7021). We only included patients who have been maintained hemodialysis more than 90 days from the date of dialysis initiation to exclude short-term dialysis due to acute kidney injury or patients who converted to peritoneal dialysis or kidney transplantation. Results During the 16-year follow-up, the number of hemodialysis patients in Korea has steadily increased from 11,251 in 2002 to 67,486 in 2017. The mean age of hemodialysis patients has gradually increased from 55.57±13.31 years in 2002 to 62.13±13.23 years in 2017. Overall, the number of men tended to be somewhat higher than that of women, and the proportion of men increased slightly from 55.56% in 2002 to 58.45% in 2017. The proportion of diabetic patients increased rapidly from 23.84% to 47.84%, and the percentage of hyperlipidemic patients rose from 18.9% to 86.7%, while the percentage of hypertensive patients did not show a significant increase. The number of incident hemodialysis patients increased significantly from 4,406 in 2003 to 12,134 in 2014 and then decreased to 8,090 in 2017. In the incident patients, the increase in the proportion of male patients and the increase in diabetes and hyperlipidemia were observed in similar manner with prevalent patients. Conclusion The incidence and prevalence of hemodialysis in Korea gradually increased from 2002 to 2017. The proportion of men, diabetes and hyperlipidemia among patients with hemodialysis also increased continuously. These findings may contribute as groundwork for epidemiological studies of hemodialysis in Korea.

P1430BETA C-TERMINAL TELOPEPTIDE OF TYPE I COLLAGEN: CORRELATIONS WITH MINERAL METABOLISM PARAMETERS AND CARDIAC VALVULAR CALCIFICATIONS IN A COHORT OF HEAMODIALYSIS PATIENTS

Abstract Background and Aims Beta-carboxyterminal telopeptide of type I collagen (beta-CTx) is considered a marker of bone resorption in patients affected by osteoporosis. Nevertheless, its role in mineral bone disorder (MBD) of CKD patients is not clear. The aim of this study was to explore in a group of haemodialysis patients (HDp): 1) The levels of beta-CTx; 2) The correlation between beta-CTx levels and other mineral metabolism (MM) parameters; 3) The association between beta-CTx and CKD-MBD specific therapy 4) The relation between beta-CTx and cardiac valvular calcifications (VC). Method We studied a group of 21 HDp (F/M 9/12, age 68[54-78] years) randomly selected from the HDp actually followed-up in our Department. Dialysis vintage was 52[23-80] months. All HDp were on a three-weekly hemodialysis schedule, with a prescribed dialysate calcium of 1.5 mmol/l. Before the first dialysis session of the week, after the long interdialytic interval, the levels of beta-CTx, total and ionized calcium (tCa and iCa), Phosphorus (P), Magnesium (Mg), intact PTH (iPTH), total and bone isoform of alkaline phosphatase (tALP and bALP), 25-hydroxyvitamin D (25OHVD), 1,25-dihydroxyvitamin D (1,25OH2VD), and other general biochemical parameters were measured (Figure 1). At the same time, data concerning MM therapies were recorded. In all the studied patients, the presence of VC was searched in the the most recent echocardiographic study. Results Beta-CTx levels showed a significant positive correlation with tALP (r 0.92, p &amp;lt;0.0001), bALP (r 0.89, p &amp;lt;0.0001) and iPTH (r 0.87, p&amp;lt;0.0001) and a negative correlation with tCa (r – 0.43, p=0.05) and iCa (r – 0.52, p=0.01). No significant correlation was found with the other MM and general biochemical parameters and with the general features of the studied cohort. 18 patients (85.7%) were taking P binders (72.2% Ca-based and 27.8% Ca-free). In 20 patients (95.2%) vitamin D therapy, either in the natural, active or both natural and active form (35%, 15% and 50%, respectively) was prescribed. 6 patients (28.6%) were in therapy with Cinacalcet. No difference was found in beta-CTx levels according to the presence and the type of each of the above mentioned therapies. Conclusion Taking into account the limitations of this preliminary small size observational study, our data showed that beta-CTx levels are high in HDp. Beta-CTx correlates with iPTH, tALP and bALP. The negative correlation with tCa and iCa probably might be influenced by the negative correlation between iPTH and serum Calcium. Beta-CTx levels are not associated with CKD-MBD specific therapy or with cardiac valvular calcifications. Further prospective and randomized studies, including a higher number of HDp and possibly bone histology are needed to elucidate the possible role of beta-CTx as a marker of bone disease in HDp.

Caregiver Burden and Spiritual Well-being in Caregivers of Hemodialysis Patients.

The number of hemodialysis patients is increasing worldwide, and the caregivers of these patients experience a great burden. This study was conducted to examine the relationship between caregiver burden and spiritual well-being in caregivers of hemodialysis patients in Kerman, Iran. This correlational study was conducted on 382 caregivers of hemodialysis patients. Data were collected using the Caregiver Burden Inventory (24 items) and Ellison and Paloutzian 20-Item Spiritual Well-being Questionnaire. Data were analyzed by descriptive and inferential statistics (t test, ANOVA, Spearman correlation, and linear regression analysis) in SPSS 20 software. The findings showed that 45 (11.8%) caregivers had mild, 214 (56%) moderate, and 123 (32.2%) high caregiver burden. Furthermore, 1 (0.3%) caregiver had mild, 349 (92.4%) moderate, and 32 (8.4%) high spiritual well-being. Also, Spearman correlation test showed a significant reveres relationship between caregiver burden and spiritual well-being scores (p < 0.001, r = - 0.41). Moreover, the results of the regression analysis showed that the patient's income, frequency of patient dialysis per week, and patient's need to receive care and spiritual well-being were predictors of caregiver burden, which explained 41% of the burden in caregivers. The results of this study revealed that spiritual well-being was negatively related to caregiver burden and was one of its predictors. Therefore, spirituality can be used as a low-cost and effective intervention to reduce the caregiver's burden.

Factors Correlating to the Development of Hepatitis C Virus Infection in Hemodialysis Patients-Findings Mainly from Asiatic Populations: A Systematic Review and Meta-Analysis.

Hemodialysis is an effective replacement therapy for chronic renal failure patients. In recent decades, the number of hemodialysis patients has grown rapidly and some measures for preventing blood-borne diseases have been implemented, but hepatitis C virus (HCV) infection remains a significant problem. The meta-analysis published in 2009 on HCV infection-related factors was based on localized study objects, and some additional studies have been published since 2009; however, the contribution of these factors remains under dispute. Our study pooled the odds ratios (ORs) or mean standard deviations (MDs) with 95% confidence intervals (CIs) and analyzed sensitivity using Review Manager 5.1 software (5.1 version Copenhagen: The Nordic Cochrane Centre; 2011) by searching data in the PubMed, Elsevier, Springer, Wiley, and EBSCO databases. Spearman correlation analysis was performed using the SPSS package. In our meta-analysis, 1715 HCV-infected hemodialysis patients and 7093 non-HCV-infected hemodialysis patients from 44 studies were analyzed. The pooled ORs with 95% CIs were: histories of blood transfusion, 4.30 (3.11, 5.96); weekly hemodialysis times > 2, 6.00 (3.25, 11.06); kidney transplantation, 5.80 (3.95, 8.52); hemodialysis units > 2, 6.90 (2.42, 19.68); shared hemodialysis devices, 5.00 (2.35, 10.65); and drug addiction, 4.73 (1.54, 14.47). The pooled MDs with 95% CIs were duration of hemodialysis (months) 27.48 (21.67, 33.30). There was a positive correlation between duration of hemodialysis and the HCV infection rate (p < 0.01). Hemodialysis patients, especially from Asia, with shared hemodialysis devices, hemodialysis units > 2, blood transfusion, kidney transplantation, and drug addiction were at increased risk of HCV infection. The HCV infection rate increased with the duration of hemodialysis. High-risk hemodialysis patients should be monitored and receive timely screening.

Treatment strategy for amyloid hip arthropathy in long-term hemodialysis patients.

The number of hemodialysis patients has been progressively increasing in our country. On the other hand, chronic hip arthropathy associated with long-term hemodialysis is a devastating problems affecting patients' quality of life. In our previous study, we proposed a classification system for radiological abnormalities seen in hemodialysis-related hip lesions. The purpose of the study was to propose the surgical strategy for hip disorders caused by long-term hemodialysis. Patients with a history of hemodialysis for more than 10 years, 191 hip lesions in 165 consecutive patients who visited our institute due to hip symptoms. Various abnormalities were identified in 116 out of 191 hips. A retrospective assessment of the patient record and radiographs was performed for the included subjects examining the natural course of the disease process as well as the results of surgical treatment. Seventy-six hip lesions (69.0%) were conservatively managed at the time of the initial visit. Surgeries were performed for 75 hips (64.7%) during the study period. Among those, surgical treatment was indicated for 40 hips at the time of the initial visit. On the other hand, surgeries were performed for 35 hips during the subsequent follow-up period due to progression of the disease process. Based on the analysis of our surgical experiences by the retrospective chart review, we have established a flowchart of the treatment strategy for chronic hip arthropathy in long-term hemodialysis patients. This study is retrospective clinical study.

Hatay İlinde Yüksek Hemodiyaliz Hasta Sayısı ve Olası Nedenler

Hatay İlinde Yüksek Hemodiyaliz Hasta Sayısı ve Olası Nedenler

Survival Analysis of Hemodialysis Patients

Survival analysis as a collection of statistical procedures for analyzing the data that its outcome variable was the time to occurrence of an event. Kaplan-Meier method is a type of survival analysis technique, this method is often called the Product Limit Method. Chronic Kidney Disease (CKD) became one of the public health problem throughout the world, including Indonesia. The number of hemodialysis patients has increased every year and have an impact on increasing the number of death in General Hospital Ibnu Sina Gresik. This study was determine the survival of hemodialysis patients using Kaplan-Meier analysis techniques. Non-reactive research with a retrospective cohort using the calculations right censoring. 155 population were taken randomly and sample size of 111. Data were collected using a checklist. The estimated survival time of female, adult age, further education, patients work, patients without insurance, patients with normal nutritional status, patients with a history of disease, patient with hypertention and patient with diabetic had a better survival time. The insurance status, nutritional status, hypertension, and diabetes mellitus were significant difference to the survival time (p-value &amp;lt;0.05). It was necessary special treatment for CKD patients through giving information, education to families and patients to maintain healthy lifestyle.

Survival Analysis of Hemodialysis Patients

Survival analysis as a collection of statistical procedures for analyzing the data that its outcome variable was the time to occurrence of an event. Kaplan-Meier method is a type of survival analysis technique, this method is often called the Product Limit Method. Chronic Kidney Disease (CKD) became one of the public health problem throughout the world, including Indonesia. The number of hemodialysis patients has increased every year and have an impact on increasing the number of death in General Hospital Ibnu Sina Gresik. This study was determine the survival of hemodialysis patients using Kaplan-Meier analysis techniques. Non-reactive research with a retrospective cohort using the calculations right censoring. 155 population were taken randomly and sample size of 111. Data were collected using a checklist. The estimated survival time of female, adult age, further education, patients work, patients without insurance, patients with normal nutritional status, patients with a history of disease, patient with hypertention and patient with diabetic had a better survival time. The insurance status, nutritional status, hypertension, and diabetes mellitus were significant difference to the survival time (p-value &amp;lt;0.05). It was necessary special treatment for CKD patients through giving information, education to families and patients to maintain healthy lifestyle.

Mortality rates and walking ability transition after lower limb major amputation in hemodialysis patients

The number of hemodialysis patients with peripheral artery disease is increasing, and critical limb ischemia develops in some of these patients. The clinical outcomes in such patients after major amputation remain unclear. We therefore examined the mortality rates after major amputation in hemodialysis patients. The study enrolled 108 hemodialysis patients undergoing their first major amputation at Community Health Care Organization Sendai Hospital between January 2005 and December 2014 and monitored them until June 2015. All-cause mortality and additional amputation-free survival were evaluated by Kaplan-Meier analysis. The most dominant primary disease of renal failure was diabetes mellitus (77%), and the duration of hemodialysis was 8.5± 6.8years. During the median follow-up period of 11.5months (20.3± 22.6months), 80 patients (74%) died, and the survival rates were 83% at 30days, 56% at 1year, and 15% at 5years. The median time to death was 19.9months (95% confidence interval, 9.8-30.0months), and the causes of death were cardiac (45%), sepsis (29%), cerebrovascular (4%), and others (22%). Thirty-one patients underwent additional amputation, and the additional amputation-free survival rates were 39% at 1year and 9% at 5years. The median time between the first and second amputations was 2.5months (5.7± 7.6months). Univariate analysis showed previous minor amputation (P= .04) and low hematocrit level (P= .04) were associated with the 30-day mortality rate, and age (P= .05) was associated with the 5-year mortality rate. On multivariate Cox proportional hazard analysis, only age was associated with mortality rate (hazard ratio, 1.02; 95% confidence interval, 0.99-1.02; P= .04). We also compared walking ability before and after major amputation among patients who survived >60days. The rate changed from 34% to 12% for of ambulatory patients, from 45% to 48% for wheelchair use, and from 21% to 40% for bedridden patients. Ambulatory patients had a significantly better survival rate than the others (P= .02). The mortality rate after major amputation in hemodialysis patients was high, and major amputation had a huge negative effect on patients' walking ability.

Epidemiology of uraemic itch: New data.

Chronic itch (CI) is a frequent and impairing symptom in haemodialysis (HD) patients. Within the last decades, worldwide variations were reported in the prevalence of itch in HD patients, ranging from 10 to 77%. Regional differences and especially the irregular pattern of itch in HD may explain why CI is still not well perceived and underestimated in HD patients. The pathogenesis is still unclear and therapy is ineffective in the majority of cases. There is a great diversity of prevalence estimates of itch used in different studies as well, as the study population greatly differs, especially when investigating CI in HD. Due to the demographic situation with a rising number of aged patients and increasing survival rates in HD, the number of HD patients will continuously grow, especially in the Western countries. Up to now, representative epidemiological data on CI in HD were missing. GEHIS (German Epidemiological Hemodialysis Itch Study) was established in 2012 as a representative prospective cross-sectional study. Eight hundred and sixty HD patients from a randomly selected cluster sample were included. The primary outcome measures were different prevalence measures of CI. The point prevalence was 25.2%, the 12-month prevalence was 27.2% and the lifetime prevalence of CI was 35.2%. General health status and health-related quality of life (HRQOl) were significantly impaired in those with CI. Due to the comparability of standards in HD quality, these results can be transferred to Western countries. This study demonstrates that CI is a frequent, long-lasting burden in HD patients affecting every fourth HD patient (point prevalence) and more than every third HD patient at some point in their lifetime.

Glycaemic Control Impact on Renal Endpoints in Diabetic Patients on Haemodialysis.

Objective. To identify the number of haemodialysis patients with diabetes in a large NHS Trust, their current glycaemic control, and the impact on other renal specific outcomes. Design. Retrospective, observational, cross-sectional study. Methods. Data was collected from an electronic patient management system. Glycaemic control was assessed from HbA1c results that were then further adjusted for albumin (Alb) and haemoglobin (Hb). Interdialytic weight gains were analysed from weights recorded before and after dialysis, 2 weeks before and after the most recent HbA1c date. Amputations were identified from electronic records. Results. 39% of patients had poor glycaemic control (HbA1c > 8%). Adjusted HbA1c resulted in a greater number of patients with poor control (55%). Significant correlations were found with interdialytic weight gains (P < 0.02, r = 0.14), predialysis sodium (P < 0.0001, r = −1.9), and predialysis bicarbonate (P < 0.02, r = 0.12). Trends were observed with albumin and C-reactive protein. Patients with diabetes had more amputations (24 versus 2). Conclusion. Large number of diabetic patients on haemdialysis have poor glycaemic control. This may lead to higher interdialytic weight gains, larger sodium and bicarbonate shifts, increased number of amputations, and possibly increased inflammation and decreased nutritional status. Comprehensive guidelines and more accurate long-term tests for glycaemic control are needed.

Patient survival on dialysis in Korea: a different story?

In a propensity score-matched analysis of their cohort study including more than 32,000 hemodialysis and peritoneal dialysis patients in South Korea, Kim and colleagues found that mortality risk was higher in peritoneal dialysis than in hemodialysis patients aged 55 years or older. Among younger patients, survival was similar for both treatment modalities. These findings are in contrast to most results from studies in Western countries. We discuss a number of factors that may explain these differences.