Population Of Hemodialysis Patients Research Articles

RF-IDH: An intelligent fall detection system for hemodialysis patients via COTS RFID

Unhealthy habits lead to a growing population of hemodialysis patients. The single treatment of hemodialysis is about four hours long. Therefore, patients usually go to the toilet during treatment and need to be checked for safety. However, existing fall detection techniques are often limited by factors such as privacy, signal interference, and the like. In this paper, we propose RF-IDH tackle the above issues, a dedicated system for detecting falls caused by complications in hemodialysis patients using RF signal. In RF-IDH, after collecting the signal, we process the collected data by three functional module clusters, namely signal preprocessing, residual feature extraction, hemodialysis patient’s fall detection, all of which are well-designed to achieve high performance in patient’s fall detection. In particular, we design a residual feature extraction (RFE) algorithm based on the hemodialysis patient safety process model, and the fall detection of hemodialysis patients is treated as a machine learning problem where four classification models are built via learning residual feature space. We implement our system on commercial off-the-shelf RFID devices and compared the evaluation metrics of four different methods in terms of system performance, efficiency, robustness, and latency. The evaluation results show that our proposed RF-IDH that optimizes the 2NN–RFE method achieves superior performance compared to other methods.

SO027ASSOCIATIONS OF MUSCLE SODIUM DEPOSITION WITH SODIUM-23 MRI IN HEMODIALYSIS PATIENTS

Abstract Background and Aims The development of sodium-23 magnetic resonance imaging (23Na MRI) allows the clinical quantification of tissue sodium. Recent studies have shown that hemodialysis (HD) patients have a tendency to retain tissue sodium due to impaired mechanisms in local tissue sodium clearance. However, the clinical significance of tissue sodium deposition in the HD patient population is unclear yet. The aim of this study was to investigate the association of tissue sodium deposition with well-established biomarkers of clinical outcomes. Method Chronic, thrice weekly HD patients underwent 23Na MRI of the leg on a non-dialysis day, during either the long or short interdialytic interval. Blood samples were also taken for the measurement of standard blood-based biomarkers. A multinuclear-capable 3.0-T MRI (GE Healthcare, Milwaukee WI) was used to acquire proton and sodium images. Maps of tissue 23Na concentration were generated using an in-house software developed within MATLAB (Mathworks, Natick, USA, R2018a). 23Na concentration maps were superimposed with the proton-anatomy images to delineate the regions of interest. Using the Horos (The Horos Project, Version 4.0.0) software, the soleus muscle was segmented (Figure, Panel A) and the sodium concentration in the region of interest was recorded for analysis. Results 28 HD patients completed both 23Na MRI and bloodwork; 7/28 (25%) patients were females; mean±SD age was 66.1±8.3 years, mean body mass index was 30.9±6.5 kg/m2, and mean HD vintage was 30.2±34.9 months. Soleus muscle sodium concentration showed a strong, negative correlation with serum albumin (Figure, Panel B; r=-0.66, p<0.0001). Furthermore, soleus muscle sodium concentration showed a minor association with plasma hemoglobin (r=-0.46, p=0.01). Conclusion Serum albumin is a recognized, powerful predictor of mortality in the hemodialysis patient population. The strong relationship between muscle sodium concentration and serum albumin levels suggests that tissue sodium deposition may be a relevant biomarker of clinical outcomes. In addition, muscle sodium deposition may be involved in the development of anemia. These findings warrant further studies investigating the consequences of sodium removal on these biomarkers.

P1302NONINVASIVE ASSESSMENT OF PULMONARY HYPERTENSION USING QUANTITATIVE IMAGING IN HEMODIALYSIS PATIENTS

Abstract Background and Aims Pulmonary hypertension (PH) is highly prevalent in the hemodialysis (HD) patient population. Right heart catheterism remains the gold standard for PH diagnosis and etiological stratification – this makes a comprehensive investigation of PH challenging in these patients. The PEPPER study suggested that postcapillary PH is the most common form of PH in HD patients, as the result of volume overload and left ventricular dysfunction. We hypothesized that novel quantitative imaging-derived biomarkers, such as pulmonary vessel volume and pulmonary artery volume, would improve our insight on the relationship between PH, volume status and left ventricular dysfunction in HD patients. In this study, we explored the combined role of noncontrast chest CT and echocardiography to investigate PH in a sample of HD patients. Method Study participants underwent noncontrast chest CT and doppler echocardiography on a non-HD day. To avoid potential confounders, chronic hemodialysis patients with previously diagnosed chronic lung disease, cancer and infections were excluded, and smoking history was limited to 20 packs/year. Pulmonary vessel volume was automatically segmented and measured using commercial software (VIDA Diagnostics Inc., Coralville, USA). Total pulmonary artery (PA) volume was segmented manually from CT, including 25 mm of the main, left and right pulmonary arteries starting from the bifurcation; volumes were calculated using a combination of in-house software (3D Quantify, Robarts Research Institute, London, Ontario, Canada; MATLAB MathWorks, Inc., Natick, Massachusetts, USA). PA volume and pulmonary vessel volume were indexed by body surface area (BSA), to correct for body size. Left atrial volume and PA systolic pressure were measured from doppler echocardiography according to current clinical guidelines. Associations between quantitative imaging biomarkers and demographics were assessed with Pearson and Spearman correlation, as appropriate. Linear fitting was performed with linear regression. Results Five HD patients were studied. Two patients had PA systolic pressure ≥ 35 mmHg. Preliminary analysis showed a nonlinear trend correlation between PA systolic pressure and pulmonary vessel volume/BSA (Panel A), PA systolic pressure and pulmonary artery volume/BSA (Panel B). Additionally, pulmonary vessel volume showed a significant, positive linear correlation with total pulmonary artery volume (Panel C) and left atrial volume (Panel D). Conclusion Preliminary correlations between pulmonary vessel volume, pulmonary artery volume, left atrial volume and PA systolic pressure suggest that intravascular volume and left ventricular dysfunction may play a significant role in determining PH in HD patients. Quantitative imaging allows screening for PH and provides additional, noninvasive, and relevant clinical information on the pathophysiology of PH in HD patients. Correlation for PA Systolic Pressure (mmHg) with pulmonary vessel volume/BSA and total PA volume/BSA (Panels A and B, respectively). Correlation for pulmonary vessel volume with left atrial volume and total PA volume (Panels C and D, respectively).

P0957DISABILITY OF DIALYSIS PATIENTS AND CONDITION OF THEIR BLOOD VESSELS

Abstract Background and Aims Epidemiological data indicate constant increase of mean age among hemodialysis patients. These population have high burden of comorbid conditions, including cardiovascular (CV) diseases, which lead to disability and the need for continuous care. The aim of the study was to analyze the problems of disability in hemodialysis patients in the context of cardiovascular complication and vascular condition. Method In this cross-sectional study 129 patients (mean age 64.5 y, 54 females, with mean dialysis vintage 61 months) were enrolled from 3 satellite dialysis centers (inclusion criteria: age ≥18 y, dialysis vintage≥3 months). Demographic and comorbidity data were collected from medical records and during interview. The degree of disability (Bartel scale), 10-year cardiovascular risk (QRISK®3 online calculator), degree of imbalance (questionnaire - Falls Efficacy Scale – International (FES-I)) were assessed. In addition, ambulatory measurements of hemodynamic parameters with Mobil-O-Graph monitor (IEM, Stolberg,Germany), which records oscillometric arm blood pressure (SBP and DBP), central systolic (cSBP) and diastolic (cDBP), pulse pressure (pPP), ejection fraktion - (EF), cardiac output - (CO) and pulse waves. It calculates augmentation index (AIx@75) as measure of wave reflections, and pulse wave velocity (PWV) as measure of arterial stiffness. Results The most common causes of renal failure in the study group were ischemic - 35%, and diabetic nephropathy 26% (Fig. 1). Only 8 out of 129 pts. (6.2%) were professionally active, 40 (31%) received disability pension and 81 (62.8%) retirement. 25 (19%) used a wheelchair for transport and 21 (16%) used crutch. More than half (51%) were independent in everyday activities reaching 80-100 points on the Bartel scale, however only 14% were fully independent (100 points). Minimally dependent (60-79 points) constituted 27% (35 pts) of all patients, partially dependent (40-59 points) - 10% (13 pts), highly dependent (20-39 points) - 7% (9 pts) and fully dependent (<20 points) 5% (6 pts). The most common causes of disability were heart problems, including heart failure in 20.9%, lower limb ischemia, diabetic foot and amputation in 13.1% and cerebrovascular event in 10.8% followed by weakness associated with dialysis and degenerative joints disease (Fig. 2). Less disable group (80-100 points on the Bartel scale) showed significantly lower PWV, lower QRISK®3 and FES I index compared to the non self-reliant group (Fig 3). The degree of disability according to Bartel scale negatively correlated with age, PWV, QRISK®3 and FES I index (Fig 4). Conclusion Our results indicate that half of the population of hemodialysis patients show some degree of functional dependence. The group of patients with higher degree of disability are older and characterize of the more advanced changes in the arteries, higher risk of the CV incidents and increase risk of fall.

Medium cut-off dialyzers in a large population of hemodialysis patients in Colombia: COREXH registry.

Expanded hemodialysis (HDx) provides increased clearance of conventional and large middle molecules through innovative medium cutoff (MCO) membranes. However, there is a paucity of real‐world data regarding the benefits and safety of HDx. This large observational study evaluated outcomes among patients in Colombia undergoing HDx at a extended dialysis clinical services provider. This was a prospective single cohort study of prevalent patients who were treated with HDx; baseline information was collected from the most recent data before patients were started on HDx. Patients were followed prospectively for 1 year for changes in serum albumin and other laboratory parameters compared with the baseline. Survival, hospitalization and safety were assessed from the start of HDx. A total of 1000 patients were invited to enroll; 992 patients met the inclusion criteria for data analysis and 638 patients completed the year of follow‐up. Seventy‐four (8%) patients died during 866 patient‐years (PY) of follow‐up; the mortality rate was 8.54 deaths/100 PY (95% confidence interval [CI], 6.8‐10.7). There were 673 hospitalization events with a rate of 0.79 events/PY (95% CI, 0.73‐0.85) with 6.91 hospital days/PY (95% CI, 6.74‐7.09). The observed variability from baseline and maximum average change in mean serum albumin levels were −1.8% and −3.5%, respectively. No adverse events were related to the MCO membrane. HDx using an MCO membrane maintains stable serum albumin levels and is safe in terms of nonoccurrence of dialyzer related adverse events.

Delivering Dialysis During the COVID-19 Outbreak: Strategies and Outcomes

Abstract Background Haemodialysis (HD) patients are at increased risk of COVID-19 infection. Although all dialysis patients meet government criteria for shielding, only those on home treatment can comply. Patients attending incentre HD units represent a large and vulnerable group, who are unable to rigorously adhere to this advice. The need to adopt strategies to protect these patients is of great importance. We report our experience of delivering dialysis during the COVID-19 outbreak, describing the interventions taken to try to protect patients from virus transmission whilst maintaining optimal treatment. Methods We implemented measures, including use of; a system of active triage and isolation of suspected cases, separate transportation, a dedicated COVID-19 HD unit, personal protective equipment, active repatriation of patients back to base units. We collected data from all COVID-19 positive HD patients in our cohort, between 14/03/2020 - 20/04/2020. Data were compared to national reports of other units, and values obtained from a dialysis-specific Susceptible-Infectious-Removed model which predicted the impact of COVID-19 on our cohort. Results Results showed 76/670 (11.3%) tested positive for COVID-19. The majority were male (61.8%) and from a minority background (61.8%). 7/76 (9.2%) patients died following infection. The model projections overestimated the incidence of COVID-19, 221 vs 76 total number of infections by 20/4/20. Our incidence of COVID-19 and mortality are lower compared to other units across London. Conclusion Implementation of measures to limit the spread of COVID-19, and optimise dialysis, could account for the low infection and mortality rates observed in our cohort of patients.

A report from the Brescia Renal COVID Task Force on the clinical characteristics and short-term outcome of hemodialysis patients with SARS-CoV-2 infection

The SARS-CoV-2 epidemic is pressuring healthcare systems worldwide. Disease outcomes in certain subgroups of patients are still scarce, and data are needed. Therefore, we describe here the experience of four dialysis centers of the Brescia Renal COVID Task Force. During March 2020, within an overall population of 643 hemodialysis patients, SARS-CoV-2 RNA positivity was detected in 94 (15%). At disease diagnosis, 37 of the 94 (39%) patients (group 1) were managed on an outpatient basis, whereas the remaining 57 (61%) (group 2) required hospitalization. Choices regarding management strategy were made based on disease severity. In group 1, 41% received antivirals and 76% hydroxychloroquine. Eight percent died and 5% developed acute respiratory distress syndrome (ARDS). In group 2, 79% received antivirals and 77% hydroxychloroquine. Forty two percent died and 79% developed ARDS. Overall mortality rate for the entire cohort was 29%. History of ischemic cardiac disease, fever, older age (over age 70), and dyspnea at presentation were associated with the risk of developing ARDS, whereas fever, cough and a C-reactive protein higher than 50 mg/l at disease presentation were associated with the risk of death. Thus, in our population of hemodialysis patients with SARS-CoV-2 infection, we documented a wide range of disease severity. The risk of ARDS and death is significant for patients requiring hospital admission at disease diagnosis.

SUN-183 DIURNAL RHYTHMS OF SERUM PHOSPHATE IN HEMODIALYSIS PATIENTS

Hyperphosphatemia is a common complication of chronic kidney disease that associates with increased risks for all-cause and cardiovascular mortality. Phosphate binder therapies are an efficacious strategy to reduce serum phosphate levels. In clinical practice, the decision on binder therapy initiation and dosage is typically determined from the pre-dialysis blood phosphate level. The healthy population exhibits diurnal rhythms in blood phosphate regulation with fluctuations of more than 1 mg/dL throughout the day (Vervloet et al. 2017). Whether such circadian rhythms persist in dialysis patients and whether the fluctuation pattern is different to that of healthy individuals is only partially understood. We profiled the diurnal rhythms of serum phosphate levels in a population of chronic hemodialysis (HD) patients. We used data from adult in-center HD patients (age ≥18 years) with HD vintage >90 days who were treated at a large dialysis organization in the United States in 2018. We computed the mean pre-dialysis blood phosphate levels at the time of the start of each HD treatment in 2-hour periods through 24 hours for the entire population, as well as stratified by phosphate binder use. Time of HD initiation was treated as time-varying exposure, allowing patients to switch time groups if they had pre-dialysis blood draws in multiple time periods of the day. The mean phosphate levels based on the time of the day with 95% confidence limits were plotted and we used a nonparametric smoothing spline model to fit data and calculate the trajectories of phosphate levels throughout the day. A total of 158,156 adult HD patients were included in the analysis. Patients were: mean age 62.8±14.3 years, 57.1% male, 58.2% white race, 15.8% Hispanic ethnicity, 41.9% with diabetes, 19.6% with congestive heart failure, and HD vintage 1509±1288 days. Mean pre-dialysis albumin was 3.8±0.4 g/dL and phosphate was 5.4±1.5 mg/dL for the population. Overall, mean phosphate levels were found to vary remarkably by 0.9 mg/dL throughout the day, with nadir levels from 0900 to 1100 hours (5.3±1.6 mg/dL), followed by a rise to a mid-day peak from 1700 to 1900 hours (5.8±1.8 mg/dL), and the highest levels had a peak time from 2300 to 0100 hours (6.2±2.1 mg/dL) (Figure 1a). Similar fluctuations and phosphate levels were observed among patients using a phosphate binder (n=143,364), however, patients not using a phosphate binder (n=14,792) exhibited absolute values of mean phosphate levels that were consistently about 1 mg/dL lower at every timepoint (Figure 1b). All patients treated with HD from 2300 through 0300 hours (n=315) were taking a phosphate binder. Our results suggest phosphate levels have a diurnal variation of about 1 mg/dL in patients on chronic hemodialysis, characterized by a nadir in the morning, a mid-day peak and a larger nocturnal peak. Further adjusted analyses are needed to confirm these results that account for patient characteristics, phosphate binder dose and duration of use.

Pain Assessment in Hemodialysis Patients.

BackgroundPain is a common complaint among hemodialysis (HD) patients; however, most patients are not assessed for this aspect and are not sufficiently treated. In these patients, pain is reported to be associated with a range of parameters like increased depression and disrupted quality of life (QOL). Previously residual renal function (RRF) was not assessed for associations with pain. The primary aim of the study is to evaluate the pain frequency in the Turkish HD patient population. In addition, the type, origin, and severity of chronic pain, the pain treatment ratio, and the relationship between pain, QOL, and RRF were investigated during the study.MethodsThis study included 328 HD patients. Pain assessment used the McGill Pain Questionnaire and neuropathic pain assessment used the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale. The correlation of pain and quality of life was evaluated with the Short Form 36 (SF-36) quality of life scale.ResultsOf patients, 244 experienced pain (74.4%), and this pain had a neuropathic character in 61.8% of these patients. Patients with pain had a longer dialysis duration than those without pain (4.00 (2.00-8.00), 3.00 (2.00-4.75), p=0.01). The most common site of pain was the lower extremities. Pain was observed more often among females and with increasing age. Only 36.4% of patients used analgesics. The quality of life of patients with pain was found to be lower. The incidence of pain was higher among patients without RRF and had more neuropathic character.ConclusionsPain is a significant problem for the majority of HD patients and is not effectively managed. To increase the quality of life of patients, the care team should regularly question pain symptoms, and it should be treated effectively. In this context, RRF should be regularly monitored and efforts should be made to preserve it.

Patient selection, education, and cannulation of percutaneous arteriovenous fistulae: An ASDIN White Paper.

End-stage kidney disease patients who are candidates for surgical arteriovenous fistula creation commonly experience obstacles to a functional surgical arteriovenous fistula, including protracted wait time for creation, poor maturation, and surgical arteriovenous fistula dysfunction that can result in significant patient morbidity. The recent approval of two endovascular devices designed to create a percutaneous arteriovenous fistula enables arteriovenous fistula creation to be placed in the hands of interventionalists, thereby increasing the number of arteriovenous fistula providers, reducing wait times, and allowing the patient to avoid surgery. Moreover, current studies demonstrate that patients with percutaneous arteriovenous fistula experience improved time to arteriovenous fistula maturation. Yet, in order to realize the potential advantages of percutaneous arteriovenous fistula creation within our hemodialysis patient population, it is critical to select appropriate patients, ensure adequate patient and dialysis unit education, and provide sufficient instruction in percutaneous arteriovenous fistula cannulation and monitoring. In this White Paper by the American Society of Diagnostic and Interventional Nephrology, experts in interventional nephrology, surgery, and interventional radiology convened and provide recommendations on the aforementioned elements that are fundamental to a functional percutaneous arteriovenous fistula.

Saturday multidisciplinary hemodialysis access clinics to enhance patient care.

Fragmentation of outpatient care is a substantial barrier to creation and maintenance of hemodialysis access. To improve patient accessibility, satisfaction, and multidisciplinary provider communication, we created a monthly Saturday multidisciplinary vascular surgery and interventional nephrology access clinic at a tertiary care hospital in a major urban area for the complicated hemodialysis patient population. The study included patients presenting for new access creation as well as those who had previously undergone access surgery. Staffing included two to three interventional nephrologists, two to three vascular surgeons, one medical assistant, one research assistant, and one practice assistant. Patient satisfaction and perception of the clinic was measured using surveys during six of the monthly Saturday hemodialysis clinics. A total of 675 patient encounters were completed (18.2 average/clinic ±6.3 standard deviation) from August 2016 to August 2019. All patients were seen by both disciplines. The average no-show rate was 19.9% throughout the study period. Patient satisfaction in all measures was consistently high with the Saturday clinic. Providers were also assayed, and they generally valued the real-time, multidisciplinary care plan generation, and its subsequent efficient execution. Saturday multidisciplinary hemodialysis access clinics offer high provider and patient satisfaction and streamlined patient care. However, no-show rates remain relatively high for this challenging patient population.

Hypocalcemia-Induced Slowing of Human Sinus Node Pacemaking

Each heartbeat is initiated by cyclic spontaneous depolarization of cardiomyocytes in the sinus node forming the primary natural pacemaker. In patients with end-stage renal disease undergoing hemodialysis, it was recently shown that the heart rate drops to very low values before they suffer from sudden cardiac death with an unexplained high incidence. We hypothesize that the electrolyte changes commonly occurring in these patients affect sinus node beating rate and could be responsible for severe bradycardia. To test this hypothesis, we extended the Fabbri et al. computational model of human sinus node cells to account for the dynamic intracellular balance of ion concentrations. Using this model, we systematically tested the effect of altered extracellular potassium, calcium, and sodium concentrations. Although sodium changes had negligible (0.15 bpm/mM) and potassium changes mild effects (8 bpm/mM), calcium changes markedly affected the beating rate (46 bpm/mM ionized calcium without autonomic control). This pronounced bradycardic effect of hypocalcemia was mediated primarily by ICaL attenuation due to reduced driving force, particularly during late depolarization. This, in turn, caused secondary reduction of calcium concentration in the intracellular compartments and subsequent attenuation of inward INaCa and reduction of intracellular sodium. Our in silico findings are complemented and substantiated by an empirical database study comprising 22,501 pairs of blood samples and in vivo heart rate measurements in hemodialysis patients and healthy individuals. A reduction of extracellular calcium was correlated with a decrease of heartrate by 9.9 bpm/mM total serum calcium (p < 0.001) with intact autonomic control in the cross-sectional population. In conclusion, we present mechanistic in silico and empirical in vivo data supporting the so far neglected but experimentally testable and potentially important mechanism of hypocalcemia-induced bradycardia and asystole, potentially responsible for the highly increased and so far unexplained risk of sudden cardiac death in the hemodialysis patient population.

Generalized and Prolonged Use of Gentamicin-Lock Therapy Reduces Hemodialysis Catheter-Related Infections Due to Gram Negatives

Introduction: The incidence of catheter-related bloodstream infections (CRBSI) ranges from 2.2 to 5.5 episodes per 1,000 catheter-days. Our aim was to evaluate the utility of a generalized and prolonged gentamicin-lock therapy in patients undergoing hemodialysis (HD) in a third-level hospital for the reduction in CRBSI. Methods: A prospective cohort analyzed before and after intervention. During intervention periods after each HD-session, the catheter lumens were locked with gentamicin/heparin for all patients compared to nonintervention periods were the same procedure was performed without gentamicin. Active surveillance was performed for HD CRBSI. Microbiologic assessment and epidemiological data were gathered. Continuous hand hygiene and water quality monitoring were performed. Results: The rates of CRBSI were reduced from 1.28 to 0.2 cases per 1,000 catheter-days when the lock therapy was employed (p = 0.001) The greatest reduction was for CRBSI caused by Pseudomonas aeruginosa were no cases were recorded during the intervention periods (p = 0.001). There was a significant reduction in the total number of isolates; Gram-negative bacterial species (–97.2%) and Gram-positive bacterial species (–61.5%) although only the former reached statistical significance (p = 0.0001). The difference in the absolute risk reduction was 20.56% (95% CI 14.46–26.66%), the calculated Number Needed to Treat was 5 (95% CI 3.8–6.9). No adverse effects were noted. Conclusion: In the current study, gentamicin-lock therapy was associated with a significant reduction in CRBSI specially with P. aeruginosa and other Gram-negative bacteria. It proved to be safe and effective intervention when applied to the entire population of HD patients.

Prevalence and Risk Factors for Chronic Kidney Disease in Family Relatives of a Cameroonian Population of Hemodialysis Patients: A CrossSectional Study

Background: In sub-Saharan Africa (SSA), the trend in the number of patients admitted for maintenance hemodialysis is on the rise. The identification of risk factors for chronic kidney disease (CKD) ensures adequate primary and secondary preventive measures geared at reducing the burden of CKD in low-resource settings. A family history of CKD is an established risk factor for CKD in high-income countries. However, data on family predisposition to CKD is scarce in the literature on SSA. Objective: The current study aimed to determine the prevalence and risk factors of CKD in family relatives of a Cameroonian population of hemodialysis patients (HDP) followed-up in a major hemodialysis referral center in Cameroon. Methods: The current cross-sectional study was conducted over four months on a consecutive sample of first-degree family relatives of end-stage renal disease patients undergoing maintenance hemodialysis at the hemodialysis unit of the General Hospital of Yaoundé. For each participating family relative, socio-demographic characteristics, clinical data, and biological data including fasting blood glucose, proteinuria, and serum creatinine were collected. Results: A total of 82 first-degree family relatives of HDP were recruited. The prevalence of CKD among the participants was 15.8%. The main identified risk factors for CKD were age (P = 0.0015), female gender (P = 0.0357), hypertension (P = 0.0004), regular intake of herbal remedies (P = 0.0214), and diabetes mellitus (P = 0.0019). Conclusion: Overall, the current findings suggest an urgent need for population education, routine screening of CKD, and the identification of risk factors in first-degree family relatives of HDP in Cameroon.

Current treatment status and medical costs for hemodialysis vascular access based on analysis of the Korean Health Insurance Database.

Background/AimsThe Republic of Korea is a country where the hemodialysis population is growing rapidly. It is believed that the numbers of treatments related to vascular access-related complications are also increasing. This study investigated the current status of treatment and medical expenses for vascular access in Korean patients on hemodialysis.MethodsThis was a descriptive observational study. We inspected the insurance claims of patients with chronic kidney disease who underwent hemodialysis between January 2008 and December 2016. We calculated descriptive statistics of the frequencies and medical expenses of procedures for vascular access.ResultsThe national medical expenses for access-related treatment were 7.12 billion KRW (equivalent to 6.36 million USD) in 2008, and these expenses increased to 42.12 billion KRW (equivalent to 37.67 million USD) in 2016. The population of hemodialysis patients, the annual frequency of access-related procedures, and the total medical cost for access-related procedures increased by 1.6-, 2.6-, and 5.9-fold, respectively, over the past 9 years. The frequency and costs of access care increased as the number of patients on hemodialysis increased. The increase in vascular access-related costs has largely been driven by increased numbers of percutaneous angioplasty.ConclusionsThe increasing proportion of medical costs for percutaneous angioplasty represents a challenge in the management of end-stage renal disease in Korea. It is essential to identify the clinical and physiological aspects as well as anatomical abnormalities before planning angioplasty. A timely surgical correction could be a viable option to control the rapid growth of access-related medical expenses.

A model of vascular refilling with inflammation

Inflammation is prevalent in hemodialysis patients and is believed to significantly contribute to cardiovascular disease progression in end stage renal disease patients undergoing hemodialysis. Increased vascular permeability associated with inflammation is likely to influence the capillary wall properties, affecting vascular refilling during hemodialysis. In this paper, we present a model that incorporates inflammation into a vascular refilling model. We investigate how inflammation may affect the fluid volume and protein concentration dynamics in the plasma and interstitial spaces. In our work, we quantify inflammation by considering the concentration of the inflammatory biomarker C-reactive protein (CRP). Traditional sensitivity functions and subset selection based on asymptotic standard errors were used to aid in parameter identification. Estimates of the parameters were calculated from numerically generated measurements for fluid flux and hematocrit. Observations on the capillary wall properties, filtration and reflection coefficients, were done using data on mean CRP and serum albumin from a large population of European hemodialysis patients in their terminal two years before death and patients surviving for at least four years after dialysis initiation.

Perceived Barriers to Adherence to Hemodialysis Dietary Recommendations.

Barriers to following dietary recommendations have been described; however, they remain poorly understood. The purpose of this qualitative study was to explore perceived barriers to adherence to dietary recommendations in a diverse hemodialysis patient population. Participants were eligible to participate in a semi-structured qualitative telephone interview prior to randomization for an ongoing clinical trial to evaluate the efficacy of an intervention designed to reduce dietary sodium intake. Interviews were digitally recorded, transcribed verbatim and coded using an iterative qualitative process. In total, 30 (37% females, 53% Caucasians) participants, 63.2 ± 13.3 years, were interviewed. Time, convenience, and financial constraints hindered dietary adherence. Dietary counseling efforts were rated positively but require individualization. Ability to follow recommended guidelines was challenging. Suggestions for addressing barriers include technology-based interventions that allow patients to improve food choices and real-time decision-making, and permit tailoring to individual barriers and preferences.

Detection of Human Herpes Virus type-6 in Patients Undergoing Hemodialysis

Aim: To investigate the epidemiology of human herpes virus type-6 (HHV-6) among hemodialysis (HD) patients. Materials &amp; methods: DNA was extracted from plasma samples of 149 patients undergoing HD with no history of organ transplantation from 2011 to 2013. Presence of HHV-6 was investigated by using real-time PCR. Results: Diabetes (36.2%) and hypertension (28.8%) were two major factors for HD. The HHV-6 DNA was identified in eight patients (5.37%). Conclusion: This study is one of the few reports of HHV-6 infection among HD patients. In HD patient population, it is critical to improve standards of infection control in dialysis and expand treatment coverage. Furthermore, studies on clinical implications of HHV-6 infection in HD patients are crucial.

Beck Depression Inventory as a screening tool for depression in chronic haemodialysis patients.

To evaluate the psychometric properties of the Beck Depression Inventory (BDI) and Cognitive Depression Index (CDI) as a potential screening tool for major depression in haemodialysis (HD) patients. Forty-five HD patients completed both the BDI/CDI and diagnostic interview. The interview was conducted by two experienced clinicians and was based on DSM-IV criteria. The sensitivity, specificity and positive (PPV) and negative (NPV) predictive values were then calculated. A diagnosis of depression was found in 6 of the 45 participants (13.3%). Optimal cut-offs were ≥18 for the BDI (sensitivity 1.0, specificity 0.90, PPV 0.60, NPV 1.0) and ≥11 for the CDI (sensitivity 1.0, specificity 0.92, PPV 0.67, NPV 1.0). Both the BDI and CDI were shown to be acceptable screening tools for depression in this population of chronic HD patients. The recommended cut-off scores for both scales are higher than those suggested for the general population and slightly higher than previously found in the chronic kidney disease literature, suggesting that altered thresholds are required when using these screening tools amongst HD patients.

Physical Health Score Assessment May Not Predict Mental Health Score of Dialysis Patients

The state of physical and mental health has been an important factor influencing the quality of life in the hemodialysis patient population. The SF-36 in the past, and now the KDQOL-36 questionnaire have been used routinely to assess illness perception and quality of life (QOL) among hemodialysis patients. However, it is not clear whether these surveys can truly predict the effect of physical illness on mental health. We present routine quality improvement data from a small cohort studied in an urban dialysis unit in which the social worker performed standard questionnaires per mandate, compared results to unstructured verbal interviews, and noted a poor correlation. The patients who were not expected to have negative perceptions of quality of life actually had negative findings. The findings were more prominent for the mental health aspect of the survey than the physical health aspect, which correlated with patients’ symptoms. A total of 92 patients were surveyed and interviewed, and their mental health score could not be correlated in 44% of patients who had a low mental health score and 17.5% of those with a high mental health score.