Post Hemodialysis Research Articles

Oxygen venous saturation is associated with subclinical myocardial systolic dysfunction in patients with end-stage renal disease undergoing hemodialysis.

The aim of this prospective study was to evaluate the impact of hemodialysis (HD) on myocardial injury, of both right and left ventricle function as well as their association with venous oxygen saturation (ScvO2) alterations. We included in the study stable consecutive patients with end-stage renal disease (ESRD) undergoing regular HD. Right and left ventricular speckle-tracking echocardiographies were performed in all patients. The examination calculates the global systolic longitudinal strain (GLS). Blood samples were obtained from the central vein in order to measure the O2 saturation (ScvO2) levels prior and post HD. High sensitive troponin (HST) was also measured in all patients before and after HD. Thirty seven patients were evaluated. We found that both mean ScvO2 and left ventricle GLS (LV GLS) were deteriorated after the dialysis session: 76.47 ±1.98 to 71.54 ±5.10, p < 0.05 and -17.73 ±3.44 to -14.21 ±3.44%, p < 0.01, respectively. HST levels were increased at the end of hemodialysis, 22.45 ±13.26 to 106.78 ±146.19 pg/ml, p < 0.01. A significant correlation was also found between the decrease of LV GLS with the ScvO2 reduction, p = 0.001, as well as with the increase of the HST levels, p = 0.001. Our data demonstrate that there is a significant worsening of the GLS of the left ventricle at the end of the dialysis, which is strongly associated with the concomitant deterioration of ScvO2. The may be a reliable index of circulatory stress indicating a subclinical myocardial dysfunction during HD.

#607 Pre- and post-hemodialysis differences in heart failure diagnosis by current heart failure guidelines in patients with end-stage renal disease

Abstract Background and Aims Patients with end-stage renal disease (ESRD) who are on hemodialysis (HD) have reduced vascular compliance and are likely to develop heart failure (HF). Dialysis patients experience a volume change of ∼3–4 kg before and after HD, which can affect hemodynamic indicators, some of which are highly influenced by a patient's volume status. Therefore, depending on when echocardiography is performed, there may be differences in hemodynamic parameters. However, it is not easy to perform echocardiography in the euvolemic state in the clinical setting. This study estimated pre- and post-HD in ESRD HF diagnosis prevalence using the current guidelines. Method We prospectively investigated ESRD patients on HD using echocardiography between pre and post HD. We used structural or functional abnormality criteria of 2021 ESC guideline. Results A total of 54 patients were enrolled. The mean age was 62.6 years and 40.1% were male. Forty-five patients (83.3%) had hypertension, 28 (51.9%) had diabetes, 20 (37.0%) had ischemic heart disease. Mean NT-pro BNP level was 11959.9pg/dL. The mean ideal body weight was 59.3 kg, mean hemodialysis time was 237.4 minutes, and mean real filtration was 2.8 kg. The mean LVEF was 62.4% and mean LVEDD was 52.0 mm in pre-HD. Post-HD echocardiography showed significantly lower LAVI (33.3 ± 15.9 vs. 40.6 ± 17.1, p = 0.030), TR jet V (2.5 ± 0.4 vs. 2.8 ± 0.4 m/s, p &amp;lt; 0.001), and RVSP (32.1 ± 10.3 vs. 38.4 ± 11.6, p = 0.005) compared with pre-HD. There was no difference in LVEF, E/E’ ratio, or LV GLS. A total of 88.9% for pre-HD and 66.7% for post-HD had at least structural or functional abnormalities in echocardiographic parameters according to recent HF guidelines, p = 0.007). Conclusion Our data showed that the majority of patients undergoing hemodialysis satisfy the diagnostic criteria for HF according to current HF guidelines, and the difference of prevalence of HF was 22.2% between pre- and post- HD.

#1328 Haemodynamic effects of low versus high dialysate bicarbonate concentration in haemodialysis patients

Abstract Background and Aims Haemodialysis (HD) treatment using standard dialysate bicarbonate concentrations cause transient metabolic alkalosis possibly associated with haemodynamic instability. We performed a detailed comparison of blood pressure (BP), haemodynamic parameters, electrolytes and orthostatic BP response with low (LDB) versus high dialysate bicarbonate concentration (HDB). Method Fifteen HD patients were examined in a single-blind, randomised, controlled, crossover study. Participants underwent a 4-hour HD session with dialysate bicarbonate concentration of 30 mmol/l (LDB) or 38 mmol/l (HDB) with one week between interventions. During HD, cardiac output (CO), total peripheral resistance (TPR), stroke volume (SV) and central blood volume were measured with ultrasound dilution technique (Transonic). Throughout dialysis, blood samples were obtained from the arterial cannula. Orthostatic BP was measured pre and post HD. Results With similar ultrafiltration volume (2.6 litres), systolic BP tended to decrease more during HDB compared to LDB (Fig. 1 and Table 1); the mean (95% confidence interval) between treatment differences in systolic BP were: 8 (-4;20) mmHg (end of HD) and 7 (0;15) mmHg (post HD). SV decreased (Fig. 2) whereas TPR increased significantly more during HDB compared to LDB with mean between treatment differences: SV: 12 (1;23) ml; TPR: -2.9 (-5.3;-0.5) mmHg/(L/min). CO tended to decrease more with HDB compared to LDB with mean between treatment difference 0.7 (0.0;1.4) L/min. HDB caused alkalosis, hypocalcaemia and lower plasma potassium, whereas patients remained normocalcaemic with normal pH during LDB (Table 1). Orthostatic BP response after dialysis did not differ significantly. Conclusion HDB compared to LDB was associated with hypocalcaemia and alkalosis and a more pronounced hypokalaemia which may impair preservation of BP, SV and CO during HD.

#500 Monitoring relative blood volume and calf bioimpedance in hemodialysis patients

Abstract Background and Aims Measurements of relative blood volume (RBV, %) are used to monitor the relative change in blood plasm during hemodialysis (HD). Continuous measurement of calf extracellular volume (cECV) during HD allows the calculation of relative change in cECV (RCE). RCE was defined as the ratio of cECV to its initial value, cECV0 (RCE = 100 × cECV/cECV0, %). The aim of our study was to investigate the relationship between RBV, RCE and the occurrence of intradialytic hypotension (IDH). Method Fifty-five HD patients were studied. We reduced the HD target weight stepwise by 0.1 to 0.2 kg per HD session until clinically defined IDH symptoms occurred. RBV was monitored using the blood volume monitor (BVM, Fresenius Medical Care, Germany). Whole body bioimpedance spectroscopy (wBIS) provided whole body ECV (wECV) and intracellular volume (wICV) pre and post HD. Continuous calf bioimpedance (Hydra 4200, Xitron Technologies, San Diego, CA USA) provided cECV during HD. Pre HD overhydration (OH) was calculated according to whole body composition model (Chamney et al, Am J Clin Nutr 2007; 85:80). Total number of HD sessions in all patients were divided into three groups according to the pre HD OH: 1) normal OH (NOH, OH &amp;lt; 1 L), 2) moderate OH (MOH, 1 ≤ OH &amp;lt; 4 L) and 3) severe OH (SOH, OH ≥ 4 L). Furthermore, patients were stratified by the presence or absence of IDH in each hydration group. Ultrafiltration rate (UFR), pre HD body weight, body mass index (BMI) were measured. Minimal RBV (RBVMin) and minimal RCE (RCEMin) in each HD session were recorded. These measures represent maximum reduction of fluid in the intravascular and interstitial spaces, respectively. Reducing cECV can be considered as refilling fluid from interstitial transferring to intravascular space driving by ultrafiltration. The difference between RCEMin and RBVMin was defined as vascular refilling capacity. Linear mixed-effect logistic regression (LMELR) analysis was applied to explore relationships between IDH with RBVMin, RCEMin, wECV and BMI. Results We studied 621 HD sessions in 55 patients. MOH was present in 57%, SOH in 22% and NOH in 21% of total number of HD sessions respectively. There were significant differences in age, UFR, RBVMin, RCEMin, pre HD wECV, BMI between three groups, while the IDH rate did not differ significantly (Table 1). RBVMin was inversely correlated with UFR (Fig. 1) in all measurements. Pre HD wECV was the only factor associated with IDH in overall measurement. Pre HD wECV was significantly lower in IDH than in non-IDH patients in the NOH group (Fig. 2). In the MOH group, UFR and RCEMin-RBVMin were higher in IDH than in non-IDH patients (Fig. 3a and Fig. 3b). In the SOH group, Pre HD OH is the major factor associated with IDH (Fig. 4). Conclusion This study found that the major factors leading to IDH are 1) lower hydration status; 2) relative higher UFR; and 3) the limited refilling capacity. RBVMin correlated with UFR, but it did not predict IDH. Combined analysis of RBV and calf bioimpedance may provide a means to quantitate the fluid transport between intravascular and interstitial compartments and could add to an early IDH warning system.

#201 Bedside lung ultrasound and bioimpedance spectroscopy for assessment of volume status in chronic kidney disease patients on hemodialysis

Abstract Background and Aims Fluid balance is important in patients with chronic kidney disease undergoing hemodialysis (HD). Majority of HD treatment incorporate a prescription for fluid removal targeted to patient's dry weight. Overestimation of dry weight causes hypertension, left ventricular hypertrophy and heart failure, while underestimation is responsible for chronic dehydration leading to the risk of hypotension. Both complications have a significant impact on the overall morbidity and mortality. Dry weight of the patient is usually assessed by using clinical parameters (edema, BP, JVP etc.), Biochemical parameters (BNP, ANP), Bioimpedance Spectroscopy (BIS) or IVC diameter and collapsibility on ultrasound (VCI index). The use of chest ultrasound to detect lung water has recently received growing attention in clinical research. Ultrasonographic lung comets (counting B-lines artifact) evaluate extravascular lung water and hence is considered as a useful tool to evaluate the hydration status of hemodialysis patients. This study aims to compare the efficacy of body fluid volume status and lung water assessment by clinical methods, Ultrasound chest and Bioimpedance Spectroscopy in chronic kidney disease patients on hemodialysis. Method A cross-sectional study was conducted over a period of 6 months. Dry weight of the patient was assessed by the attending nephrologist based on clinical criteria such as: weight, blood pressure, presence of edema or vascular congestion. A Longitudinal Ultrasound scan of the chest was performed using MicroMaxx Ultrasound System with patient in supine position from second to fourth intercostal space of left hemi-thorax and second to fifth intercostal space of right hemi-thorax along parasternal, midclavicular, anterior axillary and midaxillary lines of each side in a total of 28 sectors. B-lines were defined as hyperechogenic linear artifact emerging from the pleural line, up to the bottom of the screen. Pre and Post dialysis comet score was determined by calculating the total B-lines in each sector. Bioimpedance spectroscopy using Bodystat QuadScan 4000 was performed. Pre and post dialysis total body water (TBW), intracellular water (ICW), extracellular water (ECW) and residual fluid overload (ECW pre HD- ECW post HD) were recorded. Results We conducted 100 assessments on 34 patients presenting to the hospital for maintenance hemodialysis. The mean age of the study population was 54.3 + 11 years with a sex ratio (M/F) of 6:1. Mean systolic blood pressure was 141.1 + 19 mmHg and diastolic blood pressure was 83 + 9.3 mmHg with 3 episodes of intradialytic hypotension. The mean dry weight was 59.8 + 10 Kg and weight gain by clinical assessment was 2.1 + 1.5 Kg. Comet score assessed by ultrasound chest had a mean of 4.54 + 2.53 before dialysis and 1.73 ± 1.36 after dialysis. Residual fluid overload on Bio impedance spectroscopy was 1.11 ± 0.85 litre. The residual fluid overload on Bio impedance spectroscopy and lung ultrasound comet score after dialysis had a significant correlation (p value &amp;lt;0.0001). Of the 100 assessments, 40% had fluid overload after dialysis on Bio impedance and 35% had lung congestion on ultrasound chest even after achieving euvolemia according to the dry weight assessed clinically. Conclusion Lung comets on ultrasound chest and residual volume on bio impedance spectroscopy may precede the development of clinical sign and symptoms in a patient. Therefore, these methods are superior to clinical volume status assessment in chronic kidney disease patients on hemodialysis.

Dialysis in Critically Ill Patients with Hypokalemia: A Challenge to Beat by Adjusting Potassium Bath in Dialysate

Acute renal injury (ARI) is common in critically ill patients and frequently makes renal replacement therapy necessary. Low serum potassium level is associated with arrhythmias and mortality in critically ill patients. Adjusting dialysate fluid potassium to higher level helps preventing post hemodialysis hypokalemia. Objective: To establish role of high potassium dialysate in management of hypokalemia in critically ill patients undergoing renal replacement therapy for ARI. Methods: We did a pilot study and performed a cohort on critically ill patients who developed acute renal injury and required renal replacement therapy for acute indications. We designed two groups each consisting 50 patients. Control group underwent hemodialysis with conventional dialysate. For interventional group, we added potassium bath of 3.0meq/l. Pre and post hemodialysis serum potassium levels were measured results mentioned in the form of bar chart. Results: For intervention group mean pre and post hemodialysis serum potassium levels were 3.43±0.36mg/dl and 4.45±5.00mg/dl respectively with no statistically significant difference in pre and post hemodialysis potassium (p=0.156). While, for control group mean pre and post hemodialysis serum potassium levels were 3.69±0.38mg/dl and 2.97±0.29mg/dl respectively. Difference in pre-post mean serum potassium in control group was statistically significant (p&lt;0.001). Furthermore, three patients in control group developed atrial fibrillation in which hypokalemia was confirmed by laboratory testing. Conclusions: Acute dialysis in critical care on hypokalemic patients can be performed safely by adjusting potassium bath in dialysate.

Abstract 14782: Pre- and Post-Hemodialysis Differences in Heart Failure Diagnosis by Current Heart Failure Guidelines in Patients With End-Stage Renal Disease

Introduction: Patients with end-stage renal disease (ESRD) who are on hemodialysis (HD) have reduced vascular compliance and are likely to develop heart failure (HF). Hypothesis: This study estimated pre- and post-HD in ESRD HF diagnosis prevalence using the current guidelines. Methods: We prospectively investigated ESRD patients on HD using echocardiography between pre and post HD. We used structural or functional abnormality criteria of 2021 ESC guideline of HF Results: A total of 54 patients were enrolled. The mean age was 62.6 years and 40.1% were male. Forty-five patients (83.3%) had hypertension, 28 (51.9%) had diabetes, 20 (37.0%) had ischemic heart disease. Mean NT-pro BNP level was 11959.9pg/dL. The mean ideal body weight was 59.3kg, mean HD time was 237.4 minutes, and mean real filtration was 2.8 kg. The mean LVEF was 62.4% and mean LVEDD was 52.0 mm in pre-HD. Post-HD echocardiography showed significantly lower LAVI (33.3 ± 15.9 vs. 40.6 ± 17.1 ml/m 2 , p=0.030), TR jet V (2.5 ± 0.4 vs. 2.8 ± 0.4 m/s, p&lt;0.001), and RVSP (32.1 ± 10.3 vs. 38.4 ± 11.6 mmHg, p=0.005) compared with pre-HD. There was no difference in LVEF, E/E’ ratio, or LV GLS. A total of 88.9% for pre-HD and 66.7% for post-HD had at least structural or functional abnormalities according to recent HF guidelines (p=0.007). Conclusions: Our data show that post-HD echocardiography showed significantly reduced LAVI, TR jet V and RVSP compared to pre-HD. The difference of prevalence of HF was 22.2% between pre- and post- HD.

Perbandingan Kadar Kreatinin Pre Dan Post Hemodialisa Pada Pasien Gagal Ginjal Kronis

Chronic kidney disease is a progressive chronic disease of the kidney nephrons that can affect the body's fluid and electrolyte balance. In this condition, permanent kidney replacement is needed, namely kidney transplantation and hemodialysis. Hemodialysis is a therapy that is mostly done by patients. This study aims to determine the differences in creatinine pre and post hemodialysis in chronic kidney disease patients at Arcamanik General Hospital, Bandung City. The data obtained by the 34 patients will be recorded and displayed in the form of data tabulations and analyzed by the Normality Test using the Shapiro-Wilk with normally distributed data obtained, where the pre hemodialysis p value is 0.970 (p&gt; 0.05) and the post hemodialysis p value is 0.530 (p&gt;0.05). The pre hemodialysis creatinine level averaged 12.83 mg/dL, while the post hemodialysis creatinine level averaged 5.17 mg/dL. From the results it can be seen that the creatinine level before hemodialysis is higher than the creatinine level after hemodialysis. Based on the research conducted, it can be concluded that there is a significant difference in the comparison of pre and post hemodialysis creatinine in chronic kidney disease patients after the data is processed statistically using the Paired T-Test, with a p value of 0.001 (p &lt;0.05).

#5115 8-ZONE LUNG ULTRASOUND AND BIOIMPEDANCE ANALYSIS FOR ASSESSMENT OF HYDRATION STATUS IN HEMODIALYSIS: A PROSPECTIVE SINGLE CENTRE EXPERIENCE

Abstract Background and Aims Chronic volume overload is a major contributor to cardiovascular mortality in patients receiving maintenance hemodialysis (HD). Hence, accurately assessing volume status in this population is crucial. Bioelectrical impedance analysis (BIA) is a validated, non-invasive, and straightforward bedside technique that estimates total body water (TBW), extracellular water (ECW), intracellular water (ICW), and over hydration (OH). However, it is not suitable for use in patients with limb amputation or metallic medical devices. On the other hand, lung ultrasound (LUS) is used to evaluate extravascular lung water (EVLW) and has been shown to predict all-cause mortality and cardiac events in HD patients. Although a 28-zone LUS is the reference standard for LUS studies, recent studies have shown that an 8-zone LUS protocol can be as accurate. The aim of this study was to compare the performance of an 8-zone LUS protocol with bioelectrical impedance analysis to evaluate hydration status in an outpatient haemodialysis unit. Method Adult patients under thrice-weekly 4h HD sessions using high-flux membrane dialyzers for at least 1 month were prospectively enrolled between June and August 2022. We excluded patients with systemic infections, advanced neoplasia, metallic medical devices, decompensated cirrhosis, and limb amputations. The dry weight (DW) was established by the attending nephrologist, blind to the results. All measurements were performed in the first session of the week. BIA was assessed before HD using a portable whole body BIA device (BCM—Fresenius Medical Care D GmbH) and the OH was normalized to ECW. LUS using 8-zone protocol was performed before and after HD, with patients in the near-to-supine or supine position using a 2–5 MHz convex probe (Acuson X150®, Siemens, Germany), and the total number of B lines was recorded. Results A total of 37 patients with median age of 60 (IQR 15) years, 75% males, 65% with residual diuresis &amp;gt;300 mL/24 h were included. The median HD vintage was 9 (IQR 10) months, and median body mass index (BMI) of 22.7 (IQR 9) Kg/m2. At the beginning of HD, the median systolic blood pressure (BP) was 140 (IQR 24) mmHg and the median diastolic BP was 79 (IQR 16) mmHg. The median interdialytic weight gain was 4.2% (IQR 2.8) and median ultrafiltration (UF) was 2600 (IQR 1300) mL. The BIA showed median TBW of 38.2 (IQR 11) L, ECW 18.2 (IQR 7.73) L, ICW 20.8 (IQR 6.55) L, and normalized OH 0.138 (IQR 0.147). There was a positive correlation between BMI, TBW (r = 0.375, p = 0.045), and ECW (r = 0.486, p = 0.006), but not with ICW (r = 0.061, p = 0.755), nor normalized OH (r = 0.14, p = 0.468). Systolic BP, but not diastolic, was correlated with the water volume measured in both compartments (ECW: r = 0.498, p = 0.005; ICW: r = 0.421, p = 0.023, TBW: r = 0.423, p = 0.022). The 8-zone LUS showed a statistically significative (p&amp;lt;0.001) reduction in the number of B lines between pre and post HD evaluation (16.5 (IQR 17.25) lines to 8.5 (IQR 10.25) lines). Total evaluation time was under 8 minutes. When comparing LUS before HD with BIA assessment we found that the number of B lines correlated with the normalized OH (r = 0.454, p = 0.018), ECW (r = 0.501, p = 0.007), TBW (r = 0.418, p = 0.030), but not ICW (r = 0.239, p = 0.23). The total number of B lines post HD was also correlated with the ECW (r = 0.568, p = 0.002), TBW (r = 0.465, p = 0.017), and normalized OH (r = 0.408, p = 0.039). Conclusion The 8-zone LUS protocol provides a quick and efficient way to evaluate patients prior to HD sessions. Our study reveals a strong correlation between the total number of B lines determined by the 8-zone protocol and BIA parameters such as TBW, ECW, and normalized OH. This demonstrates that the 8-zone protocol can effectively be used in routine evaluations of HD patients. Although these techniques reflect different over-fluid compartments, they have a complementary role for fluid overload determination and dry weight guidance.

#3873 UTILITY OF BLOOD KETONE MONITORING IN HAEMODIALYSIS PATIENTS UNDER INPATIENT NEPHROLOGY CARE

Abstract Background and Aims There is a lack of evidence regarding the relationship between capillary blood glucose (CBG) &amp;gt;15 mmol/L and blood ketones in maintenance haemodialysis dialysis patients meaning the utility of ketone measurement in this group is uncertain. Despite this, guidance published by the Joint British Diabetes Society for Inpatient Care (JBDS-IP) in 2022 states that blood ketones should be measured in patients on maintenance haemodialysis with diabetes mellitus (DM) who have pre- or post-dialysis CBG &amp;gt;15mmol/L and symptoms consistent with diabetic ketoacidosis (DKA), acknowledging that these can be non-specific [1]. We sought to identify if there is a relationship between elevated CBG and blood ketone levels in haemodialysis patients, and if haemodialysis affects blood ketone levels. Method Maintenance haemodialysis patients with DM admitted to a single ward over 2 separate 2 month periods were included. Nursing staff recorded CBG and blood ketone levels pre- and post-dialysis using a FreeStyle PrecisionPro ketone meter. For each patient, further demographic data were collected from the electronic patient record. Results 79 measures were collected from 30 patients, with between 1 and 7 measures for each patient. 57% patients (n = 17) were male, 37% (n = 11) had T1DM, and 80% (n = 24) were on insulin therapy. The median pre-HD CBG for all measures was 10.5mmol/L (IQR 8.15-15.05), median post-HD CBG was 9.1mmol/L (IQR 6.8-12.95), median pre-HD ketones were 0.1mmol/L (IQR 0.1-0.2) and median post-HD ketones were 0.1mmol/L (IQR 0.1-0.3). There was no significant difference in blood ketones pre-and post-HD for all measures (p = 0.09) (Figure 1). For measures where pre-HD CBG was &amp;gt;15mmol/L (n = 21) median pre-HD and post-HD ketones were 0.1 (IQR 0.1-0.2) and 0.2mmol/L (IQR 0.1-0.2) respectively (p = 0.45). For measures where pre-HD CBG was &amp;gt;20mmol/L (n = 6) median pre-HD and post-HD ketones were 0.1 mmol/L (IQR 0.1-0.13) and 0.2 mmol/L (IQR 0.1-0.2) respectively (p = 0.13). For measures where pre-HD CBG was &amp;lt;15mmol/L, median pre-HD ketones were 0.1 (IQR 0.1-0.2). There was no significant difference in blood ketones pre-HD between those with a pre-HD CBG &amp;gt;15mmol/L and those with a pre-HD CBG &amp;lt;15mmol/L (p = 0.69). Conclusion These results demonstrate no significant relationship between elevated CBG measures (&amp;gt;15mmol/L) and blood ketone levels in haemodialysis patients, nor do they demonstrate a significant change in blood ketone levels post haemodialysis. Unwell haemodialysis patients with elevated CBG clearly warrant medical assessment, but there is a lack of evidence that blood ketones are useful to aid assessment and guide management of these patients.

Analysis of Dialysate pH and Temperature Stability on Hemodialysis Machines Using Internet of Thing Technology

Therapy for kidney replacement with hemodialysis is a treatment that is carried out in patients with Chronic Kidney Failure to survive. The purpose of this study was to determine the stability of the dialysate fluid in the hemodialysis machine by measuring the temperature using the DS18B20 sensor and measuring the dialysate pH using the 4502C sensor on pre and post-hemodialysis. The research method and the manufacture of this module use a pre-experimental research design with the type of research "one group posttest design" the independent variables are the pH value and Dialysate Temperature, the dependent variable is the pH and Temperature Sensor, the control variable is the Traceable Tool. This research made a module using an Esp32 microcontroller system with an LCD that can be monitored with Android via the Internet of Things (IoT) system. 03 and the comparison of the results of the dialysate temperature values ​​at the time of pre and post-obtained the maximum measurement error of 0.2%. From the measurement and analysis data, it can be concluded that there is no effect of pH and temperature values ​​during pre and post hemodialysis.

A Randomized Trial Examining the Impact of Timing of Intradialytic Cycling on Intradialytic Hypotension

Intradialytic cycling is often performed during the first half of hemodialysis because of concerns regarding increased frequency of intradialytic hypotension (IDH) late in hemodialysis. This increases exercise program resource needs and limits utility of intradialytic cycling to treat dialysis-related symptoms. This multicenter, randomized, crossover trial compared IDH rate when cycling during the first half versus the second half of hemodialysis in 98 adults on maintenance hemodialysis. Group A cycled during the first half of hemodialysis for 2 weeks and subsequently during the second half for 2 weeks. In group B, the cycling schedule was reversed. Blood pressure (BP) was measured every 15 minutes throughout hemodialysis. Primary outcome was IDH rate (systolic BP [SBP] decrease of >20 mmHg or SBP<90 mmHg). Secondary outcomes included symptomatic IDH rate and time to recover post hemodialysis. Data were analyzed using negative binomial and gamma distribution mixed regression. Mean age 64.7 (SD 12.0) and 64.7 (SD 14.2) years in group A (n= 52) and group B (n= 46), respectively. Proportions of females were 33% in group A and 43% in group B. Median time on hemodialysis was 4.1 (interquartile range [IQR] 2.5, 6.1]) years in group A and 3.9 years (IQR 2.5, 6.7) in group B. IDH rate per 100 hemodialysis hours (95% confidence interval [CI]) was 34.2 (26.4, 42.0) and 36.0 (28.9, 43.1) during early and late intradialytic cycling, respectively (P= 0.53). Timing of intradialytic cycling was not associated with symptomatic IDH (relative risk [RR]: 1.07 [0.75-1.53]) or time to recover post hemodialysis (odds ratio: 0.99 [0.79-1.23]). We found no association between the rate of overall or symptomatic IDH and the timing of intradialytic cycling in patients enrolled in an intradialytic cycling program. Increased use of cycling late in hemodialysis may optimize intradialytic cycling program resource use and should be studied as a possible treatment for symptoms common in late hemodialysis.

Evaluation of Serum Paraoxonase and Lipid Profile in Patients with Chronic Renal Failure Pre and post Hemodialysis

Chronic Renal Failure (CRF) is the progressive and irreversible loss of normal functioning of kidneys. this is associated with increased levels of some biochemical parameters and decreased others. This study aims to evaluate the value of serum paraoxonase-1 (PON1) activity as biochemical marker for patients with chronic renal failure (CRF) before and after hemodialysis (HD).&#x0D; The samples of this study consists of 100 patients (55 males, 45 females) and 100 apparently healthy individuals (57 males, 43 females) from 20 - 70 years old of age. All patients included in this study were those who were receiving hemodialysis therapy in the dialysis unit in Kirkuk general Hospital from the period between February 2013 and May 2014. Serum PON1, BU, Cr, TC, TG, HDL, LDL levels were measured by spectrophotometric methods.Paraoxonase1 activity level was significantly lower in cases of CRF patients than in normal healthy control in pre hemodialysis (HD). It's level was significantly increased in post HD (P&gt; 0.05). The blood urea (BU), serum creatinine (Cr), total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL) and very low density lipoprotein (VLDL) were significantly higher than normal healthy control in pre HD (P˂ 0.05), In post HD their levels were significantly decreased as compared to the pre HD (P˂ 0.05) but still lower than normal control, the serum high density lipoprotein (HDL) of CRF patients was significantly lower than normal controls (P˂ 0.05) in pre HD and was significantly increased in post HD as compared to pre HD but remained lower than normal healthy control. Conclusion: PON1 activity was significantly decreased in CRF patients before HD and significantly increased after HD but remained lower than controls. PON1 was significantly and negatively correlated with the age, BMI, duration of disease, BU, Cr, TC, TG, LDL, and VLDL. This study demonstrates that there is an increased risk of cardiovascular complications in CRF patients undergoing hemodialysis by increasing TC, TG, LDL, VLDL and decreasing HDL.

Analisis Kadar Albumin Pra dan Post Hemodialisa pada Penderita Gagal Ginjal Kronik

Chronic renal failure (CKD) is a progressive decline in kidney function so that it cannot maintain hemostasis in the body, in order to maintain hemostasis in the body, hemodialysis is carried out in patients with kidney failure, to replace kidney function. Examination of albumin is serum or plasma taken from venous blood. The purpose of this study was to analyze albumin levels in patients with chronic renal failure pre and post hemodialysis at Santa Elisabeth Hospital Medan. This research method is descriptive. The population in this study were 178 patients with a total sample of 64 respondents. The method used to examine albumin levels is Bromocresol Green (BCG). The results showed that pre-hemodialysis albumin levels in patients with chronic renal failure had an average of 3.080. g/dL. Post-hemodialysis albumin levels have an average of 3.683 g/dL. Based on the examination of albumin levels in patients with chronic renal failure pre and post hemodialysis, it was found that albumin levels had increased within normal limits. Thus, patients with chronic kidney failure undergoing hemodialysis check their blood albumin levels to avoid hypoalbumin and routinely consult nutrition.

PERBEDAAN KADAR HEMOGLOBIN DAN INDEKS ERITROSIT PADA PASIEN GAGAL GINJAL KRONIK PRE DAN POST HEMODIALISIS DI RSPAL Dr. RAMELAN SURABAYA

Chronic Kidney Disease can cause a progressive decline in kidney function which can lead to kidney failure. One of the therapies for patients with chronic kidney failure is hemodialysis, but this method can cause complications, including worsening of anemia. This study aims to determine differences in hemoglobin levels and erythrocyte index in patients with chronic renal failure before and after hemodialysis. This study is an experimental using data on hemoglobin and erythrocyte index results pre and post hemodialysis in patients with chronic kidney failure undergoing hemodialysis therapy at RSPAL dr. Ramelan Surabaya. Paired Sample T-test was used to determine differences in hemoglobin levels and erythrocyte index in patients with chronic renal failure pre and post hemodialysis. In this study, there were differences in hemoglobin levels and erythrocyte index in patients with chronic renal failure before and after hemodialysis.

A Comparative Study on Haematological Changes before and One hour after Haemodialysis in Patients with End Stage Renal Disease

Introduction: Normal kidney function is very important for maintaining homeostasis. Any deviation of normal renal function leads to deviation of normal homeostasis. End-stage renal disease (ESRD) is the last stage of chronic kidney disease (CKD) resulting from different aetiologies. Different haematological abnormalities in patients with ESRD result from multiple pathogenesis. Treatment of this condition requires multidisciplinary approach. Among all the treatment options haemodialysis (HD) is the most common, widely accepted and available treatment option. Objective: To find out the effectiveness of haemodialysis in the improvement of different haematological deviations developed during the course of ESRD. Materials and Methods: A total of 72 patients with ESRD of both sexes with the age ranging from 25 years to 70 years were included in this comparative cross sectional study and carried out in Combined Military Hospital and Armed Forces Institute of Pathology, Dhaka Cantonment from November 2014 to October 2015. Results: The pre dialysis haematological parameters found in this study were TRBC: 3.4 ± 0.5 X 1012/L, haemoglobin (Hb) level : 9.5 ± 1.4 gm/dL, Haematocrit (HCT): 29.1 ± 4.4%, Mean corpuscular volume (MCV): 83.5 ± 7 fl, Mean corpuscular Hb (MCH): 28 ± 1.8 pg, Mean corpuscular Hb concentration (MCHC): 31.0 ± 2.9 gm/dl, Total leucocyte count (TLC): 6.6 ± 1.9 X109/L, Neutrophil: 66.3 ± 7.8 %, Lymphocyte: 24.5 ± 6.9 %, Monocyte: 5.0 ± 1.8%, Eosinophil: 4.1 ± 2.4 %, Platelet: 184.3 ± 66.5 X 109/L. One hour post HD values are: TRBC: 3.6 ± 0.6 X1012/L, Hb level:10.1 ± 1.6 gm/dl, Hct: 30.9 ± 5 %, MCV:82.6 ± 6.9 fl, MCH: 29.1 ± 2.3 pg, MCHC: 32.2 ± 3.4 gm/dl,TLC: 7.3 ± 2.3 X 109/L, Neutrophil: 69.2 ± 7 %, Lymphocyte: 21.6 ± 5.5 %, Monocyte: 5.3 ± 2 %, Eosinophil: 3.9 ± 2.3%. Platelet: 206.1 ± 63.6 X109/L. Among these values TRBC, Hb level, Hct, MCH, MCHC, TLC, Neutrophil, Lymphocyte and Platelet count significantly improved after HD (p value &lt; .05). Conclusion: Haemodialysis in the management of patients with CKD/ESRD played a pivotal role in improving haematological parameters deranged by these conditions. JAFMC Bangladesh. Vol 18, No 1 (June) 2022: 39-42

Comparative study of oxidant and anti-oxidant parameters in chronic renal failure, haemodialysis (pre &amp; post) and controls

Chronic kidney disease (CKD) is featured by a progressive decline of kidney function and is mainly caused by chronic diseases such as diabetes mellitus and hypertension. CKD is a complex disease due to cardiovascular complications and high morbidity; however, there is no single treatment to improve kidney function in CKD patients. Since biological markers representing oxidative stress are significantly elevated in CKD patients, oxidative stress is receiving attention as a contributing factor to CKD pathology. Aim of our study is comparison of oxidant and anti oxidant parameters in chronic renal failure, Hemodialysis (pre and post) and control subjects. Materials and Methods: The present study was conducted on a patient group comprising of 50 patients diagnosed with CRF, 50 were pre hemodialysis, 50 were post hemodialysis (MHD). This patient group was compared to a healthy group including 100 controls. All the study participants were admitted in the department of Medicine [Nephrology department] at “Rajiv Gandhi Institute Of Medical Sciences”, Kadapa. Andhra Pradesh. India. Study Period : July 2020 to December 2020 ,The obtained serum samples were used for biochemical analysis for estimating MDA, vitamin A and Glutathione Peroxidase (GPx).

MO848: Platelet Thrombus Formation in Chronic Haemodialysis Patients Measured by the Total Thrombus-Formation Analysis System

Abstract BACKGROUND AND AIMS Patients with end-stage renal disease (ESRD) receiving haemodialysis (HD) often experience bleeding. However, mechanisms behind this bleeding tendency are incompletely understood but may involve platelet dysfunction. We therefore studied platelet-dependent thrombus formation in flowing whole blood inside a microchip coated with collagen, and its association with circulating von Willebrand factor (VWF). METHOD Blood samples were obtained in 22 patients before and after HD. The area under the 10 min flow pressure curve in a microchip (AUC10) reflecting total platelet thrombogenicity was measured, using the Total Thrombus-formation Analysis System (T-TAS01). AUC10 &amp;lt; 260 indicates platelet dysfunction. VWF-antigen and measures of VWF-activity, i.e. VWF-RCo, VWF-CBA and latex-particle based VWF activity were also assayed. RESULTS VWF levels were moderately elevated and increased further after HD (P &amp;lt; 0.01 or lower). In contrast, AUC10 before and after HD was &amp;lt; 260 in 17/22 patients and &amp;lt; 130 in 15/22 patients, with no statistically significant difference in pre- versus post-HD measurements (median AUC10 in all patients 10.2 versus 20.3, respectively), altogether indicating reduced platelet thrombogenicity, but with some variability (5/22 patients with normal platelet responsiveness). AUC10 before and after HD correlated fairly well (r = 0.77, P &amp;lt; 0.001), and all VWF-related parameters (before versus after HD) were also correlated (r = 0.74 or higher; P &amp;lt; 0.0001). In contrast, no significant correlations were found between absolute values of AUC10 and any VWF-related parameters or between changes in values (i.e delta-values for differences between pre versus post HD). CONCLUSION Most ESRD-patients display moderate to severe platelet dysfunction as assessed by shear-induced collagen-dependent platelet thrombus formation with T-TAS01.Platelet thrombus formation under high shear, as measured by the collagen-coated PL-chip, is not importantly influenced by a moderate HD-induced increase in VWF. T-TAS01 should be further evaluated as a tool in the assessment of bleeding risk in patients on HD.

Effect of a Hemodialysis Session on Markers of Inflammation and Endotoxin.

Background People receiving hemodialysis (HD) treatment have higher cardiovascular morbidity and mortality, ascribed to an increased prevalence of traditional cardiovascular risk factors. However, the role of nontraditional risk factors, such as inflammation, has become increasingly recognized. The origin of this inflammation remains elusive and one putative cause is elevated levels of circulating bacterial endotoxin. Methods In this study, serum concentrations of endotoxin and inflammatory biomarkers, including high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), interleukin-1β (IL1β), ferritin and tumor necrosis factor (TNF), were measured in 30 adults receiving HD and 10 healthy individuals without kidney disease. In people receiving HD, samples were collected immediately before dialysis (preHD), after dialysis (postHD), and 48 hours after (postHD48hrs). Results Endotoxin was detectable in only 1 of 90 samples analyzed. There were no significant differences in serum hsCRP, IL1β, and IL6 levels, before and after dialysis. Serum TNF levels decreased significantly from 30.9 (8.0, 39.5) pg/mL preHD to 13.9 (8.5, 17.3) pg/mL post-HD (p=0.002) and then increased back to 27.37 (14.5, 35) pg/mL 2 days later (p < 0.001). Ferritin increased from 1153 ng/mL (782, 1458) preHD to 1313 ng/mL (657, 1638) post HD (p < 0.001) and then decreased back to 1186 ng/mL (754, 1597) (p=0.66) postHD48hrs. Compared to controls, people receiving HD had significantly elevated levels of hsCRP [6.16 mg/L (2.1, 16.8) vs. 1.1 mg/L (0.81, 3.63) p=0.015], IL1β [1.5 pg/mL (0.05, 2.51) vs. 0.5 pg/mL (1.81, 2.95) p ≤ 0.001], and ferritin [1153 (782, 1458) vs. 132.9 (111, 257) ng/mL p ≤ 0.001], but comparable levels of in IL6 [6.15 pg/mL (4.82, 9.12) vs. 7.49 pg/mL (4.56, 10.39), p=0.77] and TNF [27.35 pg/mL ± 17.48 vs. 17.87 pg/mL ± 12.28, p < 0.12]. In conclusion, people on HD have elevated levels of inflammatory biomarkers, which are not associated with endotoxemia (which is rare) or the dialysis procedure.

Targeting Predialysis Glucose up to 180 mg/dl Reduces Glycemic Variability in End Stage Diabetic Nephropathy.

Glycemic variability plays a major role in the development as well as the progression of cardiovascular disease in diabetes. We compared the mean plasma glucose and glycemic variability (GV) parameters on and off hemodialysis (HD) in patients with End-Stage Diabetic Nephropathy (ESDN) and End-Stage Renal Disease (ESRD). Cross-sectional study. We included 23 ESDN and 6 ESRD patients who underwent continuous glucose monitoring (CGM) (iPro2) for 6 days and a glucose-free dialysate for 4 hours thrice weekly. EasyGV software was used to calculate the variability parameters {mean glucose, Time in range (TIR), Time above and below range (TAR/TBR), CV (Coefficient of Variation) and MAGE}. The quantitative data variables were expressed by using mean and SD. Unpaired t-test was used to compare the two groups. P value <0.05 was considered significant. In the ESDN group, TIR was significantly lower whereas TAR and TBR were significantly higher on HD day. MAGE (101.88 ± 40.5 v/s 89.46 ± 30.0, P < 0.007) and CV (29.41% v/s 21.67%) were higher on HD day. Subjects with pre-HD glucose values ≥180 mg/dl (Group B, n = 24) had a rapid drop with a delayed higher rise in glucose values than those with pre-HD glucose values <180 mg/dl (Group A, n = 27). Ten patients had 13 episodes of hypoglycemia. The CGM parameters were not different in the ESRD group. Targeting a pre- HD glucose value <180 mg/dl could be a good strategy to prevent larger fluctuation during and post HD.