Hemodialysis Procedure Research Articles

The effect of physical activity on biochemical myocardial markers in patients with CKD 5D

Abstract Purpose of the study to study the effects of intradialytic physical activity on myocardial markers in patients with chronic kidney disease. Materials and methods The study included 103 patients with CKD5d aged 18 to 65 years. The average HD experience is 8.45±0.57 months. When all patients were included in the study, natriuretic peptide (NUP), myocardial fraction of creatine phosphokinase (CPK-MB), and myocardial fraction of troponin (troponin T) were determined in the blood before the hemodialysis procedure, 60-90 minutes after cessation of HD. Results The study showed that intradialytic physical activity contributes to a significant reduction in the amplitude of the increase in the concentration of markers of myocardial necrosis and NUP compared with standard HD by the 60-90th minute of HD (+7.66% versus +18.04% for NUP, 87.2% versus +172 .8% for CPK-MB and +66.09% versus +263% for troponin T, p<0.001 significance of comparison between HD regimens for all three markers). And also by the end of HD against the background of HD with FN, there was a decrease in the concentration of NUP and CPK-MB, in contrast to the dynamics with standard HD (+4.17% versus 19.84% and +28.9% versus 137.1%, respectively, p<0.001 significance of the difference between HD modes for both markers). The concentration of troponin T at the end of HD with FN progressively increased, but the relative dynamics were significantly lower than during standard HD (+719.3% versus +867.8%, p<0.001). Conclusion thus, intradialytic physical activity helps to reduce markers of myocardial damage in the blood compared to standard HD and possibly has a preventive effect on cardio myocytes.

Computational Fluid Dynamics (CFD) in Arteriovenous (AV) Graft Implantation Through End-to-Side Anastomosis with Varying Tube Diameters Across Different Vascular Access Locations for Dialysis Treatment.

Background/Objectives: Arteriovenous (AV) graft is a procedure for hemodialysis performed in the arm. Optimizing AV graft design is vital to enhance haemodialytic efficiency in patients with kidney disease. Despite being a standard procedure, making it work optimally is still difficult due to various graft diameters and anastomosis configurations, which have limited studies. This research aims to find the ideal AV graft tube diameter on blood flow and pressure gradients and the ideal body site for AV graft implantation and to study their angles for dialysate flow. Methods: Nine models were designed in Autodesk Fusion 360 with 40°, 50°, and 60° angles each having 2 mm, 5.1 mm, and 14.5 mm diameters, all following specific equations on continuity, momentum (Navier-Stokes Equation)), and the Reynolds Stress Model (RSM). The CFD simulation of these models was performed in ANSYS Fluent with an established parameter of 0.3 m/s inlet velocity and stiff/no-slip graft and artery wall boundary condition. Results: As a result, the design with a diameter of 14.5 mm and a 40° angle was overall the most ideal in terms of minimal wall shear stress and turbulence. Conclusions: Thus the brachiocephalic area or the forearm is calculated to be the most optimal implantation site. Additionally, varying angles do affect dialysate flow, as smaller values cause less stress.

Residual Red Blood Cell Volume in Extracorporeal Blood Circuit after Hemodialysis: A Single-Center Study

Introduction: The factors contributing to blood loss during hemodialysis (HD) procedures remain underexplored. This study aimed to quantify blood loss during HD and identify the potential factors associated with it. Methods: The study included 70 ESRD patients undergoing HD. After dialysis, the extracorporeal blood circuits were rinsed with 1,000 mL of 0.05% NH3 solution in distilled water, and hemoglobin levels were measured. Univariate regression was used to assess the linear relationship between residual red blood cell (RBC) volume and various parameters, including HD mode, dialyzer surface area, ultrafiltration goal, hypotension during HD, blood flow rate, activated partial thromboplastin time, and C-reactive protein. Multivariate regression was also conducted to explore the relationships among these parameters. Results: The mean RBC volume remaining in the extracorporeal blood circuit after HD was 1.6 ± 0.9 mL (mode: 1.0, range: 0.3–6.5 mL). When converted to whole blood volume per patient, the mean blood volume was 5.3 ± 3.0 mL (median: 4.1 mL, mode: 4.0 mL, range: 1.0–19.0 mL). Multivariate analysis identified the dialyzer surface area as the only significant determinant of residual RBC volume. Conclusion: After HD, the remaining RBC volume in the extracorporeal blood circuit varies from 1.6 to 6.5 mL. When the RBC volume was converted to whole blood volume for each case, the blood loss ranged from 1.0 to 19.0 mL. Dialyzer surface area was the only significant determinant of residual RBC volume.

Evaluation of Dialysis Catheter Related Infections and its Relation to Patient Outcome

Abstract Background Hemodialysis (HD) is an important life-saving procedure in patients with acute kidney injury (AKI) and chronic kidney disease requiring renal replacement therapy. Well- functioning vascular access (VA) is a mainstay for performing an efficient HD procedure. Aim of the Work to asses bacterial spectrum of dialysis catheter related infection and its relation to patient outcome (either recovery or developing complications as septicemia, endocarditis, septic emboli, death). Patients and Methods This was prospective study, was conducted at Ain Shams university hemodialysis (HD) units, included 57 adult hemodialysis patients with catheter related infection selected from our HD unit. The inclusion criteria include Patient’s age 18-70 years and Patients on hemodialysis through double way venous catheter. Patients with sepsis evident by other causes that will be excluded by proper data from history, examination and individualized patient investigation according to symptoms. Results there was significant statistical difference as regard outcome (IEC, septic emboli) compared to surviving patients P-value 0.001 and IEC as a predictor of death with p-value=0.001 and Ods-ratio (Lower limit-Upper limit) = 100.00 (7.371 – 1356.594). Period of recovery was positively correlated in patient with temporary catheter with K, PO4, CRP. time to recovery was positively correlated with CRP on admission, k, total protein and R/P value was (0.828/ 0.042) (0.840 /0.036) (0.840/0.036) respectively. Conclusion Catheter related infection most common organism is Staph while complications including IEC and MDR organisms are associated with delayed recovery moreover IEC had higher mortality risk.

The Effect of Orange Inhalation Aromatherapy on Anxiety in Chronic Kidney Failure Patients Undergoing Hemodialysis

<div><table cellspacing="0" cellpadding="0" align="left"><tbody><tr><td align="left" valign="top"><p><em>Chronic renal failure patients undergoing hemodialysis often experience anxiety. The patient's anxiety stems from the patient still not knowing how the hemodialysis procedure works and its side effects. The changes experienced by chronic renal failure patients are anxiety, which causes drastic changes in patients not only physically but also mentally. This study aims to determine the effect of orange inhalation aromatherapy on anxiety in patients with chronic renal failure undergoing hemodialysis. This study is a type of experimental research with a two-group pretest-posttest design conducted at Sebelas Maret University Hospital Surakarta in March 2024. The population in this study were 77 patients with chronic renal failure undergoing hemodialysis. The sampling technique of this study was purposive sampling, so the number of samples in this study was 30, consisting of 15 control groups and 15 treatment groups. Data collection on anxiety of chronic renal failure patients was carried out using the Hamilton Anxiety Rating Scale (HARS). Data analysis test in this study used independent samples t-test. The results showed that there were differences in the effect of anxiety in patients with chronic renal failure in the control group who were not given citrus inhalation aromatherapy and the treatment group given citrus inhalation aromatherapy at Sebelas Maret University Hospital with a p-value = 0.012. It is suggested that patients with chronic renal failure undergoing hemodialysis can apply it themselves when experiencing anxiety during hemodialysis because this inhalation aromatherapy is very easy to apply and very useful</em></p><p><em> </em></p></td></tr></tbody></table></div><strong><em>Keywords: Aromatherapy, chronic kidney failure, hemodialysis, inhalation</em></strong>

Early Prediction of Native Arteriovenous Fistula for Maturation by Doppler Ultrasound Study

Introduction: There are significant chances of maturation failure in arteriovenous fistulas (AVFs) made for vascular access for hemodialysis. AVFs are usually assessed for maturation 6 weeks after the operation. Significant time is lost for performing a salvage radiological procedure or making an alternative AVF, in case the AVF fails to mature. Materials and Methods: This prospective observational study was conducted to predict the chances of maturation of AVF by Doppler ultrasound (USG) study. One hundred and thirty-seven patients in whom native AVF was made as a vascular access procedure for hemodialysis were included in the study. In five patients, palpable thrill was absent after 48 h of operation and were excluded from the study. The velocity of the blood, diameter of the vessel, and depth of the vessel from the skin were assessed by USG Doppler 3 weeks after the operation and were correlated with AVF maturation. Results: Successful maturation occurred in 114 (86.3%) AVF. The flow rate of the blood and depth of the vein were statistically different in successful and unsuccessful AVF maturation for both the groups of radial artery (RA) and brachial artery (BA) based AVF. For RA AVF, successful maturation was predicted by the flow rate of 539 mL/min (sensitivity 95% and specificity 83%) and 4.2 mm diameter of the vein (sensitivity 93% and specificity 100%). For BA AVF, successful maturation was predicted by the flow rate of 456 mL/min (sensitivity 93% and specificity 100%) and 5.7 mm diameter of the vein (sensitivity 77% and specificity 100%). The measurement of flow and depth at 3 weeks after AVF may predict the maturation of AVF. Conclusion: It will be beneficial to do a USG Doppler study 3 weeks after making AVF, as the measurement of flow may predict the maturation of AVF.

Unit Cost Analysis of Haemodialysis Services By Activity Based Costing Approach as a Strategy For Increasing Hospital Profits

One of the catastrophic diseases that is the focus of health insurance financing is kidney failure. Haemodialysis is a type of kidney replacement therapy for chronic kidney disease using special equipment. One method of financing haemodialysis procedures is the National Health Insurance Program. Hospitals, as health service providers for JKN participants, have an interest in the INACBG rates. Based on the Regulation of the Minister of Health of the Republic of Indonesia Number 3 of 2023 concerning Health Service Tariff Standards in the Implementation of the Health Insurance Program, there are changes to tariffs for haemodialysis services. With the current tariff changes, single-use and re-use services are divided into two different tariffs. The research was conducted at Siloam Hospital Bali. The data taken is secondary data originating from the Financial Division of Siloam Hospital Bali, the Medical Records Department of Siloam Hospital Bali, and the Haemodialysis Department of Siloam Hospital Bali during the period January–April 2023. The data collected and the hypothesis formulated in this research will be tested using the MANOVA (Multivariate Analysis of Variance) test method, using SPSS software. The research results show that there is a significant difference in total costs for re-use and single-use haemodialysis services; there is a significant difference in the total INACBG rates per patient for re-use and single-use haemodialysis services and there is no significant difference in the difference between INACBG rates and total costs in re-use and single-use haemodialysis services.

Hemodialysis Procedures for Stable Incident and Prevalent Patients Optimize Hemodynamic Stability, Dialysis Dose, Electrolytes, and Fluid Balance.

The demographic profile of patients transitioning from chronic kidney disease to kidney replacement therapy is changing, with a higher prevalence of aging patients with multiple comorbidities such as diabetes mellitus and heart failure. Cardiovascular disease remains the leading cause of mortality in this population, exacerbated by the cardiovascular stress imposed by the HD procedure. The first year after transitioning to hemodialysis is associated with increased risks of hospitalization and mortality, particularly within the first 90-120 days, with greater vulnerability observed among the elderly. Based on data from clinics in Fresenius Medical Care Europe, Middle East, and Africa NephroCare, this review aims to optimize hemodialysis procedures to reduce mortality risk in stable incident and prevalent patients. It addresses critical aspects such as treatment duration, frequency, choice of dialysis membrane, dialysate composition, blood and dialysate flow rates, electrolyte composition, temperature control, target weight management, dialysis adequacy, and additional protocols, with a focus on mitigating prevalent intradialytic complications, particularly intradialytic hypotension prevention.

Differences in Nutritional Status and Quality of Life in Hemodialysis Patients Compared to CAPD

Background: Patients with chronic kidney disease who undergo hemodialysis and CAPD (Continous Ambulatory Peritoneal Dialysis) modalities often experience disturbances in nutritional status and quality of life. The condition is affected by the chosen modalities and duration. Aim: This study assesses the differences in nutritional status and quality of life in individuals undergoing hemodialysis therapy with a duration of 4-hour, hemodialysis with a duration of 5-hour, and CAPD in order to determine the best modalities for patients with chronic kidney disease. Methods: Data were collected with cross-sectional from patients with chronic kidney disease at the hemodialysis polyclinic at RSUD dr. Saiful Anwar Malang, Panti Nirmala Hospital Malang, Wava Husada Kepanjen Hospital, and the CAPD polyclinic at RSUD dr. Saiful Anwar Malang. Classified into CAPD group, 4-hour hemodialysis group, and 5-hour hemodialysis group. Assessment with a questionnaire consisting of the patient’s baseline characteristics, subjective global assessment (SGA), and SF-36 are used to assess and analyze differences in nutritional status and quality of life of patients with chronic kidney disease against the selected dialysis modality. Results: The physical health of the 5-hour hemodialysis group showed significant results compared to the 4-hour hemodialysis and CAPD (p <0.05). Mental health in the 5-hour hemodialysis procedure showed significant results compared to the 4-hour hemodialysis and CAPD (p <0.05). The nutritional status of 5-hour of hemodialysis was better than 4-hour of hemodialysis and CAPD (p<0.05). Conclusion: Hemodialysis with a duration of 5-hour has a better nutritional status and quality of life compared to a duration of 4-hour or CAPD.

#857 How low can we go with dialysate flow? Does that mean we can make nephrology green?

Abstract Background and Aims Green nephrology encompasses all initiatives in kidney care that have a positive impact on the climate and environment. We know that environmental impact of dialysis is particularly high, considering water consumption and disposable waste production during each session. All that suggests a great opportunity where many improvements should be made. To prepare the dialysate 240 liters of water are needed for one four-hour session with a dialysate flow (Qd) set at 500 ml/min. Including additional water needed to rinse and sterilize the system, this gives approximately 500 liters of water used for one hemodialysis. Lower dialysate flow rate is associated with a significant reduction in the amount of water used for the hemodialysis procedure. An increase in Qd from 500 ml/min to 800 ml/min has been recommended to increase dialysis efficiency. It's benefit was not confirmed in in vivo studies which suggested that increasing the dialysate flow rate offers no benefit in terms of delivered Kt/V. Similarly, studies with a Qd of 400 ml/min showed comparable efficiency. If hemodialysis could be performed equally effectively with less dialysate consumption, water could be significantly saved. The aim of this study was to check whether change of dialysate flow from 500 ml/min to 300 ml/min has a significant impact on dialysis adequacy (measured by Kt/V). Method The study was a retrospective analysis. During the COVID19 surge in January 2022 due to administrative issues in a satellite dialysis center the dialysate flow was reduced to 300 ml/min. The center again increased Qd to 500 ml/min in February 2022. We analyzed laboratory data from 3 months before dialysate flow reduction, in the month with reduced Qd to 300 ml/min, and from 3 months thereafter with Qd set at 500 ml/min. Results 26 patients (10 men and 16 women – all dialysis patients from a satellite dialysis center) were enrolled in the study. Two of them died during observation, therefore 24 people were included in final analysis. Their median age was 72 (66-78) years. ANOVA with repeated measures showed lack of differences between three time points in terms of Kt/V (Qd 500 ml/min - 1.285±0.202, Qd 300 ml/min - 1.275±0.192 and Qd 500 ml/min - 1.337±0.199; p=0.093). Change in serum potassium during hemodialysis did not depend on dialysate flow (ΔK Qd 500ml/min - 1.5±0.5 mmol/l, Qd 300 ml//min - 1.7±0.5 mmol/l, Qd 500 ml/min - 1.6±0.4 mmol/l; p=0.197). Serum phosphorus was comparable between three time points (Qd 500 ml/min - 5.99±1.68 mg/l, Qd 300 ml/min - 5.65±1.4mg/l, Qd 500 ml/min - 6.01±1.67 mg/l; p=0.066). Conclusion Reduction in dialysate flow rate to 300 ml/min is safe for the patients and probably does not cause any short-term negative effects. Thus we can achieve the same therapeutic effect saving water consumption. Larger, long-term studies are needed to confirm the efficacy of this approach.

#1024 Lung ultrasound in 28 versus 8 places and volume status in chronic hemodialysis patients

Abstract Background and Aims Overhydration is considered a significant risk factor for cardiovascular and all-cause mortality in end-stage kidney disease patients. Measurement of total and extracellular water with bioelectrical impedance analysis (BIA), inferior vena cava diameter (IVCd) measurement, and circulating pro-B-type natriuretic peptide (proBNP) levels have previously been tested as possible indicators of volume status in hemodialysis (HD) patients, with BIA showing the most potential. Recently, it has been shown that lung ultrasound (LUS)-guided volume depletion is an effective strategy for relieving lung congestion in chronic HD patients. The aim of our study was to determine whether performing LUS on only 8 places was comparable to the regular 28 places. Method LUS was performed on 29 randomly selected patients before their regular HD procedure in 28 regular places and correlated with 8 places (4 on each side). In addition, BIA with a body composition monitor (BCM) was performed, IVCd was measured using ultrasound and serum NT-proBNP value was determined. Statistical analysis was performed using a commercially available SPSS® for Windows® (version 29.0; Chicago, IL, USA). Spearman's non-parametric test was used to determine a correlation between variables. P-values less than 0.05 were considered statistically significant. Results We included 29 chronic HD patients, 15 male (51.7 %), with a mean age of 66.3 ± 12.5 years and a median dialysis vintage of 53.0 (95% CI (40.9, 100.6)) months. Most patients (96.6 %) had a functional arteriovenous fistula, whereas only one patient (3.4 %) was dialysed using a Hickman catheter. A very strong, directly proportional correlation was found between performing LUS in 28 and 8 places (ρ=0.909; p<0.001). A significant moderate correlation was also found between both LUS in 28 and 8 places and systolic blood pressure (ρ=0.503; p=0.005 and ρ=0.467; p=0.011, respectively) (Table 1). Neither of the LUS methods statistically correlated with other tested volume markers – overhydration, intracellular and extracellular volume measured with BIA, IVCd in inspiration and expiration and IVC index, or serum NT-proBNP levels. Conclusion In our study, we found a very strong, positive, and significant correlation between performing LUS in 28 regular places and 8 places. Both also moderately correlated with systolic blood pressure. However, we did not find a statistically significant correlation between LUS and other tested volume markers.

Clinical case of mechanical and non-mechanical rhabdomyolysis complicated by acute kidney injury. Case report

To date, the problem of rhabdomyolysis remains relevant in Russia. Despite the introduction of modern methods of diagnosis, prevention and treatment, mortality remains high, up to 40%, especially with the addition of acute kidney injury. This article presents a clinical case of rhabdomyolysis, which arose as a result of the combined effects of non-traumatic (toxic effects of methadone, alcohol) and traumatic (vibration and non-physiological position during sleep) factors. This syndrome eventually led to the development of acute kidney damage up to anuria. In this clinical case, intensive infusion and detoxification therapy, including hemodialysis procedures, was carried out, which led to an almost complete restoration of the functional state of the kidneys. Thus, early diagnosis of rhabdomyolysis and AKI based on anamnesis, timely laboratory and instrumental diagnosis can prevent severe kidney damage up to terminal uremia and fatal consequences.

Current approach to venous catheterization in hemodialysis patients and important points

Hemodialysis (HD) procedure is commonly performed in hospitals. It is typically conducted due to renal dysfunction, elevated levels of urea and serum creatinine, or excessive volume overload. Additionally, emergency hemodialysis may be implemented in cases of certain poisonings. Emergency HD procedures are usually performed through a temporary venous catheter. The majority of patients undergoing continuous HD therapy access dialysis through arteriovenous fistula and permanent HD catheter. This procedure can be carried out with a very low risk of complications when performed by experienced individuals.

Cardioprotective effect of intradialytic exercise on left atrial mechanics.

Left atrial (LA) function plays a pivotal role in cardiac performance by modulating left ventricular (LV) function. Impairments in LV function are commonly reported during hemodialysis (HD), but available data describing changes in LA function are limited. There is growing evidence of the cardioprotective effect of intradialytic exercise (IDE) on LV function, but studies analyzing its effect on LA function are scarce. Our aim was to evaluate whether IDE can limit the severity of HD-induced impairment in LA myocardial function. In this prospective, open-label, two-center randomized crossover trial, 56 stable individuals receiving HD participated in 2 HD sessions in random order: standard HD and a session incorporating 30 min of aerobic exercise. LA and LV global longitudinal strains (GLSs) were obtained before and at peak stress of HD (i.e., 30 min before the HD ending). IDE totally eradicated the decline in LA reservoir strain observed during HD (estimated difference: 3.1%, 95% confidence interval: 0.4/5.8, P = 0.02), whereas it did not affect the other components of LA mechanics. A similar result favoring IDE intervention was also demonstrated on GLS changes over the HD procedure (P < 0.001). Between-session differences of changes in GLS and LA reservoir strain were correlated (r = -0.32, P = 0.03). The cardioprotective effect of IDE disappeared in patients with LA enlargement (i.e., LA volume index >34 mL/m2). In conclusion, even a short duration of IDE at moderate intensity is effective in preventing HD-associated decline in LA reservoir function. Further research is needed to explore the long-term benefits of IDE on LA function.NEW & NOTEWORTHY A single bout of intradialytic exercise (IDE) at moderate intensity can prevent the hemodialysis-associated decline in left atrial (LA) function. This was partially explained by the relative preservation of left ventricular systolic function with IDE. Benefits of IDE on LA function were lost in patients with LA dilation. Further studies are needed to explore the mechanisms behind IDE-induced cardioprotection and evaluate the clinical impacts of the repetitive cardioprotective effects of IDE on LA function.

The Effect of the Symptom Level on the Illness Perception in Individuals Undergoing Hemodialysis

Purpose: This research was conducted to identify the effect of the symptom level on the illness perception in individuals undergoing hemodialysis. Material and Methods: The study was performed with 240 participants who had the hemodialysis procedure in dialysis units of hospitals and one private dialysis center in a province and satisfied the criteria to be included in the research. Results: In the study, it was found that nearly all patients experienced symptoms such as itching, numbness/tingling in the feet, feeling tired and dry skin. In the sample group that had a negative illness perception, it was found that the symptoms experienced alongside the hemodialysis procedure affected the illness perception, and there was a moderately positive relationship between these two variables. Conclusions: In this context, it was recommended that the frequency and the severity of symptoms of patients undergoing hemodialysis be regularly followed and these patients’ illness perception levels be evaluated. Key words: Illness perception, hemodialysis, symptom

Evaluation of the risk factors of hemodialysis procedure-associated cardiac arrhythmias in end stage renal disease Egyptian patients

Background: Hemodialysis patients carry a large burden of cardiovascular disease, accounting for up to 41% of deaths, of which half are ascribed to sudden cardiac death (SCD). The pathophysiology of SCD is thought to result from the combination of a vulnerable myocardium and an acute pro-arrhythmic trigger that leads to a terminal arrhythmia. Approximately two thirds of the cardiac deaths are consistently attributed to arrhythmias. Aim: The study aimed to improve the clinical status of hemodialysis (HD) patients through detection of HD procedure associated cardiac arrhythmias, prevention of its risk factors and related complications. Subjects and Methods: Observational study that included 60 maintenance HD patients to assess the prevalence of electrocardiographic changes before, during, and after HD in patients who are on maintenance HD in the out/inpatient departments of Suez Canal University. Results: The study showed a high prevalence of electrocardiographic changes among the studied sample, representing 78.3%. Receiving HD for more than 5 years, glomerulonephritis (GN) being the primary cause of end stage renal disease (ESRD), intradialytic hypotension (IDH), and high pre-dialysis Na, K, and Po4 were all factors that were statistically significant associated with electrocardiographic changes.

Effect of Intradialytic Stretching Exercises on Lower Limbs Muscle Cramps among Patients Undergoing Regular Haemodialysis

Many patients suffer with muscle cramps and discomfort during the haemodialysis procedure. Intradialytic stretching exercises are helpful in reducing the intensity of muscle cramps. The study objective was to evaluate the effect of intradialytic stretching exercises on lower limbs muscle cramps on the patients undergoing regular haemodialysis in study group when compared with control group. Experimental research design were adopted for the study; 126 patients undergoing regular haemodialysis in outpatient haemodialysis centre were randomly allotted for study and control groups i.e. 63 in each group. The patients’ muscle cramps was assessed using cramp questionnaire chart developed by Basemath SS Morris in both groups. Intradialytic stretching exercises were provided to the patients in the study group in each leg from their 3rd to 10th sitting. Post-assessment was carried out on their 4th, 7th, and 10th sitting in the study group and the control groups. The control group patients were received routine hospital care. The lower limb muscle cramps mean score was found improvement from pre-assessment lower limb muscle cramp mean score 4.11 to post-assessment 10th sitting means score 2.086 after intradialytic stretching exercise in the study group. The study result showed that in post-assessment the lower limb muscle cramps was much better among the patients in study group who received the intradialytic stretching exercise than the patients in the control group who received routine hospital care. Intradialytic stretching exercises are reducing the intensity of muscle cramps in patients undergoing haemodialysis

Frailty in Hemodialysis Patients: A Study from Two Tertiary Care Dialysis Units

Background: Frailty is common in elderly individuals and is an important parameter predicting mortality. Multiple factors are responsible for this clinical syndrome and many are present in patients undergoing hemodialysis. Understanding the prevalence and factors associated with frailty in maintenance hemodialysis patients helps us to prognosticate and offer interventions in this vulnerable group. Aims and Objectives: ( 1) To study the prevalence of frailty in two quaternary maintenance hemodialysis units, (2) to understand factors that correlate with frailty, and (3) to look at the short-term impact of frailty on hospitalization and mortality in this cohort. Materials and Methods: A prospective study in two hemodialysis centers was conducted over a period of 6 months. Data on demographics, comorbid conditions, laboratory parameters, and nutritional parameters were collected. Nutritional assessment included information from 7-point subjective global assessment and Global Initiative on Malnutrition (GLIM). Data were also collected regarding the body composition analyses of these patients. Frailty was assessed by using the Fried’s classification. Data analysis was done looking at the prevalence of frailty in this cohort and factors associated with frailty. The cohort was followed up for another 6 months and survival outcome during this follow-up was recorded. Follow-up data were analyzed to look at the impact of frailty on short-term survival. Results: A total of 121 maintenance hemodialysis patients were included in the study. There were 44 (36%) females in the observational cohort. The mean (±standard deviation [SD]) age of the cohort was 56.59 (±13.58) years. The mean (± SD) dialysis vintage was 28.42 (±28.67) months. Sixty-eight (56.2%) patients had Type 2 diabetes mellitus and 111 (91.7%) had hypertension. Frailty (based on Fried’s classification) was seen in 107 (88.4%) patients. The incidence of frailty was distributed across all ages. There was also no significant association between frailty and nutritional parameters. Patients on thrice-weekly dialysis were found to have a higher incidence of frailty (P = 0.01). The presence of frailty did not impact short-term hospitalization and mortality. Discussion: There is a high incidence of frailty in hemodialysis patients across all ages. The underlying comorbidities and the repeated stress of the hemodialysis procedure make frailty prevalent in younger individuals, as was noted in our study. The incidence of frailty was more in patients on thrice-weekly dialysis. Frailty was not associated with hospitalizations and short-term mortality in our cohort. Conclusions: There is a high incidence of frailty across all ages in hemodialysis patients and should be assessed in all hemodialysis patients, risk factors identified, and appropriate therapeutic interventions instituted in these vulnerable patients.

Evaluation of Hemodialysis Complications among Children with Chronic Kidney Disease at District Head Quarter Hospital, Nankana Sahib

A patient with chronic kidney disease depends on hemodialysis to mechanically remove fluid, electrolytes, and waste products from the blood. Chronic kidney disease (CKD) is a universal matter of concern that affects around 15% of the population globally. Objective: To evaluate hemodialysis complications among children with chronic kidney disease. Methods: A cross-sectional descriptive study was carried out at the renal department of DHQ hospital. The duration of study was six months from April to September, 2023. The sample size was 45 children on hemodialysis with kidney disease. A purposive sampling technique was used. Data were gathered through self-administrated questionnaire. Data were analyzed through SPSS-25.0 and results were presented in the form of frequencies tables. Results: Majority of the participants suggested that initiation of hemodialysis lead to cardiovascular problems (72%), anemia (83%), and metallic taste (79%) in children. Moreover, majority of them complained about skin problem and itching as an adverse effect (78%). Other complications as indicated by participants are headache, restlessness, vertigo, nausea and vomiting (86%). Conversely, some subjects did not considered the hypertriglyceridemia (27%), gastric problems (31%), sleep problems (24%) and muscular pain (34%) as the result of initiation of hemodialysis procedure. Conclusions: Findings of present study suggested the most common complications of hemodialysis are hemodynamic instability, anemia and hypertension/hypotension, skin problems and itching. Other complications of hemodialysis as indicated by participants are headache, restlessness, vertigo, nausea, vomiting and decease concentration in children. However, most of the participants have limited understanding about additional complications of hemodialysis.

Impact of Nurse’s job Satisfaction upon Quality of Nursing Care for Patients Undergoing Hemodialysis

Objectives: This study aimed to asses’ nurses' job satisfaction levels at hemodialysis units and to find out the relationship between nurses' job satisfaction and quality of nursing care. Methods: A descriptive cross-sectional design study was carried out among nursing working in hemodialysis units at Baquba Teaching Hospital and Baladrooz general Hospital, study starting from 14th December 2022 to 10th March 2023.A non-probability (purposive) sample of (80) nurses working in hemodialysis units in Baquba and Baladrooz Hospital . The study instruments consist of three parts; Part one is involved the demographic information of nurses (8) items; the second part is involved Job Satisfaction Scale for Clinical Nurses (JSS-CN), it is comprised of (38) items and observational checklist for nurses practices of hemodialysis procedures consist from (29) items .Content validity of the questionnaire was determine through a panel of (12) experts .Reliability of the instrument scales is determined by using Pearson Correlations )0.87,084) for of job satisfaction scale and observational checklist for nurses practices respectively . The collected data will be categorized, scored, tabulated, and analyzed by computer using statistical package for social science (SPSS) version 25. Descriptive statistics will be used in the form of frequency distribution and percentages. Pearson correlation coefficient statistical tests were applied for data analysis. Results: Findings of the current study showed that (75%,65%), of the studied nurses offered moderate job satisfaction level and good quality of nursing care respectively. There was highly statistically significant relation between job satisfaction and quality of nursing care offered to patient undergoing haemodialysis. Conclusion: This study concluded that, nearly three quarter of the nurses were coping with their jobs and they are satisfied to certain extent. However, nearly two third of them offered good quality of nursing care to patient undergoing hemodialysis