Receiving Hemodialysis Treatment Research Articles

#2224 Higher serum level of indoxyl sulfate is not associated with increased abdominal aorta calcification in patients on maintenance hemodialysis

Abstract Background and Aims Vascular calcification is strongly associated with an increase in all-cause and cardiovascular mortality, especially in patients with and stage renal disease. Results of numerous experimental studies have shown direct toxic effect of microbial-derived uremic toxins on vascular endothelial and smooth muscle cells which may contribute vascular calcification. Meanwhile, the effects of these metabolites on vascular remodeling in patients receiving dialysis treatment remains largely unclear. Here we aimed to investigate the relationship between serum level of the uremic toxin indoxyl sulfate and severity of abdominal aorta calcification (AAC) in patients on maintenance hemodialysis. Method This single-center, cross-sectional study included eighty (40 men, average age – 59,7±11,8 years) clinically stable patients receiving hemodialysis treatment for 52(21,3-120) months. 13(16,3%) participants had history of smoking, 27(33,8%) were diabetic, 63(78,8%) had high blood pressure, 17(21,3%) – previous history of ischemic heart disease, including 5(6,3%) suffered a myocardial infarction. Severity of AAC was determined by lateral lumbar radiography with Kauppila scoring. The total AAC score ranged from 0 to 24 points, and a higher AAC score indicated a more pronounced degree of calcification. Routine laboratory data were collected before hemodialysis session after fasting for 12 hours. Serum concentration of indoxyl sulfate was assessed by ELISA using commercially available kit (Cloud-Clone Corp., USA). Statistical analysis was performed with IBM SPSS Statistics 26 program. Non-parametric Spearman's rank correlation method was used to evaluate the associations between the studied parameters. Value of p <0.05 was considered statistically significant in all tests. Results Median serum indoxyl sulfate was 2,1(1,4-3,0) μmol/l (the same parameter in relatively healthy individuals without impaired renal function is 0,1(0-0,3) μmol/l, р˂0,001). Serum levels of calcium (Ca) was 2,27(2,1-2,5) mmol/l, ionized calcium (Ca++) – 1,15(1,1-1,3) mmol/l, phosphate (P) – 1,6(1,3-2,0) mmol/l, intact parathyroid hormone (iPTH) – 303(162,2-492,8) pg/ml, total cholesterol (TH) – 4,5(3,5-5,4) mmol/l, low-density lipoprotein (LDL) – 2,6(2,0-3,3) mmol/l. AAC score in hemodialysis participants was 4,5(0,0-9,0) and significantly correlated with age (r=0,693; р˂0,001), Ca (r=0,208; р=0,04) and iPTH (r=0,418; р=0,021) but not with other indicators, including indoxyl sulfate concentration (r=0,164; р=0,147). Conclusion Our preliminary results do not allow to consider the elevated level of indoxyl sulfate as a factor contributing to increased AAC in patients on maintenance hemodialysis. Further prospective studies in larger populations should clarify the true role of indoxyl sulfate in vascular remodeling in individuals with chronic kidney disease.

#743 Clinical outcomes of patients hospitalized with the diagnosis of COVID-19 infection and undergoing hemodialysis: a single center experience

Abstract Background and Aims The main purpose of this study is to determine the effect of dialysis on the prognosis (admission to intensive care unit, intubation requirement, length of hospitalization, mortality) of patients with COVID-19 receiving hemodialysis treatment in our clinics. Another aim of this study is to examine the effect of the need for hemodialysis on COVID-19 prognosis in order to contribute to the data of our country. Method Cross-sectional study of 104 patients with hemodialysis and were diagnosed COVID-19 were conducted. In this study, patients were divided into three groups: (i) those with chronic renal failure (CRF) and receiving routine hemodialysis; (ii) those with chronic kidney disease (CKD) but needing urgent hemodialysis; and (iii) those who did not have a known kidney disease but needed urgent hemodialysis because of acute kidney injury (AKI) . The study was performed in accordance with the Declaration of Helsinki. The local ethical committee approved the study design (date: 21.03.2022; reference number: 133/13). Results When we evaluated the demographic, clinical and laboratory factors in our study, it was found that the factors affecting mortality were lymphopenia, emergency HD treatment under the presence of CKD, an increase in AST more than 2 times, the need for mechanical ventilation and high d-dimer (Table 1). Conclusion This case demonstrates that AKI associated with cytokine storm and developing multi-organ dysfunction situation is directly linked to mortality, particularly in patients with severe clinical condition. When the biochemical data of the patients were analysed, it was discovered that AST increase, lymphopenia, and d-dimer rise were directly found associated with increase mortality. In light of these observations, the above-mentioned biochemical laboratory values of the patients can be closely monitored, as can the clinical course of COVID-19 and renal-related mortality.

Regulation of vascular remodeling by immune microenvironment after the establishment of autologous arteriovenous fistula in ESRD patients.

Autogenous arteriovenous fistula (AVF) is the preferred dialysis access for receiving hemodialysis treatment in end-stage renal disease patients. After AVF is established, vascular remodeling occurs in order to adapt to hemodynamic changes. Uremia toxins, surgical injury, blood flow changes and other factors can induce inflammatory response, immune microenvironment changes, and play an important role in the maintenance of AVF vascular remodeling. This process involves the infiltration of pro-inflammatory and anti-inflammatory immune cells and the secretion of cytokines. Pro-inflammatory and anti-inflammatory immune cells include neutrophil (NEUT), dendritic cell (DC), T lymphocyte, macrophage (Mφ), etc. This article reviews the latest research progress and focuses on the role of immune microenvironment changes in vascular remodeling of AVF, in order to provide a new theoretical basis for the prevention and treatment of AVF failure.

The relationship between satisfaction with life, dietary attitude, and comfort level in hemodialysis patients: Analysis with machine learning approach.

Hemodialysis (HD) patients have become a serious public health problem, the number of which is increasing every year worldwide. This study aimed to determine the relationship between satisfaction with life, dietary attitude, and comfort level in patients receiving HD treatment. This research was conducted in a relational cross-sectional descriptive design. The research was conducted with 174 patients (85% of the population) receiving HD treatment between March 20 and September 30, 2023. In the study, hierarchical regression analysis was performed with SPSS 25.0. Machine learning analysis and prediction were performed using R programming language, version 4.1.3. The model used to determine the factors affecting satisfaction with life was significant and usable (F(2,171) = 25.855, p = 0.001). Attitudes of HD patients toward dietary therapy and their HD comfort levels together explained 22.3% of the total variance of satisfaction with life. In the regression model, according to the results of the t-test regarding the significance of the regression coefficient, the increase in the HD comfort levels of the participants (t = 2.668, p = 0.008) and the increase in the attitude of the HD patients toward dietary therapy (t = 5.897, p = 0.001) caused a statistical increase in "satisfaction with life." According to Shapley values, the most important variable in the prediction of satisfaction with life variable is attitude for the dietary attitude. It was determined that the increase in the comfort levels of HD patients and their positive dietary attitudes increased satisfaction with life. It is recommended to provide education to increase patients' diet attitudes and comfort levels.

Is the Bioimpedance Method Sufficient in Evaluating the Nutritional Status of Patients Receiving Hemodialysis Treatment?

Aim: The purpose of this study was to test validity of bioelectrical impedance (BIA) analysis in the nutritional assessment among patients with receiving hemodialysis. Method: This study which was cross-sectional was conducted with 166 patients with hemodialysis at the hemodialysis units in two state hospital and a private hospital. The data were collected by means of patient information form, Malnutrition Inflammation Score (MIS) and Body Composition Analyzer. Descriptive, t test, Mann-Whitney U, chi-square, Wilcoxon, ROC analysis and logistic regresyon analysis were used in statistical analysis. Results: The average ages of patients were 51.57±13.01 (21-66) years. Of the patients, 53.6% were male. Mean body mass index (BMI) was 24.4±4.98 kg/m2 of whom (%54.8) were well-nourished. Male patients had higher albumin, muscule mass, and BMI than female patients and these values were statistical difference in according to gender. A significant difference was found to hemoglobin, albümin, iron binding, tanita fat ratio, fat mass, and BMI between the well-nourished and malnourished patients. The findings of logistic regretion analysis among MIS and BIA parameters shown that performance of BIA was statistical significantly. Conclusion: The results of study indicated that bioelectrical impedance analysis was shown to identify the most suitable BIA parameters for predicting presence of malnutrition. It could be suggested that BIA method may use for assess to nutritional status among patients receiving hemodialysis.

HOPELESSNESS IN PATIENTS RECEIVING HEMODIALYSIS TREATMENT IN THE COVID-19 PANDEMIC: A DESCRIPTIVE AND CROSS-SECTIONAL STUDY

Aim: This study was conducted to reveal the hopelessness level of the patients receiving hemodialysis treatment during the COVID-19 pandemic and the factors affecting it. Method: This study was conducted with patients receiving HD treatment in dialysis centers affiliated with three hospitals in a province in Northeast Turkey between January and April 2022. The universe of the research is all patients who are treated in the dialysis units of the mentioned hospitals (N=147). The study was completed with 110 patients who met the inclusion criteria and volunteered to participate in the study. The data of the study were collected with the “Descriptive Information Form”, “Charlson Comorbidity Index” and “Beck Hopelessness Scale (BHS)”. Results: 58.2% of the patients with a mean age of 63.30±15.33 were male, and 80.0% were married. 50.9% of them were diagnosed with COVID-19, 56.4% perceived themselves in the risk group for COVID-19, and 30.0% stated that COVID-19 causes hopelessness in their daily life. The mean total score was 7.87±5.38 for the BHS and 5.34±2.35 for the Charlson Comorbidity Index. There was a significant positive correlation between BHS total score and age (p

A scale development study: Primary Caregiver Burden Scale Individuals Receiving Hemodialysis Treatment.

As hemodialysis is a long-term treatment method requiring significant self-management skills, it affects both the patient and the caregiver in many ways. It is inevitable that changes in the burden perceived by the caregiver over time will not affect the patient's health care outcomes. The aim of this study was to develop an up-to-date scale by examining the psychometric properties of items created specifically for the care burden perceived by individuals who provide care for patients receiving hemodialysis treatment. This study is a methodological study with the use of the COSMIN Checklist. The sample of the study included 404 individuals who were the primary caregivers of patients receiving hemodialysis treatment. Data were collected using descriptive characteristics form and the draft form of the Primary Caregiver Burden Scale Individuals Receiving Hemodialysis Treatment. Exploratory and confirmatory factor analysis and predictive validity were used to evaluate validity. The Cronbach's alpha reliability coefficient, item analysis, and test-retest method were employed to evaluate reliability. According to exploratory factor analysis, a scale structure with four subdimensions was determined, and goodness of fit was achieved using confirmatory factor analysis. The Cronbach's alpha coefficient of the final form of the scale consisting of 34 items was found to be 0.95 for the total scale, 0.93 for the self-management support subscale, 0.91 for the psychological support subscale, 0.91 for the caregiver symptom subscale, and 0.93 for the caregiver individual coping subscale. The Primary Caregiver Burden Scale Individuals Receiving Hemodialysis Treatment, which was found to meet the validity and reliability criteria, has a four-point Likert-type scoring structure, 34 items, and four subdimensions. It is thought that the scale can make significant contributions to the international literature if its validity and reliability are established with nursing practices and research.

Exploration of agr types, virulence-associated genes, and biofilm formation ability in Staphylococcus aureus isolates from hemodialysis patients with vascular access infections.

Staphylococcus aureus, is a pathogen commonly encountered in both community and hospital settings. Patients receiving hemodialysis treatment face an elevated risk of vascular access infections (VAIs) particularly Staphylococcus aureus, infection. This heightened risk is attributed to the characteristics of Staphylococcus aureus, , enabling it to adhere to suitable surfaces and form biofilms, thereby rendering it resistant to external interventions and complicating treatment efforts. Therefore this study utilized PCR and microtiter dish biofilm formation assay to determine the difference in the virulence genes and biofilm formation among in our study collected of 103 Staphylococcus aureus, isolates from hemodialysis patients utilizing arteriovenous grafts (AVGs), tunneled cuffed catheters (TCCs), and arteriovenous fistulas (AVFs) during November 2013 to December 2021. Our findings revealed that both MRSA and MSSA isolates exhibited strong biofilm production capabilities. Additionally, we confirmed the presence of agr types and virulence genes through PCR analysis. The majority of the collected isolates were identified as agr type I. However, agr type II isolates displayed a higher average number of virulence genes, with MRSA isolates exhibiting a variety of virulence genes. Notably, combinations of biofilm-associated genes, such as eno-clfA-clfB-fib-icaA-icaD and eno-clfA-clfB-fib-fnbB-icaA-icaD, were prevalent among Staphylococcus aureus, isolates obtained from vascular access infections. These insights contribute to a better understanding of the molecular characteristics associated with Staphylococcus aureus, infections in hemodialysis patients and provided more targeted and effective treatment approaches.

Risk Factors and Frequency of Foot Ulceration in Patients Receiving Chronic Hemodialysis Treatment.

To determine the prevalence and risk factors of foot ulceration in patients receiving hemodialysis treatment. A total of 180 patients who received hemodialysis treatment in two state hospitals and a private health center between April 2017 and September 2017 were included in the study. The researchers collected data using a patient information form and by conducting physical evaluation of the lower extremities. They used the diabetic foot risk assessment algorithm to classify risk according to the data obtained. Of the patients receiving hemodialysis treatment, 6.7% had foot ulceration, 19.4% had a history of foot ulceration, and 8.3% had a history of hospitalization associated with ulceration in a lower extremity. Infected foot ulceration was the most common (6.1%) cause of hospitalizations. In the group with current or past foot ulceration, diabetic nephropathy was the most common etiologic factor of end-stage kidney disease (48.6%); there was a significant between-group difference in diabetic nephropathy (P < .05). Etiologic factors had a significant effect on foot ulcerations: As determined by univariate logistic regression, diabetes (odds ratio [OR], 2.727; P < .05), presence of neuropathy (OR, 4.208; P < .05), low-density lipoprotein cholesterol (OR, 1.013; P < .05), and serum albumin (OR, 0.302; P < .036) all had a statistically significant effect on the presence of foot ulcerations. Patients receiving hemodialysis treatment are at high risk for foot ulceration. Therefore, patient awareness strategies should be expanded to include individuals with end-stage renal disease regardless of diabetes status. Clinical and dialysis nurses should educate these patients about foot ulcerations and foot health to prevent ulcer development.

Incidence of hyperkalemia in anuric hemodialysis patients treated with sacubitril/valsartan.

Sacubitril/valsartan is increasingly used in hemodialysis patients due to its cardioprotective benefits. However, its impact on serum potassium levels in anuric patients undergoing hemodialysis remains controversial. We conducted a retrospective data from patients undergoing hemodialysis at two dialysis centers. A total of 71 out of 332 patients receiving hemodialysis treatment were enrolled. Mean serum potassium (mean value of 6-8 determinations), peak serum potassium (maximum K value observed during follow-up observations), and other biochemical parameters were recorded at baseline and during the follow-up period. After 6 months of follow-up, mean serum potassium increased from 4.84 ± 0.45 mmol/L at baseline to 5.07 ± 0.46 mmol/L at 3 months and 5.04 ± 0.46 mmol/L at 6 months (p < 0.001). Notably, no significant group differences were found in peak serum potassium concentrations between baseline and 6 months after sacubitril/valsartan therapy (5.69 ± 0.56 vs. 5.75 ± 0.41, p = 0.419). Prior to starting sacubitril/valsartan treatment, none of the patients had severe hyperkalemia; however, after 3 and 6 months of sacubitril/valsartan therapy, two (2.80%) and three (4.20%) patients experienced severe hyperkalemia, respectively; however, this difference was not statistically significant. Additionally, there was a significant reduction in blood pressure; however, serum sodium, bicarbonate, and Kt/V values did not change significantly during either period. Sacubitril/valsartan therapy is associated with an increase in serum potassium levels in anuric hemodialysis patients. Nevertheless, the proportion of patients with severe hyperkalemia did not increase significantly. This suggests that the use of sacubitril/valsartan in anuric patients on hemodialysis is relatively safe.

AFTER THE EARTHQUAKES WITH EPICENTER IN KAHRAMANMARAŞ ON FEBRUARY 6, 2023; CRUSH SYNDROME

One of the vital problems after earthquakes that caused many deaths and injuries is crush syndrome due to traumatic muscle damage.&#x0D; After the two earthquakes of 7.7 and 7.6 magnitude affecting 11 provinces with the epicentre in Kahramanmaraş on 6 February 2023, 319 patients over the age of 18 were admitted to Sivas Cumhuriyet University Research and Practice Hospital between 6-14 February. 87 of 319 patients received inpatient follow-up and treatment. The age, gender, duration of stay in the rubble, province of residence, operation performed, duration of hospital stay, amount of fluid given in the first 24 hours, amount of urine output in the first 24 hours, body trauma sites, some laboratory parameters at the time of admission and during follow-up were retrospectively evaluated from the hospital records of all 43 patients diagnosed with crush syndrome among the inpatients between 6-28 February.&#x0D; The age of the patients was 39±19.6 years, duration of stay under the cave-in (hours) 22.74±36.32, duration of hospitalization (days) 7.26±5.42, amount of fluid given in the first 24 hours (ml) 4954.18±3142, amount of urine output in the first 24 hours (ml) 2646.42±2262.65, admission creatinine (mg/dl) 1.59±2.25, admission creatine kinase (CK) (U/L) 11716.37±18520.&#x0D; 44.2% of the patients were female, 72.1% came from Kahramanmaraş province, 46.5% underwent surgical intervention, 67.4% had an admission CK above 1000 u/l, 14% received hemodialysis treatment, 46.5% had a duration of hospitalization shorter than 7 days to reach the CK reference range and 51.2% had a duration of hospitalization longer than 21 days. &#x0D; The effect of other parameters on the duration of hospitalization and the time to reach the reference range of CK and correlation with laboratory parameters were analysed.&#x0D; As a result, it is thought that the parameters affecting the time to reach the CK reference range and the duration of hospitalization can be used to calculate and reduce the duration of hospitalization in prospective crush syndrome cases.

Relationship Between Dialysis Adequacy and Depression and Anxiety in Hemodialysis Patients

Background: Chronic kidney disease (CKD) is an irreversible condition that demands hemodialysis treatment until a kidney transplant is carried out. If dialysis is not sufficient, the patient might experience numerous physical and psychological consequences. This study aimed to examine the relationship between depression and anxiety and dialysis adequacy in patients receiving hemodialysis in Birjand, Iran.&#x0D; Methods: In this cross-sectional study, 100 patients undergoing hemodialysis treatment at Shahid Beheshti Hemodialysis Center in Birjand were examined. The state of depression and anxiety in them was evaluated according to the Hospital Anxiety and Depression Scale (HADS), and the adequacy of the patients’ dialysis was extracted from their medical records. In this study, scores ≤ 11 on the HADS scale were considered healthy. Moreover, dialysis adequacy was calculated with the KT/V formula, and cases ≥ 1.2 were considered adequate. Data analysis was performed using SPSS 19 software, independent samples t-test, and Pearson correlation coefficient.&#x0D; Results: The results showed that 18% and 82% of the participants had depression and anxiety, respectively. The patients’ depression and anxiety scores did not significantly correlate with the adequacy of dialysis (P = 0.82 and P = 0.86, respectively). The prevalence of depression and anxiety was not significantly influenced by gender or marriage; however, the results indicated that as patients aged, the prevalence of depression increased (P = 0.009) and anxiety decreased (P = 0.003).&#x0D; Conclusions: The adequacy of dialysis in patients undergoing hemodialysis treatment remains unaffected by mental disorders, such as anxiety and depression. Age has a significant impact on depression and anxiety levels in patients receiving hemodialysis treatment. To reduce anxiety and depression in younger and older patients, it is recommended to initiate support and educational programs.

Hemodiyaliz tedavisi alan hastalarda serum Isı Şok Proteini B7 (HSPB7) ve tetranektin düzeylerinin belirlenmesi

Purpose: Heart damage may develop over time in patients with chronic renal disease and undergoing hemodialysis (HD) treatment. Serum levels of Heat shock protein B7 (HSPB7) and tetranectin proteins change following damage to the heart muscle. This study aimed to determine HSPB7 and tetranectin levels in hemodialysis (HD) patients.&#x0D; Materials and Methods: The patients aged 30-60, healthy and HD patients participated in the study and two groups were formed (n = 60): Control group (n = 30) and Patient group (n = 30). Blood samples were taken from healthy subjects who applied to the hospital for check-up and from patients with kidney disease receiving HD treatment. Biochemical parameters were examined from the blood taken. HSPB7 and tetranectin levels from isolated serum samples were determined using measurement kits based on the solid phase sandwich (ELISA) principle.&#x0D; Results: There was no significant difference between the groups in gender, age, glucose and Fe values of the subjects (P

Audiological and Vestibular Measurements in Chronic Renal Failure Patients Receiving Hemodialysis Treatment.

The aim was to evaluate the changes in the audiovestibular system in adult patients with the diagnosis of chronic renal failure who were treated with hemodialysis. Thirty-five patients diagnosed with chronic renal failure and receiving hemodialysis treatment 3 days a week and 35 healthy individuals were tested with pure tone audiometry, video head impulse test, and post-head shake nystagmus test. Dizziness Handicap Inventory was applied to all participants. The Dizziness Handicap Inventory scores of the patient groups are higher than the control groups (P=.001). In the video head impulse test, there is no statistically significant difference between the patient and control groups in terms of gain asymmetry. 17.1% of the patients had both left and right lateral saccades (P=.03). A statistically significant difference was also found after the post-head shake test (P=.025). In the patient group, an inverse relationship between the presence of left anterior right posterior saccades and blood urea nitrogen-creatinine ratio and a direct relationship between the presence of right anterior left posterior saccades and creatinine elevation were determined. The presence of saccades in the video head impulse test increased significantly as the disease duration of hemodialysis patients increased. It was determined that the overt and covert saccades in the video head impulse test increased significantly as the creatinine increased and the duration of the disease increased in the patients with chronic renal failure. The common clinical usage of video head impulse test in monitoring the vestibular side effects of creatinine elevation and disease duration in chronic renal failure patients may be possible with future studies.

Effects of Continuous Nursing Care on Hemodialysis Patients' Quality of Life and Lifestyle: An Application of the Information, Knowledge, Attitude, and Practice Theory

Background: Patients undergoing hemodialysis often experience a low quality of life, which can significantly impact their lifestyle. Despite various proposed solutions, these patients continue to face ongoing challenges. Objectives: This research aimed to investigate the effects of continuous nursing care, based on the Information, Knowledge, Attitude, and Practice (IKAP) theory, on the quality of life and lifestyle of patients undergoing hemodialysis. Methods: Sixty-eight patients receiving hemodialysis treatment at 2 university hospitals in Ahvaz met the inclusion criteria for this experimental research. With the simple random method, the participants were divided into 2 equal groups: The experimental group and the control group. In addition to routine care, the experimental group received 20 to 30 minutes of continuous nursing care based on the IKAP theory every 2 weeks, while the control group received only routine care. Three questionnaires were administered: A Demographic Information Questionnaire, a Health Promoting Lifestyle Profile, and a Kidney Disease Quality of Life Questionnaire-Short Form (KDQOL-SF), which were completed before the intervention, 1 month after, and 3 months after by both groups. Data analysis employed independent samples t-tests, chi-square tests, and repeated measures analysis of variance (ANOVA). Results: The nursing intervention based on the IKAP model had a significant impact on the quality of life and lifestyle of patients undergoing hemodialysis. In the experimental group, the mean score for overall quality of life before and after the intervention showed a statistically significant difference (P &lt; 0.001), while in the control group, this difference was not significant (P = 0.807). Similarly, the mean score for lifestyle in the experimental group before and after the intervention was statistically significant (P &lt; 0.001), whereas there was no significant difference in the control group (P = 0.991). Conclusions: Nursing intervention based on the IKAP model has a positive effect on improving the quality of life and lifestyle of patients undergoing hemodialysis. Therefore, it is important to inform health care providers and policymakers about this model, which can serve as a reference for health education in hospitals and other health care centers.

The Association Between Intradialytic Symptom Clusters and Recovery Time in Patients Undergoing Maintenance Hemodialysis: An Exploratory Analysis.

Individuals receiving hemodialysis often experience concurrent symptoms during treatment and frequently report feeling unwell after dialysis. The degree to which intradialytic symptoms are related, and which specific symptoms may impair health-related quality of life (HRQoL) is uncertain. To explore intradialytic symptoms clusters, and the relationship between intradialytic symptom clusters with dialysis treatment recovery time and HRQoL. We conducted a post hoc analysis of a prospective cohort study of 118 prevalent patients receiving hemodialysis in two centers in Calgary, Alberta and Hamilton, Ontario, Canada. Adults receiving hemodialysis treatment for at least 3 months, not scheduled for a modality change within 6 weeks of study commencement, who could provide informed consent and were able to complete English questionnaires independently or with assistance. Participants self-reported the presence (1 = none to 5 = very much) of 10 symptoms during each dialysis treatment, the time it took to recover from each treatment, and weekly Kidney Disease Quality of Life 36-Item-Short Form (KDQoL-36) assessments. Principal component analysis identified clusters of intradialytic symptoms. Mixed-effects, ordinal and linear regression examined the association between symptom clusters and recovery time (categorized as 0, >0 to 2, >2 to 6, or >6 hours), and the physical component and mental component scores (PCS and MCS) of the KDQoL-36. One hundred sixteen participants completed 901 intradialytic symptom questionnaires. The most common symptom was lack of energy (56% of treatments). Two intradialytic symptom clusters explained 39% of the total variance of available symptom data. The first cluster included bone or joint pain, muscle cramps, muscle soreness, feeling nervous, and lack of energy. The second cluster included nausea/vomiting, diarrhea and chest pain, and headache. The first cluster (median score: -0.56, 25th to 75th percentile: -1.18 to 0.55) was independently associated with longer recovery time (odds ratio [OR] 1.62 per unit difference in score, 95% confidence interval [CI]: 1.23-2.12) and decreased PCS (-0.72 per unit difference in score, 95% CI: -1.29 to -0.15) and MCS scores (-0.82 per unit difference in score, 95% CI: -1.48 to -0.16), whereas the second cluster was not (OR 1.24, 95% CI: 0.97-1.58; PCS 0.19, 95% CI -0.46 to 0.83; MCS -0.72, 95% CI: -1.50 to 0.06). This was an exploratory analysis of a small data set from 2 centers. Further work is needed to externally validate these findings to confirm intradialytic symptom clusters and the generalizability of our findings. Intradialytic symptoms are correlated. The presence of select intradialytic symptoms may prolong the time it takes for a patient to recover from a dialysis treatment and impair HRQoL.

Health literacy in older adults receiving hemodialysis in Turkey: A cross-sectional study.

This study aimed to determine the health literacy level and related factors of older adults receiving hemodialysis treatment. A cross-sectional study was conducted at the five dialysis centers, using the information form and Turkish Health Literacy Survey-32 (THLS-32). A total of 336 older adults receiving hemodialysis treatment participated. The general health literacy score was found to be 25.69 ± 14.47. Based on the health literacy assessment scores, 62.5% of the participants were in the category of inadequate and limited level of health literacy. The lower level of education, perceived health status, income, and getting help in reading and writing were statistically significant predictors of the health literacy score. The health literacy of older adults receiving hemodialysis treatment was inadequate and limited. Findings of this study emphasize the importance of integrating health literacy assessment in clinical care settings and supporting the health literacy of older adults receiving hemodialysis treatment.

Depression and Anxiety in Chronic Kidney Disease Patients Undergoing Hemodialysis Therapy at Hemodialysis Installations General Hospital Dr. Moewardi Surakarta

&lt;p&gt;&lt;em&gt;This study is an analytical descriptive study with a cross-sectional design that aims to determine the proportion and level of depression and anxiety of patients, as well as the relationship between the length of hemodialysis therapy with depression and anxiety of patients with Chronic Kidney Disease undergoing hemodialysis therapy at the Hemodialysis Installation of Dr. Moewardi Surakarta Regional General Hospital. Samples in this study were taken by purposive sampling. The sample in this study amounted to 31 research subjects. The specified data analysis is a Chi-square test analysis to test the relationship between variables. The percentage of anxiety among Chronic Kidney Disease patients receiving hemodialysis treatment at Dr. Moewardi Surakarta Regional General Hospital's Hemodialysis Facility is 29%, while the percentage of depressed patients with Chronic Kidney Disease undergoing hemodialysis therapy at the same facility is 41.9%. It has been determined that there is no discernible correlation between the duration of hemodialysis therapy and the emergence of anxiety and depression in patients with Chronic Kidney Disease at this specific healthcare center. To gain a more comprehensive understanding, additional research is warranted to investigate other factors linked to anxiety and depression in patients with chronic kidney disease undergoing hemodialysis therapy. Furthermore, there is a pressing need for the implementation of a screening program for Chronic Kidney Disease patients undergoing hemodialysis therapy at hospitals, with a potential referral to the Department of Psychiatry for the assessment and management of any mental symptoms that may arise. &lt;/em&gt;&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Keyword: Anxiety, Chronic kidney disease, Depression&lt;/em&gt;&lt;/strong&gt;&lt;/p&gt;

The structure of gastrointestinal tract pathology in patients receiving hemodialysis treatment

BACKGROUND. Hemodialysis patients are characterized by a wide range of concomitant diseases, including cardiovascular, bone mineral, nutritional, cognitive, various metabolic disorders and anemia. Meanwhile, gastrointestinal tract disorders in these patients remains largely unexplored. Patients receiving treatment with programmed hemodialysis are characterized by a wide range of concomitant diseases, including cardiovascular, bone mineral, nutritional, cognitive, various metabolic disorders and anemia. Meanwhile, the pathology of the gastrointestinal tract in this category of patients remains largely unexplored.AIM: to investigate the structure of digestive diseases in patients receiving hemodialysis treatment.PATIENTS AND METHODS. This study included 180 hemodialysis patients. The median age was 60[47;68] years. Gastrointestinal Symptoms Questionnaire (GSQ) was used to evaluate gastrointestinal symptoms over the last month. The results of abdomen ultrasound, gastroscopy, colonoscopy, and complex laboratory examination were also analyzed.RESULTS. The overall prevalence of gastrointestinal symptoms was 77.2 % (139/180). The most frequent complaints were constipation (46.8 %) and abdominal pain (41 %). The most common stool frequency was one bowel action per day. The third, fourth, fifth type of stool according to the Bristol Stool Form Scale were noted by the majority of participants. Abdominal ultrasound revealed diffuse liver changes in 115 (63.9 %), signs of cirrhosis – in 7(3.9 %) patients. Ultrasound pathology of the gallbladder was represented by anomalies of its shape in 11.1 %, signs of chronic cholecystitis – in 10 %, stones (sludge) – in 7.2 %, polyps – in 2.2 % of patients. Diffuse changes in pancreatic parenchyma, steatosis, pseudocysts and dilatation of the main pancreatic duct were diagnosed respectively in 39(21,7 %), 21(11,7 %), 10(5,6 %) and 3(1.7 %) hemodialysis patients. According to 154 gastroscopies, the most common endoscopic finding in the stomach was chronic gastritis, detected in 86(55.8 %) of the subjects. Erosive gastritis was diagnosed in 22(14.3 %), gastric ulcer – in 3(2.0 %) patients. Endoscopic duodenal pathology was represented by erythematous duodenitis in 53(34.4 %), erosive duodenitis in 15(9.7 %), ulcer in 2(1.3 %), duodenal bulb abnormalities in 23(14.9 %) patients. Combined gastric and duodenal lesions were found in 88(57.1 %) patients. Сolonoscopy was performed in 56 patients, of whom 15 (26.8 %) had signs of colitis (mainly sigmoiditis), 2(3.6 %) – diverticulitis, 10(17.9 %) – diverticulosis, 12(21.4 %) – colon polyps, 8(14.3 %) – angiodysplasia mucosa, in 3(5.4 %) – dolichocolon. Despite the abundance of gastrointestinal symptoms and instrumental findings, no significant deviations in laboratory parameters (including an increase in AST, ALT, total bilirubin, amylase, lipase) were found.CONCLUSION. Hemodialysis patients are characterized by a high prevalence of gastrointestinal symptoms and various pathological changes in the gastrointestinal tract, the diagnosis and treatment of which require an individual multidisciplinary approach.

Investigation of the change in seroprevalence of viral hepatitis in patients receiving hemodialysis treatment over the years: A Single-Center Study

Objective: In this study, it was aimed to evaluate HBV, HCV, and HIV seroprevalence and their 9-year changes in patients receiving hemodialysis (HD) treatment in the Giresun province in Turkey. Material-Methods: A total of 607 patients over the age of 18 who received hemodialysis treatment in Giresun – Turkey, provincial and district hospitals in 2013 and 2022 were included in our study. The files of the patients were reviewed retrospectively. Demographic characteristics of the patients and serology results of HBV, HCV, HDV, and HIV were recorded. The data was evaluated using the IBM SPSS Statistics 25.0 program. Results: A total of 607 patients, 385 of whom received HD treatment in 2013 and 222 who received HD treatment in 2022, were included in the study. 230 (59.7%) in 2013 and 135 (60.8%) in 2022 of male patients. While the mean age of the patients was 60.26±14 years in 2013, it was 63.08±13.18 years in 2022. In 2013, HBsAg positivity was detected in 9 (2.3%), HBV-DNA positivity in 4 (44.4%), anti-HCV positivity in 31 (8.1%), and HCV-RNA positivity in 8 (25.8%) patients. In 2022, HBsAg positivity was detected in 4 (1.8%), HBV DNA positivity in 2 (50%), and anti-HCV positivity in 31 (8.1%) patients. Compared with dialysis duration, the anti-HCV positivity rate was significantly increased in patients with long dialysis duration (p&amp;lt;0.001). Conclusion: In line with the health policies, the epidemiological data obtained support a decrease in the population’s seroprevalence of HBV and HCV. However, according to the results of our study, it was determined that there was no significant decrease in HBsAg seroprevalence in patients who received HD treatment over nine years. As a result, it was concluded that it would be beneficial to closely monitor the seroprevalence of viral hepatitis in patients receiving HD treatment.