Hemodialysis Patients In Relation Research Articles

Real-World Treatment of Hypertension on Hemodialyses Data from a Large Polish Database.

The prevalence of hypertension among patients with end-stage kidney disease (ESKD) undergoing hemodialysis (HD) ranges from 72 to 88% depending on applied diagnostic criteria and the chosen method of blood pressure measurement. Despite the guidelines recommending the widespread use of renin-angiotensin system blockers (RASBs) in patients with kidney disease, their utilization in patients on HD may be suboptimal, especially in patients with preserved diuresis. This hesitance that often steams from concern is often due to fear of a decrease in eGFR and a subsequent decrease in diuresis. The aim of this study was to compare clinical characteristics, blood pressure, safety, and HD adequacy indices in hypertensive HD patients on multiple antihypertensive drug regimens, including diuretic treated with RASB (RASB group) or without RASB (no-RASB) with preserved residual diuresis. We sought to examine the real-life use of RASB in HD patients in relation to their clinical characteristics, blood pressure, safety, and HD adequacy. From a database of 5,879 patients receiving HD (mean age 65.2 ± 14.2 years, 60% of males) of the largest provider of HD in the country, we selected the subgroup treated with at least three antihypertensive medications including diuretics. We compared patients treated with RASB to counterparts without RASB (no-RASB). The RASB group has similar age and gender proportions as well as BMI and bioimpedance compared to counterparts. However, dry body mass was significantly lower in the RASB group (78.1 ± 18.3 kg vs. 80.0 ± 18.2 kg, p < 0.017). Prevalence of diabetes mellitus was similar in both groups, but RASB-treated patients have cardiovascular diseases more frequently (70.1 vs. 60.8%; p < 0.001). Systolic blood pressure and the number of antihypertensive drugs used were significantly higher in RASB patients than in counterparts (146 ± 16 mm Hg vs. 144 ± 15 mm Hg; p < 0.001 and 4.1 ± 0.9 vs. 3.5 ± 0.5; p < 0001, respectively). RASB-treated patients have significantly longer dialysis vintage (52.7 ± 44.4 months vs. 40.2 ± 40.9 months; p < 0.001) and dialysis time (722 ± 87.1 min/week vs. 713 ± 93.4 min/week; p < 0.017) than counterparts. Serum potassium was slightly but significantly higher in RASB (5.3 ± 0.8 mmol/L vs. 5.1 ± 0.7 mmol/L; p < 0.01). In the real world setting, RASB can be safely used in HD patients treated with diuretics with preserved residual diuresis. Given that many HD patients present numerous multimorbidities, RASB should not only be considered as an additional hypotensive drug in poorly controlled hypertension but also in other compelling indications in HD patients. The tendency toward hyperkalemia in HD patients could be effectively managed with appropriate diet and HD prescription adjustments.

Iron Management and Anemia in Patients on the Active Kidney Transplant List

IntroductionIron metabolism disorders and anemia are one of the main complications of end-stage renal disease that may affect the evaluation process for kidney transplantation. The study aimed to assess the iron metabolism in hemodialysis patients in relation to waiting list status. Study MethodThe study included 5068 hemodialysis patients, including those on the active waiting list (N = 449) and those who were not eligible for the waitlist (N = 4619). Demographic and biochemical data, Charlson's comorbidity index, duration of hemodialysis therapy and, respectively, hemoglobin, ferritin, and transferrin saturation levels were compared in both groups of patients. ResultsPatients on the active waiting list were significantly younger −53.2 vs 67.2 years (P < .001), with a lower Charlson comorbidity index score: 3.33 vs 4.42 (P < .001). The duration of hemodialysis therapy was similar: 66.0 vs 63.2 months (P = .416), the incidence of anemia according to World Health Organization (90.6%, vs 91.2%) and KDIGO (72.4% vs 70.4%). The degree of anemia correction in terms of hemoglobin concentration and transferrin saturation was comparable in both groups and amounted to an average of 10.9 g/dL (P = .349) for hemoglobin concentration and 32.7% vs 33.4% (P = .513) for transferrin saturation. However, there was a statistically significant difference in ferritin concentration: 554 ug/L vs 733 ug/L (P = .001). ConclusionsPatients on the active list have significantly lower ferritin levels despite similar duration of hemodialysis treatment and comparable hemoglobin values. This may be due to lower inflammation, and less frequent blood transfusions, and lead to a lower risk of immunization and an increased chance of potential kidney transplantation.

Pulmonary Hypertension versus pulmonary congestion in Haemodialysis patients in relation to increased Interdialytic weight gain

Abstract Background Volume overload is considered as an important clinical problem in end stage renal disease patients. It is associated with morbid situations such as pulmonary hypertension and lung congestion. Aim of the Work to assess the effect of increased the patient weight between haemodialysis sessions that is known as interdialytic weight gain (IDWG) on pulmonary hypertension using Echocardiography (Echo) and lung congestion using lung ultrasound (LUS) in two groups: First group with IDWG &amp;lt; 3.5% of their dry weight while Second group with IDWG &amp;gt; 3.5% of their dry weight, compare between the two groups and to detect statistically the effects of IDWG &amp; ultrafiltration on PAP and lung congestion. Patients and Methods This observational cross sectional study was conducted at on 60 patients who have end stage kidney disease &amp;are currently on haemodialysis at Nasser Institute Hospital: 30 patients with an IDWG &amp;lt; 3.5% and 30 patients with an IDWG &amp;gt; 3.5% of their dry weight. Pulmonary artery pressure was measured by echo and patients classified according to PAP into mild, moderate and severe pulmonary hypertension. Lung congestion in all patients was measured by lung ultrasound and patients classified into minimal, mild, moderate and severe lung congestion. Results Our study showed that pulmonary hypertension prevalence was 30% while lung congestion was 100%. pulmonary hypertension pathophysiology includes acute and chronic processes and HD therapy alone is not effective in complete treatment of pulmonary hypertension and require medical treatment. Patients with increased IDWG &amp;gt; 3.5% (group 2) had pre HD higher PAP than those with IDWG &amp;lt; 3.5% (group 1) and patients with IDWG &amp;gt; 3.5% had more change in their PAP post HD session than those with IDWG &amp;lt; 3.5% but no significant difference between the change after the HD session in both groups. HD duration is an important factor in PH development over years. There is a significant relation anemia and hypercalcemia with PH. Patients with more increased IDWG &amp;gt; 3.5% (group 2) had higher pulmonary congestion than those with IDWG &amp;lt; 3.5% (group 1) and patients with IDWG &amp;lt; 3.5% had more change in their lung congestion level after the HD session than those with IDWG &amp;gt; 3.5% but no statistical significance between the change in both groups. There was a significant relation between HD therapy duration with pulmonary congestion measured prior to the session. Conclusion on the short term increased IDWG% affect lung congestion more than pulmonary hypertension.

Experiences of New Zealand Haemodialysis Patients in Relation to Food and Nutrition Management: A Qualitative Study.

People receiving haemodialysis have considerable and complex dietary and healthcare needs, including co-morbidities. A recent New Zealand study has shown that few patients on haemodialysis are able to meet nutritional requirements for haemodialysis. This study aims to describe the perspectives and experiences of dietary management among patients on haemodialysis in New Zealand. This exploratory qualitative study used in-depth semi-structured interviews. Purposive sampling was used to recruit participants from different ethnic groups. Forty interviews were conducted, audio-recorded and transcribed verbatim. An inductive approach was taken using thematic analysis. Forty participants were interviewed. Participants spoke of major disruption to their lives as a result of their chronic kidney disease and being on haemodialysis, including loss of employment, financial challenges, loss of independence, social isolation and increased reliance on extended family. Most had received adequate dietary information, although some felt that more culturally appropriate support would have enabled a healthier diet. These findings show that further support to make the recommended dietary changes while on haemodialysis should focus on socio-cultural factors, in addition to the information already provided.

Screening for Chronic Kidney Disease in Relatives of Hemodialysis Patients

Objective: To estimate the prevalence and socioeconomic characteristics of Chronic Kidney Disease (CKD) in first and second-degree relatives of patients on hemodialysis Method: A questionnaire was applied on socioeconomic conditions, lifestyle, and personal pathological background. The formula of CKD-EPI and/or proteinuria greater than or equal to 1+ was used to characterize CKD. Analysis using the logistic regression model. Results: 408 individuals were evaluated and 12% had CKD. 6.61% had a glomerular filtration rate (GFR) ≤ 60 mL / min / 1.73 m2 and 5.39% proteinuria in the urine. The variables associated with the presence of CKD were age (OR = 1,60; 95% IC = 1,31-1,96), PAS (OR: 1,69; 95% IC: 1,24-2,28), PAD (OR: 1,52; 95% IC: 1,18- 1,96) and blood glucose (OR: 2,03; 95% IC: 1,38-2,99). Conclusion: It is necessary to implement routines for systematic evaluation that prevent or delay the loss of renal function, in addition to measures that improve the pre-dialysis clinical conditions of this population. Keywords: Chronic kidney disease, Family, Glomerular filtration rate. DOI: 10.7176/RHSS/11-10-06 Publication date: May 31 st 2021

Acute phase reactants in hemodialysis patients in relation to ejection fraction

Chronic Kidney Disease (CKD) is considered a public health problem because of its high prevalence, morbidity and mortality. Morbidity remains high with more than 20% of patients undergoing hemodialysis dying every year with frequent complications of heart disease, hypertension, anaemia, inflammation and physical function. Coronary artery disease has accounted for 40-50% of deaths among patients who undergo dialysis. Myocardial infarction has approximately accounted for 10-20% of these deaths which occur shortly after initiating dialysis with 29% within 1 year and 52% within 2 years. The risk increases as the kidney function declines.The present study aims to study the serum levels of hs-CRP and ferritin in hemodialysis patients and to correlate with ejection fraction as an indirect association of coronary artery disease and therefore to study the role of inflammatory markers hs-CRP and ferritin in hemodialysis patients and their role as predictive markers in coronary artery disease.The study included 50 hemodialysis patients with CAD and 50 hemodialysis patients without CAD. hs-CRP and ferritin parameters were analysed. hs-CRP and ferritin levels were significantly increased in hemodialysis patients with CAD (p&amp;#60;0.000) and the ejection fraction in patients on hemodialysis with coronary artery disease was significantly low (p&amp;#60;0.000). From the above values we can infer that hemodialysis patients with CAD have less ejection fraction when compared to hemodialysis patients without CAD. In conclusion, there was a significant elevation in the hs-CRP and ferritin levels when compared to controls furthermore it was also associated with worse prognosis for cardiovascular diseases.

Prevalence and Associated Factors of Chronic Kidney Disease among Relatives of Hemodialysis Patients in Saudi Arabia

Chronic kidney disease (CKD) is a serious health issue in the Kingdom of Saudi Arabia (KSA). In KSA, there are currently over 20,000 patients on dialysis and 9,810 patients undergoing follow up after kidney transplantation.1 The combined prevalence of renal replacement therapy in Saudi Arabia is estimated at 294.3 per million population.1

Opportunistic parasitoses among Egyptian hemodialysis patients in relation to CD4+ T-cell counts: a comparative study

BackgroundSome reports are available on the prevalence of opportunistic parasitoses among hemodialysis (HD) patients, yet there is a paucity of data on the association of CD4+ T-cell counts with such infections. Therefore, this study aimed to determine the prevalence of intestinal parasites and Toxoplasma gondii in relation to CD4+ counts among HD patients in Alexandria, Egypt.MethodsA comparative cross-sectional study was conducted on 120 HD patients and 100 apparently healthy individuals between December 2014 and January 2016. Data and samples (stool and blood) were collected from the participants after obtaining their informed consent. Stool samples were examined for parasites after concentration and staining, EDTA-blood samples were used for CD4+ counting by flow cytometry, and sera were analyzed for anti-Toxoplasma IgM and IgG antibodies.ResultsA significantly higher prevalence rate of intestinal parasitoses was found among HD patients compared to apparently healthy individuals (52.5% vs. 12.0%, respectively), with absence of helminths. Cryptosporidium species (32.5%), B. hominis(24.2%) and microsporidia (11.7%) were the most frequent parasites among HD patients, while B. hominis (13.0%), Cryptosporidium species (11.0%) and G. lamblia (4.0%) were the most frequent parasites among their counterparts. Statistically significant differences in parasite infection rates between patients and their counterparts were found for Cryptosporidium species, B. hominis and microsporidia. However, parasite species were not significantly associated with diarrhea. On the other hand, the overall T. gondii seroprevalence rate among HD patients was significantly higher than that among their counterparts (33.3% vs. 8%, respectively). HD patients with CD4+ counts < 200 cells/μl were twice more exposed to intestinal parasitoses compared to those with counts ≥200 cells/μl, but the difference was not statistically significant. However, low CD4+ counts were significantly associated with higher rates of Cryptosporidium species, microsporidia and T. gondii.ConclusionsIntestinal parasitoses and T. gondii infection rates are significantly higher among Egyptian HD patients compared to apparently healthy individuals, with Cryptosporidium species, B. hominis, microsporidia and T. gondii being the most frequent parasites. CD4+ counts < 200 cells/μl are significantly associated with Cryptosporidium species, microsporidia and T. gondii among HD patients. Therefore, regular screening of HD patients for opportunistic parasites is recommended.

The influence of hypothyroidism and substitution treatment on thyroid hormone conversion ratios and rT3 concentration in patients with end-stage renal failure.

The increasing number of patients with end-stage renal disease (ESRD) requires seeking new opportunities to improve their quality of life, not only because of kidney disease but also due to other disturbances, such as thyroid hormone disorders. The objective of the study was to evaluate the influence of coexisting hypothyroidism and thyroid hormone therapy in patients with ESRD on thyroid hormone conversion ratios and rT3 concentration. The study involved 85 patients aged 26 to 87 years, with a mean age of 59.62 ± 15.45 years. Four groups of patients were examined: G1 group - 25 persons without RF and hypothyroidism, G2 - 26 patients with ESRD treated with haemodialysis (HD), G3 - 12 patients with ESRD treated with HD and newly diagnosed hypothyroidism, and G4 - 22 HD patients with hypothyroidism treated with thyroid hormones substitution. The concentrations of TSH, T4, T3, fT4, fT3, and rT3 were measured and the fT3/fT4, T3/T4, and rT3/T4 conversion ratios and rT3/T3 ratio were calculated. Concentrations of protein, hsCRP, Hg, and blood gases were also checked; the anion gap was calculated. Patients from group G1 through G2 to G3 were older (ptrend = 0.002), with lower Hb level (ptrend < 0.001), with lower pH (ptrend < 0.001), with increased anion gap (ptrend < 0.013) and CRP concentrations (ptrend < 0.001), and decreased total protein level (ptrend < 0.001). There were increased TSH values (ptrend < 0.001) and lower T4 (ptrend = 0.024), fT3 (ptrend < 0.001), T3 (ptrend < 0.001), and rT3 (ptrend = 0.008) levels. rT3/T3 ratio did not change, the rT3/T4 ratio tended to decrease (ptrend = 0.065) similarly to T3/T4 ratio (ptrend = 0.063), and the fT3/fT4 ratio also decreased (ptrend = 0.005). It seems that the treatment of thyroid disease in patients with renal failure, treated with haemodialysis, is not associated with change of rT3 and conversion factor levels. The concentration of rT3 in HD patients in relation to healthy persons tends to decrease, and hypothyroidism increases this tendency in these patients. Hormone substitution treatment does not eliminate the influence of RF on inhibition of rT3 production. In patients with ESRD, hypothyroidism additionally reduces the conversion of thyroid hormones examined by fT3/fT4 and to a lesser extent T3/T4 ratios.

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

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

N-Terminal Prohormone of Brain Natriuretic Peptide but not C-Terminal Pre-Pro Vasopressin (Copeptin) Level is Associated with the Response to Antihypertensive Therapy in Haemodialysis Patients

Background/Aims: Volume overload, frequently clinically asymptomatic is considered as a causative factor limiting the effectiveness of antihypertensive therapy in haemodialysis (HD) patients. Therefore, the aim of this study was to assess plasma levels of N-terminal fragment of the prohormone brain natriuretic peptide (NT-proBNP) and a C-terminal portion of the precursor of vasopressin (CT-proAVP, copeptin), surrogate markers of volume overload in HD patients in relation to the number of antihypertensive drugs used in the hypertension treatment. Methods: One hundred and fifty adult HD patients (92 males) were enrolled into this study. Clinical data concerning blood pressure (BP) measurements prior haemodialysis session and pharmacotherapy were collected from all patients. In addition to routine laboratory parameters, plasma levels of NT-proBNP and CT-proAVP were measured, and daily sodium and water consumption were estimated with a portion-size food frequency questionnaire. Results: Among 145 (96.7%) hypertensive HD patients, 131 were receiving antihypertensive medication. Despite antihypertensive therapy, 31.0% had inadequate BP control. Plasma concentration of NT-proBNP was associated with systolic (R=0.19; p=0.02) but not diastolic BP values and with the number of received antihypertensive drugs (R=0.21; p=0.01). The highest NT-proBNP values were observed in patients receiving 3 or more antihypertensive drugs. In contrast, no significant correlation was found between plasma CT-proAVP concentrations and BP values as well as and the number of antihypertensive drugs. Receiver operator curve analysis showed that NT-proBNP values over 13,184 pg/mL predicted the use of at least 3 antihypertensive drugs in maximal doses in the therapy of hypertension, similar analyses performed for CT-proAVP showed much less specificity. Conclusions: 1. Increased levels of NT-proBNP seems to be a better biomarker of multidrug antihypertensive therapy requirement than CT-proAVP. 2. Whether estimation of NT-proBNP in these patients will be also better biomarker than copeptin in the prediction of cardiovascular complications related to hypertension needs further investigations.

Classification of anemia in hemodialysis patients in relation to vascular access and its correlation with hepcidin and ferritin

Background: Anemia is very common in patients with chronic kidney disease, and becoming almost universal in end stage renal disease, where dialysis or renal transplantation becoming the treatment of choice. High levels of hepcidin appear to accompany reduced renal function and serum ferritin may also be elevated.Objectives: To classify anemia in hemodialysis patients and to display the correlations between the types of anemia and inflammatory parameters like hepcidin and ferritin according to vascular access of hemodialysis.Patients and methods: This case-control study was conducted at Al-Hayat center for hemodialysis, and included 60 adult patients on hemodialysis. Also 20 healthy individuals were recruited as control group. Measurement of hemoglobin, erythrocyte sedimentation rate, transferrin saturation percentage, serum ferritin, C-reactive protein and hepcidin were done. Anemic patients were classified into; anemia of chronic disorder, iron deficiency anemia, combined, and others. Patients were also divided into two groups depending on their vascular access of hemodialysis.Results: Anemia of chronic diseases was the most frequent anemia (45%) among the patients followed by combined anemia of chronic diseases/iron deficiency anemia then iron deficiency and other causes. No significant difference was observed between types of anemia and inflammatory parameters according to patients’ vascular access of hemodialysis. There was no significant difference in the mean levels of hepcidin, ferritin, ESR and CRP of the patients according to the vascular access of hemodialysis, while hemoglobin level of patients with anemia of chronic in double lumen was significantly lower than those with arteriovenous fistula, P= 0.007.Conclusions: Anemia of chronic diseases was the most frequent in hemodialysis patients. There are higher levels of inflammatory parameters in hemodialysis patients than healthy controls.

Anxiety and depression in haemodialysis patients in relation to dialysis adequacy and nutritional status

IntroductionAnxiety and depression are distinct clinical entities associated with mortality in haemodialysis (HD) patients.AimsThis study aims to identify the prevalence of anxiety and depression in HD patients and uncover the association of anxiety and depression in relation to the dialysis adequacy and nutritional status.ObjectiveThis would help reinforce early detection and treatment to improve quality of life and patient's outcome in HD treatment.MethodForty HD patients were assessed for anxiety and depression with the Generalised Anxiety Disorder Assessment (GAD-7 and Patient Health Questionaire [PHQ-9]). The scores of GAD-7 and PHQ-9 were correlated with the demographic, clinical and laboratory variables and nutritional status assessed by a dietician through the Subjective Global Assessment (SGA).ResultsOut of the 40 HD patients, 7 (17.5%) were anxious and 15 (37.5%) were depressed. Patients were more anxious and less depressed with better nutrition. They were less anxious and depressed with increasing albumin levels, Charlston comorbidity index based on combined condition and age-related score and Kt/V. The univariate logistic regression analysis showed only a significant inverse correlation between depression and albumin level (P = 0.041, OR = 0.88 [95% CI = 0.78 to 0.99]) and Kt/V (P = 0.054, OR = 0.03 [95% CI = 0.01 to 1.07]).ConclusionDepression is more prevalent than anxiety in HD patients. The risk of depression also increases with poorer dialysis adequacy and nutritional status. Thus, by improving dialysis adequacy and nutritional status, we can reduce the incidence of depression. However, a significant correlation cannot be drawn for anxiety.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Laboratory and dialysis characteristics in hemodialysis patients suffering from chronic itch--results from a representative cross-sectional study.

BackgroundA representative cross-sectional study showed that chronic itch (lasting for a minimum of 6 weeks) affects 25.2 % (point prevalence) of hemodialysis (HD) patients. Pathophysiology and etiology of chronic itch (CI) in HD are still unclear.MethodsWe investigated 860 HD patients from a representative randomly selected cluster-sample considering the regional distributions of dialysis units in GermanyThe current analyses report comorbidities, laboratory values and dialysis characteristics of HD patients in relation to CI.ResultsDiabetes was the only comorbidity that was associated with the occurrence of itch but interestingly with less CI. Except for creatinine, phosphorus, and parathormone, there were no significant associations between the occurrence and characteristics of CI and any laboratory value. Kt/V was not associated with the presence of CI. Patients dialyzed with polyarylethersulfone-membrane showed significantly more CI in all prevalence estimates and those dialyzed with polysulfone-membrane were significantly less affected by CI.ConclusionsLong-term follow-up studies will show if the type of dialysis membrane influences the development of CI in HD patients. It is most likely that several factors e.g. elevated parathormone, origin of end stage renal disease (ESRD), type of dialysis membrane, and a neuropathic component all contribute to the occurrence of CI in HD patients. Future research should consider a multifactorial origin of itch in HD.

Effect of individual health education on hyperphosphatemia in the Hakkas residential area

The Hakka are a sub-ethnicity with unique diet customs in South China. This study investigated hyperphosphatemia in hemodialysis patients in relation to the current Hakka dietary customs and explored health education patterns for hyperphosphatemia control. Two continuous cross-sectional surveys were conducted among the local patients on dialysis. After the first survey, the patients with hyperphosphatemia were semi-randomized into regular (group 1) and individual (group 2) education groups. Regular health education was conducted for both groups. In group 2, the awareness of health knowledge and dietary customs was investigated using a self-designed questionnaire. Based on the questionnaire, individual dietary guidance was given. The second survey was performed after 3 months. In the first survey, a high-phosphorus diet was found in all 46 patients with 43 (93.5%) diagnosed with hyperphosphatemia. In group 1 and group 2, 15 patients and 25 patients completed the two surveys, respectively. In group 1, no patient changed their dietary habits; however, in group 2, some patients did. The level of serum inorganic phosphorus in group 1 increased significantly. In group 2, the data remained stable; the awareness rate of chronic kidney disease–mineral and bone disorder (CKD–MBD) increased, and six patients with good compliance showed decreased serum inorganic phosphorus (p = 0.046). High-phosphorus dietary customs and low CKD–MBD knowledge awareness are important reasons for the difficulty in hyperphosphatemia control of patients on dialysis in the Hakka region. Individual health education led by medical staff might be helpful in hyperphosphatemia control, but the pattern still needs further exploration.

Evaluation of Nutritional Knowledge in Terms of Dietary Sources of Protein, Phosphorous, Potassium and Fluids Restriction in Hemodialysis Patients

Objectives: Therefore, the present study was performed with this aim, in patients with renal failure treated with hemodialysis. Patients and Methods: Fifty hemodialysis patients were recruited. Demographic information, and anthropometric characteristics, were collected and measured. Awareness of nutrition in six parts (fluids, proteins, phosphorus, sodium, potassium, and cooking methods) was analyzed through a validated questionnaire. Results: The mean age of the participants was 47.5 ± 14.9 years. In total, 26% of the patients had a poor knowledge of nutrition, 58% had a moderate understanding, and only 16% had good nutritional knowledge. In addition, the level of nutritional knowledge was significantly greater in patients with higher educational levels than those with primary education or lower. The mean score of knowledge about dietary sources of phosphorous and potassium was significantly lower than that of the other parts (P < 0.001). Furthermore, nutritional awareness regarding dietary sources of protein did not significantly differ from fluids restriction; however, it was significantly lower than sodium and cooking methods (P < 0.001) and significantly higher than phosphorus and potassium (P < 0.01). Conclusions: Patients’ knowledge scores about dietary sources of phosphorous and potassium were significantly lower than those of other parts. It is worth noting that qualified doctors, nurses and dieticians, should educate hemodialysis patients in relation to their literacy levels, especially when describing dietary sources of phosphorus, potassium and protein.

Association of relatives of hemodialysis patients with metabolic syndrome, albuminuria and Framingham Risk Score.

Background and AimMetabolic syndrome (MetS), albuminuria, and the Framingham Risk Score (FRS) are significant predictors for cardiovascular disease (CVD). However, the relationship and clinical significance of these CVD predictors in individuals with a family history of end-stage renal disease (ESRD) are unclear. We investigated the association of relatives of hemodialysis (HD) patients with MetS, albuminuria, and the FRS.MethodsOne hundred and sixty-six relatives of HD patients and 374 age- and sex- matched community controls were enrolled. MetS was defined using the Adult Treatment Panel III for Asians. Albuminuria was defined as urine albumin-to-creatinine ratio ≥30 mg/g. CVD risk was evaluated by the FRS.ResultsA significantly higher prevalence of MetS (19.9% vs. 12.5%, P = 0.026), albuminuria (12.7% vs. 5.1%, P = 0.002) and high FRS risk ≥10% of 10-year risk (15.7% vs. 8.5%, P = 0.013) was found in relatives of HD patients compared to their counterpart controls. In multivariate analysis, being relatives of HD patients (vs. controls) was an independent determinant for MetS (odds ratio [OR], 1.785; 95% confidence interval [CI], 1.045 to 3.050), albuminuria (OR, 2.891; 95% CI, 1.431 to 5.841), and high FRS risk (OR, 1.863; 95% CI, 1.015 to 3.418). Higher low-density lipoprotein cholesterol (OR, 1.034; 95% CI, 1.017 to 1.052) and betel nut chewing (OR, 13.994; 95% CI, 3.384 to 57.871) were independent determinants for having a high FRS risk in relatives of HD patients.ConclusionsBeing relatives of HD patients was independently associated with MetS, albuminuria and high FRS risk, suggesting family members of ESRD patients may have higher CVD risks through the interactions of renal risk factors. Proactive surveillance of these CVD predictors and preventive strategies should be targeted to this high-risk population.

DIETARY PHOSPHOROUS INTAKE AMONG HAEMODIALYSIS PATIENTS IN RELATION TO DOSAGE OF PHOSPHATE BINDERS AND HYPERPHOSPHATEMIA.

Hyperphosphatemia in haemodialysis (HD) patients is associated with mineral and bone disorder and increased cardiovascular disease. Despite dietary restriction of phosphorous (P), improved dialysis therapy and phosphate binders (PB), hyperphosphatemia remains a serious problem among the dialysis population. A sub-optimal relationship between the actual dietary intake of P and the intake of PB’s may be one explanation. The aim of the present study was to investigate the dietary P intake in a group of HD patients in relation to the taken dosage of PB, and to establish what, if any, relationship exists with the patients’ plasma phosphate level. Self-reported intake of P, assessed by three-day estimated food record, and intake of PB was analysed in thirty-one adult (age 61.8±12.9 years) HD patients (17 men, 14 women), who were divided into two groups according to their plasma P levels. The mean dietary P intake among all patients was 1270±420 mg/d with a mean day-to-day variation of 390±310 mg. The P intake in one single meal ranged from <10 mg to 1430 mg, average 256±200 mg. The variation of dosing regimens of PB among the patients was large (1–4 to 12–16 per day), although each patient’s regimen was fixed and in most cases was 3 times daily. No significant differences regarding dietary P intake ( p =0.51) nor PB’s ( p =0.41) between patients with high (>1.6 mmol/l) and low (<1.6 mmol/L) plasma P levels were observed. In conclusion, the findings show a notable individual day-to-day and meal-to-meal variation in dietary P intake and in contradiction, the same individual dosing regimen of PB. Strangely, no significant difference in the dietary P intake or intake of PBs between HD patients with high or low plasma P level was found. The question of whether a PB intake better tailored to the meal and day variation in P intake could prevent hyperphosphatemia will need to be evaluated in further studies.

Renal Anemia Treatment with ESA in Hemodialysis Patients in Relation to Early versus Late Referral in Everyday Clinical Practice in Central and Eastern European Countries: Baseline Data

The aim of the study was to collect retrospective data on renal anemia management, comorbidities and prospective data on 12-month standard care erythropoiesis-stimulating agent (ESA) therapy used in 398 hemodialyzed patients in selected Central and Eastern European countries (50 centers in 3 countries). Patients were divided into three groups according to ESA therapy start: group A-ESA (after start of hemodialysis, HD), B-ESA (within 3 months from start of HD), C-ESA (more than 3 months before HD). At the chronic kidney disease diagnosis, hemoglobin in all patients was 10.3 ± 2.3 g/dl; however, ferritin, iron, TSAT were within reference limits. Early ESA therapy (C) was administered to 10% of patients only. 47% of patients received ESA after start of dialysis. Before study, the mean weekly ESA dose in group C was statistically lower than in groups B and A (p < 0.001). At baseline visit, hemoglobin in group A patients was slightly lower than in group B and C patients (p = 0.025). In conclusion, in Central and Eastern European countries renal anemia therapy with ESA starts shortly before or after start of HD. This highlights important differences in standard care in Eastern Europe. However, paradoxically, due to the tight reimbursement policy we foresee the clinical implications of the TREAT trial for the chronic kidney disease population.

Subgroups of haemodialysis patients in relation to fluid intake restrictions: a cluster analytical approach

To determine whether definable subgroups exist in a sample of haemodialysis patients with regard to self-efficacy, attentional style and depressive symptomatology and to compare whether interdialytic weight gain varies between patients in groups with different cognitive profiles. Theory-based research suggests that cognitive factors (e.g. self-efficacy and attentional style) and depressive symptomatology undermine adherence to health protective regimens. Preventing negative outcomes of fluid overload is essential for haemodialysis patients but many patients cannot achieve fluid control, and nursing interventions aimed to help the patients reduce fluid intake are ineffective. Understanding the interaction between cognitive factors and how this is related to adherence outcomes might therefore lead to the development of helpful nursing interventions. Explorative cross-sectional multicentre survey. The sample consisted of 133 haemodialysis patients. Data were collected using structured questionnaires. A brief self-report form and data on interdialytic weight gain was also used. Two-step cluster analysis was used to identify subgroups. One-way analysis of variance (anova) or Pearson's chi-square test was used for comparing subgroups. Three distinct subgroups were found and subsequently labelled: (1) low self-efficacy, (2) distraction and depressive symptoms and (3) high self-efficacy. The subgroups differed in fluid intake, but not in age, dialysis vintage, gender, residual urine output or in receiving any fluid intake advice. Clinically relevant subgroups of haemodialysis patients could be defined by their profiles regarding self-efficacy, attentional style and depressive symptoms. Based on this study, we would encourage clinical practitioners to take into account cognitive profiles while performing their work. This is especially important when a targeted nursing intervention, which aims to encourage and maintain the patient's fluid control, is introduced.