Routine Hemodialysis Research Articles

Evaluation of fluid overload markers in pediatric hemodialysis patients

Assessment of hydration status in children undergoing hemodialysis (HD) is crucial. This study aimed to identify the techniques that can be utilized to assess fluid overload in children with end-stage renal disease (ESRD) undergoing HD. The study included 9 patients aged >5 years and < 18 years who underwent 27 HD sessions and were followed up for ≥1 month. The median age of the patients was 16 years (IQR: 5-17.8 years) and the female/male ratio was 1.25:1. Symptoms of volume overload were clinically observed based on 5 (18.5%) of the 27 measurements. There was a significant positive linear correlation between fluid overload by weight and pre- and post-HD bioimpedance spectroscopy (BIS) measurements (OH) (r=0.95 [P=0.000]). There was a significant difference in median IVC diameter between pre-HD and after HD (P=0.029). The median pre-HD IVC collapsing index was 13.8% (IRQ: 4%-46%), versus 17.1% (IRQ: 4.5%-45%) after HD; the difference was significant (P=0.000). BIS is the most widely used body composition monitor for estimating fluid status in children undergoing HD. The present study investigated the sensitivity of markers of volume load in children on a routine HD program. The parameters that best indicate volume load are the differences between pre-HD and post-HD BIS measurements, physical examination findings, and heart rate measurements.

Necrotic lower extremities ulcers caused by calciphylaxis in chronic renal failure patient

Introduction: Lower extremity ulcers often create diagnostic challenges and influence patient morbidity and mortality. The most common causes are venous insufficiency, arterial insufficiency, and neuropathic. Ulcers associated with systemic condition often face diagnostic and therapeutic challenge. We report a necrotic lower extremity ulcer caused by calciphylaxis in a patient with chronic renal failure.
 Case: We reported a 48-year-old Javanese woman, complained of painful lower extremities ulcers since 1.5 months ago. The patient had a history of renal failure and hypertension, undergone routine hemodialysis since 13 years ago, and used Continuous Ambulatory Peritoneal Dialysis (CAPD) since one year ago. Dermatology status on dorsum pedis sinister as well as cruris dexter and sinister showed multiple ulcers on livid skin covered by black eschar, accompanied by tenderness. Laboratory results showed anemia (Hb 7.6), hypoalbuminemia (2.7), increased serum urea level (170.4 mg/dl), increased serum creatinine (11.23 mg/dl), increased calcium (10.4 mg/dl), high inorganic phosphorus (8.5 mg/dl) and high parathyroid hormone (2,164). BOF examination showed abdominal calcification, while radiographic examination on cruris dexter et sinister showed soft tissue calcification and osteoporosis. Histopathology result supported the presence of calciphylaxis. The patient was diagnosed with stage V chronic renal failure, hypertension, and calciphylaxis caused by secondary hyperparathyroidism. She was managed by low calcium and phosphate diet, lanthanum, paracetamol, folic acid, adalat oros, captopril and wound debridement.
 Conclusion: Calciphylaxis is rare phenomenon of cutaneous necrosis associated with end-stage renal disease. Control of end-stage renal disease may be an important factor for treatment of calciphylaxis and patient with calciphylaxis usually had a poor prognosis.

Association of anemia and hypoalbuminemia with mortality among patients undergoing routine hemodialysis

Background: The progressivity of chronic kidney disease (CKD) is associated with several clinical conditions which contribute to high morbidity and mortality, including anemia and hypoalbuminemia. This study aimed to assess the association of anemia and hypoalbuminemia with the mortality of CKD patients undergoing routine hemodialysis (HD) in Siloam Hospital Kupang.Methods: We conducted a retrospective cohort study based on Indonesia renal registry data system and hospital medical records. We studied the following variables: gender, age, etiology of CKD, vascular access of HD, and prevalence of anemia and hypoalbuminemia. All analysis was performed using SPSS software version 22.Results: There were 128 patients enrolled in this study. Of the total patients who died, most of them died within the first 3 months since the initiation of HD (62.1%). The majority of patients had anemia (67.2%) and hypoalbuminemia (69.5%). The bivariate analysis showed that anemia (p value=0.192), and hypoalbuminemia (p value=0.336) were not statistically significant associated with mortality among patients undergoing routine HD.Conclusions: Anemia and hypoalbuminemia are not statistically associated with mortality outcome of CKD patients in Siloam Hospital Kupang. However, these conditions may still have prognostic importance for CKD patients undergoing routine HD. Further studies with larger size of cohort and longer period of time are warranted.

Pola Hidup dan Dukungan Keluarga Berhubungan dengan Rutinitas Hemodialisa pada Pasien Gagal Ginjal Kronik

Introduction: Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease of the heart and blood vessels. CKD is largely treatable so it deserves greater attention for decision-making for patients and families in undergoing a course of therapy. Objective: To determine the relationship between lifestyle and family support with routine hemodialysis in patients with chronic kidney failure at Ciawi Hospital, Bogor. Methods: The research design used is a descriptive correlation. The research population was all respondents in Ciawi Hospital, Bogor. By using a total sampling technique of 72 people. The instrument used a questionnaire and the analytical tool used was the Spearman rank correlation. Results: The results showed that most of the patients with chronic kidney failure who underwent hemodialysis in the Hemodialysis room at the Ciawi Hospital, Bogor were male as many as 38 respondents (52.8%), ages 44-45 as many as 34 respondents (47.2%), SMA education was 46 respondents (63.9%), and occupations with other categories were 27 respondents (37.5%). The pattern of life with routine hemodialysis implementation at Ciawi Hospital Bogor is good for as many as 49 respondents (68.1%) and there is family support for as many as 48 respondents (66.7%) so there is a relationship between lifestyle and family support with hemodialysis routines at Ciawi Hospital, Bogor with P-value = 0.016 and OR 9.4 for lifestyle relationships, while P-value = 0.022 and OR 10.1 for family support. Conclusion: There is a relationship between lifestyle and family support with the implementation of hemodialysis in patients with chronic kidney failure in the Hemodialysis Room of Ciawi Hospital, Bogor Regency. Lifestyle has a greater influence on the suitability of the hemodialysis schedule.

Central Vein Stenosis in Patient with Routine Haemodialysis: From Diagnosis and Prompt Treatment; A Case Report

Background: Central vein stenosis (CVS) is common in hemodialysis patients and is caused by the implantation of cardiac intravascular devices, venous access, and limited vascular access. The effect may develop until an arteriovenous fistula (AVF) or graft is established in the ipsilateral arm or forearm for hemodialysis. Arm edema, significant venous dilatation, and recurring infections are common complications of having an ipsilateral arteriovenous fistula or graft Case Illustration: We present the case of a 50-year-old female who developed symptomatic CVS while being on regular hemodialysis. Venography using a catheter revealed significant stenosis of the subclavian vein. Due to central venous stenosis, this patient had substantial edema of her left arm after undergoing an ipsilateral arteriovenous graft. Multiple endovascular treatments have failed to alleviate the symptoms. Discussion: The incidence and danger of central vein stenosis in hemodialysis patients are discussed, as well as the success of endovascular therapies. The initial line of therapy should be percutaneous balloon angioplasty. Conclusion: Unfortunately, after angioplasty or stenting, primary patency is poor. If there is recurring stenosis, the procedure can be repeated.

The Correlation of Interleukin-6, Malnutrition Inflammation Score and Asymmetric Dimethylarginine in Chronic Kidney Disease Patients Undergoing Routine Hemodialysis

Introduction: Chronic kidney disease (CKD) patients undergoing routine hemodialysis (HD) have a high prevalence of protein-energy malnutrition (PEM) and inflammation. The combination of inflammation and PEM is associated with cardiovascular disease and poor outcomes. Interleukin-6 (IL-6) is an inflammatory factor that runs parallel to endothelial damage and is closely related to the nutritional status of CKD HD patients. The tool to assess nutrition status is Malnutrition Inflammation Score (MIS) and to assess endothelial damage is Asymmetric Dimethylarginine (ADMA). It is currently unclear whether there is a correlation between inflammation, malnutrition, and endothelial dysfunction. Therefore the aim of this study is to determine the correlation between IL-6, MIS and ADMA in CKD HD patients. Methods: A cross-sectional design with analytic observational study was conducted on end stage renal disease patient who undergo routine hemodialysis for at least 2 years with the duration of hemodialysis is 4-5 hours and at least twice per week. IL-6 was examined by kit (ELISA) and ADMA using LC-MS/MS at a certified laboratory in Manado city. History taking and physical examination were used to calculate MIS. Data analysis was done using SPSS version 22. Results: There were 30 participants consisting of 22 men (72%) and 8 women (28%). The median age of the subjects was 56.50 years. There was a statistically significant positive correlation between IL-6 and ADMA (r = 0.440, p = 0.015), MIS and ADMA (r = 0.378, p = 0.039), and IL-6 and MIS (r = 0.682, p = 0.0001). Conclusion: There was a significant correlation between IL-6, MIS and ADMA.

Kalıcı tünelli veya geçici hemodiyaliz kateteri ile rutin hemodiyaliz programında olan hasta grubunda kateter tipine göre Maliyet-Etkinlik araştırması

Abstract
 Background:
 In this study, our aim was to conduct a cost/effectiveness research by determining the cost , in the patients who are in the routine hemodialysis program with a hemodialysis catheter, according to type of the catheter and the number of the days in which the catheters can be used actively.
 Methods:
 Between 2013 and 2020,patients with temporary hemodialysis catheters (Group 1 , n:81) and patients tunneled hemodialysis catheters (Group 2, n:205) were identified by scanning the hospital archive. The number of days in which the catheters were actively used was calculated according to the next catheter insertion or replacement date. Then, the permanent and temporary catheter fees paid by the governmentdetermined, according to the current Health Practices Communique (SUT) pricing that learnt from the hospital accounting department. Catheter cost per day was determined using the SPSS 22 program.
 Results:
 In the analysis made according to demographic characteristics, no significant difference was found between the groups in terms of gender (p=0.129). When the mean age of the patients was examined, no difference was found between the groups (p=0.085). No statistical difference was found between the groups in comorbid conditions: diabetes, hypertension, and coronary artery disease (p=0.219, p=0.129, p=0.822). The patency period was significantly higher in group 2 (p

The Role and Function of Family in Improving the Quality of Patients’ Life: Managing Nutrition During Hemodialysis in Medan, Indonesia

Hemodialysis patients experience physiological and psychological deterioration in bodily functions due to their chronic disease. Therefore, the family has a key role in overcoming this to improve the patient's quality of life. The design used in this study is qualitative and quantitative, which aims to decide the quality of life of hemodialysis patients and determine the family's role and function in nutritional monitoring in the city of Medan. Respondents in this study were hemodialysis patients whom their families accompanied. The number of respondents was eleven patients and forty-four patient families using the purposive sampling technique. Inclusion criteria for patients undergoing routine hemodialysis, undergoing hemodialysis for more than 6 months, while undergoing hemodialysis accompanied by their nuclear family, the nuclear family directly treats the patient. The results showed that forty-four people or 68.20% of respondents had an excellent quality of life, 81.80% of the patient's family had a good role and function. Two themes were found in the role and function of the family in monitoring the patient's nutrition, namely: (1) meeting the patient's needs so that the patient's condition was stable and (2) being support for patients undergoing hemodialysis. The family is the closest person who is the companion, caring for and providing support to patients to improve the welfare of life.

Treatment of femoral head replacement in elderly patients with femoral neck fracture complicated with uremia

To investigate the treatment method and effect of artificial femoral head replacement for elderly patients with femoral neck fracture complicated with uremia. From January 2016 to December 2020, 21 elderly patients with femoral neck fracture complicated with uremia were treated with artificial femoral head replacement. There were 3 males and 18 females, aged 65 to 83 years old with an average of (77.2±1.9) years. All patients were complicated with uremia and required long-term maintenance of hemodialysis. The age of dialysis was 2 to 11 years with an average of (6.3±1.6) years, 2 to 3 times per week. The time from injury to admission to operation was 3 to 7 days with an average of (4.0±2.1) days. The anemia and hypoproteinemia of the patients were corrected preoperatively, and the serum potassium and creatinine indexes of the patients were adjusted by hemodialysis. All the incisions were healed in the first stage, and there were no complications of wound infection, prosthesis loosening, dislocation and deep vein thrombosis. All patients resumed routine hemodialysis in time to maintain the stability of serum creatinine and potassium levels. All 21 patients were followed up for 5 to 23 months with an average of (16.8±2.6) months. Harris scores changed from (24.8±2.5) scores preoperatively to (87.2±3.1) scores postoperatively. Elderly patients with femoral neck fracture combined with uremia underwent artificial femoral head replacement surgery, as long as the perioperative treatment is appropriate, with active postoperative rehabilitation treatment, can obtain a good clinical effect.

Effects of hemodialysis with cooled dialysate on high-sensitivity cardiac troponin I and brain natriuretic peptide.

Hemodialysis (HD) triggers recurrent and cumulative ischemic insults to the brain and the heart. Cooled dialysate may have a protective effect on major organs and improve hemodynamic tolerability of dialysis. The aim of the study was to compare HD with cooled dialysate with routine dialysis in terms of hemodynamic stability and levels of high-sensitivity Troponin I (hs-TnI) and N-terminal pro b-type natriuretic peptide (NTproBNP) pre and postdialysis. The 45 patients were randomized into two groups. The first group received a 35.5°C dialysate first (hypothermic dialysis) and the second group a 36.5°C dialysate first (routine dialysis). Then groups crossed over, so each group received the alternate dialysate (self-controls) For each patient, the first sample was collected at the beginning of dialysis, and a second sample was taken at the end of dialysis. hs-TnI and NTproBNP increased after routine HD by 10.7ng\ml (p< 0.001) and (12.0 pg/μl) (p< 0.001), respectively, and by -3.1ng\ml (p= 0.25) and (4.3 pg/μl) (p< 0.001), respectively after hypothermic HD. Our study results showed a tendency towards less rise in hsTnI and NTproBNP during hypothermic HD (35.5°C) as compared to routine HD (36.5°C). Neither arm experienced statistically significant changes in blood pressure. Further studies in larger cohorts and long follow up are warranted in order to confirm that lower rise in (hs-TnI) and NTproBNP actually translate into lower clinical risk for cardiovascular events.

Effectiveness of Resistance Exercise Therapy on Patients' Physiological Status during Hemodialysis: A Randomized Controlled Trial

Background: Management disorder of vital signs remains a critical issue worldwide, particularly regarding hypertension in chronic renal disease (CRD), both of which are associated with a higher risk of cardiovascular (CV) and renal events. Physical inactivity resulting in poor exercise capacity is a common consequence of chronic kidney disease and is associated with increased mortality in the general population. Nursing management for patients undergoing hemodialysis requires an experienced nurse who understands the types of complications. Objective: The present study aimed to evaluate the effectiveness of resistance exercise therapy on patients’ physiological status by utilizing a checklist of physiological parameters and comparing it with a control group. Patients and Methods: The study was designed as a randomized controlled trial (RCT), using a double-blind technique, and it was conducted on patients divided into two groups (study and control groups). A total of 63 patients were included as follows: 32 patients for the study group and 31 patients in the control group. The patients were diagnosed with chronic kidney disease and were undergoing hemodialysis. The patients were randomly assigned to receive exercise therapy under the supervision of trained therapists during the second hour of the three routine hemodialysis treatments per week and under the supervision of the researcher. The study took place in Al-Najaf Al-Ashraf City/Al-Sadder Medical City and Al-Hakeem Hemodialysis Center. Results: The study results indicated an improvement in the physiological status of the study group compared to the control group. Conclusions: Exercise therapy effectively improves the physiological status of patients with chronic kidney disease undergoing hemodialysis.

The Relationship of Duration of Hemodialysis with Coping Mechanisms of Chronic Kidney Disease Patients Underwent Hemodialysis

Chronic Kidney Disease patients undergoing hemodialysis can cause stress to the patient. The longer the patient suffers from Chronic Kidney Disease, the more the patient has a variety of experiences with stressors due to the disease. These experiences can be used as an anticipatory effort in dealing with stressors experienced by patients. The purpose of this was the relationship between the duration of hemodialysis and the coping mechanism of patients with chronic kidney disease undergoing hemodialysis. This study used descriptive quantitative, with a correlation design and a cross-sectional approach. The sample was 111 patients with chronic kidney disease undergoing hemodialysis. Sampling technique used the purposive sampling technique. The data collection instrument used a jalowiec coping scale questionnaire and length of underwent hemodialysis. The results showed that most respondents underwent hemodialysis in the category &lt;8 months (70.3%). The coping mechanisms in most patients were categorized as adaptive (55%). It was concluded that there was a relationship between the duration of hemodialysis and the coping mechanism in patients with chronic kidney disease undergoing hemodialysis (p = 0,000). The correlation strength value is 0.402 (moderate strength), and the direction of the correlation is negative, it shows that if the length of time is more than eight months, then the patient's coping mechanism becomes adaptive. The patient has accepted the situation he was undergoing, which is due to routine hemodialysis, which causes the patient to often meet other patients with the same problem so that by often telling each other they can share experiences and problems and encourage each other.

Complication of tunneled dialysis catheter of chronic ulcer in the site of vascular access entry leading to suspected squamous cell carcinoma (SCC): a case report

Introduction: Catheter-related infection (CRI) is one of the most common vascular access complications in dialysis catheter-related procedures. However, repeated chronic infected ulcer that leads to suspected malignancy in a tunneled dialysis catheter (TDC) insertion site and its risk factor have not been reported. Case description: A 37 years-old woman presented with a chronic exudative ulcer in the right breast at the entry site of a tunneled dialysis catheter. The past medical history included type 2 diabetes mellitus, chronic kidney disease, hepatitis C, and obesity. The patient had routine hemodialysis with TDC for the last 2 years and had changed the TDC access 3 times due to recurrent CRI. At first, the lesion appeared as a small pustule and enlarged recurrently. Later, the lesion progressed into an 82x80 mm raised crateriform exudative ulcer with a raw surface similar to Marjolin’s ulcer squamous cell carcinoma. The patient was referred to oncology due to limited facilities in our hospital. Conclusion: CRI is one of the most common long-term complications of TDC. In out of the case, this led to chronic infection and change in TDC, chronic inflammation then became Marjolin’s Ulcer. Risk factors for suspected SCC in our patient were immunosuppressive state from diabetes, hepatitis C, CKD, and chronic inflammation from a repeated chronic infected ulcer. SCC can be considered a long-term complication of TDC. Early prevention of CRI and risk factor controlling should be considered to prevent such complications.

Patients' and Clinicians' Perspectives on the Acceptability of Completing Digital Quality of Life Questionnaires During Routine Haemodialysis Clinics: A Mixed-Methods Study.

Advanced chronic kidney disease is a serious and common medical condition with significant treatment choices incurring varying high treatment burdens. Better understanding on how to best collect quality of life (QoL) in this unique situation may help guide critical decisions. This study investigates the acceptability of digital QoL questionnaires completed during routine haemodialysis sessions. Qualitative data was collected from patient (n=23) and clinical researcher (n=2) interviews alongside analysis of data from questionnaires completed by patients (n=101) during a 6-week validation study. Interviews refined the content and format of digital QoL questionnaires and provided novel insights regarding how patients assessed and completed QoL questions. This study suggests collecting QoL data using digital tablet technology during routine haemodialysis clinics is both feasible and acceptable to patients and has provided novel insights that are not routinely available with traditional methods.

Protein and Phosphate Intakes are Associated with Hyperphosphatemia in Hemodialysis Patients at Sanglah Hospital, Bali, Indonesia

Increased chronic kidney disease (CKD) mortality rate is significantly associated with increased blood phosphate levels. Hyperphosphatemia control is one of the main focuses in the management of hemodialysis (HD) patients. A high protein diet has been suggested to prevent malnutrition in hemodialysis patients. However, a high protein and phosphorus diet has the risk of increasing the phosphate level in the blood circulation, leading to a higher mortality rate of hemodialysis patients. This study aimed to prove that the level of protein and phosphate intake is associated with hyperphosphatemia in CKD patients with routine HD. This was cross-sectional analytical study conducted from September to October 2020 on 66 CKD patients who underwent hemodialysis. Subject characteristics and phosphorus and protein intake data were obtained from a questionnaire food recall adapted from the Food and Agriculture Organization of the United Nations. Data consumption patterns were processed using the nutritional survey software to obtain the nutritional values. Data were analyzed using the Chi-Square test to identify the relationship and risk between hyperphosphatemia and diet protein, phosphorus, and protein-phosphorus ratio. The confidence level in this study was 95%. There was a significant relationship between protein and phosphorus intake in hyperphosphatemia in CKD patients. The risk factors for hyperphosphatemia were high phosphorus intake (p=0.018; OR=3.886;95% CI: 1.212–12.460) and adequate protein intake (p=0.035; OR=3.674; 95% CI: 1.049-12.865). This study showed no significant relationship between phosphorus-protein ratio, protein-phosphorus ratio, and hyperphosphatemia incidence. In conclusion, high protein intake and excessive phosphorus intake provide a significant relationship to the incidence of hyperphosphatemia in CKD patients undergoing routine hemodialysis.

MO922: Intradialytic Plantar Electrical Nerve Stimulation During Routine Hemodialysis Process Facilitate Physical Activities of Daily Life in Adults With Diabetes and End-Stage Renal Disease––A Randomized Double-Blinded Controlled Trial

Abstract BACKGROUND AND AIMS Reduced physical activity in daily life is a persistent problem in patients undergoing hemodialysis (HD). Although exercise could be beneficial, factors such as post-dialysis fatigue, time limitation and severe frailty may result in poor compliance. We are exploring an alternative therapy using intradialytic plantar electrical nerve stimulation (IPENS) provided during the routine hemodialysis process to address this gap. METHOD A total of 20 participants undergoing hemodialysis (age = 55 ± 2.7 years, BMI = 30.6 ± 1.3 kg/m2 female = 31%) were randomly assigned to the intervention group (IG), and 18 participants (age = 56 ± 2.2 years, BMI = 32.2 ± 1.2 kg/m2 female = 41%) were assigned to the control group (CG). The IG received 1-h IPENS during the routine hemodialysis process (three sessions/week) for 12 weeks. The CG received an identical but non-functional device for the same period. Participants and therapy-providers were blinded to the group allocation. Daily life physical activity was assessed remotely at baseline and every 12 week using a pendant wearable. To determine the effect of intervention, we estimated Cohen's effect size d. In addition, time effects, group and time × group effects were estimated using a general linear model. RESULTS We observed a significant increase in (Cohen's d = 0.97, P &amp;lt; 0.01) number of postural transitions, (d = 0.71, P = 0.04) daily step counts and (d = 0.73, P = 0.03) episodes of walking due to IPENS. All participants in the IG tolerated the IPENS and completed all therapy sessions, indicating the feasibility. CONCLUSION These are early results related to IPENS therapy's feasibility and effectiveness to improve mobility among individuals undergoing routine hemodialysis. We can recommend routine IPENS therapy as a practical alternative for those who may not engage in routine exercise programs if the results will be held in the larger sample.

Persepsi Penderita Penyakit Ginjal Kronik dalam Menjalani Hemodialisa

Patients with end-stage renal failure require renal replacement therapy, one of which is hemodialysis. one of the challenges in treating CKD patients is the lack of interventions that match the beliefs, expectations, and emotional reactions associated with the disease. The purpose of this study was to determine the patient's perceptions of undergoing hemodialysis and how the patient deals with the changes that occur in him. This research is a type of qualitative research with a phenomenological method. the research was conducted in the hemodialysis room hospital in Surabaya. The research was conducted in June-July 2019. The research subjects were determined to be snowball in nature. The research subjects were 6 people, who were chronic kidney disease sufferers who performed routine hemodialysis 2-3 times a week. Data were obtained through in-depth interviews using interview guidelines. The data analysis process includes data reduction, data categorization, synthesis and ends with compiling a working hypothesis. The results of the analysis obtained several themes, namely expectations, experiences, motives, and social/family conditions. in the early stages of the disease they experience some negative disease perceptions which can ultimately affect their coping actions. The role of disease perception is to help patients develop positive disease management strategies that in turn slow the rate of disease progression and improve psychosocial outcomes.

Effect of Intradialytic cycling exercise on 2 minutes walking test and VO2max in chronic kidney disease patients

Patients with end stage CKD are characterized by low levels of physical activity and ongoing decline in physical function, especially with routine hemodialysis (HD). Physical inactivity significantly increases the risk of morbidity and mortality in patients with HD. Two Minute Walking Test (2MWT) and VO2 max are parameters that can be used to evaluate functional capacity and cardiopulmonary fitness. Exercise can improve cardiovascular ability, dialysis effectiveness, physical function, and health-related quality of life in patients undergoing HD. This study aimed to investigate the effect of intradialytic cycling exercise on the 2MWT and VO2max in CKD patients undergoing hemodialysis Thirty CKD patients participated in this study. From the total, 4 subjects dropped out, leaving twenty-six CKD patients. Subjects divided into exercise and control groups were able to follow the study until the end. The exercise group did a low-intensity intradialytic cycling exercise program for 12 weeks. Both groups were given education about physical function and cardiopulmonary fitness in CKD patients and continued drug therapy and diet as before. 2MWT and VO2max were evaluated before and after the intervention.

Humoral Response in Hemodialysis Patients Following COVID-19 Vaccination and Breakthrough Infections during Delta and Omicron Variant Predominance.

Background: The advancement of COVID-19 vaccination programs globally has been viewed as an integral strategy to reduce both the number of COVID-19 cases and consequential complications of COVID-19, particularly for high-risk patient groups. There are limited data on the antibody response and protection from disease infection and severity in patients requiring hemodialysis (HD) following COVID-19 vaccination during the Delta and Omicron variant predominance. We conducted a study aiming to evaluate humoral immunity derived from two different COVID-19 vaccines administered to our in-centre HD population and investigated the characteristics of breakthrough COVID-19 infections occurring post-vaccination within this population. Methods: This is a prospective observational study including patients receiving HD at Salford Royal Hospital. The first and second doses of COVID-19 vaccinations (Pfizer BioNTech BNT162b2 or Oxford AstraZeneca ChAdOx1 nCoV-19) were administered to this patient cohort since January 2021. The incidence of any breakthrough COVID-19 infections occurring in double vaccinated patients between 1 April 2021 and 15 January 2022 was recorded. Patients were screened weekly with nasal and pharyngeal nasopharyngeal swabs for real-time Reverse Transcription Polymerase Chain Reaction (rRT-PCR) for COVID-19, whilst SARS-CoV-2 antibody testing was performed alongside monthly routine HD bloods. Results: Four hundred eleven patients receiving HD were included in this study, of which 170 of 178 patients (95.5%) with available data on antibody status following two doses of the Pfizer BioNTech BNT162b2 vaccination had detectable antibody response, whilst this was the case for 97 of 101 patients (96.1%) who received two doses of the Oxford AstraZeneca ChAdOx1 nCoV-19 vaccine. For 12 seronegative patients who received a booster vaccine (third dose), nine seroconverted, while one remained negative and two were not tested. No statistically significant differences were observed with regards to antibody status between those receiving Pfizer BioNTech BNT162b2 and Oxford AstraZeneca ChAdOx1 nCoV-19 vaccines. Sixty-three of 353 patients with two doses of COVID-19 vaccination had breakthrough COVID-19 infection (40 during Delta and 23 during Omicron variant predominance). Of the 40 patients during the delta period, five were admitted into hospital and there were two reported deaths due to COVID-19-related illness. There were no COVID-19 associated hospitalizations or deaths during the Omicron variant predominance. Conclusions: The vast majority of HD patients who received two doses of the Pfizer BioNTech BNT162b2 or Oxford AstraZeneca ChAdOx1 nCoV-19 vaccinations developed detectable antibody responses. Our results support the value of booster vaccination with mRNA-based COVID-19 vaccine in HD patients and highlight the need for ongoing surveillance programmes with rRT-PCR and antibody testing for timely detection of positive cases.

A rare pathology of syncope: A dilemma for hypertrophic cardiomyopathy or right atrial huge thrombosis

The complications associated with central venous catheters for hemodialysis access are well known. A rare complication is the development of right-sided intracardiac thrombus, which typically occurs in the right atrium. The location of the permanent catheter tip is associated with the development of thrombi. In this case report, we describe a patient with hypertrophic cardiomyopathy diagnosed with chronic kidney failure 2 years before contrast examination. The patient presented syncope during his last routine hemodialysis, and echocardiography imaging showed a hyperechogenic mass at the tip of the catheter.