Single Dialysis Research Articles

True Arterial Stiffness Does Not Change between Dialysis Sessions during 1 Week in Outpatients on Intermitted Hemodialysis

Introduction: End-stage renal disease (ESRD) is associated with exponentially elevated cardiovascular mortality. Arterial stiffness (AS) – usually expressed with pulse wave velocity (PWV) – is an established independent predictor of cardiovascular risk beyond the traditional risk factors. Higher PWV values are frequently observed in patients with ESRD. Due to the intrinsic physiologic relationship between PWV and prevailing arterial pressure, PWV can change without relevant changes in the arterial wall structure, and thus an individual pressure-independent expression of PWV is essential. Methods: The study is a single-center observational study. Repeated measurements of blood pressure (BP) and pulse wave analysis were performed during each dialysis session of 1 week. Aortic PWV was then adjusted to 120 mm Hg central systolic BP (PWV120) based on individually determined relationship. PWV120 values were compared between single sessions. Calculation of the PWV120 was performed retrospectively. Results: Fifty-four subjects were included, 61.1% of whom were male. The median age was 75.5 years, and median dialysis vintage was 33.1 months. Mean systolic/diastolic BP was 121.4/70.5 mm Hg, and the median heart rate was 64.6 beats/min. Mean PWV was 10.9 m/s, and mean PWV120 was 11.3 m/s. PWV120 did not change across single dialysis session during 1 week, while systolic, diastolic BP, PWV, and ultrafiltration volume differed significantly. Discussion/Conclusions: Our data suggest that true AS does not change in the short-term course in dialysis patients. The observed changes in PWV are rather associated with BP change due to intrinsic pressure dependence. Our analytical approach represents a novel method for this purpose, which is easy in performance and also applicable for large interventional trials and clinical practice.

Renal Association Clinical Practice Guideline on Haemodialysis

This guideline is written primarily for doctors and nurses working in dialysis units and related areas of medicine in the UK, and is an update of a previous version written in 2009. It aims to provide guidance on how to look after patients and how to run dialysis units, and provides standards which units should in general aim to achieve. We would not advise patients to interpret the guideline as a rulebook, but perhaps to answer the question: “what does good quality haemodialysis look like?”The guideline is split into sections: each begins with a few statements which are graded by strength (1 is a firm recommendation, 2 is more like a sensible suggestion), and the type of research available to back up the statement, ranging from A (good quality trials so we are pretty sure this is right) to D (more like the opinion of experts than known for sure). After the statements there is a short summary explaining why we think this, often including a discussion of some of the most helpful research. There is then a list of the most important medical articles so that you can read further if you want to – most of this is freely available online, at least in summary form.A few notes on the individual sections:This section is about how much dialysis a patient should have. The effectiveness of dialysis varies between patients because of differences in body size and age etc., so different people need different amounts, and this section gives guidance on what defines “enough” dialysis and how to make sure each person is getting that. Quite a bit of this section is very technical, for example, the term “eKt/V” is often used: this is a calculation based on blood tests before and after dialysis, which measures the effectiveness of a single dialysis session in a particular patient.This section deals with “non-standard” dialysis, which basically means anything other than 3 times per week. For example, a few people need 4 or more sessions per week to keep healthy, and some people are fine with only 2 sessions per week – this is usually people who are older, or those who have only just started dialysis. Special considerations for children and pregnant patients are also covered here.This section deals with membranes (the type of “filter” used in the dialysis machine) and “HDF” (haemodiafiltration) which is a more complex kind of dialysis which some doctors think is better. Studies are still being done, but at the moment we think it’s as good as but not better than regular dialysis.This section deals with fluid removal during dialysis sessions: how to remove enough fluid without causing cramps and low blood pressure. Amongst other recommendations we advise close collaboration with patients over this.This section deals with dialysate, which is the fluid used to “pull” toxins out of the blood (it is sometimes called the “bath”). The level of things like potassium in the dialysate is important, otherwise too much or too little may be removed. There is a section on dialysate buffer (bicarbonate) and also a section on phosphate, which occasionally needs to be added into the dialysate.This section is about anticoagulation (blood thinning) which is needed to stop the circuit from clotting, but sometimes causes side effects.This section is about certain safety aspects of dialysis, not seeking to replace well-established local protocols, but focussing on just a few where we thought some national-level guidance would be useful.This section draws together a few aspects of dialysis which don’t easily fit elsewhere, and which impact on how dialysis feels to patients, rather than the medical outcome, though of course these are linked. This is where home haemodialysis and exercise are covered.There is an appendix at the end which covers a few aspects in more detail, especially the mathematical ideas. Several aspects of dialysis are not included in this guideline since they are covered elsewhere, often because they are aspects which affect non-dialysis patients too. This includes: anaemia, calcium and bone health, high blood pressure, nutrition, infection control, vascular access, transplant planning, and when dialysis should be started.

Single needle hemodialysis: is the past the future?

Whereas the usual way to gain access to the vascular bed for hemodialysis is by inserting two needles, an alternative option based on the introduction of only one needle has been available for several decades. Although single needle hemodialysis gradually lost popularity in the early nineties of last century, this option now seems to make a come-back, with the current change in patient mix towards more elderly and cardio-vascular disease and the appearance of more flexible hardware. Single needle hemodialysis offers several advantages, such as the possibility to puncture small or maturing access systems, a decrease in number of punctures with less potential access damage and subsequent complications, the avoidance of central vein catheter use, and an improved quality of life by reducing puncture-related pain, stress and complications. The main drawback is recirculation which however can be overcome (if considered necessary) by making dialysis somewhat longer and in addition has more impact on removal of small water soluble compounds than on clearance of the more toxic difficult to remove solutes (middle molecules and protein bound compounds). Effective dialyzer blood flow with single needle dialysis cannot be much higher than 300mL/min, which however also offers advantages by making short dialysis sessions less feasible and thus reducing the likelihood of intradialytic blood pressure falls, organ stunning and other negative outcomes of shorter dialysis. Direct outcome comparisons between single and double needle dialysis are not available but indirect data suggest no differences, in as far as efficient enough access perfusion can keep dialyzer blood flow adequate. The single needle method seems especially suited for the elderly and for home hemodialysis. Recent technological improvements have made the system more accessible and adequate, but further studies are needed to assess with modern methodologies the clearance kinetics of these systems, which could emanate in further technological fine-tuning.

Hemodialysis biomarkers: total advanced glycation end products (AGEs) against oxidized human serum albumin (HSAox).

Nephropathic patients show higher levels of advanced glycation end products (AGEs) and oxidized human serum albumin (HSAox) compared to healthy subjects. These two classes of compounds are formed as the result of oxidative insults; for this reason, they can be useful oxidative stress biomarkers. The present study examines the variation of AGEs and HSAox in hemodialysis (HD) patients before and after dialysis session, evaluating the impact of different dialytic techniques and filters on their removal. A total of 50 healthy subjects (control group) and 130 HD patients were enrolled in the study. Hemodialysis patients were subdivided based on dialytic techniques: 109 in diffusive technique and 22 in convective technique. We monitored HSAox, AGEs and other laboratory parameters at early morning in healthy subjects and in HD patients before and after the dialysis procedures. The level of HSAox decreases after a single dialytic session (from 58.5 ± 8.8% to 41.5 ± 11.1%), but the concentration of total AGEs increases regardless of adopted dialytic techniques (from 6.8 ± 5.2µg/ml to 9.2 ± 4.4µg/ml). In our study, levels of HSAox and total AGEs are similar in diabetic and non-diabetic HD patients. The increase in total AGEs after dialysis was only observed using polysulfone filters but was absent with polymethacrylate filters. HSAox is a simple and immediate method to verify the beneficial effect of a single dialysis session on the redox imbalance, always present inHD patients. Total AGEs assayed by ELISA procedure seem to be a less reliable biomarker in this population.

What volume to choose to assess online Kt/V?

Urea distribution volume (V) can be assessed in different ways, among them the anthropometric Watson Volume (VW). However, many studies have shown that VW does not coincide with V and that the latter can be more accurately estimated with other methods. The present multicentre study was designed to answer the question: what V to choose to assess online Kt/V? Pre- and postdialysis blood urea nitrogen concentrations and the usual input data set for urea kinetic modelling were obtained for a single dialysis session in 201 Caucasian patients treated in 9 Italian dialysis units. Only dialysis machines measuring ionic dialysance (ID) were utilized. ID reflects very accurately the mean effective dialyser urea clearance (Kd). Six different V values were obtained: the first one was VW; the second one was computed from the equation established by the HEMO Study to predict the single pool-adjusted modelled V from VW (VH) (Daugirdas JT et al. KI 64: 1108, 2003); the others were estimated kinetically as: 1. V_ID, in which ID is direct input in the in the double pool variable volume (dpVV) calculation by means of the Solute-solver software; 2. V_Kd, in which the estimated Kd is direct input in the dpVV calculation by means of the Solute-solver software; 3. V_KTV, in which V is calculated by means of the second generation Daugirdas equation; 4. V_SPEEDY, in which ID is direct input in the dpVV calculation by means of the SPEEDY software able to provide results quite similar to those provided by Solute-solver. Mean± SD of the main data are reported: measured ID was 190.6 ± 29.6mL/min, estimated Kd was 211.6 ± 29.0mL/min. The relationship between paired data was poor (R2 = 0.34) and their difference at the Bland-Altman plot was large (21 ± 27mL/min). VW was 35.3 ± 6.3 L, VH 29.5 ± 5.5, V_ID 28.99 ± 7.6 L, V_SPEEDY 29.4 ± 7.6 L, V_KTV 29.7 ± 7.0 L. The mean ratio VW/V_ID was 1.22, (i.e. VW overestimated V_ID by about 22%). The mean ratio VH/V_ID was 1.02 (i.e. VH overestimated V_ID by only 2%). The relationship between paired data of V_ID and VW was poor (R2 = 0.48) and their mean difference at the Bland-Altman plot was very large (- 6.39 ± 5.59 L). The relationship between paired data of V_ID and VH was poor (R2 = 47) and their mean difference was small but with a large SD (- 0.59 ± 5.53 L). The relationship between paired data of V_ID and V_SPEEDY was excellent (R2 = 0.993) and their mean difference at the Bland-Altman plot was very small (- 0.54 ± 0.64 L). The relationship between paired data of V_ID and V_KTV was excellent (R2 = 0.985) and their mean difference at the Bland-Altman plot was small (- 0.85 ± 1.06 L). V_ID can be considered the reference method to estimate the modelled V and then the first choice to assess Kt/V. V_SPEEDY is a valuable alternative to V_ID. V_KTV can be utilized in the daily practice, taking also into account its simple way of calculation. VW is not advisable because it leads to underestimation of Kt/V by about 20%.

Effect of a Single Dialysis on Cognitive Function in Chronic Kidney Disease Stage 5 Hemodialysis Patients

Abstract Background: The incidence of cognitive impairment (CI) has been widely reported in various studies among chronic kidney disease (CKD) patients. Many factors influence cognitive function including hemodialysis (HD) process itself. There is much evidence that a single HD session brings about changes in the cognitive status of patients, but just a few studies assessing whether cognitive performance varies with dialysis. Aim: To know the effect of single dialysis session on cognitive function in HD patients. Method: Sixty medically stable CKD stage 5 patients on HD maintenance at least for three months were enrolled. Cognitive testing performed thrice, 1-2 hour prior dialysis (T1), 3-4 hour into the session (T2) and 24 hour after the session (T3) using a well-validated neuropsychological test battery, Montreal Cognitive Assessment (MoCA) Indonesian version which assess the domain of cognitive function including visuospatial, executive function, naming, memory, attention, language, abstraction, recall, and orientation. Result: among 60 patients complete testing, mean age 45,45 ± 11,28 years, dialysis vintage 10,12 ± 11,88 months, 44 patients (73,3%) had CI at baseline. Cognitive function decline during dialysis (T2) (MoCA INA score 21,65 to 19,67, p < 0.001) and visuospatial, executive function, attention, language and recall was impaired during dialysis. While cognitive function reached its best 24 hour after dialysis (MoCA INA score 23,65, p < 0.001) and all the domain of cognitive function was improved except naming that didn’t change over the dialysis session. Age and dialysis adequacy were associated with the decline. Conclusion: There is effect of a single HD session on global cognitive function where cognitive function was deteriorated during HD and reached its best 24 hour after HD. Keywords: cognitive function, chronic kidney disease, hemodialysis

SAT-038 HEMODIALYSIS IN BURUNDI: DATA AND CHALLENGES

The incidence of end-stage renal disease (ESRD) is increasing worldwide at an annual growth rate of 8%. In Sub-Saharan Africa, economic and manpower factors dictate a conservative approach to therapy in most instances. The majority of those with ESRD perish because of the lack of funds, as very few can afford regular maintenance dialysis and renal transplantation is often not available. Hemodialysis remains the most common modality of management, with a very few units offering peritoneal dialysis. Chronic hemodialysis became available in Burundi in July 2014 commenced in a private unit. The country has now 6 dialysis units situated in one city, Bujumbura. Four units are in public hospitals and two in private clinics. This is a retrospective study.The data were extracted from the African Renal Registry on Burundi. All chronic hemodialysis patients from 2014 to 2017 were included. Their characteristics were analyzed with the aim of to determine the etiology, status and challenges of dialysis in Burundi. From 2014 to 2017, 65 patients have been treated by chronic hemodialysis in Burundi. There were 56 men (86.1%). The mean age was 52.16 years. Forty-eight patients (73.8%) were followed in a private unit and 28 (26.2%) in public units. The prevalence for 2017 of patients on renal replacement treatment (RRT) was 1.6 per million population. The etiology of end stage renal disease was diabetes mellitus (32.3%), hypertension (30.7%), glomerulonephritis (10.8%), cystic kidney disease (1.5%) and unknown (21.7%). The seropositive rate for hepatitis B virus was 4.6%, for hepatitis C virus 18.5% and for HIV 9.2%. The initial modality treatment was hemodialysis (98.5%) and peritoneal dialysis (1.5%). The frequency distribution of initial vascular access types was 40.6% for femoral, 59.4% for internal jugular catheter and 0% for arteriovenous fistula. The RRT vintage was 1.5 years, and majority 60% were undergoing dialysis twice, 27.7% thrice dialysis and 12.3 % only single dialysis session per week. The main complications were catheter infection (60%) and acute pulmonary edema (19%). The mortality rate was 77.7%, and 7 patients abandoned dialysis due to financial matter. The prevalence and outcomes associated with dialysis in Burundi are influenced by the following: absence of governement funding for dialysis, gross shortage of nephrologists, dialysis nurses, and technicians, lack of educational initiatives to promote dialysis, no establish health insurance to support dialysis definitely. To run dialysis in Burundi is a challenge. Our recommendations based on these observation include optimizing dialysis treatment initiatives and integrating them with other health strategies, as well as training of local health care providers, re-use of dialyzers to cut costs, implementation of a National Kidney Foundation to fund dialysis and a National Health Policy to prevent hypertension and diabetes.

Management of fungal peritonitis : a Moroccan single peritoneal dialysis unit experience

Introduction: Fungal peritonitis (PF) in peritoneal dialysis (PD) is a serious infection that involves the functional prognosis of the peritoneum and the patient's vital prognosis. It must benefit from a fast handling but nevertheless not very codified. Each center therefore ensures an individual care of its patients.&#x0D; Materiel and method: The purpose of our study is to describe our 10-year experience through our patients who presented FP. We performed a descriptive retrospective study of FP cases documented in the PD unit.&#x0D; Results: the prevalence of FP was 5,1%, which represent 9 cases. Predominant clinical signs were dialysat turbidity and abdominal pain. FP was primitive for 3 patients. The antifungal therapy used was Fluconazole, which was combined with an increased number of peritoneal exchanges. DP catheter ablation was done for 8 patients with an average delay of 5.5 days. The overall outcome was favorable and 3 patients continued PD. No death or encapsulating peritonitis was a consequence of FP.&#x0D; Discussion and conclusion: FP is an infectious complication in PD. Its’ death rate is elevated; dropping-out of PD rate too is elevated. The favorable evolution of our patients that stayed in PD let us think that it may be possible to maintain more patients in PD after FP.

Nocturnal home haemodialysis: The 17 years experience of a single Australian dialysis service.

The Barwon Health nocturnal home haemodialysis (NHHD) program was established in 2000 as the first formal NHHD program in Australia. We aimed to assess reasons for and factors associated with program exit, and technique and patient survival rates. This retrospective audit included all patients enrolled in the NHHD program from 1st September 2000 to 31st July 2017. The primary outcome was technique failure, defined as transfer to satellite haemodialysis (HD) or to peritoneal dialysis (PD) for greater than or equal to 60 days, or death. Predictors of technique failure were identified by competing risk regression analyses. Patient and technique survival were estimated by Kaplan-Meier methods. A total of 109 patients underwent 112 periods of NHHD during the study period. Technique failure occurred in 33 patients (30%), of whom 16 were transferred to satellite HD for medical reasons, 16 died, and 1 transferred to PD due to a lack of vascular access. Median technique survival was 7.8 years (interquartile range 4.1, 11.1) and median patient survival 14.6 years (interquartile range 6.2,-). Average NHHD duration for those who transferred to satellite HD was 5.2 ± 3.6 years, and for those who died was 4.7 ± 3.8 years. Older age and diabetes were associated with technique failure. However, due to a small number of events the risk of confounding in this study was high. Nocturnal home haemodialysis has excellent long-term technique and patient outcomes. Clinicians should be aware of factors associated with poorer outcomes, to ensure that additional support can be provided to patients at greatest risk.

Fluid distribution timetable on adherence to fluid restriction of patients with end-stage renal disease undergoing haemodialysis: Single-blind, Randomized-Controlled Pilot Study.

To determine the effects of a fluid distribution timetable on adherence to fluid restriction of patients with end-stage renal disease undergoing haemodialysis. Fluid restriction is necessary among patients with chronic kidney disease. However, treatment adherence remains a challenge. Single-blind, randomized-controlled pilot study. From September - December 2016, 24 consecutively-selected patients with end-stage renal disease from a single dialysis clinic were randomly assigned using computer-generated sequences of randomly permuted blocks stratified according to gender to receive the fluid distribution timetable or standard care. Adherence to fluid restriction was measured using two indicators-thirst and interdialytic weight gain- and were compared using One-way RM-MANOVA and MANCOVA. Secondary outcomes included baseline patient demographic and clinical characteristics and were compared according to treatment allocation. Both groups were followed-up for 4weeks, assessing outcome measures during the second haemodialysis session for each week. At baseline, the demographic and clinical characteristics and indicators of adherence to fluid restriction were comparable between the two groups. Thirst scores, however, were statistically lower in the treatment group than the control group on the fourth week follow-up. There was also a remarkable decrease from baseline thirst and interdialytic weight gain scores in the treatment group, with partial eta-squared of 0.43 and 0.39, respectively. The fluid distribution timetable was an effective adjunct treatment strategy in promoting adherence to fluid restriction. However, since this is just a pilot study, further investigation must be conducted to determine the effects of fluid distribution timetable. NCT03582592.

Secondary interventions in patients with implantable cardiac devices and ipsilateral arteriovenous access

ObjectiveThe number of patients with end-stage renal disease who require implantable cardiac devices is increasing. Rates of secondary interventions or fistula failure are not well studied in patients who have arteriovenous fistula (AVF) access placed on the ipsilateral side as a pacemaker. This study aimed to compare central vein–related interventions and failure rates of arteriovenous access in patients with pacemakers placed on the ipsilateral vs contralateral side. MethodsA retrospective review of a prospectively collected database at a single high-volume dialysis institution was performed; all patients 18 years or older who had both arteriovenous access and a pacemaker were included. Data points included the number of interventions such as thrombectomy, percutaneous transluminal angioplasty, and stent placement, as well as time to first intervention and failure of the fistula or graft. Patients with an implantable cardiac device who had contralateral AVF access were compared with AVF ipsilateral access using a t-test and Kaplan-Meier curves for primary patency. Outcomes evaluated included number of interventions and time to intervention from access creation. ResultsA total of 32 patients were identified; 20 had arteriovenous access on the contralateral side from the pacemaker and 12 had access on the ipsilateral side. In the contralateral group, there were a mean of 3.6 percutaneous transluminal angioplasties per patient (range, 1-12). In the ipsilateral group, there were an average of 2.8 percutaneous transluminal angioplasties per patient (range, 1-6). There was no difference in intervention rates between these cohorts; however, the time to intervention was increased in patients who had arteriovenous access on the contralateral side to their pacemaker (9.5 vs 19.5 months; P < .05). Patency rates did not differ (P = .068). ConclusionsThere was no difference in intervention rates between ipsilateral and contralateral patients; however, the time to intervention was increased in patients who had arteriovenous access on the contralateral side to their pacemaker (9.5 months vs 19.5 months). This study was limited by its lack of power. Patency rates did not differ (P = .068). Ipsilateral access placement should be considered rather than abandoning access in that extremity.

The Effect of Mechanically-Generated Vibrations on the Efficacy of Hemodialysis; Assessment of Patients' Safety: Preliminary Reports.

Muscle activity during a hemodialysis procedure improves its efficacy. We have formulated a hypothesis that vibrations generated by a specially-designed dialysis chair can, the same as physical exercise, affect the filtering of various fluids between fluid spaces during the hemodialysis procedure. This prospective and interventional study included 21 dialyzed patients. During a single dialysis session, each patient used a prototype device with the working name “vibrating chair”. The chair’s drive used a low-power cage induction motor, which, along with the worm gear motor, was a part of the low-frequency (3.14 Hz) vibration-generating assembly with an amplitude of 4 mm. Tests and measurements were performed before and after the vibration dialysis. After a single hemodialysis session including five 3-min cycles of vibrations, an increase in in relation to non-vibration ( vs. ) was seen. Urea reduction ratio increased significantly ( vs. ). A significant increase in systolic blood pressure was observed between the first and the third measurement ( vs. ). The use of a chair generating low-frequency vibrations increased dialysis adequacy; furthermore, it seems an acceptable and safe alternative to intradialytic exercise.

Protein-Bound Solute Clearance During Hemodialysis.

Indoxyl sulfate (IS) and p-cresol sulfate (p-CS) are protein-bound solutes that accumulate in the blood serum in chronic kidney disease and have a detrimental effect on the kidney and other organs' function. This study seeks to define the effectiveness of IS and p-CS clearance after single dialysis sessions and after 8-week-long cycles of hemodialysis using the following different dialysis modalities in succession: low-flux hemodialysis (lfHD), high-flux hemodialysis (hfHD), and post-dilution hemodiafiltration (HDF). We also investigated to what extent IS and p-CS serum content would associate with some other biochemical indices in patients with chronic kidney diseases. The study included 21 uremic patients. We found that a single session of each modality effectively decreased the content of both IS and p-CS, with the predominance of p-CS decrease. There were no appreciable differences depending on the modality of hemodialysis chosen. However, the leaching effect tended to wear off with the weeks' long dialysis cycles. We further found that a greater inflammation-prone level of hsCRP evoked by dialysis led to a greater removal of solutes, and thus their decrease in the serum, during a single dialysis session. Reversely, a greater protein level might result in a greater solute binding and a decrease in removal. We conclude that there are no major differences in the serum clearance of IS and p-CS depending on the dialysis modality. These protein-bound toxins are significantly cleared from the serum already during the first dialysis session, but their level tends to revert during weeks' long dialysis sessions.

Dehydration of sludge using the polyethylene glycol solution dialysis method and the mechanism of dehydration

This study was undertaken to develops a new sludge dewatering technology based on polyethylene glycol solution dialysis. This method significantly reduced the final water content of sludge when compared to conventional dewatering methods. It was found that when the osmotic pressure difference between the polyethylene glycol solution and the sludge reached 8 MPa, the moisture content in the sludge was reduced to 28.6%, facilitating deep dehydration. To further improve the dehydration effect and explore the technical feasibility of dialysis dehydration, a dehydration experiment was designed using the polyethylene glycol solution dialysis method combined with external pressure. By applying external pressure to the dialysis membranes, the particles in the sludge were compacted, which reduced the internal voids of the sludge and propelled continuous water discharge. The results demonstrated that the dehydration effect was significantly improved when compared to single dialysis. A scanning electron microscope (SEM) was used to observe and quantitatively analyze the microstructure of the sludge before and after dehydration and to compare the variations in sludge microstructure throughout the dehydration process. The relationships between the sludge moisture content and the porosity and pore equivalent diameter were obtained. This demonstrated the effectiveness of the dewatering experiment using sludge dialysis combined with external pressure. This study also investigates the dehydration mechanism of this method during the sludge dehydration process. This study provides a novel solution for sludge volume reduction that can be applied to sewage treatment in the future.

The predictive value of malnutrition for functional and cognitive status in elderly hemodialysis patients.

The study aims to objectively and precisely describe, in elderly dialysis patients from a single center, the prevalence of malnutrition and severe cognitive/functional impairment and to establish the prognostic role of malnutrition assessment for patient's severe cognitive/functional status. Cross-sectional study. A single dialysis center from north-eastern Romania. Eighty-one elderly ambulatory hemodialysis patients. The aim of the study was to establish in hemodialysis elderly patients a correlation between two malnutrition scores [Mini Nutritional Assessment (MNA) and Subjective Global Assessment (SGA)] and geriatric tests (Geriatric Depression Scale-GDS), daily activities (Activities of Daily Living-ADL, Instrumental Activities of Daily Living-IADL), and cognitive impairment scores (Mini Mental State Examination-MMSE). A correlation between objective malnutrition parameters (bioimpedance lean tissue index (LTI) and fat tissue index (FTI) by bioimpedance) was also assessed. Using area under the curve analysis, two malnutrition scores and bioimpedance assessed nutritional status were explored as possible predictors for the most severe category of functional and cognitive status. All patients had mild/moderate malnutrition by SGA, while the MNA test reported malnutrition in 14.5%, and 58% of cases. There was no correlation between subjective scores and objective biomarkers of malnutrition (albumin levels, bioimpedance-derived LTI, FTI). ROC curve analysis showed that MNA and SGA predict the most severe category of depression and functional impairment with relatively good accuracy (specificity, sensibility). The study confirms the important correlation between malnutrition and cognitive/functional impairment and confirms that malnutrition scores could be useful in predicting depression and physical dependance in elderly dialysis patients.

Encapsulating Peritoneal Sclerosis in Long-Termed Peritoneal Dialysis Patients.

Background Encapsulating peritoneal sclerosis (EPS) is a rare but serious clinical complication of long-term peritoneal dialysis (PD) patients with high mortality. The purpose of this study was to assess the clinical characteristics of patients with EPS and to search for possible factors useful for EPS prevention and early diagnosis. Method This retrospective study was performed in a single dialysis center in Taiwan between August 1990 and April 2014. Overall, a total of 565 patients were included and the medical records of those patients who had developed EPS (EPS group) and those who had not developed EPS (control group) were collected. We compared several factors between these two groups. Result In the univariate analysis, EPS was significantly associated with a change of transport state (Delta 2) (p = 0.007), duration of PD (p < 0.001), duration of peritonitis treatment (p = 0.001), number of peritonitis episodes (p = 0.002), and fungus related peritonitis (p = 0.031). After multivariate logistic model analysis, we found that only the duration of PD was independently significantly associated with EPS (p = 0.034). In addition, we used the ROC curve and found that a duration of peritoneal dialysis of about 8.4 years is the best cut-off point to predict EPS occurrence. Conclusion In this study, long-termed PD duration is the only strong independent risk factor for EPS development. Total peritonitis times, total peritonitis treatment duration, and marked increased peritoneal D/Pcr ratio were also significantly associated with the duration of PD.

An Inverse Relationship between Hyperuricemia and Mortality in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis.

Background: The results have been inconsistent with regards to the impact of uric acid (UA) on clinical outcomes both in the general population and in patients with chronic kidney disease. The aim of this study was to study the influence of serum UA levels on mortality in patients undergoing continuous ambulatory peritoneal dialysis. Methods: Data on 492 patients from a single peritoneal dialysis unit were retrospectively analyzed. The mean age of the patients was 53.5 ± 15.3 years, with 52% being female (n = 255). The concomitant comorbidities at the start of continuous ambulatory peritoneal dialysis (CAPD) encompassed diabetes mellitus (n = 179, 34.6%), hypertension (n = 419, 85.2%), and cardiovascular disease (n = 186, 37.9%). The study cohort was divided into sex-specific tertiles according to baseline UA level. A Cox proportional hazard model was used to calculate hazard ratios (HRs) of all-cause, cardiovascular, and infection-associated mortality with adjustments for demographic and laboratory data, medications, and comorbidities. Results: Multivariate Cox regression analysis showed that, using UA tertile 1 as the reference, the adjusted HR of all-cause, cardiovascular, and infection-associated mortality for tertile 3 was 0.4 (95% confidence interval (CI) 0.24–0.68, p = 0.001), 0.4 (95% CI 0.2–0.81, p = 0.01), and 0.47 (95% CI 0.19–1.08, p = 0.1). In the fully adjusted model, the adjusted HRs of all-cause, cardiovascular, and infection-associated mortality for each 1-mg/dL increase in UA level were 0.84 (95% CI, 0.69–0.9, p = 0.07), 0.79 (95% CI, 0.61–1.01, p = 0.06), and 0.79 (95% CI, 0.48–1.21, p = 0.32) for men and 0.57 (95% CI, 0.44–0.73, p < 0.001), 0.6 (95% CI, 0.41–0.87, p = 0.006), and 0.41 (95% CI, 0.26–0.6, p < 0.001) for women, respectively. Conclusions: Higher UA levels are associated with lower risks of all-cause, cardiovascular and infection-associated mortality in women treated with continuous ambulatory peritoneal dialysis.

Evaluation of the efficacy of a medium cut-off dialyser and comparison with other high-flux dialysers in conventional haemodialysis and online haemodiafiltration.

ABSTRACTBackgroundOnline haemodiafiltration (OL-HDF) has been shown to reduce all-cause mortality versus conventional haemodialysis (HD); however, it is not always available. In these situations, a novel class of membranes with a higher pore size, medium cut-off (MCO) dialysers, could be promising. The aim of this study is to evaluate the efficacy of an MCO dialyser in the removal of small and medium-size molecules and compare it with standard high-flux (HF) dialysers in HD and OL-HDF.MethodsIn this crossover study, 18 prevalent HD patients were studied in three single mid-week dialysis treatments during three consecutive weeks as follows: first week with OL-HDF with a standard HF dialyser, second week with conventional HD with a standard HF dialyser and third week with conventional HD with an MCO dialyser. Reduction ratios (RRs) of different-sized molecules and albumin losses were collected for the different dialysers.ResultsMCO HD provided a greater reduction of middle and larger middle molecules compared with standard HF HD [rate reduction (RR) β2-microglobulin 74.7% versus 69.7%, P=0.01; RR myoglobin 62.5% versus 34.3%, P=0.001; RR prolactin 60% versus 32.8%, P=0.001; RR α1-glycoprotein 2.8% versus −0.1%, P=0.01]. We found no difference in the clearance of small and larger middle molecules comparing MCO HD with OL-HDF. Albumin losses were 0.03 g/session with MCO HD and 3.1 g/session with OL-HDF (P=0.001).ConclusionMCO HD is superior to standard HF HD in the removal of middle and larger middle molecules and it is not inferior to OL-HDF in the clearance of small and larger middle molecules. Thus it could be an alternative in patients in which it is not possible to perform OL-HDF.

Altered intrinsic brain activity and memory performance improvement in patients with end-stage renal disease during a single dialysis session.

Memory deficits are considered to have a great influence on self-management, dietary restriction and therapeutic regimen for end-stage renal disease (ESRD) patients with dialysis treatment. This study was aim to investigate the spontaneous brain activity and its relationship with memory performance in ESRD patients before dialysis (T1) and after 24h (T2) during a single dialysis session. 23 ESRD patients and 25 matched healthy controls (HCs) were scanned using functional magnetic resonance imaging (fMRI) at T1, and all patients were also scanned at T2. Amplitude of low-frequency fluctuation (ALFF) and regional homogeneity (ReHo) methods were used to evaluate the spontaneous brain activity between two groups. The Auditory Verbal Learning Test-Huashan version (AVLT-H) was performed to assess memory function. Compared with HCs, ESRD group showed a significant decreases in the immediate recall total score (IR-S), short-term delayed recall score (SR-S), and long-term delayed recall score (LR-S) at T1. IR-S, SR-S, LR-S and recognition score (REC-S) were significantly increased at T2. Compared with HCs at T1, ESRD patients showed that the lower mean ALFF (mALFF) values were mainly located in dorsolateral prefrontal cortex (DLPFC), medial frontal gyrus, and precuneus. Higher ReHo in the bilateral inferior temporal gyrus and left hippocampus and lower ReHo in the right precentral gyrus, anterior cingulate cortex were found at T1 too. The mALFF values of the DLPFC and precuneus were significantly increased during a dialysis session, while no significantly difference of ReHo region was found. Furthermore, the increased mALFF values of the DLPFC were significantly positively correlated with the improvement in the IR-S. Our results indicated that increased regional spontaneous activity of the DLPFC may reflect memory performance improvement after a single dialysis treatment, which may provide insight into the effect of hemodialysis on spontaneous brain function during a single dialysis session.

Hemolysis in single needle dialysis using bovine blood

Hemolysis in single needle dialysis using bovine blood