Symptoms In Hemodialysis Patients Research Articles

The effect of conscious mindfulness-based informative approaches on managing symptoms in hemodialysis patients.

The research was conducted to determine the effect of conscious mindfulness based informative approaches applied in hemodialysis patients on reducing stress and managing symptoms. This research was conducted as a real experimental model with a control group. Research population consisted of 160 hemodialysis patients. The sample of the study was determined as 120 hemodialysis patients in total, 60 in the experimental and 60 in the control group, as a result of the power analysis. After the pre-test application, a mindfulness-based stress reduction program was applied to the experimental group. In the analysis of the data collected in the research, percentage, frequency, chi-square analysis, t-test for independent groups, t-test for dependent groups were used by means of SPSS for Windows 22.00 statistical software package. The t-test analyses of the differences between pre-test and post-test scores of hemodialysis patients in the experimental group were found to be significant in favor of the post-tests. It was found out that the conscious mindfulness-based informative approaches decreased the perceived stress and anxiety of the patients in the experimental group, whereas increased their levels of conscious mindfulness and symptom management.

Post‐COVID anxiety, depression, and quality of life among Egyptian hemodialysis patients

<scp>Post‐COVID</scp> anxiety, depression, and quality of life among <scp>Egyptian</scp> hemodialysis patients

Efficacy and safety of difelikefalin in the treatment of hemodialysis patients with pruritus: A meta-analysis and systematic review.

The incidence of pruritus associated with hemodialysis (HD) patients can be as high as 70%, and ~40% of patients suffer from moderate to severe systemic pruritus. Difelikefalin (CR845), a peripheral restrictor κ-opioid receptor agonist, activates opioid receptors on peripheral neurons and immune cells to relieve pruritus in patients. However, the clinical effect of difelikefalin on HD-related pruritus is unclear. Therefore, the purpose of this meta-analysis and systematic review was to investigate the safety and efficacy of difelikefalin in the treatment of HD-associated pruritus. This study explored the efficacy and safety of difelikefalin in the treatment of pruritus in HD patients by systematic review and meta-analysis. Randomized controlled trials on difelikefalin in the treatment of pruritus in HD patients were retrieved from PubMed, Embase, Cochrane Library, and Web of Science electronic databases. The retrieval deadline was January 1, 2023. Stata 15.0 software was used for data analysis of the included studies. A total of 4 randomized controlled trials were included, totaling 1,268 patients (736 patients in the experimental group and 532 patients in the control group). Results of the meta-analysis showed that, compared with the control group, difelikefalin could significantly improve the Worst Itch Numeric Rating Scale score (improvement &gt; 3; risk ratio (RR)=1.28, 95% confidence interval (CI) (1.07, 1.53)), decrease the 5-D itch score (standardized mean difference=-0.43, 95% CI (-0.55, -0.30)), and significantly improve adverse events (RR=1.33, 95% CI (1.13, 1.56)). Although difelikefalin can improve itching symptoms in HD patients, it can also increase adverse reactions based on the current literature. Therefore, more studies are needed to further explore the safety and efficacy of difelikefalin treatment.

Comparison of Prevalence and Severity of Depressive Symptoms in Hemodialysis Patients Before and During The Covid-19 Pandemic

Amaç: Hemodiyaliz hastalarında COVID-19 salgını öncesi ve sırasında depresif belirtilerin varlığını ve şiddetini incelemek ve pandemi ile ilişkisini değerlendirmek. Gereç ve Yöntem: Bu çalışma, Eylül 2018-Haziran 2021 tarihleri arasında Beck depresyon anketi uygulanan 21 yetişkin hemodiyaliz hastası ile retrospektif olarak gerçekleştirildi. BDE skorlarının normal dağılıma uygunluğu Shapiro-Wilk testi ile değerlendirildi. 3 farklı tekrarlı ölçüm zamanı arasındaki BDÖ skorlarını karşılaştırmak için Friedman testi, çoklu karşılaştırmalar için Bonferroni düzeltmeli Dunn testi kullanıldı. Hastaların depresyon durumunu (hayır ve evet) 3 farklı tekrarlanan ölçüm periyodu arasında karşılaştırmak için Cochran Q testi kullanıldı. P değeri &amp;lt;0.05 istatistiksel olarak anlamlı kabul edildi. Bulgular: 21 hastanın (16 erkek, 5 kadın) yaş ortalaması 66,6±9,6 yıl olup, yaşları 48 ile 84 arasında değişmektedir. Hastaların %23,8'i kadın, %76,2'si erkekti. COVID-19 salgını sırasında BDE skorlarının pandemi öncesine göre anlamlı derecede yüksek olduğu görüldü (p &amp;lt; 0,001; Tablo 1 ve Şekil 2). COVID-19 salgını sırasında depresif belirtilerin şiddeti kadınlarda erkeklere göre oldukça yüksekti (p = 0,038). Sonuç: COVID-19 salgını hemodiyaliz hastalarında BDI skorlarını artırdı. Hemodiyaliz hastalarının rutin takibinde Beck Depresyon Anketi'nin uygulanmasının, depresyona girebilecek hastaların erken tanınmasına, gerekli tedavilerin sağlanmasına ve hemodiyaliz tedavisine uyumun artmasına önemli katkı sağlayacağını düşünüyoruz.

Correlates of Rates and Treatment Readiness for Depressive Symptoms, Pain, and Fatigue in Hemodialysis Patients: Results from the TĀCcare Study.

Patients on hemodialysis (HD) often experience clinically significant levels of pain, fatigue, and depressive symptoms. We explored potential sociodemographic differences in symptom burden, current treatment, and readiness to seek treatment for these symptoms in patients screened for the TĀCcare trial. In-center HD patients from Pennsylvania and New Mexico were screened for fatigue (≥5 on 0 to10-point Likert scale), pain (Likert scale ≥4), depressive symptoms (≥10 Patient Health Questionnaire-9) and readiness to seek treatment (5-item Stages of Behavior Change questionnaire). Symptom burden and treatment status by sociodemographic factors were evaluated using chi-square, Fisher's exact tests, and logistic regression models. From March 2018-Dec 2021, 506 of 896 (57%) patients screened met eligibility criteria and completed the symptom screening (mean age 60±13.9 years, 44% females, 17% Black, 25% American Indian, 25% Hispanics). Of these, 77% screened positive for ≥1 symptom and 35% of those were receiving treatment for ≥1 of these symptoms. Pain, fatigue, and depressive symptom rates were 52%, 64%, and 24%, respectively. Age <65 was associated with a higher burden of depressive symptoms, pain, and reporting ≥1 symptom (p<0.05). The percentage of patients ready to seek treatment increased with symptom burden. More males reported readiness to seek treatment (85% vs. 68% of females, p<0.001). Among those with symptoms and treatment readiness, income was inversely associated with pain (>$60k/yr: OR=0.16, CI=0.03-0.76), and living in less walkable neighborhoods with more depressive symptoms (OR= 5.34, CI=1.19-24.05) and fatigue (OR= 5.29, CI=1.38-20.33). Pain, fatigue, and depressive symptoms often occurred together, and younger age, less neighborhood walkability, and lower income were associated with a higher burden of symptoms in HD patients. Male patients were less likely to be receiving treatment for symptoms. These findings could inform priority HD patient symptom identification and treatment targets.

Dialysis vintage is associated with a high prevalence and severity of unpleasant symptoms in patients on hemodialysis

Background The burden of physical and emotional symptoms caused by somatic illness is present in most dialysis patients. However, it’s unclear how symptom burden varies among patients with different dialysis vintages. We sought to examine differences in the prevalence and severity of unpleasant symptoms in hemodialysis patients with diverse dialysis vintage cohorts. Methods This cross-sectional study included patients on maintenance hemodialysis at the Second Hospital of Anhui Medical University. We used the Dialysis Symptom Index (DSI) to determine the associated unpleasant symptoms, which is a validated survey to assess symptom burden/severity (higher scores indicate more severe symptoms), over June 2022 – September 2022. Results We studied 146 patients: 35 (24%) had a dialysis vintage of ≤12 months (group 1) and 111 (76%) had a dialysis vintage of >12 months (group 2). Concerning Group 1 patients, the prevalence and severity of unpleasant symptoms were significantly higher in Group 2, the most common individual symptoms included feeling tired or lack of energy and trouble falling asleep (i.e., 75–85% of patients in each group), with dialysis vintage being an independent influencing factor (adjusted OR, 0.19; 95% CI, 0.16 to 0.23). Lower hemoglobin levels, iron stores, and dialysis adequacy levels are correlated with longer dialysis vintage. Conclusion We observed a high prevalence of unpleasant symptoms and symptom clusters in a diverse dialysis vintages hemodialysis cohort. Further studies are needed to accurately and routinely define the symptom burden of chronic patients with chronic kidney disease (CKD).

Patterns of Cognitive Impairment in Hemodialysis Patients and Related Factors including Depression and Anxiety.

Hemodialysis patients are at higher risk of developing cognitive impairment, but the pattern of affected cognitive domains is still undetermined. Little is also known about the symptoms of depression and anxiety in hemodialysis patients. In this cross-sectional study, we included 74 consecutive adult patients undergoing hemodialysis. Cognitive functions were assessed using the Addenbrooke Cognitive Test III. In addition, all patients were screened for symptoms of depression and anxiety using the Hospital Anxiety and Depression Scale. The mean age of hemodialysis patients was 65.69 ± 14 years. Among the patients, there were 27% and 31% of patients with mild cognitive impairment and suspected dementia, respectively. In the group of patients with suspected dementia, all cognitive functions had significantly lower values compared to these functions in incognitively unimpaired and mild cognitive impairment patients. The most impaired domain was verbal fluency, which reflects impairments in executive function. Depression and anxiety symptoms were observed in 28% and 22% of patients, respectively. Patients with anxiety symptoms had higher levels of endogenous creatinine, parathyroid hormone, and hemoglobin, as well as decreased creatinine clearance, being younger and less educated. No factors contributing to the occurrence of depressive symptoms were found. Cognitive dysfunction is a significant problem in hemodialysis patients. Our study showed that the prevalence of cognitive impairment and depression and anxiety symptoms in hemodialysis patients was high. The domain of executive functions was most affected. Furthermore, creatinine, parathyroid hormone, hemoglobin levels, creatinine clearance, and education affected the anxiety scale score.

Comparison of two self-report scales to assess anxiety and depressive symptoms in hemodialysis patients

IntroductionPsychiatric illness is prevalent among hemodialysis (HD) patients. This study compared the assessment of anxiety and depressive symptoms among HD patients using two self-administered scales; hospital anxiety and depression scale (HADS) and brief symptom inventory (BSI). MethodsA cross-sectional study was conducted among a convenience sample of HD patients (n = 352) from different dialysis centers in Jordan. Patients were interviewed in dialysis units, and demographics, clinical status, disease, and dialysis history data were collected. Symptoms of anxiety (HADS-A ≥ 8 and BSI-A ≥ 0.82) and depression (HADS-D ≥ 8 and BSI-D ≥ 0.82) were also measured. ResultsThe mean age of participants was 52.2 ± 15.6 years. The majority had been receiving HD three times daily and for >2 years. A significant moderate-strong correlation was observed between HADS-A and BSI-A (r = 0.753, p < 0.0001) as well as HADS-D and BSI-D (r = 0.588, p < 0.0001). Anxiety prevalence was 43.7 % using HADS-A ≥ 8 and 80.7 % using BSI-A ≥ 0.82, while depression prevalence was 53.1 % using HADS-D ≥ 8 and 51.7 % using BSI-D ≥ 0.82. When HADS was used as a standard, the operating characteristics reveal that a higher cut-off for BSI-A is recommended (≥1.58) for better anxiety screening. DiscussionSpecific and suitable cut-off points need to be further explored and validated for HADS and BSI scales among patients undergoing dialysis.

Relationship Between Clinical Symptoms and Skin Autofluorescence in Hemodialysis Patients as a Measure of Advanced Glycation End-Product Accumulation.

BackgroundThe purpose of this study was to investigate the relationship between skin autofluorescence (SAF), as a measure of advanced glycation end-product (AGE) accumulation and osteoporosis and clinical symptoms in hemodialysis patients.MethodologyThe study participants were 156 hemodialysis patients (97 males, 59 females, mean = 66.9 years, range = 25-92 years) who visited our hospital between October 2019 and March 2020. The average dialysis period was 10.4 years (range = 1-40 years). Age, years of dialysis, bone mineral density, bone metabolism markers (Ca, P, intact parathyroid hormone, total N-terminal propeptide of type 1 collagen, tartrate-resistant acid phosphatase-5b), clinical symptoms, and SAF were evaluated. Clinical symptoms were evaluated using the visual analog scale (VAS) score for low back pain (LBP) and leg pain ranging from 10 mm (extreme amount of pain) to 0 mm (no pain); the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ; 0-100 points); and the Roland-Morris Disability Questionnaire (RDQ; 0-24 points). We calculated Pearson correlation coefficients to assess the correlation of SAF with age, years of hemodialysis, bone density, bone metabolism markers, clinical symptoms, and biochemical markers.ResultsThe SAF of dialysis patients averaged 4.11, higher than previous reports for non-dialysis patients. Age (r = 0.435, p = 0.0001) was moderately positively correlated and hemodialysis period (r = 0.214, p = 0.00907) was weakly positively correlated with SAF. Among the clinical symptoms measured by the JOABPEQ, social life dysfunction (r = -0.257, p = 0.0108) had a weak negative correlation with SAF.ConclusionsThe level of AGEs implied by SAF was elevated in hemodialysis patients. SAF correlated with social life disorders, suggesting that SAF may be involved in disorders of activities of daily living in hemodialysis dialysis patients.

Prevalence of pruritus associated with hemodialysis and its association with sleep quality among hemodialysis patients: a multicenter study

BackgroundCKD-associated pruritus (chronic kidney disease-associated pruritus) is one of the common symptoms in hemodialysis patients, with a major effect on sleep quality because it occurs at night. The main objective of this study is to determine the prevalence of pruritus among hemodialysis (HD) patients and its impact on sleep and investigate factors associated with pruritus and sleep quality.MethodsA cross-sectional study began in January until March of 2021 in HD centers of four different hospitals in the West Bank, Palestine. Patients with HD aged 18 years or older were included in our investigation. Pruritus and sleep problems were assessed by a 5-D itching score and the Pittsburgh Sleep Quality Index (PSQI) score.ResultsOf 280 HD patients, 250 were accepted to participate in our study. The mean age of the participants was (54.9 ± 15.08). 62.8% were male, and 42.4% of the participants were elderly (age ≥ 60yrs). Pruritus was observed in 121 (48.4%). The 5-D itching score had a median [IQR] of 5.0[5.0–15.0], and 57.2% had a score ≥ 6 points. Severe pruritus was reported in 28.1% of patients. The score was significantly associated with residency (p = 0.033) and chronic comorbidities (p = 0.026). The PSQI score has a median [IQR] of 8[5–12], and 66.4% are poor sleepers with a score of < 5. The score was significantly associated with age (p = 0.017), marital status (p = 0.022), occupational status (p = 0.007), chronic comorbidities (p > 0.001), chronic medication (p = 0.008), severity of pruritus (p = 0.003) and duration of pruritus (p = 0.003). Regression analysis showed that the 5-D itching score and the total number of comorbidities were significantly associated with the PSQI score.ConclusionsPruritus is a widespread complication among HD patients in Palestine. Pruritus also has major effects on sleep quality and is associated with poor sleep quality.

Omega-3 Fatty Acids Improve Chronic Kidney Disease-Associated Pruritus and Inflammation.

Background and Objectives: Chronic kidney disease-associated pruritus (CKD-aP) is a common symptom in hemodialysis patients. A frequent and intense itching sensation largely torments patients, impacts quality of life outcomes, and it has an independent association with mortality. The objective of this study is to investigate the effects of oral supplementation with omega-3 polyunsaturated fatty acid (omega-3 PUFA) on circulating interleukin-6 (IL-6), cardiometabolic parameters, skin moisturization, and the consequent symptoms of pruritus in hemodialysis patients. Materials and Methods: Volunteers on maintenance hemodialysis with very severe pruritus symptoms were enrolled in this prospective cohort study. Subjects were instructed to consume 1000 mg fish oil once daily for 3 months. Pruritus scoring, skin moisture, plasma IL-6, and cardiometabolic parameters were measured at baseline, and at the first, second, and third month post-supplementation with fish oil for assessment of the clinical significance. Results: A total of 27 patients who had a mean age of 67.33 ± 11.06 years and 3.98 ± 3.23 years on hemodialysis completed the study. Supplementation with omega-3 PUFA significantly decreased IL-6 levels (p < 0.001), but increased the levels of c-reactive protein (CRP) (p < 0.05). Evaluation of the cardiovascular risk showed significant (all p < 0.001) decreases in the total cholesterol (CHO), low-density lipoprotein (LDL), and triglycerides (TG) levels, and an increase in the high-density lipoprotein (HDL) level. A significant decrease in plasma creatinine (CR) was observed (p < 0.001), but the decrease was limited. Supplementation with omega-3 PUFA significantly improved (all p < 0.001) skin hydration on both the face and arms, as well as disease-related symptoms of pruritus. Conclusion: Omega-3 PUFA supplementation improved inflammation, renal function, cardiovascular parameters, dry skin conditions, and the consequent symptoms of pruritus in hemodialysis patients.

MO863: Electronic Patient Reported Outcome (EPRO) Collection in Dopps: Prospective Study Designed to Understand the Severity and Temporal Changes in Pruritus Symptoms in Hemodialysis Patients

Abstract BACKGROUND AND AIMS Chronic kidney disease-associated pruritus (CKD-aP) is often seen to affect 30–40% of hemodialysis (HD) patients, and baseline CKD-aP symptoms have been associated with worse quality of life, poor sleep quality, depression and survival. A need exists for documenting CKD-aP severity longitudinally via several CKD-aP instruments to allow for temporal evaluation of different domains of CKD-aP burden, and their relationships to other patient-reported outcomes (PROs). This will help to further inform the extent to which different domains of well-being are impacted by CKD-aP over time, and its variability across patients, for tailoring individualized clinical care of HD patients afflicted by CKD-aP. The Dialysis Outcomes and Practice Patterns Study (DOPPS) is an international prospective cohort of adult in-centre HD patients, with patients randomly selected from representative national samples of HD facilities. Many prior studies by DOPPS and others have used only a baseline measure of CKD-aP, which may underestimate the strength of the true associations with clinical outcomes. With more frequent data collection to update exposures and understand trajectories, we can better evaluate the extent to which CKD-aP is episodic versus chronic. We can also assess whether patients with more consistently severe CKD-aP have worse PROs than patients who are currently—but only recently—bothered by CKD-aP. These gaps in knowledge present an opportunity to undertake a prospective study to link longitudinal clinical data with focused and frequent capture of CKD-aP and PROs to better understand the prevalence, burden and management of CKD-aP from HD patients’ perspectives. METHOD This prospective electronic PRO (ePRO) study involves &amp;gt;100 HD units from the 7 European countries participating in DOPPS 7 (Belgium, France, Germany, Italy, Spain, Sweden, UK). The ePRO will be distributed at HD facilities at 3-month intervals during an 18-month data collection period from 2021–3. The ePRO will be offered to all patients enrolled in the DOPPS, yielding a potential sample of 2000–500 patients based on expected participation and return rates (∼67%). The ePRO data collection is focused on use of mobile (tablet, phone) devices used frequently by patients, but will also be operational on a desktop or laptop computer. Patients will use their personal device to scan a unique QR code, and typically complete the questionnaire while on site at their HD facility. The ePRO will include a combination of validated CKD-aP scales, general quality of life related instruments and healthcare resource utilization (HCRU), i.e. patient reported capture of itch medications and specialist visits known to the patient but not typically in the dialysis chart. A complete list of the ePRO components is shown in Table 1. These ePRO data, together with linked longitudinal clinical data captured in DOPPS, will serve as the analytical basis for several planned research projects, including (i) comparing approaches to measure CKD-aP burden; (ii) describing within-patient trajectories of CKD-aP burden and associations with PROs; and (iii) CKD-aP and short-term outcomes including HCRU, hospitalization and mortality in the 3-months following each CKD-aP assessment. RESULTS Data collection is underway as of August 2021, with initial data expected in early 2022. While not yet available, we expect to present preliminary descriptive data at the ERA-EDTA in May 2022. CONCLUSION The community lacks longer-term, frequently captured data on pruritus severity and management in the HD setting. This DOPPS 18-month prospective ePRO will help address novel research questions investigating the longitudinal burden of pruritus from the patient perspective, using multiple validated instruments and relationships to PROs, clinical outcomes and healthcare resource utilization.

Internet-based treatment for depressive symptoms in hemodialysis patients: A cluster randomized controlled trial

ObjectiveTo investigate the effectiveness of a guided internet-based self-help intervention for hemodialysis patients with depressive symptoms. MethodChronic hemodialysis patients from nine Dutch hospitals with a depression score on the Beck Depression Inventory – second edition (BDI-II) of ≥10, were cluster-randomized into a five modules guided internet-based self-help problem solving therapy intervention or a parallel care-as-usual control group. Clusters were based on hemodialysis shift. The primary outcome depression was measured with the BDI-II. Analysis was performed with linear mixed models. ResultsA total of 190 hemodialysis patients were cluster-randomized to the intervention (n = 89) or control group (n = 101). Post-intervention measurement was completed by 127 patients (67%) and more than half of the patients (54%) completed the intervention. No significant differences were found on the BDI-II score between the groups (mean difference − 0.1, 95%CI -3.0; 2.7, p = 0.94). Per protocol sensitivity analysis showed comparable results. No significant differences in secondary outcomes were observed between groups. ConclusionsGuided internet-based self-help problem solving therapy for hemodialysis patients with depressive symptoms does not seem to be effective in reducing these symptoms as compared to usual care. Future research should examine how to best design content and accessibility of an intervention for depressive symptoms in hemodialysis patients. Trial registrationDutch Trial Register: Trial NL6648 (NTR6834) (prospectively registered 13th November 2017).

Effect of Complementary and Integrative Treatments on Fatigue Symptoms in Hemodialysis Patients: A Systematic Review.

Although hemodialysis treatment is one of the main treatment methods in chronic kidney failure, it also causes many health problems. A variety of complementary and integrative therapies are used to relieve or minimize hemodialysis symptoms. Fatigue (60%-97%) is also one of these problems. Therefore, we have conducted a systematic review to determine the effect of complementary and integrative therapies on fatigue in hemodialysis patients. Relevant studies published from 2005 to 2019, in PubMed, EBSCOhost, ScienceDirect, and Cochran Library databases have been reviewed. In the study, initially, 21 039 pieces of data were obtained, and then 14 randomized controlled studies meeting the inclusion criteria were reviewed. The methodological qualities of the articles included in the study were determined by using the quality evaluation checklist in Jadad randomized controlled studies. In the literature, acupressure, aromatherapy, reflexology, massage, and yoga practice were found to be applied to hemodialysis patients and be effective in reducing pain and anxiety as well as improving sleep quality. It is recommended that these methods be included in the routine clinical care of patients receiving hemodialysis.

Dyspepsia in Montenegrin chronic kidney disease patients undergoing hemodialysis: endoscopic and histopathological features.

The main purpose of this study was to analyze the characteristics of dyspepsia and contributing factors in Montenegrin maintenance hemodialysis patients. The study included 43 patients undergoing hemodialysis with symptoms of dyspepsia and 40 control dyspeptic subjects with preserved kidney function. All subjects underwent an interview about dyspeptic symptoms, physical and biochemical examination, and upper gastrointestinal endoscopy with pathohistological analysis of biopsy specimens. Early satiety, bloating and heartburn were the most common symptoms in hemodialysis patients but without significant difference in frequency in relation to controls. Chronic kidney disease patients had statistically lower concentration of total proteins and albumin (p < 0.001), as well lower BMI values (p = 0.002). Despite this, no significant correlation of laboratory parameters with dyspeptic symptoms was found. Pathohistological examination indicated that the most common finding in hemodialysis patients was chronic active gastritis (58%), while chronic atrophic gastritis was significantly more common in dialytic patients (p = 0.032). Patients on hemodialysis had more frequently atrophy of corpus mucosa, which was positively related to dialysis duration (p = 0.001) and negatively related to pH values (p = 0.004) and bicarbonate concentration (p = 0.049). Helicobacter pylori was considerably more common in patients who underwent shorter time on hemodialysis (p < 0.001) and had higher values of bicarbonate (p = 0.037). Maintenance hemodialysis patients are at risk for chronic gastric diseases that correlated with both dialysis vintage and duration.

Prevalence and Demographic Correlates of Pain, Depression, Fatigue, and Readiness to Seek Treatment for These Symptoms in Hemodialysis Patients

Prevalence and Demographic Correlates of Pain, Depression, Fatigue, and Readiness to Seek Treatment for These Symptoms in Hemodialysis Patients

Association of DRD4 exon III and 5-HTTLPR VNTR genetic polymorphisms with psychiatric symptoms in hemodialysis patients.

Mental illness is prevalent among hemodialysis (HD) patients. Given that the dopaminergic and serotonergic pathways are involved in the etiology of psychiatric disease, this study evaluated the genetic association of dopamine D4 receptor (DRD4) and serotonin transporter (SLC6A4) genes with psychiatric symptom susceptibility among HD patients. Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depressive symptoms among patients (n = 265). Genetic polymorphisms of DRD4 (48 bp VNTR) and SLC6A4 (5-HTTLPR VNTR and rs25531) were examined using a conventional polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique, as appropriate. Significant differences were observed in the distribution of 5-HTTLPR genotypes, SLC6A4 tri-allelic-phased genotype, and DRD4-Exon III VNTR genotypes/alleles between patients with anxiety symptoms versus those with normal/borderline conditions (p<0.05). Binary logistic regression analyses showed that the heterozygous 4,5 VNTR genotype of DRD4 was associated with a higher risk of anxiety symptoms after adjusting for other covariates (odds ratio = 4.25, p = 0.028). None of the studied polymorphisms was linked to depression in HD patients. Collectively, the current findings provide genetic clues to psychopathology in HD patients and suggest that the DRD4 exon III VNTR polymorphism is involved in the etiology of anxiety in this patient population.

The Effect of Dhamma Practice on Depression Outcomes in Hemodialysis Patients

Background: Depression impairs the quality of life (QOL), increases risk of hospitalization and death in hemodialysis patients. Antidepressant medications can lead to more severe side effects. Dhamma practice by Chanting and Anapanasati meditation may relieve depressive symptoms in hemodialysis patients. Objective: To evaluate the effect of Dhamma practice on depression outcome and QOL in hemodialysis patients. Materials and Methods: The authors conducted a quasi-experimental research, a time series design. Patients who were hemodialyzed three times a week at Bhumirajanagarindra Kidney Institute Hospital were enrolled. Participants were trained to practice the Chanting with Anapanasati meditation for 35 minutes every hemodialysis session for six months. Comparison of depression scores, severity of depression, QOL, vital signs, laboratory data, and biomarkers (F2-isoprostanes) was made between the beginning and the end of the study. Results: Forty patients were eligible for participation in the present study. The average age was 63.7±13.1 years. Median dialysis vintage was 29.5 months. After Dhamma practice for six months, diastolic blood pressure was decreased significantly (p=0.015). Median depression score decreased from 9.5 to 4 (p&lt;0.001). The proportion of depressive patients were decreased from 17.5% to 2.5%. The severity of depression trended to decrease, but without statistical significance. F2-isoprostanes was decreased significantly (p&lt;0.001). Both physical aspects (role physical, bodily pain, and physical component scale) and mental aspects (vitality, role emotional, mental health, and mental component scale) of QOL were significantly improved. Conclusion: Dhamma practice by Chanting and Anapanassati meditation significantly decreased blood pressure, and depression, and improved QOL both physically and mentally, in hemodialysis patients. Keywords: Depression, Quality of life, Hemodialysis, Meditation, Buddhist chanting, Dhamma.

Long-term intradialytic hybrid exercise training on fatigue symptoms in patients receiving hemodialysis therapy

Hemodialysis (HD) patients suffer from generalized weakness, exercise intolerance and muscle atrophy, all leading to generalized fatigue and lack of energy. HD patients spend at least 50% of their time in a functionally "switch off" mode with their fatigue sensations reaching a peak in the immediate hours after the dialysis session. The purpose of the current study was to assess the effectiveness of a nine-month hybrid intradialytic exercise program on fatigue symptoms occurring during and after hemodialysis session. Twenty stable hemodialysis patients were included in the study (59 ± 13.7 years; 16 males). All patients completed a 9-month supervised exercise training program composed of both aerobic cycling and resistance training during HD. Aspects related to physical and generalized fatigue were assessed via validated questionnaires, while physical performance was assessed by a battery of tests, before and after the intervention period. Exercise capacity and physical performance were increased by an average of 65 and 40%, respectively. Patients reported feeling better during post-dialysis hours in question 1 (p = 0.000), question 3 (p = 0.009) and question 4 (p = 0.003) after the 9-month intervention. In addition, exercise training improved scores in cognitive function (p = 0.037), vitality (p = 0.05), depression (p = 0.000) and fatigue (p = 0.039). The present study showed that a 9-month hybrid (aerobic + resistance) exercise training program improved symptoms of post-dialysis fatigue and overall general perception of fatigue. Hybrid exercise training is a safe and effective non-pharmacological approach to ameliorate fatigue symptoms in HD patients. Trial registration number The study is registered at ClinicalTrials.gov (NCT01721551, 2012) as a clinical trial.

Relationship between non‒invasive test results and clinical symptoms in hemodialysis patients with lower‒limb peripheral arterial disease

外来血液透析患者112名224肢の下肢末梢動脈疾患に対するスクリーニング検査として，SPPとABIの検査精度を検討した．下肢血管造影検査と下肢血管動脈エコーから63肢がPADと診断された．足底部，足背部，第1趾のSPPとABIの検査精度をROC分析により算出した．各部位のカットオフ値は足底部62 mmHg，足背部51 mmHg，第1趾40 mmHg，ABI値は0.92であった．SPPでは第1趾が足底部に比し，PADに対する検査精度が優れABIの検査精度は第1趾と同等であった．PAD 63肢において，算出されたカットオフ値①SPP第1趾40 mmHg未満，②ABI値0.92未満を基準とし，4つのカテゴリーに分類した．基準より①②とも下回る場合が39例，①もしくは②で下回る場合が22例，①②とも上回る場合が2例であった．透析患者のPADのスクリーニング検査はSPPとABIを併用することが推奨される．