Undergoing Dialysis Treatment Research Articles

1,3-ß-d-Glucan testing is highly specific in patients undergoing dialysis treatment

The aim of this combined in-vitro and in-vivo study was to investigate whether state of the art dialysis modalities produce false positive serum 1,3-ß-d-Glucan (BDG) levels. Dialysis fluid for simulated dialysis treatments was spiked with BDG from different sources. Samples were taken from the dialysate and dialyzer blood compartments at various time points. In addition, serum samples were obtained in three groups of patients without invasive fungal disease: a.) twelve patients on chronic hemodialysis (HD)/hemodiafiltration (HDF); b.) ten patients on continuous ambulatory peritoneal dialysis (CAPD); and c.) ten patients with stable chronic kidney disease (CKD) but without dialysis. Median BDG levels in BDG spiked dialysate were 3250.9, 2050.4, and 390.1pg/ml respectively. All corresponding samples from the blood compartments were BDG negative. In HD/HDF patients no increase of serum BDG levels could be observed over the duration of treatment. 71/72 BDG tests in this group remained negative. BDG tests were also negative in 9/10 CAPD patients, both in in- and outflow dialysates as well as in all ten patients with CKD. We conclude that state of the art renal replacement therapies using up-to-date treatments are not a cause of falsely elevated serum BDG levels.

Removal of uremic toxins by renal replacement therapies: a review of current progress and future perspectives

Accumulation of uremic toxins induces various uremia-related complications in patients with chronic kidney disease, particularly those undergoing dialysis treatment. Direct interactions of uremic toxins with organ tissues are thought to be a major pathophysiological mechanism for disease; for example, indoxyl sulfate reacts directly with macrophages and accelerates atherosclerosis. The removal of sufficient volume of uremic toxins will prevent uremia-related complications in dialysis patients. Hemodialysis with the use of a high-flux dialysis membrane, long or frequent treatment, and increased blood/dialysate flow has improved removal of water-soluble small molecular weight uremic toxins. Middle molecular weight molecules are removed more effectively with hemodialysis using a high-flux membrane, hemodiafiltration and hemofiltration, and a direct hemoperfusion method using β2-microglobulin adsorption column, which is useful in reducing serum β2-microglobulin levels as well as improving dialysis-related amyloidosis-induced clinical symptoms. With improvements in dialysis therapies, removal of low and middle molecular weight water-soluble molecules has improved; however, conventional dialysis treatment is limited in its ability to remove protein-bound uremic toxins (PBUTs). Recent findings suggest that adsorption treatments using oral charcoal adsorbent, mixed matrix membrane hollow fiber, and additive charcoal in the dialysate, in addition to conventional dialysis treatment, may effectively remove a substantial amount of PBUTs. Further improvement of renal replacement therapy, including dialysis and additional therapeutic strategies, is needed for better clearance of small and middle molecular weight molecules and PBUTs, which will lead to improved survival and quality of life for dialysis-dependent chronic kidney disease patients.

Hemodiyaliz Hastasında Sık Rastlanılan Kaşıntının Nadir Sebebi: Kyrle Hastalığı

Uremic pruritus is a common complication of chronic renal failure. It affects approximately half of patients undergoing dialysis treatment. Even if the pruritus is not hazardous alone, it causes physical and mental fatigue, insomnia, chronic fatigue, decrease in self care ability and life quality. The causes of pruritus and the pathophysiology are stil not fully understood. Xerosis, intradermal microprecipitation of divalent ions, secondary hyperparathyroidism, peripheral neuropathy, allergic reactions, hypersensitivity and histamine have been considered as pathogenetic factors. Kyrle’s disease is a rare disorder of keratinization which is one of the perforating disorders of the skin. Herein, we report a case of Kyrle’s disease which is seen rarely, as a cause of pruritus in a 68 year old female patient who is on regular hemodialysis treatment secondary to end stage renal failure due to diabetic nephropathy, in the light of existing literature. key words: Pruritus, Hemodialysis, Kyrle’s disease

The rebirth of interest in renal tubular function.

The measurement of glomerular filtration rate by the clearance of inulin or creatinine has evolved over the past 50 years into an estimated value based solely on plasma creatinine concentration. We have examined some of the misconceptions and misunderstandings of the classification of renal disease and its course, which have followed this evolution. Furthermore, renal plasma flow and tubular function, which in the past were estimated by the clearance of the exogenous aryl amine, para-aminohippurate, are no longer measured. Over the past decade, studies in experimental animals with reduced nephron mass and in patients with reduced renal function have identified small gut-derived, protein-bound uremic retention solutes ("uremic toxins") that are poorly filtered but are secreted into the lumen by organic anion transporters (OATs) in the proximal renal tubule. These are not effectively removed by conventional hemodialysis or peritoneal dialysis. Residual renal function, urine produced in patients with advanced renal failure or undergoing dialysis treatment, may represent, at least in part, secretion of fluid and uremic toxins, such as indoxyl sulfate, mediated by proximal tubule OATs and might serve as a useful survival function. In light of this new evidence of the physiological role of proximal tubule OATs, we suggest that measurement of renal tubular function and renal plasma flow may be of considerable value in understanding and managing chronic kidney disease. Data obtained in normal subjects indicate that renal plasma flow and renal tubular function might be measured by the clearance of the endogenous aryl amine, hippurate.

Reliability analysis of the heart autonomic control parameters during hemodialysis sessions.

The study of heart autonomic control (HAC) in patients with chronic kidney disease (CKD) undergoing dialysis treatment has been carried out, however, there are no studies reporting the reliability of measurements of HAC parameters involving the mentioned samples and conditions. The reliability of many HAC parameters was evaluated from patients with CKD during two sessions of hemodialysis. The successive R-R intervals were recorded during two sessions of hemodialysis from 14 CKD patients that were undergoing dialysis for at least 6 months and with no history of recurrent hypotensive events. HAC parameters were obtained with time and frequency domain analysis, as well as with nonlinear methods. The reliability was measured with the intraclass correlation coefficient (ICC). The results showed excellent reliability (ICC=0.90-0.98) for most heart rate variability (HRV) parameters, especially the parameters obtained in the time domain [square root of the mean squared differences between successive R-R intervals (RMSSD), percentage of adjacent R-R intervals that differ by more than 50 ms (pNN50), mean of the 5-min standard deviations of R-R intervals (SDNNi), and triangular index] and with non-linear methods [standard deviation of the instantaneous variability beat-to-beat (SD1), standard deviation in long-term continuous R-R intervals (SD2), detrended fluctuation analysis (DFA) α1 and α2, approximate and sample entropies, and correlation dimension (D2): ICC=0.86-0.96]. Among the parameters obtained in the frequency domain (normalized magnitude from the spectrum of low-frequency components (LFnu), normalized magnitude from the spectrum of high-frequency components (HFnu), and LF/HF ratio), the LF/HF ratio showed better reliability (ICC=0.96 vs. ICC=0.70). Measurements of HAC parameters have excellent test-retest reliability for the studied samples and conditions.

Risk factors for meticillin-resistant Staphylococcus aureus colonization in dialysis patients: a meta-analysis

Patients on dialysis are particularly vulnerable to meticillin-resistant Staphylococcus aureus (MRSA) infections and MRSA colonization is associated with increased risk for severe infections in this population. Determination of risk factors for MRSA colonization among dialysis patients. This is a systematic review and meta-analysis of studies reporting risk factors of MRSA colonization. We performed a PubMed and EMBASE literature search to identify all studies on risk factors for MRSA colonization among patients undergoing dialysis treatment. Previous hospitalization, type of dialysis access, comorbid conditions, dialysis vintage, gender, length of time on dialysis, and previous antibiotic use were extracted and assessed for possible association with MRSA colonization in this population. Ten out of 8252 articles, presenting data on 2364 dialysis patients, were included. We found that hospitalization within the previous 12 months [odds ratio (OR): 1.93; 95% confidence interval (CI): 1.04-3.58] and the use of temporary dialysis access (relative risk: 1.66; 95% CI: 1.06-2.60) were associated with a significantly higher risk of MRSA colonization. MRSA carriage was associated with lower serum albumin levels compared to non-carriage (OR: 0.8; 95% CI: 0.68-0.95) and was higher among patients with chronic lung disease (OR: 2.16; 95% CI: 1.04-4.51). There were no data on patients undergoing peritoneal dialysis. Active surveillance approaches, including potential decolonization strategies, are suggested to focus on these subgroups of haemodialysis patients with hospitalization within the previous year, temporary dialysis access, lower serum albumin levels, and chronic lung disease comorbidity.

Torque teno virus among dialysis and renal-transplant patients.

Patients who undergo dialysis treatment or a renal transplant have a high risk of blood-borne viral infections, including the Torque teno virus (TTV). This study identified the presence of TTV and its genome groups in blood samples from 118 patients in dialysis and 50 renal-transplant recipients. The research was conducted in a hospital in the city of Maringá, state of Paraná. The viral DNA, obtained from whole blood, was identified by using two nested Polymerase Chain Reactions (PCR). The frequencies of TTV were 17% and 36% in dialysis patients using the methodology proposed by Nishizawa et al . (1997) and Devalle and Niel (2004) , respectively, and 10% and 54% among renal-transplant patients. There was no statistically significant association between the frequency of the pathogen and the variables: gender, time in dialysis, time since transplant, blood transfusions, and the concomitant presence of hepatitis B, for either the dialysis patients or the renal-transplant recipients. Among dialysis patients and renal-transplant recipients, genogroup 5 was predominant (48% and 66% respectively), followed by genogroup 4 (37% and 48%) and genogroup 1 (23% and 25%). Genogroup 2 was present in both groups of patients. Some patients had several genogroups, but 46% of the dialysis patients and 51% of the renal-transplant recipients had only a single genogroup. This study showed a high prevalence of TTV in dialysis patients and renal-transplant recipients.

Use of renin-angiotensin system inhibitors is associated with reduction of fracture risk in hemodialysis patients.

BackgroundPatients with chronic kidney disease, especially those undergoing dialysis treatment and having secondary hyperparathyroidism, have a high risk of bone fracture. The renin-angiotensin system (RAS) is associated with osteoclastic bone resorption. We aimed to examine whether the use of RAS inhibitors reduces the incidence of fracture in hemodialysis patients.Methods and FindingsThis was a multicenter, 3-year, prospective, observational study. From 2008 to 2011, maintenance hemodialysis patients with secondary hyperparathyroidism (N = 3,276) treated with angiotensin converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB) at baseline were followed for a mean of 2.7 years. The association between the use of ACEI/ARB and hospitalization rate owing to fracture was examined by using Cox regression models. Effect modifications by the severity of secondary hyperparathyroidism (intact parathyroid hormone [iPTH] level), sex, and systolic blood pressure were also examined. The incidence proportion of fracture-related hospitalization was 5.42% throughout the observation period. ACEI/ARB use was associated with a lower rate of fracture-related hospitalization (adjusted hazard ratio, 0.65; 95% confidence interval [CI], 0.45–0.92). This association was not significantly affected by sex (P = 0.56) or systolic blood pressure levels (P = 0.87). The hazard ratios adjusted by iPTH levels were qualitatively different, but not statistically significant (P = 0.11): 0.77 (95% CI, 0.42–1.39), 0.38 (95% CI, 0.20–0.73), 0.59 (95% CI, 0.29–1.21), and 1.29 (95% CI, 0.58–2.42) for the first, second, third and fourth quartiles of iPTH, respectively.ConclusionsUse of RAS inhibitors is associated with a lower rate of fracture-related hospitalization in hemodialysis patients with secondary hyperparathyroidism.Trial RegistrationClinicalTrials.gov NCT00995163

NLRP3 inflammasome activation in dialyzed chronic kidney disease patients.

To assess whether NLR pyrin domain-containing protein 3 (NLRP3) inflammasome, a multiprotein complex that mediates the activation of caspase-1 (CASP-1) and pro-inflammatory cytokines IL-18 and IL-1β, could be involved in the chronic inflammatory state observed in chronic kidney disease patients undergoing hemodialysis treatment (CKD-HD), we employed several biomolecular techniques including RT-PCR, western blot, FACS analysis, confocal microscopy and microarray. Interestingly, peripheral blood mononuclear cells from 15 CKD-HD patients showed higher mRNA levels of NLRP3, CASP-1, ASC, IL-1β, IL-18 and P2X7receptor compared to 15 healthy subjects. Western blotting analysis confirmed the above results. In particular, active forms of CASP-1, IL1-β and IL-18 resulted significantly up-regulated in CKD-HD versus controls. Additionally, elevated mitochondrial ROS level, colocalization of NLRP3/ASC/mitochondria in peripheral blood mononuclear cells from CKD-HD patients and down-regulation of CASP-1, IL1-β and IL-18 protein levels in immune-cells of CKD-HD patients stimulated with LPS/ATP in presence of mitoTEMPO, inhibitor of mitochondrial ROS production, suggested a possible role of this organelle in the aforementioned CKD-associated inflammasome activation. Then, microarray analysis confirmed, in an independent microarray study cohort, that NLRP3 and CASP-1, along with other inflammasome-related genes, were up-regulated in 17 CKD-HD patients and they were able to clearly discriminate these patients from 5 healthy subjects. All together these data showed, for the first time, that NLRP3 inflammasome was activated in uremic patients undergoing dialysis treatment and they suggested that this unphysiological condition could be possibly induced by mitochondrial dysfunction.

Tip-toeing toward the finish line.

Tip-toeing toward the finish line.

Nonalcoholic fatty liver disease (NAFLD) – Is it a new marker of hyporesponsiveness to recombinant human erythropoietin in patients that are on chronic hemodialysis?

Anemia is a major consequence of chronic kidney disease (CKD) that develops early in the course of illness and affects most patients who exhibit some degree of reduced renal function. Erythropoietin (EPO) deficiency is considered the most important cause of anemia in CKD. Renal anemia has serious clinical consequence. In addition to reducing patient physical capacity and quality of life, anemia induces adaptive cardiovascular mechanisms that increase the risk of cardiovascular disease and death. Thus, treatment of anemia in CKD is very important. While EPO is effective in correcting anemia in most cases, up to 10% of patients however, have an inadequate response to therapy. The two most common and important reasons why patients become relatively unresponsive to EPO therapy are the development of true iron deficiency and the onset of an inflammatory state that impairs the response to EPO. Indeed, the role of inflammation and pro-inflammatory cytokines in resistance to EPO therapy is gaining increasing recognition. On the other hand, the main organ for C-reactive protein (CRP) synthesis is the liver and it is well known that the synthesis of an acute-phase proteins by the liver is up regulated by inflammation. The main consequence of nonalcoholic fatty liver disease (NAFLD) is sub-chronic liver inflammation that leads and contributes to dyslipidemia, inflammation, enhanced oxidative stress and endothelial dysfunction. Considering the recent data about high prevalence of NAFLD in CKD patients, probably due to shared metabolic risk factors, we hypothesized that end-stage renal disease (ESRD) patients with NAFLD will need a much higher dose of EPO to achieve the target hemoglobin levels in comparison with ESRD patients without NAFLD. The possible underlying mechanism is sub-chronic liver inflammation in NAFLD patients that leads and contributes to poor response to EPO. Therefore, we believe that NAFLD could be a new clinical marker of poor response to EPO therapy in ESRD patients. Optimizing response to EPO therapy is important for both patient outcomes and the cost of treatment, and require consideration of a growing number of factors. Detection of NAFLD by some of non-invasive methods in ESRD patients could identify responsiveness and resistance to EPO therapy. Furthermore, we propose that all the patients who undergo dialysis treatment should be screened for NAFLD in order to identify the patients that will have a poor response to EPO therapy. The work could help to determine whether we have a new marker of poor EPO response in ESRD patients.

Glomerular Diseases as Extrahepatic Manifestations of Hepatitis C Virus Infection

Hepatitis C virus (HCV) infection is a common and important health problem throughout the world not only leads to problems in liver, but also causes a variety of manifestations in almost all systems. HCV is a common virus found in chronic kidney disease. HCV can be the reason of both some pathologies which may lead to chronic kidney disease such as membranoproliferative glomerulonephritis (MPGN), and also crucial problems in patients with end-stage kidney diseases undergoing dialysis treatment. There is a positive correlation between cryoglobulinemia, secondary MPGN and HCV infection. Treatment of HCV related glomerular diseases may lead to many problems.Tolerability of drugs such as (standard and pegylated) interferon and ribavirin are reduced due to impaired renal function and require appropriate dose adaptation for the patient. In this article, hepatitis C virus induced glomerular pathologies and their treatments are discussed.

Reasons for drop-out of peritoneal dialysis and strategies of prevention: A review

Abstract Chronic kidney diseases (CKD) is a disease that has become widespread all around the world and poses a gradually increasing problem; treatment choices are basically dialysis, peritoneum dialysis and kidney transplantation. Eight % of the patients around the world that undergo dialysis treatment have PD treatment. PD is basically the solute diffusion between blood and diffusate in peritoneum capillary, causing ultrafiltration at peritoneal cavity by hypertonic solutions, and finally using peritoneum as a dialysis membrane. PD is an ESRD treatment that is cheap, enabling patients to move freely and that has no survival difference than HD and even has some common points. Interestingly, number of patients that undergo PD has decreased in recent years. Many factors are known to have played a role in that. increase in the number of large-scale dialysis organisations, recurrent peritonitis, transition to HD, increase in the number of patients that undergo transplantation, technical troubles relating to PD catheter, and social and economic condition of the individual can be referred to amongst these factors. In this review, we will endeavour to scrutinise the factors that has affected termination of PD, and strategies of prevention. Key Words : Peritoneal Dialysis, Reasons for drop-out, strategies of prevention DOI: 10.12973/ejms.2014.101p

Using the social cognitive theory to understand physical activity among dialysis patients.

The purpose of this study was to use the social cognitive theory (SCT) constructs self-efficacy, outcome expectations, and self-regulation to better understand associations of physical activity (PA) behaviors among dialysis patients after controlling for demographic and health-related factors. This study was cross-sectional in design. Participants (N = 115; mean age = 61.51 years, SD = 14.01) completed self-report questionnaires during a regularly scheduled dialysis treatment session. Bivariate and hierarchical linear regression analyses were conducted to examine relationships among SCT constructs and PA. Significant relationships between PA and self-efficacy (r = .336), self-regulation (r = .280), and outcome expectations (r = .265) were detected among people on dialysis in bivariate analyses. Hierarchical linear regression revealed significant increases in variance explained for the addition of self-efficacy, self-regulation, and covariates (p < .01). Younger age, self-efficacy, and self-regulation were associated (p < .10) with greater participation in physical activity in the final model (R² = .272). Conclusion/Implication: This research supports the use of SCT in understanding PA among people undergoing dialysis treatment. The findings of this study can help health educators and health care practitioners better understand PA and how to promote it among this population. Future research should further investigate which activities dialysis patients participate in across the life span of their disease. Future PA programs should focus on increasing a patient's self-efficacy and self-regulation.

Changes in the self-concept mode of women undergoing hemodialysis: a descriptive study

Aim: Identify the changes in the self-concept mode of Roy’s theoretical model in women undergoing hemodialysis. Method: This is a descriptive study, carried out in a city in northeastern Brazil, which involved 24 women undergoing dialysis treatment due to chronic kidney disease (CKD). Results: The main alterations were: low self-esteem in the personal self and sexual dysfunction in the physical self, in terms of the self-concept mode. Discussion: Women undergoing hemodialysis present self-adaptive problems as in Roy’s theoretical model; therefore, nurses should direct their care, emphasizing these adaptive problems. Conclusion: The changes identified in women undergoing hemodialysis were low self-esteem and sexual dysfunction, in terms of the self-concept mode of Roy’s theoretical model

The influence of emotional factors on the report of somatic symptoms in patients on chronic haemodialysis: the importance of anxiety.

To evaluate the prevalence of different somatic symptoms in chronic haemodialysis patients compared with a control group and to analyse the predictive capacity of some psychological variables (namely anxiety, depression, social support, self-efficacy and coping strategies) in the reporting of these symptoms. Forty-six patients undergoing dialysis treatment and 30 individuals without relevant illness, matched in socio-demographic variables, were evaluated with self-reported measures. Relationships between somatic symptoms and predictor variables were analysed through bivariate correlations and multiple regression analysis. Patients showed much higher somatic symptom values than control individuals, especially with regard to immunological, cardiovascular, gastrointestinal and skin-allergy symptoms. Anxiety, with a positive association, was the main independent predictor in most of the symptom categories, explaining 24.9% (p<.0001) of variance in the total number of reported symptoms. Depression, the degree of worry, and passive coping strategies (helplessness-despair and fatalism) were also associated with higher levels of somatic symptoms. By contrast, the active coping strategy of fighting spirit, self-efficacy (coping capacity) and social support were associated with lower levels of symptoms. These results have clinical implications with respect to the aspects on which psychological interventions intended to reduce somatic symptoms in chronic haemodialysis patients should be based and they suggest that psychological-emotional variables may explain some symptoms that do not have a clear aetiology in kidney patients.

P2–142 - Feasibility of Cancer Chemotherapy in Patients Who Undergo Dialysis Treatment

BackgroundsMore than 300,000 patients undergo dialysis treatment today in Japan. In these patients, malignant disease is the third leading cause of death (accounting for 9%) following congestive heart failure and infection.

Effect of Hemodialysis on Serum Copper and Zinc Levels in Renal Failure Patients

For human beings trace elements are essential nutrients with a gamut of functions. Available data regarding trace element status in hemodialysis patients are contradictory. The present study was aimed to investigate possible existence of trace element disturbances in uremic patients undergoing dialysis treatment. Blood samples of forty hemodialysis patients and twenty healthy controls were analyzed for quantitation of copper and zinc. The study revealed that serum copper and zinc concentrations in hemodialysis patients are distinctly decreased compared to that of healthy controls. Abnormalities of trace elements are primarily the result of uremia, and they may be further exacerbated by the dialysis procedure.

Prevalence and correlates of depression among chronic kidney disease patients in Taiwan

BackgroundChronic kidney disease (CKD) is a progressive disease that causes a permanent impairment of renal function and premature mortality. The associated prognosis may result in serious psychological distress to the affected individual. However, there are limited data on the psychological correlates, and in particular depression, in Chinese CKD patients. This study aimed to examine the prevalence of depression, as well as the influence of other psychosocial factors on depression, among Taiwanese CKD patients.MethodsWe used a cross-sectional research design to recruit 270 CKD patients who were not undergoing dialysis treatment at a hospital in southern Taiwan during 2011. The structured questionnaire used in this study gathered information on respondent demographic and disease characteristics, and information obtained from the Taiwanese Depression Questionnaire. Factors associated with depression were examined by a multiple logistic regression analysis.ResultsThe crude and age-standardized prevalence of depression were 22.6% and 20.6%, respectively. Those who had sleep disturbances, reported having no religious beliefs, followed no regular exercise regimen, and were diagnosed with stage III or above CKD demonstrated a significantly higher risk of depression.ConclusionOur findings are beneficial to healthcare providers, as they identify both the prevalence of depression and several of its correlates. By identifying CKD patients with a higher risk of depression, healthcare providers may be better able to ensure the provision of appropriate rehabilitation to this population.

A qualitative study of treatment burden among haemodialysis recipients

This study aims to explore the experience of renal patients undergoing dialysis treatment focusing on beliefs about their illness, prescribed treatment and the challenge of adherence. Interpretative phenomenological analysis was used to analyse the accounts of seven haemodialysis patients. Patients have a range of beliefs about their illness and their treatment consistent with the self-regulatory model of illness, that is, identity, cause, consequences, timeline and cure. Patients sometimes consciously did not act in accordance to advice when they considered an aspect of treatment less important or less easy to adhere to. Psychological factors like beliefs might play a role in non-adherence behaviour.