Undergoing Maintenance Hemodialysis Research Articles

Blood purification therapy in chronic renal failure and its impact on renal index, serological index, and inflammatory factors

Introduction: This study aimed to explore the clinical effects of blood purification therapy in patients with chronic renal disease, measured by renal function index and inflammation. Methodology: Data were collected from a tertiary care hospital in Pakistan between June 2022 and September 2023. 84 patients undergoing maintenance hemodialysis for chronic renal failure were retrospectively included in this cohort. Results: Age, sex, body mass index (BMI), course of disease, primary disease, and educational level were not related to the response to blood purification treatment. Blood purification therapy positively affected renal function, serological indices, and inflammatory factors (P<0.05). Conclusion: Blood purification therapy can improve toxin clearance and renal function and reduce inflammation. Therefore, we can conclude that this is an effective therapy for our population.

Investigation of core symptoms and symptom clusters in maintenance hemodialysis patients: A network analysis.

To construct a symptom network of maintenance hemodialysis patients and identify the core symptoms and core symptom clusters. Finally, this study provides a reference for accurate symptom management. A correlational cross-sectional design. A total of 368 patients who underwent maintenance hemodialysis were enrolled from two hemodialysis centers in Chengdu, Sichuan Province, China. A symptom network was constructed with the R coding language to analyze the centrality index. Symptom clusters were extracted by exploratory factor analysis, and core symptom clusters were preliminarily determined according to the centrality index of the symptom network. The most common symptoms in maintenance hemodialysis patients were fatigue, dry skin, and pruritus. In the symptom network, headache had the highest mediation centrality (rB = 2.789) and closeness centrality (rC = 2.218) and the greatest intensity of numbness or tingling in the feet (rS = 1.952). A total of six symptom clusters were extracted, including pain and discomfort symptom clusters, emotional symptom clusters, gastrointestinal symptom clusters, sleep disorder symptom clusters, dry symptom clusters, and sexual dysfunction symptom clusters. The cumulative variance contribution rate was 69.269%. Fatigue, dry skin, and pruritus are the sentinel symptoms of maintenance hemodialysis patients, headache is the core symptom and bridge symptom, and pain symptom clusters are the core symptom clusters of MHD patients. Nurses can develop interventions based on core symptoms and symptom clusters to improve the effectiveness of symptom management in maintenance hemodialysis patients. Understanding the core symptoms and symptom groups that plague maintenance hemodialysis patients is critical to providing accurate symptom management. To ensure that maintenance hemodialysis patients receive effective support during treatment, reduce the adverse effects of symptoms, and improve the quality of life of patients.

ADMA, neutrophil to lymphocyte, platelet to lymphocyte ratios and phase angle: effects on inflammation and nutrition in hemodialysis patients

Objectives: Neutrophil/lymphocyte ration (NLR) and platelet/lymphocyte ratio (PLR) levels can be used as systemic infallamotory parameters. Asymmetric dimethyl arginine (ADMA) inhibits endothelial nitric oxide synthase. Phase Angle (PhA) is a potential paremeter to screen for inflammatory abnormalities. In present study we aimed to determine the relations between NLR, PLR, ADMA, and PhA in terms of early markers for nutritonal status in addition to their well-known role in inflammation. Methods: A total of 89 patients undergoing maintenance hemodialysis 3 days a week at least 6 months were enrolled. To assess nutritional status, we performed the dietary questionnaire and mini nutritional assessment score (MNAS). ADMA was measured by ELISA. NLR and PLR are calculated from monthly complete blood count tests. Patients were divided into 2 groups accordng to NLR levels as group 1 (NLR≥4.6; n=48) ve and group 2 (NLR<4.6, n=41). Results: The mean ADMA level was 0.03±0.01 µmol/L, the mean PhA was 7.2±1.1º. In subgroup analysis, MNAS, albumin levels and phase angle of patients in group 1 were lower and CRP, PLR, ADMA levels were higher when compared to group 2. In correlation analysis, NLO was positively correlated with PLR, CRP and ADMA however negatively correlated with albumin and PhA levels. In regression analysis, NLR, PLR and ADMA were detected as independent predictors of MNAS. Conclusion: In conclusion our study suggests that NLR, PLR and ADMA are independent predictors for nutritional status and inflammation in patients ongoing hemodialysis.

Effects of low-dose magnesium oxide on elevated serum magnesium levels and improved constipation in hemodialysis patients: a single-center retrospective study

BackgroundThe prevention of hypomagnesemia is critical for improving the life expectancy of patients undergoing hemodialysis (HD). The administration of magnesium oxide (MgO) increases serum Mg concentrations; however, dose adjustments must be done carefully owing to the risk of hypermagnesemia in patients undergoing HD. Additionally, the laxative effects of low-dose MgO on constipation in these patients has not been reported. Therefore, in the present study, we investigated the effects of treatment with low-dose MgO on serum Mg concentration changes and the improvement of defecation in patients undergoing HD.MethodsThe present study was a single-center retrospective observational study of 43 patients undergoing maintenance HD at Shirasagi Hospital. The patients’ clinical characteristics, including serum Mg concentration, were obtained from the hospital’s electronic medical records. In the group who received MgO for constipation, the effectiveness of MgO as a laxative was categorized as effective, ineffective, or unknown on the basis of electronic medical records related to defecation.ResultsOf the 43 patients included in the present study, 23 were prescribed supplemental Mg to prevent hypomagnesemia or maintain mild hypermagnesemia and 19 to prevent constipation. All patients received diasylate with an Mg concentration of 1.0 mEq/L. Additionally, 37 patients (86%) were treated with 330 mg/day MgO. The serum Mg concentrations before and 1, 2, and 3 months after the start of MgO were 2.3 ± 0.2, 2.8 ± 0.4, 2.8 ± 0.5, and 2.8 ± 0.4 mg/dL, respectively (P < 0.001). Multiple linear regression analysis showed that dry weight was independently associated with changes in serum Mg concentration from before to 1 month after MgO administration (regression coefficient = −0.027; P = 0.020). Of the 19 patients evaluated for constipation, 8 (42%) had documented effective bowel movements after the initiation of MgO, 6 had no effect, and 5 were unknown; however, 1 patient in the ineffective group and 2 in the effective group used other laxatives prior to starting MgO.ConclusionsThe results of the present study suggest that the administration of low-dose MgO to patients undergoing HD provides a means of increasing serum Mg concentration without causing dangerous hypermagnesemia, that serum Mg concentrations increase relatively easily in lower-weight patients. In addition, this study shows that low-dose MgO may be effective as an initial treatment for constipation in this patient group in a cautious manner, but this study did not provide sufficient data for the usefulness of low-dose MgO for constipation in patients undergoing HD.

Associations between pinch strength, cardiovascular events and all-cause mortality in patients undergoing maintenance hemodialysis

Background and aimsPatients undergoing maintenance hemodialysis (MHD) experience increased mortality and cardiovascular disease (CVD) risks; however, the potential connection between pinch strength (PS) and the prognosis of these patients remains unknown. Consequently, this study aimed to comprehensively assess the influence of PS and handgrip strength (HGS) on both survival and cardiovascular events (CVE) in patients undergoing MHD.MethodsData were gathered from patients undergoing MHD at the Hemodialysis Center of Guangzhou Red Cross Hospital in March 2021. We performed a retrospective follow-up spanning 24 months, with death serving as the primary endpoint for observation and CVE as the secondary endpoint. Multifactorial Cox regression analysis, Kaplan–Meier survival curves, trend tests, and restricted cubic spline were applied to explore the association.ResultsDuring a 24-month follow-up, data were collected from 140 patients undergoing MHD with an average age of 66.71 ± 12.61 years. Among them, 52 (37.14%) experienced mortality, whereas 36 (40.00%) had CVE without baseline CVD. Kaplan–Meier survival curves demonstrated better survival rates and reduced CVE risk for patients in the second, third, and fourth quartiles compared with those in the first quartile for PS. Adjusted analyses in different models revealed higher PS levels were independently associated with all-cause mortality (major model, model 4, HR, 0.78; 95% CI, 0.64–0.95) but not with CVE risk (unadjusted HR, 0.90; 95% CI, 0.77–1.05). Compared with lower quartile PS levels, higher PS levels significantly reduced all-cause mortality (HR, 0.31; 95% CI, 0.10–1.02), and this trend remained consistent (P for trend = 0.021). Finally, the restricted cubic spline method using different models showed a linear relationship between PS and all-cause mortality (P > 0.05), when PS exceeded 4.99 kg, the all-cause mortality of MHD patients significantly decreased.ConclusionsPS was independently associated with all-cause mortality but not with CVE in patients undergoing MHD.

The non-linear associations between blood manganese level and sarcopenia in patients undergoing maintenance hemodialysis: A multicenter cross-sectional study

Background and aimsManganese (Mn), a vital element in energy metabolism, is predominantly stored in skeletal muscles and plays a crucial role in muscle function and strength. Patients on maintenance hemodialysis (MHD) often experience muscle wasting due to metabolic disruption and inflammation. This study aimed to explore the relationship between blood Mn levels and sarcopenia in a patient population. MethodsIn this multicenter cross-sectional study, conducted from March 2021 to March 2022, 386 patients on MHD from three medical centers were included. Blood Mn levels were measured using inductively coupled plasma mass spectrometry, and body composition was assessed post-dialysis using bioelectrical impedance analysis. Grip strength was measured using a digital dynamometer. The patients were categorized into groups with and without sarcopenia. Using a generalized additive model to fit a smooth curve, we employed a generalized linear model to identify the optimal inflection point and explore the threshold effect after discovering a segmented relationship. Subsequently, a binary logistic regression analysis was conducted to investigate the relationship between blood manganese levels and the risk of sarcopenia, with adjustments made for potential confounding factors. ResultsA negative correlation was observed between blood Mn levels and sarcopenia-related parameters (Appendicular Skeletal Muscle Mass Index and grip strength) in Spearman’s correlation analysis (both P < 0.05). After adjusting for confounding factors, a nonlinear association was identified. When blood Mn was ≤ 10.6 μg/L, the increase in sarcopenia was not statistically significant (P > 0.05). Conversely, when blood Mn exceeded 10.6 μg/L, each 1 μg/L increase raised the risk of sarcopenia by 0.1 times. Considering confounders, multivariate binary logistic regression confirmed an independent association between elevated blood Mn levels and sarcopenia. ConclusionThis study revealed an independent association between elevated blood Mn levels (> 10.6 μg/L) and sarcopenia in patients undergoing MHD. These findings emphasize the importance of understanding the Mn metabolism in the context of muscle health in this patient population. Further research is warranted to explore the underlying mechanisms and potential interventions for mitigating sarcopenia in patients with elevated blood Mn levels undergoing MHD.

Serum calcium, phosphorous and PTH levels in patients undergoing maintenance hemodialysis classified by their vitamin D status

Serum calcium, phosphorous and PTH levels in patients undergoing maintenance hemodialysis classified by their vitamin D status

Relationship between effective blood flow rate and clinical outcomes in maintenance hemodialysis patients: a single-center study

The association between blood flow rate (BFR) and clinical outcomes in patients undergoing maintenance hemodialysis (MHD) is inconclusive. This retrospective study included 175 patients undergoing MHD treatment between July 2015 and March 2022, divided into two groups based on time-averaged effective blood flow rate (eBFR) median value. We investigated arteriovenous fistula (AVF) outcomes and the association of eBFR with all-cause mortality and new major adverse cardiovascular events (MACE). Mean ± SD and median time-averaged eBFR values were 276 ± 24 and 275 mL/min, respectively. After adjusting for relevant factors including age, sex, vintage, diabetes, CVD, receiving hemodiafiltration (HDF) treatment and spKt/V, Cox models indicated a low time-averaged eBFR (≤ 275 ml/min) was associated with increased risks of all-cause mortality (hazard ratio [HR] 14.18; 95% confidence interval [CI], 3.14–64.1) and new MACE (HR 3.76; 95% CI, 1.91–7.40) in MHD patients. Continuous Cox models demonstrated each 20 ml/min increase in eBFR linked to a 63% decrease in the risk of all-cause mortality (HR: 0.37, 95% CI: 0.23–0.59) and a 38% decrease in the occurrence of new MACE (HR: 0.62, 95% CI: 0.46–0.84). There was no significant difference in AVF outcomes between the two groups. Our study noted higher eBFR (>275 mL/min) is associated with lower risks of both all-cause mortality and new MACE compared with low eBFR (≤275 mL/min). Increased eBFR is not associated with a higher risk of AVF failure.

The association between vascular access satisfaction and all-cause mortality in maintenance hemodialysis patients.

The mortality is significantly higher in patients undergoing maintenance hemodialysis (MHD) than in the general population. It is well-known that vascular access (VA) is critical for MHD patients. But the association between VA satisfaction and all-cause mortality in MHD patients is still not clear. The aim of this study was to explore the relationship between VA satisfaction and all-cause mortality in MHD patients with a 30-month follow-up. Two hundred twenty-nine MHD patients in two dialysis centers were enrolled in this observational prospective study. VA satisfaction was assessed using the Short Form Vascular Access Questionnaire (VAQ). Health-related quality of life (HRQoL) score was calculated with Short Form 36 (SF-36) questionnaire. Multiple logistic regression analysis was used to evaluate the influencing factors of all-cause mortality. During the 30-month follow-up period, 35 patients dropped out of the study. Among them, 31 patients died, and 4 patients stopped MHD treatment after renal transplantation. Multivariable analyses showed that the age, VAQ total score, social functioning score and dialysis-related complication score of the VAQ, the total score and MCS of the SF-36 were factors influencing all-cause mortality in MHD patients. The Kaplan-Meier curve further showed that the cumulative survival probability was significantly higher in the MHD patients with VAQ scores <7 at baseline than in patients with VAQ scores ⩾7 (p = 0.031). The present study showed that VA satisfaction was significantly associated with all-cause mortality in MHD patients. These findings suggest that a holistic approach is required for VA choice.

Intradialytic massage for leg cramps among hemodialysis patients: A single-center, randomized crossover trial

Background: Leg cramps are commonly experienced by hemodialysis patients, and its persistence may lead to treatment noncompliance. Limited studies are available examining the efficacy of intradialytic massage on reducing leg cramps. Objectives: To determine the efficacy of intradialytic leg massage on reducing leg cramps among patients undergoing maintenance hemodialysis at the East Avenue Medical Center. Methodology: This is a single-center, randomized crossover trial. A total of 44 adult patients were randomized in a 1:1 ratio into two groups—Group A (intradialytic massage followed by control) and Group B (control followed by intradialytic massage). Each patient underwent the first assigned intervention for 2 weeks, followed by a washout period of 4 weeks, then the second intervention was performed for another 2 weeks. The primary outcomes were the change in frequency, duration, and intensity of cramps. The secondary outcome was patient quality of life. Results: A higher proportion of patients during the intervention period did not experience cramps post-intervention than during the control period; however, the results were not statistically significant (p=0.2059). The median change in frequency, duration, and intensity of leg cramps did not significantly differ between intervention and control (p&gt;0.05). Moreover, quality of life measures were not significantly different between the two groups (p&gt;0.05). Conclusion: Intradialytic massage alone is not efficacious in reducing leg cramp frequency, duration, and intensity. Moreover, intradialytic massage failed to improve the quality of life of patients undergoing hemodialysis treatment. Underlying factors that lead to leg cramps should be addressed through comprehensive and individualized interventions.

A nomogram topredict the risk of acute ischemic stroke inpatients with maintenancehemodialysis: aretrospective cohort study.

Acute ischemic stroke (AIS) stands as a leading cause of death and disability globally. This study aimed to investigate the risk factors linked with AIS in patients undergoing maintenance hemodialysis (MHD) and to create and validate nomogram models. We examined the medical records of 314 patients with stage 5 chronic kidney disease (CKD5) undergoing MHD, who sought neurology outpatient department consultation for suspected AIS symptoms between January 2018 and December 2023. These 314 patients were randomly divided into the training cohort (n=222) and validation cohort (n=92). The Least Absolute Shrinkage Selection Operator (LASSO) regression model was employed for optimal feature selection in the AIS risk model. Subsequently, multivariable logistic regression analysis was used to construct a predictive model incorporating the features selected through LASSO. This predictive model's performance was assessed using the C-index and the area under the receiver operating characteristic curve (AUC). Additionally, calibration and clinical utility were evaluated through calibration plots and decision curve analysis (DCA). The model's internal validation was conducted using the validation cohort. Resaults: Predictors integrated into the prediction nomogram encompassed cardiovascular disease (CVD) (Odds Ratio [OR] 7.95, 95% confidence interval [CI] 2.400-29.979), smoking (OR 5.7, 95% CI 1.661-21.955), dialysis time (OR 5.91, 95% CI 5.866-29.979), low-density lipoprotein (LDL) (OR 2.99, 95% CI 0.751-13.007), and fibrin degradation products (FDP) (OR 5.47, 95% CI 1.563-23.162). The model exhibited robust discrimination, with a C-index of 0.877 and 0.915 in the internal training and validation cohorts, respectively. The AUC for the training set was 0.857, and a similar AUC of 0.905 was achieved in the validation cohort. Decision curve analysis (DCA) demonstrated a positive net benefit within a threshold risk range of 2 to 96%. The proposed nomogram effectively identifies MHD patients at high risk of AIS at an early stage. This model holds the potential to aid clinicians in making preventive recommendations.

Clinical characteristics and outcomes of maintenance hemodialysis patients with COVID-19 during the Omicron wave of the pandemic in Beijing: a single center retrospective study

BackgroundThe clinical manifestations and prognosis of hemodialysis patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) during the Omicron wave of the pandemic infection were still unclear. This study investigated the clinical characteristics of patients undergoing maintenance hemodialysis (MHD) infected with it.MethodsThis retrospective single-center study included 151 patients undergoing MHD. Healthcare workers were selected as control group were assessed from December 1, 2022 to March 31, 2023. Clinical data, laboratory test results, treatment protocols, and prognoses were collected and analyzed.ResultsThe study population included 146 patients with MHD, 93 (63.7%) of whom were infected with SARS-CoV-2. The number of non-severe, severe, and critical cases was 84 (90.3%), 4 (4.3%), and 5 (5.3%), respectively. Six patients (6.5%) died during the study period. The main symptoms of SARS-CoV-2 infection, including fever, cough, and fatigue, were less common in patients with MHD than the controls. During SARS-CoV-2 infection, the C-reactive protein (2.9 vs. 11.8 mg/dl, p < 0.0001) and ferritin levels(257.7 vs. 537 ng/l, p < 0.0001) were elevated. The hemoglobin(113vs 111 g/L, p = 0.0001) and albumin levels(39.4 vs. 36.1 g/L, p < 0.0001) decreased. Generally, it took two months for the hemoglobin levels to recover. Positivity rate for SARS-COV-2 serum immunoglobin G (IgG) antibodies and IgG titers were lower in dialysis patients than the controls. Age was positively associated with disease severity, while age and hyponatremia were associated with death.ConclusionsPatients with MHD and COVID-19 were primarily classified as non-severe. SARS-CoV-2 infection would soon lead to the increase of inflammation related acute response protein in dialysis patients, and then lead to the decrease of hemoglobin and albumin. About 9.6% in HD patients were severe cases and had poor prognosis. Advanced age and hyponatremia were associated with disease severity and prognosis.

Clinical Impact of the Use of Warfarin in Patients with Atrial Fibrillation Undergoing Maintenance Hemodialysis.

Background: We evaluated the impact of warfarin use on the clinical outcomes of patients with atrial fibrillation who were undergoing hemodialysis (HD). Methods: A retrospective analysis was conducted utilizing data from patients undergoing maintenance HD who participated in HD quality assessment programs. Patients who were assigned the diagnostic code for atrial fibrillation (n = 4829) were included and divided into two groups based on the use of warfarin: No group (no warfarin prescriptions (n = 4009)), and Warfarin group (warfarin prescriptions (n = 820)). Results: Cox regression analyses revealed that the hazard ratio for all-cause mortality in the Warfarin group was 1.15 (p = 0.005) in univariate analysis and 1.11 (p = 0.047) in multivariable analysis compared to that of the No group. Hemorrhagic stroke was significantly associated with warfarin use, but no significant association between the use of warfarin and ischemic stroke or cardiovascular events was observed. The subgroup results demonstrated similar trends. Conclusions: Warfarin use is associated with a higher risk of all-cause mortality and hemorrhagic stroke, and has a neutral effect on ischemic stroke and cardiovascular events in patients with atrial fibrillation who are undergoing HD, compared to those who are not using warfarin.

Retrospective analysis of predictive factors for AVF dysfunction in patients undergoing MHD.

To construct an early clinical prediction model for AVF dysfunction in patients undergoing Maintenance Hemodialysis (MHD) and perform internal and external verifications. We retrospectively examined clinical data from 150 patients diagnosed with MHD at Hefei Third People's Hospital from January 2014 to June 2023. Depending on arteriovenous fistula (AVF) functionality, patients were categorized into dysfunctional (n = 62) and functional (n = 88) cohorts. Using the least absolute shrinkage and selection operator(LASSO) regression model, variables potentially influencing AVF functionality were filtered using selected variables that underwent multifactorial logistic regression analysis. The Nomogram model was constructed using the R software, and the Area Under Curve(AUC) value was calculated. The model's accuracy was appraised through the calibration curve and Hosmer-Lemeshow test, with the model undergoing internal validation using the bootstrap method. There were 11 factors exhibiting differences between the group of patients with AVF dysfunction and the group with normal AVF function, including age, sex, course of renal failure, diabetes, hyperlipidemia, Platelet count (PLT), Calcium (Ca), Phosphorus, D-dimer (D-D), Fibrinogen (Fib), and Anastomotic width. These identified factors are included as candidate predictive variables in the LASSO regression analysis. LASSO regression identified age, sex, diabetes, hyperlipidemia, anastomotic diameter, blood phosphorus, and serum D-D levels as 7 predictive factors. Unconditional binary logistic regression analysis revealed that advanced age (OR = 4.358, 95% CI: 1.454-13.062), diabetes (OR = 4.158, 95% CI: 1.243-13.907), hyperlipidemia (OR = 3.651, 95% CI: 1.066-12.499), D-D (OR = 1.311, 95% CI: 1.063-1.616), and hyperphosphatemia (OR = 4.986, 95% CI: 2.513-9.892) emerged as independent risk factors for AVF dysfunction in MHD patients. The AUC of the predictive model was 0.934 (95% CI: 0.897-0.971). The Hosmer-Lemeshow test showed high consistency between the model's predictive results and actual clinical observations (χ2 = 1.553, P = .092). Internal validation revealed an AUC of 0.911 (95% CI: 0.866-0.956), with the Calibration calibration curve nearing the ideal curve. Advanced age, coexisting diabetes, hyperlipidemia, blood D-D levels, and hyperphosphatemia are independent risk factors for AVF dysfunction in patients undergoing MHD.

Effects of Administration and Intensity of Statins on Mortality in Patients Undergoing Hemodialysis.

(1) Background: Few studies have investigated the association between the intensity of statins and patient survival rates in patients undergoing hemodialysis (HD) as primary outcomes. This study aimed to evaluate patient survival rates according to the intensity of statins using a large sample of patients undergoing maintenance HD. (2) Methods: Data from a national HD quality assessment program were used in this study (n = 53,345). We divided the patients into four groups based on the administration and intensity of statins: Group 1, patients without a prescription of statins (n = 37,944); Group 2, patients with a prescription of a low intensity of statins (n = 700); Group 3, patients with a prescription of a moderate intensity of statins (n = 14,160); Group 4, patients with a prescription of a high intensity of statins (n = 541). (3) Results: Significant differences in baseline characteristics were observed among the four groups. Group 1 had the best patient survival among the four groups in the univariate Cox regression analyses. However, multivariable Cox regression analyses showed that the patient survival rate was higher for Group 3 than for Group 1. Cox regression analyses using data of a balanced cohort showed that, on univariate analyses, the HRs were 0.93 (95% CI, 0.91-0.95, p < 0.001) in Group 2 and 0.95 (95% CI, 0.93-0.96, p < 0.001) in Group 3 compared to that in Group 1. Group 4 had a higher mortality rate than Groups 2 or 3. The results from the cohort after balancing showed a similar trend to those from the multivariable Cox regression analyses. Young age and less comorbidities in Group 1 were mainly associated with favorable survival in Group 1 in the univariate analysis using cohort before balancing. Among the subgroup analyses based on sex, age, presence of diabetes mellitus, and heart disease, most multivariable analyses showed significantly higher patient survival rates in Group 3 than for Group 1. (4) Conclusions: Our study exhibited significant differences in baseline characteristics between the groups, leading to limitations in establishing a robust association between statin intensity and clinical outcomes. However, we conducted various statistical analyses to mitigate these differences. Some results, including multivariable analyses controlling for baseline characteristics and analyses of a balanced cohort using propensity score weighting, indicated improved patient survival in the moderate-intensity statin group compared to non-users. These findings suggest that moderate statin use may be associated with favorable patient survival.

Trying to understand the illness: A qualitative investigation of health literacy of patients undergoing maintenance hemodialysis.

Limited health literacy is high among patients with chronic kidney disease, which can pose challenges in health care. Evidence of health literacy in Indonesia, particularly regarding patients undergoing hemodialysis, is lacking. In this study, we aimed to explore health literacy in adult patients undergoing maintenance hemodialysis. An inductive qualitative study was conducted. Individual semi-structured interviews were conducted with 10 adult patients undergoing hemodialysis, four family caregivers, and four healthcare professionals. Interviews were transcribed verbatim and analyzed thematically. Three themes emerged from the data: "Trying to understand the illness," "searching and obtaining health information," and "applying health information." Understanding and accepting the illness included raising awareness of the changes in their lives and accepting these changes. Participants actively sought information from healthcare professionals and other sources and used it carefully. Behavioral changes included patients' adherence to therapy, although participants often felt bored during the illness trajectory. Understanding the illness and being willing to seek and critically evaluate health information before implementing it are important. These aspects may affect patient outcomes and require further intervention and research.

A Cross-Sectional Study Was Conducted to Evaluate Diffusion Tensor Imaging Findings of the Brain in End-Stage Renal Disease (ESRD) Patients Undergoing Maintenance Hemodialysis Using the Volume of Interest Method

Background: Cerebral small vessel disease (CSVD) is a chronic disorder affecting small vessels within the brain, increasing the risk of stroke in patients with chronic kidney disease (CKD). Diffusion tensor imaging (DTI) is a newer quantitative method for diagnosing CSVD at an early stage of pathogenesis. Objectives: This study compares various DTI parameters in multiple white matter tracts of the brain in CKD patients undergoing maintenance hemodialysis with normal controls in the Indian population using the volume of interest (VOI) method. Additionally, it correlates these DTI parameters with each other at different locations to gain insights into the pathogenesis of CSVD. Methods: After obtaining institutional ethics approval, a cross-sectional study was conducted at a tertiary care hospital over one year (June 2022 to May 2023). The study comprised seventy-five patients in the hemodialysis group and twenty-five controls. All participants underwent MRI brain examinations on a 3 Tesla MRI scanner, and the four DTI parameters - fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), and mean diffusivity (MD) - were reviewed for nine white matter tracts to evaluate statistical differences and correlations. Results: Fractional anisotropy was significantly decreased at anterior locations – corpus callosum genu (P = 0. 357 × 10-7), right anterior corona radiata (P = 0.001), and left anterior corona radiata (P = 0.45 × 10-5). In these locations, FA negatively correlated with RD (R = -0.7904, P &lt; 0.00001), and RD was also significantly increased. Axial diffusivity was significantly increased at posterior locations in the corpus callosum splenium (P = 0.108 × 10-5) and left posterior corona radiata (P = 0.244 × 10-5). However, none of the four DTI parameters showed significant differences between hemodialysis patients and the control group for the subset of patients with normal routine brain MRI features. The intraclass correlation coefficients (ICCs) were high for all four DTI parameters for both patients (0.78 to 0.85) and controls (0.82 to 0.89). Conclusions: This study on CKD patients undergoing maintenance hemodialysis reveals significant differences in some DTI parameters in widespread white matter tracts of the brain using the VOI method, with acceptable to excellent interobserver agreement.

Effect of spironolactone on survival in patients undergoing maintenance hemodialysis.

Previous studies have reported inconsistent results regarding the advantages or disadvantages of spironolactone use in patients undergoing hemodialysis (HD). This study aimed to evaluate survival according to the use of spironolactone in a large sample of patients undergoing maintenance HD. This retrospective study used laboratory and clinical data from the national HD Quality Assessment Program and claims data. The participants of the quality assessment program were patients who had been undergoing maintenance HD for ≥ 3 months, patients undergoing HD at least twice a week. Patients with no spironolactone prescription during the assessment periods were designated as the control group. Patients with one or more prescriptions of spironolactone during the assessment periods were assigned to the SPR group. The number of patients in the control and SPR groups were 54,588 and 315, respectively. The 5-year survival rates were 69.1% and 59.1% in the control and SPR groups, respectively (P < 0.001). Cox regression analyses showed that the hazard ratio in the SPR group was 1.34 (P < 0.001) in univariate analysis and 1.13 (P = 0.249) in multivariable analysis. Univariate Cox-regression analysis showed a better patient survival rate in the control group than in the SPR group; however, multivariable analyses showed similar patient survival rates between the two groups. This study showed no difference in survival between patients undergoing HD with and without spironolactone use.

Interdialytic home systolic blood pressure variability increases all-cause mortality in hemodialysis patients.

The association between Interdialytic home blood pressure variability (BPV) and the prognosis of patients undergoing maintenance hemodialysis (MHD) largely unknown. We proposed the hypothesis that interdialytic home BPV exert effect on cardiac and all-cause mortality among individuals undergoing MHD. A total of 158 patients receiving MHD at the hemodialysis unit of Wuhan Fourth Hospital between December 2019 and August 2020 were included in this prospective cohort study. Patients were divided into tertiles according to the systolic BPV (SBPV), and the primary endpoints were cardiac and all-cause death. Kaplan-Meier analysis was used to assess the relationship between long-term survival and interdialytic home SBPV. In addition, Cox proportional hazards regression models were used to identify risk factors contributing to poor prognosis. The risk of cardiac death and all-cause death was gradually increased in patients according to tertiles of SBPV (3.5% vs. 14.8% vs. 19.2%, p for trend = .021; and 11.5% vs. 27.8% vs. 44.2%, p for trend <.001). The Cox regression analysis revealed that compared to Tertile 1, the hazard ratios for all-cause mortality in Tertile 2 and Tertile 3 were 3.13 (p = .026) and 3.24 (p = .021), respectively, after adjustment for a series of covariates. The findings revealed a positive correlation between increased interdialytic home SBPV and elevated mortality risk in patients with MHD.

Coping trajectory of social isolation in individuals with maintenance haemodialysis: A descriptive qualitative study

Background: The number of individuals undergoing maintenance haemodialysis has continued to increase in recent years. This treatment method can lead to social isolation, which has a significant impact on an individual's health. Unfortunately, research on this issue is insufficient, and no effective interventions have been developed. Moreover, existing research lacks attention to and understanding of patient aspirations—a critical area that warrants further exploration. Objectives: We aimed to reveal the natural coping trajectory of individuals undergoing maintenance haemodialysis in the context of social isolation to provide a useful reference for further research and the development of effective interventions. Design: This was a descriptive qualitative study. Setting (s)This study was conducted at a haemodialysis centre in a provincial capital city of northern China. ParticipantsUsing maximum variant and purposive sampling, we recruited 15 patients undergoing maintenance haemodialysis. Methods: The interviews were transcribed verbatim, and data were analysed using deductive content analysis. ResultsThree themes were identified: (a) prerequisites for coping with social isolation; (b) maintaining the bond between coping and social isolation; and (c) the results of coping with social isolation. These themes revealed the natural trajectory of individuals undergoing maintenance haemodialysis in dealing with social isolation. Conclusion: We interpreted the findings to mean that it was necessary to establish a three-way linkage among family, hospitals, and society to develop multicomponent and multilevel intervention measures. Tweetable abstract: A study of the response of individuals undergoing maintenance haemodialysis to social isolation revealed their coping trajectory and conveyed their aspirations.