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Nassar MK, Tharwat S, Abdel-Gawad SM, Elrefaey R, Elsawi AA, Elsayed AM, Nagy E, Shabaka S, Shemies RS. Symptom burden, fatigue, sleep quality and perceived social support in hemodialysis patients with musculoskeletal discomfort: a single center experience from Egypt. BMC Musculoskelet Disord 2023; 24:788. [PMID: 37794377 PMCID: PMC10548648 DOI: 10.1186/s12891-023-06910-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 09/24/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND AND AIMS Musculoskeletal disorders (MSDs) are commonly encountered in hemodialysis (HD) patients. However, the causes linked to these disorders are still partially defined. The aim of this study was to determine the frequency of MSDs and their relationship to a variety of clinico-social characteristics such as sleep quality, mood disorders, fatigue, and social support, in addition to the patients' clinical and therapeutic profile. METHOD The study included 94 patients on maintenance HD. Clinical and Sociodemographic data was gathered. To investigate the prevalence and trends of MSDs, the Nordic Musculoskeletal Questionnaire (NMQ-E) was employed. Patients completed the modified Edmonton Symptom Assessment System, Pittsburgh Sleep Quality Index (PSQI), multidimensional Fatigue Inventory (MFI-20), and Perceived Social Support from Family Scales. Univariate and multivariate regression analysis were used to assess the determinants of MSDs. RESULTS The patients' mean age was 49.73 and 59.6% were males. Seventy-two percent of patients were afflicted by MSDs. Knee pain (48.9%), low back pain (43.6%), shoulder pain (41.6%), hip/thigh pain (35.1%), and neck pains (35.1%) were the most reported MSD domains. Pain (p = 0.001), fatigue (p = 0.01), depression (p = 0.015), and anxiety (p = 0.003) scores were substantially higher in patients with MSDs. Furthermore, patients with MSDs engaged in less physical activity (p = 0.02) and perceived less social support (p = 0.029). Patients with MSDs had lower subjective sleep quality, daytime dysfunction domains, and global PSQI scores (p = 0.02, 0.031, 0.036, respectively). Female gender (p = 0.013), fatigue (p = 0.012), depression (p = 0.014), anxiety (p = 0.004), lower activity (p = 0.029), and PSQI score (0.027), use of erythropoiesis-stimulating agents (ESAs), antihypertensive drugs, calcium and Iron supplementation were all significantly associated with MSDs. At the multivariable regression model, administration of ESAs (p = 0.017) and pain score (p = 0.040) were the only independent variables associated with the outcome. CONCLUSION MSDs are quite common among HD patients. Female gender, pain, fatigue, depression, anxiety, reduced activity, poor sleep quality, and use of ESAs are all significantly associated with MSDs in HD patients. Patients with MSD perceived less social support compared to the other group. Patients treated with antihypertensive drugs, calcium and iron supplements were more likely to suffer MSDs.
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Affiliation(s)
- Mohammed Kamal Nassar
- Mansoura Nephrology & Dialysis Unit (MNDU), Faculty of Medicine, Mansoura University, El Gomhurria St, Mansoura, 35516, Egypt
| | - Samar Tharwat
- Rheumatology & Immunology Unit, Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Sara M Abdel-Gawad
- Mansoura Nephrology & Dialysis Unit (MNDU), Faculty of Medicine, Mansoura University, El Gomhurria St, Mansoura, 35516, Egypt
| | - Rabab Elrefaey
- Mansoura Nephrology & Dialysis Unit (MNDU), Faculty of Medicine, Mansoura University, El Gomhurria St, Mansoura, 35516, Egypt
| | - Alaa A Elsawi
- Mansoura Nephrology & Dialysis Unit (MNDU), Faculty of Medicine, Mansoura University, El Gomhurria St, Mansoura, 35516, Egypt
| | | | - Eman Nagy
- Mansoura Nephrology & Dialysis Unit (MNDU), Faculty of Medicine, Mansoura University, El Gomhurria St, Mansoura, 35516, Egypt
| | - Shimaa Shabaka
- Mansoura Nephrology & Dialysis Unit (MNDU), Faculty of Medicine, Mansoura University, El Gomhurria St, Mansoura, 35516, Egypt
| | - Rasha Samir Shemies
- Mansoura Nephrology & Dialysis Unit (MNDU), Faculty of Medicine, Mansoura University, El Gomhurria St, Mansoura, 35516, Egypt.
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2
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Aghsaeifard Z, Zendehdel A, Alizadeh R, Salehnasab A. Chronic hemodialysis: Evaluation of dialysis adequacy and mortality. Ann Med Surg (Lond) 2022; 76:103541. [PMID: 35495410 PMCID: PMC9052277 DOI: 10.1016/j.amsu.2022.103541] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 11/30/2022] Open
Abstract
Objective Dialysis efficacy is one of the important issues in patients undergoing hemodialysis. This study aimed to determine the adequacy of dialysis with mortality and hospital admissions in patients undergoing hemodialysis. Methods This retrospective cohort study was conducted on patients who underwent dialysis. Dialysis adequacy was measured based on the Kt/V criterion. Age, sex, disease etiology, duration of dialysis, and access dialysis were evaluated. Results 128 patients with a mean age of 61.48 ± 13.36 years were included in the study. 8 patients had a history of kidney transplantation. The mean dialysis time in the patients was 4.30 ± 3.39 years. The mean Kt/V in the patients was 1.40 ± 1.8 years. Of the 128 patients, 53 were hospitalized for cardiac or renal reasons. The number of fatalities was 9 cases out of 128. The cause of death in all the cases was heart problems. There was a statistically significant correlation between the adequacy of dialysis in terms of Kt/V and mortality, but it was not associated with hospitalization. Conclusion Inadequate dialysis in terms of Kt/V is likely to increase the rate of mortality among dialysis patients. Dialysis efficacy is one of the important issues in patients undergoing hemodialysis. Inadequate dialysis in terms of Kt/V is likely to increase the rate of mortality among dialysis patient. The findings showed that there was no significant correlation between the dialysis adequacy and hospitalization.
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Affiliation(s)
- Ziba Aghsaeifard
- Department of Internal Medicine, School of Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Zendehdel
- Geriatrics Department, Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Family Medicine Department, Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Alizadeh
- Department of Anesthesiology and Intensive Care, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
- Corresponding author. AJA University of Medical Sciences, Tehran, Iran.
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Liu S, Zhang L, Ma S, Xiao J, Liu D, Ding R, Li Z, Zhao Z. Kt/V reach rate is associated with clinical outcome in incident peritoneal dialysis patients. Ren Fail 2022; 44:482-489. [PMID: 35285393 PMCID: PMC8928818 DOI: 10.1080/0886022x.2022.2048854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The urea clearance index (Kt/V) is an important index for predicting the clinical outcome of peritoneal dialysis (PD) patients, but it changes with time depending on the clinical condition. This study aimed to investigate the association between the Kt/V reach rate (defined as the percentage of Kt/V measurements that reached ≥ 1.70) and clinical outcome in incident PD patients. Methods In this retrospective cohort study, 210 patients were enrolled from the First Affiliated Hospital of Zhengzhou University from 1 January 2013 to 31 October 2019. The target Kt/V reach rate in the first year was applied as the predictor variable. Kaplan-Meier survival curves were drawn to evaluate differences in prognosis. The association between Kt/V reach rate and the composite clinical outcome (death or transfer to hemodialysis) was tested by Cox regression analysis. Results The dialysis adequacy group (Kt/V reach rate 3/3 times) and the dialysis intermittent adequacy group (1/3 or 2/3 times) had significantly better clinical outcomes than the dialysis inadequacy group (0/3 times). There was no difference in clinical outcome between the lower-rate group (reach rate 1/3 times) and the higher-rate group (2/3 times). Compared with the dialysis inadequacy group, the dialysis intermittent adequacy group and dialysis adequacy group had significantly lower risks of the composite outcome (HR 0.487, 95% CI 0.244–0.971, p = 0.041; HR 0.150, 95% CI 0.043–0.520, p = 0.003) in the fully adjusted analysis. Conclusion Higher Kt/V reach rates are associated with a better prognosis in incident PD patients.
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Affiliation(s)
- Shuang Liu
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lijie Zhang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuang Ma
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Xiao
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dong Liu
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Rui Ding
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhengyan Li
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhanzheng Zhao
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Marie E, Navallas M, Harvey E, Vali R, Davda S, Oudjhane K, Lorenzo AJ, Shammas A. Imaging of Peritoneal Dialysis Complications in Children. Radiographics 2022; 42:559-578. [PMID: 35030066 DOI: 10.1148/rg.210143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Worldwide, peritoneal dialysis (PD) is the preferred renal replacement therapy option for children with end-stage renal disease who are awaiting transplantation. PD involves the instillation of a specifically formulated solution into the peritoneal cavity via a PD catheter, with two-way exchange of solutes and waste products along a concentration gradient. This exchange occurs across the peritoneal membrane. The PD catheter has intraperitoneal, abdominal wall, and external components. Enormous efforts have been directed to augment the efficiency and longevity of the peritoneum as a dialysis system by preventing PD-related infectious and noninfectious complications, which may otherwise result in technique failure and a subsequent temporary or permanent switch to hemodialysis. Imaging has an instrumental role in prompt diagnosis of PD complications and in guiding the management of these complications. The main imaging techniques used in the setting of PD complications-namely, conventional radiography, US, CT, MRI, and peritoneal scintigraphy-as well as the benefits and limitations of these modalities are reviewed. The authors also describe the frequently encountered radiologic findings of each complication. Familiarity with these features enables the radiologist to play a crucial role in early diagnosis of PD complications and aids the pediatric nephrologist in tailoring or discontinuing PD and transitioning to hemodialysis if necessary. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Eman Marie
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Pediatrics, Division of Nephrology (E.H.); Department of Surgery, Division of Urology (A.J.L.); and Department of Diagnostic Imaging (K.O.), Division of Nuclear Medicine (R.V., A.S.), The Hospital for Sick Children, Toronto, ON, Canada; Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (R.V., K.O., A.S.); and Great Ormond Street Hospital for Children, NHS, London, England (S.D.)
| | - María Navallas
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Pediatrics, Division of Nephrology (E.H.); Department of Surgery, Division of Urology (A.J.L.); and Department of Diagnostic Imaging (K.O.), Division of Nuclear Medicine (R.V., A.S.), The Hospital for Sick Children, Toronto, ON, Canada; Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (R.V., K.O., A.S.); and Great Ormond Street Hospital for Children, NHS, London, England (S.D.)
| | - Elizabeth Harvey
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Pediatrics, Division of Nephrology (E.H.); Department of Surgery, Division of Urology (A.J.L.); and Department of Diagnostic Imaging (K.O.), Division of Nuclear Medicine (R.V., A.S.), The Hospital for Sick Children, Toronto, ON, Canada; Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (R.V., K.O., A.S.); and Great Ormond Street Hospital for Children, NHS, London, England (S.D.)
| | - Reza Vali
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Pediatrics, Division of Nephrology (E.H.); Department of Surgery, Division of Urology (A.J.L.); and Department of Diagnostic Imaging (K.O.), Division of Nuclear Medicine (R.V., A.S.), The Hospital for Sick Children, Toronto, ON, Canada; Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (R.V., K.O., A.S.); and Great Ormond Street Hospital for Children, NHS, London, England (S.D.)
| | - Sunit Davda
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Pediatrics, Division of Nephrology (E.H.); Department of Surgery, Division of Urology (A.J.L.); and Department of Diagnostic Imaging (K.O.), Division of Nuclear Medicine (R.V., A.S.), The Hospital for Sick Children, Toronto, ON, Canada; Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (R.V., K.O., A.S.); and Great Ormond Street Hospital for Children, NHS, London, England (S.D.)
| | - Kamaldine Oudjhane
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Pediatrics, Division of Nephrology (E.H.); Department of Surgery, Division of Urology (A.J.L.); and Department of Diagnostic Imaging (K.O.), Division of Nuclear Medicine (R.V., A.S.), The Hospital for Sick Children, Toronto, ON, Canada; Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (R.V., K.O., A.S.); and Great Ormond Street Hospital for Children, NHS, London, England (S.D.)
| | - Armando J Lorenzo
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Pediatrics, Division of Nephrology (E.H.); Department of Surgery, Division of Urology (A.J.L.); and Department of Diagnostic Imaging (K.O.), Division of Nuclear Medicine (R.V., A.S.), The Hospital for Sick Children, Toronto, ON, Canada; Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (R.V., K.O., A.S.); and Great Ormond Street Hospital for Children, NHS, London, England (S.D.)
| | - Amer Shammas
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Pediatrics, Division of Nephrology (E.H.); Department of Surgery, Division of Urology (A.J.L.); and Department of Diagnostic Imaging (K.O.), Division of Nuclear Medicine (R.V., A.S.), The Hospital for Sick Children, Toronto, ON, Canada; Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (R.V., K.O., A.S.); and Great Ormond Street Hospital for Children, NHS, London, England (S.D.)
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5
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Ding L, Johnston J, Pinsk MN. Monitoring dialysis adequacy: history and current practice. Pediatr Nephrol 2021; 36:2265-2277. [PMID: 33399992 DOI: 10.1007/s00467-020-04816-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 09/17/2020] [Accepted: 10/07/2020] [Indexed: 12/13/2022]
Abstract
Dialysis adequacy for pediatric patients has largely followed the trends in adult dialysis by judging the success or adequacy of peritoneal or hemodialysis with urea kinetic modeling. While this provides a starting point to establish a dose of dialysis, it is clear that urea is only part of the picture. Many clinical parameters and interventions now have been identified that are just as impactful on mortality and morbidly as urea clearance. As such, our concept of adequacy is evolving to include non-urea parameters and assessing the impact that following an "adequate therapy" has on patient lives. As we move to a new era, we consider the impact these therapies have on patients and how it affects the quality of their lives; we must take these factors into consideration to achieve a therapy that is not just adequate, but livable.
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Affiliation(s)
- Linda Ding
- Department of Pediatrics and Child Health, University of Manitoba, Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - James Johnston
- Department of Pediatrics and Child Health, University of Manitoba, Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Maury N Pinsk
- Department of Pediatrics and Child Health, University of Manitoba, Rady College of Medicine, Winnipeg, Manitoba, Canada.
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6
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Rees L. Protein energy wasting; what is it and what can we do to prevent it? Pediatr Nephrol 2021; 36:287-294. [PMID: 31834488 PMCID: PMC7815579 DOI: 10.1007/s00467-019-04424-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 12/23/2022]
Abstract
Some children with declining height and BMI SDS fail to respond to optimisation of nutritional intake. As well as poor growth, they have muscle wasting and relative preservation of body fat. This is termed protein energy wasting (PEW). The process results from an interaction of chronic inflammation alongside poor nutritional intake. This review discusses the causes and potential preventative therapies for PEW.
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Affiliation(s)
- Lesley Rees
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, WC1N 3JH, London, UK.
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7
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Should we abandon GFR in the decision to initiate chronic dialysis? Pediatr Nephrol 2020; 35:1593-1600. [PMID: 31418062 DOI: 10.1007/s00467-019-04333-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/31/2019] [Accepted: 08/06/2019] [Indexed: 12/20/2022]
Abstract
The best time to start chronic dialysis during the course of CKD stage 5 is controversial. The first randomised control trial of dialysis initiation either in early or late CKD stage 5 in adults (IDEAL study), and 3 studies from the two largest paediatric registries, the U.S. Renal Data System (USRDS) and the European Society of Paediatric Nephrology (ESPN) Registry, have now provided us with evidence to guide us in this important decision-making process. The message 'no benefit from early start of dialysis' is the conclusion from all four studies. However, what are the limitations of these studies? Can GFR be assessed at CKD stages 4 and 5? What are the factors used to assess the benefit of early or late start? These issues are discussed in this review.
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Grewal MK, Mehta A, Chakraborty R, Raina R. Nocturnal home hemodialysis in children: Advantages, implementation, and barriers. Semin Dial 2020; 33:109-119. [PMID: 32155297 DOI: 10.1111/sdi.12863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/08/2020] [Accepted: 02/18/2020] [Indexed: 11/28/2022]
Abstract
Chronic kidney disease and end-stage renal disease (ESRD) in children are major health concerns worldwide with increasing incidence and prevalence. Renal replacement therapies and kidney transplants have remarkably improved the management of patients with ESRD in both adult and pediatric populations. Kidney transplant has the best patient outcomes, but many a time it has a considerable waiting period. In the meantime, the majority of patients with pediatric ESRD are dependent on dialysis. The conventionally utilized hemodialysis regimen is the three times weekly, in-center hemodialysis. Many studies have demonstrated the unfavorable long-term morbidity associated with the conventional regimen. Intensified dialysis programs, which include extended nocturnal hemodialysis or short daily hemodialysis, are being increasingly advocated over the past two decades. In addition to having much better clinical outcomes as compared with the conventional regimen, the flexibility to provide dialysis at home serves as a great incentive. PubMed/Medline, Embase and Cochrane databases for literature on nocturnal home hemodialysis in children with ESRD were extensively searched. Contrary to the noticeable literature available on adult home hemodialysis, a small number of studies exist in the pediatric population. In this review, the benefits, implementation and associated barriers of nocturnal home hemodialysis in children were addressed.
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Affiliation(s)
- Manpreet K Grewal
- Department of Pediatric Nephrology, Children's Hospital of Michigan, Detroit, MI, USA
| | - Arul Mehta
- Saint Ignatius High School, Cleveland, OH, USA
| | - Ronith Chakraborty
- Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, OH, USA
| | - Rupesh Raina
- Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, OH, USA.,Department of Nephrology, Akron Children's Hospital, Akron, OH, USA
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O'Brien FJ, Sirich TL, Taussig A, Fung E, Ganesan LL, Plummer NS, Brakeman P, Sutherland SM, Meyer TW. Plasma pseudouridine levels reflect body size in children on hemodialysis. Pediatr Nephrol 2020; 35:305-312. [PMID: 31728748 DOI: 10.1007/s00467-019-04369-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 08/16/2019] [Accepted: 09/13/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dialysis in children as well as adults is prescribed to achieve a target spKt/Vurea, where Vurea is the volume of distribution of urea. Waste solute production may however be more closely correlated with body surface area (BSA) than Vurea which rises in proportion with body weight. Plasma levels of waste solutes may thus be higher in smaller patients when targeting spKt/Vurea since they have higher BSA relative to body weight. This study measured levels of pseudouridine (PU), a novel marker solute whose production is closely proportional to BSA, to test whether prescription of dialysis to a target spKt/Vurea results in higher plasma levels of PU in smaller children. METHODS PU and urea nitrogen (ureaN) were measured in plasma and dialysate at the midweek hemodialysis session in 20 pediatric patients, with BSA ranging from 0.65-1.87m2. Mathematical modeling was employed to estimate solute production rates and average plasma solute levels. RESULTS The dialytic clearance (Kd) of PU was proportional to that of ureaN (average KdPU/KdUreaN 0.69 ± 0.13, r2 0.84, p < 0.001). Production of PU rose in proportion with BSA (r2 0.57, p < 0.001). The pretreatment plasma level of PU was significantly higher in smaller children (r2 0.20, p = 0.051) while the pretreatment level of ureaN did not vary with size. CONCLUSIONS Prescribing dialysis based on urea kinetics may leave uremic solutes at higher levels in small children. Measurement of a solute produced proportional to BSA may provide a better index of dialysis adequacy than measurement of urea.
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Affiliation(s)
- Frank J O'Brien
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Tammy L Sirich
- Departments of Medicine, VA Palo Alto HCS and Stanford University, 3801 Miranda Ave, Palo Alto, CA, 94304, USA
| | - Abigail Taussig
- Departments of Medicine, VA Palo Alto HCS and Stanford University, 3801 Miranda Ave, Palo Alto, CA, 94304, USA
| | - Enrica Fung
- Loma Linda University School of Medicine and VA Loma Linda HCS, Loma Linda, CA, USA
| | | | - Natalie S Plummer
- Departments of Medicine, VA Palo Alto HCS and Stanford University, 3801 Miranda Ave, Palo Alto, CA, 94304, USA
| | - Paul Brakeman
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | | | - Timothy W Meyer
- Departments of Medicine, VA Palo Alto HCS and Stanford University, 3801 Miranda Ave, Palo Alto, CA, 94304, USA.
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Dong ZJ, Zhang HL, Yin LX. Effects of intradialytic resistance exercise on systemic inflammation in maintenance hemodialysis patients with sarcopenia: a randomized controlled trial. Int Urol Nephrol 2019; 51:1415-1424. [PMID: 31270740 PMCID: PMC6660503 DOI: 10.1007/s11255-019-02200-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 06/10/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE To investigate the effect of intradialytic resistance exercise on inflammation markers and sarcopenia indices in maintenance hemodialysis (MHD) patients with sarcopenia. METHODS Forty-one MHD patients with sarcopenia were divided into an intervention group (group E, n = 21) and a control group (group C, n = 20). Group C patients only received routine hemodialysis care, whereas group E patients received progressive intradialytic resistance exercise with high or moderate intensity for 12 weeks at three times per week (using the weight of the lower limbs and elastic ball movement of the upper limb) on the basis of routine hemodialysis care. RESULTS After 12 weeks, a significant difference in physical activity status (maximum grip strength, daily pace, and physical activity level), Kt/V, and C-reactive protein was found between groups E and C. Inflammatory factors (interleukin (IL)-6, IL-10, and tumor necrosis factor(TNF)-α) increased or decreased more significantly in group E than in group C. CONCLUSIONS This study showed that intradialytic resistance exercise can improve physical activity effectively and reduce microinflammatory reactions even if this simple exercise does not affect the muscle mass in MHD patients with sarcopenia.
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Affiliation(s)
- Zhi-Juan Dong
- Department of Nursing, The First People's Hospital of Lianyungang, No. 182, Tongguan North Road, Haizhou District, Lianyungang, Jiangsu, China
| | - Hai-Lin Zhang
- Department of Nursing, The First People's Hospital of Lianyungang, No. 182, Tongguan North Road, Haizhou District, Lianyungang, Jiangsu, China.
| | - Li-Xia Yin
- Department of Hemopurification Center, The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, China
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