Interdialytic weight gain and educational/cognitive, counseling/behavioral and psychological/affective interventions in patients on chronic hemodialysis: a systematic review and meta-analysis

Renal health: Evaluation of the spontaneous use of a new m-health technology and validation of its content to support patients undergoing peritoneal dialysis

INTRODUCTION

Chronic kidney disease is a worldwide public health problem, with a high prevalence of patients on dialysis. mHealth technologies can greatly support the treatment and monitoring of these patients. Thus, this study aimed to evaluate the spontaneous use of the application (app) Renal Health, a previously available technology, for patients on hemodialysis and validate content to support patients undergoing peritoneal dialysis.

METHODS

The first stage consisted of evaluating the spontaneous use of the app, and the second stage consisted of methodological research for the development, evaluation, and improvement of a technological instrument for use in clinical practice as a support for patients undergoing peritoneal dialysis (PD). The association between categorical variables was performed using the chi-square test, adopting a significance level of 5%.

RESULTS

The app was accessed by 753 users and of these, 34 % accessed the hemodialysis section. Most accesses were in the state of São Paulo/Brazil and performed by women. The records of biochemical tests did not vary according to gender and age group (p > 0.05). The developed and validated PD section enables section control, allowing the user to manage their sessions. The analysis of the technology by the specialists showed good results for the global content validity index (CVI) regarding objectives (CVI = 0.95), structure (CVI = 0.97), and relevance (CVI = 1.0).

CONCLUSION

It is concluded that the hemodialysis section of the Renal Health app aroused the interest of the population and that the developed peritoneal dialysis section was validated by specialists.

Effects of salt reduction education from a salt questionnaire on inter-dialysis weight gain in patients on hemodialysis

BACKGROUND

Heart failure is the leading cause of death in patients undergoing hemodialysis (HD), with fluid overload being the most common cause. Therefore, it is important for patients undergoing HD to reduce salt intake. We recently developed a highly accurate and simple self-administered salt questionnaire. Using this salt questionnaire, we aimed to determine whether salt intake and inter-HD weight gain decrease when patients with HD are instructed to reduce their salt intake.

METHODS

Seventy-eight outpatients at a maintenance HD facility were assessed for dietary salt intake using a salt questionnaire. After one month of dietary guidance, salt intake was assessed again using the salt questionnaire.

RESULTS

The mean age of the patients was 72.2 ± 11.9 years; 47 (60.3%) were men, 23 had diabetic nephropathy as the primary disease, and the median HD vintage was 74 months. Salt intake significantly decreased from 8.41 ± 2.43 g/day before the salt questionnaire intervention to 7.67 ± 2.60 g/day after the intervention (p = 0.010). Changes in salt intake before and after the intervention were significantly positively correlated with changes in weight gain before the start of HD sessions with an interval of 2 days (r = 0.24, p = 0.037). Furthermore, changes in salt intake significantly and positively correlated with changes in weight gain after adjusting for age, sex, and dry weight.

CONCLUSION

The salt questionnaire may be an effective tool for reducing salt intake and controlling weight gain during HD.

MSCTA imaging analysis of autologous arteriovenous fistula dysfunction in maintenance hemodialysis patients

OBJECTIVE

To observe the multi-slice spiral CT angiography (MSCTA) imaging features of arteriovenous fistula dysfunction in patients undergoing maintenance hemodialysis and analyze the significance of the imaging examination.

METHODS

Altogether 90 patients with end-stage renal disease treated by maintenance hemodialysis in General Hospital of China Resources & Wisco from June 2020 to February 2023 were divided into a normal function group (n=68) and a dysfunction group (n=22) according to the function of autogenous arteriovenous fistula. The clinical data of the two groups were recorded. The MSCTA was performed in each patient, and the manifestations of arteriovenous fistula dysfunction were analyzed. Additionally, the vascular access stenosis, vascular access lumen stenosis, arteriovenous diameter, blood flow, and hemodynamic indices were tested, and the value of MSCTA in predicting arteriovenous fistula function was analyzed by Logistic regression.

RESULTS

The degree of vascular access stenosis and vascular access lumen stenosis in the normal group were less than those in the dysfunctional group (P<0.05). The arteriovenous diameter, blood flow, blood flow velocity at anastomotic vein end, dialysis adequacy (spKt/V), and von Willebrand factor (vWF) function in the normal group were larger than those in the dysfunction group, and the radial artery shear force was lower than in the dysfunction group, with statistical significance (P<0.05). Among the arteriovenous fistula dysfunction, there were 3 patients with anastomotic + outflow vein stenosis, 4 patients with outflow vein stenosis, 9 patients with inflow artery + anastomosis + outflow vein stenosis, and 6 patients with superior vena cava stenosis. Logistic regression analysis showed that slow blood flow velocity at the venous end of anastomosis and high shear force of radial artery were influencing factors of arteriovenous fistula dysfunction, and the area under ROC curve of blood flow velocity at the venous end of anastomosis plus shear force of radial artery was 0.93, with a sensitivity of 0.87 and a specificity of 0.85.

CONCLUSION

MSCTA can be used to evaluate the dysfunction of autologous arteriovenous fistula in patients undergoing maintenance hemodialysis, and provide important reference information for the formulation of the next best clinical treatment plan.

Association between home meal preparers and salt intake in haemodialysis patients: a cross-sectional study

OBJECTIVES

This study aimed to examine the association between home meal preparer and salt intake among haemodialysis patients, including daily dietary status. We hypothesised that salt intake is higher among individuals who rely on meal preparation from others than those who prepare meals by themselves.

DESIGN

Cross-sectional study.

SETTING

Two medical facilities in Fukushima Prefecture, Japan.

PARTICIPANTS

237 haemodialysis outpatients who visited one of the medical facilities between February 2020 and August 2021 and were diagnosed with anuria, defined as urination of <100 mL/day, were the potential participants of the present study. Finally, 181 participants (131 male and 50 female) were included in the analysis.

OUTCOME MEASURE

Salt intake amount was calculated from the results of predialysis and postdialysis blood draws, using Watson's formula based on predialysis weight, predialysis serum sodium level, postdialysis weight and serum sodium level at the end of dialysis.

RESULTS

Salt intake was significantly higher in participants who relied on meal preparation from others ('relying on others') than those who prepared meals by themselves ('self-prepared') (B=1.359; 95% CI: 0.495 to 2.222). No statistical difference was found between individuals who ate out or ate takeout ('outsourcing') and those who prepared their own meals ('self-prepared'). These results were robust after adjustment for confounding factors.

CONCLUSIONS

The present study revealed an association between self-preparation of meals at home and reduced salt intake among dialysis patients. Our findings suggest that whoever is the home meal preparer is possibly a social determinant of salt intake. To improve the prognosis of haemodialysis patients, actively reaching out to the family and assessing their social environment, such as identifying the home meal preparer and, if the patient relies on others for meal preparation, conducting nutritional/dietary guidance for that person, are effective in enhancing salt reduction.

Using Bayesian networks with tabu algorithm to explore factors related to chronic kidney disease with mental illness: A cross-sectional study

While Bayesian networks (BNs) offer a promising approach to discussing factors related to many diseases, little attention has been poured into chronic kidney disease with mental illness (KDMI) using BNs. This study aimed to explore the complex network relationships between KDMI and its related factors and to apply Bayesian reasoning for KDMI, providing a scientific reference for its prevention and treatment. Data was downloaded from the online open database of CHARLS 2018, a population-based longitudinal survey. Missing values were first imputed using Random Forest, followed by propensity score matching (PSM) for class balancing regarding KDMI. Elastic Net was then employed for variable selection from 18 variables. Afterwards, the remaining variables were included in BNs model construction. Structural learning of BNs was achieved using tabu algorithm and the parameter learning was conducted using maximum likelihood estimation. After PSM, 427 non-KDMI cases and 427 KDMI cases were included in this study. Elastic Net identified 11 variables significantly associated with KDMI. The BNs model comprised 12 nodes and 24 directed edges. The results suggested that diabetes, physical activity, education levels, sleep duration, social activity, self-report on health and asset were directly related factors for KDMI, whereas sex, age, residence and Internet access represented indirect factors for KDMI. BN model not only allows for the exploration of complex network relationships between related factors and KDMI, but also could enable KDMI risk prediction through Bayesian reasoning. This study suggests that BNs model holds great prospects in risk factor detection for KDMI.