Interdialytic Weight Gain Effects on Hemoglobin Concentration and Cardiovascular Events

Association between Anti-Erythropoietin Receptor Antibodies and Cardiac Function in Patients on Hemodialysis: A Multicenter Cross-Sectional Study

Cardiac dysfunction is an important prognostic predictor of cardiovascular mortality in patients on hemodialysis (HD). Erythropoietin (EPO) has been reported to improve cardiac function by binding to the EPO receptor (EPOR) on cardiomyocytes. This study investigated whether anti-EPOR antibodies were associated with left ventricular cardiac function in patients undergoing HD. This multicenter, cross-sectional observational study included 377 patients (median age, 70 years; 267 (70.8%) males) with chronic kidney disease (CKD) undergoing stable maintenance HD. Serum levels of anti-EPOR antibodies were measured, and echocardiography was used to assess the left ventricular mass index (LVMI) and left ventricular ejection fraction (LVEF). Anti-EPOR antibodies were found in 17 patients (4.5%). LVMI was greater (median of 135 g/m2 vs. 115 g/m2, p = 0.042), and the prevalence of LVEF < 50% was higher (35.3% vs. 15.6%, p = 0.032) in patients with anti-EPOR antibodies than in those without. Multivariable linear regression and logistic regression analysis (after adjusting for known risk factors of heart failure) revealed that anti-EPOR antibodies were independently associated with LVMI (coefficient 16.2%; 95% confidence interval (CI) 1.0−35.0%, p = 0.043) and LVEF <50% (odds ratio 3.20; 95% CI 1.05−9.73, p = 0.041). Thus, anti-EPOR antibody positivity was associated with left ventricular dysfunction in patients undergoing HD.

Characteristics of patients undergoing hemodialysis during Covid-19 pandemic

Objective

This study aimed to explore the characteristics of hemodialysis patients during the COVID-19 pandemic.

Method

This descriptive study employed a cross-sectional approach using 30 participants purposively selected from two hemodialysis centers in Riau Province, Indonesia. A personal information form and observation sheets were used for data collection. This study was conducted in May and June 2020. Distribution frequency and Pearson Correlation tests were applied during analysis.

Results

A total of 16 (53.3%) patients were female, and most respondents (90%) were married. In addition, the predominant occupation was employees (40%), and the majority has graduated from Senior High School (43.3%). The Mean, Median, and Standard Deviation (SD) of age were 49.9, 50.5, and 11.24. These parameters were respectively 37.88, 29.5, and 34.06 months for the duration from the first dialysis, while 2.04, 2, and 0.24 were correspondingly reported in terms of dialysis adequacy. The Mean, Median, and SD of Inter-dialytic weight gain were 2.25, 2.61, and 0.65, respectively. A correlation was established between age and IDWG (p value = 0.047) with r score = −0.50, and also between IDWD and dialysis adequacy (p value = 0.014) at r score = −0.60.

Conclusion

The study identified the need for nurses to carefully consider IDWG and dialysis adequacy while caring for hemodialysis patients. This approach is expected to facilitating survival during the COVID-19 pandemic.

Evaluation of Dialysis Adequacy, Interdialytic Weight Gain and Quality of Life of Hemodialysis Patients within Coronavirus Disease 2019 Pandemic

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic harmed the world community including hemodialysis patients. It has affected the physical and psychological status of hemodialysis patients. AIM: This study aimed to evaluate the dialysis adequacy, interdialytic weight gain, and quality of life in patients undergoing hemodialysis during the COVID-19 pandemic. METHODS: A quantitative study with a cross-sectional approach was conducted on 105 regular hemodialysis patients from three hemodialysis centers in Riau Province, Indonesia. The patients were purposively recruited. Data on hemodialysis adequacy and interdialytic weight gain were collected in April–May 2020 using an observation sheet, while the quality of life was measured using SF 36. To analyze the data, Pearson’s correlation test and linear regression were performed. RESULTS: Within the sample of 53 male patients was 50.5% and 52 female patients was 49.5%. The mean score of dialysis adequacy during April–May was 1.75, while the mean IDWG was 2.2 kg, and the mean quality of life was 91.51. There was a relationship between adequacy and IDWG (p = 0.002), and between IDWG and quality of life (p =0.015). There was no relationship between adequacy and quality of life (p = 0.360). CONCLUSION: IDWG influenced the quality of life of hemodialysis patients. Health-care professionals need to help patients to keep their IDWG in the normal range to survive within COVID-19 pandemic.

The impact of the Christmas holiday effect on interdialytic weight gain in hemodialysis patients: A multicenter observational retrospective cohort study

INTRODUCTION

The 3-day interdialytic interval (IDI) is associated with high interdialytic weight gain (IDWG), but little is known about the effect of public or religious holidays on IDWG. Consequently, we evaluated the impact of the "Christmas holiday effect" on IDWG of hemodialysis patients.

METHODS

A retrospective cohort study of adult hemodialysis patients (over 18 years) was conducted across five dialysis units in Australia. Demographic and clinical data were collected from electronic medical records. IDWG was established for three time points; regular 3-day IDI, 2-day IDI preceding the Christmas holiday and a 3-day IDI that included the Christmas holiday. Paired t-tests and logistic regression were used to compare differences in mean IDWG before and after the Christmas holiday and to examine factors associated with high IDWG, respectively.

FINDINGS

Two hundred and fifty-two patients, 69% of whom were male, with mean (SD) age of 65.4 ± 15.3 years, were studied. Most had end-stage kidney disease due to diabetes (44%), and they had been on hemodialysis for a median of 25.5 (IQR, 60-10) months. There was a significant increase in absolute IDWG (MD 0.21 kg, 95% CI -0.07 to 0.36; P = 0.004) and relative IDWG (MD 0.3%, 95% CI 0.10-0.40; P = 0.01) after the holiday 3-day IDI compared with the regular 3-day IDI. Older age (OR 0.12; 95% CI 0.02-0.55) and a unit increase in hemoglobin (OR 0.94; 95% CI 0.89-0.99) were associated with lower odds of high relative IDWG while speaking a language other than English increased the odds for high relative IDWG (OR 5.03; 95% CI 1.12-22.65).

CONCLUSION

Absolute and relative IDWG increased significantly after the Christmas holiday. Individualizing dialysis needs may improve outcomes for these patients.

Symptom Clusters in Patients with End-Stage Renal Disease Undergoing Hemodialysis

Background

End-stage renal disease (ESRD) patients undergoing hemodialysis have to face many symptoms from disease progression and treatment. These symptoms cause suffering and affect physical, psychological, emotional, social, and spiritual of the patients, resulting in decreased quality of life and might increase the death rate of these patients. Therefore, the study of symptoms in ESRD patients undergoing hemodialysis will lead to effective symptom management and maximize benefits for the patients. The purpose of this study was to explore the symptom clusters of ESRD patients undergoing hemodialysis.

Materials and Methods

The sample of this descriptive study consisted of 150 ESRD patients undergoing hemodialysis from two dialysis centre of the university hospital and specialized kidney hospital in Bangkok. The instruments consisted of Personal Information Questionnaire (PIQ) and Dialysis Symptom Index-THAI (DSI-THAI). The data were analyzed by exploratory factor analysis.

Results

The 8 clusters of symptoms were found: 1) gastrointestinal, 2) musculoskeletal and fluid volume 3) neurological 4) irritation of the mucous membranes and skin 5) depression 6) sleep disturbance 7) sexual 8) anemic.

Conclusion

The results of this study can be raised awareness and used as the information for the health-care provider to develop the intervention to manage unpleasant symptoms which lead to improving the quality of life.