The Effect of Psychological Intervention on Thirst and Interdialytic Weight Gain in Patients on Chronic Hemodialysis: A Randomized Controlled Trial

Management of volume load for patients undergoing hemodialysis via WeChat and home monitoring in China: a protocol for a cluster-randomized trial

BACKGROUND

Volume overload is a major mortality risk in hemodialysis (HD) patients. Drug therapy and conventional dialysis limitations underscore the importance of managing volume load through effective lifestyle interventions. In this regard, WeChat, along with its built-in self-monitoring function, has demonstrated considerable potential for application. WeChat, a versatile social media platform in China, integrating Facebook, WhatsApp, Twitter, and PayPal functionalities, shows potential in managing volume load, especially when paired with home monitoring. This method may also reduce adverse events and improve patient outcomes.

METHOD

The study will be conducted at the Hemodialysis Center of the Hospital of Chengdu University of Traditional Chinese Medicine, recruiting 135 participants. All patients will be cluster randomly assigned to three group according to their HD schedules. The control group will receive standard care. The WeChat group will receive volume load management via WeChat message in addition to standard care. The home monitoring-feedback group will be required to monitor their blood pressure and weight at home, and upload the number to WeChat subscription account "Health Dialysis" in addition to standard care and volume load management via WeChat message. Data will be collected during the baseline period, one, two, and three months after the intervention starts, and three months after the intervention ends to evaluate the effectiveness of this intervention measure.

DISCUSSION

This study aims to effectively manage the volume load of HD patients and enhance their quality of life through a combination of intervention methods utilizing the WeChat platform and home monitoring. If this intervention measure proves effective, it will not only provide empirical evidence for managing HD patients through the WeChat platform but also serve as a reference model for other HD centers in addressing patient volume load issues. What's more, if significant differences are observed between the results of the WeChat groups and the home monitoring-feedback group, this will further substantiate the importance and impact of home monitoring in volume load management.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT06333574). Registered 13 March 2024.

Non-pharmacological interventions to reduce thirst in patients with heart failure or hemodialysis: A systematic review and meta-analysis

BACKGROUND

Thirst is a frequent and burdening symptom in many patients, especially in patients with chronic heart failure (CHF) and/or receiving hemodialysis (HD). As drug therapies are not feasible, non-pharmacological strategies are needed to reduce thirst and thirst-related burden.

OBJECTIVES

To identify non-pharmacological interventions aiming to reduce thirst in patients with CHF and/ or HD, to describe intervention components, and to evaluate the effectiveness of these interventions.

METHODS

In February 2024, we completed a systematic search in MEDLINE via PubMed, Livivo, CINAHL, Cochrane Library and Web of Science. Two reviewers independently screened titles, abstracts, and full texts, performed critical appraisal and data extraction. We checked risk of bias with the checklists of the Joanna Briggs Institute and the Cochrane Risk of Bias tool and calculated meta-analyses for sufficiently homogeneous studies using fixed-effects models.

RESULTS

We included 15 intervention studies applying non-pharmacological interventions including chewing gum (n = 8), low-sodium diet (n = 2), acupressure (n = 1), frozen strawberries (n = 1), fluid timetables (n = 1), ice cubes and mouthwash (n = 1), and a psychological intervention (n = 1). Sample sizes varied between 11 and 88 participants. Eleven intervention studies showed a reduction of thirst as intervention effect. Meta-analyses for chewing gum showed no significant effect on thirst using a visual analogue scale (IV: -2,32 [-10.37,5.73]; p = 0.57) or the dialysis thirst inventory (IV: -0.26 [- 1.83, 1.30]; p = 0.74). Quality of studies was moderate to low.

CONCLUSION

Results indicate that various non-pharmacological interventions could be helpful to reduce thirst in patients with CHF or HD, but important uncertainty remains.

Predictors of excess fluid volume in hemodialysis patients: an observational study

OBJECTIVES

to assess risk factors for excess fluid volume in hemodialysis patients.

METHODS

a retrospective case-control study was conducted. A total of 392 patients (196 cases and 196 controls) from two hemodialysis centers were included. Sociodemographic data and 23 risk factors for excess fluid volume were assessed using a data collection form. Data were analyzed using a multivariate logistic regression model.

RESULTS

the insufficient knowledge (OR=2.06), excessive fluid intake (OR=2.33), inadequate fluid removal during hemodialysis (OR=2.62) and excessive sodium intake (OR=1.91) risk factors may increase the chance of occurrence of excess fluid volume in hemodialysis patients by approximately two times. Education level (OR=0.95) and age (OR=0.97) are protective factors for excessive fluid volume.

CONCLUSIONS

knowing these risk factors may help nurses with accurate and rapid diagnostic inference of the risk of excessive fluid volume.

Evaluation of thirst severity, death anxiety, and complementary and supportive therapy use as predictors of urinary incontinence-related quality of life in older adults

PURPOSE

This correlational survey study aimed to evaluate thirst severity, death anxiety, and the use of complementary and supportive therapy as predictors of urinary incontinence-related quality of life in older adults.

METHODS

The study included 368 participants aged 60 or older. Data were collected by face-to-face interviews using a participant information form, the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), Visual Analog Scale for thirst severity, Death Anxiety Scale, a modified version of the Mini Mental State Examination, and questions about their use of complementary and supportive therapies.

RESULTS

The participants had a mean age of 70.5 ± 6.9 years (54.9% female). Mean ICIQ-SF score was significantly correlated with daytime frequency of urine leakage and thirst severity score. Multiple linear regression analysis indicated that thirst severity was a significant predictor of urinary incontinence-related quality of life. Most of the older adults said they had never used complementary or supportive therapies for urinary incontinence.

CONCLUSION

Thirst severity should be assessed in older adults with urinary incontinence in addition to other factors that may affect ICIQ-SF scores.

The effect of positive thinking training on hope and adherence to treatment in hemodialysis patients: a randomized controlled trial

BACKGROUND

Patients undergoing hemodialysis are exposed to psychological problems, such as despair, which in turn can be a trigger for them to abandon the treatment process. This study aimed to determine the effect of positive thinking training on hope and adherence to treatment in hemodialysis patients.

METHODS

This randomized controlled trial was performed on 80 hemodialysis patients referred to two hemodialysis centers in Shiraz, Iran. They were randomly divided into an intervention and a control group. Eight sessions of positive thinking skills training carried out individually on the patients' bedsides. The primary and secondary outcomes were hope and adherence to treatment, respectively. The data were collected using Snyder Hope Questionnaire, End-Stage Renal Disease Adherence Questionnaire, laboratory tests, and weight measurements. Data were analyzed by Chi-square and Paired and Independent T-test using SPSS software version 18.

RESULTS

After the intervention, the mean score of hope was significantly higher in the intervention group (42.1 ± 6.1) than in the control group (38.7 ± 6.5) (p = 0.024). Moreover, after the intervention, the mean score of adherence to treatment was significantly higher in the intervention group (1070.2 ± 80.1) compared to the control group (1018.4 ± 105.3) (p = 0.019). In addition, blood urea nitrogen, phosphate and inter-dialytic weight gain were lower in the intervention group compared to the control group after the intervention.

CONCLUSIONS

The findings showed that positive thinking interventions could lead to improvement in hope and adherence to treatment in hemodialysis patients. Positive thinking training could be used in caring of hemodialysis patients to improve their hope and adherence to treatment. Trial registration RCT Registry: Iranian Registry of Clinical Trials; RCT registration number: IRCT20180915041044N1; Registration date: 19/12/2018.

Effects of Descurainia sophia on Oxidative Stress Markers and Thirst Alleviation in Hemodialysis Patients: A Randomized Double-Blinded Placebo-Controlled Cross-Over Clinical Trial

Background

Patients undergoing hemodialysis (HD) are regularly exposed to oxidative stress and inflammation and may suffer from thirst distress with no definitive treatment to address these complications. Descurainia sophia (DS) has been used to alleviate thirst in traditional Persian medicine. This study aimed to assess the effectiveness of DS on oxidation factors and thirst score in HD patients.

Methods

This study was conducted on fifty-three HD patients referred to Tehran Shahid Modarres hospital. The patients were randomly divided into two groups: Group 1 received DS for six weeks, then underwent four weeks of washout period followed by six weeks of placebo treatment, while group 2 received placebo initially followed by treatment with DS. Biochemistry, malondialdehyde (MDA), and total antioxidant capacity (TAC) were measured in four phases: at the beginning, before washout, after washout, and at the end of the study. The patient's body weight was recorded at the start of each session to assess interdialytic weight gain. Thirst scores also were measured using a visual analog scale.

Results

A total of 53 patients, including 23 (43.4%) male and 30 (56.6%) female subjects, were included in the study. The results showed a reduction in thirst score (p=0.001), cholesterol levels (p=0.046), triglycerides (0.003), and MDA (p < 0.001) following the four-week administration of DS treatment in HD patients. The mean levels of TAC were increased (p < 0.001), and calcium, as well as Na+, remained unchanged (p > 0.05). Also, a significant decrease in the patient's weight was observed (p value <0.001). This effect persisted after shifting to a placebo. However, the two groups had no significant difference (p value = 0.539).

Conclusion

DS powder-mixed syrup may benefit HD patients by facilitating free radical scavenging and alleviating thirst distress with minimal adverse effects. The seeds could therefore be utilized as a complementary therapy for hemodialysis patients.

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

BACKGROUND

This work aimed to shed light on the notorious debate over the role of an educational/cognitive/behavioral or psychological approach in the reduction of interdialytic weight gain (IDWG) in patients on chronic hemodialysis.

METHODS

Searches were run from 1975 to January 2022 on Medline, PubMed, Web of Science, and the Cochrane Library. The search terms included "hemodialysis/haemodialysis" AND "adherence" AND ("fluid intake" OR "water intake") AND ("weight gain" OR "interdialytic weight gain" OR "IDWG") AND "patient-level interventions. Randomized controlled studies were eligible if they were in English, published in a peer-reviewed journal and regarded adults patients with on chronic hemodialysis for at least 6 months; compared educational/cognitive and/or counseling/behavioral or psychological interventions to no intervention on interdialytic weight gain. Outcome of interest was interdialytic weight gain. The review was registered on the International Prospective Register of Systematic Reviews in Health and Social Care (PROSPERO, ID number CRD42022332401).

RESULTS

Eighteen studies (1759 patients) were included in the analysis. Compared to the untreated group, educational/cognitive and/or counseling/behavioral interventions significantly reduced interdialytic weight gain with a pooled mean difference of - 0.15 kg (95% CI - 0.26, 30-0.05; P = 0.004). On the other hand, psychological/affective interventions reduced interdialytic weight gain with a pooled mean difference of - 0.26 kg (95% CI - 0.48, - 0.04; P = 0.020).

CONCLUSIONS

Educational/cognitive, counseling/behavioral or psychological/affective interventions significantly reduced the interdialytic weight gain in patients on chronic hemodialysis, although such reduction did not appear to be clinically relevant on hard outcomes.

The reliability and validity of the Turkish version of the Shortened Xerostomia Inventory in hemodialysis patients

INTRODUCTION

The aim of this study was to translate, linguistically validate and evaluate the psychometric properties of the Shortened Xerostomia Inventory (SXI) among Turkish patients undergoing hemodialysis.

METHODS

The study was conducted with 81 chronic hemodialysis patients in the hemodialysis units of two state hospitals between June and August 2020. Explanatory Factor Analysis (EFA) were implemented to test the construct validity. In addition, the test-retest method was performed to test the reliability and consistency of the scale over time.

RESULTS

A total of 81 patients participated in the study. The Cronbach's alpha coefficient of SXI was 0.788. The mean values for the test was 12.84±6.78 and re-test scores was 11.03±6.88. ICC value calculated as 0.992 and accordingly a statistically significant relationship between the test and retest scores (p<0.001).

CONCLUSIONS

Our study showed that the SXI is a valid and reliable measurement tool for Turkish hemodialysis patients.

Excessive fluid volume risk middle-range theory

ABSTRACT Objective to construct a middle range theory for developing the excessive fluid volume risk diagnostic proposition in patients undergoing hemodialysis. Method this is a methodological study, developed for the theoretical-causal validity of a nursing diagnosis. The study was carried out in four stages: study selection, identification of the main concepts of the theory, pictogram construction and proposition elaboration. These steps were operationalized through an integrative literature review, with a sample of 82 articles selected from the Web of Science, PubMed, CINAHL, Scopus and Science Direct databases. Results the data extracted from the sample articles enabled identifying five essential terms to define excessive fluid volume risk. Furthermore, 31 etiological factors of excessive fluid volume risk were identified, in addition to a pictogram and 12 propositions. Conclusion and implications for practice the construction of a middle-range theory focused on excessive fluid volume risk in patients undergoing hemodialysis refines terminology and expands the understanding of nursing phenomena. Thus, the data from this research will provide clear and robust knowledge for the conduct of nurses’ actions in clinical practice.

Teoria de médio alcance do risco de volume de líquidos excessivo

RESUMO Objetivo construir uma teoria de médio alcance para o desenvolvimento da proposição diagnóstica risco de volume de líquidos excessivo em pacientes em hemodiálise. Método trata-se de um estudo metodológico, desenvolvido para a validade teórico-causal de um diagnóstico de enfermagem. O estudo foi realizado em quatro etapas: seleção dos estudos, identificação dos conceitos principais da teoria, construção do pictograma e elaboração das proposições. Essas etapas foram operacionalizadas por meio de uma revisão integrativa da literatura, com uma amostra de 82 artigos selecionados nas bases de dados Web of Science, PubMed, CINAHL, Scopus e Science Direct. Resultados os dados extraídos dos artigos da amostra possibilitaram a identificação de cinco termos essenciais para a definição do risco de volume de líquidos excessivo. Além disso, foram identificados 31 fatores etiológicos do risco de volume de líquidos excessivo, além de construídos um pictograma e 12 proposições. Conclusão e implicações para a prática a construção de uma teoria de médio alcance voltada para o risco de volume de líquidos excessivo em pacientes em hemodiálise refina as terminologias e amplia a compreensão dos fenômenos da enfermagem. Assim, os dados desta pesquisa fornecerão conhecimentos claros e robustos para a condução das ações do enfermeiro na prática clínica.

Effects of the Combination of Auricular Acupressure and a Fluid-Restriction Adherence Program on Salivary Flow Rate, Xerostomia, Fluid Control, Interdialytic Weight Gain, and Diet-Related Quality of Life in Patients Undergoing Hemodialysis

Adherence to fluid-restriction is a clinical priority in nephrology care. This study examines the effects of a combination of auricular acupressure (AA) and a fluid-restriction adherence program on the salivary flow rate, xerostomia, fluid control, interdialytic weight gain (IDWG), and diet-related quality of life (DQOL) among hemodialysis patients in South Korea. Using a quasi-experimental design, 84 hemodialysis patients were assigned to the experimental group (AA + fluid-restriction adherence program; n = 29), the comparison group (fluid-restriction adherence program; n = 27), and the control group (usual care; n = 28). The program lasted 6 weeks, and data were collected at baseline, immediately after the intervention, and 4 months post-intervention. There was a significant interaction between group and time for salivary flow rate, fluid control, IDWG, and DQOL (all p < 0.005). Compared with the control group, the experimental group had a significantly improved salivary flow rate, fluid control, IDWG, and DQOL at weeks 6 and 22, whereas the comparison group had improved fluid control and DQOL at week 6. The combination of AA and a fluid-restriction adherence program could be provided to hemodialysis patients as cost-effective, safe, and complementary interventions to promote sustainable patient adherence to fluid-restriction.

Higher ultrafiltration rate is associated with right ventricular mechanical dispersion

Objective:

Ultrafiltration rate is one of the major determinants of adverse outcomes in patients undergoing hemodialysis (HD) therapy. Previous studies have focused on the impact of HD on right ventricular (RV) peak strain values. However, the influence of HD on the temporal characteristics of deformation has not been reported yet. The aim of the present study was to evaluate the impact of high ultrafiltration rate (HUR) on RV mechanical dyssynchrony.

Methods:

Echocardiographic images focused on the RV and left ventricle (LV) were obtained from 60 patients (49.2±17.3 years, 22 female) before and after HD. Patients were divided into two groups according to ultrafiltration rate. Changes in echocardiographic parameters with HD were examined. Two-dimensional speckle-tracking strain analysis was used to assess deformation. Mechanical dispersion was measured as the standard deviation of time to peak longitudinal strain of six segments for RV and 18 segments for LV.

Results:

The average ultrafiltrated volume and ultrafiltration rate were 3000.1±1007.9 mL and 11.4±2.9 mL/kg/h, respectively. Global longitudinal strain (GLS) of the RV and LV decreased after HD in both groups. A significant difference was observed in RV mechanical dispersion with HD for patients in the high ultrafiltration group. A mild statistically insignificant increase in LV mechanical dispersion was also observed after HD.

Conclusion:

HUR has a substantial impact on LV and RV GLS and RV dyssynchrony. Ultrafiltration rates and volumes should be kept as low as possible to achieve hemodynamic stability and tolerability.

Design and methodology of the impact of HemoDiaFIlTration on physical activity and self-reported outcomes: a randomized controlled trial (HDFIT trial) in Brazil

BACKGROUND

End stage renal disease (ESRD) patients require a renal replacement therapy (RRT) to filter accumulated toxins and remove excess water, which are associated with impaired physical function. Hemodialysis (HD) removes middle-molecular weight (MMW) toxins less efficiently compared to hemodiafiltration (HDF); we hypothesized HDF may improve physical function. We detailed the design and methodology of the HDFIT protocol that is testing whether changing from HD to HDF effects physical activity levels and various outcomes.

METHODS

HDFIT is a prospective, multi-center, unblinded, randomized control trial (RCT) investigating the impact of dialysis modality (HDF verses HD) on objectively measured physical activity levels, self-reported quality of life, and clinical/non-clinical outcomes. Clinically stable patients with HD vintage of 3 to 24 months without any severe limitation ambulation were recruited from sites throughout southern Brazil. Eligible patients were randomized in a 1:1 ratio to either: 1) be treated with high volume online HDF for 6 months, or 2) continue being treated with high-flux HD. This study includes run-in and randomization visits (baseline), 3- and 6-month study visits during the interventional period, and a 12-month observational follow up. The primary outcome is the difference in the change in steps per 24 h on dialysis days from baseline to the 6-month follow up in patients treated with HDF versus HD. Physical activity is being measured over one week at study visits with the ActiGraph ( www.actigraphcorp.com ). For assessment of peridialytic differences during the dialysis recovery period, we will analyze granular physical activity levels based on the initiation time of HD on dialysis days, or concurrent times on non-dialysis days and the long interdialytic day.

DISCUSSION

In this manuscript, we provide detailed information about the HDFIT study design and methodology. This trial will provide novel insights into peridialytic profiles of physical activity and various self-reported, clinical and laboratory outcomes in ESRD patients treated by high volume online HDF versus high-flux HD. Ultimately, this investigation will elucidate whether HDF is associated with patients having better vitality and quality of life, and less negative outcomes as compared to HD.

TRIAL REGISTRATION

Registered on ClinicalTrials.gov on 20 April 2016 ( NCT02787161 ).

Effects of Gargling with an Aroma Solution on Xerostomia, Halitosis, and Salivary pH in Hemodialysis Patients – A Randomized Controlled Trial

Background:

Despite developments in renal replacement therapy, therapeutic fluid restriction reportedly induces xerostomia in 28.2~85.5% of hemodialysis patients, which causes serious inconveniences in their daily living and is detrimental to their quality of life.

Objective:

The purpose of this study was to identify the effects of gargling with an aroma solution (A-Solution) on xerostomia, halitosis, and salivary pH in hemodialysis patients.

Methods:

This study design was a randomized controlled trial. The participants of this study were 56 hemodialysis patients of E General Hospital in Seoul, Korea. They were divided into an experimental group (n=28) treated by gargling with 20 ml of A-Solution for 15 seconds and a control group (n=28) where pateints did not gargle with A-Solution, and data were collected from October 1 to November 15, 2013. The outcome variables were measured in the pretest and at 5, 30, 60, and 120 minutes in the two groups. The collected data were analyzed using SPSS (version 18.0 for Windows).

Results:

Xerostomia was lower in the experimental group than in the control group at each time point apart from the pretest and differed significantly in the interaction between groups and time points. Salivary pH and halitosis differed significantly between the experimental and control groups, across time points, and in the interaction between group and time point.

Conclusion:

The findings of this study suggest that aroma gargling is a useful oral-care intervention for solving oral problems experienced by hemodialysis patients such as xerostomia and halitosis.

Rapid ultrafiltration rates and outcomes among hemodialysis patients: re-examining the evidence base

PURPOSE OF REVIEW

This review critically summarizes the evidence linking ultrafiltration rates to adverse outcomes among hemodialysis patients and provides research recommendations to address knowledge gaps.

RECENT FINDINGS

Growing evidence suggests that fluid-related factors play important roles in hemodialysis patient outcomes. Ultrafiltration rate - the rate of fluid removal during hemodialysis - is one such factor. Existing observational data suggest a robust association between greater ultrafiltration rates and adverse cardiovascular outcomes, and such findings are supported by plausible physiologic rationale. Potential mechanistic pathways include ultrafiltration-related ischemia to the heart, brain, and gut, and volume overload-precipitated cardiac stress from reactive measures to ultrafiltration-induced hemodynamic instability. Inter-relationships among ultrafiltration rates and other fluid measures, such as interdialytic weight gain and chronic volume expansion, render the specific role of ultrafiltration rates in adverse outcomes difficult to study. Randomized trials must be conducted to confirm epidemiologic findings and examine the effect of ultrafiltration rate reduction on clinical and patient-centered outcomes.

SUMMARY

Compelling observational data demonstrate an association between more rapid ultrafiltration rates and adverse clinical outcomes. Before translating these findings into clinical practice, randomized trials are needed to verify observational data results and to identify effective strategies to mitigate ultrafiltration-related risk.

Determinants of thirst distress in patients on hemodialysis

PURPOSE

Thirst sensation can induce nonadherence with fluid restriction in patients on hemodialysis (HD) and may lead to large interdialytic weight gain (IWG). This study aimed to evaluate thirst distress and its determinants and to explore fluid management strategies used by patients on HD.

METHODS

A cross-sectional study was conducted in a sample of 203 patients who were followed in three HD centers in Turkey, from January 2015 to June 2015. Data were collected by a personal information form, the Thirst Distress Scale (TDS) and the Visual Analogue Scale (VAS) for thirst and xerostomia. Data analysis was performed using descriptive statistics, Student's t test, the one-way analysis of variance, Pearson's correlation coefficients, and linear regression analysis.

RESULTS

The mean TDS score was 20.71 ± 8.34, which is a higher than moderate level of thirst distress. The significant determinants of thirst distress of the patients were the VAS thirst score (unstandardized β = 1.73, p < 0.001), the VAS xerostomia score (unstandardized β = 0.42, p < 0.001), and the IWG values (unstandardized β = 1.20, p = 0.003), after controlling for specific variables. The most common strategies used to reduce fluid intake or relieve thirst were avoiding salty foods (70.9 %), limiting salt on food (70.9 %), and spacing liquids over the entire day (57.6 %).

CONCLUSIONS

Patients with higher levels of thirst and xerostomia and those with a high IWG were more likely to have higher thirst distress. A greater understanding of thirst distress and its related factors could contribute to more effective interventions that improve health and well-being in patients on HD.